Algorithm for first aid for burns. Emergency first aid for burns Burns emergency care

First aid for burns at the scene consists primarily in the rapid termination of the action of the thermal agent. When clothing is ignited, the fastest and most effective means of extinguishing is pouring water on the victim or throwing a tarp, blanket, etc. It is impossible for the patient to run or rush about, as the flame will inflate even more and cover new areas. Just as quickly, you need to throw off clothes soaked in hot liquid.

Immediately following the removal of the thermal agent, cool the burnt area with cold running water or cold water bubbles or snow. Early and prolonged cooling (20 - 30 minutes) of the affected tissues quickly reduces their temperature, prevents the deepening of the burn, reduces swelling and relieves pain.

The unconscious state of the burned person should attract the attention of the doctor. Absence or confusion of consciousness is not typical for burn injury and burn shock. This may be associated with any combined lesion or disease (craniocerebral or electrical injury, carbon monoxide poisoning, alcohol, diabetic coma, etc.).

For pain relief, depending on the severity of the burn, analgesics can be used in combination with antihistamines, antipsychotics, in mild cases - analgin, baralgin, in severe cases - inhalation anesthesia using portable inhalers.

Clothing from burned areas of the body should be removed carefully so as not to tear off the exfoliated epidermis and not cause unnecessary pain. It is better to cut off the parts of clothing firmly adhering to the burnt skin, and not to tear it off. Aseptic dry or wet-drying dressings are applied to the burn surfaces (with solutions of 0.1% rivanol, 0.2% furatsilin, 5% mafenide, 3-5% boric acid, etc.).

Emergency doctors should not use topically drugs that change the appearance of burned skin (potassium permanganate, tannin, silver nitrate, etc.) and make it difficult to further clarify the diagnosis. You can leave without bandages burns on the face and burns of the first degree. In the absence of a dressing, wrap the burnt surface with a clean cloth (sheet, towel, etc.). In case of burns of the hands, it is necessary to remove the rings from the fingers, because due to the increasing edema, they can cause circulatory disorders in the distal phalanges.

For chemical burns caused by acids and alkalis, the most versatile and most effective first aid is a long (about 1 hour) washing of the burnt area on the body of the victim with plenty of running water. The sooner the chemical agent is removed from the skin, the more superficial the burn will be. It is necessary to quickly remove the clothing soaked in the substance, while continuing to wash the burnt surface of the skin. An exception for such treatment are quicklime and organic aluminum compounds (diethylaluminum hydride, triethylaluminum, etc.), the contact of which with water is contraindicated.

Thermal burns

First of all, the impact of damaging agents is stopped, the burn site and the surrounding surface are cooled (directly or through clean linen, a rag) under a stream of cold water at 20-25 ° C for 10 minutes (until the pain disappears).

Release the damaged area of the body from clothing (do not remove clothing, it is necessary to cut it after it has cooled down). Also

do not remove clothes that have stuck to the skin. In case of burns of the hands, it is necessary to remove the rings from the fingers due to the risk of ischemia!

A wet aseptic bandage with furacillin (1:5000) or 0.25% novocaine is applied to the burn site (for extensive burns, it is better to use a sterile sheet). You can't pop the blisters! It is not recommended to treat wounds with any powders, ointments, aerosols, dyes before the patient enters the hospital. Anesthesia is performed according to indications (non-narcotic analgesics). It is important not to let the child drink, so as not to overfill the stomach before the upcoming anesthesia during the initial treatment of the wound in a hospital. The victim is hospitalized in the burn unit.

Chemical burns

To remove the aggressive liquid, rinse the burnt surface with plenty of running water for 20-25 minutes (except for burns caused by quicklime and organic aluminum compounds). Neutralizing lotions are used: for acids, phenol, phosphorus - 4% sodium bicarbonate; for lime - 20% glucose solution.

When inhaling smoke, hot air, carbon monoxide, in the absence of mental disorders, the child is taken out to fresh air, mucus is removed from the oropharynx, an air duct is inserted, after which inhalation of 100% oxygen through the inhaler mask is started. With an increase in laryngeal edema, impaired consciousness, convulsions and pulmonary edema, after intravenous administration of atropine and diazepam (possibly in the muscles of the floor of the mouth), the trachea is intubated, followed by transfer to mechanical ventilation.

