Hemodynamic disturbances in cardiogenic shock. Cardiogenic shock: characteristic symptoms

If more serious medical preparations in case of burns, their appointment is carried out by the attending physician. Antibiotics for burns can be taken. Antibiotic prescription is based on integrated assessment the patient's condition, taking into account the vastness of skin defects, the depth of the burn, the stage of the burn disease, its complications, the state of the immune status, as well as the patient's age and the severity of the comorbidity.

Can antibiotics be used for burns?

Victims with various burns of 2-3 stages, as well as patients with limited solid burns, occupying a maximum of ten% of the body plane, the appointment of antibiotics, as a rule, seems inappropriate. If we talk about exceptions for taking antibiotics for burns, then they include elderly people who suffer from diabetes, infections that have passed into chronic condition, also victims who did not seek medical help in time.

Other patients are prescribed district bactericidal therapy for burns: dressings with 1% substance of iodovidone or iodopyrone, ointments, which include levomycetin or dioxidine, silver sulfadiazine. The composition of Levomekol's ointment dressing with gentamicin or neobacitracin powder in gram-negative flora proved to be an excellent remedy. The use of artificial coatings containing bactericidal substances is promising. When curing these patients, daily treatment of diseased areas with the substance of iodovidone or iodopyrone will be appropriate and effective.

When to prescribe antibiotics for burns

With the development of a burn in the victims, antibiotics are used for burns. This treatment will be appropriate and effective for large areas damaged skin. In this case, antibiotics are prescribed to prevent and cure infection after burn wounds and infectious complications which may cause burns. One of the significant events is considered to be early immunotherapy and immunoprophylaxis.

The most effective is the use of antibiotics for burns. It should be noted that in addition to the use of medicinal substances, in order to cure the patient, it is necessary to use "Clinitron", as well as antibacterial insulators, and more physical ways improving the state of the disease: laser therapy, ultraviolet radiation, ozone therapy and other procedures prescribed by a doctor. All these procedures after full course facilitate passage pain syndrome, prevent infection and, as a result, contribute to the restoration of the skin. This therapy with the chain of a speedy cure is being conducted on 2 fronts: systemic bactericidal therapy and local use antibiotics.

But write out necessary antibiotics in case of burns, only the attending physician will be able to help you, depending on the degree of damage, as well as your sensitivity to the drug.

Antibiotics for burns should be used if it is necessary to suppress microbial invasion, which slows down the healing process of the burn wound and contributes to excessive scarring. A burn can pose a significant threat to human health.

Antibacterial therapy captures the main positions in the structure of activities that are aimed at cure and prevention. different kind infections progressing in wounds after burns.

Who needs antibiotic therapy

Large-scale damage after a burn entails many serious pathologies. In this case, the burn wound contributes to the development of infection in it, which is the basis for starting antibiotics. As a result of burn wounds, a vast area of the skin is lost, the victim suffers metabolic disturbances and nerve damage.

The use of antibacterial drugs for the treatment of burns of the 2nd and 3rd degree, as well as serious wounds with an area of \u200b\u200bnot more than 10% of the body surface, is considered unjustified. The only exceptions are the following patients:

People retirement age;
patients with infection or persons with diabetes mellitus;
people who seek help in the final stages with an actively progressing infection.

For other victims, the doctor prescribes bactericidal therapy for burns, which involves the application of dressings with 1% iodopyrone. In addition, the victim must use ointments containing chloramphenicol or dioxidine. A remarkable effect is given by artificial coatings that contain bactericidal elements. In the treatment of victims, daily treatment of burn sites with the substance of iodovidone or yodopyrone should be carried out.

The attending physician prescribes antibiotics for burn wounds based on the results of a complete medical examination And general condition patient, in addition, the doctor takes into account certain parameters:

the scale of the lesion and its depth;
existing complications;
immunity and age criterion;
the state of the accompanying pathological processes;
susceptibility to prescribed drugs.

When to prescribe antibiotics for burns

In the inflammatory process in the burn wound, certain antibiotics are prescribed. This treatment is considered appropriate when large areas of the dermis are damaged. Antibacterial therapy is also necessary for preventive purposes, to remove the infection and heal wounds. These medicines help prevent the development of infectious complications after a burn. Initially, in case of a burn, immunotherapy and immunoprophylaxis should be carried out.

Effective result gives topical application antibiotics. It is important to note that, in addition to the medication used, you should use the Clinitron anti-burn bed and stay in antibacterial isolation rooms. A positive effect on the patient's health will be provided by laser therapy, ozone therapy and ultraviolet irradiation(UFO). These procedures after their complex passage will help reduce discomfort, prevent the infection process and restore the burned skin layer. In general, treatments are divided into the following types:

systemic bactericidal therapy;
local use of antibiotics.

You can buy the necessary antibiotics only by prescription, because they differ depending on the level of damage or the degree of sensitivity to a particular drug.

What medications are used to treat burns?

Medications for the treatment of burns are different. Pharmaceutical distributors offer huge assortment burn medications. Such preparations have a convenient form and help to remove all the consequences of burns. Naturally, if these are deep burn wounds with the presence of inflammatory process, then in this case it is assigned antibacterial group drugs, including antibiotics and antiseptics.

Excellent tool from burns is panthenol, produced in the form of an ointment, cream or gel. It is used for minor 1st degree burns in the form of a gel. Panthenol is applied to the affected skin. After applying the gel, a stable foam is formed, which has a light structure. Due to its regenerative abilities, the gel is quickly absorbed into the skin and restores the original skin structure. Panthenol-based ointment is recommended for active healing of wounds on the skin and for the elimination of cracks and other damage from the dermis layer.

Another remedy used for burns is actovegin. Sold as an ointment, gel or cream. With the help of its properties, it provides effective wound healing and protection of the wound from the entry of various infections into it. The use of ointments or gels is recommended only in the initial burn stages. In the process of wound healing, it is advisable to first apply the gel, and after a certain time, the ointment.

