How to handle wound after burn: means and algorithm actions. What to treat wound after burning wounds and burns

Alekseev A.A.

Scientific and practical center of thermal lesions of the Ministry of Health of the Russian Federation of the Institute of Surgery. A.V. Vishnevsky Ramna, Moscow

Methods of treating undetented currently differ fundamentally from the generally accepted 10-15 years ago. The modern tactics of treatment during burns is largely developed, thanks to the successes in the study of the pathogenesis of the burn disease and its complications. Extensive opportunities discovered the research of microbiologists and immunologists aimed at identifying the mechanisms of interaction between the body of victims of burns and infection. The most important importance to studies of metabolism with extensive burns. A special place is occupied by the study of the flow of the wound process at the present level, depending on the severity of the burn injury, the use of various, incl. Alternative treatment methods.

Solution of these and other tasks related to the study of functional morphological changes from internal organs and burned systems made it possible to propose pathogenetically substantiated methods of immunocorrection, systemic and local antibacterial therapy, parenteral and enteral nutrition, etc.

A significant improvement in the results of degenic treatment was possible due to the development and implementation of active surgical tactics into the clinical practice. Its fundamental basis is the early necritectomy with subsequent autodermoplasty of burn wounds in order to quickly restore the integrity of the entire skin. In addition, the inclusion in a complex of intensive treatment of undetented abacterial methods allows you to create optimal conditions for healing burn wounds and maintaining homeostasis.

However, the effective use of the entire arsenal of modern methods and means of treatment of victims of burns depends not only on a specialist-combstigologist working in a burn center. The first medical qualified medical care for burns is often surgeon or traumatologists of district, urban hospitals and a clinic, and with mass lesions in an extreme situation - doctors of any other specialty. At the same time, only 30% of those who gained burns need hospitalization. In addition, the vastness of our country, insufficient provision of modern means of transporting seriously discharged significantly hampered by the evacuation of victims from the scene directly in the burn branch. Therefore, Oz qualified treatment Emplooked in the surgical, traumatological, resuscitation department of hospitals even before entering the burn hospital, the fate of the patient depends largely.

The choice of treatment tactics and its methods are determined by the weight of injury.

What determines the severity of injury in burns? First of all, it is the depth and an area of \u200b\u200bthermal lesion.

Our country uses a 4-step classification of burns depth.

Hyperemia and a small swelling of the skin in the burn area are clinical signs Burn I burn. With burns of II degree, in addition, "bubbles" are formed, filled with serous contents. In case of burns, the I degree is affected only by the epidermis, when burns II burns - epidermis and papillary layer of the dermis. These burns are healing independently, due to the surviving epithelial cells and are called superficial.

With burns of IIIA degree, the thermal lesion zone includes a mesh layer of the dermis, but many follicles, shelpany bags, sweat glands are preserved, sweat glands - skin derivatives, due to which the epithelization of burn wounds occurs. However, this is not always happening, often the mosaic of skin lesions and, accordingly, most of her derivatives makes it difficult for independent healing of wounds. Especially with extensive burns, when, due to microcirculatory disorders and infection, burn wounds can "delve" and the result of autodermoplasty is required. Therefore, burning burns III is not correctly called superficial, but boundaries. These burns can be diagnosed on a thin, sufficiently movable edge or large bubbles filled with serous contents, but already with intense yellow staining.

At deep burns, the skin is affected by its entire thickness (IIIIB degree) or driving tissue - subcutaneous fiber, fascia, bones (IV degree). The burns of the IIIII degree are often accompanied by the formation of a brown shade strip, paved with the subjectable tissues, less often - the formation of large bubbles filled with hemorrhagic content. With the IV degree burns, there is always a dense dark brown or black stamp, closely faced with a leakable one. Deep burners IIIB-IV degree always requires surgical treatment.

To determine the area of \u200b\u200bburns, the so-called "Rule of Nine" is widely used. According to this rule, the entire surface of the skin of an adult is conditionally divided into eleven "nines": the head and neck - 9%, the upper limbs - 9% each, the lower limbs - by 18% (2 times 9%) each, the rear surface of the body - 18%, the front of the body is 18%. The remaining up to 100% one percent of the body surface falls on the crotch area.

For primary inspection The victims to determine the depth of burns may not be easy for a specialist. Therefore, a particular value acquires the circumstances of injury. First of all, it concerns the etiological factor of burns.

Practically, determining the etiology of burns, the doctor indirectly estimates the temperature of the affected agent and the exposition of its impact on the fabric of the victim. So, burns with a flame, especially those obtained by a dressed man, as a rule, lead to deep burns. Immersion in boiling water, hot water (often these injuries are associated with a drop in sewage wells) also lead to burns of III-IV degree. On the contrary, scalding with boiling water (usually this household injuries) causes superficial burns. Contact or electricity are more often the cause of limited, but deep burns, and chemicals - burns I-II- III degree.

It is also necessary to remember that fires in a closed room, directional explosions may be accompanied by respiratory burns and poisoning of combustion products. The thermal inflation trauma often leads to life-threatening affected complications associated with the development of bronchospasm, edema of the lungs, early pneumonia in the first days after the burn.

If deep burns occupy more than 10-15% of the body surface, or the total area of \u200b\u200bburns is more than 30% of the body surface. The affected burning disease develops.

Burning disease is a complex complex of interrelated pathogenetic reactions and their clinical manifestations, which is based on a stress response in response to thermal defeat as the first and determining state of the victim, depending on the severity of injury, the timeliness of the beginning and the fullness of the treatment.

In the structure of the burn disease, three main clinical syndrome: burn shock, intoxication, infection.

The first - burn shock, due to neuro-reflex and neuro-endocrine reactions, with the advent of a large number of different inflammation factors, which lead to a violation of central and peripheral blood circulation, including common microcirculatory disorders, increasing the permeability of vascular and cell membranes and hypovolemia due to the release of plasma from vascular The channel with the development of interstitial edema, as well as plasmopotieri through burn wounds.

The manifestation of these functional morphological disorders is the corresponding clinical picture Shock, the severity of which depends on the depth and area of \u200b\u200bburns, the time of passaged after injury, as well as from the adequacy of the treatment. In this case, under the adequacy of intensive therapy of the burn shock, it is necessary to understand the timeliness of its principle, pathogenetic validity, as well as the necessary volume and rational composition of infusion-transfusion media introduced intravenously.

The calculation of intravenous infusions in the burning shock period is based on the formula adopted all over the world for the redeelation of the rational scheme of intensive therapy of burnt:

V \u003d M x S x 2, where:

V is the amount (volume) of the internal liquid in the 1st day of the burn shock in "ml";

S - the total area of \u200b\u200bburns in "%", but not more than 50%;

M - the mass of the patient's body in "kg."

At the same time, 2/3 of this volume must be poured already in the first in the first 8 hours after injury. Crystaloids should be 2/3 - 1/2 of the specified volume, and colloidal preparations, respectively - 1/3 - 1/2, depending on the severity of the shock. In addition, it is necessary to introduce another 2 l 5% of the glucose crust.

