A burn is damage to the skin, mucous membranes, and underlying tissues, which is caused by exposure to high temperature, chemicals, electricity or radiation energy.

Types of lesions

Depending on the cause of occurrence, the following types of burns are distinguished.

Thermal. Appear upon contact with hot objects, hot air, steam, or boiling water. In case of prolonged contact, deep burns are formed. They are often caused by hot viscous substances (resin, bitumen, caramel mass) that stick to the surface of the body and lead to deep, prolonged heating of the tissues.

Electrical. Most often they occur when working with electrical equipment, sometimes during a lightning strike. With these burns, skin damage occurs, dysfunction of the heart, respiratory organs and other human vital systems occurs. Small contact with electric current causes dizziness and fainting. A more significant lesion causes respiratory arrest, and even clinical death.

Chemical. Develops as a result of contact with chemicals. The depth of this type of burn depends on the concentration of the chemical reagent and the time of its exposure to body tissue.

Radiation. This type of burn includes skin damage caused by ultraviolet rays. This usually happens on the beach or in a solarium.

Degrees of burns

Experts distinguish four degrees of burns.

I degree. Only the epidermis is affected, which is capable of rapid recovery. Within 3-5 days after the burn, swelling resolves, redness disappears, and the affected epidermis sloughs off. There are no burn marks left on the burned skin.

II degree burns. Deeper lesions of the epidermis occur. Blisters filled with clear liquid appear on the reddened skin. The skin is restored within 8-12 days. The color of the new skin is initially bright pink. After two to three weeks, the color becomes normal and traces of the burn disappear.

III degree. It is divided into IIIa and IIIb degrees.

With degree IIIa burns, almost all layers of the skin are damaged, except for the germ layer (the deepest). Bubbles appear on the damaged area, which are filled with a yellowish liquid or jelly-like mass. Often a white or yellowish scab (crust covering the surface of the burn) is formed, insensitive to touch or tingling. Healing occurs within 15-30 days from the moment of the burn. After skin restoration, pigmentation disappears after 1.5-3 months.

Degree IIIb is characterized by necrosis of all layers of the skin and subcutaneous adipose tissue. Large blisters filled with bloody fluid form on the affected area. A gray or brown scab often appears below nearby skin.

IV degree burns. In addition to necrosis of the skin and subcutaneous tissue, necrosis of muscles, tendons, and bones occurs. The damaged surface is covered with a brown or black dense crust, which is not sensitive to irritation.

After deep burns, complete tissue restoration is impossible. In their place, scars form.

First aid

The rules for providing first aid for burns depend on the type of injury.

First aid for thermal burns.

1. Elimination of the burning factor. If the victim's clothes are on fire, they are doused with water or covered with a thick cloth. If burning liquid gets on your clothing, take it off immediately.
2. In case of a 1st or 2nd degree burn, cool the damaged area for 15 minutes under running water. After which it is covered with a clean damp cloth and cold is applied. Do not treat a third degree burn with water. It is only covered with a clean damp cloth.
3. It is necessary to give the victim a pain reliever and drink water frequently.

First aid for electrical burns.

1. Disconnect the device that caused the damage from the network or turn off the power using a general switch.
2. Call an ambulance immediately.
3. If the victim loses consciousness, check his breathing and pulse. If breathing is uneven, weak, perform artificial respiration and closed heart massage.
4. If the victim is conscious, he is given warm tea and 15-20 drops of valerian tincture.

First aid for radiation burns.

1. Cooling. Lotions and compresses of cold, clean water are suitable for this.
2. Treatment with antiseptic agents - chlorhexedine, furatsilin.
3. Treatment with special anti-tanning products. Depending on the severity of the burn, you can apply creams with extracts of aloe, chamomile, and vitamin E. In more serious cases, the use of Panthenol is effective.
4. Anesthesia. To reduce pain from a burn, take Ibuprofen, Paracetamol, and Aspirin. Antihistamines will help reduce itching and burning.

The initial stage of treating burns is to provide proper first aid.

Self-treatment can only be applied to first-degree burns, unless they are complicated by concomitant diseases (immunodeficiency, diabetes) or old age.

We often get thermal or sunburn in spring and summer. If you are burned, you should treat the skin as quickly as possible to stop the damage process at the initial stage and avoid serious complications. To treat the burn surface, doctors recommend using a spray containing dexpanthenol, which has a healing and anti-inflammatory effect. This component is part of a European quality medicine - PanthenolSpray. Experts note that the drug prevents the development of inflammation, quickly relieves burning, redness and other unpleasant signs of a burn. PanthenolSpray is an original drug, tested over the years and is very popular, therefore it has many analogues in the pharmacy with very similar packaging.
Most of these analogues are registered as cosmetics according to a simplified procedure that does not require clinical trials, so the composition of such products is not always safe. In some cases, it includes parabens, potentially dangerous substances that can promote tumor growth. Therefore, when choosing a spray for burns, it is very important not to make a mistake. Pay attention to the composition, country of production and packaging - the original drug is produced in Europe and has a characteristic smiley face next to the name on the packaging

In case of II and in some cases III degree burns, treatment is carried out in a hospital. The victim is prescribed painkillers, sedatives, and antitetanus serum is administered. In this case, the blisters are incised, exfoliated areas of skin are removed, and anti-burn dressings are applied.

Treatment of IV and in some cases III degree burns is carried out in specialized departments. The victim is given anti-shock therapy to prevent the development of infection. Burn wounds are treated open or closed, surgically, including skin grafts.

