First aid for burns. Providing first emergency medical care for burns

As is known, the nature of the course and the outcome of pathological manifestations in thermal injury depend on the severity of the injury, the level of compensatory capabilities of the body and the timeliness of therapeutic measures, including at the prehospital stage. The lack of adequate medical care in the acute period quickly leads to the transition of adaptive reactions into pathological ones, depletion of the body's reserve capabilities and their failure.

All this testifies to the importance of the problem of improving the organization of medical care for victims with burns by ambulance teams.

In order to optimize the range of medical services provided at the prehospital stage to victims with thermal injury and inhalation damage to the respiratory tract, an algorithm of actions is proposed below.

Algorithm of actions in case of thermal injury

Diagnosis and assessment of the severity of thermal and combined thermal inhalation injury. A burn is an injury that occurs when body tissues are exposed to high temperature, aggressive chemicals, electric current and ionizing radiation.

• Chemical burns - burns with aggressive liquids, occur from exposure to acids and alkalis.
• Electric burns are injuries that have developed as a result of the passage of an electric current through tissues.
• Radiation burns occur when exposed to ionizing or ultraviolet radiation.

The severity of the condition of the victim with burns is determined by the depth and area of ​​the lesion, as well as the presence and degree of inhalation injury.

Burn surface area

The area of ​​the burn surface is determined by the rule of nines. The rule of "nines" is not accurate (error up to 5%), but allows you to quickly and easily estimate the area of ​​the burn, which is especially important in emergency situations.

Rule of nines sets the percentage of body part surface area to body surface area (SBA) for adults.

• head and neck make up 9%,
• anterior surface of the body - 18% (abdomen - 9% + anterior surface of the chest - 9%),
• back surface of the body - 18% (lower back and buttocks - 9% + chest behind - 9%),
• upper limb - 9%,
• lower limb - 18% (thigh - 9% + lower leg and foot - 9%),
• perineum - 1%.

To assess small-sized burns of various localizations, you can use "rule of the palm"- the area of ​​the palm of the victim is from 170 to 210 cm2 in an adult and, as a rule, corresponds to 1% of the area of ​​the skin.

Depth of defeat

Determination of the depth of the lesion is carried out according to the four-degree classification:

I degree- persistent arterial hyperemia and inflammatory exudation, pronounced pain syndrome.

II degree- exfoliation of the layers of the epidermis with the formation of small blisters filled with a transparent yellowish liquid. The intensity of pain sensations is maximum.

III degree:

• IIIa degree - damage to the dermis itself. Pain sensitivity is reduced, vascular reactions are preserved.
• III b degree - total necrosis of all layers of the skin while maintaining intact tissues located deeper than their own fascia. In the thickness of necrotic tissues - thrombosed saphenous veins. Pain sensitivity and vascular reactions are sharply reduced or absent.

IV degree- the spread of the lesion to deeper tissues (subcutaneous tissue, fascia, muscles, bones).

It is believed that burn shock in adult victims can develop with skin burns II–IIIa degree on an area of ​​​​more than 15%, in children and elderly patients on an area of ​​\u200b\u200bmore than 10% of the body surface.

Burn shock is one of the most dangerous periods of burn disease. With combined injuries - burns of the skin and damage to the respiratory tract - in the first hours from the moment of injury, one of the formidable complications is asphyxia caused by swelling of the larynx, vocal cords and periligamentous space.

As a rule, combined injury is combined with CO poisoning and other toxic combustion products, which can lead to intoxication and the development of acute lung injury syndrome.

Localization of burns on the face, neck, anterior surface of the chest, the presence of singed hair in the nasal passages, traces of soot in the nasopharynx, voice change, cough with sputum containing soot, shortness of breath may indicate a possible lesion of the respiratory tract.

To diagnose thermal and combined thermal inhalation injury and assess the severity of the victim's condition, it is recommended to use the following treatment and diagnostic algorithm.

Algorithm for diagnosing skin lesions

1. History taking: ascertaining the etiological agent, its physical characteristics, duration of exposure, the role of clothing, as well as collecting information on comorbidities and the content of first aid.

1. Inspection of the wound: identification of direct and indirect signs of the depth of the lesion (type and color of the wound, scab and its consistency), taking into account localization.

1. The use of additional diagnostic tests: determination of the vascular response, the degree of loss of pain sensitivity.

1. Determination of the burn area in percent.

Universal Lesion Severity Index

To standardize the assessment of the severity of thermal injury, an integral universal index of injury severity has been developed. It is based on the Frank index (IF), according to which each percentage of a superficial burn corresponds to 1 conventional unit (c.u.), and a deep one - 3 c.u. e.

When skin burns are combined with damage to the respiratory organs, 15, 30, 45 c.u. are added to the IF. e. depending on the severity of the respiratory tract injury (I, II, III degrees, respectively).

In patients over 60 years of age, IF is added to 1 c.u. e. for each year of life after 60 years.

It is believed that with ITP values ​​​​more than 20 c.u. e. burn shock develops, which is the first period of burn disease.

