Burns. Health care

FUNDAMENTALS OF FIRST AID
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Burns. Health care

Fundamentals of First Aid (OPMP)

Burns - damage to the skin, mucous membranes, as well as underlying tissues as a result of exposure to high temperatures (thermal burn), chemicals (chemical burn), electric current (electric burn), ionizing radiation (radiation burn).

Thermal burns. In civilian life, burns in a person most often occur as a result of the action of boiling water - in the event of overturning various containers containing hot liquid onto themselves; steam - when washing in a bath, as well as in production where steam is used; less often - due to the action of a flame: in case of fires of buildings or oil sources, road accidents, explosions and thunderstorms, when clothes are burned or due to skin contact with hot and molten metal, slag, etc.

There are four degrees of burns:

I degree - hyperemia (pronounced redness and swelling of the skin);
II - the formation of bubbles;
IIIA - necrosis of the superficial layers of the dermis;
IIIB - necrosis of all layers of the dermis;
IV - necrosis of tissues located under the skin.

First degree burns are mild. It is enough to lubricate the burnt surface with any fatty substance or powder it with soda, talc, starch, etc.

For second degree burns, various methods of treatment are used. If the blisters have not burst, a bandage with a healing ointment is applied to the burned surface; with damaged bubbles, the surface is left open. The patient is laid on a sterile sheet, a frame is placed above him, this frame is covered with a sterile sheet, and several electric bulbs attached to the frame are lit to warm the patient. Assign a plentiful drink, make drip enemas, infusions of isotonic sodium chloride solution, 5% glucose solution. The introduction of tetanus toxoid is mandatory.

III and IV degree burns suggest surgical intervention.

A burn of 1/3 of the body surface is life threatening. A burn of 1/2 of the surface of the body is almost always fatal.

Deep tissue damage occurs during fires, when clothing ignites, when using flammable substances. The use of open fire for lighting or lighting by people whose clothes are soaked in lubricating oils, drying oil or doused with gasoline is one of the frequent causes of extensive burns. Burning clothes are sometimes extinguished by throwing themselves into snowdrifts or by burrowing into a box of sand. It should be extinguished by throwing blankets and carpets over the victim, as well as with water.

Burn victims are protected from hypothermia by wrapping them in blankets and are urgently transported to the hospital after drinking warm tea.

A significant part of those burned are patients who were injured while intoxicated: their lack of self-control, a decrease in pain sensitivity cause an increased frequency of deep burns. Falling asleep with a burning cigarette, you can unexpectedly find yourself in a room engulfed in flames.

Somewhat less frequently than thermal injuries, there are burns from the action of electric current and chemicals - electrical and thermal burns.

Chemical burns caused by the action on the skin and mucous membranes of aggressive chemicals (concentrated acid, concentrated alkali, salts of heavy metals, phosphorus, slaked lime).

These burns are usually deep; they are distinguished by a slow course, gradual rejection of dead tissues, and prolonged healing. Burn shock rarely develops, it is usually mild (1-11 degrees). General complications occur only with extensive and deep burns.

Concentrated acids cause dehydration and coagulation of tissues; a dense scab is formed, which prevents the spread of acid into the depths of the tissues. When burned with sulfuric acid, the scab is dark in color, with hydrochloric acid - light, nitric acid - yellow-green.

Concentrated alkalis (caustic soda, caustic potash, caustic soda) cause protein damage, saponification of fats; melting of tissues develops, there is a tendency to spread the burn deep and wide.

In cases of burns of the mucous membranes of the mouth, esophagus, stomach, not only local changes occur in these areas, but also develops - as a result of the absorption of chemicals - a general toxic effect on the body.

Phosphorus, once in tissues, burns for 5 minutes, burns tissues deeply, can be absorbed from a burn wound and cause poisoning of the body.

When providing first medical help, the burn surface is abundantly washed with running water for 15-20 minutes, while flushing water should not fall on healthy areas of the skin. When burned with phosphorus, pieces of phosphorus are removed from the tissues first mechanically, then by copious washing with water until the glow in the dark of the affected area stops. After abundant washing, a bandage is applied to the burn site with a 5% solution of copper sulphate or with a paste containing copper sulphate. If quicklime gets on the skin, it is carefully removed mechanically and only then washed with water. Washing with water before removing the lime should not be used, since when lime comes into contact with water, slaked lime is formed, which will cause burns. Slaked lime can be washed off with water from the skin and mucous membranes. Then a sterile bandage should be applied.

After washing the areas of the skin burned with acid, bandages are applied to these areas in the form of lotions with a weak solution of alkali (2% solution of table soda), and on areas burned with alkali, with a weak solution of acid (1% acetic, 3 % boric).

In cases of poisoning with acids, alkalis, a burn of the mucous membranes develops: sharp pains in the mouth, throat, esophagus immediately appear, swelling of the mucous membranes of the lips, oral cavity, and larynx appears.

The victim should be allowed to drink as much water as possible (in case of acid poisoning, add table soda to the water - 1 teaspoon per glass of water, in case of alkali poisoning, slightly acidify the water with acetic or citric acid).