In the 2nd day of the shock, the volume of intravenous infusions decreases by 2 times, on the 3rd day - to 1/3 of the initially established volume.

To carry out this rule, the catheterization of the central vein is certainly necessary, which should be performed by all burned in a heavy or extremely serious burn shock. For elderly patients, as a rule, enough intravenous administration Half volume calculated for the affected average age group.

The second syndrome of the burn disease - intoxication is due to the appearance of a large number of toxic products of tissue, enterogenic and partially bacterial origin in the body. It manifests itself after removing the victim with extensive and deep burns from the shock of psycho-emotional disorders, a resistant increase in the body temperature, loss of appetite and the development of signs of toxic damage to internal organs (toxic myocarditis, hepatitis, etc.). This period is posted by a period of acute burning toxmia. Effective method Treatment in the period of toxmia is active disinfecting therapy using the forced diurea technique, as well as, in more severe cases, the use of plasmophoresform or hemosorption.

Development of reasonable techniques and the rational application of modern drug addicts Currently, it is currently to significantly improve the results of the treatment of seriously lowered in early periods of burn disease. On the contrary, later, the lack of insufficient volume or defective composition of infusion-transfusion therapy with severe or extremely severe burning shock can lead to a long hypovolemic spa peripheral microsudes, followed by a paralytic expansion of capillaries, pronounced disorders of water-electrolyte and protein balance.

The metabolic disorders that begin during the burn shock on this background in the period of acute burning toxemia are also progressive and acquire destructive trends. As a result against the background of microcirculatory tissue hypoxia, severe functional and morphological changes occur on the part of the internal organs and systems. These changes and determine clinical manifestations Such life-threatening complications of the burn disease as early pneumonia with the progressive development of pulmonary heart failure, erosive-ulcerative changes in the gastrointestinal tract with the development of bleeding, often profuse, and a number of others. Treatment of patients with such complications is difficult and the forecast is very dubious.

The third period, the period of burn septicotoxmia is associated with the development and progression of infection. In this period, they started still during the burning shock and acute burning toxemia, metabolic disorders and, as one of the consequences of this, the insufficiency of the immunological response to the infection.

The infection significantly agitates the course of the burn disease. It determines and maintains intoxication, suppresses the reparative processes in the wounds, is striking various organs, and in some cases it comes to generalization - it is difficult to develop a hard-heated burn sepsis.

The main cause of infection has a burning wound. The subteraral origin infection is subsequently imposed on it, as well as hospital. In addition, the long existence of burning wounds becomes the cause of burning exhaustion, the development of which creates extremely unfavorable conditions for regeneration as a whole.

Thus, initiating a multi-stage and branched circuit of disorders in a holistic body, stress and numerous pathogenetic factors associated with the presence of a burn wound are interconnected and interdependent launching mechanisms of the burn disease with severe thermal lesion. These factors determine the development of basic disease syndromes and numerous severe complications. Therefore, to the base comprehensive treatment The principle of the unity of general and local treatment should be born first of all, providing for simultaneously correction of systemic generalized violations of homeostasis and carrying out measures aimed at improving the processes of burning wound healing and early restoration of the integrity of the skin.

Local treatment begins when the injured wound has affected from the primary toilet. The wound toilet is carried out after the administration of painkillers, or with extensive lesions, under general anesthesia. Patients who received in a state of severe or extremely heavy burning shock, with an absence of the possibility of adequate anesthesia, the toilet of burn wounds is not carried out in order to avoid the risk of weighting of the overall state. In these cases, there is enough imposition of the primary bandage, and carrying out the toilet wounds is postponed before removing the patient from shock.

Patients who have reliably diagnosed burns of the I degree, usually do not need to carry out local treatment. Patients with burns of II-IIIIs are treated outpatient or hospitalized depending on the area of \u200b\u200blesion, its localization and the age of the patient. Adult patients with burns of II can be treated with an outpatient basis, if the lesion area does not exceed 10% of the body surface and do not amazed the skin of the face, lower extremities or perineum.

Cell burns IIII can be treated outpatient only with a slight area, not exceeding 5% of the body surface, if the skin of the face, limbs or perineum is not affected.

Local treatment with surface and border burns should be directed to the creation of the most favorable conditions for their healing in optimal terms and provide for the protection of the wound from mechanical damage and infection, and if necessary effective treatment Wound infection and stimulation of reparative processes.

Numerous studies show that the choice of drugs for local treatment does not have a significant impact on the timing of epithelization of non-infected superficial burns of the I-II degree.

When burning burns IIIA, treatment should be started with humid dry bandages that contribute to the formation of a thin, consisting of necrotic layers of skin and fibrin, a stamp. The formation of a thin scope contributes to the use of iodine drugs (1% solution of iodopyarone or iodopone). Under dry lap IIIa degree burns can be heated without suppuration. In these cases, there is a surface with the resulting epithelium after injury on the site of the spinning necrotic crust for 3-4 weeks after the injury. If the preceding local treatment was inadequate and dry strateps, it fails, the suppuration and demarcation inflammation develops. In these cases, in places where the demarcation line has emerged, wet Stores should be removed, as exudative-inflammatory phenomena, after rejection and removal of the stamp and the beginning of epithelialization, should be moved from humid-drying to oily and oil-balsamic bandages. Well established themselves during this period ointment on a water-soluble polyethylene glycol basis: Levosin, Levomecol, Dioxiscol and iodopron ointment. These drugs have antimicrobial and adsorbing properties and can be successfully used both in the first and second phase of the wound process.

IN last years In the treatment of border burning bodies IIIA degree and deep burns of IIIB-IV degree of flap, various wound coatings are used. In our burn center for many years, perforated pork leather is successfully used - xenocup. The latter is placed on burn wounds, ensuring their peace and protection against infection, without preventing the purification of wounds and simultaneously use for local treatment of other drugs.

The main goal of local treatment of deep burns is as quickly as possible cleaning of burn wounds from necrotic tissues and their plastic recovery in possible early deadlines.

Currently, there are two main ways to prepare deep burn wounds to autodermoplasty: chemical necrectomy with a delayed outdooramplasty and surgical necratetomy with single-stage or delayed outdooramplasty. Tactics of local treatment using chemical necritomy is fully justified with extensive deep burns more than 40% of the body surface under the condition of the extremely severe general condition of patients. Especially in the treatment of patients of elderly and senile age, which have severe concomitant pathology operational interventions In early terms it is impossible.

In these cases, from the first day after injury, local treatment should be directed to the rapid formation of a dry burn stamp, prevention of infection and deepening burn wounds. To this end, during the burning shock, cotton-gauze bandages with ointments on a water-soluble basis are used. This helps to reduce the loss of fluid from the burn surface, heating the patient, the formation of dry stamp, does not require daily dressings.

In the following days, the formation of a dry burn structure is achieved by the use of humid drying bandages. Optimal drugs During this period, 1% of iodopiron or iodopone solutions or iodopone, providing stip drying and possess a wide range of antimicrobial and antifungal action. It is also possible to use cotton-gauze dressings with ointments on a water-soluble basis. The use of ointment ointment is contraindicated.

