Thermal burn of the back according to ICD 10. Thermal and chemical burns of the outer surfaces of the body
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Thermal burn coding in the ICD
Burns are a fairly common type of injury to human skin, so they are devoted to a whole section in the document of the international classification of diseases of the 10th revision. Therefore, according to ICD 10, a thermal burn has a code that corresponds to the scale and location of the affected skin area.
- Classification
- Definition of pathology
Classification
Thermal damage to the body surface of the specified localization has a code in the range of T20-T25. Characteristic lesions in multiple form and unspecified localization are coded as T29-T30, depending on the extent of the lesion. The code T31-T32 is usually used as an addition to the headings T20-T29 in determining the scale of skin lesions on the human body as a percentage. For example, a thermal burn of 70-79% of the entire body surface has the T31.7 code, which can additionally characterize any code from the T20-T29 rubric.
In burn centers, such data of world nosology provide tremendous assistance in determining the degree of diagnostic, therapeutic measures, as well as prognosis.
For many years, highly qualified specialists have successfully applied in practice local protocols for providing first aid and managing patients with burn lesions of the skin of the body of any localization and stage of injury.
Definition of pathology
In ICD 10, a thermal burn is formed due to exposure of the skin to hot liquids, steam, flames or a strong flow of hot air. A chemical burn is obtained when aggressive solutions of a chemical composition, such as acids and alkalis, come into contact with the skin. They are able to provoke tissue necrosis even in deep layers of the skin in a short period of time.
The burn surface is distinguished and classified according to the degree of spread and damage to the skin and subcutaneous tissues as follows:
- redness and thickening of the skin area (1 degree);
- blistering (grade 2);
- necrosis of the upper layers of the skin (grade 3);
- complete necrosis of the epidermis and dermis (grade 4);
- lesions in which all layers of the skin die and subcutaneous tissues are involved in the necrotic process (grade 5).
The code for a thermal burn of the foot, arm, abdomen or back depends on the definition of the extent of the prevalence of the process, according to the recommendations of local protocols in ICD 10.
The area of the lesion is determined using the "rule of nine", that is, each part of the body corresponds to a certain percentage of the entire surface.
So the head and arm make up 9% each, the front (belly and chest), the back surface of the body (back) and leg each 18%, the perineum and genitals are allocated 1%. Experts can also use the palm, the area of which is conditionally equal to about 1% of the area of the entire human body.
For example, a thermal burn of a hand, face, or foot will account for 2% of the burn surface. When establishing the prevalence of the process, doctors take into account the conditions under which the tissue injury occurred. Important aspects are: determining the nature of the agent, the time of its exposure, the ambient temperature and the presence of aggravating factors in the form of clothing.
mkbkody.ru
Thermal and chemical burns of the body
ICD-10 → S00-T98 → T20-T32 → T20-T25 → T21.0
Thermal burn of the trunk, unspecified degree
Thermal burn of the trunk of the first degree
Thermal burn of the trunk of the second degree
Thermal burn of the trunk of the third degree
Chemical burn of the torso, unspecified degree
First degree chemical burn to the torso
Second degree chemical burn to the torso
Third degree chemical burn to the torso
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International Statistical Classification of Diseases and Related Health Problems. 10th revision.
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Date of placement in the database 22.03.2010
Relevance of the classifier: 10th revision of the International Classification of Diseases
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Home → INJURIES, POISONING AND SOME OTHER CONSEQUENCES OF EXTERNAL CAUSES → THERMAL AND CHEMICAL BURNS → THERMAL AND CHEMICAL BURNS OF THE EXTERNAL SURFACES OF THE BODY, SPECIFIED BY THEIR LOCALIZATION → Thermal and chemical burns of the ankle joint and foot
| T25.0 | Thermal burn of the ankle and foot, unspecified degree |
| T25.1 | Thermal burn of the ankle joint and foot of the first degree |
| T25.2 | Thermal burn of the ankle joint and foot of the second degree |
| T25.3 | Thermal burn of the ankle joint and foot of the third degree |
| T25.4 | Chemical burn of the ankle and foot, unspecified degree |
| T25.5 | Chemical burn of the ankle and foot area of the first degree |
| T25.6 | Chemical burn of the ankle and foot of the second degree |
| T25.7 | Chemical burn of the ankle and foot of the third degree |
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Thermal burn of the foot, thigh, lower leg: ICD-10 code
When an organ is exposed to a temperature above 55 ° or a toxic chemical compound, tissue damage is formed, called a burn. The extensive influence of an aggressive environment leads to global changes in the body and negatively affects the integrity of the skin, the work of the heart, blood vessels, and immunity.
