Calculation of the burn surface in percent. Determination of the area, depth and severity of the burn injury. Determination of the burn area by different methods - characteristic

The skin consists of the following layers:

• epidermis ( outer part skin);
• dermis ( connective tissue of the skin);
• hypodermis ( subcutaneous tissue).

Epidermis

The epidermis consists of the following layers:

• basal layer ( provides the process of reproduction of skin cells);
• spiny layer ( provides mechanical protection against damage);
• granular layer ( protects underlying layers from water penetration);
• shiny layer ( participates in the process of keratinization of cells);
• stratum corneum ( Protects the skin from invasion of pathogenic microorganisms).

Dermis

The dermis is made up of the following layers:

• papillary layer ( includes loops of capillaries and nerve endings);
• mesh layer ( contains blood vessels, muscles, sweat and sebaceous glands and hair follicles).

Hypodermis

With burns, the following damage to the layers of the skin occurs:

• superficial or complete defeat epidermis ( first and second degree);
• superficial or complete lesion of the dermis ( third A and third B degrees);
• damage to all three layers of the skin ( fourth degree).

It should also be noted that in burn injuries protective function of the skin is significantly reduced, which can lead to the penetration of microbes and the development of an infectious-inflammatory process.

The circulatory system of the skin is very well developed. The vessels, passing through the subcutaneous fat, reach the dermis, forming a deep cutaneous vascular network at the border. From this network, blood and lymphatic vessels go up into the dermis, nourishing the nerve endings, sweat and sebaceous glands, as well as hair follicles. Between the papillary and reticular layers, a second superficial cutaneous vascular network is formed.

Burns cause disruption of microcirculation, which can lead to dehydration of the body due to the massive movement of fluid from the intravascular space to the extravascular space. Also, due to tissue damage, liquid begins to flow from small vessels, which subsequently leads to the formation of edema. With extensive burn wounds, the destruction of blood vessels can lead to the development of burn shock.

Causes of burns

• thermal impact;
• chemical impact;
• electrical impact;
• radiation exposure.

thermal effect

• Fire. When exposed to fire, the face and upper respiratory tract are most often affected. With burns to other parts of the body, it is difficult to remove burnt clothing, which can lead to the development of infectious process.
• Boiling water. In this case, the burn area may be small, but deep enough.
• Steam. When exposed to steam, in most cases, shallow tissue damage occurs ( often affects the upper respiratory tract).
• hot items. When the skin is damaged by hot objects, clear boundaries of the object remain at the site of exposure. These burns are quite deep and are characterized by the second - fourth degrees of damage.

• influence temperature ( the higher the temperature, the stronger the damage);
• duration of exposure to the skin the longer the contact time, the more severe the degree of burn);
• thermal conductivity ( the higher it is, the stronger the degree of damage);
• the condition of the skin and health of the victim.

Chemical exposure

Burns due to chemical exposure can occur due to exposure of the skin to the following substances:

• Acids. The effect of acids on the surface of the skin causes shallow lesions. After exposure to the affected area in short term a burn crust is formed, which prevents further penetration of acids deep into the skin.
• Caustic alkalis. Due to the influence of caustic alkali on the surface of the skin, its deep damage occurs.
• Salts of some heavy metals ( e.g. silver nitrate, zinc chloride). Damage to the skin with these substances in most cases causes superficial burns.

electrical impact

Electrical injuries are divided into:

• low voltage;
• high voltage;
• supervoltage.

Radiation exposure

• Ultraviolet radiation. Ultraviolet skin lesions predominantly occur in summer period. The burns in this case are shallow, but are characterized by a large area of ​​damage. Exposure to ultraviolet often causes superficial first or second degree burns.
• Ionizing radiation. This effect leads to damage not only to the skin, but also to nearby organs and tissues. Burns in such a case are characterized by a shallow form of damage.
• infrared radiation. May cause damage to the eyes, mainly the retina and cornea, but also to the skin. The degree of damage in this case will depend on the intensity of the radiation, as well as on the duration of exposure.

Degrees of burns

• I degree;
• II degree;
• III-A and III-B degree;
• IV degree.

The depth of damage in case of burns depends on the following factors:

• the nature of the thermal agent;
• temperature of the active agent;
• duration of exposure;
• the degree of warming of the deep layers of the skin.

• Superficial burns. These include first, second, and third-A degree burns. These lesions are characterized by the fact that they are able to heal fully on their own, without surgery, that is, without scarring.
• Deep burns. These include burns of the third-B and fourth degree, which are not capable of full self-healing ( leaves a rough scar).

