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Burn - types, degrees, first aid. Types of burns in the medical classification Burns signs and first aid table

Greetings, friends! As always, Vladimir Raichev is with you. And let's continue to study how first aid is provided for burns? Actually I was surprised by the amount of feedback on this topic.

Here in this article I talked about the mistakes that are made when providing first aid. And I got quite a lot of feedback in which visitors share their experience of treating burns.

I decided to keep up with my readers and, without delay, talk about first aid for burns. I remember this information from the time of studying at the institute. But before proceeding to first aid, let's get to know burns a little closer.

A burn is a functional change in the surface tissues of the body when exposed to high temperature or radio emission.

If you or your loved ones have a burn, you can’t hesitate, you need to immediately begin clear coordinated actions. Initially, to help the patient, it is necessary to determine the degree of the burn.

Burns come in four degrees:

Grade one: (superficial) At the site of the burn, the skin becomes red and slightly puffy, the patient feels a burning sensation that subsides on contact with cold.
Grade Two: The burn site is edematous and marked by a blister that is filled with a yellowish fluid.
Degree three: death of the deep layers of the skin.
Degree Four: The burn site is charred, almost complete death of muscle and tendon tissue occurs.

Determining the degree of the burn, the physician looks at the volume of the total affected tissues and also at the depth of their damage.

If the affected area is less than 5%, then this is a mild form of burn. Between 20 and 60% of body lesions are severe, and over 60% are classified as extremely severe burns.

The area of the burn is easy to determine. The human palm corresponds to 1% of the area of the human body. Have you already started checking how many palms fit on your body?

What are burns?

According to the reason that caused the burn, they are divided into:

Chemical
Thermal
solar

A chemical burn is a violation of the integrity of the skin as a result of its contact with acids, alkalis and other chemical reagents.

When a burn is received from acid or alkali, a crust appears on the skin, it is loose, white in color, not framed by borders. If the burn is alkaline, then it is much deeper and its degree is much larger.

The peculiarity of a chemical burn is that even after the contact of the chemical reagent with the skin is eliminated, the destruction of the latter continues due to the absorption of the chemical into it for some more time. Therefore, the establishment of the final diagnosis in the case of a chemical burn is delayed for 7-10 days.

Urgent Care:

First of all, you need to do the following:

Immediately remove from the patient clothing soaked in a chemical reagent.
Rinse the area of damage with plenty of running water for at least fifteen minutes in order to wash off the damaging substance from the skin as much as possible. If it was not possible to remove the chemical reagent from the skin in a timely manner, then washing should be longer, about half an hour. This must necessarily be watering with running water, simply wiping with a napkin or swab is strictly prohibited, as this will only increase the penetration of the substance.
After washing after 5-10 minutes, if a burning sensation appears or intensifies, the affected area should be washed again with a plentiful stream of water.
Next, it is important to neutralize the action of the reagent:

If the cause of the burn is acid, then baking soda in a 2% solution or soap and water should be used.

If the cause is an alkaline substance, then a weak solution of lemon acid or vinegar can be used to neutralize.

If the lesion is from lime, apply a 2% sugar solution.

After neutralizing the chemical, a loose, light bandage should be applied to the affected area.

There are very complex, extreme severity chemical burns, in such cases it is extremely important to urgently contact a medical facility. What are the signs of such a lesion?

The patient develops a state of shock, he may lose consciousness, breathing becomes superficial weak, the skin turns pale.
If the affected area includes: face, esophagus, mucous membranes, groin, buttocks, legs.
If the pain does not go away even after the use of painkillers.

Thermal burn - damage to tissue when exposed to high temperature.

There is a division of thermal burns:

Lungs - up to 10% of the affected body surface.
Severe - more than 10%, with it there is a risk of developing a burn disease.

As I said earlier, the definition of the volume of the affected body surface is taken as the basis for determining the severity of injuries; for this, the “palm” rule is most often used. This rule states that a person's palm is approximately 1% of the entire surface of the skin, based on this, the percentage of the wound is determined by how many palms fit on it.

First aid for thermal burns

The very first aid should be very quick and urgent:

Remove the influence of the factor causing the defeat.
Clean the patient's nasal cavity with a cotton swab from soot and dust in a fire condition.
Make sure that the victim does not get tongue stuck and this will not lead to suffocation.
Give the person at least five liters of water to drink, after dissolving five tablespoons of salt and five teaspoons of baking soda in it.
Rinse the burnt area with cold water for at least 15 minutes.
For pain relief, you can give the patient a tablet of analgin, if the burns are too large, then you should drink two or three tablets of aspirin and one tablet of diphenhydramine.
For small household burns, an aerosol medicine, such as Panthenol, Levovinizol, Livian, should be applied to the damaged area. You can make lotions from St. John's wort herbs.

I already wrote about sunburn in this article, but just in case, I’ll remind you of the sequence of actions.
Sunburn - damage to the skin and underlying tissues due to exposure to solar radiation.

Signs:

sharp pain in the burned areas.
reddening of the skin from light to bright scarlet.
puffiness.
burn blisters.
general unexplained weakness.
headache.
increase in body temperature.

First aid for sunburn:

Cover the affected area with a damp cold cloth, which should stop the process of destruction of the cells of the dermis, or you can completely immerse the burned area in cold water.
Moisturize affected skin regularly.
If the burns are minor, then you can use special pharmacy products for the treatment of sunburn Panthenol, Livian.
Provided that the patient is experiencing very severe pain, the area of the burn lesion is more than one palm, the body temperature has risen, you should immediately contact the ambulance team for further hospitalization.

Be careful and stay healthy! And for today I have everything, subscribe to blog updates so as not to miss anything interesting and important, share the article with friends on social networks. Until we meet again, bye bye.

Types and signs of burns. Burn shock. Rules and methods of helping the burnt

Burn called tissue damage arising from local thermal, chemical, electrical or radiation exposure.

Depending on the cause of the burn, there are thermal, radiation, light, chemical, electrical and phosphorus burns.

Thermal burn

A thermal burn is a burn that appears after exposure to the body of a flame, direct contact of the skin with objects or liquids heated to high temperatures.

