Burns of the first degree usually occur without complications and the pain subsides on the 2nd day. Edema and redness last for 2-3 days, and after 5-6 days, peeling of the epidermis begins and recovery begins. II degree burns most often occur without complications, on the 5-6th day the bladder (elevated epidermis) dries up and forms a crust. If the bubble has been cut, a scab forms. The scab and crusts depart independently on the 10-15th day, and a new epidermis forms under it. With suppuration of the blisters, the healing period is delayed, granulations are formed that leave scars. Burns of the III and IV degree , combined with burns of a different localization, are difficult, complicated by shock and intoxication. Affected areas undergo necrosis and are rejected, suppuration of the wound occurs; while the patients are in fever, they lose fluid, proteins. Wounds after rejection of necrosis do not epithelize for a long time , there is a lot of purulent discharge, a marked general reaction, fever, pyoderma are noted . Burn exhaustion usually develops in the presence of burns of a different location. With burns in the nose, ears, chondritis, necrosis of the bones of the face. With the healing of burns, keloid scars, deformations, and disfiguration are subsequently formed.
Treatment for thermal burns
When providing first aid, it is not recommended to apply dressings, topical application of ointments, coloring and tannins (this makes it difficult to determine the depth of burns). As painkillers, narcotic analgesics can be used. For transportation use a light gauze bandage.
For burns of I degree and limited II degree, outpatient treatment is indicated. Subject to hospitalization are patients with deep burns of the face when spreading to vast surfaces. In the presence of severe edema and blinding, in cases of damage to the eyes and respiratory organs, with the participation of appropriate specialists, complex treatment is carried out to prevent pulmonary edema (cardiac drugs, bronchospasmolytics , oxygen inhalation), according to indications, resuscitation measures.
For burns of the oral cavity, rinse 3-4 times a day with 5% sodium bicarbonate solution or antiseptics.
In stationary conditions, treatment begins with anti-shock measures and the fight against toxemia. The pain is eliminated by the introduction of analgesics, novocaine blockade. Antibiotics are prescribed to prevent infection. A tetanus toxoid (0.5 ml) and another syringe are injected under the skin into another part of the body-3000 ME tetanus toxoid. Give plenty of hot drink.
After removing the patient from the shock using gauze balls, a gentle surgical treatment of the affected surface is carried out with preliminary anesthesia, sprayed with a warm 0.5% solution of ammonia, 0.9% isotonic solution or soap foam. Epidermal flaps and blisters are excised with scissors. The skin around the burn is cleaned with ether, gasoline or 96 ° alcohol. After the initial treatment, the burn surface is treated with cotton balls soaked in a 3% solution of hydrogen peroxide, antiseptics and dried.
In case of burns of the I-II degree, after treatment of the wound, cooling creams (equal parts of lanolin, peach oil, distilled water), and slightly disinfecting ointments containing corticosteroids are indicated . The surface can be treated with 96 ° alcohol. It is better to use an open or semi-open method of treatment.
In case of IIIA-SB burns, burn wounds should be lubricated with ointments or emulsions 3-4 times a day (5-10% liniment synthomycin, 0.5% furacilin , 0.1% gentamicin , 10% anestesin , etc.). Mandatory is the toilet of the oral cavity, eyes, nasal passages.
After rejection of necrotic tissue and in the presence of granulation of wounds, treatment under a dressing is indicated. It is necessary to prevent suppuration of wounds, to stimulate the formation of a dry necrotic scab with its subsequent rejection. With pronounced exudation from the wound (wet scab), moist-drying dressings with antiseptic solutions are indicated. To accelerate epithelialization – oil- balsamic dressings, UVD on the wound during dressings, dressings with proteolytic enzymes, keratolytic agents. A permanent toilet of the skin around the wound, rubbing with gasoline, alcohol, washing with 3% hydrogen peroxide solution is necessary.
At the same time, general therapy (food rich in proteins and vitamins) is carried out, as well as a medication that strengthens treatment.
Good results are obtained when covering the burnt surface with quick- hardening liquid polymers that form a film and contain disinfectants and painkillers.
In case of third-degree burns, after rejection of necrotic tissues, they resort to plastic closure of granulations with a free continuous skin graft. They produce skin plasticity with oncoming triangles according to Limberg . According to the testimony, a series of subsequent corrective operations are performed.
Thermal burn prognosis
With burns of the III and IV degree, combined with burns of other localizations, it is possible to increase exhaustion, the development of sepsis, which can lead to the death of the victim.
Chemical burns
They arise from the action of various substances that can cause a local inflammatory reaction, coagulation of proteins and even necrosis of tissues (acids, alkalis, salts of heavy metals). Chemical burns occur not only on the skin, but also on the mucous membrane of the oral cavity.
Three degrees of severity of tissue damage are distinguished depending on the exposure and concentration of the chemical agent. In the third degree – dry (mummification) and wet necrosis. In addition to burns, some chemical agents cause general poisoning of the body.
Chemical burn treatment
Chemical substances are removed from the skin surface by abundant washing off with water or neutralization with appropriate means within 10-15 minutes. With delayed help, the duration of washing should be increased by 2-3 times. Further treatment is the same as with thermal burns.
Burns of the oral mucosa require gentle methods of therapy and a liquid diet. With a burn of the esophagus, patients need special treatment.
Radiation burns
Tissue lesions by various physical and chemical active radiation.
Burns with ultraviolet rays (quartz, electric welding, voltaic arc, sunlight) are common, especially in the summer with the abuse of sunbathing. Burns of I and II degrees on the skin, as well as eye damage, are noted.
X-ray burns are characterized by deep biological disturbances and a severe general reaction, identical to those of burns caused by ionizing radiation.
Treatment comes down to lubricating the skin with some neutral fat.
Electric burns
They occur when a victim comes in contact with a high-voltage network, bare wires, faulty electrical appliances. In all these cases, the skin is particularly damaged.
The clinical picture. A sharp swelling of the tissues, the skin is dry, white-gray, visible signs of current, slight soreness, trophic disorders, slow regenerative processes. Depending on the severity of the process, dry necrosis of the lower jaw bone occurs, observed in the period from 2.5 to 4 months.