Rus Articles Journal

First aid at burns of

Burns - practically the most widespread type of injuries: in a year in Russia more than half a million burns are registered (according to other data, more than 700 thousand). The contribution to this statistics is made by New Year`s fireworks and summer fires, faulty electric devices and the chemicals forgotten on a table. Among patients of burn offices there is also drunk, fallen asleep with an outstanding cigarette, and a child who pulled for edge of a cloth. By amount of deaths burn defeat concedes only to an automobile trauma. Burns are especially dangerous to small children and to elderly.

Burns happen thermal, chemical, electric and beam. From them thermal burns - a flame, hot liquid, steam are most widespread. Burns hot water make 80% among all types of burns at children till 5 years. With age at children and teenagers the share of burns grows at a flame, reaching according to some information 65%. It is necessary to notice that representation as if the serious burn can cause only very hot liquid close to boiling temperature, incorrectly is widespread. Deep burns can be got also at much smaller temperature if it works considerable time. So, water with the temperature of 50 degrees can be the cause of a burn 2 - 3 degrees in 5 - 10 minutes. Cases of very heavy burns are described, up to death, received from contact with water from a water tap.

Among all types of burns thermal make more than 90%. Chemical burns of skin in life are quite rare. There are more often chemical burns of a mucous membrane of a mouth and gullet when the person by a mistake or with the suicide purpose drinks the cauterizing liquid. Prevalence of electric burns grows together with increase in quantity of electrical household appliances, and now the share of electric burns among the severe defeats demanding hospitalization reaches 8%. Beam burns in life are very rare and presented by generally solar burns.

the Characteristic of burns

Depending on depth of damage of skin are distinguished by severity of burns. The burn of 1 degree is characterized by defeat of the blanket of skin. At the same time the expressed reddening of skin, its hypostasis develops, in the struck place pains, a burning sensation are noted. These phenomena abate in rather short time, from several hours to 2 days. Within a week there is a peeling of the died cages, and there comes the absolute recovery, without any functional or cosmetic defeats.

At a burn 2 degrees epidermis completely perishes and exfoliates, at the same time the bubbles filled with transparent liquid are formed. The first bubbles appear already in a few minutes after a burn, however within 1 days new bubbles can be formed, and already existing - to increase in sizes. If the course of disease is not complicated by infection of a wound, then healing comes in 10 - 12 days. At the same time there is an expressed pigmentation which remains for several weeks or months (before half a year).

At burns 3 degrees skin is surprised practically on all depth. At the same time the massive bubbles with a thick cover filled with bloody contents, intense and very painful are formed. More rare, especially at influence of dry heat (a flame, contact with a hot subject) the surface of a burn is covered with a dense dry crust (scab). This degree of burns is in addition divided on 3a and 3b. At burns 3b degrees skin perishes completely, at burns 3a - the deepest layer of skin, so-called sosochkovy remains. The difference between these stages makes millimeter shares, however in fact it is huge - burns 3a degrees heal without formation of hems (new skin accrues on a surface of a burn wound just at the expense of the remained nipples), and after burns 3b degrees remain the rough hems causing many cosmetic and functional problems.

the Burn 4 degrees are a full death of all layers of skin, including hypodermically - fatty cellulose, and often and underlying fabrics - muscles, sinews, bones. Often at the same time there comes the carbonization of fabrics, more rare, usually at influence of damp heat (boiled water, steam) the dense whitish scab is formed.

Krom of depth of a burn, also the area of defeat is of great importance. Now the most widespread way of determination of the area of a burn is the so-called “rule of the nine“. The surface of a body is divided into sites, multiple 9, at the same time the surface of the head and neck (together), and also one hand is accepted to 9% of all surface of a body, a back half of a body (a back and buttocks), a forward half (a breast and a stomach), legs are considered for 18%, the area of a crotch is taken for 1%. At small burns accept “the rule of a palm“, taking the area of a palm for 1% and measuring a palm the area of a burn.