In peacetime, the main place is occupied by thermal burns as a result of negligence in everyday life (scalding with boiling water), fires, rarely due to industrial injuries due to non-compliance with safety regulations. From exposure to high temperatures, skin cells die. The higher the temperature of the traumatic agent and its prolonged exposure, the deeper the skin lesion.

In case of thermal burns, the fire must be extinguished as soon as possible. But remember: you can not shoot down the flame with bare hands.

A person in burning clothes usually starts to rush about, run. Take the most drastic measures to stop it, as the movement contributes to fanning the flames.

Inflamed clothing must be quickly torn off, thrown off or extinguished, poured with water, and in winter sprinkled with snow. You can also throw a thick cloth, blanket, tarpaulin over a person in burning clothes. However, keep in mind that when the burning clothes are pressed against the skin, the high temperature acts on it for a longer time and, therefore, a deeper burn is possible. In order to prevent this, it is necessary immediately after the elimination of the flame to remove the cloth thrown over.

In no case should a person in burning clothes be wrapped up with his head, as this can lead to damage to the respiratory tract and poisoning with toxic combustion products.

To reduce the time of tissue overheating and prevent severe burns, immediately after the fire is extinguished, it is tedious to start pouring cold water on the affected surface or cover it with snow for 15-20 minutes. This will help reduce pain and prevent tissue swelling.

In no case should the formed blisters be opened so as not to introduce an infection into the burn wound. The burnt surface cannot be sprinkled, lubricated with medicinal and other means, as this complicates further treatment.

If the burnt surface is small, you need to apply a dry sterile bandage to it, using a bandage or gauze. With extensive lesions, the patient is covered with ironed towels, sheets or clean linen. Give (inject) him antishock agents.

Radiation burn

Radiation burns occur when a person is exposed to ionizing radiation.

When living tissues are irradiated, intercellular bonds are broken and toxic substances are formed, which serves as the beginning of a complex chain reaction that extends to all tissue and intracellular metabolic processes. Violation of metabolic processes, exposure to toxic products and the rays themselves, first of all, affects the function of the nervous system.

In the first time after irradiation, there is a sharp overexcitation of nerve cells. After a few minutes, the capillaries expand in the tissues exposed to radiation, and after a few hours, the death and decay of the endings and nerve trunks.

When providing first aid, you must:

Remove radioactive substances from the surface of the skin by flushing with water or special solvents;

Give radioprotective agents from the individual first aid kit;

Apply an aseptic bandage to the affected surface;

Take the victim to a medical facility as soon as possible.

Light burns

Light burns occur when exposed to light energy from a ground or air explosion of nuclear weapons and laser weapons on unprotected skin. Light radiation from a nuclear explosion causes instantaneous or profile damage to exposed parts of the body facing the flash, it can affect vision, ignite combustible materials and clothing, which leads to extensive flame burns (secondary impact).

The rules and methods of providing assistance to victims of light radiation are the same as for thermal burns outlined above.

Chemical burns

Chemical burns are the result of exposure to tissues (skin, mucous membranes) of substances that have a pronounced cauterizing property (strong acids, alkalis, salts of heavy metals, phosphorus). Most chemical burns of the skin are industrial, and chemical burns of the mucous membrane of the oral cavity, esophagus, stomach are more often domestic.

The impact of strong acids and salts of heavy metals on tissues leads to the coagulation of proteins and their dehydration, therefore tissue necrosis occurs with the formation of a dense gray crust of dead tissues.

Alkalis do not bind proteins, but dissolve them, saponify fats and cause deeper necrosis of tissues, which take the form of a white soft scab.

It should be noted that determining the degree of chemical burn in the first days is difficult due to insufficient clinical manifestations.

First aid for a chemical burn is:

Immediate washing of the affected surface with a stream of water, which achieves complete removal of acid or alkali and stops their damaging effect;

Neutralization of acid residues with 2% sodium bicarbonate solution (baking soda);

Neutralization of alkali residues with a 2% solution of acetic or citric acid;

Applying an aseptic bandage to the affected surface;

Administer pain medication to the victim if necessary.

electrical burns

Electrical burns occur when an electrical current passes through human tissue or because of the resulting heat.

When providing assistance, first of all, it is necessary to eliminate the impact on the affected electric current. If respiratory and cardiac arrest occurs, immediately begin a closed heart massage and artificial respiration. These activities do not stop until the restoration of the activity of the heart and breathing, and if there is no proper effect, then until the arrival of the ambulance.

All victims of electric current, regardless of the area of the burn, must be taken to a medical facility. They need constant medical supervision, because due to the peculiarities of the impact of electric current on the body, cardiac arrest can occur even after a few hours or days from the moment of injury. Phosphorus burns.

Phosphorus burns are usually deep, as phosphorus continues to burn when it comes into contact with the skin.

First aid for burns with phosphorus is:

Immediate immersion of the burnt surface in water or abundant irrigation with water;

Cleaning the surface of the burn from pieces of phosphorus with tweezers;

Applying a lotion to the burn surface with a 5% solution of copper sulfate;

Applying an aseptic bandage;

Administering pain medication to the injured.

When burned with phosphorus, it is necessary to exclude the imposition of ointment dressings, which can enhance the fixation and absorption of phosphorus.

Depending on the depth of tissue damage, burns of four degrees are distinguished:

I degree burn - characterized by redness and swelling of the skin, burning and pain in the affected area. After 4-5 days, peeling of the skin and recovery are noted;

Burn of the 2nd degree - accompanied by the appearance of blisters on the reddened and swollen skin, filled with a transparent yellowish liquid. The burned area of the skin is sharply painful. When the blisters rupture or are removed, a painful surface of a bright red color is visible. In the case of a favorable course, without suppuration, the burn heals without scarring within 10-15 days;

A burn of the 3rd degree - can be with damage to the skin itself to its entire thickness (III A degree) or with damage to all layers of the skin (III B degree). A gray or black scab forms on the skin. Dead skin areas are gradually separated, suppuration is noted, a sluggishly healing wound is formed;

A burn of the 4th degree is manifested by the necrosis of not only the skin, but also the deeper tissues (fascia, muscles, bones).

burn shock

Burn shock is a type of traumatic shock and develops with burns of the II-IV degree, if the affected area is 15-16% of the entire body surface in adults.

