Contents
What is a thermal burn?
Thermal burn – a burn that is received by contact with a liquid, solid or gaseous heat source. Such a source of heat can be incandescent bodies, flames, steam, hot liquids. The first place in the statistics is occupied by flame burns (about 84% of all thermal burns), followed by burns with liquid substances and electrical burns (approximately 7% for each type). In 2% of victims, burns are provoked by the influence of other factors.
Several layers of the skin can damage a thermal burn at once: the epidermis (outer layer), dermis, subcutaneous tissues. Depending on the number of damaged layers, four degrees of thermal burns are distinguished. Often a burn includes all of these degrees at the same time. Many doctors, describing burns, classify them according to the depth of damage: superficial, partial, complete.
The severity of the burn also depends on the area of the affected tissue. It is expressed as a percentage relative to the area of the entire surface of the skin. When estimating a burn, the so-called “rule of the palm” is used: the area of uXNUMXbuXNUMXbthe human palm is equal to one percent of the body area.
Degrees of thermal burns
It is customary to distinguish four degrees of burns, depending on the depth and severity of the lesion. Burns of the XNUMXst and XNUMXnd degree are considered to be superficial, XNUMXrd and XNUMXth – deep.
Thermal burn I degree. The affected area swells, turns red. A person is disturbed by pain, burning, especially acutely felt when touched. The temperature of the skin in the affected area rises. The listed symptoms keep 2, sometimes 3 days, gradually disappearing. The burn site disturbs the victim for some time, the epidermis begins to peel off on it. Gradually (after 3-5 days), the injured area looks almost healthy.
Thermal burn II degree. Such a burn occurs due to prolonged or sharp exposure to high temperature. There is also redness and swelling of the tissues, but bubbles also form. They are filled with tissue fluid sweating from dilated skin vessels. Later, the contents of the blisters, due to protein coagulation, turn from a transparent mass into a jelly-like mass containing leukocytes. The tissue fluid and the skin of the blisters themselves protect the tissues under the lesion from injury and infection, for this reason the blisters cannot be opened.
Patients with second degree burns usually suffer from severe pain. But after a few days, tissue irritation and circulatory disorders begin to decrease, the liquid is gradually absorbed. At the bottom of the bubbles, epidermal cells are actively dividing, and after a week a new stratum corneum begins to appear.
Thermal burn III degree. It occurs when exposed to high temperatures for a long time. It is characterized by necrosis of the skin – tissue necrosis, which can be dry or wet. Under the action of steam or boiling water on tissues, as a rule, wet necrosis occurs. The skin becomes edematous, pasty, acquire a yellowish tint, may become covered with blisters.
Such inflammation takes place in the likeness of the melting of dead tissues. When the necrosis is dry, the skin, respectively, is also dry, dense, dark brown or black. The edges of the area with dead tissue are clearly visible. Healing of burns of this degree takes place by scarring. However, when at least small areas of the germ layer of the epithelium are preserved, epithelialization is not excluded.
Thermal burn IV degree. This is, without exaggeration, the most terrible degree of burns. Often such burns capture a large area. All layers of the skin and even tissues outside it are dead: subcutaneous fat, tendons, muscles, bones. Several large blisters often merge into one huge one; skin color becomes dark red, reaching black. Such damage threatens not only health, but also human life.
III and IV degree burns are, of course, more dangerous, but superficial burns can also be fatal if they cover more than a third of the body surface.
First aid for thermal burns
First aid includes the following steps:
The first thing to do as quickly as possible is to extinguish the flames (if any) on the victim’s clothing and skin. It is necessary to throw off burning clothes from a person or throw a cloth over his body in order to stop the access of air to the fire. A burning area of clothing can be thrown with earth, sand, snow, pour water over it.
Try to calm the victim and the people around him.
Carefully remove from the injured person the smoldering remnants of things that did not fall into the wound. Never peel off clothing stuck to the burn. Also, you can not touch the burnt body with your hands.
If it is a sunburn, you need to move the injured person to the shade.
If you do not have information about what happened, quickly clarify the circumstances of the accident (“a child knocked over a bowl of hot broth on himself”, “clothing caught fire from a fire”, etc.).
Hold the affected part of the body for 10-20 minutes under a stream of cold running water (you can lower it into a container with cool clean water). This must be done so that the heated wound does not deepen and expand. In addition, it activates the blood circulation in the wound. However, ice should not be used to cool the burnt area in order to avoid the possibility of another injury – frostbite. In extreme cases (if there is no water nearby), it is allowed to cool the wound with urine, but in practice there is almost never a reason to use this method.
Apply any available anti-burn agent to the affected surface, apply a sterile (if possible) dry bandage on top. You can not use cotton wool, only gauze, bandage – fabric materials. It happens that there is neither an anti-burn agent nor sterile bandages at hand, then any dry, clean bandage should be applied to the wound. You can’t apply any folk medicines to the burn: vegetable oil, vodka solutions, kefir, sour cream, etc. You can’t also apply Kalanchoe or aloe leaves and other “miracle remedies” to the burned skin. With a first-degree burn (if neither extensive damage to the skin nor blisters is observed), the bandage can not be applied at all, only an anti-burn spray can be applied.
If there are extensive burns of the limbs, it is necessary to carefully fix them with a splint (any improvised means), raising the burnt arms (legs).
If a large area of the body is burned and there are signs of burn shock (the person is weak, pale, he has increased anxiety, tachycardia and a drop in pressure, cold sweat appears, breathing and heart rhythm are disturbed), you should give him as much liquid as possible to drink – juice, compote or plain clean water. Due to the intake of fluid into the body, intoxication will decrease, which has arisen due to the penetration of decay products of burnt tissues into the blood.
