The concept of a burn injury:
Burns generally refer to tissue damage, mainly skin damage, caused by heat, such as hot liquids (hot water, hot oil, hot soup), flames, incandescent metals (dissolved liquids or incandescent solids), steam, and hot gases. Severe cases can injure subcutaneous tissue, muscles, bones, joints, nerves, blood vessels, and even internal organs. Since the tissue damage caused by electrical energy, chemical substances, radiation, microwaves, etc. has a similar clinical course to the general pathological changes caused by heat, it is customary to clinically refer to the tissue damage caused by them as burns as well.
Among the burns caused by many reasons, thermal burns are common, accounting for 85% to 90%. Burns in daily life are mainly caused by hot water, hot soup, hot oil, hot porridge, stove fire, electric iron, steam, firecrackers, strong alkalis, strong acids, etc.
Generally referred to burns include scalding, but the meaning of scalding is only due to hot liquid, steam and incandescent objects caused by tissue damage, can not be generalized burns.
Second burn injury injury assessment
1.The estimation of burn area.
2.The estimation of the depth of burns.
3.Burn severity classification.
4.The presence or absence of inhalation injury.
Burn area and depth are the main factors in estimating the severity of burns, and are also an important basis for treatment.
(A) Estimation of burn area.
1.Chinese new nine-point method
Area estimation of burns: The size of the burn area is expressed as a percentage of the body surface area occupied by the burned area, and is usually estimated using the nine-rules calculation method. The whole body surface area is divided into a number of 9 percent aliquots, plus 1 percent, constituting 100 percent of the body surface area, i.e., head and neck = 1 × 9 percent; double upper limbs = 2 × 9 percent; trunk = 3 × 9 percent; double lower limbs = 5 × 9 percent + 1. For children with large heads and small lower limbs, the head and neck area = [9 + (12 – age)] percent; double lower limbs area = [46 – (12 – age)] percent.
2. Palm method:
The patient’s five fingers together, the palm area is estimated as 1% of the body surface area.
Notes when estimating the area
1.When calculating the total area of burns, the area of Ⅰ degree is not counted, and the area of shallow Ⅱ degree, deep Ⅱ degree and Ⅲ degree burns should be indicated respectively after the total area for reference during treatment.
2, regardless of which method, are estimated, but seek to approximate, and recorded in whole numbers.
3, large area burns, for the convenience of calculation, can estimate the area of healthy skin, and then subtract the area of healthy skin from 100 percent is the area of burns.
4, inhalation injury is not calculated area, but in the diagnosis must be marked its severity (mild, moderate, severe).
(B) the estimation of the depth of burns
Three degrees of quadratic method (burn depth injury and level of clinical performance prognosis)
I degree superficial epidermis, the hair growth layer is alive in the local redness, burning sensation, increased skin temperature. 3-7 days after the debridement healing, no scarring.
Superficial II epidermal hair growth layer, dermal papilla layer redness and swelling is obvious, pain is severe, large blisters can be formed, the base is red. 1~2 weeks or so healing, usually no scars.
The deep II dermis, i.e. the reticular layer, is less painful, and blisters can be formed with a red and white base. If there is no infection, it heals in 3 to 4 weeks and usually leaves a scar.
In Grade III, the whole skin, or even the subcutaneous tissue, is pale, scorched or even charred, with loss of nociception, and a dendritic embolic vascular network is common. Unless the area is very small, surgical implants are usually required.
Notes for determining the depth of burns
1. The thickness of the skin varies in different parts of the body. Thus, the depth of injury caused by burns under the same conditions is not the same.
2.The thickness of the skin in the same area varies according to age, gender and occupation.
3.The causes of burns are different, and the clinical manifestations are not the same.
4.The heat insulation of the skin is greater, and the heat dissipation is also slow. After the burn injury occurs, although it is free from the heat source, the heat can continue to penetrate for a period of time, making the trauma deepen, which should be estimated dynamically.
