Burns area palm nine. How to determine the area of ​​the burn? Determination of the burn area by different methods - characteristic

There are a number of ways to determine the size of the burn area. However, most of them are laborious and time consuming. AT field conditions the following are most commonly used:

1. The rule of the palm, the area of ​​\u200b\u200bwhich is equal to 1-1.1% of the body surface (meaning the palm of the most affected). The number of palms that fit on the surface of the burn determines the percentage of the affected area, which is especially convenient for limited burns of several parts of the body;

2. The rule of nines is based on the fact that the area of ​​each anatomical region as a percentage is a multiple of nine: head-neck - 9%, upper limb - 9%, lower limbs- 18%, front and back surfaces of the body - 18% each, perineum and genitals - 1%.

These methods are easy to remember and can be used in any setting.

3. Determination of the burn area by segments using the Bercow scheme. hairy part head - 4%, face - 3%, neck - 2%, shoulder -4%, forearm - 3%, hand - 2%, torso in front - 18%, torso behind - 19%, thigh - 9%, lower leg -6 %, stop -3%. This method, as it were, details the rule of nines, and it is advisable to use it when individual segments of the human body are affected.

4. Measurement of the burn area according to G.D. Vilyavin is produced by a graphical method using a special map. On the front side On this map, two silhouettes of a person (front and back surfaces of the body) 17 cm long are drawn against the background of a millimeter grid, i.e. 10 times less than the average height of a person (1 cm of human skin area corresponds to 1 mm on the map). Silhouettes are hatched with colored pencils in accordance with the lesions that the victim has. Yellow color - burns of the 1st degree are hatched; in red - second degree burns; blue dotted oblique line - burns III A degree; in blue solid line - IIIB degree burns and in black - IV degree burns. Then count up total number shaded squares shaded within the area of ​​each degree of burn. The data obtained correspond to the size of the burn area on the human body, expressed in square centimeters. The calculation of the affected area is made according to the table printed on the back of the card.

5. Measurement of the burn area according to B.N. Postnikov is that a transparent film is applied to the burnt surface, on which the contours of the affected areas are outlined, then the area is measured in cm 2, while taking into account the total surface area of ​​the human body, which ranges from 16,000 cm 2 to 21,000 cm 2.

6. Measurement of the burn area using a special stamp proposed by V.A. Dolinin, when each segment on the stamp corresponds to 1% of the body surface.

All burns by area can be divided into 2 groups:

1. Limited burns - when up to 10% of the body surface is affected;

2. Extensive burns - there is a lesion over 10% of the body surface.

Determination of the area of ​​burns. Rule of nines: The surface area of ​​an adult human head in relation to the total body surface area is 9%, upper limb- 9%, front surface of the body - 18%, back surface of the body - 18%, thigh - 9%, lower leg and foot - 9%, neck or perineum - 1%. In children, the rule of fives is used to determine the area of ​​the burn (Fig. 4).

Palm rule: The area of ​​the palm of an adult is approximately equal to 1% of the body surface.

The distribution of the degrees of damage on the surface of the burn is visually represented by the drawing and symbols on the standard images of the contours of the silhouette of the human body.

Symptoms. Local and general manifestations of burns depend on the depth and area of ​​the lesion. Small superficial burns (5-7%) are classified as outpatient, while there may be pain of varying intensity, increased heart rate, and an increase in body temperature by 1-2 ° C.

Rice. 4. Calculation of the burn surface using the "rule of nines" in adults and the "rule of fives" in children (five years of age).

Extensive superficial and deep burns are accompanied by the development of burn disease. During this disease, periods of burn shock, acute burn toxemia, burn septicotoxemia and convalescence are distinguished. The severity of manifestations depends mainly on the area, extent and localization of damage. Victims with severe burns and manifestations of burn disease are subject to inpatient treatment. The prognosis of burn healing is determined by the depth of tissue necrosis and the thickness of the skin at the site of injury.

Handbook of the surgeon of the polyclinic. Kutushev F. Kh., Libov A. S. Michurin N. V., 1982

The rule of nines and palms to determine the area of ​​burns

A burn is an injury to the soft tissues of the human body that occurs as a result of negative thermal, electrical or chemical effects. For the correct provision of first aid and the choice of a method of subsequent treatment, it is necessary to find out the severity of the injury and the area affected by it. There are many techniques that allow you to accurately subtract the area of ​​burns.

The area of ​​the human body is approximately 21,000 square centimeters. Scientists have invented many schemes and formulas that help calculate the burn area in children and adults. If you correctly calculate the size of the injured area, then you can determine the severity of the injury that has arisen.

There are several degrees of severity of this damage:

The first, second, and third A degrees are called superficial burns, while the 3B and fourth degrees, respectively, are called deep. Superficial injuries are always associated with pain, but deep ones are not. The absence of pain in this case is explained by the complete necrosis of the affected epidermis.

Signs of a burn depend on the type of burn surface and the nature of the injury, but there are a number of main symptoms that most often occur with such an injury:

Treatment of an injury is prescribed only after an accurate determination of the nature of the injury, in order to determine the depth of damage and its severity - the area of ​​the burn should be subtracted.

The simplest way to calculate the injured surface in adults is considered the "rule of hundreds". In the event that, adding up the age of the victim and the total area of ​​\u200b\u200bthe injury, a number close to a hundred comes out, then the lesion is considered unfavorable, and it requires special treatment.

In 1951, scientist A. Wallace invented a computational method called the "rule of nines for burns." This type of calculation of the wounded surface is quite fast and easy. The data obtained as a result of the calculation is inaccurate, but quite approximate.

Is this way in the division of the human body into separate zones. Each such plot in relation to the percentage is equal to nine. The neck and head - 9%, each individual limb - 9%, the torso in front and back gives 36% as a result, and 1% is allocated to the genital area.

This method is not suitable for determining a burn in children, because the proportions of their bodies are slightly different.

I. Glumov in 1953 invented an even simpler method for calculating the injured surface. According to the rule of the palm, the burn zone is equal to the palm of the victim. Its size is approximately considered one percent of the entire surface of the human body. This method is used as often as the “rule of nine”.

The Postnikov method is a rather old definition of the burn area and is not easy. It is based on the application of a gauze bandage to the wounded surface, and a contour drawing of the injury is applied on top of it. After that, the resulting form is superimposed on graph paper and a general calculation of the surface is carried out in relation to damaged skin. Due to the difficulties that arise during such a calculation, it is practically not used.

In 1983, the Dolinin method was invented. It consists in dividing by 100 a special stamp of rubber material, which contains the silhouette of the back and front of the human body. The front side collects 51 sections, and the back side - 49. Each of the sections in a percentage ratio is 1%. In the diagram, the affected area is painted over and, after completion, the filled-in numbers added together are counted.

Burn areas by the Land and Browder method are calculated in young children. In a child under one year old, the surface of the neck and head is equal to 21%, the torso in front and behind - 16%, the femoral region - 5%, the areas of the lower leg and feet - 9%, the place of the perineum - 1%.

The complexity and effectiveness of treatment depends on the place where the damage was received and the area of ​​the burn. For example, if during an injury parts of the face, hands or genital areas are affected, the ability to work is often impaired, the skin cannot be restored, complete disability is possible, and in some cases death. Lethal outcome occurs mainly when the area of ​​injury is 40% or more.

