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SOCMInflammation and Healing
PFN: SOMCML1L
Hours: 2.5
Last updated: November 2015
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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
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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.
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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
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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
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Key Terms Related to Inflammation and Healing
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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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Vocabulary Development
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
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Vocabulary Development
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
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Vocabulary Development
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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Vocabulary Development
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
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Vocabulary Development
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
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Vocabulary Development
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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Vocabulary Development
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
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Vocabulary Development
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
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Vocabulary Development
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
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Role of Normal Defense
Non‐Specific Defense
Mechanical barriers
Inflammation
Fever
Interferons
Immunological surveillance (NK cells)
Complement proteins
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Role of Normal Defense
Macrophages
•monocytes (free macrophages)
•reticuloendothelial system
Microphages
•neutrophils•granulocytes (non‐professional phagocytes)
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Role of Normal Defense
Specific Defense
B cells (antibodies)
T cells (sensitization)
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The Changes from Normal Capillary Function During Inflammation
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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)
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Capillary Function
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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
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Inflammation
Etiology
Burns
Chemical irritants
Frostbite
Toxins
Infection
Physical injury
Immune reaction
Ionizing radiation
Foreign bodies
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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
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The Local and Systemic Effects of Acute Inflammation
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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
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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
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Serous Exudate
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Fibrinous Exudate
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Purulent Exudate
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Hemorrhagic Exudate
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Acute Systemic Inflammation
Signs/Symptoms
Fever
Malaise
Fatigue
Headache
Anorexia
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Acute Inflammation
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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
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The Pathological Basis of Chronic Inflammation
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Chronic Inflammation
Etiology
Acute inflammation that does not resolve completely
Autoimmune disorders
Chronic irritation
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Chronic Inflammation
Pathophysiology
Chronic increases
• lymphocytes
•macrophages
• fibroblasts (more fibrous scar tissue)
Granuloma
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Chronic Inflammation
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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)
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Treatments
Therapies
Rest – prevent further injury
Ice – local vasoconstriction
Compression – increase Pif
Elevation – aid fluid movement from injury
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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
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Healing
Healing Process
Injury/Inflammation
Granulation
• vascular epithelial cells
• fibroblasts
Scar tissue
• collagen fibers
• cross‐linking
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Healing
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Healing
Factors Promoting Healing
Youth
Good nutrition
Adequate hemoglobin
Effective circulation
Clean, undisturbed wound
No infection or further trauma
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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
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Healing
Complications
Loss of function
Contractures/Obstructions
Adhesions
Scar tissue (hypertrophic)
Ulcerations
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Healing
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Healing
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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
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Burns and Inflammation
Classification According to Depth
Superficial (1st degree)
Partial‐thickness (2nd degree)
Full‐thickness (3rd degree)
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Burns and Inflammation
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Burns and Inflammation
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Burns and InflammationBSA (Rule of 9’s)
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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
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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
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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
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Healing of Burns
Dependent on Severity
Non‐stick dressing
Natural skin graft (mesh)
Biosynthetic skin substitutes
Hypertrophic scar tissue is common
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Healing of Burns
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Questions?
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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
Slide 75JSOMTC, SWMG(A)
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
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Slide 76JSOMTC, SWMG(A)
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
Slide 77JSOMTC, SWMG(A)
Agenda
Communicate the inflammation and healing of burns to include classifications, effects, and healing process
Slide 78JSOMTC, SWMG(A)
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.
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Break