Degrees of leg burns
- In case of damage to the foot of the first degree, only a small area of its area suffers. Symptoms are associated with a slight change in skin color and swelling. The victim does not need to seek medical attention. It is required to anesthetize if necessary and disinfect the burn site.
- With a second-degree foot injury, a person has a pronounced pain syndrome. The skin on the leg is red, covered with blisters of various sizes with a translucent liquid. The victim should go to the emergency room, as the risk of infection is high. In addition, the patient does not have the necessary conditions for providing adequate first aid.
Pain is relieved with medication. Violation of the integrity of the swollen blisters will not help, but only increase the risk of getting inside the infection.
- In case of damage to the foot of the third degree, partial necrosis makes itself felt with the preservation of the growth zones of the skin. In a severe situation, the entire lower leg is affected. Only urgent hospitalization after first aid will help a person.
- The most severe degree, characterized by complete necrosis of the upper integument, as well as damage and charring of internal tissues (muscles, bones). With such an injury, a fatal outcome is possible. Treatment is associated with surgery and is carried out only in the hospital.
Thermal burns in the ICD
The International Classification of Diseases is designed to simplify the storage and analysis of disease names. It is used not only in the scientific world, but also in ordinary hospital cards.
Each illness and injury is assigned a code. The composition of the classification is reviewed every decade.
For burns of the foot and lower leg, the numbering is determined by the degree and nature of the damage. There are burns:
For a thermal burn of the foot, the microbial code 10 starts with 25.1 and ends with 25.3.
25.0 - foot burn of unspecified degree.
Similarly, the classification for chemical injuries is presented: from 25.4 to 25.7.
T24 are thermal and chemical burns of the hip and lower extremity, excluding the ankle and foot, of unspecified degree.
Factors and risk groups
Injuries of this kind in the ankle and heel are extremely rare: the lower part of the leg is most often protected by dense shoe material.
But sometimes doctors assign the ICD code t25 to the disease (the sub-item is determined by the degree), highlighting the following types:
- Thermal burn of the leg area. Damage occurs as a result of careless handling of any sources of thermal energy: hot objects (heaters, batteries, hot metals as a result of external influences), boiling water, steam, open flames.
- Chemical burn. It is characteristic that various toxic substances get on the skin, rapidly or gradually violating the integrity of the upper integuments. The most dangerous cases are acid and alkali.
- Radiation. Occurs when irradiated. They get it in laboratories, at the place of disposal (especially unauthorized) of this kind of waste, in areas of high radiation.
- Electric. It is obtained as a result of an electric shock to the foot.
Diagnostics
In case of damage to the ankle joint and foot of an unspecified degree, specialists seek to determine the nature of the injury.
To select the right treatment strategy, the doctor pays attention to:
- depth;
- area of the affected area.
For this, apply:
- "rule of the palm";
- "rule of nines".
In the first case, the area is calculated based on the principle: proportionally, the palm occupies 1% of the total surface of the skin.
In the second case, 1 shin and foot with a global injury are defined as 9% of the entire body.
Since children have other proportional dependencies, the Land and Brower table is used for them.
In the hospital, film meters with a printed grid come to the aid of specialists.
Treatment
The quality of first aid to the victim with burns of the ankle and (or) foot depends on further treatment, the presence of complications and the overall prognosis.
It is useful for everyone to familiarize themselves with a simple procedure for performing burns:
- Remove all clothing from the affected area. Since synthetics tend to stick to the skin, they are carefully cut off with scissors.
- Apply a sterile bandage.
You can not use any creams, ointments, powders, compresses on your own. The doctor prescribes medication.
- The victim is helped to take the most comfortable position with a motionless injured limb.
- The only medicine given to a person is painkillers.
A 1st degree burn is allowed to be treated independently. In other cases, the intervention of a specialist is required.
Further activities carried out within the medical institution are related to:
- prevention and elimination of inflammation;
- healing.
Doctors often prescribe a course of antibiotics to prevent infection.
Additional activities:
- tetanus shot;
- analgesics.
Specialists carefully monitor so that suppuration does not form.
In special cases, the operation is assigned:
- plastic;
- skin transplant.
