Features of the child's psyche with thermal burns. Features of the course of burn disease in children of the first three years of life. Boiled water burn in a child, what to do

Every small child actively and very actively explores the world around him. Parental instructions do not always protect the baby from dangerous curiosity; as a result, the child may receive various injuries.

Body burns in children are among the most frequent and rather severe traumatic injuries of the skin and soft tissues. Most often, children aged 2-3 years suffer from burns.

Parents must know how to provide first aid for a thermal burn in a child

Risk of burns for children

A burn is a traumatic injury to the skin and surrounding tissues caused by exposure to heat or a chemical, electricity, or hot sunlight. At home, chemical burns in children are extremely rare, the most common damaging factors are hot liquids (boiling water, soup), open fire or heated household items (iron, oven).

One-year-olds often grab and overturn containers with hot water, boiling water, or sit in them. In the first case, the typical location of burn lesions is the upper body, face, abdomen, arms and hands, in the second case, the buttocks, vulva and back of the lower extremities (for example, feet).

The physiological features of the structure of children's skin are such that a burn of the first or second degree can also be caused by a not very hot liquid. Imperfect compensatory and regulatory abilities of the child's body can lead to the occurrence of a burn disease. In this condition, the normal functioning of all organs and systems of the body is disrupted, up to and including death.

Symptoms of thermal burns of varying degrees

Any child, even with a small burn, cries and screams loudly, however, with extensive burns, the baby is apathetic and inhibited. Intact skin is pale, sometimes cyanotic, the pulse is quickened. The appearance of thirst and subsequent vomiting indicates the occurrence of burn shock.

Depending on the depth of tissue damage, the following degrees of burns are distinguished:

1 degree - severe redness (hyperemia) of the burn site, swelling, burning and severe soreness of the skin;
Grade 2 - blisters (blisters, bullae) with a transparent yellowish liquid form in the thickness of the skin at different depths;
Grade 3 - damage and death (necrosis) of the skin in all layers with the formation of a gray or black scab;
Grade 4 - charring of the skin, ligaments, muscles and bones.

The severity of a child's condition with a thermal burn depends on his age, the area of the burnt surface and the depth of the lesion. The younger the child, the larger the area of damage, the more severe the course of the burn, the longer the recovery will last.

First aid for a child's burn

Correctly and timely provided first aid determines the prognosis of the development of the disease. What to do if the baby was scalded with boiling water, burned on a hot iron, the skin at the site of the burn was swollen with bubbles or completely peeled off?

First of all, the parents of the victim do not need to panic, they should pull themselves together and follow the following algorithm of actions:

interrupt contact with a high-temperature or chemical agent, remove wet clothing;
cool the affected surface with a gentle stream of running cool (not icy) water for 15-20 minutes (maybe longer) until the skin feels numb;
apply a sterile gauze bandage to the affected surface;
give the child painkillers, both in tablets and in other forms (rectal suppositories, intramuscular injections - if you have the appropriate skills).

It is important to immediately call an ambulance or take the child to a children's hospital.

Before the arrival of the medical team or until the delivery of the victim to a medical facility, it is necessary to drink water to prevent dehydration. It is preferable to use saline solutions, mineral water without gas.

Features of the treatment of burns in children of different ages

Infants and children under the age of 1 year, as well as children with burns of more than 2% of the body or with injuries to the face, upper respiratory tract, eyes, external genital organs, are treated for burns exclusively in stationary conditions. Thermal burns in children are treated at home, provided that the degree of burn is not higher than the first, rarely the second, and the area of damage does not exceed 2%.

In a medical institution, primary surgical treatment is carried out: the wound surface is washed with minimally traumatic methods using antiseptic solutions. The blisters open at the base, their contents are released, the lid of the bubble is not removed.

An aseptic bandage is applied. Emergency immunization against tetanus is carried out in children who are not vaccinated according to the vaccination schedule.

Medical treatment

antiseptic solutions and sprays: Miramistin, Chlorhexidine, Dioxidine;
antibacterial ointments: Oflomelid, Levomekol, Levosin, Synthomycin emulsion, tetracycline, gentamicin ointment, etc.

It is possible to treat the burn surface using special anti-burn dressings, already impregnated with an antiseptic and having a spongy structure. These dressings do not stick to the wound and are easy to apply and remove.

Procelan ointment helps to anesthetize the wound surface. Accelerate the healing of burn wounds and tissue regeneration means based on panthenol: Bepanten, Dexpanthenol.

If the wound begins to scar, you can smear it with homeopathic ointment Traumeel S. Antihistamines will reduce the itching of the healing wound. For general anesthesia and elimination of symptoms of fever, non-steroidal anti-inflammatory drugs are used that are approved for use in children, according to age: Ibuprofen, Paracetamol.

Folk remedies

Burns of the 1st degree without violating the integrity of the skin can be treated with folk remedies only after consultation with the doctor. How to treat a baby if the child slightly burned his hand, for example, with an iron?

After cooling the wound, it is necessary to make sure that there are no blisters and burn channels penetrating deep into the underlying tissues. Then you can smear the burn with sea buckthorn oil and repeat this procedure several times a day. The anti-inflammatory and regenerating effect of this remedy will help accelerate the healing process.

Aloe juice has a similar effect. A fresh aloe leaf must be cut lengthwise into flat parts, anoint the damaged surface with a cut, leave it on the wound under a gauze bandage for an hour and a half (repeat the procedure 2 times a day).

Aloe juice has a wound healing and regenerating effect, so it is very effective in treating burn wounds.

To speed up healing, you can try grated raw potatoes with honey. Peel a medium-sized potato, grate it on a fine grater, add a teaspoon of honey, use as a compress for 15-20 minutes 2-3 times a day.

Folk remedies and pharmacy drugs can be alternated. However, if after a week of home treatment there is no improvement, the wound has acquired an unpleasant odor, a purulent discharge has appeared, it is urgent to consult a doctor.

immediately after the injury, apply an anti-burn agent - first you need to cool the affected area well;
apply raw egg white to the burn surface, tk. increased risk of wound infection
treat the burned area with any oil, Vaseline-based cream, sour cream or kefir, since the oil will clog the pores of the skin, and dairy products contain acid, which will further injure the skin;
tear off the fabric of clothing that has adhered to the burns - this way the wound is injured even more;
cool the burn site with ice - in addition to the burn wound, you can also get frostbite of the surrounding tissues;
independently open the formed blisters - the risk of joining the bacterial flora increases;
when dressing, use cotton and adhesive plaster, apply tight bandaging - these materials stick to the wound and injure the surface when changing the dressing;
smear the burn area with alcohol or aqueous solutions of aniline dyes (brilliant green, iodine).