Eyeball burns

Perform terminal anesthesia with a 2% solution of novocaine (in drops), abundant washing of the conjunctival sac (using a rubber bulb) with a solution of furacillin (1:5000); with an unknown nature of the damaging substance - boiled water. Put on a bandage. The victims are hospitalized, transportation is carried out in the prone position.

Emergency care for burn shock

Anesthesia is carried out with an area of burns up to 9% intramuscular injection of analgesics; with a burn area of 9-15% - 1% solution of promedol 0.1 ml / year / m. (if the child is older than 2 years). With an area of burns up to> 15% - 1% solution of promedol 0.1 ml / year (if the child is older than 2 years); fentanyl 0.05-0.1 mg/kg IM in combination with a 0.5% solution of diazepam 0.2-0.3 mg/kg (0.05 ml/kg) IM or IV.

At the I-II degree of burn shock at the prehospital stage, infusion therapy is not carried out. At III- IV degree of burn shock (circulatory decompensation) perform access to a vein and carry out infusion therapy with 20 ml / kg for 30 minutes with solutions of rheopoliglyukin, Ringer or 0.9% sodium chloride solution; prednisolone 3 mg/kg is administered intravenously. Oxygen therapy is carried out through a mask with 100% oxygen. The victim is urgently hospitalized in the intensive care unit of a burn center or a multidisciplinary hospital.

BLEEDING IN CHILDREN

PULMONARY BLEEDING

Causes of pulmonary hemorrhage: chest trauma; acute and chronic purulent inflammatory processes in the lungs (bronchiectasis, abscesses, destructive pneumonia), pulmonary tuberculosis; hemorrhagic thrombovasculitis; pulmonary hemosiderosis.

Clinical picture

Foamy bloody liquid is released from the mouth and nose, ichorus and sometimes scarlet blood, vomit and stool do not change color. In the lungs during auscultation, an abundance of moist, mostly finely bubbling rales is heard. The child turns pale sharply, weakness and adynamia occur.

Urgent measures

The child is given a semi-sitting position; evaluate the color of the skin and mucous membranes, determine the nature of breathing, pulse, blood pressure; examine the nasopharynx; provide free patency of the upper respiratory tract; start oxygen therapy. The patient is urgently hospitalized in the surgical department.

GASTROINTESTINAL BLEEDINGS

Causes of gastrointestinal bleeding: ulcers and erosions, tumors, diverticula of the digestive tract, varicose veins of the esophagus or stomach.

Clinical picture

There may be vomiting of the color of "coffee grounds", a black stool, less often the presence of scarlet blood in the vomit and feces is determined. Their color is affected by the location of the bleeding. There is a sharp pallor of the skin, dizziness, weakness, pain in the abdominal cavity. With significant blood loss, blood pressure decreases. In cases where bleeding occurs against the background of intussusception, thrombovasculitis, intestinal infection, it is accompanied by a detailed clinical picture of the underlying disease.

A child with any signs of gastrointestinal bleeding should be hospitalized according to the profile of the underlying disease. With massive bleeding, children are hospitalized in the surgical department. Before hospitalization, an ice pack or a cloth moistened with cold water is applied to the epigastric or umbilical region (depending on the location of the bleeding). Give to drink a 5% solution of epsilon-aminocaproic acid 5 ml/kg with thrombin. If the blood pressure is reduced, then albumin or gelatinol 10 ml / kg is dripped before intravenous transportation.

As is known, the nature of the course and the outcome of pathological manifestations in thermal injury depend on the severity of the injury, the level of compensatory capabilities of the body and the timeliness of therapeutic measures, including at the prehospital stage. The lack of adequate medical care in the acute period quickly leads to the transition of adaptive reactions into pathological ones, depletion of the body's reserve capabilities and their failure.

All this testifies to the importance of the problem of improving the organization of medical care for victims with burns by ambulance teams.

In order to optimize the range of medical services provided at the prehospital stage to victims with thermal injury and inhalation damage to the respiratory tract, an algorithm of actions is proposed below.

Algorithm of actions in case of thermal injury

Diagnosis and assessment of the severity of thermal and combined thermal inhalation injury. A burn is an injury that occurs when body tissues are exposed to high temperature, aggressive chemicals, electric current and ionizing radiation.