Significantly accelerates the formation of a dry stamp treatment of a patient in the conditions of the abacterial environment. In this case, an open method of treatment with the processing of burn wounds is used two or three times a day with a solution of iodopyarone, iodopone, or the "Naxol" preparation and the use of abacterial insulators or clinitron beds. Promotes the drying of the stamp infrared irradiation of the Russian Academy of Sciences. The formation of a dry stamp reduces protein loss from the burn surface, helps reduce intoxication, improving the overall state of the patient.

With deep circular burn burns, when a high risk of compression and ischemia in the in-wheeling tissues of the forming burns with a circular burns of a chest cell, limiting its excursion, in the coming days after injury, the execution of neotomia is shown.

After the formation of a dry "mummified" stamp, chemical necratetomy is produced using 40% salycyl ointment. The thickness of the layer of ointment should be 1-2 mm. At the same time, no more than 200 grams of ointment applies due to the danger of salicylate poisoning, the level of which in the blood can accommodit the permissible norm. After 48 hours, the burn structure is bloodlessly separated from the fabrics. Taking into account the specified circumstance, the chemical necrectomy can simultaneously be carried out on the area to 10-15% of the body surface.

After cleansing the burn surface from necrosis to prepare the wound to autodermoplasty, it is advisable to use ointments on a water-soluble basis containing antibacterial drugs, and alternating with antiseptic solutions. Positive effect on wound process Ultraviolet irradiation, monochromatic laser light, low-frequency ultrasound.

If the area of \u200b\u200bdeep burns of victims exceeds 10-15% of the body surface, it is advisable at the same time to perform the following, stage chemical necrectomy and to legitimize granulating wounds to one-time autodermoplasty on an area of \u200b\u200bup to 20% of the body surface. The implementation of such an operation is possible only using a split perforated mesh skin autoloskut, which allows to increase the transplant area in a ratio of 1: 2, 1: 4, 1: 6 or more.

In recent years, all more Supporters find a method of surgical excision of necrotic tissues. At the same time, the greatest distribution was obtained early excision of necrosis in the first 5-7 days after the burn by the type of surgical processing of the wound.

Based on these literature and their own experience, we believe that surgical necratetomy in burns is advisable to classify as follows:

1. Early surgical necrurectomy of burn wounds is a radical excision of all affected fabrics to the development of inflammation and infection (it is performed up to 5-7 days from the moment of injury).
2. Early surgical cleansing of burn wounds - obviously nera-unacted excision of the main array of necrosis in order to reduce intoxication.
3. The divergent surgical necrurectomy is a radical excision of all affected tissues with developing inflammation and infection (5-14 days from the moment of injury).
4. Late surgical treatment wounds (including surgical processing of the granulating wound).
5. Amputation and disarmation of limbs and their segments.

In case of burning items, surgical necritectomy is produced by a tangential (layer) with a special tool (dermat, a gambi knife) before the appearance of fine-point bleeding from a non-burning leather layer. For burns, IV degree surgical necritomy is performed more often than the fascia with a scalpel or electron with subsequent thorough hemostasis. Early surgical necrurectomy (tangential or fascial) with simultaneous outodermoplasty allows at deep burns IIIB-IV degree to restore the integrity of the skin after 3-4 weeks after injury on the area to 20% of the body surface.

At the same time, the mortality mortality remains high. This is determined mainly by a significant frequency of infectious complications against the background of the long existence of burn wounds and the inability to timely and efficiently perform free autodermoplasty due to the shortage of intact skin in patients with extensive deep burns. The use for transplantation of mesh skin autoloskuts with a perforation 1: 6 and no longer solves this problem, since the cells forces formed due to such perforation are extremely slow, and the transplants themselves are often lysed. The greatest perspectives in solving the problem of donor-skin deficiency should be expected, developing and implementing new methods of treatment with the use of cultured cells: fibroblasts, keratinocytes and their combinations.

Currently, at the Institute of Surgery I.A.V. Vishnevsky, RAMS developed an original, not having analogues in world practice, the active method surgical treatment undent using cultivated allofibroblasts. The essence of the method is to use for plastic closure of burns of wounds artificially grown in laboratory conditions of allofibroblasts - cells connective tissuedefining the activity of regeneration processes, incl. epithelization. They can be obtained from the skin of the donor or body material, in the cultivation of unpretentious and completely loss of antigenspecificity.

The method provides for the transplantation of cultivated fibroblasts on extensive grain wounds IIIA degree, donor wounds incl. Do not heal long, or combined outoderoplasty using the culture of fibroblasts and mesh skin autoloskuts perforated in the ratio 1: 6 and 1: 8 with deep burns of IIIB-IV degree. Operations preceded the performance of chemical or surgical necrurectomy.

The experience of surgical treatment of patients with extensive burns showed that with border burning burns IIIA degree healing of wounds occurs on average on the 8th day of polinge of transplantation of cultured fibroblasts.

With burns of IIIB-IV degree through the 2nd day after transplantation on wounds of cultured allophiblasts, they are covered with skin autotransplants, perforated with 1: 6 and 1: 8. Due to the high ability of fibroblasts to stimulate the growth of the epithelium, - in this case, the epithelium of the net flap is fast epithelization in the cells of transplanted outocuffs, its growth and adheated. At the same time, the term of complete epithelization of the Russian Academy of Sciences is from 12 to 16 days, depending on the perforation coefficient of autoloskuts. For comparison, with traditional outodermoplasty using a similar perforation coefficient, in 15-40% of cases, the lysis of transplanted skin flaps or their slow adheated for 22-25 days or more after the operation is noted.

In other words new method Surgical treatment of burnt and cultured fibroblasts allowed:

• reduce the number of skin-needed skin for skin plastic and reduce the total area of \u200b\u200bthe wound surface due to this;
• simultaneously restore the integrity of the skin on the square to 30-35% of the body surface;
• increase the efficiency of outodermoplasty and reduce 1.5-2 times the timing of the healing of extensive burn wounds.

Recent years, the method of surgical treatment of burnt-based cultured allocyboblasts is actively introduced into the clinical practice of specialized burn centers and departments of Nizhny Novgorod, Saratov, Tula, Yaroslavl, Kursk, Novosibirsk, etc.

Thus, the correct organization of specialized treatment of burnt, the introduction into the practice of its new methods makes real improvement in quality medical care Patients with thermal lesions. The timely and proper use of the entire modern complex of medical and preventive measures allows you to currently not only save the life of the hardworthy, which still in the recent past were deemed doomed, but also significantly reduce the timing of temporary disability, as well as to reduce the disability of the negligence.

* - To assess the area of \u200b\u200bburns in children, the "nine" rule in the presented form does not apply.

In what cases will wound the wound after the burn?

After receiving a burning defeat of the second or third degree, the victim faces the formation of the wound, which will mock. This happens because of the formation of blisters, which are peeling skin during injury. When the bubble is a bubble, and in the place of the defeat, the wound will inevitably arise with a wet surface.

