Helping a patient with thermal damage

As a result of local effects of high temperature, electric current, chemicals, including medicinal products, or radiation, skin damage - burns occurs. The depth of the lesion, spread, localization and age of the victim make it possible to judge the severity of the lesion, i.e.burns. Depending on the nature of the damaging agent, the following types of burns are distinguished:

• thermal burns resulting from the action of hot liquid, flame, molten metal, etc. Burns with hot liquids, the temperature of which does not exceed 100 ° C, are often superficial, andburns by flames, especially as a result of ignition of clothing, heavy;

• electric burns - burns caused by electrochemical, thermal and mechanical effects of electric current of various

power and voltage and accompanied by strong destruction of the skin and underlying tissues in places of contact with conductive objects. For such a type of burns, "signs" or "marks" are characteristic, representing the form of a cut or ragged wound, a clearly delimited scab;

• chemical - burns caused by exposure to the skin of various chemically active substances, having clear boundaries and irregular shape. By the color of the skin burned by chemical substance, it is possible to determine the nature of this substance. For example, the skin becomes brown or blackens as a result of exposure to it with sulfuric acid, yellow-brown - as a result of exposure to nitric acid;yellow - hydrochloric( hydrochloric), pale blue or gray - hydrofluoric;

• Airway burns are more common in fires and explosions in enclosed spaces, in cases of prolonged stay of the victim in a smoky environment. As a result of exposure to hot steam, airway burns are much less common. The burn of the respiratory tract is characterized by hyperemia and swelling of the mucous membrane of the oral cavity, pharynx, epiglottis, a burn of the face with hair loss in the nasal passages. Victims complain of the appearance of pain during swallowing, a feeling of perspiration in the throat, pain behind the sternum, difficulty breathing, coughing, some have hoarseness. The condition of the victims with a burn of the entire tra-hebronchial tree in comparison with the victims with isolated lesions of the larynx and trachea is characterized as more severe.

An important role for the victim is played by the degree of depth of tissue damage with high temperature. Therefore, it is customary to allocate: •

• superficial burns, when only the surface layers of the skin die, but the germ layer and the appendages of the skin( hair follicles, sweat and sebaceous glands) are preserved. Of these, a new epithelium continues to grow, and the burn wound, as a rule, heals independently. Such burns include thermal skin lesions of I, II and IIIA degrees;

• Deep burns, when the skin is damaged to its fullest depth, is classified as an SB degree. To the fourth degree are burns, in which the subcutaneous tissue, muscles and bones are affected as a result of thermal exposure. Self-healing in these cases is observed only when no more than 1% of the body surface is affected. In most cases, deep burns for healing require a transplant of your own skin taken from other parts of the body.

In terms of the depth of skin lesions, 4 degrees of burns are released as a result of thermal exposure.

I degree of burn is characterized by damage to the surface layers of the skin with the development of a subsequent aseptic inflammation. At the same time the skin turns red, swollen and painful. Symptoms persist for 2-3 days. Soon the superficial layers of the skin are completely restored, only sometimes the darkening of the burned area of ​​the skin and its peeling remain.

II degree of burn is characterized by the appearance of serous-fibrinous effusion between the horny and malpighian layer of the skin, stratum corneum stratification and the formation of blisters with serous contents that rise above the reddened and swollen skin. The horny surface layer of the skin becomes dead and exfoliates, exudate accumulates under it. When the bladder bursts, a very painful bright red deep layer of skin is exposed - easily vulnerable, vulnerable to infection. If the infection was avoided within 4-5 days, the blisters burst and dry out, their contents dissolve. Further within 1-2 weeks there is a recovery without the formation of scars, otherwise the naked surface of the epithelium appears granulation, and the healing slows down for a long time.

III degree of burn is characterized by the same phenomena as in the second degree burn, but the final depth of skin damage is detected within 5-7 days, with the necrosis of tissues, degenerative changes in tissues, and thrombosis of blood vessels due to protein folding. In some cases, with grade III severity, charring of tissues is observed.

IV degree of burns is characterized by the appearance of scabs, with the surface layers of the skin often slipped, hanging in the form of scraps or rags. Deep layers of the skin completely lose sensitivity and are turned into a hard mass of brownish or even black. Healing in this case occurs within a few weeks and even months after the separation of dead tissue and their complete rejection, provided that the wound does not get an infection. In this case, the skin is replaced with a scar tissue, which subsequently wrinkles and contracts the surrounding tissues. In the case of a large burn surface, complete healing may not occur, then a portion of the granulation surface remains.

The most common combination of burns of varying degrees.

In addition, burns are classified by the area of ​​thermal damage, often using the "rule of the palm" and "rule of nine" by Wallace. The first rule is appropriate to use with limited burns or subtotal lesions. According to him the area of ​​the palm of an adult person is 1% of the total surface area of ​​the skin.

Using the second rule, the area of ​​the unbaked areas of the body is revealed, and the percentage of skin lesions is obtained by subtracting from unaffected skin areas from 100 areas. It is necessary to know that large segments of the body have a surface area equal to 9%.Thus, the surface of the head and neck is 9% of the entire body area, the upper limb - 9%, the lower limb - 18%, the front surface of the trunk - 18%, the back - 18%, the perineum and the vulva - 1%.For adults, the front of the body is 51%, at the back-49%.