Chemical burns - burns with aggressive liquids, occur from exposure to acids and alkalis.
Electric burns are injuries that have developed as a result of the passage of an electric current through tissues.
Radiation burns occur when exposed to ionizing or ultraviolet radiation.

The severity of the condition of the victim with burns is determined by the depth and area of the lesion, as well as the presence and degree of inhalation injury.

Burn surface area

The area of the burn surface is determined by the rule of nines. The rule of "nines" is not accurate (error up to 5%), but allows you to quickly and easily estimate the area of the burn, which is especially important in emergency situations.

Rule of nines sets the percentage of body part surface area to body surface area (SBA) for adults.

head and neck make up 9%,
anterior surface of the body - 18% (abdomen - 9% + anterior surface of the chest - 9%),
back surface of the body - 18% (lower back and buttocks - 9% + chest behind - 9%),
upper limb - 9%,
lower limb - 18% (thigh - 9% + lower leg and foot - 9%),
perineum - 1%.

To assess small-sized burns of various localizations, you can use "rule of the palm"- the area of the palm of the victim is from 170 to 210 cm2 in an adult and, as a rule, corresponds to 1% of the area of the skin.

Depth of defeat

Determination of the depth of the lesion is carried out according to the four-degree classification:

I degree- persistent arterial hyperemia and inflammatory exudation, pronounced pain syndrome.

II degree- exfoliation of the layers of the epidermis with the formation of small blisters filled with a transparent yellowish liquid. The intensity of pain sensations is maximum.

III degree:

IIIa degree - damage to the dermis itself. Pain sensitivity is reduced, vascular reactions are preserved.
III b degree - total necrosis of all layers of the skin while maintaining intact tissues located deeper than their own fascia. In the thickness of necrotic tissues - thrombosed saphenous veins. Pain sensitivity and vascular reactions are sharply reduced or absent.

IV degree- the spread of the lesion to deeper tissues (subcutaneous tissue, fascia, muscles, bones).

It is believed that burn shock in adult victims can develop with skin burns II–IIIa degree on an area of more than 15%, in children and elderly patients on an area of \u200b\u200bmore than 10% of the body surface.

Burn shock is one of the most dangerous periods of burn disease. With combined injuries - burns of the skin and damage to the respiratory tract - in the first hours from the moment of injury, one of the formidable complications is asphyxia caused by swelling of the larynx, vocal cords and periligamentous space.

As a rule, combined injury is combined with CO poisoning and other toxic combustion products, which can lead to intoxication and the development of acute lung injury syndrome.

Localization of burns on the face, neck, anterior surface of the chest, the presence of singed hair in the nasal passages, traces of soot in the nasopharynx, voice change, cough with sputum containing soot, shortness of breath may indicate a possible lesion of the respiratory tract.

To diagnose thermal and combined thermal inhalation injury and assess the severity of the victim's condition, it is recommended to use the following diagnostic and treatment algorithm.

Algorithm for diagnosing skin lesions

History taking: ascertaining the etiological agent, its physical characteristics, duration of exposure, the role of clothing, as well as collecting information on comorbidities and the content of first aid.

Inspection of the wound: identification of direct and indirect signs of the depth of the lesion (type and color of the wound, scab and its consistency), taking into account localization.

The use of additional diagnostic tests: determination of the vascular response, the degree of loss of pain sensitivity.

Determination of the burn area in percent.

Universal Lesion Severity Index

To standardize the assessment of the severity of thermal injury, an integral universal index of injury severity has been developed. It is based on the Frank index (IF), according to which each percentage of a superficial burn corresponds to 1 conventional unit (c.u.), and a deep one - to 3 c.u. e.

When skin burns are combined with damage to the respiratory organs, 15, 30, 45 c.u. are added to the IF. e. depending on the severity of the respiratory tract injury (I, II, III degrees, respectively).

In patients over 60 years of age, IF is added to 1 c.u. e. for each year of life after 60 years.

It is believed that with ITP values more than 20 c.u. e. burn shock develops, which is the first period of burn disease.

The severity of burn shock is determined by the number of conventional units of the injury severity index: 20-60 c.u. e. - mild degree of burn shock (shock I degree), 61-90 c.u. e. - severe degree (shock II degree), more than 91 c.u. e. - an extremely severe degree of burn shock (shock III degree).

