Burn disease presentation. Presentation on the topic Burns. Types of burns. Sun burns. Heatstroke. Rules for quickly determining a burn

Pikuza A.V.
Assistant of the Department of Surgical Diseases
KSMU

BURN (combustio) is called damage caused by exposure to thermal, chemical, electrical and radiation energy, as well as low temperatures.

called
damage caused by exposure
thermal, chemical, electrical and
ray
energy,
A
Also
low
temperatures.
BURN
(combustion)

Etiology of thermal lesions among severely burned patients

3% 2%
25%
Hot water
Flame
Electrical burns
Chemical burns
70,5%

Classification of burns by etiological factors

1.
2.
Thermal burns from exposure
high temperature
flames, liquids
Items
Steam and gaseous substances
Chemical burns from chemical exposure
active substances
Burns with strong acids (sulphuric, hydrochloric,
nitrogen, etc.)
Burns with strong alkalis (caustic soda, caustic
potassium, caustic soda)
Heavy metal salt burns
Phosphorus burns

Electrical burns as a result
passage of electric current through tissues.
Provides, in addition to burns, biological,
electrochemical and mechanical
impact, leading to systemic
damage - electrical injury
4. Light burns (nuclear explosion, laser
weapon)
5. Radiation burns as a result of exposure
extensive doses of penetrating radiation
3

According to the depth of the lesion: (Classification of the XXVII All-Union Congress of Surgeons, 1961)

Depth of injury:
(Classification of the XXVII All-Union Congress
Surface:
1 tbsp - reactive changes
epidermis (skin hyperemia)
2 st - epidermal necrosis
(presence of serous blisters)
3A st - superficial necrosis
(up to the germ layer) dermis
Deep:
3B st - necrosis of all layers of the dermis (with
hair follicles, sweat and
sebaceous glands).
4 st - necrosis of the entire skin and
deeper tissues
(subcutaneous tissue, muscles,
tendons, bones)
surgeons, 1961)

deep burns

Left Flame Burn
hands 3a-3b degree
electrical burn
right hand 3b-4
degree

First aid for burns.

The first task is to remove the victim from
flame, extinguish clothes quickly, cut clothes off
the affected part of the body.
The affected area of ​​the body is cooled with a jet
cold
water,
handle
napkins,
moistened with 70% ethanol. Oily
dressings are recommended only for Ist burns.
Special aerosols are also used (olazol,
panthenol, oleol). After that, the area of ​​the burn
covered with a clean sheet or strips
clean linen, pre-ironed
iron. For the prevention of shock, it is recommended
administration of painkillers.

By the area of ​​the lesion: (Methods for determining the area of ​​the burn)

A. Wallace's method (1951) - "the rule
nines "(surface of the main parts
body is a multiple of "9").
Method I.I. Glumova (1953) -
"rule of the palm" (palm area
is
Schemes G.D. Vilyavina - use
stamps with the image of a silhouette of a man
front and back ("skizzy") divided into
squares corresponding to body area.
Method B.N. Postnikova (1949) - for burn
the surface is applied sterile
cellophane on which contours are applied
burn and calculate the area at
using graph paper.

Burn disease is a complex set of interrelated pathogenetic reactions and their clinical manifestations, which is based on stress.

Burn disease is a complex complex
interrelated pathogenetic reactions and their
clinical manifestations, which is based on
stress response in response to thermal injury
with a total area of ​​more than 30% or the area of ​​deep
burns more than 10-15%
Stages of burn disease:
burn shock
acute burn toxemia
burn septicotoxemia
convalescence.

The main causes of OH
is a loss
functionality
skin cover,
morphological abnormalities in
burn areas and
pathological impulses with
injury sites

pathophysiological changes in
burn shock:
spasm of peripheral vessels, and then
their extension,
slow blood flow, stasis,
coagulation disorders,
microthrombosis,
violation of metabolic processes,
hypoxia, acidosis

vascular permeability and
cell membranes,
plasma output in
interstitial space (with
burns over 30% of body surface 4
ml/kg/h),
swelling with aggravation
metabolic disorders due to
increasing the distance between
vascular wall and viable
cells
sodium loss (0.5-0.6 meq
x kg x % burn),

hypovolemia after 6-8 hours,
(due to heat loss and evaporation leaves<
(25 +% burn) x body S (m2) ml / hour,
decrease in contractile
myocardial abilities,
spasm of the pulmonary arteries due to
release of catecholamines and
permeability of vessels with the release of water into
lung parenchyma, - reduction in partial
blood oxygen pressure,

under the action of histamine, serotonin,
thromboxane A 2 increases
airway resistance and
increase in "dead space" in
airways, leading to
aggravation of hypoxia and hypoxemia,

circulatory disorder
in the kidneys (oliguria, anuria), in the liver
(early acute hepatitis) and gastrointestinal tract (erosive and ulcerative
defeat),

metabolic changes, decrease
delivery of oxygen and nutrients
substances to tissues, hyperglycemia
due to the conversion of glycogen to
liver (corticosteroids!) into glucose and
inhibition of insulin
anaerobic metabolic mechanism
due to reduced shipping
oxygen to tissues and increasing
needs, resulting in
there is a large amount of acidic
products and aggravated acidosis.

Thus, they develop

hemodynamic disturbances (increased
heart rate, drop in blood pressure)
low body temperature
oliguria, anuria, hematuria,
dyspnea,
thirst, nausea, vomiting, bloating,
gastrointestinal bleeding
psycho-motor agitation;

an increase in hemoglobin, hematocrit and
erythrocytes, hemolysis,
decrease in circulating blood volume,
decrease in partial pressure of oxygen
blood,
acidosis,
hyponatremia and hyperkalemia,
increase in blood coagulability and viscosity,
hypoproteinemia and dysproteinemia,
azotemia.

