Rules for the provision of first aid for burns: practical recommendations for thermal, chemical and electrical injury. First aid for thermal burns

01.07.2019

Death from burns occupies a leading position in the general list of types of mortality. The reason for this is not only ignoring the help of specialists in case of injuries, but also the inability to provide the necessary assistance. Therefore, the ability to determine the degree of a burn, as well as to navigate in the provision of first aid to victims of thermal, chemical, electrical burns, is relevant.

Symptoms, local and general processes after burns

Actions in case of an electrical burn before the arrival of doctors. This type of burn is characterized by the fact that when it was received, the victim passed an electric current through his body, which can cause cardiac arrest, numerous wounds. A person who has suffered from contact with electric current must consult a doctor without fail - cardiac arrest may not occur immediately, but several hours after the incident. First aid includes:

Elimination of the current source. If such a source is open, then to remove it from the victim, you need to use an object that does not pass current: wooden, rubber, plastic things.
Providing heart massage in case of no pulse. This procedure must be performed until the ambulance arrives, regardless of whether it is possible to feel the pulse or not.
Spraying with water, using ammonia- if the victim is unconscious.

The rest of the assistance measures for electrical burns are identical to those for thermal burns.

First aid for chemical burns. The latter is a consequence of the action of alkaline, acidic materials on the skin, mucous membranes. With such a burn, a change in skin color does not occur, but its soft layers can be destroyed irrevocably. To help a person who is under the influence of a chemical agent, you should:

Eliminate the source that provoked the chemical burn.
Cleanse the skin of chemicals by rinsing under running water (at least 20 minutes). If the burn was caused by calcium oxide, then water cannot be used - a strong chemical reaction can occur. In this case, a solution of water with sugar is suitable, in which it is necessary to soak the fabric and attach it to the burn site. Substances containing aluminum may ignite when in contact with ordinary water. Here you need to use oils (gasoline, kerosene).
Treat the wound with a solution of acetic acid or alkali. To do this, you need to dilute a teaspoon of vinegar or soda, respectively, in a glass of water. The first solution is used when the burn was caused by alkalis, the second type is relevant for neutralizing acids.
Give the victim at least 1 liter of purified cold water to drink, provide heat until the arrival of doctors.

General rules for prevention

A large percentage of fires and burns occur due to the negligence of people who then suffer. Here are some basic precautions you can take to help reduce burn injuries:

No smoking in bed.
Installing fire alarms in your home or office will reduce the risk of accidents. In the house, such alarms are recommended to be installed not in one, but in several copies: a kitchen, a room with a fireplace / stove.
Each company should have its own evacuation plan in case of fire. With such a plan, each employee must be familiarized with signature.
Knowing how to use a fire extinguisher is a very useful thing. It can be useful not only at work, but also at home. Each employee must know where the fire extinguisher is located.
If there is a water heater at home / at the company, the heating temperature should not exceed 50 C.
Paint products should be sealed tightly, stored in a room where it is constantly ventilated. Within the framework of the working room, such products must be placed in a special container.
It is necessary to regularly check the serviceability of the shields and their fuses. The latter must be made of reliable materials;
Place for waste paper - basement.
When organizing fireworks, the terrain must be carefully thought out, all precautions taken.

Careless handling of fire, boiling liquids, and chemicals can cause burns. The severity of injury from a burn depends on the size of the affected body surface.

First aid for chemical burns

When providing first aid for chemical burns, first of all, it is necessary to remove clothing soaked in chemicals. The area burned with acid (with the exception of sulfuric acid) or alkali is washed abundantly with water and neutralizing solutions (the acid is neutralized by an alkaline solution, for example, soda, and alkali, on the contrary, neutralizes a weak acid solution, for example, water with lemon juice or citric acid - just do not overdo it with dose).

How to determine the degree of a burn?

