Sulfuric acid burn

A sulfuric acid burn is one of the most dangerous tissue damages caused by chemicals. Let's consider its features, first aid, treatment methods and prevention.

The peculiarity of chemical burns is that after the reagent gets on the skin, a crust forms, which is practically indistinguishable from healthy tissue. The scab is on the surface, the skin turns white, and then brown. When healing, a purple crust forms. If the acid gets on the eyes, it can cause vision loss. When inhaling its vapors, a burn of the larynx occurs. High concentrations of the reagent cause hemorrhagic pneumonia and death.

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Epidemiology

The degree of burn damage, i.e. its nature and depth, depend on the duration of the action of sulfuric acid on the skin, its concentration. Epidemiology shows that after a chemical reaction, new inorganic and organic compounds appear in the wound. This is due to protein coagulation and dehydration. Peptones, proteinogens, albumoses and other compounds are formed.

The depth of a chemical burn depends on the following factors:

• Activity of the liquid and its quantity
• Depth of tissue penetration
• Mechanism of action
• Form and duration of contact

Depending on the mechanism of action, the acid has a corrosive, dehydrating, poisonous, oxidizing and destructive effect. According to the depth of damage, injuries can be deep (III-IV degree) and superficial (I-II degree). If the body is exposed to heated chemicals, this leads to the formation of thermochemical burns.

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Causes sulfuric acid burns

Chemical burns are extremely rare, unlike thermal burns. The causes of the pathology may be related to:

• Careless handling of the substance.
• Various industrial injuries due to non-compliance with safety regulations.
• Domestic accidents.
• Unprofessional performance of cosmetic procedures, etc.

According to statistics, 3-5% of burn injuries are caused by sulfuric acid. Most often, the damage is local, that is, in 90% of cases, about 10% of the body surface is affected. There are several sulfuric acid solutions with different concentrations, which have different degrees of destructive action: 10% diluted acid, 30% battery acid, 75% tower acid, and 98% concentrated acid.

The reagent is widely used in the chemical industry for the production of dyes and fibers, in the production of salt and other acids, in the production of fertilizers, for the processing and dressing of leather, in the food and oil industries. With such intensive use of the acid, situations of poisoning by its vapors or burns are not uncommon.

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Pathogenesis

When skin comes into contact with aggressive substances, it dies within a short period of time. The destructive effect lasts until the chemical reaction is completely over. Pathogenesis indicates the initial morphological manifestations of necrosis, which occurs immediately after the active substance comes into contact with living tissue. If the skin comes into contact with low-concentration solutions, morphological changes are detected after several days.

Coagulation necrosis is formed under the influence of sulfuric acid. At the same time, blisters characteristic of thermal burns rarely occur with chemical damage. Very often, the pronounced dehydrating and cauterizing effect excludes their formation. At the point of contact of the skin with the acid, a dense dry scab appears, which is localized at the level of intact tissues, clearly delimited. A hyperemic strip is formed along its contour, indicating aseptic inflammation. The degree and depth of the lesion depends on the concentration of the reagent.

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Symptoms sulfuric acid burns

In its symptoms, acid damage is very similar to the destructive effects of other chemical reagents. Let's take a closer look at the symptoms of a sulfuric acid burn:

• A crust with a white tint, not dense in consistency, with distinct borders forms on the skin.
• Burns are superficial, but the higher the concentration of liquid, the deeper the wounds.
• Immediately after contact with acid, the fabric turns white, then gray or brown.

The symptoms depend on the severity of the damage. At the first stage, there is a slight swelling and hyperemia, which are accompanied by painful sensations. This is possible when exposed to weakly concentrated acid. At the second stage, the above symptoms are more pronounced. The third stage is characterized by more severe tissue damage, which is difficult to distinguish from the fourth stage during the initial examination.

The fourth degree is the most severe, since not only the epidermis is affected, but also tendons, muscle and bone tissue. Necrosis also affects nearby tissues. The pathological condition is characterized by long-term healing, various complications and consequences are possible.

