Worst degree of burn. Skin burns - Characteristics of burns, Diagnosis, Emergency care
Burns are some types of injuries resulting from external influences. They are thermal, chemical, radiation, electrical. There are also different degrees of burns, depending on the severity of the lesion.
Burn classification
There are two generally accepted classifications. The division is carried out depending on the impact that caused the lesion. Also, burns are divided into degrees of burns, depending on the severity and depth of damage to the skin and soft tissues.
Thermal
This type is the most common among such injuries. Exposure to high temperatures from solids, liquids or steam accounts for approximately 94% of all such damage.
Most often, people get such injuries at home. Approximately half of the cases occur as a result of contact with open flames.
Rest- due to the interaction of body surfaces with hot liquids, steam, hot solid objects. A thermal burn of 2 or 3 degrees, occupying one third of the body area can lead to death.
When thermal burns occur, the severity of such burns depends on several factors. The exposure temperature matters.
Temperatures above 45 degrees are traumatic. With an increase in this indicator, the damage is aggravated. The thermal conductivity of the substance that has an effect also plays an important role. For example, while in the bath, some people like to make the air temperature from 90 degrees and above, and no injuries occur.
Gaseous substances have much lower thermal conductivity than liquids and solids. Exposure to water at a temperature of 90 degrees will certainly lead to a burn. In addition, the duration of exposure to the traumatic factor plays an important role.
Electric
Such injuries are called electrical injuries. They can occur at home, at work due to equipment malfunction or neglect of safety regulations. They are characterized by several features. The current penetrates into the body, damaging not only the surface layers of the skin.
In addition, electricity can burn you at a distance, without contact with the source. With such injuries, the severity of damage depends on the thickness of the skin and its moisture content. Do not touch electrical appliances with wet hands, even if they are in good condition.
Electrical shock is often painless due to the destruction of nerve endings. In the event of a clothing fire, electrical injury can be combined with a thermal burn. Also, people often get mechanical damage as a result of falling after an electric shock.
These include fractures, TBI, abrasions and scratches. Such lesions are rarely mild.
Chemical
These types of injuries occur as a result of exposure to certain chemical compounds. These include acids, alkalis,
Most often, such injuries are received by workers in laboratories or specific industries, but this can also happen in domestic conditions.
The most severe are burns resulting from exposure to alkali. Such injuries have characteristic signs: they heal for a long time, penetrate deeply, sometimes affecting internal organs.
Ray
These types of injuries occur under the influence of radiation. Their features and stages depend on the dosage, as well as the type of radiation beam.
This rarest type of burns can occur in the event of an accident at a specific production facility associated with radiation, during x-rays and radiotherapy.
The severity of the damage. Degrees of burns
There are several degrees of burns depending on the severity of the lesion, there are four in total. Classification by degrees allows physicians to predict the development of the situation. It also matters what percentage of the total area of the human body is damaged.
The classification is based on the determination of the required volume of therapeutic measures, as well as the possibility of tissue regeneration without surgical intervention.
First degree
Each of us received a first-degree burn, more than once throughout our lives.
The first degree of thermal burns is characterized by slight redness, an unpleasant burning sensation, and slight swelling. The injury goes away after a couple of days. If you get burned at home, you can simply act on the damaged area of \u200b\u200bthe skin with running cool water. This will relieve inflammation and pain.
When there is a 1 degree thermal burn, skin damage is minimal, only the upper layers of the epidermis are affected. They constantly die under normal conditions, this is the most common physiological process.
First-degree burns do not require special treatment, they pass quickly, moreover, completely without a trace. In most cases, they have a small area of damage.
Large-scale superficial lesions are extremely rare. If this happens, then most often a 1st degree burn is combined with deeper lesions.
Second degree
Second-degree burns show more significant damage to the skin. Traumatic impact leads to the formation of blisters filled with fluid. Sometimes they appear after a while. Such lesions have a very favorable prognosis, pass without leaving traces, noticeable scars on the skin.
The second stage is characterized by the destruction of the epidermis and the uppermost layer of the dermis. At the same time, symptoms such as severe pain, hyperemia, and edema are noted.
Burning pains, aggravated by touch, quite long. Redness around the blisters may or may not be present.
Blisters are formed by dead cells of the epidermis, and are filled with the liquid fraction of blood - plasma, penetrating into them from the damaged smallest vessels.
These types of injuries do not require medical attention and special therapeutic measures. The regeneration process can take up to two weeks. To speed it up and alleviate the pain syndrome, you can use special pharmacy ointments or gels.
Never treat damaged areas with oil. This method interferes with cellular respiration, significantly slows down healing.
The danger of such damage is that opening blisters are open gates for infections. If the affected area is large, it is better to consult a doctor. He will advise medicines to prevent infection.
Differentiation between the second and third degree is carried out with the help of pain identification. Both of these stages are characterized by the formation of blisters, but in the second there is pain, and in the third they are not, since the nerve endings are damaged.
Third degree
Degree three burns are usually divided into two subspecies. 3A - this is a violation of the dermis to the deep layers, the lowest of which remain intact.
With such a depth of penetration, independent regeneration is still possible, without surgical intervention.
This applies only to fairly minor wounds. They can be delayed due to the growth of the epithelium from the marginal zones. Grade 3B is characterized by deep damage that captures all layers of the dermis, reaching the layer of subcutaneous fat.
This layer of the skin does not have the structural elements that are necessary for the regeneration of the cells of the epidermis and dermis. Therefore, self-restoration and growth of tissue with this degree of burns does not occur.
The main signs are the formation of blisters of various sizes, filled with bloody contents, as well as the absence of pain when touched. A large amount of mucous fluid with blood impurities is released from the wound. Around the wound defects, severe swelling, redness, increased local temperature. The damaged area is inflamed.
With such deep lesions, a number of common symptoms are noted. The clinic includes an increase in general temperature, a drop in blood pressure, interruptions in the work of the heart, tachycardia, and difficulty in shallow breathing.
The third stage of the burn requires immediate hospitalization of the victim. Patients require surgery and drug therapy.
The prognosis depends on how many percent of the body area is occupied by the lesion. It has an important prognostic value, how quickly medical care is provided.
In addition, the prognosis also depends on the general condition of the victim. For example, with thermal burns received during a fire, the degree of carbon monoxide intoxication plays a role.
4th
The most rare type of this type of injury. This is the most severe type of lesion, characterized by an unfavorable prognosis even with a small wound area.
With injuries of such depth, even within a small area, there is a high probability of death or alienation of the injured limb.
The deep layers of the human body are affected: the skin burns, muscle tissues, tendons and even bones are damaged. A 4th degree burn involves the destruction of most of the nerve endings and blood vessels in the affected area.
The fourth degree can occur as a result of prolonged high-temperature exposure, acid or alkali damage, as well as electricity.
Wounds of such severity are immediately visible, they cannot be confused with anything. 4 degree burn is characterized by charring, that is, a prolonged combustion reaction, leading to a change in the chemical structure of tissue cells. The burn site becomes dark, sometimes black. The condition of the victims is extremely serious.
As a rule, people are in a state of shock or coma. If the wound defect has a significant area, medical care should be provided urgently, the count goes on for minutes. But still, the likelihood of death is very high.
In cases where such injuries occur, determination of their severity and classification is necessary only for medical professionals. When you are burned or someone has received a defeat in front of your eyes, it is necessary not to assess the damage, but to provide first aid.
If the victim is in a serious condition, timely therapeutic measures taken can save his life.
Burns: types of burns and degrees, treatment of burns with GUARDIAN balm
burns is damage to body tissues caused by exposure to heat or chemicals. Electric shock, as well as exposure to ionizing radiation (ultraviolet, x-ray, etc., including solar radiation), can also cause a burn.
Often, burns are also called skin lesions caused by the irritating effect of the plant (nettle burn, hogweed burn, hot pepper burn), although in fact 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 particular type of burns.
severity burn determined by the depth and area of tissue damage. The concept of "burn area" is used to characterize the area of skin lesions, and is expressed as a percentage. To classify the depth of the burn, the concept of "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 burns are the result of exposure to high temperatures. This is the most common domestic injury. Arise as a result of exposure to open fire, steam, hot liquid (boiling water, hot oil), hot objects. The most dangerous, of course, is open fire, since in this case the organs of vision, the upper respiratory tract can be affected. Hot steam is also dangerous for the respiratory tract. Burns from hot liquids or incandescent objects are usually not very large in area, but deep.
chemical burn
Chemical burn occurs as a result of exposure to the skin of chemically active substances: acids, alkalis, salts of heavy metals. Dangerous with a large area of damage, as well as if chemicals get on the mucous membranes and eyes.
electrical burns
Electric shock is characterized by the presence of several burns of a small area, but of great depth. Volt arc burns are superficial, similar to flame burns and occur during short circuits without current passing through the body of the victim.
Radiation burns
This type of burns include burns resulting from exposure to light or ionizing radiation. So, solar radiation can cause the well-known sunburn. The depth of such a burn is usually 1st, rarely 2nd degree. A similar burn can also be caused by artificial ultraviolet irradiation. The degree of damage in radiation burns depends on the wavelength, intensity of radiation and the duration of its exposure.
Burns from ionizing radiation are usually shallow, but their treatment is difficult, since such radiation penetrates deep and damages the underlying organs and tissues, which reduces the skin's ability to regenerate.
Degrees 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 the epidermis, dermis and subcutaneous fat (hypoderm). 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 a tanning effect. The dermis, or 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 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.
1st degree burn
I degree burns are characterized by damage to the most superficial layer of the skin (epidermis), consisting of epithelial cells. In this case, redness of the skin, a slight swelling (edema), and soreness of the skin in the burn area appear. Such a burn heals in 2-4 days, there are no traces after the burn, except for a slight itching and peeling of the skin - the upper layer of the epithelium dies off.
Second degree burn
A second degree burn is characterized by a deeper tissue damage - the epidermis is partially damaged to the entire depth, up to the germ layer. There is not only redness and swelling, but also the formation of blisters on the skin with a yellowish liquid, which can burst on their own or remain intact. Bubbles form immediately after a burn or after some time. If the bubbles burst, then a bright red erosion is formed, which is covered with a thin brown crust. Healing with a second-degree burn usually occurs within 1-2 weeks, by tissue regeneration due to the preserved growth layer. No traces remain on the skin, however, the skin may become more sensitive to temperature effects.