Chemical burn

Chemical burns occur when a chemical acts aggressively on skin tissue or mucous membranes.

The peculiarity of this type of burns is that they can appear either immediately after exposure or after several hours or days. Tissue damage and destruction often continues after exposure to the corrosive agent has ended.

Chemical burns are most often caused by the following substances:

• acids, especially dangerous is damage by “regia vodka” - a mixture of hydrochloric and nitric acids;
• alkalis - caustic soda, caustic potassium and others;
• some salts of heavy metals;
• phosphorus;
• substances that have a cauterizing effect - bitumen, gasoline, kerosene and others.

First aid for chemical burns.

1. Remove clothing that has come into contact with the chemical.
2. Wash off the chemical reagent from the skin for 25-30 minutes under running water.
3. Neutralizes the effects of chemicals. If the burn is caused by acid, wash the damaged area with a 2% soda solution or soapy water. In case of a burn with alkali, wash the damaged area with a weak solution of vinegar or citric acid.
4. Apply a cold, damp cloth to the affected area.
5. Apply a bandage made of clean, dry cloth or sterile bandage to the burned area.

Mild chemical burns heal without special treatment.

Attention!

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Make an appointment with a doctor

A burn is tissue damage as a result of high temperature, chemicals, or radiation. This is the most common injury that can occur in everyday life. This is especially true for thermal burns.

There is probably no person who has not been scalded by boiling water or burned by hot oil at least once in his life. Treatment of minor skin burns can be carried out at home; you do not always need to go to the doctor.

Most of these injuries resolve within a few days. But you need to know how to relieve pain, how to speed up healing, and in what cases you still need to seek medical help.

How do people most often get burned?

• Half of all cases are contact with open fire (fires, bonfires, flames in a stove, ignition of gasoline).
• 20% is scalding with boiling water or steam.
• 10% is contact with hot objects.
• 20% - other factors (acids, alkalis, sunburn, electric current).

Every third person burned is a child. Most often (75% of cases) the arms and hands are burned.

What are they?

Due to:

• Thermal.
• Chemical.
• Electrical.
• Radiation.

I and II degrees refer to superficial burns, in which only the top layer of skin, the epidermis, is affected. When uncomplicated, they heal without leaving scars.

III and IV degrees are deep burns, with damage to all layers of the skin and underlying tissues. They heal with the formation of a rough scar.

What burns can be treated at home?

You can treat at home:

• 1st degree burns in adults not exceeding 10% of the body area;
• 2nd degree burns not exceeding 1% of the body.

How to determine the degree?

1st degree burn – manifested by swelling, redness of the skin, pain, sensitivity to touch, and there may be small blisters.

Stage 2 is characterized by the addition of large blisters filled with liquid to the above symptoms.

How to determine area?

The easiest way to determine the burn surface area of ​​a home is the palm method. The area of ​​a person's palm is conventionally taken to be 1% of the area of ​​the entire body.

When should you seek medical help immediately?

How to treat burns at home

1. Stop contact with the burning factor. Put out the flames on your clothes and move away from the fire. If you are burned by boiling water, immediately remove clothing in contact with the body. Throw a hot object.
2. Cool the burn surface. It is best to do this under running water at a temperature of 10-18 degrees. You can immerse the limb in a container of water or apply a damp cloth. You need to cool for 5 to 10 minutes; in case of a chemical burn, rinse with running water for up to 20 minutes (except for burns with quicklime). Cooling has an analgesic effect and also prevents the spread of heating of healthy tissue at the border of the burn.
3. Anesthesia. For severe pain, you can take paracetamol, ibuprofen, ketanov, analgin, and other analgesics.
4. Local treatment. The main goal in the treatment of burns is to protect the surface from germs, relieve pain and speed up the restoration of the damaged layer of skin. They simply use sterile wipes, special wipes for burns, sprays and ointments that promote healing.
5. General treatment. It would be a good idea to take restorative medications and also follow a proper diet to ensure that the burn heals faster and without consequences. It is recommended to increase the amount of protein in the diet (meat, fish, dairy products), as well as vegetables and fruits rich in vitamins. Additionally, you can take vitamin C and Aevit. It is recommended to drink more.

Pharmacy drugs

So, you got a burn from boiling water or oil. They cooled it down, assessed that it was small and shallow, its condition was generally satisfactory, and it could be treated at home. It's worth looking into the first aid kit. Those who are prudent and thrifty may at least have a package of sterile wipes and Panthenol.

What can you ask at the pharmacy?

There is no need to buy everything at once; to treat minor burns, sometimes one sterile bandage lightly moistened with an antiseptic and Panthenol is enough. In a healthy person, everything will heal without the use of additional funds. If there are no sterile bandages, you can iron a clean cloth with a hot iron.

How long will it take to heal?

Superficial 1st degree burn injuries heal without consequences in 3-4 days. A slight pigmentation may remain, which will also disappear over time.

Second degree burns with blisters will take longer to heal. The bubble gradually subsides, the liquid resolves. It may happen that the bubble bursts with the formation of erosion; this requires additional treatment with antibacterial ointments Levomekol (130 rub) or Voskopran bandage with levomekol ointment (5 x 75, cm 350 rub, 10x10 cm 1100 rub), Silvacin, Dioxyzol. The bandage needs to be changed every other day. Such a burn heals within 10-12 days, also without scar formation.

