First aid is the most rapid cessation of the chemical agent. To do this, the affected area is washed with a large amount of running water for 20-30 minutes. If assistance is provided late, the duration of washing is increased to 30-40 minutes. If phosphorus-containing preparations are affected, it is necessary to immerse the burned surface in water. Then it is cleaned from pieces of phosphorus with tweezers. After washing with water, the residues of the chemical are neutralized using solutions:
acid burns - 2% sodium bicarbonate solution, 5% sodium thiosulfate,
alkaline burns - 1-2% solution of acetic, boric or citric acid.
burns with phosphorus-containing substances - 5% solution of copper sulfate (copper sulfate), potassium permanganate, 2% soda solution.
The damaged surface is covered with bandages. Can not be used for chemical burns ointment. For pain, analgesics are administered.
The treatment is carried out according to the same principles as thermal burns.
Electrical injury is damage to the organs and tissues of the body caused by exposure to electric current. Among all types of injuries, electric shocks range from 1–2.5%, and in 10% of cases they end in death. Electric current can have direct and indirect effects. In the case of direct action, a person is included in an electrical circuit, a number of changes occur in the body due to the heat and electrochemical action of the current. Indirect action is observed during short circuits, forming a volt arc causes burns. Atmospheric electricity-lightning may also occur.
Electric shock is different from other damage. First, a person can be amazed at a distance. Secondly, general and local changes develop in the body. Thirdly, violations are noted along the entire path of current flow in the human body.
Electric shock is divided into local (electric burns) and common. However, they are often combined.
The severity of the lesion depends on the characteristics of the electric current, its passage in the body and the state of the tissues.
The characteristics of the current determining the nature and severity of damage include current strength, voltage, frequency. Voltage above 36 V and current strength of more than 0.1 A are dangerous to humans. With a current of 0.5 A, lethal injuries are usually observed. There are lesions low (up to 500 V) and high voltage. Surprisingly, high voltage exposures are less life threatening than low ones. AC lesions are more dangerous than direct current. The most dangerous frequency is 50 Hz / s. Therefore, the defeat of alternating current household networks (220 V, 40-60 Hz / s) poses a serious threat.
The most important factors are the duration of the current and the path of its passage through the tissues ("current loops"). The most dangerous are the upper loop: "hand-hand", "hand-head", as well as a complete loop "two hands - two legs." Involving the heart and brain in an electrical circuit leads to serious life-threatening disorders. The nature of the damage depends on the type of tissue; this is due to the different fluid content and, accordingly, different resistance (ohmic resistance). The skin has the greatest resistance, smaller muscles and blood vessels.
With the passage of current through the tissues of the electrical energy is converted into heat, causing burns. The degree of damage depends on the characteristics of the current, the duration of exposure, the area of contact with the current-carrying object. On the skin in places of entry and exit formed "current labels". In the muscles and blood vessels, "heat seals" are formed, necrosis, ruptures, and muscle detachment may occur. Sequesters form in the bones. Electrical tags can be detected on the joints, as they have high resistance. The passage of current through the head, oblong, spinal cord can cause swelling, bleeding. Local damage in full may not appear in the first hours after injury. Necrosis further develops due to damage to the feeding vessels.
The overall impact on the body is determined by damage to vital organs. Death can occur from respiratory arrest or cardiac activity. Respiratory arrest may be due to paralysis of the respiratory center or titanic cramps of the respiratory muscles. Cardiac arrest occurs due to dysfunction of excitability and conduction, as a result of which arrhythmia and fibrillation of the heart develops. Cardiac arrest is possible due to impaired coronary blood flow and irritation of the vagus nerve. Damage to the central nervous system can lead to spasm of the larynx, convulsive syndrome, paralysis and paresis, impaired vision. There is also an increase in blood pressure. If the victim remains alive, all the above changes are present, but are expressed in varying degrees.
First aid for mild burns
Mild burns do not require hospitalization, as a rule, home treatment is sufficient, but only if the first aid was provided correctly. So, with such lesions, after the cessation of the impact of the traumatic factor, it is necessary:
- Free up the place of burns from clothes, if there is one. In this case, it is unacceptable to wear clothes, because it is possible to further damage the skin (if necessary, the fabric should be cut),
- Place the burned place under running cold water for 10-20 minutes or apply a cold compress. It is unacceptable to use ice to cool the skin, because freezing of the tissues may be added to the burn,
- Treat the affected area with antiseptic. It is possible to use antiburn agents, it is allowed to treat the burnt surface with alcohol. You can not use iodine, a solution of potassium permanganate, as well as oil, oily ointments and creams - that prevents air exchange. With household burns, Panthenol Spray with dexpanthenol has proven itself well. Unlike analogs, which are cosmetic products, it is a certified drug. It does not contain parabens in its composition, so it is safe for both adults and children from the first day of life. It is convenient to apply - just spray on the skin without rubbing. Panthenol Spray is produced in the European Union, in compliance with high European quality standards, you can find out the original Panthenol Spray by the emoticon next to the name on the packaging,
- Apply a non-applied sterile bandage on the damaged area of the skin, and do not use cotton wool, as its fibers are quite difficult to remove from the wound surface,
- In case of intense pain, give a pain reliever to the injured person. Paracetamol, Aspirin can be used (it is undesirable to give it to children), Nimesil, Nurofen, etc.
