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A Bad Burn by Hollie L. Leavitt Department of Biology College of Western Idaho, Nampa, ID Case copyright held by the National Science Teaching Association (NSTA). Originally published May 10, 2023. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work. Credit: Licensed image ?? Elnur | Dreamstime.com, id 109426891. Part I – Skin Anatomy “White or blue shirt for my job interview today?” Akeem had just finished his university degree in marketing and was preparing to meet with a recruiter from a Fortune 500 company later that afternoon. He held his cell phone in one hand while he talked to his brother, asking advice on what to wear. Akeem’s other hand rested on the ironing board near the hot iron he was readying for use. A knock at the door caused Scout, Akeem’s large dog, to bolt towards the door. In the process, Scout bumped the ironing board, causing the hot iron to fall onto Akeem’s hand. Akeem shouted. He dropped his phone on the floor and fumbled to get the iron off his hand. Somehow, the iron had become tangled in the shirts and both were tangled with his hand, making this more difficult. Eventually Akeem’s flailing knocked the entire ironing board to the ground, taking the iron and pile of shirts with it. “What happened! Are you okay?! I heard you scream!” Kamari, Akeem’s friend, had let himself into the apartment and rushed towards Akeem. “I burned my hand!” Akeem yelled. He clasped his hand and held it near his body. “Let me see it,” Kamari urged. Kamari had just finished his nursing degree at the same university Akeem attended, and prior to that had worked for several years as an emergency medical technician (EMT). Akeem hesitated, then anxiously held out his hand for Kamari to see. “That looks like a full-thickness burn. We need to get you to a hospital.” You will likely need to use the figures provided, your textbook, and online resources to answer the questions included in this case study. A list of websites that you may find helpful is given in the “References” section at the end of the case. Part II – Classification of Burns “Burns swell really quick, so take your ring off,” Kamari directed as he helped his friend out to the car. “And try to keep your hand above your heart level as much as you can.” Kamari drove Akeem to the nearest hospital, which was about 20 minutes away. As they neared the emergency room (ER) entrance, Kamari asked Akeem how he was feeling. “Honestly, this doesn’t hurt like I thought it would,” Akeem responded. “The area around the burn feels painful and tight, but I really don’t feel much in the center of it.” Once in the ER, Akeem was immediately taken back to triage. A nurse evaluated his injury, and then took him to a room to wait for the doctor. While they waited, Akeem noticed a chart with information about burns on the wall and began reading it. Part III – Burn Treatment After learning a little more about burns from the emergency room chart, Akeem had some questions for his friend Kamari. “So it looks like I have the most severe type of burn. A third-degree burn, or what you called a ‘full-thickness’ burn. What happens next?” Akeem asked. Kamari replied, “Normally, a severe burn is assessed by what is known as the ‘rule of nines.’ It’s a quick method for calculating the size of the burn, which needs to be known in order to plan for treatment. Basically, the rule of nines divides the body into sections that account for 9% of body area, or some multiple of 9%. For example, the entire head and neck is considered to be 9% of body area. The front of the head and neck is 4.5% of body area, and the back is another 4.5%, so all together 9%. If you came in with burns on the front and back of your head and neck, the doctors would quickly estimate that 9% of your body is burned.” Here are the approximate percentages of body surface area of different regions according to the Rule of Nines for Burns (https://www.nyp.org/healthlibrary/multimedia/rule-of-nines-for-burns, accessed 6/8/23) The size of a burn can be quickly estimated by using the “rule of nines.” This method divides the body’s surface area into percentages. The front and back of the head and neck equal 9% of the body’s surface area. The front and back of each arm and hand equal 9% of the body’s surface area. The chest equals 9% and the stomach equals 9% of the body’s surface area. The upper back equals 9% and the lower back equals 9% of the body’s surface area. The front and back of each leg and foot equal 18% of the body’s surface area. The genital area equals 1% of the body’s surface area. Read the case study and answer the questions. Summarize what they