Complications of burns. Consequences of thermal, chemical burns and frostbite

What is a burn and their classification:

IN Russian Federation Since 1960, a four-stage classification has been adopted, according to which, depending on the depth of tissue damage, first-degree burns are distinguished, characterized by redness and swelling of the skin; second degree burns, in which blisters filled with a clear, yellowish liquid form on the affected areas of the skin; III degree burns, which are divided into two groups (IIIa degree burns (dermal) are characterized by damage to the skin itself, in which there is partial necrosis of the skin with preservation of elements of the dermis, i.e.
e. the skin is not affected to its full depth; in case of IIIb degree burns, skin necrosis extends to its entire thickness, and the subcutaneous fat layer is also partially or completely affected with the formation of a necrotic scab); IV degree burns, characterized by necrosis not only of the skin, but also of underlying tissues - muscles, bones, tendons, joints.

Based on the characteristics of treatment, burns are divided into two groups: burns of I, II and II-Ia degrees are classified as superficial, and burns of IIIb and IV degrees are deep. In case of superficial burns, only the upper layers of the skin die, and restoration of the skin in these cases occurs independently, due to the preserved elements of the skin; Treatment of superficial burns is conservative. Deep burns (IIIb and IV degrees) usually require surgical treatment.
IN clinical practice As a rule, victims have a combination of burns of various degrees.

Causes of burns:

A thermal burn occurs as a result of flame, hot steam, hot metals, burning gases or liquids, radiant energy, or direct contact with a heated object or hot liquid. At thermal burns Most often, the superficial tissues of the body are affected, but damage to the respiratory tract is often noted.

In case of fires, in addition to burns, poisoning may occur from products of incomplete combustion (usually carbon monoxide) or other toxic substances (for example, when burning synthetic materials).

Signs of a burn depending on the degree:

Burns of the 1st and 2nd degrees proceed as serous inflammation, suppuration is usually not observed, after the end of the inflammation, complete regeneration (recovery) and healing of the burn wound are observed quite quickly. For third and fourth degree burns, following processes: tissue necrosis at the time of burn, traumatic swelling, inflammation purulent in nature, gradual cleansing of the burn wound from dead tissue, the formation of granulations, epithelization and scarring.

Moreover, if the epithelial cover in case of IIIa degree burns is restored due to the preserved skin elements, then in case of deep (IIIb and IV degrees) burns, incomplete regeneration is noted due to the death of skin appendages, and healing of the burn wound in these cases occurs due to marginal epithelization and scarring.

In addition to local changes, burns cause a complex of systemic disturbances in the functioning of the body. Burns can occur primarily as a local lesion or in the form of a burn disease. With superficial injuries in adults, occupying up to 10-12% of the body surface, or with deep injuries of 5-6% of the body surface, the course of burns is usually limited to local symptoms.

With more common burns, multiple disturbances in the functioning of organs and systems are observed, the totality of which is commonly called burn disease. In children, elderly and senile people, burn disease can also develop with less severe lesions. Severe burn disease in adults develops with superficial thermal lesions occupying more than 25-30% of the body surface and more than 10% with deep burns. The severity of the burn disease, its outcome, as well as the frequency of complications are determined, first of all, by the area of ​​deep damage.

The course of burn disease is divided into four periods: burn shock, acute burn toxemia, burn septicotoxemia, and recovery period.

Burn shock develops primarily as a result of pain impulses from the wound and thermal damage to the skin and underlying tissues. Acute burn toxemia develops as a result of intoxication of the body with protein breakdown products absorbed from burned tissues. During the period of septicotoxemia, the leading pathogenetic factor determining clinical symptoms is the resorption of tissue decay products and the vital activity of microorganisms.

The depth of burns largely depends on the nature of the thermal agent. When clothing catches fire, deep burns most often develop. At the same time, the instantaneous effect of even very high temperatures can be limited to superficial damage, which is observed during the outbreak of fuel vapors (gasoline, gas). Hot water and steam in adults more often cause superficial burns.

