Because Huozhuo, electricity, corrosive, or the role of radiation caused by bodily injury, characterized by varying degrees of skin damage and congestion, often blisters; in severe cases can be organized burned, according to the scope and extent of burn points as once, second degree or third degree burns
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Definition and four degree
Also known as burns. Direct contact with hot objects or body subject to change strong heat radiation occurs. Burn (burn): the damage flame, heat the solid and strong radiation burns caused by heat is called. Burns is tissue damage from the heat, caused by chemicals or electricity. Degree burns from the high and low temperature, the length of duration of action and different. Local variations can be divided into four degrees. First degree: paralysis due to vascular congestion. Second degree: the formation of blisters filled with serum burns. Third degree: tissue necrosis. Fourth: the organization of charring. When visible burn the amount of lactate in the blood increases, the lower the ph value of arterial and venous blood, capillary tissue dysfunction with emphasis anoxaemia (anoxemia) is weight. Clinical experience has shown that there can be life-threatening burns when more than one third of the body surface area. Most people think that the only reason for the high temperature caused by burns, however, certain chemicals and currents can cause burns. Skin burns often only part of the body, the subcutaneous tissue may be burned, even when no skin burns, burns may also have internal organs. For example, the drink into a very hot liquids or corrosive substances (such as acids, etc.) can burn the esophagus and stomach. In a building fire, smoke inhalation or hot air may cause lung burns. Necrotic tissue may burn. When tissue burns, intravascular fluid leaking cause tissue edema. When a large area burns, abnormal vascular permeability, lost a lot of liquid, can cause shock (see section 24). Shock, low blood pressure, brain and other vital organs flowing blood flow reduction. Electrical burns is to produce a high temperature above 5000 ℃ caused by the current flowing through the body when, sometimes called arc burns. In the current into the body, the skin is often completely destroyed and burnt (see section 278). Because skin contact resistance is high charged body, a lot of energy into heat at the surface, where burns. Most electrical burns also seriously damage the subcutaneous tissue, the scope and depth of the burn varies. Sphere of influence may be much larger than the area of skin burns. Severe electrical shock can apnea, cardiac arrhythmia, caused dangerous heart disorder. By various chemical burns and irritation caused by toxic chemicals, including acids, alkalis, phenol, toluene (organic solvent), mustard gas, and phosphorus. Chemical burns can cause tissue necrosis and slowly extended hours after the burn.
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Symptom
The severity of the burn depends on the scope and depth of the injured tissue, burn depth can be divided into Ⅰ degree, degree Ⅱ and Ⅲ degree. Ⅰ degree burns damage the lightest. Burns skin redness, pain, tenderness, drainage, or edema. Gently press the injured area when local white, but no blisters. Deep Ⅱ degree burn injuries. Skin blisters. Red or white bottom blisters filled with clear, viscous liquid. When sensitive tenderness white oppression. Ⅲ degree burns damage the most. You can burn the surface of white, soft or black, leather-like charring. As the burned skin becomes pale, white skin in humans is often mistaken for normal skin, but no discoloration oppression. Partial destruction of red blood cells can burn the skin was bright red, occasional blisters, hair pulled out easily burn area, hypoesthesia. Ⅲ degree burn area is generally no pain. Because the nerve endings in the skin are destroyed. After a few days after the burns often can distinguish deep Ⅱ and Ⅲ degree burns.
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Prognosis
Depending on the depth of burn healing and burn site. Superficial burns (Ⅰ degree or superficial Ⅱ degree burns), necrosis of the skin off, cover the bottom of the epidermal growth again, almost no scar. Such deep dermal burns skin undamaged. Dermis can not regenerate. Deep dermal burn injury. Grow new skin epidermis from the wound edge and the remnants of the burn area is very slow. Therefore, it is very slow to heal and leave a large scar. Skin burn area shrinkage, deformation, affecting functionality. Esophagus, stomach and lungs minor burns healed. However, a more serious burns can produce scarring and scar contracture. Esophageal scarring can lead to difficulty in swallowing, respiratory scar affect normal oxygen exchange.