Minor 1st-2nd degree burns usually go away in 7-10 days. The healing rate of a burn can be reduced if all the doctor's instructions are followed.

The healing injured area must be protected from sunlight, cold and other thermal irritants. The delicate new thin tissue is very sensitive to changes in temperature, reacting to frost or heat with peeling and numbness.

Burn injuries in children of any age are always the fault of the parents. It is easy to protect your baby from thermal exposure - it is enough not to let him out of your sight.

Do not leave an unfinished cup of hot coffee on the table within reach of the child, hide the matches, do not let the baby into the kitchen while the oven is operating, always check the bath water with your hand, not trusting the thermometer, do not iron clothes next to the child. These simple precautions may save your baby's health and life.

Raising a child is not easy. Especially when mom is also responsible for household chores. Children also have an interesting property - as soon as mom turns away, they immediately find adventure. Alas, not all adventures end well and are fraught with consequences. A burn in a child ranks third in childhood injuries. Before them are only injuries when falling from a height and various. It's about burns.

What are burns?

Burns are tissue damage caused by the local action of high temperatures, chemicals, ionizing radiation or electric current.

Burns are divided into several categories:

Thermal. These are burns with flames, steam, boiling liquids, burns after contact with hot objects.
Chemical. Burns as a result of exposure to household chemicals.
Radiation. This is sunburn.
Electrical. They arise under the influence of current, lightning.

Burns are distinguished by the degree of tissue damage:

1 degree. Only the skin is affected. The first degree is characterized by reddening of the skin, slight swelling, at the site of the burn, itching, burning. Healing occurs on its own in 7-10 days, no treatment is required, no scars remain.
2 degree. It is characterized by swelling, redness, the appearance of blisters with transparent contents, and severe pain. With the right approach to treatment, it heals by 14-21 days, does not leave scars. With improper treatment (especially for chemical burns), the process can deepen.
3 degree. It is characterized by edema, the appearance of blisters with bloody contents, sensitivity is reduced or absent. These burns are treated in the hospital. The wound heals with the formation of scars and scars.
4 degree. It is characterized by damage to the skin, subcutaneous fat, muscles. The wound is deep, black, not sensitive to pain. As with third-degree burns, treatment is carried out in a hospital. After recovery, scars remain.

Not only the depth is important, but also the area of the burn. The easiest way to evaluate is by the palm of the baby. The area equal to the palm is equal to one percent of the entire body area. The larger the area, the worse the prognosis.

Features of burns in children

Children have thinner skin than adults. Because burns in children are deeper;
the child is helpless at the moment of injury, does not immediately react, is not able to help himself. Because of this, exposure to the traumatic agent may be longer, which deepens the injury;
burn shock in children can occur with a smaller burn surface than in adults.

Considering all of the above, with a burn, starting from the second degree (especially with a large area of injury), you need to show the child to the doctor.

What to do before you are at the doctor, and how first aid is provided for burns, we will discuss with you now.

Child chemical burn

Children get chemical burns quite often. The reason is poorly cleaned household chemicals or nearby hidden acetic acid. Unfortunately, children not only douse themselves, but also drink liquid from beautiful packages.

What can cause a burn?

acids (sanox, adrylan, acetic acid);
alkalis (cleaning products, ammonia);
petrol;
potassium permanganate (potassium permanganate);
creams, ointments, some drugs used by adults (fortunately, these burns are not deep).

The severity of a chemical burn is affected by:

substance concentration;
how long the substance has been on the skin or mucous membrane;
amount of substance;
feature of the skin of the victim.

Features of symptoms when exposed to various chemicals:

acids. A scab appears at the site of injury, the burn spreads slowly into the depths, a dense crust forms, which prevents infection of the wound;
alkalis. The burn quickly deepens, the surface of the wound is weeping, and there are frequent cases of infection of the wound.

Chemical burns in children and first aid

The sooner you start providing first aid for a burn, the better.

Help with chemical skin burns:

Remove or cut clothing from the injured area of the body.
Rinse the wound with running water. Wash the wound for at least 15 minutes. Water should be poured onto the burn.
Apply a dry aseptic bandage, seek help from a surgeon.
With severe pain, give an anesthetic (Ibuprofen,) in an age dosage.

Chemical eye burn, first aid:

Rinse your eyes under running water as quickly as possible, try to open your eyes. Flush the wound for at least 15 minutes.
Apply a dry aseptic bandage.
Seek help from an ophthalmologist.

If a child drank household chemicals from a beautiful package, it is important not to waste time, call an ambulance. Before the doctor arrives, you can try to give the baby a drink of water and induce vomiting. Unfortunately, the younger the baby, the more difficult it is to do this.

What can not be done with chemical burns?

do not flush the wound with anything other than water. Chemical reactions only aggravate and deepen burns, especially if it is a burn on the mucous membrane or eyes;
do not rub the wound with a cloth and do not immerse the victim in the bath;
do not wait, seek medical help as soon as possible;
do not treat the wound surface with antiseptics. They can also react with the damaging substance and aggravate the situation.

Thermal burn in a child

Just like in adults, thermal burns can be classified according to the damaging factor:

burn with boiling water;
steam burn;
burns in contact with a hot surface (iron, stove, hot dishes);
flame burn.

Very often you have to see thermal burns of the legs with boiling water. These burns usually occur in children who cannot walk, but are already striving to explore the world, flatly refusing to sit somewhere. And as often happens, the mother, taking the baby in her arms, begins to cook dinner. The baby shakes its leg and hits it straight into a boiling pot.

Another option is when a child at an older age accidentally pours boiled liquid on himself.

In the second case, the burn area is larger. But most often it is not as deep as in the first case, since the liquid has time to cool.

Boiled water burn in a child, what to do?

Any liquid tends to spread. As a result, the burn area is often quite large. Therefore, first remove the child from the source of danger as soon as possible.
Remove clothing from the burned area. This will reduce the temperature at the burn site. If it is not possible to remove it, cut it off and place the wound under cold water.
After cooling the burn area, apply a bandage to the area. The bandage should not press, it should lie loosely.
If you see a 2nd degree burn on a child, there are blisters and severe pain, do not pierce the blisters.
Give the victim water to drink or any drink to the taste of the child (tea, fruit drink, juice).
Give your child an age-appropriate pain reliever.
In the case when the burn area is more than 10%, even if it is a 1st degree burn, it is better to show the doctor. If a child burns with boiling water of 2 degrees or more and an area of more than 10%, you need to take the baby to a burn hospital.

