Burn with sulfuric acid

A sulfuric acid burn is one of the most dangerous chemical damage to tissues. Consider its features, first aid, methods of treatment and prevention.

The peculiarity of chemical burns is that after the reagent enters the skin, a crust is formed, which practically does not differ from healthy tissues. The scab is on the surface, the skin becomes white, and then brown. When healing, a purple crust is formed. If acid gets into your eyes, it can cause loss of vision. If you inhale its vapors, a laryngeal burn occurs. Large reagent concentrations cause hemorrhagic pneumonia and death.

[1], [2], [3]

Epidemiology

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

The depth of a chemical burn depends on such factors:

• Fluid activity and quantity
• Depth of penetration into tissues
• Mechanism of action
• Form and duration of contact

Depending on the mechanism of action, the acid exerts a corrosive, dehydrating, poisoning, oxidizing and destroying effect. The depth of injury 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.

[4], [5], [6]

Causes of the burn with sulfuric acid

Chemical damage is extremely rare, unlike thermal burns. The causes of pathology can be related to:

• Rough handling of the substance.
• Various industrial injuries due to non-compliance with safety regulations.
• Household accidents.
• Unprofessional carrying out of cosmetic procedures and another.

According to statistics, from 3-5% of episodes of burn injuries are accounted for by sulfuric acid. Most of the damage is local, that is, in about 90% of cases, about 10% of the body surface is affected. There are several solutions of sulfuric acid with different concentrations, which have different degrees of destructive effect: 10% dilute acid, 30% rechargeable, 75% tower and 98% concentrated.

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 acid, it is not uncommon for the situation to be poisoned with vapors or burns.

[7], [8]

Pathogenesis

When the skin contacts aggressive substances, it becomes necrotic for a short period of time. The destructive effect lasts until the complete termination of the chemical reaction. Pathogenesis indicates the initial morphological manifestations of necrosis, which is formed immediately after contacting the active substance with living tissues. If the skin comes into contact with low-concentration solutions, the morphological changes are revealed after a few days.

Under the influence of sulfuric acid, coagulation necrosis is formed. In this case, typical for thermal burns, blisters with chemical damage occur rarely. Very often expressed dehydration and cauterizing action excludes their formation. In the place of skin contact with acid there is a dense dry scab, which is localized at the level of intact tissues, clearly limited. On its contour a hyperemic band is formed, indicating an aseptic inflammation. The degree and depth of the lesion depends on the concentration of the reagent.

[9], [10], [11]

Symptoms of the burn with sulfuric acid

By its features, acid damage is very similar to that of other chemical reagents. Let's look at the symptoms of a burn with sulfuric acid:

• On the skin a crust with a white tint is formed, not a dense consistency, with pronounced boundaries.
• Burns are superficial in nature, but the higher the concentration of fluid, the deeper the wound.
• Immediately after contact with the acid, the tissues become white, then gray or brown.

Symptomatology depends on the severity of the lesion. At the first stage there is a small edema and hyperemia, which are accompanied by painful sensations. This is possible when exposed to a weakly concentrated acid. In the second stage, the symptomatology described above is more pronounced. The third degree is characterized by more severe tissue damage, which at the initial examination is difficult to distinguish from the fourth stage.

The fourth degree is the most severe, since not only the epidermis but also the tendons, muscle and bone tissue are affected. Under the necrosis fall and nearby tissue. For the pathological condition is characterized by prolonged healing, various complications and consequences are possible.

[12], [13],

First signs

A burn injury with sulfuric acid leads to a severe condition, the first signs of which are difficult to confuse with other pathologies. The symptomatology depends on where the reagent hit.

Chemical vapor burn:

• Mucous membrane of the respiratory organs is injured, there is a burn, swelling, bleeding from the nose.
• Because of the defeat of the respiratory system, wheezing, spasms and pain in the throat appear. Severe spasms and swelling can trigger choking.
• Digestive organs are digested, causing severe pain.

