1. Burns can be classified based on depth and percentage of total body surface area affected. Deeper burns involving more surface area lead to worse outcomes.
2. Burns trigger a complex pathophysiological response involving fluid shifts, immune dysfunction, and metabolic alterations. Locally, burns cause tissue damage and fluid accumulation. Systemically, burns induce hypovolaemic shock, immune suppression increasing infection risk, and a hypermetabolic state.
3. Managing the pathophysiological effects of burns, especially fluid shifts and immune dysfunction, is important for treatment and recovery from burn injuries. Deeper and more extensive burns have more severe local and systemic pathophysiological consequences.
This document discusses the management and nursing care of burn injuries. It covers the pathophysiology of local and systemic effects of burns, classification of burns by depth, determining burn size and extent, and management approaches. It also details fluid therapy using the Parkland formula and the nursing care plan, including assessing risks like infection, impaired mobility, and nutrition imbalances.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
This document provides an overview of inflammation. It defines inflammation as the body's response to local injury or infection and discusses the signs and classifications. Acute inflammation is described as persisting for minutes to days and involving vascular changes like increased blood flow and permeability, as well as cellular changes such as leukocyte migration and phagocytosis. Chronic inflammation can last for weeks or years and is characterized by mononuclear cell infiltration and simultaneous tissue destruction and healing. The document also examines specific types of inflammation including granulomatous inflammation and inflammation of the pulp, periodontium, and gingiva.
This document discusses septic shock, including its definition, risk factors, signs and symptoms, pathophysiology, diagnostic tests, and medical and nursing management. Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure and multiorgan failure. It can result from sepsis when blood pressure drops dangerously low despite fluid resuscitation. Management involves identifying and treating the infection through antibiotics, supporting failing organs, and maintaining adequate tissue perfusion and oxygen delivery.
The document discusses the nursing management of patients with immunologic disorders. It provides an overview of immunity and the anatomy and physiology of the immune system, describing its basic function to remove foreign antigens. It outlines the mechanisms of the natural and acquired immune system, including white blood cells, inflammation, barriers, and immune responses like phagocytosis, humoral responses, cellular responses, and the complement system. It also discusses assessing a patient's immune status through history, physical exam, and diagnostic tests of humoral and cellular immunity. Disorders of the immune system can stem from issues with immunocompetent cells, their function, autoimmune attacks, or inappropriate responses to antigens.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
This presentation will help you to find answers for all the questions related to definition, types, causes, treatment, management and nursing care to burns patient.
This document provides an overview of inflammation. It defines inflammation and describes the cellular response and mediators involved in acute inflammation. Acute inflammation aims to remove injurious agents, repair tissue damage, and prepare the body for healing. Without inflammation, infections could not be fought off and wounds would never heal. The document outlines the signs of acute (redness, heat, swelling, pain, loss of function) and differences between acute and chronic inflammation. It discusses the cellular events and outcomes of acute inflammation, as well as special types. Chronic inflammation is characterized by mononuclear cell infiltration and tissue destruction or repair over a long period of time.
This document discusses the management and nursing care of burn injuries. It covers the pathophysiology of local and systemic effects of burns, classification of burns by depth, determining burn size and extent, and management approaches. It also details fluid therapy using the Parkland formula and the nursing care plan, including assessing risks like infection, impaired mobility, and nutrition imbalances.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
This document provides an overview of inflammation. It defines inflammation as the body's response to local injury or infection and discusses the signs and classifications. Acute inflammation is described as persisting for minutes to days and involving vascular changes like increased blood flow and permeability, as well as cellular changes such as leukocyte migration and phagocytosis. Chronic inflammation can last for weeks or years and is characterized by mononuclear cell infiltration and simultaneous tissue destruction and healing. The document also examines specific types of inflammation including granulomatous inflammation and inflammation of the pulp, periodontium, and gingiva.
This document discusses septic shock, including its definition, risk factors, signs and symptoms, pathophysiology, diagnostic tests, and medical and nursing management. Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure and multiorgan failure. It can result from sepsis when blood pressure drops dangerously low despite fluid resuscitation. Management involves identifying and treating the infection through antibiotics, supporting failing organs, and maintaining adequate tissue perfusion and oxygen delivery.
The document discusses the nursing management of patients with immunologic disorders. It provides an overview of immunity and the anatomy and physiology of the immune system, describing its basic function to remove foreign antigens. It outlines the mechanisms of the natural and acquired immune system, including white blood cells, inflammation, barriers, and immune responses like phagocytosis, humoral responses, cellular responses, and the complement system. It also discusses assessing a patient's immune status through history, physical exam, and diagnostic tests of humoral and cellular immunity. Disorders of the immune system can stem from issues with immunocompetent cells, their function, autoimmune attacks, or inappropriate responses to antigens.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
This presentation will help you to find answers for all the questions related to definition, types, causes, treatment, management and nursing care to burns patient.
This document provides an overview of inflammation. It defines inflammation and describes the cellular response and mediators involved in acute inflammation. Acute inflammation aims to remove injurious agents, repair tissue damage, and prepare the body for healing. Without inflammation, infections could not be fought off and wounds would never heal. The document outlines the signs of acute (redness, heat, swelling, pain, loss of function) and differences between acute and chronic inflammation. It discusses the cellular events and outcomes of acute inflammation, as well as special types. Chronic inflammation is characterized by mononuclear cell infiltration and tissue destruction or repair over a long period of time.
Definition of inflammation, Causes, Signs of inflammation, Types of inflammation, Triple response, Phagocytosis, TransudateĀ orĀ Exudate, Difference between transudate and exudate, Granuloma and Granulomatous inflammation
medical surgical nursing , nursing management of burn patients, it includes definition, classification of burn injury, clinical manifestaion, assessment of burn injury , management of patient with burn, care given to the patient.
