Principles of emergency care for burns. Providing first emergency medical care for burns

05.03.2020 -

AT modern life there are many dangers. The number of threats to human life does not decrease over time. Most disasters are accompanied by fires, explosions and other "additions". AT similar cases people usually get different kinds injuries at the same time. For example: a fire at work can lead not only to a flame burn, but to poisoning by the combustion products of chemicals.

Such situations can be described in many ways. The most important thing for us is to learn how to behave correctly in these conditions, to be able to competently help ourselves and those around us. You don't have to be a medical professional to do this. It is enough to be a person who is able to "pull himself together", who wants to make a feasible contribution to the preservation of life and health, if not all, then at least himself.

In order to competently provide assistance, you must first understand what a burn is and what types of burns are. The amount of help you can provide depends on this knowledge.

What parameters should be taken into account when assessing the severity of a burn? The ability to correctly orientate yourself in a situation will help you to give out high-quality and really important information an ambulance dispatcher. To do this, you need to have an idea of how the area of \u200b\u200bthe burn is determined.

It is desirable to know about the complications burn injury etc.

What is a burn?

skin burn- are injuries resulting from high temperature: flame, boiling water, steam; electric current, chemical: acids or alkalis; ionizing radiation, i.e. radiation.

What is burn disease?

After a person has received a burn, there comes a period of struggle of the body with damage. Immunity is activated, the struggle begins with an external infection and attempts to prevent those microbes that always live in us from “running free”. The body throws all its strength into restoring dead tissues, trying to get rid of dead cells that poison the body. Such a struggle takes place not only in the place of the burn, but throughout the body as a whole. Highly huge pressure lie down on the kidneys, heart, blood vessels. There is not a single body that would not participate in this process. Burn disease is a very serious condition. A significant percentage of patients fail to survive this condition even with active use all modern drugs.

What complication can occur immediately after a burn?

With an extensive and deep burn, a condition arises quite quickly, which in medical literature called shock. It is important to understand correctly what shock is.

Shock- This is a rapidly developing condition associated with damage to the body, due to which normal blood flow is disrupted. This violation of the normal movement of blood in the vessels leads to a malfunction of all organs and systems. The person begins to die rapidly.

In adults, burn shock can develop with a lesion area of 25% of the entire body area (excluding first-degree burns) and with deep burns (3-4 degree) with a lesion area of 10% ...

As you already understood, both the depth of the burn and its area matter. The question arises, how to determine the area of the burn? There are two methods for determining the area of a burn. We are talking about the rule of nines and the rule of the palm.

What is the palm rule?

palm rule- This is a method of calculating the area of a burn based on the size of the palm of the victim along with the fingers. One such palm makes up 1% of the surface of the entire human body. Accordingly, by “covering” the surface of the burn with the palm of a person, one can fairly accurately calculate the area of injury.

What is the rule of nines?

The surface of the human body can be conditionally divided into parts, the area of which is equal to 9% of the total area of the body.

Head, neck-9%
One upper limb-9%
One lower limb-9%
The back surface of the body-18% (9%x2)
Front surface of the body-18% (9%x2)
The area of the perineum is 1% of the body surface.

Now we need to determine the depth of the burn.

Degrees of thermal skin burn:

1st degree redness and swelling of the skin.

2nd degree detachment of the epidermis with the formation of blisters. The bottom of the bubble is bright pink, very painful.

3rd A degree skin lesions up to the papillary layer. A thin light brown or whitish scab is formed. Pain sensitivity is reduced. 3rd B degree- loss of skin throughout its thickness. Burns are represented by dense scabs, through which the pattern of thrombosed veins shines through.

4th stage- complete charring. Pain is absent.

Of course, without practicing counting the area of burns every day, you will quickly forget all the rules and degrees. This is fine. The most important thing to keep in mind is:

Superficial burns hurt, deep ones don't. Be sure to tell the ambulance dispatcher which part of the body suffered from the burn. This information will be enough for the dispatcher to orient himself in the situation and send a team of the required profile.

Often there is a combination of thermal burns of the skin and respiratory tract. This is a very life-threatening situation. You can suspect a burn of the upper respiratory tract by several signs.

Signs of thermal damage to the respiratory tract:

the presence of a burn of the face, neck, upper half chest.
coughing up black mucus.
hoarseness of voice, barking cough.

urgent first aid for thermal burns:

Stop exposure to the traumatic factor. For any degree of burn, it is advisable to cool the body with cold water.
Remove clothing, if possible, remove fragments of smoldering clothing. This must be done carefully so as not to violate the integrity of the skin. If the fabric has become attached to the body, it is not necessary to tear it off. It's best to cut your clothes off.
Cover the burn area with a clean cloth. Do not wash the surface of the burn with water of dubious purity, pierce blisters, touch the burn with your hands.
Provide cooling to the wound by applying cold through the dressing.
Give any pain reliever you have: Analgin, Pentalgin, Nurofen, etc.
If the victim is conscious, it is advisable to give him every 5-10 minutes in small sips any available drink. It is advisable to drink mineral water or sweet tea.

Remember:

Melted synthetic fabrics must not be torn off from the affected areas of the body! This is an additional traumatic factor, which, moreover, can cause bleeding from a torn vessel with a superficial burn.
Do not leave jewelry and watches on burnt brushes! Heated metal retains heat for a long time, which long time affects the body.
It is impossible to give medicines and drink to the victim through the mouth if he is unconscious! Liquid and pieces of tablets may be inhaled.
It is impossible to bring the patient to life with blows on the cheeks! You may not be aware of a head injury other than a burn.

Indications for hospitalization for thermal burns:

The area of a burn of the 2nd degree is more than 10%.
The burn area of 3 A degree is more than 3% -5% of the entire body surface.
Regardless of the area of damage, burns of 3B-4 degrees.
Regardless of the area of the burn, people with chemical burns, with electrical injuries, with burns of the upper respiratory tract.
Patients with burns of the face, perineum and feet are necessarily hospitalized at any degree and area.

Signs of a chemical skin burn:

When exposed to the skin and mucous membranes of concentrated acids, a dry, dark brown or black, well-defined scab quickly appears. A scab is a crust that looks like gore.

