home Audience 6 Radiation burns: clinical signs and emergency measures. Light burns. Eye burns from exposure to infrared rays

Radiation burns: clinical signs and emergency measures. Light burns. Eye burns from exposure to infrared rays

Burn– tissue damage caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. There are 4 degrees of burns based on the depth of tissue damage. Extensive burns lead to the development of the so-called burn disease, which is dangerously fatal due to disruption of the cardiovascular and respiratory systems, as well as the occurrence of infectious complications. Local treatment of burns can be carried out open or closed. It is necessarily supplemented with analgesic treatment, according to indications - antibacterial and infusion therapy.

General information

Burn– tissue damage caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. Minor burns are the most common injury. Severe burns are the second leading cause of accidental death, second only to motor vehicle accidents.

Classification

By localization:

skin burns;
eye burns;
inhalation injuries and burns of the respiratory tract.

According to the depth of the lesion:

I degree. Incomplete damage to the surface layer of the skin. Accompanied by redness of the skin, slight swelling, and burning pain. Recovery in 2-4 days. The burn heals without a trace.
II degree. Complete damage to the surface layer of the skin. Accompanied by burning pain and the formation of small blisters. When the blisters are opened, bright red erosions are exposed. Burns heal without scarring within 1-2 weeks.
III degree. Damage to the superficial and deep layers of the skin.
IIIA degree. The deep layers of the skin are partially damaged. Immediately after the injury, a dry black or brown crust forms - a burn scab. When scalded, the scab is whitish-grayish, moist and soft.

The formation of large bubbles prone to coalescence is possible. When the blisters are opened, a motley wound surface is exposed, consisting of white, gray and pink areas, on which a thin scab resembling parchment is subsequently formed during dry necrosis, and a wet grayish fibrin film is formed during wet necrosis.

Pain sensitivity of the damaged area is reduced. Healing depends on the number of remaining islands of intact deep layers of skin at the bottom of the wound. With a small number of such islands, as well as with subsequent suppuration of the wound, independent healing of the burn slows down or becomes impossible.

IIIB degree. Death of all layers of skin. Possible damage to subcutaneous fat tissue.
IV degree. Charring of the skin and underlying tissues (subcutaneous fat, bones and muscles).

Burns of degrees I-IIIA are considered superficial and can heal on their own (unless secondary deepening of the wound occurs as a result of suppuration). For IIIB and IV degree burns, removal of necrosis followed by skin grafting is required. An accurate determination of the degree of burn is possible only in a specialized medical institution.

By type of damage:

Thermal burns:

Flame burns. As a rule, II degree. Possible damage to a large area of skin, burns to the eyes and upper respiratory tract.
Liquid burns. Mostly II-III degree. As a rule, they are characterized by a small area and large depth of damage.
Steam burns. Large area and shallow depth of damage. Often accompanied by a burn of the respiratory tract.
Burns from hot objects. II-IV degree. Clear boundary, significant depth. Accompanied by detachment of damaged tissues when contact with the object ceases.

Chemical burns:

Acid burns. When exposed to acid, coagulation (folding) of the protein in the tissue occurs, which causes a shallow depth of damage.
Alkali burns. In this case, coagulation does not occur, so the damage can reach significant depth.
Burns from heavy metal salts. Usually superficial.

Radiation burns:

Burns due to exposure to sunlight. Usually I, less often – II degree.
Burns resulting from exposure to laser weapons, airborne and ground-based nuclear explosions. Cause instant damage to parts of the body facing the direction of the explosion, and may be accompanied by eye burns.
Burns resulting from exposure to ionizing radiation. As a rule, superficial. They heal poorly due to concomitant radiation sickness, which increases the fragility of blood vessels and impairs tissue restoration.

Electrical burns:

Small area (small wounds at the charge entry and exit points), large depth. Accompanied by electrical trauma (damage to internal organs when exposed to an electromagnetic field).

Damage area

The severity of the burn, prognosis and choice of treatment measures depend not only on the depth, but also on the area of the burn surfaces. When calculating the area of burns in adults in traumatology, the “rule of palm” and “rule of nines” are used. According to the “rule of the palm,” the area of the palmar surface of the hand approximately corresponds to 1% of the body of its owner. According to the "rule of nines":

the area of the neck and head is 9% of the total surface of the body;
breast – 9%;
belly – 9%;
posterior surface of the body – 18%;
one upper limb – 9%;
one hip – 9%;
one lower leg with foot – 9%;
external genitalia and perineum – 1%.

The child’s body has different proportions, so the “rule of nines” and “rule of the palm” cannot be applied to it. To calculate the burn surface area in children, the Land and Brower table is used. In specialized medical In institutions, the area of burns is determined using special film meters (transparent films with a measuring grid).

Forecast

The prognosis depends on the depth and area of the burns, the general condition of the body, the presence of concomitant injuries and diseases. To determine the prognosis, the lesion severity index (ISI) and the rule of hundreds (RS) are used.

Lesion severity index

Applicable in all age groups. With ITP, 1% of a superficial burn is equal to 1 unit of severity, 1% of a deep burn is 3 units. Inhalation lesions without respiratory dysfunction - 15 units, with respiratory dysfunction - 30 units.

Forecast:

favorable – less than 30 units;
relatively favorable – from 30 to 60 units;
doubtful – from 61 to 90 units;
unfavorable – 91 or more units.

In the presence of combined lesions and severe concomitant diseases, the prognosis worsens by 1-2 degrees.

Hundred Rule

Usually used for patients over 50 years of age. Calculation formula: sum of age in years + area of burns in percentage. A burn to the upper respiratory tract is equivalent to 20% skin damage.

Forecast:

favorable – less than 60;
relatively favorable – 61-80;
doubtful – 81-100;
unfavorable – more than 100.

Local symptoms

Superficial burns up to 10-12% and deep burns up to 5-6% occur predominantly in the form of a local process. There is no disruption of the activity of other organs and systems. In children, the elderly and people with severe concomitant diseases, the “borderline” between local suffering and the general process can be reduced by half: to 5-6% for superficial burns and up to 3% for deep burns.