Burn shock is characterized by general excitation, increased blood pressure, increased respiration and pulse rate.

The severity of clinical manifestations of burn shock depends on the area and depth of the lesion, the age of the victim, and the timeliness of anti-shock treatment. According to the degree of severity, burn shock is divided into mild, severe and extremely severe.

Light shock develops with a burn with a total area of no more than 20% of the entire surface of the body, including with deep lesions no more than 10%. Patients are often calm, sometimes excited, euphoric. Chills, pallor, thirst, muscle tremors, goose bumps, and occasionally nausea and vomiting are noted. Pulse up to 100 beats / min, blood pressure and respiratory rate are usually normal.

Severe shock occurs with burns over 20% of the body surface. The condition of the victim is severe, there is agitation, alternating with lethargy. Consciousness is usually preserved. The victim is disturbed by chills, pain in the burn area, thirst, sometimes there may be nausea and vomiting. The skin of unburned areas is pale, dry, cold to the touch. Body temperature drops by 1-2°. Breathing speeded up, pulse 120-130 beats / min. arterial pressure is lowered.

Extremely severe shock occurs with burns with a lesion area of more than 60%, including deep burns - more than 40%. It is characterized by a sharp violation of the functions of all body systems. The condition of the patients is extremely severe, the consciousness is confused. There is an excruciating thirst. Patients drink up to 4-5 liters of fluid per day, they are often worried about indomitable vomiting. The skin is pale, with a marble tint, the body temperature is significantly reduced. The pulse is thready, very frequent, blood pressure is below 100 mm Hg. Art., shortness of breath increases. The volume of circulating blood is reduced by 20-40%. Kidney function is impaired, manifested by anuria. Severe acidosis (acidification of the blood) develops.

Burn shock lasts from 2 hours to 2 days, and then, with a favorable outcome, peripheral circulation begins to recover, body temperature rises, diuresis normalizes.

Antishock therapy should begin with the introduction of painkillers, it is necessary to warm the patient. If there is no vomiting, it is necessary to give hot sweet tea, coffee, alkaline mineral water or saline-alkaline solution (2 g of baking soda and 4 g of table salt per 1 liter of water). The burn surface should be closed with a dry aseptic (contour) bandage, it can be wetted with an antiseptic (rivanol, furatsilin).

The skin consists of the following layers:

epidermis ( outer part of the skin);
dermis ( connective tissue of the skin);
hypodermis ( subcutaneous tissue).

Epidermis

This layer is superficial, providing the body with reliable protection from pathogenic environmental factors. Also, the epidermis is multi-layered, each layer of which differs in its structure. These layers provide continuous renewal of the skin.

The epidermis consists of the following layers:

basal layer ( provides the process of reproduction of skin cells);
spiny layer ( provides mechanical protection against damage);
granular layer ( protects underlying layers from water penetration);
shiny layer ( participates in the process of keratinization of cells);
stratum corneum ( Protects the skin from invasion of pathogenic microorganisms).

Dermis

This layer consists of connective tissue and is located between the epidermis and hypodermis. The dermis, due to the content of collagen and elastin fibers in it, gives the skin elasticity.

The dermis is made up of the following layers:

papillary layer ( includes loops of capillaries and nerve endings);
mesh layer ( contains vessels, muscles, sweat and sebaceous glands, as well as hair follicles).

The layers of the dermis are involved in thermoregulation, and also have immunological protection.

Hypodermis

This layer of skin is made up of subcutaneous fat. Adipose tissue accumulates and retains nutrients, due to which the energy function is performed. Also, the hypodermis serves as a reliable protection of internal organs from mechanical damage.

With burns, the following damage to the layers of the skin occurs:

superficial or complete lesion of the epidermis ( first and second degree);
superficial or complete lesion of the dermis ( third A and third B degrees);
damage to all three layers of the skin ( fourth degree).

With superficial burn lesions of the epidermis, the skin is completely restored without scarring, in some cases a barely noticeable scar may remain. However, in the case of damage to the dermis, since this layer is not capable of recovery, in most cases, rough scars remain on the surface of the skin after healing. With the defeat of all three layers, a complete deformation of the skin occurs, followed by a violation of its function.

It should also be noted that with burn lesions, the protective function of the skin is significantly reduced, which can lead to the penetration of microbes and the development of an infectious-inflammatory process.

The circulatory system of the skin is very well developed. The vessels, passing through the subcutaneous fat, reach the dermis, forming a deep cutaneous vascular network at the border. From this network, blood and lymphatic vessels extend upward into the dermis, nourishing the nerve endings, sweat and sebaceous glands, and hair follicles. Between the papillary and reticular layers, a second superficial cutaneous vascular network is formed.

Burns cause disruption of microcirculation, which can lead to dehydration of the body due to the massive movement of fluid from the intravascular space to the extravascular space. Also, due to tissue damage, liquid begins to flow from small vessels, which subsequently leads to the formation of edema. With extensive burn wounds, the destruction of blood vessels can lead to the development of burn shock.

Causes of burns

Burns can develop due to the following reasons:

thermal impact;
chemical impact;
electrical impact;
radiation exposure.

thermal effect

Burns are formed due to direct contact with fire, boiling water or steam.

Fire. When exposed to fire, the face and upper respiratory tract are most often affected. With burns of other parts of the body, it is difficult to remove burnt clothing, which can cause the development of an infectious process.
Boiling water. In this case, the burn area may be small, but deep enough.
Steam. When exposed to steam, in most cases, shallow tissue damage occurs ( often affects the upper respiratory tract).
hot items. When the skin is damaged by hot objects, clear boundaries of the object remain at the site of exposure. These burns are quite deep and are characterized by the second - fourth degrees of damage.

The degree of skin damage during thermal exposure depends on the following factors:

influence temperature ( the higher the temperature, the stronger the damage);
duration of exposure to the skin the longer the contact time, the more severe the degree of burn);
thermal conductivity ( the higher it is, the stronger the degree of damage);
the condition of the skin and health of the victim.