Burn acid in liquid form:

• If the acid has got inside, there is a pain in all digestive system, strong vomiting with a blood.
• The patient suffers from strong salivation and diarrhea.
• Because of the severe damage to the kidneys, urine acquires a bard color.
• The skin turns blue.
• Developed violations of the cardiovascular system.
• Black lips, dark tooth spots appear on the tooth enamel.

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

• Edema and hyperemia, the epidermis exfoliates.
• A soft white scab appears on the wound site.
• The wound surface has delineated boundaries.
• As the substance is exposed, the white crust darkens, acquiring a brown tinge.
• Coagulation necrosis develops.

All kinds of pathological conditions are accompanied by a severe pain shock. A lethal dose is 5 mg of sulfuric acid taken internally. In the case of skin lesions, death most often occurs with the last degrees of damage.

[14]

Stages

Sulfuric acid is a strong oxidizer that absorbs air vapors and dehydrating organic materials. Chemical damage occurs due to the ingress of acid, alkali, a mixture of chemical reagents or salts of heavy metals onto the living tissue site. From the chemical point of view, the acid is a substance with hydrogen atoms and an acid residue. Its degree of burn depends on its concentration, exposure time and amount:

• I degree - a lesion of the top layer of a skin, a burning sensation and a small hyperemia.
• II degree - the deeper layers of the epidermis are affected. The damaged area is hyperemic, there is swelling and small bubbles with fluid.
• III degree - all layers of skin, including fatty layer, are affected. The sensitivity of damaged tissues is disturbed, the vesicles are swollen and filled with a turbid liquid.
• IV degree - all layers are damaged (fatty, muscle, bones).

[15],

Complications and consequences

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

The damaging ability of an acid is directly related to its concentration. Thus, weak solutions cause mild injuries, but their prolonged exposure leads to the formation of bubbles. Highly active liquid can immediately cause a third degree of chemical burn.

• When the skin is affected, erythema develops and burns are different in complexity.
• Dangerous are burns of the oral mucosa, esophagus, stomach and pharynx. Strong painful sensations are accompanied by vomiting with blood, hoarseness of voice, spasms, toxic pulmonary edema and kidney damage.
• If the acid has got on a skull, it can cause a defeat of bones, development of subdural abscesses, a meningitis.
• With deep burns, it is not always possible to restore the lost skin, which leads to burns deformities.
• Acid causes changes in the blood and lymph vessels, nerve endings.
• Burning deformity can be accompanied by further tissue loss as a dry necrosis.
• Locally in the area of lesions develop phlegmon, purulent arthritis, gangrene.
• Vascular and nerve disorders lead to trophic changes in tissues, dermatoses.
• In some cases, squamous cell carcinoma develops at the site of the scars.
• Extensive burns provoke severe shock and sepsis.
• With deep lesions of the head and neck, rapid death is possible.

The above-described consequences and complications depend on the site of the chemically active liquid and how correctly the first medical aid was provided.

[16],

Diagnostics of the burn with sulfuric acid

In its symptoms, the burn with sulfuric acid is similar to damage from other chemicals. Diagnosis 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 burns with acid fumes, the patient's blood pH, hemoglobin level, coagulability, electrolyte concentration in plasma and urine test are measured. An increase in the parameters of the hemostasiogram (APTT and PV) against a background of a lowered pH of the arterial blood (below 7.2) indicates a severe lesion. Chemically active liquid causes metabolic acidosis with increased anionic interval.

• Radiation diagnostics

If sulfuric acid has got inside and there are suspicions of an acute stage of a burn, then the radiography of the abdomen and thorax is carried out. This is necessary to identify the perforation of the stomach, esophagus. Computer tomography determines damage to hollow organs. This method is used when there is no possibility to perform endoscopy.

• Visual inspection

If the liquid has got on the skin, then they study their condition and determine the stage of the burn disease, but only after providing first aid. In terms of its symptoms, chemical damage is difficult to confuse with thermal burns or skin diseases.