An agent used to eliminate microbes from burns, as well as having an analgesic effect, is called dioxysol. This tool has bactericidal properties. The composition of these funds includes certain anesthetics local action that help reduce pain.

A burn is considered to be one of the types of household injuries that can happen to absolutely every person. It is necessary to know how to provide first aid in this situation, therefore, funds for any burns should be in the first aid kit of each family. These can be gels, ointments or creams. If the situation is more serious, then it is necessary to use antibiotics, the course and prescription of which must be obtained from the attending physician. After a deep burn, unpleasant scars can remain on the skin. Their presence suggests that an infection got into the skin during the healing of the wound.

Antibacterial drugs

the main objective local drug treatment consists in the fight against the pathogenic microflora of the burn focus.

In order to achieve this goal, apply various means having variety dosage forms. In addition, all drugs have an individual mechanism of action.

Today, there are many classifications of antimicrobials, distinguished according to the characteristics of their chemical structure, time of exposure to the body and other factors. The range of drugs and their plural forms make it difficult to classify them. To date, you can buy a large number of drugs with combined medicinal properties.

Medicines that have antibacterial properties are antibiotics, as well as antiseptics or chemotherapeutic agents. They are used as a means local therapy with burns. According to their individual composition, they can be divided into multiple classes. chemical compounds. It should be noted that local therapy involves not only substances that have antimicrobial activity. Many of them are used to treat wounds after burns. It is necessary to choose a specific drug that is suitable for the victim, taking into account all the necessary information about the state of the microflora of the burn wound and its susceptibility to certain antibacterial substances. In addition, the selection of drugs should be carried out taking into account the phase of the wound process.

Used therapeutic drug should be appropriate at the stage of the wound process. In the initial stages, it is recommended to use medicinal solutions and combined ointments that have a hydrophilic base. In the 2nd or 3rd stage of the burn, you should additionally use fat-based products.

Therefore, in the most early dates after a burn is received, it is advisable to choose the right drug for the situation, and compliance therapeutic action this tool stages of the burn process. It should be remembered that you should not start any type of burn, because the initial phase of a burn wound is much easier to cure than the final one, while resorting to agents that have an antimicrobial effect.

Antibiotics for Various Degrees of Burns: A Review of Remedies

Preparations

Antibiotics for burns are drugs that are prescribed to heal the affected areas of the skin. They are aimed at suppressing infection in the wound. The spread of microbes slows down the restoration of the integument of the epidermis and leads to the formation of scars, which later remain unchanged.

How to use antibiotics for burns

Antibiotics are recommended only for 1-2 degree burn injuries. This method of treatment is inappropriate for stages 2-3, as well as with deep lesions, the localization of which exceeds 10-15% on the body.

In a hospital setting, the doctor will determine the stage of thermal damage to the epidermis and make complex treatment.

The doctor decides whether to prescribe antibiotics for a 2nd degree burn based on the following factors:

age;
chronic diseases(diabetes), infections;
the extent of thermal damage and the zone of localization;
sensitivity and the presence of an allergy to a particular drug.

Features of use for burns 2 and 3 degrees

Antibiotics for burns of 2 and 3 degrees are allowed to be used if the affected area is small. For home treatment, it is necessary to observe sterility, to prevent infection.

In everyday life, antibiotics are used for burns with boiling water. Unpleasant incidents are common in young children, less often in adolescents.

Antibiotics help boost the immune system pathogenic microorganisms. If they are not used, then it is possible to get complications in the form of pneumonia, sepsis, lymphadenitis.

For quick healing of the wound, they take together external antibacterial ointments and creams, homemade tinctures, solutions.

Antibiotics for external use

Topical antibiotics (those that pass through the esophagus) antimicrobial action. Here is a list of the most popular drugs:

Ointments containing silver sulfadiazine. These include drugs such as Sulfadiazine, Silvederm, Dermazin.
Yodopirone and Yodovidone. They have a strengthening effect on the immune system, most often such solutions are prescribed with a 1% concentration. Apply after sunburn treatment antiseptics such as Furacilin, Miramistin and Chlorhexidine.
Ointments Levomekol, Levosin, Clormikol.
Drugs that eliminate the source of infection when the burn blisters begin to burst. These include Dioxidin, Streptonitol (contains nitazole) and gentamicin ointment.

All products are suitable for external use at home. Before use, it is necessary to consult a doctor for contraindications and allergic reactions.

Preparations for systemic use

Internal preparations have a stronger effect than drugs local treatment.

With burns, the body's immunity decreases, as a result of which complications appear in the form of nausea and high fever, and scars may not heal for a long time. Antibiotics internal use needed to normalize functions immune system. They are prescribed by a doctor in a compartment with antiseptic ointments and creams.

Medicine offers many drugs in tablet form. We do not recommend taking pills on your own, consult your doctor.

List of the most effective antibiotics for various degrees of thermal and chemical skin lesions:

Ceclor, Cefuroxime, Cefazolin. The drugs are non-toxic and practically have no contraindications, they are used in the first and second stages, as well as in case of toxicemia.
Bicillin. Kills the root of the infection in the wound due to the main component in the composition - penicillin. Relieves swelling and itching.
Amoxicillin and disodium salt, Ampicillin. Prevent the development of sepsis and promote speedy recovery skin on hands and feet.
Aminoglycosides, which belong to the second generation, contain a beta-lactam substance. In a pharmacy they are found under the name Unazin and Sulacillin.
Cefixime, Cefotaxime, Ceftriaxone. Treat the third stages of burn injuries.
Nystatin, Fluconazole. Used for complications after healing, such as fungal infection.
Clindamycin and Metronidazole. It is prescribed for an infection that quickly spreads throughout the body.

This is not the whole list of funds that are prescribed for burn injuries. More often, the doctor recommends undergoing course therapy, which consists of taking several drugs. In the third stage of burns, when the wound localization area is too large, hospitalization is advised. home treatment in such cases will be ineffective and life-threatening.