Burn symptoms

• faces ( in most cases leads to eye damage);
• scalp;
• upper respiratory tract (there may be pain, loss of voice, shortness of breath, and a cough with a small amount of sputum or streaked with soot);
• upper and lower limbs ( with burns in the joints, there is a risk of dysfunction of the limb);
• torso;
• crotch ( can lead to disruption of the excretory organs).

Burn degree	Symptoms	A photo
I degree	With this degree of burn, redness, swelling and pain are observed. The skin at the site of the lesion is bright pink in color, sensitive to touch and slightly protrudes above the healthy area of ​​​​the skin. Due to the fact that with this degree of burn only superficial damage to the epithelium occurs, the skin after a few days, drying and wrinkling, forms only a small pigmentation, which disappears on its own after a while ( an average of three to four days).
II degree	In the second degree of burns, as well as in the first, hyperemia, swelling, and burning pain are noted at the site of the lesion. However, in this case, due to the detachment of the epidermis, small and loose blisters appear on the surface of the skin, filled with light yellow, clear liquid. If the blisters break open, reddish erosion is observed in their place. The healing of this kind of burns occurs independently on the tenth - twelfth day without scarring.
III-A degree	With burns of this degree, the epidermis and partly the dermis are damaged ( hair follicles, sebaceous and sweat glands are preserved). Tissue necrosis is noted, and also, due to pronounced vascular changes, there is a spread of edema over the entire thickness of the skin. In the third-A degree, a dry, light brown or soft, white-gray burn crust forms. Tactile-pain sensitivity of the skin is preserved or reduced. Bubbles are formed on the affected surface of the skin, the sizes of which vary from two centimeters and above, with a dense wall, filled with a thick yellow jelly-like liquid. Epithelialization of the skin lasts an average of four to six weeks, but when an inflammatory process appears, healing can last for three months.
III-B degree	For burns third-B degree necrosis affects the entire thickness of the epidermis and dermis with partial capture of subcutaneous fat. At this degree, the formation of blisters filled with hemorrhagic fluid is observed ( streaked with blood). The resulting burn crust is dry or wet, yellow, gray or dark brown. noted a sharp decline or absence of pain. Self-healing of wounds at this degree does not occur.
IV degree	With fourth-degree burns, not only all layers of the skin are affected, but also muscles, fascia and tendons up to the bones. A dark brown or black burn crust forms on the affected surface, through which the venous network is visible. Due to destruction nerve endings, pain at this stage is absent. At this stage, pronounced intoxication is noted, there is also a high risk of developing purulent complications.

Burns are divided into extensive ( lesion of 10 - 15% of the skin or more) and not extensive. With extensive and deep burns with superficial skin lesions of more than 15 - 25% and more than 10% with deep lesions, a burn disease may occur.

Burn disease is a group clinical symptoms with thermal lesions of the skin, as well as nearby tissues. Occurs with massive destruction of tissues with the release of a large amount of biologically active substances.

The severity and course of a burn disease depends on the following factors:

• the age of the victim;
• the location of the burn;
• burn degree;
• area of ​​damage.

• burn shock;
• burn toxemia;
• burn septicotoxemia ( burn infection);
• convalescence ( recovery).

burn shock

Degrees of burn shock

Burn toxemia

For intoxication syndrome, the following symptoms are characteristic:

• increase in body temperature ( up to 38 - 41 degrees with deep lesions);
• nausea;
• thirst.

Burn septicotoxemia

For burn septicotoxemia, the following symptoms are characteristic:

• weakness;
• increase in body temperature;
• chills;
• irritability;
• yellowness of the skin and sclera ( with liver damage);
• increased heart rate ( tachycardia).

convalescence

Determining the area of ​​burns

There are the following methods for determining the area of ​​the burn:

• the rule of nines;
• palm rule;
• Postnikov's method.

Rule of nines

Rule of nines	A photo
head and neck 9%
upper limbs (each hand) by 9%
anterior torso18% (chest and abdomen 9% each)
back of the body18% (top part back and lower back 9% each)
lower limbs ( each leg) by 18% (thigh 9%, lower leg and foot 9%)
Perineum 1%

palm rule

Postnikov method

First aid for burns

• elimination of the source of the acting factor;
• cooling of burned areas;
• the imposition of an aseptic bandage;
• anesthesia;
• call an ambulance.

Elimination of the source of the acting factor

Cooling of burned areas

Note: for third and fourth degree burns, this first aid measure is not performed.

Applying an aseptic dressing

Dry and clean handkerchiefs, towels, sheets can be used as an aseptic bandage. An aseptic bandage must be applied to the burn wound without pre-treatment. If the fingers or toes have been affected, it is necessary to lay additional tissue between them in order to prevent the parts of the skin from sticking together. To do this, you can use a bandage or a clean handkerchief, which must be wetted with cool water before application, and then squeezed out.

