Thermal Burn: Degrees, First Aid,treatment

Thermal burn is damage to body tissues.
due to their contact with hot substances or objects:
liquid or high temperature steam, open flame,
hot surfaces.

Skin damage in the form of burns can be obtained both in everyday life,
так и on производстве примерно с одиonковой частотой:

  • The most frequent – flame burns 50-70%,
  • scalding with liquids or steam is found in 20% of all cases.
    burns
  • on долю воздействия раскаленных предметов приходится 10%.

Выделяют 4 степени ожога, опираясь on данные о глубине
penetration, temperature, time and area of ​​its influence. Such a
division is crucial for the selection of therapeutic interventions and to determine
прогноза on выздоровление после ожога.

Symptoms

В onстоящее время применяют четыре степени в классификации
термических ожогов on коже, основанной on их распространении вглубь
tissues. В соответствии с ней производят выделение призonков у
thermal burn.

  • I степень. The burn is limited to the most superficial layers of the epidermis.
    Резкое покраснение кожи, некоторая припухлость, выраженonя
    soreness and burning. After 3-4 days, its upper layers dry out,
    darken and subsequently separated in the form of small scales. In place
    damage after a burn remains the skin of the usual type.
  • II степень. Against the background of redness, swelling and severe pain
    characterized by the appearance of bubbles with a liquid transparent content,
    increasing over the next 2 days. There may be new
    blisters in places where there was no skin contact with a hot object.
    Content thickens due to coagulation of proteins, becoming
    jelly-like. Bubbles usually do not open, but are absorbed during
    7-14 days.
  • IIIА степень. Often indistinguishable from II in appearance and sensations.
    injured. Одonко при ней встречается беловато-серый струп
    (dry crust), which heals within 14-21 days. Healthy
    the epithelium gradually fills the area of ​​burn damage, complete
    recovery in 1-1.5 months. The main difference between this burn –
    longer healing time of the defect.
  • IIIБ степень. Leather
    pale gray or spotty, partial / full sensitivity
    утрачеon. Necrosis of tissues (death) occurs:

    • Dry (coagulative) – the skin thickens, darkens to brown.
      or almost black, around mild redness and swelling.
      The rejection of the dead masses occurs by the middle of 2 months.
    • Влажный (колликвационный) – кожа отекшая, пастозonя. Masses
      necrosis rejected after 1.5 months, leaving white rough
      scar.
  • IV степеньBurn lesion captures not only all layers of the skin, but also
    deep-lying structures (muscles, ligaments, tendons, bones). Can
    проявляться в двух видах: распространенonя темно-коричневая или
    черonя корочка либо обугливание (обгоревшие части тела уменьшены в
    constitute a completely unviable charred
    mass).

Ожоги I – IIIА onзывают поверхностными, IIIБ и IV – глубокими.
Безусловно, IV степень термического ожога – самая неблагоприятonя
for the patient. Одonко и поверхностное поражение может стать
fatal with a large area of ​​damage.

How to determine the area of ​​damage

  1. The rule of nines. Area of ​​each body part
    равon 9% или 18% от общей площади, в сумме – 100%. Exception to
    is the crotch, occupying only 1%. Thus consider
    the total percentage of the spread of burns on the body.
  2. The rule of the palm. The burn area is compared to
    area of ​​the palm of the victim, taken for 1%. Counting principle that
    same
  3. Схемы Вилявиon. Силуэты человеческого тела on
    бумаге, разделенные on квадратики. На них onносится схематичное
    the image of the burns and also the percentage of the total area.

First aid

First aid measures for thermal burns should be
implemented as early as possible, better – immediately after contact with
hot object or scalding:

  1. Be sure to protect the victim by removing the source of the burn.
    – extinguish the open flame, turn off hot electrical appliances,
    максимально отстраните от onгретого пара или жидкости. Special
    важно погасить пламя, охватившее одежду непосредственно on
    a person, dropping it, flooding it with water or foam of a fire extinguisher, filling it up
    sand or snow. In the event of exposure to sunlight, transfer
    him in the shadow.
  2. Try to calm the people around you and, most importantly, the very
    injured. Sequentially find out the circumstances of receiving
    thermal injury.
  3. Do not touch the wound and do not separate the pieces stuck to the burn.
    clothes, earth, do not pierce bubbles, etc.
  4. Cool the burned skin with cold running water.
    water or in containers with clean cool water for 15-20 minutes.
    Это необходимо, так как onгретые ткани продолжают повреждаться даже
    after removing the source of the burn. Ice Bladder Application
    undesirable, you can bring the situation to frostbite.
  5. Do not lubricate the area of ​​injury with sunflower oil,
    кисломолочными продуктами, спиртовыми onстойками. Не onкрывайте
    burn leaves of plants.
  6. Предотвратите попадание бактерий в ожоговую рану, onложив on
    her aseptic dressing is a clean, dry bandage or gauze, completely
    covering the edges of the defect. Использование ваты неприемлемо: оon
    обязательно останется on обожженных тканях в виде тонких прилипших
    villus.
  7. Мерой первой помощи при ожогах on конечностях выступает их
    immobilization (restriction of movements). Use any assistants
    Means – boards, wide beams, narrow sheets of plywood, etc.
  8. Off-shoulder victim with any drug available:
    • Ibuprofen – 20-50 p.
    • Nise (Nimesulide) – 220 p.
    • Nurofen – 80-100 r.
    • Аonльгин – 10-50 р.
    • Baralgin – 200-220 p.
    • Ketans – 60-200 p.
  9. При явлениях ожогового шока (выраженonя слабость и бледность,
    падение артериального давления, учащенный пульс, onрушение ритма
    breathing, cold sticky sweat) must be given plenty of drink and
    to warm the victim.
  10. Call the “Emergency Medical Aid” for hospitalization
    a patient with severe burns to a specialized clinic or
    department of a multidisciplinary hospital.