At the first degree of a burn, redness, swelling, pain are observed. Moderate to severe burns are associated with blistering (2nd degree burns), wounding or bursting of blisters (3rd degree burns), and necrosis and charring of tissue (4th degree burns). 3rd-4th degree burns should not be cleaned or lubricated. It is necessary to apply a sterile bandage and seek medical help. It is necessary to immediately call for medical help and with extensive burns of any degree. They are life threatening.

First aid for thermal burns

It is necessary to cool the burn area. Before that, remove all things from the burnt area of the body. Adhering clothing should not be torn off from the burn - the tissue around it must be cut off. At the first and second degree - cool the burned area of the skin with running water for 10-15 minutes. For third- and fourth-degree burns, a clean, damp bandage is applied to the affected area of the skin, and a container of cold water is used for cooling. Then the victim needs rest and anti-shock measures.

First aid for thermal burns - what not to do

Lubricate the affected skin area with oil, regular cream, protein, urea, etc.
It is also impossible to apply panthenol and any other means of burns to a freshly burned area of \u200b\u200bthe skin without cooling it.
It is impossible to lubricate with these means burns of 3 and 4 degrees.
It is also impossible to tear off adhering clothes and pierce the formed bubbles.

When should you call an ambulance immediately?

Always call an ambulance if:

The area of the burn is greater than 5% (1 palm of the victim = 1% of the body)

A burn (of any degree) occurred to a child or an elderly person

If it is a 3rd degree burn (blisters have burst, wounds have formed)

If the groin area is burned

When both hands or feet are burned

When the mouth or nose, head or airways are burned*

*Respiratory tract burn equals 30% of a 1st degree burn

Burns - is tissue damage caused by heat, chemicals, electricity, or radiation. Burns are accompanied by a pronounced pain syndrome - people with extensive burn surfaces and deep burns develop shock phenomena.

Four degrees of burns

Depending on the depth of damage to the skin and tissues, four degrees of burns are distinguished (Fig. 1): mild (I), moderate (II), severe (III) and extremely severe (IV).

For burns of the 1st degree (redness and slight swelling of the skin), the burned area should be moistened with a weak solution of potassium permanganate, alcohol.

For burns of the II degree (the skin is covered with bubbles with a clear liquid), a sterile bandage moistened with a solution of potassium permanganate, alcohol should be applied to the burn. It is impossible to pierce the bubbles and remove parts of clothing adhering to the burn site.

Rice. 1. Burns of the hand: 1 - I and II degrees; 2 - II and III degree; 3 - deep burn III and IV degree

In case of burns of III and IV degrees (necrosis of the skin and underlying tissues), a sterile bandage should be applied to the burn and all measures should be taken to deliver the victim to a medical facility.

The course and severity of burns, as well as the recovery time, depend on the origin of the burn and its degree, the area of the burnt surface, the characteristics of first aid to the victim, and many other circumstances. Burns caused by flames are the most severe, since the flame temperature is several orders of magnitude higher than the boiling point of liquids.

Thermal burns

At thermal burn first of all, it is necessary to quickly remove the victim from the fire zone. At the same time, if a person’s clothes caught fire, you must immediately remove them or throw on a blanket, coat, bag, etc., thereby stopping the access of air to the fire.

After the flame is knocked down from the victim, sterile gauze or simply clean dressings from improvised material should be applied to the burn wounds. A victim with severe burns should be wrapped in a clean sheet or cloth, without undressing him, covered warmer, given warm tea and rest until the doctor arrives. The burnt face must be covered with sterile gauze. For eye burns, cold lotions should be made from a 3% solution of boric acid (half a teaspoon of acid in a glass of water). The burn surface should not be lubricated with various fats. This can cause even more harm to the victim, since dressings with any fats, ointments, oils only contaminate the burn surface and contribute to wound suppuration.

Chemical burns

Chemical burns arise as a result of exposure to the skin and mucous membranes of concentrated inorganic and organic acids, alkalis, phosphorus, kerosene, turpentine, ethyl alcohol, as well as some plants.

In the event of a chemical burn, first of all, it is necessary to quickly remove or cut clothing soaked with a chemical compound. Chemicals that have come into contact with the skin should be washed off with plenty of tap water until the specific odor of the substance disappears, thereby preventing its effects on tissues and the body.