Anesthesia

Call an ambulance

• with burns of the third and fourth degree;
• in the event that a second-degree burn in area exceeds the size of the palm of the victim;
• with first-degree burns, when the affected area is more than ten percent of the body surface ( for example, the entire abdomen or the entire upper limb);
• with the defeat of such parts of the body as the face, neck, joints, hands, feet, or perineum;
• in the event that after a burn there is nausea or vomiting;
• when after a burn there is a long ( more than 12 hours) increase in body temperature;
• when the condition worsens on the second day after the burn ( increased pain or more pronounced redness);
• with numbness of the affected area.

Burn treatment

• conservative;
• operational.

• the area of ​​the lesion;
• the depth of the lesion;
• localization of the lesion;
• the cause of the burn;
• the development of a burn disease in the victim;
• the age of the victim.

Conservative treatment

Conservative burn treatment includes:

• closed method;
• open way.

• applied dressings prevent infection of the burn wound;
• the bandage protects the damaged surface from damage;
• used medicines kill microbes, and also contribute to the rapid healing of a burn wound.

• dressing change provokes pain;
• the dissolution of necrotic tissue under the bandage leads to an increase in intoxication.

open way
This method of treatment is characterized by the use of special techniques ( e.g. ultraviolet irradiation, air cleaner, bacterial filters), which is available only in specialized departments of burn hospitals.

The open method of treatment is aimed at the accelerated formation of a dry burn crust, since a soft and moist scab is favorable environment for the reproduction of microbes. In this case, two to three times a day, various antiseptic solutions (e.g. brilliant green ( brilliant green) 1%, potassium permanganate ( potassium permanganate) 5% ), after which the burn wound remains open. In the ward where the victim is located, the air is continuously cleaned of bacteria. These actions contribute to the formation of a dry scab within one to two days.

In this way, in most cases, burns of the face, neck and perineum are treated.

There are the following advantages of the open method of treatment:

• contributes to the rapid formation of a dry scab;
• allows you to observe the dynamics of tissue healing.

• loss of moisture and plasma from a burn wound;
• high price the treatment method used.

Surgical treatment

• necrotomy;
• necrectomy;
• staged necrectomy;
• limb amputation;
• skin transplant.

necrectomy
Necrectomy is performed for third-degree burns in order to remove non-viable tissues with deep and limited lesions. This type of operation allows you to thoroughly clean the burn wound and prevent suppuration processes, which subsequently contributes to the rapid healing of tissues.

Staged necrectomy
This surgical intervention is performed with deep and extensive skin lesions. However, staged necrectomy is a more gentle method of intervention, since the removal of non-viable tissues is performed in several stages.

Amputation of a limb
Amputation of the limb is performed with severe burns, when treatment by other methods has not brought positive results or necrosis has developed, irreversible tissue changes with the need for subsequent amputation.

These methods of surgical intervention allow:

• clean the burn wound;
• reduce intoxication;
• reduce the risk of complications;
• reduce the duration of treatment;
• improve the healing process of damaged tissues.

Skin transplantation
Skin grafting is performed to close large burn wounds. In most cases, autoplasty is performed, that is, the patient's own skin is transplanted from other parts of the body.

Currently, the following methods of closing burn wounds are most widely used:

• Plastic surgery with local tissues. This method is used for deep burn lesions of small size. In this case, there is a borrowing of neighboring healthy tissues to the affected area.
• Free skin plastic. It is one of the most common methods of skin transplantation. This method consists in the fact that using a special tool ( dermatome) in the victim from a healthy part of the body ( e.g. thigh, buttock, abdomen) the necessary skin flap is excised, which is subsequently superimposed on the affected area.

Physiotherapy

• inhibition of the vital activity of microbes;
• stimulation of blood flow in the area of ​​​​impact;
• acceleration of the regeneration process ( recovery) damaged area of ​​the skin;
• prevention of the formation of post-burn scars;
• stimulation defensive forces organism ( immunity).

Burn Prevention

Prevention of sunburn

• Avoid direct contact with the sun between ten and sixteen hours.
• On particularly hot days, it is preferable to wear dark clothing, as it protects the skin from the sun better than white clothes.
• Before going outside, it is recommended to apply sunscreen to exposed skin.
• When sunbathing, the use of sunscreen is a mandatory procedure that must be repeated after each bath.
• Since sunscreens have different protection factors, they must be selected for a specific skin phototype.

• Scandinavian ( first phototype);
• light-skinned European ( second phototype);
• dark-skinned Central European ( third phototype);
• Mediterranean ( fourth phototype);
• Indonesian or Middle Eastern ( fifth phototype);
• African American ( sixth phototype).