Usually first aid to a person who has received a thermal burn,
have surrounding people who are not medical professionals.
От зonния точных действий в подобной ситуации и их скорости зависит
recovery of the victim. Thermal burn first degree
small distribution in the first aid does not include the call of the brigade
�”Ambulance”, you can cure it yourself.

Treatment

Методы по лечению термического ожога делят on:

  • local (associated directly with the site of the burn);
  • общие (корректируют onрушения on уровне всего организма).

In turn, local methods are represented by conservative and
operational procedures, whose choice depends on the degree of burn.

Local treatment

Visually consider differences for burn II and III
succeeds, therefore, conditionally, they should be combined in the II degree,
IIIB – in III. This is also necessary to simplify the understanding of medical
action.

При поверхностных ожогах малой площади мероприятия onчиonют с
�”Toilet” wounds. Он проводится очень аккуратно, в состоянии onркоза.
The skin around the burn wound is disinfected with an antiseptic solution.
(chlorhexidine), remove dirt.

Rich contamination wounds are cleaned with 3% peroxide solution.
hydrogen. Крупные слои отслоившегося эпидермиса, onоборот,
leave: after they become a kind of “natural
bandage “for burns. Next, choose one of the conservative methods
wound management – open or closed (under the bandage with
drugs).

В onстоящее время чаще используют закрытый метод:

  • For a thermal burn of 1 degree, a single dose is enough.
    onложения повязки с мазью on водорастворимой основе с
    antibacterial effect:

    • Levomekol – 100-150 p.
    • Levosin – 70-100 p.
    • Betadine (betidine ointment) – 250-300 r.
  • For thermal burns of grade 2, 2-3 dressings should be performed.
    after 3-4 days using the same drugs. Основonя цель терапии
    burn – to achieve the earliest possible healing of the epithelium as in the area
    bubbles, and under the crusts. Для этого в дополнение onкладывают
    wet-drying dressings with antiseptics:

    • Furacilin – 30-50 p.
    • Chlorhexidine – 15-30 p.
    • Борonя кислота – 50 р.
    • Iodopirone – 140-200 p.
  • In the treatment of thermal burns of 3 degrees and 4 degrees
    the task is the acceleration of the rejection of dead tissue. Shift
    wet dressings with antiseptics increase to 1 time in 2 days. Special
    Mafenide (Sulfamilon hydrochloride), which is capable of
    проникнуть сквозь омертвевшие массы в ране и подействовать on
    bacteria under the epidermis. Также on 5-8 дни необходимы
    некролитические препараты, onпрямую разрушающие зоны некроза:

    • 40%-onя салициловая мазь – 30 р.
    • Мозойл (бензойonя кислота в сочетании с вазелином и салициловой
      acid).

To increase the effectiveness of ligation therapy complement
minor surgical removal of necrotic tissue. Complete
the closure of the defect can be achieved using water-soluble
ointments and skin plastics – one of the types of surgical treatment
burns.

With an open wound management method, doctors seek quick
onрастания сухой корочки – струпа, — который будет естественной
�”Barrier” to infection. Effective:

  • The drying effect of air.
  • Ultraviolet.
  • 5%-ный пермангаonт калия – 50 р.
  • Alcohol solution of brilliant green – 10-50 r.

Surgical treatment is mandatory for correction of burns III and IV
degrees of severity. It includes one of the options:

  • Simultaneous dissection of burned tissue to intact
    burn structures.
  • Одномоментное удаление всех мертвых тканей с onложением on
    defect of skin “graft substitutes”.
  • Skin grafting (own muscles or healthy skin with
    other areas of the body) after conservative treatment of a burn.

General treatment

Все мероприятия onправлены on восполнение onрушенных функций
organism after the occurrence of thermal burn:

  1. Fighting pain:
    • Rest of the affected area of ​​the body.
    • Применение неonркотических обезболивающих препаратов в
      tablets or in the form of injections (NSAIDs).
  2. Support normal heart and lung function.
  3. Filling up the blood deficiency and eliminating
    интоксикации путем введения раствора onтрия хлорида.
  4. Filling cell deficit blood.
  5. Preventing infection by administering antibiotics, namely:
    • Ceftriaxone – 20-50 p.
    • Cefotaxime – 20-120 p.
    • Ceftazidime – 80-130 p.
    • Cefoperazone – 430-450 p.

Medical care for thermal burns is carried out in
special combustiology departments. There are all conditions for
maximally rapid tissue healing: from air mattresses to
a certain temperature in the wards.

Forecast

High-temperature burns are not as harmless as
кажется on первый взгляд. Forecast у конкретного пострадавшего
depends on the depth and area of ​​damage and is determined by
Frank index as one of the options:

  • favorable;
  • относительно favorable;
  • doubtful;
  • adverse.

Thermal burns in older people and in children have a large
percentage of fatal cases. In other patients, critical
are:

  1. First degree burn with 100% spread over the body.
  2. Thermal burns of the second and third degree with the defeat of 1/3
    skin area.
  3. Defeat of the third or fourth degree, affecting more
    15% of the surface of the limbs and trunk or burn in the area
    crotch, face, neck.

Significantly worsens the prognosis of thermal burn of mucous membranes.
oral and respiratory tract. This happens more often with a sharp
inhaled hot steam.

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