5 ways to determine the area of ​​the burn surface. Burns: area of ​​burns, determined by the rule of the palm. Classification of burns by area and degree of damage. Burn. The main thing is not to get lost

severity thermal injury It is determined mainly by the vastness of the burnt surface, the depth of the lesion of the skin and underlying tissues. Determination of the area and depth of burns as early as possible contributes to correct assessment the severity of the condition of the victim and the choice of the most rational methods of treatment.

Numerous schemes and calculations have been proposed to calculate the total area of ​​burn wounds.

Special Stamp with the image of a silhouette of a person, divided into segments corresponding to 1% of the body surface, suggested by V. A. Dolinin (1960). When making an impression in the medical history, the affected areas are shaded (with different shading depending on the depth of the lesion), and the total area of ​​burns is calculated.

A. Wallace (1951) modified the Berkow scheme, which was widely used under the name "rule of nines". According to this rule, the area of ​​individual areas of the body is equal to or a multiple of 9 and is:

• Head and neck 9%
• Upper limb 9%
• Anterior torso 18%
• Back of the body 18%
• Lower limb: 18%
• thigh 9%
• lower leg and foot 9%
• External genitalia 1%

Without touching on the other proposed schemes and methods, which are mainly of historical interest, it can be noted that the burn areas calculated with their help differ very little. T. Ya. Ariev (1966), analyzing the results of determining the area of ​​the burn with extensive lesions by various doctors, established the difference within ± 5%. For practice, an error of ±200-300 cm2 is not significant, since it does not great influence on prognosis and treatment. From this point of view, the "rule of nines" is quite accurate, despite its simplicity.

To determine the area burn surface as a percentage of total body surface area can be used "rule of the palm". The palm size of an adult is about 1%. skin body. This method can be used as a stand-alone for limited burns located in different parts of the body, to determine the area deep defeat against the background of superficial burns, with subtotal lesions, when it is necessary to determine the area of ​​unaffected areas. AT daily work It is advisable to use a combination of the “rule of nines” and the “rule of the palm”. With their help, the vastness of the burn surface, which is one of the the most important criteria severity of thermal injury.

Numerous classifications of burn wounds are also known. So far, three-degree classifications based on the one proposed in 1607 by Fabrice Hilden (cited by T. Ya. Ariez) are widespread abroad: erythema and swelling of the skin, blistering, skin necrosis.

In our country, the five-degree classification of burns is generally accepted depending on the depth of tissue damage, adopted by the XXVII Congress of Surgeons in 1961.

The degree of damage to the skin and underlying tissues during burns

• Grade I. Skin hyperemia
• Grade II. Detachment of the epidermis with the formation of blisters
• Grade IIIa. The necrosis of the superficial layers of the skin with the preservation of the epithelium of the hair follicles, sweat and sebaceous glands
• Grade IIIb. The death of all layers of the dermis
• Grade IV. Necrosis of the skin and underlying tissues

Separation of burns into superficial and deep due to a number of reasons; the main one is the possibility of restoring the lost skin. With superficial burns, as a rule, independent epithelialization occurs due to the remaining sections of the epithelium. At deep burns accompanied by the death of all layers of the dermis and epithelium, recovery is achieved using autotransplantation. Refusal of it leads to a reduction in the area of ​​deep burn wounds only due to scarring and marginal epithelization, which significantly lengthens the treatment time, leads to the development of numerous complications, and aggravates the patient's condition. Therefore, it is so important for the treatment and prognosis of the disease to accurately determine the area of ​​deep burns and differentiate the degree of tissue damage.

Diagnosis of the depth of damage presents certain difficulties, especially in the first minutes and hours after the burn, when there is an external resemblance various degrees burn. It is possible to most accurately diagnose the depth of the lesion by the 7-14th day.

Clinically on early stages burn disease the depth of burns is determined by the following features.

Grade I - redness of the skin, pastosity or mild swelling of the skin, moderate soreness. After 2-3 days, soreness, swelling, hyperemia disappear, the surface layers of the epidermis are sloughed off.

Grade II - hyperemia and swelling of the skin with exfoliation of the epidermis and the formation of blisters filled with a clear, slightly yellowish liquid, severe pain. The bottom of the burn bladder is pink, moist, shiny tissue,

Grade IIIa - swelling of the skin and underlying tissues. The contents of the burn bladder are yellowish, liquid or jelly-like. The burn wound is bright pink, wet. Tactile and pain sensitivity can be maintained, but more often reduced. In case of burns with high temperature agents, a thin, light yellow or brown scab may form, through which the vessels do not shine through.