Local injuries include limited burns in areas up to 10% of the body surface. The complex of general and local disorders - a burn disease - develops with more extensive lesions: in superficial ones - on an area of ​​more than 15%, at deep - more than 10% of the surface of the body. In children and the elderly, the symptoms of burn disease can be detected with a lesion area exceeding 5%.Burn disease is 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 by products of tissue decay and microbial activity, and the deactivation of respiratory and excretory functions of the skin. The severity and outcome of a burn disease depends on the area of ​​deep burns. Deep burns on an area of ​​more than 20% of the body surface are extremely severe. With extensive burns, when 25-50% of the body surface is affected, severe burn pain in the burn area develops a burn shock, while the blood pressure increased at the onset of shock due to vasospasm, sharply decreases as a result of paralysis of the vasomotors and vasodilatation. There is a penetration of the liquid part of the blood from the vessels into the tissues, leading to the development of edema. The protein content falls due to the loss of plasma at the burn site;the volume of circulating blood drops;the amount of excreted urine also falls, in it appear protein, erythrocytes. The blood is condensed. The destruction of erythrocytes leads to a decrease in the level of hemoglobin and, consequently, to anemia. On the 2nd-3rd day after the incident, the symptoms of toxemia appear in the patient, i.e.the temperature rises, it chills, the consciousness is darkened, the pulse and breathing speed up, the patient suffers from nausea and vomiting;there is pallor and cyanosis. Death occurs with signs of coma, such as convulsions, collapse. Distinguish early, i.e.primary, death from burn, and late. In the first case, death occurs already in the first hours or the first day after the burn, and also on the 3-5th day as a result of developed toxemia. Late death occurs in a few weeks as a result of developed sepsis.

The outcome of the disease largely depends on the competent first aid at the scene. Therefore, it should be noted that emergency care begins with the quickest possible termination of the injured agent. So, with thermal exposure, the rescuer must first throw off the victim's burning clothing or extinguish the flame. For this, the patient needs to be tightly covered with a blanket or a dense tissue, if possible, immerse it in water or pour it. In many cases, the victims panic from the type of clothing burning on themselves, lose their minds and run "where the eyes look", only worsening their situation. The assisting person must catch up with the victim, knock him to the ground, cover him tightly with a blanket or cloth to stop access of oxygen to the fire. To reduce the period of tissue hyperthermia and reduce the depth of the burn, the affected area should be poured with a stream of cold water for 10-15 minutes. If the victim has burnt clothing, then it is better not to remove it, but gently cut and removed from the burned areas. At the scene, clean, better sterile, dry bandages should be applied to burn wounds in order to prevent infection. To reduce the suffering of the victim from excruciating pain, he is recommended to give painkillers( analgin, amidopyrine, morphine, etc.).

In the event of an electric shock, it is first and foremost necessary to stop the effect on the victim by interrupting the electric current circuit in any accessible and fast way, while not forgetting your own safety and taking special measures for this purpose described in the item "Electro-trauma".First aid to the victim in this case, even in the absence of signs of life, begins with external massage of the heart and artificial ventilation of the lungs, then he is transported lying on stretchers to a hospital to continue providing medical care and further treatment.

By stopping the burn effect of chemicals on the victim, it is necessary to wash the affected surface with running water for 10-40 minutes. Then, if the burn was obtained as a result of the action of acids, the affected areas are treated with a solution of sodium hydrogencarbonate, with burns with alkali-acetic acid, and then a dry sterile dressing is applied. When rendering assistance to the victim in this case, it must be remembered that the earlier the first aid was rendered, the shorter the exposure of the chemical agent, the less the depth of the burn injury.

In case of extensive skin lesions after dressing( better sterile), giving painkillers, the victim should be given hot tea, warmly wrapped and delivered to the hospital. If the victim's delivery to the hospital is delayed for some reason, then he should be given an alkaline-salt mixture, meaning that the patient should drink at least 2 glasses of solution per hour in the first 6 hours. This will avoid dehydration of the body. The solution is prepared based on 1 teaspoon of table salt and 0.5 teaspoons of baking soda for 2 cups of water. These measures will help to prevent the development of burn shock. It is also recommended that the patient be administered tetanus antitetanus to prevent tetanus.

With the purpose of prescribing rational therapy at the prehospital stage, the total area of ​​the burn and the area of ​​deep lesion should be correctly specified.

During the admission to the hospital, victims with deep and extensive lesions should be given pain medications - narcotic analgesic in combination with antihistamines. If necessary, use inhalation mask anesthesia with a mixture of nitrous oxide and oxygen in a ratio of 2: 1;cardiovascular agents, inhalation of moistened oxygen.

In a special hospital, the department of thermal trauma hospitalized patients with severe extensive burns. Transportation is carried out on stretchers in the position of the victim lying down.

Primary treatment of burn wounds is as follows: first wipe the skin in the surroundings of the burn and the surface of unopened blisters with a 0.5% solution of ammonia, in its absence - gasoline or alcohol. With observance of asepsis rules, the bubbles are opened and the exfoliated epidermis is removed completely, the remains of the opened blisters are also removed and the surface is dried.

An extensive wound surface after a burn is treated in a hospital with an open or closed method.

Compulsory hospitalization is required:

• victims with deep burns of any area;

• affected with superficial burns on an area of ​​more than 7-10% of the body surface;

• affected with superficial burns in a smaller area( face), but received flame or steam with possible airway damage;burns II-III A degree of brushes in connection with unsatisfactory functional results of treatment;burns, obtained as a result of electric current;burns of feet, ankle joints, lower third of lower leg, perineum.