Under the influence of alkalis on the skin and mucous membranes, a wet gray-dirty eschar without clear outlines appears. Such a burn resembles boiled meat.

First aid for chemical burns:

If we are talking about a chemical burn, it is necessary to wash the burned area of \u200b\u200bthe body for several minutes. It is advisable to pass water through a stream. The jet of water should not have a high pressure, so as not to further injure the tissues of the body. It is better not to use heavily polluted water, as it is a source of infection. Of course, each situation must be assessed adequately. If there is no choice, then it is necessary to wash the surface of a chemical burn with any water. It will no longer be about the dangers of dirty water, but about saving the affected area.

Exceptions are burns:

Burn caused by hydrochloric acid. When water and hydrochloric acid come into contact, a large amount of heat is released, which can increase the severity of the burn. It is better to wash the burn area with a mild soap or soda solution.
The burn caused by quicklime is treated with a mild soapy solution only. Water cannot be used in this case.
The burn caused by exposure to phosphorus differs from the burn caused by acid or alkali in that phosphorus flares up in air and the burn becomes combined - thermal and chemical. It is better to immerse the burnt part of the body in water and remove pieces of phosphorus under water.

After rinsing, a clean bandage should be applied to the burn area. You may come across an opinion on the pages of other sites that the bandage must be soaked with a solution. If the burn was acid, then it is suggested to moisten the bandage with an alkaline solution. If the burn was alkaline, then the bandage is suggested to be moistened with a weak acid solution. As practicing physicians, we recommend leaving this activity to specialists. Instead, focus on cleaning the surface of the burn and seeking professional help. You are still in stressful situation you will not be able to properly prepare the desired solution. Often people confuse which solution should be applied to which burn. The simpler your actions, the more effective the help will be.

Remember:

It is impossible to treat the surface of the burn with fats, oils, dyes, ointments before being examined by the ambulance doctors or before admission to the hospital! First, it interferes with the examination of the patient. Secondly, these substances prevent the release of excess heat from the surface of the burn and cause additional chemical irritation.
It is impossible to treat the skin with alkali for acid burns and acid for alkali burns, unless copious washing with water has been carried out beforehand! Chemical reaction from the interaction of these substances will occur directly on the burnt surface, causing additional injury from the generated heat. It's best to use plain water.

Indication for hospitalization:

The indication for hospitalization is the presence of a chemical burn of any origin and area!

Traumatic damage to the superficial and deep tissues of the body under the influence of high temperature, radiation energy, chemical factors, electric current, accompanied by general reaction with activity disruption various bodies and systems.

Burn shock is an acute hypovolemic condition resulting from plasma loss in extensive skin burns.

Clinical picture

The clinic of burn damage consists of local changes in damaged skin and mucous membranes, symptoms of shock. Flame burns of the face and head are accompanied by signs of respiratory failure. Intravascular hemolysis is possible.

Emergency care for burns in the prehospital stage

Thermal burns

First of all, the impact of damaging agents is stopped, the place and the surrounding surface are cooled (directly or through clean linen, a rag) under a stream of cold water at 20-25 ° C for 10 minutes (until the pain disappears).

Release the damaged area of the body from clothing (do not remove clothing, it is necessary to cut it after it has cooled down). Also, do not remove clothes that have stuck to the skin. In case of burns of the hands, it is necessary to remove the rings from the fingers due to the risk of ischemia!

A wet aseptic bandage with furacillin (1:5000) or 0.25% novocaine is applied to the place (for extensive burns, it is better to use a sterile sheet). You can't pop the blisters! It is not recommended to treat wounds with any powders, ointments, aerosols, dyes before the patient enters the hospital. Anesthesia is performed according to indications (non-narcotic analgesics). It is important not to let the child drink, so as not to overfill the stomach before the upcoming anesthesia during the initial treatment of the wound in a hospital. The victim is hospitalized in the burn unit.

Chemical burns

To remove the aggressive liquid, rinse the burnt surface with plenty of running water for 20-25 minutes (except for burns caused by quicklime and organic aluminum compounds). Neutralizing lotions are used: for acids, phenol, phosphorus - 4% sodium bicarbonate; for lime - 20% glucose solution.

When inhaling smoke, hot air, carbon monoxide in the absence of mental disorders, the child is taken out to Fresh air, mucus is removed from the oropharynx, an air duct is inserted, after which inhalation of 100% oxygen through the inhaler mask is started. With an increase in laryngeal edema, impaired consciousness, convulsions and pulmonary edema after intravenous administration and diazepam (possibly in the muscles of the floor of the mouth), the trachea is intubated, followed by transfer to mechanical ventilation.

Eyeball burns

Perform terminal anesthesia with a 2% solution (in drops), abundant washing of the conjunctival sac (using a rubber bulb) with furacillin solution (1:5000); with an unknown nature of the damaging substance - boiled water. Put on a bandage. The victims are hospitalized, transportation is carried out in the prone position.

Emergency care for burn shock

Anesthesia is carried out with an area of burns up to 9% intramuscular injection of analgesics; with a burn area of 9-15% - 1% solution of promedol 0.1 ml / year / m. (if the child is older than 2 years). With an area of burns up to> 15% - 1% solution of promedol 0.1 ml / year (if the child is older than 2 years); fentanyl 0.05-0.1 mg/kg IM in combination with a 0.5% solution of diazepam 0.2-0.3 mg/kg (0.05 ml/kg) IM or IV.

At the I-II degree of burn shock at the prehospital stage, infusion therapy is not carried out. At III- IV degree of burn shock (circulatory decompensation) perform access to a vein and conduct infusion therapy 20 ml / kg for 30 minutes with solutions of rheopolyglucin, Ringer or 0.9% solution; intravenously administered 3 mg / kg. Oxygen therapy is carried out through a mask with 100% oxygen. The victim is urgently hospitalized in the intensive care unit of a burn center or a multidisciplinary hospital.

