The skin consists of the following layers:
- epidermis ( outer part of the skin);
- dermis ( connective tissue of the skin);
- hypodermis ( subcutaneous tissue).
Epidermis
This layer is superficial, providing the body with reliable protection from pathogenic environmental factors. Also, the epidermis is multi-layered, each layer of which differs in its structure. These layers provide continuous renewal of the skin.The epidermis consists of the following layers:
- basal layer ( provides the process of reproduction of skin cells);
- spiny layer ( provides mechanical protection against damage);
- granular layer ( protects underlying layers from water penetration);
- shiny layer ( participates in the process of keratinization of cells);
- stratum corneum ( Protects the skin from invasion of pathogenic microorganisms).
Dermis
This layer consists of connective tissue and is located between the epidermis and hypodermis. The dermis, due to the content of collagen and elastin fibers in it, gives the skin elasticity.The dermis is made up of the following layers:
- papillary layer ( includes loops of capillaries and nerve endings);
- mesh layer ( contains vessels, muscles, sweat and sebaceous glands, as well as hair follicles).
Hypodermis
This layer of skin is made up of subcutaneous fat. Adipose tissue accumulates and retains nutrients, due to which the energy function is performed. Also, the hypodermis serves as a reliable protection of internal organs from mechanical damage.With burns, the following damage to the layers of the skin occurs:
- superficial or complete lesion of the epidermis ( first and second degree);
- superficial or complete lesion of the dermis ( third A and third B degrees);
- damage to all three layers of the skin ( fourth degree).
It should also be noted that with burn lesions, the protective function of the skin is significantly reduced, which can lead to the penetration of microbes and the development of an infectious-inflammatory process.
The circulatory system of the skin is very well developed. The vessels, passing through the subcutaneous fat, reach the dermis, forming a deep cutaneous vascular network at the border. From this network, blood and lymphatic vessels extend upward into the dermis, nourishing the nerve endings, sweat and sebaceous glands, and hair follicles. Between the papillary and reticular layers, a second superficial cutaneous vascular network is formed.
Burns cause disruption of microcirculation, which can lead to dehydration of the body due to the massive movement of fluid from the intravascular space to the extravascular space. Also, due to tissue damage, liquid begins to flow from small vessels, which subsequently leads to the formation of edema. With extensive burn wounds, the destruction of blood vessels can lead to the development of burn shock.
Causes of burns
Burns can develop due to the following reasons:
- thermal impact;
- chemical impact;
- electrical impact;
- radiation exposure.
thermal effect
Burns are formed due to direct contact with fire, boiling water or steam.- Fire. When exposed to fire, the face and upper respiratory tract are most often affected. With burns of other parts of the body, it is difficult to remove burnt clothing, which can cause the development of an infectious process.
- Boiling water. In this case, the burn area may be small, but deep enough.
- Steam. When exposed to steam, in most cases, shallow tissue damage occurs ( often affects the upper respiratory tract).
- hot items. When the skin is damaged by hot objects, clear boundaries of the object remain at the site of exposure. These burns are quite deep and are characterized by the second - fourth degrees of damage.
- influence temperature ( the higher the temperature, the stronger the damage);
- duration of exposure to the skin the longer the contact time, the more severe the degree of burn);
- thermal conductivity ( the higher it is, the stronger the degree of damage);
- the condition of the skin and health of the victim.
Chemical exposure
Chemical burns are caused by contact with the skin of aggressive chemicals ( e.g. acids, alkalis). The degree of damage depends on its concentration and duration of contact.Burns due to chemical exposure can occur due to exposure of the skin to the following substances:
- Acids. The effect of acids on the surface of the skin causes shallow lesions. After exposure to the affected area, a burn crust is formed in a short time, which prevents further penetration of acids deep into the skin.
- Caustic alkalis. Due to the influence of caustic alkali on the surface of the skin, its deep damage occurs.
- Salts of some heavy metals ( e.g. silver nitrate, zinc chloride). Damage to the skin with these substances in most cases causes superficial burns.
electrical impact
Electrical burns occur on contact with conductive material. Electric current propagates through tissues with high electrical conductivity through blood, cerebrospinal fluid, muscles, and to a lesser extent through skin, bones or adipose tissue. Dangerous for human life is the current when its value exceeds 0.1 A ( ampere).Electrical injuries are divided into:
- low voltage;
- high voltage;
- supervoltage.
Radiation exposure
Burns due to radiation exposure can be caused by:- Ultraviolet radiation. Ultraviolet skin lesions mainly occur in the summer. The burns in this case are shallow, but are characterized by a large area of damage. Exposure to ultraviolet often causes superficial first or second degree burns.
- Ionizing radiation. This effect leads to damage not only to the skin, but also to nearby organs and tissues. Burns in such a case are characterized by a shallow form of damage.
- infrared radiation. May cause damage to the eyes, mainly the retina and cornea, but also to the skin. The degree of damage in this case will depend on the intensity of the radiation, as well as on the duration of exposure.
Degrees of burns
In 1960, it was decided to classify burns into four degrees:
- I degree;
- II degree;
- III-A and III-B degree;
- IV degree.
| Burn degree | Development mechanism | Features of external manifestations |
| I degree | there is a superficial lesion of the upper layers of the epidermis, the healing of burns of this degree occurs without scarring | hyperemia ( redness), swelling, pain, dysfunction of the affected area |
| II degree | complete destruction of the superficial layers of the epidermis | pain, blistering with clear fluid inside |
| III-A degree | damage to all layers of the epidermis up to the dermis ( dermis may be partially affected) | a dry or soft burn crust is formed ( scab) light brown |
| III-B degree | all layers of the epidermis, the dermis, and also partially the hypodermis are affected | a dense dry burn crust of brown color is formed |
| IV degree | all layers of the skin are affected, including muscles and tendons down to the bone | characterized by the formation of a burn crust of dark brown or black color |
There is also a classification of burn degrees according to Kreibich, who distinguished five degrees of burn. This classification differs from the previous one in that the III-B degree is called the fourth, and the fourth degree is called the fifth.
The depth of damage in case of burns depends on the following factors:
- the nature of the thermal agent;
- temperature of the active agent;
- duration of exposure;
- the degree of warming of the deep layers of the skin.
- Superficial burns. These include first, second, and third-A degree burns. These lesions are characterized by the fact that they are able to heal fully on their own, without surgery, that is, without scarring.
- Deep burns. These include burns of the third-B and fourth degree, which are not capable of full self-healing ( leaves a rough scar).
Burn symptoms
According to localization, burns are distinguished:
- faces ( in most cases leads to eye damage);
- scalp;
- upper respiratory tract ( there may be pain, loss of voice, shortness of breath, and a cough with a small amount of sputum or streaked with soot);
- upper and lower limbs ( with burns in the joints, there is a risk of dysfunction of the limb);
- torso;
- crotch ( can lead to disruption of the excretory organs).
| Burn degree | Symptoms | A photo |
| I degree | With this degree of burn, redness, swelling and pain are observed. The skin at the site of the lesion is bright pink in color, sensitive to touch and slightly protrudes above the healthy area of the skin. Due to the fact that with this degree of burn only superficial damage to the epithelium occurs, the skin after a few days, drying and wrinkling, forms only a small pigmentation, which disappears on its own after a while ( an average of three to four days). |  |
| II degree | In the second degree of burns, as well as in the first, hyperemia, swelling, and burning pain are noted at the site of the lesion. However, in this case, due to the detachment of the epidermis, small and loose blisters appear on the surface of the skin, filled with a light yellow, transparent liquid. If the blisters break open, reddish erosion is observed in their place. The healing of this kind of burns occurs independently on the tenth - twelfth day without scarring. |  |
| III-A degree | With burns of this degree, the epidermis and partly the dermis are damaged ( hair follicles, sebaceous and sweat glands are preserved). Tissue necrosis is noted, and also, due to pronounced vascular changes, edema spreads over the entire thickness of the skin. In the third-A degree, a dry, light brown or soft, white-gray burn crust forms. Tactile-pain sensitivity of the skin is preserved or reduced. Bubbles are formed on the affected surface of the skin, the sizes of which vary from two centimeters and above, with a dense wall, filled with a thick yellow jelly-like liquid. Epithelialization of the skin lasts an average of four to six weeks, but when an inflammatory process appears, healing can last for three months. |
|
| III-B degree | With burns of the third-B degree, necrosis affects the entire thickness of the epidermis and dermis with partial capture of subcutaneous fat. At this degree, the formation of blisters filled with hemorrhagic fluid is observed ( streaked with blood). The resulting burn crust is dry or wet, yellow, gray or dark brown. There is a sharp decrease or absence of pain. Self-healing of wounds at this degree does not occur. | |
| IV degree | With fourth-degree burns, not only all layers of the skin are affected, but also muscles, fascia and tendons up to the bones. A dark brown or black burn crust forms on the affected surface, through which the venous network is visible. Due to the destruction of nerve endings, there is no pain at this stage. At this stage, there is a pronounced intoxication, there is also a high risk of developing purulent complications. |  |
Note: In most cases, with burns, the degrees of damage are often combined. However, the severity of the patient's condition depends not only on the degree of burn, but also on the area of the lesion.
Burns are divided into extensive ( lesion of 10 - 15% of the skin or more) and not extensive. With extensive and deep burns with superficial skin lesions of more than 15 - 25% and more than 10% with deep lesions, burn disease may occur.
Burn disease is a group of clinical symptoms associated with thermal lesions of the skin and surrounding tissues. Occurs with massive destruction of tissues with the release of a large amount of biologically active substances.
The severity and course of a burn disease depends on the following factors:
- the age of the victim;
- the location of the burn;
- burn degree;
- area of damage.
- burn shock;
- burn toxemia;
- burn septicotoxemia ( burn infection);
- convalescence ( recovery).
burn shock
Burn shock is the first period of burn disease. The duration of the shock ranges from several hours to two to three days.Degrees of burn shock
| First degree | Second degree | Third degree |
| It is typical for burns with skin lesions of no more than 15 - 20%. With this degree, burning pain is observed in the affected areas. The heart rate is up to 90 beats per minute, and blood pressure is within normal limits. | It is observed with burns with a lesion of 21 - 60% of the body. The heart rate in this case is 100 - 120 beats per minute, blood pressure and body temperature are reduced. The second degree is also characterized by a feeling of chills, nausea and thirst. | The third degree of burn shock is characterized by damage to more than 60% of the body surface. The condition of the victim in this case is extremely severe, the pulse is practically not palpable ( filiform), blood pressure 80 mm Hg. Art. ( millimeters of mercury). |
Burn toxemia
Acute burn toxemia is caused by exposure to toxic substances ( bacterial toxins, protein breakdown products). This period starts from the third or fourth day and lasts for one to two weeks. It is characterized by the fact that the victim has an intoxication syndrome.For intoxication syndrome, the following symptoms are characteristic:
- increase in body temperature ( up to 38 - 41 degrees with deep lesions);
- nausea;
- thirst.
