THERMAL TRAUMA

((BURNSBURNS, , ELECTRICAL TRAUMAELECTRICAL TRAUMA, , FROST BITE (FREEZING)FROST BITE (FREEZING)))

BurnsBurns are he damage to tissues are he damage to tissues caused by their exposure to thermal, caused by their exposure to thermal, chemical, electrical, or radiation energychemical, electrical, or radiation energy

CONSTRUCTION OF THE SKIN

EpidermisD

erm

is

Bas

al la

yer

THE REASONS OF THE BURNS

THERMALTHERMAL:

Hot liquids

Steam

Flame (fire)

Hot hard solid

RADIATION

CHEMICAL

Acids

Alkalis

ELECTRICAL

THE REASONS OF THE BURNS

THE REASONS OF THE BURNS

CLASSIFICATION OF THE BURNS

According to the depth of damage:DEGREE 1

DEGREE 2 DEGREE 3A

DEGREE 3B

DEGREE 4

According to the depth of damage:SUPERFICIAL

DEEP

CLASSIFICATION OF THE BURNS

SUPERFICIAL BURNS

DEGREE 1DEGREE 1 – damage to only the epidermis. Skin in this areas reddened, with edema, sensory function is increased. Function of the tissues is intact. Treatment – application of alcohol. Heeling without crusts.

DEGREE 2DEGREE 2 – damage to the epithelium up to the basal layer. The pain is more severe, long fasting and there are blisters form, they are usually filled with light transparent contents. All types of sensation are kept. When the bare layer at the base of blister is touched the patient experiences severe pain.

DEGREE 3ADEGREE 3A - - epithelial necrosis with partial involvement of the basal epithelial necrosis with partial involvement of the basal layer; hair follicules, sweat and sebaceous glands are intact. All types of layer; hair follicules, sweat and sebaceous glands are intact. All types of sensation are less. The blisters are filled with hemorrhagic contents. sensation are less. The blisters are filled with hemorrhagic contents. Epitelization and crust are formed from 3 to 4 weeks.Epitelization and crust are formed from 3 to 4 weeks.

DEEP BURNS

DEGREE 3BDEGREE 3B – complete necroses of the dermis, basal layer and part of subcutaneous layer. All types of sensation are lost. If blisters form, they are usually filled with hemorrhagic substance. When the blisters are opened violet-blush surface is not sensitive to skin prick or irritation by alcohol. There are the areas of necrosis

DEGREE 4DEGREE 4 – complete necrosis – complete necrosis of the skin and underlying of the skin and underlying tissues.tissues.

DIFFERENTIATION BETWEEN DEGREE 3A AND DEGREE 3B

•PAIN SENSITIVITY

•THE CONTENS INTO THE BULLS

•THE FUNDUS OF THE BULLS

•BYOCHEMICAL REACTIONS

DETERMINATION OF THE AREA OF BURN

THE “RULE OF NINE”THE “RULE OF NINE”

DETERMINATION OF THE AREA OF BURN

Determination by Lund&Browders

method

THE “RULE OF PULM”THE “RULE OF PULM”

DETERMINATION OF THE AREA OF BURN

IT IS THE MOST EXACT METHOD –

WHIS HELP BY THE MILLIMETRE PAPER

EVALUATION OF SEVERITY OF BURNS

THE RULE OF Baux (BO index):

Age in years + general burns area in%:

i 100 – poor prognosis

75-100 – doubtful prognosis

j 75 – good prognosis

FRANK’S INDEX:

1% of superficial burn equals one point, a deep burn equals three points

to 30 – good prognosis

30-60 – relatively good prognosis

60-90 – doubtful prognosis; j 90 – poor prognosis

BURN DISEASE

OCCURS WHITH A BURN AREA OF:

Above 30% of body surface of the superficial burns in adults

More then 10% of body surface of the deep burns in adults

Above 5% of body surface of the superficial burns in children

BURN DISEASEThe four periods of the disease are The four periods of the disease are

identifiedidentified::Burn shockBurn shock (it is a result of the sharp pain, loss of large volume of blood plasma and intoxication of patient, local accumulation of vasoactive substances, injury the microcirculation; persistent from 48 till 72 hours).

Acute burn toxaemiaAcute burn toxaemia (it is outcome of the influence of toxic products and products of tissues decay; fever, tachycardia, dullness of heart sounds, anaemia, hypo-and dysproteinemia, abnormal hepatic and renal function; persist from the 3 till the 12-th day).

SepticemiaSepticemia (it is characterized by severe infection, may be fester of wound, general deterioration ( weight loss, dryness and pallor, muscular atrophy, bedsores; in this period proliferation of microbes is began with development of varied septic conditions: pneumonia, pressure sores, sepsis); complete skin regeneration is indicated of the end of the septicaemic period; it persists a few weeks).