Third degree burn
III degree burn is characterized by the 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 eschar 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 self-restoration of the skin surface is possible if the burn is not complicated by infection,
- and degree III B - complete death of the skin to the subcutaneous fat. As it heals, scars form.
IV degree burn
The fourth degree of a burn is the complete death of all layers of the skin, underlying tissues, charring of muscles and bones.
Determination of the area of damage in case of burns
Approximate area estimate burn can be done in two ways. The first way 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,
- back surface of the body - 18%,
- anterior surface of the body - 18%.
The remaining one percent of the body surface is in the perineal region.
The second method - the method of the palm - is based on the fact that the area of \u200b\u200bthe palm of an adult is approximately 1% of the total surface of the skin. In case of local burns, the area of damaged areas of the skin is measured with the palm of the hand; in case of extensive burns, the area of unaffected areas is measured.
The larger the area and the deeper the tissue damage, the more severe the course of 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 burn disease depends on the area of burns (especially deep), the age of the victim, the presence of concomitant injuries, diseases and complications.
Burn recovery prognosis
To assess the severity of the lesion and predict the further development of the disease, various prognostic indices are used. One of these indexes 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 burn, a burn of the respiratory tract without respiratory 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 a burn injury in adults, the "rule of hundreds" is applied: if the sum of the numbers of the patient's age (in years) and the total area of the lesion (in percent) exceeds 100, the prognosis is unfavorable. Respiratory tract burns significantly worsen the prognosis, and in order to take into account its influence on the “rule of hundreds”, it is conditionally assumed that it corresponds to 15% of a deep burn of the body. The combination of a burn with damage to bones and internal organs, with carbon monoxide poisoning, smoke, toxic combustion products, or exposure to ionizing radiation aggravates the prognosis.
Burn disease in children, especially younger ones, can develop with damage to only 3-5% of the body surface, in older children - 5-10%, and the more severe the younger the child. Deep burns of 10% of the body surface are considered critical in young children.
Burn treatment
burns I and II degrees are considered superficial, they heal without surgery. III A degree burns are classified as borderline, and III B and IV degrees are deep. With burns of degree III A, self-restoration of tissues is difficult, and treatment of burns of III B and IV degrees without surgical intervention is impossible - skin grafting is required.
Self-treatment, without consulting a doctor, is possible only with burns of I-II degrees, and only if the burn area is small. If a second-degree burn is larger than 5 cm in diameter, you should consult a doctor. Adult patients with first-degree burns, even extensive ones, can be treated on an outpatient basis. For more severe burns, adult patients can be treated on an outpatient basis if the skin of the face, lower extremities or perineum is not affected, and the burn area does not exceed:
- with burns of the II degree - 10% of the body surface;
- with burns III A degree - 5% of the body surface.
The method of treatment of a burn depends on its type, the degree of the burn, the area of the lesion and the age of the patient. So, even small burns in young children require mandatory medical intervention, and often inpatient treatment. It is also hard to tolerate burns and the elderly. Victims over 60 years of age with limited burns of II-IIIA degree, regardless of their location, should be treated in a hospital setting.
First of all, in case of a burn, it is urgent to stop the effect on the skin of the damaging factor (high temperature, chemical). In case of a superficial thermal burn - with boiling water, steam, a hot object - the burnt area is washed abundantly with cold water for 10-15 minutes. In case of a chemical burn with an acid, the wound is washed with a soda solution, and in case of an alkaline burn, with a weak solution of acetic acid. If the exact composition of the chemical is unknown, rinse with clean water.
If the burn is extensive, the victim should be allowed to drink at least 0.5 liters of water, preferably with 1/4 teaspoon of baking soda and 1/2 teaspoon of table salt dissolved in it. Inside give 1-2 g of acetylsalicylic acid and 0.05 g of Diphenhydramine.
You can try to treat a first-degree burn on your own. But if the victim has a significant burn of the II degree (a blister with a diameter of 5 cm or more), and even more so with burns of the III degree and above, you should urgently consult a doctor.
For IIIA degree burns, treatment begins with wet-drying dressings that promote the formation of a thin scab. Under a dry eschar, IIIA degree burns may heal without suppuration. After rejection and removal of the scab and the beginning of epithelization, oil-balsamic dressings are used.
For the treatment of burns of I-II degrees, as well as at the stage of epithelization in the treatment of burns of III A degree, the Guardian balm showed good results. It has analgesic, anti-inflammatory, antiseptic, regenerating properties. Balm Keeper relieves inflammation, accelerates skin regeneration, promotes wound healing, and prevents the formation of scars. It is applied directly to the affected area, or used for ointment aseptic dressings.
The causes of burns can be very diverse.
What are burns, how many degrees of burns exist and how to determine the degree of a burn - we will find out today.
By itself, a burn is a permanent damage to the tissues of the human body when exposed to some external factor.
And it is on that very factor that the classification of the etiology of burns depends. So, based on the origin, the following types of burns are distinguished:
- Thermal burn- exposure to the surface of the human body at elevated temperature: steam, boiling water, hot oil, touching a hot object, exposure to open fire on the human body.
- Burn electric- the impact on the human body of an electric discharge, which also gives damage to internal organs by an electromagnetic field.
- Chemical burn - the interaction of the human body with chemicals that can affect not only the epidermis, but also the subcutaneous layers.
- Radiation burn- damage to the epidermis and sometimes the subcutaneous layer by exposure to ultraviolet or infrared radiation.
Classification of burns by degrees and their characteristics
Each burn is unique in its own way, because the degree of damage is individual each time - it all depends on the very external factors that cause it. Treatment also depends on the degree of burns and their signs, which is why the classification of burns by degree is so important.
There are only four types of burns in degrees. All degrees of burns and their signs depend on the characteristics of the tissue lesion and on the level of the area of this lesion.
1st degree burn. The mildest form (or degree) of a burn. There is redness and very slight swelling of the affected surface. Pain is not great, and recovery after this burn occurs literally on the 4th or 5th day. There are no visible marks or scars.
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| photo of 1st degree burn |
2nd degree burn. Blisters form on reddened skin, and they may not appear immediately - up to a day after the burn. Each bubble contains a yellowish liquid, and when they break, a reddish surface of the skin is visible, which is under the bubble. If an infection has got into the place of the rupture, healing takes longer, but scars and scars are not subsequently formed.
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| photo burn 2nd degree |
3rd degree burn. With such a lesion, necrosis of the affected area of the skin occurs. In its place, a scab forms, which acquires a grayish tint. Sometimes this scab is covered with a black crust, which then falls off and under it is a reddish area of a very thin layer of skin.
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| photo burn 3 degrees |
4th degree burn. This is not only an external lesion of the layers of the skin and epidermis, it is a penetration into the deep sections of the tissues and even their charring. Many of the dead tissues are partially melted and then sloughed off. Not only muscle tissue is damaged, but also tendons and even bone.
The healing process of a 4th degree burn is very long, not only scars are formed at the site of the lesion, but also scars, which often lead to disfigurement. Cicatricial contractures form in the articular bags, which impede the mobility of the joints. This is the most severe degree of burns, which necessarily requires the supervision of specialists and a long and difficult treatment.
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| photo burn 4 degrees |
Depending on the types of burns and their degrees, there are special methods of treatment. Moreover, this classification of burns by degree is universal for the entire world medical community, and it is it that is the “reference point” for treatment and for determining the method of recovery after a burn.
Almost every person at least once in his life got into extreme situations or found himself in a life-threatening situation. As a result, you can get various injuries that cause significant harm to health. In the article we will analyze what degrees are, help with such injuries.
What are burns
You can get such an injury even at home, not to mention production. A burn is damage to the skin that is caused by thermal, chemical, electrical, radiation exposure. In most cases, such damage affects the upper layers of the skin, but in serious situations, muscles, blood vessels, and even bones can be affected.
If you ask yourself how to cure a burn, then the answer to it will depend on the degree and extent of the damage. In some cases, you can get by with home remedies, and sometimes serious specialized help is required.
Causes of burns
Burns can be caused by a variety of reasons, which are characterized by their manifestations and signs of damage. Burns can be caused by:
- thermal factors;
- chemical;
- electricity;
- radiation exposure;
- bacteria (so-called bacterial burn).
All of these factors can affect to varying degrees, so the burn will have its own manifestations and require an individual approach to treatment.
Types of burns
The most common are thermal burns, that is, those that are obtained as a result of exposure to:
- Fire. Very often damaged upper respiratory tract, face. When damage to parts of the body is observed, the process of removing clothes from the burnt areas is of great difficulty.
- Boiling water. Almost everyone has experienced this. The area may be small, but the depth is significant.
- Pair. Such a defeat usually does not cause many problems.
- Hot objects: These tend to leave sharp edges and deep lesions.
With a thermal burn, the degree of damage depends on several factors:
- temperature;
- duration of exposure;
- degree of thermal conductivity;
- general health and skin condition of the victim.
A chemical burn is damage to the skin as a result of exposure to various aggressive substances, for example:
Electrical burns can result from contact with conductive materials. The current propagates quickly enough through the muscles, blood, cerebrospinal fluid. The danger to humans is exposure to more than 0.1 A.
A distinctive feature of an electrical lesion is the presence of an entry and exit point. This is the so-called current mark. The affected area is usually small but deep.
Radiation burns can be associated with:
- With ultraviolet light. Such burns can easily be earned by lovers of sunbathing at noon. The area affected is usually large, but can often be managed with home remedies.
- With exposure to ionizing radiation. In this case, not only the skin is affected, but also neighboring organs and tissues.
- With infrared light. It often causes burns to the cornea, retina, and skin. The defeat depends on the duration of exposure to this negative factor.
And another type of burn is a bacterial burn, which can be caused by certain types of microorganisms. The severity also varies from small nodular lesions to a condition that can even threaten a person's life, such as the development of staphylococcal scalded skin syndrome.
Degrees of burns and their manifestation
Burns can be both very minor and such that urgent hospitalization is required. Depending on the complexity of the lesion, the consequences can also differ significantly from each other. There are several degrees of burns:
Most often, a burn is not one degree, but a combination of several. The severity of the situation is also determined by the area affected. Depending on this, burns are:
- Extensive, in which more than 15% of the skin is affected.
