A. The concept, classification and characteristics of burns
Burns are a common trauma. Its causes are roughly the following.
1.Thermal burns: various hot liquids such as water, hot porridge, hot vapor, flame, incandescent metal, etc.
2, chemical burns.
Common strong acids are sulfuric acid, nitric acid, hydrochloric acid burns. They are characterized by tissue dehydration, tissue protein precipitation coagulation, so there are few blisters and rapid scab formation. In general, the deeper the burn, the harder the toughness and the darker the color (brownish-yellow, yellowish-brown), but the depth is often not easily judged due to the masking of the scab color. Early infection is mild. Deep acid burns are later to debride and slower to heal.
Common strong bases are caustic soda, ammonia, lime, etc. Alkali can dehydrate tissue cells with saponified fat, and alkali ions combine with proteins to form alkaline proteins, which can penetrate into deep tissues. Therefore, if the early treatment is not timely, the trauma can continue to expand or deepen and cause pain. Caustic alkaline burn trauma, with early flushing or small blisters, is generally deeper. After the scab or necrotic tissue falls off, the wound surface is sunken and the edges are submerged, which often does not heal after a long time.
Phosphorus burns quickly after contact with air. Phosphorus particles attached to the skin still continue to burn, so that the trauma is deepening. Phosphorus combustion products phosphorus pentoxide on the cells have dehydration and oxygen capture, water into phosphoric acid, but also further damage to the tissue. Therefore, phosphorus burns are thermal and chemical compound injuries, are generally deeper, serious cases can reach the muscle and bone. The trauma surface is brown, sometimes even muscle, bone are black. Phosphorus particles and phosphorus pentoxide fumes inhalation can cause severe respiratory burns and pulmonary edema; to the trauma and mucous membrane absorption can cause systemic poisoning, serious cases can lead to liver and kidney failure, rapid death.
Hydrofluoric acid burns, in addition to general acid burns, also have the effect of dissolving fat and decalcification. The burned skin shows erythema or leather-like crust, followed by necrosis, and continues to erode around and deeper, sometimes as deep as the bones to make it necrotic, forming an incurable ulcer with severe pain.
Napalm is a viscous substance, filled with incendiary agent in the incendiary weapons, long burning time, high temperature (up to 30,000C) adhering to objects and skin is not easy to remove, burning can produce a large amount of carbon monoxide. In addition to causing deep burns and can cause respiratory burns, carbon monoxide poisoning and asphyxiation. Sometimes napalm contains phosphorus as an ignition agent, so there is the possibility of phosphorus burns.
3, electrical burns: mainly refers to the high-voltage current burns. Electric current through the body caused by local injury called electrical burns. Clinical manifestations have entrance and exit, often oval, generally limited to the conductor contact parts, but the actual damage is deeper, can reach the muscle, bone or viscera, to the entrance more serious. The appearance of local yellow-brown or scorched yellow, severe tissue completely charred, solidified, neatly edged, dry, early pain is light, edema is not obvious but after 24 to 48 hours, the surrounding tissues appear inflammatory reaction and obvious edema. The skin around the electrical burns is often burned by electrical sparks or clothing on fire, and generally also more deep burns.
As the electric current passes through the skin, it rapidly moves along the body fluids and blood vessels (blood contains electrolytes and is easily conductive), causing damage to the adjacent tissues and blood vessel walls, degeneration and thrombosis to occur. About a week after the injury began to appear progressive tissue necrosis, wound expansion and deepening, and in severe cases there are often groups of muscle gangrene; or hemorrhage occurs due to rupture of blood vessels.
4, radiation burns: such as X-rays, the treatment of malignant tumors, radiation.
Second, the impact of burns on the whole body and injury judgment
Burns are not only skin burns. Especially large area burns. The systemic reaction is very strong, because the body’s “barrier” is broken, the intense pain in the burn area, or due to the rapid leakage of plasma-like body fluids, blood concentration, water and electrolyte balance disorders, can cause shock, impaired kidney function and even renal failure. As for some special parts, such as head and face burns, edema is very serious, especially in children, who are prone to cerebral edema; circumferential burns of the neck can compress the trachea and affect breathing; respiratory burns can occur ventricular rest, etc.
Therefore, for larger and deeper burns, we cannot take it lightly when we see only the local situation or when we see that the patient does not have any special manifestations at that time.
There are several aspects to determine the severity of burns.
The area of the burn: the larger the burn area, the more serious the damage to the body.
The depth of the burn: usually divided into three degrees of four levels. The lightest is the first degree burns, localized redness and pain. The deeper the burn, the more serious the damage to the local tissue.
Burn site: the importance of different parts of the body varies. If the head and face, neck, respiratory tract and other places are burned more seriously. Burns on moving parts such as hands and joints can easily cause deformities later on.
The patient’s age, physique, old age, frailty, children and people suffering from some serious diseases have more serious reactions to burns and are more difficult to treat and slow to recover, and malnourished burn patients have slower wound healing.
Complications: Combination of burns with other injuries such as fractures is more difficult to treat and recover from than burns alone. If the burn injury is complicated by sepsis, it often affects the consequences of burn treatment, and sepsis can be a major factor in the death of serious burns.
There are two methods of calculating the body surface area of adults determined in China.
Chinese nine-point method: that is, the body is divided into l l equal parts, each equal to 9% of the body surface area, such as the head and neck accounted for a body surface area of nine, that is, 9%. Head and neck burns, the burn area should be 9%. In the head and neck can be divided into hair, face, neck. Each accounts for 3%. If only the face is burned, it is estimated that the burn area is 3%.