Grade IIIb - dense dark red, brown or gray-brown eschar. Before the formation of a dense scab, the affected skin retains a whitish color. Pain sensitivity is completely absent. Hemorrhagic contents of the remaining burn blisters are noted, the bottom of the wound is dull, pale, sometimes with small punctate hemorrhages.

Grade IV - appearance burns is similar to that at the IIIb degree. The lack of function of muscles and tendons makes one think of their defeat. As a rule, in the first hours after injury, IV degree burns can be diagnosed with certainty only with charring.

In diagnosing the depth of a burn lesion, some help can be provided by information about the nature of the thermal agent , time of its impact. Burns from flames, molten metal, superheated steam under high pressure are usually deep. Exposure to high temperature during short-term exposure (burn with a voltaic arc, explosion, burn with boiling water of exposed areas of the body) significantly more often leads to superficial damage to the skin. At the same time, relatively low-temperature agents (hot water, boiling food) with prolonged contact, which occurs when it is impossible to quickly remove clothes soaked in hot liquid, get out of hot bath, divert the jet hot water etc. may cause deep burns.

To determine the depth of burns , in addition to anamnestic data and examination, you can use pain sensitivity research. With superficial burns, it is preserved or somewhat reduced, with deep burns, as a rule, it is absent.

A characteristic symptom of a deep burn of the extremities is edema unaffected distal departments them.

The signs listed above make it possible to relatively accurately determine the depth of the lesion in the first 2 days after the injury. It is not excluded the possibility of "deepening" of superficial burns in the following days due to microthrombosis in the affected area, proteolytic processes and other factors.

To clarify the depth thermal damage in the first days after the injury, the method of infrared thermography can also be used. Studies carried out in our clinic [Smirnov S. V. et al., 1980] made it possible to establish that the deep burn zone is characterized by a decrease in heat transfer, which is manifested by “cold” fields on the thermogram.

The severity of the patient's condition is also determined by age and such a severe lesion as a burn. respiratory tract. Without taking into account these factors, it is impossible to objectively assess the severity of a burn injury.

In everyday practice, this or that type of burn is rarely encountered, a combination of superficial and deep burns, with or without damage to the respiratory tract, etc. is more characteristic. assess the severity of the burn injury.

Such Frank index (1960), which is used to assess the severity of the lesion; to a certain extent, it equalizes burns of different depths: I degree - 0.5 units, II degree - 1 unit, IIIa degree - 2 units, IIIb degree - 3 units, IV degree - 4 units.

The disadvantages of the Frank index are some cumbersomeness, overestimation of the severity of the lesion in first degree burns, and ignoring burns of the respiratory tract. For use in clinical practice more convenient is a modified version of the Frank index - the index of severity of the lesion (ITP), according to which 1% of burns of II-IIIa degree corresponds to 1 unit; 1% deep burns IIIb-IV degree - 3 units. 1st degree burns do not count. In the presence of burns of the respiratory tract, 30 units are added to the severity index of the lesion, determined by the extent and depth of the burns of the skin.

1. Burn II-IV degree (IIIb-IV degree -10%) - 30% of the body surface:

ITP \u003d (30 - 10) + 10 x 3 \u003d 50 units.

2. Burn II-IIIb degree (IIIb-15%) - 40% of the body surface, burn of the respiratory tract:

ITP \u003d (40 - 15) + (15 x 3) + 30 \u003d 100 units.

As can be seen in the modified version, the injury severity index takes into account the extent, depth of burns, as well as damage to the respiratory tract. It allows you to unite into homogeneous groups of patients with burns of different extent and depth, more objectively assess the condition of the victims, conduct adequate therapy at all stages of provision medical care. It is especially important to take this into account in terms of emergency assistance burned, since the clinical manifestations of burn disease and burn shock in particular in some cases are slightly expressed, which makes it difficult to objectively assess the severity of the condition of the burned.

Great importance has a documentary, graphical reflection of the severity of thermal injury - the creation of skizz burns to determine the area of ​​burns (Villvin G. D., 1954; Dolinin V. A., 1960; Rape, 1950; Jaeger, 1954, etc.]. skizzas are widely used in the practice of burn hospitals as one of the forms of graphic documentation.Filled out every 10 days, they allow you to reflect the process of skin restoration in dynamics.