The document summarizes the body's immune defenses against infection. It describes two main types of immunity: innate immunity, which provides nonspecific defenses like skin barriers and phagocytes; and acquired (adaptive) immunity, which develops after exposure and provides pathogen-specific responses using B cells, T cells, antibodies, and immunological memory. The immune system uses successive lines of defense, from physical barriers and phagocytes to inflammation and antibodies, to protect the body. Vaccines help produce active immunity by exposing the immune system to weakened or killed pathogens.
This document provides an overview of burn injury management. It discusses the epidemiology, pathophysiology, classification, and treatment principles for burns. The key aspects of management include initial resuscitation using fluid replacement formulas to prevent shock, wound care, infection prevention, and long-term rehabilitation to address physical and psychological impacts of severe burns. Proper management requires a multidisciplinary team to address the many systemic effects of serious burns.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document provides an overview of the management of burn patients. It discusses estimating the depth and extent of burn wounds, fluid resuscitation, burn wound management, detecting sepsis, and wound coverage. It also covers types of burn injuries such as scald, flame, hot object, electrical, and chemical burns, as well as the characteristics of superficial, partial-thickness, and deep-thickness burns. Specific guidelines are provided for chemical injuries, which include removing contaminated clothing, flushing the body with water, and irrigating the eyes until seen by a doctor.
This document defines and classifies different types of burns, including thermal, electrical, chemical, and radiation burns. It describes burns based on depth, with first degree involving the epidermis, second degree also involving the dermis and causing blisters, third degree being full thickness and causing charring, and fourth degree extending into underlying tissues. Burns are also classified based on percentage of total body surface area affected as minor, moderate, or major. The pathophysiology of burns is described, including increased vascular permeability, fluid shifts leading to hypovolemia, and increased risk of infection, renal failure, and multiorgan dysfunction. Infections from bacteria such as Streptococcus and Pseudomonas are common complications. Causes
nursing management of a patient with painancychacko89
Ā
This document discusses pain, including definitions, types, theories, assessment, and management. It defines pain as a sensory and emotional experience associated with tissue damage. There are different types of pain such as acute, chronic, neuropathic, and nociceptive. Theories discussed include specificity theory, pattern theory, and gate control theory. Pain is influenced by many factors and should be assessed using various scales tailored for different populations. Management includes pharmacological approaches like the WHO analgesic ladder as well as non-pharmacological options. Nurses play an important role in comprehensive pain assessment.
This document discusses the nursing management of patients with burns. It covers the incidence, causes, classification, effects and complications of burns. It also outlines the nursing management in the emergent/acute phase, which focuses on controlling the airway, breathing, circulation, disability and environment. Complications during rehabilitation are also discussed.
This document discusses different types of burns including thermal, chemical, electrical, and radiation burns. It describes how burns are assessed based on depth and extent of body surface area involved. First, second, and third degree burns are defined. Fluid imbalances that can occur with burns are also outlined. The phases of burn injuries - emergent, acute, and rehabilitative - are summarized along with goals, nursing interventions, and considerations for each phase. Wound care including dressing changes and skin grafting is also covered at a high level.
1) Shock is a life-threatening condition where tissue perfusion is inadequate, preventing delivery of oxygen and nutrients to vital organs and cells.
2) Shock progresses through initial, compensatory, progressive, and irreversible stages and can be caused by hypovolemia, heart problems, neurologic issues, sepsis, or allergic reactions.
3) Nursing management of shock involves rapid assessment of circulation, breathing, level of consciousness and skin signs; providing immediate care like oxygen, IV fluids, medications; and identifying and treating the underlying cause.
The document provides information about fluid and electrolyte balance, including average daily water intake and output in adults. It discusses the fluid compartments in the body and the functions of water and fluids. It also describes electrolytes, types of solutions, and nursing management for clients with burns or problems related to the genitourinary system such as renal failure.
The document discusses the immune system and its defense against disease. It defines the immune defense and immunodeficiency. It describes the body's lines of defense including physical barriers, phagocytes, inflammation, and the adaptive immune system of antibodies and memory cells. It differentiates between primary and secondary immunodeficiency. The nursing management of patients with immunodeficiency focuses on infection prevention and treatment, nutritional monitoring, education, and managing complications.
A burn is an injury to the skin or flesh caused by heat, electricity, chemicals, friction or radiation. There are three degrees of burns: first-degree burns damage the outer layer of skin, second-degree burns damage the outer and inner layers, and third-degree burns damage the deepest skin layers and tissues below. Burns can cause swelling, blistering, scarring, shock and even death if severe, and increase risk of infection by damaging the skin's protective barrier. Treatment depends on the degree of the burn, with first and second usually healing without grafts but third often requiring skin grafts.
This document provides an overview of burns, including definitions, classifications, and treatment guidelines. It defines different types of burns such as thermal, chemical, and electrical burns. Burns are classified based on depth and percentage of total body surface area affected. Guidelines for fluid resuscitation and referral to a burn center are outlined. Treatment involves fluid resuscitation, wound care, pain management, and potential transfer to a specialized burn unit for more extensive injuries.
Pathophysiology and complications of burnMohamed Amin
Ā
This document discusses the pathophysiology and complications of burns. It begins by defining burns and classifying them by degree, thickness, and percentage of total body surface area affected. It then describes Jackson's thermal wound theory and the zones of coagulation, stasis, and hyperaemia. The pathophysiology section covers the ebb and flow phases, hypermetabolic state, and systemic responses involving metabolic, cardiac, renal, blood, immunologic, and other systems. Complications discussed include burn shock, pulmonary issues, acute renal failure, infections and sepsis, Curling's ulcer, scarring, and cancer. Sepsis is defined and causes of death from burns are provided.
BURN BURN BURN
in this ppt you can find all the detail related to burn of human body
causes of burning
types of burning
classification of burning
symptoms to identify the degree of burn
prevention of burn
home made prevention for burning
Burns are caused by thermal injury and result in skin and tissue damage. They are classified by depth and extent of body surface area affected. Common types include scalds, flames, chemicals, electricity, and radiation. Management involves assessing airway/breathing, fluid resuscitation to prevent shock, wound care, pain relief, and infection control. Resuscitation aims to stabilize the patient and replace fluid losses using formulas like Parkland or Brooke, followed by acute wound management and later rehabilitation.