Prevention of household burns

To avoid burns at home, the following recommendations must be followed:

• Do not use electrical appliances with damaged insulation.
• When unplugging the appliance from the socket, do not pull the cord, it is necessary to hold the plug base directly.
• If you are not a professional electrician, do not repair electrical appliances and wiring yourself.
• Do not use electrical appliances in a damp room.
• Children should not be left unattended.
• Make sure there are no hot objects in the children's reach ( for example, hot food or liquids, sockets, included iron, etc.).
• Items that can cause burns ( e.g. matches, hot objects, chemicals and other) should be kept away from children.
• It is necessary to conduct awareness-raising activities with older children regarding their safety.
• You should stop smoking in bed, as this is one of the common causes fires.
• It is recommended to install fire alarms throughout the house or at least in places where the likelihood of a fire is higher ( e.g. in a kitchen, a room with a fireplace).
• It is recommended to have a fire extinguisher in the house.

Surely there are few people who at least once have not experienced all the “charms” of a burn. And although burns are different, the sensations caused by this type of injury cannot be confused with anything. Medicine qualifies a burn as tissue damage under the influence of various factors, the severity of which is determined by indicators such as the area of ​​the lesion and its depth.

Thermal

Thermal burns are combined into one group by temperature effects, the indicators of which are high. You can get burned:

Fire. In this case, the area affected can be quite large, but the depth is usually minimal. Of particular difficulty with such a burn is first aid, when it is necessary to clean up adhering items of clothing that have been ignited;

Depth of the burn

Burns are classified according to their depth and type of injury. In addition, attention is paid to the manifestations of a clinical nature and the type of trauma.

Degrees

The depth of the burn lesion is expressed in one of several established degrees:

• In the first degree of burn damage, only the upper layer of the epithelium suffers. The burnt area of ​​the skin turns red, swells a little and hurts. After a few days, the symptoms completely disappear, and the skin is renewed.
• The second degree burn is characterized by a deeper penetration. The defeat of the epidermis borders on the basal layer. Blisters form on the wound surface, inside of which a cloudy liquid is noticeable. Such damage heals for at least two weeks.
• The third degree of a burn wound is the deepest and has two degrees A and B.
  • A = The dermis layer is so damaged that the victim may not even feel pain because the receptors are also damaged. Burnt tissue may bubble. Without qualified assistance and appropriate treatment, there is a high probability of developing a secondary infection, which will make independent regeneration impossible.
  • B = With this variant of the third degree, the death of all layers of the epidermis is ascertained.
• With the fourth degree of burn damage, the skin and subsequent layers, including muscles, and the fat layer up to the bone, are charred.

Burn Depth Diagnosis

In order to correctly predict and determine a competent approach to the treatment of burn damage, it is necessary to identify its depth as accurately as possible. To do this, you should focus on the compiled anamnesis from the words of the victim or witnesses of the incident, as well as on the data that was formed during the examination. When asked, they set:

• localization of the burnt area;
• what caused the burn;
• how long the victim has been in contact with the thermal agent;
• what clothing was on the victim at the time of the incident;
• the patient's age should be specified.

After the survey, an inspection of the lesion site is also carried out in order to determine the depth of damage. The depth of burn injury is determined based on the signs of the types of clinical symptoms:

• necrosis;
• circulatory disorders;
• pain sensitivity.

When examining the burn and trying to establish the degree of depth of the lesion based on signs of necrosis, one should pay attention to whether there are dead tissues or blisters in the affected area, and what is the swelling and hyperemia at the time of examination. First/second degree burns are usually not characterized by necrosis. And the presence of a scab will indicate deeper damage, the degree of which will already be the third or fourth. A simple inspection is unlikely to more accurately determine the depth of the burn.

Burns are also classified by zones, which depend on the extent to which blood circulation in the burn zone is disturbed.

• hyperemia, the skin retains a pink color and may turn pale when pressed. This means that blood circulation is normal, and those morphological changes are reversible;
• stasis, its severity will manifest itself only when a day has passed after the injury. In this zone, pressing on the skin does not see a change in its color. This means that there is a deep burn lesion and later a necrotic scab forms here. The reversibility of morphological changes is possible, but it can develop, so that necrosis occurs;
• complete lack of circulation, the veins thrombose because the damage is quite deep, dry/wet necrosis is observed. Tissue death is recorded.

Also, the pain sensitivity of the victim in the injured area may indicate the depth of the burn. It can be traced by carrying out some manipulations, checking sensitivity, for example, prick with a needle wound surface. A first and second degree burn will cause a sharp reaction to pain. In the third degree A, the sensitivity of the victim will be weak and completely absent with a significant depth of the burn, which can be qualified as the third B and fourth degree of damage.