(C) the severity of burns
Mild burns: Ⅱ degree burns of less than 10% of the total area; Ⅱ degree burns of less than 5% in pediatric patients.
Moderate burns: Ⅱ degree burns with a total area of 10% to 29%, Ⅲ degree burns with an area of less than 10%; 5-15% or Ⅲ degree burns with an area of less than 5% in pediatric patients.
Severe burns: total burn area of 30% to 49%, Ⅲ degree burns area of 10% to 19%; pediatric 16-25% or Ⅲ degree less than 10%; or one of the following conditions.
1.Serious general condition or shock.
2.Compound injury
3, moderate to severe inhalation injury
4, infants and children with more than 5% head and facial burns.
Extra-severe burns: total burn area of more than 50%, Ⅲ degree burns area of more than 20%; pediatric burns total area of more than 25% or Ⅲ degree burns area of more than 10%
(D) with or without inhalation injury
Inhalation injury diagnostic criteria
1.The burning site is relatively airtight.
2, face and neck and forehead burns, especially deep burns around the mouth and nose
3, nasal hair scorching, swelling of the mouth and lips, oropharynx redness and swelling with blisters or mucous membrane whitening.
4.Irritating cough with charcoal flakes in the sputum
5.Persons with hoarseness, difficulty or pain in swallowing
6.Difficulty in breathing or/and croup can be heard in the lungs.
7, the most common and diagnostic symptoms of inhalation injury early is hoarseness and wheezing,
Inhalation injury clinical grading (extent of lesion main symptoms main signs X-ray blood gas analysis)
Mild nasal, oral, pharyngeal dryness, painful nasal hair burning nasopharynx redness
Moderate larynx, trachea hoarseness, upper airway obstruction airway obstruction wheezing, dry x-ray tracheal stenosis shadow blood gas ±
Severe bronchial, alveolar hypoxia, respiratory distress dry, wet x-ray pulmonary edema blood gas hypoxemia
Attachment: ideas for the diagnosis and treatment of burns:
Resuscitation of life-threatening compound injuries:
1.judge the presence of inhalation injury
2.Judgment of the presence or absence of compound injuries
Judgment of the severity of burns
Treatment
Three burns first aid
Burn injuries are generally sudden accidents, often accompanied by multiple personnel burns. One of the earliest aspects of burn injury treatment is on-site treatment. In the scene rescue work is often the masses of self-help and mutual aid, as well as non-professional or medical personnel to treat the injured, therefore, the popularization of burn injury scene rescue knowledge, improve the ability to self-help and mutual aid is a very important aspect. The goal of on-site resuscitation is to eliminate the cause of injury as soon as possible, from the scene and life-threatening treatment measures.
(A) quickly from the source of injury
1.Heat burns
As soon as possible to take off the fire or boiling liquid impregnated clothing, especially chemical fiber clothing. In order to avoid the continued role of heat to deepen and increase the trauma.
Douse the fire with water, or jump into a nearby pool or river ditch.
After lying down quickly, slowly roll on the ground to press out the flames. Forbid the casualty to stand or run and call when his clothes are on fire to prevent head and face burns or inhalation injuries. Do not fight the flames with your hands to avoid hand burns.
Leave the confined and poorly ventilated site quickly to avoid inhalation injury and asphyxiation.
Use non-flammable materials around you, preferably flame retardant materials, to quickly cover the fire and isolate it from the air.
napalm explosion, oil point fall, steel splash should be quickly hidden or use clothes and other will cover the body, especially the exposed parts. After the oil point falls out, will be on fire clothes quickly abandoned, and quickly leave the scene.
2.Chemical burns.
All chemical burns should be quickly removed from the clothes impregnated with chemicals.
The severity of chemical burns, in addition to the nature and concentration of chemical substances, mostly related to contact time. Therefore, all should be flushed with plenty of clean water for at least 20 minutes, which can serve to wash out the chemical and cold therapy.
