Burn disease – the complex violation of activity of bodies and systems developing owing to extensive burns. Loss of all types of functions of an integument, plasma loss, disintegration of erythrocytes, and also metabolic disorders is the cause of a burn disease. The probability of development, expressiveness and the forecast at this pathology are defined by age of the patient, the general condition of its organism and some other factors, however the leading role is played by the area of defeat. Treatment includes antibiotic treatment, infusional and dezintoksikatsionny therapy, correction of work of all bodies and systems.
Burn disease – the malfunction of bodies and systems which arose owing to extensive and/or deep burn defeat. Taking into account clinical observations in traumatology it is considered to be that the burn disease develops at deep defeat (IV and IIIB of degree) the body of 8-10% and at a superficial burn (I – IIIA of degree) of 15-20%. According to other data deep burns over 15% of a body are the cause of a burn disease at adults, elderly people and children have over 10% of a body; at superficial burns the burn disease arises in case of defeat of 20 and more percent of a body. Traumatologists, resuscitators and Combustiology (specialists in treatment of burns) are engaged in treatment of a burn disease.
Sudden formation of the extensive center of a necrosis and formation of the considerable massif of the fabrics which are in a paranecrosis phase becomes the reason of emission in blood of a large amount of toxins and elements of the breaking-up cages. In blood the level of prostaglandins, serotonin, a histamine, sodium, potassium and proteolytic enzymes sharply increases. It leads to increase in permeability of capillaries. Plasma comes out the vascular course, accumulates in fabrics, as a result OTsK considerably decreases. In response to it the organism throws out in blood the hormones causing narrowing of vessels – noradrenaline, adrenaline and catecholamines.
The blood circulation centralization mechanism is started. Peripheral departments of a body, and then and internals begin to suffer from a lack of blood supply that leads to development of gipovolemichesky shock. Along with it the condensation of blood and disorder of water-salt exchange is observed. Everything listed leads to violations of functioning of various bodies. The oligoanuriya develops. In the subsequent pathological changes are aggravated because of exhaustion of immune and endocrine system, and also toxic influence of products of disintegration of fabrics on internals. In heart and a liver there are degenerate changes, in digestive tract ulcers are formed, paresis of intestines, an embolism and thromboses of bryzheechny vessels is possible, in lungs pneumonia comes to light.
It can be observed within the first 3 days. During the first hours the patient is excited, fussy, inclined to underestimation of the state. In the subsequent excitement is succeeded by slackness and block. Confusion of consciousness, nausea, a hiccups, thirst, unrestrained vomiting and paresis of intestines are possible. Progressing of haemo dynamic violations and development of a gipovolemiya is noted. The patient is pale, pulse is speeded up, pressure is reduced, sometimes – normal, however, normal pressure in some cases is predictively an adverse sign.
At the initial stage of a burn disease the oliguriya, in hard cases – an anury develops. Urine brown, dark cherry or black. A characteristic sign of this period are disorders of thermal control, at the same time both increase, and the fall of temperature accompanied with a muscular shiver and oznoba are possible. In blood tests the giperkaliyemiya and a gipoproteinemiya, increase in a gematokrit and hemoglobin owing to a blood condensation is found . In the general analysis of urine protein comes to light, the relative density of urine is increased.
Allocate three degrees of burn shock. 1 degree or little burn shock arises at deep burn defeat to 20%. HELL is normal, electrolytic violations are insignificant, the amount of urine is not reduced, fluctuations of an hourly diuresis with a tendency to short-term decrease are noted. The 2nd degree or heavy burn shock develops at deep burn defeat of 20-40%. Excitement during the first hours, lability of arterial pressure, nausea, vomiting, decrease in a daily diuresis to 600 ml, the phenomena of metabolic acidosis and an azotemiya is characteristic. The 3rd degree or extremely heavy burn shock arises at deep defeat of 40 and more percent of a body. Block, confusion of consciousness, decrease HELL, the expressed oliguriya or an anury is observed.