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Treatment
Burns about 85% are not serious, can be treated at home, clinic or hospital emergency room. Stripped of all clothing, especially clothing had burned burn (eg burning melting synthetic shirt), contaminated with chemicals or hot tar-soaked clothing, help prevent further burns. Chemical burn burns, including acids, alkalis and organic compounds, immediately wash with plenty of water. One of the following circumstances, the best to the hospital for treatment: Face, hands, feet and genitals burn There are difficulties in family therapy burns Burns at 2 years of age or over 70 years Internal organs burns
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Minor burns
Minor burns should be possible immediately immersed in cold water. Chemical burns rinse with plenty of water for a long time. In the clinic or emergency room, the application carefully clean the wound with soap and water to remove all residues. If dirt embedded deeper in under local anesthesia, with the scrub brush. Has been broken or easily broken blisters usually have to be removed. After cleaning the wound, to applying antibiotic ointment such as silver sulfadiazine. Common gauze bandage to protect the wound from contamination and further trauma. Keep the wound clean is very important, because once the damage may begin to infect the skin and are easily spread. Antibiotics may help prevent infection, but is not always necessary. If you are not vaccinated, tetanus antitoxin should be. Upper or lower extremity burns, it should be kept in a position a little higher than the heart to reduce edema. Only be possible at the hospital to keep this position, where the bed components can be raised and used for traction. If Ⅱ degree joints or Ⅲ degree burns must splint joints, joint activities can worsen the trauma. Many burn patients need to use analgesics, anesthetics are usually, at least use a few days.
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Severe burns
Life-threatening severe burns require immediate treatment, it is best to have a specialist burns hospital for treatment. Emergency personnel use oxygen masks to the wounded, to mitigate the effects of fire on carbon monoxide and toxic gases wounded. In the emergency room, medical staff should remain unobstructed breathing wounded, check whether there is another life-threatening wounds and begin fluid and prevent infection. Sometimes severely burned patients into hyperbaric oxygen therapy needed, but not widely used, but must be carried out within 24 hours after the burn. If in the fire, burns the respiratory tract and lungs, can help smooth breathing intubation. The need for intubation according to factors such as the frequency of breathing, breathing too fast or too slow can not inhale enough air to the lungs effectively and put enough oxygen to the blood stream. Facial burns or laryngeal edema affecting the respiratory required intubation. Sometimes in an enclosed space explosion or fire, and when people burn the nose and the mouth was found charred soot or nose, suspected respiratory tract burns, and required intubation. Breathing normally, with oxygen mask oxygen. After the wound clean, applying antibiotic ointment or ointment; then covered with sterile gauze. Two or three times a day to replace the gauze. Deep burns easily cause serious infection, should intravenous antibiotics. According to the wounded before vaccination, to determine whether tetanus antitoxin. Extensive burns can cause life-threatening loss of body fluids, intravenous fluids must. Deep burns may cause myoglobinuria, because myosin released from injured muscle out damage the kidneys. If the liquid supplement is not enough, it will cause kidney failure. Burn thick crust formed on the surface of skin, called eschar, which affect the wound gradually tightening blood circulation. If the wound around the upper or lower limbs, blood circulation is limited eschar may have serious consequences. Eschar release should be cut below normal tissue. If the wound is small (no more than a coin) Just keep it clean, even deep burns, may also be self-healing. If the underlying dermis damaged area is larger, and often require skin grafts. Healthy skin graft skin grafting needed, can be taken from the patient's own does not burn burn site (autologous graft), can also be obtained from other living or dead body (allogeneic graft) or other types of animals (heterologous graft), commonly pigskin, because It is very similar to human skin. Autologous skin grafting is permanent, taken from another person or animal skin graft is temporary, is a measure of the wound healing process in order to protect the wound and take 10 to 14 days after the body should be excluded. To reduce scarring and possible retention capabilities, often require physical therapy treatment and fixed as soon as possible with the joint splint