Mild thermal and chemical burns are a common household injury. Severe cases are associated with accidents or negligence at work. Sterile materials are used and, if a degree higher than the first is suspected, they consult a doctor.
noginashi.ru
Classification of burns according to ICD 10
A burn is a local violation of the integrity of body tissues as a result of exposure to high temperature or chemical reagents. Depending on the etiology of the external factor, they are divided into thermal (temperature factor), chemical (alkalis, acids), radiation (sunstroke), electrical (lightning strike). According to WHO, thermal injuries account for about 6% of all injuries.
Clinical picture according to ICD 10
A burn according to microbial 10 is classified according to a variety of criteria (the nature of the injury, the severity of the injury, localization, and the area of the lesion) to immediately determine the method of treatment and predict the outcome.
The clinical manifestations of thermal injury are based on the depth of the skin layer lesion. At the 1st degree, the burn looks like a hyperemic and edematous area. The pain persists for three days. There is a complete regeneration of the skin without visible defects.
At the 2nd degree, the presence of blisters is characteristic. There was a median skin lesion and swelling of the papillary dermis. Severe pain appears in the damaged area, limited redness, burning, swelling up to the demarcation line.
Blisters are easily infected during the wound process. If you do not follow the rules of asepsis, a purulent-inflammatory focus may develop.
The third degree of thermal burn is characterized by sharp pain, and a black scab forms on the body. Regeneration occurs slowly, with the formation of a scar.
At the 4th degree of damage, the formation of blisters is characteristic, as well as a dark red scab.
Kinds
Thermal burns according to ICD-10 (international classification of diseases of the 10th revision) have a range code from T20 to T-32. Each species has its own code for microbial 10, which is then indicated in the diagnosis in the medical history.
T20 - T25 Thermal and chemical burns of the external parts of the body, with a certain localization. The list indicates the stage of damage. Thermal burns according to ICD-10:
- T20. Heads and necks.
- T21. The middle part of the body.
- T22. The upper free limb, excluding the wrist and phalanges of the fingers.
- T23. Wrists and hands.
- T24. lower limb, except for the ankle and the sole of the foot.
- T25. Areas of the ankle and foot.
- T26. Limited to the periorbital zone.
- T27. upper respiratory tract.
- T28. The entire area of the eyeball.
- T29. multiple areas of the body.
- T30. Uncertain localization.
Classifiers with code ciphers from T30 to T32 are compiled, depending on the affected surface of the body of an adult. The burn code defines the class of diseases.
Degrees
Classification according to the depth of tissue damage allows you to determine the level of development of the pathological process and predict further actions.Damage levels:
First degree. Occurs due to slight and short-term contact with a hot surface, liquid or vapor. The lesion affects only the layer of the epidermis.
Second. The layer of epithelial cells is damaged. Spherical protrusions are formed above the skin, containing blood plasma rich in leukocytes - a bubble.
Third. Typical skin necrosis. There are two stages:
- IIIa - necrosis at the level of epithelial cells and the surface layer of the dermis;
- IIIb - necrosis at the level of the dermis up to the reticular layer inclusive, with the destruction of hair follicles; glands of the skin, with a partial transition to the hypodermis.
Depending on the state of aggregation of the agent that has come into contact with the skin, a wet burn and a dry burn are isolated. Occurs with prolonged, massive exposure to the surface of the epithelium of the thermal factor.
Fourth. The largest degree. May lead to death. All 3 layers of the skin and underlying tissues undergo necrotic changes.
Diagnosis and grading
For reliable diagnostics, there is a special algorithm for collecting information.
- An anamnesis is collected simultaneously with the necessary studies.
The medical history should include:
- time of receipt;
- place of receipt (open / closed premises);
- how it was received;
- than received.
The general history lists:
- chronic pathologies;
- existing operations;
- the presence of allergies;
- hereditary pathologies.