Burn septicotoxemia
This period conditionally begins on the tenth day and continues until the end of the third - fifth week after the injury. It is characterized by attachment to the affected area of infection, which leads to the loss of proteins and electrolytes. With negative dynamics, it can lead to exhaustion of the body and death of the victim. In most cases, this period is observed with third-degree burns, as well as with deep lesions.For burn septicotoxemia, the following symptoms are characteristic:
- weakness;
- increase in body temperature;
- chills;
- irritability;
- yellowness of the skin and sclera ( with liver damage);
- increased heart rate ( tachycardia).
convalescence
In the case of successful surgical or conservative treatment, healing of burn wounds, restoration of the functioning of internal organs and recovery of the patient occurs.Determining the area of burns
In assessing the severity of thermal damage, in addition to the depth of the burn, its area is important. In modern medicine, several methods are used to measure the area of burns. There are the following methods for determining the area of the burn:
- the rule of nines;
- palm rule;
- Postnikov's method.
Rule of nines
The simplest and most affordable way to determine the area of a burn is considered to be the “rule of nines”. According to this rule, almost all parts of the body are conditionally divided into equal sections of 9% of the total surface of the entire body.| Rule of nines | A photo |
| head and neck 9% |  |
| upper limbs (each hand) by 9% |
|
| anterior torso18% (chest and abdomen 9% each) |
|
| back of the body18% (upper back and lower back 9% each) |
|
| lower limbs ( each leg) by 18% (thigh 9%, lower leg and foot 9%) |
|
| Perineum 1% |
palm rule
Another method for determining the area of a burn is the “rule of the palm”. The essence of the method lies in the fact that the area of the burned palm is taken as 1% of the area of the entire surface of the body. This rule is used for small burns.Postnikov method
Also in modern medicine, the method of determining the area of the burn according to Postnikov is used. To measure burns, sterile cellophane or gauze is used, which is applied to the affected area. On the material, the contours of the burnt places are indicated, which are subsequently cut out and applied to a special graph paper to determine the area of the burn.First aid for burns
First aid for burns is as follows:
- elimination of the source of the acting factor;
- cooling of burned areas;
- the imposition of an aseptic bandage;
- anesthesia;
- call an ambulance.
Elimination of the source of the acting factor
To do this, the victim must be taken out of the fire, put out burning clothes, stop contact with hot objects, liquids, steam, etc. The sooner this assistance is provided, the less the depth of the burn will be.Cooling of burned areas
It is necessary to treat the burn site as soon as possible with running water for 10 to 15 minutes. Water should be at the optimum temperature - from 12 to 18 degrees Celsius. This is done in order to prevent the process of damage to healthy tissue near the burn. Moreover, cold running water leads to vasospasm and to a decrease in the sensitivity of nerve endings, and therefore has an analgesic effect.Note: for third and fourth degree burns, this first aid measure is not performed.
Applying an aseptic dressing
Before applying an aseptic bandage, it is necessary to carefully cut off the clothes from the burnt areas. Never attempt to clean burned areas ( remove pieces of clothing, tar, bitumen, etc. adhering to the skin.), as well as popping bubbles. It is not recommended to lubricate the burned areas with vegetable and animal fats, solutions of potassium permanganate or brilliant green.Dry and clean handkerchiefs, towels, sheets can be used as an aseptic bandage. An aseptic bandage must be applied to the burn wound without pretreatment. If the fingers or toes have been affected, it is necessary to lay additional tissue between them in order to prevent the parts of the skin from sticking together. To do this, you can use a bandage or a clean handkerchief, which must be wetted with cool water before application, and then squeezed out.
Anesthesia
For severe pain during a burn, painkillers should be taken, for example, ibuprofen or paracetamol. To achieve a rapid therapeutic effect, it is necessary to take two tablets of ibuprofen 200 mg or two tablets of paracetamol 500 mg.Call an ambulance
There are the following indications for which you need to call an ambulance:- with burns of the third and fourth degree;
- in the event that a second-degree burn in area exceeds the size of the palm of the victim;
- with first-degree burns, when the affected area is more than ten percent of the body surface ( for example, the entire abdomen or the entire upper limb);
- with the defeat of such parts of the body as the face, neck, joints, hands, feet, or perineum;
- in the event that after a burn there is nausea or vomiting;
- when after a burn there is a long ( more than 12 hours) increase in body temperature;
- when the condition worsens on the second day after the burn ( increased pain or more pronounced redness);
- with numbness of the affected area.
Burn treatment
Burn treatment can be of two types:- conservative;
- operational.
- the area of the lesion;
- the depth of the lesion;
- localization of the lesion;
- the cause of the burn;
- the development of a burn disease in the victim;
- the age of the victim.
Conservative treatment
It is used in the treatment of superficial burns, and this therapy is also used before and after surgery in case of deep lesions. Conservative burn treatment includes:
- closed way;
- open way.
Closed way
This method of treatment is characterized by the application of dressings with a medicinal substance to the affected areas of the skin.
| Burn degree | Treatment |
| I degree | In this case, it is necessary to apply a sterile bandage with anti-burn ointment. Usually, it is not necessary to change the dressing with a new one, since with a first degree burn, the affected skin heals within a short time ( up to seven days). |
| II degree | In the second degree, bandages with bactericidal ointments are applied to the burn surface ( for example, levomekol, sylvatsin, dioxysol), which act depressingly on the vital activity of microbes. These dressings must be changed every two days. |
| III-A degree | With lesions of this degree, a burn crust forms on the surface of the skin ( scab). The skin around the formed scab must be treated with hydrogen peroxide ( 3% ), furacilin ( 0.02% aqueous or 0.066% alcohol solution), chlorhexidine ( 0,05% ) or other antiseptic solution, after which a sterile bandage should be applied. After two to three weeks, the burn crust disappears and it is recommended to apply bandages with bactericidal ointments to the affected surface. Complete healing of the burn wound in this case occurs after about a month. |
| III-B and IV degree | With these burns, local treatment is used only to accelerate the process of rejection of the burn crust. Bandages with ointments and antiseptic solutions should be applied daily to the affected skin surface. The healing of the burn in this case occurs only after surgery. |
There are the following advantages of the closed method of treatment:
- applied dressings prevent infection of the burn wound;
- the bandage protects the damaged surface from damage;
- the drugs used kill microbes, and also contribute to the rapid healing of the burn wound.
- changing the bandage provokes pain;
- the dissolution of necrotic tissue under the bandage leads to an increase in intoxication.
open way
This method of treatment is characterized by the use of special techniques ( e.g. ultraviolet irradiation, air cleaner, bacterial filters), which is available only in specialized departments of burn hospitals.
The open method of treatment is aimed at the accelerated formation of a dry burn crust, since a soft and moist scab is a favorable environment for the reproduction of microbes. In this case, two to three times a day, various antiseptic solutions are applied to the damaged skin surface ( e.g. brilliant green ( brilliant green) 1%, potassium permanganate ( potassium permanganate) 5% ), after which the burn wound remains open. In the ward where the victim is located, the air is continuously cleaned of bacteria. These actions contribute to the formation of a dry scab within one to two days.
In this way, in most cases, burns of the face, neck and perineum are treated.
There are the following advantages of the open method of treatment:
- contributes to the rapid formation of a dry scab;
- allows you to observe the dynamics of tissue healing.
- loss of moisture and plasma from a burn wound;
- the high cost of the treatment method used.
Surgical treatment
For burns, the following types of surgical interventions can be used:
- necrotomy;
- necrectomy;
- staged necrectomy;
- limb amputation;
- skin transplant.
This surgical intervention consists in dissection of the formed scab with deep burn lesions. Necrotomy is performed urgently in order to ensure the blood supply to the tissues. If this intervention is not performed in a timely manner, necrosis of the affected area may develop.
necrectomy
Necrectomy is performed for third-degree burns in order to remove non-viable tissues with deep and limited lesions. This type of operation allows you to thoroughly clean the burn wound and prevent suppuration processes, which subsequently contributes to the rapid healing of tissues.
Staged necrectomy
This surgical intervention is performed with deep and extensive skin lesions. However, staged necrectomy is a more gentle method of intervention, since the removal of non-viable tissues is performed in several stages.
Amputation of a limb
Amputation of the limb is performed with severe burns, when treatment by other methods has not brought positive results or necrosis has developed, irreversible tissue changes with the need for subsequent amputation.
These methods of surgical intervention allow:
- clean the burn wound;
- reduce intoxication;
- reduce the risk of complications;
- reduce the duration of treatment;
- improve the healing process of damaged tissues.
Skin transplantation
Skin grafting is performed to close large burn wounds. In most cases, autoplasty is performed, that is, the patient's own skin is transplanted from other parts of the body.
Currently, the following methods of closing burn wounds are most widely used:
- Plastic surgery with local tissues. This method is used for deep burn lesions of small size. In this case, there is a borrowing of neighboring healthy tissues to the affected area.
- Free skin plastic. It is one of the most common methods of skin transplantation. This method consists in the fact that using a special tool ( dermatome) in the victim from a healthy part of the body ( e.g. thigh, buttock, abdomen) the necessary skin flap is excised, which is subsequently superimposed on the affected area.
Physiotherapy
Physiotherapy is used in the complex treatment of burn wounds and is aimed at:- inhibition of the vital activity of microbes;
- stimulation of blood flow in the area of impact;
- acceleration of the regeneration process ( recovery) damaged area of the skin;
- prevention of the formation of post-burn scars;
- stimulation of the body's defenses ( immunity).
| Type of physiotherapy | Mechanism of therapeutic action | Application |
| Ultrasound Therapy
| Ultrasound, passing through cells, triggers chemical-physical processes. Also, acting locally, it helps to increase the body's resistance. | This method is used to dissolve scars and improve immunity. |
| ultraviolet irradiation
| Ultraviolet radiation promotes the absorption of oxygen by tissues, increases local immunity, improves blood circulation. | This method is used to speed up the regeneration of the affected area of the skin. |
| infrared irradiation
| Due to the creation of a thermal effect, this irradiation improves blood circulation, as well as stimulates metabolic processes. | This treatment is aimed at improving the healing process of tissues, and also produces an anti-inflammatory effect. |
Burn Prevention
Sunburn is a common thermal skin lesion, especially in the summer. Prevention of sunburn
To avoid sunburn, the following rules must be followed:- Avoid direct contact with the sun between ten and sixteen hours.
