Burns: types of burns and degrees, treatment of burns with keeper balm. Getting burns due to radiation Radiation burns are the predominant consequence

MINISTRY OF INTERNAL AFFAIRS OF RUSSIA

Training center of the Main Internal Affairs Directorate of the Stavropol Territory

Cycle of Special Disciplines

TEST

by discipline:

"Medical training"

Performed:

The listener of the platoon 21 l-t of militia

Borisova Yu.A.

checked :_____________________

Grade:________________________

Stavropol 2002
Content:

Introduction

Conclusion

Bibliography

INTRODUCTION

Burns are a frequent and severe injury, the mortality rate of which is still very high. Every year in Europe and the USA, more than 200 thousand patients with burns require hospital treatment. Within 1 year, about 60 thousand people die from burns in European countries; among them, a large group are children. Many of those who recover are left with disfiguring scars. Being complex and not fully understood, the problem of burns continues to attract the attention of scientists, practical surgeons and health care managers. Treatment of burns, especially childhood, labor-intensive and time-consuming. It requires special knowledge, equipment, conditions and high professional skills from medical workers.

Currently, specialized centers and departments have been created in Russia and in many countries around the world to improve medical care for those burned. They use modern methods care and treatment of patients. To work in such departments, medical personnel must be properly trained. refers to tissue damage caused by heat, chemicals, radiation, and electrical current. Respectively etiological factor burns are called thermal, chemical, radiation and electrical.

THERMAL BURNS

Thermal burns are the most common type of injury and account for 90-95% of all burns. It should be noted that burns at work account for only 25-30% of all injuries, the remaining 75% are household injuries.

The most common burns occur from exposure to flame, hot liquid, steam, and also from contact with hot objects. For the formation of a burn, not only the temperature of the traumatic factor is important, but also the duration of its impact.

In peacetime, the share of burns among other injuries is 10-12%. During the Great Patriotic War burns accounted for about 2% of all injuries. Currently, due to the use of new types of weapons (napalm, phosphorus), especially in cases of the use of nuclear weapons, the structure of sanitary losses can change dramatically: the proportion of those burned will be 80% or more of all victims. In this case, burns can be either primary (thermal and light radiation during a nuclear explosion) or secondary (fires, gas explosions, electrical injuries, etc.).

In case of burns it is always observed general reaction body to injury. If with small burns it manifests itself only as a natural reaction to pain and does not entail any significant functional changes, then with extensive burns more or less pronounced disturbances in the functioning of organs and systems always occur, up to the most severe ones, leading to death.

The pathological state of the body that occurs in response to a burn is called burn disease.

The following periods of burn disease are distinguished: 1) burn shock; 2) acute burn toxemia; 3) acute septicotoxemia; 4) convalescence.

The severity of a burn disease is determined by two factors - the extent of the burn, i.e. area defeats, and the depth of tissue damage - ste burn stump.

The skin consists of two layers - epithelial tissue- epidermis and connective tissue- dermis. The epidermis is constantly renewed due to the growth of new epithelial cells - basal and spinous. The layer of basal cells contains superficial endings blood vessels providing blood supply to the skin. If the cells of the germ layer die, the growth of the epithelium in the affected area does not occur and the defect is closed by secondary intention with the help of connective tissue - the scar.

Depending on whether the germ layer is affected or not, that is, whether epithelization is possible in the future or not, all burns are divided into superficial and deep, distinguishing four degrees, which are shown in the figure.

Figure - classification of burns.

Local manifestations: A - 1st degree - hyperemia, B - 2nd degree - blistering, C - 3rd degree - skin necrosis, D - 4th degree - charring

Burns of I, II and IIIA degrees are called superficial, since only the superficial layers of the epidermis are affected. Deeper skin lesions are observed with III and IV degree burns. Third degree burns are subdivided into IIIA and P1B degrees. With IIIA degree burns, partial damage to the germinal and basal layers of the skin occurs and independent epithelization is possible (such burns are classified as superficial). With SB degree burns, the death of all layers of the skin is noted - the epidermis and dermis (deep burns).

I degree burn - hyperemia and swelling of the affected area, burning sensation. In this case, cell death is not observed.

Second degree burn - small, relaxed blisters with light contents (blood plasma). Around the bubbles - areas of hyperemia. Burning sensation. Bubbles appear due to the detachment of the upper layers of the epidermis by blood plasma that has sweated from the vessels of the basal layer.

IIIA degree burn - extensive, tense, with jelly-like contents or destroyed blisters. In place of the destroyed bladder there is a moist pink surface with areas of pale, whitish color (affected basal layer). Pain sensitivity reduced.

Burn SB degree - extensive blisters e hemorrhagic contents. In place of the destroyed blisters there is a dense, dry, dark gray scab (thrombosis of skin vessels and coagulation of cellular protein).

