Burns generally refer to skin and soft tissue injuries caused by heat (flames, hot solids, hot liquids, hot vapors). It also includes skin and soft tissue damage mainly caused by factors such as radiation, chemistry, current, and laser.
1、 According to the "3-degree-4-point method", the severity of burns is judged as first-degree burns; Shallow second degree burns; Deep second degree burns; Third degree burn.
1. First degree burn (erythematous burn)
First degree burn involves the superficial layer of the epidermis, with redness, dryness, burning pain, and no blisters present at the burn site. It will take 3-7 days to remove debris and recover without scarring.
2. Superficial second degree burns (blister burns)
Superficial second degree burn injuries include the entire epidermis and superficial dermis. Obvious redness and swelling, severe pain; There are blisters of varying sizes with thin walls, and the wound surface is red and moist.
This type of burn can heal within 2 weeks if no infection occurs. Generally, there are no scars left, but pigmentation may occur.
3. Deep second degree burns (vesicular burns)
Deep second degree burns are more severe and can damage deep layers of the dermis. Obvious edema; The blister at the burn site is relatively small, the blister wall is thick, and the wound is slightly moist with alternating red and white.
Patients with this type of burn may experience dull pain and pain during hair removal. Healing takes 3-4 weeks, often accompanied by scar formation and pigmentation.
4. Third degree burns (eschar burns)
Third degree burns are the most severe, affecting the entire layer of skin, subcutaneous tissue, muscles, or bones.
The burn wound has no blisters and appears as wax white, burnt yellow, or even charred. After coagulation necrosis of the skin, a scab is formed, which feels like leather when touched. Branches of embolic blood vessels can be seen under the scab, and the pain sensation will disappear.
Third degree burns heal slowly and may result in scar hyperplasia or deformities.
2、 Post burn first aid
On site first aid should follow 5 principles:
1. Quickly remove the heat source
2. Save life
3. Protect the burn wound
4. Prevent shock: administer intravenous fluids, oral diluted saline or burn drinks on site
5. Transfer as soon as possible - it is recommended to transfer as soon as possible. For severe patients, transfer should be done after the condition stabilizes
3. Burn wound care
Burn wound care follows the following 2 principles:
1. Proper treatment of the wound can reduce complications such as systemic infection, which is a key link in curing burns
2. The purpose of wound treatment is to protect the wound, prevent infection, promote healing, and maximize functional recovery
4. Measures for nursing burns include debridement, selection of bandaging therapy or exposure therapy, scab removal and skin grafting for third degree burns.
1. Initial wound treatment: Burn debridement surgery
Before debridement, the hair and nails of the affected area should be trimmed to remove the decayed epidermis of the wound.
Disinfect and clean the wound with physiological saline/iodine, and if there are large blisters, drain the fluid.
2. Bandaging therapy
Used for shallow second degree burns or small area burns of the limbs or those that do not comply with the author's requirements. Apply burn ointment to the affected area and cover it with a 2-3cm thick dressing. The dressing should extend beyond the edge of the wound by 5cm. The dressing should be loose and evenly compressed. To avoid adhesion or deformity, the fingers/toes should be separated and wrapped, exposing the limbs. The nursing points of bandaging therapy:
(1) Raise the limb
(2) Observe the blood circulation at the extremities
(3) Keep the dressing dry
3. Exposure therapy
Used for burns in the head and neck, perineum, large area burns, or wounds with severe infections after injury. The wound can be exposed to clean, warm, and dry air, and ointment can also be applied. The nursing points of exposure therapy: (1) Strictly implement disinfection and isolation system, maintain appropriate indoor temperature (28-32 ℃) and humidity, and disinfect the air twice a day.
(2) Keep the wound dry
(3) Constrain the limbs
(4) Circular scab - Observe breathing and limb blood flow
(5) Regularly turn over or use a turning bed to alternately expose compressed wounds
4. Care for infected wounds
Timely drainage is necessary to remove dissolved necrotic tissue, promote wound healing, and drain pus.
5. Care for burns in special areas
(1) Inhalation injuries
① Prepare emergency supplies at the bedside, such as gas cutting bags, anesthesia laryngoscopes, etc.
② Keep the respiratory tract unobstructed
③ Timely oxygen inhalation
④ Close observation and active prevention of lung infections
(2) Head and neck injuries
Use exposure therapy more often, do a good job of facial care
(3) Perineal burns
Keep dry, abduct the thighs, and expose the wound surface; To avoid contamination from urination and defecation, clean the anus and perineum with physiological saline after use, and keep the area around the wound clean.