Do not delay the rinsing time by waiting to obtain the neutralizing agent. Moreover, the neutralization reaction can generate heat, which can deepen the wound.
In head and facial burns, attention should first be paid to the eyes, especially when the cornea has been burned, and priority should be given to flushing.
Dry lime burns should be removed first lime powder particles, and then a large amount of flowing water rinse more than 10 minutes, especially intraocular burns should be thoroughly rinsed, strictly forbidden to rub with hands or handkerchiefs, etc.. Do not immediately soak the burn site with water, so as not to aggravate the burn by generating a lot of heat in water lime.
3.Electrical burns
Electric arc-induced burns fire extinguishing methods with the general flame burns.
Electrical contact burns first aid should immediately cut off the power supply, extinguish the flame, pay attention to avoid their own electrocution.
If you find that the casualty respiratory and cardiac arrest, immediate on-site cardiopulmonary resuscitation and timely transfer to the nearest medical unit.
(II) On-site first aid
1.The principles of on-site first aid
The severity of burns caused by heat, electricity, chemical substances, radiation, etc., is closely related to the contact area and contact time, so the principle of on-site first aid is to quickly remove the cause of injury, remove the casualty from the scene, and give appropriate treatment and make preparations before transferring.
Maintain a clear airway and, if necessary, tracheotomy.
Cold therapy.
In combination with other compound injuries, treat according to the principles of trauma first aid.
Protection of burn wounds.
Sedation and pain relief, fluid therapy.
Evacuation and hospitalization of the injured.
2.The main points of on-site first aid (general treatment of burns): (1) flush (2) take off (3) soak (4) cover (5) send
(1) flush: flush the burned area with running tap water until it cools locally and reduces pain or use a cold towel on the wound for at least 10 minutes. Do not put ice directly on the wound to avoid injury to the skin tissue. The general self crude crude Xing women hyper carambola and our senior citizens are not able to support the P eye support (5) fishy exhaustion H绻诿凶挥岳岳此那榭鱿拢⒑ uranium part of the top of the clothing in the tirade H绻殖∶挥欣捎闷渌渌魏瘟沟奈藓Φ囊禾澹缗D袒蚬拮暗囊稀
(2) off: when wearing clothes scalded by hot water, hot soup, do not rush to take off clothes, but first directly with cold water poured on the clothes to cool down. After fully rinsing and soaking wet wounds, carefully remove clothing in cold water, such as clothing and skin stick together, do not tear and pull to forcefully peel off any clothing, so as not to break the blisters, blister epidermis in the early stages of burns have the role of protecting the trauma, to reduce pain and reduce exudation. Only cut off the unadhered part, and leave the adhered part on the skin for later treatment, then cover the wounded surface with clean gauze to prevent contamination. Never break a blister when it is present.
Do not apply herbs, toothpaste, vinegar, soy sauce, salad oil, etc. to the injury, as such items may cause bacterial infection of the wound and may aggravate the depth of the burn.
For acute burns, there is no first aid measure that can exceed the value of an immediate shower with running cold water!
Since the area and adjacent parts will swell after the burn, remove rings, watches, belts, shoes or other tight clothing before the injury is swollen to prevent the limb from swelling and then being unable to remove it, resulting in poor blood flow and more serious injury.
(3) Soak: Continue to immerse in cold water for at least 30 minutes, at this time, the main role is to relieve pain, and the rinsing in the very early stages of the burn can reduce the degree of burn, very important. However, for patients with large burns or younger age, do not soak for too long to avoid excessive drop in body temperature causing shock and delaying treatment
time. But when the patient is unconscious or can not wake up, it is time to stop soaking quickly to the hospital.
(4) Cover: Use clean or sterile gauze or cotton cloths to gently cover the wound and fix it. This will reduce outside contamination and irritation, help keep the wound clean and reduce pain. If not, leave small wounds exposed to the air and cover large wounds with a clean sheet, cloth sheet or gauze. Do not break the blister.
