It is Thanksgiving, and a turkey frying incident has gone terribly wrong. A man was deep frying a turkey in an outdoor fryer. He dropped the frozen turkey into the large tub of boiling hot oil that overflowed, caught fire, and "exploded" burning oil all over him. He was not wearing a shirt. He covered his face with his hands but his arms and chest were badly burned. He has very painful blisters covering both arms, from his shoulders to his fingers. His forehead is red and tender but not blistered. His Chest and abdomen are pale gray-white in color, with little swelling or pain. Yet the doctors seem most concerned about infection, dehydration, and body temperature. Why?
Severity of burns depends on effected layer of skin
Burns were caused by hot oil
1st degree
Burn Severity and location
Rule of 9th determines if burn is critical
1st degree effects only epidermal layer
Does not effect the dermal area underneath epidermis
Anterior and posterior aspect of head; 9%
Anterior lower exremity; 9%
Anterior and posterior trunk" 36%
Posterior lower extremity = 9%
Anterior and posterior upper extremity: 9%
Body divided into 11 sections accounting for 9%
1% for groin area
Epidermis made of 5 layers
Causes redness
Pain
Swelling
Layers are called Stratum
Stratum Croneum
Stratum Lucidem
Stratum Granulosum
Stratum Spinosum
Stratum Basale
Very top layer of epidermis
Keratin responsible for protective function agains abrasions
Layer contains melanin for UV protection
Cells in this layer are dead
Clearish thin layer
Present only in thick skin
Layer that is 5-10 cells thick
Largest layer, (20-30 cells)
Contais lamellar granules
Aids in water protection
Keratinization begins
Produces Keratohyaline granules
Granuelles packaged in cells.
Layer Contains the Dendrites
Aids in immunity
Helps defend the body against pathogens
Cells contain pre-keratin
Contains Melanocytes
Melanocytes make the protein melanin
Helps in UV protection
Main factor determining skin tone/ color
UV light; Main cause of skin damage
Contains the mitotic germ cells
Cells have intermediate filaments
Contain pre-keratin
Division creates 2 daughter cells
One will stay in the basal layer and divide
Other will travel toward the top layers
Will eventually reach Stratum Corneum and die
Layer is only 1 cell thick
Makes up 10-25% of the Stratum basale layer
Layer is attached to the Dermis
Contains melanin in granules; packaged form
Will eventually shed off
2nd Degree
3rd layer of the epidermis
Effects Dermis
Made of connective tissue
Epidermis is avascular
Contains 2 layers
Still contains nerves
Aids in support and tensile strength
Layer where cells start to flatten
Cell starts degrading nucleus
Helps form Keratin
Hydrophobic glycolipid
Aids in protection function of skin
Depends on dermal layer for nutrients
Cells are anucleate
2/3 of epidermis
Made of dense connective tissue.
Papillary layer
Reticular layer
Highly vascularized
Responsible for supplementing nutrients to epidermis
Top portion of the Dermis
Contains dermal papillae
ridges/ bumps of dermis
Functions to hold vessels close to epidermis for nutrient absorption
Creates friction between epidermis and dermis
Through diffusion
Cells are jointed by desmosomes and tight junctions
Functions to resits tension and tear
Layer making up majority of dermis
Contains Glands, Follicles, Vessels, Nerves, and muscle
Muscle called erector pilli
responsible for raising hair
increased insulation
Goose bumps
Contains receptors called lamellar corpuscle
Dermis contains the sebaceous glands
Secretes oils
Present on the hair follicles
Contains merocrine and apocrine sweat glans
Both utilize merocrine secretion though named differently .
one of three types of secretion method of glands
Cells utilize exocytosis to secrete fluid
Apocrine
Holocrine
Top portion goes through apoptosis
Entire cell goes through apoptosis
Merocrine sweat glands found in majority of body
Apocrine glands found in axillary region after puberty
Sits on top of subcutaneous layer
Not a layer of skin
Made of adipose tissue
3rd degree
Involves complete thickness of skin
Burns on face, palm, or feet considered critical
Burns destroy nerves
Patient with third degree burn does not feel the pain
called full thickness burns
Appear gray/white, cherry red, or blackened
Infection and loss of fluids is a major concer
Blisters on both arms
Forehead = red and tender w/o blisters
Chest and abdomen are pale/ gray-white and not painful
Blisters considered to be 2nd degree burns
Partial thickness effects up to top of dermis
Painful due to nerve endings still intact
If blisters are only on anterior portion of arm surface % effected would be 4.5% for one arm
Assuming both posterior and anterior aspects of both arms are blistered patient would have 2nd degree burns =18%
Absence of blisters and red color with pain = 1st degree burn
No blisters due to burn effecting only epidermis layer
Pain due to nerve endings not destroyed
Helps differenciate between 1st and 3rd degree burns
Since only anterior part of head is effected (forehead) Burn totals 4.5% of total surface area of body
Though makes up 4.5% of surface area, 1st degree burns not considered to be part of determining if burns are critical
Considered to be a 3rd degree burn
No pain due to nerves being destroyed
Pale/ gray-white color = burn effected entire epidermis and dermis layers
Called full thickness burns
Due to fluid loss and possible infection skin grafting is advised
Based on rule of 9th's patient has more than 10% of surface area effected by 3rd degree burns
Anterior portion of chest and abdomen = 18% of surface area of skin
10% 3rd degree = Critical.;
20% of 2nd degree burns = critical
Pathogens are able to easily invade body
Major concern for infection
Due to the loss of protective layer of skin
Can cause sepsis
Loss of fluid is also a major problem
Skin helps with fluid retention
Since underlying tissues are exposed; liquids will weap out
Patient would also have imbalance in electrolytes
Temperature regulation is another major concern
One of major factors of integumentary is temperature regulation
Exposed tissues no longer insulated
Patient is prone to hypothermia