Download Ch. 4 Integumentary and Burns

PowerPoint® Lecture Slides prepared by Vince Austin, University of Kentucky
The Integumentary
System
Human Anatomy & Physiology, Sixth Edition
Elaine N. Marieb
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings
4
Layers of the Skin
 The 5 layers are (deep to superficial):
 Stratum basale
 Stratum spinosum
 Stratum granulosum
 Stratum lucidum (lacking in thin skin)
 Stratum corneum
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How can you remember the layers?
 Mnemonic (memory device)
B
S
G
L
C
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Layers of the Epidermis: Stratum Basale
(Basal Layer) thin skin diagram = no “L”
Figure 5.2b
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Skin Appendages
 Derivatives of the epidermis
 Include: nails, sweat glands, sebaceous (oil)
glands, hair, and hair follicles
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Sweat Glands
 Also called sudoriferous glands
 Distributed over the entire body except for
the nipples and some parts of the external
genitalia
 Each person contains more than 2.5 million
glands
 Secrete sweat, cerumen (“ear wax”), and
milk, depending on the type of gland
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Structure of a Nail
 Scalelike modification of the epidermis on the
distal, dorsal surface of fingers and toes
Figure 5.4
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Hair Function and Distribution
 Functions of hair include:
 Helping to maintain warmth
 Alerting the body to presence of insects on the skin
 Guarding the scalp against physical trauma, heat
loss, and sunlight
 Hair is distributed over the entire skin surface except
 Palms, soles, and lips
 Nipples and some portions of the external genitalia
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Hair Follicle
 Root sheath extending from the epidermal
surface into the dermis
 Deep end is expanded forming a hair bulb
 A knot of sensory nerve endings (a root hair
plexus) wraps around each hair bulb
 Bending a hair stimulates these endings, hence
our hairs act as sensitive touch receptors
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Hair Follicle
Figure 5.6a
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Hair Follicle
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Functions of the Integumentary System
1. Protection – chemical, physical, and mechanical
barrier
2. Body temperature regulation is accomplished
by:
 Dilation (body cooling) and constriction
(body warming) of dermal vessels
 Increasing sweat gland secretions to cool the
body
3. Cutaneous sensation – exoreceptors sense touch
and pain
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Functions of the Integumentary System
4. Metabolic functions – synthesis of vitamin D
in dermal blood vessels
5. Blood reservoir – skin blood vessels store up
to 5% of the body’s blood volume
6. Excretion – limited amounts of nitrogenous
wastes are eliminated from the body in sweat
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Layers of the Dermis: Reticular Layer
Separation,
or less dense
regions
between
these
bundles form
cleavage or
tension lines
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Skin Color
 Redness or erythema
a. Blushing, fever, inflammation, allergy
 Pallor, blanching, whiteness
a. Emotional stress, anemia, low blood pressure
 Jaundice or yellowishness
a. Liver disorder
 Bronzing
a. Addison’s disease, hypofunction of adrenal
cortex
 Black and blue marks
a. Escaped blood, hematomas
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Too Much Sun
 Clumping of collagen – leathery skin
 Temporary depression of the immune system
 Hypersensitivity due to UV light
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Common skin cancers
Basal Cell Carcinoma
(stratum basale)
Squamous Cell Carcinoma
(stratum spinosum)
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Melanoma
(melanocytes)
PowerPoint® Lecture Slides prepared by Vince Austin, University of Kentucky
Human Anatomy & Physiology, Sixth Edition
Elaine N. Marieb
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings
Looks and tastes great, right?
You should see what a hot
liquid will do to a child’s skin
when the two come into
contact.
Be sure to keep
hot liquids out of
reach of small
children.
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Burns - Preview
First-degree – only the epidermis is damaged
 Symptoms include localized redness, swelling, and
pain
Second-degree – epidermis and upper regions of
dermis are damaged
 Symptoms mimic first degree burns, but blisters also
appear
Third-degree – entire thickness of the skin is damaged
 Burned area appears gray-white, cherry red, or black;
there is no initial edema or pain (since nerve endings
are destroyed)
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Superficial = First degree
Superficial partial-thickness = Second
degree
Deep partial-thickness = Third degree
Full-thickness = Fourth degree
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Severe Burn Injuries
Burns considered critical if:
 Over 25% of the body has second-degree
burns
 Over 10% of the body has third-degree burns
 There are third-degree burns on face, hands,
or feet
 Patient with third-degree burns is under 6 y.o.
or over 70 y.o.
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“First Degree”
Very painful, dry, red burns which
blanch with pressure. They usually
take 3 to 7 days to heal without
scarring. Also known as first-degree
burns. The most common type of
first-degree burn is sunburn. Firstdegree burns are limited to the
epidermis, or upper layers of skin.
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First Degree Burn
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First Degree
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Second Degree Burn
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“Second Degree”
Very painful burns sensitive to
temperature change and air exposure.
More commonly referred to as seconddegree burns. Typically, they blister and
are moist, red, weeping burns which
blanch with pressure. They heal in 7 to
21 days. Scarring is usually confined to
changes in skin pigment.