Classification of burns by area of ​​damage and determination of their degree

Damage to the skin membrane occurs upon contact with any heated object, acid, current, and other factors. In the domestic sphere, a burn is a frequent occurrence, getting dangerous forms injury can even be accidental.

How can the degree of a burn be determined, what features and manifestations correspond to each of the forms? In the article, we will look into these issues and additionally talk about the main methods that help calculate and determine the area of ​​the burn in children and adults.

The division of all burns into degrees is of great importance. Thus are defined medical measures, consequences, the possibility of self-restoration of the skin. For example, if the microvasculature and the germinal part of the skin are preserved, then surgical technique no treatment is applied. The body will heal the wound on its own.

The classification of burns, which will be given below, is used throughout the world. Several factors influence the formation of one degree or another:

And now let's talk about the manifestations that are characteristic of burns of 1, 2, 3, 4 degrees in a child and an adult.

Degrees of burns on the example of a hand

The damage is not considered significant because the most upper layer skin. His recovery is quite fast and after a week there is no trace of the injury. Active exfoliation of the dead layer begins the next day.

The causes that cause this form of burn may be as follows:

The main signs accompanying minor injuries are redness, burning at the moment of touching the surface, redness. There is sometimes itching and swelling. Last symptom often accompanies only extensive trauma. However, the first degree is usually very limited. Here it is necessary to take into account that superficial damage may accompany deeper ones. In such cases, the depth and vastness of the burn is just important.

Therapeutic measures are minimal, there is no burn disease, which allows the tissues to recover in 3-4 days. The integrity of the epidermis is fully restored by the seventh day, while no noticeable scars are formed.

With this form of damage, the deeper layer suffers, therefore, therapeutic measures are aimed not only at eliminating the consequences of contact with traumatic factors, but also at restoring microcirculation. Even with large damage, the 2nd degree is characterized by a very favorable course.

• The entire important network of capillaries and vessels, nerve processes are preserved, so the list of complications is quite limited.
• One of the main criteria that distinguishes grade 2 is the formation of blisters. Such bubbles at the time of injury quickly fill with plasma through the destroyed dermis. Particularly severe pain is disturbing in the first period after the burn. The damaged area itself is red, edematous.
• The treatment is purely conservative, among the surgical methods of therapy, only the practice of opening the formed blisters is used. At 2nd degree long time there may be a red area on the body, on average, which lasts about 2 weeks. As with the first form of injury, there is no burn disease.
• Among the complications, the risk of which remains with any victim, there is only the risk of infection and the development of dehydration. In almost every case, all risks are eliminated through timely medical care.
• The second form of the burn is differentiated from the third on examination. If the damaged area is painful, and the usual touch to it brings severe discomfort, then such an injury is referred to the second form.

The specialist in the video below will tell about the treatment of a second degree burn:

About what it is and what it looks like a 3rd degree burn, we will tell further.

This degree is subdivided into 2 more subcategories. In each case, the skin lesion is so deep that sometimes even the subcutaneous tissue suffers. But since the nature of the damage to the dermis varies slightly, the third form is divided in this way:

• 3a. The injury affects the entire dermis and the papillary layer below it, including important components fabrics ( nerve fibers, vessels, etc.). Only the deepest layer can survive in this subcategory of burns. All this greatly impairs the possibility of self-regeneration, even small areas injury, but still epithelialization, although slowly, but occurs. As a rule, it is marginal, i.e., new tissue grows from the edges of the wound. It can grow from healthy skin no more than 2-3 cm.
• 3b. Even the deep layers are injured. Only fatty subcutaneous tissue remains in the wound area, which does not have any ability to recover. Epithelialization does not occur and transplantation is needed in the future.

The third degree of injury is usually extensive, so the victim falls into several risk groups at once. This includes the risk of:

Despite the fact that (compared to the first two forms) the 3rd degree burn is deep, it still belongs to the superficial types of wounds. It differs in such manifestations as:

Determining the area of ​​burns

The most accessible, although rather approximate, is the determination of the area of ​​burns using Wallace's rule, known as the "rule of nines". In this case, the age of the victim must be taken into account. According to Wallace, each part of the body has a certain percentage of the total surface area and in an adult it is about 9%, with the exception of the perineum, the area of ​​\u200b\u200bwhich is 1%.

To determine the area of ​​burns, especially when they are located in different areas of the body and in a mosaic order, you can use the “rule of the palm”. It is known that the palm together with the fingers makes up about 1% of the body surface. How many palms of the victim fit over the burn surface, such is the area of ​​​​burns. There is also the Postnikov method for determining the area of ​​burns. In pediatric burn centers, to more accurately determine the area of ​​burns, Blokhin tables are used, which also reflects the depth of skin lesions.

V.Dmitrieva, A.Koshelev, A.Teplova

"Determining the area of ​​burns" and other articles from the General Surgery section

Determination of the burn area by different methods - characteristic

A burn is tissue damage caused by thermal or chemical exposure and causing excruciating pain. Diagnosis of the burned area is one of the most important parameters in order to determine the area of ​​the burn.

What does the area of ​​the burn say - determining the area of ​​the burn

The area of ​​damage is one of the indicators of the severity and depth of the injury. As you know, four stages of burns are distinguished: reddening of the skin, blisters, tissue necrosis and charring. Extensive deep lesions are very dangerous and, in order to avoid serious consequences, are subject only to inpatient treatment. Burns with an area of ​​up to 7%, in principle, can be treated at home, but under the supervision of the attending physician.

Methods for determining the area of ​​the burn

Burn area can be determined different methods. Below are the main and least time-consuming and convenient.

"Rule of nine" when calculating the area of ​​the burn

This method for determining the area of ​​the burn, proposed in 1951 by A. Wallace, helps to quickly, although rather approximately, determine the area of ​​the burn without improvised means. It consists in the conditional division of the body into zones. Each such area is equal to or a multiple of nine as a percentage. Thus, the head and neck area makes up 9% of the total skin area, the surface of each upper limb - 9% each, the lower one - 18% each, the front part of the body - 18%, the back - 18%. The remaining one percent is allocated to the genital area. In children, these proportions are somewhat different and change with age. The Wallace method has become widespread due to its availability in any conditions and simplicity.

"Rule of the palm" when determining the area of ​​the burn

An even simpler method was proposed in 1953 by I.I. Glumov. The burn zone corresponds to the area of ​​the patient's palm or its paper template. This value is approximately 1% of the entire skin surface of the human body. At present, the "rule of nines" and the "rule of the palm" are usually used in parallel.

Postnikov's method as a way to determine the area of ​​the burn

The most outdated and time-consuming method. Sterile gauze or cellophane is applied to the surface of the burn, and a contour of damage is applied to them. Next, the cut out form is superimposed on graph paper and the total burn surface is calculated in relation to the entire skin area. To date, the method, due to its complexity and duration, is practically not used.

Vilyavin's scheme is one of the methods for determining the area of ​​the burn

On a special, divided into squares, the scheme depicting a human silhouette, the affected areas are painted over. Moreover, for each degree, a different color is used. This method allows you to track the area and extent of the burn in the dynamics of its treatment.