First aid for thermal skin burns

The very first action should be to stop the effect of the thermal factor on the victim: it is necessary to take the victim out of the fire, extinguish and remove burning (smoldering) clothes from him. The burnt areas of the body are immersed in cold water for 10 minutes, a person (if he is conscious) is given any anesthetic drug - metamizole sodium, tramadol; at serious condition narcotic analgesics are administered (promedol, morphine hydrochloride). If the burned person is conscious, and the burn surface is extensive enough, it is recommended to drink it with a solution of table salt and baking soda in order to prevent dehydration. I degree burns are treated with ethyl (33%) alcohol or a 3-5% potassium permanganate solution and left without a bandage. For burns II, III, IV degrees after treatment burn surface a sterile bandage is applied to it. After these events, all victims must be taken to the hospital. Transportation is carried out on a stretcher. In case of burns of the face, head, upper half of the body, the burnt person is transported in a sitting or half-sitting position; with lesions of the chest, abdomen, front surface of the legs - lying on your back; for burns of the back, buttocks, back of the legs - lying on the stomach. If hospitalization in the near future is impossible for any reason, the victim is assisted on the spot: in order to anesthetize the burn surfaces, they are sprayed with a 0.5% solution of novocaine for 5 minutes (until the pain stops), bandages are applied to the burns with synthomycin emulsion or streptocid ointment. They continue to give him a solution of soda and salt, periodically give painkillers.

Chemical burns of the skin and mucous membranes

The difference between chemical burns and thermal burns is that with chemical burns, the damaging effect of a chemical on body tissues continues for a long time - until it is completely removed from the surface of the body. Therefore, an initially superficial chemical burn, in the absence of proper assistance, can turn into a III or IV degree burn after 20 minutes. The main chemical agents that cause burns are acids and alkalis.

Clinical manifestations As a result of an acid burn, a scab (crust) is formed from dead tissue. When exposed to alkalis, wet necrosis (necrosis) of tissues occurs and a scab does not form. It is necessary to pay attention to these signs, since the measures aimed at helping the victim with burns with acids and alkalis differ. In addition, if the patient is conscious and adequately perceives reality, they must clarify with him what substance he was in contact with. With chemical burns, as with thermal burns, there are 4 degrees of severity of tissue damage.

First aid for chemical and mucous burns of the skin

The victim is removed from clothing impregnated with a damaging agent (acid or alkali), the skin is washed with running water. There is a known case when a girl who worked in a chemical laboratory died from an acid burn simply because a man who was nearby was ashamed to undress her. For burns caused by acid exposure, sterile wipes moistened with a 4% sodium bicarbonate solution are applied to the burnt surfaces; in case of alkali burns - sterile wipes moistened with a weak solution of citric or acetic acid (at enterprises where there is contact with alkalis or acids, there must be a supply of these substances in the first-aid kit). The patient is given any painkiller and is urgently hospitalized to the nearest hospital (preferably to a hospital with burn department).

Eye burns

(module direct4)

With a burn of the organ of vision, isolated burns of the eyelids, conjunctiva or cornea, or a combination of these injuries, may occur. Eye burns, like skin burns, occur under the influence of various factors, the main of which are lesions associated with exposure to high temperatures, chemicals, and radiation. Eye burns are rarely isolated; as a rule, they are combined with burns of the skin of the face, head and trunk.

Thermal eye burn

Causes of thermal eye burns are hot water, steam, oil, open fire. As with skin burns, it is customary to distinguish 4 degrees of severity of the lesion in them.

Clinical manifestations: With a first degree eye burn, slight redness and slight swelling of the skin of the upper and lower eyelids and conjunctiva. With a II degree eye burn, blisters appear on the skin, films consisting of dead cells appear on the conjunctiva and cornea of the eye. With a burn III degree less than half of the area of the eyelids, conjunctiva and cornea is affected. Dead tissue has the appearance of a white or gray scab, the conjunctiva is pale and edematous, the cornea looks like ground glass. With IV degree burns, more than half of the eye area is affected, in pathological process the entire thickness of the skin of the eyelids, conjunctiva, cornea, lens, muscles and cartilages of the eye are involved. Dead tissue forms a gray-yellow eschar, the cornea is white, similar to porcelain.

First aid The substance that caused the burn is removed from the face of the victim. This is done with a stream. cold water and cotton swab. For some time continue to wash the eye with cold water to cool. The skin around the eye is treated with ethyl (33%) alcohol, albucid is instilled into the conjunctival sac, and a sterile bandage is applied to the eye. After providing first aid, the victim is urgently hospitalized in eye clinic.

Chemical burns to the eyes

The cause of chemical burns is the contact with the eyes of acids, alkalis, medicinal substances (alcohol tincture iodine, ammonia, concentrated solution of potassium permanganate, alcohol), preparations household chemicals(adhesives, paints, washing powders, bleaches). Chemicals, getting into the eye, have a pronounced damaging effect, penetrating into the tissues the deeper, the longer the contact continues.

Clinical manifestations Chemical burns of the eyes are divided into 4 degrees according to the severity of damage, as in thermal damage. Their clinical signs are similar to thermal eye burns.

First aid The affected eye is opened, the eyelids are turned out, after which the eyes are washed with a stream of cool water, pieces of the damaging agent are carefully removed from the conjunctiva. Then, albucid is instilled into the palpebral fissure, a sterile bandage is applied to the damaged eye, and the victim is urgently hospitalized in the eye clinic.

Burns of the oral cavity, pharynx, esophagus

More often, chemical burns of these organs occur as a result of the ingestion of acids and alkalis by mistake or due to a suicidal attempt. The most common are burns with concentrated acetic acid. Less common thermal burns are the result of exposure to hot liquids (water, oil), inhalation of hot steam.

Clinical manifestations Burns of the oral cavity, pharynx and esophagus are accompanied by the appearance of pain in the mouth, pharynx, behind the sternum (along the esophagus). The pain intensifies when trying to speak, swallowing; are celebrated increased salivation, difficulty breathing (up to suffocation) and swallowing, the inability to take any food (both solid and liquid). There may be repeated vomiting, and in the vomit there is an admixture of scarlet blood. There may be an increase in body temperature, an excited state of the victim. On examination, attention is drawn to the burnt skin on the lips and around them, red swollen oral mucosa. When a chemical burn occurs under the influence of vinegar essence, a specific vinegar smell comes from the patient.

