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Adult male presents with mild to severe burns covering his head, arms and…

- - - - medulla
      - cortex
      - cuticle
    - - Dermis
        
        underlies epidermis
        
        mostly fibrous connective tissue, vascular
        
        Papillary Layer
        
        superficial layer of loose areolar connective tissue
        
        loose fibers allow phagocytes to patrol for microorganisms
        
        Reticular Layer
        
        cleavage lines
        
        caused by many collagen fibers running parallel to skin surface
        
        important to surgeons because incisions parallel to cleavage lines heal more readily
        
        flexure lines
        
        dermal folds at or near joints
        
        skin's inability to slide easily for joint movement causes deep creases
      - Epidermis
        
        superficial region
        
        consists of epithelial tissue and is avascular
        
        keratinocytes
        
        produce fibrous keratin
        
        melanocytes
        
        produce pigment melanin
        
        dendritic cells
        
        key activators of the immune system
        
        Tactile cells
        
        sensory receptors that sense touch
    - - Protection
        
        Chemical Barriers
        
        skin secretes sweat, sebum and antimicrobial defensin
        
        acid mantle
        
        low pH of skin retards bacterial multiplication
        
        melanin protect against UV radiation
        
        Physical Barriers
        
        flat dead cells of stratum corneum block most water and water-soluble substances
        
        some chemicals have limited penetration of the skin
        
        Biological Barriers
        
        epidermis contains phagocytic cells
        
        activate immune system response
        
        dermis contains macrophages
        
        also activate immune system by presenting foreign antigens to white blood cells
      - Body Temperature Regulation
        
        sweat glands produce 500 ml/day of unnoticeable sweat
        
        insensible perspiration
        
        sensible perspiration
        
        when body temp rises, dilation of dermal vessels can increase sweat gland activity
      - Excretion
        
        skin can secrete limited amounts of nitrogenous wastes
        
        sweating can cause salt and water loss
      - Metabolic Function
        
        vitamin D synthesis
        
        chemicals from keratinocytes can disarm some carcinogens
        
        keratinocytes can activate some hormones
        
        skin makes collagenese
  - - - First- Degree Burn
        
        epidermal damage only
        
        localized redness, edema (swelling) and pain
        
        partial-thickness burn
      - Second-Degree Burn
        
        epidermal and upper dermal damage
        
        blisters appear
        
        partial-thickness burn
      - Third-degree burn
        
        entire thickness of skin involved
        
        skin turns gray-white, cherry red or blackened
        
        no edema is seen and area is not painful because nerve endings are destroyed
    - - used to estimate fluid loss
      - body is broken into 11 sections
      - each 9% + 1% perineum
    - - 25% of body has second-degree burns
      - 10% of body has 3rd-degree burns
      - face, hands or feet bear third-degree burns
  - - - deepest of the epidermal layers
      - firmly attached to the dermis
      - single row of stem cells that actively divide
    - - several layers thick
      - prekeratin filaments attached to desmosomes, allows them to resist tension and pulling
    - - flattened cells, 4-6 cells thick
      - cells above this layer die
    - - found ONLY in thick skin
      - thin, translucent band of two to three clear, flat dead keratinocytes
      - lies superficial to the stratum granulosum
    - - 20-30 rows of flat, anucleated, keratinized dead cells
      - protect deeper cells from the environment
      - prevent water loss
      - protect from abrasion and penetration
    - - on palms and soles of feet
      - has all 5 layers of skin
      - has sweat glands
      - has no hair follicles or sebaceous glands
    - - covers most of the body
      - lacks a stratum lucidum
      - has sweat glands, sebaceous glands and hair follicles
      - less pronounced stratum corneum
- - - - body temp cannot stabilize resulting in death
- - - - extreme burn can cause exposed blood vessels
  - - - Lungs
        
        exposure to burn can impair function
      - Heart
        
        exposure to burn can cause implications
  - - - stomach
        
        can malfunction from burn
      - intestines
        
        can malfunction from burn
      - liver
        
        can malfunction from burn
  - - - extreme pain experienced by pain receptors