Depending on the severity of the burn shock, a forecast of the severity of the course of the burn disease is formed. In grade I shock, the prognosis is favorable, grade II - the prognosis is doubtful, grade III shock suggests an unfavorable course of burn disease.

The main tasks of the ambulance team

assessment of the general severity of the victim's condition;
determination of the severity of thermal injury by the area and depth of lesions, the presence of inhalation injury;
if necessary, carrying out infusion therapy, maintaining airway patency;
transportation of the victim to the nearest trauma center of the first or second level during the "golden hour".

SMP algorithm for burns at the prehospital stage

Termination of the action of the thermal factor, cooling of the affected areas (at least 15 minutes).

Assessment of vital functions, if necessary, measures to restore and maintain them. In case of impaired consciousness in a victim with a thermal injury, it is necessary to exclude a possible craniocerebral injury, carbon monoxide poisoning, alcohol or drug poisoning.

Dressings (do not remove parts of clothing adhering to burn wounds, the use of coloring antiseptics at the prehospital stage is not recommended), sheets are used for extensive lesions.

oxygen therapy

An obligatory component in the provision of medical care at the prehospital stage is the provision of airway patency, oxygen therapy, and, if necessary, artificial lung ventilation with an assessment of ventilation and gas exchange parameters during transportation.

Tracheal intubation should be performed in the following cases:

lack of consciousness;
clinical signs of severe inhalation injury (respiratory failure, suffocation, stridor, signs of damage by combustion products);
tracheal intubation and mechanical ventilation can be performed in patients with extensive burns in the face, neck and chest, as well as in any other localization of burns with an area of more than 50% of the body surface, since with extensive lesions, patients' breathing is often ineffective, leads to hypoxia and aggravates her.

Pain relief and sedation

Anesthesia and sedation at the prehospital stage. Elimination of pain should take into account the specifics of the condition of burn patients.

It is recommended to exclude intravenous administration of narcotic analgesics, which contribute to impaired consciousness, the development of additional depression of it, and most importantly, respiratory depression, which sometimes even at the stage of specialized care leads to difficulties in assessing the severity of the condition, smoothing the clinical picture, not to mention immediate complications.

To stop the pain syndrome, it is enough to use 4 ml of a 50% solution of analgin in combination with antihistamines - 2 ml of a 1% solution of suprastin. In addition, the use of non-steroidal anti-inflammatory drugs, which have a pronounced anti-inflammatory and analgesic effect, is effective. To stop the pain syndrome, ketonal 100-200 mg or ketorolac 30 mg is prescribed intramuscularly or intravenously.

Benzodiazepines are recommended if anxiety occurs in victims. With strong psychomotor agitation, they can be combined with neuroleptics.

For the purpose of anesthesia and sedation at the prehospital stage, the following scheme is recommended: ketonal - 100 mg, suprastin - 20 mg, relanium - 10 mg.

It should be emphasized that narcotic analgesics and large doses of sedatives are administered in case of extremely severe lesions, followed by adequate gas exchange, stable hemodynamics and under careful instrumental monitoring of the victim.

Infusion therapy

Infusion therapy is the main pathogenetic element of antishock therapy. To ensure it, catheterization of one or two peripheral veins is necessary, and if this is not possible, catheterization of one of the central veins is performed.

The volume and rate of infusion are determined by the severity of the injury and the time of transport. Infusion therapy at the prehospital stage includes intravenous administration of balanced salt crystalloid solutions.

The volume of infusion therapy in burned patients is calculated based on the area of burns and body weight, using the Parkland formula. During the first 8 hours, half of the calculated volume is transfused, achieving a steady rate of diuresis of 1 ml/kg per hour.

Parkland formula:

V ml Ringer's solution = 4 ml x 1 kg of body weight x Burn area (%).

V ml \u003d 0.25 ml x 1 kg of body weight x Burn area (%) per hour.

Promising and quite natural is the intravenous administration of infusion antihypoxants and antioxidants, including fumarates or succinates (mafusol, polyoxyfumarin, reamberin, cytoflavin).

