In life, each of us received burns. The area of burns can be different, but the sensations are always the same: as if a hot coal was applied to the affected area. And no water, ice or cold compress can overpower this feeling.
And from a medical point of view, a burn is tissue damage caused by the action of high temperature or highly active chemicals, such as acids, alkalis, salts of heavy metals. The severity of the condition is determined by the depth of damage and the area of the damaged tissue. There are special forms of burns resulting from radiation or electric shock.
Classification
The classification of burns is based on the depth and type of injury, but there is a separation by clinical manifestations, medical tactics or type of injury.
Burns are distinguished by depth:
- The first degree is characterized by damage to only the upper layer of the skin. Outwardly, this is manifested by redness, slight swelling and pain. Symptoms disappear after three to four days, and the affected area of the epithelium is replaced by a new one.
- Damage to the epidermis to the basal layer indicates a burn of 2 degrees. Blisters with cloudy contents appear on the surface of the skin. Healing lasts up to two weeks.
- With the third degree of burns, thermal damage is received not only by the epidermis, but also by the dermis.
- Grade A: the dermis at the bottom of the wound is partially not damaged, but immediately after the injury it looks like a black scab, sometimes bubbles appear that can merge with each other. Pain at the burn site is not felt due to damage to the receptors. Independent regeneration is possible only on the condition that a secondary infection does not join.
- Grade B: complete death of the epidermis, dermis and hypodermis. - The fourth degree is the carbonization of the skin, fat layer, muscles and even bones.
Classification of burns by type of damage:
- Exposure to high temperatures:
- Fire - the area of destruction is large, but relatively shallow. Primary treatment is complicated by the fact that it is difficult to clean the wound of foreign bodies (threads from clothes, pieces of melted buttons or zippers).
- Liquid - a burn is small but deep (to the third A-degree).
- Hot steam is a significant burn, but the depth rarely reaches the second degree. Often affects the respiratory tract.
- Hot objects - the wound follows the shape of the object and can have a significant depth. - Chemical substances:
- Acids cause coagulation necrosis, and a scab of coagulated proteins appears at the site of the lesion. This prevents the substance from penetrating into the underlying tissues. The stronger the acid, the closer to the surface of the skin is the affected area.
- Alkalis form collicative necrosis, it softens tissues and caustic substance penetrates deeply, a burn of 2 degrees is possible.
- Salts of heavy metals resemble acid burns. They are only 1st degree. - Electric burns appear after contact with technical or atmospheric electricity and, as a rule, occur only at the place of entrance and exit of the discharge.
- Radiation burns can occur after exposure to ionizing or light radiation. They are shallow, and their effect is associated with damage to organs and systems, and not directly to soft tissues.
- Combined burns include several damaging factors, such as gas and flame.
- Combined can be called those injuries where, in addition to the burn, there are other types of injuries, such as fractures.
Forecast
Everyone who has ever received burns (the burn area was more than a five-ruble coin) knows that the prognosis of the development of the disease is an important detail in the diagnosis. Often, patients with injuries are injured in accidents, natural disasters, or as a result of industrial accidents. Therefore, people are brought to the emergency room in whole groups. And then the ability to predict a change in the patient’s further state will come in handy during sorting. The most difficult and difficult cases should be considered by doctors in the first place, because sometimes the bill goes for hours and minutes. Usually, the prognosis is based on the area of the damaged surface and the depth of the lesion, as well as associated injuries.
In order to accurately determine the forecast, conditional indices (for example, the Frank index) are used. For this, from one to four points are assigned for each percentage of the affected area. It depends on the degree and location of the burn, as well as on what the area of the burn of the upper respiratory tract. If there is no respiratory failure, then a head and neck burn gets 15 points, and if there is, then all 30. And then all the estimates are calculated. There is a scale:
- less than 30 points - the forecast is favorable;
- from thirty to sixty - conditionally favorable;
- up to ninety - doubtful;
- more than ninety - unfavorable.
Lesion area
In medicine, there are several ways to calculate the area of the affected surface. The determination of the area and degree of burn is possible if it is taken as a rule that the surface of different parts of the body occupies nine percent of the total skin area, according to this, the head together with the neck, chest, stomach, each arm, thighs, lower legs and feet occupy 9%, and the back surface of the body is twice as much (18%). Only one percent received a crotch and genitals, but these injuries are considered quite serious.
There are other rules for determining the area of burns, for example using the palm of your hand. It is known that the palm area of a person takes from one to one and a half percent of the entire surface of the body. This allows you to conditionally determine the size of the damaged area and suggest the severity of the condition. The percentage of burns on the body is a conditional value. They depend on the subjective assessment of the doctor.
Clinic
There are several symptoms that can cause burns. The area of burns in this case does not play a special role, since they are extensive, but shallow. Over time, the forms of clinical manifestations can replace each other in the healing process:
- Erythema or redness accompanied by redness of the skin. It occurs with any degree of burns.
- A vesicle is a bubble filled with a cloudy liquid. It may be mixed with blood. Appears due to exfoliation of the upper layer of the skin.