Sharp burn toksemiya
Begins for the 3rd days, from 3 to 15 days proceed. It is caused by return of liquid to the vascular course, and also absorption of the toxins arriving from nekrotizirovanny fabrics. Is followed by suppuration of burns and the accruing intoxication. Psychological violations are characteristic: sleeplessness, hallucinations, motive excitement and elements of nonsense. Many patients have spasms. Development of the toxic myocarditis which is followed by decrease HELL, violations of a rhythm, expansion of borders of heart, dullness of warm tones and tachycardia is possible.
From a gastrointestinal tract the meteorizm and belly-aches is observed. At some patients toxic hepatitis or dynamic intestinal impassability develops, developing of sharp stomach ulcers and intestines is probable. Violations from respiratory system are expressed in pneumonia, ekssudativny pleurisy and atelektaza. Hypostasis of lungs is possible. In blood tests of patients the accruing anemia and with shift comes to light to the left. In analyses of urine the proteinuria, micro and a makrogematuriya is defined. Density of urine is reduced.
Septikotoksemiya and convalescence
3-5 weeks proceed. Infectious complications which arise after rejection of a scab are the reason of development and usually are caused by staphylococcus, colibacillus or a sinegnoyny stick. Long intermittiruyushchy fever is characteristic. On burn surfaces – a large amount of pus and atrofichny sluggish granulations. Patients are exhausted, the muscular atrophy comes to light, quite often there are contractures of joints. At this stage of a burn disease the septic complications which are coming to an end with a lethal outcome often develop. From kidneys the polyuria is observed. According to analyses of urine and blood – a giperbilirubinemiya, a gipoproteinemiya, a resistant proteinuria.
In case of safe healing of burn wounds there comes the following stage of a burn disease – restoration of functions of all bodies and systems. Duration – 3-4 months. Improvement of the general state, normalization of temperature, increase in body weight and restoration of proteinaceous exchange is noted. Rigidity of joints is possible, late complications from a gastrointestinal tract, lungs and heart are sometimes observed: violation of functions of a liver, toxic hypostasis of lungs, pneumonia, toxic myocarditis.
The diagnosis is exposed on the basis of depth and the area of burns, the general condition of the patient, haemo dynamic indicators, laboratory data, and also assessment of function of various bodies and systems. The patient appoint the analysis of urine, the general and biochemical blood test, if necessary hold consultations of various experts: cardiologist, pulmonologist, gastroenterologist etc. At suspicion on pathological changes from lungs carry out a thorax X-ray analysis, at suspicion of myocarditis – the ECG, EhoKG and MRT of heart, at suspicion on malfunction of bodies of a digestive tract – a contrast X-ray analysis, gastroscopy, and the analysis a calla on the hidden blood.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Tactics of treatment of a burn disease is defined by the period of this pathological state and the revealed changes from various bodies. At a stage of first aid the patient is given plentiful drink, perform anesthesia, intravenously enter blood substitutes and electrolytic solutions. At an opportunity carry out oxygenotherapy or give an anesthesia nitrous oxide. Transportation in specialized medical institution is possible after stabilization of a condition of the patient.
At receipt in a hospital continue to give to the patient plentiful drink. For the purpose of anesthesia carry out novokainovy blockade, appoint not narcotic and narcotic analgetics. Shortage of OTsK is filled, making massive infusions of plasma, plazmozameshchayushchy liquids, crystal and colloidal solutions. If necessary carry out transfusions of whole blood. Use warm glycosides, glucocorticoids, anticoagulants, ascorbic acid and cocarboxylase. Carry out a kislorodoterapiya. Apply bandages with antiseptics wounds.
At a stage of a burn toksemiya and a septikotoksemiya continue dezintoksikatsionny therapy, appoint antibiotics, vitamins, anabolic steroids, proteinaceous medicines and stimulators of regeneration. In the period of a convalescence carry out medical actions for recovery of work of all bodies and systems. Upon termination of this period carry out reconstructive operations for elimination of contractures, trophic ulcers and the disfiguring pulling together hems. The forecast first of all depends on depth and the area of burn defeat. In the remote period working capacity restrictions are often observed.