- Not extensive.
If the burn is extensive and more than 25% of the skin is affected, then the likelihood of a burn disease is high.
What is burn disease?
The course of this complication and severity depend on several factors:
- The age of the victim.
- Location of the affected area.
- Burn degrees.
- area of damage.
Burn disease in its development goes through the following stages:
1. Shock. It can last from several hours to several days, it all depends on the area of \u200b\u200bdamage. There are several degrees of shock:
- The first is characterized by burning pain, normal pressure and the number of heartbeats within 90 beats per minute.
- In the second degree, the heart contracts even more often, the pressure drops, the body temperature decreases, and a feeling of thirst appears.
- If more than 60% of the skin is affected, grade 3 shock is observed. The pulse is barely palpable, the pressure is low.
2. Burn toxemia. It occurs due to the effects of tissue breakdown products on the body. It usually occurs a few days after the lesion and lasts 1-2 weeks. In this case, the person feels weakness, nausea, may be vomiting, fever.
3. Septicotoxemia. It starts on the 10th day and lasts for several weeks. An infection is noted. If the dynamics of treatment is negative, then it is fatal. This is observed if there was a 4th degree burn or a deep skin lesion.
5. Reconvalescence. Effective drug treatment ends with the healing of burn wounds and the restoration of the internal organs.
To prevent the development of a burn disease, it is necessary to deliver the victim of a burn to the hospital. Doctors will be able to assess the severity of the injuries and provide effective assistance.
First aid for burns
Regardless of the factor that caused the burn, the following steps must first be performed:
It is very important not to get confused in the situation and eliminate the damaging factor as soon as possible or take the person to a safe place. This will depend on the degree of damage to the skin. Rapid cooling helps prevent damage to healthy tissue. If the burn is 3rd degree, then such a measure is not performed.
Depending on the damaging factor, first aid measures may have their own nuances. Let's consider them further.
First aid for thermal burns
Almost everyone encounters such injuries in their lives, so you need to know how to help yourself or your loved ones in such a situation. Home care for burns of this type is as follows:
- Eliminate the impact of the damaging factor as soon as possible, that is, remove from the fire zone, remove or extinguish burning clothing.
- If the burn is small, then it is necessary to cool the affected area under running water for 10-15 minutes, and then apply a clean, damp cloth.
- For more severe burns, refrigeration is not necessary, but the burn area should be covered with a tissue.
- Remove jewelry if possible.
- Take a pain reliever, such as Ibuprofen, Paracetamol.
In case of a thermal burn, it is prohibited:
- Rip off clothing if it is stuck to the wound.
- Break blisters.
- Touch affected areas.
- Smear the wounds with oil, cream, iodine, peroxide and other substances.
- You can not apply cotton wool, ice, patches.
If the burn is severe, medical attention will be required.
chemical burn
Often such lesions are obtained in chemical industries, but it is also possible in a chemistry lesson if safety precautions are not followed. When exposed to a chemical substance, it is necessary to quickly neutralize its effect.
Help for chemical burns with acid is to treat the wound with a solution of soda or soapy water. If alkali is exposed, you will first have to rinse thoroughly with water, and then treat with a 2% solution of acetic or citric acid.
If you receive more serious chemical burns, you will have to seek help from specialists.
Help with electrical burns
You can get an electric shock at home or at work. First of all, it is necessary to neutralize the source of damage. Just do it with safety precautions. The wound must be covered with a napkin.
You can get a slight injury, and it will be enough to drink warm tea and give a sedative to the victim. In severe injuries, loss of consciousness may occur. In this case, you will have to resort to additional measures of assistance:
- Find a comfortable position for the victim.
- Make sure there is a supply of fresh air.
- Clear the airways of excess clothing.
- Turn your head to the side.
- Before the arrival of the ambulance, monitor the pulse and breathing.
- If the injury is so serious that cardiac arrest has occurred, then artificial respiration with an indirect massage of the heart muscle is urgently needed.
It must be remembered that there are situations in which a person's life depends on the speed of first aid.
Radiation burns and first aid
Such damage can be obtained under the influence of ultraviolet, infrared and radiation. This type of burns differs significantly from the others in that tissue ionization occurs, which causes changes in the structure of the protein molecule.
Radiation burns have their own degrees of complexity:
- The first degree is characterized by redness, itching and burning.
- In the second degree, blisters appear.
- The third degree, in addition to the listed symptoms, includes tissue necrosis and the addition of complications.
When providing first aid after receiving a radiation burn, it is prohibited:
- Touch the wound with your hands or apply non-sterile objects to it.
- If bubbles appear, then they cannot be pierced.
- Use cosmetics to treat wounds.
- Apply ice. This can not only lead to frostbite, but also cause burn shock from a sharp temperature drop.
Eye burns
The cause of an eye burn can be all the factors that were discussed above. Localization may be different, depending on this, they distinguish:
- retina;
- lens.
The degree of damage can be different, and if the first one is quite treatable at home and has a favorable outcome, then more serious injuries require a hospital stay, and the consequences can be the most deplorable.
Signs that will indicate an eye burn are as follows:
- Redness and swelling.
- Strong pain sensations.
- Lachrymation.
- Fear of the world.
- Decreased visual acuity.
- Change in intraocular pressure in any direction.
If radiation has occurred, then some of the above signs may not appear.
In case of contact with the eyes of chemicals, it is necessary to urgently rinse them with running water for 15 minutes. Drip antiseptic drops, for example, "Floxal". Around the eyes, the skin can be lubricated, covered with a napkin and sent to the ophthalmologist.
A burn from welding, which refers to radiation, may not appear immediately, but several hours after exposure. The characteristic signs of such a lesion are as follows:
- severe cutting pain in the eyes;
- lacrimation;
- a sharp decrease in vision;
- fear of bright light.
In case of damage to the eyes, help should be provided immediately. This will determine the effectiveness of the treatment.
Burn treatment
Since the severity of burns can be different, there are two types of treatment:
- conservative;
- operational.
The choice of therapies depends on several factors:
- the total area of the lesion;
- burn depth;
- the location of the injury;
- the reason that provoked the burn;
- development of burn disease;
- the age of the victim.
If we consider a closed method for the treatment of burns, then it is carried out by applying a bandage with a medicinal preparation to the wound. When there is a shallow and mild burn, then such a bandage does not even have to be changed often - the wound heals quickly.
In the presence of the second degree, ointments with an antiseptic effect, bactericidal ointments are applied to the burn site. , for example, "Levomikol" or "Sylvatsin". They prevent the growth of bacteria. This bandage needs to be changed every two days.
With burns of degrees 3 and 4, a crust forms, so at first it is necessary to treat the area around with antiseptic agents, and after the crust disappears (and this usually happens after 2-3 weeks), bactericidal ointments can be used.
The closed method of treatment has its advantages and disadvantages. The first ones include the following:
- The bandage prevents infection from entering the wound.
- Protects the wound from mechanical damage.
- Medicines promote faster healing.
Among the shortcomings are the following:
- When changing the bandage, the patient experiences discomfort.
- Dying tissues can provoke intoxication.
With a closed method of treatment, special techniques are used, for example, ultraviolet irradiation, bactericidal filters. They are usually available at specialized burn centers.
This method of treatment contributes to the rapid formation of a dry crust. Most often it is used for burns of the face, perineum, neck.
Surgical treatment
In some cases, when the burns are of a large degree and capture large areas, it is necessary to resort to surgical intervention. The following types are used:
- Necrotomy. The doctor cuts the scab to provide blood supply to the tissues. If this is not done, then necrosis may develop.
- Necrectomy. Most often done with burns of the 3rd degree in order to remove dead tissue. The wound is well cleaned, suppuration is prevented.
- Staged necrectomy. It is produced for deep burns and is more gentle compared to the previous method. Removal of tissues is carried out in several visits.
- Amputation. The most severe cases: when treatment fails, the limb must be removed to prevent further spread of necrosis.
All methods of surgical intervention, except for the last one, then end with skin transplantation. Most often, it is possible to transplant the patient's own skin taken from other areas.
Folk remedies for burns
Many people wonder how to cure a burn at home? As for damage to degrees 3 and 4, the issue is not even discussed here - treatment should be carried out only in a hospital. Lighter burns may well be treated at home.
There are many proven methods for traditional healers, among them the following are the most popular and effective:
- If obtained, then baking soda will perfectly help to cope with it.
- A compress of strong tea can also alleviate the condition of the victim.
- Prepare a composition from 1 tablespoon of starch and a glass of water and apply it several times a day to the affected areas.
- If you soak a gauze napkin with sea buckthorn oil and apply it to the burn site, then healing will go faster.
- Some believe that a 2nd degree burn can be cured quickly with raw potatoes. It is necessary to apply fresh potato wedges every 3 minutes. Blisters will not appear if such treatment is started immediately after an injury.
- Prepare an ointment from 3 tablespoons of sunflower oil and 1 tablespoon of beeswax. Apply this composition 3-4 times a day.
It must be remembered that you can cope on your own without health consequences only with light burns. Serious injuries require medical attention.
Complications of burns
With any burn, not only damage inspires concern, especially with a large area, but also an infection that can join at any time. Risk factors include the following:
- If more than 30% of the body area is affected.
- The burn captures all layers of the skin.
- Infant and old age.
- Antibacterial resistance of the bacteria that caused the infection.
- Improper treatment and care of the wound.
- After the transplant, rejection occurred.
To reduce the likelihood of all complications, it is necessary to carry out treatment in specialized clinics. A burn is quite a serious injury, especially for children, who also receive severe psychological trauma.
The prognosis of burn treatment always depends on several factors, but the faster the victim is taken to the clinic, the more effective the therapy will be, and recovery will come faster and with minimal risk of complications. The consequences of a burn can be irreversible if timely assistance is not provided.
RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2016
Thermal burn of 50-59% of body surface (T31.5), Thermal burn of 60-69% of body surface (T31.6), Thermal burn of 70-79% of body surface (T31.7), Thermal burn of 80-89% of body surface (T31.8), Thermal burn of 90% or more of body surface (T31.9)
combustiology
general information
Short description
Approved
Joint Commission on the quality of medical services
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 28, 2016 Minutes No. 6
burns -
damage to body tissues resulting from exposure to high temperature, various chemicals, electric current and ionizing radiation.