Often, children grab hot surfaces with their hands - stoves, irons, oven. In case of a burn from a hot surface in a child, first aid is provided in the same way as in the case of a burn with boiling water. The peculiarity of hot surfaces, for example, an iron, is only that the burn from the iron in a child will be of a small area, but perhaps deep enough - 2-3 degrees.

Flame burn in a child

If the child caught the flame on clothes or hair, the flame must be knocked down, the best option is with water. If there is no water nearby, throw a thick blanket or blanket over the victim.

The main thing is to stop the flow of oxygen to the fire.

Try not to cover the victim's face to avoid carbon dioxide poisoning and thermal burns of the respiratory tract.

Remove the smoldering clothes from the child as soon as possible, cool the wound, apply a loose aseptic dressing and take the baby to the hospital in any way possible.

What can not be done and what can aggravate the situation and deepen the burn?

Do not rub the burnt area with a cloth.
In case of a chemical burn, do not lower the victim into the bath. It is necessary to wash the wound only by pouring water on the wound.
You can not smear fresh burns with oils, petroleum jelly, and other substances that create a protective film. It is possible to smear the injury site with these agents only after the wound has completely healed.
Do not apply alcohol-based solutions to burns.
Do not pierce the blisters, as this may lead to infection of the wound.
Do not apply medicated ointments and creams immediately to a still hot burn, this can also aggravate the situation.

burn disease

First aid was rendered, and it seems that everything will soon get better by itself, the pain will pass, the wounds will heal. With a first-degree burn and a second-degree burn with a small area of damage, this is likely to be the case. But what can happen in case of a large area and deep burns? Everything can end with a burn disease.

Burn disease is a violation of the activity of all organs and systems caused by the loss of plasma and the breakdown of protein fractions in the human body.

Burn disease in children develops if the child receives deep burns of 3-4 degrees or shallow 2 degrees, but more than 10% of the area.

There are four periods of the disease:

burn shock - develops in the first three days after the burn;
acute burn toxemia;
septicotoxemia;
recovery.

Treatment of a burn disease is carried out only in a hospital.

Treatment of burns in children

What can be done to treat burns in children? Once again I remind you that treatment should be prescribed by a doctor.

If you decide to take a chance and treat a small burn of 1-2 degrees on your own, please note that all ointments and creams cannot be rubbed. They need to be applied to the skin, as if creating a protective layer. Dressings should not press, they should be applied loosely. It is impossible to apply a patch on a burnt surface.

The most famous burn remedies for children:

Dermazin. Approved for use in children from 2 months. Burn cream is used to apply to the skin 1 to 2 times a day. Can be used under a bandage or on exposed skin. Dressing needs to be done every day. The drug well resists the spread of wound infection;
Panthenol. Ointment for burns for children with dexpanthenol. Recommended for the treatment of 1st degree burns. It is applied after the burnt skin has cooled down.

Burn Prevention

Summing up, once again I would like to draw your attention to special care in the performance of household duties:

try to keep your child away from hot household appliances;
do not take the baby in your arms when preparing dinner, especially do not hold him over a boiling pot;
pouring lunch for a child, check the temperature of the dish;
wash your hands with your child, each time check the temperature of the water pouring from the tap;
do not let children play with open fire;
keep household chemicals, medicines, and hazardous chemicals locked up.

Be careful and extremely careful. The health of your kids depends on you.

Watch a video about burns in children.

Burns in children most often occur as a result of exposure to hot liquids, flames, hot objects. Clinical manifestations depend on the area of the burn, its degree, the age of the child and consist of general and local symptoms. In children, the same degrees of burns are distinguished as in adults, but with the same temperature effects, the skin of children is damaged more severely. At the first examination, it is often difficult to determine the exact degree of the burn; in children, a combination of burns of different degrees is more common. With burns with a large area of damage, shock develops, and in children it can occur already with a burn of 5-8% of the body surface, and even 3% in infancy. Therefore, it is very important to determine the burn area according to the scheme (Fig. 3) and the table.

Table for calculating the area of the burn (as a percentage of the total body surface) Fig. 3. Scheme for determining the area of the burn in children under 1 year old (as a percentage of the total body surface).

With extensive burns, it is always serious and is especially unfavorable when 50% of the body surface is affected or more. The principles of emergency care for burns in children are the same as in adults; for the purpose of anesthesia, children are administered at the rate of 0.1 ml of a 1% solution for 1 year of life. On an outpatient basis, it is permissible to treat burns of I-II degrees, in area not exceeding 2% in infants and 4% in older children. To reduce pain, cold ones are used, then the burn surface is irrigated with 70% alcohol and a dry sterile bandage is applied; bubbles are not removed. Infected burns are treated with bandages with Vishnevsky ointment. For more widespread or deeper burns, children should be hospitalized. Both general and local treatment of burns in children has some features compared to adults. Treatment begins with measures to combat shock. Blood is transfused - from 50 to 250 ml, depending on age (1 ml of 10% chloride solution is injected for every 50 ml of blood). Blood transfusions are also advisable as a prevention of shock.

Infusion therapy is of great importance in the treatment of shock. Intravenous drip injected: 10% glucose solution with insulin, Ringer's solution, isotonic sodium chloride solution, glucose-novocaine mixture. The amount of fluid administered per day should be 10% of the child's body weight. Infusion therapy is carried out within 24-48 hours. depending on the severity of the shock. In addition, the child receives through the liquid according to the physiological needs. Infusion therapy is carried out with simultaneous control of urination; it is important to measure hourly diuresis, for which a catheter is inserted into the bladder and left until the child is completely removed from shock. Only after getting out of shock, they begin to treat the burn surface under anesthesia: remove foreign bodies, contaminated epidermis, carefully cut off the opened blisters. After treatment, dressings are applied, more often with Vishnevsky's ointment, since when treating with dry dressings, the dressings are too painful for the child. do not more than 2 times a week.

