Thermal burns

Burned your finger - grab your earlobe. This phrase is often said by parents to a child who, crying, pulls his finger away from something hot. And this is the most common first aid for thermal burns, which everyone is familiar with from childhood. This also includes smearing the skin with sour cream after a long stay in the sun, when the body acquires the color of hot lava. And who among us has not burned his tongue, rushing to swallow hot food? What to do here? What to put the tongue on? What to smear it with?

Thermal burns are the consequences of exposure to high temperatures (open flame, hot liquid or solid substance) on the skin and underlying tissues.

Nature of burns

Thermal burns entered human life with the advent of fire, boiling water, hot steam and hot solid, gaseous and loose substances. Burns can be different in nature, in the area of the burn surface, in the depth of damage to the skin, and they can also be external and affect internal organs, for example, a thermal burn of the respiratory tract during a fire. Whatever the burns, they have one thing in common - they all cause suffering and require special manipulations to provide first aid.

Therefore, it is important to know how to recognize a burn, what first aid is for those who have already suffered, and what to be prepared for if you encounter such an ailment as a thermal burn in your life.

Manifestations of a second degree burn

Second-degree burns, in addition to reddening of the skin, are characterized by clearly visible blisters. There may not be any blisters at the time of the burn, but they appear after a short period of time. At first, the burned skin looks quite wrinkled. This "wrinkling" is the future blister, which will gradually fill with liquid, the color of which can vary from transparent to yellowish. The swelling is more pronounced than with a first-degree burn. The pain does not go away for several hours or even days.

Degrees of thermal burns

Thermal burns are usually divided into four categories according to their severity. The first category is the mildest and most common in everyday life. A first-degree thermal burn can be caused by minor contact of the skin with something that has a temperature of more than 50 degrees. The first summer tan, which colors the skin red and causes painful sensations, is nothing more than a first-degree thermal burn. Let's summarize. A first-degree burn leads to redness and minor painful sensations on the skin. In addition to these symptoms, slight swelling is possible around the damaged surface.

Local changes in thermal burns depend on their depth:

• at grade I - hyperemia of the skin;
• at stage II - death of the epidermis with the formation of blisters;
• at grade IIIA - partial, and at grade IIIB - complete skin necrosis;
• At stage IV, necrosis affects the underlying tissues.

Burns up to IIIA degree are considered superficial, since during their healing the skin undergoes epithelialization. Burns of IIIB-IV degree are deep, heal with the formation of fibrous scars and determine the severity of burn disease.

The area of skin damage in burns is most often determined by the "nine" rule. The head and neck, chest, abdomen, half of the back, arm, thigh, and shin have a surface area corresponding to 9% of the total body surface. In children, the ratio between different body parts changes with age, so it is better to focus on the area of the patient's palm, which approximately corresponds to 1% of the body surface. In case of a thermal burn of the respiratory tract, 10-15% is added to the total area of skin damage. Inhalation burns in children are considered a threat of progressive development of burn shock. In addition to determining the area and depth of the burn, damage to functionally important areas of the feet, hands, face, and perineum is of significant importance in assessing the severity of the condition.

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Severe degrees of thermal burns

Third and fourth degree burns are considered very dangerous because they affect the entire body and can be fatal. Symptoms include a large burn area, missing areas of skin, large blisters, sometimes merging into one large one, skin color from dark red to black. There is deep burning of the skin and muscle layer down to the bone. Here is an incomplete list of what a third- or fourth-degree burn may look like.

How to determine the degree of a burn?

The degree of a burn can be determined "by eye" only if it is first degree. Then the complications begin. In case of damage to the skin with slight redness and blisters, we can say that it is a second degree burn and there is nothing to worry about. But! If a finger is burned, worries are in vain. But what if the entire surface of the back? And what if this back belongs to a child? Here confidence falls. You need to urgently consult a doctor.

So. With third- and fourth-degree burns, the body switches on one of its defense mechanisms – it loses moisture, directing it to the skin, which leads to dehydration. The area of the burn and the depth of tissue damage play a major role. Burns over 75% of the total body area are considered fatal. Dehydration, the release of a large amount of toxic substances into the blood, an accompanying infection, pain shock – these are the companions of severe burns.

