Transcript What to do for hypothermia

Chapter 4
Skin and Body Membranes
Pathology
Essentials of Human Anatomy & Physiology, 7th ed.
by Elaine N. Marieb
Skin and Body Membranes: Integumentary System, Pathology
Pathology – the study of disease;
any deviation from a healthy,
normal, or efficient condition.
(pathos=suffering, logos=to study)
Skin and Body Membranes: Integumentary System, Pathology
Pathologies of the Integumentary System:
1. Skin Color Abnormalities
2. Acne
3. Skin Abnormalities: ringworm, boils, cold
sores, warts, contact dermatitis, pityriasis
rosea, psoriasis, eczema, decubitis
ulcers (bedsores)
4. Burns
5. Hypothermia
6. Heat exhaustion/heat stroke
7. Tissue repair
8. Skin cancer
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
Cyanosis
• If hemoglobin is poorly oxygenated, blood and
skin appears blue
• Most apparent in areas of thin skin (lips or
beneath nails)
• Common during heart failure and severe
breathing disorders
• Response to extreme cold
Skin and Body Membranes: Integumentary System, Cyanosis
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
• Erythema (redness): may indicate
embarrassment (blushing), fever,
hypertension, inflammation, skin injury,
infection, or allergy
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
• Pallor (AKA Blanching) (pale): may indicate
emotional stress (fear, anger), anemia, low blood
pressure, or impaired blood flow into the area
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
• Jaundice (yellow cast): usually signifies a liver
disorder in which excess bile pigments are
deposited in body tissues because the liver is
unable to excrete bile normally.
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
• Contusions (bruises): reveal sites where
blood has clotted in tissue spaces; clots are
called hematomas.
Skin and Body Membranes: Integumentary System, Skin Color Abnormalities
• Vitiligo: the immune system malfunctions, and
antibodies attack normal melanocytes; person has
patches of irregular white spots on their skin
Skin and Body Membranes: Integumentary System, Acne
Acne: an active infection
of the sebaceous glands
with “pimples.” Can be
mild or severe, resulting
in permanent scarring.
Skin and Body Membranes: Integumentary System, Acne
Acne
• Whitehead: forms
when a sebaceous
gland’s duct
becomes blocked
with sebum
• Blackhead: forms
when blocked
sebum oxidizes
and dries
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Ringworm
 Caused by fungal infection
• Beard: tinea barbae (folliculitis)
• Body: tinea corporis
• Feet: tinea pedis (Athlete’s foot)
• Groin: tinea cruris (jock itch)
• Scalp: tinea capitis
 Easily communicable (skin, combs, unwashed
clothing, shower and pool surfaces)
 Pets can transmit disease, too (esp. cats)
Tenia corporis
Tenia barbae
Tenia pedis
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Boils and carbuncles
• Caused by bacterial infection
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Cold sores
• Caused by herpes simplex virus
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Warts
• Caused by a virus (usually some subspecies of
human papillomavirus, HPV)
• Warts are contagious, and usually infect the skin
through areas of broken epidermis.
• They typically persist for months, but can last for
years, and often recur.
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Contact dermatitis
• Exposure to allergen or irritant causes
reaction
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Pityriasis rosea
• Common among
adults
young
• Believed to be
caused by a virus
• Not thought to be
contagious
• Most often last 4-8
(3-12 weeks)
weeks.
• The rash starts with a single large patch called a herald
patch. After several days, more skin rashes will appear
on the chest, back, arms, and legs. Usually oval shaped
patches. (Sun exposure helps.)
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Psoriasis
• Cause is unknown
• Scaly patches
• Not contagious
• Triggered by trauma,
infection, stress
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Eczema
• Immediate
hypersensitivity
response that results
in “weeping” skin
lesions and intense
itching
• Usually occurs
during first 5 years of
life (90%)
• Familial
predisposition
Skin and Body Membranes: Integumentary System, Skin Abnormalities
Decubitus ulcers (AKA Bedsores)
• Occur when people lay in the same position for
extended periods of time.
• Blood flow is cut off from skin under pressure
• Skin bacteria eat away at skin without bloodflow
(no white blood cells!)
Skin and Body Membranes: Integumentary System, Burns
Burns
 Tissue damage and cell death caused by heat,
electricity, UV radiation, or chemicals
 Associated dangers
• Dehydration
• Electrolyte imbalance
• Circulatory shock
Skin and Body Membranes: Integumentary System, Burns
First-degree burns
• Only epidermis is damaged
• Skin is red and swollen
Second degree burns
• Epidermis and upper dermis are damaged
• Skin is red with blisters
Third-degree burns
• Destroys entire skin layer
• Burn is gray-white or black
• Often painless, as sensory nerves in dermis are
destroyed
1st Degree Burn
(superficial)
2nd Degree Burn
(partial thickness)
3rd Degree Burn
(full thickness)
Skin and Body Membranes: Integumentary System, Burns
 Burns are considered critical if:
• Over 25% of body has second degree burns
• Over 10% of the body has third degree burns
• There are third degree burns of the face,
hands, or feet
• Burns complicated with musculoskeletal
injuries
• Circumferential burns
Skin and Body Membranes: Integumentary System, Severity of Burns
Rule of Nines
• Way to determine the extent of burns
• Body is divided into 11 areas for quick
estimation
• Each area represents about 9%
Rule of Palm
• Alternate way to determine extent of
burns
• Patient’s palm is ~1% of body
Skin and Body Membranes: Integumentary System, Rule of Nines
Skin and Body Membranes: Integumentary System, Treatment of Burns
Treatment of Burns
1. Stop the burning process!
2. Evaluate type of burn
•
Flame: Wet down, smother, then remove clothing
•
Semi-solid (e.g. wax, grease, tar): cool with water.
Do not remove substance
•
Water-based chemical burns: Flush with water for
15 minutes
•
Organic chemical burns: Flush with alcohol
initially, followed by water (15 min.)
•
Dry chemical burns: Brush off remaining chemical,
followed by water (15 min.)
Skin and Body Membranes: Integumentary System, Treatment of Burns
Treatment of Burns
3. Remove clothing and jewelry
4. Wrap with dry, sterile dressing
5. Burns to eyes
•
If chemical burn, flush eyes with water for at
least 20 minutes
•