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First signs

Burn damage from sulfuric acid leads to a serious condition, the first signs of which are difficult to confuse with other pathologies. Symptoms depend on where the reagent got.

Chemical Fumes Burn:

• The mucous membrane of the respiratory organs is injured, a burn, swelling, and nosebleeds occur.
• Due to damage to the respiratory system, wheezing, spasms and sore throats occur. Severe spasms and swelling can cause suffocation.
• The digestive organs are injured, causing severe pain.

Liquid acid burn:

• If the acid gets inside, pain appears throughout the digestive system, severe vomiting with blood.
• The patient suffers from severe salivation and diarrhea.
• Due to severe kidney damage, urine becomes burgundy in color.
• The skin turns blue.
• Cardiovascular disorders develop.
• The lips turn black and dark brown spots appear on the tooth enamel.

The severity of the skin burn depends on the concentration of the reagent:

• Edema and hyperemia, the epidermis peels off.
• A soft white scab appears at the site of the wound.
• The wound surface has defined boundaries.
• As the substance is exposed, the white crust darkens, acquiring a brown tint.
• Coagulative necrosis develops.

All types of pathological conditions are accompanied by severe pain shock. A lethal dose is considered to be 5 mg of sulfuric acid taken orally. In case of damage to the skin, death most often occurs at the last stages of damage.

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Stages

Sulfuric acid is a strong oxidizer that absorbs air vapor and dehydrates organic materials. Chemical damage occurs when acid, alkali, a mixture of chemical reagents or heavy metal salts enter a living tissue area. From a chemical point of view, acid is a substance with hydrogen atoms and an acid residue. The degree of the burn depends on its concentration, exposure time and quantity:

• Grade I – damage to the upper layer of the skin, burning and slight hyperemia.
• Stage II – deeper layers of the epidermis are affected. The damaged area is hyperemic, there is swelling and small blisters with fluid.
• Stage III – all layers of the skin are affected, including the fatty layer. The sensitivity of the damaged tissues is impaired, the blisters are swollen and filled with a cloudy liquid.
• IV degree – all layers are damaged (fat, muscle, bone).

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Complications and consequences

The destructive action of the acid is due to tissue dehydration and the creation of active chemical compounds that cause protein coagulation and the destruction of the colloidal state in cellular structures. The consequences and complications depend on the degree of the burn, the volume of the damaged surface and the concentration of the reagent.

The damaging power of an acid is directly related to its concentration. Thus, weak solutions cause light damage, but their prolonged exposure leads to the formation of bubbles. A highly active liquid can immediately cause a third-degree chemical burn.

• When the skin is damaged, erythema and burn injuries of varying complexity develop.
• Burns of the mucous membrane of the oral cavity, esophagus, stomach and pharynx are dangerous. Severe pain is accompanied by vomiting with blood, hoarseness, spasms, toxic pulmonary edema and kidney damage.
• If the acid gets on the skull, it can cause bone damage, the development of subdural abscesses, and meningitis.
• In case of deep burns, it is not always possible to restore the lost skin, which leads to burn deformities.
• The acid causes changes in the blood and lymphatic vessels and nerve endings.
• Burn deformation may be accompanied by further tissue death by the type of dry necrosis.
• Locally, phlegmon, purulent arthritis, and gangrene develop in the affected area.
• Vascular and nervous disorders lead to trophic changes in tissues and dermatoses.
• In some cases, squamous cell carcinoma develops at the site of the scars.
• Extensive burns can cause severe shock and sepsis.
• With deep lesions of the head and neck, rapid death is possible.

The above-described consequences and complications depend on what part of the body the chemically active liquid came into contact with and how correctly first aid was provided.

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Diagnostics sulfuric acid burns

In its symptoms, a sulfuric acid burn is similar to damage caused by other chemicals. Diagnostics allows you to determine the type of reagent, the area of damage (total area and individual areas), the presence and localization of blisters and scabs.