Local pathological changes are determined by the degree of the burn, the period of time since the injury, secondary infection and some other conditions. First degree burns are accompanied by the development of erythema (redness). Second degree burns are characterized by vesicles (small blisters), while third degree burns are characterized by bullae (large blisters with a tendency to merge). When the skin peels off, spontaneously opens or removes the blister, erosion (bright red bleeding surface, devoid of the superficial layer of skin) is exposed.

With deep burns, an area of dry or wet necrosis forms. Dry necrosis is more favorable and looks like a black or brown crust. Wet necrosis develops when there is a large amount of moisture in the tissues, large areas and a large depth of the lesion. It is a favorable environment for bacteria and often spreads to healthy tissue. After rejection of areas of dry and wet necrosis, ulcers of varying depths are formed.

Burn healing occurs in several stages:

Stage I. Inflammation, cleansing the wound from dead tissue. 1-10 days after injury.
Stage II. Regeneration, filling the wound with granulation tissue. It consists of two substages: 10-17 days - cleansing the wound of necrotic tissue, 15-21 days - development of granulations.
Stage III. Scar formation, wound closure.

In severe cases, complications may develop: purulent cellulite, lymphadenitis, abscesses and gangrene of the extremities.

General symptoms

Extensive lesions cause burn disease - pathological changes in various organs and systems, in which protein and water-salt metabolism is disrupted, toxins accumulate, the body's defenses are reduced, and burn exhaustion develops. Burn disease, combined with a sharp decrease in motor activity, can cause dysfunction of the respiratory, cardiovascular, urinary system and gastrointestinal tract.

Burn disease occurs in stages:

Stage I. Burn shock. Develops due to severe pain and significant loss of fluid through the surface of the burn. Represents a danger to the patient's life. Lasts 12-48 hours, in some cases – up to 72 hours. A short period of excitement is replaced by increasing retardation. Characterized by thirst, muscle tremors, chills. Consciousness is confused. Unlike other types of shock, blood pressure rises or remains within normal limits. The pulse quickens and urine output decreases. The urine becomes brown, black or dark cherry, and has a burning smell. In severe cases, loss of consciousness is possible. Adequate treatment of burn shock is possible only in specialized medical care. institution.

Stage II. Burn toxemia. Occurs when tissue breakdown products and bacterial toxins are absorbed into the blood. Develops within 2-4 days from the moment of injury. Lasts from 2-4 to 10-15 days. Body temperature is increased. The patient is excited, his consciousness is confused. Convulsions, delirium, auditory and visual hallucinations are possible. At this stage, complications from various organs and systems appear.

From the cardiovascular system - toxic myocarditis, thrombosis, pericarditis. From the gastrointestinal tract - stress erosions and ulcers (may be complicated by gastric bleeding), dynamic intestinal obstruction, toxic hepatitis, pancreatitis. From the respiratory system - pulmonary edema, exudative pleurisy, pneumonia, bronchitis. From the kidneys – pyelitis, nephritis.

Stage III. Septicotoxemia. It is caused by a large loss of protein through the wound surface and the body’s response to infection. Lasts from several weeks to several months. Wounds with a large amount of purulent discharge. Healing of burns stops, areas of epithelialization decrease or disappear.

Characterized by fever with large fluctuations in body temperature. The patient is lethargic and suffers from sleep disturbances. No appetite. There is a significant weight loss (in severe cases, a loss of 1/3 of body weight is possible). Muscles atrophy, joint mobility decreases, and bleeding increases. Bedsores develop. Death occurs from general infectious complications (sepsis, pneumonia). In a favorable scenario, the burn disease ends with recovery, during which the wounds are cleaned and closed, and the patient’s condition gradually improves.

First aid

Contact with the damaging agent (flame, steam, chemical, etc.) must be stopped as quickly as possible. With thermal burns, the destruction of tissue due to their heating continues for some time after the cessation of the destructive effect, so the burned surface must be cooled with ice, snow or cold water for 10-15 minutes. Then, carefully, trying not to damage the wound, cut off the clothing and apply a clean bandage. A fresh burn should not be lubricated with cream, oil or ointment - this can complicate subsequent treatment and impair wound healing.

For chemical burns, rinse the wound thoroughly with running water. Burns with alkali are washed with a weak solution of citric acid, burns with acid - with a weak solution of baking soda. A burn with quicklime should not be washed with water; instead, vegetable oil should be used. For extensive and deep burns, the patient must be wrapped up, given painkillers and a warm drink (preferably a soda-salt solution or alkaline mineral water). A burn victim should be taken to a specialized medical facility as quickly as possible. institution.

Treatment

Local therapeutic measures

Closed treatment of burns

First of all, the burn surface is treated. Foreign bodies are removed from the damaged surface, and the skin around the wound is treated with an antiseptic. Large bubbles are trimmed and emptied without removal. The peeled skin adheres to the burn and protects the wound surface. The burned limb is placed in an elevated position.

At the first stage of healing, drugs with analgesic and cooling effects and medications are used to normalize the condition of tissues, remove wound contents, prevent infection and reject necrotic areas. Aerosols with dexpanthenol, ointments and solutions on a hydrophilic basis are used. Antiseptic solutions and hypertonic solution are used only when providing first aid. In the future, their use is impractical, since the dressings dry out quickly and prevent the outflow of contents from the wound.

In case of IIIA burns, the scabs are preserved until they are rejected on their own. First, aseptic dressings are applied, and after the scab is rejected, ointment dressings are applied. The purpose of local treatment of burns at the second and third stages of healing is protection against infection, activation of metabolic processes, and improvement of local blood supply. Medicines with hyperosmolar action, hydrophobic coatings with wax and paraffin are used to ensure the preservation of the growing epithelium during dressings. For deep burns, the rejection of necrotic tissue is stimulated. Salicylic ointment and proteolytic enzymes are used to melt the scab. After cleansing the wound, skin grafting is performed.

Open treatment of burns

It is carried out in special aseptic burn wards. Burns are treated with drying antiseptic solutions (potassium permanganate solution, brilliant green, etc.) and left without a bandage. In addition, burns of the perineum, face, and other areas that are difficult to apply a bandage are usually treated openly. In this case, ointments with antiseptics (furacilin, streptomycin) are used to treat wounds.

A combination of open and closed methods of treating burns is possible.

