Affectnotonlycapillariesbuttherestofthebodyaswellforex

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affect not only capillaries but the rest of the body as well. For example, chemical mediators (see chapter 4),which are released in response to the tissue damage, contribute to changes in capillary permeability throughout the body.Substances released from the burn may also cause cells to function abnormally. Burn injuries result in an almost immediate hyper-metabolic state, which persists until wound closure. Also contributing to the increased metabolism are a resetting of the temperature control center in the brain to a higher temperature and an increase in the hormones released by the endocrine system. For example, epinephrine and norepinephrine from the adrenal glands increase cell metabolism. Compared with a normal body 
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temperature of approximately 37°C (98.6°F), a typical burn patient may have a body temperature of 38.5°C(101.3°F) despite the increased loss of water by evaporation from the burn.In severe burns, the increased metabolic rate can result in the loss of as much as 30–40% of the patient’s preburn weight. To help compensate, treatment may include doubling or tripling the patient’s caloric intake. In addition, the need for protein, which is necessary for tissue repair, is greater.The skin normally maintains homeostasis by preventing microorganisms from entering the body. Because burns damage and even sometimes destroy the skin, microorganisms can cause infections in the wounds. For this reason, burn patients are maintained in an aseptic (sterile) environment. They are also given antimicrobial drugs, which kill microorganisms or suppress their growth. Debridement (dā-brēd-montthe removal of dead tissue from the burn (figure 5E), helps prevent infection by cleaning the wound and removing tissue in which infection could develop. Skin grafts, performed within a week of the injury, also help close the wound and prevent the entry of microorganisms.Despite these efforts, infections are still the major cause of death for burn victims. Depression of the immune system during the first or second week after the injury contributes to the high infection rate. First, the thermally altered tissue is recognized as a foreign substance, which stimulates the immune system. Then the immune system is overwhelmed as its cells become less effective and fewer of the chemicals that normally provide resistance to infection are produced (see chapter 22). The greater the magnitude of the burn, the greater the depression of the immune system, and the greater the risk of infection.), 

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