to keep the functional position to prevent excessive muscle tension and skin contracture. Plywood has been retained to wound healing. Before skin grafting, using various methods of joint exercises, increased activity, maintain normal joint range of motion. Skin grafting, graft site splint application of 5 to 10 days, after a successful skin graft recovery exercise. During the healing of burn patients to consume more calories and nutrition. Difficulty eating people can drink solution or by nasogastric tube feeding nutrition. Severe burns take a long time to heal, and some even take years, so the patient may become very frustrated. Most burn centers by social workers, psychiatrists and other personnel to provide psychological support to these patients. [Interpretation] burn medicine, nonaggressive. Refers to an injury due to boiling water (oil), light, fire, electricity, radiation, or chemical effect caused by the human body. See "Qian Jin Yi Fang" Volume XX. Also known as fire sores, soup poured fire, soup burns. Qingqian usually does not affect the function of internal organs, appears only in partial flush, blistering, or rot; severe damage area is large and deep, resulting Huosheng Shangyin, very toxic heat Chi, Yin Ye Hao Shang body. And even then the heat toxin attack, or blood deficiency and other systemic symptoms, clinically visible thirst, fever, constipation, dysuria or even irritable, restless, coma and delirium. Treatment of light just outside the rule, with Burnet, rhubarb same amount, borneol a little powder, sesame oil dressing. Heavy advised syndrome differentiation, detoxification, cool camp Xifeng, or solid-gas Yin, Yang deficiency, multiple choice HJD Xijiaodihuang soup, soup or antelope Uncaria Shengmaisan, Shen Fu flavored soup If the duration of the course of time, Haoshang blood who advised qi and blood, can Bazhen decoction. External treatment methods include surface cleaning sores, blisters treatment, clear skin graft eschar or other items. These creams can be applied wound, severe cases should be timely emergency treatment in Western medicine.
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Severe burns
Life-threatening severe burns require immediate treatment, it is best to have a specialist burns hospital for treatment. Emergency personnel use oxygen masks to the wounded, to mitigate the effects of fire on carbon monoxide and toxic gases wounded. In the emergency room, medical staff should remain unobstructed breathing wounded, check whether there is another life-threatening wounds and begin fluid and prevent infection. Sometimes severely burned patients into hyperbaric oxygen therapy needed, but not widely used, but must be carried out within 24 hours after the burn. If in the fire, burns the respiratory tract and lungs, can help smooth breathing intubation. The need for intubation according to factors such as the frequency of breathing, breathing too fast or too slow can not inhale enough air to the lungs effectively and put enough oxygen to the blood stream. Facial burns or laryngeal edema affecting the respiratory required intubation. Sometimes in an enclosed space explosion or fire, and when people burn the nose and the mouth was found charred soot or nose, suspected respiratory tract burns, and required intubation. Breathing normally, with oxygen mask oxygen. After the wound clean, applying antibiotic ointment or ointment; then covered with sterile gauze. Two or three times a day to replace the gauze. Deep burns easily cause serious infection, should intravenous antibiotics. According to the wounded before vaccination, to determine whether tetanus antitoxin. Extensive burns can cause life-threatening loss of body fluids, intravenous fluids must. Deep burns may cause myoglobinuria, because myosin released from injured muscle out damage the kidneys. If the liquid supplement is not enough, it will cause kidney failure. Burn thick crust formed on the surface of skin, called eschar, which affect the wound gradually tightening blood circulation. If the wound around the upper or lower limbs, blood circulation is limited eschar may have serious consequences. Eschar release should be cut below normal tissue. If the wound is small (no more than a coin) Just keep it clean, even deep burns, may also be self-healing. If the underlying dermis damaged area is larger, and often require skin grafts. Healthy skin graft skin grafting needed, can be taken from the patient's own does not burn burn site (autologous graft), can also be obtained from other living or dead body (allogeneic graft) or other types of animals (heterologous graft), commonly pigskin, because It is very similar to human skin. Autologous skin grafting is permanent, taken from another person or animal skin graft is temporary, is a measure of the wound healing process in order to protect the wound and take 10 to 14 days after the body should be excluded. To