First aid for burns of the oral cavity, pharynx, esophagus

In case of chemical burns, the stomach is washed with a large amount of cool water (up to 5 liters) through a probe. With a burn hot water and oil (thermal) gastric lavage is not performed. If the victim is conscious, he is given to drink 10 ml of a 0.5% solution of novocaine (1 tablespoon), after which he is forced to swallow pieces of ice, vegetable oil in small portions and suck an anesthesin tablet. The patient is urgently admitted to the hospital.

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Burns: an emergency

Under the influence of adverse factors environment and other dangerous situations damage occurs skin. Depending on what led to skin injury, there are thermal, solar, chemical, electrical and radiation burns. It is on the type, location and area of the affected area that emergency care for burns will depend.

Determination of treatment tactics

In the event that a person is diagnosed with burns, emergency care should be based on determining the severity and complexity of the damage received:

A burn is called extensive when more than 25% of the entire body surface is damaged. In this case, functionally important areas of the body are affected - the face, hands, feet and perineum.
A moderate burn occupies from 15 to 25% of the entire surface of the skin and does not affect functionally important areas of the body.
If the burn affects less than 15% of the body surface, it is considered to be minor.

To determine the percentage of damage, you need to know the "rule of nine" and be able to use it. It should also be remembered that the calculation is carried out differently for adults and children. younger age. In addition to determining the size, it is necessary to establish how deep the burnt area occupies. Only after all diagnostic measures have been taken, further tactics can be determined.

Mostly people with burn injuries of the skin are treated in specialized burn centers.

To the hospital general profile hospitalization is carried out if burns:

They occupy more than 15% of the entire surface of the skin (for children under 5 years old and adults over 50 - from 5%).
They affect the entire thickness of the skin, this area covers more than 5% (for children under 5 years old and adults over 50 - more than 2%).

In cases where the area of damaged skin is less than 15% of its entire surface, treatment can take place in a department emergency care or outpatient.

First aid rules

They begin to provide assistance to the burnt immediately after the assessment of the function of the respiratory and circulatory organs is given. Also, before this, it is necessary to exclude the risk of hidden damage. In order for assistance with a burn to be provided correctly, a person who is near the victim should adhere to the following basic rules:

Initially, minimize the risk of possible contamination of the affected area. To do this, the burnt body should be wrapped in a clean and dry cloth. It is forbidden to cover the burn area with any greasy creams.
Bubbles with ice water are used only in cases where the burn surface small size. Ice is not applied directly to the site of the skin lesion, as this can contribute to increased injury. Also, ice is not used in cases where the burn area occupies more than 25% of the entire skin surface.
The burn victim is given intravenous administration medicines with an analgesic effect (Tramadol, Promedol, Morphine), as well as liquids to avoid dehydration of the body (Ringer's solution).

Once these basic steps have been completed, the patient can be transported to a location for further emergency care.

It is strictly forbidden to apply on the affected areas of the skin any vegetable oils, fermented milk products (sour cream, kefir, cream) and fats of animal origin (including medications oil based).

This is due to the fact that these substances form a fatty film on the burnt skin, which increases the severity of the burn and inhibits the cooling process. Also, in no case should you pierce the bubbles that have appeared.

Thermal burns

One of the most common types of burn injuries. First of all, regardless of the degree of damage, it is necessary to eliminate the influence of the factor that provoked the burn. A person is taken out or taken out of the danger zone. The clothes from the victim must be removed, if this cannot be done quickly, cut and removed.

Emergency care for thermal burns consists of the following steps:

For 10 minutes, the burned area of the body is kept under cool running water. This method not used for third degree burns.
In order to reduce pain sensitivity, painkillers (Tramadol) are given, in severe cases, Promedol or Morphine.
In the presence of an extensive burn surface, the victim receives solutions from table salt. This is done to prevent dehydration.

In the first degree of a thermal burn, the damaged area of \u200b\u200bthe skin is treated with a solution of potassium permanganate, you can also apply a healing agent, for example, Panthenol. For other degrees of burns, it is recommended to apply a sterile dressing after this procedure. After the victim has received needed help, in the presence of burns of the II, III and IV degrees, it must be urgently hospitalized.

During transportation of the patient, the localization of the burn surface is taken into account:

When burns are located on the face, head or upper half of the body, the victim is transferred on a stretcher in a semi-sitting or sitting position.
If the burn covers the back surface of the body, the victim is transported in the supine position.
If burns are localized in the anterior part of the chest, abdominal wall and on the anterior surface of the lower extremities, the person is placed on his back.

In cases where it is not possible to perform urgent transportation, the victim continues to receive emergency care on the spot in the form of administration of painkillers and rehydration therapy.

electrical burns

Conductive objects lead to gross damage to the skin. In the event of an electrical injury, it is necessary first of all to eliminate the current source, neutralize its influence - remove the current conductor from the victim, using a dry stick for this. At the same time, the person who provides assistance must stand on a dry board or rubber mat to protect against the action of electric current.

If the casualty is not breathing and has no heartbeat, first aid should be to indirect massage heart and artificial respiration. The principle of emergency treatment of electrical burns is the same as for thermal burns.

Regardless of what surface of the skin the lesion occupies, all victims must be hospitalized without fail. Chemical burns

Many chemical compounds can act as a burning substance - alkalis, acids and salts of some heavy metals. The nature of the burn surface depends on the type of chemicals.

Urgent removal of a chemical compound from the surface of the skin is carried out by immersing the damaged area of the body under running water (with the exception of quicklime burns). If the substance gets on clothing, it must be removed immediately. If a person is burned with alkali, the skin is treated with acetic acid. If acid has caused the burn, the affected area is washed with sodium bicarbonate solution. Then the burnt surface is covered with a sterile dressing.

The intensity of pain will depend on the depth and area of the affected area. So, with extensive and deep burns, it is often necessary to use painkillers (including narcotic analgesics, for example, morphine hydrochloride), and the victim is immediately hospitalized.

The appearance of thermochemical burns leads to the contact with the skin of certain substances, these include phosphorus, which continues to burn on the skin, respectively, causing their thermal damage. Such burns are more extensive and deep, accompanied by severe intoxication. To remove phosphorus, the affected area is placed under running water or treated with a 1-2% solution of copper sulfate. Also, pieces of the chemical can be removed with tweezers, after which it is necessary to apply a bandage with copper sulfate.