It is easy to determine the depth of the burn injury if you pull out the hair in the affected area. When the procedure turns out to be painful and troublesome, you can not be afraid of deep damage, but if the hair can be easily pulled out and the patient does not respond properly to the alleged pain, then the burn is deep.

With a clinical examination, it is quite quickly possible to diagnose the presence of a deep burn, however, it is not only difficult, but almost impossible, to calculate the outlines of its boundaries. Only during the process of direct treatment of the burn will it be possible to refine the limits in depth.

In order to objectively approach the diagnosis of burn depth, specialists also use some special methods that can only be carried out in a hospital: thermometry, fluorescence and intravital staining.

The most popular medicinal substances for the restoration of areas of the dermis affected by burns are complex preparations, made in the format of gel, ointments and creams. Depending on the degree and type of injury, they are divided into antiseptics, painkillers, anti-inflammatory and wound healing.

Rules for determining the area of ​​burns

How severe the condition of a patient who has suffered from burns depends not only on the depth of the injury, but also on its area. Taking into account these indicators, as well as the individual characteristics of the body of a person in need of help, the doctor can prescribe an appropriate therapeutic course.

Due to the lack of a complete objective picture of the condition of the victim in the first days after receiving a burn, its severity is rather difficult to determine. To clarify the situation, methods are used to calculate the area of ​​the burnt surface and presumably establish the depth of damage.

"Rule of the palm" (Glumov)

The method is as follows: if we assume that the palm of a person is approximately 1% of the entire area, his body can easily calculate what percentage falls on the burn surface. It remains only to measure it with your palms.

Wallace nines

Determining the area of ​​the burn by this method, one can expect to obtain only approximate data. According to the rules of the Wallace technique, it is necessary to zoning the body, each part of which in the corresponding zone will be equal to nine percent (neck and head - 9%, each of the limbs - 9%, a quarter of the torso of the front and back parts - 9% and 1% on intimate area). This rule works for adults, since the proportions of the child's body are slightly different.

Method of determination according to Postnikov

This is an outdated method that is inconvenient to use and time consuming. For these reasons, it is practically not used. The essence of the method is to apply sterile gauze to the damaged area and draw a contour display of the burn on it, followed by transferring it to paper with a millimeter grid. Then it is necessary to calculate the area of ​​damage relative to the total surface of the skin.

Schematic approach of Vilyavin

Take an image of a person's silhouette in tenfold reduction and paint over the corresponding lesions. For each of the degrees of damage, you need to choose a specific color. This method makes it possible to track the degree/area of ​​lesions during treatment.

Browder and Land Calculations for Toddlers

The calculations take into account the peculiarity of the age ratio of the areas of skin cover in young patients in each of the zones of their body. In babies who are under twelve months old, twenty-one percent of the total area is on the scalp and neck. skin, torso on both sides, sixteen percent, in the hips, five and a half and eight and a half on the area of ​​​​the feet and legs, as well as one percent on the perineum.

According to the Dolinin method

On a specially made silhouette rubber stamp human body its front and back are divided into equal sections: 51 parts on the front and 49 parts on the back of the surfaces. Each patch represents 1 percent of the victim's implied body. Filling in on such a diagram of the damage site and then summing them up, you can calculate the burn area.

Calculation of the burn area according to the Ariev scheme

Sketches are filled with special ink during the initial inspection. Then, upon the appointment of a course of treatment, the sketches of the sketches are corrected, and so throughout the entire treatment process, new data can be entered into the drawing, which will indicate healing or the identification of new areas of damage / depth. Some inconvenience of this scheme is the absence of side sketches, which involves the production of additional profile drawn schemes.

How to protect yourself from burn injury at home

Many burn victims receive them mainly at home. In order to avoid such injury and not harm your loved ones, it will not be superfluous to follow some rules that will not only help preserve health, but in many cases will help to avoid a fire.

• It is forbidden to smoke in bed;
• Should not be included in the program family holidays fireworks launch. Joy and impressions from him are only for a moment, but they can cause a lot of trouble. Do not forget about elementary safety, the observance of which will help to end the holiday on a good note.
• The location of the fire alarm should be optimal. Smoke detectors must be located in the kitchen, in the room with a fireplace / stove and in the sleeping quarters. It is also necessary to regularly check their serviceability.
• Care must be taken when handling equipment that runs on liquid fuel or gas: chainsaws, snow plows, lawn mowers, cultivators and other household appliances.
• It is necessary to think over and draw up an evacuation plan in case of fire. Of course, no one expects a fire, but, nevertheless, the whole family should be familiar with this drawing. It is a good idea to hang such a plan in a conspicuous place so that it catches the eye of children as often as possible.
• It is useful to keep a fire extinguisher near the kitchen area. Every housewife should be able to use it if necessary. In addition, it should be checked in a timely manner for serviceability and fullness.
• Extinguish oil or other products that have flared up in the pan by covering it with a lid.
• Accumulations of waste paper should not be present in living rooms. They should be stored in utility rooms.
• Water heaters in bathrooms can also pose a fire hazard when high temperature heating water that may boil away. It is necessary to keep the heater at around fifty degrees and add temperature only if necessary without leaving the device unattended.
• To avoid fires caused by electricity, you must use only those fuses for distribution boards that are required by the instructions, and also do not use electrical cords without grounding and insulation.
• Paints, mortars and other means household chemicals labeled "flammable" must be kept in a container. The room for their storage must be equipped with ventilation.