Contraindications

If you act incorrectly with burn injuries, you can cause irreparable harm to health and appearance. To prevent this from happening, consider a few general contraindications:

it is forbidden to lubricate the wounds with greasy creams or oils;
it is not recommended to apply ice cubes to burns, this can cause frostbite of tissue integuments;
it is forbidden to press or independently open blisters on the body;
it is forbidden to use prescriptions of alternative medicine without the approval of a doctor;
it is forbidden to use external means for the eyes, throat and other mucous membranes;
It is not recommended to give antibiotics to a child under three years of age.

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Degrees of burns, symptoms and treatment tactics by stages

The burn surface of the 1st degree is treated at home. Does not require complex activities. Sufficient treatment of damaged areas wound healing ointments, compresses from anti-inflammatory herbs.

At grade 2, blisters filled with fluid appear. If improperly processed, they become infected, become a source of a long-term non-healing defect.

Treatment of 3, 4 degrees is carried out by surgeons. Doctors open dense blisters with preservation of the crust, clean the focus from dead tissues, and carry out antiseptic sanitation.

Gradation by Russian classification allows you to determine the tactics of conducting burns. The basis for classification is the degree of damage to the germ layer of the epidermis, circulatory system. With the defeat of these anatomical links, self-healing of the skin is impossible. Even after surgical intervention the probability of healing of the defect with a scar, scab remains.

Burn stages:

1 degree - superficial lesion with redness, swelling, mild soreness;
Grade 2 - against the background of hyperemia of the skin, blisters, blisters with yellowish contents appear. When the capillaries are damaged, the internal contents are stained red. The growth layer is preserved, so healing occurs without scarring;
Grade 3 - the depth of the lesion reaches the germ layer. The skin is destroyed with the formation of a black crust (necrosis);
Grade 4 - charring of the entire thickness of tissues in the path of the thermal factor. The epidermis, muscles, bone and joint structures are affected.

A similar gradation is applied in the world with some difference in different countries. However, those skilled in the art retain the steps described above as they are convenient for determining treatments.

A qualified doctor will be able to assess the severity of lesions only on the next day after damage to the skin. When there is a distinction between dead and healthy tissues, the severity of the pathology is visible. First aid should be provided immediately after exposure to heat, solar, chemical factor.

First degree burns: main symptoms

No damage from first degree burns deep tissue, so the risk of scarring or dangerous complications minimal. Common causes of nosology:

Short stay under sunbeams;
Touching hot metal;
Wiring contact.

The danger is extensive first-degree burns due to the risk of dehydration, blood intoxication with toxic products of tissue breakdown. Clinical symptoms: redness, itching, peeling.

The burnt surface heals for several days. Consequences - hyperpigmentation, peeling. Scars do not appear.

Clinical symptoms of second degree burns

Second degree burns are characterized by the formation of blisters of various sizes filled with serous fluid. Bubbles form on the 1-2 day, which makes it difficult to early verify the stage of the disease.

Main reasons:

Action on the skin of acids, alkalis;
High electrical voltage;
Stay in an environment with a high temperature (above 70 degrees Celsius);
Contact with steam, fire.

Healing burn surface the second degree lasts 2-3 weeks.

Signs of third degree burns

The third degree is divided into 2 varieties: IIIa, IIIb. Morphological changes in pathology proceed in one of the following ways:

coagulative necrosis;
"Fixation" of changes under the influence of dry heat;
wet necrosis.

According to the principle of coagulation necrosis, at the 3rd stage of a burn, damage occurs due to the following causes:

contact with fire;
Touching hot objects;
Long lasting pair.

The clinical symptoms of the condition are a dark red color of the skin surface with black spots in the area of epithelium death. Around the focus - a zone of hyperpigmentation. Demorcation small shaft can be traced to the end of 1, 2 months. The consequence of such changes is epithelialization due to the growth of the epithelium with a convex edge, granulations. Self-healing is characterized by burns that are no more than 2 cm in diameter. If the penetration of the defect is stopped, dehydration and intoxication are prevented. Only surgical procedures it is possible to clean the lesion, treat the place with antiseptics, and eliminate the violation of microcirculation.

Self-healing of a deep burn surface occurs due to the growth of the edges of the wound inward. The growth layer is affected, so scars form.

Wet necrosis is formed when clothing smolders. Integuments in places of defeat are edematous in the beginning, get white-pink color. The epidermis looks like "rags". After cleansing, granulation is formed, but the lesions often become infected, which prolongs the healing time.

"Fixation" of the skin occurs under the influence of infrared radiation. The first three days, when palpated, the integument is cold, pale. Edema and hyperemia develop around the site of injury. Dry scab is formed for 3-4 days. After that morphological changes similar to coagulative necrosis.

Unfortunately, after stages 3a, 3b, the functionality of the affected area is partially lost. The destruction of the musculoskeletal apparatus limits the mobility of the limb. A rough scar prevents stretching of the skin layer. With extensive damage, intoxication of the body occurs with tissue decay products that are absorbed into the blood from the pathological focus. The danger of the condition is determined by the type and concentration of toxins. With extensive damage, death of a person is possible due to reflex shock (irritation of receptors by toxic products).

A 4th degree burn is accompanied by damage not only to the skin, but also to the musculoskeletal system. With pathology, damage to the internal organs occurs. The person is in a state of shock. Treatment of the form is difficult due to the extensive burn surface (more than 60%), severe dehydration, and intoxication. Patients with the fourth stage are treated in the intensive care unit.

To save a life, a person has to undergo complex transplants of internal organs. A disfigured body, limited mobility of the limbs are the consequences of a condition that long time adjusted plastic surgeons. Necrotic changes internal organs are accompanied by suppuration, which increases the risk of sepsis - bacterial infection of the blood.

