Help the patient with thermal lesions
As a result, local action of heat, electric current, chemical substances, including drugs, or radiation damage to the skin occurs - burn.The depth of the defeat, distribution, localization and age of the victim make it possible to judge the severity of the injury, ie,burns.Depending on the nature of the damaging agent is isolated following burns:..
• Thermal - burns, appearing as a result of exposure to hot liquid flame, molten metal, etc. burns from hot liquids, where the temperature does not exceed 100 ° C, are often surface,and the flame burns, especially as a result of the ignition of clothing - heavy;
• elektroozhogi - burns resulting from electrochemical, thermal and mechanical action of the electric current
different power and voltage and accompanied by strong skin and underlying tissue destruction at sites of contact with conductive objects.For this type of burns are characterized by "signs" or "tags", which are kind of cut or laceration, clearly delimited scab;
• Chemical - burns resulting
• airway burns are more common in fires and explosions in confined spaces, in cases of prolonged stay of the victim in a smoky room.As a result of hot steam airway burns are much less common.Burn the airways characterized by erythema and swelling of the mucous membrane of the mouth, pharynx, epiglottis, burn the face with hair shedding in the nasal passages.Victims complain of pain when swallowing, feeling a tickle in the throat, chest pain, shortness of breath, cough, some appears hoarseness.Status of victims with burns all tra-heobronhialnogo wood compared to victims with isolated lesions of the larynx and trachea is described as more severe.
important role for the victim plays and the degree of the depth of destruction of high temperature fabrics.Therefore, it decided to allocate:
• superficial burns that killed only the surface layers of the skin, but the sprout layer of the skin and appendages (hair follicles, sweat and sebaceous glands) are stored.Of these new epithelium it continues to grow, and burn wound usually heals independently.These burns are thermal skin lesions I, II and IIIA degrees;
• deep burns when the skin is damaged the entire depth, refer to the SB degree.To include the IV degree burns, in which as a result of thermal effects affected subcutaneous tissue, muscle and bone.Self healing in these cases, there is only affected when less than 1% of the body surface.In most cases, deep burns to heal require transplantation own skin taken from other areas of the body.
In depth skin lesions as a result of thermal effects are 4 degree burns.
I degree burn is characterized by damage to the surface layers of the skin with the development in the future of aseptic inflammation.At the same time the skin reddens, swells and is painful.Symptoms persist for 2-3 days.Soon the surface layers of the skin is completely recovered, but are sometimes darkening of the skin area burned and peeling.
II degree burn is characterized by the appearance of seroplastic effusion between the horn and the Malpighian layer of skin, the stratum corneum exfoliation and the formation of bubbles with serous content, towering over the reddened and swollen skin.Horny superficial layer of the skin and exfoliate sphacelating, exudate accumulates underneath.When the bubble burst, laid bare a painful bright red deep layer of the skin - easily vulnerable, prone to infection.If the infection has been avoided, the bubbles burst and dry up, their contents resolves within 4-5 days.In the future, within 1-2 weeks of recovery occurs without scarring, otherwise gha bare surface epithelium appear granulation and healing is slowed down for a long time.
III degree burn is characterized by the same phenomena as in the II degree burns, but the final depth of skin damage is detected within 5-7 days, while due to the coagulation of proteins produced tissue necrosis, degenerative changes in tissues, thrombosis.In some cases, III degree observed charring of tissue.
IV degree burns characterized by a rash appears, and the superficial layers of the skin often sluscheny, hang in the form of scraps and rags.The deep layers of the skin completely lose sensitivity and transformed into a rigid mass of brownish or even black.Healing occurs in this case for several weeks and even months after the removal of necrotic tissue and provided complete rejection that does not fall into a wound infection.When this skin is replaced by scar tissue, which subsequently shrinks and pulls the surrounding tissue.In the case of large surface burn complete healing may not occur, then there is lot of granulation surface.
The most common combination of burns of varying degrees.
addition, burns are classified according to the area of thermal injury, often use "palm rule" and the "rule of nines" Wallace.The first rule is advisable to use with limited burns or subtotal lesions.According to this Area palm of an adult is 1% of the entire area of the skin surface.
With the second rule reveal the area unburned parts of the body, and the percentage of lesions of the skin is obtained by subtracting 100 from the area of unaffected skin.One should know that large segments of the body have a surface area of 9%.Thus, the surface of the head and neck is 9% of the total area of the body, the upper extremity - 9% lower extremity - 18%, the front surface of the body - 18%, the rear - 18%, perineum and external genitalia - 1%.For adults, the front surface of the body is 51%, rear-49%.