Diagnostic measures provide an opportunity to recognize the early stages of burn shock (pallor of the skin, fainting, shallow breathing). Based on the results of the research, optimal methods of treatment and recovery are selected.

[17], [18], [19]

Differential diagnosis

The defeat of internal organs with sulfuric acid in its symptoms is similar to the acute manifestations of other diseases. Differential diagnosis allows one to separate one pathological state from another. Burn disease, that is, the administration of couples differentiate with diseases of the esophagus, primary and secondary esophagitis.

The main difference is that the duration of the acute period of esophagitis is much less than the damage to the esophagus, oral cavity or pharynx by chemical substances. The burn is separated from infectious diseases, allergic esophagitis and spontaneous esophagus ruptures. Both pathologies occur suddenly and have acute symptoms, as well as damage by sulfuric acid.

Endoscopy is performed for the study. The procedure is shown in the first 24 hours. According to clinical observations, this period is safe for such a survey. The doctor can identify perforation of the esophagus, severe necrosis of the stomach, duodenum and other pathologies. With the help of endoscopy, it is possible to clarify the diagnosis and make a prediction. 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 of the burn with sulfuric acid

The burn with sulfuric acid is characterized by an acute course and very painful symptoms. Treatment is aimed at minimizing discomfort and restoring damaged tissues. The volume of therapeutic measures is determined by the depth, area and location of the burn. It is important to provide timely and correct first aid. This set of measures consists of the following procedures:

• Elimination of the factor of burn damage.
• Cool the burned skin area for 1-2 hours.
• Dilution of aggressive chemical with prolonged washing with clean water.
• The victim should give a drink of salted water with the addition of baking soda.
• The burnt surfaces are covered with aseptic dressings.
• To stop the pain, non-steroidal anti-inflammatory drugs are used.

The above procedures are the basis of treatment. Before transportation of the patient to the hospital, additional anesthesia with the use of analgesics, antihistamines, neuroleptics is possible. If there is vomiting, then intravenous infusion of crystalloids and colloids, the use of alkaline-salt solutions. Also shown is inhalation with oxygen.

The initial task of doctors upon arrival of the patient in the hospital is to prevent a burn shock. Treatment of wounds depends on the location and area of damage, their depth. The patient is waiting for the toilet burned surfaces, conservative and, if necessary, surgical therapy.

First Aid for Burning with Sulfuric Acid

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, near the injured person is dangerously located, therefore special protection means, presence of ventilation or even a gas mask are required.

Algorithm for first aid in case of sulfuric acid burn:

1. Removal of reagent and washing of affected areas with clean running water. But before that, it is necessary to dry the burned areas, because when contacting with water, a large amount of thermal energy is released, which further increases the severity of injuries. The wound site should be treated with water for an hour after the injury and for two hours with the use of hydrofluoric acid.
2. Try not to touch the burned areas, as this afflicts the victim and can lead to acid residues falling on you. All manipulations should be carried out in tight gloves.
3. Try to free the wounded area from clothes, but if it does not remove, 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 care provided can be assessed by the disappearance of the chemical odor and the reduction of painful sensations. After the treatment is finished, a dry aseptic bandage is applied to the skin, anesthetics, detoxification and anti-shock measures are performed.

Let's consider some more variants of emergency help:

• If acid gets inside - first of all you should rinse the stomach with clean water and give the victim to drink the burnt magnesia or rinse the mouth with soda solution. This will ease the patient's condition.
• In case of contact with eyes, rinse thoroughly with water and apply 2% novocaine solution to reduce pain. For treatment, a peach or petrolatum oil, which is pawned behind the eyelid, is suitable.
• When inhaled acid vapors - therapy is carried out in a hospital, so the patient must be sent to the hospital. To reduce painful sensations, intramuscular injections of novocaine are used. To prevent infection, a course of antibiotic therapy is conducted. If there is bleeding in the gastrointestinal tract, the patient is shown a blood and plasma transfusion.