Solutions based on gelatin (gelofusin - 4%) and hydroxyethyl starch derivatives (hemoches 6-10%), refortan 6-10%, voluven, stabizol) are able to stabilize hemodynamics and improve the rheological properties of blood. It is recommended to use these infusion agents at the prehospital stage with pronounced signs of hypovolemia and unstable hemodynamics.

Transportation to hospitals

Transportation of those in need of hospitalization should be carried out in hospitals with specialized departments for the treatment of victims with thermal injury.

Indications for hospitalization are:

burns of the II degree on the area of more than 10% (in persons over 60 years old and in children on the area of more than 5%);
burns III and degree on the area more than 3-5%;
burns III b IV degree;
burns of functionally and cosmetically significant areas (face, perineum, hands, feet, joint areas);
electrical burns, electrical injury;
inhalation injury;
burns combined with other injuries;
burns in patients with severe comorbidities.

Transportation of severely burned patients is carried out against the background of ongoing infusion therapy, under monitor control of blood circulation and respiration parameters: blood pressure, pulse (non-invasively), body temperature registration, with the possibility of ECG registration.

It is important to perform pulse oximetry and capnometry, especially during oxygen therapy and mechanical ventilation.

The severity of changes in thermal injury and the transience of the development of pathological changes necessitate the precise implementation of specific algorithms for providing assistance to victims, primarily at the prehospital stage.

Thus, competent and timely medical care provided by the ambulance teams contributes to the prevention and reduction of the severity of long-term complications, gives a temporary margin of time to prevent severe complications and mortality in victims with thermal injury.

K. M. Krylov, O. V. Orlova, I. V. Shlyk

Thus, thermal, electrical, solar, chemical and radiation burns are distinguished. The skin, eyes and respiratory tract are most often burned.

Thermal skin burns

Thermal skin burns are the most common type of household burns.

Clinical manifestations

According to the severity of skin lesions, the depth of tissue damage, the following degrees of burns are distinguished:

I degree - persistent redness of the skin and severe pain are noted at the site of the lesion;
II degree - at the site of exposure to high temperature, blisters form with transparent contents, the site of the lesion is very painful;
III degree - necrosis (necrosis) of all layers of the skin. On examination, a combination of deathly-pale (dead) skin areas, areas of redness and blisters is revealed, all types of sensitivity disappear in the burn area, there is no pain.
IV degree - not only the skin is subjected to necrosis, but also the tissues located under it (fatty tissue, muscles, bones, internal organs), upon examination, charring of the skin is revealed.
More often there is a combination of various degrees of burns. Their III and IV degrees refer to deep burns, accompanied by a worsening of the general condition of the victim, require surgical intervention, heal with the formation of deep scars. The severity of the victim's condition depends both on the degree of the burn and on the area of the lesion. II degree burns, covering more than 25% of the body surface, as well as III and IV degree burns, covering more than 10% of the body surface, are extensive and are often complicated by the development of burn shock. The victim, who is in a state of burn shock, is restless, tries to escape, is poorly oriented in what is happening; after a while, the excitement is replaced by apathy, prostration, adynamia, and a drop in blood pressure. In children, people over 65 years of age, debilitated patients, burn shock can develop even with a smaller area of damage.

First aid for thermal skin burns

The very first action should be to stop the effect of the thermal factor on the victim: it is necessary to take the victim out of the fire, extinguish and remove burning (smoldering) clothes from him. The burnt areas of the body are immersed in cold water for 10 minutes, a person (if he is conscious) is given any anesthetic drug - metamizole sodium, tramadol; in severe condition, narcotic analgesics (promedol, morphine hydrochloride) are administered. If the burned person is conscious, and the burn surface is quite extensive, it is recommended to drink it with a solution of table salt and baking soda in order to prevent dehydration.
I degree burns are treated with ethyl (33%) alcohol or a 3-5% potassium permanganate solution and left without a bandage. For burns II, III, IV degrees after treatment of the burn surface, a sterile bandage is applied to it. After these events, all victims must be taken to the hospital. Transportation is carried out on a stretcher. In case of burns of the face, head, upper half of the body, the burnt person is transported in a sitting or half-sitting position; with lesions of the chest, abdomen, front surface of the legs - lying on your back; for burns of the back, buttocks, back of the legs - lying on the stomach. If hospitalization in the near future is impossible for any reason, the victim is assisted on the spot: in order to anesthetize the burn surfaces, they are sprayed with a 0.5% novocaine solution for 5 minutes (until the pain stops), bandages are applied to the burns with synthomycin emulsion or streptocid ointment. They continue to give him a solution of soda and salt, periodically give painkillers.