If, during the treatment, redness, swelling, pain increases, and purulent discharge from the wound appears, this is evidence of infection and a reason to consult a doctor.

What not to do and why

Folk remedies in treatment

There are many tips for treating burns with folk remedies. You shouldn’t trust them all recklessly. But some of them may be useful if the burn is received far from home and away from the first aid kit, or if a person likes to be treated with natural remedies without “any chemicals.”

Many plants are known to have antiseptic properties. The main principle here is “do no harm.” The safest folk remedies:

• Raw potato juice. Grate one medium potato, put the pulp in gauze and apply to the burned area for 10-15 minutes.
• Carrot lotion. Instead of potatoes, raw carrots are grated and used in the same way as in the previous recipe.
• Black or green tea Brew with boiling water, cool to room temperature, soak a napkin in the brew and apply to the burn.
• Calendula ointment. Brew 3 tablespoons of dry calendula with boiling water, let it brew for 15 minutes, strain. Mix the resulting infusion with Vaseline in a ratio of 1:2. Apply 2 times a day to the burned surface. Keep refrigerated.
• Dried linden flowers pour boiling water (1 tablespoon per glass of water). Leave for about an hour, strain. Apply 2-3 times a day until dry.
• Using the same principle, you can prepare a decoction from any herb or mixture of herbs that have an anti-inflammatory effect: chamomile, calendula, sage, string, plantain.

A chemical burn is an injury to the membrane, and sometimes to the deeper layers of the skin, caused by exposure to an aggressive chemical reagent. It is quite easy to get damaged, because a modern person, even in everyday conditions, is surrounded by quite a lot of chemicals.

As a rule, household injuries are easily tolerated, since they are not deep. Industrial damage is much more severe, since in these cases people come into contact with more dangerous reagents.

Features of the disease

Children and men are more susceptible to injury than others. If in the latter case the risk is associated with professional activity, then children are injured at home when they come into contact with acetic acid, household chemicals, etc.

Chemical burns caused by different reagents can be fundamentally different from each other. Some do not cause such deep injuries and occur more easily, affecting only the superficial layers.

Alkali and acid burns are considered the most dangerous, as they even affect deep tissues. Acid leads not only to destruction, but also to active dehydration, so the scab will be dry and dense. Alkalis penetrate deep into the skin very quickly, since they have the ability to dissolve fatty and protein components of cells. The scab with such damage is soft and has no boundaries.

Chemical skin burn (photo)

Read more about 1st, 2nd, 3rd, 4th degree chemical burns.

Degrees of chemical burns

For a chemical burn:

• I degree. Damage affects the epidermis. This is a minor injury, without many clinical manifestations, which does not carry any serious consequences.
• II degree. There is already damage to the dermis down to the papillary layer. The main nervous and vascular structures remain intact. Blisters are already present here, the symptoms (hyperemia, pain) become more pronounced.
• III a. Both the papillary layer and the elements involved in microcirculation are injured. There may be an open burn wound or a large blister containing bloody contents on the surface of the skin.
• III b. The skin is burned down to the fiber.
• IV degree. Deep tissues suffer - muscles, tendons, subcutaneous fat. Sometimes the injury even extends to the bone.

This video will tell you what a chemical burn is:

Causes

You can get injured due to contact with various reagents:

• volatile oils (phosphorus, bitumen);
• acid (acetic, hydrochloric, hydrofluoric);
• household chemicals;
• alkalis (barium, potassium hydroxide);
• chemical compounds (gasoline, pesticides);
• salts of heavy metals (zinc chloride, silver nitrate).

Symptoms

Symptoms depend on the depth and extent of the lesion. It may include the following signs:

• pain,
• redness,
• bubbles,
• brown or dark wound.

The resulting scab will have a different texture, depending on the substance that caused the chemical burn. It will be moist if the substance is alkaline. This injury usually involves a large area of ​​skin. With an acid lesion, the damaged area is clearly visible, the scab itself is dry.

The skin tone may also change, depending on the substance acting on it.

Diagnostics

Much attention is paid to interviewing the patient or witnesses who saw the moment of injury, since it is possible to accurately determine how much damage the burn caused only after a few days. The depth and extent of the injury are also revealed.

Read below about chemical skin burns and their treatment at home, as well as in hospital settings.

Treatment

First aid

In case of a chemical burn, first aid must be provided in a timely manner. It includes a number of actions:

1. You need to remove clothing if it has become saturated with the reagent, and then wash it off the skin. It is best to expose the limb to a cold stream, since the liquid should drain from the area and not remain on the body. Wiping the affected area with a towel or even immersing it in the sink is strictly prohibited! It takes about half an hour to wash off the reagent, and if it is very aggressive, such as alkali, then it will take longer. It is necessary to keep the affected area under the stream for a long time even in cases where the substance was on the skin for about 15 minutes.
2. Next, monitor the sensations. If a burning sensation occurs, you need to repeat the procedure of washing off the reagent.
3. If you know what substance caused the burn, you can neutralize its destructive effect on the skin. So, if the injury was caused by acid, prepare a weak concentration of an alkaline solution (for example, from soda), and then wash the surface. If the cause of the pathology is alkali, then use a weak acid solution (lemon, vinegar). If the nature of the substance is unknown, it is better not to wash the skin with anything, only with water.
4. Subsequently, a bandage is applied to the affected area. It can be dry or soaked in novocaine solution. Ointments and antiseptics are not applied so as not to interfere with doctors determining the main criteria for a burn that influence treatment tactics - its degree and depth.

