When exposed to the temperature organ over 55 ° or a poisonous chemical compound A lesion of tissues called a burn is formed. The extensive effect of the aggressive medium leads to global changes in the body and negatively reflects on the integrity of the skin, the work of the heart, vessels, immunite.

The degrees of burns legs

1. In case of damage to the first degree foot, only small in the area of \u200b\u200bits zone suffers. Symptoms are associated with a slight change in skin color and edema. The victim is not necessarily applying for medical attention. It is necessary to anesthetically in case of need and to displaced the scene.
2. At the injury of the foot of the second degree in humans, a pronounced pain syndrome is observed. Leather on the leg is red covered by blisters different size with translucent liquid. The victim should apply to the trauma, since the risk of infection is high. In addition, the patient has no necessary conditions for the provision of adequate first aid.

The pain is eliminated by medication. The violation of the integrity of the swelling bubbles will not help, but will only increase the risk of entering the infection.

1. When damaged the foot of the third degree makes itself felt the partial necrosis with the preservation of sprout areas of the skin. In a difficult situation, the entire bottom of the leg is amazed. Man will only help urgent hospitalization after first aid.
2. The most severe degree characterized by the complete necrosis of the upper cover, as well as damage and the charging of the inner tissues (muscles, bones). With such injury, death is possible. Treatment is associated with surgical intervention and is carried out only in the hospital.

Thermal burns in the ICD

The international classification of diseases is designed to simplify the storage and analysis of the names of diseases. Used not only in the scientific world, but also in ordinary hospital cards.

Each disease and injury is assigned code. The classification composition is revised every decade.

For burns of the foot and tibia, the numbering is determined by the degree and nature of damage. Distinguish burns:

• thermal;
• chemical.

For thermal burn, the Code of the ICD 10 begins with 25.1 and ends 25.3.

25.0 - the burn of the foot of an uncomputed degree.

Similarly, a classification for chemical injuries is presented: from 25.4 to 25.7.

T24 is thermal and chemical burns of the hip joint and the lower limb, excluding ankle joint and foot, unsuitable.

Risk factors and groups

Injuries of this kind in the field of ankle joint and heels are extremely rare: the lower part of the leg is most often protected by a dense material of the shoe.

But sometimes doctors assign the T25 code on the ICD (sub-clause is determined by the degree), highlighting the following types:

• Thermal burns of the foot area. The damage occurs as a result of non-accurate treatment with any sources of thermal energy: hot items (heaters, batteries, fascinated metals as a result of foreign exposure), boiling water, steam, open flame.
• Chemical burn. Characteristic to hit the skin of various poisonous substances, rapidly or gradually disturbing the integrity of the upper covers. The most dangerous cases include acid and alkali.
• Radiation. Happens when irradiated. Get it in laboratories, at the site of disposal (especially unauthorized) waste of this kind, in the zones of increased radiation.
• Electric. It turns out as a result of the stroke of the foot.

Diagnostics

In case of damage to the ankle joint and the foot of an uncomplicated degree, experts seek to determine the nature of the injury.

To select the correct treatment strategy, the doctor draws attention to:

• depth;
• the area of \u200b\u200bthe affected area.

For this applies:

• "Palm rule";
• "Rule of nine."

In the first case, the area is calculated, based on the principle: proportionally palm takes 1% of the total surface of the skin.

In the second - 1 shin and stop at global injury are defined as 9% of the whole body.

Since children have other proportional dependencies, the Land and Brower table apply for them.

In the hospital to help specialists come film meters with an applied grid.

Treatment

From the quality of the first aid to the victim in the burns of the ankle and (or), the feet depends on further treatment, the availability of complications and the general forecast.

Everyone is useful to familiarize themselves with the simple order of action, performed during burns:

1. From the affected area remove all the clothes. Since the synthetic is used to stick to the skin, it is gently cut off with scissors.
2. Impose a sterile bandage.

It is impossible to use any creams, ointments, powders, compresses. The doctor prescribes medication treatment.

1. The victim helps to take the most convenient position with a fixed injured limb.
2. The only medicine that is given to a person is an anesthetic.

Alone to treat a 1st degree burn is allowed. In other cases, the intervention of a specialist is required.

Further events held in the Medical Institution are related to:

• warning and elimination of inflammation;
• healing.

Often, doctors prescribe a course of antibiotics to prevent the development of infection.

Additional events:

• tetanus vaccination;
• analgesics.

Experts are closely monitored so that the suppurations are not formed.

In special cases, an operation is assigned:

• plastic;
• skin transplantation.

Thermal and chemical burns of easy degree - frequent household injury. Heavy cases are associated with accidents or negligence in production. Sterile materials are used and with suspected degree higher than the first to see a doctor.

RCRZ (Republican Center for Health Development MD RK)
Version: Archive - Clinical protocols MOR RK - 2007 (Order No. 764)

Thermal and chemical burns of unspecified localization (T30)

general information

Short description

Thermal burns There are due to the direct impact on the skin of the flame, steam, hot liquids and powerful thermal radiation.

Chemical burns There are resulting from the skin of aggressive substances, often strong solutions of acids and alkalis capable of causeing tissue leaning for a short time.

Protocol code: E-023 "Thermal and chemical burns of external surfaces of the body"
Profile: emergency

Purpose of the stage: Stabilization of vital functions of the body

Code (codes) on the ICD-10-10: T20-T25 Thermal burns of external surface surfaces refined on their localization

Included: thermal and chemical burns:

First degree [erythema]

Second degree [bubbles] [loss of epidermis]

Third degree [Deep necrosis underlying] [loss of all skin layers]

T20 Thermal and Chemical Heads and Neck Burns

Included:

Eyes and other areas of faces, heads and neck

Temple (area)

The scalp (any section)

Nose (partitions)

Ear (any part)

Limited area of \u200b\u200bthe eye and its apparatus (T26.-)

Mouth and pharynx (T28.-)

T20.0 thermal burn head and neck neuropsychiatric

T20.1 thermal burn head and first-degree neck

T20.2 Thermal Head Burn and Neck

T20.3 Thermal head of the head and neck of the third degree

T20.4 Chemical burn head and neck neuropsychiatric

T20.5 Chemical burn head and first-degree neck

T20.6 Chemical burn head and neck second degree

T20.7 Chemical burn head and neck third degree

T21 Thermal and Chemical Burns Torch

Included:

The side wall of the belly

Rear Passage

Inter-pumping area

Breast

Pakhova region

Penis

Sexual lip (big) (small)

Crotch

Backs (any part)

Ground walls

The walls of the belly

Jagged region

Excluded: thermal and chemical burns:

Bulk region (T22.-)

Axillary depression (T22.-)

T21.0 thermal burn torso torso

T21.1 thermal burning body burn

T21.2 Thermal Burning Block

T21.3 Thermal Burning Third Tool

T21.4 Chemical burn blasting of an uncomplicated degree

T21.5 Chemical burning body burn

T21.6 Chemical Burning Block Second Degree

T21.7 Chemical Burning Third Tool

T22 thermal and chemical burns of the area of \u200b\u200bthe shoulder belt and the upper limb, excluding the wrist and brush

Included:

Blank region

Axillary region

Hands (any part except wrist and brushes)

Excluded: thermal and chemical burns:

Inter-pumping area (T21.-)

Only wrists and brushes (T23.-)

T22.0 thermal burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, unsuitable degree

T22.1 Thermal burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, first degree

T22.2 thermal burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, second degree

T22.3 thermal burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, third degree

T22.4 Chemical burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, unsuitable

T22.5 Chemical burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, first degree

T22.6 Chemical burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, second degree

T22.7 Chemical burn area of \u200b\u200bthe shoulder belt and upper limb, excluding wrist and brush, third degree

T23 thermal and chemical wrist burns and brushes

Included:

Thumb (nail)

Finger (nail)