A fourth degree burn is a burn eschar with a dense consistency, such as thick paper or cardboard, brown or black. Sometimes you can see through it a thrombosed vascular network and charring.

CHEMICAL BURNS

Chemical burns occur as a result of contact with the skin of acids, alkalis and other chemically active substances. The depth of the burn depends on the concentration of the chemical agent, its temperature and duration of exposure.

When providing first first aid it is necessary to create conditions for the rapid removal of the chemical agent, reducing the concentration of its residues on the skin, and cooling the affected areas. The most effective way is to wash the skin with running water (except in cases of burns with quicklime). In case of a burn with acids, it is reasonable to wash the surface of the burn with weak solutions of alkalis (sodium bicarbonate), and in case of a burn with alkalis - with acids (0.01% solution of hydrochloric acid, 1-2% solution of acetic acid). The sooner the chemical agent is removed, the less destruction the tissue will undergo, so it is advisable to begin a long (at least 20-30 minutes) rinsing of the affected area with running water before preparing the neutralizing solution.

If clothing becomes saturated with a chemically active substance, you should try to remove it quickly. In some cases, it is advisable to first start rinsing with a strong stream of running water using a hose placed under clothing. This creates a layer of water that isolates the skin from clothing soaked in the chemical. After 5-10 minutes from the start of washing, be careful not to cause burns to the person providing assistance and not to spread the chemical agent to unaffected tissues, remove clothing and continue washing the burn site.

The exception is cases when, due to the chemical nature of the damaging substance, its contact with water is contraindicated. For example, diethylaluminum hydrate and triethylaluminum ignite when combined with water, and when water comes into contact with quicklime or concentrated sulfuric acid, heat is generated, which can lead to additional thermal damage. It is not recommended to extinguish napalm with small portions of water, as this will cause splashing of the mixture and significant vaporization, which may cause an increase in the affected area.

Chemical burns are in many ways similar to thermal burns, but have a number of features. Acid burns occur as coagulative necrosis, with the formation of complexes of acidic proteinates, protein breakdown and severe tissue dehydration - a dense scab appears.

Alkali burns are characterized by the formation of liquefaction necrosis. Alkalis break down proteins, forming alkaline proteinates, and saponify fats. Through damaged skin, alkalis penetrate into deeper tissues, causing their damage.

Extensive burns caused by various chemicals can lead to significant changes in internal organs. Thus, phosphorus and its compounds, picric acid have a nephrotoxic effect, tannic and phosphoric acids cause liver damage. These features must be taken into account when general treatment. Local treatment treatment of chemical burns in a hospital and clinic is not fundamentally different from the treatment of thermal burns.

ELECTRIC BURNS

Electrical burns occur at the site of direct contact with a current source, shown in the figure.

Drawing. Electric shock and lightning damage.

A is the total effect of electric current. B - local impact of electric current, C - trace of lightning action. G- removal of the action of electric current

They differ significantly from conventional thermal burns. Electrical burns in the form of a “current mark” can be pinpoint or have significant dimensions, depending on the area of ​​skin contact with the electrical agent. In the first hours, these “current marks” look like whitish or brownish spots, in place of which a dense scab subsequently forms. A feature of electrical burns is, as a rule, deep damage not only to the skin, but also to the underlying tissues. In this case, local damage to the skin can be accompanied by significant destruction of muscles and bones. The local wound process, which occurs according to general laws, is accompanied by early dates severe intoxication due to massive tissue destruction, and subsequently often gives purulent complications (phlegmon, streaks). Local treatment of electric burns and deep thermal burns has no fundamental differences.

Light burns.

Radiant energy released during the explosion (visible infrared and partly ultra-violet rays), leads to the occurrence of so-called instantaneous burns. Secondary flame burns from objects and ignited clothing are also possible. Light burns occur most often in open areas of the body facing the direction of the explosion, and are called profile or contour burns, but they can also appear in areas covered by dark-colored clothing, especially in places where clothing fits snugly against the body - contact burns. The course and treatment of light burns are the same as thermal burns.

RADIATION BURNS

Ionizing radiation, i.e., flows of elementary particles and electromagnetic quanta resulting from nuclear reactions or radioactive decay, entering the human body, are absorbed by tissues. The energy released during this process destroys the structure of living cells, depriving them of the ability to regenerate, and causes various pathological conditions, both local and general.

The biological effect of ionizing radiation is determined by the energy of the radiation, its nature, mass and penetrating power.

The first pathological condition of living tissues under the influence of ionizing radiation, which was observed after the discovery of X-rays and radioactivity, was radiation burns of the skin.

Reports of the appearance of "X-ray burns" appeared already at the beginning of 1886 and were associated with the beginning of a wide range of X-ray studies in medicine in the absence of experience in their use. Later, with the development of physics and the advent of nuclear energy, in addition to X-rays, other types of ionizing radiation appeared.