Chemical exposure

Chemical burns are caused by contact with the skin of aggressive chemicals ( e.g. acids, alkalis). The degree of damage depends on its concentration and duration of contact.

Burns due to chemical exposure can occur due to exposure of the skin to the following substances:

Acids. The effect of acids on the surface of the skin causes shallow lesions. After exposure to the affected area, a burn crust is formed in a short time, which prevents further penetration of acids deep into the skin.
Caustic alkalis. Due to the influence of caustic alkali on the surface of the skin, its deep damage occurs.
Salts of some heavy metals ( e.g. silver nitrate, zinc chloride). Damage to the skin with these substances in most cases causes superficial burns.

electrical impact

Electrical burns occur on contact with conductive material. Electric current propagates through tissues with high electrical conductivity through blood, cerebrospinal fluid, muscles, and to a lesser extent through skin, bones or adipose tissue. Dangerous for human life is the current when its value exceeds 0.1 A ( ampere).

Electrical injuries are divided into:

low voltage;
high voltage;
supervoltage.

In case of electric shock, there is always a current mark on the body of the victim ( entry and exit point). Burns of this type are characterized by a small area of damage, but they are quite deep.

Radiation exposure

Burns due to radiation exposure can be caused by:

Ultraviolet radiation. Ultraviolet skin lesions mainly occur in the summer. The burns in this case are shallow, but are characterized by a large area of damage. Exposure to ultraviolet radiation often results in superficial first- or second-degree burns.
Ionizing radiation. This effect leads to damage not only to the skin, but also to nearby organs and tissues. Burns in such a case are characterized by a shallow form of damage.
infrared radiation. May cause damage to the eyes, mainly the retina and cornea, but also to the skin. The degree of damage in this case will depend on the intensity of the radiation, as well as on the duration of exposure.

Degrees of burns

In 1960, it was decided to classify burns into four degrees:

I degree;
II degree;
III-A and III-B degree;
IV degree.

Burn degree	Development mechanism	Features of external manifestations
*I degree*	there is a superficial lesion of the upper layers of the epidermis, the healing of burns of this degree occurs without scarring	hyperemia ( redness), swelling, pain, dysfunction of the affected area
*II degree*	complete destruction of the superficial layers of the epidermis	pain, blistering with clear fluid inside
*III-A degree*	damage to all layers of the epidermis up to the dermis ( dermis may be partially affected)	a dry or soft burn crust is formed ( scab) light brown
*III-B degree*	all layers of the epidermis, the dermis, and also partially the hypodermis are affected	a dense dry burn crust of brown color is formed
*IV degree*	all layers of the skin are affected, including muscles and tendons down to the bone	characterized by the formation of a burn crust of dark brown or black color

There is also a classification of burn degrees according to Kreibich, who distinguished five degrees of burn. This classification differs from the previous one in that the III-B degree is called the fourth, and the fourth degree is called the fifth.

The depth of damage in case of burns depends on the following factors:

the nature of the thermal agent;
temperature of the active agent;
duration of exposure;
the degree of warming of the deep layers of the skin.

According to the ability of self-healing, burns are divided into two groups:

Superficial burns. These include first, second, and third-A degree burns. These lesions are characterized by the fact that they are able to heal fully on their own, without surgery, that is, without scarring.
Deep burns. These include burns of the third-B and fourth degree, which are not capable of full self-healing ( leaves a rough scar).

Burn symptoms

According to localization, burns are distinguished:

faces ( in most cases leads to eye damage);
scalp;
upper respiratory tract ( there may be pain, loss of voice, shortness of breath, and a cough with a small amount of sputum or streaked with soot);
upper and lower limbs ( with burns in the joints, there is a risk of dysfunction of the limb);
torso;
crotch ( can lead to disruption of the excretory organs).

Burn degree	Symptoms	Photo
*I degree*	With this degree of burn, redness, swelling and pain are observed. The skin at the site of the lesion is bright pink in color, sensitive to touch and slightly protrudes above the healthy area of the skin. Due to the fact that with this degree of burn only superficial damage to the epithelium occurs, the skin after a few days, drying and wrinkling, forms only a small pigmentation, which disappears on its own after a while ( an average of three to four days).
*II degree*	In the second degree of burns, as well as in the first, hyperemia, swelling, and burning pain are noted at the site of the lesion. However, in this case, due to the detachment of the epidermis, small and loose blisters appear on the surface of the skin, filled with a light yellow, transparent liquid. If the blisters break open, reddish erosion is observed in their place. The healing of this kind of burns occurs independently on the tenth - twelfth day without scarring.
*III-A degree*	With burns of this degree, the epidermis and partly the dermis are damaged ( hair follicles, sebaceous and sweat glands are preserved). Tissue necrosis is noted, and also, due to pronounced vascular changes, edema spreads over the entire thickness of the skin. In the third-A degree, a dry, light brown or soft, white-gray burn crust forms. Tactile-pain sensitivity of the skin is preserved or reduced. Bubbles are formed on the affected surface of the skin, the sizes of which vary from two centimeters and above, with a dense wall, filled with a thick yellow jelly-like liquid. Epithelialization of the skin lasts an average of four to six weeks, but when an inflammatory process appears, healing can last for three months.
*III-B degree*	With burns of the third-B degree, necrosis affects the entire thickness of the epidermis and dermis with partial capture of subcutaneous fat. At this degree, the formation of blisters filled with hemorrhagic fluid is observed ( streaked with blood). The resulting burn crust is dry or wet, yellow, gray or dark brown. There is a sharp decrease or absence of pain. Self-healing of wounds at this degree does not occur.
*IV degree*	With fourth-degree burns, not only all layers of the skin are affected, but also muscles, fascia and tendons up to the bones. A dark brown or black burn crust forms on the affected surface, through which the venous network is visible. Due to the destruction of nerve endings, there is no pain at this stage. At this stage, there is a pronounced intoxication, there is also a high risk of developing purulent complications.

Note: In most cases, with burns, the degrees of damage are often combined. However, the severity of the patient's condition depends not only on the degree of burn, but also on the area of the lesion.

Burns are divided into extensive ( lesion of 10 - 15% of the skin or more) and not extensive. With extensive and deep burns with superficial skin lesions of more than 15 - 25% and more than 10% with deep lesions, burn disease may occur.