It is prohibited to wash the injured area with ordinary running water in cases where the burn was caused by organic aluminum compounds.

Physiotherapeutic method

Physiotherapeutic treatment is started in the later stages of healing. Physiotherapy simultaneously stimulates tissues for better regeneration and restores a person's defenses, improves blood flow and prevents microbial activity in the wound. To treat a chemical burn, the following types of physiotherapy are used:

• irradiation with infrared waves,
• ultraviolet or
• ultrasound.

Read below about which remedy to choose and how to treat a chemical burn at home and in a hospital setting.

This video will tell you what first aid is for chemical burns:

Medication method

Conservative treatment methods are usually used for injuries of degrees I, II, IIIa. Bandages are regularly applied to the skin, under which ointments or special antiseptic compounds are applied. This may be sufficient if the burn is limited. In cases where it affects large areas of tissue, additional infusion therapy, detoxification and antibacterial measures are carried out. All procedures take place in the burn department.

The damage is treated locally in order to create good healing conditions, accelerate regeneration, and at the same time prevent the development of pathogenic microflora in the wound. At first, for chemical skin burns, it is better to use ointments with a light texture (water-soluble). These include:

• Oflocaine,
• Levosin,

These medications will help clear the wound of necrotic matter and speed up recovery. For mild burns you can also use:

• Bepanten,
• Agrosulfan,

If the damage is deep, then ointments will be used at the very last stage, when healing begins actively.

Operation

Surgical intervention is performed not in the early period, but in the late period. The method of operation is selected individually. There are several of them:

1. Amputation. It is used only for very severe injuries when saving the limb is not possible. Sometimes this intervention is resorted to when necrosis spreads to healthy areas of tissue or if other techniques have not brought any effect.
2. Necrotomy. The intervention technique involves excision of the resulting scab, which helps restore general blood supply to the damaged area. This is the only operation that can be performed urgently, since it is designed to prevent the spread of necrosis.
3. Necrectomy used for 3rd degree burns if the area is limited. The wound is thoroughly cleaned of dead tissue, which has a beneficial effect on overall recovery, as purulent processes are prevented.
4. Staged necrectomy is the intervention described above, only the operation is performed in parts. The gentle technique helps to better tolerate the removal of extensive lesions.
5. Skin transplantation. If the injury covers a large area, the patient undergoes a transplant of his own or donor skin.

Prevention of disease

Maintain safety when working with any chemical compounds. If the profession involves the need to use caustic acids, then the employee must undergo special training.

To prevent household chemical burns you need to:

• keep all chemical products tightly closed;
• put containers in hard-to-reach places;
• Do not store aggressive substances near food and medicine;
• contact with toxic products only if the exposed surface of the body is protected;
• do not allow the compounds to evaporate, and if this happens, be sure to ventilate the room.

Complications

Some substances have the property of spontaneous combustion, which creates the risk of receiving additional. We must not forget that the compounds can be toxic. In this case, they will have an even more destructive effect not only at the site of the burn, but also on the entire body.

The most common complications that occur from chemical burns are:

1. Kidney dysfunction (2%).
2. Sepsis (1%).
3. Shock (6%).
4. Lung problems (2%).
5. Toxemia (15%).

Forecast

The prognosis is greatly influenced by the depth of the burn and a number of other features:

• aggressiveness and concentration of the reagent;
• how long was the contact with the substance;
• general health;
• amount of chemical;
• skin sensitivity.

With the first two degrees of burn, healing proceeds actively even without active drug therapy. The prognosis for grades III and IV injury is less favorable.

Dr. Komarovsky himself will tell you in this video what to do if a child has a chemical burn to the eye:

itchy skin

diaper rash

dermatitis

peeling and dry skin

cuts

frostbite

abrasions

calluses

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

Burns is damage to body tissue caused by exposure to high temperatures or chemicals. A burn can also result from electric shock, as well as exposure to ionizing radiation (ultraviolet, x-ray, etc., including solar radiation).

Often burns are also called skin lesions caused by the irritating effect of a plant (nettle burn, hogweed burn, hot pepper burn), although in essence 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 type of burn.

Heaviness burn determined by the depth and area of ​​tissue damage. The concept of “burn area” is used to characterize the area of ​​skin damage and is expressed as a percentage. To classify the depth of a burn, the concept “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 burn is the result of exposure to high temperature. This is the most common household injury. They occur as a result of exposure to open flame, steam, hot liquid (boiling water, hot oil), or hot objects. The most dangerous, of course, is open fire, since in this case the organs of vision and the upper respiratory tract can be affected. Hot steam is also dangerous for the respiratory tract. Burns from hot liquids or hot objects are usually not very large in area, but deep.

Chemical burn

Chemical burn occurs as a result of exposure to chemically active substances on the skin: acids, alkalis, salts of heavy metals. They are dangerous if the affected area is large, as well as if chemicals come into contact with mucous membranes and eyes.

Electrical burns

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

Radiation burns

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

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

Degree 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 epidermis, dermis and subcutaneous fat (hypodermis). 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 the tanning effect. The dermis, or the 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 the 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.

First degree burn

I degree burn is characterized by damage to the most superficial layer of the skin (epidermis), consisting of epithelial cells. In this case, redness of the skin, slight swelling (edema), and soreness of the skin in the burn area appear. Such a burn heals in 2-4 days, no traces remain after the burn, except for minor itching and peeling of the skin - the upper layer of the epithelium dies.