General therapeutic measures

Patients with recent burns have increased sensitivity to analgesics. In the early period, the best effect is ensured by frequent administration of small doses of painkillers. Subsequently, an increase in dose may be required. Narcotic analgesics depress the respiratory center and are therefore administered by a traumatologist under breathing control.

The selection of antibiotics is based on determining the sensitivity of microorganisms. Antibiotics are not prescribed prophylactically, as this can lead to the formation of resistant strains that are resistant to antibiotic therapy.

During treatment, it is necessary to replace large losses of protein and fluid. For superficial burns of more than 10% and deep burns of more than 5%, infusion therapy is indicated. Under the control of pulse, diuresis, arterial and central venous pressure, the patient is administered glucose, nutrient solutions, solutions to normalize blood circulation and acid-base status.

Rehabilitation

Rehabilitation includes measures to restore the patient’s physical (therapeutic gymnastics, physiotherapy) and psychological state. Basic principles of rehabilitation:

early onset;
clear plan;
eliminating periods of prolonged immobility;
constant increase in physical activity.

At the end of the primary rehabilitation period, the need for additional psychological and surgical assistance is determined.

Inhalation lesions

Inhalation injuries occur as a result of inhalation of combustion products. They develop more often in people who have received burns in a confined space. They aggravate the victim’s condition and can pose a danger to life. Increase the likelihood of developing pneumonia. Along with the area of burns and the age of the patient, they are an important factor influencing the outcome of the injury.

Inhalation lesions are divided into three forms, which can occur together or separately:

Carbon monoxide poisoning.

Carbon monoxide prevents the binding of oxygen to hemoglobin, causing hypoxia, and with a large dose and prolonged exposure, death of the victim. Treatment is artificial ventilation with 100% oxygen.

Burns of the upper respiratory tract

Burn of the mucous membrane of the nasal cavity, larynx, pharynx, epiglottis, large bronchi and trachea. Accompanied by hoarseness of voice, difficulty breathing, sputum with soot. Bronchoscopy reveals redness and swelling of the mucous membrane, in severe cases - blisters and areas of necrosis. Swelling of the airways increases and reaches its peak on the second day after injury.

Damage to the lower respiratory tract

Damage to the alveoli and small bronchi. Accompanied by difficulty breathing. If the outcome is favorable, it will be compensated within 7-10 days. May be complicated by pneumonia, pulmonary edema, atelectasis and respiratory distress syndrome. Changes on the x-ray are visible only on the 4th day after the injury. The diagnosis is confirmed when the partial pressure of oxygen in arterial blood decreases to 60 mm or lower.

Treatment of burns of the respiratory tract

Mostly symptomatic: intensive spirometry, removal of secretions from the respiratory tract, inhalation of a humidified air-oxygen mixture. Prophylactic treatment with antibiotics is ineffective. Antibacterial therapy is prescribed after bacterial culture and determination of the sensitivity of pathogens from sputum.

itchy skin

diaper rash

dermatitis

peeling and dry skin

cuts

frostbite

abrasions

calluses

Burns: types of burns and degrees, treatment of burns with KEEPER balm

Burns is damage to body tissue caused by exposure to high temperatures or chemicals. Electric shock, as well as exposure to ionizing radiation (ultraviolet, X-ray, etc., including solar radiation), can also cause a burn.

Often burns are also called skin lesions caused by the irritating effect of a plant (nettle burn, hogweed burn, hot pepper burn), although in essence this is not a burn - it is phytodermatitis.

Depending on the area of tissue damage, burns are divided into burns of the skin, eyes, mucous membranes, burns of the respiratory tract, esophagus, stomach, etc. The most common are, of course, skin burns, so in the future we will consider this type of burn.

Heaviness burn determined by the depth and area of tissue damage. The concept of “burn area” is used to characterize the area of skin damage and is expressed as a percentage. To classify the depth of a burn, the concept “degree of burn” is used.

Types of burns

Depending on the damaging factor, skin burns are divided into:

thermal,
chemical,
electrical,
sun and other radiation burns (from ultraviolet and other types of radiation)

Thermal burn

Thermal burn is the result of exposure to high temperature. This is the most common household injury. They occur as a result of exposure to open flame, steam, hot liquid (boiling water, hot oil), or hot objects. The most dangerous, of course, is open fire, since in this case the organs of vision and the upper respiratory tract can be affected. Hot steam is also dangerous for the respiratory tract. Burns from hot liquids or hot objects are usually not very large in area, but deep.

Chemical burn

Chemical burn occurs as a result of exposure to chemically active substances on the skin: acids, alkalis, salts of heavy metals. They are dangerous if the affected area is large, as well as if chemicals come into contact with mucous membranes and eyes.

Electrical burns

Electrical shock is characterized by the presence of several burns of a small area, but of great depth. Voltage arc burns are superficial, similar to flame burns and occur during short circuits without current passing through the victim’s body.

Radiation burns

This type of burn includes burns that occur as a result of exposure to light or ionizing radiation. Thus, solar radiation can cause the well-known sunburn. The depth of such a burn is usually 1st degree, rarely 2nd degree. A similar burn can also be caused by artificial ultraviolet irradiation. The extent of damage from radiation burns depends on the wavelength, intensity of radiation and duration of exposure.

Burns from ionizing radiation are usually shallow, but their treatment is difficult, since such radiation penetrates deeply and damages the underlying organs and tissues, which reduces the skin's ability to regenerate.

Degree of skin burn

The degree of burn is determined by the depth of damage to the various layers of the skin.

Recall that human skin consists of epidermis, dermis and subcutaneous fat (hypodermis). The top layer, the epidermis, in turn consists of 5 layers of varying thickness. The epidermis also contains melanin, which colors the skin and causes the tanning effect. The dermis, or the skin itself, consists of 2 layers - the upper papillary layer with capillary loops and nerve endings, and the reticular layer containing blood and lymphatic vessels, nerve endings, hair follicles, glands, as well as elastic, collagen and smooth muscle fibers, giving the skin strength and elasticity. Subcutaneous fat consists of bundles of connective tissue and fat accumulations, penetrated by blood vessels and nerve fibers. It provides nutrition to the skin, serves for thermoregulation of the body and additional protection of organs.

