A characteristic sign of a thermal burn of the 1st degree. Degrees of burns - types of lesions and first aid algorithm

Burns are open damage to body tissues by thermal, electrical sources, chemically active substances, and radiation.

Classification of burns by degrees

Depending on the depth of the lesion, it is customary to distinguish 4 degrees of burns.

This is a mild burn skin inflammation develops.

The skin becomes red, swollen and sore.

These symptoms are observed for about a week, then the surface layer of the skin dies off. At the site of the burn, pigment spots remain. The skin is flaky.

Arise bubbles with a clear or turbid, slightly yellowish liquid.

The burn site is very sore, the skin is red, inflamed.

The wound spontaneously closes after 10-15 days without scarring.

At this stage tissue cells die. III degree is divided into III A and III B.

III A

The surface of the skin dies.

Cells of sweat, sebaceous glands, hair follicles are preserved.

III B

All layers die. A dense, thick scab is formed from coagulated proteins and blood.

A granular, easily bleeding granulation tissue develops, protecting the wound from external influences. Gradually, it is replaced by connective tissue.

A deep star-shaped scar is formed.

IV degree

The most severe form of burn.

Under the influence of high temperatures tissues are charred. The process includes all layers of the skin, nerve endings, tendons, bones, muscles.

Due to decay products, internal organs suffer and lose functionality, the composition of the blood changes.

Burn shock develops and lasts up to 3 days. At first, it is manifested by increased pressure and excitability of the victim. These processes are replaced by inhibition, indifference.

The patient's skin is pale, with an earthy tint. Possible lethal outcome.

Burns I - III A degree heal on their own. III B and IV degree requires surgical intervention.

What are burns

Depending on the source of damage, burns are classified into thermal, chemical, electrical and radiation.

Thermal

Thermal burns, the origin of which is due to thermal exposure, account for about 95% of all burn injuries.

Most of them are domestic injuries..

In half of the cases, the cause of thermal burns is fire, less often - hot steam, boiling water, contact with hot objects, molten materials.

Thermal damage can cover the skin, mouth, respiratory tract, esophagus and stomach.

Head burns are the most dangerous, as they are accompanied by injuries to the eyes, respiratory organs and strongly affect the patient's condition.

In 47% of cases, thermal burns are localized on the legs.

Perineal burns are extremely dangerous, because. lead to injuries and loss of functionality of the pelvic organs.

Burning 1/3 of the surface of the body can lead to death.

The critical level of heating of the skin - 45°C. If it lasts longer than a minute, the properties of the protein change, cells are destroyed, the respiration of tissues is paralyzed and the metabolism in them is destroyed. At the same time, overheating continues, even if the thermal source has ceased its operation.

The spread of the burn can be stopped if the tissues are quickly cooled.

Tissue that has become dead under the influence of high temperature is called a scab. Heating tissues up to 60 ° C forms a wet scab (colliquation), with higher heating - a dry (coagulation) scab. The density and size of the scab varies.

The degree of damage to thermal burns depends on a number of factors:

Temperatures. The burn occurs when the temperature reaches 45 ° C and is aggravated when it rises.
Thermal conductivity of a substance(air, water, metal, etc.) in contact with the body. Centigrade air in the sauna will not cause harm, however, boiling water of the same temperature can be fatal. The higher the thermal conductivity, the more serious the injury.
Duration contact with a heat source.
Air humidity level(the burn is aggravated by high humidity).
General physical condition the victim and his outer coverings.

In extensive burn injuries, burn shock.

Burn shock is a syndrome of deep burns.

Externally manifested by muscle tremors, convulsions, chills, rapid breathing, tachycardia, thirst, nausea and vomiting. The skin becomes gray, dry, cold.

First, the victim is excited, then apathy sets in.

The consciousness of the victim becomes confused or lost.

Chemical

Chemical burns appear due to unprotected contact with acids and salts of heavy metals.

