Terminal Learning Objective - JSOMTCslides.jsomtc.org/SOMCML1L/SOMCML1L.pdf · Purulent –like pus...

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Slide 1JSOMTC, SWMG(A)

SOCMInflammation and Healing

PFN: SOMCML1L

Hours: 2.5

Last updated: November 2015


Terminal Learning Objective

Action: Communicate knowledge of “Inflammation and Healing”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


References

Pathophysiology for the Health Professions (4th edition; 2011; Gould; Dyer)

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Reason

As a Special Operations Combat Medic, you will be responsible for identifying and managing various inflammation conditions and promoting rapid healing.

An understanding of pathophysiology will assist in the correlation of disease processes, effected anatomy and physiology, as well as appropriate treatments.


Agenda

Define the key terms related to inflammation and healing

Communicate the role of normal defenses in preventing disease

Communicate the changes from normal capillary function during inflammation

Identify inflammation and its causes


Agenda

Communicate the local and systemic effects of acute inflammation

Communicate the pathological basis of chronic inflammation

Identify the different treatments for inflammation

Identify the types of healing and the factors of the healing process

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Agenda

Communicate the inflammation and healing of burns to include classifications, effects, and healing process


Key Terms Related to Inflammation and Healing


Vocabulary Development

Abscess –a localized pocket of infection or purulent exudatesurrounded by inflammation

Adhesions –a band of fibrous scar tissue forming an abnormal connection between two surfaces or structures

Anorexia – loss of appetite

Chemical mediators –a chemical released in the body during an inflammatory response or immune response

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Chemotaxis– the movement of cells toward or away from an area of the body in response to chemical signals (e.g., phagocyticcells move to an area of tissue injury)

Collagen– the common protein making up connective tissue and bone

Contracture–shortening of a muscle or scar tissue causing immobility and deformity of a joint or structure

Diapedesis–the passage of leukocytes through intact capillary walls to a site of inflammation



Erythrocyte sedimentation rate (ESR)– the rate at which RBCs settle out of a blood specimen (containing anticoagulant); an elevation in ESR is a general characteristic of inflammation

Exudate–a fluid that accumulates and may leak from tissue (e.g., a serous exudate due to allergy, a purulent exudate, or pus associated with infection)

Fibrinogen– the plasma protein that is formed into solid fibrin strands during the clotting process



Fibrinous–pertaining to or of the nature of fibrin

Fibroblast–any cell from which connective tissue is developed; it produces collagen, elastin, and reticular protein fibers

Glucocorticoids –the steroid hormones from the adrenal cortex (e.g., cortisol hydrocortisone) that increase blood glucose levels and act to decrease inflammation and allergic reaction

Granulation tissue –newly developed fragile tissue, consisting of fibroblasts and blood vessels, formed during healing

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Granuloma –a nodular destructive mass associated with some chronic inflammation or infection

Hematocrit–percentage of erythrocytes in a blood sample

Hematopoiesis –the production and development of blood cells, normally in the bone marrow

Hydrostatic pressure–pertaining to the pressure of liquids in equilibrium and to the pressure exerted on liquids



Hyperemia –increased blood flow to an area, resulting in a warm, red area

Interferons –a group of antiviral glycoproteins produced by virally‐infected cells

Intraarticular– into the joint cavity or joint space

Isoenzymes –cell enzymes, specific to certain organs, that differ slightly in structure, but have similar functions

Leukocyte –a WBC or white corpuscle

Leukocytosis –an above‐normal number of leukocytes (WBCs) in the blood



Macrophage –a monocytes that has left the circulation and settled and matured in a tissue

Malaise –a general feeling of discomfort or unease, of being unwell

Neutrophil –a granular WBC, the most common type, responsible for much of the body's protection against infection

Osmotic pressure – the force with which a solvent, usually water, passes through a semipermeable membrane separating solutions of different concentrations

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Perforation –a hole through the wall of a tube or hollow structure

Permeability – the quality of being permeable; that which may be transversed

Phagocytosis –a three‐stage process by which phagocytes engulf and destroy microorganisms, other foreign antigens and cell debris