• Laboratory research

If there is a suspicion of an acid vapor burn, the patient's blood pH, hemoglobin level, coagulation parameters, plasma electrolyte concentration are measured, and a urine sample is taken. An increase in the hemostasiogram parameters (APTT and PT) against the background of a decreased arterial blood pH (below 7.2) indicates a severe injury. Chemically active liquid causes metabolic acidosis with an increased anion gap.

• Radiation diagnostics

If sulfuric acid has got inside and there is a suspicion of an acute stage of the burn, then an X-ray of the abdomen and chest is performed. This is necessary to identify perforation of the stomach and esophagus. Computer tomography determines damage to hollow organs. This method is used when it is not possible to perform endoscopy.

• Visual inspection

If the liquid has come into contact with the skin, then their condition is examined and the stage of burn disease is determined, but only after first aid has been provided. In terms of their symptoms, chemical damage is difficult to confuse with thermal burns or skin diseases.

Diagnostic measures make it possible to recognize the early stages of burn shock (pale skin, fainting, shallow breathing). Based on the results of the studies, optimal methods of treatment and recovery are selected.

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Differential diagnosis

The symptoms of damage to internal organs by sulfuric acid are similar to acute manifestations of other diseases. Differential diagnostics allows us to separate one pathological condition from another. Burn disease, that is, steam discharge, is differentiated from diseases of the esophagus, primary and secondary esophagitis.

The main difference is that the duration of the acute period of esophagitis is significantly shorter than the damage to the esophagus, oral cavity or pharynx by chemicals. The burn is distinguished from infectious diseases, allergic esophagitis and spontaneous ruptures of the esophagus. Both pathologies occur suddenly and have acute symptoms, as does damage by sulfuric acid.

Endoscopy is performed for the examination. The procedure is indicated in the first 24 hours. According to clinical observations, this period is safe for such an examination. The doctor can detect esophageal perforation, severe necrosis of the stomach, duodenum and other pathologies. With the help of endoscopy, it is possible to clarify the diagnosis and make a prognosis. Skin burns do not require differentiation. The doctor's task is to determine the substance that damaged the epidermis, the stage of the disease and the volume of damaged surfaces.

Treatment sulfuric acid burns

A sulfuric acid burn is characterized by an acute course and very painful symptoms. Treatment is aimed at minimizing discomfort and restoring damaged tissue. The scope of therapeutic measures is determined by the depth, area and localization of the burn. Timely and correct first aid is of great importance. This set of measures consists of the following procedures:

• Elimination of the burn injury factor.
• Cooling the burned area of skin for 1-2 hours.
• Dilute the aggressive chemical by prolonged rinsing with clean water.
• The victim should be given salted water with baking soda added to drink.
• Burnt surfaces are covered with aseptic dressings.
• Non-steroidal anti-inflammatory drugs are used to relieve pain.

The above procedures are the basis of treatment. Before transporting the patient to the hospital, additional pain relief may be provided using analgesics, antihistamines, and neuroleptics. If there is vomiting, intravenous infusion of crystalloids and colloids, and intake of alkaline-salt solutions are performed. Oxygen inhalation is also indicated.

The initial task of doctors upon arrival of the patient to the hospital is to prevent burn shock. Treatment of wounds depends on the localization and area of damage, their depth. The patient will have to wash the burnt surfaces, conservative and, if necessary, surgical therapy.

First aid for sulfuric acid burns

In order to provide first aid for a sulfuric acid burn, it is necessary to have information about the specific properties of chemical liquids. In some cases, it is dangerous to be near the victim, so special protective equipment, ventilation, or even a gas mask are required.