All these changes take place in
within 6-8 hours after receiving
injury, so the sooner will
started
preventive measures and
compensating them, the more
chance of a favorable course
burn disease, and lower frequency
severe complications.

Practical experience has shown that clinically expressed manifestations of the general reaction of the body to thermal injury with the possibility of adverse

Practical experience has shown that clinically
pronounced manifestations of a general reaction
body for thermal injury with
the possibility of an unfavorable outcome
develop with burns
over 15-20% of the body surface.
Therefore, all over the world adopted an immediate
conducting such patients with infusion or
oral fluid therapy, which
reduces the severity of the onset disorders and
their consequences, called burn shock.

Refusal to carry out antishock
measures for such burns should be
be considered a gross error.

COMPENSATED burn
shock is observed in young and
middle-aged with unburdened
history, with burns 15-20%
body surface. If defeat
predominantly superficial,
patients experience severe pain and
burning in places of a burn. Therefore, in
the first minutes, and sometimes hours,
victims may be agitated.

COMPENSATED SHOCK

Pulse rate up to 90 beats per minute.
Blood pressure is negligible
elevated or normal. Breath not
changed. Hourly diuresis is not reduced.
If fluid therapy is not
is produced or its start is delayed
for 6-8 hours, can be observed
oliguria and develop moderately
pronounced hemoconcentration

DECOMPENSATED
REVERSIBLE BURNS 21-60%
body surface and is characterized
rapid increase in inhibition,
adynamia with preserved consciousness.
Expressed tachycardia (up to 110 beats per 1
min.). Blood pressure stays
stable only with infusion
therapy and the use of cardiotonic drugs.

DECOMPENSATED REVERSIBLE
Patients are thirsty.
They have dyspepsia.
Intestinal paresis and acute
expansion of the stomach.
Decreases urination. Diuresis
provided only by the use
medical means.

DECOMPENSATED REVERSIBLE
Pronounced hemoconcentration, hematocrit reaches 65/35. From the first
hours after injury is determined
moderate metabolic acidosis with
respiratory compensation.
The victims are cold, body temperature
below the norm. Shock duration
36 - 48 hours.

DECOMPENSATED
IRREVERSIBLE
burn shock develops with
thermal damage over 60%
body surface. Condition of patients
extremely heavy.

1-3 hours after the injury, consciousness
becomes confused, comes
retardation and stupor. Pulse
thready, blood pressure in
the first hours after injury decreases to
80 mmHg and below (against the background of the introduction
kadiotonic, hormonal and
other medications).

Breathing is superficial. Often
vomiting is observed, which may be
repeated, the color of "coffee grounds".
Paresis of the gastrointestinal tract develops
tract.

Urine in the first portions with signs
micro and macrohematuria, then
dark brown with sediment.
Anuria sets in quickly.
Hemoconcentration is detected after 2-3
hours and hematocrit may be over
70/30.

Increasing hyperkalemia and
uncompensated mixed acidosis.
Body temperature may be below 36
degrees C.

Treatment

treatment

ensuring the patency of the respiratory
ways,
central vein catheterization and
start of infusion
bandages on burnt
surface,
bladder catheterization,
insertion of a probe into the stomach.

need to address the issue of
shock or the possibility of its development;
with a positive decision
question should start
implementation of activities
providing active
antishock therapy;

burn surfaces must be closed
dressings with antiseptic ointments or
solutions. With deep, circular
burns of the neck, chest and extremities,
causing circulatory disorders and
breathing requires necrotomy.
If skin burns are combined with
thermoinhalation lesion
respiratory tract, it is necessary to determine
the degree of violation of their patency and
provide for the implementation of cervical vagosympathetic novocaine blockades according to
method of A.V. Vishnevsky.

In the anti-shock chamber it is necessary
provide a microclimate with temperature
air 37.0-37.5 C.

Anesthesia
Volume correction
Rheology improvement
Organ protection

morphinomimetics, taking into account
constitutional and age
characteristics of patients.

Widespread
synthetic opioids with
agonist-antagonistic properties
towards opiate receptors.
The distinguishing feature of the data
analgesics is their minimum
influence on indicators of central and
peripheral hemodynamics in
patients with burn injury
more when there are initial
changes in the above indicators in
period of burn shock.

Additionally used
tranquilizers in small doses,
antipsychotics (mainly droperidol),
GHB. Special attention should be paid
focus on delivery methods
analgesics - intravenous, which
due to existing violations
microcirculation in patients with burn
shock.

Immediate
Start
fluid injection
into the body

It has been found that in burn shock
compensated and
decompensated reversible
absorptive function is preserved and
peristalsis of the gastrointestinal
tract.

Therefore, in the absence of infusion
means should start oral administration
solution of an alkaline-salt mixture, consisting
from 1/2 teaspoon dissolved in 0.5 l of water
drinking soda and 1 teaspoon
salt.
Shown high efficiency
use of dosed administration
fluids through a gastric tube
peristaltic pump.
It is advantageous to combine this method with
infusion therapy

V \u003d 2 ml x burn area in% x mass
body in kg + 2000 ml 5% solution
glucose.
This formula is used for burns
less than 50% of the body surface.

. In severe shock in the calculated volume
should be 2/3 crystalloids and 1/3
colloids, and in extremely severe shock and
burns over 50% of the body surface
crystalloids and colloids are taken in
ratio 1: 1. In burnt older than 50 years
daily volume of infusions due to
small circle overload dangers
blood circulation decreases by 1.5 - 2 times
compared with the calculated one using the Evans formula.

