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Burns

A burn is tissue damage due to careless handling of fire, chemicals, and electricity.

Pathophysiology

• Burn damage - open damage or destruction of the skin, its appendages, mucous membranes by thermal, chemical, electrical factors, radiation energy, or a combination thereof. For burns, not only the type of damage factor is important, but also the duration (exposure) of its action.

• According to the factor that caused the damage, burns are divided into: thermal, electrical, chemical, radiation (radiation).

• The largest proportion in the structure of all burns is thermal burns. The intensity of tissue heating depends on several factors: physical characteristics of the thermal agent (solid, liquid, gaseous); heat transfer method (conducting, convection, radiation, evaporation); from the duration of heating; heat-protective properties of the protective coating of the skin (a thick layer of the epidermis, clothing, and the like).

• Victims of electric burns make up 8% of inpatients in specialized burn wards.

• Chemical burn injuries are less common than thermal and electrical burns. They are a consequence of the actions of harmful agents - chemicals (mainly acids and alkalis). Chemical damage is usually much deeper than it appears at the initial inspection. There are five factors that determine the severity of damage caused by a given chemical agent: the strength of the agent is what enters into a chemical reaction with tissue with a greater or lesser intensity; amount of agent - depends on the volume and concentration of the agent; method and duration of contact: the longer and stronger contact of the agent with the tissue, the stronger and deeper the destruction; degree of penetration - varies greatly depending on the degree to which the agent is neutralized or binds to tissues; mechanism of action.

• A relatively rare type of lesion is radiation burns, which appear during prolonged exposure to the surface of the skin of radioactive substances emitting a- and p-particles, or under the external influence of γ-radiation and neutron radiation. Radiation burns are sometimes called radiation dermatitis. It is characteristic that the clinical picture is very dependent on the dose of radiation absorption in the skin. Y- and neutron radiation affects all layers of the skin and underlying tissue. Unlike them,? - and? -Radiation affects mainly only the surface of the skin.

• Burn shock - a pathological condition that occurs in response to significant burns of the skin, mucous membranes, underlying tissues and leading to severe disorders in the body of the burned, to the formation of a critical condition.

• With superficial burns, when they occupy an area greater than 30% bp in adults, and with deep burns (III-IV degrees), when they occupy an area greater than 10% bp in adults or 5% - in children and the elderly - usually a burn disease develops. Burns of the IV degree can sometimes cause a burn disease even with an area of ​​3%.

Initial inspection

• Check the vital parameters of the patient, note the presence or absence of hypotension, which may be a sign of shock, a decrease in oxygen saturation.

There are 4 degrees of burns. Burns of the I-II degree are superficial and heal without scarring. Burns of the III degree are deep, accompanied by scarring. For their healing, you often have to resort to free skin plastic. With burns of the fourth degree, limb necrosis may occur, requiring amputation. Burns of the first degree are characterized by persistent hyperemia of burnt skin, severe pain; with II degree burns, against the background of hyperemic skin, bubbles of various sizes arise, filled with transparent contents; with III degree burns, against the background of areas of hyperemia, opened blisters, areas of white (“pig”) skin with scraps of the epidermis are visible; IV degree burn - carbonization of the skin.
The degree of burn is determined on the basis of characteristic symptoms, area - according to the "rule of nines" (head - 9%, arm - 9%, front surface of the trunk 1 8%, leg - 18%, genitals and perineum - 1%) or according to the "rule palms ”, remembering that the area of ​​the palm is approximately 1% of the surface area of ​​the skin. Extensive burns (superficial - more than 30% of the skin area, deep - more than 10%) are complicated by burn shock, which is characterized by a long erectile phase with psychomotor agitation, and moderately high blood pressure.

• Find out what caused the burn.

• Listen to the lungs for wheezing, note the presence or absence of shortness of breath, difficulty breathing.

• Listen to the heart rhythm, note the nature of the abnormalities (rapid or rare heartbeat, etc.).

• Determine the depth of tissue damage.

• If you suspect a burn II or more, note that the patient has chills, headache, swelling, nausea, and vomiting.

• With burns of the II degree of severity, blisters appear on the skin, with the III degree of burns, the skin is brown or black, without bubbles.

• Check if there is a burn of the respiratory organs; if necessary, immediately begin pulmonological resuscitation.

• Check your heart rate.

First aid

• Provide additional oxygen access, if necessary, prepare the patient for endotracheal intubation and mechanical ventilation.

• Place patient in Fowler position.

• Establish continuous monitoring of cardiac activity.

• Remove clothing from the patient in the burn area, remove rings, bracelets, watches, and other items pinching the skin.

• For minor burns, apply cold compresses.

• Cover the area of ​​damage with an antibacterial dressing.

• Perform tetanus prophylaxis.

• In case of severe burns, prepare the patient for excision of a burn scab.

• As directed by your doctor, administer painkillers. Drugs must be administered intravenously, and not intramuscularly, since damaged tissues can interfere with the complete absorption of the drug.

• Take measures to prevent hypovolemia.

• If necessary, as directed by your doctor, start antibiotic therapy.

• Use bronchodilators.

• Prepare the patient for transfer to the burn department.

Following actions

• Check vital signs of the patient, monitor cardiac, respiratory, neurovascular and neurological status.

• Blood analysis.

• Determine the gas composition of the blood.

• Take a urine test for myoglobinuria and hemoglobinuria.