Clinical and morphological classification of burns, adopted at the XXVII All-Union Congress of Surgeons in 1961, distinguishes 4 degrees burn.

First degree burn

I degree burn is characterized by damage to the most superficial layer of the skin (epidermis), consisting of epithelial cells. In this case, redness of the skin, slight swelling (edema), and tenderness of the skin in the burn area appear. Such a burn heals in 2-4 days, no traces remain after the burn, except for minor itching and peeling of the skin - the upper layer of the epithelium dies.

Second degree burn

A second degree burn is characterized by deeper tissue damage - the epidermis is partially damaged to the full depth, down to the germ layer. Not only redness and swelling are observed, but also the formation of blisters with a yellowish liquid on the skin, which can burst on their own or remain intact. Bubbles form immediately after a burn or after some time. If the bubbles burst, a bright red erosion forms, which is covered with a thin brown crust. Healing for a second degree burn usually occurs in 1-2 weeks, through tissue regeneration due to the preserved germ layer. There are no marks left on the skin, but the skin may become more sensitive to temperature influences.

Third degree burn

III degree burn is characterized by complete death of the epidermis in the affected area and partial or complete damage to the dermis. Tissue necrosis (necrosis) and the formation of a burn scab are observed. According to the accepted classification, III degree burns are divided into:

degree III A, when the dermis and epithelium are partially damaged and independent restoration of the skin surface is possible if the burn is not complicated by infection,
and degree III B - complete death of the skin down to the subcutaneous fat. As healing occurs, scars form.

IV degree burn

A fourth degree burn is the complete destruction of all layers of skin and underlying tissues, charring of muscles and bones.

Determination of the area affected by a burn

Approximate area estimate burn can be produced in two ways. The first method is the so-called “rule of nines”. According to this rule, the entire surface of the skin of an adult is conditionally divided into eleven sections of 9% each:

head and neck - 9%,
upper limbs - 9% each,
lower limbs - 18% (2 times 9%) each,
posterior surface of the body - 18%,
anterior surface of the body - 18%.

The remaining one percent of the body surface is in the perineal area.

The second method - the palm method - is based on the fact that the area of the palm of an adult is approximately 1% of the total surface of the skin. For local burns, use the palm to measure the area of damaged skin areas; for extensive burns, measure the area of unaffected areas.

The larger the area and deeper the tissue damage, the more severe the burn injury. If deep burns occupy more than 10-15% of the body surface, or the total area of even shallow burns makes up more than 30% of the body surface, the victim develops a burn disease. The severity of a burn disease depends on the area of the burns (especially deep ones), the age of the victim, the presence of concomitant injuries, diseases and complications.

Prognosis for recovery from burns

To assess the severity of the lesion and predict the further development of the disease, various prognostic indices are used. One of these indices is the lesion severity index (Frank index).

When calculating this index, each for each percentage of the burn area gives from one to four points - depending on the degree of the burn, a burn of the respiratory tract without breathing impairment - 15 points additionally, with a violation - 30. The index values are interpreted as follows:

< 30 баллов - прогноз благоприятный
30-60 - conditionally favorable
61-90 - doubtful
> 91 - unfavorable

Also, to assess the prognosis of burn injury in adults, the “hundred rule” is applied: if the sum of the numbers of the patient’s age (in years) and the total area of damage (in percent) exceeds 100, the prognosis is unfavorable. Burns of the respiratory tract significantly worsen the prognosis, and to take into account its influence on the “rule of hundreds” indicator, it is conventionally accepted that it corresponds to 15% of a deep burn of the body. The combination of a burn with damage to bones and internal organs, with carbon monoxide poisoning, smoke, toxic combustion products or exposure to ionizing radiation aggravates the prognosis.

Burn disease in children, especially younger ones, can develop when only 3-5% of the body surface is affected, in older children - 5-10%, and is more severe the younger the child. Deep burns of 10% of the body surface are considered critical in young children.

Treatment of burns

Burns Grades I and II are considered superficial and heal without surgery. Burns of III A degree are classified as borderline, and III B and IV degrees are deep. In case of burns of degree III A, independent tissue restoration is difficult, and treatment of burns of degrees III B and IV without surgical intervention is impossible - a skin graft is required.

Self-treatment, without consulting a doctor, is only possible for I-II degree burns, and only if the burn area is small. If the area of the second degree burn is more than 5 cm in diameter, you should consult a doctor. Treatment of adult patients with first-degree burns, even extensive ones, can be carried out on an outpatient basis. For more severe burns, adult patients can be treated on an outpatient basis in cases where the skin of the face, lower extremities or perineum is not affected, and the burn area does not exceed:

for second degree burns - 10% of the body surface;
for III A degree burns - 5% of the body surface.

The method of treating a burn depends on its type, the degree of the burn, the area affected and the age of the patient. Thus, even small-area burns in young children require mandatory medical intervention, and often hospital treatment. Elderly people also suffer from burns with difficulty. It is advisable to treat victims over 60 years of age with limited degree II-IIIA burns, regardless of their location, in a hospital setting.

First of all, in case of a burn, you must urgently stop the action of the damaging factor (high temperature, chemical substance) on the skin. For a superficial thermal burn - with boiling water, steam, or a hot object - wash the burned area generously with cold water for 10-15 minutes. In case of a chemical burn with acid, the wound is washed with a soda solution, and in case of a burn with alkali - with a weak solution of acetic acid. If the exact composition of the chemical is unknown, wash with clean water.

If the burn is extensive, the victim should be given at least 0.5 liters of water to drink, preferably with 1/4 teaspoon of baking soda and 1/2 teaspoon of table salt dissolved in it. Give 1-2 g of acetylsalicylic acid and 0.05 g of diphenhydramine orally.

You can try to treat a first-degree burn yourself. But if the victim has a significant burn of the second degree (blister with a diameter of 5 cm or more), and even more so with burns of the third degree or higher, you need to urgently consult a doctor.

For IIIA degree burns, treatment begins with wet-dry dressings that promote the formation of a thin scab. Under a dry scab, IIIA degree burns can heal without suppuration. After rejection and removal of the scab and the beginning of epithelization, oil-balsamic dressings are used.