Emergency care for burns in children without clinical signs of shock

Start by cooling the burn site and the surrounding skin surface with a neutral liquid (water) until the pain disappears, but not less than 10 minutes, in order to stop the skin damage process. In adolescents, irrigation with cold water (15-20 °C) is carried out for 30 minutes. It is necessary to free the damaged areas of skin from clothing before it cools down, cutting off non-adherent clothing around the damaged area and not opening blisters, so as not to create conditions for their infection.

If skin burns up to grade IIIA have a lesion area of less than 9% (in children under 5 years of age - less than 5%), for pain relief, a 50% solution of metamizole sodium (analgin) 10 mg per 1 kg of body weight and a 1% solution of diphenhydramine (diphenhydramine) 0.1 ml per year of life or a 5% solution of tramadol (tramal) at a dose of 1-1.5 mg per 1 kg of body weight are administered intramuscularly.

In case of grade IIIA skin burns with a lesion area of more than 9%, burn shock usually develops, therefore, for pain relief, narcotic analgesics are administered intravenously - 1-2% solution of trimeperidine (promedol) or omnopon 0.1 ml per year of life or 0.2 mg per 1 kg of body weight (in children over 6 months of age).

In case of burns of the genitals and perineum, it is necessary to insert a catheter into the bladder already at the pre-hospital stage, since tissue edema can lead to urinary retention. Active infusion therapy for burns at the pre-hospital stage, especially at an early age, is not practiced, since hypovolemia due to plasmorrhagia develops after 4-6 hours. Such treatment is necessary for burn shock, when hemodynamic disturbances develop already in the first minutes from the moment of injury.

Emergency tetanus prophylaxis for children and adolescents is carried out in case of violations in the vaccination schedule:

• unvaccinated (over 5 months) - 0.5 ml of tetanus toxoid and 250 IU of human tetanus immunoglobulin;
• if the last revaccination was missed - 0.5 ml of tetanus toxoid:
• If only 1-2 vaccinations were administered in the anamnesis less than 5 years ago, 0.5 ml of tetanus toxoid is administered, and if more than 5 years ago, 1 ml of tetanus toxoid and 250 IU of human tetanus immunoglobulin are administered.

In case of inhalation burn of the respiratory tract with hot air and severe burn of the face, it is advisable to perform tracheal intubation, chest X-ray, determination of blood gas composition, and carboxyhemoglobin level.

In case of thermal burns of the eyelids and eyeball, anesthetic substances are instilled into the conjunctival cavity - 3-5 drops of 0.25% tetracaine (dicaine) solution or 2% lidocaine solution. An aseptic binocular bandage is applied to the eye area.

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First aid for first degree thermal burns

There is no strict algorithm for providing first-degree medical care for a burn. It is enough to hold the damaged surface under a stream of cold running water or, if this is not possible, apply a towel soaked in cold water to the burnt area. An ice pack will also do. In a word, cold is the simplest remedy. Cold will relieve unpleasant painful sensations, remove swelling by narrowing small blood vessels. Five to ten minutes of a cold compress will be quite enough. You can use modern aerosol products that have a disinfectant and, at the same time, an analgesic effect.

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First aid for second degree thermal burns

It consists of treating the surface with special anti-burn agents, which are available in abundance in any pharmacy and should definitely be in the home medicine cabinet of every family. Cool the burnt area under running water, if possible, and apply an anti-burn aerosol. It is not necessary to apply bandages, it is better to treat the wound in the so-called "open way". It is advisable to seek professional medical help without delay. You should not open the blisters yourself, this operation can lead to infection on the wound surface, and instead of relief, you will get an aggravation of the situation and a purulent process.

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First aid for thermal burns of 3-4 degrees

It consists of an urgent call to a medical team. Self-help can worsen the situation. A safe intervention is to give the victim a cool drink, a painkiller, preferably in the form of an intramuscular injection. If it is not possible to give an injection, then a strong painkiller in tablets will also have time to give an effect before the doctors arrive. As a rule, victims who have received extensive burns are left for treatment in a hospital. If the burn is local, occupies a small area, then treatment is carried out in a dispensary.

First aid for thermal burns, as practice shows, should be provided immediately. The life and further well-being of the patient often depend on the intervention of doctors.