Burn shock can last up to 3
days.

Infusion therapy should be carried out all
time without interruption.
However, on the second day, its volume decreases.
2 times
and on the third day - 3 times compared with
the first days. Fluid infusion rate
the first day should be such that for
the first 8 hours after the burn was
entered at least half of the calculated
daily volume.

This means that if the infusion
therapy starts 2 hours after
injury, then half of the calculated
amount of liquid should be
entered in 6 hours, for which it is necessary
use 2 veins.

In the future, the volume and rate of introduction
medicinal products is adjusted for
based on urine output,
hematocrit, hemoglobin, pulse and
blood pressure dynamics.

Which
from infusion
drugs
most
efficient and
shown at
burn shock and
Why?

For burns from the vascular bed together
plasma leaves a large amount
sodium ions. Therefore liquid
therapy is primarily
the purpose of filling the vascular bed and
restoring the content
sodium. For this, they are used
saline solution or
Ringer's lactate solution.
The latter is more preferable
because its composition is closer to
extracellular fluid.

After the blood pressure
stabilizes, it is advisable to start
administration of isotonic crystalloids.
8-10 hours after the start of treatment with
stable hemodynamics and sufficient
hourly diuresis rate of infusion can be
gradually decrease

Introduction of protein colloidal solutions
it is advisable to start after 12-16 hours
after the start of infusion therapy, when
there is a balance within
and extravascular sectors. largest
the effect is provided by native plasma, which
has all the protein fractions and affects
osmotic and oncotic properties of blood.

Currently in burn shock
do not produce blood transfusions, however,
with large blood loss due to
necrotomy or massive hemolysis
immediately after the patient is taken out of shock
blood transfusion is good
Effect.

For severe and extremely severe
burn shock, with late start
therapy is not possible.
maintain blood pressure
above 90 mm Hg. introduction
crystalloids and colloids in the calculated
quantities.

In such cases, it is advisable not
increase the volume of fluids administered
How can this lead to an increase
interstitial and intracellular
liquid,
and use inotropic drugs,
such as dopamine at a dose of 5-10 mg/kg/min. IN
at this dosage, dopamine improves
myocardial contractility and increase
cardiac output. At a dosage of 1-3 mg / kg / min.
it improves renal perfusion.

If fluid therapy is started at
victim with low blood pressure
pressure after a few hours
injury, then to restore hemodynamics
need for more efficient
large molecular colloid preparations
REFORTAN, STABIZOL, GELOFUZIN

The introduction also applies
glucocorticoid hormones.
During infusion it is necessary to inject
also 6% solution of vitamin C - 10-15 ml,
vitamin B 1 - 1 ml, 2.5% solution
vitamin B 6 - 1 ml, vitamin B solution
12 - 200 micrograms per day.

The greatest difficulty in treatment
burnt occur when combined
skin burns with thermoinhalation
respiratory tract injury. Such
patients for shock abruptly
aggravated by toxic
effects on the respiratory tract and
body as a whole poisonous products
burning.

Features of infusion therapy in
these patients is a necessity
great care in defining
volume and rate of infusion
there is a constant risk of edema development
lungs, and a decrease in the rate and number
intravenous fluids
causes a decrease in renal perfusion,
contributes to the preservation and aggravation
hypovolemia.

In such cases, you can enter
hypertonic sodium solution. Wherein
care must be taken to ensure that the level
plasma sodium did not exceed 160 meq/l.
Administration of hypertonic saline
it is advisable to limit the first 8-10
hours after getting burned, that is
time, the most pronounced violations
permeability of the vascular wall.

In cases where the development
symptoms of respiratory failure,
patients need to be
artificial lung ventilation with
positive expiratory pressure.

Almost always, those who have been burned develop
acidosis. Most often it is metabolic,
compensated by pulmonary function. At
thermoinhalation lesions acidosis
becomes mixed and
uncompensated. Therefore, sick
solution
sodium bicarbonate.
the introduction of 4-5% is necessary

Normalization of rheological properties
blood is carried out by the described
higher than infusion therapy, i.e. at the expense
correction of hypovolemia, as well as due to
use of low doses of heparin (up to
20.000 units per day).

FREQUENCY of Curling stress ulcers in
has decreased recently. It succeeded
be achieved through a comprehensive
organoprotective therapy, complete
anesthesia and normalization of volemic
and rheological indicators. However
essential is the appointment from the first
hours of injury H 2 histamine blockers
receptors (KVAMATEL) and inhibitors
perton pump (OMEZ, LOSEK).

Upon admission of victims with
always gets up with extensive burns
question about the method and place of venipuncture
for infusion therapy. At present
being widely used
central venous catheterization
(subclavian, jugular or
femoral). Such methods of administration
provide an opportunity for adequate
infusion in the first days after injury.

But years of experience have shown that
prolonged use of central
veins for infusion there is a large
number of complications, including
septic, so
catheter and puncture site
meticulous care: regular change
dressings, catheter and heparin application
to prevent thrombosis.

Criteria for the adequacy of the therapy

systolic blood pressure - 95 - 130 mm Hg.
Art.;
CVP - 40 - 60 mm of water;
diuresis (without stimulation) - at least 50 ml / hour;
Heart rate 100 - 120 / min.
Normalization of diuresis, stabilization of arterial
pressure, decrease in hemoconcentration, increase
temperature
body,
termination
dyspeptic
disorders and assimilation of the drunk liquid are
indicators of the adequacy of treatment and the exit of the patient from
burn shock.