Murazyan R.I. Panchenkov N.R. Emergency care for burns, 1983

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

The principle of determining the area of ​​a burn according to the rule of nines is based on the fact that the entire surface of the body is divided into areas whose area is 9% of the body surface. So, the surface of the head is 9%, the front surface of the body is 9X2 = 18%, the back surface of the body is also 18%, the surface of the thigh is 9%, the lower leg with the foot is 9% and the perineum is 1% (Fig. 13).

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

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

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

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

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

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

Table 1

Calculation of the burn area in children

Body area Burn area depending on age, %

up to 1 year from 1 year to 6 to 12 years 5 years

Head 21 19 15

Upper limb 9 9 9

Trunk front or back 16 15 16

Lower limb 14 15 17

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

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

As a universal predictive test that determines the severity and possible outcome of a burn, both in adults and in children, the Frank index (1966) can be used, but to calculate it, you need to know the area of ​​\u200b\u200ba deep burn. The Frank index is based on the assumption that a deep burn makes the patient's condition three times worse than a superficial burn, so 1% of the superficial burn is taken as the main unit, and a deep burn corresponds to three units. For example, the total burn area is 35% of the body surface, while 20% is deep burns, so the Frank index will be equal to the surface burn area (35 - 20 \u003d 15) plus three times the deep burn area index (20 X 3 \u003d 60). The sum of the indicators of the area of ​​superficial and deep burns (15 + 60 = 75) is the Frank index. If the Frank index is less than 30, then the burn prognosis is favorable, 30-60 is relatively favorable, 61-90 is doubtful, and more than 91 is unfavorable.

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

Burns are also classified according to the etiology of the injury. The largest share in the structure of all burns is thermal burns. They have their own characteristics.

Thermal burns

The intensity of tissue heating depends on several factors: physical characteristics thermal agent (solid, liquid, gaseous); heat transfer method (conduction, convection, radiation, evaporation); from the duration of heating; heat-shielding properties of the protective coating of the skin (thick layer of the epidermis, clothing, etc.).

electrical burns

To date, the constant growth in the number of sources of electricity, associated with the development of scientific and technological progress, certainly increases the level of comfort of life, but, at the same time, causes a high incidence of electrical injuries and electrical burns. Victims of electrical burns account for up to 8% of inpatients in specialized burn units.

Chemical burns

Chemical burn injuries are less common than thermal and electrical ones. They are a consequence of the actions of harmful agents - chemical substances(mainly acids and alkalis). Chemical damage usually much deeper than they appear on first examination. There are five factors that determine the severity of the damage caused by a given chemical agent: The strength of the agent is that inherent quality of the agent that enters into chemical reaction with tissue with greater or lesser intensity; the amount of the agent - depends on the volume of the agent, as well as on the concentration, that is, on the number of agent molecules reaching the tissue; method and duration of contact - the longer and stronger the contact of the agent with the tissue, the stronger and deeper the destruction will be; the degree of penetration - varies greatly depending on the degree to which the agent is neutralized or associated with tissues; mechanism of action - serves as a useful classification of various chemical damaging agents.

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

Figure 9.3.

"The Rule of Nines" it is advisable to use in determining the area of ​​extensive burns. If burns occupy, for example, the head, the front surface of the trunk and the left thigh, then the total area of ​​the lesion in this case will be 36% (9 + 18 + 9).

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

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

The main factor determining the severity of burns is not so much the total area of ​​the burn, but the area of ​​deep damage (burn III6 - IV degree). Therefore, when formulating a diagnosis, it is necessary 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, in the numerator of which is the total area of ​​the burn and next in brackets the area of ​​deep damage (in percent), and in the denominator - the degree of damage (in Roman numerals).

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

Table 9.4.

Figure 9.5.

BURN SCHEME

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

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

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

It is necessary to pay attention to the smell of fuel, because after the delivery of the corpse to the morgue, it can disappear. Taken as 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, knocking it down from 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. However, this posture is characteristic of any corpse (regardless of the cause of death) that has been exposed to a flame for a long time, which contributed to dehydration and more action flexor muscles. Important Conclusion about the lifetime of combustion is done with caution and, as a rule, after a complete examination of the corpse.

One of the most reliable evidence of the lifetime action of the flame is the detection of soot in the respiratory tract, as well as in the esophagus and stomach, and sometimes in 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, such chemical compounds, such as hydrogen cyanide, acrolein, acronicryl, formaldehyde and others, which even in small doses create a total toxic effect or, if detected, can be misleading as to the cause of death, which under 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 liquid intravital bubbles twice more protein than in postmortem.