The severity of burn shock is determined by the number of conventional units of the injury severity index: 20-60 c.u. e. - mild degree of burn shock (shock I degree), 61-90 c.u. e. - severe degree (shock II degree), more than 91 c.u. e. - an extremely severe degree of burn shock (shock III degree).

Depending on the severity of the burn shock, a forecast of the severity of the course of the burn disease is formed. In grade I shock, the prognosis is favorable, grade II - the prognosis is doubtful, grade III shock suggests an unfavorable course of burn disease.

The main tasks of the ambulance team

• assessment of the general severity of the victim's condition;
• determination of the severity of thermal injury by the area and depth of lesions, the presence of inhalation injury;
• if necessary, carrying out infusion therapy, maintaining airway patency;
• transportation of the victim to the nearest trauma center of the first or second level during the "golden hour".

SMP algorithm for burns at the prehospital stage

Termination of the action of the thermal factor, cooling of the affected areas (at least 15 minutes).

Assessment of vital functions, if necessary, measures to restore and maintain them. In case of impaired consciousness in a victim with a thermal injury, it is necessary to exclude a possible craniocerebral injury, carbon monoxide poisoning, alcohol or drug poisoning.

Bandaging (do not remove parts of clothing adhering to burn wounds, the use of coloring antiseptics at the prehospital stage is not recommended), sheets are used for extensive lesions.

oxygen therapy

An obligatory component in the provision of medical care at the prehospital stage is the provision of airway patency, oxygen therapy, and, if necessary, artificial lung ventilation with an assessment of ventilation and gas exchange parameters during transportation.

Tracheal intubation should be performed in the following cases:

• lack of consciousness;
• clinical signs of severe inhalation injury (respiratory failure, suffocation, stridor, signs of damage by combustion products);
• tracheal intubation and mechanical ventilation can be performed in patients with extensive burns in the face, neck and chest, as well as in any other localization of burns with an area of ​​​​more than 50% of the body surface, since with extensive lesions, patients' breathing is often ineffective, leads to hypoxia and aggravates her.

Pain relief and sedation

Anesthesia and sedation at the prehospital stage. Elimination of pain should take into account the specifics of the condition of burn patients.

It is recommended to exclude intravenous administration of narcotic analgesics that contribute to impaired consciousness, the development of additional depression, and, most importantly, respiratory depression, which sometimes even at the stage of specialized care leads to difficulties in assessing the severity of the condition, smoothing the clinical picture, not to mention immediate complications.

To stop the pain syndrome, it is enough to use 4 ml of a 50% solution of analgin in combination with antihistamines - 2 ml of a 1% solution of suprastin. In addition, the use of non-steroidal anti-inflammatory drugs, which have a pronounced anti-inflammatory and analgesic effect, is effective. To stop the pain syndrome, ketonal 100-200 mg or ketorolac 30 mg is prescribed intramuscularly or intravenously.

Benzodiazepines are recommended if anxiety occurs in victims. With strong psychomotor agitation, they can be combined with neuroleptics.

For the purpose of anesthesia and sedation at the prehospital stage, the following scheme is recommended: ketonal - 100 mg, suprastin - 20 mg, relanium - 10 mg.

It should be emphasized that narcotic analgesics and large doses of sedatives are administered in extremely severe lesions, followed by adequate gas exchange, stable hemodynamics and under careful instrumental monitoring of the victim.

Infusion therapy

Infusion therapy is the main pathogenetic element of antishock therapy. To ensure it, catheterization of one or two peripheral veins is necessary, and if this is not possible, catheterization of one of the central veins is performed.

The volume and rate of infusion are determined by the severity of the injury and the time of transport. Infusion therapy at the prehospital stage includes intravenous administration of balanced salt crystalloid solutions.

The volume of infusion therapy in burned patients is calculated based on the area of ​​burns and body weight, using the Parkland formula. During the first 8 hours, half of the calculated volume is transfused, achieving a steady rate of diuresis of 1 ml/kg per hour.

Parkland formula:

V ml Ringer's solution = 4 ml x 1 kg of body weight x Burn area (%).

V ml \u003d 0.25 ml x 1 kg of body weight x Burn area (%) per hour.

Promising and quite natural is the intravenous administration of infusion antihypoxants and antioxidants, including fumarates or succinates (mafusol, polyoxyfumarin, reamberin, cytoflavin).

Solutions based on gelatin (gelofusin - 4%) and hydroxyethyl starch derivatives (hemoches 6-10%), refortan 6-10%, voluven, stabizol) are able to stabilize hemodynamics and improve the rheological properties of blood. It is recommended to use these infusion agents at the prehospital stage with pronounced signs of hypovolemia and unstable hemodynamics.

Transportation to hospitals

Transportation of those in need of hospitalization should be carried out in hospitals with specialized departments for the treatment of victims with thermal injury.

Indications for hospitalization are:

• second-degree burns on an area of ​​more than 10% (in persons over 60 years of age and in children on an area of ​​more than 5%);
• burns III and degree on the area more than 3-5%;
• burns III b IV degree;
• burns of functionally and cosmetically significant areas (face, perineum, hands, feet, joint areas);
• electrical burns, electrical injury;
• inhalation injury;
• burns combined with other injuries;
• burns in patients with severe comorbidities.