For the treatment of I-II degree burns, as well as at the stage of epithelization in the treatment of III A degree burns, the Guardian balm showed good results. It has analgesic, anti-inflammatory, antiseptic, regenerating properties. Balm Guardian relieves inflammation, accelerates skin regeneration, promotes wound healing, and prevents scar formation. Apply directly to the affected area, or use for ointment aseptic dressings.

Radiation, or radiation, burns are skin lesions caused by ion or light irradiation, their structure reminiscent of burns received from the sun. Such injuries can occur due to nuclear accidents, radioactive fallout, radiation treatments and x-ray diagnostics. A radiation burn differs from a sunburn primarily in its delayed manifestation, which means that a person does not immediately detect the consequences of an incident or procedure.

Burn degrees

A radiation burn to the eyes or skin can have one of 4 degrees of severity:

I degree. Burns appear approximately 2 weeks after a small dose of radiation and are the least dangerous. The lesion is small and is expressed in the form of slight redness and exfoliation of the upper layers of the skin;
II degree. With such a burn, symptoms appear less than 2 weeks after receiving average doses of radiation. Damage of this degree is characterized by the appearance of blisters, secondary erythema, extensive redness and is sometimes accompanied by pain;
III degree. The onset of symptoms is observed from 3 to 6 days, accompanied by the appearance of skin swelling, severely healing ulcers and erosions, blisters with possible manifestation of necrosis.
IV degree. Radiation skin burns of this type are considered the most severe and dangerous. Symptoms appear almost immediately after negative exposure. Such a burn is expressed by damage to the upper layer of the skin and muscles, the occurrence of ulcers, and necrotic processes.

To damage from degrees II to IV, in addition to the above manifestations, regional lymphadenitis, fever and leukocytosis may also be added.

Symptoms of radiation burn

Burns from radiation and ionizing radiation may have the following symptoms, which vary in severity.

with mild severity, itching, a slight burning sensation appears, the skin begins to peel, pigment spots appear, slight swelling, and baldness of the injured area may also occur;
moderate burns are accompanied by the appearance of blisters, headache, nausea, secondary erythema, lethargy and weakness;
Severe radiation burns combine the appearance of swelling, painful erythema, erosions, ulcers, which are accompanied by high leukocytosis and fever.

The most severe level of damage, usually called extremely severe, includes many of the symptoms listed above, and is also known for the appearance of necrosis of the muscles and the top layer of skin.

Course of the disease

During radiation damage to the skin and mucous membranes, a total of 4 periods are distinguished.

If thermal burns are characterized by coagulation of proteins, then a radioactive burn is accompanied by ionization of tissues with secondary degeneration (tissue and cellular degeneration) of proteins.

First aid

First aid for radiation burns is performed by applying wipes soaked in a disinfected solution to the affected area. In the first 10 hours after irradiation, the affected areas are washed with soapy water.. It is advisable to apply baby ointment to the damaged area. When possible, a full treatment is performed in a medical facility and anti-tetanus serum and anesthetic are administered.

Treatment

I and II degree burns do not require medical treatment. Rehabilitation of the affected areas occurs independently. To speed things up, it is also recommended to adhere to a high-calorie, salt-free diet, use folk remedies that help accelerate skin regeneration, preferably including sea buckthorn and aloe extracts, as well as additional balms and gels that eliminate both damage and itching, burning, etc.

The skin of the affected area is rewound with a bandage pre-moistened in an antiseptic solution; this method is used to stop the inflammatory process. If the wound gets infected, the doctor prescribes a course of sulfonamides and antibiotics. If the victim has severe pain, then analgesics are prescribed. The entire period of treatment is accompanied by taking vitamins.

If the problem cannot be eliminated by conservative treatment methods, then surgical intervention comes to the rescue. This treatment method is used even for moderate burns. During internal treatment, the area affected by necrosis is removed.

Disease prevention

During therapy, it is impossible to avoid radiation burns, but there are several recommendations that can significantly reduce the chance of such damage:

the doctor who is engaged in treatment must individually, based on the condition of your body, prescribe the frequency and dose of ionizing radiation;
areas of the skin that are exposed to radiation should be periodically lubricated with products that promote effective healing. It is recommended to perform such procedures at night.

Complications

Complications can be caused not only by a radiation burn, but also by the radiation therapy itself. Damage of this type can cause a deterioration in a person’s general condition; the most dangerous consequences include possible bleeding and infection of injured areas. If severe damage is received, the condition of the entire human body deteriorates significantly, and the greatest harm is caused to the organ that is located closest to the irradiation site.

Under no circumstances should you self-medicate. As soon as you see similar symptoms, immediately contact a specialist. If the doctor prescribes an effective course of treatment, the recovery period will be significantly shorter than with self-medication, and the risk of complications will be significantly reduced.

MINISTRY OF INTERNAL AFFAIRS OF RUSSIA

Training center of the Main Internal Affairs Directorate of the Stavropol Territory

Cycle of Special Disciplines

TEST

by discipline:

"Medical training"

Performed:

Listener of the 21st police platoon

Borisova Yu.A.

Checked :_____________________

Grade:________________________

Stavropol 2002
Content:

Introduction

Conclusion

Bibliography

INTRODUCTION

Burns are a frequent and severe injury, the mortality rate of which is still very high. Every year in Europe and the USA, more than 200 thousand patients with burns require hospital treatment. Within 1 year, about 60 thousand people die from burns in European countries; Among them, a large group are children. Many of those who recover are left with disfiguring scars. Being complex and not fully understood, the problem of burns continues to attract the attention of scientists, practical surgeons and health care managers. Treatment of burnt victims, especially children, is labor-intensive and time-consuming. It requires special knowledge, equipment, conditions and high professional skills from medical workers.

Currently, specialized centers and departments have been created in Russia and in many countries around the world to improve medical care for those burned. They use modern methods of care and treatment of patients. To work in such departments, medical personnel must be properly trained. refers to tissue damage caused by heat, chemicals, radiation, and electrical current. According to the etiological factor, burns are called thermal, chemical, radiation and electrical.

THERMAL BURNS

Thermal burns are the most common type of injury and account for 90-95% of all burns. It should be noted that burns at work account for only 25-30% of all injuries, the remaining 75% are household injuries.

