A burn injuries

A burn injuries Interpretation Exercise Burn injuries are most often caused when the skin comes in direct contact with a naked flame or a hot surface. Scalding can occur when there is contact with a hot liquid. There are several other types of burns such as chemical, caused by strong acids or bases, and radiation, the most commonly known example being sunburn from UV light. Burns are classified by degree, where severity increases with a higher degree. A newer classification system separates burns into three categories: superficial, partial thickness and full thickness burns. The patient in the scenario has a full thickness third degree burn. This usually results in loss of the outer skin layer (epidermis) causing the patients skin to be numb and feel hard and leathery to the touch. This degree of burn requires immediate medical attention as they do not heal on their own. Proteins at the site of injury denature and cells eventually die, marked by the formation of black eschar at the centre of the wound. Once the skin barrier has been broken, the homeostatic functions of the skin are lost. There is rapid loss of body fluid and blood plasma which can sometimes cause visible swelling. As the skin is the bodys first line of defence, burn wound infections correlate with the size of the burn injury. The epidermis constantly sheds off and takes harmful bacteria with it. Furthermore, the acidic nature of the skin prevents the entry of microorganisms that generally prefer neutral conditions. Burns are also associated with a depressed immune response. Given this information, it is no surprise that infection is the principal cause of death in burn victims. As it is a third degree burn, the patient will have spent some time in hospital where there is a greater risk of infection. Patient to patient contact via hospital equipment and staff allows rapid transmission of pathogenic bacteria. The burn wound is a favourable site for opportunistic colonization by pathogens because the eschar provides a moist, protein rich environment which encourages bacterial growth. The excess of necrotic tissue provides a rich growth medium for the microorganism. In the clinical presentation, the patient complained of fever, chills and an unpleasant smelling discharge from the burn wound. These are all signs of infection so the doctor was correct to prescribe the patient an antibiotic. However, on the basis of the array of microbiology data collected in the laboratory, the doctors choice of antibiotic was incorrect. A two week course of flucloxacillin 500mg was prescribed to the patient to be taken orally 4 times daily. Flucloxacillin is an antibiotic belonging to the penicillin group. It is used to treat infections caused by gram-positive bacteria, most commonly Staphylococcus aureus. In the laboratory, the microscopic slide was examined under a microscope using the oil immersion lens. Rod shaped microorganisms were observed and they were stained a pink/red colour. This indicates the bacteria present in the pus samples is gram negative. Therefore, flucloxacillin would have no therapeutic effect to the patient as it is only bactericidal again st gram-positive cells. The three agar plates were examined and observations on the colour, shape, size and smell of the colonies was noted. There was no visible growth on the Mannitol salt agar (MSA) plate. This type of selective agar is used to isolate Staphylococcus aureus as it inhibits most other bacteria due to its high sodium chloride concentration (7.5 %w/v). The absence of growth on the MSA plate provides further evidence that there is no Staphylococcus aureus colonisation in the patient. The colonies on the cetrimide agar were a pale, cloudy brown colour and gave off the smell of rotting fruit. The use of cetrimide agar as a selective and differential agar allows for the isolation of Pseudomonas aeruginosa, a gram-negative microorganism. Cetrimide is an ammonia compound which inhibits most bacteria, including some Pseudomonas species (but not P. aeruginosa). It also enhances production of the pigment pyocyanin which results in bright green colonies. However, some strains of P. aeruginosa do not produce the pigment. The growth on this plate confirmed the pathogen present in the patient is Pseudomonas aeruginosa and the colourless colonies indicate it is a non-pigment producing strain. There was also growth on the MacConkey agar where the colonies were somewhat colourless but had an orange tinge. MacConkey agar is a selective differential medium used to identify gram-negative bacteria and determine whether they are lactose fermenters. Fermenters appear as bright red colonies whilst non-fermenters are relatively colourless. As there was growth on this plate, the microorganism is definitely gram-negative but not a fermenter due to the absence of red colonies. P. aeruginosa does not ferment lactose which explains the colour of the colonies. An oxidase test was carried out which gave a positive result, indicated by a deep blue colour at the end of the test stick. An oxidase positive microbe possesses the enzyme required in the final stage of respiration to form metabolic water. Only aerobic or facultatively anaerobic microorganisms give a positive result. This biochemical test presents further evidence that P. aeruginosa is the infection causing bacteria because it is