Modern medicine is engaged in the study of subtle morphological, pathophysiological, biochemical mechanisms that occur in the body during burns. Greater number patients dying from stage III-IV burns have internal changes that are incompatible with life. If the formation of toxins is prevented in a timely manner, dehydration is prevented, pathological intracellular reactions are stopped, the lethal outcome will not occur. Medicine does not have fast-acting drugs that affect molecular level Therefore, the main method of treatment of deep burn lesions remains surgical.

How does deep necrosis proceed?

Damage muscle tissue accompanied by the release of toxins into the bloodstream that disrupt the functioning of the kidneys and liver. Dark brown skin, a rough scab on the surface are specific manifestations of coagulation tissue death.

Pronounced changes are characterized by the formation of a scab about 1 cm thick, through which the affected muscles and tendons can be traced. When the condition is present, surgeons perform deep excision to prevent intoxication. Often a radical way out is amputation of limbs.

The larger the area of excision, the higher the likelihood of a bacterial infection.

Medical aspects of burn treatment

Local changes For 3rd degree burns:

Soft superficial eschar;
The color of the skin depends on the provoking factor - gray or white;
Vesicles with yellowish serous contents.

Histological examination reveals the following morphological indicators:

Desquamation of the epithelium;
Complete necrosis squamous epithelium;
Disorganization of the papillary layer;
Swelling of connective tissue fibers;
Puffiness, congestion blood vessels;
Pastosity of adipose tissue.

Subtle morphological changes are accompanied by the following external manifestations:

Grayish or black color;
Red pink papillae;
Granulations on the periphery of the focus;
Accumulation of lymphocytes, lymphoid cells on the periphery of the focus;
Multiple individual foci of epithelialization;
The growth of the epithelium inside the focus of the "flaps".

Clinical studies indicate that with a stage IIIa burn surface, the wound is not a stable formation. It tends to deepen, regardless of the time of occurrence. Activation of necrosis occurs due to vasoconstriction, damage to blood vessels by blood clots, and edema. Prolonged stagnation contributes to the death of hair follicles, skin appendages. In such a situation, a rapid deepening of the necrosis zone is possible.

The reserves of the body are so significant that, according to statistics, about 1/3 of third-degree burns heal on their own (if no more than 60% of the skin is affected). It takes about 3 months to heal the wound. Reparation at the first or second stage occurs in 10-20 days. The difference is in the nature of the changes. The healing of deep necrotic burns is characterized by the formation of rough scars.

The burn surface of the first, second stage heals without scarring. Notable changes, except for peeling and hyperpigmentation, is not traced. With small volumes of lesions, the foci heal on their own. Doctors prescribe only symptomatic treatment. Favorable outcome with stage 2 pathology, it is possible with the correct provision of first aid.

Some clinical researches confirm that gross deformations, colloidal scars are formed with the irrational use of ointment dressings.

The main task of local therapy for burn surface II, Stage III- to avoid tissue ischemia in order to limit the zone of necrosis, to prevent its progression. Optimal conditions for local wound healing are created as a result of timely anti-shock therapy in order to full recovery microcirculation.

Deepening of burns of 2-3a degree occurs when using creams against the background of suppuration of the inner layers with a bacterial infection. The condition is accompanied by unstable external symptoms, in which the risk of generalization of the infection increases. The lesions partially heal. Then a greenish discharge appears from them. With extensive lesions of grade 3b-4, the healing process is absent, despite massive treatment. A qualified specialist with a similar picture will detect an infection, which will be confirmed laboratory tests.

For the treatment of thermal, chemical, sunburns, it is more rational to use an etiopathogenetic approach that allows you to optimally determine the tactics of managing a patient and prevent deepening of burns. Scientists are reconsidering the feasibility of using antibiotics for burn wounds in order to reduce the number of surgical interventions.

Antibiotics in the treatment of burns 2-3a degree

For the application of antibiotics (antiseptics), the closed dressing method is optimal. For administration, solutions of furacillin, chlorhexidine, chloracil, ethony, iodovidone, iodonol are recommended. Funds have a wide antibacterial spectrum. With purulent melting of tissues, it is better to use iodopyrin (1%), which has a directed action against Pseudomonas aeruginosa, Proteus, Staphylococcus aureus.

Combined ointments against burns with antibiotics:

Dioxidine;
Iodopyrone;
Sulfamekol;
Dioxycol;
Levonorsin;
Levosin;
Levomekol.

The composition of the preparations, in addition to antiseptics, is “enriched” with a metabolic regulator, an anesthetic, polyethylene dioxides with a molecular weight of 400, 1500. Based on the results of a morphological assessment of treatment with water-soluble ointments, a decrease in the number of neutrophils is determined, mast cells, microbes in the area of skin lesions. The picture indicates the beginning of the restoration.

Severe dehydrating (prevention of fluid loss), necrolytic, antimicrobial action allows drugs to be an option in the treatment of third-degree burns.

European doctors prefer to use flamazin and sulfamilon to stop all pathological parts of the burn process.

Protective bandages for burns

With extensive border burns of the third stage, an extensive dressing is used:

Algipor is a herbal preparation;
Epigarde, syncrite - synthetic means;
Biological dressings (amniotic membrane, collagen preparations).

Of interest are clinical studies on the treatment of burn injuries with a bandage based on pigskin. The drug has a good regenerative property. A morphological study of changes in patients while taking the drug confirmed a positive effect. Cytograms indicate consistent change inflammatory type reactions to inflammatory-regenerative in pig skin therapy. True, the duration of treatment and the timing of healing when using xenoskin have not been clarified.

Second degree burns can be treated with amniotic tape. According to different authors, the agent forms a protective sheath over the damaged epithelium, which eliminates pernicious influence aggressive environmental factors, reduces the number of dressings. The amniotic film does not cause toxic reactions and allergies, but sometimes there are purulent complications.

Suppurations are observed in patients treated with algipore coating. Studies have shown a decrease drainage function epidermis when using the product.

The above facts point to the impossibility of creating an ideal burn dressing without consequences with good healing effect.