- On particularly hot days, it is preferable to wear dark clothing, as it protects the skin from the sun better than white clothes.
- Before going outside, it is recommended to apply sunscreen to exposed skin.
- When sunbathing, the use of sunscreen is a mandatory procedure that must be repeated after each bath.
- Since sunscreens have different protection factors, they must be selected for a specific skin phototype.
- Scandinavian ( first phototype);
- light-skinned European ( second phototype);
- dark-skinned Central European ( third phototype);
- Mediterranean ( fourth phototype);
- Indonesian or Middle Eastern ( fifth phototype);
- African American ( sixth phototype).
Prevention of household burns
According to statistics, the vast majority of burns occur in domestic conditions. Quite often, children who suffer due to the carelessness of their parents are burned. Also, the cause of burns in the domestic environment is non-compliance with safety rules.To avoid burns at home, the following recommendations must be followed:
- Do not use electrical appliances with damaged insulation.
- When unplugging the appliance from the socket, do not pull the cord, it is necessary to hold the plug base directly.
- If you are not a professional electrician, do not repair electrical appliances and wiring yourself.
- Do not use electrical appliances in a damp room.
- Children should not be left unattended.
- Make sure there are no hot objects in the children's reach ( for example, hot food or liquids, sockets, iron on, etc.).
- Items that can cause burns ( e.g. matches, hot objects, chemicals and other) should be kept away from children.
- It is necessary to conduct awareness-raising activities with older children regarding their safety.
- Smoking should be avoided in bed as it is one of the common causes of fires.
- It is recommended to install fire alarms throughout the house or at least in places where the likelihood of a fire is higher ( e.g. in a kitchen, a room with a fireplace).
- It is recommended to have a fire extinguisher in the house.
Bone crepitus
5. painful swelling in the area of injury
Relative signs of fractures include
1. pain in the area of injury
2. painful swelling
3. hemorrhage in the area of injury
4. crepitus
The absolute signs of a penetrating wound of the chest are:
1. Dyspnea
2. pallor and cyanosis
3. gaping wound
4. the sound of air in the wound when inhaling and exhaling
5. subcutaneous emphysema
Typical symptoms of traumatic brain injury are:
1. agitated state after recovery of consciousness
2. headache, dizziness after recovery of consciousness
3. retrograde amnesia
4. Seizures
5. loss of consciousness at the time of injury
1. chest compressions
3. with precordial beat
4.
The imposition of a heat-insulating bandage for patients with frostbite is required:
1. in the pre-reactive period
2. in the reactive period
Cooling the burnt surface with cold water is shown:
1. in the first minutes after injury
2. only with a burn of the 1st degree
3. not shown
The optimal position for a patient with acute left ventricular failure is:
1. lying in a raised foot end
2. lying on your side
3. sitting or semi-sitting
The first priority for acute left ventricular failure is:
1. administration of strophanthin intravenously
2. injection of lasix intramuscularly
3. giving nitroglycerin
4. application of venous tourniquets on limbs
5. blood pressure measurement
Mandibular extension:
1. eliminates slipping of the tongue
2. prevents aspiration of the contents of the oropharynx
3. restores airway patency at the level of the larynx and trachea
Air duct introduction:
1. eliminates the retraction of the tongue
2. prevents aspiration of the contents of the oropharynx
3. restores airway patency
The appearance of a pulse on the carotid artery during an indirect heart massage indicates:
2. proper heart massage
3. about the revival of the patient
The necessary conditions for artificial lung ventilation are:
1. elimination of retraction of the tongue
2. air duct application
3. sufficient volume of blown air
4. roller under the patient's shoulder blades
The movements of the patient's chest during mechanical ventilation indicate:
1. about the effectiveness of resuscitation
2. about the correctness of the artificial lung ventilation
3. about the revival of the patient
Signs of the effectiveness of ongoing resuscitation are:
1. pulsation on the carotid artery during heart massage
2. chest movements during mechanical ventilation
3. decrease in cyanosis
4. pupillary constriction
5. dilated pupils
Effective resuscitation continues:
5. until recovery
Ineffective resuscitation continues:
3. 30 minutes
5. until recovery
The imposition of venous tourniquets in cardiac asthma is indicated:
1. for low blood pressure
2. with high blood pressure
3. with normal blood pressure
The optimal position for a patient in a coma is the position:
1. on the back with the head end down
2. on the back with the foot end lowered
3. on the side
4. on the stomach
The patient in a coma is given a stable lateral position in order to:
1. prevention of tongue retraction
2. prevention of aspiration of vomit
3. shock warning
Patients in a coma with spinal injuries are transported in the position:
1. on the side on a regular stretcher
2. on the stomach on a regular stretcher
3. on the side on the shield
4. on the back on the shield
For a patient with an unidentified coma, the nurse should:
1. secure the airway
2. start oxygen inhalation
3. inject intravenously 20 ml of 40% glucose
5. lead intramuscular cordiamine and caffeine
The optimal position for a patient with shock is:
1. side position
2. semi-sitting position
3. elevated limb position
Three main preventive anti-shock measures in trauma patients
1. the introduction of vasoconstrictor drugs
2. oxygen inhalation
3. Anesthesia
4. stop external bleeding
5. fracture immobilization
In the cold season, a hemostatic tourniquet is applied:
1. for 15 minutes
2. for 30 minutes
3. for 1 hour
4. for 2 hours
With a fracture of the ribs, the optimal position for the patient is the position:
1. lying on a healthy side
2. lying on a sore side
3. sitting
4. lying on your back
Patients with acute poisoning are hospitalized:
1. in a serious condition of the patient
2. in cases where gastric lavage failed
3. in the unconscious state of the patient
4. in all cases of acute poisoning
Conditions under which nitroglycerin should be stored:
1. temperature 4-6°C
2. Darkness
3. sealed packaging
Contraindications for the use of nitroglycerin are:
1. low blood pressure
2. myocardial infarction
3. acute cerebrovascular accident
4. traumatic brain injury
5. hypertensive crisis
Patients with electrical injuries after assistance:
2. do not need further examination and treatment
3. hospitalized by ambulance
On the burnt surface is superimposed:
1. bandage with furacillin
2. dressing with synthomycin emulsion
3. dry sterile dressing
4. dressing with a solution of tea soda
With a penetrating wound of the abdomen with organ prolapse, the nurse should:
1. set the organs that have fallen out
2. bandage a wound
3. give hot drink inside
4. administer an anesthetic
With penetrating wounds of the eyeball, a bandage is applied:
1. on a sore eye
2. for both eyes
3. dressing not shown
With a sudden drop in blood pressure in a patient with myocardial infarction, a nurse should:
1. inject epinephrine intravenously
2. enter strophanthin intravenously
3. inject mezaton intramuscularly
4. raise the foot end
5. introduce cordiamine s.c.
In case of electrical injuries, assistance should begin:
1. chest compressions
2. with mechanical ventilation
3. with precordial beat
4. with the cessation of exposure to electric current
3. unbutton clothes
4. lay the patient on his side
5. call a doctor
Insufflation of air and compression of the chest during resuscitation carried out by one resuscitator are carried out in the ratio:
1. 2: 30
Insufflation of air and compression of the chest during resuscitation carried out by two resuscitators are performed in the ratio:
2. 2: 30
Indirect cardiac massage is performed:
1. on the border of the upper and middle thirds of the sternum
2. at the border of the middle and lower thirds of the sternum
3. 1 cm above the xiphoid process
Compression of the chest during chest compressions in adults is performed with a frequency
1. 40-60 per min
2. 60-80 per min
3. 80-100 per min
4. 100-120 per min
If a patient who has received an electrical injury is unconscious, but there are no visible respiratory and circulatory disorders, the nurse should:
1. make intramuscular cordiamine and caffeine
2. give a sniff of ammonia
3. unbutton clothes
4. lay the patient on his side
5. call a doctor
6. start oxygen inhalation
1. Lay down
2. give nitroglycerin
3.
5.
At the clinic of cardiac asthma in a patient with high blood pressure, a nurse should:
1. put the patient in a sitting position
2. give nitroglycerin
3. start oxygen inhalation
4. inject strophanthin or corglicon intravenously
5. inject prednisolone intramuscularly
6. inject lasix intramuscularly or give it by mouth
In the clinic of cardiac asthma in a patient with low blood pressure, the nurse should:
1. give nitroglycerin
2. apply venous tourniquets to the limbs
3. start oxygen inhalation
4. enter strophanthin intravenously
5. inject lasix intramuscularly
6. administer intramuscular prednisone
A tourniquet is applied:
1. with arterial bleeding
2. with capillary bleeding
3. with venous bleeding
4. with parenchymal bleeding
When the bones of the forearm are fractured, a splint is applied:
1. from the wrist joint to the upper third of the shoulder
2. from fingertips to upper third of shoulder
3. from the base of the fingers to the upper third of the shoulder
When the humerus is fractured, a splint is applied:
1. from the fingers to the shoulder blade on the affected side
2. from fingers to shoulder blade on healthy side
3. from the wrist joint to the scapula on the healthy side
For open fractures, transport immobilization is performed:
1. first
2. in the second place after stopping the bleeding
3. in the third place after stopping the bleeding and applying a bandage
When the bones of the lower leg are fractured, a splint is applied:
1. from fingertips to knee
2. from the fingertips to the upper third of the thigh
3. from the ankle to the upper third of the thigh
In case of a hip fracture, a splint is applied:
1.From fingertips to hip joint
2.From fingertips to armpit
3. from the lower third of the leg to the armpit
The imposition of an airtight bandage with a penetrating wound of the chest is carried out:
1. directly to the wound
2. over a cotton-gauze napkin
First aid to a patient with acute myocardial infarction includes the following measures:
1. Lay down
2. give nitroglycerin
3. ensure complete physical rest
4. immediately hospitalize by passing transport
5. if possible, administer painkillers
Resuscitation must be carried out:
1. only doctors and nurses in intensive care units
2. all medical professionals
3. all adults
Resuscitation shown:
1. in each case of death of the patient
2. only with sudden death of young patients and children
3. in sudden onset terminal states
When drowning in cold water, the duration of clinical death:
1. shortened
2. lengthens
3. does not change
In the pre-reactive period, frostbite is characterized
1. pale skin
2. lack of skin sensitivity
4. numbness
5. hyperemia of the skin
A typical angina attack is characterized by:
1. retrosternal localization of pain
2. duration of pain for 15-20 min
3. duration of pain for 30-40 minutes
4. duration of pain for 3-5 minutes
5. effect of nitroglycerin
6. irradiation of pain
The main symptom of a typical myocardial infarction is:
1. cold sweat and severe weakness
2. bradycardia or tachycardia
3. low blood pressure
4. chest pain lasting more than 20 minutes
A patient with myocardial infarction in the acute period may develop the following complications:
1. shock
2. acute heart failure
3. false acute abdomen
4. circulatory arrest
5. reactive pericarditis
Atypical forms of myocardial infarction include:
1. abdominal
2. asthmatic
3. cerebral
4. asymptomatic
5. fainting
In the abdominal form of myocardial infarction, pain can be felt:
1. in the epigastric region
2. in the right hypochondrium
3. in the left hypochondrium
4. be enveloping
5. all over the stomach
6. below the navel
Cardiogenic shock is characterized by:
1. restless patient behavior
2. mental arousal
3. lethargy, lethargy
4. lowering blood pressure
5. pallor, cyanosis
6. cold sweat
The clinic of cardiac asthma and pulmonary edema develops with:
1. acute left ventricular failure
2. acute vascular insufficiency
3. bronchial asthma
d) acute right ventricular failure
Situational tasks:
Task 1. A man with no signs of life was taken from the river. Pulse and respiration are absent, heart sounds are not auscultated, the pupil is maximally dilated, there is no reaction to its light. Describe the sequence of providing EMF.