Feature of other types of burns

Chemical burns are caused by influence of various substances: acids, alkalis, not extinguished lime, salts of heavy metals, phosphorus, gasoline, kerosene. Weight of defeat at a chemical burn depends on features of the damaging agent, on its concentration and duration of influence. Severity of chemical burns decides approximately as well as thermal, on that difference that bubbles are less characteristic of a chemical burn. The surface of a burn, especially deep (3 - 4 degrees), is usually covered with a scab - dense and dry at acid influence, friable and soft at a burn alkali. Burns alkali, as a rule, deeper and painful, than acid as acids coagulate proteins, and the scab which is formed at the same time interferes with further penetration of acid deep into, and alkalis saponify fats, dissolve proteins and at the expense of it get deeply in fabrics. The burn combination to poisoning is characteristic of a chemical burn. At the same time it is necessary to notice that chemical burns in itself seldom happen such heavy as thermal, at them the burn disease practically does not develop. Chemical burns longer and heavier, than thermal, with formation of the deep involved hems heal.

chemical burns mucous - oral cavities, a gullet, a stomach are Very dangerous. It happens when the irritating substance (most often it happens acetic essence, accumulator electrolyte, liquid ammonia) is swallowed, is casual or in the suicide purposes. In such cases severe poisoning, as a rule, develops, painful shock can develop, quite often vapors of acid or alkali cause an inhalation burn of a trachea that leads to breath violation. In the further ambassador of rejection of a scab there can be a perforation of hollow body (a gullet or a stomach) or bleeding from large blood vessels, and further - cicatricial narrowing of a gullet up to full impassability.

Electric burns result from passing of electric current through fabrics and transformations of electric energy into thermal. Except burns electric current leads also to system defeat - an electric trauma. The main reason for electric traumas in life - violation of the rules of safety measures when using of electric devices.

Electric burns always deep. Extensiveness and weight of defeat depend on tension and current, the area of contact, and also a state of health of the victim. Moist skin, exhaustion, exhaustion promote more severe defeat. The more current tension, the is more extensive burns; the more force - the more dangerous to life defeat. It is important to track a way of passing of current through an organism (a current loop). The most life-threatening damages are caused by passing of electric current through area of heart or a brain. The electric trauma of heart can lead to various violations of a warm rhythm up to cardiac arrest, and also to infarktopodobny changes of a cardiac muscle. At current more than 15 ma at the victim develop spasms (“not releasing current“), and from - for a spasm of vocal chords the victim cannot shout, call to the aid.

Beam burns in life meet extremely seldom. In most cases they occur from - for gross violation of safety regulations on production, are characterized by a long and heavy current and quite often are followed by radiation sickness. However, there is one type of burns which can be considered as option beam and which meets usually just in life - it is solar burns. Small depth of defeat is characteristic of them (1, the 2nd degree is more rare). It is necessary to remember that solar burns arise under the influence of the ultra-violet, but not thermal radiation therefore burns can be got also in cold, even frosty day, and also through a sheet of water when bathing.

Treatment of a thermal burn

First that should be made at assistance to the victim is to stop influence of the striking factor. If it is about a burn boiled water, then it is necessary to remove as soon as possible (to cut off) the clothes impregnated with hot liquid. At influence by a flame by the most correct will be to extinguish the burning clothes water, and then to remove. If there is no enough water, it is necessary to extinguish make-shifts - dense fabric, sand, the earth. At the same time it is not necessary to close the victim with the head - it can lead to inhalation of products of burning with the subsequent burn of airways and/or to poisoning. It is also not necessary to force down a flame barehanded as at the same time the rescuer himself can pass into the category of victims.

should not Delete the clothes which stuck to a body as at the same time there is a risk in addition to damage the burned surface.

At burns of a brush should remove immediately rings, hours, bracelets as hypostasis of an affected area will develop further, and these objects can squeeze fabrics with violation of blood circulation up to development of a necrosis.

Whenever possible should cool an affected area - immersion in cold water, applying of packages of ice, blowing with cold air.

This measure not only reduces pain (that in itself is very important), but also in some measure reduces defeat depth. The matter is that a burn - process not one-stage. Even when the striking factor is terminated, it continues to develop and go deep because blankets of skin play a role of a hot compress for underlying. Cooling a body surface, it is possible to interrupt this process. Duration of influence of cold depends on depth and the area of a burn and fluctuates from 3 - 5 to 15 - 20 minutes. Too long it is not necessary to cool the burned place not to cause an angiospasm with the subsequent violation of blood circulation in an affected area. This measure is effective within 2 hours after receiving a burn.

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needs Further adequate anesthesia. Any anesthetizing preparations - analginum, nayz, voltaren are for this purpose suitable. Treatment of a burn of 1 degree on it in principle can be finished.

in case of deep burns should abstain from any manipulations. It is not necessary to try to clear independently a wound of the stuck scraps of clothes and other pollution, it is not necessary to open independently bubbles, even intense. It is necessary to apply a dry sterile bandage (at extensive burns to wrap the victim in a pure sheet) a burn wound, then to see a doctor. Mazevy bandages at this stage should not be applied.

