Abduction:                    Movement of a body part AWAY from the median plane 
                                      (of the body, in the case of limbs; of the hand or foot, in the case of digits).

Adduction:                     Movement of a body part TOWARD the median plane 
                                       (of the body, in the case of limbs; of the hand or foot, in the case of digits).


Addiction:                      Habitual psychological and physiologic dependence on a substance or practice 
                                       that is beyond voluntary control.

Aura:                              1. Epileptic ictal phenomenon/phenomena perceived only by the patient.
                                       2. Subjective symptoms at the onset of a migraine headache.

Oral:                               Relating to the mouth.

Arteriosclerosis:            Condition in which the walls of arteries become hard and thick, 
                                        sometimes interfering with blood circulation.

Atherosclerosis:              A type of arteriosclerosis in which fatty deposits (atheromas) build up 
                                         in the inner lining of an artery and together with smooth muscle cells 
                                         and leukocytes form a plaque, which may slow down or stop blood flow.  

     T	           TPartial Thickness	     TFull Thickness

   Depth	              Superficial	                            Deep
   Sensation               Present    	                            Absent
   Healing	              Complete	                           Scars and Contractures


 Symptoms of burns 

Besides skin, burn injuries can affect muscles, bones, nerves, and blood vessels.  
The respiratory system can be damaged, with possible airway obstruction, respiratory 
failure and respiratory arrest. Burns impair the body's normal fluid/electrolyte 
(water & salt) balance, body temperature, body thermal regulation, joint function, 
and manual dexterity. Patients may also suffer emotional and psychological problems.

 Depth of injury 

First-degree burns are superficial injuries that involve only the epidermis or outer layer 
of skin. They are the most common and the most minor of all burns. The skin is reddened and 
extremely painful. The burn will heal on its own without scarring within two to five days. 
There may be peeling of the skin and some temporary discoloration. 

Second-degree burns occur when the first layer of skin is burned through and the second layer, 
the dermal layer, is damaged but the burn does not pass through to underlying tissues. The skin 
appears moist and there will be deep intense pain, reddening, blisters and a mottled appearance 
to the skin. Second-degree burns are considered minor if they involve less than 15 percent of 
the body surface in adults and less than 10 percent in children. When treated with reasonable 
care, second-degree burns will heal themselves and produce very little scarring. Healing is 
usually complete within three weeks. 

Third-degree burns involve all the layers of the skin. They are referred to as 
full- thickness burns and are the most serious of all burns. These are usually charred 
black and include areas that are dry and white. While a third-degree burn may be very painful, 
some patients feel little or no pain because the nerve endings have been destroyed. This type 
of burn may require skin grafting. As third degree burns heal, dense scars form. 

FIRST-AID 

 Remove patient from source of burn. 

 Remove smoldering or contaminated clothes.

 Apply cold running water over the burnt area. 

 Cover the victim with clean dry cloth or cling-film. 

 Elevate the patient.

TREATMENT OF BURNS 

Local treatment in partial thickness wounds

 Cleaning

 Dressing with non-adherent paraffin gauze

 Medication in the form of cream 

Full-thickness wounds 

Immediate excision and skin grafting give good results in the long run. Donor skin may be 
taken from, other unaffected areas, from a relative, from skin banks or from the skin of pigs, 
which are normally compatible with human skin (xenograft). 

General treatment

 Relieve pain with intravenous pain relievers or local anesthetic creams 

 Fluid replacement into the body to compensate the fluid loss 

 Therapy to combat infection that can occur in the burnt area 

 Anti microbial therapy 

 Nutritional support

Calculating the area of burn

Area burnt is calculated using the "Rule of Nine" 

1. < 15 years: Patients hand size used to measure burn is 1%
2. > 15 years: Rule of 9
        a.  Head 9%
             Infants 18%, >1 year reduce 1%/year (until 9%)
        b.  Each arm 9%
        c.  Anterior trunk 18%
        d.  Posterior Trunk 18%
        e.  Perineum 1%
        f.  Each leg 18%
             Infants 14%, >1yr add 1%/year (until 18%)

Complications of Burns

Occurring at the local site

 Wound infection 

 Scarring 

 Wound contractures 

Occurring throughout the body

 Generalized Infection 

 Acute peptic ulceration 

 Seizures 

 Kidney failure 

 Psychological disturbance

Condition induced in a patient by a physician's activity, manner, or therapy. Used especially 
to refer to an infection or other complication of treatment.

Iatros means physician in Greek, and -genic, means induced by. Combined, of course, they become 
iatrogenic, meaning physician-induced.  In common usage, iatrogenic disease is now applied to 
any adverse effect associated with any medical practitioner or treatment. The practitioner need 
not be a physician, he might be a nurse or a lab technician, or any one of the scores of 
differentiated healthcare workers encountered in hospitals, clinics, nursing homes, or offices.

Treatment is a term stretched beyond reason. It might refer to something as tangible as surgery 
or as subtle as a conversation, if the person conducting the conversation is considered a 
health care professional.  It might be a potent drug or a placebo.
   

Example:
Moxilin, Trimox, Amoxil etc are the brand names for the antibiotic, amoxicillin (generic).  
The common analgesic and antipyretic medicine, acetaminophen (generic) has brand names 
like Tylenol, Valorin, Feverall etc.

The only exception to this rule is, if you are starting a sentence with the generic 
name of a medicine, the first letter should be capitalized.  You do not start a sentence 
with a lower case letter.


Example:
In the PLAN part the doctor may start the dictation as 'Amoxicillin 500 mg q.8 h. for 10 days; 
so the sentence has to start with an upper case letter even if he is mentioning the generic 
name of a medicine.

Examples:
The patient was admitted, and he underwent surgery after admission. 

Hourly temperatures were taken by the mom, and the child's fever was noted 
to abate by early morning.

Examples:
He tolerated the surgery well, but he had chest pain that evening.  

Laboratory workup was done last week, but the results are pending.

Examples:
That day he felt fine, yet his daughter expressed concern about his condition.   

The patient has been responding very well to the medication, yet she complained 
of excruciating back pain yesterday.