Treatment of the masculine burn involve systematic drying of the wound using the means forming the elastic film on the damaged surface.

General principles of treatment

Treatment

Getting Started to treat the teaching burn, begin to carry the procedure driving wound. For this:

• processes damage to the anti-sparkling antiseptic;
• sprinkle with streptocidal powder;
• cover from gauze sterile bandage.

Another option for the treatment of the wound is an open method of drying - medicines are applied to the wound area to stop the formation of moisture without a burning bodge. At the same time perform the following actions:

• sterile tampon wedged wound;
• on the suspected area, not rubbing, the drug is applied against the burn in the form of ointments / cream;
• for reliable antiseptics and recovery, the medication should be applied both on the area of \u200b\u200bdamage and the adjacent areas of the skin;
• after absorbing the drug in the wound zone, the application of ointments can be resumed;
• the procedure for the open method of treatment is repeated several times a day;

Do not worry due to sensations of burning after applying medication or formation of skin redness, which indicates the active action of the medication.

Duration of healing

The burning burn heals, as a rule, in a five-day period, provided that the damage was small and depth. More serious lesions may require two weeks treatment.

The application of anti-sparkling preparations with pre-drying wound significantly reduces the period of recovery, but if the area of \u200b\u200bthe lesion is large, and dry the wound fails, you should use dried antiseptics and conduct an open method of therapy. Of course, it will take more time to tighten the damage.

Treatment of wet burn preparations

Priority application

The wound surfaces of the wet nature occur in three stages, respectively, which are carried out medical events.

Inflammation

At the initial inflammatory stage, the lesion zone should be treated with antiseptic effects, such as peroxide, chlorinexedin, furacilin, mormistine, followed by imposing sterile bandages with hygroscopicity properties.

As a rule, at this stage, a transparent liquid exudate is actively highlighted from the wound, which cleans it and promotes healing. If the allocations are abundant, the treatment of the wound should be open. If the dressings are still used, it means that they are subject to frequent shift. The extensive areas of the burn are successfully treated with the use of Biathen AG bandages.

By changing the bandage, the wound surface is treated with an antiseptic. If there is a prescription of the doctor, practicing the processing by drying agents with antibacterial properties (iodine, betadine).

In the development of the necrotic phase with the formation of a pus under an armband, overlay is recommended antibacterial drugs In the form of water-soluble masses Mafenide acetate, Levosyn, Levomecol. The exceptions are external means that do not contain antibiotic compounds, since they do not contribute to the purification of the lesion.

To relieve pain can be used aerosols for local application, as well as injections or pills.

The pharmacological properties of the Actovegin are as follows:

• activation of the exchange processes in the tissues of the whole organism;
• improving trophic;
• activation of regeneration processes;
• helps to increase the tissue resistance to oxygen starvation;
• an increase in the cellular energy resource;
• acceleration of wound surface healing;
• makes a significant contribution to the treatment of burn, peptic lesions and trophic violations;
• manifestation of insulin-like activity.

Regeneration

If the inflammation is removed, a counter-grade plaster can be applied to the restored pure fabrics. The wellness effect of the plaster is impregnated by a unique medicine, which in contact with the wound surface becomes gelling, and purposefully affects the regenerating cover of the skin.

Scarring

When therapy approaches the stage of completion, and the damaged surface begins to scar, practicing the application of the contract. Ointment is used to three times a day, covering the sterile bandage from gauze.

The most effective means

Today in any pharmacy you can purchase outdoor drugs to provide therapeutic assistance in burns. Almost all of these funds are released without the appointment of a doctor.

• Ointment / Gel Salcossuril leads among other wound healing drugs, differing high therapeutic effect. It includes components that deliver oxygen to tissues, and also nourish and restore them. SalkoSeril gel is used in the therapy of wet burning lesions, and the ointment is treated dry damage.
• Gel Loksazin - high-tech healing remedy with pain relief effect. The drug quickly lies damage and prevents the infection penetration in any of the periods of treatment.
• Aerosol Amprovizol is a combined tool from burns with menthol, propolis, vitamin D and anesthesia in the composition. The spectrum of its impact includes analgesic, antitrog, antiseptic and anti-inflammatory effect. Quickly regenerates skin.
• Spray Olazol is used for burning harness. Contains sea buckthorn oil. Acts as an antibacterial, epithelial, analgesic drug. With its use, the reduction process of tissues is significantly accelerated and the exudate separation is reduced.

10 funds of traditional medicine

Using potatoes, eucalyptus, onions of the replist, daisy pharmacy, aloe juice, medicinal calendula, ordinary Aira, a cured Hypericum, as well as sea buckthorn oils, not one century helps heal the burn at home. Of course, the use of traditional medicine in anti-skin therapy is permissible within reasonable limits when the damage is small and shallow. Otherwise, it is not necessary to do without medical care. The treatment of burns on the recipes of folk healers in aggregate with drug therapy has proven itself.

1. Potato . Fresh tubers need to be cleaned from the peel and rub on a shallow grater. Juice squeeze and impregnate bindings them. Attach to the wound. The bandage is subject to shift every 6 hours.
2. Picking herbal medicinal. It is connected by 40 grams of each type of drug raw materials (St. John's wort, chamomile, field hat) and stirred. Take a pair of tablespoons of the obtained collection and weave with hot water not more than half of the liter. Obtained after boiling (fifteen minutes on the stove) decoction in a warm form can be processed damage and apply compresses.
3. Bulb onions. The bulb, exterior on the grater capable of cleaning the wound and reduce pain / swelling. For this, the casis is wrapped in a gauze and applied to the place of defeat.
4. Eucalyptus. With Nasty from Eucalyptus, you can make a row on the wound and the baths for small damage. For its preparation you need to take a glass with water and pour crushed leaves dried no more than ten grams. Boil to spend ten minutes, and then, insistent more than half an hour add honey (40 g).
5. Aloe (juice). Collect the foliage of the tree plant and the juice squeeze out of them. The prepared drug is impregnated with gauze bandage for burning to burn.
6. Pharmacy chamomile. Nasty from the daisies of the pharmacy is washed harmful damage. For its manufacture, fifteen grams of dried medicinal raw materials are taken and no more glasses are poured boiling water. They insist thirty minutes and filter.
7. Ordinary AIR. An infusion made from AIRA is used in the processing of burn damage as a binding. A spoonful of crushed root to pour boiling water (200 milliliters) and warm up a quarter of an hour on a water / steam bath. Cool and strain.
8. Calendula. No less effective processing of burnt damage in the calendula flowers. For which ten grams of vegetable raw materials are taken and is poured with hot water of at least 250 milliliters. It is half an hour to insist and after the filping can be applied by checking so that the infusion is cooled to comfortably.
9. Sea buckthorn oil . Butter boil and cool. Soak the napkin from the marlevary tissue and apply to the treated wound. Use several times a day.
10. An oil with a hunter. Perfectly heal burns with hormour oil. For its manufacture, you need to take the oil of olive and flowers of the plant in the proportion of 2 to 1. Mix. Leave in the dark for thirty days.