Answer:
Determine the signs of biological death and, in their absence, create a “drainage position”.
Start the ABC complex.
Determine the effectiveness criteria of the resuscitation complex for every 2 minutes.
Provide a call to the scene of the resuscitation team
Task 2. You found a person on the street with no signs of life: consciousness is absent, there are no chest excursions, the pulse on the carotid artery is not palpable. How to determine in what phase of the body's dying is the victim?
Answer:
Determine the presence of signs of biological death (drying of the cornea of the eyes, the symptom of "cat's eye", the presence of rigor mortis, the presence of cadaveric spots); if available, provide a call to the scene of the ambulance crew and law enforcement agencies.
Task 3. The person walking in front of you suddenly screamed and fell, the visible convulsive twitching of the limbs had stopped by the time you approached him. Upon examination, a wire hanging from an electric pole, clamped in his hand, is visible. What is the sequence of providing EMF in this situation?
Answer:
Observing the rules of personal safety, eliminate the effect of electric current on the body of the victim.
According to the indications, proceed with the ABC complex.
Act according to the "EMF Algorithm for Sudden Death".
Task 4. In the garage, you found a man lying by a car with a running engine. On examination: against the background of pallor of the skin, bright red spots are visible on it, there is no breathing, the pulse is not determined, the pupils are wide, rare muffled heart sounds are heard. What about the injured? Assess his condition. What activities should you provide? EMF sequence.
Answer:
1. Acute inhalation poisoning by exhaust gases of an internal combustion engine.
2. The agonal period of the organism dying.
3. Remove the victim from the garage to an open area.
4. Start the ABC complex.
5. Provide a call to the scene of a specialized ambulance team.
Task 5. A man suddenly fell on the bus. The muscles of the face, neck, limbs randomly contract. Convulsions are accompanied by sharp turns of the torso to the sides, a frothy liquid is released from the mouth, the face is cyanotic, puffy, breathing is noisy, increased. After 3 minutes, the convulsions disappeared, breathing is even, like that of a sleeping person, involuntary urination. What disease does the man suffer from? Why is paroxysm dangerous? The order of the EMF in this situation.
Answer:
1. Epilepsy.
2. The resumption of the seizure with its transition to status epilepticus.
3. Determine the presence of possible mechanical injuries at the time of the fall.
4. Ensure the patency of the upper respiratory tract; prevent the possibility of biting the tongue; call a specialized ambulance team to the scene.
Task 6. A 62-year-old woman suddenly received news of her husband's death, screamed, lost consciousness, and fell. The skin is pale, heart rate is 92 per minute, blood pressure is 100/60 mm Hg, breathing is deep, 15 per minute. What about the patient? Provide EMP.
Answer:
1. Fainting (if the loss of consciousness is not more than two minutes).
2. Provide fresh air, loosen tight clothing.
3. Raise your legs, splash your face with cold water.
4. If possible, allow ammonia vapors to be inhaled.
5. In the presence of medicines, parenterally administer analgesics.
Task 7. 3 hours after eating boiled mushrooms, all family members developed abdominal pain, salivation, headache, vomiting, loose stools. What happened to the poisoning? What is the EMF order? Is inpatient treatment necessary if the hemodynamics of all victims is stable, within age limits?
Answer:
1. Enteral poisoning with poisonous mushrooms.
2. Give activated charcoal inside against the background of heavy drinking with inducing repeated vomiting.
3. Call a specialized ambulance team with subsequent hospitalization of acutely poisoned.
Task 8. In the toilet, the patient felt dizzy, followed by loss of consciousness. Pale, covered with cold sweat, pulse 130 per minute of weak filling. There is a large amount of tar-like liquid in the toilet bowl, with a sharp unpleasant putrefactive odor. What is your presumptive diagnosis? What is the cause of this condition? EMP order.
Answer:
1. Collapse.
2. Gastrointestinal bleeding as a complication of peptic ulcer.
3. Give pieces of ice inside, cool the epigastric region.
4. Calling the SMP team for emergency hospitalization in a surgical hospital, infusion therapy
Task 9. As a result of the bites of an unknown dog on the legs of a woman, many lacerations were found, moderately bleeding. What is the procedure for emergency medical care? Is rabies vaccination necessary?
Answer:
1. Aseptic dressings for wounds of the lower extremities with a temporary stop of bleeding.
2. Transportation to a trauma center or surgical hospital with compulsory administration of the rabies vaccine according to the scheme.
Task 10. 30 minutes after the start of the ABC complex, independent cardiac activity and respiration did not resume. The pupils are wide, there is no reaction to light, there is no symptom of "cat's eye". What does the examination of the patient indicate? How will you act in this situation?
Answer:
1. The absence of signs of pupillary constriction during the resuscitation complex for 30 minutes, as a cardinal criterion for its effectiveness, indicates the beginning of the biological death of the organism.
Resuscitation in this situation must be stopped due to the danger of the development of "social death" as a result of decortication.
Topic 17. Organization of psychological and psychiatric assistance to the population and participants in the liquidation of the consequences of emergency situations. Deontological aspects in organizing and conducting medical and sanitary measures to eliminate the consequences of emergencies.
Content: Organization and results of the work of the Center for Psychological Assistance in Emergency Situations (Moscow). Issues of ethics of employees of the QMS and MS GO when receiving, conducting medical sorting and providing medical care to victims in emergencies. Relations with the victims, observance of the principles of protecting the interests of the victims. Providing optimal medical care to the victim. Respectful attitude of a medical worker to the traditions, rituals and religious beliefs of the victims. Relationships with third parties. Respect for the confidentiality of victims.
Test questions:
1. Deontological aspects in the organization and conduct of medical and sanitary measures to eliminate the consequences of emergency situations.
2. Organization of psychological and psychiatric assistance to the population and participants in the liquidation of the consequences of emergency situations
1. Sumin S.A., Rudenko M.V., Borodinov I.M. - Anesthesiology, resuscitation and intensive care - M .: Ministry of Health of the Russian Federation, 2002. - p.
2. Sakhno I.I., Sakhno V.I. Venous and extreme medicine (organizational issues) / textbook for students of higher medical and pharmaceutical educational institutions. - M .: GOU VUNMTs of the Ministry of Health of the Russian Federation, 2002. - 560 pages.
3. Zilber A.P. "Medicine of critical conditions", Publishing house
4. Petrozavodsk University, Petrozavodsk 1995.
5. Galkin R.A., Dvoinikov S.I. Nursing in Surgery
6. Moscow, 1999
7. Negovsky V.A. et al. Postresuscitation disease - M, 1972
8. Order of the Ministry of Health of Russia dated 04.03.03 No. 73 “On approval
9. Instructions for determining the criteria and the procedure for determining
10. The moment of death of a person, the termination of resuscitation measures "
11. Nursing (under the editorship of G.P. Kotelnikov), Moscow, 2004, 2 volume,
12. Ryabov G.S. Syndromes of critical conditions /. "Medicine",. Moscow, 1994 - 351 pages
13. Guide to anesthesiology and resuscitation, edited by Professor Yu.S. Polushina / \ St. Petersburg, 2004
14. Federal Law N 68-FZ of November 11, 1994 "On the protection of the population and territories from natural and man-made emergencies"
15. Trifonov S.V. Selected lectures on disaster medicine / textbook for students of higher medical educational institutions. - M: GEOTAR-MED., 2010
16. Civil defense: textbook / ed. V.N. Zavyalova. - M. medicine, 1989.
The list of resources of the information and telecommunication network "Internet", necessary for the development of the discipline.
1. Electronic library system "KnigaFond" http://www.knigafund.ru
2. Electronic library system "Student Advisor" http://www.studmedlib.ru
3. Electronic library system "URAIT" www.biblio-online.ru
4. Scientific electronic library http://elibrary.ru
5. Electronic journal "Health" http://m.e.zdravohrana.ru/
6. Medical Electronic Library http://meduniver.com/Medical/Book/
7. Medical information and search site "MEDNAVIGATOR" http://www.mednavigator.ru/
8. Electronic medical library. Electronic versions of medical literature http://www.booksmed.com/
burns- these are damages caused by the action of high temperature (flame, hot steam, boiling water) or caustic chemicals (acids, alkalis). A special form of burns is radiation burns (solar, radiation, x-ray, etc.).
Modern extreme situations are very often accompanied by the occurrence of burns of varying degrees in victims.
Degrees of burns.
There are 4 degrees of burns (depending on the depth of tissue damage):
- I degree is characterized by hyperemia (redness) of the skin, swelling and a feeling of pain. Under the action of high temperature, the expansion of capillaries and the formation of edema occur;
- II degree is accompanied by hyperemia, edema, the formation of blisters filled with a transparent yellowish liquid. Serous effusion, accumulating, exfoliates the epidermis, which causes the formation of blisters, the size of which can be very different;
- III degree is accompanied by necrosis of the skin with the formation of a scab, which occurs as a result of the coagulation of tissue proteins.
