To continue after WaiKit's.
Am posting up the whole story of the process.
For a brief summary, please get ppt slides from me. =)
The proliferative phase
Collagen deposits, angiogenesis, granulation, tissue development, wound contraction
Ideal repair is complete restoration of normal anatomy and function by regeneration of the anatomy and specialized functional (parenchymal) cells of the organ.
Healing is a process that occurs when regeneration is not possible or is incomplete and additional mending of the site is required by fibrous repair – the production of a scar. Occurs under following circumstances:
- The damage to tissue is extensive that the supporting framework is destroyed.
- The injured tissue is composed of permanent cells such as myocardium, skeletal muscle or brain.
Fibrous repair
1. Fibrocyte migration and proliferation – to provide raw material for repair
2. Angiogenesis – growth of new blood vessels to nourish the process
3. Scar development – the synthesis of extracellular matrix proteins and deposition of collagen followed by contraction (shrinking), reshaping (remodelling) and strengthening of the fibrous tissue
Cell migration
Leucocytes produce cytokines that stimulate migration and proliferation of fibroblasts
Fill space not occupied by regenerating parenchymal cells, synthesize collagen fibers to knit back together the disrupted tissue
Provide permanent structure to support additional cell growth
Endothelial cells fr nearby bv sprout angioblast
Angioneogenesis
Vascular endothelial growth factor and other factors stimulate new vessels to sprout fr existing veesels
1. Normal capillary with intact basement membrane and endothelial cells
2. Dissolution of the basement membrane of the parent vessels in the injured site by proteolytic enzymes released by inflammatory cells
3. Migration and proliferation of angioneoblastic endothelial cells through the defect and up the gradient of cytokines released by inflammatory cells and injred cells
4. Organization of a new capillary branch as the tube of endothelial cells generates a basement membrane.
Scar development
Follows angioneogenesis
1. Migration and proliferation of fibroblasts and new blood vessels into the injured site
2. Deposition of an extracellular matrix of collagen and other supportive proteins
3. Maturation, remodelling, contraction and strengthening of fibrous tissue
Granulation tissue
= mixture of capillaries, fibroblasts, residual edema, small no of leucocytes
Fibroblast contract, pulling edges of the wound inwards, decreasing the volume to be healed
At the same time, fibroblast produce collagen and other extracellular components to bind the wound firmly and give strength
Fluid is resorbed, inflammatory cells disappear, site becomes more collagenous tissue.
Blood vessels shrink or disappear as workload decreases.
More collagen accumulates to bind the wound tightly, fibroblast shrink and disappear
Healing by first intention
Day 1 : Neutrophils accumulate at the margin of the fibrinous clot in the cut. Stem cells in the epidermis (near basement membrane) begin to proliferate
Day 2-3: Neutrophils are gradually replaced by macrophages, new capillaries begin to appear. Fibroblasts and endothelial cells begin to migrate into the wound
Days3-7: Angiogenesis peaks and richly vascular granulation tissue fills the incision space.
Fibroblasts produce large amounts of collagen to bridge the space between the edges of the wound. Growth of epidermal stem cells has produced a thin layer of epithelium to cover the wound
Second week: Fibroblastic proliferation continues and collagen accumulates. Inflammatory cells, edema fluid, and blood vessels are disappearing rapidly.
End of first month: Pink (vascularised) scar is present. It is composed largely of collagen, is devoid of imflammatory cells, has a declining number of blood vessels, and is covered by normal epidermis. The tensile strength of the wound countinues to improve as fibroblasts contract and continue to add collagen.
After several months or a year: A narrowed, white, fitted scar is present. Skin tensile strength has returned to near normal.
Freshly sutured wound has about 70% of normal tensile strength if sutures are placed After sutured removal at one week, tensile strength is about 10%. Strength improves to about 75% at three months and after a year has returned to near normal.
Healing by second intention is much the same as healing by first intention: inflammation first, followed by macrophage clean-up, neovascularization and scarring. However, the volume of necrotic tissue to be removed is greater, the reepithelialisation of the surface is slower because the wound is wider. Healing by second intention is characteristic of ulcers, infarcts, abscesses, or other wounds where the defect is largeand wound edges are not close together. A greater volume of necrotic and inflammatory debris must be removed, and a large amount of granulation tissue is required to fill the gap. The granulation tissue is replaced by scar tissue, which in turn contracts so that the filnal volume of the scar may be as little as 10% of the original defect. In tissue covered by epithelium, new epithelial cells advanced inward from the edges, first forming a thin membrane of immature cells that rest on underlying granulation tissue and then differentiate into mature epithelium as the wound below matures into scar.
Maturation Phase
Remodelling of scar occurs
- structural modifications of collagen
eg. Cross linking
Increasing fiber size
Recovery of tensile strength results from collagen synthesis exceeding degradation during the first 2 months.
Wound strength reaches 70%-80% of normal by 3 months.
Thursday, May 21, 2009
Summary
Summary :
Types of burns :
• Chemical burns
• Electrical burns
• UV light burn
• Radiation injury
Signs and Symptoms :
Burn
• First-degree burns:
red, swollen, and painful. The burned area whitens (blanches) when lightly touched but does not develop blisters.
• Second-degree burns:
pink or red, swollen, and painful, and they develop blisters that may ooze a clear fluid. The burned area may blanch when touched.
• Third-degree burns :
usually are not painful. The skin becomes leathery and may be white, black, or bright red. The burned area does not blanch when touched, and hairs can easily be pulled from their roots.
Infection
• Change in color of the burnt area or surrounding skin
• Purplish discoloration, particularly if swelling is also present
• Change in thickness of the burn (the burn suddenly extends deep into the skin)
• Greenish discharge or pus
• Fever
Severity of Wound
• Depth
• Surface Area (Rule of nine, Rule of palm)
• Body part
• Pre-existing medical problem
• Age
Classification of Wound :
• 1st degree (epidermis)
• 2nd degree (epidermis + part of dermis)
• 3rd degree (epidermis + dermis)
Investigations for wound infection :
Wound culture:
• help determine whether wound infected
• identify bacteria
• prepare sample for susceptibility testing
• steps
o collecting sample
o stimulating growth (media)
o identification (e.g. gram stain)
o antimicrobial susceptibility testing (for treatment)
Complications:
Minor burns :
• usually superficial and do not cause complications.
Severe burns and some moderate burns :
• Dehydration
o Cause shock if dehydration is severe
• Chemical imbalances
• Destruction of muscle tissue (rhabdomyolysis)
• Infection cause severe illness or death.
• Thick, crusty surfaces (eschars)
o cutting off blood supply to healthy tissues or impairing breathing.
Normal process of healing :
Hemostasis
• growth factors are released.
• Constriction of blood vessels
• Adherence of platelets to damaged epithelium
• Discharge of adenosine diphosphate – promote thrombocyte clumping
• Clot forms to close blood vessels
• Cytokines initiate inflammatory phase
Inflammation
• Polymorphonuclear leukocytes released
• Activation of complement
• Macrophage formation
The proliferative phase
-collagen deposits
-angiogenesis
-granulation
-tissue development
- wound contraction
Maturation Phase
-remodelling of the scar
- strength of scar tissue
Treatment and Management :
• Wound Management.
• First Aid
o CPR
o Airway
Check airways that may cause breathing problems.
o Breathing
o Circulation
Fluid resuscitation (IV therapy)
• Chemical Burns
• Electrical Burns
• Skin Grafts
o Types – (Pinch Grafts, Split-thickness grafts, Full thickness grafts , Pedicle grafts)
• Skin Treatment Medication
• Follow-Up
o Physiotherapy
o Counseling and Support Groups
o Rehabilitative Care
Complementary medicine :
• Nutrition and diet supplement
• Herbs
• Acupuncture
• Massage therapy
• Physical therapy
• Homeopathy
• Mind-body Medicine
• Therapeutic Touch
• Maggot Therapy
Diseases spread by food handlers:
Agents of Food-borne diseases:
• Microorganisms, including:
o bacteria
o viruses
o parasitic protozoa
o worms
• natural toxins
• chemical residues
• prions.
List of potential diseases:
• Typhoid fever
• Gastroenteritis - norovirus, rotavirus, adenovirus, astrovirus, Helicobactor pylori
• Hepatitis A
• Cholera
• Listeriosis
• Hemolytic uremic syndrome
• hemorrhagic colitis
• Septicaemia
• Bovine Spongiform Encephalopathy (BSE)
• Strep throats
• Foodborne botulism
• Hemorrhagic colitis
• Salmonellosis
• Meningitis
Route of transmission (main diseases only)
Typhoid fever - stool of persons infected with typhoid fever or carriers, water
Gastroenteritis - fecal/oral, oral/oral, or gastric/oral pathways.
Campylobacter - from the consumption of undercooked meat, unpasteurized milk
Shigella - typically spread from person to person
Hepatitis A- by the fecal-oral route of transmission.
Cholera - through contamination of water sources and contamination of food.
Bovine Spongiform Encephalopathy (BSE)
–through an agent related to scrapie in sheep, which contaminated recycled bovine carcasses used to make meat and bone meal additives for cattle feed.
-contaminated bovine-based food products
Listeria - bacteria found in soil and water, raw foods as well as in processed foods and foods made from unpasteurized milk
Prevention of burns
• keep hot liquids away from table & counter edges
• don't hold or pass hot liquids over children
• keep cups & bowls with hot contents out of reach
• keep children out of kitchen while cooking
• keep iron or curling iron cords out of child's reach
• Never leave candles unattended. Blow them out when you leave the room.
• Test the water temperature before you or your children get into the tub or shower.