The most common burns occur from exposure to flame, hot liquid, steam, and also from contact with hot objects. For the formation of a burn, not only the temperature of the traumatic factor is important, but also the duration of its impact.

In peacetime, the share of burns among other injuries is 10-12%. During World War II, burns accounted for about 2% of all injuries. Currently, due to the use of new types of weapons (napalm, phosphorus), especially in cases of the use of nuclear weapons, the structure of sanitary losses can change dramatically: the proportion of those burned will be 80% or more of all victims. In this case, burns can be either primary (thermal and light radiation during a nuclear explosion) or secondary (fires, gas explosions, electrical injuries, etc.).

With burns, there is always a general reaction of the body to injury. If with small burns it manifests itself only as a natural reaction to pain and does not entail any significant functional changes, then with extensive burns more or less pronounced disturbances in the functioning of organs and systems always occur, up to the most severe ones, leading to death.

The pathological state of the body that occurs in response to a burn is called burn disease.

The following periods of burn disease are distinguished: 1) burn shock; 2) acute burn toxemia; 3) acute septicotoxemia; 4) convalescence.

The severity of a burn disease is determined by two factors - the extent of the burn, i.e. area defeats, and the depth of tissue damage - ste burn stump.

The skin consists of two layers - epithelial tissue - epidermis and connective tissue - dermis. The epidermis is constantly renewed due to the growth of new epithelial cells - basal and spinous. The layer of basal cells contains the superficial endings of blood vessels that provide blood supply to the skin. If the cells of the germ layer die, the growth of the epithelium in the affected area does not occur and the defect is closed by secondary intention with the help of connective tissue - the scar.

Depending on whether the germ layer is affected or not, that is, whether epithelization is possible in the future or not, all burns are divided into superficial and deep, distinguishing four degrees, which are shown in the figure.

Figure - classification of burns.

Local manifestations: A - 1st degree - hyperemia, B - 2nd degree - blistering, C - 3rd degree - skin necrosis, D - 4th degree - charring

Burns of I, II and IIIA degrees are called superficial, since only the superficial layers of the epidermis are affected. Deeper skin lesions are observed with third and fourth degree burns. Third degree burns are divided into IIIA and P1B degrees. With IIIA degree burns, partial damage to the germinal and basal layers of the skin occurs and independent epithelization is possible (such burns are classified as superficial). With SB degree burns, the death of all layers of the skin is noted - the epidermis and dermis (deep burns).

First degree burn - hyperemia and swelling of the affected area, burning sensation. In this case, no cell death is observed.

Second degree burn - small, relaxed blisters with light contents (blood plasma). Around the blisters there are areas of hyperemia. Burning sensation. Bubbles appear due to the detachment of the upper layers of the epidermis by blood plasma that has sweated from the vessels of the basal layer.

IIIA degree burn - extensive, tense, with jelly-like contents or destroyed blisters. In place of the destroyed bladder there is a moist pink surface with areas of pale, whitish color (affected basal layer). Pain sensitivity is reduced.

SB degree burn - extensive blisters with hemorrhagic contents. In place of the destroyed blisters there is a dense, dry, dark gray scab (thrombosis of skin vessels and coagulation of cellular protein).

A fourth degree burn is a burn eschar with a dense consistency, such as thick paper or cardboard, brown or black. Sometimes you can see through it a thrombosed vascular network and charring.

CHEMICAL BURNS

Chemical burns occur as a result of contact with the skin of acids, alkalis and other chemically active substances. The depth of the burn depends on the concentration of the chemical agent, its temperature and duration of exposure.

When providing first aid, it is necessary to create conditions for the rapid removal of the chemical agent, reducing the concentration of its residues on the skin, and cooling the affected areas. The most effective way is to wash the skin with running water (except in cases of burns with quicklime). In case of a burn with acids, it is reasonable to wash the surface of the burn with weak solutions of alkalis (sodium bicarbonate), and in case of a burn with alkalis - with acids (0.01% solution of hydrochloric acid, 1-2% solution of acetic acid). The sooner the chemical agent is removed, the less destruction the tissue will undergo, so it is advisable to begin a long (at least 20-30 minutes) rinsing of the affected area with running water before preparing the neutralizing solution.

If clothing becomes saturated with a chemically active substance, you should try to remove it quickly. In some cases, it is advisable to first start rinsing with a strong stream of running water using a hose placed under clothing. This creates a layer of water that isolates the skin from clothing soaked in the chemical. After 5-10 minutes from the start of washing, be careful not to cause burns to the person providing assistance and not to spread the chemical agent to unaffected tissues, remove clothing and continue washing the burn site.

The exception is cases when, due to the chemical nature of the damaging substance, its contact with water is contraindicated. For example, diethylaluminum hydrate and triethylaluminum ignite when combined with water, and when water comes into contact with quicklime or concentrated sulfuric acid, heat is generated, which can lead to additional thermal damage. It is not recommended to extinguish napalm with small portions of water, as this will cause splashing of the mixture and significant vaporization, which may cause an increase in the affected area.

Chemical burns are in many ways similar to thermal burns, but have a number of features. Acid burns occur as coagulative necrosis, with the formation of complexes of acidic proteinates, protein breakdown and severe tissue dehydration - a dense scab appears.

Alkali burns are characterized by the formation of liquefaction necrosis. Alkalis break down proteins, forming alkaline proteinates, and saponify fats. Through damaged skin, alkalis penetrate into deeper tissues, causing their damage.

Extensive burns caused by various chemicals can lead to significant changes in internal organs. Thus, phosphorus and its compounds, picric acid have a nephrotoxic effect, tannic and phosphoric acids cause liver damage. These features must be taken into account when carrying out general treatment. Local treatment of chemical burns in a hospital and clinic is not fundamentally different from the treatment of thermal burns.

ELECTRIC BURNS

Electrical burns occur at the site of direct contact with a current source, shown in the figure.

Drawing. Electric shock and lightning.