Thermal burns can range from superficial first degree burns affecting just the epidermis to full thickness third degree burns extending through the dermis. Jackson's theory describes three zones of injury - the zone of coagulation nearest the heat source suffers the most damage, the zone of stasis surrounding it has decreased blood flow, and the outer zone of hyperemia has increased blood flow. Burn depth and extent determine severity and influence fluid shifts, metabolic changes, and risk of infection in the acute phase after injury.
Definition of inflammation, Causes, Signs of inflammation, Types of inflammation, Triple response, Phagocytosis, TransudateĀ orĀ Exudate, Difference between transudate and exudate, Granuloma and Granulomatous inflammation
medical surgical nursing , nursing management of burn patients, it includes definition, classification of burn injury, clinical manifestaion, assessment of burn injury , management of patient with burn, care given to the patient.
The document summarizes the body's immune defenses against infection. It describes two main types of immunity: innate immunity, which provides nonspecific defenses like skin barriers and phagocytes; and acquired (adaptive) immunity, which develops after exposure and provides pathogen-specific responses using B cells, T cells, antibodies, and immunological memory. The immune system uses successive lines of defense, from physical barriers and phagocytes to inflammation and antibodies, to protect the body. Vaccines help produce active immunity by exposing the immune system to weakened or killed pathogens.
This document provides an overview of burn injury management. It discusses the epidemiology, pathophysiology, classification, and treatment principles for burns. The key aspects of management include initial resuscitation using fluid replacement formulas to prevent shock, wound care, infection prevention, and long-term rehabilitation to address physical and psychological impacts of severe burns. Proper management requires a multidisciplinary team to address the many systemic effects of serious burns.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document provides an overview of the management of burn patients. It discusses estimating the depth and extent of burn wounds, fluid resuscitation, burn wound management, detecting sepsis, and wound coverage. It also covers types of burn injuries such as scald, flame, hot object, electrical, and chemical burns, as well as the characteristics of superficial, partial-thickness, and deep-thickness burns. Specific guidelines are provided for chemical injuries, which include removing contaminated clothing, flushing the body with water, and irrigating the eyes until seen by a doctor.
This document defines and classifies different types of burns, including thermal, electrical, chemical, and radiation burns. It describes burns based on depth, with first degree involving the epidermis, second degree also involving the dermis and causing blisters, third degree being full thickness and causing charring, and fourth degree extending into underlying tissues. Burns are also classified based on percentage of total body surface area affected as minor, moderate, or major. The pathophysiology of burns is described, including increased vascular permeability, fluid shifts leading to hypovolemia, and increased risk of infection, renal failure, and multiorgan dysfunction. Infections from bacteria such as Streptococcus and Pseudomonas are common complications. Causes
nursing management of a patient with painancychacko89
Ā
This document discusses pain, including definitions, types, theories, assessment, and management. It defines pain as a sensory and emotional experience associated with tissue damage. There are different types of pain such as acute, chronic, neuropathic, and nociceptive. Theories discussed include specificity theory, pattern theory, and gate control theory. Pain is influenced by many factors and should be assessed using various scales tailored for different populations. Management includes pharmacological approaches like the WHO analgesic ladder as well as non-pharmacological options. Nurses play an important role in comprehensive pain assessment.
This document discusses the nursing management of patients with burns. It covers the incidence, causes, classification, effects and complications of burns. It also outlines the nursing management in the emergent/acute phase, which focuses on controlling the airway, breathing, circulation, disability and environment. Complications during rehabilitation are also discussed.
This document discusses different types of burns including thermal, chemical, electrical, and radiation burns. It describes how burns are assessed based on depth and extent of body surface area involved. First, second, and third degree burns are defined. Fluid imbalances that can occur with burns are also outlined. The phases of burn injuries - emergent, acute, and rehabilitative - are summarized along with goals, nursing interventions, and considerations for each phase. Wound care including dressing changes and skin grafting is also covered at a high level.
1) Shock is a life-threatening condition where tissue perfusion is inadequate, preventing delivery of oxygen and nutrients to vital organs and cells.
2) Shock progresses through initial, compensatory, progressive, and irreversible stages and can be caused by hypovolemia, heart problems, neurologic issues, sepsis, or allergic reactions.
3) Nursing management of shock involves rapid assessment of circulation, breathing, level of consciousness and skin signs; providing immediate care like oxygen, IV fluids, medications; and identifying and treating the underlying cause.
The document provides information about fluid and electrolyte balance, including average daily water intake and output in adults. It discusses the fluid compartments in the body and the functions of water and fluids. It also describes electrolytes, types of solutions, and nursing management for clients with burns or problems related to the genitourinary system such as renal failure.
The document discusses the immune system and its defense against disease. It defines the immune defense and immunodeficiency. It describes the body's lines of defense including physical barriers, phagocytes, inflammation, and the adaptive immune system of antibodies and memory cells. It differentiates between primary and secondary immunodeficiency. The nursing management of patients with immunodeficiency focuses on infection prevention and treatment, nutritional monitoring, education, and managing complications.
A burn is an injury to the skin or flesh caused by heat, electricity, chemicals, friction or radiation. There are three degrees of burns: first-degree burns damage the outer layer of skin, second-degree burns damage the outer and inner layers, and third-degree burns damage the deepest skin layers and tissues below. Burns can cause swelling, blistering, scarring, shock and even death if severe, and increase risk of infection by damaging the skin's protective barrier. Treatment depends on the degree of the burn, with first and second usually healing without grafts but third often requiring skin grafts.
This document provides an overview of burns, including definitions, classifications, and treatment guidelines. It defines different types of burns such as thermal, chemical, and electrical burns. Burns are classified based on depth and percentage of total body surface area affected. Guidelines for fluid resuscitation and referral to a burn center are outlined. Treatment involves fluid resuscitation, wound care, pain management, and potential transfer to a specialized burn unit for more extensive injuries.