T23.0 Thermal wrist burns and an uncomfortable degree brushes

T23.1 Thermal wrist burns and first degree brushes

T23.2 Thermal wrist burns and second degree brushes

T23.3 Thermal wrist burn and third degree brushes

T23.4 Chemical wrist burns and uncomfortable brushes

T23.5 Chemical wrist burns and first degree brushes

T23.6 Chemical wrist burns and second degree brushes

T23.7 Chemical Wrist Burn and Third Degree Brushes

T24 thermal and chemical burns of hip joint and lower limb, excluding ankle joint and stop

Included: Legs (any part, excluding ankle joint and stop)

Excluded: thermal and chemical burns only ankle joint and foot (T25.-)

T24.0 thermal burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and stop, unsuitable degree

T24.1 thermal burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and stop, of the first degree

T24.2 thermal burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and foot, second degree

T24.3 Thermal burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and foot, third degree

T24.4 Chemical burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and foot, unsuccessful degree

T24.5 Chemical burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and stop, of the first degree

T24.6 Chemical burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and foot, second degree

T24.7 Chemical burn area of \u200b\u200bthe hip joint and lower limb, excluding ankle joint and stop, third degree

T25 thermal and chemical burns of the area of \u200b\u200bthe ankle and foot

Included: fingers (s) legs

T25.0 thermal burn area of \u200b\u200bthe ankle joint and the feet of an inadvenous degree

T25.1 thermal burn area of \u200b\u200bthe ankle joint and first degree feet

T25.2 Thermal burn area of \u200b\u200bthe ankle joint and the foot of the second degree

T25.3 Thermal burn area of \u200b\u200bthe ankle joint and the foot of the third degree

T25.4 Chemical burn area of \u200b\u200bthe ankle joint and the foot of an uncomputed degree

T25.5 Chemical burn area of \u200b\u200bthe ankle joint and the foot of the first degree

T25.6 Chemical burn area of \u200b\u200bthe ankle joint and the foot of the second degree

T25.7 Chemical burn area of \u200b\u200bthe ankle joint and the foot of the third degree

Thermal and chemical burns of multiple and unspecified localization (T29-T32)

T29 thermal and chemical burns of several areas of the body

Included: thermal and chemical burns classified by more than one of the columns T20-T28

T29.0 Thermal burns of several areas of an inadvertent degree

T29.1 Thermal burns of several body areas indicating no more than the first degree of burns

T29.2 Thermal burns of several body areas indicating no more than the second degree of burns

T29.3 Thermal burns of multiple body areas with an indication of at least one third-degree burn

T29.4 Chemical burns of several areas of an uncomfortable degree

T29.5 Chemical burns of multiple body areas indicating no more than the first degree of chemical burns

T29.6 Chemical burns of several body areas indicating no more than the second degree of chemical burns

T29.7 Chemical burns of several body areas with an indication of at least one chemical burn of a third degree

T30 Thermal and Chemical Burns of Unclean Localization

Excluded: thermal and chemical burns with an acclaimed area

Body Surface (T31-T32)

T30.0 thermal burns of unspecified degree of unspecified localization

T30.1 Thermal Burn of the first degree of unspecified localization

T30.2 Thermal Burn of the Second Degree of Unspecified Localization

T30.3 Thermal Burn of the third degree of unspecified localization

T30.4 Chemical burns of unspecified degree of unspecified localization

T30.5 Chemical burns of the first degree of unspecified localization

T30.6 Chemical Burn of the Second Degree of Unsuitable Localization

T30.7 Chemical burns of the third degree of unspecified localization

T31 Thermal burns classified depending on the area of \u200b\u200bthe affected body surface

Note: This heading should be used for primary statistical development only in cases where the localization of thermal burn is not specified; If localization is clarified, this heading can be used as an additional code with T20-T29 headings if necessary.

T31.0 thermal burn less than 10% body surface

T31.1 thermal burn 10-19% body surface

T31.2 thermal burn 20-29% body surface

T31.3 thermal burn 30-39% body surface

T31.4 thermal burn 40-49% body surface

T31.5 thermal burn 50-59% body surface

T31.6 thermal burn 60-69% body surface

T31.7 thermal burn 70-79% body surface

T31.8 thermal burn 80-89% body surface

T31.9 thermal burn 90% body surface and more

T32 Chemical burns classified depending on the area of \u200b\u200bthe affected body surface

Note: This heading should be used for primary development statistics only in cases where the localization of the chemical burn is not clarified; If localization is clarified, this heading can be used as an additional code with T20-T29 headings if necessary.

T32.0 Chemical burn less than 10% body surface

T32.1 Chemical burn 10-19% body surface

T32.2 Chemical burn 20-29% body surface

T32.3 Chemical burn 30-39% body surface

T32.4 Chemical burn 40-49% body surface

T32.5 Chemical burn 50-59% body surface

T32.6 Chemical burn 60-69% body surface

T32.7 Chemical burn 70-79% body surface

T31.8 Chemical burn 80-89% body surface

T32.9 Chemical burn 90% of the body surface and more

Classification

The severity of local and general manifestations of burns depends on the depth of damage to the tissues and the area of \u200b\u200bthe affected surface.

The following degrees of burns distinguish:

Foreign burns I degree - resistant hyperemia and skin infiltration.

Burns of the II degree - peeling the epidermis and the formation of bubbles.

Cell burns of the IIII - partial skin necrosis with preservation of deep-lived layers of dermis and its derivatives.

Burns IIIIB degree - the death of all skin structures (epidermis and dermis).

Burns of IV degree - leather sacrifice and driving fabrics.

Definition of burn area:

1. "Rule of nine."

2. Head - 9%.

3. One upper limb - 9%.

4. One bottom surface - 18%.

5. Front and rear body surfaces - 18%.

6. Fit organs and crotch - 1%.

7. The rule "Palm" is conditionally, the palm area is approximately 1% of the total body surface area.

Risk factors and groups

1. Nature agent.

2. Conditions for getting a burn.

3. The exposure time of the agent.

4. The magnitude of the burn surface.

5. Multifactor damage.

6. Environmental temperature.

Diagnostics

Diagnostic criteria

The depth of lesion during the burn is determined on the basis of the following clinical signs.

Gores I degreemanifests hyperemia and skin swelling, as well as a feeling of burning and pain. Inflammatory changes pass within a few days, the surface layers of the epidermis are listed, healing comes to the end of the first week.

Burns II degree accompanied by pronounced edema and hyperemia of the skin with the formation of bubbles filled with yellowish exudate. Under the epidermis, which is easily removed, is a bright pink painful wound surface. For chemical burns of the II degree, the formation of bubbles is not characteristic, since the epidermis is destroyed, forming a thin necrotic film, or completely discovered.

With III burnsinitially, either dry light brown stamp is formed (with flame burns), either whipless gray wet stamp (exposure to steam, hot water). Sometimes thick-walled bubbles filled with exudate are formed.

With burns IIIIIdead fabrics form scrap: with burns with flame - dry, dense, dark brown; With hot liquids and ferry burns - pale gray, soft, test consistency.

Gores IV degree accompanied by the death of tissues located under their own fascia (muscles, tendons, bones). Strong thick, dense, sometimes with signs of charring.

For deep sologa acid It is usually formed dry dense stamp (coagulative necrosis), and with the damage to the alkali, the first 2-3 days are soft (collicration necrosis), gray, and in the future it is subjected to purulent melting or dries.

Electrologiza Almost always are deep (IIIB-IV degree). Fabrics are damaged in places of input and current output, on the contactful surfaces of the body along the path of the shortest passage of the current, sometimes in the ground zone, the so-called "current tags", having a kind of whorescent or brown spots, on the site of which are formed dense stamp, as if depressed in relation to To the surrounding intact skin.

Electrical burns are often combined with thermal, outbreak of electrical arc, ignition of clothing.