In no case do not use ointment dressings, as they increase the absorption of phosphorus.

emergency room

After the victim has been taken to medical institution he was immediately admitted to the emergency room. Here, first of all, they give an assessment of the functional ability of the respiratory and circulatory organs, reveal hidden damage.

Given that skin burns cause a decrease in circulating plasma volume, the main goal emergency care- restore blood flow. To do this, Ringer's solution is injected into the human body. When calculating the amount of the drug, the area of the burn must be taken into account.

For moderate and extensive burns, urinary catheter control the amount of urine produced. If necessary, the victim continues to administer painkillers that were previously used. For preventive purposes, intramuscular injection tetanus toxoid.

Local therapy consists in cleansing the burn surface - scraps of the epidermis are removed, blisters are opened and local antibacterial drugs. After that, the wound is closed with a pressure gauze bandage.

For the victim, until the moment of improvement of his condition, constant monitoring is carried out.

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Burns: emergency care and treatment

The treatment of burns is a topic in which there are many misconceptions and frankly bad advice. Most of the common tips and techniques folk therapy(by the type of urine on a wound or decoctions of herbs) with thermal burns are completely useless. And often they only harm, leading to complications and the formation of scars on the skin. However, faith in their miraculous power does not decrease. It is important to always remember how to properly provide emergency care if burns have formed on the skin. In addition, you need to be able to treat them later at home in order to restore the integrity of the skin as quickly as possible.

Help with thermal burns

There is a certain plan for conducting emergency care to yourself, and loved ones, or even strangers, in the presence of thermal lesions of the skin. Proper Compliance These items will help reduce the severity of burn injuries, reduce the likelihood of complications, and sometimes can also save the victim's life and health. First of all, if this flame is on clothes or on hair, on the skin, it must be immediately knocked down by covering the body with a dense cloth. This reduces the supply of oxygen to the fire area. If possible, immediately remove or discard the smoldering fabric (outerwear). In extreme cases, the burning flame is extinguished by throwing earth, you can sprinkle it with snow in winter, and sand in summer, douse it with water or lower the burning part of the body into it.

It is important not to panic, to calm the burnt person and everyone who happened to be nearby. Panic is the worst helper if there is a thermal burn. Give the task to onlookers to immediately call an ambulance while you provide emergency assistance. After the flame is extinguished, remove from the charred person the remnants of that clothing that has not been baked to the wounds. But it is forbidden to tear off pieces of tissue adhering to open wounds. If you have scissors, trim loose pieces of clothing around. Do not touch wounds and blisters with your hands and any instruments - this is both painful and fraught with additional injuries. In parallel with the provision of assistance, if the victim is conscious, find out the circumstances of how the thermal burn occurred, if you were not a witness to it - this will distract the victim and give you information for the arriving doctors.

Step-by-step actions for skin burns

The skin burns very strongly and hurts. The most important thing to do immediately is to cool the burnt area. It is most optimal to place the body or burned limb for 15 or more minutes under water (using flowing or containers with liquid). This will cool the skin, prevent further tissue damage, and reduce pain and burning. If there is no running water, you can cool the skin with an ice pack through a napkin or ice and snow wrapped in a bag and a towel.

Without physicians, burnt skin is not processed by anything, especially since any fatty compounds cannot be applied to it. It is permissible to apply a moistened clean cloth or a dry sterile dressing from bandages to the damaged area. It is forbidden to apply cotton wool to the skin, its particles will then remain in the wound and it will be difficult to remove them. If the body is affected on a sufficient surface, torn sheets or duvet covers can be used as a dressing. If there is a thermal burn of the limbs, they are fixed as in case of fractures, using splints and giving an elevated posture to the victim, so as not to disturb blood circulation. If the skin is affected over a large area, and there are signs of shock development, you need to give the person as much liquid as possible in the form of ordinary water, warm tea, compote. This will replenish the loss of fluid from the affected skin and reduce the manifestations of toxicosis.

If the body is affected in the chest, back, groin, more than 15-20% of the skin surface is burned, this threatens with a painful shock. This state manifests itself as a sharp weakness with pallor, palpitations and reduced pressure, disorders respiratory function, consciousness.

For the purpose of pain relief, various available painkillers are used. When breathing or cardiac activity stops, resuscitation techniques are carried out.

Burn treatment: what can be used at home

Not all thermal burns are dangerous to life and health, although they are painful and require proper first aid. Therefore, it is quite possible with a small area and 1-2 degrees of treatment for burns at home.

For thermal burns, it is forbidden to apply various ointments or creams, eggs, plant juices, oils, fats, dairy products to fresh damage. In the first degree, you can do without bandages, only using external agents - foams, gels for the treatment of burns.

If blisters have formed on the body, they cannot be opened, as well as sealed with a band-aid. An autopsy and their processing can only be carried out by a doctor who needs to be contacted at the emergency room. He will tell you how to carry out further treatment of burns. Dressings are carried out once or twice a day, after preparing everything you need and carefully treating your hands. The previous dressing must be removed. If part of it stuck to the wound, you need to soak it antiseptic solutions or hydrogen peroxide. Intact skin around a thermal burn is treated with antiseptics, and a special spray, foam or solution is applied to the wound, which treats burns and stimulates their healing.

When additional medical advice is needed

If a thermal burn during treatment shows signs of infection with swelling of the edges of the wounds, the appearance of a purulent discharge or an unpleasant odor - fever, chills, pain in the wound, you should immediately consult a doctor. Burns less than 1% of the body and located in the area of the palms, face, genitals or feet also require the participation of a doctor. If the treatment of burns does not lead to healing, the wound expands, becomes wet, and the help of a surgeon is also needed.

It is important to treat in a hospital or doctor's office burns received in nature, into which earth, ash particles, wood chips or foreign objects. This is also necessary because such wounds can become a source of tetanus. In addition, the doctor will assess the condition of the wound, remove foreign objects from it, which can become a source of suppuration.

In the future, the treatment of burns will continue at home, under the supervision of a specialist until complete healing.