The degree of burns
There are four degrees:

The first - the skin on the place of the defeat blushes,
The second - a blister appears,
The third - dying and more depth layers of skin,
The fourth - the affected place is charred.

The degree of damage is affected by the volume of affected tissues, as well as how deep the body has passed the damaging factor. The lesion area in the medical environment is measured as a percentage of total leather area. The body at the scene of the burn in severe degrees of the lesion becomes insensitive, veins can be allocated. Often, the actual depth of thermal exposure can be revealed only five to seven days after the incident. This is due to the fact that new, suffering from lack of food, join the already destroyed tissues. In the event that more than 10 - 15% of the body surface is affected, the patient develops a burn disease. The severity of its flow depends on whether the respiratory authorities are affected, as well as what is the general condition of the patient, its age. If more than 15% of the body area is affected, a burn shock develops.

What can I do?

1. Before transferring the patient or its transportation, it is necessary to check: whether there are still fractures except burns, and the respiratory organs are affected.

2. Processing the affected surface with any infirous and folk remedies, it may aggravate the state.

3. Without anesthesia and sterile bandages try to clean the wound.

4. Enter bandages, if you do not know how this is done in a particular case. Since incorrectly imposed bandage provokes a strengthening.

5. Use harness if there is no emergency readings for this. The burn disease is enhanced, there is a chance of fission to dieties and subsequent amputation.

6. If the victims are somewhat, you should first of all pay attention to those who are unconscious or in a state of shock, as their condition is worse than those who can call for help.

7. Do not punch formed bubbles.

8. Do not skip clothes sticking to wounds.

First aid for thermal defeat

1. Eliminate heat source (fire, hot liquid, steam).

2. Remove the fabric from the affected place, with the defeat of the first or second degree, it is necessary to pour into place the damage to the cool water for 5 to 10 minutes. If the fabric charging is observed or an open wound (third and fourth degree), a clean wet fabric is superimposed.

3. Give a drink 500 ml of water and a half teaspoon of salt and a quarter of a teaspoon of soda.

4. Give 0.05 grams. DIMEDROLA (in the form of injection) and 1 - 2 grams. Aspirin.

5. Remove all things that can be removed from the affected body part, including decorations, clock, belts, if clothes stuck to the wound, you need to trim it carefully around.

6. Call an ambulance.
Be sure to call "ambulance" if:
suffered baby or old man,
The area of \u200b\u200bthe affected surface is more than five palms of the victim himself,
there is open wounds,
amazed groa
hit the head
Breath organs, mouth and nose,
Two hands are affected or two legs (or one hand and one leg).

Bapten - swiss preparation Based on provitamin B5, which contributes to the restoration of damaged tissue cells and accelerate the process of skin regeneration after burn, injury, etc.
Due to the chlorhexidine dihydrochloride ointment, the ointment has a bright antiseptic effect, prevents the development of infection in the place of skin damage. The drug is fully safe, so it can be used to treat burns even in the youngest children. The main contraindication: the intolerance of the components of the means, side effects from the use of ointment Bepanten are not identified.

Argosulfan is an antimicrobial drug, as part of which is active in relation to various types of bacteria substance - sulfatiazole and silver ions contributing to the slowdown in the process of dividing bacterial cells.
Ointment is not appointed with some hereditary diseases, intolerance of its components, pregnancy, lactation, for the treatment of children up to 2 months. Among side effects From its use: urticaria, itching, burning in the field of application, leukopenia.

Panthenol is a regenerating agent based on pantothenic acid derivatives, a stimulant of tissue reduction, is produced in the form of ointments, cream, spray, emulsion, injection solution. The main active substance is decantenol.

Levomecole is one of the degrees appointed in front of burns, contributing to the acceleration of the regeneration processes of damaged tissues. The active components of ointment: methyluracil (accelerates the division of healthy cells, has a light anti-inflammatory effect), chloramphenicol (active in relation to various types of antibiotic bacteria).
Levomecol is contraindicated in the presence of hypersensitivity to its components, treatment during pregnancy is carried out under the control of the specialist. Allergic skin rashes are noted from the side effects of the drug. The duration of the course of treatment depends on the severity of the burn, the presence of complications.

Right and timely processing of the wound will not only help avoid various complications, but also increase the wound healing rate.

• Treat the wound only with clean hands.
• Before processing from the wound, it is necessary to remove foreign bodies, after which we rinse with clean water (better boiled and running), do not use soap. If there are no foreign bodies in the wound, then immediately proceed to processing.
• If the wound is badly bleeding, it is first necessary to stop the blood, in this you can help the cold, it narrows the vessels, which will reduce blood flow to the damaged place.
• If insides can be seen from the wound, do not touch them, impose a bandage and consult a doctor.
• After the wound was washed, treat it with an antiseptic (for example, chloruessidine). Remember that iodine and greencraft are used only for the processing of the edges of the wound, you can not pour out these means to the wound itself.
• After you have treated the wound, it should be protected from dirt and microbes. To do this, you will need a plaster, bandage, and if possible, a sterile napkin for processing wounds. If the wound is not big, then simply shut it with the plaster, so that the fabric layer is on the rusty itself. If the wound is large, then it is necessary to put a napkin with a moistened with an antiseptic, and then reconstate, or fasten it with a patch.
• It is not worthwhile to turn the wound just a bandage - it will be hard to change it, as it will stick to the wound.
• The bandage must cover and wound and some skin around it.
• The bandage needs to be changed daily, but neatly not to disturb damaged tissues.
• If you do not have special Tools For the processing of the wound, you can cover it with a clean nose handkerchief.
• If the wound is deep, you need to consult a doctor to avoid deposits. The doctor will prescribe the necessary analyzes, possibly X-ray, and treatment.
• Absadines and small scratches are not worth binting. They are better and faster to heal outdoors.
• If the napkin sticks to the wound, drop the hydrogen peroxide on it and gently separate from the wound.

Everyone knows that hydrogen peroxide has a disfiguring effect, but it is not very long. How to handle wound peroxide? For the processing of the wound, a three-percent peroxide solution is suitable for the solution with a cotton swab, or a disk, and handle the edges of the wound several times, then a moistened sterile napkin apply to the wound and dressing.

How to handle open wound

If the wound is bleeding, and the cold does not help, then you should apply a gulling bandage. You can not touch the wound with your hands, remove all foreign bodies, for this you can use the treated tweezers, then process the edges of the wound with an antiseptic. The bandage on the wound should not be very dense and thick.

How to treat a purulent wound

The treatment of such a wound is simply an antiseptic will not give the proper effect, since all bacteria are contained in fusion tissues, after normal processing of such a wound, an ointment of the Vishnevsky (or its analogs) is put on the napkin, and make a dressing.

Responding to a question how to treat the wound, it is worth understanding if the wound is serious, then after the primary processing, you need to see the doctor as soon as possible.

Antiseptics:

Zelenka. The use of greenflaw is prohibited if there is a very bleeding wound or damage to the mucous membrane. Only the edges of the wound.

