The main clinical-physiological manifestations and methods of complex treatment of burn disease

Pages: 1 2

Burns treat severe traumatic lesions of thermal origin, widespread, both in peace and in wartime. According to the who, the share of thermal lesions in peacetime have from 5 to 10% of all household and industrial injuries.
In past wars in the structure of sanitary losses gunshot wounds and fractures prevailed over burns and frostbites. Now in case of use of nuclear weapons, according to experts, burns (in combination with mechanical defects and radiation damage) can be up to 85% of all lost in battle. It is known that after the explosions of atomic bombs dropped on the Japanese cities of Hiroshima and Nagasaki, only from burns killed about 84 thousand people.
Most dangerous is the use of different incendiary mixtures, such as Napalm, flame temperature up to 1500-2000 degrees. Napalm burns are of high severity of the damage.
The severity, variety of clinical manifestations and character of pathological changes at burns are defined by the area burnt surface and depth of the defeat of the skin and tissues. Proceeding from this, everything burns, according to modern classification, are divided into 4 stages.
I degree burn is characterized by damage of the surface layer of the skin (epidermis) and is accompanied by redness, swelling and significant pain. With burns of II degree (bullous) in the thickness of the epidermis blisters filled with clear liquid, part of the epidermis dies. Burns I and II degrees belong to the surface. The burn of the III degree divided into III-A and III-b burns III-a degree of necrosis of epithelial and germ layers, with burns III-B class - necrosis of the skin at all its depth. To IV degree include burns, accompanied by the destruction of all skin layers and deep tissues, including tendons, muscles and even the bone tissue (up to them charring). Burns III-B - IV degree attributed to deep.
For superficial burns enough 1-5 weeks of conservative treatment. Deep burns require surgical intervention-transplant skin flap (autodermoplastike).

cicatricial contracture after burn
Fig. 32. Cicatricial contracture of the shoulder and elbow joints after burn of the III-a B degree

Clinical manifestations of burn injury largely depend on the age of the victim, previously transferred and related diseases. In addition, the patient may have an impact localization burn in connection with different thickness of the skin and uneven distribution in them nerve endings. So, burn defeat functionally active areas of the body (neck, chest, joints of upper and lower extremities) can lead to the development of contractures (Fig. 32).
Extensive superficial or deep burns cause not only local changes in the affected areas of the body, but also a deep disruption of the whole organism.
The specificity and diversity of pathological processes in burn injuries, allow to consider this state as a manifestation of burn disease.
Burn disease - pathological state the organism is developing owing to extensive and deep burn and are accompanied with violations functions of the nervous, cardiovascular and respiratory systems, deterioration of metabolic, endocrine disorders, etc. To the development of burn disease cause severe burns.
The period of burn disease is characterized by the development of a series of pathological reactions that allows to distinguish the following stages: burn shock, acute toxemia, burn septicotoxemia and recovery (recovery).
Burn shock develops in the initial stages of burn disease as a result of pain pulsation in casualties with extensive or deep lesions of the skin and occurs most often when the flame burns. This is the shortest period of burn disease. It lasts 2-3 days, but is associated with serious dangers to the life of the victim.