A - general effect of electric current. B - local impact of electric current, B - trace of lightning. G - removal of the effect of electric current

They differ significantly from ordinary thermal burns. Electrical burns in the form of a “current mark” can be pinpoint or have significant dimensions, depending on the area of skin contact with the electrical agent. In the first hours, these “current marks” look like whitish or brownish spots, in place of which a dense scab subsequently forms. A feature of electrical burns is, as a rule, deep damage not only to the skin, but also to the underlying tissues. In this case, local damage to the skin can be accompanied by significant destruction of muscles and bones. The local wound process, which occurs according to general laws, is accompanied in the early stages by severe intoxication due to massive tissue destruction, and subsequently often gives purulent complications (phlegmon, edema). Local treatment of electrical burns and deep thermal burns has no fundamental differences.

Light burns.

The radiant energy released during the explosion (visible infrared and partly ultraviolet rays) leads to so-called flash burns. Secondary flame burns from objects and flaming clothing are also possible. Light burns most often occur on open areas of the body facing the direction of the explosion, and are called profile, or contour, but can also appear on areas covered by dark-colored clothing, especially in places where clothing fits tightly to the body - contact burns. The course and treatment of light burns are the same as thermal burns.

RADIATION BURNS

Ionizing radiation, i.e., flows of elementary particles and electromagnetic quanta resulting from nuclear reactions or radioactive decay, entering the human body, are absorbed by tissues. The energy released during this process destroys the structure of living cells, depriving them of the ability to regenerate, and causes various pathological conditions, both local and general.

The biological effect of ionizing radiation is determined by the radiation energy, its nature, mass and penetrating ability.

The first pathological condition of living tissues under the influence of ionizing radiation, which was observed after the discovery of X-rays and radioactivity, was radiation burns of the skin.

Reports of the appearance of “X-ray burns” appeared already at the beginning of 1886 and were associated with the beginning of widespread X-ray studies in medicine in the absence of experience in their use. Subsequently, with the development of physics and the advent of nuclear energy, in addition to X-rays, other types of ionizing radiation appeared.

The effect of radiation on the body is measured by the amount of radiation energy absorbed by tissues, the unit of which is the gray (Gy). In practice, measuring the absorbed energy is very difficult. It is much easier to measure the amount of ionization of air with X-rays or rays. Therefore, for the radiometric assessment of ionizing radiation, another unit is widely used - the roentgen (P) [coulomb per kilogram (C/kg)].

Ionizing radiation can lead to both the development of general phenomena - radiation sickness, and local ones - radiation damage to the skin (burns). This depends on the nature of the radiation, its dose, time and area of irradiation. Thus, irradiation of the whole body at a dose of more than 600 R leads to the development of severe radiation sickness, but does not cause skin lesions.

Acute radiation burns most often occur after a single high-dose irradiation of a separate area of the body and do not lead to the development of radiation sickness. Such burns are usually observed during prolonged X-ray examination, careless handling of radioactive substances, and treatment of cancer patients. The radiation dose in this case is 1000-1500 R or more. When the whole body is irradiated with such a dose, it develops acute radiation sickness, which leads to the death of the victim before the appearance of burns.

Radiation burns of the skin, like thermal burns, are divided into 4 degrees depending on the depth of the lesion: I degree - erythema, II - blisters, III - total damage to the skin and IV degree - damage to the subcutaneous tissue, muscles, internal organs. However, with thermal injuries, the clinical symptoms of a burn appear immediately after the injury, and with radiation injuries, a typical periodicity and phasic course of the disease is observed.

Typically, the clinical picture of radiation skin lesions is divided into 4 periods: 1st period - primary local reaction (primary erythema); 2nd-hidden; 3rd - development of the disease and 4th period - reparative.

The duration of the period and depth of damage depend on the dose of ionizing radiation. The 1st period is characterized by patient complaints of itching of the skin, hyperemia at the time of irradiation with large doses or immediately after it. With less massive radiation doses, these phenomena may be absent. In the 2nd period there were no pathological changes in the irradiation zone. Sometimes there is skin pigmentation remaining after primary erythema. The duration of this period depends on the radiation dose: the higher the dose, the shorter the latent period and the more significant and deeper the damage. If the latent period is 3-4 days, then the radiation dose is high and subsequently leads to necrosis of the irradiated areas like III-IV degree burns. During a latent period of up to 7-10 days, blisters appear (second degree burn), and if it lasts about 20 days, erythema occurs (1st degree burn).

The clinical sign of the 3rd period is the appearance on the skin of signs of radiation injury - a radiation burn, the depth of which depends on the radiation dose and the duration of the latent period.

Thus, the duration of the latent period and clinical signs can be used not only to predict the severity and depth of the lesion, but also to determine the radiation dose. The nature of the radiation (m-rays, fast neutrons, etc.) and the individual characteristics of the organism are of great importance. Typically, a III-IV degree burn occurs with local irradiation at a dose of 1000-4000 R and a latent period of 1-3 days.

In the 4th period, rejection of necrotic tissue and regeneration processes occur. With deep lesions, this period can be extremely long. Due to a violation of the reparative ability of cells, healing proceeds extremely slowly with the formation of scars and ulcers that do not close for a long time.

Therapeutic measures for radiation skin lesions are carried out in accordance with the periods of burn development and the individual characteristics of their manifestation in a given patient.

Treatment should begin from the moment the primary erythema appears, which can facilitate the further course of the disease.

In case of severe primary erythema, it is recommended to apply an aseptic bandage to the affected area. Local application of cold to the irradiated area is helpful.

In the latent period or at the beginning of the development of the disease, intravenous administration of a 0.5% solution of novocaine (10 ml), as well as novocainization of the affected area, is indicated.

For superficial burns of the 1st-2nd degree, ointment bandages are applied to the affected area, after removing blisters and superficial necrotic tissue. Tetanus is prevented and antibiotics are administered.

Subsequently, after clearly delineating areas of necrosis, surgical treatment is indicated, which consists of excision of non-viable tissues followed by their plastic surgery.

CONCLUSION

Damage to living tissues caused by exposure to high what temperature, chemical substances, electrical or radiant energy, taken on call it a burn. First of all, the skin is affected by burns, and then deeper-lying formations - subcutaneous fatty tissue, sheets of fascia that separate layers of tissue, tendons, muscles, blood vessels and nerves, periosteum and bone. In rare cases, as a result of prolonged exposure to a harmful factor that has a very high temperature, not only the integumentary tissues, but also internal organs can be destroyed. If a traumatic agent gets on the mucous membrane of the mouth, digestive tract or respiratory tract, burns of the mucous membrane are formed. In conclusion, I would like to give a brief description of all types of burns.