The proportion of chemical burns is about 7%.

As a rule, they happen in chemical industries or in laboratories.

Acting from the outside, concentrated acid affects the outer skin and mucous membranes. If the acid is taken orally, digestive organs suffer.

The clinic of chemical burns is determined by the source of the lesion:

Reaction to acids and salts of heavy metals

A dark crust of coagulated blood and dead tissue (eschar) forms on the wound. It prevents the introduction of the chemical agent. Redness and swelling are moderate.

Thermal burns with alkalis

The eschar is white, soft, moist. Alkaline burns are harsher than acid burns. They do not interfere with the penetration of alkali, respectively, the burn goes deep. A deep burn with alkalis is characterized by a voluminous swamp-colored scab, severe redness and swelling.

Chemical burns have more than just external symptoms. Often chemical compounds, once in the body, affect the kidneys and liver.

Chemical burns are characterized by slow wound healing and tissue regeneration. Burn shock is rare.

Electrical

An electrical burn, or electrical injury, occurs upon contact with household or atmospheric electricity.

Alternating current above 120 V threatens human life.

Electrical injury features:

Tunneling. The current destroys not only the outer covers, but also penetrates the body of the victim.
Non-contact defeat, impact at a distance.
The quality of the skin of the victim is of great importance: its thickness and moisture content.

As a rule, electrical injuries occur due to equipment breakdown or non-compliance with safety regulations.

Contact electrical burns form the so-called "current marks". They are indicated at the points of entry, exit and on the path of electric current. They are skin lesions up to three centimeters in diameter with a charred depression in the center and a thickening along the edges. Healthy skin around the burn area resembles a honeycomb. Due to damage to the nerve fibers, it practically does not hurt.

Multiple electrical burns are explained by contact with several current-carrying units.

In the event of a clothing fire electrical burn can be combined with thermal.

A combined lesion is often observed: victims, receiving an electric shock, recline sharply and receive mechanical tissue damage, craniocerebral injuries, and break bones.

Weak electric burns practically do not happen.

As a rule, they cause necrosis of the skin, subcutaneous tissues, muscles and bones, damage to blood vessels and thrombosis.

It is almost impossible to determine the depth of electric burn injury. As a rule, what is seen on the surface does not correspond to the true extent of the injury.

Minor current marks after healing leave scars behind. Extensive electrical burns are accompanied by inflammatory processes, suppuration, rejection of dead tissues, and bleeding.

Radiation

A fairly rare type of skin lesions. Radiation burns, or radiation dermatitis, occur due to the effects of radiation on the body.

Manifestations resemble a sunburn.

Occur during nuclear accidents, radiation therapy, X-ray studies.

The course of the disease is determined by the type and dose of radiation.

The peculiarity of radiation injury is that it does not appear immediately and occurs on several areas of the skin. Radiation burn has several stages in development:

Initial

Accompanied by redness (erythema), small rash, swelling. Lasts up to two days.

Hidden

Lasts up to three weeks. Defeat does not show up outwardly.

Acute inflammatory process

Blisters appear, increase and open, erosions and ulcers occur. This period can last several months;

Recovery

May last for years. Erosions and ulcers heal. The affected skin atrophies and flakes off. There is hair loss and brittle nails.

Radiation burn can lead to chronic radiation sickness, which is expressed in chronic fatigue, weakness, vascular dystonia, dysfunction of organs, bleeding.

Definition of severity

In assessing the severity of a burn injury, the leading place is occupied by determination of the area of the burn.

There are unified counting methods adopted throughout the world. Their results are not 100% accurate due to differences in age, weight, individual characteristics of the victims.

The method is based on the fact that the area of the palm of an adult is approximately 1% of the total. That is, how many palms fit into the burn area, this is the percentage of the lesion.

The measurer must correlate the size of his hand with the hand of the victim.

Percentages are neglected.