Degrees of burns and their characteristics.

In 1960 at the XXVII All-Union Congress of Surgeons were adopted and approved 4 degree burns.

According to this classification, each degree has its own characteristic, which determines the depth of damage to the skin and underlying tissues.

1 degree- the most mild, manifested by redness and swelling of the skin.

For burns 2 degrees- blisters appear on the skin various sizes filled with clear liquid yellowish color.

3 degree characterized by damage to the surface layers of the dermis - the death of the germ layer occurs and blisters appear.

For burns 4 degrees necrosis extends not only to the skin, but also to deep structures: muscles, tendons, bones.

Determination of the area of ​​the burn.

The main thing is the correctness of determining the degree of burn. In addition to depth, a significant factor in determining the severity of injury is the area of ​​the burn.

Numerous schemes have been proposed for its determination. Here is some of them:

Among the simplest and most affordable methods for determining the area of ​​a burn, which can be used in any conditions, are "rule of nines" and "rule of the palm".

Simple mnemonic "rule of nines" allows you to quickly, although not quite accurately, determine the area of ​​the burn. According to this rule, the area of ​​individual anatomical regions as a percentage is equal to a multiple of 9. The head and neck make up 9%, the front and back surfaces of the body are 9 × 2 = 18 each (36%), the upper limbs are 9% each (18% in total), lower limbs by 9 × 2 = 18 (total 36%), perineum and genitals - 1%.

The second is based on the fact that the area of ​​the palmar surface of the hand is approximately 1% of the body surface in women and 1.2% in men.

The area of ​​the lesion is determined by the number of palms that fit on the surface of the burn.

About 20% of all victims of various types of burns are children. Burns in children are deeper than in adults, so for them there is a separate table for determining the degree of injury in percent.

Schematically, the diagnosis is formulated as a fraction. The numerator in percent indicates the total area of ​​the lesion and the area of ​​deep burns in brackets, in the denominator - the degree of burn. The severity of general disorders is determined mainly by the area of ​​deep damage.

Treatment of burns and their consequences. V.V. Yudenich.

The severity of the burn depends not only on the depth, but also on the area of ​​the lesion. The simplest and most convenient method for determining the area of ​​a burn is to measure it with the palm of your hand or using the rule of nines. The palm area of ​​the affected person is approximately 1% of the surface of his body. Given this, it is possible to calculate the area of ​​the burn with a sufficient degree of probability.

The principle of determining the area of ​​a burn according to the rule of nines is based on the fact that the entire surface of the body is divided into areas whose area is 9% of the body surface. So, the surface of the head is 9%, the front surface of the body is 9X2 = 18%, the back surface of the body is also 18%, the surface of the thigh is 9%, the lower leg with the foot is 9% and the perineum is 1% (Fig. 12).

SCHEME OF DOCUMENTATION OF BURNS AND MEASUREMENTS OF THE AREA OF BURNS BY THE VILYAVIN METHOD

1. N° of the medical history ______________ 2. Date of filling out the scheme ____

3. Surname and initials of the patient _____________________________

4. Date of admission ____________ 5. Date of injury _______________

6. Size of burns by degrees, cm2.1 degree _________, II degree

III degree __________, IV degree _________

7. Total affected area, cm2 __________________ , % _______

8. Dimensions of transplanted skin flaps, cm2 _________________

Usually, when measuring the area of ​​a burn, both the rule of nines and the rule of the palm are used simultaneously.

The contours of the burn are applied to the diagram with multi-colored pencils, after which the first degree of the burn is painted over yellow, II - red, ITT A - blue stripes, SB - solid blue, IV - black. Knowing the area of ​​the squares that fell into the contours delineating the boundaries of the lesion, it is possible to calculate the area of ​​the burn of each degree both in general in square centimeters and as a percentage in relation to the entire surface of the body.

BURN AREA DETERMINATION

V. A. Dolinin suggested using a rubber stamp to measure the area of ​​the burn, which depicts the silhouettes of a person (front and back surfaces), divided into segments. The anterior surface contains 51, and the posterior - 49 equal sections, each of which is approximately 1% of the body surface. The degree of burn is indicated by the corresponding shading (Fig. 14).

It is also convenient to document the depth and area of ​​the burn (Fig. 15) by making the so-called skits (sketches).

T. Ya. Ariev suggests using ink when filling out skits, rightly noting that in an environment of mass influx of the affected, the use of colored pencils is difficult and technically inconvenient.

During the treatment of burns, the sketches are corrected; new data are entered into them, noting the disappearance of healed burns of I and II degrees, the identification of new areas of burns of III-IV degrees, the appearance of wounds closed with grafts, donor sites, etc.

The disadvantage of skits is that side surfaces, which make up a significant part of the body, are not indicated on them. This can be made up for by additional profile skits or skits of individual areas of the body (Fig. 16).

Documentation of the burn area using skits. The numbers on the silhouettes indicate the area of ​​the body parts limited by the lines in percent.

Various types of skits.

It is difficult to predict the severity of the burn and its outcome, especially in the early days, due to the lack of reliable objective signs of the depth of the lesion. Most of these calculations are based on the determination of the total area of ​​the lesion and the relatively accurate determination of the area of ​​deep burns. The simplest prognostic tool for determining the severity of a burn is the hundreds rule. If the sum of the numbers indicating the age of the affected person and the total area of ​​the burn approaches 100 or exceeds 100, then the prognosis of thermal damage becomes doubtful or unfavorable. The hundred rule can only be used in adults; it is not applicable to predicting a burn in children.

The prognostic index according to the hundreds rule (age + total burn area) has the following values: up to 60 - favorable prognosis, 61-80 - relatively favorable prognosis, 81-100 - doubtful, 101 or more - unfavorable prognosis.

As a universal prognostic test that determines the severity and possible outcome of a burn in both adults and children, the Frank index (1966) can be used, but to calculate it, you need to know the area of ​​​​a deep burn. The Frank index is based on the assumption that deep burn three times worsens the patient's condition compared to a superficial burn, therefore, 1% of a superficial burn is taken as the main unit, and a deep burn corresponds to three units. For example, the total burn area is 35% of the body surface, while 20% is deep burns, so the Frank index will be equal to the surface burn area (35 - 20 \u003d 15) plus three times the deep burn area index (20 X 3 \u003d 60). The sum of the indicators of the area of ​​superficial and deep burns (15 + 60 = 75) is the Frank index. If the Frank index is less than 30, then the burn prognosis is favorable, 30-60 is relatively favorable, 61-90 is doubtful, and more than 91 is unfavorable.

The integrity of the skin plays important role in maintaining homeostasis. The skin takes part in thermoregulation, respiration, metabolism, excretion of metabolic products, it is also a sensory organ, resorption, blood deposition, protection and performs an integumentary function. Burns of the skin, as well as the mucous membrane of the respiratory tract, depending on the depth and extent of the lesion, cause a number of pathological changes in the body, manifested clinical picture burn disease.

Determination of the area of ​​burns. The rule of "nines": the surface area of ​​the head of an adult in relation to the total body surface is 9%, the upper limb - 9%, the front surface of the body - 18%, the back surface of the body - 18%, the thigh - 9%, the lower leg and foot -9 %, neck or perineum-1%. In children, the rule of fives is used to determine the area of ​​the burn (Fig. 4).