The impact of radiation on the body is measured by the amount of radiation energy absorbed by the tissues, the unit of which is gray (Gy). In practice, measuring the absorbed energy is very difficult. It is much easier to measure the amount of air ionization by x-rays or rays. Therefore, for the radiometric assessment of ionizing radiation, another unit is widely used - the roentgen (R) [coulomb per kilogram (C/kg)].

Ionizing radiation can lead to both the development of general phenomena - radiation sickness, and local - radiation damage to the skin (burns). This depends on the nature of the radiation, its dose, time and area of ​​irradiation. Thus, irradiation of the whole body at a dose of more than 600 R leads to the development of severe radiation sickness, but does not cause skin lesions.

Acute radiation burns most often occur after a single exposure to a large dose of a separate part of the body and do not lead to the development of radiation sickness. Such burns are usually observed during long-term X-ray examination, careless handling of radioactive substances, and treatment of cancer patients. The radiation dose in this case is 1000-1500 R or more. When the whole body is irradiated with such a dose, it develops acute radiation sickness which leads to the death of the victim before the appearance of burns.

Radiation burns of the skin, as well as thermal ones, depending on the depth of the lesion, are divided into 4 degrees: I degree - erythema, II - blisters, III - total defeat skin and IV degree - damage to subcutaneous tissue, muscles, internal organs. However, with thermal injuries clinical symptoms burns appear immediately after injury, and with radiation injuries, a typical periodicity and phasic course of the disease is observed.

Usually in clinical picture radiation skin lesions are divided into 4 periods: 1st period - primary local reaction (primary erythema); 2nd-hidden; 3rd - development of the disease and 4th period - reparative.

The duration of the period and depth of damage depend on the dose of ionizing radiation. The 1st period is characterized by patient complaints of itching of the skin, hyperemia at the time of irradiation with large doses or immediately after it. With less massive radiation doses, these phenomena may be absent. In the 2nd period any pathological changes no in the irradiation zone. Sometimes there is skin pigmentation remaining after primary erythema. The duration of this period depends on the radiation dose: the higher the dose, the shorter the latent period and the more significant and deeper the damage. If the latent period is 3-4 days, then the radiation dose is high and subsequently leads to necrosis of the irradiated areas like III-IV degree burns. During a latent period of up to 7-10 days, blisters appear (second degree burn), and if it lasts about 20 days, erythema occurs (1st degree burn).

The clinical sign of the 3rd period is the appearance of signs on the skin radiation injury- radiation burn, the depth of which depends on the radiation dose and the duration of the latent period.

Thus, the duration of the latent period and Clinical signs can be used not only to predict the severity and depth of damage, but also to determine the radiation dose. The nature of the radiation (m-rays, fast neutrons, etc.) and the individual characteristics of the organism are of great importance. Typically, a III-IV degree burn occurs with local irradiation at a dose of 1000-4000 R and a latent period of 1-3 days.

In the 4th period, rejection of necrotic tissue and regeneration processes occur. With deep lesions, this period can be extremely long. Due to a violation of the reparative ability of cells, healing proceeds extremely slowly with the formation of scars and ulcers that do not close for a long time.

Therapeutic measures for radiation skin lesions are carried out in accordance with the periods of burn development and the individual characteristics of their manifestation in a given patient.

Treatment should begin from the moment the primary erythema appears, which can facilitate the further course of the disease.

In case of severe primary erythema, it is recommended to apply an aseptic bandage to the affected area. Local application of cold to the irradiated area is helpful.

In the latent period or at the beginning of the development of the disease, intravenous administration 0.5% novocaine solution (10 ml), as well as novocainization of the affected area.

For superficial burns of the 1st-2nd degree, ointment bandages are applied to the affected area, after removing blisters and superficial necrotic tissue. Tetanus is prevented and antibiotics are administered.

Subsequently, after clear delineation of areas of necrosis, it is shown surgery, which consists of excision of non-viable tissues followed by their plastic surgery.

CONCLUSION

Damage to living tissues caused by exposure to high what temperature, chemical substances, electrical or radiant energy, taken on call it a burn. First of all, the skin is affected by burns, and then deeper-lying formations - subcutaneous fatty tissue, sheets of fascia that separate layers of tissue, tendons, muscles, blood vessels and nerves, periosteum and bone. In rare cases, as a result of prolonged exposure to a harmful factor that has a very high temperature, not only the integumentary tissues, but also internal organs. If a traumatic agent gets on the mucous membrane of the mouth, digestive tract or respiratory tract, burns of the mucous membrane are formed. In conclusion I would like to give brief description all types of burns.

Burns come in different types Dov- thermal, chemical, electrical and radiation.