• Install a urinary catheter.

• Monitor fluid intake and excretion.

• Watch for signs of infection.

• For chemical burns, ensure that the surface of the burn is washed frequently with saline.

• If necessary, prepare the patient for surgery (tissue transplant, etc.).

• Weigh the patient daily.

• Keep the patient calm.

Preventive measures

• It is necessary to promote the basics of life safety (parents should remove matches, vinegar, chemicals, keep mugs of boiling water, etc. out of the reach of children, observe safety precautions when using candles, heaters, gas and electric stoves, you need to monitor the condition of the wiring in the house, if possible, keep a fire extinguisher in the car at home, and always)

• Warning that smoking in bed is not permitted.

• Explain the importance of reporting a gas odor to the gas service.
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Burns

  1. Burns
    A burn is an injury that occurs when a body is exposed to high temperature, aggressive chemicals, electric current, and ionizing radiation. Burned is a person who has suffered a thermal injury. The frequency of burns is 5-10% of the total number of peacetime injuries. In the structure of burn injury, household burns prevail. A third of the number of burned are children.
  2. Burns
    Clinical characteristics of burns in children Burns are injuries to the skin and other tissues that occur under the influence of a thermal, chemical, electrical or radiation agent. Depending on the depth of the lesion, the following degrees of tissue damage in children are distinguished: 1) burns of the first degree - damage to the upper layers of the epidermis, redness and swelling of the skin, pain in the area of ​​damage; 2) burns II
  3. Burns
    Burns (burnio) - damage to body tissues resulting from local effects of high temperature, chemicals, electric current or ionizing radiation. On the etiological basis, thermal, chemical, electrical and radiation burns are distinguished. Thermal burns are I-IV degrees. A degree I burn, or superficial burn, is characterized by the appearance of pain
  4. Burns
    Damage to tissues from exposure to high temperature (thermal burns) or chemicals (chemical burns) or both factors (thermochemical burns). The depth of the lesion distinguishes surface burns (I, II, GPA art.) And deep (111B, IV art.). If the lesion exceeds 10-20% of the body surface with a superficial burn or 5-10% - with a deep burn, a "burn disease" develops, in
  5. BURNS
    A burn is tissue damage caused by high temperatures (thermal burns) or caustic chemicals (chemical burns). The main cause of burn injuries in cats is the carelessness of the owners. Symptoms Depending on the severity of the lesion, redness, swelling and soreness of the skin, the appearance of blisters with their subsequent breakthrough, carbonization and tissue necrosis are observed.
  6. Burns
    Thermal lesions are a fairly common occurrence in childhood, often they lead to disability and death. Burns make up 1/5 of all household injuries requiring treatment in a hospital setting. Most often, burns in children occur due to exposure to high temperature fluids (hot water, milk, soup), flame burns are less common, and even less often chemical
  7. Eye burns
    CLASSIFICATION By etiology, eye burns are divided into: ¦ chemical; ¦ thermal; ¦ radiant energy (during powerful flashes, explosions, voltaic arc, exposure to intense visible light with a significant proportion of ultraviolet radiation). The severity distinguishes: ¦ Light severity (I degree). ¦ Moderate severity (II degree). ¦ Severe burns (grade III). CLINICAL PICTURE Clinical picture
  8. Burns of the pharynx and larynx
    There are thermal and chemical burns. Thermal burns occur when exposed to hot liquids, vapors, gases. Chemical burns are more common. They are observed when swallowing acids and alkalis by mistake or with the aim of suicide. The most common burns are vinegar essence, ammonia and caustic soda. The degree of burn (from catarrh to necrosis) depends on
  9. Burns
    Burns occur as a result of damage to the integumentary tissues by high temperature, electric shock, aggressive chemicals and ionizing radiation. D - ka: In the diagnosis of burns, 4 degrees are distinguished: 1 degree - redness and swelling of the skin; 2 degree - detachment of the epidermis with the formation of blisters. The bottom of the blisters is bright pink, very painful. 3 degree "a" -
  10. Larynx burns
    Larynx burns are of two types - chemical and thermal. As a rule, they are combined with damage to the oral cavity, pharynx, and when swallowing poisonous or hot matter, the esophagus (see. “Burns of the pharynx and esophagus”). Chemical burns occur as a result of ingestion or inhalation of concentrated chemical solutions (acids, alkalis, etc.). Most often affected
  11. Burns
    Burns occur as a result of damage to integumentary tissues by high temperature, electric shock, harsh chemicals and ionizing radiation. DIAGNOSTICS There are 4 degrees of burns: - I degree - redness and swelling of the skin. - II degree - detachment of the epidermis with the formation of blisters. The bottom of the blisters is bright pink, very painful. - ІІІА degree - skin damage to
  12. Thermal burns
    Thermal burns are a type of injury that occurs as a result of exposure to body tissues of high temperature (flame, steam, boiling water, hot metals, gases, electromagnetic radiation of the optical range). Clinical diagnosis The severity of the condition of the affected child is determined by the depth and prevalence of tissue damage and manifestations of burn shock. Distinguish
  13. Burns
    Burn - damage to the skin and underlying tissues arising from local thermal, chemical, electrical or radiation exposure. Thermal burns Thermal burns arise from direct exposure to high temperatures (flame, boiling water, burning liquids, etc.). The severity of the damage depends on the height of the temperature, the duration of exposure, the extent of the lesion and location
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