When counting, the human body is divided into anatomical regions, each of which is 9% of the total area, or a multiple of nine:

head and neck - 9%;
one hand - 9%;
one thigh - 9%;
one lower leg and one foot - 9%;
torso in front - 18% (9% each for chest and abdomen);
back torso - 18%.

The crotch area is taken as 1%.

For children's burns, it is taken into account that the child's head and neck make up approximately 21%.

Method B.N. Postnikova

Burns are outlined on cellophane or gauze. Then the drawing is applied to graph paper and its area is calculated.

The percentage of burn is determined by the table.

Method G.D. Vilyavina

Similar to the previous one. The silhouette of a person is drawn on a grid, each square of which corresponds to 1 cm² of the body surface. The burn is sketched on this contour, while the drawing is painted in different colors depending on the depth of the lesion.

The result of extensive burns can be a burn disease, in which organs and systems lose their functions, neuropsychiatric disorders, heart disease, pulmonary edema, and anemia are recorded.

The most dangerous for human life and health, but the latter is diagnosed much less frequently. Let us consider in detail under what conditions and from what it is possible to get a third-degree burn, what it is fraught with, how to provide first aid and how long the treatment will last.

Classification of burns by degrees

As already mentioned, burns are usually classified according to degrees, depending on the depth of damage to the skin.

First degree burn. After contact with the influencing factor, the skin slightly reddens and swells. The injury does not require special treatment and heals on its own after 5-7 days. The scar from the burn does not remain.
Second degree burn. Redness and swelling is accompanied by swelling of the upper layer of the skin and the formation of blisters filled with yellow liquid. When the bladder is pierced, a bright red layer of skin is visible, touching it causes severe pain to the victim. The probability is high therefore the healing period is approximately two weeks.
Third degree burn. It is characterized by the cessation of tissue vital activity (necrosis), the wound is covered with a gray or brown crust.

Fourth degree burns. The most severe and deep damage to the skin. Characteristic features are blackening or charring of the injured area, in certain cases involving bones in the process. The recovery period is long, deep scars remain at the site of exposure.

If a person has suffered damage to the cervical region or joints during fourth-degree burns, motor activity will be noticeably impaired during the formation of scars.

Third degree burns

In medicine, it is customary to separate burns of the third degree.

Form 3-A

When an injury of this form occurs, the patient has a complete lesion of the epidermis. The dermis is partially and shallowly affected. The main part of the basal layer stops its activity and dies. The germinal layer, which is responsible for the restoration of skin cells, is partially damaged. The remaining, deep layers, fully retain their functional abilities.

In the injured area, the patient practically does not feel touch. Reinforced is accompanied by increased pain reactions of the body. An accurate diagnosis requires constant medical supervision and monitoring of the regenerative abilities of the skin.

Form 3-B

The lesion is characterized by complete necrosis of the skin in the injured area. To the damage of the skin indicated in degree 3-A, the cessation of the vital activity of the subcutaneous tissue is added.

In the clinical picture, doctors note the complete absence of pain and reactions to tactile contact in the patient. The process of blood circulation and metabolism of the skin are disturbed.

The concept and clinic of thermal burns

Thermal burns occur when the skin comes into contact with high temperatures of various origins. With severe damage, tissue necrosis and severe redness occur. The surface of the affected area is dry or wet, depending on the nature of the thermal exposure. Upon contact with steam or boiling water, the patient will have wet necrosis. The skin becomes red-yellow or red-brown in color and covered with fluid-filled blisters. The nature of the damage can be compared with the process of melting skin tissues.

On contact with hot objects, such as iron or iron, dry-type necrosis occurs. The skin at the site of exposure is covered with a dense crust, has a dark color, in severe cases it can turn black. The boundaries of the wound are clearly visible. All degrees of thermal burns heal with the subsequent formation of scars on the tissues. In exceptional cases, while maintaining even the slightest sections of the epithelial layer, skin regeneration is possible.