Emergency immunization against tetanus (see Immunization, table,) is carried out for children who have not received prophylactic vaccinations, and with obvious contamination of the burnt surface. When treating burns of the II degree in the face and, given the difficulties of care and the high possibility of infection, the Nikolsky-Bettman method can be used in children: under anesthesia, the burn surface is cleaned from exfoliated epidermis and blisters using wipes moistened with alcohol and lubricated with 5% an aqueous solution, and then a 10% solution of nitrate (lapis). There is a healing of the burn under the crust, which is rejected on the 8-14th day. Surgical treatment, consisting in the excision of non-viable tissues and the closure of defects with the help of autoplasty, is used for deep burns of III and IV degrees. In the process of caring for children, you need to pay attention to. In order to prevent cicatricial contractures and deformities, joint stiffness, dressings are applied so that the burn surfaces do not touch, the limbs are fixed with a splint, a splint in the middle physiological position, methods are used. With deep burns, the prevention of contractures and deformities is ensured by timely surgical intervention. Prevention of burns is ensured by increased supervision of children.

Burns account for up to 8.5% of the total number of all surgical diseases in children; in toddlers and preschool children, burns account for 63.2% of the total number of injuries. Most often in children, burns are observed with hot liquids (liquid food, water), less often with fire and even less often with chemicals. Burns are more common in children of preschool age, when the child is very mobile. Localization of burns is the most diverse, in most cases on the lower half of the trunk and legs.

Clinical picture and course. Unlike an adult patient, the nature and severity of burns in children primarily depend on their age: the younger the age, the more severe the burn with the same area of damage. Burns that occupy an area of more than 1/3 of the body surface are life-threatening for the child. Mortality among children with body burns has recently decreased to 1.86%; it remained relatively high in children under 3 years old - 6.8%.

Shock in children is already observed with burns of a small surface, especially with an electric current burn. These children have severe torpid shock with small local changes. During the period of shock, convulsions, vomiting, and high fever are sometimes noted.

In the first hours of a burn disease, edema appears in the affected area; due to hypoxia, morphological changes occur in the myocardium, liver, kidneys, adrenal glands, pancreas and thyroid glands. In young children, swelling of the brain often occurs. In the first two days of the disease, up to 20% of the total number of erythrocytes is destroyed, the number of leukocytes increases to 16 - 39 thousand, there is a significant deviation from the norm of biochemical parameters, indicating a change in carbohydrate, protein and fat metabolism in the child's body: the amount of residual nitrogen, globulins increases , sugar content, the amount of albumin decreases, etc.

Complications. During the first day of the disease with extensive burns, toxemia very often occurs. To combat it, constant parenteral administration of protein preparations, salts and glucose is necessary. On the 14-21st day, sepsis often develops. "Scarlet fever" rash is a rare complication that occurs on the first day of a burn disease.

Treatment. For the treatment of burn shock in children, various types of anesthesia are used (omnopon, pipolfen; chloral hydrate, nitrous oxide, etc.) with simultaneous restoration of the volume and composition of circulating blood. In severe cases, it is recommended to use a lytic mixture consisting of largactyl, fenergan and dolantin. The child should be kept warm. Most pediatric surgeons insist on limiting parenteral fluids. During the first day of the disease, blood or its substitutes are administered at the rate of 1.5 ml per 1 kg of the patient's weight and 1% of the burnt surface and 1 ml of physiological saline solution per 1 kg of weight and 1% of the burn surface. In the absence of vomiting, a plentiful drink is prescribed.

After removing from the state of shock, the burn surface is treated. The most common is the closed method of treatment. The burn surface is washed with saline and 1/2% solution of novocaine, and then with alcohol. Scraps of the epidermis are removed. Exfoliated edematous epidermis is not removed. After treatment, a bandage is applied with various drugs: fish oil, carotene, petroleum jelly, tripaflavin, imanin, furatsilin, Shnyrev's ointment with various combinations of antibiotics, etc. On the face, buttocks, the burn surface is treated according to the Nikolsky-Buttman method (5% tannin solution , then 10% solution of silver nitrate) and lead openly. At the end of the treatment, according to indications, the burnt limb is immobilized in a functionally advantageous position.

Recently, necrectomy has become widely used, which is most appropriate to use in children by the end of the 2nd - 3rd week after the burn.

Prevention burns is primarily associated with the supervision of children, primarily toddlers and preschoolers.

FEATURES OF BURNS IN CHILDREN Damage to living tissues caused by exposure to high temperature, chemicals, electrical or radiant energy is commonly called a burn (combustio)

CHARACTERISTICS OF BURNS IN CHILDREN n n n More than 1 million children in the world suffer from burns. At the same time, 25-50% die from burns annually. Up to 70% of cases of burns are burns received at home.

FEATURES OF BURNS IN CHILDREN n n n Thermal burns account for 25 to 50% of other types of childhood injuries In 18% of cases require hospital treatment Among children of all ages, they are the third most common cause of death from injuries, and in toddlers (1-3 years) - leading cause of violent death

FEATURES OF BURNS IN CHILDREN n n In infancy, burns account for 58% In nursery - 50% In preschool -27 -30% At school -20 -23%

FEATURES OF BURN IN CHILDREN The frequency of burn damage in children of different sexes depends on age - in children under 3 years old - more often in boys (more mobile, inquisitive, naughty) - at school age (7-14 years old) more often in girls (begin actively engage in household chores)

FEATURES OF BURNS IN CHILDREN n The main causes of burns in children are liquids (boiling water, hot milk, soup, compote, other liquid and semi-liquid foods, soapy solutions for washing clothes) n n n Scalding Burns from contact with hot metal objects Burns with hot tar, bitumen Flame burns Electrical burns

FEATURES OF BURNS IN CHILDREN SCALDING about 70% of all thermal injuries - 44% of burns as a result of exposure to hot liquids - 10% of overturning liquids due to negligence - 9% during bathing About 10% - deep More than 54% - extensive

FEATURES OF BURNS IN CHILDREN From contact with hot metal objects are found in 18 -27% Sources of injury - hot oven or oven doors, metal parts of a gas burner, hot irons, steam radiators, etc.

FEATURES OF BURNS IN CHILDREN Only 6-7% of burned children receive FLAME BURNS. ELECTRIC BURN from low and high voltage currents. Children under the age of 3 are most often affected

FEATURES OF THE COURSE OF BURNS IN CHILDREN n n Burns with an area of 5-8% cause signs of shock, over 20% are life-threatening

FEATURES OF THE COURSE OF BURNS IN CHILDREN n Causes of a more severe course of burns in children anatomical and physiological features n n Thinness of the skin, poor development of the protective keratinized layer of the skin Other ratios between body weight and the area of its skin. A 5% burn in a child corresponds to a 10% burn in an adult

FEATURES OF THE COURSE OF BURN IN CHILDREN n n Other ratios between different segments of the body (the head in children is 20%, in an adult - 9% of the body surface) Incomplete growth, weakness of compensatory and protective mechanisms Immaturity of the central nervous system contributes to the generalization of the pathological process Greater need for oxygen, proteins. Rapid onset of disorders metabolism and exhaustion

FEATURES OF THE COURSE OF BURN IN CHILDREN Tendency to the rapid development of connective tissue. Excessive growth of scar tissue. n Post-burn scars hinder bone growth, cause the formation of secondary deformities in the joints and shortening of the limb. n

FEATURES OF BURNS IN CHILDREN Currently n for infants and toddlers, burns of more than 30% are considered critical, n For older children, deep burns exceeding 40% of the body surface n The cause of death in most children is an infection

Classification and clinical characteristics of burns Depth of burn skin lesions according to the classification adopted at the 27th Congress of Surgeons in 1962

Classification and clinical characteristics of burns Burns 1 tbsp. (combustio erythematosa) - characterized by redness, swelling (edema) and pain.