Algorithm for providing first aid for a sulfuric acid burn:

1. Removing the reagent and washing the affected areas with clean running water. But before this, it is necessary to dry the burned areas, since contact with water releases a large amount of thermal energy, which further aggravates the injuries. The wound area must be treated with water within an hour after the injury and with hydrofluoric acid for two hours.
2. Try not to touch the burnt areas, as this will cause pain to the victim and may result in acid residue getting on you. All manipulations should be carried out in thick gloves.
3. Try to free the wound area from clothing, but if it does not come off, do not tear it off. This will cause even more damage. After washing, the affected area is treated with a solution of baking soda, 1% solution of citric or acetic acid.
4. The positive effect of the assistance provided can be assessed by the disappearance of the chemical smell and the reduction of painful sensations. After the treatment is completed, a dry aseptic bandage is applied to the skin, painkillers, detoxification and anti-shock measures are carried out.

Let's look at a few more emergency assistance options:

• If acid is ingested, first of all, the stomach should be washed with clean water and the victim should drink burnt magnesia or rinse the mouth with a soda solution. This will ease the patient's condition.
• If it gets into your eyes, rinse them thoroughly with water and put in 2% novocaine solution to reduce pain. Peach or Vaseline oil, which is placed behind the eyelid, is suitable for treatment.
• In case of inhalation of acid vapors - therapy is carried out in a hospital setting, so the patient must be sent to the hospital. To reduce pain, intramuscular injections of novocaine are used. To prevent infection, a course of antibacterial therapy is carried out. If there is bleeding in the gastrointestinal tract, then the patient is shown a blood and plasma transfusion.

Timely first aid provides a chance to save the victim’s life and minimize the destructive effects of the acid.

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Medicines

When aggressive substances get on the skin or inside, the first thing to do is to eliminate their pathological effect. Medicines are used both at the stage of first aid and during further restorative therapy. When acid gets on tissue, it forms a scab - a white soft crust. For disinfection and as a drying agent, alcohol-free silver-based preparations and iodine solutions are used. Regenerating and blood supply-improving medications are mandatory.

Popular and effective medications for sulfuric acid burns:

1. Sodium bicarbonate

A medicinal product that affects tissue metabolism processes, used to correct ionic and acid-base balance. Belongs to the pharmacological group - alkalis and acids. 100 ml of infusion solution contains: 4 g of sodium bicarbonate, water for injection and disodium ethylenediaminetetraacetic acid. It is used to restore the alkaline state of the blood and metabolic acidosis. Increases the excretion of chlorine and sodium ions from the body, alkalizes urine, increases diuresis.

• Indications for use: decrease in blood pH below 7.2, uncompensated metabolic acidosis in case of extensive burns, shock, severe postoperative period. Helps with acute blood loss, severe hypoxia, kidney and liver damage, diabetic coma, as well as with uncontrollable vomiting and prolonged fever.
• The medication is prescribed to adults and children - intravenously by drip. Depending on the severity of pathological symptoms, it is used both undiluted and diluted with a 5% glucose solution 1:1. In case of overdose, tetanic seizures and hyperalkalosis may develop. For treatment, 1-3 g of calcium gluconate is administered.
• Contraindications: hypokalemia, respiratory alkalosis, hypernatremia. Side effects are manifested by the following symptoms: vomiting, nausea and abdominal pain, headaches, arterial hypertension, increased anxiety. During treatment, it is necessary to monitor the acid-base parameters of the blood.

2. Actovegin

The gel form of the drug is used to treat chemical burns. Actovegin relieves pain and helps cleanse the wound surface. It is effective during the recovery period, accelerates the regeneration process of damaged skin areas. Affects the process of tissue metabolism. Belongs to the pharmacological group of biogenic stimulants.

• The active ingredients activate metabolism at the cellular level by increasing the accumulation and transport of oxygen and glucose. Stimulates the energy processes of functional metabolism and increases blood supply.
• Indications for use: extensive burn injuries, tissue necrosis, trophic disorders, cerebral circulatory failure, skin nutrition disorders, arterial and venous circulation. Ulcers of various origins, radiation injuries. It is used for burn and ulcerative damage to the cornea and sclera.
• The method of application and dosage depend on the severity of the disease. The gel is applied to open wounds, ulcers and burns to cleanse and treat them. The product is applied in a thin layer to the skin or used under a bandage. The duration of treatment should not exceed 4 weeks.
• Side effects: allergic reactions, fever, itching and burning in the area of application. Contraindicated in case of intolerance to the components. Prescribed with special caution for pregnant women and during breastfeeding.