Timely first aid gives chances to save the life of the victim and minimize the destructive effect of acid.

[20], [21], [22]

Medications

If 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 rendering first aid, and with further rehabilitation therapy. Getting on the fabric, the acid forms a scab - a white soft crust. For disinfection and as a drying agent use preparations without alcohol based on silver and iodine solutions. It is mandatory to use regenerating and blood-improving medicines.

Popular and effective medicines for burns with sulfuric acid:

1. Sodium bicarbonate

A drug that affects the processes of tissue metabolism, used to correct ionic and acid-base equilibrium. It is part of the pharmacological group - alkalis and acids. 100 ml of the infusion solution contains: 4 g of sodium bicarbonate, water for injection and ethylenediaminetetraacetic acid disodium salt. Used to restore the alkaline state of the blood and metabolic acidosis. Increases the excretion of the body's ions of chlorine and sodium, alkalinizes urine, increases diuresis.

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

2. Actovegin

To treat chemical burns, the gel form of the drug is used. Actovegin relieves painful sensations and helps to clean the wound surface. It is effective in the recovery period, accelerates the regeneration process of damaged skin areas. Affects the process of tissue metabolism. Refers to the pharmacological group of biogenic stimulants.

• The active substances activate the metabolism at the cellular level through an increase in the accumulation and transport of oxygen and glucose. Stimulates energy processes of functional metabolism and enhances blood supply.
• Indications for use: extensive burn injuries, necrosis of tissues, trophic disorders, cerebral circulatory insufficiency, disturbed skin nutrition, arterial and venous circulation. Ulcers of various origin, radiation injuries. It is used for burns and ulcers of the cornea and sclera.
• The method of administration and dosage depends on the severity of the disease. The gel is applied to open wounds, ulcers and burns for their cleansing and treatment. The agent is applied a thin layer on the skin or used under a bandage. Duration of treatment should not exceed 4 weeks.
• Side effects: allergic reactions, fever, itching and burning in the area of application. Contraindicated with intolerance of components. With special care appoint for pregnant women and during breastfeeding.

3. Baneocin

Antibacterial combined topical agent for open wounds. Used for burns of 2-3 degrees, minimizes pain, almost not absorbed through the skin, has a minimum of side effects. Refers to the pharmacological group of aminoglycosides. Contains two bactericides with synergistic properties. Antimicrobial action is effective against most Gram-positive and Gram-negative microorganisms.

• Indications for use: prevention of bacterial skin infections, surface 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 otorhinolaryngology and pediatric practice.
• Before use, it is recommended to check the sensitivity of the microflora that caused the disease. Ointment or powder is applied a thin layer on the affected tissue or used under a bandage. Duration of therapy is 5-7 days. For patients with burns occupying 20% of the body surface, the powder is allowed to apply on the wounds no more than 1 time per day.
• Side effects: dry skin, hyperemia, rashes, itching, burning in the place of application. It is contraindicated to use with intolerance of antibiotic-kamamino-glycosides, bacitracin and neomycin. With special care appoint to patients with acidosis, muscle weakness, lesions of neuromuscular conduction, during pregnancy and lactation.

4. Solcoseryl

Biogenic stimulant on a fat-free basis. Thanks to the gel form it quickly penetrates into the deeper layers of the skin and dries up the wound surfaces. Improves metabolism in tissues, accelerates the recovery process.

• Indications for use: burns of 2-3 degrees, necrosis of tissues, obliterating diseases of the vessels of the extremities, disturbance of the tone of blood vessels, softening and destruction of tissues due to prolonged exposure to liquids, inflammation and chemical burns of the cornea, trophic ulcers.
• The drug has several forms of release, so it can be used intramuscularly, intravenously and topically. As a rule, combined therapy, that is, the use of ointments and injections at the same time. The duration of treatment depends on the nature of the pathological process and its course, most often this is 4-8 weeks. The drug is well tolerated.