It is difficult to predict the depth of the burn when injured by hot viscous liquids - plastics or bitumen. Clothing generally protects against burns, however, for example, woolen fabric soaked in hot liquid prolongs the time of thermal exposure and increases the depth of damage; artificial fabrics (such as nylon or nylon) melt when burned and cause deep burns. Thus, the depth of the burn injury depends not only on the duration of thermal exposure, but also on the type of clothing.

In addition to the depth of the lesion, for the development of burn disease great importance has a affected area. There are many ways to determine the area of ​​the burn surface. Since the palm of an adult is approximately equal to 1% of the surface of his body, the “rule of the palm” can be used to roughly estimate the area of ​​​​the lesion. The number of palms placed on the surface of the burn corresponds to the percentage of the affected area.

The “rule of nines” is also widely used in clinical practice. This rule is based on the fact that the area of ​​individual parts of the adult human body is equal to or a multiple of 9% of the total body surface. According to the "rule of nine", the surface of the head and neck is about 9%, one upper limb - 9%, one lower limb- 18%, anterior surface of the body - 18%, posterior surface of the body - 18%, perineum - 1% of the total surface of the body. In addition to the “palm” and “nines” rules, special tables have been developed for calculating the affected body surface, which are usually used in the corresponding hospitals.

Symptoms of thermal burns:

1st (first) degree:

2 (second) degree:

In typical cases, after 2-3 days the contents of the bubbles thicken and become jelly-like. After 7-10 days, the burns heal without scarring, but redness and pigmentation may persist for several weeks. Sometimes suppuration is possible in the blisters: in these cases, the liquid filling the blisters becomes yellow-green. In addition, an increase in swelling of the tissue surrounding the burn and an increase in redness are simultaneously noted. To a greater extent than with first-degree burns, with second-degree burns, redness, swelling and pain are expressed.

3 (third) degree:

Subsequently, demarcation (separation) of dead tissue occurs, accompanied, as a rule, by infection and suppuration. Rejection of the scab usually begins after 7-14 days, its melting continues for 2-3 weeks. In typical cases, IIIa degree burns, regardless of the area of ​​damage, epithelialize by the end of the 1st to the middle of the 2nd month due to independent island and marginal processes.

IIIb degree burns (deep) can clinically manifest themselves in the form of dry (coagulation) necrosis, wet (colliquation) necrosis and so-called skin fixation. Under the influence of a flame or upon contact with hot objects, coagulation (dry) necrosis develops: the affected skin appears dry, dense, brown, dark red or black. In the area of ​​large joints, the skin forms rough folds and wrinkles. A characteristic sign of dry necrosis is slight swelling and a rather narrow zone of redness around the lesion.

A dry scab does not change externally for quite a long time - right up to the onset of purulent inflammation. The process of recovery under the scab begins already on the 5-6th day, however, the formation of a demarcation shaft (demarcation) and the separation of necrosis zones ends only by the end of the 1st - mid-2nd month, when complete rejection of the scab is observed. Unlike superficial burns, epithelization in deep thermal lesions occurs only due to the marginal process and proceeds slowly, and independent epithelization of deep burns is possible only with very small lesions (no more than 2 cm in diameter).

When scalded (less often when clothes smolder on the body), wet necrosis develops. Dead skin with wet necrosis is pasty, swollen, and the swelling extends beyond the burn surface. Skin color varies from white-pink, mottled to dark red, ashy or yellowish. The epidermis usually hangs down in patches, but occasionally blisters may form. Unlike dry necrosis, with wet necrosis the demarcation line is not so clearly expressed, inflammation spreads beyond the burn wound; The development of granulations in the area of ​​wet necrosis is characteristic.

Cleansing of a burn wound with wet necrosis occurs on average 10-12 days earlier than with dry necrosis. With distant (from the Latin distantia - distance) burns that develop from intense infrared radiation, a kind of thermal damage occurs, the so-called “fixation” of the skin. First, with this exposure, the clothing above the burn may not catch fire. Secondly, the burned skin in the first 2-3 days is paler and colder than the surrounding undamaged areas. A narrow zone of redness and swelling forms around the circumference of the lesion. The formation of a dry scab with this type of lesion is observed after 3-4 days.