Preventing Radiation Burns
• Use a sunscreen
• Avoid exposure to UV (ultraviolet) radiation from sunlamps or tanning beds.
Preventing Chemical Burns
• Wear gloves and other protective clothing when you handle chemicals. Store chemicals, including gasoline, out of the reach of children.
• Store Chemicals in Locked Cabinet
• Purchase Potentially Dangerous Chemicals in Safety Containers
• Avoid Prolonged Chemical Exposure
Preventing Electrical Burns
• keep electrical outlets covered from children
• put covers on any electrical outlets that are within children's reach.
Public Health Issue :
General Requirement for food premises
• Location
• General design
• Water supply
• Cleanliness of food premises
• Pest control in food premises
• Disposal of refuse
Specific Requirements for Food premises
• Floor surfaces
• Wall surfaces
• Lighting
• Ventilation
• Ceiling
• Door
• Furniture, fitting and food contact surfaces
• Food storage
• Changing room
• Wash basin
• Toilet room
• Drainage facility
Food Handler
• Food handlers training
• Clothing of food handler
• Medical examination and health condition of food handler
• Personal hygiene of food handler
• Duty to keep food premises clean
Types of burns :
• Chemical burns
• Electrical burns
• UV light burn
• Radiation injury
Signs and Symptoms :
Burn
• First-degree burns:
red, swollen, and painful. The burned area whitens (blanches) when lightly touched but does not develop blisters.
• Second-degree burns:
pink or red, swollen, and painful, and they develop blisters that may ooze a clear fluid. The burned area may blanch when touched.
• Third-degree burns :
usually are not painful. The skin becomes leathery and may be white, black, or bright red. The burned area does not blanch when touched, and hairs can easily be pulled from their roots.
Infection
• Change in color of the burnt area or surrounding skin
• Purplish discoloration, particularly if swelling is also present
• Change in thickness of the burn (the burn suddenly extends deep into the skin)
• Greenish discharge or pus
• Fever
Severity of Wound
• Depth
• Surface Area (Rule of nine, Rule of palm)
• Body part
• Pre-existing medical problem
• Age
Classification of Wound :
• 1st degree (epidermis)
• 2nd degree (epidermis + part of dermis)
• 3rd degree (epidermis + dermis)
Investigations for wound infection :
Wound culture:
• help determine whether wound infected
• identify bacteria
• prepare sample for susceptibility testing
• steps
o collecting sample
o stimulating growth (media)
o identification (e.g. gram stain)
o antimicrobial susceptibility testing (for treatment)
Complications:
Minor burns :
• usually superficial and do not cause complications.
Severe burns and some moderate burns :
• Dehydration
o Cause shock if dehydration is severe
• Chemical imbalances
• Destruction of muscle tissue (rhabdomyolysis)
• Infection cause severe illness or death.
• Thick, crusty surfaces (eschars)
o cutting off blood supply to healthy tissues or impairing breathing.
Normal process of healing :
Hemostasis
• growth factors are released.
• Constriction of blood vessels
• Adherence of platelets to damaged epithelium
• Discharge of adenosine diphosphate – promote thrombocyte clumping
• Clot forms to close blood vessels
• Cytokines initiate inflammatory phase
Inflammation
• Polymorphonuclear leukocytes released
• Activation of complement
• Macrophage formation
The proliferative phase
-collagen deposits
-angiogenesis
-granulation
-tissue development
- wound contraction
Maturation Phase
-remodelling of the scar
- strength of scar tissue
Treatment and Management :
• Wound Management.
• First Aid
o CPR
o Airway
Check airways that may cause breathing problems.
o Breathing
o Circulation
Fluid resuscitation (IV therapy)
• Chemical Burns
• Electrical Burns
• Skin Grafts
o Types – (Pinch Grafts, Split-thickness grafts, Full thickness grafts , Pedicle grafts)
• Skin Treatment Medication
• Follow-Up
o Physiotherapy
o Counseling and Support Groups
o Rehabilitative Care
Complementary medicine :
• Nutrition and diet supplement
• Herbs
• Acupuncture
• Massage therapy
• Physical therapy
• Homeopathy
• Mind-body Medicine
• Therapeutic Touch
• Maggot Therapy
Diseases spread by food handlers:
Agents of Food-borne diseases:
• Microorganisms, including:
o bacteria
o viruses
o parasitic protozoa
o worms
• natural toxins
• chemical residues
• prions.
List of potential diseases:
• Typhoid fever
• Gastroenteritis - norovirus, rotavirus, adenovirus, astrovirus, Helicobactor pylori
• Hepatitis A
• Cholera
• Listeriosis
• Hemolytic uremic syndrome
• hemorrhagic colitis
• Septicaemia
• Bovine Spongiform Encephalopathy (BSE)
• Strep throats
• Foodborne botulism
• Hemorrhagic colitis
• Salmonellosis
• Meningitis
Route of transmission (main diseases only)
Typhoid fever - stool of persons infected with typhoid fever or carriers, water
Gastroenteritis - fecal/oral, oral/oral, or gastric/oral pathways.
Campylobacter - from the consumption of undercooked meat, unpasteurized milk
Shigella - typically spread from person to person
Hepatitis A- by the fecal-oral route of transmission.
Cholera - through contamination of water sources and contamination of food.
Bovine Spongiform Encephalopathy (BSE)
–through an agent related to scrapie in sheep, which contaminated recycled bovine carcasses used to make meat and bone meal additives for cattle feed.
-contaminated bovine-based food products
Listeria - bacteria found in soil and water, raw foods as well as in processed foods and foods made from unpasteurized milk
Prevention of burns
• keep hot liquids away from table & counter edges
• don't hold or pass hot liquids over children
• keep cups & bowls with hot contents out of reach
• keep children out of kitchen while cooking
• keep iron or curling iron cords out of child's reach
• Never leave candles unattended. Blow them out when you leave the room.
• Test the water temperature before you or your children get into the tub or shower.
Preventing Radiation Burns
• Use a sunscreen
• Avoid exposure to UV (ultraviolet) radiation from sunlamps or tanning beds.
Preventing Chemical Burns
• Wear gloves and other protective clothing when you handle chemicals. Store chemicals, including gasoline, out of the reach of children.
• Store Chemicals in Locked Cabinet
• Purchase Potentially Dangerous Chemicals in Safety Containers
• Avoid Prolonged Chemical Exposure
Preventing Electrical Burns
• keep electrical outlets covered from children
• put covers on any electrical outlets that are within children's reach.
Public Health Issue :
General Requirement for food premises
• Location
• General design
• Water supply
• Cleanliness of food premises
• Pest control in food premises
• Disposal of refuse
Specific Requirements for Food premises
• Floor surfaces
• Wall surfaces
• Lighting
• Ventilation
• Ceiling
• Door
• Furniture, fitting and food contact surfaces
• Food storage
• Changing room
• Wash basin
• Toilet room
• Drainage facility
Food Handler
• Food handlers training
• Clothing of food handler
• Medical examination and health condition of food handler
• Personal hygiene of food handler
• Duty to keep food premises clean
Severity of Wounds + Investigation (Summary)
Summary
Severity of Wounds
- Depth
- Surface Area (Rule of nine, Rule of palm)
- Body part
- Pre-existing medical problem
- Age
Classification of Wounds
- 1st degree (epidermis)
- 2nd degree (epidermis + part of dermis)
- 3rd degree (epidermis + dermis)
Investigation for Wound Infection
Wound culture:
- help determine whether wound infected
- identify bacteria
- prepare sample for susceptibility testing
- steps
- collecting sample
- stimulating growth (media)
- identification (e.g. gram stain)
- antimicrobial susceptibility testing (for treatment)
PUBLIC HEALTH ISSUE (FOOD HYGIENE REGULATIONS 2009 – will be enforced in 1st March 2010)
General Requirement for food premises
Location
- Food premises shall be located away from sources of contamination including aeration ponds, septic tanks and waste disposal sites
General design
- Food premises shall be designed and constructed as such to facilitate cleaning and disinfection
Water supply
- There shall be ample supply of potable water and adequate facilities for its storage and distribution, where necessary.
- The water supply shall be adequately protected against any contamination
Cleanliness of food premises
- Food premises shall be maintained at all times in a good, clean, and tidy condition
- Food premises shall be free from any accumulation of boxes, tin, empty bottles, rubbish or any other article not connected with the business of the food business to prevent the entrance and harbourage of pest
- The cleaning of food premises shall be carried out at least once daily and includes the removal of food residues and dirt, whenever necessary
- There shall be provided an adequate facilities for the cleaning, disinfecting, and storing of appliances used in food premises and such facilities shall be constructed from corrosion resistant materials and easily cleaned and, where necessary, have an adequate supply of hot and cold potable water
- There shall be provided and made available at all times an adequate supply of suitable cleaning agents, disinfectant and tools to enable regular and proper cleaning of food premises and all appliances used in the food premises
- Every cleaning agent and disinfectant used in the food premises shall be adequately labelled and not to be stored in areas where food is stored or handled
- The Director or an officer authorised by him may, for the purpose of maintaining the cleanliness of the food premises, require any proprietor, owner, or occupier of food premises to make any structural alteration, repair, renovation, plumbing or drainage work in the premises within such time as may be specified by the Director or an officer authorised by him
Pest control in food premises
- A proprietor, owner or occupier of food premises shall, at all times, keep the food premises free from any pest.
- A proprietor, owner or occupier of food premises shall, on becoming aware of the presence of any pest in the premises, forthwith take all practicable measures to destroy the pest and to prevent reinfestation.
- A pest control treatment shall only be carried out by using a suitable chemical, physical or biological agent and without posing a threat to the safety of food.
