Burns: area burns, determination by the rule of the palm. Classification of burns by area and degree of injury
In life, each of us received burns. The area of burns can be different, but the sensations are always the same: as if the burned coal is applied to the affected area. And no water, ice or cold compress can overpower this feeling.
And from a medical point of view, a burn is tissue damage caused by the action of high temperature or highly active chemicals, for example acids, alkalis, heavy metal salts. The severity of the condition is determined by the depth of damage and the area of the damaged tissue. There are special forms of burns, obtained from radiation or electric shock.
Classification of burns is based on the depth and type of damage, but there is a separation according to clinical manifestations, medical tactics or the type of injury.
In depth, burns are distinguished:
- The first degree is characterized by the defeat of only the upper layer of the skin. Outwardly this is manifested by reddening, minor swelling and painful sensations. Symptoms disappear after three to four days, and the affected area of the epithelium is replaced by a new one.
- Damage to the epidermis before the basal layer indicates a burn of grade 2.On the surface of the skin appear bubbles with cloudy contents. The healing lasts up to two weeks.
- With a third degree of burn, thermal damage not only gets the epidermis, but also the dermis.
- Degree A: The dermis on the bottom of the wound is partially undamaged, but immediately after the injury it looks like a black corpse, sometimes bubbles appear that can merge with each other. Pain in the burn site is not felt due to damage to the receptors. Self-regeneration is possible only if secondary infection does not join.
- Degree B: complete destruction of the epidermis, dermis and hypodermis.
- The fourth degree is charring of the skin, fat layer, muscles and even bones.
Classification of burns by type of damage:
- Exposure to high temperatures:
- Fire - the area affected is large, but relatively shallow depth. Primary treatment is complicated by the fact that it is difficult to clean the wound from foreign bodies( filaments from clothing, pieces of melted buttons or lightning).
- Liquid - a small burn, but deep( up to the third A-degree).
- Hot steam is a significant length of burn, but the depth rarely reaches the second degree. Often affects the respiratory tract.
- Incandescent objects - the wound repeats the shape of the object and can have a significant depth.
- Acids cause coagulation necrosis, and a scab of coagulated proteins appears on the site of the lesion. This prevents the substance from penetrating into the underlying tissues. The stronger the acid, the closer to the surface of the skin is the affected area.
- Alkalis form colliquated necrosis, it softens tissues and corrosive substance penetrates deeply, a possible 2 degree burn is possible.
- Heavy metal salts resemble externally burns with acid. They are only 1st degree.
- Electrical burns appear after contact with technical or atmospheric electricity and, as a rule, occur only at the entrance and exit points of the discharge.
- Radiation burns can occur after exposure to ionizing radiation or light. They are shallow, and their effects are associated with damage to organs and systems, rather than directly soft tissue.
- Combined burns include several damaging factors, such as gas and flame.
- Combined, you can name those injuries where, in addition to the burn, there are other types of injuries, for example fractures.
Everyone who has ever received burns( the area of burns was more than a five-ruble coin) knows that the prognosis of the development of the disease is an important detail in the diagnosis. Often patients with injuries are injured in accidents, natural disasters or as a result of emergencies at work. Therefore, people in the waiting room brought in groups. And then the ability to predict a change in the patient's future condition will come in handy during sorting. The most difficult and complex cases should be considered by doctors in the first place, because sometimes the account goes for hours and minutes. Usually the forecast is based on the area of the damaged surface and the depth of the lesion, as well as the concomitant injuries.
To accurately determine the forecast, conditional indexes are used( for example, the Frank index).To do this, for each percentage of the affected area is assigned from one to four points. It depends on the extent and location of the burn, and also on what the burn area of the upper respiratory tract. If there is no breathing, then the head and neck burn gets 15 points, and if there is, then all 30. And then they count all the estimates. There is a scale:
- less than 30 points - favorable outlook;
- from thirty to sixty - conditionally favorable;
- up to ninety - doubtful;
- more than ninety - unfavorable.
Area of defeat
In medicine, there are several ways to calculate the area of the affected surface. Determination of the area and degree of burn is possible if one takes as a rule that the surface of different parts of the body occupies nine percent of the total area of the skin, according to this, the head along with the neck, chest, abdomen, each arm, hips, shins and feet occupy 9%and the back surface of the body is twice as large( 18%).The perineum and the genitals received only one percent, but these injuries are considered quite severe.
There are other rules for determining the area of burns, for example, using the palm. It is known that the area of the palm of a person takes from one to one and a half percent of the entire surface of the body. This allows us to conditionally determine the size of the damaged area and assume the severity of the condition. Percentages of burns on the body are conditional. They depend on the subjective evaluation of the doctor.
Clinic There are several symptoms that burns can manifest. The area of burns in this case does not play a special role, because they are extensive, but shallow. Over time, forms of clinical manifestations can change into each other during healing:
- Erythema or redness, accompanied by reddening of the skin. Occurs at any degree of burns.
- Vesicle is a vial filled with a cloudy liquid. It can be with an admixture of blood. Appears due to detachment of the upper layer of the skin.