- Based on the information received, the doctor conducts a general examination:
- Assess the area of the lesion depending on the proportions of the body;
- The degree of damage (1-4);
- The area of undamaged parts of the body is determined;
- It turns out the localization of thermal injury (on the lower extremities in general, diffusely on the leg and foot);
The surgeon determines the indications for hospitalization, conducts the necessary therapeutic measures.
beztravmy.ru
ICD-10: T24 - Thermal and chemical burns of the hip joint and lower limb, excluding the ankle and foot
Diagnosis code T24 includes 8 clarifying diagnoses (ICD-10 subcategories):
- T24.0 Thermal burn of hip and lower limb, excluding ankle and foot, unspecified
- T24.1 First degree burns of hip and lower limb, excluding ankle and foot
- T24.2 Second degree burns of hip and lower limb, excluding ankle and foot
- T24.3 Third-degree thermal burn of hip and lower limb, excluding ankle and foot
- T24.4 Chemical burns of hip and lower limb, excluding ankle and foot, unspecified
- T24.5 First-degree chemical burn of hip and lower limb, excluding ankle and foot
- T24.6 Second degree chemical burn of hip and lower limb, excluding ankle and foot
- T24.7 Third-degree chemical burn of hip and lower limb, excluding ankle and foot
The diagnosis also includes: legs (any part, excluding the ankle joint and foot)
Diagnosis does not include: - thermal and chemical burns of ankle and foot only (T25.-)
Burns are a fairly common type of injury to human skin, so they are devoted to a whole section in the document of the international classification of diseases of the 10th revision. Therefore, according to ICD 10, a thermal burn has a code that corresponds to the scale and location of the affected skin area.
Classification
Thermal injuries of the body surface of the specified localization have a code in the range of T20-T25. Characteristic lesions in multiple form and unspecified localization are coded as T29-T30, depending on the extent of the lesion. The code T31-T32 is usually used as an addition to the headings T20-T29 in determining the scale of skin lesions on the human body as a percentage. For example, a thermal burn of 70-79% of the entire body surface has the T31.7 code, which can additionally characterize any code from the T20-T29 rubric.
In burn centers, such data of world nosology provide tremendous assistance in determining the degree of diagnostic, therapeutic measures, as well as prognosis.
For many years, highly qualified specialists have successfully applied in practice local protocols for providing first aid and managing patients with burn lesions of the skin of the body of any localization and stage of injury.
Definition of pathology
In ICD 10, a thermal burn is formed due to exposure of the skin to hot liquids, steam, flames or a strong flow of hot air. A chemical burn is obtained when aggressive solutions of a chemical composition, such as acids and alkalis, come into contact with the skin. They are able to provoke tissue necrosis even in deep layers of the skin in a short period of time.
The burn surface is distinguished and classified according to the degree of spread and damage to the skin and subcutaneous tissues as follows:
- redness and thickening of the skin area (1 degree);
- blistering (grade 2);
- necrosis of the upper layers of the skin (grade 3);
- complete necrosis of the epidermis and dermis (grade 4);
- lesions in which all layers of the skin die and subcutaneous tissues are involved in the necrotic process (grade 5).
The code for a thermal burn of the foot, arm, abdomen or back depends on the definition of the extent of the prevalence of the process, according to the recommendations of local protocols in ICD 10.
The area of the lesion is determined using the "rule of nine", that is, each part of the body corresponds to a certain percentage of the entire surface.
So the head and arm make up 9% each, the front (belly and chest), the back surface of the body (back) and leg each 18%, the perineum and genitals are allocated 1%. Experts can also use the palm, the area of which is conditionally equal to about 1% of the area of the entire human body.
For example, a thermal burn of a hand, face, or foot will account for 2% of the burn surface. When establishing the prevalence of the process, doctors take into account the conditions under which the tissue injury occurred. Important aspects are: determining the nature of the agent, the time of its exposure, the ambient temperature and the presence of aggravating factors in the form of clothing.
15-10-2012, 06:52
Description
SYNONYMS
Chemical, thermal, radiation damage to the eyes.
ICD-10 CODE
T26.0. Thermal burn of the eyelid and periorbital region.
T26.1. Thermal burn of the cornea and conjunctival sac.
T26.2. Thermal burn leading to rupture and destruction of the eyeball.
T26.3. Thermal burns of other parts of the eye and its adnexa.
T26.4. Thermal burn of the eye and adnexa of unspecified localization.
T26.5. Chemical burn of the eyelid and periorbital region.
T26.6. Chemical burn of the cornea and conjunctival sac.
T26.7. Chemical burn leading to rupture and destruction of the eyeball.
T26.8. Chemical burn of other parts of the eye and its adnexa.
T26.9. Chemical burn of the eye and adnexa of unspecified localization.
T90.4. Sequelae of an eye injury in the periorbital region.
CLASSIFICATION
- I degree- hyperemia of various parts of the conjunctiva and the limbus zone, superficial erosion of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
- II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
- III degree- necrosis of the conjunctiva and cornea to deep layers, but not more than half of the surface area of the eyeball. The color of the cornea is "matte" or "porcelain". Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Perhaps the development of toxic cataracts and iridocyclitis.