Iodine 5% solution. The iodine solution should not be mixed with the ammonia alcohol or ichthyol (ichthyol ointment), it is not used for processing wounds on mucous surfaces. Only the edges of the wound.

Hydrogen peroxide 3% solution. The hydrogen peroxide solution is useful for wigging the suction bandages. Hydrogen peroxide is very sensitive to storage in light: its antibacterial properties are inactivated during the day, especially if the container stood with it open.

Chlorhexidine Digluconat. Released in the form of a solution. It has a fairly wide range of action: it affects not only on bacteria, but also for viruses, on the simplest and mushrooms. It is used for primary processing of wounds after it was cleaned with hydrogen peroxide, and for the treatment of purulent wounds. For this, it is not necessary to apply it a large amount, enough of several milliliters, which are recruited in a syringe, from which the wound is water.

Manganese. The weak solution of this powder in the saline (it should be barely pink) is used for rinsing wounds (both on the skin, and on mucous membranes) as both primary processing and ventilated, especially when there is a danger of entering anaerobic microorganisms . Before washing the wounds, it is necessary to prepare fresh solution every time.

Alcohol. Only the edges of the wound.

Mazi for processing wounds:

Levomecol

Balsam Vishnevsky

Burn- damage to tissues caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. In the depth of the lesion of the tissues, 4 degrees of burns are distinguished. Extensive burns lead to the development of the so-called burn disease, a dangerous fatal outcome due to violations in the work of cardiovascular and respiratory systems, as well as the occurrence of infectious complications. Local burning of burns can be carried out open or in a closed way. It is necessarily complemented by anesthetic treatment, according to the testimony - antibacterial and infusion therapy.

General

Burn- damage to tissues caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. Light burns are the most common injury. Heavy burns occupy second in the amount of fatal outcomes as a result of an accident, inferior only by road traffic accidents.

Classification

Localization:

• skin burns;
• eye burns;
• inhalation damage and burns of respiratory tract.

At the depth of the defeat:

• I degree. Incomplete damage to the surface layer of the skin. Accompanied by redness of the skin, insignificant swelling, burning pain. Recovery in 2-4 days. Burn heals without a trace.
• II degree. Full damage to the surface layer of the skin. Accompanied by burning pain, the formation of small bubbles. When opening bubbles, bright red erosion is exposed. Burns are healing without the formation of scars within 1-2 weeks.
• III degree. Damage to surface and deep leather layers.
• IIIA degree. Deep skin layers are partially damaged. Immediately after the injury, a dry black or brown crust is formed - a burning stamp. When scalding Strup Beleso-grayish, wet and soft.

It is possible to form large bubbles prone to merge. When the bubbles are opened, the wound surface, consisting of white, gray and pink plots, is exposed, on which a thin scrup is formed during dry necrosis, resembling a parchment, and a wet gray fibrin film is formed during wet necrosis.

Painful sensitivity of the damaged area is reduced. Healing depends on the number of preserved islets of intact deep layers of the skin at the bottom of the wound. With a small number of such islets, as well as upon subsequent suppuration of the wound, the independent healing of the burn slows down or becomes impossible.

• IIIIB degree. The death of all layers of skin. Possible damage to subcutaneous fatty fiber.
• IV degree. Charring leather and tissue (subcutaneous fatty fiber, bones and muscles).

The I-III degree burns are considered superficial and can be heated independently (if the secondary deepening of the wound occurred as a result of suppuration). With burns IIIIB and IV degree, necrosis is required with subsequent skin plastic. The exact definition of the degree of burn is possible only in a specialized medical institution.

By type of damage:

Thermal burns:

• Flame burns. As a rule, II degree. It is possible to defeat a large area of \u200b\u200bthe skin, burn eye and upper respiratory tract.
• Liquid burns. Mostly II-III degree. As a rule, they are characterized by a small area and a great depth of the defeat.
• Ferry burns. Large area and small depth of lesion. Often accompanied by the burn of the respiratory tract.
• Burns hot objects. II-IV degree. Clear border, considerable depth. Accompanied by the detachment of damaged tissues when the contact is terminated with the object.

Chemical burns:

• Acid burns. When exposed to acid, coagulation (folding) of the protein in the tissues, which causes a small depth of the lesion.
• Burns alkali. Coagulation, in this case it does not happen, so damage can achieve considerable depth.
• Burns of heavy metals salts. Usually superficial.

Radi burns:

• Burns as a result of the effects of sun rays. Usually i, less often - II degree.
• Burns as a result of the effects of laser weapons, air and ground nuclear explosions. Call an instantaneous lesion of body parts facing an explosion may be accompanied by eye burns.
• Burns as a result of the effects of ionizing radiation. As a rule, superficial. It is bad to heal because of the concomitant radial disease, in which the breakdoms of the vessels increase and the restoration of tissues is worse.

Electric burns:

Small area (small wounds at the input and output points), great depth. Accompanied by electrician (damage internal organs when exposed electromagnetic field).

Square lesion

The severity of the burn, the forecast and the selection of therapeutic activities depend not only from the depth, but also from the area of \u200b\u200bburn surfaces. When calculating the area of \u200b\u200bburns, adults in traumatology use the "palm rule" and "Rule of nine". According to the "Palm Regulation", the area of \u200b\u200bthe palm surface of the brush approximately corresponds to 1% of its owner's body. In accordance with the "Rule of Nine":

• the area of \u200b\u200bthe neck and head is 9% of the entire body surface;
• breasts - 9%;
• belly - 9%;
• the rear surface of the body is 18%;
• one upper limb – 9%;
• one thigh is 9%;
• one shin with a foot - 9%;
• exterior genitals and crotch - 1%.

The child's body has other proportions, so "the rule of nine" and the "palm rule" cannot be applied to it. To calculate the area of \u200b\u200bthe burn surface in children, the Table of Land and Brower is used. In specialized honey. Institutions The area of \u200b\u200bburns is determined using special film meters (transparent films with a measuring mesh).

Forecast

The forecast depends on the depth and area of \u200b\u200bburns, the overall condition of the body, the presence of concomitant injuries and diseases. To determine the forecast, the severity index (ITP) and the rule of hundreds (PS) are used.

The index of gravity lesions

It is used in all age groups. In the ITP 1% of the surface burn is 1 unit of gravity, 1% of deep burns - 3 units. Inhalation lesions without disrupting the respiratory function - 15 units, with impaired respiratory function - 30 units.

Forecast:

• favorable - less than 30 units;
• relatively favorable - from 30 to 60 units.;
• doubtful - from 61 to 90 units;
• adverse - 91 or more.

In the presence of combined lesions and severe concomitant disease, the forecast is worsening by 1-2 degrees.

The rule of hundreds

Usually used for patients over 50 years old. Formula of the calculation: the amount of age in years + area of \u200b\u200bburns in percent. The burning of the upper respiratory tract is equal to 20% skin lesions.

Forecast:

• favorable - less than 60;
• relatively favorable - 61-80;
• dubious - 81-100;
• unfavorable - more than 100.