Thermal burns arise from the action of flame, molten metal, steam, hot liquid, or from contact with a heated metal object. The higher the temperature of the harmful factor acting on the skin and the longer the time of its exposure, the more serious the consequences it causes. The deepest and most extensive burns occur when the victim's clothing catches fire. Burns of the skin, combined with burns of the mucous membrane of the upper respiratory tract. Such combinations are possible if the victim breathed hot smoke and air. This usually occurs during a fire in an enclosed space. Burns of the skin and mucous membranes during a fire can sometimes be combined with carbon monoxide poisoning of the body.

Chemical burns come from the action of concentrated acids, caustic alkalis and other chemicals that fall on living tissues and cause their destruction. One type of chemical burn is phosphorus, which has the ability to combine with fat. Burns with acids and alkalis can also be observed on the mucous membrane of the mouth, esophagus and stomach if the victim, by mistake or ignorance, drank a toxic solution, mistaking it for water. Due to the careless attitude of adults towards chemicals and objects
Small children are often affected by household chemicals.

Electrical burns are obtained due to contact with electric current and its passage through tissue from one electrode to another or into the ground. In this case, electrical energy is converted into heat. Heat, concentrating at the point where the current passes through the skin, destroys tissue. When exposed to high voltage current, the amount of heat generated in the tissues is so great that deep-lying main vessels that provide blood circulation to the limb can be destroyed. In such cases, the death of the entire limb is inevitable. When exposed to low voltage currents, the affected areas are not deep or extensive.

Radiation burns . Sunburns are common in everyday life. Direct exposure to sunlight is especially dangerous for infants and toddlers, since, in addition to burns, it can cause overheating of the entire body. Burns to exposed parts of the body can also be caused by bright light radiation generated during the explosion of modern nuclear sources. They occur at a distance of several kilometers from the center of the explosion. The course of these burns is unusual, as it is complicated by the action of penetrating radiation.

BIBLIOGRAPHY

Kazantseva N.D. Burns in children. M. 1998

Yumashev. G.S. First aid. M. 1995

4685 0

When atomic bombs explode, thermal damage occurs as a result of the combined effect of ultraviolet, visible and infrared rays on the body. When an atomic bomb explodes, about one-third of the energy is released in the form of light radiation, 56% of which is infrared rays, 31% visible rays and 13% ultraviolet rays. There are two types of damage: 1) damage caused by primary radiation at the moment of a light flash (“instant burns”), and 2) damage that can occur when fuel, equipment, buildings, etc. ignite.

During an instantaneous flash, predominantly exposed parts of the body facing the direction of the explosion are affected, which is why such burns are called “profile” burns. The most important role is played by infrared radiation, which occurs in a fireball, where the temperature reaches several million degrees. Depending on the distance, bomb caliber, terrain conditions, weather, burns of varying degrees are observed.

Instant burns, in the terminology of a number of authors, were called because they occur in a very short period of time of exposure to light radiation, measured in fractions of a second, with an extremely high intensity of light radiation and the absence of direct contact with a heat source. This is why burns occur only on the side facing the source.

The simultaneous impact of thermal and other damaging factors of an atomic explosion extremely aggravates the course of burn disease. The greatest danger comes from combined injuries: burns combined with penetrating radiation.

With combined lesions, severe forms of shock sometimes develop, which in such cases is a consequence of the combined effect of a number of unfavorable factors - fear, mental depression, penetrating radiation and trauma.

With combined thermal and mechanical damage and simultaneous exposure of the body to penetrating radiation, a syndrome of mutual aggravation is observed, the latent period is reduced and the period of the height of radiation sickness becomes more severe, which in turn worsens the course of the burn.

Scars formed after burns tend to develop into keloids. Their occurrence is associated with the development of purulent complications and disruption of trophic processes in the wound. Even during the period of resolution of radiation sickness, the granulation tissue that appears on the affected surface is characterized by insufficient maturity, is easily injured during dressings and bleeds. Epithelization of the burn surface is also extremely slow.

Contamination of the burned surface with radioactive substances is determined by dosimetric monitoring using special instruments. Radioactive substances that enter the burn surface, as a result of the destructive ability of alpha, gamma and beta rays, cause degenerative processes and tissue death.

Injuries from direct contact of massive doses of radioactive substances with the skin or exposure to beta radiation are referred to as so-called radiation burns, which occur atypically. During such burns, four periods are distinguished.

The first period is an early reaction to radiation, manifests itself several hours after the lesion in the form of erythema of varying intensity. Erythema lasts from several hours to 2 days.

The second period is hidden, lasting from several hours to 3 weeks. During this period, there are no external manifestations of the lesion.

The third period - acute inflammation - is characterized by the appearance of secondary erythema, and in severe cases - the appearance of blisters. Later, erosions and ulcers form at the site of the opened blisters, which heal very poorly. This period lasts from 2-3 weeks to several months.

The fourth period is recovery, when the erythema gradually disappears, and erosions and ulcers granulate and heal. Healing of ulcers occurs slowly and sometimes lasts for years. Often the ulcers recur. Trophic changes in the skin and underlying tissues are characteristic (atrophy of the skin and muscles, hyperkeratosis, hair loss, deformation and brittleness of nails).