Burn disease is a group of clinical symptoms associated with thermal lesions of the skin and surrounding tissues. Occurs with massive destruction of tissues with the release of a large amount of biologically active substances.

The severity and course of a burn disease depends on the following factors:

the age of the victim;
the location of the burn;
burn degree;
area of damage.

There are four periods of burn disease:

burn shock;
burn toxemia;
burn septicotoxemia ( burn infection);
convalescence ( recovery).

burn shock

Burn shock is the first period of burn disease. The duration of the shock ranges from several hours to two to three days.

Degrees of burn shock

First degree	Second degree	Third degree
It is typical for burns with skin lesions of no more than 15 - 20%. With this degree, burning pain is observed in the affected areas. The heart rate is up to 90 beats per minute, and blood pressure is within normal limits.	It is observed with burns with a lesion of 21 - 60% of the body. The heart rate in this case is 100 - 120 beats per minute, blood pressure and body temperature are reduced. The second degree is also characterized by a feeling of chills, nausea and thirst.	The third degree of burn shock is characterized by damage to more than 60% of the body surface. The condition of the victim in this case is extremely severe, the pulse is practically not palpable ( filiform), blood pressure 80 mm Hg. Art. ( millimeters of mercury).

Burn toxemia

Acute burn toxemia is caused by exposure to toxic substances ( bacterial toxins, protein breakdown products). This period starts from the third or fourth day and lasts for one to two weeks. It is characterized by the fact that the victim has an intoxication syndrome.

For intoxication syndrome, the following symptoms are characteristic:

increase in body temperature ( up to 38 - 41 degrees with deep lesions);
nausea;
thirst.

Burn septicotoxemia

This period conditionally begins on the tenth day and continues until the end of the third - fifth week after the injury. It is characterized by attachment to the affected area of infection, which leads to the loss of proteins and electrolytes. With negative dynamics, it can lead to exhaustion of the body and death of the victim. In most cases, this period is observed with third-degree burns, as well as with deep lesions.

For burn septicotoxemia, the following symptoms are characteristic:

weakness;
increase in body temperature;
chills;
irritability;
yellowness of the skin and sclera ( with liver damage);
increased heart rate ( tachycardia).

convalescence

In the case of successful surgical or conservative treatment, healing of burn wounds, restoration of the functioning of internal organs and recovery of the patient occurs.

Determining the area of burns

In assessing the severity of thermal damage, in addition to the depth of the burn, its area is important. In modern medicine, several methods are used to measure the area of burns.

There are the following methods for determining the area of the burn:

the rule of nines;
palm rule;
Postnikov's method.

Rule of nines

The simplest and most affordable way to determine the area of a burn is considered to be the “rule of nines”. According to this rule, almost all parts of the body are conditionally divided into equal sections of 9% of the total surface of the entire body.

Rule of nines	Photo
head and neck 9%
upper limbs (each hand) by 9%
anterior torso18% (chest and abdomen 9% each)
back of the body18% (upper back and lower back 9% each)
lower limbs ( each leg) by 18% (thigh 9%, lower leg and foot 9%)
Perineum 1%

palm rule

Another method for determining the area of a burn is the “rule of the palm”. The essence of the method lies in the fact that the area of the burned palm is taken as 1% of the area of the entire surface of the body. This rule is used for small burns.

Postnikov method

Also in modern medicine, the method of determining the area of the burn according to Postnikov is used. To measure burns, sterile cellophane or gauze is used, which is applied to the affected area. On the material, the contours of the burnt places are indicated, which are subsequently cut out and applied to a special graph paper to determine the area of the burn.

First aid for burns

First aid for burns is as follows:

elimination of the source of the acting factor;
cooling of burned areas;
the imposition of an aseptic bandage;
anesthesia;
call an ambulance.

Elimination of the source of the acting factor

To do this, the victim must be taken out of the fire, put out burning clothes, stop contact with hot objects, liquids, steam, etc. The sooner this assistance is provided, the less the depth of the burn will be.

Cooling of burned areas

It is necessary to treat the burn site as soon as possible with running water for 10 to 15 minutes. Water should be at the optimum temperature - from 12 to 18 degrees Celsius. This is done in order to prevent the process of damage to healthy tissue near the burn. Moreover, cold running water leads to vasospasm and to a decrease in the sensitivity of nerve endings, and therefore has an analgesic effect.

Note: for third and fourth degree burns, this first aid measure is not performed.

Applying an aseptic dressing

Before applying an aseptic bandage, it is necessary to carefully cut off the clothes from the burnt areas. Never attempt to clean burned areas ( remove pieces of clothing, tar, bitumen, etc. adhering to the skin.), as well as popping bubbles. It is not recommended to lubricate the burned areas with vegetable and animal fats, solutions of potassium permanganate or brilliant green.

Dry and clean handkerchiefs, towels, sheets can be used as an aseptic dressing. An aseptic bandage must be applied to the burn wound without pretreatment. If the fingers or toes have been affected, it is necessary to lay additional tissue between them in order to prevent the parts of the skin from sticking together. To do this, you can use a bandage or a clean handkerchief, which must be wetted with cool water before application, and then squeezed out.

Anesthesia

For severe pain during a burn, painkillers should be taken, for example, ibuprofen or paracetamol. To achieve a rapid therapeutic effect, it is necessary to take two tablets of ibuprofen 200 mg or two tablets of paracetamol 500 mg.

Call an ambulance

There are the following indications for which you need to call an ambulance:

with burns of the third and fourth degree;
in the event that a second-degree burn in area exceeds the size of the palm of the victim;
with first-degree burns, when the affected area is more than ten percent of the body surface ( for example, the entire abdomen or the entire upper limb);
with the defeat of such parts of the body as the face, neck, joints, hands, feet, or perineum;
in the event that after a burn there is nausea or vomiting;
when after a burn there is a long ( more than 12 hours) increase in body temperature;
when the condition worsens on the second day after the burn ( increased pain or more pronounced redness);
with numbness of the affected area.

Burn treatment

Burn treatment can be of two types:

conservative;
operational.