RecoveryRecovery (it is the restoration of bodily function, after the full heeling of burn’s wounds, can persist for as long as 2-4 years after the trauma )

THE FIRST AID AFTER THE BURN

1. STOP THE ACTION OF THE THERMICAL AGENT

2. COOL THE BURN’S SURFACE.

THE FIRST AID AFTER THE BURN

3. APPLY THE ASEPTIC BANDAGE.

TREATMENT THE PLACE OF BURN

1. PRIMARY SURGICAL TREATMENT.

2. CLOSED METHOD OF TREATMENT.

3. OPENED METHOD OF TREATMENT.

OPENED METHOD OF TREATMENT OF BURNS

CLOSED METHOD OF TREATMENT OF BURNS

COVERING OF THE BURN’S SURFACE

USE OF THE XENOTRANSPLENTANT ALLOWS:

- TO DECREASE THE LOOSING OF PLASMA;

- TO PREVENT THE DEVELOPMENT OF INFECTION AND INTOXICATION;

- TO STIMULATE OF THE REPARATION OF SKIN;

- TO DECREASE THE TIME OF TREATMENT INTO THE HOSPITAL.

TREATMENT OF BURN’S DESEASES

BURN SHOCK:TREATMENT OF HYPOVOLEMIA AND TOXEMIA, ANALGETICS, ANTYBIOTICS, TREATMENT OF SYMPTOMS

ACUTE BURN TOXEMIA:KORRECTION OF WATER-ELECTROLITIC BALANS, NETRALIZATION AND EXTRACTION OF TOXINS, STIMULATION OF THE HOMEOSTASIS, ANALGETICS, PREVENT OF DEVELOPMENT OF INFECTION

SEPTICEMIAANTYBIOTICS, IMMUNOSTIMULATION, PARENTERAL EATING.

CHEMICAL BURNS

ACIDS – coagulation necrosis

ALKALI– colliquative necrosis

RADIATION BURNS

IT IS PRESENT ON A BASE OF THE RADIATION DEEASES AND IT’S TREATMENT

IS VERY DIFFICULT

ELECTRICAL TRAUMAELECTRICAL TRAUMA

IT IS NECESSARY TO PAY GREAT ATTENTION TO:

Power and stress of current, resistance of skin, time of action, kind of current (constantly, chaining), the way of the spreading of current across the body, conditions during the trauma.

ELECTRICAL TRAUMAELECTRICAL TRAUMA

CLINICAL SYMPTOMS:

General

Local

FIRST AID AFTER THE ELECTRICAL TRAUMA

1. STOP THE ACTION OF CURRENT.

2. CARDIAL-LUNG REANIMATION.

3. ASEPTIC BANDAGE.

LOCAL TREATMENT OF THE PLACE OF CURRENTS ACTION

1. NECRECTOMIA.

2. AMPUTATION.

3. REPLACMENT OF SKIN.

4. RECONSTRACTIVE OPERATIONS.

FROST BITE (FREESING)

CLASSIFICATION OF THE FROST BITE (FREESING)

1. ACUTE:

- LOCAL FREESING

- GENERAL HYPOTERMIA

2. CHRONICAL.

CLASSIFICATION OF THE FROST BITE (FREESING)

ACCORDING TO THE LEVEL OF TEMPERATURE:

- FREESING AFTER THE 0°C

- FREESING AFTER THE TEMPERATURE LESS THAN 20°C

- CONTACT FREESING

PERIODS OF FROSBITE

- LATENT (PRE-REACTIVE)

- REACTIVE

DEPTH OF FROSTBITE

DEPTH OF FROSTBITE

DEPTH OF FROSTBITE

DEGREE 1

DEGREE 2

DEPTH OF FROSTBITE

DEGREE 4

DEGREE 3

DIFFERENT TYPES OF FROSTBITE

CHANGINGS INTO THE PATIENT’S BODY

1. IN PRE-REACTIVE PERIOD - IT IS MINIMAL).

2. IN REACTIVE PERIOD:

- DISTROY THE MICROCIRCULATION INTO THE KIDNIES

- DEVELOPMENT OF THE TOXEMIA

- DESTROY THE FUNCTION OF CNS, CVS, LUNGS.

GENERAL HYPOTERMIA

GENERAL HYPOTERMIA

THERE ARE 4 PERIODS:

1. COMPENSATION (t° is the 37°)

2. ADYNAMIC (decrease t° of body on to 1-2°)

3. AVERAGE (STUPOR FORM) - (decrease t° of body till the 26-27°)

4. CONVULSIVE FORM (fall in the body temperature as low as 26°)

FIRST AID AFTER THE FROSTBITE

FIRST AID AFTER THE FROSTBITE

FIRST AID AFTER THE GENERAL HYPOTERMIA

TREATMENT OF FROSTBITE

CONCERVATIVE TREATMENT

1. ANTICOAGULATIVE AND ANTIAGREGANT THERAPY.

2. SPASMOLITICS.

3. DESENSIBILIZATTION.

4. DETOXICATION.

5. ANTIINFLAMMATORY THERAPY.

6. SIMPTOMATHYC THERAPY.

SURGICAL TREATMENT

NECROTOMIA

NECRECTOMIA

SURGICAL TREATMENT

AMPUTATION