an obligate aerobe and therefore possess the cytochrome oxidase enzyme. Broth bottles containing growth medium, a bacterial culture and an antibiotic at five different concentrations (all in  µg/ml) were observed. Cloudy broth dilutions indicated the bacteria was resistant and was able to grow. Clear broth dilutions showed the bacteria was sensitive to the antibiotic and its growth was inhibited. The bacteria was resistant to erythromycin at all concentrations used (1.25-20 µg/ml). Erythromycin is a macrolide antibiotic related to penicillin. The results indicate it would have no therapeutic effect if prescribed to the patient. Amoxicillin showed antimicrobial activity against the microorganism at concentrations of 20 µg/ml and 40 µg/ml. However, at concentrations above 12 µg/ml, the bacterium is considered resistant to amoxicillin so it has no therapeutic effect to the patient. Penicillins do not seem to have significant antimicrobial effects for this pathogen which shows the doctor was incorrect in his prescription of flucloxacillin as it is too a member of the penicillin group. The dose of 500mg will unlikely be high enough to be beneficial and any therapeutic doses would be at too high a concentration and therefore impractical. Cefuroxime, a second generation cephalosporin, was effective at concentrations of 16 µg/ml and 32 µg/ml. Again, this was above the intermediate concentration range so does not benefit the patient. A newer generation cephalosporin may need to be used as they provide coverage against a broader spectrum of bacteria. The broth dilution containing ticarcillin was clear at concentrations of 8 µg/ml and 16 µg/ml. The intermediate concentration range for this drug is 10-20 µg/ml so the minimum inhibitory concentration is 8 µg/ml. This drug is a carboxypenicillin a sub group of the penicillin family. The bacteria showed moderate sensitivity to the drug but only at fairly high concentrations. Amikacin was also effective below its intermediate range (6-10 µg/ml) and inhibited bacterial growth at concentrations of 4 µg/ml, 6 µg/ml and 8 µg/ml. Amikacin is an aminoglycoside and is a suitable antibiotic to use against this pathogen as it showed high sensitivity to the drug. The doctors choice of antimicrobial therapy will not be beneficial to the patient as flucloxacillin is effective against gram-positive bacteria only and the patient is infected with gram-negative P. aeruginosa. Unnecessary use of this antibiotic could cause bacterial resistance. P. aeruginosa is naturally resistant to a wide range of antibiotics and thus infections where it is the causative agent can be difficult to treat. Broad-spectrum agents are required as they are the only drugs which provide coverage against the bacteria. The patient could be treated with an aminoglycoside such as amikacin. Gentamicin could also be used but the experimental data shows the pathogen is definitely sensitive to amikacin and studies have found that P. aeruginosa is more likely to develop resistance to gentamicin than amikacin. Aminoglycosides are bactericidal and act by interfering with the bacterial ribosome, leading to incorrect reading of messenger RNA. This would be used along with a third gener ation cephalosporin such as ceftazidime. Carboxypenicillins could also be used (e.g. ticarcillin) but they have only moderate activity against Pseudomonas species and research has shown that bacteria quickly develop resistance to them. Third generation cephalosporins provide coverage against P. aeruginosa, unlike 1st and 2nd generation which have a more limited spectrum of activity. They are also bactericidal and exert their effect by interfering with cell wall synthesis. Although there is no significant evidence of the benefits to using the two drugs in combination, it is rational to do so as it prevents the emergence of mutant genes resistant to one of the agents. Both drugs are also thought to have a synergistic effect when used together. Neither of these drugs are absorbed via the gastrointestinal tract so must be administered via the parenteral route. Amikacin is given via intramuscular injection at a dose of 15mg/kg daily in two divided doses. The dose must be decided carefull y as high levels of amikacin in the blood stream can cause damage to the ear (ototoxicity). Ceftazidime is given by intravenous infusion at a dose of approximately 2g every 12 hours, depending on the severity of the infection. In summary, the available microbiology data indicates that the doctors presumptive diagnosis was incorrect and that the patient has a burns infection caused by Pseudomonas aeruginosa. The absence of growth on the MSA plate disproved the idea of a staph aureus related infection. Gram-negative rods observed on the slide and growth on the MacConkey agar clarified that the microorganism was gram-negative. Growth on the cetrimide agar plate confirmed the presence of Pseudomonas aeruginosa in the patients pus sample. Examination of the broth dilutions helped determine a suitable combination of antibiotics for the patient to take. These would be need therapeutic and possess antimicrobial activity against the pathogen, unlike the doctors prescription of flucloxacillin. Use of a third generation cephalosporin with an aminoglycoside should effectively clear up the infection in the patient following completion of the course of antibiotics.

