injuries caused by heat, cold, electrical current, chemicals m. hakl, md, phd. departement of...
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Injuries caused by heat, cold, electrical current, chemicals
M. Hakl, MD, PhD.
Departement of Anaesthesiology and Intensive Medicine
Pain Management Centre
St. Ann´s Teaching Hospital, Brno
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Skin - anathomy
• One of the larges organs, plays important roles in protecting the body agains injury and infection.
• Major function of the skin is to help maintain body temerature (36-37 dg. C), 97-99 dg. F)
• Skin consists of two leyers– Outer, epidermis, protected by oily substance
(sebum) secreted from glands.– Lower, dermis, contains vessels, nerves, muscles,
glands. Dermis registered sensations (heat, cold, pain)
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Burns
• In case of burns skin loose its barrier functions and as a result of demagein of soft veesels may leak tissue fluid (serum)
• This fluid either collects under epidermis and form blisters or leaks thorugh injuried skin.
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Burns – according to severity• 1st degree (epidermal):
Damageing of surface layer of the skin (epidermis), Clinical symptom: local erythemaDuration of healing: several days
• 2nd degree (dermal):Demageing of dermisClinical symptoms: Blister formation and erythema, sharp pain, loss of plasma, risk of infection Duration of healing: several 2-3 weeks
• 3rd degree (subdermal) Demageing of the skin and deepar tissues (muscles, tendoms, fat..)Clinical symptoms: Eschars, destruction of skin and subcutis, loss of pain sensation, skin may look waxy, pale and charred
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Extension of burns
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Severity of burns – adults(age, degree, extension)
• Slight2nd degree up to 10%, 3rd degree up to 2%
• Medium2nd degree up to 20% of body surface, 3rd degree up to 5% of body surface –reffered surgical department
• Severe2nd degree over 20% of body surface, 3rd degree over 5% of body surface –reffered to specialised clinic
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Sever burns - children
• Children under 2 years – 2nd degree over 5% of body surface
• Children 2-8 years – 2nd degree over 10% of body surface
• 3rd degree burns are severe in children regardless their extent
Theese all types of burns are sever
Sever burns are have to be reffered to the specialised clinic!!!!!!
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The List of hospital with specialised Burns Departemnd
• Teaching Hospital Brno Bohunice
• Teaching Hospital Královské Vinohrady
• Teaching Hospital Ostrava
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Minor burns – first aid
• Flood the injuried part with cold water for at least 10 minutes to stop the burning and relive the pain.
• Gently remove any jewelery, watches, belts or constricting clothing.
• Cover the burned area with sterile dressingNotice:• Dont break blister, do not apply adhesive
dressings, do not apply butter, oils, fats…
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Severe burns – First Aid
• Help the person lay down, if possible, try to prevent the burned area from coming into contact with the ground.
• Flood the burns with plenty of cold liquid )10 minutes at least). Gently remove any jewelery, watches, belts or constricting clothing.
• Cover burns with sterile dressing• Record details of the injuries, monitor vital
signs.• Call for medical help
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Heat stroke
• Causes: Heatstroke happens in hot and usually wet
environment, during intense physical effort and lack of liquids, in hot and poorly ventilated rooms
• Symptoms: Feeling of heat, thirst, weakness, nausea, emesis,
disorientation, loss of consciousness. Skin is dry, hot, red face. Respiration and pulse getting faster, in final stage get slower
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First Aid
• Put the afflicted to cool place, fresh air, shade.• Lower body temperature – cold wrap, shower,
bath, immerse to water (25o C)• Serve by spoonfulls cold liquids with salt and
vitamin C, cold black coffee, tea• In case of unconsciousness – stabilised position• Cardiac and respiration arrest –
Cardiopulmocerebral resuscitation
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Sunstroke
• Cause:
Direct exposure to sunbeams
• Symptoms
1st to 2nd degree burns, headache, buzzing in ears, nausea, emesis, body temperature around 40o C, possible cramps. Respiration and pulse getting faster.
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First Aid
• Remove the afflicted from sunlit place
• The is conscious – semi-sitting position, cold compress on forehead, neck and limbs, serve cold liquids
• The afflicted is unconscious – same procedure as in case of heatstroke
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Hypothermia• Symptoms
Feeling of cold, fatigue, sleepiness, apathy, disorientation, hallucinations, unconsciousness with restrained respiration
• First Aid• Carry to leeward, dry and warm place, remove wet clothes.• The afflicted is conscious – active and passive limb
movements, pressure massages, bath 37 – 40o C. Serve hot drinks. NO alcohol!
• The afflicted is unconscious – ensure clear airways, put warm compress on chest and neck, wrap in blankets. Call ambulance.
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Frostbite
Mostly affects fingers, toes and limbs, ears, nose, cheeks
• Symptoms1st degree: pale skin, purple marbleised, sharp
stabbing pain2nd degree: white to greyish skin, substantial
soreness, blisters and swellings after warming3rd degree: wax-like white and tough skin,
insensitive centres, danger of tissue necrosis
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First Aid
• DO NOT RUB frostbitten areas with snow or ice• Carry the afflicted to warm place (25o C)• Undress and remove shoes very carefully – danger of
ripping off blisters and spreading infection• Affected area without blisters can be immerged for 30
min to water 37o C hot.• Treat secondary injuries (e.g. fractures)• Serve tea with vitamin C• Take antishock measures• Call ambulance
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Chemical burns of cornea and conjunctivae
Rinse eye for 30 min with a lot of running water. Rinse direction is from the inner corner to outer corner. Apply antiseptic bandage to both eyes, take antishock measures, call ambulance.
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Chemical burns of skin and mucous membranes
• Unknown agentRemove clothes by while flooding injuries. Rinse with running water, apply antiseptic bandage, call ambulance.
• Acid burnsRemove clothes and underwear stained with acid, rinse with running water (min 20), simultaneously prepare neutralising solution, apply antiseptic bandage moistened in the solution (alkaline soap or edible salt– 6 - 8%)
• Alkali burnsRemove clothes stained with caustic agent, rinse, apply antiseptic bandage with diluted acetic or citric acid
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Electrotrauma• Low voltage up to 1000 V
Discontinue connection with conductor, monitor basic life functions, treat burns, treat other injuries, take antishock measures, transport
• High voltage above 1000 VEnsure switching off the electricity by a specialist, keep safe distance 18 m, after disconection current (by fire-fighters or other specialists) ensure basic life functions, treat burns, take antishock measures
• Strike by lightningSimilar procedure as in case of high voltage strike, only do not wait for linesman
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