Superficial and borderline burns (II- IIIAArt.)- damage, with preservation of the dermal or papillary layer, with the possibility of self-restoration of the skin.
deep burns- full-thickness skin lesions. Self healing is not possible. To restore the skin, surgical intervention is necessary - skin grafting, necrectomy.
Burn disease - this is a pathological condition that develops as a result of extensive and deep burns, accompanied by peculiar violations of the functions of the central nervous system, metabolic processes, the activity of the cardiovascular, respiratory, genitourinary, hematopoietic systems, damage to the gastrointestinal tract, liver, the development of DIC, endocrine disorders, etc. d.
the datedevelopmentprotocol: 2016
Protocol Users: combustiologists, traumatologists, surgeons, anesthesiologists-resuscitators, general practitioners, emergency and emergency physicians.
Level of evidence scale:
Table 1
| BUT | High-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to the appropriate population. |
| AT | High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias, the results of which can be generalized to the appropriate population . |
| FROM |
Cohort or case-control or controlled trial without randomization with low risk of bias (+). The results of which can be generalized to the appropriate population or RCTs with a very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the appropriate population. |
| D | Description of a case series or uncontrolled study or expert opinion. |
Classification
Classification of burns according to 4 degrees(adopted at the XXXVII All-Union Congress of Surgeons in 1960):
I degree - reddening of the skin with clear contours, sometimes on an edematous basis, the epidermis is not affected. Disappears in a few hours or 1-2 days.
II degree - the presence of thin-walled blisters with transparent liquid contents. Abundant exudation persists for 2-4 days. Self-epithelialization occurs after 7-14 days.
III-A degree - the presence of thick-walled blisters with jelly-like plasma contents, partially opened. The exposed bottom of the wound is moist, pink, with areas of white and red color - the papillary layer of the skin itself, often covered with a thin, whitish-gray, soft scab, petechial hemorrhages, pain sensitivity is preserved, vascular reaction is often absent. Self-epithelialization occurs after 3-5 weeks.
· III-B degree - the defeat of the entire thickness of the skin with the formation of coagulation (dry) or coagulation (wet) necrosis. With dry necrosis, the scab is dense, dry, dark red or brown-yellow, with a narrow zone of hyperemia, and slight perifocal edema. With wet necrosis, the dead skin is edematous, of a doughy consistency, the remaining thick-walled blisters may contain hemorrhagic exudate, the bottom of the wound is motley, from white to dark red, ashy or yellowish, there is widespread perifocal edema. Vascular and pain reactions are absent.
IV degree - accompanied by necrosis of not only the skin, but also formations located below the subcutaneous tissue - muscles, tendons, bones. The formation of a thick, dry or moist, whitish, yellowish-brown or black scab of a doughy consistency is characteristic. Under it and in the circumference, tissue edema is pronounced, the muscles look like “boiled meat”.
Classification of the degree (depth) of a burn according to ICD-10
The ratio of the classification of burn degrees according to ICD-10 with the classification of the XXVII Congress of Surgeons of the USSR in 1960
table 2
| Characteristic | Classification of the XXVII Congress of Surgeons of the USSR | Classification according to ICD-10 | Burn depth |
| Skin hyperemia | І degree | І degree | Superficial burn |
| Blistering | II degree | ||
| skin necrosis | III-A degree | II degree | |
| Complete skin necrosis | III-B degree | III degree | deep burn |
| Necrosis of the skin and underlying tissues | IV degree |
Classification of burn disease (OB)
· Burn shock (OS) - lasts up to 12-72 hours, depending on the severity of the injury, premorbid background, duration of the pre-hospital stage, therapy.
· Acute burn toxemia (BOT) - proceeds from 2-3 to 7-14 days from the moment of injury.
Septicotoxemia - lasts from the moment of suppuration of the scab until the complete restoration of the skin.
Reconvalescence - begins after the complete restoration of the skin and lasts for several years.
OB flow.
There are three degrees of the course of the period of ABOUT light, severe and extremely severe (as in burn shock). Accordingly, OOT and septicotoxemia, depending on the area of the burn, are divided into mild, severe and extremely severe.
Diagnostics (outpatient clinic)
DIAGNOSTICS AT OUTPATIENT LEVEL
Diagnostic criteria
Complaints:
On burning pains in the area of exposure to a thermal agent, chemicals.
Anamnesis:
· Exposure to high temperatures, acids, alkalis.
Physical examination:
· An assessment of the general condition is carried out; external respiration (respiratory rate, assessment of freedom of breathing, airway patency); pulse rate is determined, blood pressure is measured.
Local status:
The appearance of the wounds, the presence of detachment of the epidermis, areas of de-epithelialization, a scab (the nature of the scab is described - wet, dry), the prescription of the origin of the wound, localization, area are assessed.
Laboratory studies: no.
Instrumental studies: no.
Diagnostic algorithm:
History - the circumstances and place of burns.
· Visual inspection.
· Determination of respiratory rate, heart rate (HR), blood pressure (BP).
Determination of difficulty breathing or hoarseness
Diagnostics (ambulance)
DIAGNOSTICS AT THE STAGE OF EMERGENCY AID
Diagnostic measures:
Collection of complaints and anamnesis;
physical examination (measurement of blood pressure, temperature, counting the pulse, counting the respiratory rate) with an assessment of the general somatic status;
Examination of the lesion site with an assessment of the area and depth of the burn;
The presence or absence of signs of thermal inhalation injury: hoarseness, hyperemia of the mucous membranes of the oropharynx, sooting of the mucous membranes of the nasal passages, oral cavity, respiratory sufficiency.
Diagnostics (hospital)
DIAGNOSTICS AT THE STATIONARY LEVEL
Diagnostic criteria at the hospital level
Complaints:
on burning and pain in the area of burn wounds, chills, fever;
Anamnesis:
A history of exposure to high temperatures, acids, alkalis. It is necessary to find out the type and duration of the damaging agent, the time and circumstances of the injury, concomitant diseases, and an allergic history.
Physical examination:
· An assessment of the general condition is carried out; external respiration (respiratory rate, assessment of damage and freedom of breathing, airway patency), auscultation of the lungs; pulse rate, auscultation is determined, blood pressure is measured. The oral cavity is examined. The appearance of the mucous membrane, the presence of soot in the respiratory tract, oral cavity, the presence of a mucosal burn are described.
Laboratory research
Blood sampling for laboratory tests is carried out in the intensive care unit or in the intensive care unit of the emergency department.
Complete blood count, determination of glucose, capillary blood clotting time, blood type and Rh factor, blood potassium / sodium, total protein, creatinine, residual nitrogen, urea, coagulogram (prothrombin time, fibrinogen, thrombin time, plasma fibrinolytic activity, APTT, INR), acid-base balance, hematocrit, microreaction, urinalysis, feces for worm eggs.
Instrumental Research(UD A):
ECG - to assess the state of the cardiovascular system and examination before surgery (LE A);
X-ray of the chest - for the diagnosis of toxic pneumonia and thermal inhalation lesions (LEA);
Bronchoscopy - with thermoinhalation lesions (UD A);
Ultrasound of the abdominal cavity and kidneys, pleural cavity - to assess the toxic damage to internal organs and identify background diseases (LE A);
· FGDS - for the diagnosis of burn stress Curling ulcers, as well as for the setting of a transpyloric probe in paresis of the gastrointestinal tract (UD A);
Other research methods
· According to the indications in the presence of concomitant diseases and injuries. Blood for HIV, hepatitis B, C (for recipients of drugs and blood components). Bacterial culture from the wound for microflora and sensitivity to antibiotics, bacterial blood culture for sterility.
Diagnostic algorithm:, UD A (scheme)
· Anamnesis - circumstances and place of burns - first aid, the presence of vaccinations against tetanus.
History of life and the presence of somatic diseases.
· Visual inspection.
Determination of difficulty in breathing or hoarseness of voice, respiratory rate, auscultation of the lungs.
Determination of pulse, blood pressure, heart rate, auscultation.
Examination of the oral cavity, tongue, assessment of the condition of the mucous membrane, palpation of the abdomen.
Determination of the depth and area of burns.
Interpretation of laboratory tests
Interpretation of the results of instrumental examinations
List of main diagnostic measures:
1. Complete blood count, determination of glucose, capillary blood clotting time, blood type and Rh factor, blood potassium / sodium, total protein, creatinine, urea, coagulogram (prothrombin time, fibrinogen, thrombin time, APTT, INR), acid-base balance, hematocrit, urinalysis, feces for worm eggs, ECG
2. Determination of the depth and area of the burn.
3. Diagnosis of damage to the respiratory tract
4. Diagnosis of burn shock
List of additional diagnostic measures, (UD A) :
Bacterial culture from wounds - according to indications or when changing antibiotic therapy (LE A);
· X-ray of the chest according to indications - for the diagnosis of toxic pneumonia and thermoinhalation lesions (LE A);
FBS - with thermoinhalation lesions (UD A);
FGDS - for the diagnosis of burn stress Curling ulcers, as well as for setting up a transpyloric probe in paresis of the gastrointestinal tract (LE A).
Determining the area of the burn
The most acceptable and fairly accurate are simple methods for determining the size of the burnt surface by the method proposed by A. Wallace (1951), the so-called rule of nines, as well as the rule of the palm, the area of \u200b\u200bwhich is equal to 1-1.1% of the body surface.
"Rule of nines" (method proposed by A.Wallace, 1951)
Based on the fact that the area of each anatomical region in percent is a multiple of 9:
- head and neck - 9%
- front and back surfaces of the body - 18% each
- each upper limb - 9%
- each lower limb - 18%
- perineum and genitals - 1%.
"Palm Rule" (J.
Yrazer, 1997)
As a result of anthropometric studies, J. Yrazer et al. came to the conclusion that the palm area of an adult is 0.78% of the total body surface area.
The number of palms that fit on the surface of the burn determines the percentage of the affected area, which is especially convenient for limited burns of several parts of the body. These methods are easy to remember and can be used in any setting.
To measure the area of burns in children, a special table is proposed, which takes into account the ratio of body parts, which differ depending on the age of the child (Table 4).