Transportation of severely burned patients is carried out against the background of ongoing infusion therapy, under monitor control of blood circulation and respiration parameters: blood pressure, pulse (non-invasively), body temperature registration, with the possibility of ECG registration.

It is important to perform pulse oximetry and capnometry, especially during oxygen therapy and mechanical ventilation.

The severity of changes in thermal injury and the transience of the development of pathological changes necessitate the precise implementation of specific algorithms for providing assistance to victims, primarily at the prehospital stage.

Thus, competent and timely medical care provided by the ambulance teams contributes to the prevention and reduction of the severity of long-term complications, gives a temporary margin of time to prevent severe complications and mortality in victims with thermal injury.

K. M. Krylov, O. V. Orlova, I. V. Shlyk

1. For first-degree burns without blistering and intact skin integrity, apply cold to the burn site or place it under cold water for 5-10 minutes. Treat the burnt surface with alcohol, cologne or vodka.

2. For II-IV degree burns with damage to the skin, treat the burn surface with foaming aerosols or cover with a sterile (clean) sheet or napkin.

3. Place ice packs, snow packs, or cold water over a clean cloth.

4. Give the victim 2-3 tablets of analgin.

5. Prior to arrival and when waiting for an ambulance for a long time, give a plentiful warm drink.

Remember! Unacceptable!

1. Lubricate the burn surface with grease, sprinkle with starch or flour, and rip off the remnants of clothing from the damaged surface.

2. Open burn blisters.

3. Tightly bandage the burnt surface, apply a patch.

4. Wash off dirt and soot from damaged skin.

5. Treat the damaged skin surface with alcohol, iodine and other alcohol-containing solutions.

Providing first aid for chemical burns.

In case of damage by any aggressive liquid (acid, alkali, solvent, special fuel, oils, etc.):

1. Immediately remove clothing soaked in the chemical;

2. Rinse thoroughly under cold running water or milk, soapy water, mild baking soda solution.

Phosphorus, getting on the skin, it flares up and causes a double burn - chemical and thermal. Immediately dip the burned area in cold running water for 10-15 minutes, remove the pieces of phosphorus with a stick, apply a bandage.

If it gets on the skin quicklime, in no case should it be allowed to come into contact with moisture - a violent chemical reaction will occur, which will increase the injury. Remove the lime with a dry cloth and treat the burn with vegetable or animal oil.

Remember!

1. Do not use strong and concentrated solutions of acids and alkalis for the neutralization reaction on the skin of the victim.

2. The burnt person needs to drink water more often (in small portions): dissolve a teaspoon of salt or baking soda in 1 liter of water.

3. For the purpose of disinfection, iron the cloth applied to the burn with an iron or soak it in vodka, or hold it over the fire.

Frostbite and hypothermia

Signs of frostbite of the extremities: the skin is pale, hard and cold, there is no pulse at the wrists and ankles, loss of sensation, when tapping with a finger - a "wooden" sound.

Providing emergency care:

1. Take the victim to a room with a low temperature.

2. Do not remove clothes and shoes from frostbitten limbs.

3. Immediately cover the injured limbs from external heat with a cooled heat-insulating bandage with plenty of cotton wool and blankets, clothes. It is impossible to accelerate the warming of frostbitten parts of the body. Warmth should arise inside with the restoration of blood circulation.

4. Give plenty of warm drink, small doses of alcohol. Make it move. Feed.

5. Give 1-2 tablets of analgin.

6. Call a doctor.

Remember! It is forbidden!

1. Rub frostbitten skin.

2. Place frostbitten limbs in warm water or cover them with heating pads.

3. Lubricate the skin with oils or petroleum jelly.

Signs of hypothermia: chills, muscle tremors, lethargy and apathy, delirium and hallucinations, inappropriate behavior (“worse than drunk”), blue or blanching of the lips, decrease in body temperature.

Providing emergency care for hypothermia:

1. Cover the victim, offer warm sweet drinks or foods high in sugar.

2. Give 50 ml of alcohol and deliver within 1 hour to a warm room or shelter.

3. In the room, take off your clothes, rub your body.

4. Place the victim in a 35-40°C water bath (tolerates the elbow). You can lie down next to it or overlay it with a large number of warm heating pads (plastic bottles).

5. After a warming bath, be sure to put warm, dry clothes on the victim, cover with a warm blanket.

6. Keep giving warm sweet drinks.

7. Call a doctor.

poisoning

Carbon monoxide poisoning occurs from embers if the chimney is closed before the stove is completely heated. While red, not extinguished coals are visible, the chimney must not be closed!

Signs: pain in the eyes, ringing in the ears, headache, nausea, loss of consciousness.

Actions:

1. Get down on the floor (this gas is lighter than air and accumulates at the top), make your way to the window or door, open them wide.

2. Take a few deep breaths.

3. Help those who have lost consciousness. Remove to fresh air, pour cold water on your head. You can pour water into your mouth with a few drops of ammonia.

4. If the victim is breathing heavily, with effort, start mechanical ventilation and continue until the victim comes to his senses.