Pathophysiology and complications of burnMohamed Amin
Ā
This document discusses the pathophysiology and complications of burns. It begins by defining burns and classifying them by degree, thickness, and percentage of total body surface area affected. It then describes Jackson's thermal wound theory and the zones of coagulation, stasis, and hyperaemia. The pathophysiology section covers the ebb and flow phases, hypermetabolic state, and systemic responses involving metabolic, cardiac, renal, blood, immunologic, and other systems. Complications discussed include burn shock, pulmonary issues, acute renal failure, infections and sepsis, Curling's ulcer, scarring, and cancer. Sepsis is defined and causes of death from burns are provided.
BURN BURN BURN
in this ppt you can find all the detail related to burn of human body
causes of burning
types of burning
classification of burning
symptoms to identify the degree of burn
prevention of burn
home made prevention for burning
Burns are caused by thermal injury and result in skin and tissue damage. They are classified by depth and extent of body surface area affected. Common types include scalds, flames, chemicals, electricity, and radiation. Management involves assessing airway/breathing, fluid resuscitation to prevent shock, wound care, pain relief, and infection control. Resuscitation aims to stabilize the patient and replace fluid losses using formulas like Parkland or Brooke, followed by acute wound management and later rehabilitation.
Thermal burns can range from superficial first degree burns affecting just the epidermis to full thickness third degree burns extending through the dermis. Jackson's theory describes three zones of injury - the zone of coagulation nearest the heat source suffers the most damage, the zone of stasis surrounding it has decreased blood flow, and the outer zone of hyperemia has increased blood flow. Burn depth and extent determine severity and influence fluid shifts, metabolic changes, and risk of infection in the acute phase after injury.
1) Burns are wounds caused by heat, chemicals, electricity or radiation that lead to skin tissue death. Thermal burns include flame, scald, smoke or radiation burns.
2) Burns are classified based on depth and percentage of total body surface area affected. Deeper burns involving deeper skin or muscle layers require grafting to heal.
3) Large burns trigger systemic inflammatory responses, increasing vascular permeability and fluid shifts that can cause shock. This impacts the cardiovascular and respiratory systems.
Burns are caused by thermal, chemical, electrical or radiation injury leading to tissue damage. The extent and severity of burns is classified based on the percentage of total body surface area affected and depth of tissue injury. Major systemic effects include circulatory shock, respiratory complications, metabolic changes and increased risk of infection due to suppression of the immune system. Prompt resuscitation and treatment is needed to prevent further tissue damage and organ failure.
This document provides an overview of burns and pressure sores. It begins with definitions of the skin and its layers. It then discusses burns in depth, including the pathophysiology and zones of burns, burn classifications based on causative agent, depth and total body surface area affected. Pressure sores are also briefly introduced. In-depth information is provided on assessing burn depth and the characteristics of first to fourth degree burns.
BURNS MANAGEMENT PPT BY DR SUJITH CHADALA MD GEN MED , PGPC , IDCCMDr Sujith Chadala
Ā
Dr. Sujith Chadala provides definitions and information about different types of burns. Thermal burns are caused by dry heat, moist heat, smoke or inhalation and result in coagulative necrosis of tissue. The extent of damage from thermal burns depends on temperature, amount of heat and duration of exposure. After a burn, the body undergoes pathophysiological changes including fluid shifts from blood vessels into tissue, metabolic changes causing a hypermetabolic state, and suppressed immune responses increasing infection risk. The body's response involves an emergent phase of pain and increased heart rate, a fluid shift phase of up to 24 hours, and a hypermetabolic phase lasting days to weeks during which nutrient needs increase for repair.
This document provides an overview of burn injuries including:
1. It defines burn injuries and discusses the local and systemic effects including damage to the skin, airways, and metabolic effects.
2. Burn injuries are classified based on etiology (thermal, chemical, electrical, radiation), depth (first through fourth degree), and severity (mild, moderate, major). Common thermal burn mechanisms like scalds, flames, and contact burns are described.
3. A thorough clinical assessment of burn wounds including characteristics of different degree burns is outlined to classify burn depth and severity.
Thermal injury is caused by temperatures exceeding tissue damage thresholds. Burns are classified by depth and cause. Superficial burns involve the epidermis while deep second degree burns involve the dermis. Third degree burns destroy the entire dermis. Systemic effects include hypovolemic shock, cardiac dysfunction, and increased infection risk. Burn assessment tools include the Rule of Nines and Lund-Browder chart. Treatment involves fluid resuscitation, wound care, infection prevention and rehabilitation to address complications like contractures.
1. A burn is an injury to the skin or flesh caused by heat, electricity, chemicals, friction or radiation. The severity depends on the temperature and duration of exposure.
2. About 2.4 million people suffer burns annually in the US, with 700,000 cases requiring medical treatment. The main causes are thermal, electrical, chemical and radiation burns.
3. Burns are classified by depth and extent of the affected body surface area. Depth is classified as superficial, partial-thickness, or full-thickness. Extent is classified using methods like the Rule of Nines or Lund and Browder chart.
An extensive presentation on the anatomy, physiology, classification and management of various degree of burns. I made this in the final year of my Anesthesia residency and I have tried to add the maximum information as possible to make this a useful source for anyone.
This document provides an overview of burn injuries including:
1. The pathophysiology of burns including fluid shifts, systemic changes, and the hypermetabolic response.
2. Classification of burns by depth and severity. Thermal burns can cause damage from coagulation to hyperemia.
3. Management of burns focuses on airway control, fluid resuscitation using formulas like Parkland, and wound care including escharotomy, fasciotomy, and debridement.