Do not wash off chemical compounds that ignite or explode on contact with water. In no case should you treat the affected skin with swabs or napkins moistened with water, since in this case the chemical compounds are rubbed into the skin even more.

A dressing with a neutralizing or disinfecting agent or a clean, dry dressing is applied to the damaged areas of the skin. Ointment (vaseline, fat, oil) dressings only accelerate the penetration into the body through the skin of many fat-soluble chemicals (for example, phosphorus). After applying the bandage, you need to try to eliminate or reduce the pain, for which you give the victim an anesthetic inside.

Acid burns are usually very deep. A dry scab forms at the site of the burn. If acid comes into contact with the skin, rinse the affected areas with plenty of water under running water, then neutralize the acid and apply a dry bandage. If the skin is damaged by phosphorus and its compounds, the skin is treated with a 5% solution of copper sulfate and then with a 5-10% solution of baking soda. First aid for burns with alkalis is the same as for burns with acids, with the only difference being that alkalis are neutralized with a 2% solution of boric acid, solutions of citric acid, table vinegar.

In case of contact with acid or its vapors in the eyes or in the oral cavity, it is necessary to rinse the eyes or rinse the mouth with a 5% solution of baking soda, and if caustic alkalis get into contact with a 2% solution of boric acid.

electrical burns

electrical burns arise from the action of an electric current, the contact of which with tissues, primarily with the skin, leads to the transition of electrical energy into heat, resulting in coagulation (coagulation) and destruction of tissues.

Local tissue damage during an electrical burn manifests itself in the form of so-called current signs (marks). They are observed in more than 60% of the victims. The higher the voltage, the worse the burns. Current above 1000 V can cause an electrical burn throughout the limb, on the flexion surfaces. This is due to the occurrence of an arc discharge between two contacting surfaces of the body during convulsive muscle contraction. Deep electrical burns occur when struck by a current of 380 V and above. In electrical trauma, there are also thermal burns from exposure to a voltaic arc flame or ignited clothing, sometimes they are combined with true burns.

According to the depth of the lesion, electrical burns, like thermal burns, are divided into four degrees.

The appearance of an electrical burn is determined by its location and depth. Due to convulsive muscle contraction, gross immobility of the joints (contracture) is observed, scars are formed more coarse than with a thermal burn. After healing of electrical burns, in addition to contractures and rough scars, neurinomas (nodular formations on the affected nerves) and long-term non-healing ulcers develop. If the electric burn was in the head area, then baldness develops.

First aid consists in releasing the victim from the action of electric current, if necessary, carrying out resuscitation measures. Aseptic dressings are applied to the burn areas. After providing first aid, all victims of electric current should be sent to a medical institution for observation and treatment.

Radiation burns

Radiation burns- lesions resulting from local exposure to the skin of ionizing radiation.

The nature of radiation injury depends on the dose of ionizing radiation, the features of spatial and temporal distribution, as well as on the general condition of the body during the period of exposure. High-energy X-ray and gamma radiation, neutrons, which have a high penetrating power, affect not only the skin, but also the deeper tissues. Low-energy beta particles penetrate to a shallow depth, causing lesions within the thickness of the skin.

As a result of skin irradiation, its cells are damaged with the formation of toxic products of tissue decay.

Radiation burns can be the result of local tissue overexposure during radiation therapy, nuclear reactor accidents, and skin contact with radioactive isotopes. In the conditions of the use of nuclear weapons, with the fallout of radioactive fallout, the occurrence of radiation sickness on unprotected skin is possible. With simultaneous general gamma-neutron irradiation, the occurrence of combined lesions is possible. In such cases, burns will develop against the background of radiation sickness.

Periods of radiation burn

There are four periods of radiation burn.

First- early radiation reaction - detected after a few hours or days from exposure and is characterized by the appearance of erythema (redness).

Erythema gradually subsides, and manifests itself second period - hidden - during which no manifestations of a radiation burn are observed. The duration of this period is from several hours to several weeks, the shorter, the more severe the lesion.