5. Lay the victim in a bed, warm with heating pads.

6. Hold the attention of the victim, make him speak, sing, count. Don't let him forget for an hour.

Food, drug poisoning

Signs: weakness, drowsiness, nausea, vomiting, loose stools, cold sweat, dizziness, headache, increased heart rate, shortness of breath, convulsions, fever.

Giving help:

1. Urgently call a doctor. Present wrappers from medicines.

2. If victim is conscious, give 10-20 crushed tablets or 1 tablespoon of activated charcoal with water. In its absence - grated crackers, starch, chalk, tooth powder, charcoal.

3. Rinse the stomach, if the condition allows: give 300-400 ml of water at room temperature to drink and induce vomiting by pressing on the root of the tongue; repeat this procedure at least 10 times.

4. Give 10-20 tablets of powdered activated charcoal and a laxative (2 tablespoons of vegetable oil) to drink again.

5. Lay the victim on his stomach and do not leave unattended.

6. In the absence of consciousness and pulse, proceed to resuscitation.

7. When the condition improves, give tea, provide warmth and peace.

Foreign bodies

Depending on the form, all foreign bodies can be divided into three groups:

1. Wide and flat objects are classified as coin-like bodies. These are the coins themselves, and buttons similar to them, as well as any flat rounded plates.

2. Another group combines objects that are spherical or pea-shaped - dragees and monpensier, all kinds of pellets and balls, as well as unchewed pieces of sausage, cucumbers, potatoes or apples.

3. The last group, to which special attention should be paid, includes foreign bodies that resemble a rocker in shape. Most often, these are pieces of barbecue, connected by a thin, but very strong fascial film.

Such a classification is of fundamental importance for determining the tactics of first aid.

Ways to provide emergency care:

Extraction of spherical objects. If a child chokes on a pea, a piece of an apple or any other spherical object, then the most reasonable thing would be to turn the baby head down as quickly as possible and tap the palm of your hand several times on the back at the level of the shoulder blades. The so-called "Pinocchio effect" will work. If after 2-3 blows between the shoulder blades the foreign body did not fall on the floor, then you should immediately proceed to other methods of extracting it.

If the height and weight of the child do not allow him to be lifted by the legs to the full length of the body, then it will be quite enough to bend the upper half of the torso over the back of the chair, bench or through his own thigh so that the head is as low as possible below the level of the pelvic part of the torso. There is nothing complicated in these actions, and, as practice shows, they are quite effective.

Extraction of coin-like objects. When coin-shaped foreign bodies hit, especially when the foreign body has advanced below the glottis, it is not necessary to expect success from the previous method: the “piggy bank effect” will work. In this situation, you should resort to methods aimed at concussion of the chest as soon as possible. It is necessary to force the foreign body to change its position. Most often, the foreign body is in this case in the right bronchus. This will enable a person to breathe at least one lung, and, therefore, SURVIVE.

There are several ways to concussion chest. The most common of these is tapping the palm on the back. The greatest effect occurs with short, frequent blows to the interscapular region. Blows on the back can only be applied with an open palm and in no case with a fist or with the edge of the palm.

Another, more efficient method is called "the American police way". By itself, it is quite simple and has two options.

First option is carried out as follows: it is necessary to stand behind the choking person, take him by the shoulders and, moving him away from himself on outstretched arms, sharply hit his own chest with force. The blow can be repeated several times.

Second option: stand behind the patient and wrap your arms around him so that your hands, folded into the lock, are below his xiphoid process, and then with a sharp movement, press hard under the diaphragm and hit your chest with your back. This will allow not only to shake strongly, but also to squeeze out the rest of the air from the lungs due to a sharp displacement of the diaphragm, i.e. significantly increase the displacement of the foreign body.

Scheme of first aid when a foreign body enters the larynx or trachea:

1. Turn a child under 5 years old upside down and lift it by the legs.

2. Bend an adult over the back of a chair or your own thigh.

3. Hit several times with the palm between the shoulder blades.

4. In case of failure and with preserved consciousness, use one of the options for the "American police" method.

5. In case of loss of consciousness, turn the choking person on his side and hit the back with an open palm several times.

7. Even after successful extraction of a foreign body, it is imperative to consult a doctor.

Remember! Unacceptable!

1. Get a foreign body (fingers or tweezers).

2. To strike with a fist on the spine.

3. Immediately open your hands when conducting the "American police" method (a blow to this area can provoke a sudden cardiac arrest).

Content

Such injuries cause a person to develop a severe general condition due to changes in the composition of the blood, disruption of the central nervous system and the functions of internal organs due to intoxication. Timely and correctly rendered assistance will reduce the damage from a burn to a minimum.

Burn classification

The severity of the injury depends on several factors, including the height of the temperature, the duration of exposure to the harmful factor on the skin / mucous membranes, and the location of the injury. Pressurized steam and flames cause particularly serious damage. More often people have burns of the limbs and eyes, less often - the head and trunk. The larger the surface of damaged tissues and the deeper the lesion, the higher the danger to the victim. Thus, a burn of 30% of the body surface is often fatal.

