The abnormal condition that occurs with severe burns requiring urgent medical intervention is a burn shock, i.e., the response of the human nervous and sympathetic system to unbearable pain. It manifests itself as a result of a significant lesion of the dermis and is the first dangerous period of a burn disease. In the adult population, this phenomenon occurs with damage to 15% or more of the skin, and in children and the elderly it can occur at 5-10%. The state of shock instantly progresses and has several stages of development. Without emergency care, this process becomes irreversible.
Classification of burn shock
With burns, there are often no distinct signs that characterize shock, and there are many clinical manifestations that make it difficult to classify clinicians. For convenience, the disease is divided into the following phases:
- erectile - observed within two hours after the occurrence of an accident;
- torpid - the first phase passes into it, six hours after the onset of the lesion;
- terminal - develops in case of failure to provide assistance to medical workers. Lethal outcome is possible.
Given the data of laboratory studies and the clinic of the course of the disease, it is customary to distinguish four degrees of shock in severity:
- mild - lesions make up to 20% of the dermis;
- medium - occurs with damage from 20 to 40% of the skin surface area;
- severe - the area of the affected surface is up to 60%;
- extremely severe - occurs when more than 60% of the skin is affected.
Mild degrees of shock
This is a shock that occurs with a burn, the healing of which takes place using conservative treatment. The following degrees of severity are attributed to them:
- The first is easy. The patient maintains a clear consciousness, has a pale skin color, blood pressure and body temperature are not elevated. Slight tachycardia, trembling in the muscles, and a feeling of thirst may be observed. Erythema (redness of the skin), swelling and burning appear on the damaged area. Inflammation disappears in a few days. The patient's condition at the first degree of burn shock is normalized in a day, and healing occurs in a week.
- The second is average. The death of the surface layer of the epidermis occurs. Bubbles with a yellowish liquid form. The surface layer is easily removed, underneath it is a bright pink hue surface that delivers pain. The patient experiences a strong overexcitation, which subsequently becomes inhibition. Shortness of breath begins, chills, the skin turns pale, the pressure decreases, but the consciousness does not leave the patient. A malfunction of the allocation system occurs. Healing lasts about two weeks. Pigmentation of the dermis lasts up to three weeks.
Severe shock
They occur with deep damage to the skin associated with the death of the epithelium and requiring plastic repair. This group includes shock of the following severity:
- The third is heavy. The area of the affected surface makes up a large part of the body, while the entire thickness of the skin is deadened and a scab forms. With the rejection of the dead dermis, purulent foci appear. The victim has a confused consciousness. Muscle contractions, rapid pulse, shortness of breath, thirst are observed. The skin becomes cold, acquiring a grayish tint. There is a violation of the kidneys. Burn wound healing lasts up to six weeks.
- Fourth - an extremely severe degree of burn shock occurs when most of the skin is damaged. Muscles, tendons and bones are affected. A thick scab forms with subsequent purulent complications. Events develop very rapidly, the patient loses consciousness, his condition is in danger. The skin takes on a pale bluish color, temperature and pressure are lowered. The pulse becomes weak, it is impossible to feel. Strong shortness of breath begins, wet rales are heard. Renal activity is impaired, anuria is present. A positive prognosis is extremely rare, most often fatal.
Why does shock occur?
The main cause of burn shock is a very strong pain that, when exposed to the nervous system, causes it to be upset. Pain occurs as a result of damage to the integument of the skin.
There is an intense decrease in plasma in the blood, which dramatically reduces the volume of circulating blood. In addition, burn necrosis of tissues and toxins is added. All this adversely affects both the central nervous system, the circulatory and cardiovascular systems, and other organs. As a result, shock develops. This is a protective reaction of the body. It reduces the pain of a person and frees up time for emergency care.
Pathogenesis
The mechanism of the onset and development of the disease begins after a pain impulse enters the central nervous system, and this occurs:
- general strain caused by pain;
- intense emotional, speech and motor activity;
- intoxication of all body systems due to tissue damage;
- a large loss of plasma causes dehydration and an increase in blood viscosity, which leads to thrombosis;
- a decrease in blood volume disrupts its circulation, lowering the supply of internal organs with nutrients;
- kidney damage due to poor blood circulation causes kidney failure.
Symptoms of a burn disease
The primary signs of burn shock are as follows:
- severe excitability, motor anxiety;
- heart palpitations;
- rapid intermittent breathing;
- pallor of the skin;
- body temperature is normal or slightly lower;
- secretion of cold sticky sweat;
- intense thirst;
- chills, muscle tremors.
With further development of burn shock, the following are observed:
- progression of inhibited state;
- the occurrence of nausea and vomiting;
- increased tachycardia;
- poor outflow of urine;
- the color of urine becomes dark, closer to black;
- increased pain.
In case of untimely assistance by medical workers, the patient’s condition worsens rapidly, breathing slows down, the fullness of the pulse weakens, the skin turns blue, and loss of consciousness occurs.
First aid for extensive burns
The development of burn shock depends on how quickly assistance was provided to the victim, so it is very important to perform the following actions:
- Prior to the arrival of the doctors, release the victim from the damaging factor, rid the clothing of the damaged area of the dermis by cutting it with scissors.