List of major diagnostic activities:

1. Collection of complaints, the history of general therapist.

2. Visual inspection of general therapist.

3. Measure arterial pressure on peripheral arteries.

4. Study of the pulse.

5. Measurement of heart rate.

6. Measurement of breathing frequency.

7. Calpation general Eurapeutic.

8. The percussion of general therapist.

9. Auscultation general Eurapeutic.

List of additional diagnostic events:

1. Pulse oximetry.

2. Registration, decoding and description of the electrocardiogram.

Differential diagnosis

Differential diagnosis It is carried out on the basis of the assessment of local clinical signs. Determine the depth of the defeat, especially in the first minutes and hours after the burn, when there is an external similarity different degrees Burn is quite difficult. It is necessary to consider the nature of the agent and the conditions for injury. Lack of pain reaction with a needle cheelery, hair pulling, touching the burned alcohol tampon surface; The disappearance of the "Capillary Games" after a short-term finger press indicate that the defeat is not less than IIIIB degree. If there is a drawing of the subcutaneous thrombic veins under dry lap, then the burn is reliably deep (IV degree).

In case of chemical burns, the boundary of the lesion is usually clear, the trams are often formed - narrow strips of affected skin, separation from the periphery of the main focus. Appearance The burn area depends on the type of chemical. For burns with sulfuric acid, brown or black, nitric - yellow-green shade, salt - light yellow. In early terms, the smell of the substance that caused the burn may also be felt.

Treatment abroad

Treat treatment in Korea, Israel, Germany, USA

Get advice on medical examination

Treatment

Tactics of treatment

The purpose of treatment is the stabilization of the vital functions of the body.First of all, it is necessary to stop the action of the striking agent and deletevictim from the heat radiation, smoke, toxic productsburning. It is usually done before ambulance arrival. Impregnated hotliquid clothing must be immediately reset.

Local hypothermia (cooling) of burnt fabrics immediately after terminationthe actions of the thermal agent contributes fast decline interstitialtemperature that weakens its damaging effect. For this may beused water, ice, snow, special cooling bags, especially whenlimited burn burns.

With chemical burns after removal of clothing impregnated with chemicalsubstance, and abundant kneading for 10-15 minutes (when the appeal is notless than 30-40 minutes) of the affected area with a large number of running coldwater, proceed to the use of chemical neutralizers that increasefirst aid efficiency. Then they impose dryaseptic bandage.

Agrowing agent	Neutralization tools
Lime	Summary with 20% sugar solution
Carbolic acid	Bandages with glycerol or lime milk
Chromic acid	Bandage with 5% sodium thiosulfate solution *
Hydrofluoric acid	Weapons with% 5 with aluminum carbon dioxide or glycerin mixture And Magnesium Oxide
Borogenic compounds	Alcohol
Selena oxide	Pads with 10% sodium thiosulfate solution *
Aluminum organic connections	Running the affected surface with gasoline, kerosene, alcohol
White phosphorus	Bandage with 3-5% copper sulfate solution or 5% solution Permanganate potassium *
Acid	Sodium bicarbonate *
Alkalis	1% acetic acid solution, 0.5-3% solution boric acid*
Phenol	40-70% ethanol*
Chromium compounds	1% hyposulfite solution
Mustard gas	2% chlorine solution, calcium hypochloride *

With thermal damage, clothing from burnt areas are not removed, but cut and carefully removed. After that, the bandage is superimposed, and in its absence any clean fabric is used. Before imposing a dressing can not be cleanedthe burned surface from sticking clothes, delete (calculate) bubbles.

For the removal of pain syndrome, especially with extensive burns injuredmust be introduced sedative - diazepams * 10 mg - 2.0 ml in / in (Seduxen, Elenaium, Relanium,sibazone, Valium), anesthetic - narcotic analgesics (Promedol(trimepyridine hydrochloride) 1% -2.0 ml, morphine 1% -2.0 ml, fentanyl 0.005% -1.0 ml in / c),and in their absence - any painful agents (Baratgin 5.0 ml in / B, Analgin 50% -2.0 V / B, Ketamine 5% - 2.0 * ml in / c) and antihistamines - DiPhenhydramine 1% -1.0mL * V / B (Dimedrol, Diprazine, Supratin).

If the patient has no nausea, vomiting, even if he has no thirst, it is necessarypersuade to drink 0.5-1.0 l liquid.

Severely ill, having burns with a total area of \u200b\u200bmore than 20% of the body surface,immediately begin infusion therapy: intravenously inkivo glucosolesalesolutions (0.9% sodium solution chloride *, trisol *, 5-10% solution of glucose *), in volume,providing stabilization of hemodynamic parameters.

Indications for hospitalization:
- I burns I degrees more than 15-20% of the body surface;

Burns of the II degree on the area of \u200b\u200bmore than 10% of the surface of the body;
- Burns of IIII on Squaremore than 3-5% of the body surface;
- burns of IIIB-IV degree;
- Face burns, brushes, stop,crotch;
- Chemical burns, electrician and electricity.

All victims in a state burning Shock with pronouncedhemodynamic disorders (weak and frequent pulse, sharp and stable hypotension,chills, thirst, vomiting), with inhalation lesions of the respiratory tract, with poisoningcarbon monoxide, with general hyperthermia, violation heart Rhythm Need toproviding urgent resuscitation assistance. During transportation

11. * Trisole - 400.0 ml, FL.

* - Preparations included in the list of basic (vital) drugs.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of 28.12.2007)
   1. 1. Clinical recommendations based on evidence-based medicine: per. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. -2-E ed., Speed. - M.: Goeotar-Honey, 2002. - 1248 C.: IL. 2. Guidelines for emergency medical care / ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, recycled and supplemented - St. Petersburg.: Bin. Laboratory of Knowledge, 2005.-704c. 3. Tactics of keeping and ambulance medical care for emergency conditions. Guide for doctors. / A.L. Veltkin - Astana, 2004.-392c. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and protocols of diagnosis and treatment, taking into account modern requirements. Guidelines. Almaty, 2006, 44 s. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 "On approval of a list of basic (vital) medicines." 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 "On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854" On Approval of the Instructions for the Formation of the List of Basic (Vital Medicines) ".

Information

Head of the Department of Emergency and Emergency Medical Aid, internal Diseases No. 2 of the Kazakh National Medical University. S.D. Asphendiyarova - D.M., Professor Turlanov KM

Employees of the emergency and emergency medical care, domestic diseases No. 2 of the Kazakh National Medical University. S.D. Asphendiyarova: Ph.D., Associate Professor Vodnev VP; Ph.D., Associate Professor Diasebyev B.K.; K.M.N., Associate Professor Akhmetova G.D.; Ph.D., Associate Professor Babybaeva G.G.; Almukhambetov MK; Laskin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute of Improvement of Doctors - Ph.D., Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute of Improvement of Doctors: Ph.D., Associate Professor Solchev Yu.I.; Volkova N.V.; Hairulin R.Z.; Sedrenko V.A.