In most cases (to 90%) burns are treated by

on an outpatient basis. However in certain cases of victims it is necessary to hospitalize. Indications for hospitalization are:

Small (1 - 2%) burns of 1 - 2 degree can treat independently, without seeing a doctor.

two ways of treatment of a burn - opened and closed Are. Open it is applied if localization of a burn and an occupation of the victim allow to exclude additional traumatizing and/or infection. At the same time the affected area is not closed by a bandage that allows it “to breathe“ freely, creates conditions for drying and excludes damages when bandaging. In some cases (especially at a burn of 1 degree) the place of a burn in general is processed nothing. Burns 2 degrees can be processed solutions with the disinfecting and tanning properties - weak solution of permanganate of potassium, aniline dyes (“brilliant green“, fukortsiny). If owing to an arrangement of a burn or a profession and a way of life of the victim to avoid damages or pollution it is difficult to avoid, then it is better to conduct a burn in the closed way, that is to close a bandage, as a rule, of mazevy. Ointments with pantenoly (bepanten, pantoten), with sea-buckthorn oil (“Olazol“), dogrose oil, ointments on the basis of a calendula are used. If circumstances of receiving a burn assume its contamination, then use of ointments with antibacterial effect - “Levomikol“, sintomitsinovy ointment makes sense.

At small children burns practically always treat in the closed way.

First aid at other types of a burn

the Chemical burn

As always, first aid begins with cancellation of the striking factor. If the irritating substance impregnated clothes, it should be removed immediately (to cut off). Then it is necessary to wash an affected area very large amount of water, flowing or in high-capacity. It is necessary to wash out carefully and long, in some cases literally for hours. Not extinguished lime and the concentrated sulfuric acid should be removed at first whenever possible completely by land as at interaction of these substances with water a lot of heat is allocated that will lead to additional defeat. Certain surgeons consider that at a burn acid or alkali it is necessary to use correctives (weak solution of soap or cooking soda at a burn acid, lemon or acetic acid - at a burn alkali). However there is also such opinion that it is not necessary to do it as at reaction of neutralization heat can be allocated.

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At a chemical burn of a gullet and stomach neutralized solutions categorically as at interaction of solutions gas which will stretch the burned stomach walls can be emitted. It can lead to their gaps. It is also impossible to cause vomiting - that contents of a stomach did not cause a repeated burn of a gullet and that again - there was no rupture of the damaged stomach walls. It is impossible to give anesthetics in tablets (in candles or it is inyektsionno possible). In fact, first aid at burns of a gullet is reduced to the immediate address to the doctor. In some cases (if it is obviously impossible to get to the doctor to the next few hours) is admissible to give to the victim to drink a little milk or crude egg white - these substances “will connect“ acid or alkali, obvolonut the injured mucous membrane.

the Electric burn

At an electric burn first of all should terminate electric current - to switch off current or to take away from an affected wire (a dry stick, a piece of rubber, plastic, dense dry fabric). It is dangerous to touch the victim with the unprotected hands before shutdown of electric current! The basic what it is necessary to pay attention at electric defeat to, is a maintenance of breath and warm activity. If necessary carrying out indirect massage of heart and an artificial respiration is necessary. Anyway the victim has to be immediately hospitalized. Hospitalization has to be carried out in a prone position and under continuous supervision (as violations of breath and warm activity can happen not only at the time of defeat, but also later).

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As for actually burn, at a stage of its pre-medical help, as well as any other, follows it is closedsterile bandage.

the Solar burn

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As always, it is necessary to begin with cancellation of the striking factor. In this case the victim should go to the room, and at impossibility to make it - to close struck the place with clothes. At a burn of 1 degree damp wrappings are during the first hours recommended. It not only reduces pain and an itch, but also restores the interfabric liquid lost by fabrics under the influence of a solar ultraviolet. Further it is possible to use different means: the ointments for reduction of an itch and hypostasis containing antihistaminic substances (fenistit, psit - balm), or the preparations accelerating regeneration on the basis of a pantenol. Healing is accelerated also by such preparations as aktovegin, juice scarlet. All these substances can be used also at small burns 2 degrees. At extensive burns 2 degrees, especially with localization on a face, are desirable to see a doctor. Anyway plentiful drink for prevention of the general dehydration is recommended to the victim. Further it is necessary to remember that the skin site which once underwent a solar burn will be more sensitive further to an ultraviolet.