Inflammation Part 2:Therapies, Healing,

Complications and Burns

Ms. Harris

Pathophysiology

Fall 2009

Inflammation Therapy…a review

1. Which medication would you advise for a slight hemophiliac athlete suffering from chronic tendonitis?

2. How about for a 75 year old female with a history of strokes who is suffering from an abcessed molar?

Other (non-drug) Therapies

• RICE-– R: Rest ?– I: Ice ?– C: Compression ?– E: Elevation ?

• Physical Therapy

Healing

Healing can be accomplished in many ways:

• Resolution- only if the tissue damage is MINOR; cells/tissue return to normal within a short period of time.

Healing

• Regeneration: if cells are capable of mitosis (???) and are too damaged to repair themselves, they will be replaced with new cells.

Healing

• Replacement: scar tissue forms if there is major tissue damage or if cells are incapable of mitosis.– Extensive injury/infection or chronic

inflammation

The Healing Process

1. Blood clot forms.

2. Foreign material is removed by phagocytosis.

3. Granulation tissue forms.• Pink in color due to high vascularization

What happens when you peel off a scab too early?

Healing process cont.

4. If possible, mitosis occurs.

5. Collagen is produced to create scar tissue.

6. Gradually, capillaries in the area decrease (red pink white)

Scar Tissue

• Not normal!– No specialized structures like hair follicles or

sweat glands.– Only there to fill in a gap

Complications of Scar Tissue

• Lack of proper function

• Contracture- fibrous scar tissue immobilizes a joint

• Stenosis – if scar tissue forms in a tube or duct (ex. Esophagus)

• Hypertrophic scar tissue- excessive collagen production (ex. Keloids)

New developments

• Skin grafts

• “Tissue Engineering”- Trying to make biosynthetic skin.

Factors that may affect healing

• Age

• Nutrition

• Hemoglobin levels (anemia)

• Effective circulation

• Cleanliness

• infection

Burns

Burns are not Excellent…

How are the classified?

• 2 ways:– Depth of skin damage– Percentage of body covered

Old/New names

• First Degree: now called “partial thickness”– Damages epidermis only– Painful from onset

• Second degree burns: now called “deep partial thickness” burns– Epidermis and dermis are damaged– More easily becomes infected– Very painful from onset

• Third degree (now called Full-thickness burns)– Damage to the epidermis, dermis, and the

subcutaneous tissue (hypodermis).• ScarTissue on the top (called eschar) shrinks while

attempting to heal. If on chest, it can cause difficulty breathing.

– Usually painless at first, but as inflammation sets in, becomes excruciating

– VERY easily infected

Full Thickness Burn

Calculating BSA

• “Body Surface Area” used when calculatin fluid replacement or therapeutic interventions as well as reporting burn damage.

• Rule of 9’s:– Head and each arm = 9%– Each leg= 18%– Anterior/posterior trunk= 18% each– Groin area= 1%

• Parts can obviously be subdivided, if necessary

• Observe the patient above. Describe her burns in terms of depth and coverage, assuming all burn damage is visible in this picture.

“Burning Questions”

1. Using the rule of 9’s, what would the approximate area of partial-thickness burn be in an adult with burns to the left are and chest area?

2. State 2 reasons why full-thickness burns are more serious than partial thickness burns.

3. Why does a sunburn heal so readily?

Effects of a Burn

• Shock- no bleeding involved with a burn, but inflammatory response can lead to shock if burn is large enough.

• Respiratory problems- carbon monoxide if fire, chemicals inhaled if chemical burn can damage mucosa.

• Eschar

• Growth in children can be affected. If extensive burns in a child, additional grafts and surgery are usually required.

Case Study

• In pairs, read and respond thoroughly to Case Study B on page 41.

• After your responses are thorough and complete, create your own case study on a separate sheet of paper using the one in the book as your model.