The Integumentary System

1. The Integumentary System 4

2. Layers of the Skin • The 5 layers are (deep to superficial): • Stratum basale • Stratum spinosum • Stratum granulosum • Stratum lucidum (lacking in thin skin) • Stratum corneum

3. How can you remember the layers? • Mnemonic (memory device) BSGLC

4. Layers of the Epidermis: Stratum Basale (Basal Layer) thin skin diagram = no “L” Figure 5.2b

5. Skin Appendages • Derivatives of the epidermis • Include: nails, sweat glands, sebaceous (oil) glands, hair, and hair follicles

6. Sweat Glands • Also called sudoriferous glands • Distributed over the entire body except for the nipples and some parts of the external genitalia • Each person contains more than 2.5 million glands • Secrete sweat, cerumen (“ear wax”), and milk, depending on the type of gland

7. Structure of a Nail • Scalelike modification of the epidermis on the distal, dorsal surface of fingers and toes Figure 5.4

8. Hair Function and Distribution • Functions of hair include: • Helping to maintain warmth • Alerting the body to presence of insects on the skin • Guarding the scalp against physical trauma, heat loss, and sunlight • Hair is distributed over the entire skin surface except • Palms, soles, and lips • Nipples and some portions of the external genitalia

9. Hair Follicle • Root sheath extending from the epidermal surface into the dermis • Deep end is expanded forming a hair bulb • A knot of sensory nerve endings (a root hair plexus) wraps around each hair bulb • Bending a hair stimulates these endings, hence our hairs act as sensitive touch receptors

10. Hair Follicle Figure 5.6a

11. Hair Follicle

12. Functions of the Integumentary System • Protection – chemical, physical, and mechanical barrier • Body temperature regulation is accomplished by: • Dilation (body cooling) and constriction (body warming) of dermal vessels • Increasing sweat gland secretions to cool the body • Cutaneous sensation – exoreceptors sense touch and pain

13. Functions of the Integumentary System • Metabolic functions – synthesis of vitamin D in dermal blood vessels • Blood reservoir – skin blood vessels store up to 5% of the body’s blood volume • Excretion – limited amounts of nitrogenous wastes are eliminated from the body in sweat

14. Layers of the Dermis: Reticular Layer Separation, or less dense regions between these bundles form cleavage or tension lines

15. Skin Color • Redness or erythema • Blushing, fever, inflammation, allergy • Pallor, blanching, whiteness • Emotional stress, anemia, low blood pressure • Jaundice or yellowishness • Liver disorder • Bronzing • Addison’s disease, hypofunction of adrenal cortex • Black and blue marks • Escaped blood, hematomas

16. Too Much Sun • Clumping of collagen – leathery skin • Temporary depression of the immune system • Hypersensitivity due to UV light

17. Common skin cancers Melanoma (melanocytes) Basal Cell Carcinoma (stratum basale) Squamous Cell Carcinoma (stratum spinosum)

18. Burns

19. Looks and tastes great, right? You should see what a hot liquid will do to a child’s skin when the two come into contact. Be sure to keep hot liquids out of reach of small children.

20. Burns - Preview First-degree– only the epidermis is damaged • Symptoms include localized redness, swelling, and pain Second-degree– epidermis and upper regions of dermis are damaged • Symptoms mimic first degree burns, but blisters also appear Third-degree– entire thickness of the skin is damaged • Burned area appears gray-white, cherry red, or black; there is no initial edema or pain (since nerve endings are destroyed)

21. Classification of Burns Superficial = First degree Superficial partial-thickness = Second degree Deep partial-thickness = Third degree Full-thickness = Fourth degree

22. Severe Burn Injuries Burns considered critical if: • Over 25% of the body has second-degree burns • Over 10% of the body has third-degree burns • There are third-degree burns on face, hands, or feet • Patient with third-degree burns is under 6 y.o. or over 70 y.o.

23. “First Degree” Very painful, dry, red burns which blanch with pressure. They usually take 3 to 7 days to heal without scarring. Also known as first-degree burns. The most common type of first-degree burn is sunburn.First-degree burns are limited to the epidermis, or upper layers of skin. Superficial

24. First Degree Burn

25. First Degree

26. Second Degree Burn

27. Superficial Partial-Thickness “Second Degree” Very painful burns sensitive to temperature change and air exposure. More commonly referred to as second-degree burns. Typically, they blister and are moist, red, weeping burns which blanch with pressure. They heal in 7 to 21 days. Scarring is usually confined to changes in skin pigment.

28. Second Degree

29. Third Degree Burn

30. Deep Partial-Thickness “Third degree” Blistering or easily unroofed burns which are wet or waxy dry, and are painful to pressure. Their color may range from patchy, cheesy white to red, and they do not blanch with pressure. They take over 21 days to heal and scarring may be severe. It is sometimes difficult to differentiate these burns from full-thickness burns.