Rule of the "palm": the area of ​​\u200b\u200bthe palm of an adult is approximately equal to 1% of the body surface.

The distribution of the degrees of damage on the surface of the burn is visually represented by the drawing and symbols on the standard images of the contours of the silhouette of the human body.

Symptoms. Local and general manifestations of burns depend on the depth and area of ​​the lesion. Small superficial burns (5-7%) are classified as outpatient, while there may be pain of varying intensity, increased heart rate, and an increase in body temperature by 1-2 ° C.

Rice. 4. Calculation of the burn surface using the "rule of nines" in adults and the "rule of fives" in children (five years of age).

Extensive superficial and deep burns are accompanied by the development of burn disease. During this disease, periods of burn shock, acute burn toxemia, burn septicotoxemia and convalescence are distinguished. The severity of manifestations depends mainly on the area, extent and localization of damage. Victims with severe burns and manifestations of burn disease are subject to inpatient treatment. The prognosis of burn healing is determined by the depth of tissue necrosis and the thickness of the skin at the site of injury.

Handbook of the surgeon of the polyclinic. Kutushev F. Kh., Libov A. S. Michurin N. V., 1982

More articles on this topic:

Thermal burns. The concept and classification of burns

Burns: classification and clinical manifestations

First aid for burns

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autouristi.ru

When providing first aid for external chemical burns shown:

This is how the area of ​​the burn in adults is determined. In order to understand the extent of a burn in children under the age of five, the “rule of fives” is usually applied. It works exactly on the same principle, only each designated area of ​​the body is 5%.

In order to determine the area of ​​affected tissues during burns, the “rule of nines” is used. Its essence lies in the fact that the skin area on each individual part of the body has its own percentage of the total area of ​​​​the tissues of the whole body:

Regardless of where the burn was received, it is necessary to understand the degree of its danger and be able to competently provide first aid, especially when it comes to children.

Another practical method for determining the area of ​​a burn is the “rule of the palm”. The palm represents 1% of the skin surface of the entire body. For small burns, the affected areas are marked with the rule of the palm. With extensive thermal or chemical injuries of the epidermis, this rule is used to determine the surviving areas of the skin.

1. Remove burnt clothing. Tissue that has adhered to the wound should not be torn off.
2. Cool affected areas under running water or a bag filled with ice or snow.
3. Apply sterile gauze dressings to the burns.
4. Give the victim painkillers.
5. Provide plentiful drink.
6. Immobilize.

In everyday life and at work, there is always a risk of damage to the skin when exposed to high temperatures, sunlight, alkalis, acids, electric current and other sources. Such damage to body tissues is called a burn.

Methods for determining the area of ​​the burn

It is advisable to divide the stage of septicotoxemia into 2 periods:

By clinical course There are 3 degrees of burn shock:

At thermal injury a large number of inflammatory mediators are released, which causes severe plasma loss, hemolysis, impaired microcirculation, water-salt balance and kidney function. Blood is deposited in internal organs. through the burn surface going strong evaporation of water.

- occurs with deep burns with an area of ​​​​15-20% of the body surface.

The period of excitation (erectile phase) is longer and more pronounced.

Nonspecific toxins: histamine, serotonin, prostaglandins, hemolysis products.

Currently, the formula for designating burns according to Yu.Yu. Dzhanelidze is often used: in the numerator of the fraction, the area of ​​the lesion is indicated in percent (in brackets - the percentage of deep burns), and in the denominator - the degree of burn. In addition, an etiological factor is indicated before the shot, and after it - the affected area.

LECTURE #25

Currently, due to the unfavorable situation regarding terrorist activities great importance accepts the need for the ability to diagnose and treat burn disease.

If the burn shock was successfully stopped, the next stage of the course of the burn disease begins - acute burn toxemia. It is accompanied by the entry into the blood of a significant amount toxic substances formed as a result of tissue breakdown. Toxico-resorptive syndrome is accompanied by the appearance of fever, its degree depends on the extent of the lesion. In addition, a significant amount of toxins affects all organs and systems, significantly disrupting their activities. So, the heart muscle reacts to intoxication by increasing the heart rate, with auscultation, deafness of tones is noted. The need for dynamic monitoring laboratory indicators for early diagnosis of organ failure. The next period of septicotoxemia is accompanied by the development purulent complications against the background of a sharply reduced general resistance of the organism.

4. Pathogenetic bases of damage to the body with burn lesions of the skin

According to the depth of the lesion, deep and superficial burns are distinguished. There is a classification according to which the depth of tissue damage during burns is divided into several degrees.

Burns are damage to the skin as a result of exposure to high temperatures, concentrated acids or alkalis, and other chemically active substances. Skin lesions in the form of burns are often found in young children as a result of insufficient attention from adults, in this case, burns are most often observed when overturning dishes with hot (sometimes even boiling) water, food. Often, burns of a similar nature occur in adults with inattentive behavior in everyday life. Occupational burns occur as a result of non-compliance with safety regulations when working with chemically active and explosive substances. Burns as a result of exposure to various types of weapons are found among fighters in the battle zone. Sometimes burns occur during suicidal attempts (burns of the esophagus). Burns can be caused when intruders try to disfigure a person's appearance. Extensive burns can be observed in persons caught in a burning room during a fire. Here are the main groups of patients in burn centers.

burn disease is a complex of pathophysiological changes in the body, the most important of which are hemodynamic disorders, severe intoxication of the body. Burn disease has several stages in its development. The first of these is burn shock. The leading pathogenetic aspect of its occurrence is severe dehydration of the body. This is hypovolemic shock. As a result of dehydration, there is a decrease in the volume of circulating blood. There is a discrepancy between the volume of the vascular bed and the amount of circulating blood. In addition, an increase in blood viscosity, resulting from the release of the liquid part of the blood into the tissues, causes a violation of microcirculation, blood slugging. Compensatory centralization of blood circulation occurs. Clinically, burn shock can be suspected in a patient if, during dynamic observation, a drop in blood pressure is noted (in the elderly, who suffered before the disease hypertension with a constant level of pressure at high numbers, shock can develop even at blood pressure values ​​​​of 120/80 mm Hg. Art.), increased heart rate, tachypnea, lethargy, drowsiness. It is necessary to make dynamic monitoring of kidney function, since a decrease in the amount of urine separated, observed in dynamics, makes it possible to suspect the development of acute kidney failure. Patients note thirst, during examination, dryness of the skin, mucous membranes, and tongue is noted.

In order to determine the area of ​​the burn, several methods are used. The simplest, not requiring additional tools and fairly accurate method is the “palm” method. After some research, it was reliably revealed that the size of the human palm corresponds to 1% of the skin of the human body. Thus, by comparing the area of ​​the burn with the size of the palm, the exact area of ​​the burn can be determined. Another rule for determining the area of ​​​​a burn is also quite simple - this is the rule of "nines". It is known that the area of ​​various areas of the body is 9% of the total surface of the skin, with the exception of the perineal area, the area of ​​which is 1%. 9% of the total area correspond to the upper limb, thigh, lower leg with foot, as well as the head and neck. 18% of the total area are the anterior and posterior surfaces of the body.