It should be remembered that compliance with fire safety rules in your area and in the house will contribute to the peace and health of the whole family. Since it is in cases of fire at home that people often get the largest number of burns.

Burns are among the most common household injuries of the body. As a rule, in everyday life, burn injuries occur as a result of injury to the body by steam, boiling water, hot liquids, or harmful chemicals. Occupational burns are also found in medical practice, but the percentage of their ratio with household burns far less. Industrial burns most often occur as a result of injury by acids, alkalis, high-temperature substances, electricity.

It is very important to know the rules of rendering primary care when the body is damaged by chemical or thermal burns. In addition, it is important to be able to recognize the severity of the burn in order to properly assess the degree of damage to the body of the victim.

Burn classification

Traumatic cases resulting from burns caused by harmful substances or high-temperature liquids are classified as follows:

When classifying a burn, the age of the victim must be taken into account, accompanying illnesses and individual characteristics organism.

How to determine the area of ​​damage in case of burns?

When determining the area of ​​the body affected by burns in adults, the “method of nines” is used. In this case, the following percentage is calculated:

For children, the area of ​​burn damage is calculated in a different way: the area of ​​the child's open palm corresponds to 1% of the area of ​​the affected area of ​​the body. As a rule, a similar method for determining burns is used for skin lesions of less than 10% of the entire body.

The ratio of the area of ​​the burn and the degree of damage

1. First degree burns - easy stage. If the age of the victim is more than 10 and less than 50 years, then the percentage of the affected area of ​​the skin or mucous membrane should be less than 15%. If the age category of the victim corresponds to the limits of up to 10 years and more than 50 years, then the percentage of the area of ​​injury should be no more than 10%. A single burn at a mild stage should correspond to no more than 2% of the total injury area.
2. Second degree burns are the middle stage. The age of the victim is from 10 to 50 years - the percentage of the burn area of ​​the skin is from 15 to 25%. With the age category of the victim equal to less than 10 years and older than 50 years, the percentage of the area of ​​the affected area of ​​the skin or mucous membrane is from 10 to 20%. A single burn corresponds to 2% to 10%.
3. Third degree burns are severe. If the age of the victim is more than 10 years and less than 50 years, then the total area of ​​skin lesions should be more than 25% in accordance with the entire body surface. With an age category of less than 10 years and more than 50 years, the burn area is more than 20% of the total area of ​​the skin of the entire body. A single burn with a third degree of severity is more than 10%.
4. A fourth-degree burn is a difficult stage. The total area of ​​a superficial burn is more than 30%, with internal burns the total degree of damage is more than 10%.

Symptoms:

1. pain of a mild nature;
2. redness of the skin;
3. slight swelling of the burned area of ​​the body;
4. with burns of the mucosa, perspiration or itching is manifested.

This injury belongs to the mild stage, so the victim does not need hospitalization.

10 - 15% body burns

Symptoms:

1. sharp pain;
2. redness of the injured integument of the body;
3. swelling of the burnt place;
4. blistering.

• providing primary care using cooling of the burn area and neutralization of the chemical reagent;
• subsequent treatment must be prescribed by a doctor after examining the victim. As a rule, at this stage, analgesic, anti-inflammatory and anti-infective therapy is carried out;
• lotions are prescribed to the victim with medicines moisturizing and regenerating effect on the area of ​​injury on the skin;
• alternative therapy includes the treatment of the burn area with ointments based on the pulp of aloe, gruel raw potatoes or propolis.

15 - 30% body burns

Symptoms:

1. sharp pain;
2. deformation of the skin;
3. necrosis of superficial tissues.

• first aid is to remove clothing from the victim that touches the burned area of ​​​​the body. After that, it is required to apply a sterile napkin to the affected skin and call an emergency team. It is impossible to cool and wash the burn with neutralizers on your own;
• burns are treated in a hospital. Necessarily carried out therapy with the use of painkillers, antibiotics, anti-inflammatory drugs;
• the surface of the burn area is treated with anti-burn ointments;
• application folk therapy are not allowed.

