Nausea and vomiting after burns
Introduction
Introduction Nausea and vomiting after burns are one of the early symptoms of burn shock. A common cause is also cerebral hypoxia. Vomiting is generally the contents of the stomach. In severe shock, there may be brown or bloody vomit, suggesting severe congestion, edema or erosion of the digestive tract mucosa. When the amount of vomiting is too large, acute gastric dilatation or paralytic ileus should be considered.
Cause
Cause
Due to cerebral hypoxia, it is a symptom of burn shock.
Nausea and vomiting: mainly caused by hypoxia in the brain and digestive tract and edema of the gastric mucosa. Unreasonable drinking water and eating after injury can also cause nausea and vomiting.
Examine
an examination
Related inspection
Urine routine blood routine
According to the history of burns and nausea and vomiting, it is possible to diagnose whether there is cerebral hypoxia due to burns and take corresponding measures as soon as possible.
Close observation, accurate record: make a record of the amount of access, from the time of injury, within the first 48 hours after the injury, the first and second 24 hours summary, and each of them is summarized once every 8 hours, calculate the colloid, Crystal and moisture input, including oral intake. The output includes: urine volume, vomiting volume, stool volume, and gastrointestinal decompression discharge. Body temperature, pulse, and breathing: These 3 vital signs should be tested once every 2 hours and recorded. Blood pressure should also be measured regularly.
The degree of burn varies depending on the temperature and duration of the action. Local changes can be divided into four degrees:
First degree: congestion due to vasospasm.
Second degree: the formation of serum-filled burn vesicles.
Third degree: tissue necrosis.
Fourth degree: carbonization of the organization.
When burned, the amount of lactic acid in the blood increased, the pH of the arteriovenous blood decreased, and the anoxemia increased with the increase of tissue capillary dysfunction. Clinical experience has shown that burns can be life-threatening when they reach more than one-third of the body surface area.
Most people think that high temperature is the only cause of burns, however, certain chemicals and currents can also cause burns. The skin is often only part of the body burns, the subcutaneous tissue may also be burned, and even if there is no skin burn, there may be internal organ burns. For example, drinking a very hot liquid or corrosive substances (such as sulfuric acid) can burn the esophagus and stomach. In a building fire, inhalation of smoke or hot air may cause lung burns. Burned tissue may be necrotic. When tissue burns, fluid exudation in the blood vessels causes tissue edema.
In large-area burns, vascular permeability is abnormal, and a large amount of fluid is lost, which may cause shock. At shock, blood pressure is low and blood flow to the brain and other vital organs is reduced. Electric burns are caused by high temperatures above 5000 °C when current flows through the body, sometimes referred to as arc burns.
At the point where current enters the body, the skin is often completely destroyed and burnt. Because the skin resistance of the contacted charged body is high, a large amount of electrical energy is converted into heat there to burn the surface. Most electrical burns also severely damage the subcutaneous tissue, and the extent and depth of the burn varies. The range of impact may be much larger than the area of burned skin. Severe electrical shock can cause apnea, irregular heartbeat, and cause dangerous heart rate disorders. Chemical burns can be caused by a variety of irritating and toxic chemicals, including strong acids, strong bases, phenols, toluene (organic solvents), mustard gas, phosphorus, and the like. Chemical burns can cause tissue necrosis and slowly spread a few hours after burns.
Diagnosis
Differential diagnosis
In order to better recommend patients to burn centers in different fields in a timely and effective manner, the American Burn Association has developed a differentiation system to help doctors make faster decisions and judgments in the first place. Under this system, burns are divided into severe, moderate, and mild degrees. This is measured by a series of factual factors, such as the total surface area of the burn (TBSA), whether it hurts the critical anatomical area, the patient's age and associated injuries.
Severe burn
* People between the ages of 10 and 50: burns above the second degree account for more than 25% of the total surface area.
* People younger than 10 years old and older than 50 years old: burns with a shallow second degree or more account for more than 20% of the total surface area.
* Third or third degree burns account for more than 10% of the total surface area.
* Any burn involving the hands, face, feet or perineum.
* Burns cover the main joints.
* A burn around a random part of the limbs
* Any burn that hurts the respiratory tract.
* Electric burn
* Burns combined with fractures or other traumatic injuries
* Infant burns
* Burns occur in high-risk groups that are prone to complications
The above types of burns require the patient to be sent to a professional burn department as soon as possible.
Moderate burn
* People between the ages of 10 and 50: burns above the second degree account for between 15% and 25% of the total surface area.
* People younger than 10 years old and older than 50 years old: burns with a shallow second degree or above account for 10% to 20% of the total surface area.
* Third or third degree burns account for between 2% and 10% of the total surface area.
The above types of burn patients need immediate medical attention for burn diagnosis and treatment.
Mild burn
* People between the ages of 10 and 50: burns with a shallow second degree or more account for less than 15% of the total surface area.
* People younger than 10 years old and older than 50 years old: burns with a shallow second degree or more account for less than 10% of the total surface area.
* Third or third degree burns account for less than 2% of the total surface area.
The above types of burn patients need immediate medical attention.
3) Calculated according to area
Burns can also be distinguished by total surface area ratio (TBSA) and then by depth. Once burns (only erythema, no bubbles) are not included. The commonly used method, called the nine-point method, helps doctors quickly determine the body surface area of a patient's injury.
A more precise method is to distinguish between different proportions of the body of an adult and a child through the Lund-Broude table. A person's hand (palm and finger) is about 1% of the total surface area. The actual average surface area should be 0.8%, so using 1% may slightly overestimate the burn area. 10% of children with burns and 15% of adult burns may have a life-threatening risk due to reduced blood volume and need to be infused as soon as possible and monitored in the burn department.