For first aid, it is important to know what type of burn was received. The speed and degree of recovery of the patient's tissues after an injury largely depends on how correctly the pre-medical measures were chosen. Incorrect actions that do not correspond to the type of burn can aggravate the situation, further harming a person’s health.

Depth of damage

Minor burned areas of the body can be treated at home without resorting to medical help.

With extensive areas of burns, a large number of nerve endings are damaged and traumatic shock develops, so it is extremely important to go to the hospital in a timely manner.

There are such degrees of injury from fire, electricity and chemicals:

1. First. These are superficial tissue damage, in which swelling, redness of the skin, and burning pain are observed. Symptoms disappear within 3-6 days, after which the dermis begins to renew itself by exfoliation. Pigmentation remains at the site of injury.
2. Second. It is characterized by the appearance of blisters (blisters filled with liquid). In the damaged area, immediately or after some time, the surface layer of the skin begins to exfoliate. Bubbles burst, which is accompanied by intense pain. If tissue infection does not occur, healing occurs in about 2 weeks.
3. Third. There is necrosis (necrosis) of the deep layers of the dermis. After such burns, scars are sure to remain.
4. Fourth. This stage is characterized by necrosis and charring of deep tissues. Damage can affect muscles, bones, subcutaneous fat, tendons. Healing is very slow.

By type of damaging factors

First aid for a burn depends on the nature of the impact. There are several types of damaging factors by which burns are classified.

First aid for burns

The first thing to do is to eliminate the damaging factor. After treatment of the affected areas of the body (the choice of method depends on the type of burn), an aseptic dressing should be applied to prevent infection of the body. First aid for burns also includes measures to prevent shock and transport the victim to a medical facility. It is extremely important to perform any actions carefully, avoiding further tissue damage. First aid includes:

• extinguishing burning clothes;
• evacuation of a person from the danger zone;
• removing smoldering or heated clothing;
• careful removal of stuck things (they are cut off around the injury);
• applying an aseptic bandage (if necessary, even over the remaining piece of clothing).

The main task of a person who provides first aid is to prevent infection of the burn tissue. For this purpose, use a bandage from a sterile bandage or an individual package.

In the absence of these funds, it is allowed to use clean cotton fabric ironed or treated with an antiseptic (alcohol, vodka, potassium permanganate, etc.).

Pre-hospital measures

The rules for providing first aid for burns provide for pre-medical measures only for 1-2 degrees of damage. If the affected area occupies an area of ​​​​more than 5 cm, multiple blisters are observed on the tissues, the victim feels intense pain, you should immediately call an ambulance. In case of serious burn injuries of degree 2 or higher, or if more than 10% of the person's body is damaged, they are urgently hospitalized. It is forbidden to do as part of first aid:

• move or carry the victim without first checking the pulse, breathing, the presence of fractures, after losing consciousness due to electric shock or other types of injuries;
• treat burned tissues with any improvised means (oil or sour cream), this will aggravate the situation, since fatty foods disrupt the heat transfer of the skin;
• independently clean the wound in the absence of sterile bandages, cover the affected areas with tissues with pile or cotton wool;
• apply a tourniquet without an open wound with serious blood loss (this measure will lead to tissue death and limb amputation);
• apply dressings without understanding how to do it correctly (in case of urgent need, it is possible to easily wrap the area of ​​​​the burn injury with sterile material without pulling the tightly burned place);
• pierce blisters (this is how you introduce an infection);
• tear off clothes that have stuck to the wound (dry tissues should first be soaked, or better, wait for the doctors to arrive).

First aid for thermal burns

Mild injuries are often successfully treated at home, but only if first aid has been provided correctly. Upon receipt of thermal lesions, after the cessation of exposure to the traumatic factor, you need to:

1. Cool the injured area under running cold water (the procedure should last at least 10-20 minutes).
2. Treat the skin with an antiseptic (but not iodine), then lubricate with an anti-burn agent.
3. Apply a sterile loose bandage to the wound.
4. With intense pain, give the victim an anesthetic - Nurofen, Aspirin, Nimesil, or others.
5. If necessary, take the patient to a medical facility.

With chemical

First, it is imperative to determine which substance caused damage to the skin / mucous membranes. First aid for chemical exposure includes the following activities:

1. The injured area is thoroughly washed with water for at least 15 minutes. The exception is when the burn is caused by substances that react with water, such as quicklime.
2. If the fabrics have been burned with a powdered substance, it is removed with a dry cloth before washing.
3. An antidote is used (for alkaline exposure, it is recommended to use a weak solution of citric acid or vinegar, for lime burns, the skin is treated with fat or lard, the acid is neutralized with a soda solution).
4. If the victim has swallowed the chemical, gastric lavage must be carried out.

With electrical

First aid for burns is to isolate from the damaging factor, after which you should check the victim for breathing, pulse and call an ambulance. If there are no vital signs, you need:

1. Make a closed heart massage.
2. Perform mouth-to-mouth or mouth-to-nose breathing.
3. Perform resuscitation until the ambulance arrives.
4. Superficial injuries resulting from electric shock are treated in the same way as for thermal burns.