Thermal injuries to the body can occur from various heat sources and cause burns or scalds of different depths. Scalds are caused by moist heat and result in blistering while burns are caused by dry heat and cause tissue desiccation and necrosis. The degree of burn is classified based on depth of tissue injury. Proper assessment of burn size, depth, and inhalation injury is important. Major burns can lead to hypovolemic shock, infection, organ dysfunction and death if not managed promptly with fluid resuscitation, wound care, infection control and surgery. Outcomes depend on percentage of body surface area burned, depth of burn and presence of inhalational injury.
Burns are classified based on depth and extent of tissue damage. First degree burns involve only the epidermis, while second degree burns extend deeper into the dermis and may cause blistering. Third degree burns extend through the entire thickness of skin. Proper first aid and fluid resuscitation are important to prevent further tissue damage. Hospitalization is recommended for burns covering over 10% of total body surface area or involving sensitive areas like the hands, face or genitals. Management involves wound care, pain control, nutrition and physical therapy.
The document summarizes the pathophysiology of burns in three phases. The initial ebb phase occurs in the first 24 hours and involves hypotension, low cardiac output, and hypoventilation. The flow phase follows and involves increases in cardiac output and oxygen consumption. A hypermetabolic hyperdynamic response peaks at 10-14 days. Systemic effects include metabolic, cardiac, renal, blood, immunologic, lung, GI, and infectious responses. Burn-induced inflammatory mediators cause widespread vascular permeability and organ dysfunction. Successful resuscitation is needed to avoid multi-organ failure from hypovolemia and infection risk due to impaired immunity and skin barrier function.
This document provides a classification and overview of burn injuries. It discusses:
1. The classification of burns based on etiology including thermal, electrical, chemical, radiation, and inhalation injuries.
2. The degrees of burn injuries from first to fourth degree based on depth of tissue damage.
3. Key aspects of burn management including emergent resuscitation focusing on airway, circulation and fluid replacement to maintain organ function in the first 24-48 hours.
4. Wound care including open and closed methods and use of antimicrobial agents like silver sulfadiazine cream.
This document discusses the pathophysiology and management of burn patients. It covers:
1) Major burns cause massive tissue destruction and inflammatory response, leading to burn shock from fluid shifts and systemic effects if >20% TBSA.
2) Burns trigger a hypermetabolic response for weeks, with increased cardiac work and protein catabolism impairing healing.
3) Resuscitation follows the Parkland formula to replace fluid losses. Fluid management aims to maintain urine output and prevent organ dysfunction.
Burn Injury classification and managementDr Alok Kumar
Ā
1. The document discusses various types of burn injuries including thermal burns from heat or flames, scalds from hot liquids, and non-thermal burns from electricity, chemicals, radiation, or cold.
2. It describes the pathology of burns including the severity and depth of tissue damage, vascular changes that can cause shock, and high risks of infection when the skin is destroyed.
3. The management of burns is outlined including treatment of shock, general wound care and infection prevention, skin grafting, and physiotherapy to prevent complications and aid rehabilitation.
This document provides an overview of burn management. It begins with definitions and epidemiology, noting that burns are a global health problem disproportionately impacting children and low-income countries. It then covers burn classification based on depth, severity, and etiology. The pathophysiology section outlines the local and systemic effects of burns, including impacts on respiratory, gastrointestinal, immune, and other systems. Management priorities are stopping the burning process, providing fluid resuscitation based on the Parkland formula, and treating for complications like infection and inhalation injury. The document provides context and guidelines to inform burn patient assessment and treatment.
Burn injuries can cause significant damage and require careful management. The document discusses:
1) The classification, pathophysiology, and stages of management for burn injuries including the emergent/resuscitative, acute, and rehabilitative phases.
2) Key aspects of the emergent phase include airway management, fluid resuscitation using formulas like Parkland, and wound care/debridement to prevent infection.
3) The acute phase focuses on wound healing through techniques like escharotomy, skin grafting using temporary or permanent options, and nutritional/physical therapy.
The document discusses eyelid reconstruction, including:
1. It describes the anatomy of the eyelid, including the palpebral fissure size, positions of the canthi and eyelid margins, and layers of the eyelid.
2. Common reasons for eyelid reconstruction include congenital anomalies, tumors, and trauma. Principles of reconstruction include thorough evaluation, debridement of nonviable tissue, and aligning all tissue layers.
3. Various flap techniques are described for reconstructing different areas of the eyelid, including tarsoconjunctival flaps, cheek flaps, forehead flaps, and V-Y flaps. Complications of reconstruction include issues like corneal abrasion
This document discusses vascular anomalies including infantile hemangioma and various types of vascular malformations such as capillary, venous, arteriovenous, and lymphatic malformations. It covers the classification, clinical features, investigations, management, and complications of these conditions. Key points include that infantile hemangiomas have a distinct growth cycle of proliferation, involution, and involuted phases while vascular malformations are present at birth and grow proportionally with the child. Management involves observation, medications like corticosteroids and propranolol, laser therapy, surgery, and embolization depending on the specific anomaly and risk of complications.
Tissue expansion is a surgical technique used to generate additional skin and soft tissue for reconstructive purposes. It involves inserting a temporary implant called a tissue expander under the skin and gradually inflating it with saline over 6-12 weeks to stretch the overlying tissue. This causes mechanical and biological tissue growth. The expander is then removed and the expanded skin is advanced to reconstruct areas of skin loss or defects. Complications can include hematoma, seroma, expander deflation or migration, and skin thinning or necrosis but tissue expansion provides a good source of autologous tissue for reconstruction when other options are limited.
Tendon transfers involve rerouting a functioning muscle tendon unit to restore lost function according to established principles. The key principles are having supple joints at the donor and recipient sites, maintaining soft tissue equilibrium, ensuring the donor has adequate excursion and strength, choosing an expendable donor, maintaining a straight line of pull, selecting donors and recipients with synergistic functions, and performing single tendon transfers for single functions. Tendon transfers can restore grasp, pinch and upper extremity motions according to these principles.
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
1. Tendon transfers involve rerouting a functioning muscle tendon unit to restore a function lost due to nerve injury or other conditions. Common indications include nerve injuries or trauma.