As the scab is rejected, regardless of the type of necrosis, granulation tissue becomes visible. With positive dynamics of the burn process and adequate therapy, the granulations are bright pink, protrude above the skin level, coarse-grained, the purulent discharge is scanty, and the process of epithelization is noticeable along the edges of the burn wound. The following signs indicate a negative course of the burn process: gray granulations, flabby, flat, rather dry; the surface of the wound is covered with purulent-fibrinous plaque; marginal epithelization slows down or stops.

4 (fourth) degree:

Visually, IV degree burns can appear:
the formation of a dense scab of dark brown or black color;
charring and subsequent cracking of a dense and thick scab, through the breaks of which the affected muscles or even tendons and bones are visible;
the formation of a whitish scab of relatively soft consistency, formed as a result of prolonged exposure to low-intensity - up to 50 ° C - thermal radiation.

It is typical for IV degree burns that it is almost impossible to accurately determine the future boundaries of muscle necrosis in the first days after injury, which is due to the unevenness of their damage. The development of foci of secondary necrosis of externally unchanged muscles located at a considerable distance from the point of application of heat is possible several days after thermal injury. IV degree burns are also characterized by a slow progression of the burn process (cleansing of the wound from dead tissue, formation of granulations), frequent development of local (primarily purulent complications) - abscesses, phlegmon, arthritis.

Injuries to the respiratory system are observed, as a rule, with deep flame burns of the face, neck and chest. The thermal agent directly affects the mucous membranes of the pharynx, pharynx and larynx, and damage to the trachea, bronchi and alveoli is caused by the action of combustion products. The burned person experiences difficulty breathing, hoarseness of voice, and mechanical asphyxia rarely develops. Upon examination, cyanosis of the lips, singed nasal hair, swelling, hyperemia (redness) and white spots of necrosis on the mucous membranes of the lips, tongue, hard and soft palate, back wall throats. Subsequently, pneumonia often develops. Damage to the respiratory system due to thermal injuries is equated to an increase in the area of ​​a deep burn by 10-15% of the body surface.

Burn disease:

Burn shock:

In the first minutes, less often hours after burn injury(erectile phase) general excitement and motor restlessness are noted. The victim's consciousness is usually preserved. Chills and muscle tremors are expressed; those who are burned groan and complain of pain in the burned areas. There is an increase in blood pressure, increased respiration and heart rate. Body temperature usually does not increase, and in severe shock it decreases. This phase is not always sufficiently pronounced.

After 2-6 hours, the erectile shock phase is replaced by a torpid phase - inhibition phenomena come to the fore. In the first 1-2 days, thirst is expressed. Nausea is often observed, repeated vomiting is possible, including “coffee grounds”, which indicates stomach bleeding. On the part of the respiratory system, shortness of breath is observed; dry, and later wet rales are heard in the lungs against the background of hard breathing. Impaired renal function is characteristic of burn shock, which is clinically manifested by oliguria or anuria, and the urine is rich yellow or dark brown.

Timely therapy is of utmost importance, as it can significantly alleviate the course or even prevent the development of the torpid phase of shock. At the same time, additional traumatization of burned people and delayed medical care contribute to the development and more severe course of the torpid phase. Heaviness clinical manifestations burn shock is determined by the depth and area of ​​thermal damage, age and general condition the health of the victim, timely and adequate anti-shock treatment. Depending on the severity, they are divided into mild burn shock, severe and extremely severe shock.

Mild burn shock develops when the total affected area is no more than 20% of the body surface, including deep ones - no more than 10%. Consciousness remains clear, sometimes short-term excitement is noted. The skin of those affected is pale, thirst, muscle tremors are noted, " goose pimples", sometimes there is chills. Nausea and vomiting are rare. Patients are often calm, sometimes excited, euphoric. Breathing, as a rule, does not increase, pulse reaches 100-110 beats per minute, blood pressure remains within normal limits. Urination is not impaired.