- Bulla is a few vesicles that merge into one bubble over one and a half centimeters in diameter.
- Erosion is a burn surface on which there is no epidermis. It is bleeding, or a mother tree stands out. Occurs during removal of blisters or bullae, necrotic tissue.
- An ulcer is a deeper erosion affecting the dermis, hypodermis and muscles. The value depends on the area of previous necrosis.
- Coagulation necrosis - dry dead tissue of black or dark brown color. Easily removed by surgery.
- Collication necrosis is a moist rotting tissue that can spread both deep into the body and to the sides, capturing healthy tissue.
Burn disease
This is the systemic response of the body to burn injury. This condition can occur both with superficial injuries, if the body burn is 30% or more, and with deep burns, occupying no more than ten percent. The weaker the person’s health, the more this type of shock is manifested . Pathophysiologists distinguish four stages of the development of a burn disease:
- Burn shock. It lasts the first two days, with severe damage - three days. It occurs due to improper redistribution of fluid in shock organs (heart, lungs, brain, kidneys).
- Acute burn toxemia develops before infection, lasts from a week to nine days. Pathophysiologically similar to prolonged crushing syndrome, that is, tissue breakdown products enter the systemic circulation and poison the body.
- Burn septicotoxemia appears after infection. It can last up to several months until all bacteria are eliminated from the wound surface.
- Recovery begins after burn wounds are covered by granulation tissue or epithelium.
Endogenous intoxication, infection and sepsis
A body burn is accompanied by poisoning of the body by protein denaturation products. The liver and kidneys can hardly cope with the increased load with a decrease in pressure in the systemic circulation. In addition, after an injury, the human immunity is in a state of high alert, but prolonged poisoning of the body disrupts the defense mechanisms, and secondary immunodeficiency forms. This leads to the fact that the wound surface is colonized by putrefactive microflora.
Sorting burn victims
As mentioned above, one victim who has burns is rarely brought to the emergency room . The area of burns and the number of patients significantly exceed the capabilities of medical personnel, so it is necessary to sort the incoming people according to the severity of the condition in order to know who to provide medical care in the first place:
- Severely wounded have superficial burns of more than twenty percent of the body or deep burns - more than ten percent, as well as burns of the upper respiratory tract. Such patients need emergency medical care and are transported to a medical institution by means of sanitation.
- The average severity corresponds to superficial burns of less than twenty percent or deep - not more than ten percent of the surface of the body. Medical assistance should be rendered to such injured persons secondarily, but this does not mean that they can be left without attention for a long time.
- The mild degree is characterized by superficial burns, which occupy less than fifteen percent of the skin surface, or deep burns, which extend by no more than five percent and do not affect the upper respiratory tract.
- Mortally wounded are those who have a deep burn of the body (50% or more), as well as the elderly, with thirty percent of the surface affected. Such victims are given only symptomatic treatment. Victims of large-scale industrial disasters may have 90% of body burns. This is fatal damage, and in this case it is impossible to help, you can only try to alleviate their suffering with strong analgesics (artificial coma) or give inhalation anesthesia.
First aid
For a good prognosis, self-help and mutual assistance play a large role. The speed of the reaction can significantly reduce the area of the burn and its depth. First of all, it is necessary to interrupt the contact between the traumatic agent and the person, for example, put out the fire or turn off the power, flush / neutralize the chemical reagent.
At the pre-medical stage, it is not recommended to use oil-based ointments and other fat-containing agents, since they form a film on the surface of the wound and do not allow heat to escape. In addition, the hospital will also have to remove the “medical pollution”, causing pain to the victim. It is not necessary to treat the wound at home, such as the removal of foreign bodies, particles of charred skin and the like. This can lead to infection, because the proper aseptic / antiseptic regimen will not be respected. Plus, without proper pain relief, the person you are trying to help is likely to fall into a state of pain shock.
Anesthesia and Wound Treatment
Depending on the severity of the patient's condition, the anesthetist selects the appropriate drug and anesthesia technique. It can be non-steroidal anti-inflammatory drugs, analgesics, antipyretics or local conduction anesthesia. For severe cases, narcotic analgesics are suitable.
After the injury site has been anesthetized, the surgeon proceeds to the initial treatment of the wound surface. It exfoliates the epidermis, opens or drains the bubbles, foreign bodies are taken out. Then, the cleaned wound surface is covered with a clean gauze dressing. For burns of the second or more degrees, the patient must enter tetanus toxoid.
Local treatment
There are two known methods for treating burns - indoor and outdoor. They can be used both individually and together. In order to prevent infection of the wound, it is actively dried so that dry necrosis appears. The open method is based on this. Substances, for example, alcohol solutions of halogens, which can coagulate proteins, are applied to the wound surface. In addition, physiotherapeutic methods such as infrared radiation can be used.
Closed treatment implies the presence of dressings that prevent bacteria from entering, and the drains provide fluid outflow. Under the bandage, drugs are applied that promote granulation of the wound, improve fluid outflow and have antiseptic properties. Most often, for this method, broad-spectrum antibiotics are used, which have a complex effect.