Local symptoms

Superficial burns up to 10-12% and deep burns up to 5-6% proceed mainly in the form of a local process. Violations of other bodies and systems are not observed. In children, the elderly and persons with severely accompanying diseases, the "border" between the local suffering and the general process can be shrinking: up to 5-6% with surface burns and up to 3% with deep burns.

Local pathological changes are determined by the degree of burn, time period from the moment of injury, secondary infection and some other conditions. Burns of the I degree are accompanied by the development of erythema (redness). For burns II degree characterized by vesicles (small bubbles), for burns of the III degree - Bully (large bubbles with a fusion trend). When skin peeling, spontaneous opening or removal of the bubble, erosion is exposed (bright red-haired bleeding surface, devoid of the surface layer of the skin).

With deep burns, a section of dry or wet necrosis is formed. Dry necrosis occurs more favorably, looks like a black or brown crust. Wet necrosis develops with a large amount of moisture in tissues, significant areas and a great depth of lesion. It is a favorable medium for bacteria, often spreads to healthy fabrics. After rejection of the sections of dry and wet necrosis, ulcers of various depths are formed.

Burn healing occurs in several stages:

• Stage I. Inflammation, wound cleansing from dead fabrics. 1-10 day after injury.
• Stage II. Regeneration, filling wound with granulation tissue. Consists of two substands: 10-17 days - purification of wounds from necrotic tissues, 15-21 days - granulation development.
• III stage. Formation of the scar, closing the wound.

In difficult cases, the development of complications are possible: purulent cellulite, lymphadenitis, abscesses and gangrenes of limbs.

General symptoms

Extensive lesions cause a burn disease - pathological changes on the part of various organs and systems in which protein and water-salt exchange is disturbed, toxins are accumulated, the protective forces of the body are reduced, burning exhaustion develops. Burning disease in combination with a sharp decrease in motor activity can cause impaired functions of the respiratory, cardiovascular, urinary system and the gastrointestinal tract.

The burn disease proceeds in stages:

Stage I. Burn shock. Develops due to strong pain and a significant loss of fluid through the burn surface. Represents the danger to the life of the patient. It lasts 12-48 hours, in some cases - up to 72 hours. A short period of excitation is replaced by increasing inhibition. Characteristic thirst, muscular trembling, chills. Consciousness is confused. Unlike other types of shock, arterial pressure Raises or remains within the normal range. Pulse is studied, urine is reduced. Water becomes brown, black or dark cherry, acquires the smell of Gary. In severe cases, loss of consciousness is possible. Adequate treatment of burn shock is possible only in specialized honey. institution.

Stage II. Burn toxemia. It occurs when suction to the blood of the decay of tissues and bacterial toxins. Developed by 2-4 days from the moment of damage. It lasts from 2-4 to 10-15 days. The body temperature is raised. The patient is excited, his consciousness is confused. Clear cramps, nonsense, auditory and visual hallucinations are possible. At this stage there are complications from various organs and systems.

From side of cardio-vascular system - toxic myocarditis, thrombosis, pericarditis. From the head of the GCT - stressful erosion and ulcers (may be complicated by gastric bleeding), dynamic intestinal obstruction, toxic hepatitis, pancreatitis. From the side of the respiratory system - pulmonary swelling, exudative pleurisy, pneumonia, bronchitis. From the side of the kidneys - pyelit, jade.

III stage. Septicotoxemia. Due to a large loss of protein through a wound surface and the body's response to an infection. It lasts from a few weeks to several months. Wounds with lots of purulent discharge. The healing of burns is suspended, the epithelization areas are reduced or disappeared.

Characteristic fever with large fluctuations in body temperature. The patient is sluggish, suffers from sleep disorders. No appetite. A significant reduction in weight is noted (in severe cases, loss of 1/3 body weight is possible). Muscles are atrophy, the mobility of the joints decreases, the bleeding is enhanced. Develop a breakdown. Death comes from common infectious complications (sepsis, pneumonia). With a favorable version of the development of events, the burn disease ends with restoration, during which the wounds are cleaned and closed, and the patient's condition is gradually improved.

First aid

It is necessary to stop contact with the damaging agent (flame, ferry, chemical, etc.) as soon as possible. With thermal burns, the destruction of tissues due to their heating continues some time after the termination of the destructive effects, so the burned surface must be cooled with ice, snow or cold water For 10-15 minutes. Then neatly, trying not to damage the wound, cut off the clothes and impose a clean bandage. Fresh burn can not be lubricated with cream, butter or ointment - it may complicate the subsequent processing and worsening the wound healing.

With chemical burns, it is necessary to rinse the wound to be rinsed with a wound water. Burns alkali is washed with a weak solution of citric acid, with acid burns with a weak solution of drinking soda. It is impossible to wash the burn with an oversight lime, instead, vegetable oil should be used. With extensive and deep burn burns, it is necessary to bite, give an anesthetic and warm drink (better - soda saline or alkaline mineral water). The victim with a burn should be delivered as quickly as possible to specialized honey. institution.

Treatment

Local medical events

Closed treatment of burns

First of all, they produce the processing of the burn surface. From the damaged surface, foreign bodies are removed, the skin around the wound is treated with an antiseptic. Big bubbles cut and empty, without deleting. The detailed skin sticks to the burn and protects the wound surface. The burned limb attached an elevated position.

At the first stage of healing, preparations with anesthetic and cooling effects and drugs for normalizing the state of tissues, removal of wound content, prevention of infection and rejection of necrotic sites are used. Used aerosols with decanteral, ointment and hydrophilic-based solutions. Antiseptic and hypertensive solutions are applied only when first aid is provided. In the future, their use is inappropriate, since the dressings quickly dry and prevent the outflow of the content from the wound.

In case of cuts of the III, the degree of Strip remains until the moment of independent rejection. Initially, there are aseptic dressings, after rejection of the stamp - ointment. The purpose of the local treatment of burns in the second and third healing stage is protection against infection, the activation of metabolic processes, improving local blood supply. Apply drugs with hyperosmolar effect, hydrophobic coatings with wax and paraffin, ensuring the preservation of the growing epithelium during dressings. With deep burns, the rejection of necrotic tissues is stimulated. Salicyl ointment and proteolytic enzymes are used to melt the stamp. After cleansing the wounds perform skin plastic.

Open treatment of burns

It is carried out in special aseptic burn chambers. The burns are treated with drying solutions of antiseptics (a solution of manganese, diamond green, etc.) and leave without a dressing. In addition, openly usually treat the crotch burns, faces and other areas to which it is difficult to impose a bandage. For processing of the Russian Academy of Sciences, in this case, ointment with antiseptics (furacin, streptomycinic) are used.

A combination of open and closed methods of treating burns is possible.

General medical events

Patients with fresh burns increases sensitivity to analgesics. In the early period, the best effect is provided by frequent administration of small doses of painkillers. Subsequently, a dose increase may be required. Narcotic analgesics depress the respiratory center, so they are introduced by a traumatologist under the control of breathing.