Disposal of refuse
- All food waste, non edible by-products and other refuse shall be
- removed from any room where food is present as soon as possible to avoid their accumulation;
deposited in closable containers or other types of containers of an appropriate construction and kept in a good condition, easily cleaned and where necessary, disinfected; and
eliminated in a hygienic and environmentally friendly way in accordance with the relevant law applicable to that effect, and is not to constitute a direct or indirect source of contamination.
- removed from any room where food is present as soon as possible to avoid their accumulation;
- There shall be adequate provision for the storage and disposal of food waste, non edible by-products and other refuse.
- All food waste, non edible by-products and other refuse stores shall be designed and managed in such a way as to enable them to be kept clean and, where necessary, free of animals and pests.
Specific Requirements for Food premises
Floor surfaces
- All floors in food premises shall be–
- maintained in a good condition, easily cleaned and where necessary, disinfected;
- of impervious, non-absorbent, washable and non-toxic materials unless the proprietor, owner or occupier of food premises can satisfy the Director or an officer authorized by him that other materials used are appropriate; and
- Adequately drained.
- maintained in a good condition, easily cleaned and where necessary, disinfected;
Wall surfaces
- All walls in food premises shall be–
- maintained in a good condition, easily cleaned and where necessary, disinfected; and
of impervious, non absorbent, washable and non toxic materials and require a smooth surface up to a height appropriate for a food process unless the proprietor, owner or occupier of food premises can satisfy the Director or an officer authorized by him that other materials used are appropriate.- All angles between a wall and a floor in a food premises shall be sealed and coved to facilitate cleaning, where necessary.
- maintained in a good condition, easily cleaned and where necessary, disinfected; and
Lighting
- Every food premises shall be provided with adequate natural or artificial lighting which does not lead, or cause any contamination of food.
Ventilation
- A ventilation system in food premises shall be–
- suitable and sufficient which does not lead to, or cause any contamination of food; and
- constructed to enable filters and other parts requiring cleaning or replacement be readily accessible.
- suitable and sufficient which does not lead to, or cause any contamination of food; and
- A mechanical airflow of a ventilation system shall not flow from a contaminated area to a clean area.
Ceiling
- All ceilings or where there is no ceiling, the interior surface of the roofs and overhead fixtures of food premises shall be constructed and in finish form which able to prevent the accumulation of dirt and shedding of particles and to reduce condensation and growth of undesirable mould.
Door
- All doors in food premises shall be–
- easily cleaned and where necessary, disinfected; and
- of smooth, non absorbent surface and self closing.
- easily cleaned and where necessary, disinfected; and
Furniture, fitting and food contact surfaces
- All furniture, fittings and food contact surfaces used or to be used for the preparation, serving, storage, conveyance or distribution of food in any food premises shall be well maintained and kept clean at all times.
- All furniture, fittings and food contact surfaces used or to be used in any processing area of food premises shall be of impervious material and easily cleaned.
Food storage
- There shall be a suitable storeroom of adequate size for the storage of food in all food premises.
- There shall be a different storeroom for the storage of raw food materials and ingredients, and for the storage of processed food materials in all food premises.
- All fittings or equipments used or to be used for storage of food in all food premises shall–
- be made of suitable material;
- be designed and constructed to permit adequate cleaning and disinfection; and
Have adequate space to enable proper storage of food.
- be made of suitable material;
- Where any food needs to be stored in a chilled or frozen condition, the storage facility for such food shall comply with the following requirements:
- a separate refrigerated storage for raw food materials and processed food materials is sufficiently provided;
- the facility is defrosted whenever necessary to maintain refrigeration efficiency;
the inner layer of the facility is made of a smooth and non-toxic metal or other impervious material, and of is light coloured and easily cleaned;- any device used to record temperature in the facility is accurate to a plus or minus 1C; and
- the air vent of the facility is sited away from excessive light, warm air, oven or air-conditioning outlets.
- a separate refrigerated storage for raw food materials and processed food materials is sufficiently provided;
- If the storage facility referred to in subregulation (4) is a cold room, the doors to such facility shall be fitted with an air curtain or other effective means to avoid loss of cold air or any sudden rise in temperature.
Changing room
- There shall be provided a changing room, where necessary, for the use of a food handler in food premises.
Wash basin
- There shall be provided an adequate number of wash-basin suitably located and designated for washing hand.
- wash-basin shall, at all times, be—
supplied with adequate running water;- supplied with soap or suitable liquid detergent in a dispenser;
supplied with paper towel or automatic hand dryer;
kept clean and maintained in a good condition; and
equipped with non-hand operated taps for the use of food handler.
- There shall be different wash-basin for washing hand and washing food in food premises.
Toilet room
- There shall be provided an adequate number of toilet room in food premises.
- The toilet room shall—
- be provided with running water, toilet paper, soap or suitable liquid detergent in a dispenser, hand drying facility or clean roller towels or paper towels at all times;
- be kept clean and free from malodour at all times: and
- not directly open to any room or compartment used for the storage, production and serving of food.
- be provided with running water, toilet paper, soap or suitable liquid detergent in a dispenser, hand drying facility or clean roller towels or paper towels at all times;
Drainage facility
- A drainage facility in food premises shall be adequate, designed and constructed to avoid any risk of contamination to food.
- A drainage facility in a kitchen or food preparation areas of food premises shall be made of smooth type material, fitted with food trap and connected to the main outlet drain of the food premises.
- The drainage channels in food premises shall be fully or partially open and appropriately designed to ensure that waste does not flow from a contaminated area towards or into a clean area.
Food Handler
Food handlers training
- All food handlers shall undergo a food handlers training in, and obtain a Certificate of Food Handlers Training from, an institution specified by the Director.
- The Minister may, if he thinks necessary, require any food handler to attend any additional food handlers training in any institution specified by the Director.
- Any food handler who works in any food premises fails to undergo a training or obtain a certificate referred to in subregulation (1) or fails to attend any additional training referred to in subregulation (2) commits an offence and shall, on conviction, be liable to a fine not exceeding ten thousand ringgit or to imprisonment for a term not exceeding two years.
Clothing of food handler
- A food handler shall wear―
a clean, suitable and proper clothing which shall not contribute to any contamination of food; and- a clean, suitable and light-coloured outer overall or a light-coloured apron, head cover and footwear, or any other clothing which is suitable to the opinion of the Director or an officer authorized by him.
- The clothing specified in paragraph (1)(b) shall not be worn other than in food premises and shall be kept in a suitable cupboard or locker when not in use.
- Any food handler who fails to comply with subregulation (1) or (2) commits an offence and shall, on conviction, be liable to a fine not exceeding one thousand ringgit.
Medical examination and health condition of food handler
- A food handler shall be medically examined and vaccinated by a registered medical practitioner.
- Any food handler who suffers from, or is a carrier of food-borne diseases or suspected to be suffering from, or to be a carrier of food-borne diseases shall—
- not be allowed to enter food premises or handle food;
immediately report to the management of food premises pertaining to his health condition; and- be suspended from working in food premises until he is certified cured from the disease and medically fit to work by a registered medical practitioner before he is allowed to enter the food premises or handle food.
- not be allowed to enter food premises or handle food;
- Any food handler who fails to comply with subregulations (1) or (2) commits an offence and shall, on conviction, be liable to a fine not exceeding ten thousand ringgit or to imprisonment for a term not exceeding two years.
Personal hygiene of food handler
- A food handler while handling, preparing, packing, carrying, storaging, displaying and serving of food shall―
- maintain a high degree of personal cleanliness which includes the keeping of short and clean fingernails;
- remove his overall or head cover or apron before visiting toilet;
- wash his hands before commencing work, immediately after using the toilet and after handling raw food or any contaminated material;
not engage in any behaviour or action that could result in contamination of food;- not place any articles in the pocket of any garment or apron which may contribute to any contamination of food; and
- not wear jewelleries, watches, pins or other accessories.
- maintain a high degree of personal cleanliness which includes the keeping of short and clean fingernails;
- Any food handler who fails to comply with subregulation (1) commits an offence and shall, on conviction, be liable to a fine not exceeding ten thousand ringgit or to imprisonment for a term not exceeding two years.
Duty to keep food premises clean
- A food handler shall ensure that food premises where the food is handled are kept clean and free from rubbish, pest, dirt or soot, sweepings, ashes, wastes and cobwebs at all time.
- Any food handler who fails to comply with subregulation (1) commits an offence and shall, on conviction, be liable to a fine not exceeding ten thousand ringgit or to imprisonment for a term not exceeding two years.
References:
http://fsq.moh.gov.my/uploads/Peraturan2_Kebersihan_Makanan_2009__BI_%5B1%5D.pdf
Signs and symptoms of burns and infection
Burn
Infection
- Change in color of the burnt area or surrounding skin
- Purplish discoloration, particularly if swelling is also present
- Change in thickness of the burn (the burn suddenly extends deep into the skin)
- Greenish discharge or pus
- Fever
Wednesday, May 20, 2009
Summary for Hemostasis and Inflammation
Hemostasis
When injury occurs, chemical mediators and intercellular messengers called growth factors are released.
-next, blood leaking from inflamed, dilated or broken veselss, begin to coagulate.
-platelets adhere to the damaged epithelium
-discharge adenosine diphosphate to promote thrombocyte clumping
-releases cytokines to initiate inflammatory phase
Alpha granules release growth factors
– PDGF(Platelet-derived growth factor)
– Platelet factor 4
– TGF-b(Transforming growth factor beta)
Serotonin and histamine also released
Thrombin forms , clot forms to close small vessels and stop bleeding
Inflammation
Polymorphonuclear leukocytes released. They clear the debris from the wound.
Activation of complement
C5a-attract neutrophils. Release histamine. Capillary permeability and vasodilation.