III degree burns are divided into IIIA degree burns, in which necrosis captures only the surface layer of the skin, part of the growth layer of the epidermis remains, and IIIB, in which the entire thickness of the skin dies along with the growth layer of the epidermis.
- IV degree - accompanied by charring of the skin and deep-lying tissues (muscles, tendons, up to the bone).
Usually, the affected are combined with burns of various degrees. Facial burns may be accompanied by eye burns, burns of the upper respiratory tract are possible.
The severity of the burn depends not only on the depth of tissue damage, but also on the size of the burn area. The larger the area of the burn, the more severe its course.
When clothing ignites, they try to throw it off, knock down the flame with water, earth or press the burning cloth to the ground, immerse the burning areas in water. Do not remove clothing adhering to the surface of the burn, and close the wound, if possible, with an aseptic or special anti-burn dressing.
It is very dangerous to get clots of combustible substance on the skin and clothes.
For large burns of the limbs, transport tires are applied.
In case of extensive burns of the torso, it is necessary to wrap the victim in a sterile sheet or apply an anti-burn bandage.
Help must be provided very carefully so as not to increase pain.
Give painkillers, hot drinks. Where there is a favorable environment and facilities, medical assistance should be provided as quickly as possible.
If a burn injury is received in a fire in an enclosed space or in the focus of an incendiary mixture, the victim is taken out of the zone of fire and smoke as soon as possible. A dry aseptic bandage is applied to the burnt surface. It is not recommended to clean the burnt surface and puncture blisters. In case of chemical burns with acids and alkalis, it is necessary to wash them off the skin with a jet of cold water and neutralize the action of the acid with soapy water, and alkalis with a weak solution of vinegar. After neutralization, an aseptic bandage is applied. In cases of asphyxia (suffocation) arising from thermochemical exposure or poisoning by combustion products, the victim is cleared of the oral cavity and pharynx from mucus and vomit and proceed to artificial respiration.
A thermal burn occurs from exposure to the skin of boiling water, flame, molten, red-hot metal. To reduce pain and prevent swelling of the tissues, you must immediately substitute the burned hand (leg) under a stream of cold water and hold until the pain subsides.
Then, for a first-degree burn (when the skin only turned red), lubricate the affected area with alcohol or cologne. A bandage may not be applied. It is enough to treat burned skin several times a day with special aerosols such as Levian, Vinizol, Oxycyclozol, Panthenol, which are designed to treat superficial burns and are sold in pharmacies without a prescription.
In case of a second-degree burn (when blisters have formed, some of which have burst and the integrity of the epidermal cover - the upper layer of the skin has been violated), it is not necessary to treat the burn area with alcohol, as this will cause severe pain and burning. Bubbles should never be pierced: they protect the burn surface from infection. Apply a sterile bandage (sterile bandage or iron-ironed cloth) to the burn area.
Burnt skin should not be lubricated with fat, brilliant green, a strong solution of potassium permanganate. This will not bring relief, and it will be difficult for the doctor to determine the degree of tissue damage.
If there is no water at hand, throw a blanket, thick fabric over the victim. But keep in mind: the effect of high temperature on the skin is the more destructive, the longer and denser the smoldering clothes are pressed against it. A person in burning clothes should not be wrapped with his head in order to avoid damage to the respiratory tract and poisoning with toxic combustion products.
After extinguishing the flame, quickly remove the victim's clothing by cutting it. Affected areas of the body for 15-20 minutes. splash with cold water.
In case of extensive lesions, cover the victim with ironed towels, sheets, tablecloths. Give him 1-2 tablets of analgin or amidopyrine, call an ambulance or take him to a medical facility.
A chemical burn is caused by concentrated acids, alkalis, salts of some heavy metals that have got on the skin. The chemical must be removed as soon as possible! First of all, remove any clothing that has been exposed to chemicals from the victim. Try to do it in such a way that you yourself do not get burned. Then wash the affected surface of the body under a plentiful stream of water from a tap, shower, hose for 20-30 minutes. Do not use a swab moistened with water, as any chemical is rubbed into the skin and penetrates into its deep layers.
If the burn is caused by alkali, treat the affected areas of the skin washed with water with a solution of citric or boric acid (half a teaspoon per glass of water) or table vinegar, half diluted with water.
Wash areas of the body that have been burned by some kind of acid (except hydrofluoric acid) with an alkaline solution: soapy water or a solution of baking soda (one teaspoon of soda in a glass of water). In case of a burn with hydrofluoric acid, which, in particular, is part of the brake fluid, to remove the fluorine ions contained in it, it is necessary to rinse the skin under running water for a very long time, 2-3 hours, since fluorine penetrates deep into it.
If the burn is caused by quicklime, do not wash it off with water! When lime and water interact, heat is generated, which can aggravate thermal injury. First, carefully remove the lime from the surface of the body with a piece of clean cloth, and then rinse the skin with running water or treat with any vegetable oil.
Apply a dry sterile dressing to the burn area.
In all cases of a chemical burn, after providing first aid, the victim must be taken to a medical facility.
Frostbite is damage to any part of the body (up to necrosis) under the influence of low temperatures. Most often, frostbite occurs in cold winters at ambient temperatures below -10 o C - -20 o C. With a long stay outdoors, especially at high humidity and strong wind, frostbite can be obtained in autumn and spring when the air temperature is above zero.
Frostbite in the cold is caused by tight and damp clothes and shoes, physical overwork, hunger, forced prolonged immobility and uncomfortable position, previous cold injury, weakening of the body as a result of previous diseases, sweating of the legs, chronic diseases of the vessels of the lower extremities and the cardiovascular system, severe mechanical damage with blood loss, smoking, etc.
Frostbite I degree (the mildest) usually occurs with short exposure to cold. The affected area of the skin is pale, reddened after warming, in some cases it has a purple-red tint; edema develops. Skin necrosis does not occur. By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Full recovery occurs by 5-7 days after frostbite. The first signs of such frostbite are a burning sensation, tingling, followed by numbness of the affected area. Then there is skin itching and pain, which can be both minor and pronounced.
Frostbite II degree occurs with prolonged exposure to cold. In the initial period, there is blanching, cooling, loss of sensitivity, but these phenomena are observed at all degrees of frostbite. Therefore, the most characteristic sign is the formation of blisters filled with transparent contents in the first days after the injury. Full restoration of the integrity of the skin occurs within 1-2 weeks, granulation and scarring are not formed. With frostbite of the II degree after warming, the pain is more intense and prolonged.
With frostbite of the III degree, the duration of the period of cold exposure and decrease in temperature in the tissues increases. The blisters formed in the initial period are filled with bloody contents, their bottom is blue-purple, insensitive to irritations. There is a death of all elements of the skin with the development of granulations and scars as a result of frostbite. Descended nails do not grow back or grow deformed. Rejection of dead tissues ends on the 2nd-3rd week, after which scarring occurs, which lasts up to 1 month.
Frostbite IV degree occurs with prolonged exposure to cold, the decrease in temperature in the tissues with it is the greatest. It is often combined with frostbite III and even II degree. All layers of soft tissues become dead, bones and joints are often affected.
The damaged area of the limb is sharply cyanotic, sometimes with a marble color. Edema develops immediately after warming and increases rapidly. The temperature of the skin is much lower than that of the tissues surrounding the area of frostbite. Blisters develop in less frostbitten areas where there is frostbite III-II degree. The absence of blisters with significantly developed edema, loss of sensitivity indicate frostbite of the IV degree.
Under conditions of a long stay at low air temperature, not only local lesions are possible, but also a general cooling of the body. Under the general cooling of the body, one should understand the state that occurs when the body temperature drops below 34 o C.
First aid consists in stopping the cooling, warming the limb, restoring blood circulation in the tissues affected by cold and preventing the development of infection. The first thing to do with signs of frostbite is to deliver the victim to the nearest warm room, remove frozen shoes, socks, gloves. Simultaneously with the implementation of first aid measures, it is urgent to call a doctor, an ambulance to provide medical assistance.
In case of frostbite of the 1st degree, the cooled areas should be warmed to redness with warm hands, light massage, rubbing with a woolen cloth, breathing, and then apply a cotton-gauze bandage.
With frostbite II-IV degree, rapid warming, massage or rubbing should not be done. Apply a heat-insulating bandage to the affected surface (a layer of gauze, a thick layer of cotton, again a layer of gauze, and on top of an oilcloth or rubberized cloth). The affected limbs are fixed with the help of improvised means (a board, a piece of plywood, thick cardboard), applying and bandaging them over the bandage. As a heat-insulating material, you can use padded jackets, sweatshirts, woolen fabric, etc.
The victims are given hot drinks, hot food, a small amount of alcohol, one tablet of aspirin, analgin, 2 tablets of "No-shpa" and papaverine.
It is not recommended to rub the sick with snow, as the blood vessels of the hands and feet are very fragile and therefore they can be damaged, and the resulting micro abrasions on the skin contribute to infection. You can not use the rapid warming of frostbitten limbs near the fire, uncontrolled use of heating pads and similar sources of heat, as this worsens the course of frostbite. An unacceptable and ineffective first aid option is rubbing oils, fat, rubbing alcohol on tissues with deep frostbite.
In practice, there are also cold injuries that occur when warm skin comes into contact with a cold metal object. As soon as a curious kid grabs some piece of iron with his bare hand or, even worse, licks it with his tongue, he will firmly stick to it. You can get rid of the shackles only by tearing them off along with the skin. The picture is downright heartbreaking: the child squeals in pain, and his bloody hands or mouth shock the parents.
Fortunately, the "iron" wound is rarely deep, but still it must be urgently disinfected. Rinse it first with warm water and then with hydrogen peroxide. The released oxygen bubbles will remove the dirt that has got inside. Then try to stop the bleeding. A hemostatic sponge applied to the wound helps well, but you can get by with a sterile bandage folded several times, which must be properly pressed and held until the bleeding stops completely. But if the wound is very large, you should immediately consult a doctor.
It happens that a stuck child does not run the risk of breaking away from the insidious piece of iron, but loudly calls for help. Pour warm water over the stuck area (but not too hot!). Having warmed up, the metal will surely let go of its unlucky prisoner.
There are a few simple rules that will allow you to avoid hypothermia and frostbite in severe frost:
- Do not drink alcohol - alcohol intoxication causes a large loss of heat, while at the same time causing the illusion of warmth.
- Do not smoke in the cold - smoking reduces peripheral blood circulation.
- Wear loose clothing - this promotes normal blood circulation. Dress like a "cabbage" - while between the layers of clothing there are always layers of air that perfectly retain heat. Outerwear must be waterproof.