Video

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

Discuss

First aid for burns - types of lesions, step-by-step algorithm of pre-medical actions

Thus, thermal, electrical, solar, chemical and radiation burns are distinguished. The skin, eyes and respiratory tract are most often burned.

Thermal skin burns

Thermal skin burns are the most common type of household burns.

Clinical manifestations

According to the severity of skin lesions, the depth of tissue damage, the following degrees of burns are distinguished:

I degree - persistent reddening of the skin and severe pain are noted at the site of the lesion;
II degree - at the site of exposure to high temperature, blisters form with transparent contents, the site of the lesion is very painful;
III degree - necrosis (necrosis) of all layers of the skin. On examination, a combination of deathly-pale (dead) skin areas, areas of redness and blisters is revealed, all types of sensitivity disappear in the burn area, there is no pain.
IV degree - not only the skin is subjected to necrosis, but also the tissues located under it (fatty tissue, muscles, bones, internal organs), upon examination, charring of the skin is revealed.
More often there is a combination of various degrees of burns. Their III and IV degrees refer to deep burns, accompanied by a worsening of the general condition of the victim, require surgical intervention, heal with the formation of deep scars. The severity of the victim's condition depends both on the degree of the burn and on the area of ​​the lesion. II degree burns, covering more than 25% of the body surface, as well as III and IV degree burns, covering more than 10% of the body surface, are extensive and are often complicated by the development of burn shock. The victim, who is in a state of burn shock, is restless, tries to escape, is poorly oriented in what is happening; after a while, the excitement is replaced by apathy, prostration, adynamia, and a drop in blood pressure. In children, people over 65 years of age, debilitated patients, burn shock can develop even with a smaller area of ​​damage.

First aid for thermal skin burns

The very first action should be to stop the effect of the thermal factor on the victim: it is necessary to take the victim out of the fire, extinguish and remove burning (smoldering) clothes from him. The burnt parts of the body are immersed in cold water for 10 minutes, a person (if he is conscious) is given any anesthetic drug - metamizole sodium, tramadol; in severe condition, narcotic analgesics (promedol, morphine hydrochloride) are administered. If the burned person is conscious, and the burn surface is quite extensive, it is recommended to give him a solution of table salt and baking soda to drink in order to prevent dehydration.
I degree burns are treated with ethyl (33%) alcohol or a 3-5% potassium permanganate solution and left without a bandage. For burns II, III, IV degrees after treatment of the burn surface, a sterile bandage is applied to it. After these events, all victims must be taken to the hospital. Transportation is carried out on a stretcher. In case of burns of the face, head, upper half of the body, the burnt person is transported in a sitting or half-sitting position; with lesions of the chest, abdomen, front surface of the legs - lying on your back; for burns of the back, buttocks, back of the legs - lying on the stomach. If hospitalization in the near future is impossible for any reason, the victim is assisted on the spot: in order to anesthetize the burn surfaces, they are sprayed with a 0.5% solution of novocaine for 5 minutes (until the pain stops), bandages are applied to the burns with synthomycin emulsion or streptocid ointment. They continue to give him a solution of soda and salt, periodically give painkillers.

Chemical burns of the skin and mucous membranes

The difference between chemical burns and thermal burns is that with chemical burns, the damaging effect of a chemical on body tissues continues for a long time - until it is completely removed from the surface of the body. Therefore, an initially superficial chemical burn, in the absence of proper assistance, can turn into a III or IV degree burn after 20 minutes. The main chemical agents that cause burns are acids and alkalis.

Clinical manifestations
As a result of an acid burn, a scab (crust) is formed from dead tissue. When exposed to alkalis, wet necrosis (necrosis) of tissues occurs and a scab does not form. It is necessary to pay attention to these signs, since the measures aimed at helping the victim with burns with acids and alkalis differ. In addition, if the patient is conscious and adequately perceives reality, be sure to clarify with him what substance he was in contact with. With chemical burns, as with thermal burns, there are 4 degrees of severity of tissue damage.

First aid for chemical and mucous burns of the skin

The victim is removed from clothing impregnated with a damaging agent (acid or alkali), the skin is washed with running water. There is a known case when a girl who worked in a chemical laboratory died from an acid burn simply because a man who was nearby was ashamed to undress her. For burns caused by acid exposure, sterile wipes moistened with a 4% sodium bicarbonate solution are applied to the burnt surfaces; in case of alkali burns - sterile wipes moistened with a weak solution of citric or acetic acid (at enterprises where there is contact with alkalis or acids, there must be a supply of these substances in the first-aid kit). The patient is given any painkiller and is urgently hospitalized in the nearest hospital (preferably in a hospital with a burn department).

Eye burns

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With a burn of the organ of vision, isolated burns of the eyelids, conjunctiva or cornea, or a combination of these injuries, may occur. Eye burns, like skin burns, occur under the influence of various factors, the main of which are lesions associated with exposure to high temperatures, chemicals, and radiation. Eye burns are rarely isolated; as a rule, they are combined with burns of the skin of the face, head and trunk.