Local damage include restrictions on the area of burns to 10% of the body surface.Complex general and local disorders - burn disease - develops with more extensive lesions: when the surface - in the area of more than 15%, while the deep - more than 10% of the body surface.In children and the elderly the symptoms of burn disease can be identified by the defeat of the area, more than 5%.Burn disease accompanied by severe general disorders: severe irritation of the peripheral and central nervous system, violation of hemodynamics, acid-base balance, rapidly developing signs of intoxication decay products of tissues and germs of life, turn off the respiratory and excretory functions of the skin.The severity and outcome of burn disease depend on the area of deep burns.Deep burns on more than 20% of the body surface are extremely heavy.With extensive burns when affected 25-50% of the body surface, as a result of a sharp excruciating pain in burns develops burn shock, with blood pressure, increased at the beginning of shock due to spasm of blood vessels, decreases sharply as a result of paralysis vasomotors and vasodilatation.There is penetration of the liquid portion of the blood vessel in the tissue, leading to the development of edema.The protein content drops due to loss of plasma in place of the burn;blood volume falls;urine output also falls, it appears white, the red blood cells.Blood thus thickens.The destruction of erythrocytes leads to a decrease in hemoglobin and, consequently, to anemia.By the 2-3-th day after the incident, the patient shows signs of toxemia, iefever, it beats chills, darkened consciousness, pulse and breathing become more frequent, the patient suffers from nausea and vomiting;appear pale, and cyanosis.Death occurs when symptoms of coma, such as convulsions, collapse.There are early, ie,primary, death from burns, and later.In the first case death occurs in the first hours or the first days after the burn, and the 3-5-th day as a result of which developed toxemia.Late death occurs within a few weeks as a result of established sepsis.
disease outcome depends largely on the competent first aid at the scene.Therefore, you should know that emergency care begins with the earliest possible termination of the victim to the harmful agent.Thus, when the thermal effects of salvation must first be reset to the victim burning clothes or extinguish the flame.To this end, the patient should be tightly covered with a blanket or a thick cloth, if possible, immerse it in water or throw it.In many cases, the victims come in a panic on the type of burning his clothes, lose my mind and run, "aimlessly" will only worsen their situation.Provide assistance to catch up with the victim, knocking him to the ground, tightly cover with a blanket or cloth to stop the access of oxygen to the fire.To shorten the period of hyperthermia tissue and reduce the depth of the burn, the affected area should pour a stream of cold water for 10-15 minutes.If victim has burnt clothes, it is better not to shoot, and carefully cut and remove the burnt areas.In place of the accident on the burn wounds should impose a clean, better than a sterile, dry bandages to prevent the introduction of infection.In order to reduce the suffering of the victim from the excruciating pain, it is recommended to give anesthetics (analgin, aminopyrine, morphine, etc.).
In the case of electric shock, you must first stop its effect on the victim by interrupting the electrical current circuit by any available and quick way, without forgetting about their own safety and for the adoption of special measures described in paragraph "electric shock".The first aid to the victim in this case, even in the absence of signs of life begins with external cardiac massage and artificial respiration, then it is transported lying on a stretcher to a hospital for further medical care and further treatment.
Stopping burns effects of chemicals on the victim, it is necessary to wash the affected area with running water for 10 to 40 minutes.Then, if the burn was obtained due to the action of acids, the affected area is treated with a solution of sodium hydrogen carbonate, alkali burns at - acetic acid, followed by a dry sterile bandage applied.In assisting the victim in this case, it must be remembered that the earlier provided first aid, the shorter the exposure of the chemical agent, the shallower the depth of burn injury.
With extensive skin lesions after the imposition of bandages (preferably sterile), garden painkillers victim should be given hot tea, warm wrap and deliver to the hospital.If the delivery of the victim to the hospital for some reason is delayed, it should give to drink alkaline salt mixture, keeping in mind that the patient should drink at least 2 glasses of solution per hour for the first 6 hours.This will prevent dehydration.The solution is prepared at the rate of 1 h. Spoon of table salt and 0.5 hours. Tablespoons baking soda to 2 cups of water.These measures will prevent the development of the victim of burn shock.It is also recommended that a victim of tetanus toxoid for the prevention of tetanus.
In order to designate a rational therapy in the prehospital phase should correctly specify the overall area burned and deep lesion area.
During route to the hospital suffered a deep and extensive lesions should be administered analgesics - narcotic analgesic in combination with antihistamines.If necessary, apply a mask inhalation anesthesia with a mixture of nitrous oxide and oxygen in the ratio 2: 1;cardiovascular agents, humidified oxygen inhalation.
in a special hospital, Department of thermal injuries hospitalized patients with severe extensive burns.Transported by the victim on a stretcher in the prone position.
Primary treatment of burn wounds as follows: first wipe the skin surrounded by a burn and unopened surface blistering 0.5% solution of liquid ammonia, in the absence thereof - gasoline or alcohol.With aseptic bubbles reveal and remove flaking epidermis completely revealed the remains of bubbles are also removed, and the surface is dried.
extensive wound surface after the burn is treated in a hospital open or closed method.
Compulsory hospitalization subject:
• suffered deep burns of any size;
• affected with superficial burns on more than 7-10% of the body surface;
• affected with superficial burns on a smaller area (s), but obtained by flame or steam to the possible defeat of the respiratory tract;burns II- III A degree of hands due to poor functional outcomes of treatment;burns received as a result of exposure to electric current;burns of the feet, the ankles, the lower third of the leg, perineum.