Chemical burns of the skin and mucous membranes

The difference between chemical burns and thermal burns is that with chemical burns, the damaging effect of a chemical on body tissues continues for a long time - until it is completely removed from the surface of the body. Therefore, an initially superficial chemical burn, in the absence of proper assistance, can turn into a III or IV degree burn after 20 minutes. The main chemical agents that cause burns are acids and alkalis.

Clinical manifestations
As a result of an acid burn, a scab (crust) is formed from dead tissue. When exposed to alkalis, wet necrosis (necrosis) of tissues occurs and a scab does not form. It is necessary to pay attention to these signs, since the measures aimed at helping the victim with burns with acids and alkalis differ. In addition, if the patient is conscious and adequately perceives reality, they must clarify with him what substance he was in contact with. With chemical burns, as with thermal burns, there are 4 degrees of severity of tissue damage.

First aid for chemical and mucous burns of the skin

The victim is removed from clothing impregnated with a damaging agent (acid or alkali), the skin is washed with running water. There is a known case when a girl who worked in a chemical laboratory died from an acid burn simply because a man who was nearby was ashamed to undress her. For burns caused by acid exposure, sterile wipes moistened with a 4% sodium bicarbonate solution are applied to the burnt surfaces; in case of alkali burns - sterile wipes moistened with a weak solution of citric or acetic acid (at enterprises where there is contact with alkalis or acids, there must be a supply of these substances in the first-aid kit). The patient is given any painkiller and is urgently hospitalized in the nearest hospital (preferably in a hospital with a burn department).

Eye burns

(module direct4)

With a burn of the organ of vision, isolated burns of the eyelids, conjunctiva or cornea, or a combination of these injuries, may occur. Eye burns, like skin burns, occur under the influence of various factors, the main of which are lesions associated with exposure to high temperatures, chemicals, and radiation. Eye burns are rarely isolated; as a rule, they are combined with burns of the skin of the face, head and trunk.

Thermal eye burn

The causes of thermal eye burns are hot water, steam, oil, open fire. As with skin burns, it is customary to distinguish 4 degrees of severity of the lesion in them.

Clinical manifestations
With a first degree eye burn, slight redness and slight swelling of the skin of the upper and lower eyelids and conjunctiva are noted. With a II degree eye burn, blisters appear on the skin, films consisting of dead cells appear on the conjunctiva and cornea of the eye. With a third-degree burn, less than half of the area of the eyelids, conjunctiva and cornea is affected. Dead tissue has the appearance of a white or gray scab, the conjunctiva is pale and edematous, the cornea looks like ground glass. With IV degree burns, more than half of the eye area is affected, the entire thickness of the skin of the eyelids, conjunctiva, cornea, lens, muscles and cartilages of the eye are involved in the pathological process. Dead tissue forms a gray-yellow eschar, the cornea is white, similar to porcelain.

First aid
The substance that caused the burn is removed from the face of the victim. This is done with a jet of cold water and a cotton swab. For some time continue to wash the eye with cold water to cool. The skin around the eye is treated with ethyl (33%) alcohol, albucid is instilled into the conjunctival sac, and a sterile bandage is applied to the eye. After providing first aid, the victim is urgently hospitalized in an eye clinic.

Chemical burns to the eyes

The cause of chemical burns is the ingress of acids, alkalis, medicinal substances into the eyes (alcoholic tincture of iodine, ammonia, a concentrated solution of potassium permanganate, alcohol), household chemicals (adhesives, paints, washing powders, bleaches). Chemicals, getting into the eye, have a pronounced damaging effect, penetrating into the tissues the deeper, the longer the contact continues.

Clinical manifestations
Chemical burns of the eyes are divided according to the severity of damage into 4 degrees, as with thermal damage. Their clinical signs are similar to thermal eye burns.

First aid
The affected eye is opened, the eyelids are turned out, after which the eyes are washed with a stream of cool water, pieces of the damaging agent are carefully removed from the conjunctiva. Then, albucid is instilled into the palpebral fissure, a sterile bandage is applied to the damaged eye, and the victim is urgently hospitalized in the eye clinic.