Area as a percentage of the total body surface area of the surface of the anatomical regions by age
Table 4
| Anatomical area | newborns | 1 year | 5 years | 10 years | 15 years | Adult patients |
| Head | 19 | 17 | 13 | 11 | 9 | 7 |
| Neck | 2 | 2 | 2 | 2 | 2 | 2 |
| Anterior surface of the body | 13 | 13 | 13 | 13 | 13 | 13 |
| Posterior surface of the body | 13 | 13 | 13 | 13 | 13 | 13 |
| Buttock | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 |
| Crotch | 1 | 1 | 1 | 1 | 1 | 1 |
| Hip | 5,5 | 6,5 | 8 | 8,5 | 9 | 9,5 |
| Shin | 5 | 5 | 5,5 | 6 | 6,5 | 7 |
| Foot | 3,5 | 3,5 | 3,5 | 3,5 | 3,5 | 3,5 |
| Shoulder | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 |
| Forearm | 3 | 3 | 3 | 3 | 3 | 3 |
| Brush | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 | 2,5 |
OH diagnostics
All patients with a total burn area of more than 50%, deep burns of more than 20% are admitted with a clinic of severe or extremely severe OR (Table 5)
Severity of burn shock in adults
Table 5
OR refers to the hypovolemic type of hemodynamic disorders. Burn shock is characterized by:
1. Persistent hemoconcentration due to the loss of the liquid part of the circulating blood volume (“white bleeding”).
2. Plasma loss occurs constantly throughout the entire period of burn shock (from 12 to 72 hours).
3. Pronounced nociceptive impulsation.
4. In most cases, a hyperdynamic type of hemodynamics is manifested.
5. In the first 24 hours, the permeability of the vascular wall increases significantly, through which large molecules (albumin) are able to pass, which leads to interstitial edema of the paranecrosis zone, “healthy” tissues and aggravates hypovolemia.
6. Destruction of cells (including up to 50% of all erythrocytes) is accompanied by hyperkalemia.
At light degree of OR (burn area less than 20%), patients experience severe pain and burning at the burn sites. In the first minutes and hours there may be excitement. Tachycardia up to 90. Blood pressure is normal or slightly elevated. There is no shortness of breath. Diuresis is not reduced. If treatment is delayed by 6-8 hours or is not carried out, oliguria and moderate hemoconcentration may be observed.
At heavy OR (20-50% b.t.) lethargy and adynamia rapidly increase with preserved consciousness. Tachycardia is more pronounced (up to 110), blood pressure is stable only with infusion therapy and the introduction of cardiotonic drugs. Patients are thirsty, dyspeptic symptoms (nausea, vomiting, hiccups, bloating) are noted. Paresis of the gastrointestinal tract, acute expansion of the stomach is often observed. Decreases urination. Diuresis is provided only by the use of medications. Hemoconcentration is expressed - hematocrit reaches 65. From the first hours after the injury, moderate metabolic acidosis with respiratory compensation is determined. Patients freeze, body temperature is below normal. The shock may last 36-48 hours or more.
At the 3rd (extremely severe) degree of OR (burn more than 50% b. t.) the condition is extremely serious. 1-3 hours after the injury, consciousness becomes confused, lethargy and stupor set in. The pulse is thready, blood pressure drops to 80 mm Hg. Art. and lower (against the background of infusion therapy, the introduction of cardiotonic, hormonal and other drugs). Shortness of breath, shallow breathing. Often there is vomiting, which can be repeated, the color of "coffee grounds". Pronounced paresis of the gastrointestinal tract. Urine in the first portions with signs of micro- and macrohematuria, then dark brown with sediment. Anuria sets in quickly. Hemoconcentration is detected after 2-3 hours, hematocrit rises to 70 or more. Increases hyperkalemia and decompensated mixed acidosis. Body temperature drops below 36°. The shock can last up to 3 days. and more, especially with a burn of the respiratory tract (OD).
Diagnosis of thermoinhalation injury (TIT).
Diagnostic criteria for TIT by frequency of occurrence:
· Data of fibrobronchoscopy (FBS) - in 100% of cases;
· Anamnesis (closed room, burnt clothes, loss of consciousness during a fire) - in 95% of cases;
Burns of the face, neck, oral cavity - in 97%;
· Singing of the hair of the nasal passages - in 73.3%;
Cough with soot in sputum - in 22.6%;
Dysphonia (hoarseness of voice) - in 16.8%;
Stridor (noisy breathing), bronchospasm, tachypnea - in 6.9% of cases.
Provision and indications for diagnostic FBS upon admission to the hospital(category of evidence A) , LE A
Table 6
| Indications | Security |
| Anamnestic data of TIT |
Under local anesthesia, except in cases of intolerance to local anesthetics, pronounced alcohol intoxication, psychomotor agitation, status asthmaticus and aspiration syndrome |
| Dysphonia | |
| Soot in the oropharynx or sputum | |
| Consciousness< 9 баллов по шкале Глазго | With tracheal intubation |
| Stridor, shortness of breath | |
| Deep burns on the face and neck | |
| PaO2/FiO2< 250 |
The severity of TIT according to FBS(Institute of Surgery named after A.V. Vishnevsky, 2010):
1. Hyperemia and slight swelling of the mucosa, accentuation or "blurring" of the vascular pattern, the severity of the tracheal rings, mucous secretion (in a small amount).
2. Severe hyperemia and mucosal edema, erosion, solitary ulcers, fibrin plaque, soot, mucous, mucopurulent or purulent secret (tracheal rings and main bronchi are not visible due to mucosal edema).
3. Severe hyperemia and edema of the mucosa, friability and bleeding, multiple erosions and ulcers with a significant amount of fibrin, soot, mucous, mucopurulent or purulent secret, areas of pallor and icterus of the mucosa.
4. Total lesion of the tracheobronchial tree, pale yellow mucosa, absence of a vascular pattern, dense soot deposit adhering to the underlying tissues, early (1-2 days) desquamation is possible.
Diagnostic measures in the ICU (PRIT), (UD A)
Table 7
| Event | Patient category | |||
| 1st day after injury | 2nd day after injury | 3rd day after injury | 4th and subsequent days | |
| Collection of complaints | All patients | All patients | All patients | All patients |
| Collection of anamnesis | All patients | - | - | - |
| Evaluation of the area and degree of burn | All patients | All patients | - | - |
| Assessment of consciousness on the Glasgow scale | All patients | All patients | All patients | All patients |
| Assessment of moisture and turgor of the skin | All patients | All patients | All patients | All patients |
| Body thermometry | All patients | All patients | All patients | All patients |
| HR, HR, BP | All patients | All patients | All patients | All patients |
| CVP | All patients | All patients | All patients | All patients |
| SpO2 | All patients | All patients | All patients | All patients |
| Diuresis | All patients | All patients | All patients | All patients |
|
ECG |
All patients | According to indications | According to indications | According to indications |
|
X-ray WGC graphic |
All patients | Patients with TITS, SOPL | Patients with TIT, ARDS | Patients with ARDS |
| Diagnostic FBS | According to the table 3 | - | - | - |
| Diagnostic FGDS | - | - | GI patients | GI patients |
| General blood analysis | All patients | - | All patients | All patients |
| Hb, Ht blood every 8 hours | All patients | All patients | GI patients | GI patients |
| General urine analysis | All patients | - | All patients | All patients |
| Urine specific gravity every 8 hours | All patients | All patients | - | - |
| ALT, AST blood | All patients | - | Patients with sepsis | Patients with sepsis |
| total blood bilirubin | All patients | - | Patients with sepsis | Patients with sepsis |
| Blood albumin | All patients | All patients | All patients | All patients |
| blood glucose | All patients | - | Patients with sepsis | Patients with sepsis |
| blood urea | All patients | - | Patients with sepsis | Patients with sepsis |
| Blood creatinine | All patients | - | Patients with sepsis | Patients with sepsis |
| Blood electrolytes | - | - | Patients with sepsis | Patients with sepsis |
| APTT, INR, blood fibrinogen | - | All patients | Patients with sepsis | Patients with sepsis |
| The gas composition of the blood | Patients with TIT | Patients with TIT | Patients with severe TIT | Patients with severe TIT |
| Urine myoglobin | With damage to muscle tissue | - | - | |
| Blood carboxyhemoglobin | Fire patients with loss of consciousness ≤ 13 points on the Glasgow Scale | - | - | - |
| Blood and urine alcohol | Patients with loss of consciousness ≤ 13 points on the Glasgow scale; with signs of alcohol intoxication | - | - | - |
The following are subject to treatment in the ICU:
patients with OH;
patients with a burn area of more than 20% of the body surface with severe acute burn toxemia;
affected sTIT until complete relief of signs of respiratory failure;
Patients with electrical injury before the exclusion of heart damage;
Patients with sepsis, gastrointestinal bleeding, psychosis, burn exhaustion, impaired consciousness;
Patients with signs of multiple organ failure.
Patients in a satisfactory condition with a superficial burn, in which a mild OR ended in the first 8-12 hours, there is no high fever and leukocytosis, the motility of the gastrointestinal tract does not suffer, and diuresis is not less than 1/ml/kg/hour, no further intensive therapy is needed .