Severe shock occurs with deep burns covering more than 20% of the body surface. Sometimes, in young healthy people, severe shock can develop with an affected area of ​​up to 40% of the body surface. Severe shock is characterized by a serious condition of the patient. In this case, consciousness is often preserved. Short-term psychomotor agitation is often observed, followed by retardation. The skin of unburned areas and visible mucous membranes are pale, dry, and cold to the touch. Body temperature is usually reduced by 1.5-2°C. Those affected experience chills, pain in the burn area, increased thirst, and many patients experience nausea and vomiting. Acrocyanosis (blue discoloration of the ends of the body) is often expressed. Breathing is rapid, pulse is 120-130 beats per minute, blood pressure is characterized by instability, but more often it decreases. Kidney damage is pronounced: a decrease in daily diuresis (urine output) reaches 600 (oliguria), blood is detected in the urine.

Extremely severe shock develops with deep lesions occupying 40% or more percent of the body area. There may be short-term excitement, which is soon replaced by lethargy and apathy. In extremely severe shock, consciousness is confused, but often remains preserved. The condition of the patients is extremely serious. The skin is pale, bluish, often with an earthy tint, cold to the touch, with a marbled tint.

Excruciating thirst is typical - the victim drinks up to 4-5 liters of liquid per day, after which uncontrollable vomiting often develops. Body temperature is significantly reduced. Breathing is frequent, shortness of breath and cyanosis of the mucous membranes are pronounced. The pulse decreases to thread-like and may not be detected. Arterial pressure decreases significantly (maximum - up to 100 mm Hg). Anuria develops, oliguria is less common. Extremely severe burn shock is characterized by sharp hemoconcentration (blood thickening) and a decrease in circulating blood volume by 20-40%.

Burn shock lasts from 2 to 48 hours, in rare cases it lasts up to 72 hours. With a favorable outcome and timely treatment, peripheral blood circulation first begins to be restored, then urination normalizes.

Burn toxemia:

Burn septicotoxemia:

The condition of those affected during the period of septicotoxemia remains severe - the high temperature remains, and intoxication is pronounced. Clinically, the period of septicotoxemia is manifested by purulent-resorptive fever, which can be constant, remitting (with ups and downs), less often the fever is hectic (debilitating) in nature. Characterized by insomnia, lethargy, and delirium may occur. Increased heart rate is evident, toxic myocarditis and microcirculation disorders persist. Nutritional disorders associated with decreased appetite (up to anorexia - its complete absence) and disruption of all functions of the gastrointestinal tract, including dysfunction of the liver and pancreas, are worsening. Due to toxic inhibition of erythropoiesis and blood loss during dressings and operations, secondary anemia persists, and bacteremia may develop, turning into sepsis.

With the improvement of the condition of the burned, as necrotic tissues are rejected and granulations develop, the course of the burn disease becomes subacute with a noticeable improvement clinical condition sick.

With a less favorable course of the pathological process, burn exhaustion may develop. It is usually observed in deep burns with long-term existence of burn wounds occupying at least 15-20% of the body surface, but in cases of inadequate and untimely treatment can also develop with smaller (within 10%) deep burns. With burn exhaustion, the body weight of those affected can decrease by 10-20%, and with especially severe defeat- even by 25-30%. With burn exhaustion, weight gain is observed clinical symptoms- granulations become pale and flabby, and bleed easily. General lethargy and immobility are expressed, bedsores form, anemia and a decrease in protein content are detected in the blood.

The recovery period begins after the elimination of acute manifestations of the burn disease and complications, but does not mean final recovery. First of all, there is an improvement in the condition of the patients - the body temperature decreases, the psyche of the victims normalizes, and their activity increases. However, even with slight physical activity the number of heartbeats increases sharply. The examination reveals dysfunction of the kidneys and liver, which indicates the incompleteness of the pathological process. Metabolic disorders (dysproteinemia, anemia), changes in the cardiovascular system (tachycardia, hypotension), disorders of the respiratory system (shortness of breath during exercise), gastrointestinal tract (including increased or decreased appetite), and kidneys may be recorded for a long time. During the recovery period, scar formation begins.

All of these disorders are expressed to varying degrees and in different combinations, their duration and outcome depend on the severity of the pathological process and the quality of therapy.

