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Burns


Damage caused by thermal, chemical or radiation energy. The severity of the burn is determined by the size of the area and the depth of tissue damage. Four degrees stand out.
1 degree - hyperemia (redness) and swelling of the skin. II degree - the formation of bubbles filled with a transparent yellowish liquid, IIIA degree - the spread of necrosis to the entire or almost the entire epidermis. IIIB degree - necrosis of all skin layers. IV degree - necrosis not only of the skin, but also of the underlying tissues (fascia, tendon, bone).
To determine the severity of the burn, measuring the area of ​​the lesion is of great importance. For a quick, but rough estimate, apply the rule "palm" or "nines." The entire human body area is divided into multiples of nine: the victim’s palm is approximately 1%, the head and neck - 9%, the chest and stomach - 18%, the back and buttocks - 18%, upper limbs - 9%, lower limbs - 18%, perineum - 1%.
Symptoms and course:
Small burns occur as a local process. With more significant lesions, burnt patients have serious general disorders. During this disease, periods of burn shock, acute burn toxemia, burn septicotoxemia and convalescence (recovery) are distinguished.
Shock develops due to irritation of a huge number of nerve elements in the affected area. The larger the burn area, the more and more severe the shock. With burns of more than 50% of the body surface, it is observed in all victims and is the main cause of their death.
Toxemia (poisoning of the body by tissue breakdown products) begins from the first hours after a burn, gradually increases and after getting out of shock determines the patient’s condition in the future (toxemia phase during a burn). With burns, hypoproteinemia (lack of proteins), metabolic disorders are noted.
With the development of an infection of the exposed surface, the temperature rises, chills appear, leukocytosis and neutrophilia increase, anemia and others develop, septic phenomena increase (septic phase of the burn).
Severe and extensive burns are accompanied by lethargy, drowsiness, vomiting, convulsions, and cold sweat appears. Blood pressure decreases, the pulse becomes frequent and small, the temperature decreases, severe intoxication, dehydration and hypoproteinemia increase, which is associated with a large loss of plasma. In especially severe cases, there are impaired liver and kidney function, bleeding from the mucous membranes appears, ulcers on the mucous membrane of the gastrointestinal tract sometimes form.
Local changes in burns have the following sequence: under the influence of high temperature, hyperemia develops, leading to inflammatory exudation of tissues, the development of edema. Some tissues die as a result of direct exposure to high temperature or in connection with circulatory disorders. Inflammatory exudate, tissue breakdown products act on nerve formations, causing severe pain. In patients with 1 degree burns, circulatory disorders and inflammatory exudation soon cease, swelling decreases, pain disappears and the process is eliminated.
With II degree burns, all phenomena also gradually subside, the exudate is absorbed, the surface of the burn is epithelized, and after 14-16 days, recovery begins.
With infection of burns of the II degree, a purulent process develops. In these cases, healing is delayed for several weeks or even months.
Necrotizing the entire thickness of the skin, and sometimes the underlying tissues with burns of the III-IV degree, leads to the process of rejection of dead tissues, then the defect is filled with granulations with the formation of a scar. Extensive scars during secondary healing often restrict movement (scar contracture).
First aid at the scene should ensure the termination of the traumatic agent, prevention of infection of the burn surface, shock and the evacuation of the victim to a medical institution. Having stopped the effect of high temperature (removal from the fire, removal of hot objects, etc.), clothes are removed from the affected areas of the body or, less traumatic, and aseptic dressing is applied to burned surfaces and painkillers are administered. After that, they are immediately sent to a medical institution.
In the hospital, urgent measures are taken to eliminate shock, after which tetanus toxoid serum is administered and primary treatment of the burn surface is performed.
Treatment:
The choice of method is determined by the severity of the burn, the time elapsed since the injury, the nature of the primary treatment and the environment in which the treatment will be carried out. Most patients with burns need inpatient treatment. Dressings with a 0.5% solution of novocaine give a good analgesic effect.
Chemical burns are the result of the action on tissues of substances with a pronounced cauterizing effect (strong acids, alkalis, salts of heavy metals, phosphorus). Most chemical burns of the skin
- production, and the mucous membrane of the mouth, esophagus, stomach - often household.
The action of strong acids and salts of heavy metals on the tissue leads to coagulation, coagulation of proteins and their dehydration, therefore, coagulation necrosis of tissues occurs with the formation of a dense crust from dead tissue, which prevents the action of acid-rich tissues.
Alkalis do not coagulate proteins, but dissolve them, saponify fats (kollikvatsiopny necrosis) and cause a deeper necrosis of tissues, which take the form of a white, soft scab.
Determining the degree of chemical burn in the early days is difficult due to the scarcity of clinical manifestations. Often, during the subsequent course of the burn, a greater depth of the lesion is revealed than was determined in the first days. After healing, rough, deep scars usually form. The processes of cleansing the wound from necrotic tissue and regeneration with chemical burns are slow, sluggish. They are also characterized by an almost complete absence of changes in the state of the body, shock and toxemia are almost never encountered.
First aid for chemical burns "consists in immediately washing the affected surface with a jet of water to reduce the concentration of acid or alkali and stopping their action. After washing with water, you can begin to neutralize the acid residues with 2% sodium hydrogen carbonate solution, and with alkali burns - 2% acetic solution or citric acid.
Phosphorus burns are deep, since phosphorus continues to burn when it gets on your skin. First aid consists in immediately immersing the exposed surface in water or in abundant irrigation with water to extinguish phosphorus. At the same time, the surface is cleaned of pieces of phosphorus with tweezers. After washing, apply lotions with 5% copper sulfate solution after washing. Further treatment is carried out, as with other burns, but with the exception of ointment dressings, which can enhance the fixation and absorption of phosphorus.