C3b-opsonize bacteria-enhance phagocytosis by neutrophils and macrophage.
C5,6,7,8,9-form Membrane Attack Complex that lyse bacteria
Macrophage formation
-cytokine production-TNF,IL-8,IL-1,IL-6.
1) Has chemoattractants that recruit and activate additional macrophages at the site of injury,
2) growth factors that promote cellular proliferation and protein synthesis,
When injury occurs, chemical mediators and intercellular messengers called growth factors are released.
-next, blood leaking from inflamed, dilated or broken veselss, begin to coagulate.
-platelets adhere to the damaged epithelium
-discharge adenosine diphosphate to promote thrombocyte clumping
-releases cytokines to initiate inflammatory phase
Alpha granules release growth factors
– PDGF(Platelet-derived growth factor)
– Platelet factor 4
– TGF-b(Transforming growth factor beta)
Serotonin and histamine also released
Thrombin forms , clot forms to close small vessels and stop bleeding
Inflammation
Polymorphonuclear leukocytes released. They clear the debris from the wound.
Activation of complement
C5a-attract neutrophils. Release histamine. Capillary permeability and vasodilation.
C3b-opsonize bacteria-enhance phagocytosis by neutrophils and macrophage.
C5,6,7,8,9-form Membrane Attack Complex that lyse bacteria
Macrophage formation
-cytokine production-TNF,IL-8,IL-1,IL-6.
1) Has chemoattractants that recruit and activate additional macrophages at the site of injury,
2) growth factors that promote cellular proliferation and protein synthesis,
Diseases spread by food handlers, Route of transmission, Prevention of burns
Diseases spread by food handlers
Agents of Food-borne diseases:
Microorganisms, natural toxins, and chemical residues, prions.
Microorganisms, including:
bacteria (eg Campylobacter),
viruses (eg Norwalk virus),
parasitic protozoa (eg Cryptosporidium),
and worms (eg Trichinella spiralis).
List of potential diseases:
Typhoid fever
Gastroenteritis - norovirus, rotavirus, adenovirus, astrovirus, Helicobactor pylori
Hepatitis A
Cholera
Listeriosis
Hemolytic uremic syndrome
hemorrhagic colitis
Septicaemia
Bovine Spongiform Encephalopathy (BSE)
Strep throats
Foodborne botulism
Hemorrhagic colitis
Salmonellosis
Meningitis
Route of transmission (main diseases only)
Typhoid fever - Salmonella Typhi present in stool of persons infected with typhoid fever or carriers. More common in areas of the world where hand washing is less frequent and water is likely to be contaminated with sewage. Can be contracted from handling poultry or reptiles such as turtles that carry the germs.
Gastroenteritis - fecal/oral, oral/oral, or gastric/oral pathways. Improper hand washing following a bowel movement or handling a diaper can spread the disease from person to person.
Viruses:
Adenoviruses
Parvoviruses
Astroviruses
Bac:
Campylobacter - from the consumption of undercooked meat, unpasteurized milk
Shigella - typically spread from person to person
Hepatitis A- by the fecal-oral route of transmission. An infected food employee can transmit these pathogens to consumers through the contamination of food or food utensils by Hep A virus present in stool of persons infected with Hep A.
Cholera - V. cholerae is introduced to humans through contamination of water sources and contamination of food. The cycle of transmission is closed when infected humans shed the bacteria into the environment and contaminate water sources and food. V. cholerae survives for up to 14 days in some foods, especially when contamination occurs after preparation of the food. Cooking and heating the food eliminate the bacteria. Epidemics of cholera associated with the ingestion of leftover rice, yellow rice in a restaurant, raw fish,cooked crabs, eafood, raw oysters, and fresh vegetables and fruits have been documented.
Bovine Spongiform Encephalopathy (BSE), a fatal, transmissible, neurodegenerative disease of cattle, was first discovered in the United Kingdom in 1985. The cause of the disease was traced to an agent related to scrapie in sheep, which contaminated recycled bovine carcasses used to make meat and bone meal additives for cattle feed. Recycling of the BSE agent led to a distributed common source epidemic of more than 180,000 diseased animals in the UK alone. Humans can be infected if exposed to contaminated bovine-based food products
Listeria, caused by Listeria monocytogenes, bacteria found in soil and water. It can be in a variety of raw foods as well as in processed foods and foods made from unpasteurized milk. Listeria is unlike many other germs because it can grow even in the cold temperature of the refrigerator.
Prevention of burns
keep hot liquids away from table & counter edges
keep handles on cooking pots turned in
don't hold or pass hot liquids over children
keep cups & bowls with hot contents out of reach
keep children out of kitchen while cooking
always keep oven door closed
turn hot water heater temperature down to 120 F
never place beds or cribs near radiators
never place torch lamps near curtains & bedding
never leave hot iron on floor or on top of bed
keep iron or curling iron cords out of child's reach
never smoke in bed
never pour flammable liquids onto a hot BBQ
Never leave candles unattended. Blow them out when you leave the room.
Don't wear clothing with long, loose sleeves when you are cooking.
Test the water temperature before you or your children get into the tub or shower. Don't let young children touch the faucet handles during a bath.
Prevent prolonged exposure to steam
Preventing Radiation Burns
Use a sunscreen that has a sun protection factor (SPF) of at least 30 or higher. Sunscreens that say "broad-spectrum" can protect the skin from ultraviolet A and B (UVA and UVB) rays. Sunscreens come in lotions, gels, creams, and ointments.
Avoid exposure to UV (ultraviolet) radiation from sunlamps or tanning beds.
Preventing Chemical Burns
Wear gloves and other protective clothing when you handle chemicals. Store chemicals, including gasoline, out of the reach of children.
Store Chemicals in Locked Cabinet
Purchase Potentially Dangerous Chemicals in Safety Containers
Avoid Prolonged Chemical Exposure
Preventing Electrical Burns
keep electrical outlets covered from children
put covers on any electrical outlets that are within children's reach. Throw out electrical cords that are frayed or damaged in any way.
References:
WHO
http://www.who.int/mediacentre/factsheets/fs124/en/
UC San Diego Medical Center
http://health.ucsd.edu/specialties/burn/about.htm
FamilyDoctor.org
http://familydoctor.org/online/famdocen/home/healthy/safety/safety/649.printerview.html
American College of Emergency Physicians
http://www3.acep.org/patients.aspx?id=25990
Healthline
http://www.healthline.com/channel/chemical-burns_prevention
http://www.healthline.com/galecontent/food-borne-diseases
Northwest Burn Foundation
www.nwburn.org
CDC
http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-foodhandlers.htm
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm#mostcommon
http://www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm
KidsHealth
http://kidshealth.org/parent/infections/stomach/campylobacter.html
MedlinePlus
http://www.nlm.nih.gov/medlineplus/botulism.html
Merck
http://www.merck.com/mmhe/sec09/ch122/ch122b.html
Complications
Minor burns are usually superficial and do not cause complications. However, deep second-degree and third-degree burns swell and take more time to heal. In addition, deeper burns can cause scar tissue to form. This scar tissue shrinks (contracts) as it heals. If the scarring occurs in a limb or digit, the resulting contracture may restrict movement of nearby joints.
Severe burns and some moderate burns can cause serious complications due to extensive fluid loss and tissue damage. These complications may take hours or days to develop. The deeper and more extensive the burn, the more severe are the problems it tends to cause. Young children and older adults tend to be more seriously affected by complications than other age groups. The following are some complications of some moderate and severe burns:
Dehydration eventually develops in people with widespread burns, because fluid seeps from the blood to the burned tissues and, if burns are deep and extensive enough, to the whole body.
Shock develops if dehydration is severe.
Chemical imbalances can result from extensive burns.
Destruction of muscle tissue (rhabdomyolysis) sometimes occurs with deep third-degree burns. The muscle tissue releases myoglobin, one of the muscle's proteins, into the blood. If present in high concentrations, myoglobin harms the kidneys.
Infection can complicate burn wounds. Sometimes the infection can spread throughout the bloodstream and cause severe illness or death.
Thick, crusty surfaces (eschars) are produced by deep third-degree burns. Eschars can become too tight, cutting off blood supply to healthy tissues or impairing breathing.
Severe burns and some moderate burns can cause serious complications due to extensive fluid loss and tissue damage. These complications may take hours or days to develop. The deeper and more extensive the burn, the more severe are the problems it tends to cause. Young children and older adults tend to be more seriously affected by complications than other age groups. The following are some complications of some moderate and severe burns:
Dehydration eventually develops in people with widespread burns, because fluid seeps from the blood to the burned tissues and, if burns are deep and extensive enough, to the whole body.
Shock develops if dehydration is severe.
Chemical imbalances can result from extensive burns.
Destruction of muscle tissue (rhabdomyolysis) sometimes occurs with deep third-degree burns. The muscle tissue releases myoglobin, one of the muscle's proteins, into the blood. If present in high concentrations, myoglobin harms the kidneys.
Infection can complicate burn wounds. Sometimes the infection can spread throughout the bloodstream and cause severe illness or death.
Thick, crusty surfaces (eschars) are produced by deep third-degree burns. Eschars can become too tight, cutting off blood supply to healthy tissues or impairing breathing.
Complementary Therapy
Nutrition and Diet Supplement
-Often given high-calorie, high-protein diets to speed recovery
-Eat antioxidant food (beta-carotene, vitamin C and E)
*Fruits : blueberries, tomatoes, cherries, papaya, guava etc.
*Vegetables : broccoli, spinach, green pepper etc.
^neutralize free radicals by offering their own electrons
-Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
-Drink 6 - 8 glasses of filtered water daily.