The provision of first aid for chemical burns has a certain specificity. The shorter the action of aggressive substances that have fallen on the skin, the less the depth of tissue damage. It is necessary to immediately - in the first 10-15 seconds after the injury - washing the affected surface with a large amount of running cold water. Processing should continue for at least 10-15 minutes.

Water-insoluble phenol derivatives should be removed from the skin surface with 40% alcohol. Put on a bandage. Give the patient a plentiful drink: for burns with acids - burnt magnesia and other slightly alkaline solutions, and for burns with alkalis - weak solutions of citric or acetic acid.

Burn due to electric shock. Such lesions occur as a result of the action of technical or atmospheric electric current. The inept use of electrical appliances - both in technology and in everyday life, as well as the malfunction of these devices lead to electrical injuries. Electric shock is a complex physical and technical process, consisting of thermal, electrolytic and mechanical effects on the body. A current of 3-5 mA is already felt by a person, and a current of 20-25 mA causes involuntary muscle contractions.

A significant number of deaths and disabilities puts electric shock in one of the first places among all causes of injury. It is sometimes very difficult to establish the causes and even the fact of electric shock; in addition, electrical injury is easily confused with other types of injuries (contact thermal burns of a small body surface, fractures when falling from a height after electric shock, etc.).

Electrical injuries occur more often in spring-summer and autumn, when the human sweat glands are more active, and there is also the possibility of being struck by lightning during a thunderstorm - with a significant accumulation of electrical charges in the atmosphere.

Dangerous electric shock with a fatal outcome can occur at a voltage of 127-220 V. In case of electric shock with a voltage of more than 10 V, death occurs primarily from extensive burns. Low-voltage currents also cannot be considered safe. It is noted that at the same voltage, alternating current is more dangerous than direct current. When struck by a current of a higher voltage, the victims have a greater number of electrical burns.

The path of the current from the point of entry to the point of exit from the body is called the "current loop". Distinguish lower, upper and full loop. The lower loop is from leg to leg, the upper loop is from arm to arm (more dangerous). A full loop, in which the current passes not only through the limbs, but also through the heart, is the most dangerous loop that can cause cardiac dysfunction. Electric burns are formed at the points of current entry and exit, the most characteristic of which are "current signs" - these are areas of dry skin necrosis of a round, ellipsoidal or linear shape, ash or dirty gray, pale yellow or milky. There is a darkish retraction in the center with raised and lighter edges. The hair around the "current signs" is not scorched, but twisted like a corkscrew. Usually the "signs of the current" are more pronounced at the points of current entry; at the exit, they are formed upon contact with the metal. "Current signs" can also be formed along the electric current at the places of skin folds, folds.

There are four degrees of electrical injury:

I degree - convulsive muscle contraction, without loss of consciousness;
II - convulsive muscle contraction with loss of consciousness;
III - loss of consciousness with impaired cardiac activity and respiratory distress;
IV - the state of clinical death.

The clinical picture of electric shock consists of general and local signs. The subjective sensations of the victim during the passage of an electric current through his body are varied: a slight push, burning pain, convulsive muscle contraction, trembling, etc.

Signs: pallor and cyanosis of the skin, increased saliva, sometimes vomiting, as well as intermittent, varying degrees of pain in the region of the heart and muscles.

After eliminating the impact of the current, the victim feels fatigue, weakness, heaviness throughout the body; there is a depressed state or, conversely, excitement. Loss of consciousness is observed in 80% of the victims. Patients in an unconscious state are sharply excited, restless. They have a rapid pulse, possibly involuntary urination.

With an electrical injury that caused convulsive muscle contraction and a fall from a height, various bone fractures and joint dislocations can occur. In case of electrical injury with extensive burns, the damage to internal organs, as a rule, is much less pronounced. This is due to the fact that charred and burned tissues create an obstacle to the penetration of current beyond the burn. Electric burns of a small area immediately after exposure to current have clear boundaries, there is a lighter rim around dead black tissue. Swelling of the surrounding tissues develops very quickly. Pain in the area of an electric burn, as a rule, is absent.

How to avoid electric shock?

Before turning on an unfamiliar electrical appliance, carefully read the instructions. This will help not only to master the new product faster, but also save you and those around you from serious problems;
if you are going to remove the back wall of any electrical appliance, make sure that its mains plug is in your hands, and not in the socket;
even to repair the outlet, use the services of a master: it is better to pay with money than with your own life;
do not use electrical appliances in the bathroom, bath, pool, sauna;
do not put glasses of water on electrical appliances, do not put wet towels;
protect wiring from heat, dampness and sharp corners;
if the electrical appliance sparks, smokes, heats up, immediately unplug it from the mains;
check the grounding of electrical appliances;
do not plug two or more household appliances into one outlet;
check sockets and plugs: they should fit tightly to each other;
It is better not to use extension cords: they can cause a short circuit in the circuit;
do not place the extension cord where it can be tripped over.

Authors: Aizman R.I., Krivoshchekov S.G.

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