Burn
Burn - tissue damage caused by local thermal (thermal), chemical, electrical or radiation effects. The most common in clinical practice are thermal burns. The degree and prevalence of a local thermal burn is determined at the time of examination of the victim. Overheating of tissues above 52 "C leads to irreversible coagulation clotting of tissue proteins.The severity of damage depends on the height of the temperature, the duration of exposure, the extent of the lesion and the location of the burn.Especially severe burns cause flames, molten metal, pressurized steam, boiling oil, hot gas. There are burns to hands, feet, eyes.
The general consequences of burns. With relatively limited burns there is an increase in temperature. Often there is a shock: with burns of I degree, affecting more than 30% of the body surface; II-IV degree, more than 10%. Burn shock develops 1-2 hours after the burn. Strong pain, thirst, skin pale, the temperature of unaffected areas is reduced. After several hours of confusion, clonic convulsions and delirium may develop. Vomiting and diarrhea are poor prognostic signs.
There is often a decrease in diuresis up to anuria; collapse. If treatment is not performed, patients often die in the first 12-48 hours from acute cardiovascular failure.
Burn shock is caused by neurovascular reflexes (pain, fear) with ejection of catecholamines; Thermal damage of capillaries in the burn zone leads to the release of albumins into the tissue (decrease of the BCC). The development of histamine, prostaglandin and other mediators of inflammation are also important. By the 3rd day, the phenomena of shock are usually docked.
Acute burn intoxication begins after a shock phase with severe burns (high fever, tachycardia, decreased appetite, slow healing of Burn wounds); It is caused by the absorption of the products of decomposition of calcined tissues. The duration of the period is 4-12 days. With suppuration develops septicopyemia, which can lead to burn-out depletion.
Local effects of burns. Burns are divided into 4 degrees: 1 degree (erythema) - redness of the skin, swelling and pain. Inflammatory events subsided in 3-6 days, leaving only skin peeling; II degree (blistering) - severe pain with intense reddening, detachment of the epidermis with the formation of bubbles filled with a clear or slightly turbid liquid. There is no damage to the deep layers of the skin, and if the infection has not joined, all layers of the skin are regenerated in a week without the formation of a scar. Complete recovery occurs in 10-15 days. In case of infection, the recovery is dramatically prolonged, the healing proceeds by secondary tension; III degree:
A) the jet captures the thickness of the skin to the growth layer; B) necrosis of the entire thickness of the skin. A dense scab forms beneath which there are damaged tissues. Healing occurs by secondary tension with the formation of a coarse rumen; IV degree (charring): occurs when very high temperatures (flame, molten metal, etc.) are applied to the tissue. More often it is fires in case of accidents on motor vehicles, airplanes, accidents at mines. There is damage to the muscles, tendons, bones. If the upper or lower extremity is affected, the life of the victim can be saved only by timely amputation. The burn area can be roughly determined by the rule of "nine"; The adult surface of the head and neck - 9% of the body surface, the leg - 18%, the arm - 9%, the front and back surface of the trunk - 18%, the genitals and perineum - 1%.
First aid for burns. Remove the victim from the fire zone, do not tear off clothes, it is better to cut them off (in the cold season the victim should not undress, as cooling dramatically worsens the overall condition). Aseptic bandages (no powders or ointments). Anti-shock activities: drugs, do not cause pain, carefully lay the injured person. In case of extensive burns, the injured person should be wrapped in a sterile sheet and taken to a hospital; A massive plasmapheresis is shown with the replacement of fresh frozen plasma, albumin.
All burns of I and II degrees (up to 10% of the body surface) are treated on an outpatient basis (except for face burns and brushes). In other cases, emergency hospitalization is indicated.
The prognosis depends on the degree and extent of the lesion. Especially high mortality of children under 3 years old and elderly (over 60 years
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