- With integral skin, cool the surface with cold water for 20 minutes.
- To prevent dehydration of the victim should be drunk with warm water. Sweet tea, mineral alkaline water are suitable, and you can also use a soda solution.
- Cover the injured person with a burn shock during chills with warm clothing or a blanket.
- Give sedatives.
- For analgesia, enter intramuscularly “Analgin” or “Paracetamol”. When using medicines in tablets, it is better to grind them to speed up absorption.
- Apply sterile wipes moistened with hydrogen peroxide, chlorhexidine or furatsilin to the burned surface.
- Upon receipt of a chemical burn, it is necessary to thoroughly wash the damaged surface of the skin with water. This will help reduce the depth of the wound.
To determine the area of damage, a palm is applied, assuming that its area is 1% of the affected area. If necessary, do artificial respiration and indirect heart massage. Having finished providing first aid, the patient is transported to the hospital for subsequent treatment.
Emergency measures
In case of burn shock, emergency care is provided by qualified medical personnel. They conduct resuscitation antishock therapy, during which they perform:
- Anesthesia - is carried out using analgesics or drugs. Often used: "Morphine", "Promedol", "Analgin."
- Correction of bcc (volume of circulating blood) - the procedure is carried out at the location of the victim or in an ambulance. For the treatment of drugs used: "Hemodez", "Reoglyuman", "Polyglukin" or glucose solution.
- Rescue breathing - do with damage to the respiratory tract. For this purpose, they give an oxygen mask, apply an indirect heart massage and make artificial respiration.
- Impact on damaged skin surfaces - cool the damaged areas with a cold stream of water for 20 minutes, then apply sterile dressings.
Burn shock: clinical guidelines for treatment
Treatment of a shock condition is carried out in a hospital under the supervision of a doctor.
A course of therapy is selected that contributes to the restoration of the disturbed volume of circulating blood in the vessels and the normalization of all metabolic processes. It includes the following activities:
- Removal of pain syndrome - it accompanies the patient until damaged areas of the skin are restored. Strong pain prevents a person from sleeping, resting and recovering calmly. Analgesics and antihistamines are prescribed to reduce suffering.
- Bringing metabolic processes to normal - the lack of potassium and sodium is compensated by introducing solutions of salts and minerals containing these elements through a dropper.
- In the treatment of burn shock, psychosomatic reactions are removed with sedatives with hypnotic effect, which contribute to the relaxation of the nervous system.
- Decreased intoxication - occurs due to heavy drinking and saline solutions, which are administered intravenously with droppers.
- Monitoring the work of vital organs - appropriate medications are used to maintain the lungs, kidneys, brain and heart. The vital activity of a patient who is in an unconscious state is supported by special life support equipment.
- Restoring vascular tone - carried out with corticosteroid drugs, using "Hydrocortisone" and "Prednisolone".
- Frequent treatment of wounds and dressings accelerate the regeneration of the skin.
Recovery of the victim after the treatment of burn shock is determined by the following signs:
- normalization of body temperature;
- restoration of the level of red blood cells and hemoglobin;
- establishment of blood flow through the vessels;
- normal allocation of daily urine volume.
Therapy of seriously ill patients takes a long period, very laborious and multi-stage. The time of treatment depends on the quality and timely provision of medical care. Its absence can be fatal.
Features of the course
The features of the course of burn shock are due to the fact that the shock state is established immediately after injury. In addition to severe pain, it is affected by a large loss of blood plasma released through the affected surfaces, and the decay products of damaged tissues that poison the body. Only intensive therapy can help save the patient, contributing to the correction of all important body functions. The duration of shock with intensive care is from two to three days. Features of burn shock, unlike others, are as follows:
- The duration of the erectile phase is from one to two hours. The stricken man is in an excited state: he talks a lot and moves, often trying to run.
- Blood pressure is normal or slightly increased. This is due to the release of a large amount of adrenaline into the blood.
- The rapid entry into the blood of potassium from damaged tissues and destroyed red blood cells clogs the renal tubules, and this develops renal failure. Excess potassium in the blood leads to disruption of the heart muscle.
- Blood thickening occurs due to a large loss of plasma through wound surfaces and can account for up to 70% of bcc. Thick blood circulates slowly and leads to thrombosis.
After the first phase of shock comes the second - torpid, characterized by inhibition of the cerebral cortex. It lasts from 2 to 3 days. Patients are conscious, but come into contact slowly, taciturnly. They are often shivering, they are thirsty, vomiting and slowing down the flow of urine into the bladder is possible. If the upper respiratory tract is damaged, the course of shock becomes heavier. The patient develops shortness of breath, hoarse voice, cough, sore throat. Such burns most often occur indoors.
Conclusion
Shock from a burn occurs due to colossal thermal damage to the skin and tissues. It causes severe consequences associated with impaired blood circulation and metabolic processes in the body.
This situation requires the immediate provision of qualified medical care, otherwise the process may become irreversible. Therapy begins at the scene and in the ambulance. Urgent hospitalization in the department of thermal injury is required. From inaccessible places the patient is delivered using air transport.