Therapeutic activities in the ICU
Table 8
| Intensive therapy | Patient category | ||||
| 1st day after injury | 2nd day after injury | 3rd day after injury | 4th and subsequent days | ||
| Promedol 2% - 1 ml every 4 hours IV (in children 0.1-0.2 mg / kg / hour IV) - I option | All patients (one or more options) | All patients (one option) | Pain patients (one option) | Patients with severe pain syndrome (one of the options) | |
| Tramadol 5% - 2 ml every 6 hours IV (in children after 1 year, 2 mg / kg every 6 hours IV) - II option | |||||
| Ketorolac 1 ml every 8 hours (except for children under 15 years old) IM up to 5 days - III option | |||||
| Metamizole sodium 50% - 2 ml every 12 hours IV, IM (in children, analgin 50% 0.2 ml / 10 kg every 8 hours IV, IM) - IV option | All patients | All patients | |||
| Decompression strip necrotomy | Patients with deep circular burns of the neck, chest, abdomen, extremities | - | |||
| Prednisolone 3 mg/kg/day IV | Patients with mild OH | - | - | - | |
| Prednisolone 5 mg/kg/day IV | Patients with severe OH | Patients with severe OH | - | - | |
| Prednisolone 7 mg/kg/day IV | Patients with extremely severe OH | Patients with extremely severe OH | - | - | |
| Prednisolone 10 mg/kg/day IV | Patients with TIT | Patients with TIT | - | - | |
| Ascorbic acid 5% - 20 ml every 6 hours IV drip | All patients | Except for patients with mild OH | - | - | |
| Furosemide 0.5-1 mg/kg IV every 8-12 hours at an IV infusion rate | Patients with diuresis< 1 мл/кг/час | Patients with diuresis< 1 мл/кг/час | Patients with diuresis< 1 мл/кг/час | Patients with diuresis< 1 мл/кг/час | |
| Heparin 1000 units/hour IV (in children - 100-150 units/kg/day s/c) without heparin inhalation | Except for patients with mild OH | Except for patients with mild OH | - | - | |
| Enoxaparin 0.3 ml (or Nadroparin 0.4 ml, Cibor 0.2 ml), except for children under 18 years old 1 time per day s / c | - | - | Patients with sepsis | Patients with sepsis | |
| Insulin (Rapid) every 6 hours s.c. | Patients with blood sugar ≥ 10 mmol/l | Patients with blood sugar ≥ 10 mmol/l | Patients with blood sugar ≥ 10 mmol/l | ||
| Omeprazole 40 mg (in children 0.5 mg/kg) 1 time per night IV drip | Except for patients with mild OH | Except for patients with mild OH | All patients | All patients | |
| Omeprazole 40 mg (in children 0.5 mg/kg) every 12 hours IV drip | - | - | GI patients | GI patients | |
| (in adults category of evidence A) | |||||
| Sterofundin Iso (Ringer, Disol, Sodium chloride 0.9%) | According to the table 9 | According to the table 9 | - | - | |
| Sterofundin G-5 (Ringer, Disol, Sodium chloride 0.9%) | - | According to the table 9 | - | - | |
| HEC | According to the table 9 | According to the table 9 | - | - | |
| Albumin 20% | - | According to the table 9 | According to the table 9 | Patients with albumin ≤ 30 g/l (total protein ≤ 60 g/l) | |
| Normofundin G-5 (up to a maximum of 40 ml / kg / day) | - | - | According to the table 9 | All patients | |
| Reamberin 400-800 ml (in children 10 ml/kg) per day up to 11 days | - | - | - | All patients | |
| III generation cephalosporins IV, IM | - | All patients | All patients | All patients | |
| Ciprofloxacin 100 ml every 12 hours (except children) | - | - | Patients with sepsis | Patients with sepsis | |
| Amikacin 7.5 mg/kg every 12 hours (including children) IV, IM | - | - | |||
| PSS 3000 units | - | - | - | According to Appendix 12 to the Order of the Ministry of Health of the Russian Federation No. 174 dated May 17, 1999 | |
| PSFI | - | - | - | ||
| SA | - | - | - | ||
| DPT | - | - | - | ||
| Invasive ventilation | Patients with loss of consciousness< 9 баллов по шкале Глазго (категория доказательности А); глубоким ожогом >40% (evidence category A); deep burns on the face and progressive soft tissue edema (evidence category B); severe TIT with damage to the larynx and the risk of obstruction (category of evidence A); severe TIT by combustion products (evidence category B); ARDS | ||||
| Adrenaline 0.1% every 2 hours inhalation up to 7 days | Patients with TIT | Patients with TIT | Patients with severe TIT | Patients with severe TIT | |
| ASS 3-5 ml every 4 hours inhalation up to 7 days | Patients with TIT | Patients with TIT | Patients with severe TIT | Patients with severe TIT | |
| (Evidence category B) | |||||
| Heparin 5000 units for 3 ml fiz. solution every 4 hours (2 hours after ASS) inhalation up to 7 days | Patients with TIT | Patients with TIT | Patients with severe TIT | Patients with severe TIT | |
| (Evidence category B) | |||||
| Sanitation FBS every 12 hours | Patients with TIT by combustion products | Patients with severe TIT by products of combustion | - | ||
| Surfactant BL 6 mg/kg every 12 hours endo-bronchially or by inhalation up to 3 days | Patients with severe TIT | Patients with severe TIT | Patients with ARDS | Patients with ARDS | |
| Regidron in probe | According to the table 9 | - | - | - | |
| Enteral protein mixture into a tube in a volume of up to 45 kcal / kg / day (evidence category A) through an infusion pump | 800 gr | According to the table 9 | According to the table 9 | Patients who cannot or do not want to eat | |
| 3-component bag for parenteral nutrition up to 35 kcal/kg/day through an infusion pump | - | - |
Patients who cannot tolerate enteral mixture |
Patients who are unable or unwilling to eat and cannot tolerate enteral formula | |
| Immunovenin 25-50 ml (in children 3-4 ml / kg, but not more than 25 ml) 1 time in 2 days up to 3-10 days | - | - | Patients with severe sepsis | Patients with severe sepsis | |
| Glutamine enterally 0.6 g/kg/day or IV 0.4 g/kg/day | - | All patients (category of evidence A) | |||
| erythrocyte mass | In chronic anemia and with hemoglobin below 70 g/l, indications for transfusion of erythrocyte-containing blood components are clinically pronounced signs of anemic syndrome (general weakness, headache, tachycardia at rest, shortness of breath at rest, dizziness, episodes of syncope), which cannot be eliminated in for a short time as a result of pathogenetic therapy. The level of hemoglobin is not the main criterion for determining the presence of indications. Indications for transfusion of erythrocyte-containing blood components in patients can be determined not only by the level of hemoglobin in the blood, but also taking into account the delivery and consumption of oxygen. Transfusion of erythrocyte-containing components can be indicated with a decrease in hemoglobin below 110 g / l, normal PaO2 and a decrease in oxygen tension in mixed venous blood (PvO2) below 35 mm Hg, that is, an increase in oxygen extraction above 60%. The wording of the indication is “reduction in oxygen delivery in case of anemia, Hb ____g / l, PaO2 ____ mm Hg, PvO2 ______ mm Hg. Art. If, at any level of hemoglobin, the indicators of venous blood oxygenation remain within the normal range, then transfusion is not indicated. (Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501) | ||||
| FFP |
The indications for transfusion of FFP are: 1) hemorrhagic syndrome with laboratory-confirmed deficiency of coagulation hemostasis factors. Laboratory signs of deficiency of coagulation hemostasis factors can be determined by any of the following indicators: prothrombin index (PTI) less than 80%; prothrombin time (PT) more than 15 seconds; international normalized ratio (INR) more than 1.5; fibrinogen less than 1.5 g/l; active partial thrombin time (APTT) more than 45 seconds (without previous heparin therapy). .(Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501) |
||||
Summary table of rehydration during the OH period
Table 9
| Days since injury | 1st day | 2nd day | 3rd day | |||
| 8 ocloc'k | 16 hours | 24 hours | 24 hours | |||
|
Volume, ml Compound |
2 ml x kg x % burn* |
2 ml x kg x % burn* |
2 ml x kg x % burn* |
35-45 ml/kg (in / in + peros + through a probe) |
||
|
Sterofundin isotonic. Sterofundin G-5 (on the 2nd day) |
100% volume | Remaining volume |
remaining volume |
- | ||
| HEC | - |
10 - 20 - 30 ml/kg |
10 - 15 ml/kg |
- | ||
| Albumin 20% (ml) | - | - |
0.25 ml x kg x % burn |
with blood albumin ≤ 30 g/l | ||
| Normofundin G-5 | - | - | - | no more than 40 ml/kg | ||
| parenteral nutrition | - | - | - | according to indications | ||
| Through the probe | Regidron | 50-100 ml/hour | 100-200 ml/hour | - | - | |
| Enteral protein nutrition (EP) | 800gr | - | 50 ml/hour x 20 hours |
75 ml/hour x 20 hours |
||
| Diet | Easy OR | drink | ATS | ATS | ATS | |
| Severe OH | Regidron | Regidron | EP or WBD | EP or WBD | ||
| Extremely severe OH | Regidron | Regidron | EP | EP | ||
* - if the burn area is more than 50%, the calculation is carried out at 50%
** - it is possible to take into account the liquid administered enterally
*** - It is permissible to take ½ of the content of total blood protein as the level of blood albumin. Calculate the volume of albumin solution using the formula:
Albumin 10% (ml) \u003d (35 - blood albumin, g / l) x BCC, l x 10
where BCC, l \u003d FMT, kg: 13
Indications for transfer to the burn department from the ICU.
Transfer of victims to the burn department is allowed:
1. after the expiration of the OR period, as a rule, on the 3rd-4th day from the moment of injury in the absence of persistent violations of the life support function.
2. during the period of OT, septicotoxemia in the absence or compensation of respiratory disorders, cardiac activity, central nervous system, parenchymal organs, restoration of gastrointestinal function.
Non-drug treatment, UD A ;
· Table 11, mode 1, 2. Installation of a nasogastric tube, bladder catheterization, central vein catheterization.
Table 10
| Equipment / Apparatus | Indications | Number of days |
| Enteral protein nutrition (nutritive support) | Extensive burns, inability to replenish losses on their own | 5 - 30 days |
|
Staying on a fluidized burn bed (Redactron or "SAT" type) |
Extensive burns on the back of the body | 7 - 80 |
|
Placement of the patient in wards with laminar heated air flow up to 30-33*C, air-ionizing unit, anti-decubitus mattresses, covering the patient with a heat-insulating blanket. |
Extensive burns to the body | 7 - 40 days |
| Argon multipurpose scalpel. | During surgical interventions | |
| VLOK | Extensive burns, intoxication | |
| UFOK | Extensive burns, intoxication | Period of toxemia and septicotoxemia |
| Ozone therapy | Extensive burns, intoxication | Period of toxemia and septicotoxemia |
infusion therapy. IT for burns is carried out in the presence of clinical indications - a pronounced loss of fluid through the wound surface, high hematocrit, in order to normalize microcirculation. The duration depends on the severity of the condition and can be several months. Physiological saline, saline solutions, glucose solution, amino acid solution, synthetic colloids, blood components and preparations, fat emulsions, multicomponent preparations for enteral nutrition are used.
Antibacterial therapy. With extensive burns, antibiotic therapy is prescribed from the moment of admission. Semi-synthetic penicillins, cephalosporins of I-IV generations, aminoglycosides, fluoroquinolones, carbopenems are used according to indications.