31. Third degree

32. Full-Thickness “Fourth degree” Burns which cause the skin to be waxy white to a charred black and tend to be painless. Healing is very slow, if at all, and may require skin grafting. Severe scarring usually occurs.

33. Fourth degree

34. First Aid for Skin Injuries

35. The most important function of the skin is to act as a barrier against infection. The skin prevents loss of body fluids, thus preventing dehydration. The skin also regulates the body temperature by controlling the amount of evaporation of fluids from the sweat glands. The skin serves a cosmetic effect by giving the body shape.

36. When the skin is burned, these functions are impaired or lost completely. The severity of the skin injury depends upon the size of the injury, depth of the wound, part of the body injured, age of the patient, and past medical history. Because of the importance of the skin, it becomes clear that injury can be traumatic and life threatening. Recovery from burn injury involves four major aspects: burn wound management, physical therapy, nutrition, and emotional support.

37. Treatment • Treatment should begin immediately to cool the area of the burn. This will help alleviate pain.

38. Treatment • For deep partial-thickness burns or full- thickness burns, begin immediate plans to transport the victim to competent medical care. For any burn involving the face, hands, feet, or completely around an extremity, or deep burns; immediate medical care should be sought. Not all burns require immediate physician care but should be evaluated within 3-5 days.

39. Treatment • Remove any hot or burned clothing, if doing so will not further damage the skin.

40. Treatment 4. Use cool (54 degree F) saline solution to cool the area for 15-30 minutes. Avoid ice or freezing the injured tissue. Be certain to maintain the victim’s body temperature while treating the burn.

41. Treatment 5. Wash the area thoroughly with plain soap and water. Dry the area with a clean towel. Ruptured blisters should be removed, but the management of clean, intact blisters is controversial. You should not attempt to manage blisters but should seek competent medical help.

42. Treatment 6. If immediate medical care is unavailable or unnecessary, antibiotic ointment may be applied after thorough cleaning and before the clean gauze dressing is applied.

43. Special considerations • Scalding-typically results from hot water, grease, oil or tar. Immersion scalds tend to be worse than spills, because the contact with the hot solution is longer. They tend to be deep and severe and should be evaluated by a physician. Cooking oil or tar tends to be full- thickness requiring prolonged medical care. • Remove the person from the heat source. • Remove any wet clothing which is retaining heat. • With tar burns, after cooling, the tar should be removed by repeated applications of petroleum ointment and dressing every 2 hours.

44. Special considerations Flame a. Remove the person from the source of the heat. b. If clothes are burning, make the person lie down to keep smoke away from their face. c. Use water, blanket or roll the person on the ground to smother the flames. d. Once the burning has stopped, remove the clothing. e. Manage the persons airway, as anyone with a flame burn should be considered to have an inhalation injury.

45. Special considerations Electrical burns: are thermal injuries resulting from high intensity heat. The skin injury area may appear small, but the underlying tissue damage may be extensive. Additionally, there may be brain or heart damage or musculoskeletal injuries associated with the electrical injuries. a. Safely remove the person from the source of the electricity. Do not become a victim.

46. Special considerations - Electrical burns b. Check their Airway, Breathing and Circulation and if necessary begin CPR using an AED (Automatic External Defibrillator) if available and EMS is not present. If the victim is breathing, place them on their side to prevent airway obstruction. c. Due to the possibility of vertebrae injury secondary to intense muscle contraction, you should use spinal injury precautions during resuscitation. d. Elevate legs to 45 degrees if possible. e. Keep the victim warm until EMS arrives.

47. Special considerations Chemical burns-Most often caused by strong acids or alkalis. Unlike thermal burns, they can cause progressive injury until the agent is inactivated. a. Flush the injured area with a copious amount of water while at the scene of the incident. Don’t delay or waste time looking for or using a neutralizing agent. These may in fact worsen the injury by producing heat or causing direct injury themselves.

48. Burn Percentage in Adults: Rule of Nines – know this! • You can estimate the body surface area on an adult that has been burned by using multiples of 9. • In an adult who has been burned, the percent of the body involved can be calculated as follows: • Head = 9% • Chest and abdomen = 18% • Upper/mid/low back and buttocks = 18% • Each arm = 9% • Groin = 1% • Each leg = 18%

49. Burn Percentage in Adults: Rule of Nines • As an example, if both legs (18% x 2 = 36%), the groin (1%), and the chest and abdomen (18%) were burned, this would involve 55% of the body.

50. Conclusion Burns are serious injuries. If you have a burn injury, seek appropriate medical attention. Medical questions concerning burn injuries and their treatment should be directed to your personal physician or other appropriate medical professionals. For information on fire safety and prevention, contact the National Fire Protection Association website @ www.nfpa.org