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Thermal burns

Local action. Pathological changes in organs and tissues, resulting from local exposure to high temperature, called the thermal burns. They are caused by the flames, hot liquids, resins, gases, steam, hot objects, molten metal, and other
Among thermal lesions greatest expert importance burns, resulting from the action of flame. Cause burns of respiratory ways are often the fire and vapour may also thermochemical impact of toxic products. In the explosions and fires in enclosed areas, along with heat may occur mechanical damage to the mucosa of the respiratory tract, lung tissue breaks with the development of subcutaneous emphysema, pneumo - and hemothorax. For burns, respiratory complicate factors such as smoke, toxic combustion products (known more than 100 chemical compounds produced during combustion), the lack of oxygen in the ambient air and the high content in it monoxide and carbon dioxide. High humidity increases the conductivity of hot air that cools slower and causes more severe defeat mucous membrane of the respiratory tract. Lesions usually localized in the upper divisions of the respiratory tract, at least - in segmental bronchi.
Constant companion thermal lesions of the respiratory tract and respiratory failure. It is based on the expressed spasticity reduction of small bronchi and bronchioles, leading to a sharp narrowing of the lumen of the latter. On the autopsy of the dead find spastic small bronchi, with slit-like or scalloped clearance partially filled endothelial epithelium, leucocytes and edema fluid. Separate bronchi, on the contrary, paralytics expanded. In the alveolar tissue appear multiple microsatellites and larger tricks collapse of the lung tissue, and foci of emphysema. There are plethora of vessels of the bronchial walls, small extravasate in spastic bronchitis, a plethora of small arteries and veins; the plethora and disclosure backup pulmonary capillaries; perivascular and focal alveolar edema, perivascular hemorrhage. Thus, the disorganization of the functions of the small bronchi and bronchioles combined with the disorganization of hemodynamics. Typically, swelling of the Airways develops later bronchospasm (after 18-24 hours after burn injury). If the swelling of the Airways and lungs develops in the first hours after thermal injury forecast heavy. The cause of death, most of the patients with thermal lesions of the respiratory tract are pneumonia. After brief exposure to hot water affects only the superficial layers of the skin. Burns the flame of this impact increases by 5-7 times. The most severe burns occur from combustion of clothing on the body of the victim. That is why burns hot liquids surface, and flame - deep. This is the meaning of the expediency of local cooling in the area of the burn, that considerably reduces the period of after-burn overheating tissues, resulting in the reduction of the depth of necrotic lesions.
Depending on the depth of damage to the skin and underlying tissue in the Advisory practice, to distinguish between four degrees of burns.
Burns first degree is characterized by redness and swelling of the affected area of the skin due to acute inflammation of its surface layers with the formation of a small number of sero-fibrinous of exudate. Such a burn develops when the short-term action and low temperature thermal factor that does not cause coagulation of protein. Recovery usually occurs within 3-5 days, the consequences burn limited only by peeling of the surface layer of the skin.
Burns of II degree occurs during prolonged or sudden high temperature. It is characterized by the formation of bubbles in the acute serous inflammation of the skin. The fluid in the blisters first transparent, then quickly becomes cloudy due to clotting protein, contains cellular elements (leukocytes). Wall bubbles formed debonded Horny layer of the epidermis, the bottom - germ. The surrounding skin is sharply redness,, swollen. After 3-4 days disorders of blood circulation and exudative phenomena are reduced, the liquid is absorbed. At the bottom of bubbles is increased cell division germ layers of the epidermis and to 7-10 th day, a new stratum corneum.
Burn of the III degree occurs with prolonged high temperature. It is characterized by wet or dry skin necrosis. Wet necrosis is usually observed during the action of boiling water, steam (boiling). The skin at the site of wet necrosis yellowish, swollen, pasty, sometimes covered with blisters. Inflammation of the proceeds by type of melting of dead tissue. At a dry necrosis of the skin is dry, thick, brown or black, and plot dead tissue clearly distinguished. The healing of burn of the III degree by scarring, and in case of preservation of even a small plots germ layer of epithelium possible epithelization. Burns IV degree irreversible skin changes, the underlying tissues, including bone, when exposed to flame - charring.