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Second Degree
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Third Degree Burn
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“Third degree”
Blistering or easily unroofed burns which
are wet or waxy dry, and are painful to
pressure. Their color may range from
patchy, cheesy white to red, and they do
not blanch with pressure. They take over 21
days to heal and scarring may be severe. It
is sometimes difficult to differentiate these
burns from full-thickness burns.
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Third degree
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“Fourth degree”
Burns which cause the skin to be
waxy white to a charred black and
tend to be painless. Healing is very
slow, if at all, and may require skin
grafting. Severe scarring usually
occurs.
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Fourth degree
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The most important function of the skin
is to act as a barrier against infection.
The skin prevents loss of body fluids,
thus preventing dehydration. The skin
also regulates the body temperature
by controlling the amount of
evaporation of fluids from the sweat
glands. The skin serves a cosmetic
effect by giving the body shape.
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When the skin is burned, these functions are
impaired or lost completely. The severity of
the skin injury depends upon the size of the
injury, depth of the wound, part of the body
injured, age of the patient, and past medical
history. Because of the importance of the
skin, it becomes clear that injury can be
traumatic and life threatening. Recovery
from burn injury involves four major
aspects: burn wound management, physical
therapy, nutrition, and emotional support.
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1. Treatment should begin
immediately to cool the area
of the burn. This will help
alleviate pain.
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2. For deep partial-thickness burns or fullthickness burns, begin immediate plans to
transport the victim to competent medical
care. For any burn involving the face,
hands, feet, or completely around an
extremity, or deep burns; immediate
medical care should be sought. Not all
burns require immediate physician care
but should be evaluated within 3-5 days.
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3. Remove any hot or
burned clothing, if
doing so will not further
damage the skin.
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4. Use cool (54 degree F) saline
solution to cool the area for
15-30 minutes. Avoid ice or
freezing the injured tissue. Be
certain to maintain the
victim’s body temperature
while treating the burn.
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5. Wash the area thoroughly with
plain soap and water. Dry the area
with a clean towel. Ruptured
blisters should be removed, but the
management of clean, intact
blisters is controversial. You
should not attempt to manage
blisters but should seek competent
medical help.
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6. If immediate medical care is
unavailable or unnecessary,
antibiotic ointment may be
applied after thorough cleaning
and before the clean gauze
dressing is applied.
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Scalding-typically results from hot water, grease, oil or
tar. Immersion scalds tend to be worse than spills,
because the contact with the hot solution is longer.
They tend to be deep and severe and should be
evaluated by a physician. Cooking oil or tar tends to
be full- thickness requiring prolonged medical care.
a. Remove the person from the heat source.
b. Remove any wet clothing which is retaining heat.
c. With tar burns, after cooling, the tar should be
removed by repeated applications of petroleum
ointment and dressing every 2 hours.
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Flame
a. Remove the person from the source of the heat.
b. If clothes are burning, make the person lie down to
keep smoke away from their face.
c. Use water, blanket or roll the person on the ground
to smother the flames.
d. Once the burning has stopped, remove the clothing.
e. Manage the persons airway, as anyone with a flame
burn should be considered to have an inhalation
injury.
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Electrical burns: are thermal injuries
resulting from high intensity heat. The skin
injury area may appear small, but the
underlying tissue damage may be extensive.
Additionally, there may be brain or heart
damage or musculoskeletal injuries associated
with the electrical injuries.
a. Safely remove the person from the source of
the electricity. Do not become a victim.
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b. Check their Airway, Breathing and Circulation and
if necessary begin CPR using an AED (Automatic
External Defibrillator) if available and EMS is not
present. If the victim is breathing, place them on
their side to prevent airway obstruction.
c. Due to the possibility of vertebrae injury secondary
to intense muscle contraction, you should use spinal
injury precautions during resuscitation.
d. Elevate legs to 45 degrees if possible.
e. Keep the victim warm until EMS arrives.
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Chemical burns- Most often caused by strong
acids or alkalis. Unlike thermal burns, they can
cause progressive injury until the agent is
inactivated.
a. Flush the injured area with a copious amount
of water while at the scene of the incident. Don’t
delay or waste time looking for or using a
neutralizing agent. These may in fact worsen the
injury by producing heat or causing direct injury
themselves.
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Burn Percentage in Adults: Rule of Nines – know this!
 You can estimate the body surface area on an adult
that has been burned by using multiples of 9.
 In an adult who has been burned, the percent of the
body involved can be calculated as follows:
 Head = 9%
 Chest and abdomen = 18%
 Upper/mid/low back and buttocks = 18%
 Each arm = 9%
 Groin = 1%
 Each leg = 18%
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Burn Percentage in Adults: Rule of Nines
 As an example, if
both legs (18% x 2
= 36%), the groin
(1%), and the
chest and
abdomen (18%)
were burned, this
would involve 55%
of the body.
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Conclusion
Burns are serious injuries. If you have a burn
injury, seek appropriate medical attention.
Medical questions concerning burn injuries
and their treatment should be directed to your
personal physician or other appropriate
medical professionals.
For information on fire safety and
prevention, contact the National Fire
Protection Association website @
www.nfpa.org
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