If thermal burn, don’t try to open eyelids.
Cover both eyes with sterile, dry gauze pads.
Skin and Body Membranes: Integumentary System, Pathology
Skin Response to Extreme Temperature
1. Hypothermia – cold
• Skin response: vasocontriction
2. Hyperthermia – hot
• Skin response: vasodilation
Skin and Body Membranes: Integumentary System, Hypothermia
Hypothermia
Core Body Temperature
Symptoms
99-96oF
Shivering, vasoconstriction, skin appears
pale, cyanosis
96-91oF
Intense shivering, difficulty speaking
91-86oF
Shivering replaced by strong muscular
rigidity, muscle coordination is affected,
thinking is less clear, possible total amnesia
86-81oF
Loss of contact with environment, stuporous
state, muscle rigidity, pulse and respirations
are slow
81-78oF
Loss of consciousness, most reflexes fail,
heart slows until cardiac arrest
Skin and Body Membranes: Integumentary System, Hypothermia
What to do for hypothermia:
1. Passive rewarming: remove any wet clothing, put on dry
clothing, wrap in dry, warm blankets, do not massage
extremities
2. Active rewarming: same as passive rewarming plus: apply
heat to body by way of heat packs, hot water bottles, electric
heating pads, warm air, even body heat, drink warm fluids
(but no stimulants)…Do not warm too quickly! Cold, stagnant
blood from the extremities will circulate to the core,
dropping core body temperature. This could cause cardiac
arrest.
• Central rewarming: apply heat to lateral chest, neck,
armpits, and groin. –Do not apply heat to extremities.
Skin and Body Membranes: Integumentary System, Hypothermia
Localized cold injuries – affecting only particular parts of the body
•Most commonly affects the ears, nose, face, fingers/hands,
toes/feet
•Early = superficial
Brought on by direct contact with cold air, water or cold object. Skin
appears red (if light-skinned) or lighter in color (if dark-skinned). In
more advanced instances, the skin takes on a grey/white blotchy
appearance.
Skin and Body Membranes: Integumentary System, Hypothermia
What to do for hypothermia:
Superficial Local Hypothermia
• Warm affected area: Obtain a container of warm water
(~100-105oF). It should feel comfortably warm. Immerse
entire affected area into water until sensation and skin color
return to normal.
• Do not rub or
massage.
Skin and Body Membranes: Integumentary System, Hypothermia
Localized cold injuries – affecting only particular parts of the body
•Most commonly affects the ears, nose, face, fingers/hands,
toes/feet
•Late = deep
Skin becomes numb, due to reduced circulation. Continued exposure to cold
leads to all loss of sensation, and the skin becomes dead white with a waxy
appearance.
Skin and Body Membranes: Integumentary System, Hypothermia
What to do for hypothermia:
Deep Local Hypothermia
• Only if you cannot get to a hospital should you warm the affected
area: Obtain a container of warm water (~100-105oF). It should
feel comfortably warm. Immerse entire affected area into water
until sensation and skin color return to normal.
• Do not rub or massage. Ice
crystals may have formed in
the affected tissue.
Agitation could further
damage cells.
Skin and Body Membranes: Integumentary System, Hyperthermia
Hyperthermia
• Normal body temperature ranges from about 97-99.5oF.
Any temperature above that is considered
hyperthermic. If body temperature rises above 104oF, it
considered life-threatening – seek medical attention!
• Core temperature can rise due to
exercise, fever, or prolonged exposure to
a hot environment. Hyperthermia follows
two stages:
1. Heat Exhaustion
2. Heat Stroke
Skin and Body Membranes: Integumentary System, Hyperthermia
Characteristics of Heat Exhaustion:
1. Skin appears moist, red (if light-skinned) or darker
(if dark-skinned), and normal-cool to the touch
2. Heavy perspiration
3. Rapid, shallow breathing
4. Normal-weak pulse
5. Weakness and/or dizziness
6. Muscular cramps (usually in legs and abdomen)
Skin and Body Membranes: Integumentary System, Hyperthermia
What to do for Heat Exhaustion
1. Get to a cool environment, cool passively
2. Lie down on your back with legs elevated
3. Apply moist towels over cramps
4. Drink water
(not too
cold) if not
nauseated
Skin and Body Membranes: Integumentary System, Hyperthermia
Characteristics of Heat Stroke:
1. Skin appears moist or dry, pale, and hot to the touch
2. Little or no perspiration
3. Weakness and/or dizziness, possibly unconscious
4. No muscular cramps, but possibly seizures
5. Rapid, shallow breathing
6. Full, rapid pulse
7. Dilated pupils
Skin and Body Membranes: Integumentary System, Hyperthermia
What to do for Heat Stroke:
1. Get to a cool environment, cool actively
2. Lie down on your back with legs elevated
3. Remove clothes and place cool packs to neck, groin, and armpits.
If you cannot get to a hospital, immerse your entire body in cool
water.
4. Drink water (not
too cold) if not
nauseated
Tissue Repair
Skin and Body Membranes: Tissue Repair
When continuous tissues like the skin, mucosae,
and blood vessels are broken, the body initiates the
inflammatory response.
1. Injured cells and certain white blood cells
release inflammatory hormones (e.g.
histamines).
2. Nearby capillaries dilate and become leaky.
3. Clotting proteins in the blood form a scaffold
that traps platelets, leading to a clot. (stops
bleeding and isolates pathogens)
4. White blood cells attack pathogens, dead cells,
and other debris.
Skin and Body Membranes: Tissue Repair
Even as the clot is forming, tissue repair
begins immediately. Depending on the
tissue, and severity of injury, tissues will
regenerate or be replaced by scar
tissue (or both).
• Regeneration = Replacement of destroyed
tissue by the same kind of cells
• Fibrosis = Repair by
dense fibrous
connective tissue
(scar tissue)
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
Skin and Body Membranes: Tissue Repair
Tissue Regeneration
1. Blood clot is replaced by granulation tissue.
• Capillaries grow in from nearby areas, forming new capillary bed.
• Fibroblasts produce growth factors (encourage mitosis) and collagen
fibers.
• Some fibroblasts even help to pull the wound together.
2. Large white blood cells digest clot.
3. Granulation tissue is replaced either by original tissue type.
Fibrosis
1. Same as above, except granulation tissue is replaced by fibrous
connective tissue.
2. Always occurs in cuts, scrapes, punctures, burns to some extent. May be
visible at surface or not.
3. Over time scar tissue might be replaced by original tissue type.
4. Pure infections rarely lead to fibrosis. (only occurs in destructive
infections)
Skin and Body Membranes: Tissue Repair