BURN DISEASE.

Stage of toxemia: reaches its maximum 2-3 days after the burn and
lasts 1-2 weeks. The patient's body temperature rises
facial features are sharpened, the skin becomes gray, and the lips become cyanotic.
There is a headache, nausea, vomiting, appetite disappears. Sick
may be agitated or apathetic. Increased leukocytosis and ESR,
there is a shift of the leukocyte formula to the left. progresses
hypoproteinemia, the content of residual nitrogen increases,
observed hyperglycemia and acidosis. Protein appears in the urine and
formed elements of blood. The greatest danger is
loss of proteins (up to 150 g / day), and a decrease in BCC can lead to
anuria. Lack of blood supply and tissue hypoxia leads to
to the occurrence of hemorrhages in the mucosa of the gastrointestinal tract
(hemorrhagic erosive gastritis, acute stomach ulcers).

BURN DISEASE.

Stage of septicotoxemia: develops in the next 2-3 weeks
burn disease and depends on a properly constructed and
implemented local treatment and care plan. IN
in some cases, it can be prevented. Sepsis
clinically characterized by a sharp increase in body temperature,
chills, general malaise. The sick are exhausted. growing
leukocytosis and neutrophilia. The content of hemoglobin falls. Processes
epithelialization of wounds stops, granulations become sluggish,
lifeless, pus accumulates under the scab. May form
purulent streaks and phlegmon, bedsores appear. are growing
hepato-renal
failure,
dehydration,
acidosis,
hypoproteinemia, disorders of oxidative processes.

BURN DISEASE.

Stage of convalescence: the timing of its onset depends on
the depth of the burn and the duration of the third stage.
Signs of convalescence are obvious - appearance
the patient improves, appetite appears, increases
body mass. body temperature normalizes and
laboratory parameters (blood, urine).

Local treatment of burns

Treatment of burn injuries can be conservative and
operational. The choice of treatment method depends on the depth of the lesion.
With superficial burns (I-II stage) the only and final
treatment is a conservative method.
With deep (III-IV stage) burns, surgical treatment is necessary -
removal of necrotic tissue and plastic replacement
wounds. Conservative treatment in these cases is only
stage of preoperative preparation.

Local treatment of burns begins with the primary treatment of wounds - treatment with antiseptics, removal of exfoliated epidermis, and foreign bodies (

Local treatment of burns begins with the primary treatment of wounds - treatment
antiseptics, removal of exfoliated epidermis, and foreign bodies
(dermabrasion).
Large bubbles are not removed, they are cut at the base.
1. conservative treatment
carried out: a) in a closed way or b) in an open way.
a) Closed method (using bandages)
For first degree burns, ointment dressings on a water-soluble basis are applied to the wound. At
the development of purulent complications, an additional toilet is carried out and wet-drying dressings are applied with antiseptic solutions (furatsilin, betadine, boric acid ...).
With superficial dermal burns (II st.), they strive to preserve or form dry
scab. For this, wet-drying dressings are used. At 2-3 weeks the scab is rejected
and the surface is epithelized.
With deep burns (III-IV stage), local treatment is aimed at accelerating rejection
necrotic tissues. For this purpose, proteolytic enzymes (trypsin, trivase) are used,
keratolytic agents (40% salicylic, benzoic acid). Necrotic tissues through 48
hours are melted and bloodlessly removed. The bottom of the wound is granulation tissue.
Gradually, the wound is cleared of the remainder of necrosis and epithelized from the edges. extensive wounds
covered with skin plastic.

Primary burn treatment

DERMABRASIA

NECROTOMY

Conducted during the formation
dense circular necrosis,
which, like an armor, covers
limbs or causes
circulatory disorders or
breathing
Necrotomy of the hand with deep CHEMICAL BURNS: Chemical
burns
arise
V
result
direct exposure to chemicals (acids,
alkalis, salts of heavy metals, phosphorus).
Chemical burns of the skin are usually observed. On the second
place in frequency are chemical burns of the oral cavity,
esophagus, stomach. Arising from accidental admission to
domestic conditions of acetic acid, electrolyte, alkali and
etc. Signs of chemical burns can develop with
exposure to chemical warfare agents (mustard gas, lewisite,
napalm).
According to the depth of the lesion, chemical burns are subdivided
on degree:
I degree - erythema and tissue edema.
II degree - the formation of bubbles.
III degree - skin necrosis.
IV degree - damage to deep tissues.

BURNS WITH ACIDS AND SALT OF HEAVY METALS:

Among acids, the most common cause of burns are
sulfuric, hydrochloric, nitric, acetic and oxalic. Act on
tissue very quickly, with its free hydrogen ion
acids take away water from them, bind alkalis and coagulate
cellular proteins, forming acidic albuminates, creating
barrier on the surface of the organ (due to which the penetration
agent in depth is difficult). Coagulation develops
necrosis. A scab is quickly formed, the color of which can
determine the nature of the chemical (for burns with sulfuric
black acid scab, and in case of burns with nitric acid -
yellowish). Under the action of organic acids (acetic,
oxalic) coagulation scab is not formed and aggressive
the reagent easily penetrates into the blood, causing severe
intoxication leading to the development of acute hepatic-renal
insufficiency. When providing first aid - immediate
copious washing for 5-10 minutes. running water, and
then the affected area is treated with a neutralizing
solution - 2% sodium bicarbonate (baking soda) and
apply a dry bandage.