Palm method.
Third, the scene of first aid
1, extinguish the “fire”: to quickly take effective measures to extinguish the fire as soon as possible to eliminate the cause of injury. Heat injury, feasible “trauma cooling therapy”. With clean water (such as tap water, river water, well water, etc.), water temperature 5-200C, cold compress or soak the trauma, need to last 1/2-1 hours, to take out no pain or slightly painful so far. Suitable for medium and small area burns, especially head, face and extremities.
(1) general fire extinguishing: remain calm, avoid running, running is windy aggravate burning. Quickly remove the burning clothes, or lie down on the ground, slowly roll to extinguish the flames, or jump into the nearby pool, ditch fire. Other rescue, the casualty will be pressed down, while using convenient materials such as quilts, raincoats, blankets, snow or sand to extinguish the flames.
(2) napalm burning fire: napalm explosion, that is, with a raincoat or other things to cover the body, to be thrown off the cover after the oil drops fall, and leave the burning area. Do not use your hands to fight fire directly, you can cover with wet cloth or sand, or jump into the water, such as smoke, with a wet cloth to cover the mouth and nose to protect the respiratory tract.
(3) phosphorus burns: the characteristics of phosphorus is natural in the air, the deeper the burn on the skin. Phosphorus can be absorbed through the trauma, causing liver and kidney damage and symptoms of central nervous system poisoning. Phosphorus and phosphorus oxides in contact with the skin mucosa, can cause burns. Treatment of phosphorus burns on the trauma should be covered with a damp cloth submerged in water, with 1% copper sulfate solution after washing to remove the black copper phosphide particles, and 2-3% sodium bicarbonate solution to neutralize phosphoric acid. Do not expose the trauma to the air, and do not use ointment dressing (phosphorus dissolved in grease, dissolved and absorbed). Cover the mouth and nose with a wet cloth can prevent the inhalation of phosphoric acid respiratory tract, if the cloth soaked with potassium permanganate solution is good.
(4) First aid for chemical burns: In addition to lime, various reactive metals, other acids and alkalis burned skin, should immediately rinse clean with water repeatedly, as soon as possible to shorten the time of chemical contact with the skin. When asphalt burns and skin, also quickly rinse with water to cool, and then use glycerin, turpentine or gasoline to wash away asphalt in combination with debridement. The time required for rinsing with water in first aid after strong alkaline burns is longer, 15~20 minutes on site, 2 hours is still effective, and neutralizing agent is generally not used. The key to hydrofluoric acid burns is early treatment, rinse or infiltrate with a lot of water, or soak with saturated calcium chloride or 25% magnesium sulfate solution, so that the residual hydrofluoric acid on the surface precipitates as calcium fluoride, magnesium fluoride . With calcium away from the penetration of treatment trauma better.
(5) electric burns first aid: human electrocution, such as current and voltage to a certain intensity, especially when the current through the head or chest, can immediately occur loss of consciousness, and even respiratory, cardiac arrest and in a “pseudo-death” state. Such as timely rescue can recover, should not be easily abandoned.
First aid: disconnect from the power supply; immediate implementation of cardiopulmonary resuscitation.
2, protect the trauma: after the fire, in addition to the necessary to remove the clothes (or cut along the seam), the casualty will be placed on a stretcher or appropriate place, available a variety of ready-made dressings for the initial dressing or clean clothes and sheets to cover the trauma, the purpose is to protect the trauma, to avoid recontamination or injury, there is no need to make other trauma treatment.
3, pain relief: pain after burns is very intense, it is necessary to give timely painkillers, such as oral painkillers or injection of dulcolax. Combined with respiratory burns or cranio-cerebral injury avoid morphine, so as not to inhibit breathing.
4, supplemental fluids: oral light salt water, light salt tea or burns drink. If the condition is serious, intravenous fluids (such as saline, dextrose, plasma, etc.) should be given early when available. Do not give large amounts of saline-free tea or simply enter large amounts of 5% glucose solution orally, as this may aggravate tissue edema.
Burn beverage tablets: each tablet contains 0.3g of salt, 0.15g of baking soda, 0.005 of luminal, and the right amount of sugar. Dissolved in 100 ml of water is the burn drink.
5, other measures: oral or injectable antimicrobial, pay attention to the treatment of combined injuries. Eye burns should be rinsed eyes, coated with antibiotic eye ointment. Inject tetanus antitoxin 1500 units. When it is cold, pay attention to keep warm.
Third, the evacuation and hospitalization of the injured
When rescued from the scene of a large number of burn casualties, small and medium-sized burns in principle should be organized nearby to rescue, in order to timely treatment and reduce pain. For large area burn casualties, should also be local rescue, sometimes need to consider transferring to a better condition of the medical unit. When transferring casualties, it is best to send to the destination within 4 hours after the injury. If you can not this time to send, should be in place to fight shock, to shock has been basically stable before sending. Transfer should try to infuse fluids, sedatives, and minimize bumps when necessary. In wartime, if you can not save shock in place, must be transferred in the shock period, it should be set up in the middle of the transit station, to carry out segmental infusion.
After the casualty is sent to the hospital to deal with: the area of 20% or less, you can take oral burn drink, wound cleaning after bandaging or exposure. For burns with an area of 21-40%, oral rehydration solution plus intravenous infusion can be administered, with crystal-based intravenous rehydration solution and colloid available with dextrose. For those with an area of 40% or more, intravenous fluids are administered, and blood transfusion should be considered, with appropriate amounts of oral fluids.