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First Aid for Burns

Burns - tissue damage as a result of exposure to high temperature, electric current, chemicals. Depending on the nature of the damaging agent, there are the following types burns.

Thermal burns occur as a result of exposure to hot liquids, flames, molten metal, etc. Burns with hot liquids (their temperature usually does not exceed 100 ° C) are more often superficial, and flame burns are usually severe. The most severe burns result from the ignition of clothing.

Electrical burns are usually accompanied by gross destruction of the skin and underlying tissues at the points of contact with conductive objects due to the electrochemical, thermal and mechanical effects of electric current. Electric burns are characterized by "signs" or "marks" that look like cut or laceration, a clearly demarcated eschar.

Chemical burns occur as a result of exposure to the skin of various chemically active substances. Such burns often have clear boundaries, irregular shape. The color of the skin depends on the nature of the chemical: when burned with sulfuric acid, the skin is brown or black, with nitric acid - yellow-brown, with hydrochloric acid - yellow, with hydrofluoric acid - pale blue or gray.

Burns of the respiratory tract are observed during fires and explosions in enclosed spaces, in cases long stay victim in a smoky room. Less commonly observed when exposed to hot steam on the respiratory tract. Clinical signs burns of the respiratory tract are hyperemia and swelling of the mucous membrane of the oral cavity, pharynx, epiglottis, burns of the face with singed hair in the nasal passages. Patients report pain when swallowing, a feeling of sore throat, chest pain, shortness of breath, cough. Often there is a hoarse voice. The condition of patients with a burn of the entire tracheobronchial tree is more severe than with an isolated lesion of the larynx and trachea.

According to the depth of the lesion, burns of 4 degrees are distinguished.

A first degree burn is characterized by redness and swelling of the skin. With second-degree burns against the background of hyperemic and edematous skin, there are blisters different sizes filled with a clear yellowish liquid. Third-degree burns are accompanied by necrosis of the deep layers of the dermis, and with fourth-degree burns, the skin and underlying tissues (subcutaneous fatty tissue, muscles, bones) become dead. Most often there is a combination of burns of varying degrees.

When providing first aid, you should clarify total area burns and the estimated area of deep damage. This helps to outline rational therapy at the prehospital stage.

Burns are also classified according to the area of thermal injury. Wallace's "rule of the palm" and "rule of nines" are the most widely used. According to the first rule, the area of the palm of an adult is 1% of the area of the entire surface of the skin. It is advisable to measure the area of the burn surface with the palm of your hand with limited burns or subtotal lesions. AT last case the area of unburned areas of the body is measured, and the percentage of skin lesions is obtained by subtracting the area of unaffected skin from 100.

According to the "rule of nines", large body segments have a surface area of 9%. So, the surface of the head and necks is 9% of the total area of the body, upper limb - 9%, lower limb- 18%, front surface of the body - 18%, back - 18%, perineum and external genital organs - 1%. For adults, the body surface in front is 51%, behind - 49% (Fig. 67).

Limited burns on an area up to 10% of the body surface are classified as local damage. With more extensive lesions (with superficial ones on an area of more than 15%, with deep ones - more than 10% of the body surface), the victim develops a complex of general and local disorders, called burn disease. Symptoms of burn disease in children and elderly people can be detected when the area of the lesion exceeds 5%. The severity of burn disease and its outcome mainly depend on the area of deep burns. It is generally accepted that deep burns over an area of more than 20% of the body surface are extremely severe.

Rice. 67. "Rule of nines" by Wallace for calculating the area of the burn surface.

Urgent care. The provision of first aid at the scene of an accident is an important task, since the outcome of the disease often depends on its quality. In case of thermal burns, it is necessary to stop the action of the damaging agent. To do this, either quickly throw off burning clothes from the victim, or extinguish the flame by tightly covering the patient with a blanket, thick cloth, or immersing him in water. To reduce the period of tissue hyperthermia and reduce the depth of the burn, it is advisable to pour cold water over the affected area. Clothing should not be removed, it should be cut and removed from the burnt areas. Dry sterile dressings are applied to burn wounds. To reduce pain, painkillers are administered to all victims (1 ml of a 1% solution of promedol, 1 ml of a 2% solution of pantopon).

In case of electric shock, first of all, you need to stop the effect of the latter on the victim - interrupt the electric current circuit: turn off the switch, unscrew the safety plugs, remove the current conductor from the victim's body with a dry stick. You can cut the wire with an ax or an iron shovel with a wooden handle, cut it with a knife or have a snack with scissors if they have insulation on the handles. In all such situations, the caregiver must isolate himself from the ground by standing on a dry board, a rubber mat, a stack of paper, etc. First aid to victims of electric current in the absence of signs of life begins with an external heart massage and artificial ventilation lungs (by breathing apparatus or mouth-to-nose, mouth-to-mouth). All victims are hospitalized. Transported on a stretcher in the prone position.

When providing first aid to patients with chemical burns, it is necessary to stop the action of substances that have got on the skin as soon as possible. To do this, wash the affected surface with running water for 10-40 minutes. Then, in case of acid burns, the affected areas are washed with a solution of sodium bicarbonate, in case of alkaline burns, with acetic acid and a dry sterile bandage is applied. The earlier first aid is provided, the shorter the exposure of the chemical agent, the less the depth of the burn injury. When providing first aid and on the way to the hospital, patients with extensive and deep burns must be given painkillers, usually narcotic analgesic in combination with antihistamines: for example, 2 ml of a 2% solution of promedol in combination with 1 ml of a 1% solution of diphenhydramine or 1 ml of a 2.5% solution of pipolfen. At severe pain in the SMP machine, inhalation mask anesthesia is used with a mixture of nitrous oxide and oxygen in a ratio of 2: 1. When indicated, cardiovascular agents, inhalation of humidified oxygen are used.

Patients with severe extensive burns are hospitalized in a special hospital (thermal injury department). Transported on a stretcher in the prone position. Mandatory hospitalization in a specialized hospital is subject to victims with the following thermal injuries:

1) deep burns of any area;

2) superficial burns on an area exceeding 7-10% of the body surface;

3) superficial burns on a smaller area:

a) flame or steam burns of the face due to a possible burn of the respiratory tract,

b) II-IIIA degree burns of the hands due to unsatisfactory functional results of treatment,

c) burns resulting from exposure to electric current, d) burns of the feet, ankle joints, lower third of the leg, perineum.