If the victim complains of pain, then in order to avoid pain shock, he should be given any available pain reliever (spasmalgon, analgin, etc.).
If a person has no cardiac and (or) respiratory activity, cardiopulmonary resuscitation (artificial respiration, chest compressions) should be performed.
In case of severe burns, call an ambulance for hospitalization of the victim or independently deliver him to a specialized medical institution. It is preferable to use the services of an ambulance, since not everyone can say with accuracy in which hospital or in which department burns are treated. It is good when it is a specialized clinic or at least a specialized department.
Treatment of thermal burns
Treatment of thermal burns involves the use of various means.
These can be creams and ointments, gels and sprays, or special dressings impregnated with a therapeutic composition:
Often, Levomekol antibacterial and wound healing ointment is used to treat a burn. The use of this tool allows you to achieve an analgesic effect. You can apply Levomekol from the first day after receiving a burn.
Ointment Povidone-Iodine is aimed at accelerating tissue regeneration, and also prevents infection from penetrating deep into the wound. This is possible due to the iodine that is part of the ointment, which acts as an antibacterial component.
If a person prefers to use products based on natural ingredients, then you should opt for the Rescuer balm. It does not contain synthetic antibiotics or hormones. Applying a balm to a burn will heal damaged tissues in the shortest possible time.
So that the wound does not become infected, and also heals faster, you can combine several drugs at once. So, in the complex, Levomekol ointment and Panthenol ointment (or Panthenol Spray) are often used.
In addition to ointments, a cream can be applied to the burn. Creams are recommended to start using during the period of restoration of damaged tissues. They prevent the formation of scars and scars. So, when getting sunburn, it is good to use Panthenol cream-foam. If you compare it with an ointment, then the effects will be similar, but the light texture of the foam penetrates the tissues faster.
A burn is always painful. Often, even the application of drugs is accompanied by painful sensations. In this case, experts recommend using sprays. The method of their application is reduced to non-contact spraying on the affected surface, which ensures minimal discomfort during treatment.
Also on sale you can find anti-burn dressings that are impregnated with therapeutic solutions. They allow you to relieve pain, accelerate healing and disinfect affected tissues.
Gels are often used to treat thermal burns, for example, Appolo and Burns net. They are suitable for primary wound treatment, as they have an antiseptic effect. Also, these gels make it possible to relieve pain and accelerate healing. Therefore, they can be used at any stage of treatment. Studies show that the use of gels allows you to quickly clean the wound from dead tissue and prevent inflammation, which is the best prevention of further formation of scars and scars.
If you get a serious burn, what should you do?
Of course, you need to see a doctor or, in extreme cases, call an ambulance. In a specialized clinic (specialized department), under anesthesia, the primary gentle treatment of wounds and the skin surrounding them is carried out with gauze napkins moistened with warm soapy water or a 0,5% solution of ammonia. After that, the burn surface is gently washed with warm water or alcohol (40-70 degrees), dried and irrigated with antiseptic solutions.
Very dirty areas of the burn are cleaned with a 3% hydrogen peroxide solution. Particles of the epidermis are removed from superficial burns with tweezers or scissors. Small blisters are not opened, and large exfoliated blisters are cut at the base, and then emptied by lightly pressing them with a gauze swab. For burns with resins, bitumen, refined gasoline is used.
With the open method of treatment, a thin layer of a special ointment or other synthetic (biological) coating is applied to the surface of the wound. With a closed method of treatment, a bandage is applied to the burn with a special ointment (synthomycin, streptomycin) or an emulsion (for example, sulfidine). Vishnevsky’s anti-burn oil-balsamic emulsion is also effective. Such dressings do not interfere with the healing of the burn, do not cause pain when changing, and provide high-quality protection of the wound from infection. The bandage is carefully bandaged, slightly pressing on the tissue. It should not move, with a successful course of the disease, the bandage is not removed until 7-9 days. This period is enough for the burn surface to epithelialize.
If the limbs are burned, immobilization is required, i.e. temporary immobilization. The position is chosen any convenient for the victim. In order to avoid the negative consequences of immobilization, every 2-3 days it is necessary to suspend immobilization in order to make movements in the joints.
There is no single correct opinion about what should be done with burn blisters. Some doctors quickly remove them, explaining that their internal contents are not sterile, other doctors release liquid from the blisters, but do not remove the blisters themselves.
To restore the body of a victim who received a IV degree burn, both quick competent treatment and skin grafting are required.
The prognosis of thermal burns
Pathophysiological changes that inevitably develop in the body affected by a burn provoke violations of the vital systems of the body and even threaten human life. The prognosis largely depends on the area of the lesion, the extent of the lesion, and the age of the victim. High mortality from burns in the elderly over 60 years and children under 3 years. However, even for patients of this age, burns cannot be considered a sentence.
The critical condition is considered to be 100% – a total burn of the 10st degree, and burns of the 15nd-XNUMXrd degree with damage to more than a third of the body surface. Life-threatening burns are III and IV degrees, where the genitals, faces, perineum are affected (if they hit XNUMX% of the body surface), and burns of the trunk and limbs, if the affected area is more than XNUMX%. For more accurate forecasts of burns, special techniques have been developed – the “Rule of hundreds”, “Frank Index”, which take into account the depth, vastness of the affected area and the age of the victim.
You need to know: if the thermal effect on the skin lasts longer than 1 minute and exceeds 45 ° C, this inevitably leads to overheating of cells and their death due to enzyme inactivation, protein denaturation, paralysis of tissue respiration and other metabolic disorders. After the cessation of thermal exposure, hyperthermia in the tissues does not stop, but continues and even becomes more active!