The concept and clinic of a chemical burn

In a person who has received treatment, it should be carried out as directed and after examining the patient by doctors. Damage to the skin of this type can be obtained by contact with aggressive substances, such as alkalis or acids. If a person received a third-degree chemical burn, all layers of the skin in the injured area undergo necrosis. The top layer of the wound is covered with a dark, hard, immovable crust. Tactile contact is not sensitive.

The final diagnosis regarding the degree of damage is possible only after the rejection of dead areas. The majority of burns are diagnosed in the third degree.

For those who received a chemical burn, the treatment and wound healing process is long. Approximately three weeks are needed for the complete rejection of the scab. As a result, deep scars form at the site of the lesion.

Characteristic manifestations of a burn

The main signs of third-degree burns are a change in the surface layers of the skin from a natural color to a dark red tint. In places where the epithelium has completely stopped its vital activity, the skin color becomes black, which indicates that the place of contact with the influencing factor is hyperpigmented.

Depending on the nature of the burn, fluid-filled vesicles, crusts of a dense dark brown structure, erosions and ulcers may appear on the injured area.

A third-degree burn of category "A" is classified as superficial, category "B" is a deep lesion.

Third degree burn clinic

In most cases, patients who have received a third-degree burn, in addition to the main signs of injury, complain about a deterioration in well-being. With a global lesion, body temperature may rise, there is a feeling of nausea with bouts of vomiting.

A small tissue outgrowth forms on the border of the injured area of the skin, which forms approximately 2 months after the burn. This is due to the epithelialization of damaged skin and the growth of a new layer. Its edges are convex, granulated.

If the burn does not exceed two centimeters in diameter, its self-healing is permissible, but it is necessary to create conditions to prevent infection, as well as intoxication of the body. Such treatment with the use of antiseptic drugs is performed in a clinic.

With the defeat of the germ layer, doctors note the formation of scars.

How to give first aid to the victim

It is not possible to cure a third-degree burn on your own. Therapeutic procedures are represented by a set of measures that help relieve pain and restore the skin.

Due to these features of the injury, the victim should be taken to the burn center or call for emergency care as soon as possible. In about 80% of clinical cases, the patient needs surgical intervention.

The first aid complex is based on the following algorithm:

isolation of the victim from the influencing factor;
with a small area of damage, the injured area, if possible, lift up;
put a sterile napkin on the burn site.

It should be noted that a patient who has received a third-degree burn is strictly forbidden to give painkillers. This will only aggravate the process of taking anamnesis and add ambiguity to the clinical picture.

Treatment of third degree burns

If the patient is brought to the burn center, this guarantees that he will receive the correct medical care in a timely manner. Patients with such injuries are treated in a hospital setting. Self-treatment of third-degree burns is strictly prohibited.

Primarily, doctors relieve pain. For this, painkillers of the narcotic group are used. The surface of the wound is regularly sprayed with an antiseptic, the rest of the drugs are administered intravenously according to the developed scheme.

A third-degree burn is treated only in a complex way, therefore, painkillers are prescribed:

Drugs that block an attack of anaphylactic shock.
Glucocorticosteroids that suppress the inflammatory process.
Regular dressing changes.
Sedative drugs.
Medicines that eliminate post-traumatic shock.
Droppers for removing toxins.
Droppers that make up for the lack of fluid.

If the lesion is large-scale, it requires surgical treatment in several stages of a third-degree burn. How much an injury is treated depends on the area of the lesion. After 20 days, the process of reparation of the skin will be noticeable, complete healing lasts about three months. With extensive damage to the skin by chemical agents or thermal exposure, a burn scar always remains and looks like a scar.

Inadmissible measures of the third degree

If there are people near the victim, they should know a number of actions that will not help the patient and aggravate the course of treatment.

So, with burns it is forbidden:

wash the site of exposure with cold water, antiseptic and other medications;
apply frozen food or ice to the affected area;
remove clothes from the victim;
give any medication.

