Burns: area burns, determination by the rule of the palm. Classification of burns by area and degree of injury
In life, each of us received burns. The area of burns can be different, but the sensations are always the same: as if the burned coal is applied to the affected area. And no water, ice or cold compress can overpower this feeling.
And from a medical point of view, the burn istissue damage caused by high temperature or highly active chemicals, such as acids, alkalis, heavy metal salts. The severity of the condition is determined by the depth of damage and the area of the damaged tissue. There are special forms of burns, obtained from radiation or electric shock.
In depth, burns are distinguished:
- The first degree is characterized by defeat onlythe top layer of the skin. Outwardly this is manifested by reddening, minor swelling and painful sensations. Symptoms disappear after three to four days, and the affected area of the epithelium is replaced by a new one.
- Damage to the epidermis to the basal layer indicates a burn of grade 2. On the surface of the skin appear bubbles with cloudy contents. The healing lasts up to two weeks.
- With the third degree of burn, thermal damage does not only get to the epidermis, but also to the dermis.
- Degree A: The dermis on the bottom of the wound is partially undamaged, but immediately after the injury it looks like a black corpse, sometimes bubbles appear that can merge with each other. Pain in the burn site is not felt due to damage to the receptors. Self-regeneration is possible only if secondary infection does not join.
- Degree B: complete destruction of the epidermis, dermis and hypodermis.
- The fourth degree is charring of the skin, fat layer, muscles and even bones.
Classification of burns by type of damage:
- Exposure to high temperatures:
- Fire - the area of defeat is large, butrelatively small depth. Primary treatment is complicated by the fact that it is difficult to clean the wound from foreign bodies (filaments from clothing, pieces of melted buttons or lightning).
- Liquid - a small burn, but deep (up to the third A-degree).
- Hot steam - a significant length of burn, but the depth rarely reaches the second degree. Often affects the respiratory tract.
- Incandescent objects - the wound repeats the shape of the object and can have a significant depth.
- Chemical substances:
- Acids cause coagulation necrosis, and onThe place of the lesion appears a scab of coagulated proteins. This prevents the substance from penetrating into the underlying tissues. The stronger the acid, the closer to the surface of the skin is the affected area.
- Alkalis form colliquated necrosis, it softens tissues and corrosive substance penetrates deeply, it is possible to burn 2 degrees.
- Salts of heavy metals resemble externally burns with acid. They are only 1st degree.
- Electrical burns appear after contact with technical or atmospheric electricity and, as a rule, occur only at the entrance and exit points of the discharge.
- Radiation burns can occur after exposure to ionizing radiation or light. They are shallow, and their effects are associated with damage to organs and systems, rather than directly soft tissue.
- Combined burns include several damaging factors, such as gas and flame.
- Combined can be called those injuries, where, in addition to the burn, there are other types of injuries, for example fractures.
Everyone who has ever received burns (areaburns was more five-ruble coins), knows that the prognosis of the development of the disease is an important detail in the diagnosis. Often patients with injuries are injured in accidents, natural disasters or as a result of emergencies at work. Therefore, people in the waiting room brought in groups. And then the ability to predict a change in the patient's future condition will come in handy during sorting. The most difficult and complex cases should be considered by doctors in the first place, because sometimes the account goes for hours and minutes. Usually the forecast is based on the area of the damaged surface and the depth of the lesion, as well as the concomitant injuries.
In order to accurately determine the forecast,Conditional indexes are used (for example, the Frank index). To do this, for each percentage of the affected area is assigned from one to four points. It depends on the extent and location of the burn, and also on what the burn area of the upper respiratory tract. If there is no breathing, then the head and neck burn gets 15 points, and if there is, then all 30. And then they count all the estimates. There is a scale:
- less than 30 points - favorable outlook;
- from thirty to sixty - conditionally favorable;
- up to ninety - doubtful;
- more than ninety - unfavorable.
Area of damage
In medicine, there are several wayscalculating the area of the affected surface. Determination of the area and degree of burn is possible if one takes as a rule that the surface of different parts of the body occupies nine percent of the total area of the skin, according to this, the head along with the neck, chest, abdomen, each arm, hips, shins and feet occupy 9% and the back surface of the body is twice as large (18%). The perineum and the genitals received only one percent, but these injuries are considered quite severe.
There are other rules for determining the areaBurns, for example with the help of the palm. It is known that the area of the palm of a person takes from one to one and a half percent of the entire surface of the body. This allows us to conditionally determine the size of the damaged area and assume the severity of the condition. Percentages of burns on the body are conditional. They depend on the subjective evaluation of the doctor.
There are several symptoms that canto show burns. The area of burns in this case does not play a special role, because they are extensive, but shallow. Over time, the forms of clinical manifestations can change into each other during the healing process:
- Erythema or redness, accompanied by reddening of the skin. Occurs at any degree of burns.
- Vesicles are a vial filled with a cloudy liquid. It can be with an admixture of blood. Appears due to detachment of the upper layer of the skin.