Burns: determination of the degree and first aid

Burns are classified according to severity. AT Russian Federation There are four degrees of burn severity, foreign countries A classification has been adopted, according to which there are three degrees of damage.

• a child less than a year old, even if the burn caused only a slight reddening;
• if the burn is quite extensive or deep;
• with second and third degree burns;
• if the burn is caused by a fire.

When laying the injured person in bed, to reduce friction of the damaged body surface on the sheet, you can sprinkle the last large quantity talc.

One of the most effective folk remedies treatment of sunburn is the application several times a day to the damaged areas of fermented milk products (kefir, curdled milk, sour cream). However, with severe skin lesions accompanied by blisters, the use of this method may have reverse effect.

How to determine the area of ​​the burn according to the "rule of nines" and "rule of the palm"?

• Since the sun has its maximum activity from about 10 to 15 hours of the day, then The best way protect yourself from burns - do not expose yourself to sunlight during these hours. If you still have to be in the sun at this time, you need to protect your skin as much as possible.
• To prevent sunburn and effective protection hats should be worn from the sun, Sunglasses and clothing covering arms and legs. Dark clothes block the sun's rays better than light clothes.
• Use sunscreens with a high degree of protection (SPF). Apply funds should be on exposed areas of the body (face, neck and ears) at least 20 minutes before sun exposure and then every 2 hours, especially after swimming.
• Keep out of direct sunlight for newborns and children under 6 months of age.

It is recommended to place a small pillow or folded blanket under the burnt leg or arm of a lying person in order to create an elevated position for the damaged parts of the body.

Determination of the burn area by different methods

A burn is tissue damage caused by thermal or chemical exposure and causing burning excruciating pain. Diagnosis of the burned area is one of the most important parameters in order to determine the area of ​​the burn.

An even simpler method was proposed in 1953 by I.I. Glumov. The burn zone corresponds to the area of ​​the patient's palm or its paper template. This value is approximately 1% of the entire skin surface of the human body. At present, the "rule of nines" and the "rule of the palm" are usually used in parallel.

Vilyavin's scheme is one of the methods for determining the area of ​​the burn

Postnikov's method as a way to determine the area of ​​the burn

The area of ​​damage is one of the indicators of the severity and depth of the injury. As you know, four stages of burns are distinguished: reddening of the skin, blisters, tissue necrosis and charring. Extensive deep lesions are very dangerous and, in order to avoid serious consequences, are subject only to inpatient treatment. Burns with an area of ​​up to 7%, in principle, can be treated at home, but under the supervision of the attending physician.

This method for determining the area of ​​the burn, proposed in 1951 by A. Wallace, helps to quickly, although rather approximately, determine the area of ​​the burn without improvised means. It consists in the conditional division of the body into zones. Each such area is equal to or a multiple of nine as a percentage. Thus, the head and neck zone makes up 9% of the total skin area, the surface of each upper limb - 9% each, the lower one - 18% each, the front part of the body - 18%, the back - 18%. The remaining one percent is allocated to the genital area. In children, these proportions are somewhat different and change with age. The Wallace method has become widespread due to its availability in any conditions and simplicity.

The most outdated and time-consuming method. Sterile gauze or cellophane is applied to the surface of the burn, and a contour of damage is applied to them. Next, the cut out form is superimposed on graph paper and the total burn surface is calculated in relation to the entire skin area. To date, the method, due to its complexity and duration, is practically not used.

Thermal burns: classification, depth of injury and prognosis for life

This is what granulation tissue looks like, which can then turn into scar tissue.

According to press reports, the victims in Pinsk were wearing a synthetic work uniform, which burned down almost completely, which is unacceptable from the point of view of fire safety. Clothing should be non-combustible and protect against burns, not contribute to them.

The localization of burns is also very important, since the thickness of the skin and the degree of protection of clothing differ. For example, burns to the face and front of the neck are much more likely to be deep than, for example, burns to the feet.

In Russia, a 4-degree classification of burns by depth (I degree, II, IIIa, IIIb, IV) is common, and in the West - a 5-degree classification (there the Russian IIIa stage is identical to III; IIIb - IV, and IV - V, respectively).

Example: a 27-year-old girl in February 2007 received a thermal burn with a IIIa-IIIb degree flame of 25% of the body surface, including the face, neck and front surface chest. Since only conservative methods were used in the treatment of the burn, the victim developed a severe cicatricial contracture of the neck of the 4th degree, accompanied by cicatricial eversion lower lip. The example is taken from the site http://www.pirogov-center.ru/infoclinic/13/139/ (N. I. Pirogov National Medical and Surgical Center).

Areas of circulatory disorders in burns varying degrees.

Flame burns are among the most severe, because the flame temperature reaches 2000 - 3000 ° C and additional poisoning occurs carbon monoxide and other combustion products.

Third and fourth degree burns are dangerous to human life, you must immediately seek help from a highly qualified specialists.

• Dolinin's method - on a special rubber form with an imprint of the silhouette of the body, divided into one hundred equal sections (51 on the front surface and 49 on the rear), burned places are marked. It remains only to add the obtained numbers and determine the areas of the burn surface.

• Vilyavin's scheme - in the figure depicting a reduced copy of the human torso, the affected area is painted over, depending on the nature of the injury, the areas were marked different colors. With this technique, you can easily track the degree and depth of lesions.

• The rule of nine for burns - the procedure quickly determines the degree of damage without the use of additional devices. The disadvantage of this tactic is that the calculations obtained are not accurate. The technique is based on the visual division of the body into zones, each area is equal to nine percent (neck and head, the surface of the limbs), the rear and frontal parts of the body are 36%. The remaining interest is groin. The areas of burns in children are not calculated by this method, since the child has smaller body proportions.

As mentioned above, various medical methods are used to determine the location of burns, namely:

If, nevertheless, a burn is received, it is necessary to wash the affected area with plenty of running water, treat the wound with antiseptic agents and apply a sterile bandage. With strong pain syndromes, to avoid getting shock, it is recommended to drink painkillers.

Carefully observe safety precautions when working with electric heating devices, chemical reagents. store detergents away from children in a place inaccessible to them.

The rule of nines and palms to determine the area of ​​burns

The first, second, and third A degrees are called superficial burns, while the 3B and fourth degrees, respectively, are called deep. Superficial injuries are always associated with pain, but deep ones are not. The absence of pain in this case is explained by the complete necrosis of the affected epidermis.

This method consists in dividing the human body into separate zones. Each such plot in relation to the percentage is equal to nine. The neck and head - 9%, each individual limb - 9%, the torso in front and back gives 36% as a result, and 1% is allocated to the genital area.

In 1951, scientist A. Wallace invented a computational method called the "rule of nines for burns." This type of calculation of the wounded surface is quite fast and easy. The data obtained as a result of the calculation is inaccurate, but quite approximate.

• change in skin color from reddish to black. The color depends on the nature and severity of the damage;
• the appearance of blisters (see burn blister: what to do), which are filled with a special liquid;
• the formation of a dryish crust in the injured area;
• severe pain;
• death of the skin;
• charring of the skin.