Burns of the oral cavity, pharynx, esophagus

More often, chemical burns of these organs occur as a result of the ingestion of acids and alkalis by mistake or due to a suicidal attempt. The most common are burns with concentrated acetic acid. Less common thermal burns are the result of exposure to hot liquids (water, oil), inhalation of hot steam.

Clinical manifestations
Burns of the oral cavity, pharynx and esophagus are accompanied by the appearance of pain in the mouth, pharynx, behind the sternum (along the esophagus). The pain intensifies when trying to speak, swallowing; there is increased salivation, difficulty breathing (up to suffocation) and swallowing, the inability to take any food (both solid and liquid). There may be repeated vomiting, and in the vomit there is an admixture of scarlet blood. There may be an increase in body temperature, an excited state of the victim. On examination, attention is drawn to the burnt skin on the lips and around them, red swollen oral mucosa. When a chemical burn occurs under the influence of vinegar essence, a specific vinegar smell comes from the patient.

First aid for burns of the oral cavity, pharynx, esophagus

In case of chemical burns, the stomach is washed with a large amount of cool water (up to 5 liters) through a probe. In case of a burn with hot water and oil (thermal), gastric lavage is not performed. If the victim is conscious, he is given to drink 10 ml of a 0.5% solution of novocaine (1 tablespoon), after which he is forced to swallow pieces of ice, vegetable oil in small portions and suck an anesthesin tablet. The patient is urgently admitted to the hospital.

Under the influence of adverse environmental factors and other dangerous situations, damage to the skin occurs. Depending on what led to skin injury, there are thermal, solar, chemical, electrical and radiation burns. It is on the type, location and area of the affected area that emergency care for burns will depend.

Determination of treatment tactics

In the event that a person is diagnosed with burns, emergency care should be based on determining the severity and complexity of the damage received:

A burn is called extensive when more than 25% of the entire body surface is damaged. In this case, functionally important areas of the body are affected - the face, hands, feet and perineum.
A moderate burn occupies from 15 to 25% of the entire surface of the skin and does not affect functionally important areas of the body.
If the burn affects less than 15% of the body surface, it is considered to be minor.

To determine the percentage of damage, you need to know the "rule of nine" and be able to use it. It should also be remembered that the calculation is carried out differently for adults and young children. In addition to determining the size, it is necessary to establish how deep the burnt area occupies. Only after all diagnostic measures have been taken, further tactics can be determined.

Mostly people with burn injuries of the skin are treated in specialized burn centers.

Hospitalization is carried out in a general hospital if burns:

They occupy more than 15% of the entire surface of the skin (for children under 5 years old and adults over 50 - from 5%).
They affect the entire thickness of the skin, this area covers more than 5% (for children under 5 years old and adults over 50 - more than 2%).

In cases where the area of damaged skin is less than 15% of its entire surface, treatment can take place in an emergency department or outpatient setting.

First aid rules

They begin to provide assistance to the burnt immediately after the assessment of the function of the respiratory and circulatory organs is given. Also, before this, it is necessary to exclude the risk of hidden damage. In order for assistance with a burn to be provided correctly, a person who is near the victim should adhere to the following basic rules:

Initially, minimize the risk of possible contamination of the affected area. To do this, the burnt body should be wrapped in a clean and dry cloth. It is forbidden to cover the burn area with any greasy creams.
Bubbles with ice water are used only in cases where the burn surface is small. Ice is not applied directly to the site of the skin lesion, as this can contribute to increased injury. Also, ice is not used in cases where the burn area occupies more than 25% of the entire skin surface.
The victim of burns is given intravenous administration of drugs with an analgesic effect (Tramadol, Promedol, Morphine), as well as liquids to avoid dehydration of the body (Ringer's solution).

Once these basic steps have been completed, the patient can be transported to a location for further emergency care.

It is strictly forbidden to apply any vegetable oils, fermented milk products (sour cream, kefir, cream) and animal fats (including fat-based drugs) to the affected areas of the skin.

This is due to the fact that these substances form a fatty film on the burnt skin, which increases the severity of the burn and inhibits the cooling process. Also, in no case should you pierce the bubbles that have appeared.