reduce scarring and possible retention capabilities, often require physical therapy treatment and fixed as soon as possible with the joint splint to keep the functional position to prevent excessive muscle tension and skin contracture. Plywood has been retained to wound healing. Before skin grafting, using various methods of joint exercises, increased activity, maintain normal joint range of motion. Skin grafting, graft site splint application of 5 to 10 days, after a successful skin graft recovery exercise. During the healing of burn patients to consume more calories and nutrition. Difficulty eating people can drink solution or by nasogastric tube feeding nutrition. Severe burns take a long time to heal, and some even take years, so the patient may become very frustrated. Most burn centers by social workers, psychiatrists and other personnel to provide psychological support to these patients. [Interpretation] burn medicine, nonaggressive. Refers to an injury due to boiling water (oil), light, fire, electricity, radiation, or chemical effect caused by the human body. See "Qian Jin Yi Fang" Volume XX. Also known as fire sores, soup poured fire, soup burns. Qingqian usually does not affect the function of internal organs, appears only in partial flush, blistering, or rot; severe damage area is large and deep, resulting Huosheng Shangyin, very toxic heat Chi, Yin Ye Hao Shang body. And even then the heat toxin attack, or blood deficiency and other systemic symptoms, clinically visible thirst, fever, constipation, dysuria or even irritable, restless, coma and delirium. Treatment of light just outside the rule, with Burnet, rhubarb same amount, borneol a little powder, sesame oil dressing. Heavy advised syndrome differentiation, detoxification, cool camp Xifeng, or solid-gas Yin, Yang deficiency, multiple choice HJD Xijiaodihuang soup, soup or antelope Uncaria Shengmaisan, Shen Fu flavored soup If the duration of the course of time, Haoshang blood who advised qi and blood, can Bazhen decoction. External treatment methods include surface cleaning sores, blisters treatment, clear skin graft eschar or other items. These creams can be applied wound, severe cases should be timely emergency treatment in Western medicine. Burn area is estimated: China nine points of law: estimation method based on actual body surface area obtained for evaluation of a large area burns, the whole body surface area is divided into 11 equal portions 9%, plus 1%, constituting 100% of that head. Neck = 1 * 9%: two upper = 2 * 9%; torso = 3 * 9%; lower limbs = 5 * 9% +1%, for a total of 11 * 9% +1% can be abbreviated as: 3 , 3,3 (head face neck), 5,6,7 (hands, forearms, double arm), 13, 13 (front trunk, the trunk), a (perineum), 5,7,13,21 (Shuangtun , both feet, both legs, two thighs)
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Disease Encyclopedia
Disease name: Burn Diseases Code: 949.001 Home system: Other Medication program: First aid and transport to lift causes of injury, do on-site rescue and recovery, protect the wound, good transport preparations. Prevention and treatment of burn shock burn shock is more common in severe burns. Early conscious thirst, restlessness, nausea, vomiting, decreased urine output. Appears fast heart rate, pulse, blood pressure drops. Tip shock. Severe burns, even when no shock performance also should shock therapy. Oral burns to drink (100ml water and add sodium chloride 0.3g, sodium bicarbonate 0.15g). There are symptoms of shock and have the infusion conditions, you should immediately establish intravenous access, input and colloidal liquid crystals. Generally half the amount of colloidal crystals and supplies. Liquid crystal Ringer lactate solution or balanced, with plasma colloid is preferred times for dextran. Fluid volume calculations adult per kilogram of body weight per 1% burn area fill 1.5ml, children make up 1.8ml, baby fill 2.0ml; together with the date of the physiological requirements (Adult 2000ml, children 60 ~ 80ml/kg, baby 100ml/kg ) to supply 5% glucose solution. 8h supply the calculated amount of the front half, the two's complement 8h a total of 1/4. The second first day computing 24h fill 1/2, plus physical requirements. But since there are differences in the burn patient's condition and the condition of the body, fluid effects are also different, therefore, must be closely observed changes in perfusion according to the amount of urine, changes in consciousness and peripheral circulation, timely adjustment. The main principles of burn wound treatment is to relieve pain, prevent wound infection and deepened, early removal of necrotic tissue and skin grafting wound closure. 6 ~ 8h after injury, you should seek as soon as possible in aseptic conditions downstream debridement. When there is shock, should anti-shock therapy. Improved after removal. Often with soap and water to clean the skin around the water rinse hair after shave, cut nails. 