– Tight shoes, lack of insoles, wet and dirty socks are often the main prerequisite for the appearance of scuffs and frostbite.
- Do not go out into the cold without mittens, a hat and a scarf. The best option is mittens made of water-repellent and windproof fabric with fur inside. Gloves made of natural materials, although comfortable, do not save from frost. Cheeks and chin can be protected with a scarf. In windy cold weather, before going outside, lubricate open areas of the body with a special cream.
- Do not take off shoes from frostbitten limbs in the cold - they will swell and you will not be able to put on shoes again. If your hands are cold, try warming them under your arms.
– Hide from the wind - the likelihood of frostbite in the wind is much higher.
- Do not wet the skin - water conducts heat much better than air. Don't go out into the cold with wet hair after a shower. Wet clothes and shoes must be removed, wiped with water, put on dry ones if possible, and the person should be brought to warmth as soon as possible. In the forest, it is necessary to kindle a fire, undress and dry clothes, during this time vigorously doing physical exercises and warming up by the fire.
- It can be useful for a long walk in the cold to take with you a pair of interchangeable socks, mittens and a thermos with hot tea. Before going out into the cold, you need to eat - you may need energy.
Electrical injury most often occurs when victims come into contact with uninsulated electrical wires.
The volume of first aid depends on the degree of damage and consists of the following measures: open the circuit (turn off the circuit breaker or switch); separate the current-carrying part from the victim (pull it out of the person’s hands, pull the victim away from the current source). In this case, it is impossible to take with bare hands the current-carrying part and the victim. It is necessary to use objects that do not conduct electric current (dry stick, clothes, rope, rope, dry rag, cap, leather and rubber gloves, paper, etc.). To isolate from the ground, you need to stand on a dry board, rubber (rubber mat, tire, etc.). You can chop or cut the current-carrying wires with an ax with a dry wooden handle and special wire cutters (with insulated handles). Each phase of the wire must be cut separately (so that there is no short circuit). You can stand on some kind of insulated pad (rubber mat, board).
If the victim is at a height, it is necessary to remove him from there (opening the circuit to release the victim from the current can lead to him falling from a height).
An aseptic dressing should be applied to the burn site, if the general condition of the victim does not require other urgent measures, and refer to a doctor.
The effect of current on the body depends on its strength, voltage, resistance, as well as on the initial state of the nervous system of the victim. People who have suffered an electrical injury can lose their ability to work for a long time.
A sharp muscle spasm during the passage of an electric current can lead to bone fractures, dislocations, and compression of the vertebrae.
During the action of the electric current, the victims often experience a violation of breathing and cardiac activity, the violations can be so deep that cardiac and respiratory arrest occurs - clinical death. If such a victim is not assisted in restoring blood circulation and respiration within 6-8 minutes, then biological death occurs.
First aid in case of clinical death consists in immediate (at the scene) artificial respiration and chest compressions.
When teaching artificial respiration, one must remember the anatomy and physiology of the respiratory system.
Respiration is a physiological process in which gases are exchanged between the body and the external environment. At the same time, the body receives oxygen, which is necessary for all its cells and tissues, and releases carbon dioxide accumulated as a result of their vital activity.
The respiratory organs include the airways (nasal cavity, larynx, trachea, bronchi) and lungs. The air inhaled through the nose or mouth through the larynx, trachea, and then the bronchi enters the lungs. The bronchus in the lung branches into smaller and smaller branches. The smallest terminal branches of the bronchus end in alveolar vesicles. Through the thin wall of the alveoli, gas exchange occurs; oxygen enters the blood, carbon dioxide is released from the blood into the alveoli. Thus, the exhaled air contains more carbon dioxide, and less oxygen than the air entering the lungs during inhalation: in the inhaled air, oxygen is 20.94%, and carbon dioxide is 0.03%, in the exhaled air, respectively, 16.3 and 4% .
The breathing process consists of rhythmically repeated inhalations and exhalations. When you inhale, due to the contraction of certain muscles (intercostal muscles, diaphragm), the chest expands, the air fills the bronchi and alveoli, as a result of which the lungs expand. Following this, the muscles relax, the chest collapses, squeezing the lungs and forcing air out of them - exhalation occurs. The respiratory rate in a healthy adult is 16-18 per minute.
Each lung lies in an isolated cavity lined with a membrane - the pleura. There is no air in the pleural cavity and the pressure in it is negative. With a chest injury and damage to the pleura, air enters the pleural cavity - the lung collapses and loses its ability to participate in breathing.
When starting to carry out artificial respiration, it is first necessary, if possible, to ensure the flow of fresh air to the victim - unfasten his collar, belt, belt and other parts of clothing that restrict breathing.
The index finger, wrapped in a scarf or piece of gauze, cleans the mouth of the victim from mucus, sand, etc. The simplest and at the same time the most effective is mouth-to-mouth artificial respiration. The head of the victim is thrown back as much as possible. To keep it in this position, something is placed under the shoulder blades. Holding the head of the victim in a tilted position with one hand, the lower jaw is pressed down with the other so that the mouth is half open. Then, taking a deep breath, the helper puts his mouth to the victim's mouth through a handkerchief or piece of gauze and exhales air from his lungs into him. At the same time, with the fingers of the hand holding the head, he pinches the victim's nose. At the same time, the victim's chest expands - inhalation occurs. Inhalation of air is stopped, the chest collapses - exhalation occurs. The helper takes a breath again, blows air into the lungs of the victim again, etc. Air should be blown in at a rate corresponding to that of a healthy person (Fig. 1). Blowing air into the lungs of the victim can also be done through a special tube - an air duct (Fig. 2). If the victim's jaws are tightly compressed, air must be blown into his lungs through the nose (mouth-to-nose method). To do this, the head of the victim is also held with one hand in a tilted position, and with the other hand they close his mouth. Then the person assisting, taking a deep breath, covers the victim’s nose with his lips through a handkerchief and blows air into it. As soon as the victim's chest expands, the helper takes his mouth away from his nose and removes his hand from his mouth - an exhalation occurs.
Artificial respiration by other methods is performed only when, for some reason (for example, a wound to the face), the use of mouth-to-mouth and mouth-to-nose methods is impossible.
Sylvester's way. The victim lies on his back. The person assisting stands at his head, takes both of his hands by the forearms and stretches them over his head - a breath occurs. Then he presses the victim’s arms bent at the elbow joints to his chest and, continuing to hold them by the forearms, with his own hands puts pressure on the victim’s lower chest - exhalation occurs. Movements (inhale - exhale) are repeated at a frequency of 16-18 per minute. The method is not applicable if the victim has damage to the hands or chest.
Along with respiratory arrest, the victim may stop the activity of the heart. This is recognized by the absence of a pulse, the dilation of the pupils, and the absence of a cardiac impulse when listening with the ear attached to the left side of the chest in the nipple area. In this case, an indirect heart massage is performed simultaneously with artificial respiration. If two persons are involved in providing assistance, then one makes artificial respiration according to the “mouth-to-mouth” or “mouth-to-nose” method, while the second, standing on the left side of the victim, puts the palm of one hand on the lower third of his sternum, puts his second hand at the first and at the time when the victim is exhaling, rhythmically makes several (3-4) energetic jerky pressures on the sternum with the base of the palm, after each push, quickly taking the hands away from the chest. If assistance is provided by one person, then, having made several pressures on the sternum, he interrupts the massage and once blows air through the mouth or nose into the lungs of the victim, then again makes pressure on the sternum, again blows air, etc.
Just as with electric shock, assistance is provided to victims of lightning strikes. The opinion, widespread among ignorant persons, that those struck by electric shock should be buried in the ground is erroneous. You don't need to do this.
Fainting is a momentary loss of consciousness due to a temporary lack of blood in the brain. This usually occurs when the body's blood vessels dilate and the volume of blood then cannot support the pressure in the upper body. Sometimes fainting is caused by an unexpected slowing of the heartbeat. The most common reasons are listed below.
Stuffy or overheated air.
Long standing.
Fear or intense anger.
Prolonged cough.
Strain during defecation.
Symptoms
Pallor.
Sweating.
Dizziness.
Visual impairment.
Tinnitus.
Loss of consciousness.
The fall.
Help with fainting
1. Put the patient to bed.
2. Raise his legs higher.
3. Loosen tight clothing.
The mildest degree of fainting - swoon- begins with a sudden slight clouding of consciousness, dizziness, ringing in the ears, yawning. Patients turn pale, there is a coldness of the hands and feet, drops of sweat on the face. Actions: the patient should be immediately laid on his back (in mild cases, you can simply sit with your back supported on the back of a chair, armchair). Please note that nothing is placed under the head! The head must be at least level with the body. It is necessary to provide good access to oxygen (often this alone leads to the cessation of fainting) - unbutton the collar, if a lot of onlookers crowded around the fallen person - part. It is necessary to calm the patient, the fear that arises can provoke a spasm of the cerebral arteries and increase cerebral ischemia. You can splash cold water on your face or bring a cotton swab moistened with alcohol to your nose. Usually an attack of lipothymia lasts a few seconds, but, in any case, if you managed to put the patient down and provide him with oxygen, then you can be calm, he will not lose consciousness.
simple fainting usually also begins with clouding of consciousness (i.e., like lipothymia), and subsequently there is a complete loss of consciousness with the exclusion of muscle tone, the patient slowly settles. Blood pressure is low, breathing is shallow, hardly distinguishable. The attack lasts several tens of seconds (up to 4-5 minutes maximum), followed by a quick and complete recovery of consciousness. Actions: if the patient has already lost consciousness, you do not need to pull him or try to raise him. Consciousness will return when the normal blood supply to the brain is restored, and this requires a horizontal position of the body (vascular tone is sharply reduced and if we raise our head or body, the blood will simply flow into the lower limbs and, of course, there will be no talk of any normal blood supply). No need to try to find a pulse, due to low pressure and loss of vascular tone, the pulse wave is very weak, and you may simply not feel it. Doctors determine in such cases the pulse on the neck, on the carotid artery (if you think you know where the carotid artery is located, you can try to find the pulse there). Otherwise, as well as with lipothymia - oxygen access, ammonia. Do not try to pour half a bubble of ammonia on the patient or wipe his temples with it - this is an ammonia solution, and it does not restore cerebral circulation, but stimulates the respiratory center through the nerve endings in the nasopharynx (a person takes a reflex breath and a large portion of oxygen enters the body with inspiration). You can, while continuing to hold the cotton wool with ammonia near your nose, cover your mouth with your palm for a couple of seconds - all the inhaled air will go through the nose and ammonia vapor will enter the nasal cavity. You can, at worst, just click on the tip of the nose - a painful stimulus can also sometimes stimulate the restoration of consciousness.
