Burns are injuries caused by thermal, chemical, or radiation energy. The severity of the burn is determined by the size of the area and the depth of tissue damage. There are four grades.
- I degree – hyperemia (redness) and swelling of the skin.
- II degree – the formation of blisters filled with a clear yellowish liquid.
- IIIA degree – the spread of necrosis to the entire or almost the entire epidermis.
- IIIB degree – necrosis of all layers of the skin.
- IV degree – necrosis of not only the skin, but also deep tissues (fascia, tendons, bones).
To determine the severity of the burn, the measurement of the affected area is of great importance. For a quick but approximate clarification, the rule of “palms” or “nines” is used. The entire area of the human body is divided into multiples of nine: the palm of the victim is approximately 1%, the head and neck – 9%, the chest and abdomen – 18%, the back and buttocks – 18%, the upper limbs – 9% each, the lower limbs – each 18%, perineum – 1%.
Symptoms and course. Small burns proceed as a local process. With more significant lesions in the burnt, serious general disorders are observed. During this disease, periods of burn shock, acute burn toxemia, burn septicotoxemia and convalescence (recovery) are distinguished.
Shock develops due to irritation of a huge number of nerve elements in the affected area. The larger the area of the burn, the more frequent and severe the shock. With burns of more than 50% of the plane of the body, it is observed in all victims and is the main cause of their death.
Toxemia (poisoning of the body by tissue decay products) begins from the first hours after the burn, gradually increases and, after the shock comes out, determines the condition of the patient in the future (the toxemia phase during the burn). With burns, hypoproteinemia (lack of proteins), metabolic disorders are noted.
With the development of an infection of the naked plane, the temperature rises, chills are detected, leukocytosis and neutrophilia increase, anemia develops, etc., septic phenomena increase (the septic phase of the burn course).
Severe and extensive burns are accompanied by lethargy, drowsiness, vomiting, convulsions, and cold sweat appears. Blood pressure decreases, the pulse becomes frequent and small, the temperature decreases, severe intoxication, dehydration and hypoproteinemia increase, which is associated with a large loss of plasma. In especially severe cases, there are violations of the liver and kidneys, bleeding from the mucous membranes appears, sometimes ulcers form on the mucous membrane of the gastrointestinal tract.
Local changes in burns have the following sequence: under the influence of high temperature, hyperemia develops, leading to inflammatory exudation of tissues, the development of edema. Part of the tissue dies as a result of direct exposure to high temperature or in connection with circulatory disorders. Inflammatory exudate, tissue breakdown products act on nerve formations, causing severe pain.
In patients with I degree burns, circulatory disorders and inflammatory exudation soon stop, swelling is reduced, pain disappears and the process is eliminated.
With second-degree burns, all phenomena also gradually subside, the exudate is absorbed, the burn surface is epithelialized, and recovery begins after 14-16 days.
At infection of burns of the II degree the purulent process develops. In these cases, healing is delayed for several weeks or even months.
Necrotization of the entire thickness of the skin, and sometimes deep tissues with III-IV degree burns, leads to the process of rejection of dead tissues, then the defect must be filled with granulations with the formation of a scar. Extensive scars in secondary healing do not often restrict movement (scar contractures).
First aid at the scene is required to ensure the termination of the traumatic agent, the prevention of infection of the burn plane, shock and the evacuation of the victim to a medical facility. Having stopped exposure to high temperature (removal from the fire, removal of hot objects, etc.), the affected areas of the body are removed or, which is less traumatic, clothes are cut off and an aseptic bandage is applied to the burnt planes and painkillers are injected. After that, they are immediately sent to a medical institution.
In the hospital, urgent measures are taken to eliminate shock, after which tetanus toxoid is injected and the burn plane is treated first.
Treatment. The choice of method is determined by the severity of the burn, the time elapsed since the injury, the nature of the primary treatment and the setting in which the treatment will be carried out. Most patients with burns need hospital treatment. A good analgesic effect is given by dressings with a 0.5% solution of novocaine.
Chemical burns are the result of the action on tissues of substances that have a pronounced cauterizing effect (strong acids, alkalis, salts of heavy metals, phosphorus). Most chemical burns of the skin are industrial, and the mucous membranes of the mouth, esophagus, and stomach are more often domestic.
The impact of strong acids and salts of heavy metals on tissues leads to coagulation, coagulation of proteins and their dehydration, therefore, coagulation necrosis of tissues begins with the formation of a dense crust of dead tissues, which interferes with the action of acids on deep tissues.
Alkalis do not coagulate proteins, but dissolve them, saponify fats (colliquation necrosis) and cause deeper necrosis of tissues, which take the form of a white, soft scab.
Determining the degree of a chemical burn in the first days is difficult due to the scarcity of clinical manifestations. Often, in the subsequent course of a burn, a greater depth of damage is revealed than was determined in the first days. After healing, rough, deep scars are traditionally formed. The processes of cleansing the wound from necrotic tissues and regeneration in chemical burns are slow and sluggish. They are also characterized by an almost complete absence of changes in the state of the body, shock and toxemia almost never occur.
First aid for chemical burns consists in immediately washing the affected surface with a jet of water to reduce the concentration of acid or alkali and stop their action. After washing with water, you can begin to neutralize the acid residues with a 2% solution of sodium bicarbonate, and for burns with alkalis, with a 2% solution of acetic or citric acid.
Phosphorus burns are deep, because when it comes into contact with the skin, phosphorus continues to burn. First aid consists in immediately immersing the naked plane in water or in abundant irrigation with water to extinguish the phosphorus. At the same time, the surface is cleaned of pieces of phosphorus with tweezers. After washing, lotions with a 5% solution of copper sulfate are applied to the burned surface. Further treatment is carried out as with other burns, but with the exception of ointment dressings, which can enhance the fixation and absorption of phosphorus.