- Bulla is a few vesicles that have merged into one bubble over one and a half centimeters in diameter.
- Erosion is a burn surface on which there is no epidermis. It bleeds, or the saccharum is allocated. Occurs during removal of blisters or bulls, necrotic tissue.
- Ulcer - deeper erosion affecting the dermis, hypodermis and muscles. The value depends on the area of the previous necrosis.
- Coagulation necrosis is a dry, deadened tissue of black or dark brown color. Easily removed surgically.
- Colliquated necrosis is a moist rotting tissue that can spread both deep into the body and sideways, capturing healthy tissues.
This is the systemic response of the body to a burn injury. This condition can occur both in case of superficial injuries, if the body burns 30% or more, and with deep burns occupying not more than ten percent. The weaker the health of a person, the stronger this type of shock is. Pathophysiologists distinguish four stages of the development of a burn disease:
- Burn shock. It lasts the first two days, with severe damage - three days. It arises because of incorrectly redistribution of fluid in the shock organs( heart, lungs, brain, kidneys).
- Acute burn toxemia develops before infection, lasts from a week to nine days. Pathophysiologically similar to the syndrome of prolonged crushing, that is, the products of tissue disintegration fall into the systemic bloodstream and poison the body.
- Burns septicotoxemia appears after infection. It can last up to several months, until all the bacteria are eliminated from the wound surface.
- Recovery begins after the burn wounds are closed with a granulation tissue or epithelium.
Endogenous intoxication, infection and sepsis
The body burn is accompanied by poisoning the body with protein denaturation products. The liver and kidneys are almost unable to cope with the increased load with a decrease in pressure in the systemic circulation. In addition, after trauma, human immunity is in a state of high alertness, but long-term poisoning of the body disrupts the mechanisms of protection, and secondary immunodeficiency is formed. This leads to the fact that the wound surface is colonized by putrefactive microflora.
Sorting of victims with burns
As mentioned above, one victim who has burns is rarely brought to the emergency room. The area of burns and the number of patients significantly exceed the capabilities of medical personnel, so it is necessary to sort out the incoming people for the severity of the condition in order to know who to provide medical care first:
- Severely wounded have superficial burns of more than twenty percent of the body or deep burns - more than ten percent, andburns of the upper respiratory tract. Such patients need urgent medical aid and are transported to a medical institution with the help of sanaviation.
- The average severity corresponds to superficial burns of less than twenty percent or deep - no more than ten percent of the body surface. Such affected medical aid should be provided in the second place, but this does not mean that they can be left unattended for a long time.
- The mild degree is characterized by superficial burns that occupy less than fifteen percent of the skin surface, or deep burns that spread no more than five percent and do not affect the upper respiratory tract.
- Mortally wounded are people who have a deep body burn( 50% or more), as well as older people with a lesion of thirty percent of the surface. Such victims are only symptomatic treatment. Victims of large-scale industrial accidents can have 90% of body burns. This is a fatal injury, and you can not help in this case, you can only try to relieve their suffering with strong analgesics( artificial coma) or give an inhalation anesthesia.
For a good prediction, the rendering of self- and mutual assistance plays a big role. The rapidity of the reaction can significantly reduce the burn area and its depth. First of all, it is necessary to interrupt the contact between the traumatizing agent and the person, for example to put out the fire or to de-energize the network, to wash out / neutralize the chemical reagent.
At the pre-hospital stage, it is not recommended to use oil-based ointments and other fat-containing products, since they form a film on the wound surface and do not allow heat to escape. In addition, the hospital will also have to remove "medical pollution", causing pain to the victim. It is not necessary to perform wound treatment at home, such as removing foreign bodies, particles of charred skin and the like. This can lead to infection, because the proper aseptic / antiseptic regimen will not be followed. Plus, without proper pain relief, the person you are trying to help with will most likely fall into a state of painful shock.
Analgesia and wound treatment
Depending on the severity of the patient's condition, the anesthetist selects the appropriate medication and anesthesia technique. These can be non-steroidal anti-inflammatory drugs, analgesics-antipyretic drugs or local conductive anesthesia. For severe cases, narcotic analgesics are suitable.
After the place of injury is anesthetized, the surgeon proceeds to the primary treatment of the wound surface. It exfoliates the epidermis, opens or drains the blisters, removes foreign bodies. Then the cleaned surface of the wound is closed with a clean gauze dressing. For second- and more-severe burns, the patient must be injected with tetanus toxoid serum.
There are two methods of treating burns - closed and open. They can be used both individually and together. To prevent infection of the wound, it is actively dried to dry necrosis. An open method is based on this. On the wound surface, substances such as alcohol solutions of halogens, which can coagulate proteins, are applied. In addition, physiotherapy techniques such as infrared radiation can be used.
Closed treatment implies the presence of bandages that prevent the ingress of bacteria, and drains provide the outflow of fluid. Under the dressing, drugs are applied that contribute to the granulation of the wound, improve the outflow of fluid and have antiseptic properties. Most often for this method, antibiotics of a wide spectrum are used, which have a complex effect.