ALKALINE BURNS:

Alkalis (caustic potassium, ammonia, carbon dioxide
sodium, calcium oxide (quicklime), caustic
soda, etc.), acting with hydroxyl ions, take away
tissue water, break down proteins, saponify fats.
colic necrosis develops, causing
changes in deeper layers, as alkali is not
fold proteins. The eschar is thick, pale in color, soft and
loose, after removing it, bleeding is observed. IN
As a result of the breakdown of proteins, toxic
products that cause general intoxication. At
first aid - immediate copious
washing for 5-10 minutes. running water and then
the affected area is treated with a neutralizing
solution - 1-2% acetic, lemon or boric
acid and apply a dry bandage.

ELECTRIC INJURY

The classification of electrical injuries includes 4 degrees of damage:
I degree - short-term convulsive muscle contractions without loss
consciousness;
II degree - convulsive muscle contraction with loss of consciousness, but
preserved breathing and heart function;
III degree - loss of consciousness and violation of cardiac activity and
(or) breathing;
IV degree - instant death.

Staged treatment of victims with electrical burns and electrothermal lesions:

Stage 1 - the place of the incident, first-aid post, ambulance.
Stage 2 - qualified medical assistance in surgical or
traumatology department of the Central District Hospital or Central City Hospital.
Stage 3 - specialized medical care (inter-district and
regional burn departments and cenirs).
Stage 4 - specialized assistance in burn centers

RADIATION INJURIES

Sunstroke.
Heatstroke.
Radiation sickness.

slide 2

Burn (combustion)

This is damage to body tissues that occurs as a result of local action of high temperature, as well as chemicals, electric current or ionizing radiation.

slide 3

Classification of burns: (according to the nature of the damaging factor)

Thermal Chemical Electrical Radiation Mixed (thermal + chemical, radiation + thermal, etc.)

slide 4

By localization:

Functionally active parts of the body (limbs) Fixed parts (torso) Face Scalp Upper respiratory tract Perineum

slide 5

According to the depth of the lesion: (Classification of the XXVII All-Union Congress of Surgeons, 1961)

Superficial: 1 st-reactive changes in the epidermis (skin hyperemia) 2 st-epidermal necrosis (the presence of serous blisters) 3A st- superficial necrosis (up to the growth layer) of the dermis Deep: 3B st-necrosis of all layers of the dermis (with hair follicles, sweat and sebaceous glands). 4 st-necrosis of the entire skin and deeper tissues (subcutaneous tissue, muscles, tendons, bones)

slide 6

According to the depth of the lesion: (Classification of the V.K. Gusak INVH of the Academy of Medical Sciences of Ukraine, approved by the XX Congress of Surgeons of Ukraine, 2002)

Ist-epidermal burn (1+2 st.) IIst - dermal superficial burn (3a st.) IIIst - dermal deep burn (3B st.) IVst - subfascial burn (4th st.) 1961

Slide 7

Superficial burns

Burn with boiling water of the anterior surface of the chest, abdomen, left hand of the 1st degree Burn with boiling water of the right hand of the 2-3a degree

Slide 8

deep burns

Flame burn of the left hand, 3a-3b degree Electric burn of the right hand, 3b-4 degree

Slide 9

By the area of ​​the lesion: (Methods for determining the area of ​​the burn)

The method of A. Wallace (1951) is the “rule of nines” (the surface of the main parts of the body is a multiple of “9”). Method I.I. Glumov (1953) - "rule of the palm" (the area of ​​the palm is G.D. Vilyavin's schemes - the use of stamps with the image of a silhouette of a person in front and behind ("skitz"), divided into squares corresponding to the area of ​​\u200b\u200bthe body. Method of B.N. Postnikov (1949 ) - a sterile cellophane is applied to the burn surface, on which the contours of the burn are applied and the area is calculated using graph paper.

Slide 10

First aid for burns

Terminate the action of the thermal agent on the skin Cool the burnt areas (ice pack or a jet of cold water - for 10-15 minutes) Apply an aseptic dressing Anesthesia and anti-shock therapy (infusion of rheopolyglucin, refortan, hecodese, gelatinol) Delivery of the victim to the hospital

slide 11

With extensive (more than 15-20% of superficial) and deep (more than 10%) lesions, a general reaction of the body develops, which is characterized as a burn disease

Periods of burn disease: I period - burn shock (may last up to 3 days) II period - acute burn toxemia (within 10-15 days before the onset of suppuration) III period - septicotoxemia (from 2-3 weeks to 2-3 months, for throughout the entire period of rejection of necrosis) IV period - convalescence (after healing of burn wounds)

slide 12

Schematic diagram of the treatment of burns

slide 13

General treatment of burns The basis of the general treatment of burns is the impact on the following components: a) Pain control b) Treatment of burn shock c) Treatment of burn toxemia d) Prevention and treatment of infectious complications a) Pain control It is carried out by creating rest, prescribing non-narcotic and narcotic drugs . b) Treatment of burn shock Consists of: Ensuring airway patency, oxygen inhalations Central vein catheterization and infusion therapy Applying dressings on burned surfaces Bladder catheterization Insertion of a probe into the stomach

Slide 14

c) Treatment of burn toxemia is provided by: - ​​infusion therapy - detoxification therapy (plamapheresis, hemosorption) - treatment of acute renal failure - correction of acidosis + 2000 ml of 5% glucose V- volume of infusion, M- weight of the patient in kg, SII-IV- area of ​​burns II-IV stage. in%. The first third of the volume should be administered in the first 8 hours, the second third - in the period of 9-24 hours, the rest during the second day.

slide 15

d) prevention and treatment of infectious complications is carried out in two directions: - antibacterial therapy - stimulation of the immune system Antibiotics are prescribed from the first day after a burn with an area of ​​\u200b\u200bmore than 10% of the body surface. To stimulate the immune system, active immunization with staphylococcal toxoid is used and passive - the introduction of antistaphylococcal plasma, γ-globulin. Recently, Roncoleukin has been successfully used at a dose of 0.5-1 million units.

slide 16

Local treatment of burns

Treatment of burn lesions can be conservative and operative. The choice of treatment method depends on the depth of the lesion. With superficial burns (I-II stage), the only and final method of treatment is a conservative method. With deep (III-IV stage) burns, surgical treatment is necessary - removal of necrotic tissues and plastic replacement of wounds. Conservative treatment in these cases is only a stage of preoperative preparation.