2. Key principles of tendon transfer include having supple joints, adequate excursion of the donor muscle, and maintaining a straight line of pull. Common procedures restore functions like finger extension, thumb opposition, and wrist extension.
3. Rehabilitation after tendon transfer focuses on immobilization followed by gentle range of motion and strengthening exercises over 8-12 weeks before returning to full activity.
- The temporomandibular joint (TMJ) is located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. It is a bi-arthroidal hinge joint containing synovial fluid that allows for translational and rotational movements.
- Temporomandibular disorders (TMD) is a collective term used for clinical problems involving the masticatory muscles, TMJ, and associated structures. Common signs and symptoms include pain and limited opening of the mouth.
- Disc displacement is the most common TMJ articular disorder and can involve reduction or lack of reduction of the articular disc. Conservative treatments include
The document describes various suture techniques including simple interrupted sutures, which are the gold standard, subcuticular sutures which avoid external knots, half-buried horizontal mattress sutures which keep knots on one side, continuous over-and-over sutures which can be placed rapidly but are less precise than interrupted sutures, skin staples which are a timesaving alternative to sutures, skin tapes and adhesives which can be used in low tension areas, and Z-plasties which help prevent or limit scarring and contractures. It also outlines indications, contraindications and potential complications of Z-plasty techniques.
1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
2. Factors that determine replantation success include patient health, injury details, and surgical team skill.
3. The operative technique prioritizes veins, arteries, bones, tendons, and nerves with the goal of minimizing warm ischemia time.
1. Skin banking involves procuring skin from donors after death, processing it which may include cryopreservation or lyophilization, and storing it to be used for burn patients or other wounds.
2. The first skin bank was established in 1971 and they continue to improve techniques like reducing immunogenicity and potential for disease transmission.
3. Skin culture techniques also allow creating skin substitutes using fibroblasts, keratinocytes and endothelial cells grown on collagen gels or cadaver dermis in organotypic culture.
The document summarizes the anatomy and branches of the ulnar, radial, and median nerves in the upper limb. It describes the course and branches of each nerve in the axilla, arm, and forearm. It also discusses the separation of motor and sensory components within the nerves and provides diagrams of fascicular patterns. Key points include that the ulnar nerve supplies medial forearm muscles and skin of the little and half of the ring finger, the radial nerve innervates posterior forearm muscles and skin of the dorsal hand, and the median nerve gives branches in the forearm and palm.
This document discusses various surgical approaches for forehead and brow lifting as well as neck lifting. For forehead lifts, it describes techniques like the coronal approach and its disadvantages like scalp numbness. It also covers other approaches like the temple approach and endoscopic approach. For neck lifts, it discusses factors to consider like skin elasticity and platysma muscle treatment. It provides details on the surgical process for different grades of neck laxity and describes techniques like subcutaneous lipectomy and platysma plication. Post-operative care is also outlined for both forehead and neck procedures.
This document discusses the classification, diagnosis, and treatment of mandibular fractures. Key points include:
- Mandibular fractures are classified based on location and examined clinically and radiographically.
- Treatment options include closed or open reduction, with closed reduction used for minimally displaced fractures and open reduction for more complex cases.
- Internal fixation methods like miniplates are used to achieve rigid stabilization during open reduction, while intermaxillary fixation can be used short-term for closed reduction.
- Potential complications include hemorrhage, infection, nonunion, and neurosensory changes. Proper treatment aims to restore occlusion and minimize complications.
This document discusses the stages of skin graft take, including plasmatic imbibition, inosculation and capillary ingrowth, and revascularization. It describes graft fixation, contraction, reinnervation, pigmentation, and factors that can lead to graft failure. The stages of graft take typically involve serum imbibition for 24-48 hours, development of fine vasculature in a fibrin layer, and eventual blood flow as the graft becomes pink. Revascularization may occur through direct vessel anastomoses, new vascular channel formation, or a combination. Proper fixation and aftercare are important for successful graft take.
Liposuction is a surgical procedure to remove unwanted fat deposits from beneath the skin. It was originally introduced in the 1980s and involves using suction to aspirate fat through small incisions. There are several techniques including traditional suction-assisted liposuction, ultrasound-assisted, power-assisted, vaser-assisted, and laser-assisted liposuction. Patient selection, pre-operative evaluation and planning, anesthesia technique, and post-operative care are important considerations to achieve optimal results and avoid complications from liposuction.
This document describes different types of local flaps that can be used in skin grafting and reconstructive procedures. It outlines pivotal flaps, advancement flaps, and hinge flaps. Pivotal flaps involve rotation, transposition, or interpolation of skin and come in various shapes. Advancement flaps can be unipedicled, bipedicled, or in a V-Y or Y-V configuration. They take advantage of skin elasticity or use Burrow triangles to advance the skin. Pantographic expansion is another advancement technique but carries more risk.
Flexor tendon repair requires protecting the tendon repair while allowing early controlled motion to minimize adhesions. This involves splinting the fingers in flexion after primary repair or tendon grafting, followed by progressive range of motion exercises. Complications can include infection, scarring and joint contractures, but good outcomes are achieved with protocols emphasizing early motion like Duran or Kleinert methods.
The parascapular flap uses skin and bone from the back to reconstruct large cheek defects. It provides reliable reconstruction with appropriate bulk and contour for the cheek. The flap has the disadvantages of a tedious dissection due to numerous branches that must be divided and no possibility for a sensate flap.
The free fibula osteocutaneous flap uses the fibula and overlying skin to reconstruct mandibular, maxillary and other bone defects. It has advantages of large vessels, long vascular pedicle, well-vascularized bone that can be shaped. Disadvantages include donor site morbidity such as delayed wound healing and nerve injury. Preoperative vascular problems and poor skin quality can also be issues.