Second degree burn

A second degree burn is characterized by deeper tissue damage - the epidermis is partially damaged to the full depth, down to the germ layer. Not only redness and swelling are observed, but also the formation of blisters with a yellowish liquid on the skin, which can burst on their own or remain intact. Bubbles form immediately after a burn or after some time. If the bubbles burst, a bright red erosion forms, which is covered with a thin brown crust. Healing for a second degree burn usually occurs in 1-2 weeks, through tissue regeneration due to the preserved germ layer. There are no marks left on the skin, but the skin may become more sensitive to temperature influences.

Third degree burn

III degree burn is characterized by complete death of the epidermis in the affected area and partial or complete damage to the dermis. Tissue necrosis (necrosis) and the formation of a burn scab are observed. According to the accepted classification, III degree burns are divided into:

• degree III A, when the dermis and epithelium are partially damaged and independent restoration of the skin surface is possible if the burn is not complicated by infection,
• and degree III B - complete death of the skin down to the subcutaneous fat. As healing occurs, scars form.

IV degree burn

A fourth degree burn is the complete destruction of all layers of skin and underlying tissues, charring of muscles and bones.

Determination of the area affected by a burn

Approximate area estimate burn can be produced in two ways. The first method is the so-called “rule of nines”. According to this rule, the entire surface of the skin of an adult is conditionally divided into eleven sections of 9% each:

• head and neck - 9%,
• upper limbs - 9% each,
• lower limbs - 18% (2 times 9%) each,
• posterior surface of the body - 18%,
• anterior surface of the body - 18%.

The remaining one percent of the body surface is in the perineal area.

The second method - the palm method - is based on the fact that the area of ​​the palm of an adult is approximately 1% of the total surface of the skin. For local burns, the area of ​​damaged skin is measured using the palm of the hand; for extensive burns, the area of ​​unaffected areas is measured.

The larger the area and deeper the tissue damage, the more severe the burn injury. If deep burns occupy more than 10-15% of the body surface, or the total area of ​​even shallow burns makes up more than 30% of the body surface, the victim develops a burn disease. The severity of a burn disease depends on the area of ​​the burns (especially deep ones), the age of the victim, the presence of concomitant injuries, diseases and complications.

Prognosis for recovery from burns

To assess the severity of the lesion and predict the further development of the disease, various prognostic indices are used. One of these indices is the lesion severity index (Frank index).

When calculating this index, each for each percentage of the burn area gives from one to four points - depending on the degree of the burn, a burn of the respiratory tract without breathing impairment - 15 points additionally, with a violation - 30. The index values ​​are interpreted as follows:

• < 30 баллов - прогноз благоприятный
• 30-60 - conditionally favorable
• 61-90 - doubtful
• > 91 - unfavorable

Also, to assess the prognosis of burn injury in adults, the “hundred rule” is applied: if the sum of the numbers of the patient’s age (in years) and the total area of ​​damage (in percent) exceeds 100, the prognosis is unfavorable. Burns of the respiratory tract significantly worsen the prognosis, and to take into account its influence on the “rule of hundreds” indicator, it is conventionally accepted that it corresponds to 15% of a deep burn of the body. The combination of a burn with damage to bones and internal organs, carbon monoxide poisoning, smoke, toxic combustion products or exposure to ionizing radiation aggravates the prognosis.

Burn disease in children, especially younger ones, can develop when only 3-5% of the body surface is affected, in older children - 5-10%, and is more severe the younger the child. Deep burns of 10% of the body surface are considered critical in young children.

Treatment of burns

Burns Grades I and II are considered superficial and heal without surgery. Burns of III A degree are classified as borderline, and III B and IV degrees are deep. In case of burns of degree III A, independent tissue restoration is difficult, and treatment of burns of degrees III B and IV without surgical intervention is impossible - skin grafting is required.

Self-treatment, without consulting a doctor, is only possible for I-II degree burns, and only if the burn area is small. If the area of ​​the second degree burn is more than 5 cm in diameter, you should consult a doctor. Treatment of adult patients with first-degree burns, even extensive ones, can be carried out on an outpatient basis. For more severe burns, adult patients can be treated on an outpatient basis in cases where the skin of the face, lower extremities or perineum is not affected, and the burn area does not exceed:

• for second degree burns - 10% of the body surface;
• for III A degree burns - 5% of the body surface.

The method of treating a burn depends on its type, the degree of the burn, the area affected and the age of the patient. Thus, even small-area burns in young children require mandatory medical intervention, and often hospital treatment. Elderly people also suffer from burns with difficulty. It is advisable to treat victims over 60 years of age with limited degree II-IIIA burns, regardless of their location, in a hospital setting.

First of all, in case of a burn, you must urgently stop the action of the damaging factor (high temperature, chemical substance) on the skin. For a superficial thermal burn - with boiling water, steam, or a hot object - wash the burned area generously with cold water for 10-15 minutes. In case of a chemical burn with acid, the wound is washed with a soda solution, and in case of a burn with alkali - with a weak solution of acetic acid. If the exact composition of the chemical is unknown, wash with clean water.

If the burn is extensive, the victim should be given at least 0.5 liters of water to drink, preferably with 1/4 teaspoon of baking soda and 1/2 teaspoon of table salt dissolved in it. Give 1-2 g of acetylsalicylic acid and 0.05 g of diphenhydramine orally.