- IV degree- deep lesion, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is "porcelain", a tissue defect over 1/3 of the surface area is possible, in some cases perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.
ETIOLOGY
Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.
CLINICAL PICTURE
Common signs of eye burns:
- the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization by the post-burn period);
- a tendency to recurrence of the inflammatory process in the choroid at different times after receiving a burn;
- a tendency to the formation of synechia, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.
- Stage I (up to 2 days) - the rapid development of necrobiosis of the affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acid polysaccharides;
- Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
- Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
- Stage IV (from several months to several years) - a period of scarring, an increase in the amount of collagen proteins due to an increase in their synthesis by corneal cells.
DIAGNOSTICS
Diagnosis is based on history and clinical presentation.
TREATMENT
Basic principles of treatment of eye burns:
- providing emergency care aimed at reducing the damaging effect of a burn agent on tissues;
- subsequent conservative and (if necessary) surgical treatment.
Washing is not carried out with a thermochemical burn if a penetrating wound is found!
Surgical interventions on the eyelids and the eyeball in the early stages are carried out only in order to preserve the organ. Vitrectomy of burned tissues, early primary (in the first hours and days) or delayed (in 2-3 weeks) blepharoplasty with a free skin flap or a skin flap on a vascular pedicle with a simultaneous transplantation of automucosa on the inner surface of the eyelids, arches and sclera are performed.
Planned surgical interventions on the eyelids and the eyeball with the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since allosensitization to the graft tissues occurs against the background of autosensitization of the body.
For severe burns, 1500-3000 IU of tetanus toxoid should be injected subcutaneously.
Treatment of stage I eye burns
Prolonged irrigation of the conjunctival cavity (within 15-30 minutes).
Chemical neutralizers are used in the first hours after the burn. In the future, the use of these drugs is impractical and may have a damaging effect on the burned tissue. For chemical neutralization, the following means are used:
- alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
- acid - 2% sodium bicarbonate solution.
NSAIDs
H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg 1 time per day after meals for 7-10 days), or fexofenadine (orally 120-180 mg 1 time per day after meals for 7-10 days).
Antioxidants: methylethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections).
Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml for pain intramuscularly).
Preparations for instillation into the conjunctival cavity
In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.
Antibacterial agents: ciprofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% ( eye drops, 1-2 drops 3-6 times a day).
Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.
Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5% 1-2 drops 3-6 times a day).
NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).
Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 5% 2-3 times a day for 7-10 days).
Corneal regeneration stimulators: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid 1 drop 2-3 times a day).
Surgery: sectoral conjunctivotomy, paracentesis of the cornea, necrectomy of the conjunctiva and cornea, genonoplasty, biocovering of the cornea, eyelid surgery, layered keratoplasty.
Treatment of stage II eye burns
Groups of drugs are added to the ongoing treatment, stimulating immune processes, improving the utilization of oxygen by the body and reducing tissue hypoxia.
fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.
Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).
Enzyme preparations: systemic enzymes 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.
Antioxidants: methylethylpyridinol (1% solution of 0.5 ml parabulbarno 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, inside 100 mg, 20-40 days).
Surgery: layered or penetrating keratoplasty.
Treatment of stage III eye burns
The following are added to the treatment described above.
Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).
Antihypertensive drugs: betaxolol (0.5% eye drops, twice daily) or timolol (0.5% eye drops, twice daily) or dorzolamide (2% eye drops, twice daily).
Surgery: keratoplasty according to emergency indications, antiglaucoma operations.
Treatment of stage IV eye burns
The following are added to the ongoing treatment.
Glucocorticoids: dexamethasone (parabulbar or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbar or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week 3-4 injections.
Enzyme preparations in the form of injections:
- fibrinolysin [human] (400 IU parabulbarno):
- collagenase 100 or 500 KE (the contents of the vial are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). It is injected subconjunctivally (directly into the lesion: adhesion, scar, ST, etc. using electrophoresis, phonophoresis, and also applied to the skin. Before use, the patient's sensitivity is checked, for which 1 KE is injected under the conjunctiva of the diseased eye and observed for 48 hours. In the absence of an allergic reaction, treatment is carried out for 10 days.
Non-drug treatment
Physiotherapy, eyelid massage.