Selection of antibiotics is carried out on the basis of determining the sensitivity of microorganisms. Prophylactically antibiotics are not prescribed, as this can lead to the formation of sustainable strains, immunity to antibacterial therapy.

During treatment, it is necessary to reimburse large protein and fluid losses. With superficial burns, more than 10% and deep more than 5% are infusional therapy. Under the control of the pulse, diurea, arterial and central venous pressure, the patient is injected with glucose, nutrient solutions, solutions for normalizing blood circulation and acid-alkaline state.

Rehabilitation

Rehabilitation includes measures to restore physical (therapeutic gymnastics, physiotherapy) and the psychological state of the patient. Basic rehabilitation principles:

• early start;
• clear plan;
• elimination of periods of long immobility;
• permanent extension of motor activity.

At the end of the primary rehabilitation period, the need for additional psychological and surgical care.

Inhalation lesions

Inhalation lesions arise as a result of inhalation of combustion products. More often develop in persons who have gained burns in a closed space. We take the condition of the victim, can be dangerous to life. Increase the likelihood of the development of pneumonia. Along with the area of \u200b\u200bburns and the patient's age, are an important factor affecting the outcome of injury.

Inhalation lesions are divided into three forms that can meet together and individually:

Carbon monoxide poisoning.

Carbon monoxide prevents the binding of oxygen with hemoglobin, causes hypoxia, and with a large dose and long exposure - the death of the victim. Treatment - artificial ventilation of the lungs with a supply of 100% oxygen.

Burns of the upper respiratory tract

Burn of the mucous membrane of the nose, larynx, pharynx, nastestrian, large bronchi and trachea. Accompanied by hoarseness of the voice, difficult breathing, the release of sputum with Soch. At bronchoscopy, redness and swelling of the mucous membrane are revealed, in severe cases - bubbles and areas of necrosis. The swelling of the respiratory tract is growing and reaches his peak on the second day after the injury.

Defeat of the lower respiratory tract

Damage to Alveol and small bronchi. Accompanied by difficulty breathing. With a favorable outcome compensated for 7-10 days. It may be complicated by pneumonia, pulmonary edema, atelectasis and respiratory distress syndrome. Changes on radiographs are visible only on day 4 after injury. The diagnosis is confirmed by reducing the partial pressure of oxygen in arterial blood to 60 mm and below.

Treatment of respiratory burn burns

For the most part, symptomatic: intense spirometry, removal of the secretion of the respiratory tract, inhalation of the moistened air-oxygen mixture. Preventive treatment Antibiotics ineffective. Antibacterial therapy is prescribed after bakposhev and determining the sensitivity of sputum pathogens.

The skin burn in everyday life is quite a common phenomenon with which everyone faced. But, unfortunately, even at home, with steam, boiling water or other chemical substances, or items that have a high temperature, you can get a damage to the skin of varying severity. As a result of personal carelessness or holding circumstances, a wound is formed on the skin, which in order for skin cover to recover faster and no complications arose, you need to proceed correctly. How to do what drugs to use what needs to be taken to ensure that the recovery process is as easier and faster as possible in detail in this article.

What burns are there

TO
laming burns has several characteristics by which they differ from each other. Depending on the cause of skin damage, burns are thermal and chemical. In the first case, the exposure to high temperatures is associated with the contact of the skin with hot water or any other liquid, ferry, hot objects, as well as with a long stay under the right solar rays. In the second, it is hit by chemical reagents.

At home, thermal burns occur most often, although chemicals also happen (when acetic acid appears on the skin, alkalis).

Also distinguish between burns and gravity lesions. In total, there are three degrees, in some classifications you can find four. If at and ІІ is possible treatment at home, then heavy (I and VI) require treatment exclusively in the hospital, since with deep and extensive lesions of the skin requires its partial or complete transplant.

Treatment of chemical burns should also be carried out only with medical personnel in the hospital.

Therefore before starting independent treatment wound after burns need to do the following:

• visually assess the degree of damage;
• find out the cause of the burn;
• to give first aid (remove the remnants of clothes, rinse the damaged area with cold running water during the minimum of fifteen minutes, impose a non-sterile bandage, if necessary, drink painkillers);
• when chemical (eats) and severe skin damage under the influence of high temperatures, immediately seek medical help.

How to process wounds in burns і and іі degree

It is important immediately after injury to provide first aid. At the same time, it is necessary to do it correctly. Remember any vegetable oils And the fats of animal origin cannot be used, because they fall on the wound, create a film there and the high temperature remains under it and the injury continues. Also, it is impossible to contact alcohol-containing substances. The chief assistant in the first minutes after injury is a cold running or water-scored water. It reduces the temperature at the scene of the burn and pain.

With the first degree of burns, on the restoration of the skin goes in general three to four days. As a rule, with such an injury, the damaged area blues, slightly swells, and in rare cases, bubbles occur.

The second degree is characterized by a more pronounced manifestation: red, swelling, numerous bubbles, including self-escaped.

Remember several important rules:

• burn primarily cool;
• rinse antiseptic solution, without the content of alcohol (chlorhexidine);
• we proceed with anti-spare spray or ointment (Panthenol, Olazol);
• we apply a non-sterile bandage (change every four hours).

In the case when the bubbles burn themselves on their own, it is impossible to cool this wound with cold running water. In this case, rinse with it with an antiseptic solution, then apply a sterile bandage, and on top of it, put the package with ice. If there is an opportunity, it is best to apply to the medical institution to the primary processing of such a burn wound.

Let us dwell in more detail on the processing of burn wounds with blisters. Most often, they arise with the bogs of the second degree, and if the area of \u200b\u200bthe damaged skin area is less than ten percent, then it can be treated independently. To do this, after the antiseptic treatment of the wound, on the burn area with blisters are applied to a thin layer of SalkoSeril gel. His hob does not include fats, which is very important. Therefore, the wound heals well. After applying a drug, a sterile bandage is imposed on the damaged area. As the wound heals, when the blisters begin to push a little, the ointment of SalkoSeril is used.

One of effective drugs With burns, it is considered "Levomekol". This is an antsody and antimicrobial means, thanks to which, it is possible to avoid purulent processes and speed up the restoration of damaged tissues. It is imposed on the wound once a day.

In the first days, immediately after the burn, the Olazole aerosol can be used. In addition to antibacterial and healing action, it has a good painkillery effect. It can be used up to four times a day.

Spray Panthenol is also an indispensable assistant when processing wounds after burns.

With thermal burns of first and second degree, you can use some folk Methods Treatment, however, their choice should be thought-out and not contrary to the general rules that were indicated above. It can be a row of raw eggs, compresses from aloe meat or raw grated potatoes. But, you need to remember that any folk remedies Good in a complex with medical.

And so, the main algorithm of action during the processing of the wounds after the burn:

• antiseptic washing;
• using medicinal preparations (gels, sprays, ointment folk remedies);
• overlay sterile dressing.

Specifiable actions for first aid for burns and their further treatment make it possible to avoid complications and speed up the recovery process.

Take care of yourself, many domestic thermal damage in most cases can be avoided. Be healthy.