How to treat a burn depends on the following factors:

the area of the lesion;
the depth of the lesion;
localization of the lesion;
the cause of the burn;
the development of a burn disease in the victim;
the age of the victim.

Conservative treatment

It is used in the treatment of superficial burns, and this therapy is also used before and after surgery in case of deep lesions.

Conservative burn treatment includes:

closed way;
open way.

Closed way
This method of treatment is characterized by the application of dressings with a medicinal substance to the affected areas of the skin.

Burn degree	Treatment
*I degree*	In this case, it is necessary to apply a sterile bandage with anti-burn ointment. Usually, it is not necessary to change the dressing with a new one, since with a first degree burn, the affected skin heals within a short time ( up to seven days). With household burns, Panthenol Spray with dexpanthenol has proven itself well. Unlike analogues, which are cosmetics, this is a certified drug. It does not contain parabens in its composition, which makes it safe for both adults and children from the first day of life. It is easy to apply - just spray on the skin without rubbing. Panthenol Spray is produced in the European Union, in compliance with high European quality standards, you can recognize the original Panthenol Spray by the smiley next to the name on the package.
*II degree*	In the second degree, bandages with bactericidal ointments are applied to the burn surface ( for example, levomekol, sylvatsin, dioxysol), which act depressingly on the vital activity of microbes. These dressings must be changed every two days.
*III-A degree*	With lesions of this degree, a burn crust forms on the surface of the skin ( scab). The skin around the formed scab must be treated with hydrogen peroxide ( 3% ), furacilin ( 0.02% aqueous or 0.066% alcohol solution), chlorhexidine ( 0,05% ) or other antiseptic solution, after which a sterile bandage should be applied. After two to three weeks, the burn crust disappears and it is recommended to apply bandages with bactericidal ointments to the affected surface. Complete healing of the burn wound in this case occurs after about a month.
*III-B and* *IV degree*	With these burns, local treatment is used only to accelerate the process of rejection of the burn crust. Bandages with ointments and antiseptic solutions should be applied daily to the affected skin surface. The healing of the burn in this case occurs only after surgery.

There are the following advantages of the closed method of treatment:

applied dressings prevent infection of the burn wound;
the bandage protects the damaged surface from damage;
the drugs used kill microbes, and also contribute to the rapid healing of the burn wound.

There are the following disadvantages of the closed method of treatment:

changing the bandage provokes pain;
the dissolution of necrotic tissue under the bandage leads to an increase in intoxication.

open way
This method of treatment is characterized by the use of special techniques ( e.g. ultraviolet irradiation, air cleaner, bacterial filters), which is available only in specialized departments of burn hospitals.

The open method of treatment is aimed at the accelerated formation of a dry burn crust, since a soft and moist scab is a favorable environment for the reproduction of microbes. In this case, two to three times a day, various antiseptic solutions are applied to the damaged skin surface ( e.g. brilliant green ( brilliant green) 1%, potassium permanganate ( potassium permanganate) 5% ), after which the burn wound remains open. In the ward where the victim is located, the air is continuously cleaned of bacteria. These actions contribute to the formation of a dry scab within one to two days.

In this way, in most cases, burns of the face, neck and perineum are treated.

There are the following advantages of the open method of treatment:

contributes to the rapid formation of a dry scab;
allows you to observe the dynamics of tissue healing.

There are the following disadvantages of the open method of treatment:

loss of moisture and plasma from a burn wound;
the high cost of the treatment method used.

Surgical treatment

For burns, the following types of surgical interventions can be used:

necrotomy;
necrectomy;
staged necrectomy;
limb amputation;
skin transplant.

Necrotomy
This surgical intervention consists in dissection of the formed scab with deep burn lesions. Necrotomy is performed urgently in order to ensure the blood supply to the tissues. If this intervention is not performed in a timely manner, necrosis of the affected area may develop.

necrectomy
Necrectomy is performed for third-degree burns in order to remove non-viable tissues with deep and limited lesions. This type of operation allows you to thoroughly clean the burn wound and prevent suppuration processes, which subsequently contributes to the rapid healing of tissues.

Staged necrectomy
This surgical intervention is performed with deep and extensive skin lesions. However, staged necrectomy is a more gentle method of intervention, since the removal of non-viable tissues is performed in several stages.

Amputation of a limb
Amputation of the limb is performed with severe burns, when treatment by other methods has not brought positive results or necrosis has developed, irreversible tissue changes with the need for subsequent amputation.

These methods of surgical intervention allow:

clean the burn wound;
reduce intoxication;
reduce the risk of complications;
reduce the duration of treatment;
improve the healing process of damaged tissues.

The presented methods are the primary stage of surgical intervention, after which they proceed to further treatment of the burn wound with the help of skin transplantation.

Skin transplantation
Skin grafting is performed to close large burn wounds. In most cases, autoplasty is performed, that is, the patient's own skin is transplanted from other parts of the body.

Currently, the following methods of closing burn wounds are most widely used:

Plastic surgery with local tissues. This method is used for deep burn lesions of small size. In this case, there is a borrowing of neighboring healthy tissues to the affected area.
Free skin plastic. It is one of the most common methods of skin transplantation. This method consists in the fact that using a special tool ( dermatome) in the victim from a healthy part of the body ( e.g. thigh, buttock, abdomen) the necessary skin flap is excised, which is subsequently superimposed on the affected area.

Physiotherapy

Physiotherapy is used in the complex treatment of burn wounds and is aimed at:

inhibition of the vital activity of microbes;
stimulation of blood flow in the area of impact;
acceleration of the regeneration process ( recovery) damaged area of the skin;
prevention of the formation of post-burn scars;
stimulation of the body's defenses ( immunity).

The course of treatment is prescribed individually, depending on the degree and area of the burn injury. On average, it may include ten to twelve procedures. The duration of the physiotherapy usually varies from ten to thirty minutes.