Attached files

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The flow and outcomes of the burn injury are largely dependent on the timeliness of the provision of first aid and rational treatment throughout the disease. For burns more than 10%, and in small children, 5% of the body surfaces there is a real danger of shock development, so when first aid, it is necessary to take measures to prevent shock and infection in the wound. For this purpose, painkillers are introduced (50% analgin solution with 1% solution of diphedrol or 2% solution of priedol). When the epidermis has been preserved, the burned surface is advisable to cool the jet cold water or other available means, and to the wound to impose a sterile bandage. Reducing the hypertermia of tissues, inflammatory response, edema, depth of necrosis, resorption of toxic substances from burnt tissues, the intrication of the body contributes to the early (for the first hour after injury) with liquid nitrogen cryotherapy. When localizing burns on the limbs with the involvement of functionally active sites, it is necessary to provide transport immobilization. The victims are evacuated into the medical institution of the surgical profile, the treatment in which necessarily includes the introduction of anti-trummy serum and toilet wounds.
When I burn burns, the bandage does not impose, sufficiently local use of weak-coming drugs. It is advisable to irrigation from aerosol cylinders with medicinal mixtures containing corticosteroid hormones.
With burns of II, the wound toilet is carried out against the background of the introduction of painkillers (2% solution of priedol or pantopone). It consists in cleaning the wound and the surrounding skin with warm soap water, 0.25% ammonia solution, antiseptic solutions (etchridine lactate, furaciline, chlorocyl, detergents solutions), removal foreign languages And scraps of the epidermis. If the epidermis is not sized, then the burned surface is treated with alcohol. Whole bubbles are cut or punctured by removing content. The preserved epidermal film protects the wound from external stimuli, the healing under it proceeds faster and less painfully.
The burns of the II degree can be performed open in the open method, as well as burns of III, in the absence of abundant purulent discharge and creating optimal conditions for reparative processes in the wound. In the absence of abacterial treatment conditions after the WC toilet, to prevent the secondary infection and the suppuration on the wounds impose bandages with antiseptic solutions (Rivanol 1: 1000; Furacilin 1: 5000; 0.1-1% Dioxidine solution and) or used aerosol anti-inflammatory drugs (Panthenol, Visal, Leggoicht, Olazol, Oxycort). In the cold season, it is preferable to close the wound with a bandage with low-fat creams or ointments (syntomicin liniment, 0.5% furacin and 15% propolis ointment, a balsamic line by A. V. Vishnevsky).
Under conditions of mass lesions, after a thorough toilet of the burn wound, it is advisable to apply aerosols with film-forming polymers (fursoofst, iodium, lifesol, plastubol, acutol, acrylasept and). The advantage of them is to significantly reduce the duration of the processing of the burned surface, saving the dressing material. The film protects the wound from infection, prevents the loss of fluid through the wound, facilitates control over the course of the wound process (if it is transparent), which makes it possible to make adjustments to the treatment of wound in a timely manner. With a smooth flow of a wound process, healing occurs under the primaryly applied film. Film coatings exclude the possibility of impregnating them with liquids and more reliably than the dressings, protect the wound from pollution and infection. If necessary, the primary toilet of the burn wound can be postponed. It should not be done if there is a shock of victims with heavy burns. In such cases, burn wounds close a slightly heated bandage with ointment, and their toilet is postponed before stabilizing the state of the patient and remove it from the state of the shock. Also act with the mass arrival of patients.
Primary imposed bandage do not change within 6-8 days. The indication to its replacement for burns of the II of the degree is the suppuration, as evidenced by pain in the wound and specific clocking of the dressing. With the suppuration of the burn wound after its toilet using hydrogen peroxide or the antiseptic solution, they impose a moist-drying dressings containing antiseptics or antibiotics to which the sensitive of the microflora of the Russian Academy of Sciences.
Healing of burns of II degree occurs within 10-12 days. The recovery of patients with burns I degree occurs 3-5 days after injury.
When burning burns, the dermal leather of the skin occurs, therefore, their suppuration is observed more often, which can lead to the death of the skin derivatives and the formation of granulating wounds. The main task in the treatment of burns shakes is to prevent their deepening. This is achieved by timely removal of dead tissues and targeted combating wound infection. During the dressings, which should be made after 1-2 days, gradually remove wet necrotic scrap (starting from 9-10th day) if the stred is dry, then it should not be rushing with its removal, since epithelization can occur under it.
For dressings for burning items, it is advisable to use bandages with antiseptics (ethanidine lactate, furaciline, 0.25% solution of chloroqing, 0.5% silver nitrate solution or antibiotics. Infrared and ultraviolet irradiation of the RAS allows preventing wet necrosis, helps to reduce purulent and faster epithelialization.
As the exudation is saccuming at the final stage of the treatment of burns after rejection of necrotic tissues, it is necessary to move to the masses and oilyobalzamic bandages (5-10% syntheicin liniment, 0.5% furacilic, 0.1% gentamicinic, 5-10% dioxidic, 15% propolis ointment , Levosin, Levomecol, Olazol and), promoting the acceleration of healing and providing a pronounced bactericidal effect. Ointments are not annoyed by the wound, give a softening and pain relief effect. The shift of the dressings produced as they are blocked by the purulent separated (after 1-2 days).
Treatment of burns II-III degrees can be carried out in local insulators with a regulated medium in an open method, which reduces the level of bacterial seeding of the Russian Academy of Sciences and promotes their faster spontaneous epithelization.
Infusion-transransfusion therapy of extensive and deep burns. Infusion-transransfusion therapy B. complex treatment Patients with extensive burns takes one of the leading places. With extensive burns, significant energy costs reaching 5000-6000 kcal, or 60-70 kcal per 1 kg of body weight, and the loss of nitrogen with the wound surface is 20-50% of the total losses, which leads to a negative nitrogenous balance. In this regard, in the treatment of a burn disease, infusion-repellentransfusion therapy gives exceptional importance to all its periods, from the correct and timely implementation of which the possibility of surgical treatment of patients with deep burns, as well as the outcome of the disease depends.
All patients with deep burns are 10-15%, and children - 3-5% of the body surface with 1 g about a day after injury need intensive infusion-transmission therapy. With pronounced intoxication, intravascular injections are produced daily by an individual program in accordance with the severity of thermal injury.
With a burn shock, infusion-repeated therapy provides for the replenishment of the liquid volumes of electrolytes, proteins and erythrocytes in the vascular bed, improve exchange processes, kidney functions and disinfectivity of the body.
In patients with burns less than 10-15% of the body surface, if they do not have vomiting, it is possible to fill the losses of the fluid by administering the 5% glucose solution with vitamins C and group B, alkaline solutions. The replenishment of liquid volumes of the vascular channel is achieved by intravascular injection of the liquid, as well as by returning depositated blood for active circulation using hemodulution.
In order to carry out anti-depository and disinfection of the body, saline solutions are used (Ringer - Lockery, lactasol), plasma and colloid plasma-substituting drugs (REOPOLIGLUKIN, hemodez, polydetis, gelatinoly and) in the amount of 4-6 liters, 5-10% glucose solution with vitamins with and groups in a dose of 500-1000 ml in the 1st day after an injury in adults. With a slight burn shock, the therapy is carried out without hemotransphus. In the case of severe and extremely heavy Shock Hemotransphus (250-1000 ml) is carried out by the end of 2 or on the 3rd day, depending on the severity of the state, hematological indicators and kidney functions. In order to combat acidosis, a 4% solution of sodium bicarbonate is used, which is prepared before applying and administered, taking into account the basis deficit in quantity.
In individuals of the elderly and senile age, the volume of the intravenous fluid should not exceed 3-4 l, and in children 2-3 l per day. The amount of infusion-transransfusion therapy with a burn shock in children can be approximately determined by the Wallace scheme: the tripled mass of the child's body (in kilograms) multiply on the burn area (in percent). The resulting product is the amount of liquid (in milliliters), which must be introduced to the child during the first 48 hours after the burn. It does not include the physiological need for water (700-2000 ml per day depending on the age of the child), which is satisfied, additionally giving a 5% glucose solution.
The ratio of colloidal (protein and synthetic) and crystalloid solutions is determined by the severity of the burn shock. Approximately with a lightweight burn shock, the ratio of colloidal, saline solutions and glucose should be 1: 1: 1, with severe - 2: 1: 1, and with extremely heavy - 3: 1: 2. Two thirds of the daily amount of infusion media are introduced into the first 8-12 total volume of intra-uudio fluid on the 2nd day after injury, reduced by 2 times.
After replenishing liquid volumes in the vascular bed, as evidenced by the improvement of the indicators of the BCC, osmotic diuretics are used. Mannitol in the form of a 20% solution is administered at the rate of 1 g of dry matter per 1 kg of body weight of the injured, urea solution (20%) - in a volume of 150 ml at a speed of 40-60 drops per minute. An efficient diuretic means is Laziks, which is prescribed at a dose of 60-250 mg / day after eliminating the BCC deficiency.
When conducting infusion therapy of the burn shock, a 20% solution of sorbitol can be used, which is administered at the rate of 1.5-2.5 g of dry matter per 1 kg of body weight of the patient per day. The expressed diuretic effect usually occurs 40-60 minutes after the introduction of osmotic diuretics. If necessary, after 3-4 hours, they can be reused.