3. Baneocin

Antibacterial combination agent for local use for open wounds. Used for 2-3 degree burns, minimizes pain, is practically not absorbed through the skin, has a minimum of side effects. Belongs to the pharmacological group of aminoglycosides. Contains two bactericidal substances with synergistic properties. Antimicrobial action is effective against most gram-positive and gram-negative microorganisms.

• Indications for use: prevention of bacterial skin infections, superficial wounds and burns. Treatment of bacterial infections of the epidermis and mucous membranes: impetigo, furuncles, pustular lesions, folliculitis, abscesses. The drug is effective in secondary infections, dermatoses, ulcers and eczema. It is used in otolaryngology and pediatric practice.
• Before use, it is recommended to check the sensitivity of the microflora that caused the disease. The ointment or powder is applied in a thin layer to the affected tissues or used under a bandage. The duration of therapy is 5-7 days. For patients with burns covering 20% of the body surface, the powder is allowed to be applied to wounds no more than once a day.
• Side effects: dry skin, hyperemia, rash, itching, burning at the site of application. Contraindicated for use in case of intolerance to antibiotics-aminoglycosides, bacitracin and neomycin. With special caution, prescribe to patients with acidosis, muscle weakness, neuromuscular conduction disorders, during pregnancy and lactation.

4. Solcoseryl

Biogenic stimulator on a fat-free basis. Due to the gel form, it quickly penetrates into the deep layers of the skin and dries the wound surfaces. Improves metabolism in tissues, accelerates recovery processes.

• Indications for use: 2-3 degree burns, tissue necrosis, obliterating diseases of the vessels of the extremities, vascular tone disorders, softening and destruction of tissue due to prolonged exposure to liquid, inflammation and chemical burns of the cornea, trophic ulcers.
• The medicine has several forms of release, due to which it can be used intramuscularly, intravenously and locally. As a rule, combined therapy is carried out, that is, the use of ointment and injections simultaneously. The duration of treatment depends on the nature of the pathological process and its course, most often it is 4-8 weeks. The drug is well tolerated.

5. Panthenol

A pharmaceutical vitamin product that includes dexpanthenol, an analogue of pantothenic acid. It participates in intracellular metabolic processes, accelerates the regeneration of damaged tissues and mucous membranes. For ease of use, it is available in several forms: an aerosol spray in cans and a 35% ointment in tubes.

• Indications for use: treatment of burns, aseptic postoperative wounds, acceleration of healing of epidermal damage. Effective for vesicular dermatitis and skin grafts. Duration of treatment and frequency of use depend on the complexity of the wounds and doctor's recommendations.
• Side effects manifest as hypersensitivity reactions. Contraindicated for use in case of intolerance to active components. In case of overdose, toxic side effects may develop.

In addition to the above-described medications, ichthyol ointment, Bepanten, rosehip and sea buckthorn oils can be used for burns. Dexpanthenol is used as an anti-inflammatory agent. Antiseptic medications accelerate the healing of wound surfaces. If burns have begun to fester, patients are prescribed Miramistin.

Herbal medicines are used without fail - Alfogin, Sudocrem. They have antimicrobial, wound-healing and analgesic properties, but at the same time have a minimum of contraindications and side effects. Since a chemical burn has a destructive effect on tissue, timely use of medicines is required to speed up recovery.