have learned and apply their knowledge to a clinical situation Responses: Part I 1. Match each of the following sublayers of the skin with its description: epidermis, dermis, hypodermis. Consists of keratinocytes and melanocytes Contains sweat glands, blood vessels, hair follicles, and sensory nerve endings Contains loose connective tissue and fat cells 2. Figure 4.11 in your text shows the structure of the epidermis in “thin” skin, which is what covers the dorsum (top) of the hand. Do some research to learn how thick skin (such as that found on the palm of the hand) differs from thin skin. 3.Look closely at Figure 4.11 in your text. Notice where blood vessels are present. Blood vessels are responsible for bringing oxygen and nutrients to all cells and tissues of the body. How do the cells of the epidermis get oxygen and nutrients when the epidermis has no blood vessels? 4. Epidermal cells produced in the deep layer of the epidermis are dead when they reach the outer layers, and are eventually shed from the body. Explain why these cells start to die as they move further from the deep layer of the epidermis. 5.Describe the structure and function of the hypodermis. Is this layer considered a part of the skin? Part II Research first-, second-, and third-degree burns. For each type of burn, what are the skin layers damaged, the characteristics of the burn, potential complications, and treatment? First degree burns Skin layers damaged: Characteristics: Potential complications: Treatment: Second degree burns Skin layers damaged: Characteristics: Potential complications: Treatment: Third degree burns Skin layers damaged: Characteristics: Potential complications: Treatment: When he first saw Akeem’s injury, Kamari indicated that the burn appeared to be “full-thickness.” What does that mean? 3. Blisters are a characteristic of second-degree burns but are not seen with first- or third-degree burns. Explain what causes blisters to form, and why they are present only with second-degree burns. 4. The stem cells that are capable of regenerating skin are located near hair follicles embedded in the dermis. Kamari said that because Akeem’s burn was full-thickness they needed to go to the hospital for treatment. Why would a full-thickness burn not heal on its own? 5. Kamari also told Akeem to take his ring off and keep his burned hand “above heart level” as much as possible. Why is taking off his ring a good idea? Why is elevating the burn necessary? 6. Akeem indicated that his burn wasn’t really painful. How could this be? Part III – Burn Treatment Suppose you are an ER doctor treating a patient, Mark, who has severe burns on his anterior lower limbs, genitalia, and anterior trunk. Calculate the percentage of Mark’s body that is burned. Explain your reasoning. Akeem has burns on just the dorsum of his right hand. The information given above on the Rule of Nines does not provide enough detail to exactly calculate the size of Akeem’s burn, but what is your best estimate for the percentage of Akeem’s skin surface that is burned? Explain your reasoning. 3. In Chapter 4 of your text, you learned that epidermal cells produce proteins and lipids that createe a hydrophobic barrier within the skin. This barrier makes the epidermis impermeable to water; it keeps internal body fluids inside the body, and prevents external fluids from entering the body. One dangerous potential complication of a severe burn is dehydration and electrolyte loss due to destruction of this hydrophobic barrier. Internal body fluids and blood seep out of the wound site without the barrier intact. These fluids and electrolytes must be replaced as part of the burn treatment. Based on the size of their burns, who would need more fluid and electrolyte replacement during treatment, Akeem (who has a severe burn on the dorsum of one hand) or Mark (who has severe burns on his anterior lower limbs, genitalia, and anterior trunk)? Explain your answer. 4. Why did Dr. Martinez order a broad-spectrum antibiotic for Akeem? 5. What is an escharotomy, and how is it done? 6. Do some research on skin grafts (autografts and allografts) and use this information to compare the two types regarding description of each, pros and cons, and when to use. 7. Which type of graft would be best for Akeem based on what you know about his injury? Be sure to justify your reasoning. be sure to cite any and all sources correctly Figure 4.11 Image transcription text @ Hair Hair Free Hair Small root folicle nerve shaft blood Hair Hair follicle root The two layers of skin (epidermis and dermis) rest on a supportive layer (hypo… Show more

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