-Avoid fatty food (saturated fats, trans-fats) and processed food
-Avoid refined foods, such as white breads, pastas, and sugar.
-Vitamin C (1,000 mg two to six times per day)
*helps skin heal by enhancing new tissue growth and strength.
-Vitamin E (400 - 800 IU a day) promotes healing.
*May be used topically once the burn has healed and new skin has formed.
*Higher doses may help in healing burns.
-Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil, one to two times daily
*to help decrease inflammation, and for healing and immunity.
*Cold-water fish, such as salmon or halibut, are good sources.
-Coenzyme Q10
*for antioxidant and immune activity.
Herbs
-Gotu kola (Centella asiatica) as a cream
*contains chemicals called triterpenoids
*In animal and lab studies, these compounds appear to help heal wounds.
*For example, some studies indicate that triterpenoids strengthen the skin, boost antioxidants in wounds, and increase blood supply to the area
-Calendula (Calendula officinalis), or pot marigold
*contains high amounts of flavonoids, plant-based antioxidants
*Animal studies show that calendula does appear to speed wound healing, possibly by increasing blood flow to the wounded area and by helping the body produce collagen proteins, which are used to heal skin and connective tissue.
-Aloe Vera
*“Burn plant”
*contains over 75 known active ingredients including a wide range Vitamins A,B,C,and E, antioxidant, minerals, calcium, essential Amino Acids, Sugars, Digestive Enzymes, Anti-inflammatory Enzymes, Plant Sterols, Lignin, Saponins, Anthraquinones and more.
stimulate skin growth and repair
*ability to provide essential nutrients needed to promote healthy tissue growth
^by reducing inflammation
^killing bacteria and other foreign organisms
*Aloe Vera’s cooling effect offers instant relief from burns
^prevent, or greatly reduce, blistering when applied immediately after receiving a burn.
*In a review of the scientific literature, researchers found that patients who were treated with aloe vera healed an average of almost 9 days sooner than those who weren't treated with the medicinal plant.
-Honey
*Current interest in medicinal honey focuses largely on its antibacterial effects.
*It is acidic
^prevent infection
*High concentration of sugar
^absorb fluid that weeps from the wound
*Contains natural plant chemicals that are anti-bacterial.
*May help the body remove dead tissue
*Anti-inflammatory activity reduces edema and minimizes scarring
*Stimulates growth of granulation and epithelial tissues to speed healing
*Removes malodor
*Hydrogen Peroxide
^When honey is applied as a wound dressing, it is diluted with fluids from the damaged tissue and
^combines with an enzyme added by the bee to form hydrogen peroxide
^the same antiseptic found in drugstores.
^Diluted honey- an excellent antiseptic
^naturally occurring hydrogen peroxide won’t harm the tissues and no scarring will occur.
*The evidence :
^level 2 evidence that honey is effective for healing superficial burns and scalds.
^unclear what type of honey product (eg, natural honey, medicated dressings) is best for burns.
^not safe or effective as a dressing for more serious burns (level 2 evidence).
^None of the honey-based or other dressings tested were reported to cause adverse effects.
*Ancient Egyptian surgical texts recommended using honey on wounds, and some animal studies and trials suggest the sweet solution may speed up healing.
Acupuncture
-Electrical Stimulation
*Transcutaneous electrical nerve stimulation (TENS) uses controlled, low-voltage electrical stimulation of the skin to relieve pain.
*Recent studies have suggested that TENS applied to acupuncture points (called electroacupuncture) on the ear (auricular acupuncture) may relieve pain for people with burns.
Masssage Therapy
-"hands-on" therapy
-muscles and other soft tissues of the body are manipulated to improve health and well-being.
-electrical signals are transmitted both to the local area and throughout the body
*heal damaged muscle,
*stimulate circulation,
*clear waste products via the lymphatic system,
*boost the activity of the immune system,
*reduce pain and tension, and
*induce a calming effect.
*stimulate the release of endorphins (natural painkillers and mood elevators)
*reducing levels of certain stress hormones.
-People receiving a massage reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only.
Physical Therapy
-to improve movement and function of the areas affected by a burn.
-reduce scar formation.
-Practices include :
*Body and limb positioning
*Splinting
*Help with activities of daily living until normal function and ability are recovered
*Passive (physical therapist moves the person's limbs) and active exercises
*Help with walking
Homeopathy
-important principles : dilution and succussion.
*Remedies are diluted and then "succussed," or shaken,
^to increase their potency.
-act as catalysts that aid the body's inherent healing mechanisms
-Examples:
*Place the burned area in cold water until the pain goes away (at least a few minutes).
*Arnica Montana -- taken orally immediately after the burn.
*Hypericum perforatum -- used on the skin if there are sharp, shooting pains with the burn.
*Causticum -- taken orally for burning pains with great rawness (as from an open wound) or when there are long-term physical or emotional symptoms after a burn.
Mind Body Medicine
-healing that uses the power of thoughts and emotions to positively influence physical health
-Hypnotise
*a person's body relaxes
^thoughts become more focused and attentive -in the state of deep concentration
^people are highly responsive to a hypnotherapist's suggestions.
^reduce pain and anxiety and enhance relaxation
-Therapeutic Touch
*based on the theory that the body, mind, and emotions form a complex energy field
*correct the body's imbalances by moving their hands just over the body.
^"the laying on of hands.“
*studies have shown conflicting results
Maggot Therapy
-For maggots to function optimally :
*require a moist environment;
*saline soaks were therefore applied for 48 hours
*to moisten the wound
^remove excess SSD prior to application of maggots.
-Maggot secretions appear to
*amplify the healing effects of host epidermal growth factor
^allantoin and urea (antimicrobial activity)
^calcium carbonate (stimulation of phagocytosis) and
^proteolytic enzymes (slough/necrotic tissue breakdown)
^The resultant enzymatic degradation products are subsequently ingested and digested by the maggots.
-Micromassage of the wound by maggot movement is thought to
*stimulate the formation of granulation tissue and wound exudate by the host
-accelerated debridement of slough and necrosis
-a reduction in the bacterial load of the wound,
*leading to earlier healing, reduced wound odour and less pain.
-Evidence suggests that maggots can be used successfully in a wide variety of wounds (trauma, vascular, infected, malignant and a single report in an infected burn wound
-Often given high-calorie, high-protein diets to speed recovery
-Eat antioxidant food (beta-carotene, vitamin C and E)
*Fruits : blueberries, tomatoes, cherries, papaya, guava etc.
*Vegetables : broccoli, spinach, green pepper etc.
^neutralize free radicals by offering their own electrons
-Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
-Drink 6 - 8 glasses of filtered water daily.
-Avoid fatty food (saturated fats, trans-fats) and processed food
-Avoid refined foods, such as white breads, pastas, and sugar.
-Vitamin C (1,000 mg two to six times per day)
*helps skin heal by enhancing new tissue growth and strength.
-Vitamin E (400 - 800 IU a day) promotes healing.
*May be used topically once the burn has healed and new skin has formed.
*Higher doses may help in healing burns.
-Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil, one to two times daily
*to help decrease inflammation, and for healing and immunity.
*Cold-water fish, such as salmon or halibut, are good sources.
-Coenzyme Q10
*for antioxidant and immune activity.
Herbs
-Gotu kola (Centella asiatica) as a cream
*contains chemicals called triterpenoids
*In animal and lab studies, these compounds appear to help heal wounds.
*For example, some studies indicate that triterpenoids strengthen the skin, boost antioxidants in wounds, and increase blood supply to the area
-Calendula (Calendula officinalis), or pot marigold
*contains high amounts of flavonoids, plant-based antioxidants
*Animal studies show that calendula does appear to speed wound healing, possibly by increasing blood flow to the wounded area and by helping the body produce collagen proteins, which are used to heal skin and connective tissue.
-Aloe Vera
*“Burn plant”
*contains over 75 known active ingredients including a wide range Vitamins A,B,C,and E, antioxidant, minerals, calcium, essential Amino Acids, Sugars, Digestive Enzymes, Anti-inflammatory Enzymes, Plant Sterols, Lignin, Saponins, Anthraquinones and more.
stimulate skin growth and repair
*ability to provide essential nutrients needed to promote healthy tissue growth
^by reducing inflammation
^killing bacteria and other foreign organisms
*Aloe Vera’s cooling effect offers instant relief from burns
^prevent, or greatly reduce, blistering when applied immediately after receiving a burn.
*In a review of the scientific literature, researchers found that patients who were treated with aloe vera healed an average of almost 9 days sooner than those who weren't treated with the medicinal plant.
-Honey
*Current interest in medicinal honey focuses largely on its antibacterial effects.
*It is acidic
^prevent infection
*High concentration of sugar
^absorb fluid that weeps from the wound
*Contains natural plant chemicals that are anti-bacterial.
*May help the body remove dead tissue
*Anti-inflammatory activity reduces edema and minimizes scarring
*Stimulates growth of granulation and epithelial tissues to speed healing
*Removes malodor
*Hydrogen Peroxide
^When honey is applied as a wound dressing, it is diluted with fluids from the damaged tissue and
^combines with an enzyme added by the bee to form hydrogen peroxide
^the same antiseptic found in drugstores.
^Diluted honey- an excellent antiseptic
^naturally occurring hydrogen peroxide won’t harm the tissues and no scarring will occur.
*The evidence :
^level 2 evidence that honey is effective for healing superficial burns and scalds.
^unclear what type of honey product (eg, natural honey, medicated dressings) is best for burns.
^not safe or effective as a dressing for more serious burns (level 2 evidence).
^None of the honey-based or other dressings tested were reported to cause adverse effects.
*Ancient Egyptian surgical texts recommended using honey on wounds, and some animal studies and trials suggest the sweet solution may speed up healing.
