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A thermal burn is a tissue damage that a person receives when in contact with any heat source (liquid, gaseous or solid) of high temperature.
Most often, thermal burns are obtained by contact with open flames or hot liquids. This type of lesion is dangerous because it can immediately damage several layers of the skin, starting from the outer layer (epidermis), ending with the dermis and even subcutaneous tissues.
Based on how many layers of the skin were damaged, the patient is diagnosed with the degree of burn, which can range from 1 to 4. Also in the medical environment, when describing burn processes, it is customary to differentiate the degree of burns according to the criteria of superficial, partial or complete damage, and according to the affected area on the body, which is measured as a percentage of the entire area of the skin.
Burn degrees
In terms of depth and severity, burns are of four degrees, of which the first 2 degrees are considered in medicine to be the lightest – superficial.
With a thermal burn of the 1st degree, the burned area of the body swells and turns red, it hurts, the skin burns, and it is very painful to touch the affected area. At the site of the lesion, the temperature rises, all these symptoms persist in a pronounced form from 2 to 3 days, gradually disappearing. After the main symptoms of the lesion disappear, the skin at the site of the burn begins to dry out and peel off, after 5-7 days this area of the skin is not much different from the rest of the epidermis in appearance.
With a thermal burn of the 2nd degree of severity, the heat source acted on the affected area for a long time or very sharply, which led to deeper penetration. In addition to swelling and redness, blisters appear at the site of the lesion with effusion of tissue fluid from dilated vessels. The liquid is gradually saturated with leukocytes, becoming jelly-like. Together with the upper skin, it protects the site of the lesion from infections, so it is absolutely impossible to pierce, open or cut the blisters that occur during burns.
With burns of the 2nd degree, the patient is tormented by severe pain, which gradually disappears after 3-5 days. During this period, the liquid from the blisters is gradually absorbed into the skin, and in its place, with active cell division, a new epidermis grows.
Prolonged exposure to high temperatures leads to burns of the 3rd degree of severity. At the same time, tissue necrosis occurs at the site of the lesion, which can be both dry and wet. Wet is formed when a burn occurs by contact with hot steam or water. At the same time, in addition to edema, the tissue becomes pasty, icteric, covered with blisters. With dry necrosis, the skin at the site of the lesion remains dry, dense, brown-black. The boundaries of the affected area are clearly delineated. All burns of the 3rd degree with scarring heal, with rare exceptions, when the smallest areas of germinal epithelium can be preserved in the affected areas, which ensures epithelization.
The most severe and terrible degree of burns is the fourth. This degree is diagnosed with large areas of skin lesions with its necrosis, as well as with necrosis of subcutaneous fat, tendons, muscle and even bone tissue at the site of the lesion. Large blisters can coalesce into a single huge blister, the skin darkens, becoming almost black. Burns of 4 degrees of severity carry a threat to human life.
If any burn occurs over a large area, you should always seek medical help, since even 1-2 degree burns, involving more than 50% of the skin, are fraught with serious complications or death of the patient.
First aid for thermal burns
In the event of a thermal burn, it is important to provide first aid in a timely manner. It must necessarily include the elimination of the flame at the object of ignition (burning clothes are eliminated, burned skin is extinguished). If it is not possible to remove the burning clothes, it is necessary to cut off the supply of oxygen to the flame by throwing a dense cloth over the body of the victim or dousing him with water. After the source of the fire is eliminated, the victim must be calmed so that the extent of his defeat can be assessed. Clothing from a person must be removed without touching the places where a direct burn occurred (it is impossible to tear off the fabric from the affected skin). Burnt places on the body should also not be touched.
If a thermal burn was obtained with the help of sunlight, the victim must move to shady places, and preferably indoors.
Under unclear circumstances of burning, they must be clarified as soon as possible, since how and with what help the victim was burned can later determine the course of the entire treatment.
Burned areas should be washed under cold water for 10-20 minutes to avoid deepening the burn process. Cold at the burn site will lead to increased blood circulation. It is absolutely impossible to cool the burned area with ice – ice can provoke frostbite on the affected tissues, and then even a 1st degree burn can result in tissue necrosis. After cooling, a special anti-burn ointment should be applied to the burned skin and the body should be covered with a dry sterile bandage. The dressing should not contain cotton wool, and if the first aid provider does not have gauze or bandage, a dry and clean cloth to apply to the burn should not be fleecy.