During the recovery period, complete or almost complete healing of the burn wound occurs, and the patient’s ability to move and basic self-care is restored. The course of a burn disease may be accompanied by mental disorders, which are characterized by: acute onset and the correspondence between disorders of the psycho-emotional sphere and severity somatic symptoms. Mental disorders in burn disease refer to somatogenic, symptomatic disorders caused mainly by stress, intoxication, infectious and other complications of internal organs.

Mental disorders in burn disease are characterized by motor agitation and asthenic syndrome, which usually develops during the recovery period and persists for a long time. Mental disorders in burn disease are characterized by sleep disturbances and nightmares, the content of which often reflects immediate events associated with the burn injury. Asthenic syndrome can persist for a long time (for 1-1.5 years). A specific manifestation of mental disorders in the long-term period may be obsessive fear fire. A typical manifestation of this disorder is the fear of lighting a fire, in other cases - the fear of looking at the fire.

In elderly and senile people, features of the course of burn disease are noted, associated both with the frequent presence of various diseases (diabetes, ischemic disease heart disease, hypertension, etc.), and with a natural physiological decrease in the protective and adaptive abilities of the body. Under these conditions, even limited superficial thermal damage can be accompanied by the development of quite serious disorders. In the elderly, it is possible to develop burn shock with relatively smaller lesions (shock in the elderly can occur with burns of II-IV degrees on an area of ​​8-12% of the body surface). In elderly and senile people, toxemia and septicotoxemia are more severe, and a higher number of serious complications with less severe burn injuries.

Complications from burns:

When the affected area is more than 15-20% of the body surface, many victims develop a specific complication of burn disease - burn exhaustion. The development of this complication is associated with the burn wound itself, which contributes to prolonged intoxication of the body, resorption of tissue decay products, microorganisms and their waste products. Protein deficiency and dysfunction of the digestive organs, including the liver, are also important.

Symptoms of burn exhaustion are recorded from the beginning of the period of septicopyemia; subsequently, a smooth progression of signs of burn exhaustion is observed: weakness increases, sleep disturbance, irritability, severe lethargy and asthenia are noted. Despite appropriate therapy and adequate nutrition, there is a decrease in the patient’s weight, reaching in some cases 30% of body weight. In general, the symptoms of burn exhaustion are characterized by a process of general atrophy.

Body temperature often remains normal or increases slightly even with the addition of infectious complications, characterized by progressive adynamia, tachycardia, a tendency to hypotension, bedsores, muscle atrophy, neuritis, edema, anemia. At various stages of a burn disease, usually during periods of toxemia and (or) septicotoxemia, pneumonia can develop. In the first days after a burn, pneumonia is usually caused by damage to the respiratory system by combustion products. For timely diagnosis of pneumonia, X-ray examination is of paramount importance, since in case of a burn in the area chest It is difficult to hear wheezing using a phonendoscope.

Various complications from the digestive system are possible. Burned people often develop acute ulcers of the gastrointestinal tract, which may be accompanied by bleeding or perforation. Cholecystitis is less common; it is also possible to develop thrombosis of abdominal vessels, acute pancreatitis, acute appendicitis. It should be noted that in case of burn disease, the diagnosis of acute surgical diseases abdominal cavity is objectively difficult.

With severe burn intoxication, the development of toxic hepatitis and liver failure is possible. Late after burns, the kidneys may be affected with the development of pyelitis and pyelonephritis. With burn exhaustion, urinary stones can form and polyneuritis can develop.

Local complications of thermal injuries include furunculosis, phlegmon, purulent arthritis, as well as gangrene of the extremities with circular burns. Incomplete restoration of the skin and underlying tissues lost as a result of a deep burn leads to the development late complications- burn deformities, contractures, subluxations and dislocations, ankylosis, as well as long-term trophic ulcers.