Thermal burns

One of the most common types of burn injuries. First of all, regardless of the degree of damage, it is necessary to eliminate the influence of the factor that provoked the burn. A person is taken out or taken out of the danger zone. The clothes from the victim must be removed, if this cannot be done quickly, cut and removed.

Emergency care for thermal burns consists of the following steps:

For 10 minutes, the burned area of the body is kept under cool running water. This method is not used for third-degree burns.
In order to reduce pain sensitivity, painkillers (Tramadol) are given, in severe cases, Promedol or Morphine.
In the presence of an extensive burn surface, the victim receives solutions from table salt. This is done to prevent dehydration.

In the first degree of a thermal burn, the damaged area of the skin is treated with a solution of potassium permanganate, you can also apply a healing agent, for example, Panthenol. For other degrees of burns, it is recommended to apply a sterile dressing after this procedure. After the necessary assistance is provided to the victim, in the presence of burns of II, III and IV degrees, he must be urgently hospitalized.

During transportation of the patient, the localization of the burn surface is taken into account:

When burns are located on the face, head or upper half of the body, the victim is transferred on a stretcher in a semi-sitting or sitting position.
If the burn covers the back surface of the body, the victim is transported in the supine position.
If burns are localized in the anterior part of the chest, abdominal wall and on the anterior surface of the lower extremities, the person is placed on his back.

In cases where it is not possible to perform urgent transportation, the victim continues to receive emergency care on the spot in the form of administration of painkillers and rehydration therapy.

electrical burns

Conductive objects lead to gross damage to the skin. In the event of an electrical injury, it is necessary first of all to eliminate the current source, neutralize its influence - remove the current conductor from the victim, using a dry stick for this. At the same time, the person who provides assistance must stand on a dry board or rubber mat to protect against the action of electric current.

If the victim is not breathing and has no heartbeat, the first emergency aid should be chest compressions and artificial respiration. The principle of emergency treatment of electrical burns is the same as for thermal burns.

Regardless of what surface of the skin the lesion occupies, all victims must be hospitalized without fail. Chemical burns

Many chemical compounds can act as a burning substance - alkalis, acids and salts of some heavy metals. The nature of the burn surface depends on the type of chemicals.

Urgent removal of a chemical compound from the surface of the skin is carried out by immersing the damaged area of the body under running water (with the exception of quicklime burns). If the substance gets on clothing, it must be removed immediately. If a person is burned with alkali, the skin is treated with acetic acid. If acid has caused the burn, the affected area is washed with sodium bicarbonate solution. Then the burnt surface is covered with a sterile dressing.

The intensity of pain will depend on the depth and area of the affected area. So, with extensive and deep burns, it is often necessary to use painkillers (including narcotic analgesics, for example, morphine hydrochloride), and the victim is immediately hospitalized.

The appearance of thermochemical burns leads to the contact with the skin of certain substances, these include phosphorus, which continues to burn on the skin, respectively, causing their thermal damage. Such burns are more extensive and deep, accompanied by severe intoxication. To remove phosphorus, the affected area is placed under running water or treated with a 1-2% solution of copper sulfate. Also, pieces of the chemical can be removed with tweezers, after which it is necessary to apply a bandage with copper sulfate.

In no case do not use ointment dressings, as they increase the absorption of phosphorus.

emergency department

After the victim is taken to a medical facility, he is immediately admitted to the emergency room. Here, first of all, they give an assessment of the functional ability of the respiratory and circulatory organs, reveal hidden damage.

Given that skin burns cause a decrease in circulating plasma volume, the main goal of emergency therapy is to restore blood flow. To do this, Ringer's solution is injected into the human body. When calculating the amount of the drug, the area of the burn must be taken into account.

With moderate and extensive burns, a urinary catheter is installed, the amount of urine excreted is controlled. If necessary, the victim continues to administer painkillers that were previously used. For prophylactic purposes, an intramuscular injection of tetanus toxoid is carried out.

Local therapy consists in cleansing the burn surface - scraps of the epidermis are removed, blisters are opened and local antibacterial drugs are applied. After that, the wound is closed with a pressure gauze bandage.

For the victim, until the moment of improvement of his condition, constant monitoring is carried out.