severe burns
Introduction
Introduction Extra-heavy burns refer to those whose area >51% or III-degree area >21% or more, which seriously endangers the patient's life. If the early treatment (within 48 hours after injury) is improperly handled, it will greatly increase the mortality and disability rate.
Cause
Cause
Wounds are the main source of systemic infections. For large-area III-degree burns, early cuts are taken, and the wounds are immediately covered with allogeneic skin (or xenogenic skin) and autologous skin. At the same time, deep necrotic tissue should be removed. For the infected area (ie, wound sepsis), the lesion should be removed immediately. For electric shock, combined crush injury, and ring-shaped III degree burn, special attention should be paid to deep muscle necrosis. When the local swelling continues to retreat, the fascia should be cut and reduced in time, and the stench and the symptoms of systemic poisoning should be aggravated. The submucosal exploration should be performed on the suspicious part as soon as possible to completely remove the necrotic muscle and pay attention to the presence or absence of anaerobic. Bacterial infection.
Examine
an examination
Related inspection
Blood electrolyte examination, renal function test, blood routine
Diagnosis: The surface of the burn can be white, soft or black, charred leather. Since the burnt skin becomes pale, it is often mistaken for normal skin in white-skinned people, but it does not change color when pressed. Destroyed red blood cells can make the skin of the burn appear bright red, occasionally blisters, and the hair in the burned area is easily pulled out and the feeling is reduced.
Diagnosis
Differential diagnosis
Differential diagnosis:
1. Chemical burns:
Chemical burns are more complicated than simple thermal burns. Because of the nature of the chemical itself, the damage to the tissue is different, so it has its characteristics in emergency treatment.
The common chemical burns are described as follows:
1, strong acids: strong acids such as hydrochloric acid, sulfuric acid, nitric acid, aqua regia (hydrochloric acid and nitric acid). Carbolic acid, etc., when the skin is injured, due to its concentration, liquid volume, area and other factors, resulting in different weight and damage.
The contact of the acid with the skin immediately causes the coagulation of the tissue protein to dehydrate the tissue and form a thick sputum. The formation of thick sputum prevents the acid from continuing to penetrate deep tissue and reduce damage. It is extremely beneficial to the health of the wounded.
Burns of hydrochloric acid and carbolic acid, the wound surface is white or grayish yellow; the wound surface of sulfuric acid is brown; the wound of carbonic acid is yellow.
If it is soaked through clothes, it should be removed immediately, and the wound surface should be washed repeatedly with plenty of water. After thoroughly washing, neutralizer can also be used - weak alkaline liquid such as baking soda (sodium bicarbonate), soapy water . Carbolic acid burns are neutralized with alcohol. Nitric acid burns are neutralized with a negligible solution and the effect is better. However, if there is no neutralizing agent, it is not necessary to force it, because sufficient water washing is the most fundamental measure.
2, strong bases: strong bases such as caustic (potassium hydroxide, sodium hydroxide), lime and so on.
Strong bases are more destructive to tissues than strong acids. Because of their strong permeability, deep tissue dehydrates cells, dissolves tissue proteins, and forms strong base protein compounds to deepen the wound surface.
If the alkaline solution is soaked in the clothes, immediately remove the contaminated clothing and rinse the wound thoroughly with plenty of water.
After thorough cleaning, dilute hydrochloric acid, dilute acetic acid (or vinegar) neutralizing agent can be used, and then neutralized with sodium bicarbonate solution or alkaline soap. Depending on the situation, ask the doctor to take other measures.
3. Phosphorus: Phosphorus burns are often seen in industrial and agricultural production. Phosphorus bomb explosions often cause burns during wartime. Phosphorus and phosphorus compounds are highly flammable in air and oxidized to phosphorus pentoxide. The wound can smoke during the day. There is phosphorescence at night. This is why phosphorus continues to burn on the skin. Therefore, the wound surface is deeper, and phosphorus is a highly toxic substance that can cause systemic poisoning after being absorbed by the body.
Phosphorus is highly toxic to the liver, causing necrosis of hepatocytes and hepatic steatosis; it can cause extensive bleeding to vascular injuries: it is toxic to the kidneys, heart muscles and nerves.
Phosphorus poisoning patients generally have exhaustion, dizziness, headache, general malaise, pain in the liver area, swelling, jaundice, and abnormal liver function. Less urine, urine examination of red brain, protein, can also see hematuria, severe urinary closure. Subcutaneous capillary hemorrhage, visible purple sputum (red small bleeding point, the pressure does not fade). In severe cases of liver damage, toxic hepatitis can occur, and acute yellow liver atrophy can cause death.
The principle of first aid treatment is to extinguish the phosphorus and then wrap it with the relevant liquid. If phosphorus is still burning on the skin, it should be quickly extinguished and rinsed with plenty of water. After rinsing, carefully observe the presence or absence of residual phosphorus, or observe it in the dark. If there is light, remove it with a small forceps. The portion was covered with a 1% copper sulfate gauze so as to cause residual phosphorus to form black diphosphorus tri-copper, which was then washed away. It can also be washed with 3% hydrogen peroxide or 5% sodium hydrogencarbonate solution to oxidize phosphorus to phosphoric anhydride. If there is no such liquid, it can be washed with a large amount of water.
General burns are often used in the oil yarn layout department, but should be disabled in the case of phosphorus injury. Because phosphorus is easily soluble in oil, it causes the body to absorb and cause systemic poisoning. Instead, it is applied with 2.5% sodium bicarbonate solution for two hours, and then wrapped with dry gauze.
For systemic patients, the main treatment is to protect the liver, such as intravenous injection of 50% hypertonic glucose solution, or intravenously 5-10% glucose solution, adding a large amount of vitamin C. Take other liver protection drugs such as Liver. Kidney damage, proteinuria, hematuria, can be applied with alkaline drugs such as sodium bicarbonate, bed rest. For bleeding, apply vitamin K. Treat symptomatic treatment for shock or other serious conditions.
2. Electric burns:
The local damage caused by the current passing through the human body is called electric burn. The clinical manifestations are entrance and exit, often elliptical, generally limited to the contact area of the electrical conductor, but the actual damage is deep, reaching the muscles, bones or internal organs, and the entrance is more serious. The appearance of local yellow brown or browning, severe tissue completely carbonized, coagulated, neat edges, dry, early pain is mild, edema is not obvious, but after 24 to 48 hours, the surrounding tissue showed inflammatory reaction and obvious edema. The surrounding skin of electric burns is often burned by electric sparks or clothes, and it is usually deep burns.
As the current passes through the skin, it rapidly moves along the body fluids and blood vessels (the blood contains electrolytes, which are easy to conduct), causing damage to adjacent tissues and blood vessel walls, and denaturation and thrombosis occur. Progressive tissue necrosis began to appear around a week after the injury, and the wounds expanded and deepened. In severe cases, there were groups of muscle gangrene; or major bleeding due to rupture of blood vessels.
Diagnosis: The surface of the burn can be white, soft or black, charred leather. Since the burnt skin becomes pale, it is often mistaken for normal skin in white-skinned people, but it does not change color when pressed. Destroyed red blood cells can make the skin of the burn appear bright red, occasionally blisters, and the hair in the burned area is easily pulled out and the feeling is reduced.