In the third period - acute inflammation, the appearance of blisters, radiation ulcers is possible. This period is long - several weeks or even months.

The fourth period is recovery.

Degrees of radiation burns

There are three degrees of radiation burns.

First degree radiation burns(lungs) occur at a radiation dose of 800-1200 rad. There is usually no early reaction, the latent period is more than 2 weeks. In the third period, there is a slight swelling, erythema, burning and itching in the affected area. After 2 weeks, these phenomena subside. At the site of the lesion, hair loss, peeling and brown pigmentation are noted.

Radiation burns of the second degree(moderate) occur at a radiation dose of 1200-2000 rad. An early reaction is manifested in the form of mild transient erythema. Sometimes weakness, headache, nausea develop. The latent period lasts about 2 weeks. During the period of acute inflammation, severe erythema and edema appear, affecting not only the skin, but also the underlying tissues. In place of the former erythema, small blisters filled with a clear liquid appear, which gradually merge into large ones. When the blisters open, a bright red erosive surface is exposed. During this period, the temperature may rise, pain in the affected area increases. The recovery period lasts 4-6 weeks or more. Erosions and ulcerations are epithalized, the skin of these areas becomes thinner and pigmented, thickens, an expanded vascular network appears.

Radiation burns of the third degree(severe) occur when exposed to a dose of more than 2000 rad. An early reaction develops rapidly in the form of edema and painful erythema, which lasts up to 2 days. Latent period up to 3-6 days. In the third period, edema develops, sensitivity decreases. There are petechial hemorrhages and foci of necrosis of the skin of purple-brown or black color. At high doses of radiation, not only the skin, but also subcutaneous tissue, muscles and even bones die, and vein thrombosis occurs. Rejection of dead tissue is very slow. Formed ulcers often recur. Patients have fever, high leukocytosis. Occurs with severe pain. The recovery period is long - many months. In places of healed scars, unstable rough scars are formed, ulcers often form on them, prone to degeneration into cancerous ones.

With superficial radiation burns that are not accompanied by a general reaction of the body, only local treatment is indicated. Large bubbles open. Bandages with antiseptics, antibiotics and wet-drying bandages are applied to the affected surface. Under the bandages, small blisters dry up, in their place a scab forms.

For more severe radiation burns, complex, including surgical, treatment is carried out in a hospital, including restorative therapy, blood transfusion and blood substitutes.

Re-briefing All employees pass at least once every six months according to programs developed for conducting initial briefings at the workplace.

Unscheduled briefing carried out: when new or amended legislative and other regulatory legal acts containing labor protection requirements, as well as instructions on labor protection, are introduced; when changing technological processes, replacing or upgrading equipment, fixtures, tools and other factors affecting labor safety; in case of violation by employees of labor protection requirements, if these violations created a real threat of serious consequences (accident at work, accident, etc.); at the request of officials of state supervision and control bodies; during breaks in work (for work with harmful and (or) dangerous conditions - more than 30 calendar days, and for other work - more than two months); by decision of the employer (or a person authorized by him).

Targeted coaching is carried out when performing one-time work, during the elimination of the consequences of accidents, natural disasters and work for which a work permit, permit or other special documents are issued, as well as when mass events are held in the organization.

The specific procedure, conditions, terms and frequency of conducting all types of labor protection briefings for employees of individual industries and organizations are regulated by the relevant industry and intersectoral regulatory legal acts on labor safety and protection.

First aid for thermal, chemical, electrical burns.

burns- tissue damage caused by high temperature, electric current, acids, alkalis or ionizing radiation. Accordingly, thermal, electrical, chemical and radiation burns are distinguished.