Infusion-repeated therapy with a burn shock is carried out in a complex with measures aimed at pain relief, prevention or elimination of oxygen deficiency, violations of the function of cardiovascular, respiratory systems and other organs. For this purpose, cardiotonic agents are used, antihypoxants, antihistamines. Corglikon is administered intravenously, Cordamin 1-2 ml 2-3 times a day, prescribed oxygen to inhalation. The action of cardiac glycosides is enhanced when the caocarboxylase is appointed 50-100 mg 2 times a day, which favorably affects the exchange of carbohydrates. A significant improvement in the blood supply of heart and kidney muscle contributes to Eufillin, which also has a diuretic effect, which is introduced as a 2.4% solution with a 5% glucose solution of 5-10 ml to 4 times a day.
In order to the anesthesia, a 1% solution of morphine or a 2% solution of priedol in combination with a 50% solution of analgin is introduced intravenously. The use of the neuroleptic of droperidol in the form of a 0.25% solution ensures the elimination of psychomotor excitation.
With severe and extremely heavy burn shock, when infusion-repeated therapy is not effective enough, the normalizing effect on hemodynamics and kidney function has corticosteroids. They increase cardiac ejection, Improve the blood supply to the heart muscle, eliminate the spasm of peripheral vessels, restore their permeability and increase the diuresis. In the presence of burns of the respiratory tract, they contribute to the decrease in the edema of the bronchial tree. The patients are prescribed hydrocortisone intravenously at 125 mg in the composition of infusion media or a prednical at a dose of 30-60 mg 3-4 times for 1 days of anti-aggregate therapy before the normalization of hemodynamics and diuresis.
Due to the disruption of oxidizing agent processes in burnt and deficit in their body of vitamins in the implementation of infusion-transmission therapy, it is necessary to introduce ascorbic acid at 5-10 ml of 5% of the solution to 2-3 times, Bi, Bi vitamins 1 ml and vitamin VITS 100-200 μg 3 times a day nicotinic acid 50 mg.
Oxibutirate sodium is successfully used as an antihypoxic agent (GOM, sodium salt oxymalassic acid). Sodium oxybutirate levels braid shifts, reduces the number of non-surfacing products in the blood, improves microcirculation. With a burn shock, the drug is prescribed intravenously at 2-4 g 3-4 times a day (daily dose 10-15 g).
In order to inhibit proteolysis and enzymes of the kallikrein system in infusion environments, it is advisable to enter 100,000 units or Trasilol in 500,000 units per day, which contributes to the normalization of the permeability of the vascular wall.
In patients with a burn shock 6 hours after injury, there is a significant increase in the content of histamine in the blood. In this regard, the pathogenetically justified is the use of antihistamine drugs: 1% diphrol solution of 1 ml 3-4 times a day, 2.5% pipolphine solution 1 ml 2-3 times per day.
Infusion-repeated therapy is carried out under the control of the CVD and Hell, the rate of pulse and its filling, hourly diurea, hematocrit, blood hemoglobin, concentration of potassium and sodium in plasma, braids, blood sugar and other indicators.
Relatively low CVD (less than 70 mm of water) indicates an insufficient reimbursement of the BCC and serves as a basis for increasing the volume and tempo of the introduction of infusion media (if there is no danger of the development of pulmonary edema). High CVD is a sign of heart failure, in connection with which it is necessary to reduce the intensity of infusion therapy or temporarily stop it.
When controlling hourly diuresis, it is focused on a level 40-70 ml / when carrying out infusion therapy, it is necessary to ensure that the sodium concentration in the plasma was not less than 130 mmol / l and not higher than 145 mmol / l. Plasma potassium concentration must be maintained at 4-5 mmol / l. The rapid correction of hyponatremia is achieved by infringing 50-100 ml of a 10% solution of sodium chloride, and hypercalemia is usually eliminated. Otherwise, the introduction of 250 ml of 25% glucose solution with insulin is shown.
Transfusion media with burn diseases are administered by venopunction or venessice of available subcutaneous veins. In this case, it is necessary to strictly observe the principles of asepsis and antiseptics. In the event that the conducting therapy has experience of catheterization of a subclavian, jugular or femoral vein, then it is preferred. The catheterization of the central veins more reliably provides the necessary amount of infusion-repeated therapy during the entire period while the victim is in a state of shock.
When the catheterization of the central veins, in order to avoid thromboembolic complications, the catheter introduced into a vein must be systematically ringed with an isotonic solution of sodium chloride with heparin (2-3 times a day). After the end of the infusion, the catheter is filled with a solution of heparin (2500 units per 5 ml of isotonic solution) and close the cork. When signs of phlebitis or perifelucite infusion in this vein should be immediately discontinued. In the case of the development of the purulent process in burn wounds, especially in the late periods of the burn disease, the catheter from the vein should be removed so that it does not appear by the conductor of purulent infection and the cause of the occurrence of the pitnoseceptic complications.
Control of adequacy of infusion-transransfusion therapy in the absence of laboratory studies can be carried out by clinical signs Burning shock. Pale, cold and dry skin indicates a disturbance of peripheral blood circulation, to restore which REOPOLIGULUKIN, GETALITY, HEMODAC, POLIDES, can be used. Strong thirst is observed in a patient with a shortage of water in the body and the development of hypernatremia. In this case, it is necessary to intravenously to introduce a 5% solution of glucose, and in the absence of nausea and vomiting - increase the method of fluid inside. The falling of the subcutaneous veins, hypotension, lowering the leather turgora is observed with sodium deficiency. Infusion of electrolyte solutions (lactasol, Ringer's solution, 10% sodium chloride solution) contribute to elimination. Strong headache, convulsions, impairment, vomiting, salivation, indicating cell hyperhydration and water intoxication, serve as indications for the use of osmotic diuretics. The main features indicating the exit of the exhaled out of shock are the resistant stabilization of central hemodynamics and the recovery of diuresis, the elimination of the peripheral veins spasm, the warming of the skin and the beginning of the fever.
In the period of burning toxemia, infusbnotransfusion therapy continues in a volume of 2-4 l, or 30-60 ml per 1 kg of body weight. In order to combat alkalosis in patients with severe burns, it is advisable to influence a 20% glucose solution to 500-600 ml per day with insulin at the rate of 1 units per 2-4 g of glucose and 0.5% solution of potassium chloride to 500 ml under the control of potassium content and sodium in the serum of the patient.
For the purpose of disintellation and prevention of anemia, hypo and disproteinemia, systematic transfuses of freshly consisted resusismic one-line blood or its components (erythrocytic mass, native and dry plasma, albumin, protein) 2-3 times a week of 250-500 ml adults and 100-200 ml Children under the control of hematological indicators (hemoglobin level, the number of erythrocytes), which must comply age norm. A particularly pronounced disinfect action is provided by direct hemotransfusion, transfusion of fresh-indarcent blood or blood and plasma of reconvalued, since the recovery of which not more than 1 year has passed after burns.
Reduced intoxication contribute to the complex of infusion media Osmotic diuretics (mannitol, lazic, 30% urea solution), the influx of which is advisable to alternate with intravenous administration low molecular weight plasma-substituting solutions (hemodez, reopolyglyukin), which provides forced diuresis.
For the purpose of disinfecting for burns and acute surgical infection, hemodialysis, hemosorption, plasma and lymphosorption are used. One of the mechanisms of therapeutic effect of hemosorption are to reduce the level of proteasesemia and peptide, a decrease in the toxicity of plasma and the severity of metabolic disorders. Sorption allows you to securely and quickly free the body of burnt from toxic metabolites. However, hemosorption is accompanied by loss of uniform elements of blood (platelets, leukocytes, red blood cells), chills, changing the physicochemical properties of red blood cells. The positive effect of hemosorption is preserved no more than 2-3 days. To ensure effective detoxification, it is necessary to conduct repeated hemosorption at the interval 24-48 in connection with this, hemosorption is justified primarily in cases where other healing measures are ineffective. Hypovolemia and hemodynamic instability observed with extensive burns are contraindicated to the use of hemosorption.
During the period of septicotoxemia, intensive infusion-transmission therapy is particularly necessary in preparation for surgical operations and during their implementation when an increased replenishment of the organism's energy costs is required. During this period, blood transfusion is 250-500 ml 2-3 times a week, alternating with transfusions of blood protein preparations and plasma-substituting solutions of disinfecting action are the main component of infusion-transransfusion therapy.
Along with the hemotransphus for replacing the continuing losses of the protein, the improvement of the colloid-free and transport function of the blood is essential, the transfusion of dry and native plasma is of 250-500 ml 2 times a week, which allow stabilizing the levels of common protein and serum albumin. If blood transfusions do not improve the indicators of the albumin fraction of serum proteins, it is advisable to apply a 5-10% albumin solution of 200-250 ml for 3-4 days, especially in patients of elderly and senile age. Albumin solution is highly efficient when compensating for the loss of extracellular protein and eliminate hypo and disproteinemia, maintaining the normal colloid nosmotic plasma pressure, treatment of toxic hepatitis at the burnt. Maintaining the level of total serum protein 6.5-7 g% and albumin 3.5-4.0 g% is needed to ensure a favorable course of the wound process, successful preparation for operational interference on the restoration of the skin and its implementation.
The high energy costs in the organism of the baked are ensured due to the destruction of lipids, carbohydrates and proteins. In this case, serum proteins and fabric proteins, especially skeletal muscles are consumed. The most pronounced disorders of the protein exchange occur during the first weeks of burn disease in patients with severe burns. Catabolism is mainly subjected to albumin and only some of the vanity, the hypo and disproteinmey, the deficiency of intracellular and extracellular proteins, protein failure. Clinically, it is manifested by exhaustion, muscle atrophy, decreasing body weight.
To replenish the energy costs and restoring a nitrogen balance in the late period of the burn disease, it has great importance parenteral nutritionwhich allows you to provide patient with easily digestible nutrients and compensate for deep violations of all types of exchange. For parenteral nutrition, protein hydrolyzates are used at the rate of 15 ml / kg (on average 800 ml), amino acid preparations (10 ml / kg), which are injected at no more than 45 drops per minute, and energy components (glucose, fat emulsions).