Acupuncture
-Electrical Stimulation
*Transcutaneous electrical nerve stimulation (TENS) uses controlled, low-voltage electrical stimulation of the skin to relieve pain.
*Recent studies have suggested that TENS applied to acupuncture points (called electroacupuncture) on the ear (auricular acupuncture) may relieve pain for people with burns.
Masssage Therapy
-"hands-on" therapy
-muscles and other soft tissues of the body are manipulated to improve health and well-being.
-electrical signals are transmitted both to the local area and throughout the body
*heal damaged muscle,
*stimulate circulation,
*clear waste products via the lymphatic system,
*boost the activity of the immune system,
*reduce pain and tension, and
*induce a calming effect.
*stimulate the release of endorphins (natural painkillers and mood elevators)
*reducing levels of certain stress hormones.
-People receiving a massage reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only.
Physical Therapy
-to improve movement and function of the areas affected by a burn.
-reduce scar formation.
-Practices include :
*Body and limb positioning
*Splinting
*Help with activities of daily living until normal function and ability are recovered
*Passive (physical therapist moves the person's limbs) and active exercises
*Help with walking
Homeopathy
-important principles : dilution and succussion.
*Remedies are diluted and then "succussed," or shaken,
^to increase their potency.
-act as catalysts that aid the body's inherent healing mechanisms
-Examples:
*Place the burned area in cold water until the pain goes away (at least a few minutes).
*Arnica Montana -- taken orally immediately after the burn.
*Hypericum perforatum -- used on the skin if there are sharp, shooting pains with the burn.
*Causticum -- taken orally for burning pains with great rawness (as from an open wound) or when there are long-term physical or emotional symptoms after a burn.
Mind Body Medicine
-healing that uses the power of thoughts and emotions to positively influence physical health
-Hypnotise
*a person's body relaxes
^thoughts become more focused and attentive -in the state of deep concentration
^people are highly responsive to a hypnotherapist's suggestions.
^reduce pain and anxiety and enhance relaxation
-Therapeutic Touch
*based on the theory that the body, mind, and emotions form a complex energy field
*correct the body's imbalances by moving their hands just over the body.
^"the laying on of hands.“
*studies have shown conflicting results
Maggot Therapy
-For maggots to function optimally :
*require a moist environment;
*saline soaks were therefore applied for 48 hours
*to moisten the wound
^remove excess SSD prior to application of maggots.
-Maggot secretions appear to
*amplify the healing effects of host epidermal growth factor
^allantoin and urea (antimicrobial activity)
^calcium carbonate (stimulation of phagocytosis) and
^proteolytic enzymes (slough/necrotic tissue breakdown)
^The resultant enzymatic degradation products are subsequently ingested and digested by the maggots.
-Micromassage of the wound by maggot movement is thought to
*stimulate the formation of granulation tissue and wound exudate by the host
-accelerated debridement of slough and necrosis
-a reduction in the bacterial load of the wound,
*leading to earlier healing, reduced wound odour and less pain.
-Evidence suggests that maggots can be used successfully in a wide variety of wounds (trauma, vascular, infected, malignant and a single report in an infected burn wound
Tuesday, May 19, 2009
Monday, May 18, 2009
Types of burns
Burns are usually caused by heat (thermal burns), such as fire, steam, tar, or hot liquids. Burns caused by chemicals are similar to thermal burns, whereas burns caused by radiation , sunlight , and electricity differ significantly. Events associated with a burn, such as jumping from a burning building, being struck by debris, or being in a motor vehicle crash, may cause other injuries.
Thermal and chemical burns usually occur because heat or chemicals contact part of the body's surface, most often the skin.
Chemical burns
Burns can also occur when chemicals are spilled onto the body and generate a reaction that creates heat. Chemical burns may be classified by their pH or acidity.
Acids are those with pH less than 7 and include common household compounds like acetic acid, hydrochloric acid, or sulfuric acid.
Bases or alkali compounds have a pH greater than 7. Ammonia is a common alkali found in the home.
A variety of household products fits this description:
Bleach
Concrete mix
Drain or toilet bowl cleaners
Metal cleaners
Pool chlorinators
Pathophysiology
Agents that cause chemical burns are described by mechanism of injury. The chemical classification scheme includes such categories as desiccants, vesicants, oxidizing agents, protoplasmic poisons, acids, and alkali agents.
Acids act through coagulative necrosis, forming an eschar that limits the penetration of the acid. Strong alkali cause liquefactive necrosis, resulting in saponification of fats and denaturation of proteins, ultimately allowing deeper penetration of the chemical. Oxidizing agents also denature proteins and often cause cell damage via cytotoxic effects. Protoplasmic poisons, such as hydrofluoric acid (HF), can form salts with cellular proteins. Desiccants dehydrate cells through an exothermic reaction. Finally, vesicants are thought to produce physiologic reactions that cause the release of amines along with a variety of other damaging processes. Despite these categories, precise classification of chemical agents remains difficult because agents often cause injury by more than one mechanism.
Tissue damage from chemical burns depends on several factors.
The strength or concentration of the agent
The site of contact (eye, skin, mucous membrane)
Whether swallowed or inhaled
Whether or not skin is intact
With how much of the agent you came into contact
The duration of exposure
How the chemical works
Signs and symptoms of chemical burns include the following:
Redness, irritation, or burning at the site of contact
Pain or numbness at the site of contact
Formation of blisters or black dead skin at the contact site
Vision changes if the chemical gets into your eyes
Cough or shortness of breath
Self-Care at Home
Begin basic first aid. Immediately call 911 if you have a severe injury, any shortness of breath, chest pain, dizziness, or other symptoms throughout your body. If you are aiding an injured person with these symptoms, lay the person down and immediately call 911.
Remove yourself or the victim from the accident area.
Remove any contaminated clothing.
Wash the injured area to dilute or remove the substance, using large volumes of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected parts of your body. Gently brush away any solid materials, again avoiding unaffected body surfaces.
Especially wash away any chemical in your eye. Sometimes the best way to get large amounts of water to your eye is to step into the shower.
Remove contaminated clothing
Brush away any dry powders or particles
Rinse the area with large amounts of water.
Treatment
Before burns are treated, the burning agent must be stopped from inflicting further damage. For example, fires are extinguished. Clothing—especially any that is smoldering (such as melted synthetic shirts), covered with a hot substance (for example, tar), or soaked with chemicals—is immediately removed.
Hospitalization is sometimes necessary for optimal care of burns. For example, elevating a severely burned arm or leg above the level of the heart to prevent swelling is more easily accommodated in a hospital. In addition, burns that prevent people from carrying out essential daily functions, such as walking or eating, make hospitalization necessary. Severe burns, deep second- and third-degree burns, burns occurring in the very young or the very old, and burns involving the hands, feet, face, or genitals are usually best treated at burn centers. Burn centers are hospitals that are specially equipped and staffed to care for burn victims.
Smoke Inhalation
Many people who have been burned in fires have also inhaled smoke. Sometimes people inhale smoke without sustaining skin burns. Smoke inhalation often causes no serious, lasting effects. However, if the smoke contains certain poisonous chemicals, is unusually dense, or inhalation is prolonged, serious problems can develop.
Hot smoke sometimes burns the throat, resulting in swelling. As the swelling narrows this area, airflow into the lungs is obstructed. Breathing hot steam can burn the lungs as well as the throat, causing severe breathing problems.
Inhalation of chemicals released in the smoke, such as hydrogen chloride, phosgene, sulfur dioxide, and ammonia, can cause swelling and damage to the windpipe (trachea) and even the lungs. Eventually, the small airways leading to the lungs narrow, further obstructing airflow. Smoke can also contain chemicals that poison the body's cells, such as carbon monoxide (see Poisoning: Carbon Monoxide Poisoning) and cyanide.
Damage to the trachea or the lungs can cause shortness of breath, which can take up to 24 hours to develop. Obstruction of airflow due to swelling of the airways can produce difficulty breathing air in, wheezing, and shortness of breath. People may have soot in the mouth or nose, singed nasal hairs, or burns around the mouth. Lung damage may cause chest pain, coughing, and wheezing. If the oxygen supply is depleted due to smoke, people may pass out. High levels of carbon monoxide in the blood may cause confusion or disorientation or may even be fatal.
To assess the extent of injury due to smoke inhalation, doctors may pass a flexible viewing tube (bronchoscope) into the trachea. Doctors may assess lung damage with a chest x-ray or with a test that determines the level of oxygen in the blood.
People who have inhaled smoke are given oxygen through a face mask. If a tracheal burn is suspected, a breathing tube is inserted through the nose or mouth in case the trachea later swells and obstructs airflow. If people begin to wheeze, drugs that open small airways such as albuterol may be given, usually as a mist that is combined with oxygen and inhaled through a face mask. If lung damage causes shortness of breath that persists despite use of a face mask and albuterol, a ventilator may be necessary. Relieving the stress of breathing conserves people's energy and usually allows faster recovery.
Electrical burns
Electrical burns may cause serious injury that is not readily apparent. Often the entry and exit points for the electrical shock may not be easily found.
Electricity flows more easily through tissues in the body that are designed to deal with electricity. Nerves and muscles are "wired" for this task and often are damaged. If significant muscle damage occurs, muscle fibers and chemicals can be released into the bloodstream causing electrolyte disturbances and kidney failure.
An electrical injury occurs when a current passes through the body, interfering with the function of an internal organ or sometimes burning tissue.
Often the main symptom is a skin burn, but not all people have visible injuries.
Doctors check the person for abnormal heart rhythms, fractures, dislocations, and spinal cord or other injuries.