Classification and clinical characteristics of burns Burns 2 tbsp. (combustio bullosa) - only the upper layers of the skin (epidermis) are affected, but redness, pain and swelling are more pronounced

Classification and clinical characteristics of burns n n Burns 3 a Art. (combustio escharotica) affects the deep layers of the skin - incomplete necrosis of the skin Burns 3 b Art. - total necrosis of the skin. At the site of the lesion, a deep area of necrosis occurs - a scab, which includes the entire thickness of the skin.

Classification and clinical characteristics of burns Burns 4 tbsp. - the eschar includes the skin and underlying anatomical formations.

Classification and clinical characteristics of burns It is almost impossible to accurately determine the depth of thermal damage in the first hours and days after a burn.

Determination of the area of the burns N N N. The Rules of the palm (1%) are the entire surface of the body - the entire surface of the body is divided into areas whose area is 9% (head, thigh surface, front surface of the body) n pattern (table) of Postnikov - percentage of the size of the burn to the total surface of the human skin n VILYAVIN'S SCHEME - BURN CONTOURS ARE APPLIED ON THE SCHEME WITH THE IMAGE OF THE SILHOUETTE OF A HUMAN, MULTI-COLORED PENCILS. n n 1 st - yellow, 2 st - red, 3 a - blue stripes, 3 b - solid blue, 4 tbsp. - black

DETERMINATION OF THE AREA OF THE BURN n VILYAVIN'S SCHEME - THE CONTOURS OF THE BURN ARE APPLIED TO THE SCHEME WITH THE IMAGE OF THE SILHOUETTE OF A HUMAN, MULTI-COLORED PENCILS. n n 1 st - yellow, 2 st - red, 3 a - blue stripes, 3 b - solid blue, 4 tbsp. - black

DETERMINATION OF THE AREA OF THE BURN n BLOKHIN method - the area of the burn in square centimeters is divided by the age coefficient: 1 year - 30; 2 years - 40; 3 years - 50; 4 years - 60; 5-6 years - 70; 7-8 years - 80; 8 -15 years - 90.

Burn disease n A burn and the body's reaction to thermal injury is considered a burn disease. THE SET OF CHANGES IN THE ORGANISM OF THE SUFFICIENT ARISING AS A RESULT OF AN EXTENSIVE BURN IS USED TO CALL THE BURN DISEASE The term "burn disease" was first used by Wilson in 1929 n

Burn disease There are 4 periods of burn disease - the period of burn shock - acute burn toxemia - septicotoxemia - convalescence

Burn disease - THE PERIOD OF BURN SHOCK occurs immediately after injury and lasts 2-3 days. The victim does not complain of pain, he is pale, lethargic, apathetic. Often he is tormented by thirst, but drinking water immediately causes vomiting. Urine output is markedly reduced. The pulse quickens, decreases, and in a critical condition, blood pressure drops.

Burn disease ACUTE BURN TOXEMIA anemia increases, the amount of protein in plasma decreases, ESR increases. There is a poisoning of the body with toxic decay products and waste products of the infection developing on the burn wound. Lasts about 2 weeks. Accompanied by high fever, confusion, convulsions.

Burn disease n SEPTICOTOXEMIA - various complications develop (pneumonia, pleurisy, pericarditis, hepatitis, phlegmon and abscesses). After two and a half weeks, burn exhaustion develops. It can take from 2-3 weeks to 2-3 months.

Burn disease n RECONVALECTION - during this phase, all the functions of the child's body are aligned and normalized

TREATMENT OF BURN INJURY Treatment of burns is determined by the degree and size of the burnt surface of the body, the conditions under which the treatment takes place and consists of: - first aid at the scene; - in the fight against complications (shock, etc.); - in the primary treatment of the burn surface; - local and general treatment in a medical institution

TREATMENT OF BURN INJURY FIRST AID consists in: - termination of the action of the traumatic agent, - in the prevention of shock, infection of the burn surface, ensuring the evacuation of the victim to a medical institution

TREATMENT OF BURN INJURY FIGHTING BURN SHOCK is carried out according to the same basic principles as the fight against traumatic shock. It is advisable to carry out its correction in the following areas:

TREATMENT OF BURN INJURY - - - Ensuring psycho-emotional rest (neuroleptic drugs, refusal of the primary toilet of burn wounds); Maintaining the necessary oxygen regime; Correction of impaired blood circulation; Prevention and treatment of disorders of the acid-base state;

TREATMENT OF BURN INJURY - - - Prevention and treatment of disorders of water-salt metabolism and excretory function of the kidneys; Fight against disorders of energy metabolism; Fight against intestinal autoflora and endotoxemia

TREATMENT OF BURN INJURY The choice of the subsequent method of treatment will depend on: - the environment in which the treatment is performed (clinic, hospital); - localization and degree of burn; - the size of the burn surface; - the time elapsed from the moment of the incident to the start of treatment of the burn; - the nature of the primary treatment of the burn

TREATMENT OF BURN INJURY SUPERFICIAL BURNS are usually treated conservatively. If there is no pronounced suppuration of wounds, then dressings are done after 2-3 days. Superficial burns usually heal in 10 to 15 days.

TREATMENT OF BURN INJURY Treatment of DEEP BURNS depends on their nature, the general condition of the patient and the medical tactics adopted in this medical institution. All the variety of methods of local treatment can be divided into closed and open

TREATMENT OF BURN INJURY The open method of treatment is most often used for burns of the face, neck, and perineum. The terms of healing of burn wounds are determined not so much by the area of the burn, but by the speed of cleansing the wound from necrotic tissues and covering it with an autograft.