The most important means of preventing radiation burns is the possible early and complete removal of radioactive substances from the skin and burn surface, achieved through sanitary treatment. Bubbles are emptied by puncture and suction of the contents. Locally apply dressings containing antibiotics and anesthetics.
The use of fractional blood transfusions, novocaine blockades and antibiotics is indicated.

In case of deep lesions, after the period of acute inflammation has ended, it is often necessary to resort to excision of ulcers and replacement of the resulting defects with free skin flaps or Filatov skin stem.

A.N. Berkutov

The cause of radiation burns is local exposure to radiant energy (isotope, X-rays, UV rays). A peculiarity of skin irradiation is the simultaneous general exposure to radiant energy with the development of radiation sickness.

Changes in tissues are based on a disorder of capillary blood flow with stasis of red blood cells, the formation of edema and degenerative changes in nerve endings. A large dose of radiation can cause dry necrosis of deeper tissues.

The course of radiation burns undergoes three phases: the primary reaction, the latent period, and the period of necrotic changes.

Primary reaction develops a few minutes after irradiation and is manifested by moderate pain, hyperemia and swelling of the irradiation site with simultaneous general manifestations in the form of weakness, headache, nausea, and sometimes vomiting. This period is short-term (several hours), after which both general and local manifestations gradually disappear, and latent period which can last from several hours (days) to several weeks. Its duration depends on the type radiation therapy: the shortest period of imaginary well-being is with sunburn (several hours), the longest period is with exposure to ionizing radiation.

After the imaginary well-being (hidden period) begins period of necrotic changes. There appears hyperemia of skin areas, dilation of small vessels (telangiectasia), detachment of the epidermis with the formation of blisters filled with serous fluid, areas of necrosis, upon rejection of which radiation ulcers are formed. At the same time, manifestations of radiation sickness occur: weakness, malaise, nausea, sometimes vomiting, rapidly progressing thrombocytopenia, leukopenia, anemia, bleeding of the mucous membranes at the slightest injury, hemorrhages in the skin.

With radiation ulcers, the ability of tissue to regenerate is practically absent; they are covered with scanty gray discharge without signs of granulation and epithelialization.

Treatment of radiation burns(radiation ulcers) are carried out against the background of radiation sickness therapy using blood components and even bone marrow transplantation. Without such therapy, treatment of radiation ulcers is futile. Local treatment involves the use of necrolytic agents (proteolytic enzymes), antiseptics, ointment dressings with regeneration stimulants after cleansing the ulcers.

Frostbite

Under the influence of low temperatures, local cooling (frostbite) and general cooling (freezing) are possible.

Frostbite- local cold damage to the skin and underlying tissues.

Classification of frostbite

1) According to the depth of the lesion:

I degree - circulatory disorder with the development of reactive inflammation;

II degree - damage to the epithelium up to the germ layer;

III degree - necrosis of the entire thickness of the skin and partially subcutaneous tissue;

IV degree - necrosis of the skin and deeper tissues.

2) By flow periods: a) pre-reactive (hidden); b) reactive.

Pathogenesis and clinical picture

Tissue damage is caused not by direct exposure to cold, but by circulatory disorders: spasm, in the reactive period - paresis of blood vessels (capillaries, small arteries), slowing of blood flow, stasis of blood cells, thrombosis. Subsequently, morphological changes in the vascular wall are added: swelling of the endothelium, plasma impregnation of endothelial structures, the formation of necrosis, and then the formation of connective tissue, obliteration of the vessels.

Thus, tissue necrosis during frostbite is secondary; its development continues during the reactive phase of frostbite. Changes in blood vessels due to frostbite create a background for the development of obliterating diseases and trophic disorders.

Most often (95%) the extremities are affected by frostbite, since when they cool down, blood circulation in them is quickly disrupted.

During frostbite, two periods are distinguished: pre-reactive (latent) and reactive. preactive period, or a period of hypothermia, lasts from several hours to a day - until warming begins and blood circulation is restored. Jet period begins from the moment the affected organ is warmed and blood circulation is restored. There are early and late reactive periods: the early period lasts 12 hours from the start of warming and is characterized by impaired microcirculation, changes in the vascular wall, hypercoagulation, and blood clot formation; the late one comes after it and is characterized by the development of necrotic changes and infectious complications. It is characterized by intoxication, anemia, hypoproteinemia.