In severe burns, glucose is introduced in the form of a 10-20% insulin solution. To reduce insulin resistance, often developing in patients with severe burns, and improving glucose utilization processes It is advisable to apply tocopherol in the form of a 10% solution of 1 ml 1 time per day. For the purpose of parenteral nutrition, sorbitol and fat emulsions can be used.
In many patients, parenteral nutrition can be successfully replaced by enteral - using the probe introduced through the nasal stomach in the stomach or duodenal gut. For enteral probes, mixtures containing glucose, proteins and fats are used, which are injected with a dropping method (20-30 drops per minute). They can only be administered after restoring the suction and motor intestinal function.
During the period of acute burning toxemia and septicotoxmia, infusion-transransfusion therapy should be carried out against the background of rational nutrition using high-calorie food containing 120-140 g of protein, mineral salts, vitamins A, C, group B, energy value which is at least 3500-4000 kcal.
Refrigerated inflammation in the burn wound leads to melting and rejection of necrotic tissues. At the same time, the intricensication of the body increases due to the absorption of products of the purulent melting of tissues and microbial toxins. Incixation of the body can be largely reduced in the treatment of patients under a controlled abacterial environment using open fashion Wound keeping in insulators with infrared irradiation on a bed with a constant blowing of wounds with warm air and oxygen therapy. The constant unidirectional movement of heated sterile air significantly reduces the energy flow at the burnt, reduces the exudation and microbial disgraceability of burn wounds, turns wet necrosis in dry, due to which the loss of protein decreases, the activity of proteolytic enzymes in the wound decreases, the accelerated epithelization is decreased during surface burns, it appears. Remove the burn structure in earlier time and prepare a wound to restore the skin.
The presence of damaged tissues is the main cause of the development of the burn disease, therefore, the removal of necrotic tissues and the restoration of the skin is the main task of treating patients with deep burns. All other activities carried out in the process of integrated general and local treatment are aimed at preparing for skin plastic operations.
Surgery. Indications, the choice of method and the timing of the skin plastic. The general condition and age of the victim, the extensiveness of the lesion and the localization of deep burns, the presence of donor skin resources and the state of the perceive bed are crucial when setting the timing and selection of the method of operational intervention, as well as the method of rehabilitation of the skin.
With limited deep burns, the most rational method is the total excision of necrotic tissues in the first 2 days after injury with the simultaneous overlapping of the seams on the wound, if its size is allowed, the condition of the patient and the surrounding tissues. If it is not possible to bring the edges of the wound, it is carried out primary free or combined (combination of free and local skin plastics) skin plastic.
Early excision is possible only with dry stamp. It is especially necessary when localizing limited deep burns in the field of joints, brushes and fingers. Due to the high functional activity of brushes and fingers, the complexity of their functions is advisable to excrove the necrotic stamp and in cases where the skin derivatives are preserved (bows of shallow degree) and epithelization of wounds is possible, usually accompanied by scarring.
In front of burns accompanied by osteonosis in functionally active areas, it is advisable to produce early excision of non-viable sections of the bone, without expecting its spontaneous sequestration, while simultaneously replacing the defect by combined skin plastics, if the condition of the surrounding tissues allows the condition of the surrounding tissues. In this case, the bone tissue is closed with rotary flap of leather with subcutaneous fatty tissue or flap on the feeding leg, and the newly formed defect is eliminated using free skin plastics.
At the same time, we showed our experimental and clinical observations, with burns in the area of \u200b\u200bthe skull, with damage to the bones, treatment is quite possible with the preservation of non-viable bones. In the absence of suppuration in the wound, unwanted soft fabrics, It is used ultrasound cavitation and multiple craniotomy conical and spherical cutter to a bleeding bone layer and osteioncase focus are covered with blood-well-supplied leather-fascial flap from local tissues or from remote parts. In such cases, osteonectic sections are not sequisited and resorption of non-viable bone elements occurs with its gradual neoplasm.
Early necrectomy produced in the first 4-10 days after injury in the conditions of abacterial patients, is the most optimal operation method. By this time, the most distinct boundary of deep burn becomes the most distinct stabilization of the patient's condition with extensive lesions. The exception is the patients who have circular deep burns of the body, when the threat of a sharp disorder of respiration is created due to the compression of the chest or the same limbs in which the blood supply to their distal departments and driving tissues is disturbed. In such cases, an emergency multiple decompressive necrotomy or partial necrurectomy is shown, which allows you to eliminate compression and disorders caused by it.
Tactics and technique necratectomy. In the implementation of early necrectomy, it is most advisable to produce layer-by-layer excision of a burning stamp with the help of an electrodematome to the appearance of a continuous uniformly bleeding wound surface. Such an excision of a burning stamp to greater extent allows to preserve viable tissues, significantly reduce the duration of the most traumatic stage of the operation and create a smooth surface of the wound, which ensures better adjacent of grafts under skin plastic and more favorable conditions for their adheated.
Hemostasis during surgery is achieved by applying gauze napkins with hydrogen peroxide solution or aminocaproic acid. Large blood vessels ligate. Due to the difficulties arising from stopping bleeding, in some cases the operation is performed in two stages. At the second stage, carried out 2-3 days after nectectomy, produce free skin plastic previously prepared bed. By this time, reliable hemostasis occurs after the imposition of a tight aseptic dressing, and the areas of obscured tissue are detected, which were not removed at the first stage. An additional removal of non-visual tissues contributes to a more successful outcome of the skin transplant operation. In aseptic wound, which is formed after the early excision of necrotic tissues, the optimal conditions for the adheated of the skin grafts are created.
Primary and early skin plastic, if success, prevents the progression of intoxication from the focus of the defeat, the development of infection in the wounds and the further development of the burn disease, which leads to the primary healing of burn wounds as soon as possible. Early regeneration of the skin leads to a decrease in the duration of treatment and provides more favorable functional and cosmetic results of free skin plastics.
Extensive necrurectomy with simultaneous skin plastic is a traumatic operation accompanied by significant blood loss. After the operation, the degradation of the patient's condition occurs, if there was no complete substitution of the wounds of the skin autotransplants or full adheated. The use of carbon dioxide for excision of a burning stamp allows to reduce blood loss, but the difficulties arising from determining the depth of tissue damage, and the trauma of the operation restrain its application. In connection with this, early necrectomy is produced mainly in burns no more than 10-12% of the body surface.
Extensive necrurectomy and skin plastic in early terms can only be carried out in specialized burning branches of surgeons that have experience of plastic surgery, subject to adequate reimbursement of blood loss during surgery and anesthesiological manual.
Indications for secondary skin plastic. With a serious condition of patient and deep burns, more than 10-15% of the body surface indicate that the secondary skin plastics on the granulating surface after rejection of necrotic tissues. To remove these tissues, it is advisable to use the step-in bloodless necrectomy as they are scheduled for rejection. This contributes to the use of enzymatic and chemical necrolis. Removing a burn stamp with 40% salicyl Mazi., benzoic acid or ointment containing 24% salicylic and 12% of lactic acid allows for 5-7 days to reduce the duration of preoperative preparation. The systematic use of hygienic baths, rational, faster rejection of necrotic tissues. general treatmentaimed at raising the reactivity of the body, prevention of anemia and heavy protein exchange disorders. These events and a thorough toilet of the Russian Academy of Sciences during dressings after taking off the burning stamp to reduce the bacterial dissemination allow for 2.5-3 weeks after injury to prepare patients with skin plastic on bright, juicy and clean granulations.
Timely thorough preparation of the Russian Academy of Sciences eliminates the need to excise granulation before skin plastic, if they do not explicitly pathological character And no perversion of the wound process is observed. IN clinical practice Nevertheless, difficulties often arise in determining the readiness of granulating wounds to the skin plastic. A large sampling of the wound surface of the pathogenic microflora in weakened patients usually coincides with a poor granulation type, the perversion of reparative processes and expressed inflammation phenomena in the wound, which in turn aggravates their general condition and leads to the generalization of infection. Free skin plastic in these conditions is contraindicated. In such cases, vigorous tall treatment and thorough local antibacterial therapywhich is carried out until the patient's condition improves and regenerative processes in the wound will increase.
The irrigation of RAS irrigation with antiseptic solutions, hygienic baths with detergents, local use of magnetotherapy, ultrasound, multiple laser irradiation, treatment on the Klinitron Beds and the use of the most affordable method - frequent change of dressings with antiseptic samples is used. In patients with burning exhaustion and sluggish flow of a wound process, hormonal therapy with glucocorticoids and anabolic steroids amid antibiotics under the control of sensitivity to them microflora wounds.
The presence of uniform, grainy, juicy, but not loose and not bleeding granulations with a moderate separated and pronounced border epithelization around the wound serves as a good indicator of her suitability to the skin plastic.
The most favorable perceiving lies for skin grafts is a young granulation fabric, rich blood vessels and with a small amount of fibrous elements, which usually contributes to a period of 2.5 to 6 weeks after burn. This is the optimal term for performing free skin plastic on the granulating surface.