You can try to treat a first degree burn yourself. But if the victim has a significant second-degree burn (blister with a diameter of 5 cm or more), and even more so with third-degree burns and higher, you need to urgently consult a doctor.

For IIIA degree burns, treatment begins with wet-dry dressings that promote the formation of a thin scab. Under a dry scab, IIIA degree burns can heal without suppuration. After rejection and removal of the scab and the beginning of epithelization, oil-balsamic dressings are used.

For the treatment of I-II degree burns, as well as at the stage of epithelization in the treatment of III A degree burns, the Guardian balm showed good results. It has analgesic, anti-inflammatory, antiseptic, regenerating properties. Balm Guardian relieves inflammation, accelerates skin regeneration, promotes wound healing, and prevents scar formation. Apply directly to the affected area, or use for ointment aseptic dressings.

Burn– tissue damage caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. There are 4 degrees of burns based on the depth of tissue damage. Extensive burns lead to the development of the so-called burn disease, which is dangerously fatal due to disruption of the cardiovascular and respiratory systems, as well as the occurrence of infectious complications. Local treatment of burns can be carried out open or closed. It is necessarily supplemented with analgesic treatment, according to indications - antibacterial and infusion therapy.

General information

Burn– tissue damage caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. Minor burns are the most common injury. Severe burns are the second leading cause of accidental death, second only to motor vehicle accidents.

Classification

By localization:

• skin burns;
• eye burns;
• inhalation injuries and burns of the respiratory tract.

According to the depth of the lesion:

• I degree. Incomplete damage to the surface layer of the skin. Accompanied by redness of the skin, slight swelling, and burning pain. Recovery in 2-4 days. The burn heals without a trace.
• II degree. Complete damage to the surface layer of the skin. Accompanied by burning pain and the formation of small blisters. When the blisters are opened, bright red erosions are exposed. Burns heal without scarring within 1-2 weeks.
• III degree. Damage to the superficial and deep layers of the skin.
• IIIA degree. The deep layers of the skin are partially damaged. Immediately after the injury, a dry black or brown crust forms - a burn scab. When scalded, the scab is whitish-grayish, moist and soft.

The formation of large bubbles prone to coalescence is possible. When the blisters are opened, a motley wound surface is exposed, consisting of white, gray and pink areas, on which a thin scab resembling parchment is subsequently formed during dry necrosis, and a wet grayish fibrin film is formed during wet necrosis.

Pain sensitivity of the damaged area is reduced. Healing depends on the number of remaining islands of intact deep layers of skin at the bottom of the wound. With a small number of such islands, as well as with subsequent suppuration of the wound, independent healing of the burn slows down or becomes impossible.

• IIIB degree. Death of all layers of skin. Possible damage to subcutaneous fat tissue.
• IV degree. Charring of the skin and underlying tissues (subcutaneous fat, bones and muscles).

Burns of degrees I-IIIA are considered superficial and can heal on their own (unless secondary deepening of the wound occurs as a result of suppuration). For IIIB and IV degree burns, removal of necrosis followed by skin grafting is required. An accurate determination of the degree of burn is possible only in a specialized medical institution.

By type of damage:

Thermal burns:

• Flame burns. As a rule, II degree. Possible damage to a large area of ​​skin, burns to the eyes and upper respiratory tract.
• Liquid burns. Mostly II-III degree. As a rule, they are characterized by a small area and large depth of damage.
• Steam burns. Large area and shallow depth of damage. Often accompanied by a burn of the respiratory tract.
• Burns from hot objects. II-IV degree. Clear boundary, significant depth. Accompanied by detachment of damaged tissues when contact with the object ceases.

Chemical burns:

• Acid burns. When exposed to acid, coagulation (folding) of the protein in the tissue occurs, which causes a shallow depth of damage.
• Alkali burns. In this case, coagulation does not occur, so the damage can reach significant depth.
• Burns from heavy metal salts. Usually superficial.

Radiation burns:

• Burns due to exposure to sunlight. Usually I, less often – II degree.
• Burns resulting from exposure to laser weapons, airborne and ground-based nuclear explosions. Cause instant damage to parts of the body facing the direction of the explosion, and may be accompanied by eye burns.
• Burns resulting from exposure to ionizing radiation. As a rule, superficial. They heal poorly due to concomitant radiation sickness, which increases the fragility of blood vessels and impairs tissue restoration.

Electrical burns:

Small area (small wounds at the charge entry and exit points), large depth. Accompanied by electrical trauma (damage to internal organs when exposed to an electromagnetic field).

Damage area

The severity of the burn, prognosis and choice of treatment measures depend not only on the depth, but also on the area of ​​the burn surfaces. When calculating the area of ​​burns in adults in traumatology, the “rule of palm” and “rule of nines” are used. According to the “rule of the palm,” the area of ​​the palmar surface of the hand approximately corresponds to 1% of the body of its owner. According to the "rule of nines":

• the area of ​​the neck and head is 9% of the total surface of the body;
• breast – 9%;
• belly – 9%;
• posterior surface of the body – 18%;
• one upper limb – 9%;
• one hip – 9%;
• one lower leg with foot – 9%;
• external genitalia and perineum – 1%.