5. Panthenol

Pharmaceutical vitamin means, which includes dexpanthenol - an analogue of pantothenic acid. Participates in metabolic intracellular processes, accelerates the regeneration of damaged tissues and mucous membranes. For convenience of use it has several forms of release: aerosol spray in cylinders and 35% ointment in tubes.

• Indications for use: treatment of burns, aseptic postoperative wounds, acceleration of healing of damage to the epidermis. Effective in bladder dermatitis and skin grafts. The duration of treatment and the frequency of use of the remedy depend on the complexity of the wounds and the medical recommendations.
• Side effects are manifested as reactions of increased sensitivity. Contraindicated use when intolerance of active ingredients. In case of an overdose, toxic side effects may develop.

In addition to the above medications for burn disease, you can use ichthyol ointment, Bepanten, dogrose oil and sea buckthorn. As an anti-inflammatory drug - Dexpanthenol. Antiseptic drugs accelerate the healing of wound surfaces. If the burns started to fester, the patients are prescribed Miramistin.

Compulsory use of medicines on a plant basis - Alfogin, Sudokrem. They have antimicrobial, wound-healing and analgesic properties, but they have a minimum of contraindications and side effects. Since chemical burns have a destructive effect on the tissues, the timely use of drugs to accelerate recovery is required.

Physiotherapeutic treatment

Once the threat to the patient's life is eliminated, physiotherapy is indicated. It is a complex of procedures for the complete restoration of the volume of movements in the joints, the elimination of cosmetic problems and consists of such procedures:

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

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

1. Ultraviolet irradiation at the site of damage - accelerates the regeneration of tissues, stops the inflammatory process and stimulates local immunity.
2. For resorption of scar tissue, anesthesia and improve blood supply, phonophoresis and ultrasound therapy are used.
3. Aeroionotherapy is suitable for improving skin permeability and reducing pain sensitivity. During the procedure, analgesics can be used to enhance the therapeutic effect by penetrating ions through damaged and undamaged tissues.
4. Electrotherapy has an anesthetic and bactericidal effect, improves blood supply, stimulates the rejection of necrotic tissue, has an anti-stress effect.
5. Magnetotherapy - improves blood supply, biostimulation and recovery processes. It is used to stabilize the patient's psychoemotional 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. Physiotherapy rehabilitation methods are aimed at minimizing the residual manifestations of the pathological condition and help the victim to return to normal life.

Alternative treatment

The effect of sulfuric acid on a living organism is destructive. Self-treatment of such damages is unacceptable and dangerous for life. Alternative treatment can be used only after the acute stage of the pathological process is eliminated, that is, to accelerate healing and anesthesia.

1. Warm the burned area with running water, treat it with baking soda and make a compress soaked in decoction of oak bark or mother-and-stepmother. To prepare the broth fill the dry grass with boiling water, cook over low heat and let it brew for 2-3 hours.
2. Warm compresses based on chamomile, cones of hops and mint soothe the damaged skin, relieve burning and itching. Bandages soaked with infusion of herbs should be applied to the wounds 3-4 times a day for 10-15 minutes.
3. The ointment with aloe has regenerating properties. To prepare the medicine, take a couple of leaves of the plant, rinse and cut off the thorns from them. Aloe must be crushed to a homogeneous gruel, mixed with melted pork fat and let it thicken.
4. If the acid got into the eyes, then use a decoction of birch buds and leaves for treatment. Vegetable raw pour 500 ml of boiling water and cook for 5-10 minutes over low heat. The resulting broth should be cooled, filtered and used for eye rinses.
5. With a burn of the esophagus, a medicine from violets will help. 20 grams of a dry plant, pour a glass of boiling water and let it brew for 1-2 hours. Cooled broth should be filtered, add to it 50 ml of milk and a spoonful of honey. Means are taken at a time.