Chemical burns:

Chemical burns most often affect open areas body, however, if acids and (or) alkalis are accidentally ingested, burns of the mucous membrane of the mouth and esophagus are possible. Peculiarity chemical burns consists in the fact that liquid aggressive substances that come into contact with the skin spread over its surface. Chemical burns are usually limited in area, with clear boundaries of the lesion, have an irregular shape and are characterized by the formation of smudges along the periphery - traces of the spreading of the chemical substance. The areas of skin that were initially affected by the aggressive substance are more deeply affected.
Chemical burns (as well as thermal burns) are divided into four degrees according to the depth of tissue damage.

1st (first) degree:

2 (second) degree:

3-4 degrees:

Burns in children:

The main causes of burns in children are contact with hot liquids on the skin (69% of cases) and touching hot objects (18%). Such burns are typical for children aged 1 to 3 years. Flame is ranked third as a cause of childhood burns. The main patterns of development of skin damage and burn disease in children and adults do not differ, but due to the anatomical and functional characteristics of the child’s body, these changes manifest themselves more intensely than in adults.

This is explained by immaturity children's immunity and anatomy: compared to adults, the skin of children is thinner and more delicate, has a more developed network of blood and lymphatic vessels, and therefore has higher thermal conductivity. This feature of the skin leads to the fact that deep burns occur in children as a result of the action of a thermal agent, which in an adult will cause only superficial damage.

The development of burn disease in children, especially younger age groups, is possible when only 5% of the body surface is affected.

In this case, the more severe the burn disease is, the younger the child’s age. The area of ​​deep thermal damage in a child is already 10% critical. The immaturity of regulatory and compensatory mechanisms in young children can lead to the development of a clinical situation when a sudden, uncontrollable medicinal correction The child’s condition may deteriorate within a few minutes after the burn injury.

In children under 3 years of age, shock can develop with burns that occupy 3-5% of the body surface, in older children - with damage to 5-10% of the body surface. Features of burn shock in children include a more severe course of the disease than in adults and a higher intensity of clinical manifestations. Children develop faster metabolic and circulatory disorders, and dysfunction of the most important organs and systems. Children have pronounced symptoms such as agitation, sometimes with convulsive seizures, followed by lethargy, chills with twitching of facial muscles, severe pallor of the skin, cyanosis of the nasolabial triangle, thirst, nausea, and repeated vomiting. In children of younger age groups, one of the features of burn shock is a pronounced increase in body temperature. Shock is most severe in newborns.

Acute burn toxemia develops, as a rule, after a short-term satisfactory state of health of the child. Features of clinical manifestations of toxemia in children: high temperature up to 40°C, often accompanied by delirium, confusion, convulsions, development of complications (pneumonia, acute erosive-ulcerative gastritis, toxic hepatitis, myocarditis. The duration of acute burn toxemia in children most often ranges from 2 up to 10 days.

The period of septicotoxemia in children, which develops after suppuration of a burn wound, is characterized by severe sleep disturbance, depression, irritability, lack of appetite, as well as a remitting type of fever with a range of up to 2°C.

Recovery in children proceeds with bright positive dynamics, when mood clearly changes, sleep improves, appetite appears, and temperature decreases.

Complications of burn disease in children are more often observed during the period of septicotoxemia. Typical complications in children include otitis media, ulcerative stomatitis, recurrent pneumonia, lymphadenitis, abscesses, phlegmon, nephritis, hepatitis.

The most severe complication of the period of septicotoxemia is burn exhaustion, in the development of which inadequate treatment plays a significant role. Burn exhaustion in children is often complicated by sepsis with the formation of multiple purulent foci in the internal organs.

Among the complications remote period It should be noted the possibility of changes in the activity of the endocrine glands, which may result in the child’s growth arrest and delayed puberty.

Treatment:

Thermal burns:

In cases where it is not possible to remove clothing, it is necessary to stop the access of air to the burning area: cover it with thick cloth or a blanket; extinguish with a stream of water; sprinkle with earth or sand; As a form of self-help, you need to lie on the ground so as to press the burning surface to it. You can knock down the flames by rolling on the ground; if there is a pond or container with water, you need to jump into it or immerse the burned organ in water. You cannot knock out the flames with unprotected hands, or run in burning clothes, as this will intensify the burning. To reduce the duration of thermal effects on tissue and to reduce the depth of damage, the affected area should be quickly cooled available means(immersion in cold water, snow, etc.).

