First aid for burns

First aid for burns has the same priority as for trauma: airway patency, breathing and blood circulation; in case of inhalation injury - 100% O2. It is necessary to stop the victim's contact with burning traumatic factors, remove ash and hot materials. Remove all clothing from the victim. Chemicals, with the exception of powdered ones, are washed off with water. First aid for burns with powdered substances consists of brushing them off, having previously sprinkled them with water. Burns with acids, alkalis or organic substances (e.g. phenols, cresols) are washed with plenty of water for at least 20 minutes until they are completely visibly removed.

First aid for burns at the scene of the incident involves removing the victim from the danger zone, stopping the action of damaging factors, undressing, taking the burned person out into the fresh air (if there is no breathing, artificial respiration is performed). It is necessary to cool the affected areas of the body with water or cold objects, administer painkillers, apply bandages to the wounds from sterile dressings or improvised materials (sheets, scraps of fabric, etc.). In case of burns of the hands, it is necessary to remove the rings to prevent ischemia of the fingers (as a result of the development of edema).

The most effective method of providing first aid for burns is cooling the burnt surface, which leads to the cessation of tissue hyperthermia and a decrease in the depth of the burn lesion. It is carried out with cold water and other liquids, application of cooled objects (ice, cold water bubbles, snow, cryopackages), irrigation with chloroethyl or liquid nitrogen vapors. The greatest efficiency is achieved with cryotherapy immediately after the burn. However, delayed (up to 30-60 minutes) cooling can also be quite effective.

In shock or burns of >15% of the body surface, intravenous fluids are started. If possible, 1 or 2 peripheral intravenous catheters of 14-16 G are inserted into undamaged areas of the body. Venesection, which carries a high risk of infection, should be avoided.

Primary fluid replacement is aimed at treating the clinical manifestations of shock. In the absence of shock, the purpose of fluid administration is to replenish losses and maintain normal fluid balance in the body. The Parkland formula is used to determine the volume required to eliminate fluid deficit. According to this formula, it is necessary to administer 3 ml of crystalloids (lactated Ringer's solution) for each kilogram of body weight, multiplied by the percentage of body surface area, during the first 24 hours (for example, a person weighing 70 kg and with a burn area of 40% requires 3 ml 70 40 = 8400 ml in the first 24 hours). Half of this amount is administered in the first 8 hours after the established time of injury, the remaining part - in the next 16 hours. Some clinicians prescribe colloidal solutions for two days after the injury to patients with extensive burns, very young or elderly patients, and people with heart disease.

First aid for burns also includes treatment of hypothermia and pain. Opioid analgesics are always administered intravenously. Tetanus toxoid at a dose of 0.5 ml is administered subcutaneously or intramuscularly to patients who have previously been fully vaccinated and to those who have not received the toxoid in the last 5 years. Patients who have been vaccinated earlier or have not been vaccinated in the last 5 years are administered 250 units of human tetanus immunoglobulin intramuscularly with parallel active vaccination.

For minor burns, the affected body part is sometimes quickly immersed in cold water, although this has not been proven to reduce the depth of the burn. After anesthesia, the wound is washed with soapy water and all remnants of nonviable tissue are removed. Blisters are treated, with the exception of small blisters located on the palms, soles, and fingers. If the patient is planned for transportation to a burn center, clean, dry dressings can be used (burn creams will interfere with the assessment of the burns at the receiving center). In this case, the patient is warmed and opioid analgesics are administered to maintain relative comfort.

After cleaning the wound, the burn surface is covered with antibacterial ointment and covered with a sterile dressing. Most often, 1% sulfadiazine is used in the form of silver salt for topical application. It has a broad spectrum of antimicrobial action. However, in patients sensitive to sulfur preparations, allergic reactions are possible in the form of pain upon application or local rash. The drug can also cause moderate, transient and usually clinically insignificant leukopenia.

To ensure normal respiratory excursion of the lungs or blood supply to the limb in case of severe burns, a scab may be required (cutting the burn scab). However, if the victim is expected to be delivered within several hours, the scab can almost always be postponed until then.

Antibiotics are not prescribed for prophylactic purposes.

After providing first aid for burns and stabilization, the need for hospitalization is determined.

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