Based on the depth of the lesion, four degrees of frostbite are distinguished: degrees I and II - superficial frostbite, III and IV - deep. With frostbite of the first degree, there is a circulatory disorder without necrotic tissue changes. Full recovery occurs by 5-7 days. Frostbite of the second degree is characterized by damage to the surface layer of the skin, while the germ layer is not damaged. Destroyed skin elements are restored after 1-2 weeks. In the third degree of frostbite, the entire thickness of the skin is exposed to necrosis, the necrosis zone is located in the subcutaneous tissue. Skin regeneration is impossible; after the scab is rejected, granulation tissue develops, followed by the formation of scar tissue, unless skin grafting is performed to close the defect. In degree IV, not only the skin, but also the underlying tissues undergo necrosis; the border of necrosis at depth passes at the level of bones and joints. Dry or wet gangrene develops in the affected organ, more often in the distal parts of the extremities (feet and hands).

When examining a patient, it is necessary to find out complaints, medical history, conditions under which frostbite occurred (air temperature, humidity, wind, duration of the victim’s stay in the cold, volume and nature of first aid).

It is extremely important to establish the presence of factors that reduce both the general resistance of the body to the effects of cold (exhaustion, fatigue, blood loss, shock, vitamin deficiencies, alcohol intoxication) and local resistance of tissues (obliterating vascular diseases, innervation disorders, trophic disorders in tissues, previous frostbite) .

In the pre-reactive period, patients first note the appearance of paresthesia in the area of ​​the cooled part of the body, and then a feeling of numbness is added. Pain does not always occur. The skin in the area of ​​frostbite is most often pale, less often cyanotic, cold to the touch, its sensitivity is reduced or completely lost. It is impossible to determine the degree of frostbite during this period - one can only assume a severe degree of frostbite in the absence of sensitivity.

When the limb warms up as blood circulation is restored, a reactive period begins. In the area of ​​frostbite, tingling, burning, itching and pain appear (with deep frostbite, the pain does not intensify), the limbs become warmer. The skin becomes red, and with deep frostbite - cyanotic, with a marbled tint or severe hyperemia. As you warm up, tissue swelling appears; it is more pronounced with deep frostbite.

Establish the prevalence and degree of frostbite is possible only with the development of all signs, i.e. in a few days.

With frostbite of the first degree, patients complain of pain, sometimes burning and unbearable during the period of warming up. As the skin warms up, the paleness of the skin is replaced by hyperemia, the skin is warm to the touch, tissue swelling is insignificant, limited to the affected area and does not increase. All types of sensitivity and movements in the joints of the hands and feet are preserved.

With second degree frostbite, patients complain of skin itching, burning, and tissue tension that lasts for several days. Characteristic sign- formation of bubbles; more often they appear on the first day, sometimes on the 2nd, rarely on the 3-5th day. The blisters are filled with transparent contents; when they are opened, a pink or red surface of the papillary layer of skin, sometimes covered with fibrin, is determined (Fig. 94, see color incl.). Touching the exposed layer of the bottom of the bubble causes a pain reaction. Skin edema extends beyond the affected area.

With third degree frostbite, more significant and prolonged pain is noted, and there is a history of prolonged exposure to low temperature. In the reactive period, the skin is purplish-bluish in color and cold to the touch. Bubbles are rarely formed, filled with hemorrhagic contents. In the very first days and even hours, pronounced swelling develops, extending beyond the boundaries of the skin lesion. All types of sensitivity are lost. When the blisters are removed, their bottom is blue-purple in color, insensitive to injections and the irritating effect of a gauze ball moistened with alcohol. Subsequently, dry or wet skin necrosis develops, and after its rejection, granulation tissue appears.

IV degree frostbite in the first hours and days is not much different from III degree frostbite. The affected area of ​​skin is pale or bluish. All types of sensitivity are lost, the limb is cold to the touch. Bubbles appear in the first hours, they are flabby, filled with dark-colored hemorrhagic contents. Swelling of the limb develops quickly - 1-2 or several hours after it is warmed up. The edema occupies an area much larger than the necrosis zone: when the fingers are frostbitten, it spreads to the entire hand or foot, and when the hand or foot is affected, it spreads to the entire lower leg or forearm. Subsequently, dry or wet gangrene develops (Fig. 95, see color on). In the first days, it is always difficult to distinguish between grade III and IV lesions by appearance. After a week, the swelling subsides and forms demarcation line- separation of necrotic tissues from healthy ones.

As a result of prolonged repeated (with alternating cooling and warming) cooling of the legs at temperatures from 0 to +10 ° C at high humidity, a special type of local cold injury develops - "trench foot" The duration of cooling is usually several days, after which, after a few days, aching pain in the legs, burning, feeling of stiffness.

On examination, the feet are pale, swollen, and cold to the touch. Characterized by loss of all types of sensitivity. Then there are bubbles with hemorrhagic contents, the bottom of which are areas of the necrotic papillary layer of the skin. There are pronounced signs of intoxication: heat body, tachycardia, weakness. Sepsis is often associated.

Three types of radiation cause radiation burns - solar ultraviolet, ionizing (alpha, beta and neutron) and electromagnetic - photon (beta and x-rays). This is a local effect on tissue. Radiation burns are not the most common traumatic lesions of body tissue. Their peculiarity is that they are very severe and difficult to treat. In some cases, it is impossible to predict recovery.