As a rule, these first aid measures for mild burns are quite sufficient. Such damages heal within 10-14 days, the main task in their treatment is to prevent additional injury to the affected area and infection.
First aid for severe burns
In the case of thermal lesions of III and IV degrees, as well as II degree burns affecting large areas of skin or anatomically significant areas, help is provided in the hospital, therefore it is necessary to call the victim as soon as possible. In anticipation of the arrival of the doctor and after the elimination of the damaging factor, first aid measures for severe burns are as follows:
- It is necessary to make sure that there are no smoldering clothing areas left. No need to remove scraps of clothing from damaged skin,
- Close the burned surface with as possible a sterile, or at least clean loosely fitting dressing,
- In case of deep injuries, the injured part of the body should not be immersed under water, and ice should not be used. Instead, moisten the dressing with cold water,
- To drink the victim with warm tea or warm salted alkaline water (for its preparation, mix 1-2 g of baking soda and 3 g of salt in 1 l of water),
- Place the injured person in such a way that the burned part of the body is above the level of the heart.
To use drugs of local purpose, even such as Panthenol, in this case should not be, the treatment of wounds will be done in the hospital.
First aid for electric burns
First aid for electric burns is to isolate the victim from the effects of a damaging agent, after which it is necessary to check the presence of a pulse and respiration. If they are absent, it is necessary to proceed to resuscitation - a closed heart massage, mouth-to-mouth or mouth-to-nose breathing. As soon as possible, you should call an ambulance, continuing resuscitation until the pulse and breathing stabilize or until the arrival of the doctor.
Superficial skin lesions resulting from an electric burn are treated in the same way as with a thermal burn.
First aid for chemical burns
A chemical burn is caused by exposure to the skin or mucous membrane of acids, alkalis and other caustic substances. Despite the fact that the damaging agents may be different, first aid for burns of this type begins the same way: the damaged area must be placed under running water for 10-20 minutes. This is true for all chemical burns, with the exception of burns with quicklime and sulfuric acid.
After washing with water, the burn site is treated with a weak alkali solution, for example soda (1 teaspoon per glass of water) or soapy water (it is advisable to take household soap, without additives). Burns with sulfuric acid should be treated with a weak alkaline solution, without prior washing with water.
Alkaline burns after washing process with a weakly acidic solution - a solution of vinegar or citric acid will do.
Burns caused by quicklime are treated immediately with oil or fat - and this is the only case where fatty ointments are used in rendering first aid for burns.
It should be borne in mind that alkali burns are more dangerous because they do not form a clear boundary between the damaged area and healthy tissue. This is the so-called colliquation necrosis, which tends to spread even after the completion of the impact of the damaging agent.
* Instructions for medical use Panthenolsprey Reg. beats. P # 012187/01 dated 08.22.2011
Possible degrees of chemical exposure
The degree of chemical burn may be 4. The easiest is considered to be the 1 degree at which only the upper layer of the epidermis is affected. Such a lesion is expressed in slight redness and swelling. The area of the lesion may ache slightly, especially in cases when it is affected. In the event of a lesion in the deeper layers of the skin, 2 degrees of chemical burns are diagnosed. This degree differs from the previous one by the additional appearance of blisters with liquid on the swollen and reddened skin.
If, in addition to the epidermis, chemical damage has spread to the closely located fatty subcutaneous tissue, a grade 3 chemical burn is diagnosed. At this stage, the blistering is considered not transparent, as with 2 degrees of damage, but a cloudy or bloody liquid. In addition, the pain in the lesions is absent due to a violation of the sensitivity of tissues. If, for all such signs, the lesion reaches the tendons and bone tissue, doctors will diagnose 4 degrees of chemical burns.
Alkaline and acid effects
In case of acid or alkaline burns, a specific crust, a scab, immediately appears on the skin. The scab has a loose and soft structure, it is white in color and has no clear boundaries. If we compare the degree of penetration of burns when exposed to alkalis and acids, it can be noted that alkaline chemical burns are deeper and more complex.
Under the acidic effect, the crust forms a dry, hard, with clearly defined edges, which stands out against the background of healthy skin. Such injuries are most often superficial and in small lesions do not pose a serious threat to health.
The color of the skin in case of chemical damage depends largely on what caused the damage. For example:
- with sulfuric acid, the skin whitens first, and then acquires a gray-brown tint,
- with nitric acid, the skin acquires a yellow-green or brownish-yellowish tint,
- with a hydrochloric acid burn, the skin becomes yellowish,
- with acetic acid, a dirty brown tint appears on the skin,
- with carbolic acid, the affected area first whitens, and then changes its color to brown,
- for burns with concentrated hydrogen peroxide, the skin becomes gray.