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Burn - tissue damage caused by thermal factors, chemicals, electric shock, sunlight or radiation.

A first-degree burn affects only the outer layer of the skin (epidermis). A second-degree burn affects both the epidermis and the underlying skin layers. With a burn III degree damage or destruction of the entire skin occurs; in addition, all underlying tissues are damaged. The burnt area swells, blisters form on it due to the leakage of plasma through the walls of damaged blood vessels.

There are the following types of burns: 1. Thermal; 2. Chemical;

3. Radiation, including sunburn, - as a result of ultraviolet and other types of radiation.

Factors contributing to getting radiation burns: 1. Excessive exposure to direct sunlight. 2. Light, low-pigmented skin. 3. The use of photosensitizing drugs (sulfonamides; tetracycline antibiotics, etc.).

4. Exposure to industrial sources of ultraviolet radiation.

Symptoms requiring referral to a doctor. 1. With thermal and chemical burns: - charring of the skin - third-degree burn (possibly no pain); - formation of blisters on a large area of the skin (more than 5 cm in diameter); - any burn on an infant or small child;

Chemical burn of the pharynx, larynx, esophagus.

2. With sunburn: - confusion; - dry mouth, decreased or absent urination; - sunken eyes; - wrinkled or saggy skin; - temperature above 39 °С; - formation of blisters on a large area of the skin (more than 5 cm in diameter);

Strong pain.

Treatment of burn wounds.

[[First aid for burns]]

Locally for burns, it is recommended to cool the burned area, eliminate its contact with clothing, anti-inflammatory creams and ointments. As general measures apply introduction a large number liquids (2-4 ml for each percent of the burnt surface), painkillers. In severe cases, antishock therapy is indicated, prompt removal necrotic tissues; measures that promote skin regeneration; skin graft; vitamins that stimulate healing.

The specifics of the treatment of burn wounds

Local treatment of burn wounds depends on their type and has some differences. Deep, borderline or superficial - they are all treated differently.

Uninfected II degree burns: apply atraumatic dressings, hydrogel coatings, as well as wet-drying dressings with antibiotic or antiseptic solutions. For the treatment of these burns, emulsions and ointments with bactericidal and analgesic effects are also used. In particular, argosulfan, 1% silver sulfazine, levomekol and levosin are used.

Extensive IIIA degree burns: methods of drying the burn surface are used using preparations containing iodine, in particular iodopyrone, iodovidone and water-soluble ointments (dioxidine ointment, levomekol). Moreover, ointments are recommended to be used in combination with atraumatic mesh dressings, such as waxopran, parapran or branolind H. In the case of abundant wound discharge, it is preferable to use branolind H dressings, since they have a sufficient cell size. The combination of film dressings with preparations based on silver salts is optimal.

good effect also gives the use of Ebermin ointment, which has the ability to accelerate the healing of burns, especially II and III degrees, and the drug argosulfan. The latter, being a product containing 2% silver sulfathiazole and made in the form of a cream, has high efficiency in relation to the main pathogenic microorganisms that are detected during burns in an infected wound.

Deep burns of IIIB - IV degree: treatment is aimed at the rapid formation of a dry burn scab, as well as at preventing the deepening of burn wounds and their infection. For this purpose, preparations containing iodine (iodopyrone or iodovidone), as well as ointments based on water-soluble polyethylene glycol, are used.

To accelerate the cleansing of burn wounds, it is possible to use proteolytic enzymes such as trypsin, chymotrypsin, proteolitin and streptokinase. You can also use dressings based on daltextrypsin. After cleansing the burn surface from dead areas, it is recommended to use water-soluble ointments containing antibacterial drugs. It is also recommended to alternate them with antiseptic solutions and modern synthetic dressings.

Local conservative treatment of this type of burn is actually carried out in order to prepare the victim for free skin grafting. Surgery burns are performed by skin transplantation in specialized clinics around the world, for example here.

And the general treatment in this case includes the introduction of antibiotics, if necessary, vitamins, blood products, as well as blood substitutes and serum of burn convalescents and antihistamines. medicines.

Leader's recommendations. 1. Moisten the burnt area cold water. 2. Lubricate the burnt surface with an anti-inflammatory cream (once). 3. Do not break the integrity of the formed blisters, i.e. do not pierce or open them. 4. Overlay sterile dressing on areas with penetrating skin lesions. 5. For shallow and non-extensive burns, apply drying ointments and pastes to weeping areas. 6. To accelerate healing, enrich the diet with vitamins C, B, especially A and E (inside and outward in the form of an ointment, which helps to avoid the formation of scars). 7. Do not use oils, ointments, aerosols and creams that cause local anesthesia, as they can slow down recovery or cause allergic reaction. 8. Protect the burnt area from exposure to the sun, hot water, irritating substances.

9. In sunny weather, use protective creams, ointments, wear a hat and sunglasses.

Over-the-counter drugs for burns. 1. Inside painkillers: paracetamol, acetylsalicylic acid, ibuprofen, naproxen.

2. Ointments, creams, pastes, gels are used externally) - hydrocartisone, zinc, ichthyol, kamagel. Sunburn is treated with Betamethasone (Celestoderm).

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You can not use drugs on their own, without a doctor's prescription. This can aggravate the situation and cause unpleasant consequences, scars and scars.

In a hospital, the doctor will determine the stage of thermal damage to the epidermis and will make a comprehensive treatment.

The doctor decides whether to prescribe antibiotics for, referring to the following factors:

age;
chronic diseases (diabetes), infections;
the extent of thermal damage and the zone of localization;
sensitivity and the presence of an allergy to a particular drug.

Features of use for burns 2 and 3 degrees

Antibiotics for burns of 2 and 3 degrees are allowed to be used if the affected area is small. For home treatment, it is necessary to observe sterility, to prevent infection.

In everyday life, antibiotics are used for. Unpleasant incidents are common in young children, less often in adolescents.

Treatment should consist of several methods. Damage to the mucous membranes of the body, as well as burns in the groin, genitals, and face are considered dangerous.