Nontraditional methods must be agreed with the attending physician, as some of them can cause serious complications.

[23], [24],

Herbal Treatment

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

Consider effective herbal recipes:

• Take a couple of leaves of aloe, rinse and grind with a blender. The resulting gruel should be recoated through a sieve. The remaining aloe juice is used to impregnate the gauze bandage. Marl to adjust on the wound 2-3 times a day for 30-40 minutes. According to this recipe, it is possible to prepare a medicine from a herb birdwort.
• 100 g of dried clover meadow flowers, pour 500 ml of hot water and cook over medium heat for 10 minutes. For treatment, you can use gauze compresses soaked with decoction or plant flowers wrapped in bandage.
• The medicinal properties of the burdock. Leave a couple of leaves of the plant thoroughly, chop it into a gruel and spread it over the gauze bandage. Compress apply to fired surfaces 2-3 times a day for 10-15 minutes.
• To treat burns, you can use compresses from grated carrots or pumpkin juice. Fresh carrots rub on a small grater, wrap in gauze and attach to the wound. This will help relieve the pain. To make pumpkin juice, you can use a juicer or rub a pumpkin on a grater and squeeze out the juice. The resulting liquid soak the compress and apply to the burn surface.
• To handle large burns, you can use a special lotion: 5 g of boric acid mix with the same amount of yellow corn Canadian and myrrh. All the ingredients must be poured ½ cup of boiling water and let it brew for 1.5-2 hours. The solution relieves pain, soothes the skin and helps with deep injuries.

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

Homeopathy

An alternative kind of medicine is homeopathy. It is used in the treatment of many diseases, including burns with sulfuric acid. To apply homeopathic preparations it is possible only on purpose of the doctor of a homeopathist.

Consider effective medicines for the treatment of burn injuries:

1 degree

• Urtica urens - can be applied or applied to the epidermis. The drug is taken 5-6 times a day. To prepare a solution of 20 drops of tincture dilute in ½ cup of water.
• Cantharis - suitable for the treatment of painful burns and lesions with blisters. The drug is taken 5-6 times every 15 minutes.
• Calendula - prescribe for wounds with bursting bubbles and pus. Suitable for both indoor and outdoor use. Dosage: 3 times a day for 3-4 days.
• Causticum - is applied in the event that after healing there are strong pains. The drug is taken 3 times a day for 3 days.

2 degree

• Cantharis - burns of any intensity, blisters with fluid, chemical eye damage. The dosage is determined by the doctor.
• Apis - burning, wet wounds, swelling of tissues.
• Rhus tox - decaying blisters, severe itching and burning.

3 and 4 degree

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

Irrespective of the degree of burns, as a rule, patients are given Cantharis. If no improvement occurs within 30 minutes, Urtica ureas is taken. Both drugs take three pellets every two hours until the symptomatology improves. If after three doses of change has not come, then use another medicine. Homeopathy reduces painful sensations, accelerates the regeneration of tissues and prevents the formation of scars.

Operative treatment

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

• Operations of decompressive type
• Necrectomy and osteonecrectomy
• Dermoplasty: allodermoplasty, autodermoplasty, xenodermoplasty
• Amputation

The type and nature of the operation depends on how much time passed after the injury, from the location of the burn and the general condition of the patient. From the correctness of the indications for the operation and the chosen technique for restoring the skin, the duration and overall outcome of the treatment depends.

Consider the main types of surgery:

1. Necrotomy

Used in the formation of dense burn necrosis, which, like a shell, swept limbs, chest or other parts of the body, causing respiratory and circulatory disorders. The procedure is performed without anesthesia. The doctor dissects the scab all the way down to the appearance of blood. If the incision is made correctly, the edges diverge. As a rule, several parallel longitudinal cuts are performed.

2. Early necrosis with closure of the defect

The spontaneous rejection of necrotic masses and the healing process depend on the depth and localization of burns. Typically, this occurs within 20-35 days. This period is dangerous by 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 by a skin graft. Removing the scab reduces inflammation to a minimum of chemical factors and prevents scarring.