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

Depending on the degree of the burn, bruises, abrasions are not detected on their surface, and with IV degree burns, even wounds. 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, even a preliminary conclusion, 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. Therefore, it is necessary to pay attention to the fact that the post-mortem hematoma has a sickle-shaped, and not spindle-shaped, shape that compresses the brain; that it 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 is in the fact that when a corpse burns 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. Therefore, an intact or less burned skin area can be seen on a corpse, and knowing the explanation, it is important not to draw an erroneous conclusion about the strangulation furrow.

When burning corpses before, charring burns not only soft tissues but also exposed bones. They 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 cremated in order to conceal the crime due to the fact that it is impossible to identify the person, to resolve the issue of the cause of death, the category of death. Often this difficult action requires preliminary dismemberment of the corpse of an adult and, in the presence of sufficient fuel, depending on its quality, time of at least 8-10 hours. At the same time, 2-3 kg of ash remains and a lot of solid residues in the form of teeth and small bones(especially articular surfaces). It should be noted that the bone remains make it possible to determine the species, the teeth have individual characteristics. Other issues are also resolved on the bone remains. The ash itself is also subjected to research, which allows spectrographic identification of the combustion material, as well as the type and amount of fuel.

In life, each of us has received burns. The area of ​​burns is different, but the sensations are always the same: as if a hot coal is applied to the affected area. And no water, ice or cold compress can't get over this feeling.

A with medical point vision burn is tissue damage caused by the action of high temperature or highly active chemicals, such as acids, alkalis, salts heavy metals. The severity of the condition is determined by the depth of damage and the area damaged tissue. There are special forms of burns obtained from radiation or electric shock.

Classification

The classification of burns is based on the depth and type of damage, but there is a division according to clinical manifestations, medical tactics or type of injury.

By depth, burns are distinguished:

1. The first degree is characterized by damage to only the upper layer of the skin. Outwardly, this is manifested by redness, slight swelling and painful sensations. Symptoms disappear after three to four days, and the affected area of ​​the epithelium is replaced by a new one.
2. Damage to the epidermis down to the basal layer indicates a 2nd degree burn. Bubbles with cloudy contents appear on the surface of the skin. Healing lasts up to two weeks.
3. With thermal damage, not only the epidermis, but also the dermis receives.
   - Grade A: the dermis at the bottom of the wound is partially intact, but immediately after the injury looks like a black scab, sometimes blisters appear, which can merge with each other. Pain at the burn site is not felt due to damage to the receptors. Self-regeneration is possible only if a secondary infection does not join.
   - Degree B: complete loss of the epidermis, dermis and hypodermis.
4. The fourth degree is the charring of the skin, fat layer, muscles and even bones.

Classification of burns by type of damage:

1. Impact high temperatures:
   - Fire - the area of ​​destruction is large, but relatively small depth. Primary treatment is complicated by the fact that it is difficult to clean the wound from foreign bodies (threads from clothing, pieces of melted buttons or zippers).
   - Liquid - a small but deep burn (up to the third A-degree).
   - Hot steam - a significant extent of the burn, but the depth rarely reaches the second degree. Often affects the respiratory tract.
   - Hot objects - the wound repeats the outlines of the object and may have considerable depth.
2. Chemical substances:
   - Acids cause coagulative necrosis, and a scab of coagulated proteins appears at the site of the lesion. This prevents the substance from penetrating into the underlying tissues. The stronger the acid, the closer to the surface of the skin is the affected area.
   - Alkalis form colliquational necrosis, it softens the tissues and the caustic substance penetrates deeply, a 2nd degree burn is possible.
   - Heavy metal salts look like acid burns. They are only 1st degree.
3. Electrical burns occur after contact with technical or atmospheric electricity and, as a rule, occur only at the point of entry and exit of the discharge.
4. Radiation burns can occur after exposure to ionizing or light radiation. They are shallow, and their impact is associated with damage to organs and systems, and not directly to soft tissues.
5. Combined burns include several damaging factors, such as gas and flame.
6. Combined can be called those injuries where, in addition to burns, there are also other types of injuries, such as fractures.

Forecast

Everyone who has ever received burns (the area of ​​burns was more than a five-ruble coin) knows that the prognosis for the development of the disease is an important detail in making a diagnosis. Often patients with injuries are injured in accidents, natural disasters or industrial emergencies. Therefore, people are brought to the emergency room in whole groups. And then the ability to predict change further state the patient will come in handy during triage. The most severe and complex cases should be considered by doctors first of all, because sometimes hours and minutes count. Typically, the prognosis is based on the area of ​​the damaged surface and the depth of the lesion, as well as associated injuries.