Antibiotics help strengthen the immune system, fight pathogens. If they are not used, then it is possible to get complications in the form of pneumonia, sepsis, lymphadenitis.

For quick healing of the wound, they take together external antibacterial ointments and creams, homemade tinctures, solutions.

Antibiotics for external use

Topical antibiotics (those that pass through the esophagus) have an antimicrobial effect. Here is a list of the most popular drugs:

Ointments containing silver sulfadiazine. These include drugs such as Sulfadiazine, Silvederm, Dermazin.
Yodopirone and Yodovidone. They have a strengthening effect on the immune system, most often such solutions are prescribed with a 1% concentration. Apply after sunburn treatment with antiseptic agents such as Furacilin, Miramistin and Chlorhexidine.
, Levosin, Clormikol.
Drugs that eliminate the source of infection when the burn blisters begin to burst. These include Dioxidin, Streptonitol (contains nitazole) and gentamicin ointment.

All products are suitable for external use at home. Before use, it is necessary to consult a doctor for contraindications and allergic reactions.

Preparations for systemic use

Preparations for internal use have a stronger effect than topical treatments.

With burns, the body's immunity decreases, as a result of which complications appear in the form of nausea and high fever, and scars may not heal for a long time. Antibiotics for internal use are needed to normalize the functions of the immune system. They are prescribed by a doctor in a compartment with antiseptic ointments and creams.

Medicine offers many drugs in tablet form. We do not recommend taking pills on your own, consult your doctor.

List of the most effective antibiotics for various degrees of thermal and chemical skin damage:

Ceclor, Cefuroxime, Cefazolin. The drugs are non-toxic and practically have no contraindications, they are used in the first and second stages, as well as in case of toxicemia.
Bicillin. Kills the root of the infection in the wound due to the main component in the composition - penicillin. Relieves swelling and itching.
Amoxicillin and disodium salt, Ampicillin. They prevent the development of sepsis and contribute to the speedy restoration of the skin on the arms and legs.
Aminoglycosides, which belong to the second generation, contain a beta-lactam substance. In a pharmacy they are found under the name Unazin and Sulacillin.
Cefixime, Cefotaxime, Ceftriaxone. Treat the third stages of burn injuries.
Nystatin, Fluconazole. They are used for complications after healing, such as a fungal infection.
Clindamycin and Metronidazole. It is prescribed for an infection that quickly spreads throughout the body.

This is not the whole list of funds that are prescribed for burn injuries. More often, the doctor recommends undergoing course therapy, which consists of taking several drugs. In the third stage of burns, when the wound localization area is too large, hospitalization is advised. Home treatment in such cases will be ineffective and life-threatening.

Contraindications

If you act incorrectly with burn injuries, you can cause irreparable harm to health and appearance. To prevent this from happening, consider a few general contraindications:

it is forbidden to lubricate the wounds with greasy creams or oils;
it is not recommended to apply ice cubes to burns, this can cause frostbite of tissue integuments;
it is forbidden to press or independently open blisters on the body;
it is forbidden to use prescriptions of alternative medicine without the approval of a doctor;
it is forbidden to use external means for the eyes, throat and other mucous membranes;
It is not recommended to give antibiotics to a child under three years of age.

Hello dear friends! Are you taking antibiotics? What for? Some resort to such treatment for any slightest reason, making a serious mistake.

Antibiotics are dangerous drugs that are addictive and have many negative effects. The more you drink them, the less they help you.

Knowing the danger of such drugs, the question arises: why then are antibiotics prescribed for burns? It would seem that a burn is often a minor injury that is not life-threatening and passes quickly enough.

Why, then, treat him with such serious medicines? You will find the answer to the question in the article.

Antibacterial drugs are intended for the prevention and control of various types of infections. Infections can easily enter the body through an open wound.

Dead soft tissues present in place burn injury, serve as an ideal food for pathogenic microbes.

So why inject antibiotics after burns? To prevent infection of an open wound.

The vital activity of pathogenic microbes slows down wound healing, contributes to excessive scarring, and even poses a threat to life.

Is it advisable to use antibiotic preparations to treat all burns? Of course not. Our skin has powerful protective functions.

In most cases, it is able to protect itself from infections on its own. I suggest that you familiarize yourself with the situations in which antibacterial treatment is really necessary.

Who is eligible for antibiotic therapy?

The reason for the appointment of such therapy are deep and large-scale lesions of the skin, mucous membranes, respiratory system or internal organs.

During the loss of a significant area of the above soft tissues in the body, a violation of the most important metabolic functions occurs. At the same time, they violate protective functions immunity, in particular anti-infective.

Antibiotics are useful for: thermal burns; for chemical damage.

These types of injuries are considered the most common. In addition, bacterial burns of pears, apple trees, plums and other useful plants are treated with antibiotic drugs of a certain group.

Grade 2 and 3 burn injuries rarely require antibiotic treatment. In addition, antibiotic drugs are not used for:

deep but limited wounds;
wounds, the size of which is less than 10% of the surface cover;
burns of the 1st degree (epidermal) in children and adults.

An exception is a certain group of victims, which includes: the elderly; owners chronic infections; diabetics; people who triggered the injury and provoked the infection in this way.

Who prescribes antibiotics and why?

Serious treatment can only be prescribed by a traumatologist or dermatologist. I want to note once again that the treatment of burns of the 2nd degree is not carried out in this way.

If the severity of the injury is higher, then therapy with an antibacterial effect may be prescribed, but only after a thorough examination of the victim. During the survey, the following factors are determined:

the depth and extent of the injury;
degree;
the presence of complications;
the age and level of immune protection of the victim;
type and severity of complications;
sensitivity to antibiotic drugs.

What medicines are used for burns?

What antibiotic medicines are used to treat injuries caused by boiling water, fire, steam, acid, or alkali? Only the attending specialist after a thorough examination is able to answer this question. I strongly do not recommend that you self-medicate!