Abnormal heart rhythms are monitored, burns are treated, and, if the burn caused extensive internal damage, intravenous fluids are given.
Electrical injury may result from contact with faulty electrical appliances or machinery or inadvertent contact with household wiring or electrical power lines. Getting shocked from touching an electrical outlet in the home or by a small appliance is rarely serious, but accidental exposure to high voltage causes about 400 deaths each year in the United States.
Thermal and chemical burns usually occur because heat or chemicals contact part of the body's surface, most often the skin.
Chemical burns
Burns can also occur when chemicals are spilled onto the body and generate a reaction that creates heat. Chemical burns may be classified by their pH or acidity.
Acids are those with pH less than 7 and include common household compounds like acetic acid, hydrochloric acid, or sulfuric acid.
Bases or alkali compounds have a pH greater than 7. Ammonia is a common alkali found in the home.
A variety of household products fits this description:
Bleach
Concrete mix
Drain or toilet bowl cleaners
Metal cleaners
Pool chlorinators
Pathophysiology
Agents that cause chemical burns are described by mechanism of injury. The chemical classification scheme includes such categories as desiccants, vesicants, oxidizing agents, protoplasmic poisons, acids, and alkali agents.
Acids act through coagulative necrosis, forming an eschar that limits the penetration of the acid. Strong alkali cause liquefactive necrosis, resulting in saponification of fats and denaturation of proteins, ultimately allowing deeper penetration of the chemical. Oxidizing agents also denature proteins and often cause cell damage via cytotoxic effects. Protoplasmic poisons, such as hydrofluoric acid (HF), can form salts with cellular proteins. Desiccants dehydrate cells through an exothermic reaction. Finally, vesicants are thought to produce physiologic reactions that cause the release of amines along with a variety of other damaging processes. Despite these categories, precise classification of chemical agents remains difficult because agents often cause injury by more than one mechanism.
Tissue damage from chemical burns depends on several factors.
The strength or concentration of the agent
The site of contact (eye, skin, mucous membrane)
Whether swallowed or inhaled
Whether or not skin is intact
With how much of the agent you came into contact
The duration of exposure
How the chemical works
Signs and symptoms of chemical burns include the following:
Redness, irritation, or burning at the site of contact
Pain or numbness at the site of contact
Formation of blisters or black dead skin at the contact site
Vision changes if the chemical gets into your eyes
Cough or shortness of breath
Self-Care at Home
Begin basic first aid. Immediately call 911 if you have a severe injury, any shortness of breath, chest pain, dizziness, or other symptoms throughout your body. If you are aiding an injured person with these symptoms, lay the person down and immediately call 911.
Remove yourself or the victim from the accident area.
Remove any contaminated clothing.
Wash the injured area to dilute or remove the substance, using large volumes of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected parts of your body. Gently brush away any solid materials, again avoiding unaffected body surfaces.
Especially wash away any chemical in your eye. Sometimes the best way to get large amounts of water to your eye is to step into the shower.
Remove contaminated clothing
Brush away any dry powders or particles
Rinse the area with large amounts of water.
Treatment
Before burns are treated, the burning agent must be stopped from inflicting further damage. For example, fires are extinguished. Clothing—especially any that is smoldering (such as melted synthetic shirts), covered with a hot substance (for example, tar), or soaked with chemicals—is immediately removed.
Hospitalization is sometimes necessary for optimal care of burns. For example, elevating a severely burned arm or leg above the level of the heart to prevent swelling is more easily accommodated in a hospital. In addition, burns that prevent people from carrying out essential daily functions, such as walking or eating, make hospitalization necessary. Severe burns, deep second- and third-degree burns, burns occurring in the very young or the very old, and burns involving the hands, feet, face, or genitals are usually best treated at burn centers. Burn centers are hospitals that are specially equipped and staffed to care for burn victims.
Smoke Inhalation
Many people who have been burned in fires have also inhaled smoke. Sometimes people inhale smoke without sustaining skin burns. Smoke inhalation often causes no serious, lasting effects. However, if the smoke contains certain poisonous chemicals, is unusually dense, or inhalation is prolonged, serious problems can develop.
Hot smoke sometimes burns the throat, resulting in swelling. As the swelling narrows this area, airflow into the lungs is obstructed. Breathing hot steam can burn the lungs as well as the throat, causing severe breathing problems.
Inhalation of chemicals released in the smoke, such as hydrogen chloride, phosgene, sulfur dioxide, and ammonia, can cause swelling and damage to the windpipe (trachea) and even the lungs. Eventually, the small airways leading to the lungs narrow, further obstructing airflow. Smoke can also contain chemicals that poison the body's cells, such as carbon monoxide (see Poisoning: Carbon Monoxide Poisoning) and cyanide.
Damage to the trachea or the lungs can cause shortness of breath, which can take up to 24 hours to develop. Obstruction of airflow due to swelling of the airways can produce difficulty breathing air in, wheezing, and shortness of breath. People may have soot in the mouth or nose, singed nasal hairs, or burns around the mouth. Lung damage may cause chest pain, coughing, and wheezing. If the oxygen supply is depleted due to smoke, people may pass out. High levels of carbon monoxide in the blood may cause confusion or disorientation or may even be fatal.
To assess the extent of injury due to smoke inhalation, doctors may pass a flexible viewing tube (bronchoscope) into the trachea. Doctors may assess lung damage with a chest x-ray or with a test that determines the level of oxygen in the blood.
People who have inhaled smoke are given oxygen through a face mask. If a tracheal burn is suspected, a breathing tube is inserted through the nose or mouth in case the trachea later swells and obstructs airflow. If people begin to wheeze, drugs that open small airways such as albuterol may be given, usually as a mist that is combined with oxygen and inhaled through a face mask. If lung damage causes shortness of breath that persists despite use of a face mask and albuterol, a ventilator may be necessary. Relieving the stress of breathing conserves people's energy and usually allows faster recovery.
Electrical burns
Electrical burns may cause serious injury that is not readily apparent. Often the entry and exit points for the electrical shock may not be easily found.
Electricity flows more easily through tissues in the body that are designed to deal with electricity. Nerves and muscles are "wired" for this task and often are damaged. If significant muscle damage occurs, muscle fibers and chemicals can be released into the bloodstream causing electrolyte disturbances and kidney failure.
An electrical injury occurs when a current passes through the body, interfering with the function of an internal organ or sometimes burning tissue.
Often the main symptom is a skin burn, but not all people have visible injuries.
Doctors check the person for abnormal heart rhythms, fractures, dislocations, and spinal cord or other injuries.
Abnormal heart rhythms are monitored, burns are treated, and, if the burn caused extensive internal damage, intravenous fluids are given.
Electrical injury may result from contact with faulty electrical appliances or machinery or inadvertent contact with household wiring or electrical power lines. Getting shocked from touching an electrical outlet in the home or by a small appliance is rarely serious, but accidental exposure to high voltage causes about 400 deaths each year in the United States.
The severity of the injury ranges from minor to fatal and is determined by the following factors:
Intensity of the current
Type of current
Pathway of the current through the body
Duration of exposure to the current
Electrical resistance to the current
Symptoms
Often, the main symptom of an electrical injury is a skin burn (see Burns), although not all electrical injuries cause external damage. High-voltage injuries may cause massive internal burns. If muscle damage is extensive, a limb may swell so much that its arteries become compressed (compartment syndrome—see Fractures: Compartment Syndrome), cutting off blood supply to the limb. If a current travels close to the eyes, it may lead to cataracts. Cataracts can develop within days of the injury or years later. If large amounts of muscle are damaged (a disorder called rhabdomyolysis), a chemical substance, myoglobin, is released into the blood. The myoglobin can damage the kidneys.
Treatment
First the person must be separated from the current's source. The safest way to do so is to shut off the current—for example, by throwing a circuit breaker or switch or by disconnecting the device from an electrical outlet. No one should touch the person until the current has been shut off, particularly if high-voltage lines could be involved.
High-voltage and low-voltage lines are difficult to distinguish, especially outdoors. Shutting off current to high-voltage lines is done by the local power company. Many well-meaning rescuers have been injured by electricity when trying to free a person.
Once the person can be safely touched, the rescuer should check to see if the person is breathing and has a pulse. If the person is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started immediately (see First Aid: First-Aid Treatment). Emergency medical assistance should be called for any person who has more than a minor injury. Because the extent of an electrical burn may be deceptive, medical assistance should be sought if any doubt exists regarding severity.
People with rhabdomyolysis may receive large amounts of fluids intravenously. A tetanus shot is given if needed.
Skin burns are treated with burn cream (such as silver sulfadiazine, bacitracin,or sterile aloe vera) and sterile dressings. A person with only minor skin burns can usually be treated at home. If the injury is more severe, the person is admitted to the hospital, ideally a burn center. The person is kept in the hospital for 6 to 24 hours if any of the following exists:
The results of an ECG are abnormal
The person has lost consciousness
The person has symptoms of a heart problem (for example, chest pain, shortness of breath, awareness of heartbeats [palpitations])
The person has other severe injuries
The person is pregnant (in many, but not necessarily all, cases)
The person has a known heart problem (in many, but not necessarily all, cases)
UV light burn
Treatment: The key to minimizing the damaging effects of the sun is avoiding further sun exposure. Damage that is already done is difficult to reverse. Moisturizing creams and makeup help hide wrinkles. Chemical peels, alpha-hydroxy acids, tretinoin
creams, and laser skin resurfacing may improve the appearance of thin wrinkles and irregular pigmentation. Deep wrinkles and substantial skin damage, however, require significant treatment to be reversed.
Radiation injury
damage to tissues caused by exposure to ionizing radiation.
Large doses of ionizing radiation can cause acute illness by reducing the production of blood cells and damaging the gastrointestinal tract.