TREATMENT OF BURN INJURY The expediency of carrying out early removal of a burn eschar is based on the following provisions: - Necrotic tissue is the entrance gate for infection; - Early necrectomy and immediate skin transplantation significantly shorten the period of burn disease, prevent its complications (sepsis, bedsores, thrombosis, contractures, etc.), reduce the volume of intensive care measures, accelerate wound healing and hospitalization.

TREATMENT OF BURN INJURY - - - Promotes the restoration of skin sensitivity; Promotes earlier activity of the patient, which improves his general condition; Eliminates the need for frequent painful dressings.

TREATMENT OF BURN INJURY Absolute contraindications for primary necrectomy are: - Severe damage to the respiratory system and complications that arose during the period of burn shock; - Disorders of the central nervous system (disorientation, convulsions, etc.); - Dysfunction of the kidneys, liver, heart.

TREATMENT OF BURN INJURY There are the following types of necrectomy - Tangential (provides for layer-by-layer removal of necrosis within the actual skin); - Sequential (layered) excision to the subcutaneous tissue; - Necrectomy to the fascia - excision to the fascia or even deeper tissues;

TREATMENT OF BURN INJURY - - Enzymatic - consistent and gradual cleansing of the wound with the preservation of viable elements under the action of proteolytic enzymes (trypsin, pancreatin, travasa) Chemical - use 40% salicylic ointment, 40% benzoic acid solution.

TREATMENT OF BURN INJURY For the final closure of the wound, autodermatoplasty is performed using one of the following methods: - Brand method - Split skin grafts (for burns up to 25% of the body surface) - Perforated mesh flap (for extensive burns)

TREATMENT OF BURN INJURY - Temporary biological covers (dressings): homo- or allograft (obtained from a living or recently deceased person) - - Hetero- or xenograft (animal) Embryo membranes - amnion and chorion

TREATMENT OF BURN INJURY - layers of sponge - films of specially processed collagen or fibrin: = kombutek = algipore = artificial skin substitutes = film-forming biopolymer (polycaprolactone)

TREATMENT OF BURN INJURY - - - Treatment in an acaberial environment - a chamber with a laminar vertical air flow, which contributes to the creation of an ultra-clean environment; The use of infrared radiation - household electric fireplaces "Quartz-2 M"; The use of gnotobiological methods - isolators with a controlled air environment.

TREATMENT OF BURN INJURY In the wake of the fire in Perm in the club "Lame Horse" No region, no institute, no clinic is able to have a large number of professionals "at the ready" and even in the whole country with experience in working with burn patients. Andrey Fedorov - Deputy Director of the Institute of Surgery. A. V. Vishnevsky

COMPLICATIONS OF BURN INJURY Meet often, up to 44.2% of all admitted patients. They are divided into local and general (more often 7-8 times). Local: - most often - various types of contractures (up to 30%); - Bedsores (9%); - Arthritis (4 -6%) - Osteomyelitis, ankylosis, pathological dislocations, skeletal deformities.

COMPLICATIONS OF BURN INJURY General: - Burn exhaustion (36%). The main criterion is weight loss. - Pneumonia (about 2%) - Septic processes (sepsis, septicopyemia) -10% - They can also develop - hemorrhagic diathesis, mental disorders, pathology of the kidneys, liver, etc.

ELECTRIC BURN Electrical burns occur when a victim comes into direct contact with an electric shock and passes through the body from one electrode to another or into the ground. Children under 3 years of age are especially affected. The vast majority of electrical burns occur at home from low voltage currents.

ELECTRIC BURN Children are most often exposed to alternating electric current when they come into contact with a lighting network with a voltage of 110-220 V and a frequency of 50 Hz.

ELECTRIC BURN Types of impact of electric current on the body: - Electric - develop deep biochemical changes in tissues; - Thermal (thermal) - at the point of contact with the conductor of electric current, the so-called "Signs of current" appear on the skin, yellow-brown areas on the skin ranging in size from a point to 2-3 cm in diameter with an impression in the center and a roller-like thickening of the edges, charring may develop

ELECTRIC BURN - - Biological - proceeds most severely, observed when current passes through the chest; Mechanical - causes painful contraction of muscle fibers, leading to their rupture.

ELECTRIC BURN (clinic) Not only local, but also general changes occur in the body, which are called electrical injuries. Factors that determine the severity of electric shock: - The duration of exposure to current with short-term exposure is more often observed vascular spasm and tonic contraction of skeletal muscles; - with prolonged exposure - ventricular fibrillation of the heart

ELECTRIC BURN (clinic) - - Power and voltage. According to the figurative expression: "Amps - kill, volts - burn"; The nature of the current loop (the path of electric current through the body) - Longitudinal loop - the current line runs along the body of the victim, which can lead to the development of: due to spasm of vascular smooth muscles);

ELECTRIC BURN (clinic) - a transverse loop - the current line passes through the heart, which leads to arrhythmias, ventricular fibrillation; - The defeat of the "voltaic" arc. Observed during a "short circuit". An electric flash causes damage to exposed areas of the body. The reaction from the eyes of electrophthalmia, passes without consequences.

ELECTRIC BURN (clinic) Clinical symptoms (degrees of electric shock): 1 degree - tonic muscle contraction without loss of consciousness. There is lethargy or agitation, pallor of the skin, shortness of breath, tachycardia, increased blood pressure, pain can be expressed.

ELECTRIC BURN (clinic) 2 degree - consciousness is lost, but quickly (after 15-20 minutes) is restored, lowering blood pressure; Grade 3 - consciousness to coma, respiratory failure caused by laryngospasm, heart sounds are muffled, arrhythmia; Grade 4 - a picture of clinical death, cardiac arrest in the form of ventricular fibrillation.

ELECTRIC BURN (clinic) With low-voltage burns, necrosis penetrates deeper than the subcutaneous fat. In the first hours after the burn, the swelling of the surrounding tissues is not pronounced, there is no pain reaction. The general condition is not broken. Later, the swelling of the soft tissues increases, the area of necrosis may remain white or acquire a black color - mummify.

ELECTRIC BURN (clinic) High-voltage burns are more severe, as they are constantly accompanied by electrical injury of the 3rd or 4th degree, occupy a large area and often capture the entire organ. Characterized by tissue charring.