Effect of rays on the skin

Prolonged intense exposure to sunlight provokes inflammatory damage to the surface layers of the skin. Within a few hours, pronounced symptoms appear. Ultraviolet radiation causes skin burns in the summer when exposed to the sun for a long time. Excessive exposure to rays from tanning beds can damage your skin at any time of the year. Such burns can be treated quickly and successfully.

The penetrating ability of alpha particles that cause burns is low. They affect the upper layers of the skin and mucous membranes. Beta rays are a little more intense. These rays penetrate very deeply:

Alpha rays do not penetrate healthy skin; they are dangerous to the mucous membranes of the eyes and cause burns to the outer layer of the skin, similar to solar radiation. Once in the body with air, it can affect the mucous membranes of the respiratory tract, including the larynx. Beta radiation penetrates into tissues in open areas to a depth of 2 cm. Therefore, the skin and underlying tissues are affected.

The penetrating power of X-rays, neutrons and gamma rays is very high. They damage all organs and tissues. They are difficult to defend against. The causes of this type of injury from ionizing radiation and photon radiation are:

• the use of nuclear weapons during military operations;
• man-made accidents and catastrophes at enterprises using nuclear energy, processing and transporting radioactive materials, nuclear research facilities;
• use of medical devices for examination and radiation therapy;
• receiving local exposure from radioactive fallout due to stellar explosions and solar flares.

Small doses of radiation on working equipment are used in medical institutions without harming the patient’s health. Currently, local treatment is very effective. oncological diseases radiation. Its doses can be significant.

Irradiation affects not only tumor cells, but also healthy tissues located nearby. It damages them. Burns after radiation therapy appear after a while, before their visualization can take months. They often develop severely, with complications, in particular:

Exposure to ionizing and photon radiation depends on the dose, intensity and depth of penetration. Such burns are characterized by slow development and tissue restoration. If up to 10% of the entire surface of the body is affected, it is a burn; if more, it is a burn disease.

Manifestations and possible consequences

In the development of radiation burns, there are 4 degrees of severity, which determine the area and depth of tissue damage:

In severe burns, the temperature rises, the lymph nodes adjacent to the affected area become inflamed, and leukocytosis is detected in a blood test. In degree 2, blisters may open, dry out, and heal without scarring. Third degree radiation burns must be treated.

Please note! Those with very severe injuries are referred only to specialized clinics or centers. Patients have severe intoxication of the body, and the development of negative consequences is possible. Treatment is difficult and lengthy.

There are risk factors for the development of negative consequences after radiation burns:

The presence of at least one factor can provoke the development of major complications:

• burn wound infection;
• bleeding.

To prevent tetanus, it is necessary to administer antitetanus serum. In the future, the occurrence of trophic ulcers and the development of skin cancer at the site of the healed burn is possible.

How to help the victim?

First aid for radiation burns is to prevent infection of the wound surface. For this purpose, the patient is taken away from the radiation exposure area. Do not touch the burn surface with your hands. It is important to ensure sterility of hands and dressings. This will prevent infection and complications associated with it. With clean hands apply napkins, gauze or a bandage to the wound and quickly transport the patient to a specialized medical facility.

The prognosis for recovery is favorable in the presence of 1st and 2nd degree burns. Less optimistic prognosis for grade 3 and 4 lesions. Much depends on the timeliness of the treatment started and its quality, the age of the patient, and his state of health.
The choice of treatment also depends on the extent of the damage:

Minor burns – 1st and 2nd degree are treated with simple remedies traditional medicine. To do this, you can use the following tools:

Severe 3rd and 4th degree burns can only be treated under conditions medical institution, where qualified specialists will be able to provide the necessary assistance and prevent serious complications that can cost the patient’s health and even life. In case of timely and proper treatment Such injuries usually have a favorable outcome.

Radiation sickness is a burn injury to the body that occurs under the influence of various types radioactive rays, whose volume and range exceed the load that human immunity can tolerate. Radiation burn causes dangerous disease, in which many systems, organs, and tissues suffer.

A characteristic feature is the presence of a latent period of development. We are talking about the late onset of external manifestations: symptoms radiation exposure make themselves felt after a short period of time. Most often, injury is found in several areas of the skin.

Radiation burns are caused by the following forms of radiation:

• ultraviolet (sun);
• ionizing (alpha, beta and neutron);
• electromagnetic – photons (beta and x-rays).

Alpha radionuclides are safe for humans. They can only affect the upper layers of the skin and mucous membranes (you need to protect your eyes, mouth, throat, and esophagus from them). Beta radiation penetrates 2-3 cm deep into the body. The body is most affected by X-rays, neutrons and gamma rays. They damage all internal organs and tissues. It is possible to be irradiated with such types of energy after the use of nuclear weapons, during man-made, industrial nuclear disasters, in contact with radioactive waste.