Purulent – like pus (microbes, WBCs, and cell debris); thick, yellowish material in tissue often resulting from bacterial infection



Pyrexia – fever

Pyrogens –a substance that causes fever, a rise in body temperature

Regeneration – tissue repair through replacement by identical, functioning cells

Replacement – the restoration of a structure to its original position

Resolution –decomposition; absorption or breaking down of the products of inflammation



Scar –a mark left in the skin or an internal organ by the healing of a wound, sore, or injury because of replacement by connective tissue of the injured tissue

Serous –watery secretion

Stenosis–narrowing of a tube, valve, or opening (stricture)

Ulcer –an open, crater‐like lesion on the skin or mucous membranes

Vasodilation–an increase in the diameter of blood vessels, which increases blood flow and lowers blood pressure

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The Role of Normal Defenses in Preventing Disease


Role of Normal Defense

Non‐Specific Defense

Mechanical barriers

Inflammation

Fever

Interferons

Immunological surveillance (NK cells)

Complement proteins



Macrophages

•monocytes (free macrophages)

•reticuloendothelial system

Microphages

•neutrophils•granulocytes (non‐professional phagocytes)

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Specific Defense

B cells (antibodies)

T cells (sensitization)


The Changes from Normal Capillary Function During Inflammation


Capillary Function

HP = Pc – Pif

HP (net hydrostatic pressure)

Pc (capillary hydrostatic pressure)

Pif (interstitial fluid hydrostatic pressure)

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Capillary Function

NFP = (Pc – Pif) – (πp – πif)

or NFP = HP – (πp – πif)

NFP (net filtration pressure)

πp (plasma oncotic pressure)

πif (interstitial fluid oncotic pressure)


Capillary Function


Capillary Function

Altered Capillary Function

Edema

• increased Pc (hypertension)

• decreased πp (loss of albumin)

Dehydration

• decreased Pc (hypotension)

• increased πp (high serum sodium)

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Inflammation and its Causes


Inflammation

Etiology

Burns

Chemical irritants

Frostbite

Toxins

Infection

Physical injury

Immune reaction

Ionizing radiation

Foreign bodies


Inflammation

Signs

Dolor (pain)

Calor (heat)

Rubor (redness)

Tumor (swelling)

Functio laesa (loss of function)

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Inflammation

Inflammation – a localized protective response elicited by injury or destruction of tissues, which serves to sequester (wall off), destroy, or dilute both the injurious agent and the injured tissue


The Local and Systemic Effects of Acute Inflammation


Acute Inflammation

Chemical Source Major Action

Histamine Mast cells vasodilation, capillary permeability

Cytokines T cells, Macrophages

fever, chemotaxis, leukocytosis

Leukotrienes Mast cells vasodilation, capillary permeability (delayed)

Prostaglandins Mast cells pain, vasodilation

Kinins Plasma Protein vasodilation, chemotaxis

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Acute Inflammation

Response to Tissue Damage

1. Immediate transient vasoconstriction

2. Local vasodilation

3. Hyperemia

4. Increased capillary permeability

5. Migration of leukocytes


Acute Local Inflammation

Local Signs (rubor, calor, dolor, tumor, functio laesa)

Exudate

Serous – watery

Fibrinous – thick/sticky (high fibrin)

Purulent – thick/yellow‐green (pus)

Hemorrhagic – blood vessels damaged


Serous Exudate

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Fibrinous Exudate


Purulent Exudate


Hemorrhagic Exudate

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Acute Systemic Inflammation

Signs/Symptoms

Fever

Malaise

Fatigue

Headache

Anorexia


Acute Inflammation


Acute Inflammation

Diagnostics

Leukocytosis – increased numbers of WBCs

Differential count – WBC proportions

Plasma proteins – increased fibrinogen

C‐reactive protein – dramatic increase

ESR – rate which RBCs settle in sample

Cell enzymes – some are tissue specific

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Acute Inflammation

Complications

Secondary infection

Ulcers/perforation

Skeletal muscle spasms

Local complications


The Pathological Basis of Chronic Inflammation


Chronic Inflammation

Etiology

Acute inflammation that does not resolve completely

Autoimmune disorders

Chronic irritation

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Pathophysiology

Chronic increases

• lymphocytes

•macrophages

• fibroblasts (more fibrous scar tissue)