In order to accurately determine the forecast, conditional indices are used (for example, the Frank index). To do this, for each percentage of the affected area is assigned from one to four points. It depends on the degree and localization of the burn, as well as on the area of ​​the burn of the upper respiratory tract. If there is no respiratory failure, then the burn of the head and neck gets 15 points, and if there is, then all 30. And then they count all the marks. There is a scale:

Less than 30 points - the prognosis is favorable;
- from thirty to sixty - conditionally favorable;
- up to ninety - doubtful;
- more than ninety - unfavorable.

Damage area

In medicine, there are several ways to calculate the area of ​​the affected surface. Determining the area and extent of the burn is possible if we take as a rule that the surface different parts of the body occupies nine percent of the total skin area, according to this, the head along with the neck, chest, abdomen, each arm, hips, shins and feet each occupy 9%, and the back surface of the body - twice as much (18%). The perineum and genitals received only one percent each, but these injuries are considered quite severe.

There are other rules for determining the area of ​​burns, for example, using the palm of your hand. It is known that the area of ​​the human palm occupies from one to one and a half percent of the entire surface of the body. This allows you to conditionally determine the size of the damaged area and suggest the severity of the condition. The percentage of burns on the body is a conditional value. They depend on the subjective assessment of the doctor.

Clinic

There are several symptoms that can manifest burns. The area of ​​burns in this case does not play a special role, since they are extensive, but shallow. Over time forms clinical manifestations can replace each other in the healing process:

1. Erythema or redness accompanied by redness of the skin. Occurs with any degree of burns.
2. A vesicle is a vesicle filled with a cloudy liquid. It may be contaminated with blood. Appears due to the exfoliation of the upper layer of the skin.
3. A bulla is a series of vesicles that have merged into a single vesicle more than one and a half centimeters in diameter.
4. Erosion is a burn surface on which there is no epidermis. She bleeds, or ichor is released. It occurs during the removal of blisters or bullae, necrotic tissues.
5. An ulcer is a deeper erosion affecting the dermis, hypodermis, and muscles. The value depends on the area of ​​the previous necrosis.
6. Coagulative necrosis - dry dead tissue of black or dark- Brown color. Easily removed surgically.
7. Colliquated necrosis is a wet, rotting tissue that can spread both deep into the body and to the sides, capturing healthy tissues.

burn disease

It is the body's systemic response to burn injury. This state may occur as superficial damage, if the burn of the body is 30% or more, and with deep burns, occupying no more than ten percent. The weaker a person's health, the stronger this manifestation is. Pathophysiologists distinguish four stages in the development of a burn disease:

1. Burn shock. It lasts the first two days, with severe injuries - three days. It occurs due to improper redistribution of fluid in shock organs (heart, lungs, brain, kidneys).
2. Acute burn toxemia develops before the onset of infection, lasts from a week to nine days. Pathophysiologically similar to the syndrome prolonged crushing, that is, the decay products of tissues enter the systemic circulation and poison the body.
3. Burn septicotoxemia appears after the addition of infection. It can last up to several months until all bacteria are eliminated from the wound surface.
4. Recovery begins after burn wounds are closed granulation tissue or epithelium.

Endogenous intoxication, infection and sepsis

A burn of the body is accompanied by poisoning of the body by the products of protein denaturation. The liver and kidneys are almost unable to cope with the increased load when the pressure in the systemic circulation decreases. In addition, after an injury, the human immunity is in a state of high alert, but prolonged poisoning of the body disrupts the defense mechanisms, and secondary immunodeficiency is formed. This leads to the fact that the wound surface is colonized by putrefactive microflora.

Triage of burn victims

Local treatment

There are two ways to treat burns - closed and open. They can be used both separately and together. To prevent infection of the wound, it is actively dried so that dry necrosis appears. This is based on the open method. On the wound surface apply substances such as alcohol solutions halogens that can coagulate proteins. In addition, physiotherapeutic methods such as infrared radiation can be used.

Closed treatment involves the presence of dressings that prevent the entry of bacteria, and drains ensure the outflow of fluid. Under the bandage, drugs are applied that promote wound granulation, improve fluid outflow and have antiseptic properties. Most often, broad-spectrum antibiotics are used for this method, which have a complex effect.