Burns and scalds caused by various reasons are very common in hospital emergency departments and daily life. Because patients have obvious and sudden pain, they are prone to psychological fear and anxiety. Improper treatment after burn will not only delay diagnosis and treatment, but also endanger life. Therefore, nurses working in the emergency department should fully understand and master the first aid and nursing principles of burns and scalds. The following are the first aid and nursing principles for burns and scalds that I brought to you. Welcome to reading.

(A) the classification of burns

Burns are caused by different external heat sources that contact the skin, such as flame, chemicals, friction, current, radiation and high temperature. Therefore, burns can be divided into thermal burns, chemical burns and electric burns.

1. Thermal burns: including injuries caused by flame, hot water, steam, explosion, hot air flow, hydrothermal solution, electric spark and direct contact with hot objects (such as stoves and asphalt). This is what we usually call thermal burns.

2. Chemical burn: it is the damage caused by the contact of the body with necrotic chemicals, mainly strong acids and alkalis. Because protein is rapidly solidified by acid to form a barrier and easily neutralized by tissue fluid, protein is hydrolyzed and liquefied by alkali, resulting in secondary infection, so alkali burn is more difficult to treat than acid burn.

3. Electric burn: It often causes large-area coagulative necrosis of tissues. The resistance of the tissue affects the degree of damage, and the tissue with low resistance is more likely to be damaged. The order of tissue resistance in vivo is: blood vessel, nerve, muscle, skin, fat, tendon and bone tissue. The characteristic of electric burn is that the current inlet and outlet may be small, but there is extensive damage inside, which is prone to complications.

(2) manifestations of burns and scalds

The severity of burns and scalds is mainly judged by the location, area and depth of burns and scalds. Burns and scalds on the head and face, or not on the head and face, but with large area and deep depth, are all serious.

Burns and scalds are generally divided into three degrees and four points according to depth. The clinical manifestations are: ①I-degree burn, also known as erythema burn, with local dryness, pain, slight swelling and redness, and no blisters. After 3 ~ 5 days, the local area changes from red to light brown, and the epidermis shrinks and falls off, exposing the red, tender and smooth epithelial surface and healing, leaving no scars, and there may be changes such as pigmentation in a short time. ② Second-degree burn Shallow second-degree burn is also called vesicular burn, with obvious swelling and blisters of different sizes, which contain yellow (or reddish) plasma-like liquid or protein-coagulated peptone. After the blister burst, a soft, high temperature, intense pain and sensitive flushing wound surface can be seen, and countless dilated and congested capillary networks can be seen, which are veins or granules, especially after 1 ~ 2 days. There is no scar after healing, but there may be pigmentation at different stages. Deep second-degree burns are swollen locally, with white or brownish yellow epidermis and occasional small blisters. After removing necrotic skin, the wound surface is slightly wet, reddish or red and white, tough, insensitive, low temperature and painful depilation. Pinholes or millet-sized red spots can be seen, which are more obvious 1 ~ 2 days after injury. This is caused by the expansion of capillaries around sweat glands and hair follicles. If there are dilated, congested or embolized small vascular branches (congestion or embolism of dermal vascular plexus), it often means that deep second-degree burns are deeper. ③ Ⅲ degree burn is also called eschar burn. Due to the different degree of injury, the local manifestations can be pale, yellowish brown and brown. In severe cases, people are anxious or carbonized, the skin loses elasticity, feels as hard as leather, the wound is dry, there is no exudation, chills, acupuncture is painless, and plucking is painless. After the injury, a large embolic vascular network (subcutaneous vascular plexus embolism) can be seen, such as dendritic, especially in the thin skin of the inner limbs. But sometimes it takes 1 ~ 2 days, especially the eschar caused by burns, which can only appear after drying.

(3) On-site rescue of burns and scalds

According to the degree of burns, different rescue measures are taken.

1. For first-degree burns and scalds, immediately soak the wound with cold water? Cooling therapy? It has the functions of reducing temperature, reducing residual heat damage, reducing swelling, relieving pain and preventing foaming. If there is ice, you'd better apply it to the wound. ? Cooling? The pain can be completely relieved in about 30 minutes. Then apply egg white or flower oil or scald cream to the scalded area, and it only takes 3-5 days to heal itself. If the burn is not on your hands or feet, you can't soak the wound with water? Cooling therapy? Sometimes you can wrap the injured part with a towel, and then water it on the towel. Ice compress may be better.

What about burns and scalds? Cooling therapy? After a certain period of time, it still hurts and hurts, and blisters appear on the wound. Does this mean? Second degree burns? . Don't break the blisters at this time, and go to the hospital for treatment. 3. Third-degree burns and scalds should be simply bandaged with clean sheets or clothes immediately to avoid pollution and re-injury. Don't rub medicine on the wound, keep the wound clean and send it to hospital quickly.