In most cases, drugs based on silver sulfadiazine are used after a burn.

In addition, the treatment is carried out with the help of local (external) drugs: dressings with 1% solutions of iodovidone and iodopyrone; ointments from chloramphenicol and dioxidine.

Preparations for oral intake and for intramuscular / intravenous administration are prescribed to victims in exceptional cases, if the wound is deep and occupies more than 10% of the skin area.

If the infectious concomitant process proceeds easily, then it is enough only intramuscular injections. In more severe cases, intravenous injections are prescribed.

Systemic antibiotic therapy is carried out with the help of medicines that have a wide range actions. These medicines include:

cefoperazone and sulbactam (often drugs are combined);
semi-synthetic penicillins;
3rd generation cephalosporins;
aminoglycosides and fluoroquinolones.

If the wound has spread to bone structures, then lincomycin is prescribed. For the treatment of fungal infections of the wound, it is customary to use fluconazole or nystatin.

What happens if you refuse antibiotic treatment?

Infectious processes that develop in a burn wound never pass without a trace without treatment. By refusing the antibiotics prescribed by the attending specialist, you can start the situation so much that serious complications arise:

sepsis;
pulmonary and bronchial ailments;
purulent arthritis;
infections of the genitourinary system;
myocarditis;
lymphadenitis.

Relatively mild burns are treated with one specific antibiotic. Several antibiotic medications can be prescribed only if the wound has already become infected and the disease is severe.

That's all, dear readers. Treatment with antibacterial drugs can indeed be prescribed for burn injuries.

Now you know which ones are drunk and which ones are used for topical treatment for similar purposes. I remind you that superficial burns of 1-3 degrees are not treated with such serious drugs.

Take care of your health, do not drink antibiotics in vain! Share what you read with your friends on social media. networks, and do not forget to subscribe to site updates. All the best!

Cardiogenic shock

Protocol code: SP-010

ICD codes-10:

R57.0 Cardiogenic shock

I50.0 Congestive heart failure

I50.1 Left ventricular failure

I50.9 Heart failure, unspecified

I51.1 Rupture of chord tendons, not elsewhere classified

I51.2 Rupture of papillary muscle, not elsewhere classified

Definition: Cardiogenic shock- extreme degree of left ventricular failure

sti, characterized by a sharp decrease in myocardial contractility (fall

shock and minute ejection), which is not compensated by an increase in vascular

strong resistance and leads to inadequate blood supply to all organs and tissues,

First of all, the vital organs. When a critical amount of myocardium is left

ventricle damaged, pumping failure can be recognized clinically

as pulmonary insufficiency or as systemic hypotension, or both options have a

hundred at the same time. With severe pumping insufficiency, pulmonary edema may develop.

to their. The combination of hypotension with pumping failure and pulmonary edema is known as

cardiogenic shock. Mortality ranges from 70 to 95%.

Classification with the flow:

True cardiogenic.

lecturer and arrhythmic shocks, which have a different genesis.

Risk factors:

1. Extensive transmural myocardial infarction

2. Repeated myocardial infarctions, especially heart attacks with rhythm disturbance and conduction

3. Zone of necrosis equal to or greater than 40% of the mass of the myocardium of the left ventricle

4. Decreased contractile function of the myocardium

5. Decrease in the pumping function of the heart as a result of the remodeling process, on-

beginning in the first hours and days after the onset of acute coronary occlusion

6. Cardiac tamponade

Diagnostic criteria:

True cardiogenic shock

The patient's complaints about severe general weakness, dizziness, "fog in front of

eyes”, palpitations, a feeling of interruptions in the region of the heart, retrosternal pain, suffocation.

1. Symptoms of peripheral circulatory insufficiency:

Gray cyanosis or pale cyanotic, "marbled", moist skin

acrocyanosis

collapsed veins

Cold hands and feet

Test of the nail bed for more than 2 s (decreased peripheral blood flow)

2. Disturbances of consciousness: lethargy, confusion, less often - arousal

3. Oliguria (reduced diuresis less than 20 mm / hour, in severe cases - anuria)

4. Decreased systolic blood pressure less than 90 - 80 mm Hg.

5. Decrease in pulse arterial pressure up to 20 mm Hg. and below.

Percussion: expansion of the left border of the heart, with auscultation, heart sounds are deep

chie, arrhythmias, tachycardias, protodiastolic gallop rhythm (pathognomonic symptom

severe left ventricular failure).

Breathing is shallow, rapid.

The most severe course of cardiogenic shock is characterized by the development of cardiac

noah asthma and pulmonary edema. There is suffocation, bubbling breathing, cough worries with

pink frothy sputum. On percussion of the lungs, dullness is determined

percussion sound in the lower parts. Here, crepitus, small

wheezing. With the progression of alveolar edema, wheezing is heard more

over 50% of the lung surface.

The diagnosis is based on the detection of a decrease in systolic blood pressure

less than 90 mm Hg, clinical signs of hypoperfusion (oliguria, mental

pallor, sweating, tachycardia) and pulmonary insufficiency.

A . Reflex shock (pain collapse) develops in the first hours of the disease, in

a period of severe pain in the region of the heart due to a reflex drop in the total periphery

vascular resistance.

Systolic blood pressure is about 70-80 mm Hg.

Peripheral circulatory failure - pallor, cold sweat

Bradycardia is a pathognomonic symptom of this form of shock.

The duration of hypotension does not exceed 1–2 hours, the symptoms of shock disappear spontaneously.

alone or after pain relief

Develops with limited myocardial infarctions of the posterior lower sections

Characterized by extrasystoles, atrioventricular blockade, rhythm from the AV junction

The clinic of reflex cardiogenic shock corresponds to I degree of severity

B . Arrhythmic shock

1. Tachysystolic (tachyarrhythmic variant) of cardiogenic shock

More often it develops in the first hours (less often - the days of the disease) with paroxysmal

ventricular tachycardia, also with supraventricular tachycardia, paroxysmal

atrial fibrillation and atrial flutter. The general condition of the patient is severe.