The child’s body has different proportions, so the “rule of nines” and “rule of the palm” cannot be applied to it. To calculate the burn surface area in children, the Land and Brouwer table is used. In specialized medical In institutions, the area of ​​burns is determined using special film meters (transparent films with a measuring grid).

Forecast

The prognosis depends on the depth and area of ​​the burns, the general condition of the body, the presence of concomitant injuries and diseases. To determine the prognosis, the lesion severity index (ISI) and the rule of hundreds (RS) are used.

Lesion severity index

Applicable in all age groups. With ITP, 1% of a superficial burn is equal to 1 unit of severity, 1% of a deep burn is 3 units. Inhalation lesions without respiratory dysfunction - 15 units, with respiratory dysfunction - 30 units.

Forecast:

• favorable – less than 30 units;
• relatively favorable – from 30 to 60 units;
• doubtful – from 61 to 90 units;
• unfavorable – 91 or more units.

In the presence of combined lesions and severe concomitant diseases, the prognosis worsens by 1-2 degrees.

Hundred Rule

Usually used for patients over 50 years of age. Calculation formula: sum of age in years + area of ​​burns in percentage. A burn to the upper respiratory tract is equivalent to 20% skin damage.

Forecast:

• favorable – less than 60;
• relatively favorable – 61-80;
• doubtful – 81-100;
• unfavorable – more than 100.

Local symptoms

Superficial burns up to 10-12% and deep burns up to 5-6% occur predominantly in the form of a local process. There is no disruption of the activity of other organs and systems. In children, the elderly and people with severe concomitant diseases, the “borderline” between local suffering and the general process can be reduced by half: to 5-6% for superficial burns and up to 3% for deep burns.

Local pathological changes are determined by the degree of the burn, the period of time since the injury, secondary infection and some other conditions. First degree burns are accompanied by the development of erythema (redness). Second degree burns are characterized by vesicles (small blisters), while third degree burns are characterized by bullae (large blisters with a tendency to merge). When the skin peels off, spontaneously opens or removes the blister, erosion (bright red bleeding surface, devoid of the superficial layer of skin) is exposed.

With deep burns, an area of ​​dry or wet necrosis forms. Dry necrosis is more favorable and looks like a black or brown crust. Wet necrosis develops when there is a large amount of moisture in the tissues, large areas and a large depth of the lesion. It is a favorable environment for bacteria and often spreads to healthy tissue. After rejection of areas of dry and wet necrosis, ulcers of varying depths are formed.

Burn healing occurs in several stages:

• Stage I. Inflammation, cleansing the wound from dead tissue. 1-10 days after injury.
• Stage II. Regeneration, filling the wound with granulation tissue. It consists of two substages: 10-17 days - cleansing the wound of necrotic tissue, 15-21 days - development of granulations.
• Stage III. Scar formation, wound closure.

In severe cases, complications may develop: purulent cellulite, lymphadenitis, abscesses and gangrene of the extremities.

General symptoms

Extensive lesions cause burn disease - pathological changes in various organs and systems, in which protein and water-salt metabolism is disrupted, toxins accumulate, the body's defenses are reduced, and burn exhaustion develops. Burn disease, combined with a sharp decrease in motor activity, can cause dysfunction of the respiratory, cardiovascular, urinary system and gastrointestinal tract.

Burn disease occurs in stages:

Stage I. Burn shock. Develops due to severe pain and significant loss of fluid through the surface of the burn. Represents a danger to the patient's life. Lasts 12-48 hours, in some cases – up to 72 hours. A short period of excitement is replaced by increasing retardation. Characterized by thirst, muscle tremors, chills. Consciousness is confused. Unlike other types of shock, blood pressure rises or remains within normal limits. The pulse quickens and urine output decreases. The urine becomes brown, black or dark cherry, and has a burning smell. In severe cases, loss of consciousness is possible. Adequate treatment of burn shock is possible only in specialized medical care. institution.

Stage II. Burn toxemia. Occurs when tissue breakdown products and bacterial toxins are absorbed into the blood. Develops within 2-4 days from the moment of injury. Lasts from 2-4 to 10-15 days. Body temperature is increased. The patient is excited, his consciousness is confused. Convulsions, delirium, auditory and visual hallucinations are possible. At this stage, complications from various organs and systems appear.

From the cardiovascular system - toxic myocarditis, thrombosis, pericarditis. From the gastrointestinal tract - stress erosions and ulcers (may be complicated by gastric bleeding), dynamic intestinal obstruction, toxic hepatitis, pancreatitis. From the respiratory system - pulmonary edema, exudative pleurisy, pneumonia, bronchitis. From the kidneys – pyelitis, nephritis.

Stage III. Septicotoxemia. It is caused by a large loss of protein through the wound surface and the body’s response to infection. Lasts from several weeks to several months. Wounds with a large amount of purulent discharge. Healing of burns stops, areas of epithelialization decrease or disappear.

Characterized by fever with large fluctuations in body temperature. The patient is lethargic and suffers from sleep disturbances. No appetite. There is a significant weight loss (in severe cases, a loss of 1/3 of body weight is possible). Muscles atrophy, joint mobility decreases, and bleeding increases. Bedsores develop. Death occurs from general infectious complications (sepsis, pneumonia). In a favorable scenario, the burn disease ends with recovery, during which the wounds are cleaned and closed, and the patient’s condition gradually improves.