Signs of a burn depend on the type of burn surface and the nature of the injury, but there are a number of main symptoms that most often occur with such an injury:

In 1983, the Dolinin method was invented. It consists in dividing by 100 a special stamp of rubber material, which contains the silhouette of the back and front of the human body. The front side collects 51 sections, and the back side - 49. Each of the sections in a percentage ratio is 1%. In the diagram, the affected area is painted over and, after completion, the filled-in numbers added together are counted.

The Postnikov method is a rather old definition of the burn area and is not easy. It is based on the application of a gauze bandage to the wounded surface, and a contour drawing of the injury is applied on top of it. After that, the resulting shape is superimposed on graph paper and a general calculation of the surface is carried out in relation to the damaged skin. Due to the difficulties that arise during such a calculation, it is practically not used.

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STAMP V.A. DOLININA FOR DETERMINING THE AREA OF BURN

Figure 9.3.

The "Rule of nines" is useful when determining the area of ​​extensive burns. If burns occupy, for example, the head, the front surface of the body and the left thigh, then the total area of ​​the lesion in this case will be 36% (9+18+9).

Measurement by the palm (the area of ​​the palm of an adult is approximately 1 - 1.1% of the total surface of the skin) is used either for limited burns, or, conversely, for very extensive (subtotal) lesions. In the first case, the number of palms that fit on the surface of the burn is the percentage of the lesion. In the second, the area of ​​\u200b\u200bthe remaining unaffected areas of the body is determined and the resulting figure is subtracted from 100, the difference will be the percentage of damage to the skin.

To measure the area of ​​burns in children, a special table should be used, which shows the surface area of ​​individual anatomical regions depending on the age of the child (Table 9.4.).

The main factor determining the severity of burns is not so much the total area of ​​the burn, but the area of ​​deep damage (burn III6 - IV degree). For this reason, when formulating a diagnosis, it is extremely important to reflect not only a number of features of the injury - the type of burn (thermal, electrical, chemical), its localization, degree, total area of ​​​​the lesion, but also the area of ​​\u200b\u200bdeep lesion, if any.

The diagnosis (as a whole in the medical history) should be recorded as follows.

The area and depth of the lesion are indicated as a fraction, in the numerator of which is the total area of ​​the burn and next in brackets the area of ​​deep damage (in percent), and in the denominator - the degree of damage (in Roman numerals).

trunk and right upper limb. In the case history, for greater clarity, a burn diagram is attached to the “place of illness” section, on which, using symbols, the area, depth (degree) and localization of the lesion are indicated (Fig. 9.5.). This allows a more concise description of the burn area in the text and makes it possible to clearly and demonstratively display the nature of the lesion.

Table 9.4.

Figure 9.5.

BURN SCHEME

The most important question when examining burnt corpses of people found at the scene, in the fire zone, it is necessary to establish the lifetime of burns.

Indicative signs at the scene may be the absence or lesser burning of the skin in the folds of the face, which indicates that a living person was screwed up at the moment of the flame reaching the face.

On the surface of the corpse, which was pressed to the ground, burning does not occur, in this place the skin and even part of the clothes remain intact. This indicates that the corpse was burning, and not a living person who is unable to remain motionless, from severe pain he thrashes about, crawls, or rolls over, pressing the flame to the ground. As a result, around such a corpse, many scraps of half-burnt clothes, hair, as well as traces of body movement are visible.

It is necessary to pay attention to the smell of fuel, because after the delivery of the corpse to the morgue, it can disappear. Mistaken for traces of fuel and lubricants, stains on clothing are most often stains of molten subcutaneous fat.

Vitality can be indicated by a strong burning of the palmar surfaces of the hands compared to other parts of the body when trying to extinguish the flame, knock it off dangerous places.

When examining such (often charred) corpses, attention is paid to the fact that the limbs are bent and, like the head, are brought to the body (pose of a boxer or fencer). Ignorant people at the sight of such a posture make an unreasonable conclusion about the struggle that preceded death, about the resistance of a person. Moreover, this posture is typical for any corpse (regardless of the cause of death), which has been exposed to flame for a long time, ĸᴏᴛᴏᴩᴏᴇ contributed to dehydration and more action flexor muscles. Important Conclusion about the lifetime of combustion is done with caution and, as a rule, after a complete examination of the corpse.

One of the most reliable evidence of the lifetime action of the flame is the detection of soot in the respiratory tract, as well as in the esophagus and stomach, and sometimes in blood vessels, in the liver, bladder. When opening the trachea, bronchi pay attention to the swollen bright red mucosa, covered with soot. Histological examination of lung pieces shows blackish inclusions of soot in the alveoli.

Another sure proof that a person burned alive is the detection in the blood of a compound of carbon monoxide (an inevitable companion of combustion) with blood hemoglobin - carboxyhemoglobin.

For this study, blood is taken from the heart of vessels and sent in sealed vials to a forensic chemical laboratory. The detection of carboxyhemoglobin indicates that the person burned alive, and the establishment of more than 60% also indicates that death occurred from carbon monoxide poisoning, even in the presence of fatal burns. This study is carried out in advance and directly at the dissecting table, using a chemical or spectral method. By the way, carbon monoxide is the main, but not the only poison that enters the body in a gaseous state when a person breathes. As a result of the combustion of plastic, fiberglass, carpet used in residential premises and transport, chemical compounds such as hydrogen cyanide, acrolein, acronicryl, formaldehyde and others are formed, which, even in small doses, create a total toxic effect or, if detected, can introduce misleading about the cause of death, which in some circumstances must be borne in mind.

Of lesser practical importance is the study of the contents of burn blisters for protein, fibrin and leukocytes. In a biochemical study in the fluid of intravital blisters twice more protein than in postmortem.

Another important sign of such an examination of corpses is the establishment of signs of intravital mechanical injury and her character. The difficulty lies in the fact that, on the one hand, the flame destroys damage, and on the other, it masks or changes them. And, on the contrary, the flame leads to such post-mortem changes that simulate intravital trauma, followed by careless or deliberate thermal burning of this area.

Given the dependence on the degree of burns, bruises, abrasions are not detected on their surface, and even wounds in case of IV degree burns. In other cases, the wounds persist, but sharply decrease in size, their shape is distorted, and the signs change. Such wounds skin flap are removed and placed in an acetic-alcohol solution with the addition of hydrogen peroxide for restoration. After 2-3 days, the skin becomes soft, brightened, easily straightened, the wound becomes similar to the original.

At the site of severe burning of all layers of tissues, it is even impossible to detect a bone fracture from the action of a limited blunt object or sharp and firearms. This should be reflected in correctly formulated conclusions.

At the same time, dehydration and the one-sided action of the flame lead to skin ruptures that have a linear shape, even smooth edges and sharp ends, resembling cut wound. Such a conclusion, even a preliminary one, leads to false versions, arousing the imagination of relatives and witnesses, and can direct the investigation along the wrong path. It must be borne in mind that such post-mortem cracks are in the direction of the elastic fibers of the skin, very superficial, intact brownish subcutaneous fat with a wavy relief is visible from their narrow lumen.