Ambulance health care, ed. B. D. Komarova, 1985

Under the influence of adverse environmental factors and other dangerous situations, damage to the skin occurs. Depending on what led to skin injury, there are thermal, solar, chemical, electrical and radiation burns. It is on the type, location and area of the affected area that emergency care for burns will depend.

Determination of treatment tactics

In the event that a person is diagnosed with burns, emergency care should be based on determining the severity and complexity of the damage received:

A burn is called extensive when more than 25% of the entire body surface is damaged. In this case, functionally important areas of the body are affected - the face, hands, feet and perineum.
A moderate burn occupies from 15 to 25% of the entire surface of the skin and does not affect functionally important areas of the body.
If the burn affects less than 15% of the body surface, it is considered to be minor.

To determine the percentage of damage, you need to know the "rule of nine" and be able to use it. It should also be remembered that the calculation is carried out differently for adults and young children. In addition to determining the size, it is necessary to establish how deep the burnt area occupies. Only after all diagnostic measures have been taken, further tactics can be determined.

Mostly people with burn injuries of the skin are treated in specialized burn centers.

Hospitalization is carried out in a general hospital if burns:

They occupy more than 15% of the entire surface of the skin (for children under 5 years old and adults over 50 - from 5%).
They affect the entire thickness of the skin, this area covers more than 5% (for children under 5 years old and adults over 50 - more than 2%).

In cases where the area of damaged skin is less than 15% of its entire surface, treatment can take place in an emergency department or on an outpatient basis.

First aid rules

Initially, minimize the risk of possible contamination of the affected area. To do this, the burnt body should be wrapped in a clean and dry cloth. It is forbidden to cover the burn area with any greasy creams.
Bubbles with ice water are used only in cases where the burn surface is small. Ice is not applied directly to the site of the skin lesion, as this can contribute to increased injury. Also, ice is not used in cases where the burn area occupies more than 25% of the entire skin surface.
The victim of burns is given intravenous administration of drugs with an analgesic effect (Tramadol, Promedol, Morphine), as well as liquids to avoid dehydration of the body (Ringer's solution).

Once these basic steps have been completed, the patient can be transported to a location for further emergency care.

It is strictly forbidden to apply any vegetable oils, fermented milk products (sour cream, kefir, cream) and animal fats (including fat-based drugs) to the affected areas of the skin.

Thermal burns

Emergency care for thermal burns consists of the following steps:

For 10 minutes, the burned area of the body is kept under cool running water. This method is not used for third-degree burns.
In order to reduce pain sensitivity, painkillers (Tramadol) are given, in severe cases, Promedol or Morphine.
In the presence of an extensive burn surface, the victim receives solutions from table salt. This is done to prevent dehydration.

In the first degree of a thermal burn, the damaged area of \u200b\u200bthe skin is treated with a solution of potassium permanganate, you can also apply a healing agent, for example, Panthenol. For other degrees of burns, it is recommended to apply a sterile dressing after this procedure. After the necessary assistance is provided to the victim, in the presence of burns of II, III and IV degrees, he must be urgently hospitalized.

During transportation of the patient, the localization of the burn surface is taken into account:

When burns are located on the face, head or upper half of the body, the victim is transferred on a stretcher in a semi-sitting or sitting position.
If the burn covers the back surface of the body, the victim is transported in the supine position.
If burns are localized in the anterior part of the chest, abdominal wall and on the anterior surface of the lower extremities, the person is placed on his back.

In cases where it is not possible to perform urgent transportation, the victim continues to receive emergency care on the spot in the form of administration of painkillers and rehydration therapy.

electrical burns

If the victim is not breathing and has no heartbeat, the first emergency aid should be chest compressions and artificial respiration. The principle of emergency treatment of electrical burns is the same as for thermal burns.

Regardless of what surface of the skin the lesion occupies, all victims must be hospitalized without fail. Chemical burns

Many chemical compounds can act as a burning substance - alkalis, acids and salts of some heavy metals. The nature of the burn surface depends on the type of chemicals.

In no case do not use ointment dressings, as they increase the absorption of phosphorus.

emergency room

After the victim is taken to a medical facility, he is immediately admitted to the emergency room. Here, first of all, they give an assessment of the functional ability of the respiratory and circulatory organs, reveal hidden damage.

Given that skin burns cause a decrease in circulating plasma volume, the main goal of emergency therapy is to restore blood flow. To do this, Ringer's solution is injected into the human body. When calculating the amount of the drug, the area of the burn must be taken into account.

With moderate and extensive burns, a urinary catheter is installed, and the amount of urine excreted is controlled. If necessary, the victim continues to administer painkillers that were previously used. For prophylactic purposes, an intramuscular injection of tetanus toxoid is carried out.

Local therapy consists in cleansing the burn surface - scraps of the epidermis are removed, blisters are opened and local antibacterial drugs are applied. After that, the wound is closed with a pressure gauze bandage.

For the victim, until the moment of improvement of his condition, constant monitoring is carried out.

burns- damage to tissues as a result of exposure to high temperature, electric current, chemicals. Depending on the nature of the damaging agent, the following types of burns are distinguished.

Thermal burns arise due to exposure to hot liquids, flames, molten metal, etc. Burns with hot liquids (their temperature usually does not exceed 100 ° C) are more often superficial, and flame burns are usually severe. The most severe burns result from the ignition of clothing.

Electrical burns are usually accompanied by gross destruction of the skin and underlying tissues at the points of contact with conductive objects due to the electrochemical, thermal and mechanical action of electric current. Electric burns are characterized by "signs", or "marks", which look like a cut or lacerated wound, a clearly delimited scab.

Chemical burns occur as a result of exposure to the skin of various chemically active substances. Such burns often have clear boundaries, irregular shape. The color of the skin depends on the nature of the chemical: when burned with sulfuric acid, the skin is brown or black, with nitric acid - yellow-brown, with hydrochloric acid - yellow, with hydrofluoric acid - pale blue or gray.