Thermal eye burn

The causes of thermal eye burns are hot water, steam, oil, open fire. As with skin burns, it is customary to distinguish 4 degrees of severity of the lesion in them.

Clinical manifestations
With a first degree eye burn, slight redness and slight swelling of the skin of the upper and lower eyelids and conjunctiva are noted. With a II degree eye burn, blisters appear on the skin, films consisting of dead cells appear on the conjunctiva and cornea of ​​​​the eye. With a third-degree burn, less than half of the area of ​​​​the eyelids, conjunctiva and cornea is affected. Dead tissue has the appearance of a white or gray scab, the conjunctiva is pale and edematous, the cornea looks like ground glass. With IV degree burns, more than half of the eye area is affected, the entire thickness of the skin of the eyelids, conjunctiva, cornea, lens, muscles and cartilages of the eye are involved in the pathological process. Dead tissue forms a gray-yellow eschar, the cornea is white, similar to porcelain.

First aid
The substance that caused the burn is removed from the face of the victim. This is done with a jet of cold water and a cotton swab. For some time continue to wash the eye with cold water to cool. The skin around the eye is treated with ethyl (33%) alcohol, albucid is instilled into the conjunctival sac, and a sterile bandage is applied to the eye. After providing first aid, the victim is urgently hospitalized in an eye clinic.

Chemical burns to the eyes

The cause of chemical burns is the ingress of acids, alkalis, medicinal substances into the eyes (alcoholic tincture of iodine, ammonia, a concentrated solution of potassium permanganate, alcohol), household chemicals (adhesives, paints, washing powders, bleaches). Chemicals, getting into the eye, have a pronounced damaging effect, penetrating into the tissues the deeper, the longer the contact continues.

Clinical manifestations
Chemical burns of the eyes are divided according to the severity of damage into 4 degrees, as with thermal damage. Their clinical signs are similar to thermal eye burns.

First aid
The affected eye is opened, the eyelids are turned out, after which the eyes are washed with a stream of cool water, pieces of the damaging agent are carefully removed from the conjunctiva. Then, albucid is instilled into the palpebral fissure, a sterile bandage is applied to the damaged eye, and the victim is urgently hospitalized in the eye clinic.

Burns of the oral cavity, pharynx, esophagus

More often, chemical burns of these organs occur as a result of the ingestion of acids and alkalis by mistake or due to a suicidal attempt. The most common are burns with concentrated acetic acid. Less common thermal burns are the result of exposure to hot liquids (water, oil), inhalation of hot steam.

Clinical manifestations
Burns of the oral cavity, pharynx and esophagus are accompanied by the appearance of pain in the mouth, pharynx, behind the sternum (along the esophagus). The pain intensifies when trying to speak, swallowing; there is increased salivation, difficulty breathing (up to suffocation) and swallowing, the inability to take any food (both solid and liquid). There may be repeated vomiting, and in the vomit there is an admixture of scarlet blood. There may be an increase in body temperature, an excited state of the victim. On examination, attention is drawn to the burnt skin on the lips and around them, red swollen oral mucosa. When a chemical burn occurs under the influence of vinegar essence, a specific vinegar smell comes from the patient.

First aid for burns of the oral cavity, pharynx, esophagus

In case of chemical burns, the stomach is washed with a large amount of cool water (up to 5 liters) through a probe. In case of a burn with hot water and oil (thermal), gastric lavage is not performed. If the victim is conscious, he is given to drink 10 ml of a 0.5% solution of novocaine (1 tablespoon), after which he is forced to swallow pieces of ice, vegetable oil in small portions and suck an anesthesin tablet. The patient is urgently admitted to the hospital.

burns- damage to tissues as a result of exposure to high temperature, electric current, chemicals. Depending on the nature of the damaging agent, the following types of burns are distinguished.

Thermal burns arise due to exposure to hot liquids, flames, molten metal, etc. Burns with hot liquids (their temperature usually does not exceed 100 ° C) are more often superficial, and flame burns are usually severe. The most severe burns result from the ignition of clothing.

Electrical burns are usually accompanied by gross destruction of the skin and underlying tissues at the points of contact with conductive objects due to the electrochemical, thermal and mechanical effects of electric current. Electric burns are characterized by "signs", or "marks", which look like a cut or lacerated wound, a clearly delimited scab.

Chemical burns occur as a result of exposure to the skin of various chemically active substances. Such burns often have clear boundaries, irregular shape. The color of the skin depends on the nature of the chemical: when burned with sulfuric acid, the skin is brown or black, with nitric acid - yellow-brown, with hydrochloric acid - yellow, with hydrofluoric acid - pale blue or gray.

Respiratory burns are observed during fires and explosions in enclosed spaces, in cases of prolonged stay of the victim in a smoky room. Less commonly observed when exposed to hot steam on the respiratory tract. Clinical signs of a burn of the respiratory tract are hyperemia and swelling of the mucous membrane of the oral cavity, pharynx, epiglottis, burns of the face with singed hair in the nasal passages. Patients report pain when swallowing, a feeling of sore throat, chest pain, shortness of breath, cough. Often there is a hoarse voice. The condition of patients with a burn of the entire tracheobronchial tree is more severe than with an isolated lesion of the larynx and trachea.