On-site first aid according to the causes of burns and scalds.

1, open flame burns

If the burning clothes on the wounded are difficult to take off, you can roll on the ground to put out the fire, or douse the flame with water. Don't run with the fire, and don't beat it with your hands, otherwise it may make the fire burn with the wind and your hands will be burned. Don't shout loudly in the fire, so as not to cause respiratory tract burns. Cover your nose and mouth with a wet towel to prevent suffocation or poisoning caused by inhalation of smoke. Remember when you gave first aid to burns? Rush, take off, soak, pack and deliver? Five-word keyword. Rinse: rinse the burn wound with clean water; Take off: take off the coat of the burned person with gentle movements while rushing. If the clothes stick to the meat and can't be pulled hard, you can cut them open with scissors; Soak: soak the wound with cold water; Bag: wrap the wound with clean cloth and clothes; Send: Send it to a hospital with experience in treating burns as soon as possible.

2, boiling water burns

After being scalded by boiling water, the simplest and most effective first aid method is to rinse with a large amount of running water for about 20 minutes to keep the temperature of the affected area consistent with the normal skin temperature around. In the process of washing, it should be noted that the impulse of running water should not be too great, and the integrity of blisters after scalding should be preserved as much as possible. If there are clothes, they should be cut off after cooling, but they should not be forcibly peeled off to avoid tearing out blisters.

Do not treat wounds according to folk remedies, especially colored ones? Commodities? Or? Purple potion? Even use soy sauce to avoid affecting the doctor's judgment on the severity of burns. After the above simple treatment, you can use an ice pack to compress the wound to relieve the pain, and at the same time go to a specialized hospital or burn plastic surgery department for treatment.

3, electric shock burns

The biggest danger of electric shock burns is internal burns. When someone gets an electric shock, please follow the following steps immediately? Cut off the power supply first, or remove the power supply with insulators, such as dry sticks, branches, broom handles, etc. When the power supply is unknown, remember not to touch the person who gets an electric shock directly with your hands.

In the bathroom or wet place, the rescuer should wear insulating rubber shoes and rubber gloves or stand on a dry board to protect himself. If the injured person has no heartbeat or breathing, call 120 for an ambulance and perform cardiopulmonary resuscitation immediately. Don't give up easily until the doctors and nurses arrive. Patients with local burns should immediately cool down, and then take local materials to wrap the wound and send it to hospital for treatment.

4, boiling oil burns

When scalded by hot oil, immediately wipe off the spilled oil with a soft cotton cloth, and then wet the scalded area with a clean towel dipped in cold water, provided that the affected area is not damaged. Remove high-temperature oil and apply it with cold water. The purpose of this is to lower the body temperature and relieve the pain. Minimize the depth of burns. Burn degree is shallow, generally won't leave a scar. But there will be pigmentation after the wound heals and dries, but it will take some time for these pigmentation to disappear completely, ranging from a few days to a month. It is best to avoid spicy food, alcohol and tobacco, and try not to eat ginger and soy sauce before the wound heals.

5, chemical burns

The on-site treatment of chemical skin burn is to leave the scene immediately and take off the clothes, shoes and socks contaminated by chemicals quickly. Burns caused by concentrated sulfuric acid and quicklime cannot be washed with water immediately, but should be dried with a clean cloth first. Don't apply ointment or mercuric chloride to fresh wounds at will, and don't wrap them with dirty cloth. When burned by yellow phosphorus, wash with plenty of water, soak or cover the wound with multiple layers of wet cloth. At the same time, burns are often accompanied by fractures, bleeding and other injuries, and should be treated in time at the scene. Burn patients should be sent to the hospital in time.

6, electric iron burns

First of all, cut off the power immediately, then rinse or soak in cold water, or wrap ice cubes with towels and apply them to the scalded area instead of applying drugs or vegetable oil or soybean oil. Applying soybean oil and vegetable oil is a folk prescription, so it is not recommended. Large-scale burns must be sent to the hospital immediately for emergency treatment.

7, drinking water burns

When scalded by drinking boiled water, patients will cough violently and have hoarse voice; At the same time, it is accompanied by symptoms such as sore throat and dysphagia, which is a mild injury. In case of throat burns: First, you can slowly swallow cold water immediately to relieve the pain. Do not eat hard or hot food, mainly liquid food; 2. Chinese herbal medicines 10g, namely Folium Isatidis, Herba Schizonepetae, Herba Menthae, Rhizoma Coptidis, Radix Platycodi and Radix Glycyrrhizae, can be decocted in water and swallowed frequently. The third is to avoid irritation and spicy food. If the throat edema is serious and obviously affects breathing, they should be sent to the hospital immediately for diagnosis and treatment.