Thermal burns. Open fire can injure the skin in just a second. The same can be said about superheated water vapor and hot metal. However, “harmless” water with a temperature of about 50 ° C can injure the skin, but within a few minutes. The consequences of exposure to high temperatures are very different: from impaired skin functions (breathing, touch, protection against infections, blood circulation) to complete necrosis (necrosis) of not only all layers of the skin, but also muscle tissue. Doctors distinguish burns of four degrees. The first is characterized by persistent reddening of the skin; swelling is possible. The second degree burn adds to this the formation of blisters filled with serous (serum) fluid. In no case should you open blisters: this is a direct road to infection and scars. Do not use creams or ointments without consulting your doctor. Both of these degrees of burns are superficial, after healing they do not leave scars, but. even a first-degree burn of a large area can cause the death of the victim due to a violation of the respiratory function of the skin and general intoxication of the body. With a third-degree burn, large blisters appear, filled with an amber-colored liquid, then yellow or white scabs appear in their place, and scars remain on the injured area of \u200b\u200bthe skin. The fourth degree is the burnout of the skin and even more deeply located tissues. There is a dense black or brown scab, blood vessels are thrombosed.

First aid for burns is to immediately eliminate the source of heat. Burning clothes are extinguished with water, snow, sand. A dense cloth is thrown over the victim, stopping the flow of oxygen that supports combustion. Clothes are cut off, not removed! The affected areas of the skin are cooled with a jet of cold water and treated with vodka or an alcohol solution. Sterile dry napkins are applied to burn wounds, with extensive burns the patient is wrapped in a clean sheet. The victim of burns should be well insulated, as chills and a decrease in body temperature are possible. You need a plentiful warm drink: tea or a solution of 1 teaspoon of table salt and half a teaspoon of baking soda in 1 liter of water. If possible, it is useful to give the victim painkillers. For minor first and second degree burns, it is helpful to urinate on the injured area. Extensive burns, as well as burns of the third and fourth degrees, require urgent hospitalization with gentle (!) Transportation to the hospital. Significant in area, as well as deep burns lead to the development of burn disease. First of all, burn shock occurs, then the body undergoes severe intoxication with the decay products of damaged tissues. Infection of burnt surfaces leads to suppuration. Self-treatment of a burn disease is almost impossible, qualified medical assistance is required. Do not self-medicate or practice on others, especially with thermal burns to the eyes or respiratory organs.

If housekeeping, working conditions, or your own inattention make small first- and second-degree burns a common occurrence, it is useful to prepare for the future and have simple traditional medicine on hand: 3% propolis solution: apply a sterile napkin moistened with it to the burnt place; Pour 40 g of dry crushed nettle leaves with 200 ml of a 40% alcohol solution (vodka), close tightly in a glass container and leave for two days. Strain. Moisten a clean cloth with infusion and bandage the burnt area. From ready-made medicines in a home medicine cabinet, doctors recommend having vinylin, Kalanchoe juice, calendula ointment, Vishnevsky liniment.

Chemical burns The cause of chemical burns is exposure to aggressive chemicals, most often acids and alkalis. The health, and sometimes the life of the victim, depends on the speed and effectiveness of first aid before the arrival of doctors. First of all, it is necessary to remove clothing soaked in a caustic reagent and immediately start washing the affected areas with cold running water. This procedure should last 10-15 minutes if flushing is started immediately, and at least half an hour if there is a delay. Only after that, the affected area is treated with a solution of baking soda, if the burn is caused by acid, and a weak solution of vinegar, if the cause of the burn is alkali. It is possible to determine which chemical caused the burn by the colored burn surface: a burn with sulfuric acid gives a brown or black color, with nitric acid a yellow-brown color, and with hydrochloric acid a yellow one. Alkali burns are colorless. Quicklime is not washed off the skin, but cleaned off! Otherwise, the reaction of quicklime with water will lead to additional thermal damage. The burnt surface is covered with a sterile dry bandage and the patient is given an anesthetic. Very often, chemical burns are accompanied by general poisoning of the body, requiring medical intervention. The burn of the cornea with alkali is especially dangerous: it causes irreversible clouding of the cornea.

Chemical and thermal burns occur most often due to negligence, inattention, violation of the simplest safety rules. Follow an elementary precaution, then this article will remain general educational for you, and you will be able to competently provide the very first aid to the victim if necessary.