According to the depth of the lesion, burns of 4 degrees are distinguished.

A first degree burn is characterized by redness and swelling of the skin. With second-degree burns against the background of hyperemic and edematous skin, there are blisters of various sizes filled with a clear yellowish liquid. Third-degree burns are accompanied by necrosis of the deep layers of the dermis, and with fourth-degree burns, the skin and underlying tissues (subcutaneous fatty tissue, muscles, bones) become dead. Most often there is a combination of burns of varying degrees.

When providing first aid, the total area of ​​the burn and the estimated area of ​​deep damage should be clarified. This helps to outline rational therapy at the prehospital stage.

Burns are also classified according to the area of ​​thermal injury. Wallace's "rule of the palm" and "rule of nines" are the most widely used. According to the first rule, the area of ​​the palm of an adult is 1% of the area of ​​the entire surface of the skin. It is advisable to measure the area of ​​the burn surface with the palm of your hand with limited burns or subtotal lesions. In the latter case, the area of ​​unburned areas of the body is measured, and the percentage of skin lesions is obtained by subtracting the area of ​​unaffected skin from 100.

According to the "rule of nines", large body segments have a surface area of ​​9%. So, the surface of the head and necks makes up 9% of the total area of ​​the body, the upper limb - 9%, the lower limb - 18%, the front surface of the body - 18%, the back - 18%, the perineum and external genital organs - 1%. For adults, the body surface in front is 51%, behind - 49% (Fig. 67).

Limited burns on an area up to 10% of the body surface are classified as local injuries. With more extensive lesions (with superficial ones on an area of ​​more than 15%, with deep ones - more than 10% of the body surface), the victim develops a complex of general and local disorders, called burn disease. Symptoms of burn disease in children and elderly people can be detected when the area of ​​the lesion exceeds 5%. The severity of burn disease and its outcome mainly depend on the area of ​​deep burns. It is generally accepted that deep burns over an area of ​​more than 20% of the body surface are extremely severe.

Rice. 67. "Rule of nines" by Wallace for calculating the area of ​​the burn surface.

Urgent care. The provision of first aid at the scene of an accident is an important task, since the outcome of the disease often depends on its quality. In case of thermal burns, it is necessary to stop the action of the damaging agent. To do this, either quickly throw off burning clothes from the victim, or extinguish the flame by tightly covering the patient with a blanket, thick cloth, or immersing him in water. To reduce the period of tissue hyperthermia and reduce the depth of the burn, it is advisable to pour cold water over the affected area. Clothing should not be removed, it should be cut and removed from the burnt areas. Dry sterile dressings are applied to burn wounds. To reduce pain, painkillers are administered to all victims (1 ml of a 1% solution of promedol, 1 ml of a 2% solution of pantopon).

In case of electric shock, first of all, you need to stop the effect of the latter on the victim - interrupt the electric current circuit: turn off the switch, unscrew the safety plugs, remove the current conductor from the victim's body with a dry stick. You can cut the wire with an ax or an iron shovel with a wooden handle, cut it with a knife or have a bite with scissors if they have insulation on the handles. In all such situations, the assisting person must isolate himself from the ground by standing on a dry board, a rubber mat, a stack of paper, etc. First aid for victims of electric current in the absence of signs of life begins with an external heart massage and artificial ventilation of the lungs (by a breathing apparatus or by mouth in nose, mouth to mouth). All victims are hospitalized. Transported on a stretcher in the prone position.

When providing first aid to patients with chemical burns, it is necessary to stop the action of substances that have got on the skin as soon as possible. To do this, wash the affected surface with running water for 10-40 minutes. Then, in case of acid burns, the affected areas are washed with a solution of sodium bicarbonate, in case of alkaline burns, with acetic acid and a dry sterile bandage is applied. The earlier first aid is provided, the shorter the exposure of the chemical agent, the less the depth of the burn injury. When providing first aid and on the way to the hospital, patients with extensive and deep burns must be given painkillers, usually a narcotic analgesic in combination with antihistamines: for example, 2 ml of a 2% solution of promedol in combination with 1 ml of a 1% solution of diphenhydramine or 1 ml of 2.5% pipolfen solution. With severe pain in the SMP machine, inhalation mask anesthesia is used with a mixture of nitrous oxide and oxygen in a ratio of 2: 1. When indicated, cardiovascular agents, inhalation of humidified oxygen are used.

Patients with severe extensive burns are hospitalized in a special hospital (thermal injury department). Transported on a stretcher in the prone position. Compulsory hospitalization in a specialized hospital is subject to victims with the following thermal injuries:

1) deep burns of any area;

2) superficial burns on an area exceeding 7-10% of the body surface;

3) superficial burns on a smaller area:

a) flame or steam burns of the face due to a possible burn of the respiratory tract,

b) II-IIIA degree burns of the hands due to unsatisfactory functional results of treatment,

c) burns resulting from exposure to electric current, d) burns of the feet, ankle joints, lower third of the leg, perineum.

Ambulance, ed. B. D. Komarova, 1985