The gracilis muscle is a thin muscle in the thigh that can be used as a free flap for reconstruction. It is 25-30 cm in length with a 10-12 cm tendon. The muscle is innervated by the obturator nerve and receives its blood supply from the gracilis vessels of the medial femoral circumflex artery system. It is commonly used in head and neck reconstruction or to repair soft tissue defects. The latissimus dorsi muscle is one of the largest muscles in the body and can be harvested as a pedicled or free flap, often with a skin paddle. It is innervated by the thoracodorsal nerve and receives its blood supply from the thoracod
This document describes two types of flaps: the gastrocnemius flap and the forehead flap. The gastrocnemius flap uses the medial or lateral head of the gastrocnemius muscle and surrounding tissue to cover defects of the proximal or anterior leg. The forehead flap uses skin and tissue from the forehead, supplied by the supratrochlear artery, to reconstruct nasal or periorbital defects. Key details about the vascular anatomy, dimensions, and applications of each flap are provided.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
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Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
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Statistics- Statistics is the science of collecting, organizing, presenting, analyzing andĀ interpreting numerical data to assist in making more effective decisions.
Ā A statistics isĀ a measure which is used to estimate the population parameter
Ā Parameters-It is used to describe theĀ properties of an entire population.
Examples-Measures of central tendency Dispersion,Ā Variance,Ā Standard Deviation (SD), Absolute Error,Ā Mean Absolute Error (MAE), Eigen Value
PGx Analysis in VarSeq: A Userās PerspectiveGolden Helix
Ā
Since our release of the PGx capabilities in VarSeq, weāve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your labās goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
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Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
8. Depth of burn
ā¢ Determined by :
ā Temperature
ā Length of exposure to the specific heat source
producing the burn
9. ā¢ Even low temperature (<44C) results in tissue
death if exposure long enough.
ā¢ Between 44 & 51C the rate of cell destruction
doubles with each degree rise in temperature.
ā¢ >70C tissue destruction instantaneous
10. Immersion time to produce full thickness burns
Temperature (C) Time
65 <1 second
60 2 seconds
55 10 seconds
50 30 seconds
47.5 1 minute
45 10 minutes
11. Superficial burn (1st degree)
ā¢ Only the epidermis
ā¢ Red and tender
ā¢ Mild discomfort
13. Superficial partial-thickness burn
(Superficial 2nd degree burn)
ā¢ Epidermis and part of the dermis
ā¢ Blistered, red, blanches with pressure
ā¢ Often seen with scalding injuries
ā¢ Sensitive to light touch or pinprick
ā¢ Heal time 1-3 weeks
15. Deep partial-thickness
(Deep 2nd degree)
ā¢ Epidermis and most of the dermis
ā¢ Appears white or poor vascularized; may not
blister
ā¢ Less sensitive to light touch than superficial
form
ā¢ Extensive time to heal (3-4 weeks)
17. Full-thickness (3rd degree)
ā¢ Epidermis, dermis and into subcutaneous
tissue
ā¢ Dry, leathery and insensate. Typically no
blistering
ā¢ Commonly seen when clothes are caught on
fire or skin is directly exposed to flame
ā¢ Extensive healing time
26. Zones of a burn (Jackson):
ā¢ Zone of coagulation
ā¢ Zone of Stasis (middle zone)
ā Stagnation of microvasculature flow:
ā¢ Early (0 to 4 hours)
ā¢ Delayed (4 to 24 hours)
ā¢ Zone of hypereamia (outermost zone)
ā Epidermis: reversibly injured
ā Dermis: microvasculature dilated.
ā Minimal fluid loss
27.
28.
29. Causes of stasis:
1. Endothelial injury
2. Arteriolar (1-2 hours post burn) and venular (3-4
hours post burn) dilatation
3. RBC aggregation
4. WBC clumping (8-24 hours post burn)
5. Platelet thrombi formation
6. Increased blood viscosity (due to plasma loss and
haemoconcentration)
7. Thromboplastin release
30. Zone of stasis may progress with
ā¢ Inadequate resuscitation
ā¢ Infection
ā¢ Sepsis
ā¢ Wound dries out
31. Proinflammatory
phenomena known as
systemic inflammatory
response syndrome
ā¢ macrophage
ā¢ cytokines TNF-Ī±
ā¢ interleukin-6 (IL-6)
ā¢ Bax, Bcl-xl, and caspase-3
ā¢ reactive oxygen species
(ROS), such as
ā¢ superoxide anion, hydroxyl
radical, hydrogen peroxide,
ā¢ reactive nitrogen species,
such as nitric oxide (NO)
and peroxynitrite
Anti-inflammatory/ counter
antiinflammatory response
syndrome
ā¢ T lymphocytes of helper Th-
2
ā¢ Cytokines IL-4/IL-10
ā¢ TGF
33. 1. Locally at burn site:
- Due to oedema formation
- Loss to exterior
- Loss into blisters
2. In burns > 30% TBSA
- Oedema of non-burned tissue
3. Systemic fluid shifts due to effects of
hypovolaemic shock
34. LOCAL OEDEMA AT BURN SITE
1. Increased microvascular permeability
2. Venular obstruction (RBC, WBC, platelets).
3. Increased interstitial osmolality (Bostwick)
secondary to protein shifts.
4. Dilatation of precapillary resistance vessels
35. An increase in microvascular permeability is the
predominant mechanism- Biphasic
1. Immediate and transient phase-
ā Histamine mediated
ā Lasts 5-10 minutes
ā Slight increase in permeability with little
contribution to oedema formation.
36. 2. Delayed prolonged phase
ā¢ Begins + 2 hours post burn, lasts + 8 hours.
ā¢ Due to:
ā (1) Direct heat injury and destruction of
vasculature.
ā (2) Mediators
ā¢ Arachidonic acid metabolites
ā¢ Free oxygen radical
ā¢ kinins, serotonin, etc.
37. ā¢ Worsens oxygen delivery to the tissues.
ā¢ Peaks + 6 hours post burn (later in large
burns).
ā¢ Starts resolving after about 24 hours. Resolves
by end of first week.
ā¢ Magnitude depends on depth and extent of
burn.
ā¢ Full thickness burns may result in less oedema
due to coagulation of vessels.