30 - 50% body burns

Symptoms:

1. shock state;
2. necrosis of the affected areas of the body;
3. charring of the affected tissues.

• the victim must be immediately taken to a medical institution;
• in a hospital, therapy is carried out with the use of painkillers, sedatives, anti-inflammatory drugs and antibiotics;
• if necessary, carry out treatment with physiotherapy;
• anti-burn compresses are applied to the affected area.

50% or more body burns

Symptoms:

1. shock state;
2. charring of the superficial and deep layers of the skin;
3. often - the death of the victim.

• carrying out antishock therapy;
• external and internal treatment;
• skin grafting through surgery.

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).

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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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 plenty of fluids.
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:

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

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.

- 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 ​​\u200b\u200bdamage is indicated as a percentage (in brackets - the percentage of deep burns), and in the denominator - the degree of burn. In addition, before the fraction indicate etiological factor, 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 of 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. Dynamic monitoring of laboratory parameters is necessary for the timely diagnosis of organ failure. The next period of septicotoxemia is accompanied by the development of 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 from exposure different kind weapons are found with 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 a fall is noted during dynamic observation. blood pressure(in the elderly, before the disease suffered 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 discharge, observed over time, makes it possible to suspect the development of acute renal 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 perineum, 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, in 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 to bed, to reduce friction of the damaged body surface on the sheet, you can sprinkle the latter with a small amount of talc.

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

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 in the treatment of burns were used exclusively conservative methods, the victim developed severe cicatricial contracture of the neck of the 4th degree, accompanied by cicatricial eversion of the 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, in addition, carbon monoxide poisoning and other combustion products occur.

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 downside of this tactic is that the resulting calculations are not precise character. 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 percentages are in the groin area. 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 antiseptics and apply a sterile dressing. In case of severe pain syndromes, it is recommended to drink painkillers to avoid getting shock.

Carefully observe safety precautions when working with electric heating devices, chemical reagents. Keep detergents away from children and out of their reach.

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.

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.

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 deep defeat(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 damage, 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, the numerator of which is the total area of ​​the burn and next to it in parentheses is the area of ​​deep damage (in percent), and the denominator is 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 issue in the examination of burnt corpses of people found at the scene, in the fire zone, is 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 rushes 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 flames for a long time, ĸᴏᴛᴏᴩᴏᴇ contributed to dehydration and more action flexor muscles. An important conclusion about the lifetime of combustion is made 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 the 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 in 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. At biochemical research in the fluid of intravital blisters there is twice as much protein as in postmortem ones.

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 an intravital injury, 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 with 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 have the direction of the elastic fibers of the skin, they are 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 she is separated from meninges jelly-like fluid, and not fused with it, like a lifetime hematoma due to TBI. Definitively resolves the issue histological examination brain with membranes, revealing hemorrhage in intravital damage.

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 burning 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, blacken, internal organs sharply decrease in size, thicken. 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 the burning of the skin surface with the destruction of special signs and features of the 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 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.

Burn- tissue damage caused by local exposure to high temperatures (more than 55-60 C), aggressive chemicals, electric current, light and ionizing radiation. According to the depth of tissue damage, 4 degrees of burns are distinguished. Extensive burns lead to the development of the so-called burn disease, which is dangerous for death due to disruption of the cardiovascular and respiratory systems, as well as the occurrence of infectious complications. Local treatment of burns can be carried out in an open or closed way. It is necessarily supplemented with analgesic treatment, according to indications - antibacterial and infusion therapy.

III stage. Septicotoxemia. It is caused by a large loss of protein through the wound surface and the body's response to infection. It lasts from several weeks to several months. Wounds with much purulent discharge. The healing of burns is suspended, the areas of epithelialization decrease or disappear.

Fever with large fluctuations in body temperature is characteristic. The patient is lethargic and suffers from sleep disturbance. There is no appetite. Significant weight loss was noted severe cases possible loss of 1/3 of body weight). Muscles atrophy, joint mobility decreases, bleeding increases. Bedsores develop. Death occurs from common infectious complications (sepsis, pneumonia). With a favorable scenario, the burn disease ends with recovery, during which the wounds are cleaned and closed, and the patient's condition gradually improves.

First aid

It is necessary to stop contact with the damaging agent (flame, steam, chemical, etc.) as soon as possible. With thermal burns, the destruction of tissues due to their heating continues for some time after the cessation of the destructive effect, so the burned surface must be cooled with ice, snow or cold water for 10-15 minutes. Then, carefully, trying not to damage the wound, cut off the clothes and apply a clean bandage. A fresh burn should not be lubricated with cream, oil or ointment - this can complicate subsequent treatment and impair wound healing.

