Outline of burns

2021-01-26 12:00 AM

Up to 80% of the total number of patients is superficial burns, occupying less than 20% of the body skin area. For this type of burn, the treatment is very simple

Outline

Burns are a common emergency in everyday life. Occasional mass-burn emergencies.

Up to 80% of the total patients suffering from superficial burns on narrow areas, accounting for less than 20% of the body skin area. For this type of burn, the treatment is very simple: give the patient rest, relieve pain and fight superinfection.

The remaining 20% ​​are both extensive and deep burns. This type is very heavy and requires a strong focus on resuscitation, especially during the first 8 hours. The mortality rate of this type is still very high.

Causes of burns

Burns due to heat: Due to boiling water, gas burns ... Burns from low temperatures: ice, cold nitrogen ...

Burns caused by sparks (especially high voltage), by lightning.

Burns caused by chemicals: phosphorus, acid, caustic soda ...

Burns caused by radiation.

How to calculate the burn area

There are many ways to calculate the burn area, adults differ from children because in children the ratio of head - face - neck to limbs is greater than that of adults:

Wallace's "law 9" adults:

Location

Acreage (%)

Plus

Head - face - neck

9%

9%

Body front

9% x 2

18%

Body behind

9% x 2

18%

An upper limb

9%

18% (2 hands)

One lower limb

9% x 2

36% (2 feet)

The genital anal area

first %

first %

 

 

100%

 Palm calculation (from Faust): Each patient's palm is calculated by 1% of burned skin area.

For children: The younger a child is, the greater the ratio of head to neck to lower limb than adults.

 

Newborn

1 year old

5 years old

10 years old

13 years old.

Top of the face

20%

17%

13%

ten %

8 %

The thighs

11%

13%

16%

18%

19%

Legs

9%

ten %

11%

twelfth %

13%

 Burns over 15% of the body area in adults and over 8% in children are severe burns.

 

Classification of burn depth

 People rely on the cause of the burn (burning gasoline deeper than boiling water ...), the time it causes burns (soaking in boiling water is worse than being transient ...) and clinical progress (from mild severe ...) that divide the depth of burns into categories: superficial burns, deep burns, intermediate burns.

Superficial burns: is a minor burn, easy to heal and when it does not leave a scar.

Burns 1 degree is a burn in the horny layer. The skin is burned red, burning, 2-3 days, then heal and leave no scars. Common: burns in the sun, burns boiling water without clothes.

Burns 2: Damage to the epidermis. On a red background, blisters with clear fluid appear. Since it has not reached the basal cell layer, it leaves no scars when it is gone. Healed after 10-14 days. Common: burns boiling water where there are clothes ...

Deep burns: Severe and very severe burns, the burn causes destroy the basal cell layer, leaving the skull cramped, most of which need to be patched.

Burns 3: the basal cell layer is destroyed, burns spread to the dermis, causing extensive skin necrosis. Because of the loss of the reproductive cells, the skin is not protected, so burns of this type are mostly infected. Common burns due to gasoline, acid, electric burns ...

Burns level 4: The burn causes destroy all the skin, burns to the muscles, bones, an entire area of ​​the limb is burned black. Commonly caused by high voltage, lightning, house fire (in high-rise buildings fire disasters), car fires, etc.).

Intermediate burn: A type of burn located between the limits of superficial burns and deep burns. Burns spread to part of the basal cell layer (shallow layer, the part that curls up and down). This type of burn goes well, but can also get worse and become a deep burn. Common burns of boiling water where clothes are ...

Diagnose the depth of burns

Some simple methods to diagnose superficial and deep burns:

Try feeling the skin is burned necrotic: use a sharp needle, a cotton swab.

Burns of the epidermis: Pain will increase.

Burns of the dermis: still painful but relieved.

Burns deep: Does not know pain.

Hair removal pair in burn necrosis area: If not painful, easy withdrawal is deep burn.

Burn area circulatory test: Place the cloth ring of the HA gauge on top of the burned limb area. Pump air to 80 - 90 mmHg for 10 minutes. If the burn is shallow, the colour will gradually purple. If it is a deep burn, the colour will not change (due to an obstruction).

Prognosis of burns

Causes of burns: Burns caused by chemicals are heavier than heat burns ...

Burn area and depth: extensive burns are heavier than narrow burns ..., deep burns are heavier than superficial burns ...

Patient background: burns in children and the frail elderly have a severe prognosis. Adults, degree 2 burns over 30%, degree 3 over 15% serious burns. But in children, a degree 2 burn of more than 12%, a degree 3 of more than 6% is already severe.

Based on the location of the burn: Respiratory burns are rarer but very severe. Burns in the face, severe prognosis is probably due to vasomotor disorders causing ischemia, brain oedema. Burns in the anal genital area are susceptible to infection. Burns of the hand cause scarring and lead to loss of function of the hand ...

The clinical course of burns

Most burns are shallow, narrow in area, so the prognosis is mild, with only local care to cure. Severe burns progress through stages:

First stage: burn shock: In the first 48 hours.

Due to pain: Patient is screaming, vomiting and nausea, gradually lying lethargic, indifferent, sweating on his forehead, nose, cold in his limbs.

Due to decreased volume of circulation: plasma escapes out of vessels, infiltrates organization causing oedema. The victim was lethargic, had a small rapid pulse, and decreased BP.

Blood test: Concentrated blood, decreased alkaline reserve, acidosis. Blood potassium increases, creatinine increases.

The organs affected by shock are Brain, liver, kidney, in which the kidneys are most severely affected. Easy to get nephritis due to burning shock: less urine, thick red, hemoglobinuria, protein ... From oliguria, gradually becoming anuria - acute kidney failure.

Without early and complete circulating mass supplementation, the mortality rate is very high.

Stage 2: Acute intoxication starts from the 3rd letter onwards (3 - 15 days) due to infection, due to absorption of necrotic toxins.

Clinically: Patients with strenuous stimulation, drowsiness, diminished perception, may go into a coma. The patient has a high fever of 40 - 410 C, cold skin, cyanosis. The patient has shallow, irregular, rapid breathing due to pneumonia. Patients with anorexia, vomiting, diarrhoea and even gastrointestinal bleeding.

In the blood: Red blood cell count due to blood concentration, electrolyte disturbances and blood acidosis. Urea and creatinine increased; protein decreased.

This is the most dangerous stage of a burn because it can easily lead to death. Therefore, it is necessary to treat on the spot, filter to organize the necrosis well, supplement enough circulating volume, balance male electrolytes for the patient. 

Stage 3: Primary infection is caused by the loss of a large area of ​​skin and for a long time. Common bacteria are staphylococcus, hemolytic streptococci, green pus bacillus, possibly tetanus. Infection at the burn site can cause sepsis. In severe burns, if the burn shock period is passed, 70% will die during this period.

Regarding treatment: blood supplementation, adequate fluid and early skin patching for the patient.

Stage 4: Recovery and depletion

If good treatment, minor burns, early skin patching ..., the patient gradually recovers.

If poor treatment, severe burns ... patients gradually deteriorate - a vicious circle: Anemia, lack of protein, infection ... the more ulcers, the peeling patch does not achieve.