15-10-2012, 06:52

Description

Synonyms

Chemical, thermal, radiation eye damage.

Code of the ICD-10

T26.0.. Thermal burn of the eyelid and the near-eyed area.

T26.1.. Thermal burner burn and conjunctival bag.

T26.2. Thermal burn leading to the rupture and destruction of the eyeball.

T26.3. Thermal burn of other parts of the eye and its apparatus.

T26.4.. Thermal burn eye and its apparatus of unspecified localization.

T26.5.. Chemical burns of the century and the near-eyed area.

T26.6. Chemical burns of the cornea and conjunctival bag.

T26.7. Chemical burn leading to the rupture and destruction of the eyeball.

T26.8. Chemical burns of other parts of the eye and its apparatus.

T26.9. Chemical burn eye and its apparatus of unspecified localization.

T90.4.The consequence of the injury of the eye of the near-eyed area.

CLASSIFICATION

• I degree- hyperemia of various departments of the conjunctiva and the zone of limb, surface erosion of the cornea, as well as hyperemia of the skin of the eyelid and their swelling, lightweight.
• II Stepnb - Ischemia and superficial necrosis conjunctivations with the formation of easily removable protein stuffing, roinsing the cornea due to damage to the epithelium and surface layers of stroma, the formation of bubbles on the skin of the eyelids.
• III degree - Necrosis conjunctiva and cornea to deep layers, but not more than half the area of \u200b\u200bthe surface of the eyeball. The color of the cornea is "matte" or "porcelain". Notes changes in the ophthalmotonus in the form of a short-term increase in WFD or hypotension. The development of toxic cataracts and iridocyclitis is possible.
• IV degree - Deep defeat, necrosis of all the layers of the age (up to charred). Defeat and necrosis conjunctivations and sclera with ischemia vessels on the surface of over half of the eyeball. The cornea "porcelain" is possible a fabric defect. Over 1/3 of the surface area, in some cases it is possible to run. Secondary glaucoma and heavy vascular disorders - front and rear uveitis.

ETIOLOGY

Conditionally allocate chemicals (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and raughter burns.

Clinical picture

General signs of burn burns:

• the progressive nature of the burning process after stopping the impact of the damaging agent (due to the impairment of metabolism in the tissues of the eye, the formation of toxic products and the occurrence of the immunological conflict due to autoinoxication and autosensibilization to the post-commencement period);
• next to recurrence inflammatory process in the vascular shell at different times after receiving the burn;
• trend towards the formation of synechs, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

Stage of the burn process:

• Stage I Stage (up to 2 days) - rapid development of necrobiosis of affected tissues, excessive hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
• Stage II (2-18 days) - manifestation of severe trophic disorders due to fibrinoid swelling:
• III stage (up to 2-3 months) - trophic disorders and vascularization of the horn shell due to tissue hypoxia;
• The IV stage (from several months to several years) is the period of scarring, increasing the number of collagen proteins due to the increase in their synthesis of cornea cells.

DIAGNOSTICS

The diagnosis is based on the anamnesis and clinical picture.

TREATMENT

Basic principles of eye burns treatment:

• provision emergency careaimed at reducing the damaging effect of the burn agent on the tissue;
• subsequent conservative and (if necessary) surgical treatment.

When rendering emergency care, the victim is necessarily intensively washing a conjunctive cavity with water for 10-15 minutes with a mandatory twist of the eyelids and washing the tears, thorough removal of foreign particles.

Washing is not conducted with a thermochemical burn if a penetrating wound is detected!

Operational interventions on eyelids and eyeballs in early terms are carried out only with the aim of preserving the body. Conduct vitrectomy of burned fabrics, early primary (in the first hours and days) or a delayed (after 2-3 weeks) blepharoplasty with a free skin flap or skin flap on a vascular leg with a single-metoslamist transplant to the inner surface of the eyelids, archs and on the scler.

Planned surgical interventions on centuries and eyeballs with the consequences of thermal burns are recommended after 12-24 months after the burn injury, because on the background of autosensibilization of the body arises allevousinization to the tissues of the transplant.

With heavy burns, it is necessary to introduce subcutaneously 1500-3000 ME anticipable serum.

Treatment of I Stage Burns Eye

Long irrigation of the conjunctival cavity (for 15-30 minutes).

Chemical neutralizers are used in the first hours after the burn. Subsequently, the use of these drugs is inappropriate and can provide a damaging effect on buried fabrics. For chemical neutralization, the following means apply:

• click - 2% Boric acid solution, or 5% citric acid solution, or 0.1% solution of lactic acid, or 0.01% acetic acid:
• acid - 2% sodium hydrocarbonate solution.

With pronounced symptoms of intoxication, intravenously drip 1 time per day Belvidon to 200-400 ml per night drip (up to 8 days after injury), or a 5% dextrose solution with ascorbic acid 2.0 g in volume 200-400 ml, or 4- 10% Dextran solution [cf. Like. Weight 30 000-40 000], 400 ml intravenously drip.

NSAID

H1 receptor blockers: chloropiramine (inside 25 mg 3 times a day after eating for 7-10 days), or Loratadine (inside 10 mg 1 time per day after eating for 7-10 days), or fexofenenadine (inside 120-180 mg 1 time per day after eating for 7-10 days).