Physiotherapy treatment

Once the threat to the patient's life has been eliminated, physiotherapy treatment is indicated. It is a set of procedures for the complete restoration of the range of motion in the joints, the elimination of cosmetic problems and consists of the following procedures:

• Improving blood supply
• Prevention and treatment of purulent complications
• Acceleration of regeneration and removal of necrotic tissue
• Anesthesia
• Treatment of cicatricial changes
• Improving the healing of skin grafts

Rehabilitation begins on the day of injury and its main task is to prevent anatomical deformation. Let's consider popular physiotherapy procedures:

1. Ultraviolet irradiation at the site of injury accelerates tissue regeneration, stops the inflammatory process and stimulates local immunity.
2. Phonophoresis and ultrasound therapy are used to dissolve scar tissue, relieve pain and improve blood supply.
3. Aeroionotherapy is suitable for improving skin permeability and reducing pain sensitivity. During the procedure, analgesics can be used to enhance the therapeutic effect due to the penetration of ions through damaged and undamaged tissues.
4. Electrotherapy has an analgesic and bactericidal effect, improves blood supply, stimulates the rejection of necrotic tissue, and has an anti-stress effect.
5. Magnetotherapy – improves blood supply, biostimulation and recovery processes. It is used to stabilize the patient’s psycho-emotional state.
6. Laser therapy – anti-inflammatory effect, stimulation of tissue regeneration.

Treatment of chemical burns should be comprehensive, involving highly specialized specialists and even psychologists. Burn injuries are a strong psycho-emotional factor that can lead to depression and suicidal thoughts. Physiotherapeutic rehabilitation methods are aimed at minimizing the residual manifestations of the pathological condition and help the victim return to normal life.

Folk remedies

The effect of sulfuric acid on a living organism is destructive. Self-treatment of such damage is unacceptable and life-threatening. Folk treatment can be used only after eliminating the acute stage of the pathological process, that is, to speed up healing and pain relief.

1. Rinse the burnt area with running water, treat with baking soda and make a compress soaked in a decoction of oak bark or coltsfoot. To prepare the decoction, pour boiling water over the dry grass, simmer over low heat and let it brew for 2-3 hours.
2. Warm compresses based on chamomile, hop cones and mint soothe damaged skin, relieve burning and itching. Bandages soaked in herbal infusion should be applied to wounds 3-4 times a day for 10-15 minutes.
3. Aloe ointment has regenerating properties. To prepare the medicine, take a couple of leaves of the plant, wash them and cut off the thorns. Aloe should be crushed to a homogeneous gruel, mixed with melted pork fat and allowed to thicken.
4. If acid gets into the eyes, then a decoction of birch buds and leaves is used for treatment. Pour 500 ml of boiling water over the plant material and simmer for 5-10 minutes over low heat. The resulting decoction should be cooled, filtered and used for washing the eyes.
5. A violet medicine will help with a burn of the esophagus. Pour 20 g of the dry plant with a glass of boiling water and let it brew for 1-2 hours. Strain the cooled broth, add 50 ml of milk and a spoonful of honey. Take the remedy at one time.

Alternative methods must be agreed upon with your doctor, as some of them can cause serious complications.

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Herbal treatment

The use of herbal ingredients to eliminate chemical burns of varying degrees is one of the options of alternative medicine. Herbal treatment should be agreed with the attending physician. As a rule, such therapy is used at the recovery stage, that is, to accelerate the healing of affected surfaces and pain relief.

Let's look at effective herbal recipes:

• Take a couple of aloe leaves, wash them and grind them with a blender. The resulting gruel must be rubbed through a sieve. The remaining aloe juice is used to soak a gauze bandage. Apply the gauze to the wound 2-3 times a day for 30-40 minutes. According to this recipe, you can prepare a medicine from the herb knotweed.
• Pour 100 g of dried red clover flowers with 500 ml of hot water and boil over medium heat for 10 minutes. For treatment, you can use gauze compresses soaked in the decoction or the flowers of the plant wrapped in a bandage.
• Burdock has medicinal properties. Wash a couple of leaves of the plant thoroughly, grind into a gruel and spread it on a gauze bandage. Apply the compress to the burnt surfaces 2-3 times a day for 10-15 minutes.
• To treat burns, you can use compresses made from grated carrots or pumpkin juice. Grate fresh carrots on a fine grater, wrap them in gauze and apply to the wound. This will help relieve pain. To prepare pumpkin juice, you can use a juicer or grate the pumpkin and squeeze out the juice. Soak the compress in the resulting liquid and apply to the burn surface.
• To treat large burns, you can use a special lotion: mix 5 g of boric acid with the same amount of goldenseal and myrrh. All ingredients should be poured with ½ cup of boiling water and left to brew for 1.5-2 hours. The solution relieves pain, soothes the skin and helps with deep damage.