(5) Send: the first time to call the 120 emergency number, before the arrival of the emergency vehicle, check the patient’s airway, breathing conditions and pulse, and prepare for emergency cardiopulmonary resuscitation, such as monitoring the state of consciousness, the number of breaths and pulse. Zhangqiu City People’s Hospital Burn and Plastic Surgery Department outpatient phone number 83251519
Attachment: treatment of oral and pharyngeal burns
(1) Burns of the face, mouth and throat are very dangerous because they may cause rapid swelling and inflammation of the respiratory tract, and the lumps can rapidly obstruct the respiratory tract and lead to breathing difficulties, thus requiring prompt medical attention.
(2) Measures can be taken to improve the casualty’s breathing, such as untying the collar.
(3) If the casualty is unconscious, be prepared for CPR at all times.
(4) Pay attention to keep the airway open, to promptly tracheal intubation or tracheotomy, do not wait for the performance of respiratory distress before doing treatment.
Four burn patients transfer
The timing of transfer
1.Casualties with burn area less than 29% can be transferred at any time according to local conditions.
2. If the burn area of 30-49% of the casualty can be sent to the designated hospital within 8 hours, it is better; or while replenishing fluids intravenously, choose a smooth means of transport to transfer.
3, burns more than 50% of the area, especially more than 70% of the casualty should generally be in place to fight shock, and those who have the conditions should seek professional technical forces to assist in treatment, and then transferred after 48 hours after the injury. If the local medical conditions are too poor or too many casualties, can also be under the guidance of professional personnel for such casualties in the active replenishment of blood volume under the premise of rapid and smooth transport transfer.
The above points can be used as a reference to grasp the timing of casualty transfer, but in the specific decision of casualty transfer, should also take into account the specific circumstances of the casualty and the conditions of transfer.
Patients with burns in our city can be transferred by the local health center or by calling “City Hospital 120” to send an ambulance if there are no serious complications.
Pre-transfer treatment
1. analgesia, sedation generally available pethidine or morphine, but with cranio-cerebral injury or respiratory depression contraindicated, can be replaced by diazepam.
2, proper protection of trauma wound area clothing to avoid stripping, available scissors to cut, as far as possible to retain the trauma blister; trauma area should be covered with sterile dressings or clean sheets, do not cover the trauma with plastic; trauma surface forbidden to apply colored or irritating drugs or items.
3. Rehydration fluid should be given to the seriously injured and those who are transferred for a long time.
4, other combined injuries, such as fractures should be fixed first; combined with poisoning, should be symptomatic treatment; moderate or severe inhalation injury, should be tracheotomy or cricothyroid puncture to prevent asphyxiation. Injuries with more than 30% of the burn area should be left with a catheter; to prevent infection, antibiotics should be applied as appropriate.
Precautions during transfer
1.The choice of transfer tool is not strictly required for light and moderate burn patients; however, for serious injuries, the transfer tool with fast speed and less bumps should be chosen, and there should be treatment and emergency treatment equipment on the way.
2. Rehydration fluid transfer, the general wounded can take oral rehydration salt solution; severe wounded, those who have appeared shock signs or with serious gastrointestinal disorders, should be intravenous rehydration fluid.
3. First aid on the way to transfer should carry the necessary first aid drugs and equipment, such as tracheotomy kits, various first aid drugs and oxygen, etc.
Five preventive measures
Vigorously carry out publicity and education, so that each society and family members grasp the basic knowledge of burn protection and can carry out self-help and mutual help.
(1) Families with young children, the kitchen and dining room are separated as much as possible. Do not allow young children to play in the kitchen while cooking. Don’t put hot water bottles in the home where young children may get them to prevent them from being accidentally knocked over and causing burns. It is best not to lay tablecloths on the table to avoid curious children pulling at them.
Hot dishes and soups can be pulled off and cause burns.
(2) Put hot pots and pans and kettles of water that have just come off the fire in a safe place.
(3) When cooking hot pot, making coffee or tea, be careful not to trip over wires and tip over teapots, hot pots or hot water bottles, etc.