- Bulla is a few vesicles that have merged into one bubble more than one and a half centimeters in diameter.
- Erosion is a burn surface on which there is no epidermis. It bleeds, or the saccharum is allocated. Occurs during removal of blisters or bulls, necrotic tissue.
- Ulcer - deeper erosion affecting the dermis, hypodermis and muscles. The value depends on the area of the previous necrosis.
- Coagulation necrosis is a dry, deadened tissue of black or dark brown color. Easily removed surgically.
- Colliquated necrosis is a moist rotting tissue that can spread both deep into the body and sideways, capturing healthy tissues.
This is the systemic response of the body to burn injuriesThis state may occur both at the surface damage if the body burns 30% or more, and with deep burns, occupying no more than ten percent. The weaker the health of a person, the stronger this type of shock is. Pathophysiologists distinguish four stages of the development of a burn disease:
- Burn shock. It lasts the first two days, with severe damage - three days. It arises because of incorrectly redistribution of fluid in the shock organs (heart, lungs, brain, kidneys).
- Acute burn toxemia develops tothe infection lasts from a week to nine days. Pathophysiologically similar to the syndrome of prolonged crushing, that is, the products of tissue disintegration fall into the systemic bloodstream and poison the body.
- Burn septicotoxemia appears after infection. It can last up to several months, until all the bacteria are eliminated from the wound surface.
- Restoration begins after the burn wounds are closed with a granulation tissue or epithelium.
Endogenous intoxication, infection and sepsis
The body burn is accompanied by poisoning the bodyproducts of denaturation of proteins. The liver and kidneys are almost unable to cope with the increased load with a decrease in pressure in the systemic circulation. In addition, after trauma, human immunity is in a state of high alertness, but long-term poisoning of the body disrupts the mechanisms of protection, and secondary immunodeficiency is formed. This leads to the fact that the wound surface is colonized by putrefactive microflora.
Sorting victims with burns
As mentioned above, the reception room is rarelybring one victim who has burns. The area of burns and the number of patients significantly exceed the capabilities of medical personnel, so it is necessary to sort out the incoming people for the severity of the condition, in order to know who to provide medical care in the first place:
- Severely wounded have superficial burns moretwenty percent of the body or deep burns - more than ten percent, as well as burns of the upper respiratory tract. Such patients need urgent medical aid and are transported to a medical institution with the help of sanaviation.
- The average severity correspondssurface burns of less than twenty percent or deep - no more than ten percent of the body surface. Such affected medical aid should be provided in the second place, but this does not mean that they can be left unattended for a long time.
- An easy degree is characterized by superficialburns that occupy less than fifteen percent of the skin surface, or deep burns that spread by no more than five percent and do not affect the upper respiratory tract.
- Mortally wounded are people who havea deep burn of the body (50% or more), as well as older people with a lesion of thirty percent of the surface. Such victims are only symptomatic treatment. Victims of large-scale industrial accidents can have 90% of body burns. This is a fatal injury, and you can not help in this case, you can only try to relieve their suffering with strong analgesics (artificial coma) or give an inhalation anesthesia.
For a good forecast plays an important rolerendering self- and mutual assistance. The rapidity of the reaction can significantly reduce the burn area and its depth. First of all, it is necessary to interrupt the contact between the traumatizing agent and the person, for example to extinguish the fire or to de-energize the network, to wash out / neutralize the chemical reagent.
At the pre-hospital stage is not recommendeduse oil based ointments and other fat-containing products, since they form a film on the surface of the wound and do not allow heat to escape. In addition, the hospital will also have to remove "medical pollution", causing pain to the victim. It is not necessary to perform wound treatment at home, such as removing foreign bodies, particles of charred skin and the like. This can lead to infection, because the proper aseptic / antiseptic regimen will not be followed. Plus, without proper pain relief, the person you are trying to help with will most likely fall into a state of painful shock.
Anesthesia and wound treatment
Depending on the severity of the patient's conditionThe anesthetist selects the appropriate drug and anesthesia technique. These can be non-steroidal anti-inflammatory drugs, analgesics-antipyretic drugs or local conductive anesthesia. For severe cases, narcotic analgesics are suitable.
After the injury site was relieved, the surgeonproceeds to primary treatment of the wound surface. It exfoliates the epidermis, opens or drains bubbles, and removes foreign bodies. Then, the cleaned wound surface is covered with a clean gauze bandage. In case of burns of the second and more degrees, the patient must enter tetanus toxoid serum.
There are two known methods for treating burns - closed andopen. They can be used both individually and together. In order to prevent infection of the wound, it is actively dried so that dry necrosis appears. The open method is based on this. Substances, for example alcoholic halogen solutions that can coagulate proteins, are applied to the wound surface. In addition, physiotherapeutic methods such as infrared radiation can be used.
Closed treatment implies the presence of dressings,prevent bacteria from entering, and drains allow fluid to drain. Under the bandage applied drugs that contribute to the granulation of wounds, improve the outflow of fluid and have antiseptic properties. Most often for this method are used broad-spectrum antibiotics, which have a complex effect.