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  <head>
    <title>034-02 Barrier failure, lesion morphology, wound physiology, and dermatological emergencies</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Barrier failure, morphology, wounds, emergencies">
      <outline text="Observation before interpretation">
        <outline text="Separate observation from interpretation"/>
        <outline text="Describe lesion, border, surface, colour, evolution"/>
        <outline text="Plaque raised and broad; vesicle clear fluid"/>
        <outline text="Pustule purulent but not necessarily infected"/>
        <outline text="Secondary changes obscure the initiating lesion">
          <outline text="Early photographs recover lost morphology"/>
        </outline>
        <outline text="Distribution identifies mechanism">
          <outline text="Sharp exposed pattern: contact or light"/>
          <outline text="Grouped dermatomal vesicles: zoster"/>
          <outline text="Advancing annular scale: dermatophyte"/>
        </outline>
        <outline text="Drug and viral eruptions begin on the trunk">
          <outline text="Mucosa and systemic features set urgency"/>
        </outline>
      </outline>
      <outline text="Barrier and topical treatment">
        <outline text="Keratinocytes, moisturising factors, organised lipids"/>
        <outline text="Damage raises transepidermal water loss">
          <outline text="Antigen entry, inflammation, further damage"/>
          <outline text="Emollients are mechanistic treatment"/>
        </outline>
        <outline text="Occlusion aids penetration but macerates"/>
        <outline text="Ointment for dry thick, cream for flexural sites"/>
        <outline text="Thin skin absorbs more and atrophies"/>
        <outline text="Specify potency, quantity, duration">
          <outline text="Apply thinly is not a dose: fingertip units"/>
        </outline>
        <outline text="Failure: review diagnosis, allergy, application"/>
      </outline>
      <outline text="Inflammatory disease mechanisms">
        <outline text="Atopic dermatitis: interacting links">
          <outline text="Scratching disrupts the stratum corneum"/>
          <outline text="Weeping alone does not prove infection"/>
          <outline text="Punched-out erosions: eczema herpeticum"/>
        </outline>
        <outline text="Psoriasis: accelerated keratinocyte proliferation">
          <outline text="Small area can still carry high burden"/>
          <outline text="Pustular or erythrodermic: homeostasis fails"/>
        </outline>
        <outline text="Urticaria: migrating wheals leave normal skin">
          <outline text="Lesions beyond a day suggest vasculitis"/>
        </outline>
        <outline text="Angioedema: histamine versus bradykinin">
          <outline text="Bradykinin forms lack wheals, resist antihistamines"/>
        </outline>
      </outline>
      <outline text="Cellulitis and necrotising infection">
        <outline text="Mimics: stasis, lymphoedema, gout, venous thrombosis">
          <outline text="Symmetric erythema without fever: reconsider"/>
        </outline>
        <outline text="Redness may expand transiently after treatment"/>
        <outline text="Necrotising infection spreads along fascia">
          <outline text="Early skin findings modest"/>
          <outline text="Scores and imaging cannot rule it out"/>
          <outline text="Antibiotics alone cannot reach dead tissue"/>
        </outline>
      </outline>
      <outline text="Wound healing and chronic wounds">
        <outline text="Overlapping phases, not a rigid sequence"/>
        <outline text="Platelets, macrophages, fibroblasts coordinate repair"/>
        <outline text="Persistent inflammation arrests progression"/>
        <outline text="Treat the cause before dressing brand">
          <outline text="Pulses, perfusion, sensation, oedema, pressure"/>
          <outline text="Compression can worsen arterial insufficiency"/>
          <outline text="Off-load painless neuropathic ulcers"/>
          <outline text="Stable ischaemic heel eschar may protect"/>
        </outline>
        <outline text="Surface culture may show only colonisers">
          <outline text="Integrate clinical signs to diagnose infection"/>
        </outline>
      </outline>
      <outline text="Pressure injury">
        <outline text="Deformation, shear, impaired reperfusion"/>
        <outline text="Deep muscle injured before epidermis"/>
        <outline text="Repositioning interval is individualised"/>
        <outline text="Tubing, masks, and devices create focal risk"/>
        <outline text="Nutrition cannot overcome ongoing pressure"/>
      </outline>
      <outline text="Burns">
        <outline text="Depth evolves with oedema and hypoperfusion"/>
        <outline text="Surface area estimate excludes simple erythema"/>
        <outline text="Electrical injury: deep damage, small wound"/>
        <outline text="Chemical burns: remove clothing, irrigate long"/>
        <outline text="Inhalation injury: early airway oedema">
          <outline text="Secure the airway before swelling"/>
        </outline>
        <outline text="Fluid formula is only a starting estimate">
          <outline text="Under-resuscitation impairs organ perfusion"/>
          <outline text="Excess fluid worsens oedema, compartment pressure"/>
        </outline>
      </outline>
      <outline text="Severe drug reactions">
        <outline text="Simple morbilliform: no mucosal or organ injury"/>
        <outline text="Eosinophilic systemic reaction after latency"/>
        <outline text="Stevens-Johnson syndrome, toxic epidermal necrolysis">
          <outline text="Withdraw drugs, burn-level supportive care"/>
        </outline>
        <outline text="Drug timeline up to eruption onset"/>
        <outline text="Organ injury does not parallel skin area"/>
        <outline text="Record the specific drug and reaction"/>
      </outline>
      <outline text="Pigmented lesions and skin of colour">
        <outline text="Prioritise evolution and difference from background"/>
        <outline text="Nodular lesions uniform but fast-growing"/>
        <outline text="Amelanotic melanoma pink or red"/>
        <outline text="Excision biopsy measures Breslow thickness"/>
        <outline text="Erythema violaceous, grey, or warmth only"/>
        <outline text="Palpation and comparison with unaffected skin"/>
        <outline text="Emergencies are physiological"/>
        <outline text="Supportive care not delayed for results"/>
      </outline>
    </outline>
  </body>
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