(4) The temperature of meals should be appropriate when eating.
(5) Do not use empty drink bottles with dangerous solutions to avoid accidental ingestion by family members. It is best not to put strong acids, strong alkalis and other dangerous items in the home.
(6) Electric irons, electric stoves, electric heaters and other electrical equipment used at home should be placed out of the reach of children.
(7) When bathing, you should put cold water first and then add hot water to prevent scalding. Water temperature of about 38 ℃ ~ 40 ℃, to hot and not hot is appropriate.
(8) mosquito nets do not point mosquito incense; if the heater at home does not have a package, should be covered with a towel, or with furniture to block; if there is a stove at home, to use the stall to separate.
Six burns first aid in the “misunderstanding”
1.After being burned, you can’t use tap water to flush, it will lead to infection.
Wrong. The best first aid measure after a burn is to use a lot of cold water, not only to reduce pain, but more importantly, to reduce the degree of burn, through the rush of cold water, bubble, take away the heat in the tissue to avoid further damage. So once the burns occur, the first thing to think about is how to get away from the heat source as soon as possible, in the case of water immediately for bubble, bubble should last ten minutes – thirty minutes or more, the cleanliness of tap water has been relatively high, can be completely safe to use, to be disinfected after treatment to a specialist hospital, bandage the wound, so as to reduce both the degree of burns The degree, and will not occur infection.
2, after being burned not at all painful that the burn is not heavy, all right.
Wrong. On the contrary, the less painful the wound feels, but the more serious the injury. Because the boiling water or open fire first damage to the skin epidermis, and then to the middle layer of the skin, the pain nerve is destroyed you will not feel pain. So if you feel no pain at all, this means that the extent of the burn may be very serious, has been damaged to the deep tissue, should be promptly to the specialist treatment. If it hurts a lot, then don’t worry too much, the injury is never as bad as your pain.
3, after the burn on the traumatic surface smear.
Wrong. After a burn, many people apply toothpaste, soy sauce, alcohol, purple potion, red mercury, gentian violet smear on the wound, etc., not knowing that these are harmful to the wound instead. In the burn wounds coated with colored drugs will affect the doctor’s judgment of the depth of the burn, the depth of the burn is a very important basis for the doctor to develop a treatment plan. Furthermore, there are many folk “native methods” for treating burns or scalded wounds, such as applying badger oil, herbal ash, or even certain Chinese medicinal preparations to the wound. From the point of view of modern medicine, these folk treatment methods often cause trauma infection and aggravate trauma damage, so it is not advisable.
4, if the burn produced after the blister must be picked through.
This depends on the situation. General boiling water burns formed blisters are sterile, the epidermis is not broken, at this time, if the blisters are not very large.
On the one hand, because the skin is kept intact, bacteria are not easy to invade and infection is not likely to occur. On the other hand, preserving the skin can play a role in protecting the wound. However, if the blister is too large, pain is evident, and protein coagulation is possible, the blister should be punctured with a sterile needle stick and the water squeezed out of the blister to cover the blister skin as it is. A better method is to use biological dressing, when the necrotic epidermis is completely removed, cleaned and disinfected, covered with biological dressing, this method greatly reduces the infection rate, and the pain of dressing change is greatly reduced.
5, burns the wound is exposed to heal quickly, can not be wrapped, will “cover bad”.
Wrong. Basic and clinical research at home and abroad has long confirmed that trauma drying, dehydration will aggravate the trauma stasis with progressive necrosis of tissue, increase trauma pain, damage the residual attachments with regenerative capacity, resulting in deepening of the trauma, delaying trauma healing. The current medical consensus is that only in wet conditions can host phagocytes function to promote inflammation regression and prevent infection. A wet environment also prevents the exposure and death of nerve endings, reduces wound pain, facilitates the dissolution of necrotic tissue and promotes the release of multiple growth factors, providing an ideal environment for wound healing and thus promoting wound healing.