Granuloma




The Different Treatments for Inflammation

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Treatments

Medications

NSAID

• acetylsalicylic acid

• Ibuprofen/naproxen/indomethacin/piroxicam

• ketorolac

• COX‐2 inhibitors

Acetaminophen

Corticosteroids (glucocorticoids)


Treatments

Therapies

Rest – prevent further injury

Ice – local vasoconstriction

Compression – increase Pif

Elevation – aid fluid movement from injury


The Types of Healing and the Factors of the Healing Process

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Healing

Types of Healing

Resolution – damaged cells recover

Regeneration – adjacent cells undergo mitosis

Replacement – scar/fibrous tissue formation

• primary intention

• secondary intention


Healing

Healing Process

Injury/Inflammation

Granulation

• vascular epithelial cells

• fibroblasts

Scar tissue

• collagen fibers

• cross‐linking


Healing

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Healing

Factors Promoting Healing

Youth

Good nutrition

Adequate hemoglobin

Effective circulation

Clean, undisturbed wound

No infection or further trauma


Healing

Factors Delaying Healing

Advanced age, reduced mitosis

Poor nutrition, dehydration

Anemia or other disorders (diabetes, cancer)

Circulatory problems

Infection, irritation

Chemotherapy or radiation exposure

Prolonged glucocorticoid use


Healing

Complications

Loss of function

Contractures/Obstructions

Adhesions

Scar tissue (hypertrophic)

Ulcerations

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Healing


Healing


The Inflammation and Healing of Burns to Include Classifications, Effects, and Healing Process

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Burns and Inflammation

Burns

Acute inflammation/tissue destruction

Most occur in the home

Can cause drastic physiological changes

Severity depends on:

• cause

• temperature

• duration of contact

• burn surface area/location



Classification According to Depth

Superficial (1st degree)

Partial‐thickness (2nd degree)

Full‐thickness (3rd degree)



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Burns and InflammationBSA (Rule of 9’s)


Effects of Burns

Shock

No bleeding

Fluid shift

• hypovolemia/hypotension

• increased hematocrit

• protein shift

• acute renal failure

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Effects of Burns

Respiratory

Toxic heated gases

• carbon monoxide

• cyanide

Airway burns

• heated air/gases and steam

• if facial burns present, assume airway burns


Effects of Burns

Pain

Extreme (aggressive pain management)

Persist until healing is complete

Infection

First line of defense is gone

Susceptible to normally occurring microbes

• hair follicles

• opportunistic bacteria


Effects of Burns

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Effects of Burns

Metabolic Needs (Hypermetabolism)

Increased nutrition demands from damaged tissue

Heat loss from skin disruption (hypothermia)

Recurrent stress response (anemia)

• damaged RBCs

• reduced hematopoiesis

Stress ulcers


Healing of Burns

Dependent on Severity

Non‐stick dressing

Natural skin graft (mesh)

Biosynthetic skin substitutes

Hypertrophic scar tissue is common


Healing of Burns

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Questions?


Terminal Learning Objective

Action: Communicate knowledge of “Inflammation and Healing”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


Agenda

Define the key terms related to inflammation and healing

Communicate the role of normal defenses in preventing disease

Communicate the changes from normal capillary function during inflammation

Identify inflammation and its causes

26


Agenda

Communicate the local and systemic effects of acute inflammation

Communicate the pathological basis of chronic inflammation

Identify the different treatments for inflammation

Identify the types of healing and the factors of the healing process


Agenda

Communicate the inflammation and healing of burns to include classifications, effects, and healing process


Reason

As a Special Operations Combat Medic, you will be responsible for identifying and managing various inflammation conditions and promoting rapid healing.

An understanding of pathophysiology will assist in the correlation of disease processes, effected anatomy and physiology, as well as appropriate treatments.

27


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Terminal Learning Objective - JSOMTCslides.jsomtc.org/SOMCML1L/SOMCML1L.pdf · Purulent –like pus...

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