The only correct action that others can take for the victim is to transport him to the clinic as soon as possible or call an ambulance.

The concept of "degree of burns" is used to classify the injuries received by victims of thermal, chemical, electrical or radiation burns. From how large the area of the affected skin surface is and how deeply the burn has penetrated into the tissues, it is assigned a degree from the first to the fourth.

For more effective rendering, one should have an idea of the severity of the burn. We offer to understand the classification and find out what actions should be taken with symptoms of burns of varying degrees.

1st degree burn

Remember how your shoulders once “burned out” on the beach. Or you burned your hand with boiling water in the kitchen. This is a 1st degree burn. When exposed to a damaging factor, superficial damage to the upper layers of the skin (epidermis) occurs. There are painful sensations, redness and swelling of the skin, small erythema (inflammation of the skin caused by the expansion of capillaries) at the site of the burn.

First aid

A 1st degree burn does not require special treatment. It is enough to cool the burn area under cool water. After 2-4 days, the burn will pass by itself, leaving behind a slight itching and peeling of the skin at the site of injury.

2nd degree burn

A 2nd degree burn is characterized by the formation of vesicles (vesicles up to 1.5 cm in diameter). Such a burn affects the top 2 layers of the skin - the epidermis and dermis. Often accompanied by severe pain, which can last up to 2 days.

It should be noted that with a 2nd degree burn, the area of the affected surface should also be taken into account. This circumstance is important, because with a significant area of the burn, even if its degree does not exceed the second, there is a danger of developing burn shock and further burn disease, and these terrible complications require inpatient treatment. So if you fell asleep on the beach under the scorching sun, and your whole body has acquired a bright crimson color - this can already lead to and serve as a reason for hospitalization.

First aid for 2nd degree burns

Cool the affected area (cold water or a cool, damp compress). We give the victim an analgesic (analgesic or an analgesic and anti-inflammatory combined agent such as ketanov or ketoralak) and provide plenty of fluids. In no case do we pierce the formed blisters, as this threatens to introduce an infection into the wound. If the affected area is more than 10% of the skin, or the victim is elderly with comorbidities, hospitalization and inpatient treatment are necessary.

3rd degree burn

3rd degree burns are divided into 2 subgroups: A and B. The difference lies in the depth of the skin lesion and is only a few millimeters. But for the victim, this seemingly small difference can be quite noticeable. The thing is that 3rd degree B burns affect the growth layer of the skin to the subcutaneous fat. There is burn shock, complete damage to the epidermis, the appearance of bullae (large blisters with a diameter of more than 2 cm), erosions and ulcers on the skin.

Burns of the 3rd degree may appear due to exposure to flame, hot metal surfaces, when the clothes on the victim are ignited. Also, exposure to high concentrations of chemicals (acids, alkalis, etc.) on the skin can lead to severe chemical burns.

What to do with a 3rd degree burn?

The first step is to distance yourself from the damaging factor, or, if the victim is unconscious, move him away from the source of the lesion (knock the flame off his clothes, pull him away from open fire). Then you need to call an ambulance. Before the arrival of specialists, the victim must be relieved of pain shock. For this, it is best to use solutions of analgesics (morphine, promedone, pantopon). Simultaneously it is necessary to enter (diphenhydramine, suprastin, travegil).

For local treatment of burns, sterile dressings with a 33% solution of medical alcohol can be used.

4th degree burn

Deep burns of the 4th degree are characterized by the complete destruction of the skin, damage to tissues, muscles, tendons and bones. A dense dark brown or dark brown scab forms on damaged surfaces. At the edges of the burn, thrombosed veins and hanging films of thin epidermis remain open.
With a 4th degree burn, the victim experiences a severe pain shock: breathing and pulse become more frequent, blood pressure rises. The next (torpid) phase of shock is accompanied by lethargy and confusion, nausea and vomiting, and the pressure slowly decreases.