Approximate periods of incapacity for work
Depending on the severity of the lesion, they are 14-28 days. Possible disability in the event of complications, loss of vision.
Further management
Observation of an ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state of ST, retina. With a persistent increase in IOP and the absence of compensation on a medical regimen, antiglaucomatous surgery is possible. With the development of traumatic cataract, removal of the cloudy lens is indicated.
FORECAST
Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim's admission to the hospital, the correctness of the appointment of drug therapy.
Article from the book: .
A burn is a local violation of the integrity of body tissues as a result of exposure to high temperature or chemical reagents. Depending on the etiology of the external factor, they are divided into thermal (temperature factor), chemical (alkalis, acids), radiation (sunstroke), electrical (lightning strike). According to WHO, thermal injuries account for about 6% of all injuries.
A burn according to microbial 10 is classified according to a variety of criteria (the nature of the injury, the severity of the injury, localization, and the area of the lesion) to immediately determine the method of treatment and predict the outcome.
The clinical manifestations of thermal injury are based on the depth of the skin layer lesion. At the 1st degree, the burn looks like a hyperemic and edematous area. The pain persists for three days. There is a complete regeneration of the skin without visible defects.
Characterized by the presence of blisters. There was a median skin lesion and swelling of the papillary dermis. Severe pain appears in the damaged area, limited redness, burning, swelling up to the demarcation line.
Blisters are easily infected during the wound process. If you do not follow the rules of asepsis, a purulent-inflammatory focus may develop.
It is characterized by sharp pain, and a black scab forms on the body. Regeneration occurs slowly, with the formation of a scar.
At the 4th degree of damage, the formation of blisters is characteristic, as well as a dark red scab.
Kinds
Thermal burns according to ICD-10 (international classification of diseases of the 10th revision) have a range code from T20 to T-32. Each species has its own code for microbial 10, which is then indicated in the diagnosis in the medical history.
T20 - T25 Thermal and chemical burns of the external parts of the body, with a certain localization. The list indicates the stage of damage. Thermal burns according to ICD-10:
- T20. Heads and necks.
- T21. The middle part of the body.
- T22. The upper free limb, excluding the wrist and phalanges of the fingers.
- T23. Wrists and hands.
- T24. lower limb, except for the ankle and the sole of the foot.
- T25. Areas of the ankle and foot.
- T26. Limited to the periorbital zone.
- T27. .
- T28. All .
- T29. multiple areas of the body.
- T30. Uncertain localization.
Classifiers with code ciphers from T30 to T32 are compiled, depending on the affected surface of the body of an adult. The burn code defines the class of diseases.
Degrees
Classification according to the depth of tissue damage allows you to determine the level of development of the pathological process and predict further actions.
Damage levels:
First degree. Occurs due to slight and short-term contact with a hot surface, liquid or vapor. The lesion affects only the layer of the epidermis.
Second. The layer of epithelial cells is damaged. Spherical protrusions form above the skin, containing blood plasma rich in leukocytes - a bubble.
Third. Typical skin necrosis. There are two stages:
- IIIa - necrosis at the level of epithelial cells and the surface layer of the dermis;
- IIIb - necrosis at the level of the dermis up to the reticular layer inclusive, with the destruction of hair follicles; glands of the skin, with a partial transition to the hypodermis.
Depending on the state of aggregation of the agent that has come into contact with the skin, a wet burn and a dry burn are isolated. Occurs with prolonged, massive exposure to the surface of the epithelium of the thermal factor.
Fourth. The largest degree. May lead to death. All 3 layers of the skin and underlying tissues undergo necrotic changes.
Diagnosis and grading
For reliable diagnostics, there is a special algorithm for collecting information.
- An anamnesis is collected simultaneously with the necessary studies.
The medical history should include:
- time of receipt;
- place of receipt (open / closed premises);
- how it was received;
- than received.
At this stage, the doctor finds out the quality of first aid, collects a general history. It is necessary for drawing up the scheme of the subsequent treatment.
The general history lists:
- chronic pathologies;
- existing operations;
- the presence of allergies;
- hereditary pathologies.
- Based on the information received, the doctor conducts a general examination:
- Assess the area of the lesion depending on the proportions of the body;
- The degree of damage (1-4);
- The area of undamaged parts of the body is determined;
- It turns out the localization of thermal injury (on the lower extremities in general, diffusely on the leg and foot);
The surgeon determines the indications for hospitalization, conducts the necessary therapeutic measures.