Disaggregants: p about indications acetylsalicylic acid, pentoxifylline, low molecular weight heparins, etc. in age dosages.
Local treatment of wounds., (UD A).
The goal of local treatment is to cleanse the burn wound from necrotic scab, prepare the wound for autodermoplasty, create optimal conditions for epithelialization of superficial and borderline burns.
The drug for the local treatment of superficial burns should help create favorable conditions for the implementation of the reparative capabilities of the epithelium: it should have bacteriostatic or bactericidal properties, should not have an irritating and painful effect, allergic and other properties, should not stick to the wound surface, keep a moist environment. All these qualities the drug should keep for a long time.
For local treatment, dressings with antiseptic solutions, ointments and gels on a water-soluble and fatty basis (octenidine
dihydrochloride, silver sulfadiazine, povidone-iodine, multicomponent ointments (levomekol, oflomelide), various coatings with antibiotics and antiseptics, hydrogel coatings, polyurethane foam dressings, dressings of natural, biological origin.
Dressings are carried out in 1 - 3 days. During dressings, it is necessary to carefully remove only the upper layers of the dressing after soaking with sterile water, antiseptic solutions. The layers of gauze presenting to the wound are removed only in areas where there is purulent discharge. It is impractical to completely change the dressing if it does not separate freely. Forcible removal of the lower layers of gauze violates the integrity of the newly appeared epithelium, interferes with the normal process of epithelization. In cases of a favorable course, the dressing applied after the primary dressing of the wound can remain on the wound until complete epithelialization and does not require a change.
Effective is the treatment of the wound surface with a shower of running sterile water using washing antiseptic solutions, cleaning of wound surfaces with hydrosurgical systems, piezotherapy, and ultrasonic debridement of wounds with ultrasonic devices. After washing, the wound is closed with bandages with ointments, foamed polyurethane, non-adhesive dressings with antiseptics.
If the possibility of early surgical necrectomy is limited, it is possible to perform a chemical necrectomy using Salicylic ointment 20% or 40%, benzoic acid.
List of Essential Medicines, (LE A) (Table 11)
Table 11
| The drug, release forms | Dosing | Application duration | Probability % | Level of Evidence | ||||
| Local anesthetic drugs: | ||||||||
| Local anesthetics (procaine, lidocaine) | According to the release form | According to indications | 100% | BUT | ||||
| Means for anesthesia | BUT | |||||||
| Antibiotics | ||||||||
| Cefuroxime | 1.5 g in / in, in / m, according to the instructions | According to the indications, according to the instructions | BUT | |||||
|
Cefazolin |
1 - 2 g, according to the instructions |
According to the indications, according to the instructions | 80% | BUT | ||||
| Ceftriaxone | 1-2 gr according to the instructions | According to the indications, according to the instructions | 80% | BUT | ||||
| Ceftazidime | 1-2 g IM, IV, according to the instructions | According to the indications, according to the instructions | 80% | BUT | ||||
| cefepime | 1-2 g, i / m / in / in according to the instructions | According to the indications, according to the instructions | BUT | |||||
|
Amoxicillin/clavulanate |
600mg iv according to directions | According to the indications, according to the instructions | 80% | BUT | ||||
| Ampicillin/sulbactam | 500-1000 mg, in, m, in / in, 4 times a day | According to the indications, according to the instructions | 80% | BUT | ||||
| Vancomycin | powder / lyophilisate for solution for infusion 1000 mg, according to the instructions | According to the indications, according to the instructions | 50% | BUT | ||||
| Gentamicin | 160 mg IV, IM, as directed | According to the indications, according to the instructions | 80% | BUT | ||||
| Ciprofloxacin, solution for intravenous infusion | 200 mg 2 times / in, according to the instructions | According to the indications, according to the instructions | 50% | BUT | ||||
| Levofloxacin | solution for infusion 500 mg / 100 ml, according to the instructions | According to the indications, according to the instructions | 50% | BUT | ||||
| Carbapenems | according to instructions | According to the indications, according to the instructions | BUT | |||||
| Analgesics | ||||||||
|
Tramadol solution for injections 100mg/2ml, 2 ml in ampoules 50 mg capsules, tablets |
50-100 mg. in / in, through the mouth. the maximum daily dose is 400 mg. |
According to the indications, according to the instructions | BUT | |||||
| Metamizole sodium 50% | 50% - 2.0 intramuscularly up to 3 times | According to the indications, according to the instructions |
80% |
BUT | ||||
| Ketoprofen | according to instructions | According to the indications, according to the instructions | BUT | |||||
| Other NSAIDs | according to instructions | According to the indications, according to the instructions | BUT | |||||
| Narcotic analgesics (promedol, fentanyl, morphine) | According to the indications, according to the instructions | 90% | BUT | |||||
| Disaggregants and anticoagulants | ||||||||
| Heparin | 2.5 - 5 tons. ED - 4 - 6 times a day | According to the indications, according to the instructions | 30% | BUT | ||||
| Nadroparin calcium injection | 0.3, 0.4, 0.6 U s/c | According to the indications, according to the instructions | 30% | BUT | ||||
| Enoxaparin injection in syringe | 0.4, 0.6 6 units s/c | According to the indications, according to the instructions | 30% | BUT | ||||
| Pentoxifylline 5% - 5.0 | in / in, through the mouth | According to the indications, according to the instructions | 30% | BUT | ||||
| Acetylsalicylic acid 0.5 | through the mouth | According to the indications, according to the instructions | 30% | BUT | ||||
| Medications for topical treatment | ||||||||
| Povidone-iodine | Bottle 1 liter | According to the indications, according to the instructions | 100% | BUT | ||||
| Chlorhexedine | Bottle 500 ml | According to the indications, according to the instructions | 100% | BUT | ||||
| Hydrogen peroxide | Bottle 500 ml | According to the indications, according to the instructions | 100% | BUT | ||||
| Octenidine dihydrochloride 1% |
Bottle 350 ml, 20 gr |
According to the indications, according to the instructions | 100% | BUT | ||||
| Potassium permanganate | To prepare an aqueous solution | According to the indications, according to the instructions | 80% | BUT | ||||
| Water-soluble and fat-based ointments (silver-containing, antibiotic and antiseptic containing, multicomponent ointments) | Tubes, bottles, containers | According to the indications, according to the instructions | 100% | BUT | ||||
| dressings | ||||||||
| Gauze, gauze bandages | meters | According to the indications, according to the instructions | 100% | BUT | ||||
| Medical bandages | PCS. | According to the indications, according to the instructions | 100% | BUT | ||||
| Elastic bandages | PCS. | According to the indications, according to the instructions | 100% | BUT | ||||
| Wound dressings (hydrogel, film, hydrocolloid, etc.) | plates | According to the indications, according to the instructions | 80% | BUT | ||||
| Xenogenic wound dressings (pigskin, calf skin, preparations based on pericardium, peritoneum, intestines) | plates | According to the indications, according to the instructions | 80% | BUT | ||||
| Cadaverous human skin | plates | According to the indications, according to the instructions | 50% | BUT | ||||
| Suspensions of skin cells cultured by biotechnological methods | vials | According to the indications, according to the instructions | 50% | BUT | ||||
| Infusion preparations | ||||||||
| Sodium chloride, solution for infusion 0.9% 400ml | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Ringer's lactate solution | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Sodium chloride, potassium chloride, sodium acetate, | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Sodium chloride, potassium chloride, sodium bicarbonate | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Glucose 5, 10% | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Glucose 10% | Ampoules 10 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Glucose 40% | Bottles 400 ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Dextran, 10% solution for infusion | 400ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Other medicines (as indicated) | ||||||||
| B vitamins | ampoules | According to the indications, according to the instructions | 50% | BUT | ||||
| C vitamins | ampoules | According to the indications, according to the instructions | 50% | BUT | ||||
| Group A vitamins | ampoules | According to the indications, according to the instructions | 50% | BUT | ||||
| Tocopherols | capsules | According to indications. according to instructions | 80% | BUT | ||||
| H2 blockers and proton pump inhibitors | ampoules | According to the indications, according to the instructions | 80% | BUT | ||||
| Etamzilat, solution for injection in ampoule 12.5% | ampoules 2ml | According to the indications, according to the instructions | 50% | BUT | ||||
| Aminocaproic acid | vials | According to the indications, according to the instructions | 50% | BUT | ||||
| Diphenhydramine | Ampoules 1%-1ml | According to the indications, according to the instructions | 50% | BUT | ||||
| Prednisolone | Ampoules 30mg | According to the indications, according to the instructions | 50% | BUT | ||||
| metoclopramide | Ampoules 0.5%-2ml | According to the indications, according to the instructions | 50% | BUT | ||||
| human insulin | Bottles 10ml/1000u | According to the indications, according to the instructions | 90% | BUT | ||||
| Aminophylline | Ampoules 2.5%-5ml | According to the indications, according to the instructions | 50% | BUT | ||||
| Ambroxol | 15mg-2ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Furosemide | Ampoules 2ml | According to the indications, according to the instructions | 50% | BUT | ||||
| Nystatin | tablets | According to the indications, according to the instructions | 50% | BUT | ||||
| Ambroxol | Syrup 30mg/5ml 150ml | According to the indications, according to the instructions | 80% | BUT | ||||
| Nandrolone decanoate | Ampoules 1ml | According to indications | 50% | BUT | ||||
|
Enteral protein nutrition (nutritive support) Sterile mixture in the ratio of protein-7.5 g, Fats-5.0g, carbohydrates-18.8g. Daily volume from 500 ml to 1000 ml. |
Bags of 800gr | According to indications | 100% | BUT | ||||
| 3-component bag for parenteral nutrition up to 35 kcal/kg/day 70/180, 40/80 through an infusion pump | Bags volume 1000, 1500 ml | According to indications | 50% | BUT | ||||
*OB occurs with damage to all organs and systems of the human body, therefore, it requires the use of various groups of medicines (for example, gastroprotectors, cerebroprotectors). The above table cannot cover the entire group of medicines used in the treatment of burn disease. Therefore, the table shows the most commonly used drugs.
Surgical intervention
1. Operation - Primary surgical treatment of a burn wound.
All patients underwent primary surgical treatment of the burn wound. (PHOR).
The purpose of the operation - Cleansing wound surfaces and reducing the bacterial count in the wound.