ELECTRIC BURN (clinic) Severe burns of extremities by high voltage currents are characterized by the following signs: - Muscle spasm causing flexion contracture; - Acute circulatory disorders due to vasospasm and compression of their scab; - Excruciating squeezing pains; - Secondary bleeding from large vessels

ELECTRIC BURN (treatment) Release the victim from the effects of electric current using any dielectric. For any severity of electrical injury, apply a bandage with a solution of furacilin to the burn wound

ELECTRIC BURN (treatment) At 1 tbsp. - calm the child (introduce seduxen, pipolfen), enter analgin At 2 tbsp. - taking into account hypotension, therapy is supplemented by intravenous infusion of colloidal blood substitutes - 10 ml / kg At 3 tbsp. - the main task is the elimination of respiratory disorders. To eliminate laryngospasm, it is necessary to introduce muscle relaxants, followed by tracheal intubation and mechanical ventilation. - performing cardiopulmonary resuscitation

CHEMICAL BURNS Chemical substances of both inorganic and organic origin can cause various skin lesions: - burns; - dermatitis; - eczema, etc.

CHEMICAL BURNS Burns can be caused by solid, liquid and gaseous substances. The degree of skin damage, the prevalence of burns, the duration of healing depend on the amount of the ingested substance, its concentration, residence time on the skin, as well as the speed of removal of the substance.

CHEMICAL BURNS Acids: - sulfuric, nitric, hydrochloric, carbolic, formic, acetic, etc. Alkalis: - caustic soda, caustic potash, caustic lime, caustic soda, fluorine, phenols, etc.

CHEMICAL BURNS In case of a chemical burn, there is: - a deep violation of the physico-chemical properties of the cell; - the formation of highly toxic protein products associated with ions of a chemical irritant. Blisters are rare in chemical burns. They occur in no more than 20% of all cases and appear a few days after the burn.

CHEMICAL BURNS Under the action of inorganic acids on the skin, tissue proteins coagulate and turn into acidic albumins. In the place of greatest contact with acid, a dense dry scab is formed from coagulated protein, acidic albumins and cell fragments. The scab has clear boundaries, depressed along the edges. Around the scab there is redness as a result of a reaction from the blood and lymph vessels.

CHEMICAL BURNS Concentrated alkalis, unlike acids, dissolve and emulsify the fats of the stratum corneum, resulting in a rapid violation of the integrity of the skin barrier. Concentrated alkalis cause the formation of wet necrosis: the scab is loose, off-white in color, easily separated, exposing a bleeding ulcer. In the circumference of the ulcer, inflammation develops.

CHEMICAL BURNS Burns caused by chemical substances are divided into 4 groups depending on the degree of damage: - 1st degree burns are caused by substances that do not have sharply irritating properties of the skin, or substances in small concentrations. Manifested in redness of the skin, accompanied by slight swelling. Swelling and redness have a sharp border and sometimes resemble erysipelas. The burn is accompanied by a burning sensation. Pass in 2-3 days.

CHEMICAL BURNS 2nd degree burns - tissue edema is more pronounced, hyperemia is more intense. Detachment of the stratum corneum of the epidermis by plasma leads to the formation of blisters. The duration of treatment for an uncomplicated burn is from 10 to 20 days.

CHEMICAL BURNS 3rd degree burns are caused by concentrated acids and alkalis. After different periods, from several hours to several days, at the site of redness and swelling, a darkening of the tissue appears or, conversely, its whitening, followed by the formation of a scab. Healing - 2 months or more.

CHEMICAL BURNS Burns of the 4th degree are manifested in deep necrotic damage not only to the skin, but to deeper tissues. Fatal outcomes are possible in the first 6 hours with symptoms of pain shock.

CHEMICAL BURNS (Treatment) The basic principle of first aid for an injured person in contact with a chemical substance on the skin is the immediate removal of this substance. The best remedy for this is a long flush with a stream of water for 1-15 minutes.

CHEMICAL BURNS (treatment) For outpatient treatment of chemical burns, it is best to use dressings with tannins: - 10% solution of tannin in alcohol; - 4 -5% aqueous solution of potassium permanganate; - lead lotion.

Frostbite (congelatio) Local cold injuries - frostbite are relatively rare in childhood - 0.5%. The severity of frostbite is due to: - the intensity of the cold; - duration of exposure; - concomitant factors: - external environment (wind, high humidity, contact with cold objects) - reducing the body's resistance to cooling (exhaustion, overwork,

Frostbite (congelatio) The generally accepted is the 4-degree classification of frostbite (T. Ya. Ariev) 1 degree - the period of tissue hypothermia is short. After warming, the skin of the frostbitten area is cyanotic or marbled. There are no signs of necrosis.

Frostbite (congelatio) 2 degree - the border of skin necrosis passes in the uppermost zones of the papillary epithelial layer. A characteristic feature is the presence of blisters filled with light exudate. Upon recovery, a complete restoration of the normal structure of the skin occurs.

Frostbite (congelatio) 3rd degree - death of all skin elements is observed, blisters contain hemorrhagic exudate, their bottom is insensitive to mechanical irritation. Upon recovery, scars form at the site of the lesion.

Frostbite (congelatio) 4 degree - a deep necrotic process captures the bones and joints of the limb. In the future, mummification or wet gangrene develops. The process ends with the rejection of the dead segment and the formation of a stump.

Frostbite (congelatio) Clinical picture. In contrast to mechanical injury, cold injury is longer in time and has a so-called latent period. Determination of the degree and size of the lesion is possible only by 4-5, and sometimes by 14-16 days after the injury and even later.

Frostbite (congelatio) Clinically, there are: - a period of hypothermia (lasting from several hours to a day or more); - the reactive period that occurs after tissue warming.

Frostbite (congelatio) The manifestation of the disease during hypothermia is characterized by coldness, blanching and loss of sensitivity From the moment signs of acute inflammation appear in the area of the affected segment - pain, hyperemia, edema - a reactive period begins.

Frostbite (congelatio) It is at this time that secondary tissue necrosis occurs due to spasm and thrombosis of blood vessels. There are 4 stages during the reactive period: - shock (the first day); - toxemia (from 2 hours to 10-12 days); - infectious-septic; - reparative, arising after rejection or removal of necrotic masses

Frostbite (treatment) Treatment of frostbite should be aimed at: - reducing pain; - removal of vasospasm; - elimination of edema; - prevention of local purulent process.

Frostbite (treatment) The most effective way to provide first aid is to quickly warm the affected body segment in warm water baths with the obligatory mechanical restoration of blood circulation (rubbing, massage). To improve the general condition, they take measures aimed at general warming, prescribe drugs, heart drugs, and prevent tetanus.

Frostbite (treatment) Local treatment of a frostbitten area includes: - toilet with alcohol; - removal of fragments of the epidermis; - opening of tense bubbles.