3. Skin plastic

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

When closing burn wounds, the following methods are used:

• Plastics with local tissues - used only on small deep injuries.
• Free skin plastic - a skin flap excised from the donor's place of the injured and sutured to a wound defect. In this case, the connection of the donor site with the zone of damage should be absent.
• Transplantation of a single skin flap - at the donor site, no epithelial elements are left, so local tissues are taken to prevent defects. This significantly limits the indications for carrying out the procedure, since it is possible to prepare a small flap of tissue.
• Transplantation of a split skin flap - suitable for closing large wound surfaces. For tissue transplantation, the hip surfaces, lateral surfaces of the abdomen or lower leg are most often used. For the operation, a skin flap of 0.5 mm is taken, it should contain part of the dermis and epithelium.
• Plastics with a flap on the feeding leg - tissues with subcutaneous tissue are used, since they have a high degree of engraftment. Rags have an increased mechanical strength, so they can achieve good cosmetic results.
• Italian plastic - there is a simultaneous preparation of the flap and its movement to the defect. Most often, tissues are taken from those parts of the body that can be moved to distances, for example, lower or upper limbs. The disadvantage of the method is the impossibility of collecting large flaps and the patient's continued presence in a forced posture.
• Use of cultured allofroblasts. In a special environment, monolayered cellular structures are grown from epithelial elements, which are transferred to the wound surface.
• Temporary biological closure of the wound - this method is suitable for plasma loss, to stimulate marginal epithelialization and prevent infections. This allows you to wait time for skin plasty from the donor site, again after epithelialization. For the operation, the skin of a corpse, a donor, synthetic materials, skin of pigs or calves is used.

After burn damage, pathological scars may remain. Isolate atrophic, keloid and hypertrophic scars. They are formed when there are such factors:

• Uneven wound healing
• Burn in the sternum or on the shoulders
• Wound lesions of the functionally mobile area
• Metabolic disorders (diabetes mellitus, hypovitaminosis, atherosclerosis)
• Accession of secondary infection

Very often the process of scarring is complicated by necrotic, allergic and purulent-inflammatory processes. Several methods are used for treatment. It can be laser resurfacing, ultrasound therapy, regenerating ointments, sprays, creams. Scars of large size are eliminated by excision of excess keloid tissue.

Prevention

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

• Do not leave chemicals unattended.
• All containers containing sulfuric acid and the substances in which it enters must be tightly closed and contain a warning label.
• Chemically active liquids are contraindicated to store next to medicines or food. This is necessary to prevent poisoning.
• Do not mix household products with toxic components on your own.
• After working with chemicals, carefully ventilate the working area to prevent burns with reagent vapors.
• Work with sulfuric acid should be carried out in special protective clothing (acid-resistant boots, mask and glasses for face from plexiglas), protecting the skin from possible damage.

Failure to follow preventive recommendations can lead to serious burns and the administration of vapors.

[25], [26], [27]

Forecast

Depending on the degree and depth of the burn, its location and the individual characteristics of the affected organism depends on the duration of recovery. The forecast is calculated by the rule "hundreds". To do this, the patient's age and the amount of damaged surface as a percentage of healthy tissues are summed up. Inclusion in the calculation of the age of the victim is explained by immune, compensatory-adaptive and reparative capabilities of the body for the elimination of the pathological process. The formula is used only for patients of adult age. The forecast depends on the amount received:

• <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 there was a shock state, then the outcome of the pathology significantly worsens. The possibility of complete recovery is affected by functional anatomical disorders.

The burn with sulfuric acid, which affects large areas of the body, is accompanied by a prolonged inflammatory process. The pathological condition entails the formation of severe scarring, not only in the area of the lesion, but also beyond its borders. This leads to a restriction of mobility and contractures, which significantly worsens the prognosis for recovery.