Tissues that regenerate easily:
Epithelial tissue, fibrous connective tissue, areolar
tissue, bone, blood-forming tissue

Tissues that regenerate moderately:
Smooth muscle, dense regular connective tissue

Tissues that regenerate poorly:
Skeletal muscle, cartilage

Tissues that are replaced largely with scar
tissue:
Cardiac muscle, nervous tissue within the brain
and spinal cord
Skin and Body Membranes: Tissue Repair
Sometimes, the body goes
overboard with tissue repair.
This can lead to hypertrophic
scars AKA keloids.
Skin and Body Membranes: Integumentary System, Skin Cancer
Skin Cancer
• Skin cancer is the most common type of
cancer
• Biggest risk factor is overexposure to UV
radiation in sunlight
Graph of skin cancer rates?
Skin and Body Membranes: Integumentary System, Skin Cancer
Basal cell carcinoma
• Least malignant
• Most common type
• Arises from statum basale
Skin and Body Membranes: Integumentary System, Skin Cancer
Squamous cell carcinoma
• Arises from stratum spinosum
• Metastasizes to lymph nodes
• Early removal allows a good chance of cure
Skin and Body Membranes: Integumentary System, Skin Cancer
Malignant melanoma
• Most deadly of skin cancers
• Cancer of melanocytes
• Metastasizes rapidly to lymph and blood
vessels
• Detection uses
ABCD rule
Skin and Body Membranes: Integumentary System, Skin Cancer
ABCD Rule
 A = Asymmetry
• Two sides of pigmented mole do not match
 B = Border irregularity
• Borders of mole are not smooth
 C = Color
• Different colors in pigmented area
 D = Diameter
• Spot is larger than 6 mm in diameter
So what can I do to
take care of my skin?