All the above recipes are recommended to be combined with a special tea that stimulates blood circulation and accelerates healing. Mix equal proportions of valerian powder and peppermint, pour 200 ml of boiling water and let it brew. This tea calms the nerves and relieves pain.

Homeopathy

An alternative form of medicine is homeopathy. It is used to treat many diseases, including sulfuric acid burns. Homeopathic medicines can only be used as prescribed by a homeopathic physician.

Let's look at effective medications for treating burn injuries:

1st degree

• Urtica urens – can be taken internally or applied to the epidermis. The drug is taken 5-6 times a day. To prepare a solution, dilute 20 drops of tincture in ½ glass of water.
• Cantharis – suitable for the treatment of painful burns and blistering injuries. The remedy is taken 5-6 times every 15 minutes.
• Calendula – prescribed for wounds with burst blisters and pus. Suitable for both internal and external use. Dosage: 3 times a day for 3-4 days.
• Causticum – used if severe pain remains after healing. The remedy is taken 3 times a day for 3 days.

2nd degree

• Cantharis – burns of any intensity, fluid blisters, chemical eye damage. The dosage is determined by the doctor.
• Apis – burning, weeping wounds, tissue swelling.
• Rhus tox – rotting blisters, severe itching and burning.

3 and 4 degrees

• Arsenicum album – necrotic tissue, severe pain, wounds with black edges and blisters.
• Causticum – complex chemical burns of mucous membranes and poorly healing skin lesions.

Regardless of the degree of burns, patients are usually given Cantharis. If there is no improvement within 30 minutes, then Urtica ureas is taken. Both preparations are taken three granules every two hours until the symptoms improve. If there is no change after three doses, then another medicine is used. Homeopathy reduces pain, accelerates tissue regeneration and prevents scarring.

Surgical treatment

Depending on the degree of burns, the most appropriate method of therapy is selected. Surgical treatment is indicated for deep burns and injuries that have caused anatomical or cosmetic defects. In such cases, surgery has several directions:

• Decompression type operations
• Necrectomy and osteonecrectomy
• Dermoplasty: allodermoplasty, autodermoplasty, xenodermoplasty
• Amputation

The type and nature of the operation depend on how much time has passed since the injury, the location of the burn and the general condition of the patient. The duration and overall outcome of the treatment depend on the correctness of the indications for the operation and the chosen method of skin restoration.

Let's consider the main types of surgical intervention:

1. Necrotomy

It is used when forming dense burn necrosis, which, like a shell, covers the limbs, chest or other parts of the body, causing respiratory and circulatory disorders. The procedure is performed without anesthesia. The doctor cuts the scab to the full depth until blood appears. If the cut is made correctly, the edges diverge. As a rule, several parallel longitudinal cuts are made.

2. Early necrectomy with defect closure

Spontaneous rejection of necrotic masses and the healing process depend on the depth and location of the burns. As a rule, this occurs within 20-35 days. This period is dangerous due to the development of complications (plasma loss, intoxication, infection), so if there is a suspicion of deep lesions, then early release of the wound is carried out. For this, necrotic tissues are excised, and the defect is closed with a skin graft. Removal of the scab minimizes the effect of chemical factors of inflammation and prevents scarring.

3. Skin plastic surgery

It is performed after conservative therapy, rejection of the scab and elimination of wound infection. Plastic surgery is possible only if the wound area is covered with granulation and there is no pathogenic microflora on its surface. As a rule, it is performed 2-6 weeks after the injury. The technique is gentle, but implies a long recovery period, the possibility of developing infectious complications or intoxication of the body, tissue rejection.