First aid

Contact with the damaging agent (flame, steam, chemical, etc.) must be stopped as quickly as possible. In case of thermal burns, the destruction of tissue due to their heating continues for some time after the cessation of the destructive effect, so the burned surface must be cooled with ice, snow or cold water for 10-15 minutes. Then, carefully, trying not to damage the wound, cut off the clothing and apply a clean bandage. A fresh burn should not be lubricated with cream, oil or ointment - this can complicate subsequent treatment and impair wound healing.

For chemical burns, rinse the wound thoroughly with running water. Burns with alkali are washed with a weak solution of citric acid, burns with acid - with a weak solution of baking soda. A burn with quicklime should not be washed with water; instead, vegetable oil should be used. For extensive and deep burns, the patient must be wrapped up, given painkillers and a warm drink (preferably a soda-salt solution or alkaline mineral water). A burn victim should be taken to a specialized medical facility as quickly as possible. institution.

Treatment

Local therapeutic measures

Closed treatment of burns

First of all, the burn surface is treated. Foreign bodies are removed from the damaged surface, and the skin around the wound is treated with an antiseptic. Large bubbles are trimmed and emptied without removal. The peeled skin adheres to the burn and protects the wound surface. The burned limb is placed in an elevated position.

At the first stage of healing, drugs with analgesic and cooling effects and medications are used to normalize the condition of tissues, remove wound contents, prevent infection and reject necrotic areas. Aerosols with dexpanthenol, ointments and solutions on a hydrophilic basis are used. Antiseptic solutions and hypertonic solution are used only when providing first aid. In the future, their use is impractical, since the dressings dry out quickly and prevent the outflow of contents from the wound.

In case of IIIA burns, the scabs are preserved until they are rejected on their own. First, aseptic dressings are applied, and after the scab is rejected, ointment dressings are applied. The purpose of local treatment of burns at the second and third stages of healing is protection against infection, activation of metabolic processes, and improvement of local blood supply. Medicines with hyperosmolar action, hydrophobic coatings with wax and paraffin are used to ensure the preservation of the growing epithelium during dressings. For deep burns, the rejection of necrotic tissue is stimulated. Salicylic ointment and proteolytic enzymes are used to melt the scab. After cleansing the wound, skin grafting is performed.

Open treatment of burns

It is carried out in special aseptic burn wards. Burns are treated with drying antiseptic solutions (potassium permanganate solution, brilliant green, etc.) and left without a bandage. In addition, burns of the perineum, face, and other areas that are difficult to apply a bandage are usually treated openly. In this case, ointments with antiseptics (furacilin, streptomycin) are used to treat wounds.

A combination of open and closed methods of treating burns is possible.

General therapeutic measures

Patients with recent burns have increased sensitivity to analgesics. In the early period, the best effect is ensured by frequent administration of small doses of painkillers. Subsequently, an increase in dose may be required. Narcotic analgesics depress the respiratory center and are therefore administered by a traumatologist under breathing control.

The selection of antibiotics is based on determining the sensitivity of microorganisms. Antibiotics are not prescribed prophylactically, as this can lead to the formation of resistant strains that are resistant to antibiotic therapy.

During treatment, it is necessary to replace large losses of protein and fluid. For superficial burns of more than 10% and deep burns of more than 5%, infusion therapy is indicated. Under the control of pulse, diuresis, arterial and central venous pressure, the patient is administered glucose, nutrient solutions, solutions to normalize blood circulation and acid-base status.

Rehabilitation

Rehabilitation includes measures to restore the patient’s physical (therapeutic gymnastics, physiotherapy) and psychological state. Basic principles of rehabilitation:

• early onset;
• clear plan;
• eliminating periods of prolonged immobility;
• constant increase in physical activity.

At the end of the primary rehabilitation period, the need for additional psychological and surgical assistance is determined.

Inhalation lesions

Inhalation injuries occur as a result of inhalation of combustion products. They develop more often in people who have received burns in a confined space. They aggravate the victim’s condition and can pose a danger to life. Increases the likelihood of developing pneumonia. Along with the area of ​​burns and the age of the patient, they are an important factor influencing the outcome of the injury.

Inhalation lesions are divided into three forms, which can occur together or separately:

Carbon monoxide poisoning.

Carbon monoxide prevents the binding of oxygen to hemoglobin, causing hypoxia, and with a large dose and prolonged exposure, death of the victim. Treatment is artificial ventilation with 100% oxygen.

Burns of the upper respiratory tract

Burn of the nasal mucosa, larynx, pharynx, epiglottis, large bronchi and trachea. Accompanied by hoarseness of voice, difficulty breathing, sputum with soot. Bronchoscopy reveals redness and swelling of the mucous membrane, in severe cases - blisters and areas of necrosis. Swelling of the airways increases and reaches its peak on the second day after injury.

Damage to the lower respiratory tract

Damage to the alveoli and small bronchi. Accompanied by difficulty breathing. If the outcome is favorable, it will be compensated within 7-10 days. May be complicated by pneumonia, pulmonary edema, atelectasis and respiratory distress syndrome. Changes on the x-ray are visible only on the 4th day after the injury. The diagnosis is confirmed when the partial pressure of oxygen in arterial blood decreases to 60 mm or lower.

Treatment of burns of the respiratory tract

Mostly symptomatic: intensive spirometry, removal of secretions from the respiratory tract, inhalation of a humidified air-oxygen mixture. Prophylactic treatment with antibiotics is ineffective. Antibacterial therapy is prescribed after bacterial culture and determination of the sensitivity of pathogens from sputum.