It is important to understand that chemicals are able to actively invade the skin, and even after removing the source of burns, the active substance can continue to be absorbed into the deeper layers, increasing the degree of damage. This factor is very important and determines the complexity of chemical burns, because in the first hours and even days after getting an injury it is often impossible to determine the degree of burning of the skin. Experts can make a precise definition only a week after the incident according to the characteristics of the suppurations of the formed crusts. At the first stage, specialists differentiate the severity of the effects received by the lesion area, which indicates the degree of danger to the patient's life of the chemical effect obtained.
When urgent hospitalization is required
Sometimes, when you get a chemical burn, you can’t lose a minute and you should immediately send the victim to the hospital without first aid. This may be in a situation where the victim after the defeat plunged into a state of shock, lost consciousness, his pulse stopped feeling and breathing was observed. If a person has a total diameter of the affected area exceeds 7.5 centimeters, then this is also the reason for an urgent appeal for medical help. It is necessary to take a person to the hospital with a severe pain syndrome, which does not decrease even after the use of painkillers, as well as when the legs, groin, buttocks, face, hands, areas of large joints, the oral cavity and the esophagus were burned.
Chemical eye burn
Occurs when exposed to aggressive chemical compounds that fall on the surface of the cornea or in the conjunctival sac. Since these tissues are tender and sensitive, any of their chemical burns are considered severe damage and require only specialized treatment. Their danger is the possibility of penetration of chemical particles into the deeper layers of the eye and irretrievable loss of vision. In other cases, there may be a widespread corneal burn that will not be able to restore its structure.
Clinical manifestations are so vivid that they do not make you take a long time to help with such burns. The more aggressive the substance is, the more pronounced the burning sensation, pain, cramps, tearing, photophobia, and the inability to open eyes. Even an instant loss of sight or decrease in its sharpness is possible.
First aid measures should be instantaneous. Much will depend on it.As with chemical burns of the skin, it is necessary to wash out and remove the remnants of the chemical compound from the surface of the cornea and conjunctiva. To do this, wash the eyes with a stream of water for at least 15 minutes. It is not necessary to neutralize substances, even in the case of the known nature of the chemical compound. It can only hurt. It is enough to rinse with water, after which a dry bandage-gauze bandage is applied to the eye. Without exception, all victims should be examined by an ophthalmologist.
Chemical burn of the esophagus
This type of damage is severe and requires only specialized treatment. You can get it by accidentally or intentionally after drinking a liquid with an aggressive chemical compound. The mucous membrane of the esophagus is very vulnerable and sensitive. Considering the fact that its lumen is in a practically collapsed state, even a small portion of acid or alkali can burn the mucous along its entire length.
Clinical manifestations of chemical burns of the esophagus are distinguished by their particular severity and progressive development. Immediately after the substance is drunk, there is a burning sensation and pain in the chest, accompanied by vomiting, drooling, difficulty in swallowing and breathing. Victims are torn, can not find a place because of the pain. Very early begin to appear signs of intoxication in the form of tachycardia (rapid heartbeat), rapid breathing and a drop in blood pressure until the state of shock.
The urgency of measures in such states is beyond doubt. Therefore, immediately after receiving the burn, it is necessary to wash the esophagus and stomach with plenty of cold water. If the chemical nature of the damaging agent is known, appropriate neutralizing solutions of weak acids and alkalis can be immediately used for washing. The victim should drink about a liter of water, which, after causing vomiting, is removed back from the stomach. The total amount of fluid is about 10 liters. After washing with the purpose of anesthesia, you can drink 20-30 ml of a 1% solution of novocaine, a raw egg or almagel (almagel A). After that, the patient must be delivered to the nearest medical facility.
Chemical burn treatment
All therapeutic measures for treating a chemical burn are carried out after the establishment of its degree, area and localization. Superficial injuries, which include burns 1-2-3A degrees, are treated conservatively under ointment or wet-drying dressings. In the case of limited minor burns, general measures are not required. For extensive injuries or deep wounds of any prevalence, infusion, detoxification and antibacterial therapy is indicated only in a specialized burn ward. All other cases can be treated on an outpatient basis under the supervision of a specialist.
Local surface treatment for chemical burns pursues the following goals: antibiotic prophylaxis, creation of an optimal healing environment, acceleration of regenerative and reparative processes in the wound. For skin burns in the early stages, ointments are used on a water-soluble basis (levomekol, oflokain, syntomycin, levocin), contributing to the rejection of necrotic tissue and cleansing the wound. With the first degree of burn, you can lubricate the affected areas with salve, agrosulfan, betadine, bepanten, panthenol. In the case of deeper damage, they are connected to the wound regeneration stage. From antiseptics neutral agents with good antimicrobial properties (chlorhexidine, dioxidine, decasan) are shown.
Deep burns of the skin and underlying tissues are subject to surgical treatment. Surgical interventions are carried out in a remote period, after a clear burn restriction. These include necroctomy (removal of non-viable tissue within healthy ones) and plastic replacement of the resulting wound defects. For these purposes, use the donor skin of the patient from healthy areas or different types of xenochose.
In the treatment of chemical burns of the esophagus, the most important importance belongs to the early anti-shock infusion therapy and bougienage. The last event is aimed at preventing stenosis (narrowing) and obstruction of the esophagus, and begins a week after receiving the burn.
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from an educational and scientific medical center for managing the affairs of the President of the Russian Federation.