Essay on Honor in Richard II -- Richard II Richard III Essays

The Importance of Honor in Richard II  Ã‚        Ã‚  Ã‚  Ã‚  The tension-charged exchange between Bolingbroke and Mowbray in the first scenes of Richard II provides exciting action for the audience, and gives a glimpse into trial by combat and the importance of honor in Shakespeare's plays. Trial by combat, or a judicial duel was a traditional way to settle disputes in England and Europe for many generations. People dueled to defend their own honor, and to prove personal claims against the honor of others. Honor. Honor is the accumulation of virtuous deeds that instills a respect in others and in you. Possessing, seeking, and defending the elusive trait of honor are crucial elements of Richard II. The concept of honor has different meanings to individual members of a modern audience, just as it did to an Elizabethan audience. What is honorable? What makes someone honorable? Aristotle thought: there is no true honor in the world but that which commeth from vertue. Vertue seeks no greater or ampler theater to shew her selfe in, then her owne conscience. The higher the Sunne is the lesse shadow it makes, and the greater a mans vertue is the lesse glorie it seekes. (qtd. in Council 28)    So, by Aristotle's rationale, those people who seek honor are in fact not honorable because they are deliberately seeking honor, which is a vice. Council sums Aristotle's argument very well, "virtue consists in action; the reward of that action is honor; to pursue more honor than virtuous action warrants or to pursue honor for its own sake is a vice" (19). Honor is also eloquently described by Rabelais's definition of honor to the Thelemites, "because men that are free, well-born, and well-bred, and conversant in honest companies, have natu... ...mon. New York: W W Norton, 1994. 12. Seldon, John. Table-Talk. [1689]. Ed. Edward Arber. London: Alex, Murray & Son, 1868. 13. Shakespeare, W. "The Tragedy of King Richard the Second." The Complete 14. Signet Classic Shakespeare. Toronto: Harcourt Brace Johanovich, Publishers, 1972.    You may wish to begin your essay with the quotes below:    Bolingbroke: My body shall make good upon this earth, Or my divine soul answer it in heaven. Thou art a traitor and a miscreant.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   (Richard II, 1.1.37-39)    Mowbray: I take it up; and by that sword I swear, Which gently laid my knighthood on my shoulder, I'll answer thee in any fair degree Or chivalrous design of knightly trial; And when I mount, alive may I not light, If I be traitor or unjustly fight.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   (Richard II, 1.1.78-83)   

“Interpreting The Day the Earth Stood Still for Contemporary Film Audiences” Review Essay