Burns come in different types Dov- thermal, chemical, electrical and radiation.

Thermal burns arise from the action of flame, molten metal, steam, hot liquid, or from contact with a heated metal object. The higher the temperature of the harmful factor acting on the skin and the longer the time of its exposure, the more serious the consequences it causes. The deepest and most extensive burns occur when the victim's clothing catches fire. Skin burns combined with burns of the mucous membrane of the upper respiratory tract are especially life-threatening. Such combinations are possible if the victim breathed hot smoke and air. This usually occurs during a fire in an enclosed space. Burns of the skin and mucous membranes during a fire can sometimes be combined with carbon monoxide poisoning of the body.

Chemical burns occur from the action of concentrated acids, caustic alkalis and other chemicals that enter living tissues and cause their destruction. One type of chemical burn is damage by phosphorus, which has the ability to combine with fat. Burns with acids and alkalis can also be observed on the mucous membrane of the mouth, esophagus and stomach if the victim, by mistake or ignorance, drank a toxic solution, mistaking it for water. Due to the careless attitude of adults towards chemicals and objects
Small children are often affected by household chemicals.

Electrical burns are obtained due to contact with electric current and its passage through tissue from one electrode to another or into the ground. In this case, electrical energy is converted into heat. Heat, concentrating at the point where the current passes through the skin, destroys tissue. When exposed to high voltage current, the amount of heat generated in the tissues is so great that deep-lying main vessels that provide blood circulation to the limb can be destroyed. In such cases, the death of the entire limb is inevitable. When exposed to low voltage currents, the affected areas are not deep or extensive.

Radiation burns . Sunburns are common in everyday life. Direct exposure to sunlight is especially dangerous for infants and toddlers, since, in addition to burns, it can cause overheating of the entire body. Burns to exposed parts of the body can also be caused by bright light radiation generated during the explosion of modern nuclear sources. They occur at a distance of several kilometers from the center of the explosion. The course of these burns is unusual, as it is complicated by the action of penetrating radiation.

BIBLIOGRAPHY

Kazantseva N.D. Burns in children. M. 1998

Yumashev. G.S. First aid. M. 1995

A burn is tissue damage that occurs under the influence of high temperature (thermal burn), acids and alkalis (chemical burn), electric current (electrical burn) or ionizing radiation (radiation burn). Each type of burn has its own rules for first aid.

Thermal burn.

Cause of thermal burn can become the rays of the sun, hot water, water vapor (not to be confused with chemical vapors), open flames, hot oil, molten metal, hot food, hot heating devices, electric and gas stoves, soldering equipment, hot dishes and much more.

Stop exposure to the damaging factor (if the victim is burning, extinguish the flame by throwing on a coat, blanket, wet cloth, pour water on or dip the victim in water).
Remove the burned part of the body from clothing, cutting it off around the burned area. Leave the stuck fabric in place.
Not touch the burned surface with your hands, Not pop bubbles Not lubricate with ointment, fat, alcohol (alcohol can be treated only surface of a sunburn) and other substances.
Cool small burn surfaces with cold water, ice, or snow.
Apply a clean sterile bandage (in the field, as a rule, sterile tissue cannot be found, so a clean handkerchief, disposable napkins and, in extreme cases, cellophane will do). For extensive burns that occupy a large surface of the body, the victim is wrapped in a clean sheet.
At eye burn Apply a sterile bandage to the eyes.
Treat the surface around the burn (without touching the burn site itself) with alcohol or vodka in order to fix the pathogenic microflora in place.
Provide plenty of fluids

Chemical burn.

Cause of chemical burn may become chemical reagents of industrial acids and alkalis; fumes of acids and other chemicals; smoke generated by the combustion of plastic (it contains phosgene and gaseous hydrocyanic acid, such smoke is poisonous and causes chemical burns), food acids (acetic essence, vinegar).

Procedure (pre-medical):

Stop exposure to the damaging factor.
If clothing becomes saturated with a chemically active substance, you should try to quickly remove it.
In addition to quicklime burns the affected surface is washed with plenty of tap water as quickly as possible to reduce the concentration of the substance.
Neutralization of a surface doused with acid with a 2% solution of baking soda (or any soda solution that you have time to prepare).
Neutralization of a surface doused with alkali with a 2% solution of acetic or citric acid (or any solution of acetic or citric acid that you have time to prepare).
At acid burn of the larynx or esophagus acid enters the stomach, in which, as a result of the neutralizing reaction, carbon dioxide will be released and can swell the stomach) 2% sodium bicarbonate solution (baking soda), burnt magnesia or almagel.
At burn of the larynx or esophagus with alkali rinse the mouth and drink (except for cases of alkali getting into the stomach, in which Do not drink the neutralizing solution, since as a result of the neutralizing reaction carbon dioxide will be released and can swell the stomach) 1% acetic acid solution.
take antispasmodics to relieve spasm of the esophagus.

Electrical burn.

Cause of electrical burn is an electric shock. First aid consists of stopping the impact of the damaging factor on the victim (de-energizing) and then, if the person is fully conscious, measures are taken according to the scheme of assistance for thermal burns (see above).

Radiation burn.

Cause of radiation burn is a high dose of radioactive radiation (alpha, beta, gamma X-rays), received, for example, as a result of a violation of safety precautions when working with radioactive sources. Such X-rays in therapeutic doses cause local damage - burns. Their degree depends on the radiation dose.

Procedure (pre-medical):

Shelter from exposure to a source of ionizing radiation
In order to weaken the effect of penetrating radiation, give antidotes to the victim
The victim should take an antiemetic
Get rid of contaminated clothing
Begin decontamination of the affected area and even the entire body by rinsing with soapy water or just water from a shower, hose or brush
Treat the burn site with a 0.5% hydrogen peroxide solution to remove radionuclides
Apply an aseptic bandage to the affected surface
Give painkiller
Transport the victim to a medical facility as soon as possible