Slide 17

Local treatment of burns begins with the primary treatment of wounds - treatment with antiseptics, removal of exfoliated epidermis, and foreign bodies (dermabrasion). Large bubbles are not removed, they are cut at the base.

1. Conservative treatment is carried out: a) in a closed way or b) in an open way. a) Closed method (using dressings) For first-degree burns, ointment dressings on a water-soluble basis are applied to the wound. With the development of purulent complications, an additional toilet is carried out and wet-drying dressings are applied with antiseptic solutions (furatsilin, betadine, boric acid ...). With superficial dermal burns (II st.), they strive to preserve or form a dry scab. For this, wet-drying dressings are used. At 2-3 weeks, the scab is torn off and the surface is epithelialized. With deep burns (III-IV stage), local treatment is aimed at accelerating the rejection of necrotic tissues. For this purpose, proteolytic enzymes (trypsin, trivase), keratolytic agents (40% salicylic, benzoic acid) are used. Necrotic tissues are melted after 48 hours and bloodlessly removed. The bottom of the wound is granulation tissue. Gradually, the wound is cleared of the remainder of necrosis and epithelized from the edges. Extensive wounds are closed with skin grafting.

To use the preview of presentations, create a Google account (account) and sign in: https://accounts.google.com

Slides captions:

BURN The work of a student of grade 4A GBOU secondary school No. 491 of St. Petersburg Krasnokutsky A.

A burn is one of the dangerous injuries of the skin, mucous membrane

Burns are divided into: Thermal burn (burn as a result of exposure to higher temperatures) Chemical burn (concentrated acids, caustic alkalis) Electrical burn (from electric current) Radiation burn (from ionizing radiation)

Classification of burns 1st degree burns - redness and swelling; 2nd degree burn - blistering; 3rd degree burn - death of the skin (dry or wet death with the melting of dead tissues); 4th degree burn - charring of the skin and underlying tissues (muscles, bones).

First aid for burns First aid for any burns is to eliminate the cause - the damaging factor. Hold the burned area in cool water or apply a wet cold compress (The action of cold water helps to stop the process of skin damage if the burn is mild - 1, 2 degrees) The next step is to apply an aseptic dressing to prevent infection (or cover the entire burn with a clean, dry cloth) If the burn severe, call a doctor.

What not to do with burns Touch the burn with your hands; pierce a blister; Wash the burn injury (if the burn is severe); Tear off sticky clothes; Lubricate the burn with oil, grease, petroleum jelly (will lead to infection, complicates the primary surgical treatment of the injury)

On the topic: methodological developments, presentations and notes

Finding the area of ​​an equilateral triangle....

Presentation on the topic: Burns. Types of burns. Sun burns. Heatstroke

1 out of 30

Presentation on the topic: Burns. Types of burns. Sun burns. Heatstroke

slide number 1

Description of the slide:

slide number 2

Description of the slide:

slide number 3

Description of the slide:

Thermal burns Flame A person gets burns, mainly from burning clothes. Synthetic materials melt and penetrate deep into the skin, and then it is very difficult to separate them. Flame burns are uneven, spotted. 2) Water The skin absorbs water well, therefore such burns are usually large, significant in area and larger than with primary contact. 3) Contact burns occur as a result of skin contact with solid bodies. They occur in 10% of cases.

slide number 4

Description of the slide:

Thermal burns 4) Burns that occur upon contact with various other substances - fats, oils. Burns are small in depth and area, since fats and oils do not spread over the surface of the skin, they have a patchy character. 5) Viscous Substances (tar, tar). 6) A burn with a voltaic arc, similar to a burn with a flame. Skin turns black due to metal impregnation

slide number 5

Description of the slide:

slide number 6

Description of the slide:

Chemical burns 8) Alkali and acid burns Alkali burns are much more dangerous than acid burns, in which coagulation of proteins occurs and a crust is formed, a scab that prevents penetration into the deeper layers. 9) Burns caused by plant alkaloids, for example, those belonging to the buttercup snowdrop family 10) Phosphorus and lime burns

slide number 7

Description of the slide:

Radiation burns 11) Radiation burns include: UV radiation burns. UV radiation causes 2 types of damage: skin cancer and immune system suppression; radiation has a major effect on the hematopoietic, immune, central nervous system.

slide number 8

Description of the slide:

Classification of burns Burns of the 1st degree are manifested by pronounced redness of the skin and swelling of the tissues, accompanied by burning pain and damage to the upper layers of the skin. Second degree burns - In addition to the severe symptoms noted in the 1st degree, the formation of blisters filled with serous fluid is noted. Third degree burns affect all layers of the skin. IV burns are complete destruction of the skin and underlying muscle layer. V degree burns are accompanied by necrosis of deeper layers of tissues and charring of the skin or even an organ, necrosis of not only the skin, but also the underlying tissues.

slide number 9

Description of the slide:

slide number 10

Description of the slide:

First aid for thermal burns The goal is to reduce pain and prevent life-threatening complications. Assistance with burns of I and II degrees: 1) Place the burnt surface under a stream of cold water as soon as possible and hold for 5-10 minutes. 2) Cover with a dry, clean cloth. 3) Apply cold over the fabric (an ice pack or a bag of cold water or snow. - It is unacceptable to lubricate the damaged areas with creams and fats, sprinkle with flour and starch. - Open the bubbles and remove the stuck fabric.

slide number 11

Description of the slide:

First aid for thermal burns Assistance for III, IV and V degree burns: 1) Apply a clean film or cloth to the damaged surface. 2) Place ice packs on top of the film. 3) Give the victim an analgin tablet (if he is conscious) 4) When waiting for an ambulance for a long time, provide the victim with plenty of warm drink.

slide number 12

Description of the slide:

slide number 13

Description of the slide:

Help for chemical burns 1) If the burn is caused by acid (but not sulfuric), then you can wash the burn area with a stream of cold water, and then with an alkaline solution: soapy water or a solution of baking soda. 2) If the burn is from alkali, then after washing with water, it is good to apply a cloth moistened with weak vinegar or lemon juice. Before going to the hospital, the burn is covered with a bandage. 3) If phosphorus gets on the skin, it flares up. The burnt area must be submerged under water. Remove pieces of phosphorus with a stick, apply a bandage. 4) When quicklime gets on the skin, in no case should moisture be allowed to get there - a violent chemical reaction will begin. Burns are treated with any oil.

slide number 14

Description of the slide:

Help with the action of electric current In case of electrical injury, damage occurs not only in the place of direct influence of the current, but the whole body suffers. There may be redness and loss of sensation at the site of impact. But if the current strength was large, if it acted for a long time, if the skin was wet, and for a number of other reasons, deep burns resembling craters can occur at the place of current entry and exit.

slide number 15

Description of the slide:

Help with the action of electric current First of all, it is necessary to stop the action of the electric current. At the same time, it must be remembered that the body of the affected person is a conductor, and if you carelessly touch it, then the assisting person will also receive an electrical injury. Therefore, it is best to turn off the current using a knife switch, electrical plugs. If this is not possible, you need to take the wire away from the affected object with the help of non-conductive current objects: a wooden thing, a cotton product. Burns are covered with a bandage. In severe cases, artificial respiration and chest compressions are performed. And get to the hospital as soon as possible!

slide number 16

Description of the slide:

Lightning strike A lightning strike is a powerful electrical injury. And all the phenomena that occur during the defeat of household electricity will be observed in this case. But there are also differences. When struck by lightning, dark blue spots appear on the skin, resembling the branching of a tree. This is due to paralysis of the vessels. General phenomena in case of lightning strike are also more pronounced. Characterized by the development of paralysis, deafness, dumbness and respiratory paralysis.

slide number 17

Description of the slide:

How to avoid being struck by lightning? If a thunderstorm catches in the forest, you should not hide under tall trees. Free-standing oak, poplar, spruce and pine are especially dangerous. Lightning rarely strikes birch and maple. Being in a thunderstorm in an open place, it is better to sit down in a dry hole or ditch. The body should have as little contact with the ground as possible. During thunderstorms in the mountains, ridges, rock ledges and other elevated points should be avoided.

slide number 18

Description of the slide:

Specialized treatment of burns 1) Closed method In the closed method of treatment, dressings with various substances are applied to the surface of the burn (anti-burn ointment, synthomycin emulsion, dioxidine ointment, etc.) 2) Open method The open method of treatment is used in two forms: a) without treatment of the burn surface tanning agents b) with the creation of a crust (scab) on the surface of the burn by treatment with coagulating preparations.

slide number 19

Description of the slide:

Specialized treatment of burns 3) Mixed method The development of suppuration of the burn surface makes it necessary to switch from the open to the closed method and the use of dressings with various preparations. 4) Surgical method Homoplastic skin grafts are performed for temporary closure of extensive defects in severe condition of the victims.

Description of the slide:

main causes of death Infection. With the development of infection on the burned surface, septic phenomena occur (septic phase of the disease), body temperature rises, chills appear, leukocytosis and neutrophilia increase, anemia, ulcers, etc. develop. Toxemia. It starts from the first hours after the burn, gradually intensifies and, after coming out of shock, determines the condition of the victim in the future. In the development of toxemia, absorption from the burn zone of tissue decay products, toxins plays a role.

slide number 22

Description of the slide:

Stages of care for severe burns The emergency period, depending on the severity of the injury, takes from two days to two weeks after the burn. The acute period begins immediately after the end of the emergency period and continues until all deep injuries are covered with autografts (skin flaps taken from other parts of the patient's body). Rehabilitation is the return of the patient to his usual way of life.

slide number 23

Description of the slide:

Eye burns Thermal burns are caused by flames, hot air and liquids, molten metal, heated or burning particles. Symptoms: sharp pain in the eye, blepharospasm, lacrimation, swelling of the eyelids and conjunctiva, decreased vision. Emergency care: it is necessary to rinse the eyes with water, drip into the eyes a 20% solution of sulfacyl sodium; 20% sul - fapiridazine - sodium; lubricate the wounded surface of the skin with antibiotic ointment. An aseptic bandage is applied to the eye. Anti-tetanus serum (1500-ZOOOME) is injected intramuscularly.

slide number 24

Description of the slide:

Eye burns Chemical burns are acidic and alkaline. Acid burns cause rapid protein clotting, so a limited eschar forms in the first hours. This protects the subject tissue from further damage. Symptoms and course. Complaints of pain, photophobia, lacrimation, decreased vision. The eyelids are hyperemic, edematous. The cornea becomes edematous, dull, with a grayish tinge, in severe cases it acquires a milky tint. First Aid: Flush eyes with water for 10-15 minutes as soon as possible. A 20% solution of sulfacyl sodium, a 10% solution of sulfapyridazine sodium, a solution of furacilin are instilled into the conjunctival cavity.

slide number 25

Description of the slide:

Eye burns Alkaline burns are less favorable. Alkali dissolves the protein and freely penetrates into the tissues. Not only the skin, conjunctiva and cornea suffer. The iris, lens and other tissues of the eye are affected. First aid: flush eyes with plenty of water for 15-30 minutes. If there are particles of a damaging agent, then they must be removed with a tight cotton swab or tweezers, washed again with water. After that, drip a solution of antibiotics, sulfonamides into the eye. A dry aseptic bandage is applied, the patient is sent to the hospital.

Description of the slide:

Prophylaxis Sunscreens Light-blocking creams contain zinc oxide or titanium dioxide, which almost completely block ultraviolet radiation. They are good for sensitive skin areas such as the nose and lips. Sun-reflecting agents They contain substances that partially reflect ultraviolet rays. The most common cause of sunburn is day one excitement. Increase your time in the sun gradually: go from half an hour the first time to no more than 2 hours a day. The most active sun is from noon to 2 o'clock, so it is better not to sunbathe at this time.

slide number 28

Description of the slide:

Heat Stroke HEAT STROKE is a painful condition caused by general overheating of the body and resulting from exposure to external thermal factors. Symptoms The patient has a feeling of general weakness, weakness, headache, dizziness, tinnitus, drowsiness, thirst, nausea. On examination, hyperemia of the skin is revealed.

slide number 29

Description of the slide:

First aid The patient is urgently taken out to a cool place, provided with access to fresh air, freed from clothes, given cold water to drink, a cold compress is applied to the head. In more severe cases, wrapping sheets soaked in cold water, dousing with cool water, ice on the head and groin areas is indicated. But in no case should you give alcohol, drinks containing theine and caffeine (tea, coffee, cocoa).

slide number 30

Description of the slide:

The body's response to hot weather. A person can withstand a temperature of 71°C for 1 hour, 82°C for 49 minutes, 93°C for 33 minutes, and 104°C for only 26 minutes. In 1828, a case was described of a man staying in a furnace for 14 minutes, where the temperature reached 170 ° C. In Belgium, in 1958, a case was registered when a person spent several minutes in a heat chamber at a temperature of 200 ° C! In the naked state, a person can withstand a rapid increase in temperature up to 210 ° C, and in wadded clothing - up to 270 ° C.

Presentation on the topic "Burns" on life safety in powerpoint format. A voluminous presentation will tell you what a burn is, what burns are, how to provide first aid for different types of burns, and also talk about sunburn and heat stroke.

Fragments from the presentation

burns called damage caused by thermal, chemical or radiation energy. The severity of the burn is determined by the size of the area and the depth of tissue damage.

The science that studies burns is called combustiology.

Thermal burns

• Flame. A person receives burns, mainly from catching fire. Synthetic materials melt and penetrate deep into the skin, and then it is very difficult to separate them. Flame burns are uneven, spotted.
• Water. The skin absorbs water well, therefore such burns are usually large, significant in area and larger than with initial contact.
• Contact burns result from contact of the skin with solid bodies. They occur in 10% of cases.
• Burns resulting from contact with various other substances - fats, oils. Burns are small in depth and area, since fats and oils do not spread over the surface of the skin, they have a patchy character.
• Viscous Substances (tar, tar).
• A voltaic arc burn is similar to a flame burn. Skin turns black due to metal impregnation
• Electric shock burns: can be from lightning and household (from electrical appliances). Burns on the area are insignificant, about deep, muscles and bones are damaged.

Chemical burns

• Burns with alkali and acid. Alkali burns are much more dangerous than acid burns, in which coagulation of proteins occurs and a crust is formed, a scab that prevents penetration into the deeper layers.
• Burns caused by plant alkaloids, such as those belonging to the buttercup snowdrop family
• Phosphorus and lime burns

Radiation burns

Radiation burns include: UV radiation burns. UV radiation causes 2 types of damage: skin cancer and immune system suppression; radiation has a major effect on the hematopoietic, immune, central nervous system

Burn classification

• Burns of the 1st degree are manifested by pronounced redness of the skin and swelling of the tissues, accompanied by burning pain and damage to the upper layers of the skin.
• Second degree burns - In addition to the severe symptoms noted in the 1st degree, the formation of blisters filled with serous fluid is noted.
• Third degree burns affect all layers of the skin.
• IV burns are complete destruction of the skin and underlying muscle layer.
• V degree burns are accompanied by necrosis of deeper layers of tissues and charring of the skin or even an organ, necrosis of not only the skin, but also deep-lying tissues.

First aid for chemical burns

1. If the burn is caused by acid (but not sulfuric), then you can wash the burn with a stream of cold water, and then with an alkaline solution: soapy water or a solution of baking soda.
2. If the burn is from alkali, then after washing with water, it is good to apply a cloth moistened with weak vinegar or lemon juice. Before going to the hospital, the burn is covered with a bandage.
3. If phosphorus gets on the skin, it flares up. The burnt area must be submerged under water. Remove pieces of phosphorus with a stick, apply a bandage.
4. When quicklime gets on the skin, in no case should moisture be allowed to get there - a violent chemical reaction will begin. Burns are treated with any oil.