Question

Burn Victim Case Study – BIO 168 Chief Complaint: 7-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house. History: Helen Hogan, a 7-year-old white female, was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns and excessive smoke inhalation. In the emergency room, Helen was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU). Helen regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic. Helen began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

Questions: Research the following questions about Helen’s case fully using lecture notes, your textbook, and any other sources to help you. Answer in full, complete sentences using proper terminology.

1.Briefly describe the three major layers that make up healthy skin and the connective tissue that holds it on. What is found in each layer and what purpose does each layer serve?

2.Briefly describe the extent of damage seen in first-degree, second-degree, and third-degree burns. How are they different?

3.Why was Helen (the patient) relatively pain-free when she woke up? Would she have been pain-free if she had suffered first-degree burns rather than third-degree burns?

4.Explain why Helen’s blood pressure was so low and her heart rate so high upon arrival at the emergency room.

5.Why was it important to immediately administer intravenous fluids to Helen?

6.What is a “broad-spectrum” antibiotic, and why did Helen need one so quickly?

Answer 1

1. Three MAJOR layers of skin

1.EPIDERMIS

2.DERMIS

3.HYPODERMIS

Epidermis- it is the outermost layer ,thin mainly protective barrier made of keratinized stratified (4-5layers) squamous epithelium

Innermost layer of this epithelium is basal layer (basal cell)

Fuction-protective barrier

Detmis- it is the inner layer ,thick contains mainly connective tissues

It contains fibroblast, sweatgland,hair, sebaceous glands ,nerves , blood vessels, arrector pili muscle, RECEPTORS

Upperpart of dermis form dermal papillae

Function: thermoregulation by sweat glands

Sensations by receptors

Protection

Hypodermis- innermost layer mainly contain adipose tissue

Function - metabolic function and thermoregulation

2.based on the extent of severity there are three types of burn

First degree- effect superficial skin that is outermost layer (epidermis)

And it is mildest form ,it will produce redness over affected area ,pain and swelling and no blister formation

It won't damage nerve and recovery is full

Second degree- it effect deeper part of skin than first degree (partial thickness burn),painfull , extremely red , swelling and blister formation

It effect epidermis and dermis

It is severe than first degree and most painful

Third degree - most severe form of burn effect entire thickness of skin ( full thickness burn) skin become black, brown, yellow or white and charred

There won't be any PAIN

3. She was in relatively pain-free because of third degree burn ,her nerve ending are damaged .she will have severe pain in first degree burn

4. Blood pressure was so low and her heart rate was so high because of loss of large amount of fluid

5.otherwise due to loss of large amount of fluid she will go into hypovolemic shock and multiple organ failure

6.broadspectrum antibiotics are the antibiotics which can act on wide range of infectious bacteria.she need broad spectrum antibiotics because of burn her protective skin barrier is compromised so there is greater chance of invasion of disease causing bacteria