With a severe burn, it is categorically impossible to use various folk remedies, such as sour cream, butter, aloe, vodka tinctures. If the victim has a 1st degree burn, then it will be enough just to lubricate it with a special pharmacy anti-burn preparation, and you can not apply a bandage on top. Burnt limbs (with a large area of damage) should be fixed with improvised means or splints so that they are above the level of the whole body.
About large burns on the body, the occurrence of burn shock (weakness, pallor, cold sweat, tachycardia, hypotension), the victim must be given plenty of drinks – tea, juice, compote, water. So it is possible to reduce the intoxication formed when the decay products of burnt tissues enter the bloodstream. To alleviate the pain syndrome, the victims are given painkillers.
If the victim is not breathing, he has no pulse, he needs to perform artificial respiration or chest compressions. For any severe burns, it is important to urgently call an ambulance or take the victim to the hospital. However, calling an ambulance is more preferable in this case, since during transportation the condition of the victim can be aggravated by the wrong position, you can go to the wrong hospital, and so on.
How are thermal burns treated?
All treatment of thermal burns is aimed at resuming the functioning of burned tissues in the body. At the initial stage, it is important to carry out anti-shock therapy, which, based on the degree of burn, the condition of the victim and other criteria, may consist of:
- elimination of pain syndrome;
- replenishment of blood deficiency;
- preventive procedures aimed at preventing or eliminating signs of hypoxia;
- adjustment of protein metabolism and acid-base balance in the blood of the victim;
- detoxification procedures;
- compensatory measures for energy costs;
- treatment and prevention of cardiovascular and hepatic-renal diseases.
In hospitals and burn centers, the affected areas are first gently washed and treated with antiseptic preparations.
This can be done under anesthesia, if the degree of burn is very high. Dirt from the burnt area is removed with hydrogen peroxide, epidermal particles from superficially burnt skin are removed with tweezers, small blisters are not opened, and large ones are emptied according to a special surgical technique so that the infection does not get under them.
If an open method of treatment is used in burn therapy, the surface of the burned skin is lubricated with special anti-burn ointments, and if it is closed, a sterile bandage impregnated with special preparations (often with Vishnevsky’s oil-balsamic emulsion) is applied to the lesion site. Such dressings do not aggravate pain, do not bring discomfort during replacement, and effectively protect the skin from infection. They are applied for 7-9 days until tissue epithelialization.
A large area of burns on the limbs requires their immobilization or immobilization. At the same time, in order not to disrupt the performance in the joints, it is important to break the immobilization every 2-3 days, and then resume it again. Blisters for burns are treated differently in different cases, sometimes they are opened, sometimes they are pierced, sometimes they are left in their original state until they dissolve. If a person has received a 4th degree burn, he needs prompt medical attention and often a skin graft.
Medical prognosis for burns
Burns very often provoke such conditions in the human body that can threaten the further health and life of the patient. This is affected by the degree of burns, the area of affected tissues, the age of the victim. It is believed that such conditions are worst tolerated up to 3 and after 60 years.
A critical condition can occur with complete damage to the skin with 1 degree of burn severity or with 30% damage to the body with burns of 2 and 3 degrees. With burns of 3 and 4 degrees more than 10% of the body in the face, perineum, genitals, experts speak of a danger to life. The same can be said about lesions of more than 15% of the skin on the trunk or limbs. In order to anticipate the seriousness of the situation with body burns, it is important to be able to calculate the percentage of skin burns. To do this, you can use the “rule of the palm”, which takes into account that the area of u1buXNUMXbthe human palm is approximately equal to XNUMX% of the entire surface of the skin, and, based on this, already calculate the total percentage of damage.
For an adult, another calculation rule can be applied – the “rule of nine” – which says that the entire arm, half of one leg, half of the back, head, stomach, chest are covered with 9% of the skin (each unit).
When providing first aid for thermal burns, it is necessary to understand how long a person has been in contact with a heat source, since contact with an object with a temperature above 45 degrees for 1 minute invariably leads to the death of skin cells due to inactivation of enzyme particles, denaturation of protein particles and other violations in the course of cell metabolism. Even when contact with hot ends, hyperthermia in the tissues continues, and often even intensifies.