Respiratory burns are observed during fires and explosions in enclosed spaces, in cases of prolonged stay of the victim in a smoky room. Less commonly observed when exposed to hot steam on the respiratory tract. Clinical signs of a burn of the respiratory tract are hyperemia and swelling of the mucous membrane of the oral cavity, pharynx, epiglottis, burns of the face with singed hair in the nasal passages. Patients report pain when swallowing, a feeling of sore throat, chest pain, shortness of breath, cough. Often there is a hoarse voice. The condition of patients with a burn of the entire tracheobronchial tree is more severe than with an isolated lesion of the larynx and trachea.

According to the depth of the lesion, burns of 4 degrees are distinguished.

A first degree burn is characterized by redness and swelling of the skin. With second-degree burns against the background of hyperemic and edematous skin, there are blisters of various sizes filled with a clear yellowish liquid. Third-degree burns are accompanied by necrosis of the deep layers of the dermis, and with fourth-degree burns, the skin and underlying tissues (subcutaneous fatty tissue, muscles, bones) become dead. Most often there is a combination of burns of varying degrees.

When providing first aid, the total area of the burn and the estimated area of deep damage should be clarified. This helps to outline rational therapy at the prehospital stage.

Burns are also classified according to the area of thermal injury. Wallace's "rule of the palm" and "rule of nines" are the most widely used. According to the first rule, the area of the palm of an adult is 1% of the area of the entire surface of the skin. It is advisable to measure the area of the burn surface with the palm of your hand with limited burns or subtotal lesions. In the latter case, the area of unburned areas of the body is measured, and the percentage of skin lesions is obtained by subtracting the area of unaffected skin from 100.

According to the "rule of nines", large body segments have a surface area of 9%. So, the surface of the head and necks makes up 9% of the total area of the body, the upper limb - 9%, the lower limb - 18%, the front surface of the trunk - 18%, the back - 18%, the perineum and external genital organs - 1%. For adults, the body surface in front is 51%, behind - 49% (Fig. 67).

Limited burns on an area up to 10% of the body surface are classified as local injuries. With more extensive lesions (with superficial ones on an area of more than 15%, with deep ones - more than 10% of the body surface), the victim develops a complex of general and local disorders, called burn disease. Symptoms of burn disease in children and elderly people can be detected when the area of the lesion exceeds 5%. The severity of burn disease and its outcome mainly depend on the area of deep burns. It is generally accepted that deep burns over an area of more than 20% of the body surface are extremely severe.

Rice. 67. "Rule of nines" by Wallace for calculating the area of the burn surface.

Urgent care. The provision of first aid at the scene of an accident is an important task, since the outcome of the disease often depends on its quality. In case of thermal burns, it is necessary to stop the action of the damaging agent. To do this, either quickly throw off burning clothes from the victim, or extinguish the flame by tightly covering the patient with a blanket, thick cloth, or immersing him in water. To reduce the period of tissue hyperthermia and reduce the depth of the burn, it is advisable to pour cold water over the affected area. Clothing should not be removed, it should be cut and removed from the burnt areas. Dry sterile dressings are applied to burn wounds. To reduce pain, painkillers are administered to all victims (1 ml of a 1% solution of promedol, 1 ml of a 2% solution of pantopon).

In case of electric shock, first of all, you need to stop the effect of the latter on the victim - interrupt the electric current circuit: turn off the switch, unscrew the safety plugs, remove the current conductor from the victim's body with a dry stick. You can cut the wire with an ax or an iron shovel with a wooden handle, cut it with a knife or have a snack with scissors if they have insulation on the handles. In all such situations, the assisting person must isolate himself from the ground by standing on a dry board, a rubber mat, a stack of paper, etc. First aid for victims of electric current in the absence of signs of life begins with an external heart massage and artificial ventilation of the lungs (by a breathing apparatus or by mouth in nose, mouth to mouth). All victims are hospitalized. Transported on a stretcher in the prone position.

When providing first aid to patients with chemical burns, it is necessary to stop the action of substances that have got on the skin as soon as possible. To do this, wash the affected surface with running water for 10-40 minutes. Then, in case of acid burns, the affected areas are washed with a solution of sodium bicarbonate, in case of alkaline burns, with acetic acid and a dry sterile bandage is applied. The earlier first aid is provided, the shorter the exposure of the chemical agent, the less the depth of the burn injury. When providing first aid and on the way to the hospital, patients with extensive and deep burns must be given painkillers, usually a narcotic analgesic in combination with antihistamines: for example, 2 ml of a 2% solution of promedol in combination with 1 ml of a 1% solution of diphenhydramine or 1 ml of 2.5% pipolfen solution. With severe pain in the SMP machine, inhalation mask anesthesia is used with a mixture of nitrous oxide and oxygen in a ratio of 2: 1. When indicated, cardiovascular agents, inhalation of humidified oxygen are used.

1) deep burns of any area;

2) superficial burns on an area exceeding 7-10% of the body surface;

3) superficial burns on a smaller area:

a) flame or steam burns of the face due to a possible burn of the respiratory tract,

b) II-IIIA degree burns of the hands due to unsatisfactory functional results of treatment,

c) burns resulting from exposure to electric current, d) burns of the feet, ankle joints, lower third of the leg, perineum.

Ambulance, ed. B. D. Komarova, 1985

Principles of emergency care for burns. Providing first emergency medical care for burns

Clinical picture

Emergency care for burns in the prehospital stage

Thermal burns

Chemical burns

Eyeball burns

Emergency care for burn shock

First aid for thermal skin burns

Chemical burns of the skin and mucous membranes

First aid for chemical and mucous burns of the skin

Eye burns

Thermal eye burn

Chemical burns to the eyes

Burns of the oral cavity, pharynx, esophagus

First aid for burns of the oral cavity, pharynx, esophagus

Burns: an emergency

Determination of treatment tactics

First aid rules

Thermal burns

electrical burns

emergency room

Burns: emergency care and treatment

Help with thermal burns

Step-by-step actions for skin burns

Burn treatment: what can be used at home

When additional medical advice is needed

First Aid for Burns

Determination of treatment tactics

First aid rules

Thermal burns

electrical burns

emergency room

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