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PATHOPHYSIOLOGY OF CHEMICAL BURN

Risk Factors: Fire/Combustion Firefighter, Industrial Worker, Occupant of burning structures, Chemical Exposure, Industrial Worker Electrical Exposure Electrician, Electrical Power Distribution Worker Accidents Explosion
2nd degree burn injury in the right side of the head, face and neck, left upper extremity and chest, right ear, with noted redness over and surrounding the area, presence of blisters on the area

Risk Factors: (patient-based) Life threatening event Incidental pouring of strong acid or base Chemical spilling (strong acid) Rule of Nines: Head = 9% (front and back) Chest(front) = 9% Chest back (right side only) = 4.5% Arm (left upper extremity front and back) = 9% Total = 31.5% 2 nd degree burn

Impaired skin integrity r/t skin and tissue damage secondary to major chemical burn 2nd degree

Body in contact with the strong acid Major burn >25% body surface area in adults

Disturbed body image r/t disrupted skin and tissue membrane

Skin and tissue trauma/disruption

Hematology result as of : WBC=19.86(increa sed), Neutrophils= 0.84(increased)

Increase capillary permeability

SURGICAL TREATMENT: Emergency Debridement

Nociceptors of the dermis

Disruption of cell membrane

Open wound

Sodium, water and protein shift from IVS to ITS

Risk for deficient fluid volume r/t capillary damage (resolved)

Stimulation of the thermosensit ive pain receptors Sultamicillin 750mg TID Clindamycin 300mg BID

Inflammatory process

Site/location: Left side of the head, face and neck, left upper extremity and chest, left ear

Increase concentration of blood cells

Decrease circulating blood volume up to 50%

Hyponatremia

Migration of neutrophils

Risk for infection r/t loss of protective dermal barrier secondary to destruction of skin and tissue

Increase blood viscosity

Hypovolemia

Pain impulse

PATHOPHYSIOLOGY OF CHEMICAL BURN Neutrophils releases lipases including phospholipase A2(produces AA from membrane phospholipids)
During admission at the ER: >Pain rated as 10/10, 10 as the highest and most painful, radiating on the head part, left upper extremity, chest and back, pain characterized as burning and pinching pain, aggravated by touch and movement >Grimacing and crying >Unable to move affected or burned area >screaming

Primary afferent neuron in the peripheral nerve

Increase myocardial depressant factor

Massive stress, SNS activation

Decreas e in BP

Second order neuron in the dorsal horn of the spinal cord

Cyclooxygenase converts AA to Prostaglandin

Adrenal corticoid hormone and catecholamine release

Release of other biochemical pain mediators

Peripheral vasoconstriction

Tachycardia

Pain is modified by modulation factors Spinothalamic tract Brain stem

PAIN

thalamus

During assessment(latest) >Pain rated as 8/10, 10 as the highest and most painful, radiating on the head part, left upper extremity, chest and back, pain characterized as burning and pinching pain, aggravated by touch and movement >Grimacing >presence of numbness, tingling and burning pain on the area >with complaints of itchiness on the right arm

Peripheral resistance

Increased afterload

Decreased cardiac output (RESOLVED)

PATHOPHYSIOLOGY OF CHEMICAL BURN Somatic sensory cortex Acute pain r/t destruction of skin and tissues secondary to major chemical burn in jury 2nd degree WDR neuron activation = spinal cord wind up = NMDA activation

PAIN PERCEPTION

Celecoxib 200mg BID Tramadol 50mg BID

Descending system

Release of endogenous opioids, serotonin, norepinephrine

Amplification of pain signals

Inhibits incoming/ ascending pain impulse

Pain persists

Inhibitory neurons are shortlived as they are reabsorbed into the nerves

NMDA receptors calcium channel opens

Pain reaches the CNS

PAIN ON THE SITE