After the thermal agent ceases to act, a dry aseptic bandage is applied to the burned part of the body. In case of extensive burns, the victim is wrapped in a sterile sheet, clean cloth, linen, protected from cooling and transported to the hospital as carefully as possible. Apart from applying an aseptic dressing, you should not perform any manipulations on the burn wound. If the hands are affected, it is necessary to urgently remove existing rings and (or) rings. It is important to know that damaged clothing is not removed from burned areas of the body in order to prevent additional trauma; you need to cut it or rip it apart along the seam and remove it as carefully as possible. It is not always necessary to remove all clothing from the victim, especially in cold weather.

In case of damage to the respiratory system and in case of poisoning by toxic substances formed during combustion (primarily synthetic materials), the most important priority measures are to ensure the victim's airway is open, supply clean air and monitor airway patency.

If possible, before the arrival of an ambulance or when independently transporting the injured person to a hospital, it is necessary to administer painkillers and sedatives to the injured person before hospitalization.

In the ambulance along the route, to prevent burn shock, painkillers (including narcotic analgesics), antihistamines and cardiovascular drugs are administered; infusion therapy- blood substitutes of hemodynamic action - polyglucin, reopolyglucin, etc. - are administered intravenously by drip or stream. Seduxen injections are used to eliminate agitation.

In case of cardiac and respiratory arrest on the spot, before the arrival of specialists (ambulance, rescue service), the entire range of resuscitation measures is carried out - artificial respiration, indirect massage hearts.

The final treatment of burns is carried out in specialized hospitals - burn centers and burn clinics, which have experienced, trained medical and nursing personnel and the necessary equipment. According to indications, transfusion detoxification therapy is carried out, modern sorption methods of therapy are used, and infectious complications are combated. Surgical treatment burns involves the most complete restoration of the skin, including the use of modern methods of dermatoplasty.

Chemical burns:

If washing is performed immediately after an injury, it should last at least 10-15 minutes, if assistance is delayed - at least 40-60 minutes, and in case of damage with hydrofluoric acid - for 2-3 hours. The criterion for the sufficiency of washing the affected area is the disappearance the smell of an aggressive substance. Do not wash burns caused by organic aluminum compounds with water, since these substances ignite when interacting with water; they are removed from the skin with organic solvents - kerosene, gasoline, alcohol, etc.

Having completed washing the affected area, chemical neutralization of aggressive chemical substances is used: for burns with acids, use a 2-3% solution of sodium bicarbonate; when damaged by alkalis, weak acids are used; for lime burns, use a 20% sugar solution in the form of lotions; for burns with carbolic acid, bandages with glycerin and milk of lime are applied; for burns with chromic acid, use a 5% solution of sodium thiosulfate; For burns caused by salts of heavy metals, apply bandages with a 5% solution of copper sulfate.

The burn surface when exposed to chemicals is treated according to general rules. Toilet of a burn wound with phosphorus damage should be carried out in a dark room, since the phosphorus residues in the wound are not visible in the light.

Treatment of burns in children:

Then you should carefully remove the burned child’s clothes and wrap him in a clean sheet; if age allows, give an anesthetic (Panadol, analgin, etc.) orally and immediately call an ambulance. Indications for infusion therapy during hospitalization occur more often in children than in adults. Treatment of children in a hospital is carried out according to the same principles as the treatment of adult patients - toileting of burn wounds, application of aseptic dressings, administration of anti-tetanus serum and toxoid, etc.

Peculiarities antishock therapy in children with burns:
All children with burns on an area of ​​more than 10%, and children under 3 years old - more than 3-5% of the body surface, need anti-shock therapy;
in the first 8 hours after a burn injury, children need to be administered 2 times more infusion solutions than in the remaining 16 hours, since the most intense loss and redistribution of fluid in the body of children is observed in the first 12-18 hours, especially in the first 8 hours. To calculate the amount of infusion solutions administered per day, use the following formula: 3 ml should be multiplied by body weight (kg) and by the area of ​​the burn (%). Half of this dose is administered in the first 8 hours after burn injury.