Convulsive syncope characterized by the addition of seizures to the picture of fainting (generalized, generalized or single twitching of individual muscles). In principle, almost every cerebral hypoxia (lack of oxygen) lasting more than 20-30 seconds can lead to the appearance of such symptoms. The actions do not differ from those with a simple faint, but it is necessary to ensure that during convulsions there is no mechanical damage to the head, body, hands. Please note: convulsions can be characteristic of an epileptic seizure (with typical signs being a bite of the tongue, often there are screams or groans at the beginning of the seizure (vocalization of the seizure), reddening and cyanosis of the face often appear) and for a hysterical seizure.
Bettolepsy- this is a syncope that occurs against the background of chronic lung diseases. It is due to the fact that during prolonged bouts of coughing in the chest cavity, the pressure rises significantly and the venous outflow of blood from the cranial cavity becomes much more difficult. True, in all these cases, it is necessary to study the cardiovascular system to exclude pathology from the heart. No special action is required. The duration of syncope is most often small.
Drop attacks- These are unexpected, sudden falls of patients. At the same time, there is almost never a loss of consciousness, although there may be dizziness, severe weakness. Usually observed in patients with osteochondrosis of the cervical spine, complicated by the development of vertebrobasilar insufficiency, as well as in completely healthy young pregnant women.
Vasodepressor syncope - more often in children, more often occurs with overwork, lack of sleep, emotional stress, being in a stuffy room. It has a rather complex genesis of development. The actions do not differ from those generally accepted, but a thorough examination is required to exclude possible diseases of the nervous system.
orthostatic syncope- occurs with a sharp transition from a horizontal to a vertical position, when the cardiovascular system does not have time to rebuild to fully provide the brain. It is especially pronounced when taking beta-blockers, diuretics, nitrates, etc. at the same time. More often, however, it is not fainting, but the so-called. presyncope, expressed in sudden weakness, dizziness, blackout in the eyes when changing body position.
Carotid sinus hypersensitivity syndrome proceeds according to the type of simple or less often, convulsive fainting. It is caused by hyperactivity of the carotid reflex (from the carotid sinuses located on the anterior-lateral surfaces of the neck), which causes sudden onset bradycardia, short-term cardiac arrest, arrhythmia. Provoking factors may be a sharp turn of the head, wearing tight collars - hence the conclusion: when providing assistance, never forget to loosen the collar, free the victim's neck.
Arrhythmic syncope- some types of arrhythmias can also lead to loss of consciousness. The main rhythm disturbances that can lead to loss of consciousness are paroxysmal forms of atrial flutter and fibrillation, complete transverse blockade, long QT syndrome, and paroxysmal ventricular tachycardia. Other forms of arrhythmias rarely lead to loss of consciousness, however, it is advisable for every patient suffering from arrhythmia (and especially the arrhythmias listed above) to consult with the attending physician about the possibility of this complication and, together with the doctor, develop rules of conduct that would reduce minimize the risk of such complications.
Chemical burns can be caused by such liquid or solid mineral and organic substances that actively interact with body tissues. Not only the skin can be affected (especially severe burns are observed when the substance gets under the nails), but also the mucous membranes. Burns of the mucous membranes and, especially, the cornea of the eyes, as a rule, have more severe consequences than burns of the skin.
Substances that cause chemical burns may belong to different classes of compounds: mineral and some carboxylic acids (for example, acetic, chloroacetic, acetylenedicarboxylic, etc.), acid chlorides (for example, chlorosulfonic acid, sulfuryl and thionyl chlorides), phosphorus and aluminum halides, phenol, caustic alkalis and their solutions, alkali metal alcoholates, as well as neutral substances - liquid bromine, white phosphorus, dimethyl sulfate, silver nitrate, bleach, aromatic nitro compounds.
Chemical burns are caused by many organic substances. For example, phenol and most substituted phenols, on contact with the skin, cause weeping lichen. With prolonged exposure, tissue necrosis occurs and scabs appear. Most nitro compounds of the benzene series, as well as polynitro and nitroso compounds, cause eczema. Halodinitrobenzenes and nitrosomethylurea, which is used to produce diazomethane, are especially strong. Chemical burns are caused by dialkyl sulfates, especially dimethyl sulfate.
Of the mineral acids, the most dangerous are hydrofluoric and concentrated nitric acids, as well as mixtures of nitric acid with hydrochloric (“aqua regia”) and concentrated sulfuric (“nitrating mixture”) acids. Concentrated hydrofluoric acid corrodes skin and nails very quickly; at the same time, extremely painful and long-term non-healing ulcers are formed. When concentrated nitric acid comes into contact with the skin, a strong burning sensation is immediately felt, the skin turns yellow. With prolonged contact, a wound is formed.
Concentrated sulfuric and chlorosulfonic acids are also very dangerous, especially to the eyes. However, if sulfuric acid is immediately washed off the damaged area of the skin with plenty of water, and then with 5% sodium bicarbonate solution, a burn can be avoided. Chlorosulfonic acid is more aggressive than sulfuric acid, and its contact with the skin causes severe chemical burns. With prolonged contact, these acids cause charring of the skin and the formation of deep ulcers. Contact with these acids in the eyes in most cases leads to partial and even complete loss of vision. The least dangerous of the mineral acids is hydrochloric acid. It causes only itching, not penetrating deep into the tissues. The skin becomes hard and dry and after a while begins to peel off.
Thionyl chloride, phosphorus halides and aluminum chloride have a similar effect on the skin. Being hydrolyzed by skin moisture, they decompose with the formation of hydrochloric and phosphoric acids, which cause chemical burns.
Caustic alkalis and their solutions cause more severe chemical burns than acids, as they cause swelling of the skin and therefore cannot be quickly washed off with water from the affected area. With prolonged action, very painful deep burns are formed. It is recommended to remove the alkali solution from the affected area not with water, but with a dilute solution of acetic acid.
Contact with alkali in the eyes almost always causes complete blindness.
Alcoholates and their alcohol solutions act on the skin and mucous membranes similarly to caustic alkalis, but they are more aggressive.
Particular care must be taken when grinding solid alkalis, calcium carbide, lithium hydride and sodium amide, which cause severe damage not only to the skin, but also to the mucous membranes of the respiratory tract and eyes. When performing these works, in addition to the obligatory use of protective gloves and a mask (and not goggles), a gauze bandage should be worn to protect the nose and mouth.
First aid:
- In case of chemical burns, the affected area is washed with a stream of water from the tap for a long time - at least 15 minutes.
- Further, for burns with acids and acid-like cauterizing substances, lotions are applied with a 2% solution of sodium bicarbonate, and for burns with alkalis - with a 2% solution of acetic, citric or tartaric acids.
– If an aggressive substance has come into contact with the skin through clothing, it should be cut with scissors before removal so as not to increase the affected area.
– Synthetic clothing can dissolve in some aggressive substances, such as sulfuric acid. When washed off with water, the polymer coagulates and covers the skin with a sticky film. In this case, washing does not reach the goal. You must first wipe the acid off the skin as thoroughly as possible with a dry cotton cloth and only then rinse with water.
Resuscitation is a set of special measures aimed at reviving a person who is in a state of clinical death.
With the onset of clinical death, breathing and cardiac activity are absent. This is manifested as follows: lack of consciousness, pulsation in the carotid arteries, breathing, sharply dilated pupils, cyanosis or a sharp pallor of the skin and mucous membranes.
Loss of consciousness is determined by the lack of reaction of the victim to a sound or tactile stimulus (hail, pat on the cheek, shake it slightly).
The absence of a pulse on the carotid artery is regarded as a sign of a "catastrophe". It is determined with the index and middle fingers 2-3 cm away from the thyroid cartilage protruding on the neck or along the internal contour in the middle of the length of the sternocleidomastoid muscle.
Respiratory arrest is easily seen by the absence of respiratory movements of the chest or diaphragm. To clarify, you can put your ear to your mouth or nose, bring a smooth object to the victim's mouth - the lid of a tin can, compass glass or a mirror - and check whether it fogs up or not.
Pupil dilation and lack of reaction to light are detected by opening the upper eyelid and illuminating the eye. If the pupil is significantly dilated (into the entire iris) and does not narrow in the light, then this sign is always alarming.
Clinical death is a stage of dying, reversible only by resuscitation. The maximum duration of clinical death is 5-6 minutes.
The success of resuscitation of a person largely depends on the sequence of methods of resuscitation, which is carried out in the following order:
A - free the airways from mucus and foreign bodies;
B - start artificial ventilation of the lungs (artificial respiration) according to the "mouth-to-mouth" or "mouth-to-nose" method;
C - restore blood circulation by external heart massage.
To ensure the patency of the respiratory tract, the maximum extension of the head of the victim is necessary. The assisting person places one hand on the back of the neck, the other in the forehead and produces a slight but vigorous extension of the head backwards. This can be achieved by placing a roll of folded clothing under the patient's shoulders. Next, you need to examine the oral cavity, clean it of foreign bodies (with a finger wrapped in a napkin or handkerchief) and dry the mouth with improvised material. At the end of the toilet of the oral cavity, they immediately begin to carry out artificial ventilation (IVL).
Artificial ventilation of the lungs according to the “mouth-to-mouth” method: after a deep breath, completely covering the victim’s mouth and pinching his nose with his fingers, make a sharp energetic exhalation into his airways, after which they take their head to the side. The effectiveness of inflation can be seen by the increase in chest volume and the noise of exhaled air. For hygiene purposes, place a tissue or handkerchief over the victim's mouth. IVL should be carried out at a frequency of 12-15 times in 1 min.
If mechanical ventilation is carried out for a child, then air should be blown in carefully, without using the entire vital capacity of the lungs, in order to avoid rupture of the lung tissue. For infants, the volume of air in the mouth of the resuscitator is sufficient. IVL should be carried out at a frequency of 20 times in 1 min.
Technique of external heart massage. The victim is laid on his back on a hard and even base (floor, ground). The assisting person takes a position on the side of the patient, gropes for the end of the sternum in the epigastric region, and at a distance of 2 transverse fingers upward along the midline, lays the palm of the hand with its widest part perpendicular to the longitudinal axis of the body. The second palm is placed crosswise on top. Without bending the arms, it produces strong pressure on the sternum. Push-squeeze is performed quickly, using the efforts of the shoulder girdle and body weight. After that, the pressure is stopped, allowing the chest to straighten out, without taking the hands off the surface of the chest. During this time, the heart passively fills with blood. These movements are repeated at a frequency of at least 60 per 1 min. Compress the chest vigorously under metered pressure to cause a pulse wave in the carotid artery.