38.
39.
40. ā¢ PMN - microvascular occlusion both
systemically and locally
ā¢ Endothelial cells and PMN release:
ā PMN-derived proteases
ā Toxic oxygen radicals
ā Hydrogen peroxide and hydroxyl radicals.
ā¢ Peroxidation of lipids in cell membranes and
resultant cell lysis and thrombosis
41.
42. ā¢ Collagen denaturation - ground substance
destruction results in increased negativity of
colloid osmotic pressure of interstitial fluid
43. NON BURNED TISSUE
ā¢ > 25% TBSA- Generalised oedema of all body
tissues
ā¢ Arturson: General increase in capillary
permeability.
ā¢ Demling: Hypoproteinaemia is the main
cause. Effect of burns is increased flow to
CNS, heart, liver and adrenals and diminished
flow to skin, muscle, gut and kidneys
45. 2. Compensatory Mechanisms:
I. Collapse, hyperventilation
II. Microcirculatory changes (resorption of
fluid from interstitial & intracellular
spaces)
III. Neurohumoral changes
IV. Splanchnic vasoconstriction
ā¢ Hepato-renal dysfunction
ā¢ Ileus, gut ischaemia and translocation
46. 3. Decompensation, if overwhelming shock
I. Cellular failure (Na-K pump, mitochondria,
lysozomal and cellular lysis)
II. Microcirculatory failure (massive fluid leak from
vasculature)
III. Organ failure - MOF
48. ā¢ Suppression of host defence mechanisms
ā¢ Infection: primary or major cause of death in
75%
1. INTEGUMENT
2. NON SPECIFIC IMMUNITY (Early acute
inflammatory response)
3. HUMORAL IMMUNITY
4. CELL MEDIATED IMMUNITY
49. INTEGUMENT
EARLY ā
ā¢ Skin damage results in loss of protection against
microbial invasion.
ā¢ Inhalational burns destroy respiratory tract
mucosa.
ā¢ Intestinal mucosa is affected by splanchnic
vasoconstriction
ā¢ Increased systemic bacterial and endotoxin load
LATE ā
ā¢ Coagulated skin and eschar form an ideal growth
media for micro-organisms
54. IgG
ā¢ - Most affected. The most important opsonic
Ab for both G-ve and G+ve bacteria.
ā¢ - Level of depletion can be correlated
prognostically with septic complications.
IgM
ā¢ - Because of its size, is least affected
55. CELL MEDIATED IMMUNITY
Depressed by burns:
1. - Blast transformation and lymphocyte
proliferation is impaired.
2. - Decreased T-helper : T-suppressor cell ratio.
3. - Diminished activity of T-helper and T-killer
cells.
56.
57. 4. Suppressor cells proliferate maximally at
about 7 to 14 days post injury, coinciding
with the appearance of septic complications.
5. Impaired response to antigens
6. Prolonged allograft survival
7. Diminished resistance to tumours
58. OTHER FACTORS AFFECTING
IMMUNITY
1. Extremes of age
2. Concomittant disease (eg. Diabetes)
3. Poor nutritional status
4. Drugs (Antibiotics, topical agents, steroids)
5. Blood transfusions
6. Surgery
62. ā¢ Persists until remodelling is complete- Many
months.
ā¢ Increase BMR/Energy expenditure (2-3X
increase in 60% TBSA burn)
ā¢ Increased nitrogen losses (via normal channels
and from burn directly)
63. ā¢ Mediated by the hypothalamic-pituitary axis
which receives
ā Neuronal (pain, fear, anxiety, hypoxia,
hypotension) signals
ā humoral (prostoglandins, interleukins, C',
endotoxins) signals.
ā¢ Volume, chemo, osmo and baro receptors act
on the hypothalamus resulting in a
neurohumoral response
65. 1. GLUCOSE METABOLISM
1. Increased glycolysis
2. Increased gluconeogenesis
3. Hyperglycaemia due to insulin resistance
4. Increased utilization and oxidation of glucose
5. Increased futile cycles (Cori and glucose-alanine
cycles)
66. 2. FAT METABOLISM
1. Increased lipolysis
2. Increased cycling (TG FFA + Glycerol)
- Increasingly recognised role of fats in
immunological function:
* Prostinoid substrates
* Lipoproteins
* Cell membranes
- Dietary fat supplementation is important
67. 3. PROTEIN METABOLISM
ā¢ Massive proteolysis and muscle catabolism
occur leading to a negative N balance.
ā¢ Urinary nitrogen losses: 30 gm per day in the
fasting severely burned patient.
ā¢ Exudative wound protein losses: 150 gm per day.
ā¢ Average 70 kg male has: 4500 gm of skeletal
muscle protein and 8500 gm of visceral, plasma
and bone protein. Loss of > 40% of body protein
is fatal
68. ā¢ Protein is also mobilised from other tissues
(eg, gut, leading to translocation), which is
used for:
ā Gluconeogenesis
ā Acute phase proteins
ā Components of immune system: cells, Ig, clotting
factors, etc.
ā Wound repair.
78. Conclusion
The aim of the body's metabolic response to a
severe burn is
ā¢ to provide an effective physiological response
to fluid depletion, shifts and hypovolaemia;
ā¢ to mount a protective immunological barrier
to micro-organism invasion and infection and
ā¢ to mobilise the body's substrate resources so
as to allow effective wound healing and a
return to health
79. References
ā¢ Total Burn Care; David N Herndon. 3rd edn
ā¢ Burns: Pathophysiology of Systemic
Complications and Current Management;
Colton B. Nielson, Nicholas C. Duethman,
James M. Howard. American Burn Association
ā¢ ABC of burns: Pathophysiology and types of
burns; Shehan Hettiaratchy, Peter Dziewulski
Editor's Notes
most common sunburns
Plasma leaking into the skin is the blisters. Most common are scald burns
Notice the pink areas of the skin, that typically means there is still blood flow to that area. It may be difficult to class the burns before removal of skin and blisters