Type of physiotherapy	Mechanism of therapeutic action	Application
*Ultrasound Therapy*	Ultrasound, passing through cells, triggers chemical-physical processes. Also, acting locally, it helps to increase the body's resistance.	This method is used to dissolve scars and improve immunity.
*ultraviolet irradiation*	Ultraviolet radiation promotes the absorption of oxygen by tissues, increases local immunity, improves blood circulation.	This method is used to speed up the regeneration of the affected area of the skin.
*infrared irradiation*	Due to the creation of a thermal effect, this irradiation improves blood circulation, as well as stimulates metabolic processes.	This treatment is aimed at improving the healing process of tissues, and also produces an anti-inflammatory effect.

Burn Prevention

Sunburn is a common thermal skin lesion, especially in the summer.

Prevention of sunburn

To avoid sunburn, the following rules must be observed:

Avoid direct contact with the sun between ten and sixteen hours.
On particularly hot days, it is preferable to wear dark clothing, as it protects the skin from the sun better than white clothes.
Before going outside, it is recommended to apply sunscreen to exposed skin.
When sunbathing, the use of sunscreen is a mandatory procedure that must be repeated after each bath.
Since sunscreens have different protection factors, they must be selected for a specific skin phototype.

There are the following skin phototypes:

Scandinavian ( first phototype);
light-skinned European ( second phototype);
dark-skinned Central European ( third phototype);
Mediterranean ( fourth phototype);
Indonesian or Middle Eastern ( fifth phototype);
African American ( sixth phototype).

For the first and second phototypes, it is recommended to use products with maximum protection factors - from 30 to 50 units. The third and fourth phototypes are suitable for products with a protection level of 10 to 25 units. As for people of the fifth and sixth phototype, to protect the skin, they can use protective equipment with minimal indicators - from 2 to 5 units.

Prevention of household burns

According to statistics, the vast majority of burns occur in domestic conditions. Quite often, children who suffer due to the carelessness of their parents are burned. Also, the cause of burns in the domestic environment is non-compliance with safety rules.

To avoid burns at home, the following recommendations must be followed:

Do not use electrical appliances with damaged insulation.
When unplugging the appliance from the socket, do not pull the cord, it is necessary to hold the plug base directly.
If you are not a professional electrician, do not repair electrical appliances and wiring yourself.
Do not use electrical appliances in a damp room.
Children should not be left unattended.
Make sure there are no hot objects in the children's reach ( for example, hot food or liquids, sockets, iron on, etc.).
Items that can cause burns ( e.g. matches, hot objects, chemicals and other) should be kept away from children.
It is necessary to conduct awareness-raising activities with older children regarding their safety.
Smoking should be avoided in bed as it is one of the common causes of fires.
It is recommended to install fire alarms throughout the house or at least in places where the likelihood of a fire is higher ( e.g. in a kitchen, a room with a fireplace).
It is recommended to have a fire extinguisher in the house.

The causes of burns can be very diverse.

What are burns, how many degrees of burns exist and how to determine the degree of a burn - we will find out today.

By itself, a burn is a permanent damage to the tissues of the human body when exposed to some external factor.

And it is on that very factor that the classification of the etiology of burns depends. So, based on the origin, the following types of burns are distinguished:

Thermal burn- exposure to the surface of the human body at elevated temperature: steam, boiling water, hot oil, touching a hot object, exposure to open fire on the human body.
Burn electric- the impact on the human body of an electric discharge, which also gives damage to internal organs by an electromagnetic field.
Chemical burn - the interaction of the human body with chemicals that can affect not only the epidermis, but also the subcutaneous layers.
Radiation burn- damage to the epidermis and sometimes the subcutaneous layer by exposure to ultraviolet or infrared radiation.

Classification of burns by degrees and their characteristics

Each burn is unique in its own way, because the degree of damage is individual each time - it all depends on the very external factors that cause it. Treatment also depends on the degree of burns and their signs, which is why the classification of burns by degrees is so important.

There are only four types of burns in degrees. All degrees of burns and their signs depend on the characteristics of the tissue lesion and on the level of the area of this lesion.

1st degree burn. The mildest form (or degree) of a burn. There is redness and very slight swelling of the affected surface. Pain is not great, and recovery after this burn occurs literally on the 4th or 5th day. There are no visible marks or scars.

photo of 1st degree burn

2nd degree burn. Blisters form on reddened skin, and they may not appear immediately - up to a day after the burn. Each bubble contains a yellowish liquid, and when they break, a reddish surface of the skin is visible, which is under the bubble. If an infection has got into the place of the rupture, healing takes longer, but scars and scars are not subsequently formed.

photo burn 2nd degree

3rd degree burn. With such a lesion, necrosis of the affected area of the skin occurs. In its place, a scab forms, which acquires a grayish tint. Sometimes this scab is covered with a black crust, which then falls off and under it is a reddish area of a very thin layer of skin.

photo burn 3 degrees

4th degree burn. This is not only an external lesion of the layers of the skin and epidermis, it is a penetration into the deep sections of the tissues and even their charring. Many of the dead tissues are partially melted and then sloughed off. Not only muscle tissue is damaged, but also tendons and even bone.

The healing process of a 4th degree burn is very long, not only scars are formed at the site of the lesion, but also scars, which often lead to disfigurement. Cicatricial contractures form in the articular bags, which impede the mobility of the joints. This is the most severe degree of burns, which necessarily requires the supervision of specialists and a long and difficult treatment.

photo burn 4 degrees

Depending on the types of burns and their degrees, there are special methods of treatment. Moreover, this classification of burns by degree is universal for the entire world medical community, and it is it that is the “reference point” for treatment and for determining the method of recovery after a burn.

Regardless of the type and degree of the burn, assistance to the victim should be provided as early as possible: a layman can lose sight of the alarming symptoms, and seemingly minor damage can lead to necrotic complications. What are the burns, and what needs to be done to alleviate the suffering of the victim, everyone should know.

Degrees of thermal burns, their signs and how to provide first aid

Burns - damage to body tissues as a result of exposure to high temperature, chemicals or electric current, respectively, thermal, chemical and electrical burns are distinguished.

Speaking about what types of burns are most common, thermal burns are first of all mentioned: they account for about 90-95% of all burns. The most common burns are from exposure to flames, hot liquids, steam, and also from contact with hot objects. Burns caused by an open flame are especially dangerous when the upper respiratory tract and a significant part of the body are affected. The more extensive the burn, the more severe the general condition of the victim and the worse the prognosis.