Deep burn 4 degrees - what to do?

The sequence of urgent actions for a 4th degree burn is as follows:

Calling an ambulance or speedy delivery of the victim to the emergency room;

If possible, pain relief with analgesics;

Before the arrival of doctors, it is important to lay the victim in a horizontal position, provide him with peace and warm drink.

Further assistance should be provided in a medical facility.

Dmitry Belov

pruritus

diaper rash

dermatitis

peeling and dry skin

cuts

frostbite

abrasions

calluses

Burns: types of burns and degrees, treatment of burns with GUARDIAN balm

burns is damage to body tissues caused by exposure to heat or chemicals. Electric shock, as well as exposure to ionizing radiation (ultraviolet, x-ray, etc., including solar radiation), can also lead to a burn.

Often, burns are also called skin lesions caused by the irritating effect of the plant (nettle burn, hogweed burn, hot pepper burn), although in fact this is not a burn - it is phytodermatitis.

Depending on the area of tissue damage, burns are divided into burns of the skin, eyes, mucous membranes, burns of the respiratory tract, esophagus, stomach, etc. The most common are, of course, skin burns, so in the future we will consider this particular type of burns.

severity burn determined by the depth and area of tissue damage. The concept of "burn area" is used to characterize the area of skin lesions, and is expressed as a percentage. To classify the depth of the burn, the concept of "degree of burn" is used.

Types of burns

Depending on the damaging factor, skin burns are divided into:

thermal,
chemical,
electrical,
sun and other radiation burns (from ultraviolet and other types of radiation)

Thermal burn

Thermal burns are the result of exposure to high temperatures. This is the most common domestic injury. Arise as a result of exposure to open fire, steam, hot liquid (boiling water, hot oil), hot objects. The most dangerous, of course, is open fire, since in this case the organs of vision, the upper respiratory tract can be affected. Hot steam is also dangerous for the respiratory tract. Burns from hot liquids or incandescent objects are usually not very large in area, but deep.

chemical burn

Chemical burn occurs as a result of exposure to the skin of chemically active substances: acids, alkalis, salts of heavy metals. Dangerous with a large area of damage, as well as if chemicals get on the mucous membranes and eyes.

electrical burns

Electric shock is characterized by the presence of several burns of a small area, but of great depth. Volt arc burns are superficial, similar to flame burns and occur during short circuits without current passing through the body of the victim.

Radiation burns

This type of burns include burns resulting from exposure to light or ionizing radiation. So, solar radiation can cause the well-known sunburn. The depth of such a burn is usually 1st, rarely 2nd degree. A similar burn can also be caused by artificial ultraviolet irradiation. The degree of damage in radiation burns depends on the wavelength, intensity of radiation and the duration of its exposure.

Burns from ionizing radiation are usually shallow, but their treatment is difficult, since such radiation penetrates deep and damages the underlying organs and tissues, which reduces the skin's ability to regenerate.

Degrees of skin burn

The degree of burn is determined by the depth of damage to the various layers of the skin.

Recall that human skin consists of the epidermis, dermis and subcutaneous fat (hypoderm). The top layer, the epidermis, in turn consists of 5 layers of varying thickness. The epidermis also contains melanin, which colors the skin and causes a tanning effect. The dermis, or skin itself, consists of 2 layers - the upper papillary layer with capillary loops and nerve endings, and the reticular layer containing blood and lymphatic vessels, nerve endings, hair follicles, glands, as well as elastic, collagen and smooth muscle fibers, giving skin strength and elasticity. Subcutaneous fat consists of bundles of connective tissue and fat accumulations, penetrated by blood vessels and nerve fibers. It provides nutrition to the skin, serves for thermoregulation of the body and additional protection of organs.

Clinical and morphological classification of burns, adopted at the XXVII All-Union Congress of Surgeons in 1961, distinguishes 4 degrees burn.