Long lasting flame on the head leads to the groaning of blood from the vessels into the cavity between the bones of the cranial vault and the dura mater. The post-mortem hematoma formed in this way can be mistaken for intravital traumatic brain injury. For this reason, attention should be paid to the fact that the post-mortem hematoma has a sickle-shaped, rather than spindle-shaped, shape that compresses the brain; that it is separated from the meninges by a jelly-like fluid, and not fused with it, like a lifetime hematoma due to TBI. The question is finally solved by a histological examination of the brain with membranes, which reveals a hemorrhage in an intravital injury.

Another feature lies in the fact that when a corpse is burned in clothes, the latter is completely destroyed, but the part of it tightly pressed to the body (knee socks, bra, belt, buttoned collar) is damaged much later and delays the combustion of the skin underneath. For this reason, an intact or less burned area of ​​skin can be seen on a corpse and, knowing the explanation, it is important not to make an erroneous conclusion about the strangulation furrow.

When burning corpses to charring, not only soft tissues are burned, but also exposed bones. Οʜᴎ become brittle, turn black, internal organs sharply decrease in size, become denser. In the study of such corpses, the question often arises of establishing the identity of a person. An already difficult task in such cases is difficult due to the lack of clothing and burning of the skin surface with the destruction special signs and features of a linden or other parts of the body, which occurs during mass lesions in a fire, during a plane crash, etc.

Sometimes the corpse of a deceased person is deliberately burned in order to conceal the crime due to the fact that it is impossible to identify the person, to resolve the issue of the cause of death, the category of death. Often this difficult action requires preliminary dismemberment of the corpse of an adult and, in the presence of sufficient fuel, depending on its quality, time of at least 8-10 hours. At the same time, 2-3 kg of ash remains and a lot of solid residues in the form of teeth and small bones (especially articular surfaces). It should be noted that the bone remains make it possible to determine the species, the teeth have individual characteristics. Other issues are also resolved on the bone remains. The ash itself is also subjected to research, which allows spectrographic identification of the combustion material, as well as the type and amount of fuel.

one). palm rule(method of I.I. Glumov) is used to assess small burns: the area of ​​a person's palm = 1% of the area of ​​his body.

2). Rule of nines(Wallace method) is used for extensive burns: head and neck = 9% of the body area, arm = 9%, thigh = 9%, lower leg with foot = 9%; and back = 18%, chest with stomach - 18%.

3). Postnikov method: the surface of the burn is circled on a plastic film, after which the area is calculated on a special millimeter paper.

four). Scheme G.D. Vilyavina is intended both for documentation and for calculating the area of ​​the burn and is a contour of the front and back surfaces of the body, while burns of different depths are indicated in different colors (I degree - yellow, II - red, IIIA - blue stripes, IIIB - solid blue, IY - black).

A combination of methods is possible (for example, a combination of the rule of the palm and the rule of nines).

The area of ​​a burn in a child can be calculated using the table:

Currently often used the formula for designating burns according to Yu.Yu. Dzhanelidze: in the numerator of the fraction indicate the area of ​​the lesion in percent (in brackets - the percentage of deep burns), and in the denominator - the degree of burn. In addition, an etiological factor is indicated before the shot, and after it - the affected area.

Burn disease General disorders in the body are observed with extensive and deep burns and are called burn disease.

Burn disease in young and middle-aged people develops when more than 15% of the body surface is affected by a deep burn, in children and the elderly it can also be observed with a smaller area of ​​a deep burn, limited to 5-10% of the skin.

In the course of a burn disease, 4 stages are distinguished:

one). burn shock(first 3 days)

- occurs with deep burns with an area of ​​​​15-20% of the body surface.

Two mechanisms play a role in its development:

Irritation of a large number of nerve endings. This causes excitation of the sympathetic nervous system, which leads to vasospasm, redistribution of blood and a decrease in BCC.

During thermal injury, a large number of inflammatory mediators are released, which causes pronounced plasma loss, hemolysis, impaired microcirculation, water-salt balance and kidney function. There is a deposition of blood in the internal organs. Through the burn surface there is a strong evaporation of water.

BCC deficiency leads to hypoxia and the development of acidosis. As a result of the fall in blood pressure, urinary retention develops, which leads to the development of uremia.

Differences between burn shock and traumatic shock:

The period of excitation (erectile phase) is longer and more pronounced.

Absence of blood loss.

Severe plasma loss.

• BP drops a little later.

According to the clinical course, 3 degrees of burn shock are distinguished:

burn shockIdegrees(with a burn of 15-20% of the body surface) is characterized by excitation, mild tachycardia up to 100 per minute, oliguria may develop.

burn shockIIdegrees(with damage to 20-60% of the body surface) is characterized by lethargy, tachycardia up to 120 per minute, a drop in blood pressure to 80 mm Hg, a decrease in diuresis up to anuria.

burn shockIIIdegrees(with damage to more than 60% of the body surface) is characterized by an extremely serious condition: severe lethargy, thready pulse up to 140 per minute, blood pressure drops below 80 mm Hg, which leads to a decrease in blood supply to internal organs, acidosis, hypoxia and anuria. Characterized by the development of acute ulcers of the gastrointestinal tract (Curling's ulcer). Body temperature often drops to 36 ° C and below.

2). Burn toxemia(3-15 days)

- characterized by intoxication (nausea, pallor of the skin, tachycardia, heart failure, psychosis) associated with the accumulation of burn wound decay products in the blood:

Nonspecific toxins: histamine, serotonin, prostaglandins, hemolysis products.

Specific burn toxins: glycoproteins with antigenic specificity, “burn” lipoproteins and toxic oligopeptides (“medium molecules”).

3). Burn septicotoxemia(is superimposed on the stage of toxemia, starting from the 4th-5th day)

- begins from the moment of rejection of the burn scab, tk. this creates conditions for the development of infectious complications - suppuration of the wound, pneumonia, phlegmon, etc. Patients with extensive burns may develop sepsis. The period of septicotoxemia usually lasts about 2 weeks (until the burn wound closes).

It is advisable to divide the stage of septicotoxemia into 2 periods:

From the beginning of the rejection of the scab to the complete cleansing of the wound. Patients have decreased appetite high fever, tachycardia, anemia, toxic hepatitis, pyelonephritis may develop.

Phase of the granulating wound. This phase is characterized by the appearance of various infectious complications: pneumonia, acute gastrointestinal ulcers (more often in the duodenal bulb and antrum). Possible generalization of infection - burn sepsis (early - before cleansing the burn wound or late - after cleansing).

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Burn. The main thing is not to get lost!

23.03.2016

Burns are thermal, chemical and radiation. Thermal burns occur when the skin or mucous membranes (integumentary tissues) are exposed to high temperature, the source of which is a flame, hot objects and liquids, hot gaseous substances, combustible substances, etc.

Thermal burns are severe injuries, leading in some cases to disability and even death. They can be observed at work, but much more often we are faced with household lesions.

The severity of the burn depends on the area and depth of tissue damage. Even local lesions of integumentary tissues can cause serious disturbances in various systems life support of the body and cause a burn disease, in particular, its first stage - burn shock.

The prognosis for burns is determined, in addition to the area and depth of tissue damage already mentioned, by the presence of burn shock and its duration, the degree of damage to the respiratory tract, the age of the victim, the nature concomitant diseases and, of course, the time of initiation of adequate treatment.