External heart massage in children is carried out according to the same rules, but with one hand and with a frequency of 80 pressures per 1 minute, in infants - with the tips (2 and 3) of two fingers, they press on the middle part of the sternum with a frequency of 120 pressures per 1 minute.
The effectiveness of massage is judged by a change in the color of the skin of the face, the appearance of a pulse on the carotid artery, and constriction of the pupils.
If assistance is provided by one person, then the ratio of manipulations should be 2 to 15. For every 2 quick blows of air into the lungs, there should be 15 massage compressions of the sternum.
If assistance is provided by 2 people, then the ratio of receptions should be 1 to 5. One performs an external massage, the other - artificial respiration after every 5 compression of the sternum at the time of expansion of the chest.
Burns can be caused by thermal, chemical, electrical, radiation factors. Depending on the degree and localization, they can be located on the skin of the extremities, face, perineum and genital organs, oral mucosa, esophagus and respiratory tract.
The depth of the lesion can reach both superficial layers and deep-lying tissues, on which their classification depends. Depending on the area, their severity is determined.
Thermal burns
Thermal burns are the most common and can be caused by the direct action of hot objects, open flames, and boiling liquids. They are of particular danger in children and the elderly, since they cause a significant loss of fluid from the burn surface and intoxication with severe local manifestations and negative reactions of a general type. The volume of therapeutic measures aimed at eliminating the problem at the pre-hospital stage does not depend on the degree of the burn and consists of a clear order.
Termination of the action of high temperatures on damaged tissues. The faster the contact of the patient with the damaging thermal agent is limited, the less damage will be caused.
Releasing damaged areas from clothing, foreign objects and hot elements. The exception is cases of burns with various substances that form a dense scab and connection with damaged skin.
Cooling fired tissue. A very important point that must be fulfilled. This is due to the fact that hyperthermia is maintained for a long time in tissues exposed to high temperatures. This contributes to an increase in the degree and area of the burn compared to the initial indicators. To prevent this from happening, cooling is carried out with cold water or ice.
Closure of the burn surface. This is necessary in order to limit its contact with the surrounding aggressive world, which will prevent the reproduction of harmful microorganisms in damaged tissues. For this, bandage-gauze dressings of various types can be used, both dry and based on water-soluble ointments (levomekol, oflokain, levosin, methyluracil, synthomycin, panthenol, betadine). The main requirement for them is that they should not cause irritation of wounds and increase pain. To reduce pain, you can periodically water them with a cool solution of novocaine or furacilin.
Adequate anesthesia. For these purposes, tableted and injectable forms of non-steroidal anti-inflammatory painkillers (ketalgin, dexalgin, diclofenac, nimesil, paracetamol), as well as standard preparations of analgin, diphenhydramine, tempalgin and others can be used.
Transportation of the victim to the nearest surgical or traumatological hospital. Here, measures should be taken to prevent or reduce the manifestations of burn disease and infection of injured surfaces. For this purpose, broad-spectrum antibacterial drugs, infusion solutions are introduced, taking into account the severity of the burn and fluid loss, hemotransfusion of blood components and colloidal solutions, drugs that normalize microcirculation processes, local treatment of burned areas is carried out using plastic techniques for replacing wound defects with donor skin.
Burns of the upper respiratory tract and eyes
Burns of the upper respiratory tract and eyes are a special type of thermal burns, which are mainly caused by hot flames and smoke. They are also very dangerous, since in a matter of hours they can lead to the death of the patient due to progressive respiratory failure due to obstruction of the trachea and bronchi. It is very difficult to help such patients at the pre-hospital stage. It is necessary to evacuate the victims from the danger zone as soon as possible and provide free access to fresh air, administer painkillers and urgently deliver the patient to the nearest hospital.
Under these conditions, antibacterial and infusion therapy should be carried out, as well as sanitation bronchoscopy (examination of the trachea and bronchi), with the help of which thick mucus and foreign particles are evacuated, which will restore the patency of the respiratory tract. If necessary, repeat bronchoscopy is performed. In case of progressive respiratory failure, patients are transferred to artificial lung ventilation.
In case of eye burns of thermal or chemical origin, it is necessary to rinse them with plenty of water. This will cool the tissues and free them from aggressive chemical compounds. The eyes are instilled with drops containing local anesthetics (novocaine, dicaine, lidocaine) and antibacterial drugs (levomecithin, tobrex). All victims should seek medical attention from an ophthalmologist.
Chemical burns
Chemical burns can be represented by damage to the skin and mucous membranes of the oropharynx and esophagus as a result of exposure to aggressive acids, alkalis and various chemical compounds used as poisons and household chemicals. In this case, special types of tissue necrosis of coagulation or colliquation types arise. The first, characteristic of acid burns, when a dense scab is formed, the second - for alkalis with the formation of long-term non-healing weeping surfaces.
The scope of measures for such burns includes the following complex:
Stop contact of the skin surface or mucous membranes with the chemical as soon as possible;
Remove any objects in contact with the burnt surface;
Rinse the burn wound with plenty of running water. This will wash away the remaining substance and neutralize them. If it is possible to use neutralizing solutions in cases of known nature of the chemical compound. To neutralize alkalis, the wound is washed with weak acids, for acids - with alkalis;
Adequate anesthesia;
Closure of the wound surface with a dry bandage. It is not recommended to use various ointments and panthenol foam due to the fact that the formation of aggressive compounds with substance residues is possible;
Mandatory hospitalization in a medical institution where specialized medical care will be provided.
A special type of this type of burns are damage to the esophagus. Medical care should never be delayed, as they are fraught with the development of extensive ulcerative mucosal surfaces, which can be complicated by bleeding and post-burn stenosis with obstruction even for liquid food.
In order to avoid dangerous complications, at the slightest suspicion of intentional or accidental use of unknown chemical compounds, the stomach and esophagus must be washed with plenty of water, followed by its evacuation from the stomach using a probe. This will wash away the aggressive components and dilute the chemical compounds that have already arrived. In the future, in a hospital, early bougienage (expansion) of the narrowed sections of the esophagus is carried out, enveloping agents such as Almagel, Phosphalugel, Venter, Maalox are prescribed, antibiotic prophylaxis and infusion-transfusion therapy are carried out.
do not happen so often, but differ in their severity and scale of the lesion. The burn surface itself can be insignificant and limited only to the fingers of the hand or the heel region, which close the electric arc. But at the same time, they are completely charred with concomitant bone fractures, ruptures of muscles, tendons, nerves and blood vessels. You can help the victim only by taking the victim away from the source of electric current and hospitalizing him in a hospital. Do not touch a person who is under the influence of electricity with bare hands. For these purposes, materials that do not have electrical conductivity should be used. Local treatment of the affected limbs consists in immobilizing them with splints or splints made from improvised materials, covering the burn surface with a dry bandage. In case of cardiac arrest or ventricular fibrillation, resuscitation measures are indicated in the form of electrical defibrillation or chest compressions.
Radiation burns
Radiation burns are caused by radiation released during atomic explosions and therefore occur infrequently. If sunburns are attributed to this group, then this group of injuries is more frequent. Possible radiation burns in cancer patients after radiation therapy. They can be located on the skin or mucous membrane of the stomach and intestines. This type of burn is also much more severe than thermal burns, causing severe suffering to patients.
First aid is mainly provided in the lesion and should be organized as soon as possible. Damaged areas of the skin are washed with soap and water, all clothing is completely removed, which always turns out to be contaminated with radioactive particles. Dry dressings or soaked in solutions of aqueous antiseptics (furatsilin, chlorhexidine, decasan) are applied to the burned surfaces.
Home care for burns
Naturally, many people who have received thermal burns refuse specialized assistance, trusting only traditional medicine. This is not always correct. On your own at home, you can treat only small first-degree burns, which are manifested by reddening of the skin, or limited second-degree injuries in the form of blisters. More complex injuries must be hospitalized.
The most important thing to remember is that the need to cool the burnt surface. The duration of the procedure is 30-40 minutes with a 10-15 minute interval. This is necessary so that microcirculation in the affected tissues is not disturbed. The total cooling time should be several hours. The true degree of the burn can be assessed only on the next day.
Parallel to cooling, it can be applied to the burnt surface compress of thin strips of potatoes or a jelly-like mass of starch and oats, or an infusion of flax seeds. After 2-3 days, first-degree burns can be treated with sea buckthorn oil. In no case should any oil solutions be applied to the burn in the early period. They form a thermal shield that limits heat transfer from the affected surface, thereby increasing the temperature and degree of damage.
Burns can be caused by dry heat (fire), moist heat (steam or hot liquids), electricity; as well as harsh chemicals. When assisting with a burn, it is necessary first of all to eliminate its cause (for example, to extinguish the flame). The affected area should be cooled as soon as possible by placing in cold water or running cold tap water. Anyway NEVER do not apply any ointments or creams to burns, and do not break blisters that may form on the skin. After giving first aid, seek emergency medical attention in the following cases: if the burn covers a large area, if the skin is significantly damaged or charred, if many blisters have formed, or if the victim is in severe pain. Even small burns on the face and hands can cause scarring, so it is advisable to seek medical help without delay.
small burns
Burns, even those with significant redness and blistering, can be safely treated at home if only the surface layer of the skin is damaged in a small area. These types of burns are usually sunburns. Superficial burns are very painful, so first aid should focus primarily on cooling the burnt surface to reduce pain. If possible, soak the burnt area in cold water or running cold tap water for at least 10 minutes or until the pain stops. If blisters form on the burnt surface, do not open them. If blisters appear on the skin in a place where they can be damaged by clothing, cover them with a soft cloth pad. Do not apply any cream, grease, or ointment to burns. The exception is mild sunburn, which can be treated with a half-alcohol solution.First aid for burns
- Remove clothing that has been soaked in hot fat, boiling water, or chemicals from the burnt area, except where it is firmly stuck to the skin. Dry charred cloth should be left.
- Place the burned area in cold, preferably running, water for at least 10 minutes. If the affected area is large, cover it with a clean towel or sheet soaked in cold water.
- After you have cooled the burn area, place a clean, dry gauze or cloth over it. Do not use cotton wool or fluffy fabrics for this purpose. If you take the victim to the hospital, do not cover the burnt surface - any bandage in the hospital will be removed anyway.
- Keep the burned limb elevated. If the victim is conscious, give him a few sips of cold water while waiting for medical attention.
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