1:1000 Bromogeramine wound with saline solution and wash the wound several times and wipe clean with a cotton ball or gauze to remove pollution degrees. Full-sized blisters can cut a small opening in the low subretinal fluid. The contaminated skin exfoliation cut off. Then using the dressing or exposure therapy according to the condition and location. ⑴ bandaging: After debridement, place a layer of oil on the wounds of antibiotic-soaked gauze or gauze, plus washing strong sterile gauze pad or surface dressing. Moderately elastic, uniform pressure, means (toe) separated with gauze to avoid adhesions. Joints to maintain functional position. Ⅱ degree of contamination of the wound is usually used for light, multi-purpose limbs. After dressing, superficial Ⅱ degree burns, when there is no obvious infection, may not have to change dressings, about two weeks to heal. Deep Ⅱ degree oozing more frequent replacement of the outer layer of the dressing to keep the wound dry, infection, should be promptly cut off or change dressings. Foci open to facilitate drainage. ⑵ exposure therapy: After debridement, the wound does not cover any dressing. Can be coated with the convergence of anti-inflammatory effect of drugs or directly exposed to warm, dry air, so that the wounds quickly dry scab and reduce the chances of infection. Suitable for head, face, perineum and Ⅲ degree burns or serious pollution Ⅱ degree burns. Exposure therapy must have certain conditions, such as wards clean, warm equipment, must be frequently changed and sterile gauze pad sheets, to regularly stand up and so on. Ⅲ degree burn can also be made of 2% iodine scab. Conditional when deep Ⅱ degree above the wound, according to the site, the situation and the size of the area of the patient, using tangential excision, excision and grafting or eroded by the scab off fast skin grafts. Prevention and treatment of sepsis, burn burn sepsis usually occurs when the absorption of edema back (after injury 48 ~ 72h) and eschar separation or extensive excision. Few occur together with shock, saying the outbreak of septicemia. In fact, when the wound healed, bacteria are likely to invade the blood circulation, especially when the body resistance is lowered, more likely. The main clinical manifestations are sudden high fever of 39 ℃ or more, with the cold station or below 36 ℃. Shallow and rapid breathing, rapid pulse. Irritability, and soon transferred to a semi-conscious or unconscious. Nausea, vomiting, abdominal distension. Necrotic tissue increased, the smell. White blood cell and neutrophil counts were significantly elevated or reduced. Mostly positive blood culture. Control measures: proper handling and early wound closure can significantly reduce sepsis, wound infection should be promptly removed. The most common aerobic bacteria, fungi, and another small amount of anaerobic bacteria. It should be rational use of antibiotics, the principle is early enough, in combination. General use penicillin after burn within 2 ~ 3d, around back and wide excision of absorption to be replaced potent cephalosporins and aminoglycosides. There culture and sensitivity results should be timely exchange of sensitive antibiotics. Amphotericin choice for fungal infections, such as Nystatin, against Pseudomonas aeruginosa infection choice amikacin, piperacillin, ceftazidime and other drugs. Severe nutritional support, especially the sick and wounded with severe burn metabolic changes are ultra high metabolism, the best way is to complement the nutritional intake of protein, carbohydrates, fats through the gastrointestinal tract, replenishing essential vitamins and trace elements, arginine and glutamine supplements etc., not oral using total parenteral nutrition (TPN). Also note that water, electrolyte, acid-base imbalance corrected.
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Wikipedia Encyclopedia
shaoshang Burn burn Burns. Thermal (flame, hot gases, liquids or solids, etc.) caused by the damage. Because of pathology and clinical course of energy, chemicals, radiation-induced tissue damage, such as thermal burns with very similar, the ancient capital will go to burn its category. Burns covering more than 30%, Ⅲ degree burns covering more than 10%, or severe burns if not handled properly can be fatal. Past that burns covering more than 70% can not be cured. 1958 Shanghai Ruijin Hospital (formerly Kuangtse Hospital) heal burns covering 89%, Ⅲ degree burns up to 23% of the steel workers Chiu Choi Kang opened a new chapter in the history of medicine burns. Since then, the level of China's treatment of burns has been in the forefront of the world. The biggest area of burn patients heal at home and abroad is the First Affiliated Hospital of Zhongshan Medical University burn unit cure burn area 100%, Ⅲ degree burns up to 96% and severe inhalation injury patients Hewei Ting.