A very large dose of ionizing radiation can also damage the heart and blood vessels (cardiovascular system), brain, and skin.
Ionizing radiation can increase the risk of cancer, and damage to sperm and egg cells can increase the risk of genetic defects in offspring.
In general, ionizing radiation refers to high-energy electromagnetic waves (x-rays, gamma rays) and particles (alpha particles, beta particles, neutrons) that are capable of stripping electrons from atoms (ionization). Ionization changes the chemistry of affected atoms and any molecules containing those atoms. By changing molecules in the highly ordered environment of the cell, ionizing radiation can disrupt and damage cells.
onizing radiation is emitted by radioactive substances (radionuclides), such as uranium, radon, and plutonium. It is also produced by man-made devices, such as x-ray and radiation therapy machines.
Radio waves, such as from cell phones and AM and FM transmitters, and visible light also are forms of electromagnetic radiation. However, because of their lower energy, these forms of radiation are not ionizing, and thus public exposure levels from these common sources do not damage cells. In this discussion, “radiation” refers exclusively to ionizing radiation.
Contamination is contact with and retention of radioactive material, usually as a dust or liquid. External contamination is that on skin or clothing, from which some can fall or be rubbed off, contaminating other people and objects. Internal contamination is radioactive material deposited within the body, which it may enter by ingestion, inhalation, or through breaks in the skin. Once in the body, radioactive material may be transported to various sites, such as the bone marrow, where it continues to emit radiation, increasing the dose, until it is removed or emits all its energy (decays). Internal contamination is more difficult to remove than external contamination.
Irradiation is exposure to radiation but not to radioactive material, that is, no contamination is involved. A common example is diagnostic x-rays, such as for a broken bone. Radiation exposure can occur without direct contact between people and the source of radiation (such as radioactive material or an x-ray machine). When the source of the radiation is removed or turned off, irradiation ends. People who are irradiated but not contaminated are not radioactive, that is, they do not emit radiation, and their dose from that source of radiation does not continue to increase.
Effects of Radiation
The damaging effects of radiation depend on several factors:
The amount (dose)
How rapidly the dose is received
How much of the body is exposed
The sensitivity of particular tissues to radiation
Treatment
Physical injuries are treated before irradiation is treated because they are more immediately life-threatening. Irradiation has no emergency treatment, but doctors closely monitor people for the development of the various syndromes and treat the symptoms as they arise.
Contamination should be removed promptly to prevent the radioactive material from continuing to irradiate the person and to prevent the radioactive material from being taken up by the body. Contaminated wounds are treated before contaminated skin. Doctors decontaminate wounds by flushing them with a salt water solution and wiping them with a surgical sponge. After decontamination, wounds are covered to prevent recontamination as other sites are washed. Contaminated skin should be gently scrubbed with large amounts of soap and warm (not hot) water. Skin folds and nails need extra attention. Harsh chemicals, brushes, or scrubbing that may break the skin surface should be avoided. If hair cannot be decontaminated with soap and water, clipping it off with scissors is preferable to shaving. Shaving may cut the skin and allow contamination to enter the body. Skin and wound decontamination should continue until the Geiger-Muller counter shows that the radioactivity is gone or almost gone, until washing does not substantially reduce the amount of radioactivity measured, or until further cleaning risks damaging the skin. Burns should be gently rinsed but not scrubbed.
http://emedicine.medscape.com/article/1089490-overview
medline
merck.com
http://www.medicinenet.com/burns/page3.htm#tocf
Intensity of the current
Type of current
Pathway of the current through the body
Duration of exposure to the current
Electrical resistance to the current
Symptoms
Often, the main symptom of an electrical injury is a skin burn (see Burns), although not all electrical injuries cause external damage. High-voltage injuries may cause massive internal burns. If muscle damage is extensive, a limb may swell so much that its arteries become compressed (compartment syndrome—see Fractures: Compartment Syndrome), cutting off blood supply to the limb. If a current travels close to the eyes, it may lead to cataracts. Cataracts can develop within days of the injury or years later. If large amounts of muscle are damaged (a disorder called rhabdomyolysis), a chemical substance, myoglobin, is released into the blood. The myoglobin can damage the kidneys.
Treatment
First the person must be separated from the current's source. The safest way to do so is to shut off the current—for example, by throwing a circuit breaker or switch or by disconnecting the device from an electrical outlet. No one should touch the person until the current has been shut off, particularly if high-voltage lines could be involved.
High-voltage and low-voltage lines are difficult to distinguish, especially outdoors. Shutting off current to high-voltage lines is done by the local power company. Many well-meaning rescuers have been injured by electricity when trying to free a person.
Once the person can be safely touched, the rescuer should check to see if the person is breathing and has a pulse. If the person is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started immediately (see First Aid: First-Aid Treatment). Emergency medical assistance should be called for any person who has more than a minor injury. Because the extent of an electrical burn may be deceptive, medical assistance should be sought if any doubt exists regarding severity.
People with rhabdomyolysis may receive large amounts of fluids intravenously. A tetanus shot is given if needed.
Skin burns are treated with burn cream (such as silver sulfadiazine, bacitracin,or sterile aloe vera) and sterile dressings. A person with only minor skin burns can usually be treated at home. If the injury is more severe, the person is admitted to the hospital, ideally a burn center. The person is kept in the hospital for 6 to 24 hours if any of the following exists:
The results of an ECG are abnormal
The person has lost consciousness
The person has symptoms of a heart problem (for example, chest pain, shortness of breath, awareness of heartbeats [palpitations])
The person has other severe injuries
The person is pregnant (in many, but not necessarily all, cases)
The person has a known heart problem (in many, but not necessarily all, cases)
UV light burn
Treatment: The key to minimizing the damaging effects of the sun is avoiding further sun exposure. Damage that is already done is difficult to reverse. Moisturizing creams and makeup help hide wrinkles. Chemical peels, alpha-hydroxy acids, tretinoin
creams, and laser skin resurfacing may improve the appearance of thin wrinkles and irregular pigmentation. Deep wrinkles and substantial skin damage, however, require significant treatment to be reversed.
Radiation injury
damage to tissues caused by exposure to ionizing radiation.
Large doses of ionizing radiation can cause acute illness by reducing the production of blood cells and damaging the gastrointestinal tract.
A very large dose of ionizing radiation can also damage the heart and blood vessels (cardiovascular system), brain, and skin.
Ionizing radiation can increase the risk of cancer, and damage to sperm and egg cells can increase the risk of genetic defects in offspring.
In general, ionizing radiation refers to high-energy electromagnetic waves (x-rays, gamma rays) and particles (alpha particles, beta particles, neutrons) that are capable of stripping electrons from atoms (ionization). Ionization changes the chemistry of affected atoms and any molecules containing those atoms. By changing molecules in the highly ordered environment of the cell, ionizing radiation can disrupt and damage cells.
onizing radiation is emitted by radioactive substances (radionuclides), such as uranium, radon, and plutonium. It is also produced by man-made devices, such as x-ray and radiation therapy machines.
Radio waves, such as from cell phones and AM and FM transmitters, and visible light also are forms of electromagnetic radiation. However, because of their lower energy, these forms of radiation are not ionizing, and thus public exposure levels from these common sources do not damage cells. In this discussion, “radiation” refers exclusively to ionizing radiation.
Contamination is contact with and retention of radioactive material, usually as a dust or liquid. External contamination is that on skin or clothing, from which some can fall or be rubbed off, contaminating other people and objects. Internal contamination is radioactive material deposited within the body, which it may enter by ingestion, inhalation, or through breaks in the skin. Once in the body, radioactive material may be transported to various sites, such as the bone marrow, where it continues to emit radiation, increasing the dose, until it is removed or emits all its energy (decays). Internal contamination is more difficult to remove than external contamination.
Irradiation is exposure to radiation but not to radioactive material, that is, no contamination is involved. A common example is diagnostic x-rays, such as for a broken bone. Radiation exposure can occur without direct contact between people and the source of radiation (such as radioactive material or an x-ray machine). When the source of the radiation is removed or turned off, irradiation ends. People who are irradiated but not contaminated are not radioactive, that is, they do not emit radiation, and their dose from that source of radiation does not continue to increase.
Effects of Radiation
The damaging effects of radiation depend on several factors:
The amount (dose)
How rapidly the dose is received
How much of the body is exposed
The sensitivity of particular tissues to radiation
Treatment
Physical injuries are treated before irradiation is treated because they are more immediately life-threatening. Irradiation has no emergency treatment, but doctors closely monitor people for the development of the various syndromes and treat the symptoms as they arise.
Contamination should be removed promptly to prevent the radioactive material from continuing to irradiate the person and to prevent the radioactive material from being taken up by the body. Contaminated wounds are treated before contaminated skin. Doctors decontaminate wounds by flushing them with a salt water solution and wiping them with a surgical sponge. After decontamination, wounds are covered to prevent recontamination as other sites are washed. Contaminated skin should be gently scrubbed with large amounts of soap and warm (not hot) water. Skin folds and nails need extra attention. Harsh chemicals, brushes, or scrubbing that may break the skin surface should be avoided. If hair cannot be decontaminated with soap and water, clipping it off with scissors is preferable to shaving. Shaving may cut the skin and allow contamination to enter the body. Skin and wound decontamination should continue until the Geiger-Muller counter shows that the radioactivity is gone or almost gone, until washing does not substantially reduce the amount of radioactivity measured, or until further cleaning risks damaging the skin. Burns should be gently rinsed but not scrubbed.
http://emedicine.medscape.com/article/1089490-overview
medline
merck.com
http://www.medicinenet.com/burns/page3.htm#tocf
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