Depending on the source (cause) of the lesion, there are several types of radiation burns:

1. As a result (ultraviolet radiation). This type is most common: after prolonged exposure to the sun, a person burns. If it is prone to overreacting to ultraviolet light, burning may occur due to low intensity exposure. People with a weakened immune system, patients with diabetes mellitus, do not tolerate the sun well.
2. Caused by ground and air nuclear explosions and laser weapons. Such powerful sources instantly affect all parts of the body. Often accompanied by damage to the eyeballs.
3. From ionizing radiation. They do not affect internal organs, affecting only the superficial layers of the skin. With radiation sickness, burns heal slowly, the regeneration process stops. The vessels become brittle and poorly nourish the damaged surfaces.
4. Burns after radiation therapy. May occur as a result of radiotherapy (various types of radiation) in order to cure a disease, most often of a tumor oncological nature (breast cancer, esophagus, larynx, cervix, etc.)

There are different ones depending on the affected area:

• skin;
• mucous membrane (eye during welding);
• internal organs.

Each type requires a separate treatment method, taking into account the nature, area of ​​damage, and degree of damage.

Degrees and periods

There are 4 degrees of severity of radiation burns:

1. Grade 1 severity occurs when exposed to low doses of radiation and becomes apparent after 10-14 days. These are reddened areas of the skin, sometimes with the effect of peeling of its upper layers.
2. Grade 2 appears 5-10 days after the body has experienced moderate exposure. These lesions result in large areas of redness with blistering, itching and pain.
3. Stage 3 appears within 3-6 days after irradiation. Symptoms of this degree are slowly healing ulcers, swelling of the skin, erosions, blisters, and extensive necrotic areas.
4. 4th degree, radiation burn - a dangerous injury. Immediately after exposure to rays on the skin, severe damage to the epidermis, muscle tissue, discharge mixed with pus occurs, the body is covered with ulcers and areas of necrosis.

The development of radiation injury occurs in three periods:

• period of primary reaction;
• latent period;
• necrotic changes.

The primary reaction, the first stage, occurs immediately after exposure to radiation. The first few hours pass. Slight swelling, redness, pain, and burning appear in the area of ​​damaged tissue. The victim may immediately feel nauseous, headache, malaise.

The latent clinical period occurs after the signs of the primary reaction to the burn have smoothed out. A feature of this stage is the almost complete absence of any symptoms, as if the lesion had receded. Visible well-being can be observed from the first few hours to three weeks, depending on the source of radiation.

Necrotic changes are manifested by pain, severe redness, swelling and the appearance of seals on the skin. In some cases, the deep layers of the skin are damaged, hair falls out, large blisters, erosion appear. Necrotic zones are poorly restored and renewed, often get wet, exuding serous fluid, and periodically fester.

Throughout the entire period of illness, the affected person experiences signs of damage: weakness, nausea. In severe burns, anemia, superficial and internal bleeding, and infection of the affected areas often occur.

First aid

The provision of first aid to a person with radiation burns must be done as soon as possible. Apply wipes soaked in a disinfectant solution to the affected area. For several hours, the surface of the skin must be washed with soapy water. Afterwards, you need to lubricate the damage with baby ointment.

Severe radiation burns require not home, but emergency medical care in the clinic. The first medical aid consists in the qualified treatment of wounds and the introduction of painkillers, means are prescribed to improve the regeneration of affected tissues.

Further treatment of radiation burns

In the hospital, a patient affected by radiation energy receives painkillers, antiseptic drugs, and protective dressings are applied to the damaged surface. If the lesions are grade 1 or 2, local anesthesia is administered.

If the patient is in critical condition, antishock therapy is administered. Cardiac activity and indicators are monitored blood pressure. If necessary, the patient is operated on: necrotic formations are removed at the burn sites.

The main treatment is to take antibacterial drugs, taking a course of infrared radiation to remove acute form diseases, accelerating the regenerative functions of tissues and preventing the reproduction of microbes in the affected area. Anti-burn medications (solutions, balms, ointments) are prescribed. More needs to be added to the diet healthy products, eliminate salt, drink more water. Folk remedies strictly prohibited!

Possible complications

• radiation reaction: dysfunction of the nervous, cardiovascular, endocrine systems;
• atrophic, hypertrophic, chronic radiation dermatitis;
• functional disorders of the lungs and bronchi;
• sclerotic processes in the myocardium, lungs, liver, kidneys and other organs;
• radiation pericarditis (heart damage);
• damage to the walls, intestinal mucous membranes, erosion;
• functional kidney failure;
• radiation cystitis;
• radiation lymphostasis;
• radiation tumors.

Prevention and prognosis

To prevent damage in areas of increased radio radiation or in areas of high solar activity, it is recommended to use.