(D) Preventive measures for post-burn care

First, the body fluid exudation stage (shock stage)

Usually 48-72 hours after injury. On the one hand, skin edema is caused by body fluid exudation caused by burn heat, and on the other hand, the normal function of internal organs is affected by the decrease of body fluid. If not treated in time, it will be life-threatening. So do it: 1. Keep quiet and lie flat, don't move and scream. 2. Thirst is the normal reaction of the body to diseases, which will last for a certain time and degree. The nursing staff will take fasting water/a small amount of drinking water within a certain period of time (usually within 48 hours) according to the needs of your illness, hoping that patients can cooperate. 3. If there are other discomforts, such as unbearable pain, cold, dyspnea, etc. , can signal or tell the nursing staff.

Second, the infection period

A period of time from the beginning of a burn to the healing of a wound. Because burns destroy the normal defense function of the skin, a large number of wound necrotic tissues are suitable for bacterial reproduction and infection. At this time, you may have fever, chills, headache, fatigue, loss of appetite and other symptoms. This is a dangerous and critical period for you, and the nursing staff will take some necessary treatment measures for you, including:

1. isolation measures-Because wound exposure is the main means of burn treatment, the exposed wound is prone to infection, which may come from your own wound or from the external environment, so on the one hand, you should pay attention to aseptic operation of your wound, on the other hand, you should be isolated as necessary, such as being unaccompanied and controlling the number of visits.

2. dressing change-dressing change is always accompanied by your whole course of disease, especially at this stage, the change of wound surface is a complex dynamic process. Odor and pus will appear on the wound surface after scab dissolution (removal). This is a natural process of serious illness. Please don't be too nervous. Even if the dressing change is light, it may hurt. I hope you will try your best to be patient.

3. surgery-surgery is a treatment for burned skin that cannot be repaired by itself. By cutting off the damaged skin tissue and covering the autologous or allogenic skin, the environment for bacterial growth and reproduction can be eliminated, and the functions of functional parts such as hands and feet can be preserved to the maximum extent.

4. Full-body or local immersion bath-can completely remove sepsis and necrotic tissue from wound surface, reduce local bacterial content, control infection, promote circulation and improve function.

5. Nutritional support-Burn has the characteristics of high consumption and high metabolism, so nutritional support should be strengthened. In addition to intravenous supplementation, we should actively cooperate and adopt a correct and effective diet.

Third, the wound repair period.

Shallow second-degree wounds generally heal within 10- 14 days, leaving no scars, but pigmentation can disappear spontaneously after several months to several years. The superficial and deep second degree can heal in 2-3 weeks without infection, but there are scars left. Deep two or three degrees can only be repaired by skin grafting, and there are scars left. During this period, you have made the following achievements:

1. Many operations are often performed during this period and need your active cooperation. 2. Strengthen nutrition.

3. Under the guidance of medical staff, carry out functional exercise step by step.

Fourth, the recovery period.

You may encounter the following problems within a period of time after the wound heals.

1. Appearance change and deformity-this is caused by scar contracture. Plastic surgery will help you to some extent, but you need to keep a good attitude and treat the problems that have arisen correctly.

2. dysfunction-caused by contracture deformity of functional parts. When actively cooperating with orthopedic surgery, you should strengthen functional exercise and exercise the compensation of the healthy side.

3. Dysthermoregulation, sensitive to cold and heat-sweat glands are destroyed by burns, and the skin's thermoregulation ability is lost. Need to dissipate heat and keep warm in time.

As an emergency nurse, we should pay special attention to the care of patients with severe burns: First, keeping warm is very important. Because the patient loses a lot of heat, the patient's room must have a suitable temperature; Second, take off the pillow and lie on your back, turn over every 4 hours to keep the wound dry. Third, keep the respiratory tract unobstructed: large-area burn patients and facial burn patients are often accompanied by inhalation injury. Prepare a tracheotomy bag at the bedside, prepare an aspirator, and continue to inhale oxygen at a low flow rate. 4. Temperature, pulse and respiration: These three vital signs should be measured 1 time every 2 hours and recorded. Blood pressure should also be measured regularly. Fifth, observe closely and record accurately: record the input and output, and summarize the first and second 24 hours within 48 hours after injury, and summarize every 8 hours 1 time, and calculate the input of colloid, crystal and water, including the input of oral liquid. The output includes urine volume, vomiting volume, stool volume and gastrointestinal decompression output.

;