There are five degrees of skin damage in burns:

I degree - redness and swelling of the skin at the site of the lesion;
II degree - damage to the stratum corneum with detachment and blistering immediately after the burn;
IIIA degree - Partial necrosis of the skin. These are the so-called superficial burns.
IIIB degree - complete death of the skin itself;
IV degree - necrosis of the skin and deep-lying tissues, down to the bone.

Superficial burns heal almost on their own. With deep burns, dead tissues are rejected, followed by filling the defect.

The depth of the lesion has several degrees: I degree - redness and swelling of the skin and mucous membranes; II degree - the formation of blisters filled with a light yellow liquid, the blisters are small, the area around the edema is small; IIIA degree - large tense blisters, the wall of which, as a rule, is torn, the bottom of the wound is pink, moist. pain sensitivity at the bottom of the bubble is maintained or reduced. In later periods, a light yellow scab may form, sometimes with a brown and gray tint; IIIB degree - a bladder with clearly bloody contents, its wall is most often destroyed, the bottom is dry, whitish, with separate pale spots, sometimes with marble pattern. Pain sensitivity is reduced or absent, the scab, if it forms, is dark or brown; IV degree - a characteristic black or brown scab, under which thrombosed veins can be translucent, underlying tissues (muscles, tendons, etc.) are affected. In the first days after the burn, it is difficult to judge the true depth of the lesion, this can only be done after the scab is rejected. When providing first aid, the depth of the lesion is determined approximately, while it is better to assume its greater degree.

Burn area and total affected area calculated as a percentage of the total surface area of ​​the human body according to the rule of nines and the rule of the palm. By the rule of nines in adults, the surface area of ​​individual parts of the body and limbs (head and neck; chest; abdomen; shins and feet; hips; back; lower back and buttocks) accounts for 9% of the surface of the entire body (or this figure is a multiple of 9%), only the area the surface of the external genitalia and perineum is 1%.

By rule palm burn area is defined as follows: the area of ​​the palm of an adult is taken as 1% of the area of ​​the whole body.

In practice, both of these methods are used. For small burns, the rule of the palm is used, for large burns, the rule of nines, and individual minor lesions are measured according to the rule of the palm, after which everything is summed up.

Determining the severity of a burn

Knowing the area and depth of the lesion, you can determine its severity.

Light burns Less than 5% of the body surface is affected. burns moderate- less than 20% of the body surface is affected, and deep burns are no more than 10%. Severe burns- from 20 to 60% of the body surface is affected, while deep burns account for no more than half. Extremely severe burns - more than 60% of the body surface suffers, more than half of deep burns.

Minor burns in adults can be treated on an outpatient basis. Treatment of children requires an individual approach depending on the location of the lesion. All other burns are subject to treatment in specialized hospitals.

burn shock

This severe complication of burns is acute and is due to extensive thermal damage skin and underlying tissues, leading to circulatory disorders. The volume of circulating blood decreases due to its concentration and thickening, the amount of urine separated decreases.

The prognosis depends on early diagnosis and early effective treatment of burn shock. Unlike traumatic shock burn cannot be recognized in early period based on lowering blood pressure and heart rate. Arterial pressure usually does not fall significantly and may even be elevated; its sharp decrease in burns is a poor prognostic sign.

Almost always, with a burn area of ​​15-20% or more and a deep burn of more than 10% of the body surface area, burn shock develops. The degree of its severity also depends on the area of ​​the burn: if it is less than 20% of the body surface, then they speak of mild shock, from 20 to 60% - severe, more than 60% - extremely severe. These degrees can pass one into another depending on the characteristics of the course of shock in each case and the time of onset and intensity of treatment.

For the early diagnosis of burn shock, the following clinical manifestations and symptoms are important: the victim is agitated or inhibited, consciousness is confused or absent, the skin and mucous membranes (outside the burn) are pale, cold, the cyanosis of the mucous membranes and extremities is pronounced, the pulse is increased, shortness of breath, vomiting, thirst, chills, muscle tremors, muscle twitching, urine of a dark color, up to brown, its amount decreases sharply - a characteristic sign of burn shock.

In children, the signs of burn shock are mild, which is the reason for the difficulties of early diagnosis. First of all, weakness, lethargy, cyanosis of the skin, cold extremities, muscle tremors, and vomiting are noted. All children with burns over 10% of the body surface and children under 3 years of age with burns over 5% of the body need anti-shock treatment.

In the elderly, burn shock occurs against the background of a variety of concomitant diseases ( diabetes, heart failure, liver disease, etc.), affecting its outcome. Therefore, antishock treatment is carried out for all victims over 60 years of age with superficial burns of more than 10% and deep burns of more than 5-7% of the body surface.

Significantly increases the risk of burn shock respiratory tract burn arising from the inhalation of hot air, steam, smoke, etc. Respiratory burns should be suspected if the victim was indoors or outdoors at the time of the fire. enclosed space. In addition, a burn of the nose, lips or tongue, singed hair testifies to a burn of the respiratory tract. Examination of the oral cavity reveals redness and blisters on soft palate and the wall of the throat. There are also sore throat, hoarseness of voice, difficulty breathing. The final diagnosis of a burn of the respiratory tract is made by an otolaryngologist. With a combination of a skin burn and a burn of the respiratory tract, burn shock can occur with a lesion area half as large as with a skin burn alone. It is believed that a burn of the respiratory tract has the same effect on the affected person as a deep burn of the skin with an area of ​​\u200b\u200babout 10-12% of the body surface.

When providing first aid for a burn treatment of the burn surface is not carried out. Apply an aseptic dressing or a special anti-burn dressing, if available. It is allowed to use a wet-drying dressing with antiseptics or antibiotics.

For mild burns, the treatment of which can be outpatient, after preliminary anesthesia (1-2 ml of a 1% solution of promedol), the toilet of the burn wound is performed: the skin around the burn is wiped with a 0.25% or 0.5% solution ammonia, warm soapy water or an antiseptic solution, after which they are treated with alcohol or iodonate solution. Then wipe with a swab moistened with an antiseptic solution (furacillin 1: 5000, chloracil, rivanol), then with a 0.25% solution of novocaine and carefully remove extraneous layers, foreign bodies, scraps of the surface layer of the skin. Whole bubbles are not removed. Very tense bubbles strike at the base.

Further burn surfaces, with the exception of lesions of the face and perineum, are treated with a closed method. For superficial burns up to 30% of the body surface area, dressings with low-fat creams, Vishnevsky ointments, synthomycin emulsion, solutions of furacillin, chloracil, antibiotics in a 0.5% solution of novocaine (monomycin, kanamycin, polymyxin, etc.) can be used.

First-degree burns heal in 3-4 days, II-degree burns - in most cases in 10-14 days, if there is no suppuration. With suppuration, the dressings are changed after 6-8 days, soaking them in a weak solution of potassium permanganate.

For burns of the face, neck, perineum II degree bandages are not applied.

After the toilet of wounds, their surface is plentifully lubricated 2-4 times a day. vaseline oil, synthomycin or streptocidal emulsions. In this case, brownish burn scabs are formed, which should be removed only after their complete rejection. Second degree facial burns usually heal within 12 days.

Local measures for IIIA degree burns in the first 7-8 days do not differ from those for II degree burns. With suppuration, the surgeon continues the treatment of the patient.

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