All clinical signs of shock are expressed:

Significant arterial hypotension

Symptoms of peripheral circulatory insufficiency

Oligoanuria

30% of patients develop severe acute left ventricular failure

Complications - ventricular fibrillation, thromboembolism in vital or-

Relapses of paroxysmal tachycardias, expansion of the necrosis zone, development of

diogenic shock

2. Bradysystolic(bradyarrhythmic variant) cardiogenic shock

It develops with complete atrioventricular blockade with conduction 2:1, 3:1, medical

lenny idioventricular and junctional rhythms, Frederick's syndrome (combination of complete

atrioventricular block with atrial fibrillation). Bradysystolic cardio-

gene shock is observed in the first hours of the development of an extensive and transmural infarction

that myocardium

shock is severe

Mortality reaches 60% or more

Causes of death - severe left ventricular failure, sudden asyst-

heart failure, ventricular fibrillation

There are 3 degrees of severity of cardiogenic shock, depending on the severity

clinical manifestations, hemodynamic parameters, response to ongoing

Events:

1. First degree:

Duration no more than 3-5 hours

BP systolic 90 -81 mm Hg

Pulse blood pressure 30 - 25 mm Hg

Symptoms of shock are mild

Heart failure is absent or mild

Rapid sustained pressor response to treatment

2. Second degree:

duration 5 – 10 hours

BP systolic 80 - 61 mm Hg,

Pulse blood pressure 20 - 15 mm Hg

Signs of shock are severe

Severe symptoms of acute left ventricular failure

Delayed unstable pressor response to therapeutic measures

3. Third degree:

More than 10 hours

Systolic BP less than 60 mm Hg, may fall to 0

Pulse blood pressure less than 15 mm Hg

The course of shock is extremely severe

Severe heart failure, rapid pulmonary edema,

There is no pressor response to treatment, an areactive state develops

List of main diagnostic measures:

ECG diagnostics

List of additional diagnostic measures:

CVP level measurement (for resuscitation teams)

Medical care tactics:

With reflex shock, the main therapeutic measure is quick and complete.

anesthesia.

For life-saving arrhythmic shock, cardioversion or

pacing.

In shock associated with myocardial rupture, only emergency surgery is effective.

human intervention.

Treatment program for cardiogenic shock

1.General activities

1.1. Anesthesia

1.2. oxygen therapy

1.3. Thrombolytic therapy

1.4. Heart rate correction, hemodynamic monitoring

2. Intravenous fluid

3. Decreased peripheral vascular resistance

4. Increased myocardial contractility

5. Intra-aortic balloon counterpulsation

6. Surgical treatment.

Emergency treatment is carried out in stages, quickly moving on to the next stage.

with the ineffectiveness of the previous one.

1. In the absence of pronounced stagnation in the lungs:

Lay the patient down with the lower limbs raised at an angle of 20º;

Carry out oxygen therapy;

Pain relief - morphine 2-5 mg IV, repeated after 30 minutes or fentanyl 1-2 ml

0.005% (0.05 - 0.1 mg with droperidol 2 ml 0.25% IV diazepam 3-5 mg for psychomotor

arousal;

Thrombolytics according to indications;

Heparin 5000 IU i/v bolus;

Carry out heart rate correction (paroxysmal tachycardia with a heart rate of more than 150 in 1

min - absolute indication for cardioversion)

2. In the absence of pronounced stagnation in the lungs and signs of increased CVP:

200 ml 0.9; sodium chloride in / in for 10 minutes, controlling blood pressure, CVP, respiratory rate,

auscultatory picture of the lungs and heart;

In the absence of signs of transfusion hypervolemia (CVD below 15 cm of water.

Art.) continue infusion therapy using reopoliglyukin or dextran or 5%

glucose solution at a rate of up to 500 ml / hour, monitoring the performance every 15 minutes;

If blood pressure cannot be quickly stabilized, proceed to the next step.

3. If in/ fluid administration is contraindicated or unsuccessful, introduce peri-

pherical vasodilators - sodium nitroprusside at a rate of 15 - 400 mcg / min or

isoket 10 mg in infusion solution intravenously drip.

4. Inject dopamine(dopamine) 200 mg in 400 ml of 5% glucose solution as an intravenous

intravenous infusion, increasing the infusion rate from 5 mcg / kg / min) until a mini-

low sufficient blood pressure;

No effect - additionally prescribe norepinephrine hydrotartrate 4 mg in 200 ml

5% glucose solution intravenously, increasing the infusion rate from 5 μg / min to reach

minimum sufficient blood pressure

Main dangers and complications:

Inability to stabilize blood pressure;

Pulmonary edema with increased blood pressure or intravenous administration

liquids;

Tachycardia, tachyarrhythmia, ventricular fibrillation;

asystole;

Recurrence of anginal pain;

Acute renal failure.

List of essential medicines:

1.*Morphine hydrochloride 1% 1 ml, amp

2.*Heparin 5 ml vial, with an activity of 5000 IU in 1 ml

3.*Alteplase 50 mg powder for solution for infusion, vial

4.*Streptokinase 1,500,000 IU, powder for solution, vial

5.*Sodium chloride 0.9% 500 ml, vial

6.*Glucose 5% 500 ml, fl

7.*Reopoliglyukin 400 ml, fl

8.*Dopamine 4% 5 ml, amp

List of additional medicines

1.*Fentanyl 0.005% 2 ml, amp

2.*Droperidol 0.25% 10 ml, amp (fl)

3.*Diazepam 0.5% 2 ml, amp

5.* Isosorbide dinitrate (isoket) 0.1% 10 ml, amp

6.* Norepinephrine hydrotartrate 0.2% 1 ml, amp

Health Care Performance Indicators:

Relief of pain syndrome.

Relief of rhythm and conduction disturbances.

Relief of acute left ventricular failure.

Stabilization of hemodynamics.