The following methods are used to close burn wounds:

• Local tissue plastic surgery is used only for small, deep injuries.
• Free skin grafting – a flap of skin is excised from the donor site of the victim and sutured to the wound defect. In this case, there should be no connection between the donor site and the damaged area.
• Transplantation of a whole skin flap - no epithelial elements are left at the donor site, so local tissues are used to prevent defects. This significantly limits the indications for the technique, since a small tissue flap can be prepared.
• Split skin graft transplantation – suitable for covering large wound surfaces. The thigh, lateral abdominal or shin surfaces are most often used for tissue transplantation. A 0.5 mm skin flap is taken for the operation; it should contain part of the dermis and epithelium.
• Plastic surgery with a flap on a feeding pedicle - tissues with subcutaneous tissue are used, as they have a high degree of engraftment. Flaps have increased mechanical strength, therefore they allow achieving good cosmetic results.
• Italian plastic surgery – a flap is prepared and moved to the defect at the same time. Most often, tissue is taken from those parts of the body that can be moved over distances, for example, the lower or upper limbs. The disadvantage of the method is the impossibility of taking large flaps and the patient being in a forced position for a long time.
• Use of cultured allofibroblasts. In a special medium, monolayer cell structures are grown from epithelial elements, which are transferred to the wound surface.
• Temporary biological wound closure – this method is suitable for plasma loss, for stimulating marginal epithelialization and preventing infections. This allows you to wait for skin grafting from the donor site, secondarily after epithelialization. The skin of a corpse, donor, synthetic materials, piglet or calf skin are used for the operation.

After a burn injury, pathological scars may remain. Atrophic, keloid and hypertrophic scars are distinguished. They are formed in the presence of the following factors:

• Uneven wound healing
• Burn in the chest area or on the shoulders
• Wound injuries of the functionally mobile area
• Metabolic disorders (diabetes mellitus, hypovitaminosis, atherosclerosis)
• Secondary infection

Very often, the scarring process is complicated by necrotic, allergic and purulent-inflammatory processes. Several methods are used for treatment. This can be laser resurfacing, ultrasound therapy, regenerating ointments, sprays, creams. Large scars are eliminated by excising excess keloid tissue.

Prevention

Compliance with safety precautions and personal protective measures when working with sulfuric acid of any concentration minimizes the risk of burns and poisoning by the substance. Prevention is based on compliance with the following rules:

• Do not leave chemicals unattended.
• All containers containing sulfuric acid and substances containing it must be tightly closed and contain a warning label.
• Chemically active liquids should not be stored near medicines or food products. This is necessary to prevent poisoning.
• Do not mix household chemicals with toxic components on your own.
• After working with chemicals, thoroughly ventilate the work area to prevent burns from reagent vapors.
• Work with sulfuric acid must be carried out in special protective clothing (acid-resistant boots, a mask and face goggles made of plexiglass) to protect the skin from possible damage.

Failure to follow preventive recommendations may result in serious burns and inhalation of vapors.

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Forecast

The duration of recovery depends on the degree and depth of the burn, its location and the individual characteristics of the victim's body. The prognosis is calculated using the "hundred" rule. To do this, the patient's age and the size of the damaged surface as a percentage of healthy tissue are summed up. The inclusion of the victim's age in the calculation is explained by the immune, compensatory-adaptive and reparative capabilities of the body to eliminate the pathological process. The formula is used only for adult patients. The prognosis depends on the resulting sum:

• <60 – favorable
• 61-80 – relatively favorable
• 81-100 – doubtful
• >100 – unfavorable

Minor, superficial burns with minimal damage to tissues or internal organs have a favorable prognosis. But if a state of shock occurs, the outcome of the pathology is significantly worsened. The possibility of full recovery is affected by functional and anatomical disorders.

A sulfuric acid burn that affects large areas of the body is accompanied by a long-term inflammatory process. The pathological condition entails the formation of severe scars not only in the affected area but also beyond it. This leads to limited mobility and contractures, which significantly worsens the prognosis for recovery.