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Integumentary System - Coggle Diagram

- - - - dry heat (flame/hot surface)
      - moist heat (lsteam/hot liquids)
      - Electricity (lightning/current)
      - Chemicals (corrosive substances)
      - Friction
      - Radiant & EM enery
      - most common: thermal injury from fires :arrow_right: frostbites
  - - - Second-Degree Burns
        
        Third-Degree Burns
        
        *Fourth-Degree Burns
        
        Full-thickness with muscle/bone involvement
        
        epidermis+dermis+epidermal appendages destroyed; injury involves CT+muscle+bone
        
        cause: electrical current, prolonged contact w/ flame (e.g. unconscious)
        
        wound: dry, charred, mottled, insensate, limited/no movement of involved extermities
        
        requires skin grafting, amputation
        
        Full-thickness burns
        
        epidermis+dermis+epidermal appendages destroyed
        
        cause: prolonged contact w/ flame/scalding liquids/steam
        
        wound: dry, leather-like, pale, mottled brown/red, thrombosed vessels, insensate
        
        requires skin graft
        
        Superficial partial-thickness burns
        
        epidermis destroyed, minimal damage to dermis, epidermal appendages instact
        
        cause: brief exposure to flash, flame, hot liquids
        
        wound: moist & weepy, pink/red, blisters, blanching, hypersensitive
        
        complete healing within 21d w/ minimal/no scarring
        
        Deep partial-thickness
        
        epidermis destroyed, dermis damaged, some epidermal appendages intact
        
        cause: intense radiant energy, scalding liquids/hot semi-liquids/solids; flame
        
        wound: pale, decreased moistness, blanching absent/prolonged, some pain receptors damaged so have sense pressure (but not pricking)
        
        prolonged healing (>21d), may require skin graft
      - Superficial burns
        
        superficial tissue destruction - outermost later, skin intact
        
        cause: prolonged UV exposure, scalds
        
        self-limiting - complete healing in3-6 d w/o scarring/pigmentation
        
        therapy: simple analgesia
        
        wound: erythemotous, hypersensitive, no blister formation
  - - - prehospital settings & ER
        
        rough estimate of TBSA
    - - used in burn centres
        
        more precise esp. for children <10yo
  - - - coagulation of soft tissue
        
        reperfusion :arrow_right: release of vasoactive substances
        
        ROS formation :arrow_right:, :arrow_up: capillary permeability (leaky capillaries)
        
        fluid loss, :arrow_up: plasma viscosity
        
        microthrombi formation
      - burn >20% TBSA in adults = major burn injury
        
        massive evaporative water loss (EWL) & flux of fluid+electrocytes in body tissues
        
        Clinical signs:
        
        generalised edema
        
        circulatory hypovolemia
        
        hypotension
    - - immediately surrounding zone of coagulation w/ microvascular injury
        
        tissue can survive w/ adequate fluid resuscitation & prevention of infection
    - - zone of vasodilation w/ increased perfusion d/t release of inflammatory mediators fr adjacent injured tissue
    - - zone of max irreversible injury & loss d/t protein coagulation
    - - Cellular response
        
        membrane potential changes
        
        Na-K pump impaired
        
        changes in Na+, K+, Ca2+, Mg2+, phosphate
      - Metabolic response
        
        response to sympathetic NS & homeostatic regulators
        
        :arrow_up: catecholamines, cortisol, glucagon, insulin, etc.
        
        changes in gluconeogenesis, lipolysis, proteolysis
        
        HYPERMETABOL IC STATE: increased body T (fever), tachycardia, hypercapnia, body wasting
      - Cardiovascular response
        
        decreased cardiac output
        
        inadequate capillary perfusion
        
        Reasons:
        
        myocardia; depressant factors, :arrow_down: intravascular volume
        
        Complication:
        
        burn shock & death
      - Immunologic response
        
        immunosuppression
        
        susceptibility to system burn wound sepsis
        
        inflamatory cytokines + bacterial products :arrow_right: multiple organ failure
  - - - immediate (acute) systemic physiological consequence
        
        hypovolemic shock d/t massive fluid loss ( :arrow_up: capillary permeability) & shift to interstitial space fr circulating blood volume
        
        cardiovascular & cellular/immunological changes
        
        Management: immediate fluid resuscitation (e.g. IV lactated Ringer's solution)
        
        End point: 'Capillary Seal'
    - - Wound infection
        
        Diagnosis:
        
        clinical examination
        
        culture data (quantitative biopsy/quantitative swab)
        
        tissue histopathology (quantify & evaluate infection depth & non-burned skin involvement)
        
        routine wound cultures to monitor response
        
        Signs of Sepsis
        
        temp >39C or <36.5C
        
        progressive tachycardia (>110bpm)
        -progressive tachypnea
        
        thrombocutopenia
        
        hyperglycaemia
        
        abdominal distension
        
        high gastric residuals
        
        uncontrollable diarrhoea
      - Prevention
        
        Management
        
        protection fr direct sunlight
        
        rage of motion exercises (physiotherapy)
        
        support garments (pressure therapy)
        
        pathophysiological process: dysfunctional wound healing
        
        flexor sontractures
        
        hypertrophic scarring
        
        Keloid formation
        
        wound healing (rehabilitation phase)
      - Precautions
        
        Wound care
        
        focus of medical care: prevent infection
        
        Goals of wound care
        
        cleanse & debride wound of necrotic tissue
        
        minimise further destruction of viable tissue
        
        prevent cross-contamination
        
        preserve body heat & energy
        
        if infection develops, aggressive surgical excision (wound closure w/ autograph, allograft, skin subs), antimicrobial therapy
- - - - stratum germinativum
      - deepest layer
      - 1 layer basal cells
      - bind to dermis via basement membrane
      - Melanocytes
      - Merkel cells
      - Constantly dividing
    - - Desmosomes - appears spiny
      - 8-10 layers keratinocytes (from SB)
      - Langerhans cells
      - Release water-repelling glycolipid
      - new keratonocytes > SB > SS > SG
    - - grainy appearance-keratin & keratohyalin
      - 3-5 layers keratinocytes
      - flatter & thicker
      - neiclei&organelles disintegrate when cells die
    - - smooth, translucent layer
      - only found in thick skin (palm, soles)
      - dead & flattened keratinocytes
      - packed w/ eleidin (derived from keratohyalin)
    - - superficial layer
      - exposed to external
      - keratinisation/cornification
      - 15-30 layers
      - barrier against microbes/water loss, mechanical barrier against abrasion
      - shed periodically in 4 wks (replaced fr SG/SL)
      - Procedure: Microdermabrasion (cosmetic procedure that removes this layer)
  - - - loose connective tissue
      - leukocytes, macrophages
      - capillary
      - Meissner's corpuscles
    - - Lymph vessels, hair follicles
      - Involuntary muscles
      - Sudoriferous (sweat) glands
        
        apocine & eccrine glands
      - Elastic & Collagenour fibres
        
        allow flexibility&movement
      - Sebaceous (oil) glands
        
        secrete sebum
      - Nerve endings
      - Blood vessels
    - - for strength
        
        Pacinian corpuscles (sense pressure)
  - - - protection, insulation, temperature regulation
  - - - distributed
      - rate of degradation
      - produced
- - - - goose bumps
  - - - forms central core
    - - contains melanin, gives hair colour
    - - covers shaft of hair
    - - layer of mitotically active basal cells
    - - made of connective tissue, contains blood capillaries & nerve endings from dermis