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Burns


Damage caused by thermal, chemical, or radiation energy. The severity of a burn is determined by the size of the area and the depth of tissue damage. There are four degrees.
1 degree - hyperemia (redness) and swelling of the skin. Grade II - the formation of bubbles filled with a clear yellowish liquid; Grade IIA - the spread of necrosis to all or almost all of the epidermis. Grade IIIB - necrosis of all skin layers. IV degree - death not only of the skin, but also of deep-seated tissues (fascia, tendons, bones).
To determine the severity of a burn, measuring the area of ​​the lesion is of great importance. For quick but approximate clarification, the rule of "palm" or "nines" is applied. The total area of ​​a person’s body is divided into multiples of nine: the victim’s palm is approximately 1%, the head and neck are 9%, the chest and abdomen are 18%, the back and buttocks are 18%, the upper limbs 9% each, and the lower limbs 18%, crotch - 1%.
Symptoms and course:
Small burns occur as a local process. With more significant lesions in burned there are serious general disorders. During this disease, there are periods of burn shock, acute burn toxemia, burn septic toxicosis and convalescence (recovery).
Shock develops due to the irritation of a huge number of nerve elements in the affected area. The larger the burn area, the more often and more severe the shock. With burns over 50% of the body surface, it is observed in all victims and is the main cause of their death.
Toxemia (poisoning of the body with tissue decay products) begins from the first hours after the burn, gradually increases and, after coming out of the shock, determines the patient’s condition later (the toxemia phase of the burn). When burns marked hypoproteinemia (lack of proteins), metabolic disorders.
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 (the septic phase of the burn course).
Severe and extensive burns are accompanied by lethargy, drowsiness, vomiting, convulsions, cold sweat appears. Blood pressure decreases, the pulse is made frequent and small, the temperature decreases, and severe intoxication, dehydration and hypoproteinemia increase, which is associated with a large loss of plasma. In severe cases, there are abnormal functions of the liver and kidneys, bleeding from mucous membranes appears, ulcers on the mucous membrane of the gastrointestinal tract are sometimes formed.
Local changes in burns have the following sequence: under the influence of high temperature, hyperemia develops, leading to inflammatory exudation of tissues, development of edema. Some tissues die as a result of direct exposure to high temperature or due to circulatory disorders. Inflammatory exudate, tissue breakdown products act on nerve formations, causing severe pain. In patients with grade 1 burns, circulatory disorders and inflammatory exudation soon cease, edema decreases, pain disappears and the process is eliminated.
In case of second-degree burns, all phenomena also gradually subside, the exudate is absorbed, the surface of the burn epithelizes, and after 14-16 days, recovery occurs.
When infection burns II degree 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 deep tissues with III-IV degree burns, leads to the process of rejection of dead tissues, followed by the filling of the defect with granulations with the formation of a scar. Extensive scars in secondary healing often limit movement (cicatricial contractures).
First aid at the scene should ensure the cessation of the traumatic agent, the prevention of infection of the burn surface, shock and the evacuation of the victim to the hospital. Having stopped the effect of high temperature (removal from the fire, removal of hot objects, etc.), they remove or, what is less traumatic, remove clothing from the affected areas of the body and impose an aseptic bandage on the burned surfaces and inject anesthetics. After that, immediately sent to a medical facility.
In the hospital, urgent measures are taken to eliminate the shock, after which tetanus toxoid serum is administered and the burn surface is first treated.
Treatment:
The choice of method is determined by the severity of the burn, the time elapsed since the moment of injury, the nature of the primary treatment and the environment in which the treatment will be carried out. Most patients with burns need hospital treatment. A good anesthetic effect is given by dressings with a 0.5% solution of novocaine.
Chemical burns are the result of action on the tissue 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 domestic.
The impact of strong acids and salts of heavy metals on tissue leads to coagulation, coagulation of proteins and their dehydration, therefore coagulation tissue necrosis occurs with the formation of a dense crust of dead tissue, which prevents the action of acid-deeper tissues.
Alkalis do not coagulate proteins, but dissolve them, saponify fats (colliquatiopic necrosis) and cause deeper tissue necrosis, which take on the appearance of a white, soft scab.
Determining the degree of chemical burns in the first days is difficult due to the scarcity of clinical manifestations. Often, during the subsequent course of a burn, a greater depth of damage is detected than was determined in the first days. After healing, coarse, deep scars are usually formed. The processes of wound cleansing from necrotic tissue and regeneration with chemical burns proceed slowly, sluggishly. They are also characterized by an almost complete absence of changes on the part of the state of the body, and shock and toxemia are almost never encountered.
First aid for chemical burns "consists in immediately washing the affected surface with a stream of water to reduce the concentration of acid or alkali and stop their action. or citric acid.
Phosphorus burns are deep, as with the contact with the skin the phosphorus continues to burn. First aid is to immerse the exposed surface immediately in water or to irrigate it abundantly with water to extinguish phosphorus. At the same time, the surface is cleaned from pieces of phosphorus using tweezers. After washing, lotions with 5% copper sulphate solution are placed on the burned surface. 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.