The skin is the most important barrier of the human body, once the skin is broken and missing, the bacteria will “have holes to enter”, so after the burn, how to protect the wound from the invasion of bacteria is the most important, through the sterile dressing dressing is to play this protective role, at the same time, the dressing can absorb the tissue fluid exuded from the wound. However, the dressing is not completely sterile, and bacteria may invade and multiply after a certain period of time 24-48 hours, so it is necessary to change the dressing in time, which is often called “dressing change”, to keep the wound relatively sterile by cleaning and disinfecting it again, and to use some drugs that promote the growth of the wound to make it heal earlier. Healing.
6.Burn patients who are dehydrated should drink water to replenish.
Wrong. Usually small area burns patients will not have serious dehydration symptoms, because the body has a certain regulatory function. But in the larger area of burns patients, there is a large amount of exudate in the trauma will have dehydration symptoms, the patient has a strong sense of thirst, if this time arbitrarily give the patient to drink plain water or drinks, which may lead to water poisoning or acute gastric dilatation, at the same time due to the stress of large burns, digestive system dysfunction, there may be nausea and vomiting and other symptoms, so do not drink water, should be appropriate oral salt drinks or salt Boiled water, more importantly, should be promptly to the hospital for intravenous rehydration, and
7.Burns only hurt a little skin
Wrong. Many people think: burns are only superficial wounds are not relevant, casually in a small clinic bandage can be. In fact, burns are very serious trauma, larger area (adult burn area of 20%, infants and children burn area greater than 5% body surface area) burns may soon lead to shock, do not give shock resuscitation in a timely manner, several hours heart, liver, brain, lungs, kidneys, gastrointestinal organs are subject to varying degrees of damage, serious life-threatening. So serious burns should be immediately to a specialist hospital to prevent accidents.
8.Some kind of medicine has special effects, healing fast after use will not fall scar
Wrong. Many people believe that a panacea or a secret recipe can cure all burn wounds and heal quickly without scarring. In fact, different burn causes, different heat source temperatures, different contact times, different burn sites lead to different depths of burns and therefore different healing times, and whether or not a scar falls depends on the depth of the burn rather than the use of any magic pill. Different burn sites, different burn depths, different treatment periods, and different burn causes have strict indications for medication, and one should never blindly believe in a particular drug or a particular treatment method, as experienced professional doctors will develop suitable treatment plans according to different situations, and whether a scar falls or not depends mainly on the depth of the burn and whether it is properly treated. It is easy to get infected if you apply it indiscriminately, and it is more likely to deepen the wound, thus making it scarred.
9.Can’t eat hair after injury
Wrong. The so-called hair products, refers to certain foods that can aggravate the disease or the recurrence of old diseases, such as fish, shrimp, mutton, dog meat, leeks, parsley, etc.. In fact, hairy food is a folk saying, and in practice we have not found any actual cases of aggravation or relapse of old diseases after eating hairy food. On the contrary, because these foods contain a variety of vitamins and proteins, but for the healing of burn wounds have a lot of help. Therefore, as long as there is no special reaction to these foods, you can eat more after the burn to facilitate the healing of the wound.
Summary: how to do after being burned?
1, do not panic, quickly get away from the source of injury, immediately nearby with clean cold water rinse or wet compress wound area 15-30 minutes.
2, the wounded area clothing to avoid stripping, available scissors to cut out, as far as possible to retain the trauma blister, the wounded area with gauze or clean towels, sheets and clothes near the simple bandage to prevent re-contamination.
3.Forbid to apply colorful or irritating drugs or items on the wound surface, such as nail violet, red mercury, soy sauce, toothpaste, various types of black ointment, etc., so as not to aggravate the wound damage again or affect the judgment of the depth of the burn wound in the subsequent treatment and clean up the wound.
4.Call the nearest city hospital “120” for early formal treatment to reduce the occurrence of scars and other sequelae caused by delayed treatment or informal treatment.