Indications- The presence of burn wounds.
Contraindications.
PHOR technique: swabs moistened with antiseptic solutions (povidone-iodine solution, nitrofuran, octenidine hydrochloride, chlorhexedine), the skin around the burn is cleaned of contamination, foreign bodies and exfoliated epidermis are removed from the burnt surface, tense large blisters are incised and their contents released. Wounds are treated with antiseptic solutions (povidone-iodine solution, octenidine dihydrochloride, nitrofuran, chlorhexidine). Dressings with antiseptic solutions, hydrogel, hydrocolloid biological and natural coatings are applied.
2. Necrotomy.
The purpose of the operation- dissection of scars for decompression and restoration of blood supply to the limb, chest excursion
Indications. Circular compression with a dense necrotic scab of the chest, limbs with signs of circulatory disorders.
Contraindications. With a clinic of compression and the threat of necrosis of the limb, there is no contraindication.
After processing the surgical field three times with a solution of povidone-iodine, a longitudinal dissection of the burn scab is performed to healthy tissues. There may be 2 or more cuts. In this case, the edges of the incision should diverge, not interfere with the blood supply to the limb and the excursion of the chest.
2. Operation - Necrectomy
Necrectomy is divided into the following types by deadlines.
RHN - early surgical necrectomy 3-7 days.
PCN-late surgical necrectomy 8-14 days.
HOGR - surgical treatment of a granulating wound later than 15 days.
Depth of tissue to be removed.
Tangential.
Fascial.
Initially, the timing of the upcoming necrectomy, the type and volume of the upcoming surgical intervention are planned. The average time for necrectomy is 3-14 days.
Depth of tissue to be removed.
Tangential.
Fascial.
The operation is traumatic, costly, requires massive transfusion of components and blood products, the presence of allogeneic, xenogenic, biological, synthetic wound coverings, highly qualified anesthesiologists, resuscitators, combustiols.
Taking into account the severe traumatization of tissues during these operations and massive blood loss during their performance, reaching up to 300 ml from one percent of the removed skin, when planning a necrectomy of more than 5%, it is necessary to form a supply of one-group FFP and erythrocyte mass. In order to reduce blood loss, it is necessary to use hemostatics both locally - aminocaproic acid, and general - trinixanoic acid, etamsylate.
The purpose of the operation- Excision of the burn eschar in order to cleanse the wound and prepare for skin transplantation, reduce infectious complications, intoxication.
Indications. The presence of a necrotic scab on the surface of the wound.
Contraindications. Extremely serious condition of the patient, severe infection of burn wounds, massive burns complicated by damage to the respiratory organs, severe damage to the liver, kidneys, heart, central nervous system associated with a burn injury, diabetes mellitus in a decompensated form, bleeding from the gastrointestinal tract, a state of intoxication psychosis in patient, persistent violation of normal hemodynamics, Violation of blood clotting.
Methodology for the procedure/intervention:
Necrectomy is performed in the operating room under general anesthesia.
After 3-fold treatment of the surgical field with povidone-iodine solution, injection is performed according to the indications of subcutaneous fat in order to level the relief and reduce blood loss.
With the help of a necrotome: as a necrotome, you can use electrodermatomes, Gambdi knives, ultrasonic, radio wave, hydrosurgical desectors of the type of various manufacturers, an argon multifunctional scalpel.
Within viable tissues, necrectomy is performed. In the future, hemostasis is performed, both local (aminocaproic acid, hydrogen peroxide, electrocoagulation) and general (trinixanoic acid, FFP, coagulation factors).
In the future, after the formation of stable hemostasis during limited necrectomy on an area of up to 3% and a stable condition of the patient, autodermoplasty is performed with free split autografts taken by the dermatome from donor sites.
When performing necrectomy on an area of more than 3%, there is a high risk of non-radical removal of necrotic tissues, wound surfaces are closed with wound dressings of a natural (allogeneic skin, xenogenic coatings), biological or synthetic nature, in order to restore the lost barrier function of the skin.
After complete cleansing of the wound surface, the skin is restored by skin transplantation.
Operation - Surgical treatment of a granulating wound (HOGR)
Target: excision of pathological granulations and improvement of engraftment of split skin grafts.
Indications.
1. Granulating burn wounds
2. Residual non-healing wounds
3. Wounds with pathological granulations
Contraindications. Extremely serious condition of the patient, persistent violation of normal hemodynamics.
Methodology for the procedure/intervention:
For HOGR of extensive burns, a prerequisite is the presence of an electric dermatome, a Gumby knife. More effective and less traumatic is the treatment of granulation with hydrosurgical devices.
The surgical field is treated with a solution of povidone-iodine, chlorhexidine, and other antiseptics. Excision of pathological granulations is performed. With heavy bleeding, the operation is accompanied by the introduction of components and blood products. The operation may result in xenotransplantation, skin allotransplantation, transplantation of keratinocyte layers, wound coverings of 2-4 generations.
Operation - Autodermoplasty (ADP).
It is the main operation for deep burns. ADP can be carried out from 1 to 5-6 (or more) times until the lost skin is completely restored.
The purpose of the operation- eliminate or partially reduce the wound resulting from burns by transplantation of free thin skin flaps cut from undamaged parts of the patient's body.
Indications.
1. Extensive granulating burn wounds
2. Wounds after surgical necrectomy
3. Mosaic wounds, residual wounds on an area of more than 4 x 4 cm 2 of the body surface
4. with extensive burns of 3A degree after tangential necrectomy to accelerate the epithelization of burn wounds.
Contraindications.
Methodology for the procedure/intervention:
For extensive burns ADP, a prerequisite is the presence of an electric dermatome, a skin perforator. Manual methods of taking the skin lead to the loss ("damage") of the donor site, which complicates subsequent treatment.
Treatment of donor sites three times with alcohol 70%, 96%, povidone-iodine solution, chlorhexidine, octenidine dihydrochloride, skin antiseptics. A split skin flap 0.1 - 0.5 cm 2 thick is removed with an electrodermatome over an area of up to 1500 - 1700 cm 2. A gauze bandage with an antiseptic solution or film, hydrocoloid, hydrogel wound dressings is applied to the donor site.
Split skin grafts (if indicated) are perforated with a perforation ratio of 1:1, 5, 1:2, 1:3, 1:4, 1:6.
Perforated grafts are transferred to the burn wound. Fixation to the wound (if necessary) is carried out with a stapler, sutures, fibrin glue. In case of a serious condition of the patient, in order to increase the area of wound closure, a combined autoallodermoplasty, autoxenodermoplasty (mesh in a mesh, transplantation in sections, etc.), transplantation with laboratory-grown skin cells - fibroblasts, keratinocytes, mesenchymal stem cells - is performed.
The wound is closed with a gauze bandage with an antiseptic solution, an ointment on a fatty or water-soluble basis, and synthetic wound dressings.
Operation - Transplantation of xenogenic skin, tissues.
The purpose of the operation
Indications.
Contraindications. Extremely serious condition of the patient, severe infection of burn wounds, persistent violation of normal hemodynamics.
Methodology for the procedure/intervention:
Treatment of the surgical field with an antiseptic solution (povidone-iodine, alcohol 70%, chlorhexidine). Wounds are washed with antiseptic solutions. Whole or perforated plates of xenogenic skin (tissue) are transplanted onto the surface of the wounds. In combined transplantation of split autoskin and xenogeneic skin (tissue), the xenogeneic tissue is superimposed over perforated autoskin with a high perforation ratio (mesh in mesh). The wound is closed with a gauze bandage with an ointment or antiseptic solution.
Operation - Transplantation of allogeneic skin.
The purpose of the operation- Temporary closure of the wound in order to reduce losses from the wound surface, protect against microorganisms, create optimal conditions for regeneration.
Indications.
1. deep burns (grade 3B-4) on an area of more than 15-20% of the body surface when simultaneous skin autotransplantation is impossible due to heavy bleeding during necrectomy. When cutting skin grafts, the total area of wounds increases for a time until the wounds are epithelialized at the site of cut autografts and engraftment of transplanted grafts occurs;
2. shortage of donor skin resources;
3. the impossibility of simultaneous skin autotransplantation due to the severity of the patient's condition;
4. as a temporary cover between the stages of autoskin transplantation;
5. during the preparation of granulating wounds with deep burns for skin autotransplantation in patients with severe concomitant diseases, with a sluggish wound process with a change in CT at each dressing;
6. with extensive burns of 3A degree after tangential necrectomy to accelerate the epithelization of burn wounds.
7. with extensive borderline burns in order to reduce losses through the burn wound, reduce pain, prevent microbial contamination
Contraindications. Extremely serious condition of the patient, severe infection of burn wounds, persistent violation of normal hemodynamics.
Methodology for the procedure/intervention:
Treatment of the surgical field with an antiseptic solution (povidone-iodine, alcohol 70%, chlorhexidine). Wounds are washed with antiseptic solutions. Whole or perforated plates of allogeneic skin are transplanted onto the surface of the wounds. In combined transplantation of split autoskin and allogeneic (cadaveric) skin, cadaveric skin is superimposed on top of perforated autoskin with a high perforation ratio (mesh in mesh). The wound is closed with a gauze bandage with an ointment or antiseptic solution.
Other treatments
Transplantation of cultured fibroblasts, transplantation of cultured keratinocytes, combined transplantation of cultured skin cells and autoskin.
Indications for expert advice
Table 12
Indications for transfer to the intensive care unit and resuscitation:
1. Deterioration of the patient's condition with the appearance of respiratory, cardiovascular, hepatic and renal insufficiency.
2. Complication of burn disease - bleeding, sepsis, multiple organ failure
3. Severe condition after extensive skin autoplasty
Treatment effectiveness indicators
Cleansing of the wound from necrotic tissues, clinical readiness of the wound for the perception of a skin graft, the percentage of engraftment of skin grafts, the duration of inpatient treatment. rehabilitation;
restoration of motor function and sensitivity of the affected segment of the skin;
epithelialization of wounds;
duration of inpatient treatment. rehabilitation;
Further management.
After the patient is discharged from the hospital, he is subject to observation, treatment in the clinic by the surgeon, traumatologist, and therapist.
Differential Diagnosis
With a known history, the fact of receiving extensive burns, a differential diagnosis is not carried out.
Treatment abroad