For chemical burns, rinse the wound with plenty of running water. Alkali burns are washed with a weak solution citric acid, burns with acid - a weak solution drinking soda. Quicklime burns should not be washed with water, but should be used instead. vegetable oil. With extensive and deep burns, the patient must be wrapped up, given an anesthetic and warm drink (better - soda-salt solution or alkaline mineral water). The victim with a burn should be delivered to a specialized medical facility as soon as possible. institution.

Treatment

local curative measures

Closed burn treatment

First of all, the burn surface is treated. Foreign bodies are removed from the damaged surface, the skin around the wound is treated with an antiseptic. Large bubbles are cut and emptied without being removed. Exfoliated skin adheres to the burn and protects the wound surface. The burnt limb is given an elevated position.

At the first stage of healing, drugs with analgesic and cooling effects and drugs are used to normalize the condition of tissues, remove wound contents, prevent infection and reject necrotic areas. Use aerosols with dexpanthenol, ointments and solutions on a hydrophilic basis. antiseptic solutions and hypertonic solution used only in first aid. In the future, their use is impractical, since the dressings dry out quickly and prevent the outflow of the contents from the wound.

With IIIA degree burns, the scab is kept until the moment of self-rejection. First impose aseptic bandages, after rejection of the scab - ointment. Target local treatment burns at the second and third stages of healing - protection from infection, activation of metabolic processes, improvement of local blood supply. Drugs with hyperosmolar action, hydrophobic coatings with wax and paraffin are used, which ensure the preservation of the growing epithelium during dressings. With deep burns, stimulation of the rejection of necrotic tissues is carried out. Salicylic ointment and proteolytic enzymes are used to melt the scab. After cleansing the wound, skin plastic surgery is performed.

Open burn treatment

It is carried out in special aseptic burn wards. Burns are treated with drying solutions of antiseptics (solution of potassium permanganate, brilliant green, etc.) and left without a bandage. In addition, burns of the perineum, face, and other areas that are difficult to bandage are usually treated openly. For the treatment of wounds in this case, ointments with antiseptics are used (furacilin, streptomycin)

A combination of open and closed methods of treating burns is possible.

General therapeutic measures

In patients with fresh burns, sensitivity to analgesics increases. In the early period best effect provided by the frequent administration of small doses of painkillers. In the future, you may need to increase the dose. Narcotic analgesics are depressing respiratory center, therefore, they are introduced by a traumatologist under the control of breathing.

Selection of antibiotics is carried out on the basis of determining the sensitivity of microorganisms. Antibiotics are not prescribed prophylactically, as this can lead to the formation of resistant strains that are unresponsive to antibiotic therapy.

During treatment, it is necessary to compensate for large losses of protein and fluid. With superficial burns of more than 10% and deep burns of more than 5%, infusion therapy. Under the control of pulse, diuresis, arterial and central venous pressure, the patient is administered glucose, nutrient solutions, solutions to normalize blood circulation and acid-base status.

Rehabilitation

Rehabilitation includes measures to restore the physical (physiotherapy, physiotherapy) and psychological state patient. Basic principles of rehabilitation:

• early start;
• clear plan;
• exclusion of periods of prolonged immobility;
• constant increase in physical activity.

At the end of the primary rehabilitation period, the need for additional psychological and surgical assistance is determined.

Inhalation lesions

Inhalation injuries occur as a result of inhalation of combustion products. More often develop in persons who have received burns in a confined space. Aggravate the condition of the victim, may be life-threatening. Increase the chance of developing pneumonia. Along with the area of ​​burns and the age of the patient, they are an important factor influencing the outcome of the injury.

Inhalation lesions are divided into three forms, which can occur together and separately:

Carbon monoxide poisoning.

Carbon monoxide prevents the binding of oxygen to hemoglobin, causes hypoxia, and with a large dose and prolonged exposure, death of the victim. Treatment - artificial ventilation of the lungs with the supply of 100% oxygen.

Burns of the upper respiratory tract

Burns of the nasal mucosa, larynx, pharynx, epiglottis, large bronchi and trachea. Accompanied by hoarseness of voice, shortness of breath, sputum with soot. Bronchoscopy reveals redness and swelling of the mucosa, in severe cases - blisters and areas of necrosis. The edema of the airways increases and reaches its peak on the second day after the injury.

Injury to the lower respiratory tract

Damage to the alveoli and small bronchi. Accompanied by difficulty breathing. With a favorable outcome, it is compensated within 7-10 days. May be complicated by pneumonia, pulmonary edema, atelectasis, and respiratory distress syndrome. Changes on the radiograph are visible only on the 4th day after the injury. The diagnosis is confirmed by a decrease in the partial pressure of oxygen in the arterial blood to 60 mm and below.