The severity of burns is determined by the area and depth of tissue damage. Depending on the depth of the lesion, 4 degrees of thermal burns are distinguished, and the third degree is divided into two (A and B):

1st degree burn characterized by slight damage to the most superficial layer of the skin. The victim has redness, swelling, swelling, local increase in skin temperature and soreness. After 3-4 days, all these phenomena disappear.
Second degree burn characterized by the development of a more pronounced inflammatory reaction. Signs of a thermal burn of this degree: the appearance of blisters filled with a yellowish liquid against the background of redness. If the blisters burst, then a painful wound with a bright red bottom is exposed. With this burn, there is no damage to the deep layers of the skin, therefore, if there is no infection of the burn surface, after 6-7 days the damaged layers of the skin are restored.
Third degree burn characterized by a greater depth of damage and a more pronounced necrosis of tissues with the formation of a burn scab. Among burns of the III degree, burns of III-A and III-B degrees are distinguished. With III-A degree burns, the epithelial elements of the skin are preserved, which are the starting material for self-healing of the wound without scarring. With a III-B degree burn, all layers of the skin completely die and the resulting wound heals through granulation and scarring.
IV degree burns accompanied by charring of the skin and damage to deeper tissues - subcutaneous adipose tissue, muscles, tendons, bones and joints. This is the most severe form of burns.
Burns I - III-A degree considered superficial, burns III-B - IV degree - deep.

First aid for thermal burns with any signs should be aimed at stopping the effects of high temperature on the victim:

Before treating a thermal burn, extinguish flames on clothing.
Remove the victim from the high temperature area.
Regardless of the degree of thermal burn, when providing first aid, smoldering clothing should be removed from the surface of the body. It is impossible to tear off clothes from the skin, as this will only aggravate the injury. The clothing is cut off around the burn.
Apply an aseptic dressing over the burn. The imposition of a dry aseptic dressing prevents infection of the burn surface. The same measures are taken for burns with molten bitumen or resin adhering to the skin.
Do not remove blisters and blisters from the burnt surface, as well as lubricate them with various fats and oils. Fats and oils do not reduce pain, do not disinfect the surface of the burn and do not help healing, they only interfere with the doctor's primary surgical treatment of the wound.
The victim must be placed in a position in which pain is the least disturbing.
With a limited thermal burn, you should immediately start cooling the burn site with running water for 15-20 minutes.
With extensive burns, it is better to wrap the victim in a clean, ironed sheet.

How to provide first aid for a chemical burn

Chemical burns occur from exposure of the body to concentrated acids (hydrochloric, sulfuric, nitric, acetic, carbolic), alkalis (caustic soda, quicklime) and other chemically active substances (phosphorus, silver nitrate, zinc chloride). The severity and depth of damage depends on the type, temperature, concentration and duration of exposure to the chemical.

Here's how to treat chemical burns before a doctor arrives:

The affected surface should be washed with plenty of running water as soon as possible.
Rinse the burnt area with cold water.
When providing first aid for chemical burns with quicklime and sulfuric acid, it is impossible to wash the burnt surface with water, since when interacting with water, these substances emit a large amount of heat, which can increase the degree of burn.
In the case of impregnation with a chemically active substance, clothing must be removed quickly.
In case of burns caused by phosphorus, the burned part of the body is immersed in water, pieces of phosphorus are removed under water with a stick or cotton wool.
In case of burns with concentrated acids, washing the burnt surface with soda solutions gives a good effect.
For burns caused by alkalis, washing the burnt surface with a weak solution of acetic acid (1 teaspoon of table vinegar per 300 milliliters of water) is effective. After treatment, a sterile dressing moistened with the composition that treated the burn is applied to the burn site.

After providing first aid, the victim must be urgently taken to a medical facility. When transporting it, the caregiver should provide the patient with maximum peace and comfortable position.

It is impossible to allow hypothermia of the patient. It must be well covered.

Electrical burn and its symptoms

Electrical injury causes general and local disturbances in the body. Local changes in electrical trauma are manifested in the form of tissue burns at the points of entry and exit of electric current, the so-called current signs.

Signs of this type of burns can be pinpoint or large, depending on the area of skin contact with the electric current source. Even a local lesion of the skin can be accompanied by significant destruction of soft tissues and bones. The resulting wounds are crater-shaped, and a dense scab subsequently forms in their place.

How to treat burns with folk remedies at home

There are many ways to treat burns with folk remedies, but this does not mean that you do not need to seek the advice of a specialist. Before treating burns at home, consult your doctor.

For the treatment of burns with folk remedies, the following medicinal herbs are used:

Aloe tree (agave). Saturate a napkin with the juice from the leaves and close the burn surface.
Black elderberry. Boil freshly picked leaves with boiling water or hot milk and apply to the burnt surface.
Veronica officinalis. Boil freshly harvested grass with boiling water, grind and infuse for 10 days with an equal amount of boiled sunflower oil by weight. Strain. Apply for dressings.
Hypericum perforatum. Take 100 g of St. John's wort and pour 600 ml of sunflower oil. Boil for 30 min. Cool and strain. St. John's wort oil is used to dry the burn surface and regenerate tissues.
Potentilla erect (galangal). Preparation of a decoction: 1 tbsp. pour a spoonful of crushed rhizomes with 1 glass of water, boil over low heat for 15 minutes. insist 2 hours strain. To prepare this folk remedy for burns, you need 1 tbsp. Boil a spoonful of chopped rhizomes for 5 minutes in 1 cup of unsalted butter, strain while warm. Apply to lubricate the burn surface after treatment with a decoction of rhizomes.
Blueberry common. Boil freshly picked berries for 10 minutes in a small amount of water. Drain the water. Berries cool and grind. Apply crushed berries to the burn surface, fixing with a bandage.
Sushenitsa marsh. An infusion of the herb is used to wash burn surfaces, and an ointment is used for dressings. Preparation of ointment: 1 tbsp. a spoonful of powder is rubbed with 0.5 cups of butter and 0.5 cups of honey.
Pumpkin ordinary. Fresh pumpkin pulp is applied to inflamed burns.