The local effect of high temperature manifests itself in the form of burns, which appear from the action of a flame, heated metal objects, hot gas, and sunlight.

Changes from the action of hot liquids, steam, are called scalding.

Before proceeding with the provision of medical care, it is necessary to stop the effect of the temperature factor. For extinguishing, both standard and improvised means are used. For example, when clothes ignite, the flame is extinguished by covering the victim with a dense cloth.

Thermal burns account for 3-5% of the total number of burns, but they are massive in a fire. Such burns are the most typical and demonstrative in terms of the study of burn injury. Thermal burns can be caused by hot liquids, steam, gas, flames, heated solids. Damage to the tissue of a living organism occurs when exposed to high temperatures from 45-500 C and above. The pain temperature threshold of the skin is 440 C. Any exposure to a higher temperature for a minute or longer causes overheating and cell death. The depth, prevalence of a burn wound and its consequences depend on the temperature and time of exposure, on the state of the body, and on the age of the victim. For example, hot water vapor burns are less likely to cause shock than flame burns. The elderly, children, weakened and sick people are more difficult to tolerate burns.

Skin burns.

The area of \u200b\u200bthe skin in a person is about 2 m2 (with a growth of 1 m 70 cm, it is 1.7 m2, with a growth of 1 m 65 cm - 1.65 m2). The thickness of the skin is about 3 mm, the weight is about 5 kg, the amount of water in the skin is 10% of the total amount of water in the body, despite the fact that the body consists of 70-80% of water. The skin contains about 1 liter of blood (out of 5 liters of blood in the body). The functions of the skin are very important, it protects against damage (barrier function), participates in heat transfer (thermoregulation), in the regulation of water metabolism, in nervous regulation, is associated with the psyche (touch), vitamin D is synthesized in it.

The structure of the skin.

The surface of the skin is covered with a thin layer of fat and sweat - "acid mantle", pH 5.5. This layer protects against numerous microbes that are on the surface of the skin.

The top layer of the skin, the epidermis, is an epithelium that is prone to keratinization. Under it is the actual layer of the skin - the dermis, which contains a large number of nerve endings, sweat and sebaceous glands, hair follicles, capillaries. Then the next layer is the subcutaneous fatty tissue, under which the muscles and then the bones are located.

Depending on the depth of the skin lesion, burns can be superficial or deep. According to the depth of tissue damage, 4 degrees of burn severity are distinguished:

1 degree, when the epithelium suffers. Signs of such a burn are pain, redness, swelling (edema), local temperature increase.
The 2nd degree of severity of the burn implies detachment of the epithelium, small unstressed blisters with light yellow contents appear.
Grade 3 - necrosis of all layers of the skin occurs. The bubbles are filled with a dark liquid (with blood), tense and burst.
4 degree of severity of the burn - there is charring of tissues - necrosis.

You should know this feature - if you stop exposure to high temperature (for example, a hot object) at the site of the burn, the tissue temperature continues to increase (hyperthermia increases). When providing first aid, the burn surface area is of primary importance for choosing assistance measures.

To determine it, apply such rules as the “rule of nines” and the “rule of the palm”. The first rule is based on head+neck area 9%, upper limb 9% (two = 18), lower limb 18% (two = 36%). Anterior and posterior parts of the body 18% each, perineum 1% (Fig. 29, A). The rule of the palm - the human palm is 1.2% of the total area of the skin of the body (Fig. 29, B). 10 palms - 12%, etc.

In the event that the burn wound is 10% or more, the development of burn shock is possible. With a burn of more than 30%, the prognosis is unfavorable. To assess the severity of the condition of the victim, the so-called index-100 is used. In the event that the sum of the age of the victim and the area of his burn is more than 100, the prognosis is considered unfavorable. Superficial burns with an area of less than 10% are mild, more than 10% - shockogenic, 30% or more - with an unfavorable prognosis. The consequence of a burn can be a burn disease, in which there is a disorder of cardiac and brain activity, blood circulation, kidney function is impaired, etc.