Frostbite (treatment) Superficial frostbite of 1st and 2nd degree is treated in an open way, lubricating the affected surface with tannins (an alcoholic solution of iodine, methylene blue). With frostbite 3 and 4 degrees apply bandages with camphor alcohol, Vishnevsky ointment. Electrophoresis with hydrocortisone is effective to combat edema

Frostbite (treatment) The main treatment for deep frostbite is surgery. The nature of surgical interventions depends on the existing local changes and the time elapsed since the injury.

CHILLING (pernio) Chilling can be considered as chronic frostbite of the 1st degree. With severe chills at a young age, skin ulceration and the development of secondary dermatitis are observed.

CHILLING (pernio) Chilling is observed with repeated mild frostbite, and sometimes after a single frostbite, it manifests itself in the form of chronic inflammation of the skin: - red-blue spots with a purple tint; - severe itching. Most often, the hands, feet, nose, and ears are chilled.

HYPOCOOLING, FREEZING Hypothermia, freezing is a pathological decrease in the heat content of the whole body. Factors that reduce the adaptive limits to the effects of low temperatures in children: - relatively large body surface with increased heat transfer; - physiological centralization of blood circulation, which does not reduce heat transfer; - insufficient maturity of the central link of thermoregulation.

HYPOCOOLING, FREEZING Changes in the body caused by hypothermia: - vasospasm of the skin and subcutaneous tissue, followed by trophic disorders; - muscle trembling and subsequent muscle stiffness; - neurohumoral exhaustion (drowsiness, coma, insufficiency of the adrenal cortex, hyperglycemia).

HYPOCOOLING, FREEZING Clinical symptoms (depending on the decrease in body temperature). There are 3 degrees of hypothermia (freezing): 1 degree - body temperature is reduced to 32-30 C, the child is sharply inhibited, shortness of breath, muscle tremors, tachycardia are pronounced. Lowering blood pressure.

HYPOCOOLING, FREEZING Grade 2 - body temperature is reduced to 29-28 C, consciousness is impaired to coma, hyporeflexia, muscle rigidity, respiratory and circulatory depression. Grade 3 - body temperature is reduced to 27 -26 C, clinical death, the duration of which, with hypothermia (freezing), is lengthened.

HYPOCOOLING, FREEZING Treatment. - changing clothes; - gradual warming of the victim; - oxygen therapy, mechanical ventilation (with icing, mechanical ventilation is contraindicated); - cardiopulmonary resuscitation with defibrillation.

Burns are more common in children under 3 years of age. Burns of the I-II degree of the delicate skin of a child are caused by a liquid of even a not very high temperature.

The severity of the condition of the injured child depends on the area of the burn surface, the depth of the burn and the age of the child.

Deep and extensive burns pose a great danger to the life of a child who develops a burn disease. Burn disease has phases: burn shock, acute toxemia, septicotoxemia and convalescence.

Burn shock develops with a 10% deep burn in an adult or 25% superficial.

In a child with a burn II stage. 20% should be expected burn shock, and with a deep burn and a smaller area.

4. Types of cold injury.

frostbite - tissue damage caused by prolonged exposure to low temperatures (below 0 degrees). Distinguish between general freezing and local frostbite of the integument of the body.

Cold, acting on tissues, causes vasoconstriction, which leads to impaired blood circulation in this area of the skin, manifested by blanching of the skin.

If the exposure to cold is not stopped in a timely manner and assistance is not provided, tissue necrosis may occur due to vascular thrombosis.

Depending on the depth of tissue damage, there are 4 degrees of frostbite.

First aid for frostbite.

Do not rub frostbitten areas with snow - there is a risk of skin damage and infection.

An aseptic (I-II stage) or thermally insulating (III-IV stage) bandage is applied to the frostbitten surface of the body. The patient is gradually warmed up in a moderately warm room. The bandage applied on the street is not removed in a warm room.

Layers of heat-insulating bandage:

Aseptic dressing

heat insulating material

3. The victim is given a warm drink to drink.

2 frostbite periods:

a) pre-reactive

b) reactive

First aid is the treatment of frostbite in pre-reactive period. Clinically, during this period, there is a slight tingling, slight pain, coldness, blanching of the skin, anesthesia is objectively noted. Reactive the period begins after the warming of frostbitten tissues. In the pre-reactive period, it is impossible to determine the depth of the lesion.

1st help in the pre-reactive period.

Cessation of cold.

Warming of the limb for 1 hour.

Restoration of blood circulation - local and general methods.

Thermal bandage.

Hot tea, cardiac drugs, intravenous antispasmodics warmed up to 37 0.

epidural blockade.

Antiplatelet therapy - heparin.

Anticoagulant therapy - aspirin, heparin.

Detoxification of the body.

General alkalization - soda intravenously.

Treatment of frostbite in the reactive period:

(general complex therapy)

Warming of the limb, restoration of blood circulation in it.

Local treatment:

AtI – IIArt. warming begins in a general or local bath, in which the water temperature rises from 20 to 40 degrees in 1 hour. At the same time, the limbs are massaged from the periphery to the center. Continue the massage until warming and pinking of the skin. Then the affected areas are wiped with alcohol, covered with a dry aseptic bandage wrapped in a thick layer of cotton wool. The limbs give an elevated position. Spend novocaine blockade according to Vishnevsky, physiotherapy procedures: with Ist. UHF and UFO

AtIIst. The skin is treated with alcohol, bursting blisters are removed or cut at the base. On the hands, the bubbles do not break off. they have a strong coating of the epidermis, which allows you to practically do without a bandage.

With frostbiteIIIst. - blisters are removed, aseptic or ointment dressings are applied (with neutral ointments) or an open method of treatment is used.

If suppuration develops, they are treated according to the principle of treating purulent wounds.

After the appearance of granulations, dressings are applied with Vishnevsky ointment, antibiotics, sulfonamides.

frostbite treatmentIVArt. lies in necrotomy, dissection of dead tissue and necrectomy - removal of them. The operation is performed without anesthesia, usually on the 7th day. The operation of choice is amputation, or articulation in the joint, within healthy tissues.

3. Resuscitation and intensive care.

4. Prevention of tetanus and purulent infection.

5. Measures to improve regeneration processes - high-calorie nutrition, blood transfusion.

6. Measures to improve cardiovascular activity (exercise therapy, cardiac drugs)

7. Means that improve the functioning of parenchymal organs - 20-40% glucose in / in.

8. Fight against intoxication (oxygen therapy).

9. Anticoagulant therapy - heparin IV, IM.