In the article â€Å"Interpreting The Day the Earth Stood Still for Contemporary Film Audiences† written in 2008, the Author, Joshua Pardon, writes about the messages that were sent to the American film audience of 1951 through the film The Day the Earth Stood Still, based on a short story by Harry Bates written in 1940. These messages ranged from topics like the societal costs of atomic technology and both a negative and positive view of militarism, to criticism of the mass media. He also writes about how, unlike TV shows, and stories by the baby boom generation portrayed the 1950’s as a time when everything was wonderful for every citizen all the time, the argument can be made that it was a â€Å"strange and weird† time full of uncertainty, fear, and paranoia; and this film portrays these feelings, with strong messages that Pardon suggest could be applied to current world events. To make you better understand his article, he added a very well written summery of the movie followed by interpretations of the film’s scenes that could be applied to what was happening in America in 1951 and events happening in 2008. He compares the Cold War’s potential to lead to atomic catastrophe to the current war on terrorism; the public’s confusion on whether to trust scientist to the current debate of stem cell research, climate change and the scientific basis of evolution; and the media’s need to sensationalize current events take away from the real issues both in 1951 and today. I would have to say that Pardon’s article is very convincing and well written; the amount of information given by the author is very satisfactory. There is plenty of background information on what were the current events in the 1950s on every interpretation on the not so hidden messages of the movie that allow you to see the similarity of today’s issues and clearly see how the movie can be relatable today. Also, it goes into details of every important character, and even compares characters to specific iconic people from that era, such as Albert Einstein; and even the character Tom Stevens, a co mpany man with selfish intentions as a negative portrayal of a greedy American business culture. Such great details of interpretation make this article a very good and fulfilling read. In my opinion, the weakest part of this article is that, although the information given allows you to paint a clear picture of what the author is trying to communicate, it often added too much information of what almost felt like irrelevant information. Additionally, I felt that the author jumped from one subject to the next,  just to bring it back up later in the article, and even though it wasn’t confusing and the information was always different, it made the subject feel redundant. To sum up, Pardon’s article on the interpretation of the film The Day the Earth Stood Still, was a very informative and eye opening article that clearly shows all the political messages in the film. His words were able to paint a very good picture of what was happening in 1951, when the movie was made, so that you can better understand the messages that were being sent by the film that allowed us to b etter see how, even though it had been over 60 decades since this article was written, the film is still relevant today.

The Wood Bird Poem Analysis - 1078 Words

Living in the 21st century, getting caught up in the hectic pace of life is easy. Our egoistic and obsessive natures are forever fantasizing about always wanting more. However, when that doesn’t happen, we quickly blame life and disregard the fact that maybe this could be one of those bad experiences that mold us into becoming a better person. Perhaps influenced by this, John Reibetanz wrote the poem â€Å"The Wood Bird†, revealing the selfish nature of humans and their inability to appreciate. As the relationship between water and a piece of wood is discovered, Reibetanz shows his readers how the word ‘water’ viscously shapes a piece of wood to its perfection, representing precisely the imperfectness of life shapes us. This creation versus†¦show more content†¦Thus, the poet’s use of metaphor in this sense helps show how the relationship between water and the piece of wood is very similar to the relationship between life and humans. Natural ly, with metaphors comes personification. Reibetanz uses personification to establish a connection between water and the piece of wood, allowing readers to instantly recognize this and compare it with reality. In the poem, Reibetanz description of water goes from being so innocent to all of a sudden, violent and strong: â€Å"The shiver / that might have followed a more savage find / came on now, its strength surprising me.† (Reibetanz 30-32). This personification shows that water is powerful, but powerful in the sense that it is able to create such a masterpiece from a blunt piece of wood. Relating this to life, we know it’s flawed, but it being flawed gives us the chance to improve and perfect ourselves. Furthermore, when the poet writes, â€Å"fingerless, blind, the waves had carved / and planed, distressed and sanded the wood† (Reibetanz 33-34), he describes how water, being a lifeless object, was able to create such a perfect piece of art. 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