Burn shock

In case when 15-20% of the body surface is affected with superficial burns and 10% - with deep burns, a burn shock develops. It develops as a result of the action of a thermal agent on the body, which results in irritation of the sensitivity of nerve endings, which leads to pronounced pain sensations that lead to changes in the central nervous, sympathetic-adrenal systems. In addition, the effect of the thermal agent on the tissue disrupts the permeability of the capillaries, which leads to the exit from the vascular bed into the tissues of the liquid and protein. A large amount of fluid is lost by the body during exudation from the burn surface, in addition, part of the fluid leaves the vascular bed, as with burns in the surrounding tissues develops edema. With burns II-IIIA degree, the greatest loss of fluid is observed, with deep burns the body loses less fluid. The loss of plasma for burns directly depends on the total area of ​​the affected surface and can be up to 6-8 liters or more per day.

Burn shock is characterized by a decrease in the volume of circulating blood, while as a result of plasma loss the blood viscosity increases, the blood flow in the capillaries slows. In addition, as a result of the action of the thermal factor, the destruction of erythrocytes occurs. As a result of microcirculation disorders, metabolic and biochemical changes occur in the body;develops acidosis. Thus, the provision of pre-hospital care for burn shock is reduced to the elimination of pain and circulatory disorders, mainly to replenish the volume of circulating blood.

Burn shock occurs in 2 stages.

The first stage is characterized by an agitated state of the victim, while he complains of severe pain, he is "shaken" by chills and shivers;the pulse is rhythmic, it speeds up to 120 beats / minute. Arterial pressure usually rises or may remain on the initial data.

The second stage of burn shock develops in the absence of prehospital care for severe burns after 6-12 hours. At this time, the victim no longer feels pain;his breathing becomes shallow;the body covers cold sweat;the patient may experience attacks of vomiting, and vomit reminiscent of coffee grounds in such cases;the pulse is frequent, blood pressure drops.

Before starting first aid to the victim, it is necessary to find out:

• the effect of which thermal agent caused the burn;

• the exact time of the burn;

• the amount of the affected surface. The "Nines Rule" by Wallace allows the most accurate determination of the size of the affected surface. The surface area of ​​the head and neck is 9% of the total surface of the body;upper limb - 9%;anterior surface of the trunk - 18%;the posterior surface of the trunk - 18%;hips - 9%;shanks - 9%;of the external genitalia - 1%.

When providing first aid, all actions of the rescuer should be directed:

• for anesthesia. For this, the patient is intravenously injected with morphine, omnopon, promedol, fentanyl. To old people and children, in order to prevent the stopping of breathing, these drugs are injected slowly and in dilution 1 ml narcotic analgesic per 5 ml isotonic sodium chloride solution. A good analgesic effect is possessed by a combination of narcotic analgesics and antihistamines( dimedrol 1 ml, pipolpene 1 ml), which can be administered in one syringe in dilution and very slowly;

• Restoring the volume of circulating blood, which starts with the injection of polyglucin intravenously in a volume of 800 ml, provided that the transportation time of the victim is from 4 to 30 minutes, 800 ml of polyglucin are injected, and if transportation takes more time, then an additional 400 ml of 4%solution of sodium hydrogencarbonate;

• Transportation, which in any case should be carried out with great care. In this case, the victim is laid in the supine position on the undamaged part of the body. All victims who are in a state of burn shock should be taken to burn centers or to intensive care units.