Antioxidants: methyl ethylpyridinol (1% solution of 1 ml intramuscularly or 0.5 ml of parabulbarno 1 time per day, per course 10-15 injections).

Analgesic: Sodium metamizole (50%, 1-2 ml intramuscularly with pain) or ketorolac (1 ml with intramuscular pain).

Preparations for instillations in the conjunctival cavity

For heavy conditions And in early postoperative period The multiplicity of instillation can reach 6 times a day. As the inflammatory process decreases, the duration between the instillations increases.

Antibacterial agents: Ciprofloxacin ( eye drops 0.3% 1-2 drops 3-6 times a day), or offloxacin (eye drops 0.3% 1-2 drops 3-6 times a day), or Tobramycin 0.3% (eye drops, 1 -2 drops 3-6 times a day).

Antiseptics: Plexoxidin 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone ( eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisone (drops of eye 0.5% 1-2 drops 3-6 times a day).

NSAID: Diclofenac (inward 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (in-25 mg 2-3 times a day after meals, course 10-14 days).

Midryatiki: Cyclopentolate (eye drops 1% 1-2 drops 2-3 times a day) or tropiacal (eye drops 0.5-1% 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 , 5% 2-3 times a day for 7-10 days).

Corneal Regeneration Stimulants:actovegin (gel of the eye of 20% for the lower eyelid one drop 1-3 times a day), or solicoryl (gel of the eye of 20% for the lower eyelid one drop 1-3 times a day), or decapantenol (gel eye 5% for the lower eyelid 1 drop 2-3 times a day).

Surgery: Sectoral conjunctivotomy, paracentesis, necratetomy conjunctivations and cornea, genonoplasty, corneal bioproopy, plastic age, layered keratoplasty.

Treatment of II Stage Burns Eye

PDP groups, stimulating immune processes that improve the utilization of oxygen and reduce tissue hypoxia are added to the treatment.

Fibrinolysis inhibitors:aprotinin in 10 ml intravenously, for a course of 25 injections; Installing the solution in the eye 3-4 times a day.

Immunomodulators: Levamizol 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: Systemic enzymes of 5 tablets 3 times a day 30 minutes before meals, drinking 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methyl ethylpyridinol (1% solution of 0.5 ml of parabulbarno 1 time per day, per course 10-15 injections) or vitamin E (5% oily solution, inward 100 mg, 20-40 days).

Surgery: layered or through keratoplasty.

Treatment III Stages Burns eye

The following is added to the treatment described above.

Midships of short-term action: Cyclopentolate (eye drops 1% 1-2 drops 2-3 times a day) or tropicamid (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Hypotensive drugs: Betaxolol (0.5% eye drops, 2 times a day), or thymolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: Ceratoplasty for emergency testimony, anti-cloudomatous operations.

Treatment of IV stages of burn burns

The following is added to the treatment.

Glucocorticoids:dexamethasone (parabulbarno or under conjunctiva, 2-4 mg, per course 7-10 injections) or betamythazone (2 mg of Betamethazone phosphate dynatory + 5 mg of betamethazone dipropionate) parabulbarno or under conjunctival 1 time per week 3-4 injections. Triamcinolone 20 mg 1 time per week 3-4 injections.

Enzyme preparations in the form of injections:

• fibrinolysin [person] (400 units Parabulbarno):
• collagenase 100 or 500 KE (the contents of the vial dissolve in a 0.5% solution solution, 0.9% solution of sodium chloride or water for injections). Impact subconjunctivally (directly in the lesion center: Spike, scar, art, etc. with the help of electrophoresis, phonophoresis, and also apply from you. Before use, they check the patient's sensitivity, for which 1 ke is introduced under the conjuncture of the patient and observe 48 hours Absence allergic reaction Conduct treatment for 10 days.

Non-media treatment

Physiotherapy, eyelid massage.

Approximate disability

Depending on the severity of the lesion, 14-28 days are. Invalidation is possible in case of complications, loss of vision.

Further maintenance

Observation of the ophthalmologist at the place of residence for several months (up to 1 year). Control of ophthalmotonus, state status, retina. With a raising increase in WFD and the absence of compensation on drug regimens, an anti-cloudsomatous operation is possible. With the development of traumatic cataracts, the removal of a turbid lens is shown.

FORECAST

It depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the arrival of the victim in the hospital, the correctness of the appointment of drug therapy.

Article from the book :.

Thermal burn (code on the ICD-10) is skin damagewhich distinguish international Classification Diseases. This system has been operating since 1998 to this day. The article will analyze the degree of thermal burns and ways to provide first aid.

The burning of the epithelium or deeper layers of the skin arising from open fire, the heated objects are called thermal. The impact emanating from solid, liquid and gaseous substances having a high temperature is taken into account.

Damaged damage is dangerous, and may cause death. Among the thermal burns, the code on the ICD-10 T20-30 is the bolery, impact strikes, radiation, friction, electric strokes and heating appliances. This classification does not include diseases caused by ultraviolet radiation, Erythema.

Causes of lesions:

• the fire;
• boiling water or steam;
• touching hot objects.

Depending on the depth of the lesion and the type of damage, the severity of the patient's condition is diagnosed. At the launched stages of this kind of injury are the causes of death.

The treatment is complex, long, because the skin overheating is accompanied by the destruction of proteins involved in the tissue update and cellular construction.

Features of burns at different parts of the body on the ICD

Differ in the area of \u200b\u200bdefeat on the human body:

1. Head and neck.
2. Torso.
3. Shoulder belt and upper limbs.
4. Brushes, wrists.
5. Hip zone, leg, legs.
6. The ankle joints and feet.

Damage to the head and neck includes a violation of the integrity of the cover of the ears, eyes, the hair. Separately, wounds, limited to the eye area, mouth and pharynx are considered separately. Danger is proximity to the nasal mucosa, eyes.

If the side or straight walls of the abdomen are damaged, back, rib cage, groin, genitals, then they are classified according to the ICD 10 T21. Exceptions are the wounds of the scaling area and the axillary zones discussed in T22.

When the wound is distributed between zones or it is impossible to determine the severity of the lesion, it is referred to in unspecified localization.

Thermal effect on the shoulders, the forearms of the brush and hands are classified to T22.

Burning the skin of wrists, brushes, including nails, palms - a separate item. T24 over MKB-10 refers thermal burn Hips, limb injuries. Damage to the foot and ankle - in paragraph T25.

The degree of thermal burns and their consequences

Under the influence of high-temperature modes, human skin is injured. If the flame was affected, with the initial processing of the wound, it is difficult to remove the remains of burnt clothing. In the future, the flats will cause infection.

The hot liquid that fell on the epidermis leads to the formation of the wound. When burning a shallow, but often affects the respiratory tract. When touched with hot objects, the wound is clearly defined, deep, but when removing the focus of exposure, an additional detachment occurs. There are several degrees of thermal exposure on the ICD-10:

• soreness of the epithelium;
• formation of bubbles;
• burning fiber;
• fabric death, charging of muscle and bone joints.

At the first degree, the tour is damaged, they appear red, swelling. Two or three days later, the location suffered the thermal creation is healing. At the end of the lunch of the dermis, the tracks from the outside disappear. The thermal burn of the foot or fingers on the ICD-10 in the second stage is less dangerous than damage to the face and chest. When burning to a spike layer, bubbles filled with gray are formed. Regeneration of the consequences lasts a month or more.

The epithelium, dermis suffer to the third degree. Wound - Strip of black, brown, painful sensitivity below. In the absence of infectious complications and secondary recesses, the cover is independently restored for six months. When destroying bone tissues, the fourth degree is diagnosed.

Urgent help

Oil ointments and fat do not apply. It only aggravates the state, and subsequently you will have to remove the film from the oil, which will hurt the victim. Incorrect bandage imposition will worsen the patient's condition, lead to edema and the occurrence of suppuration.

The striking factor should be eliminated, and the burned zone is cooled under running water half an hour, if the integrity of the epidermis is not violated.

The use of a harness without need will result in loss of limb. The most correct solution when receiving the burn is the appeal to medical institutionwhere pain relief and processing.