An abnormal condition that occurs with severe burns that require urgent medical intervention is burn shock, that is, the response of the human nervous and sympathetic system to unbearable pain. It manifests itself as a result of a significant lesion of the dermis and is the first dangerous period of a burn disease. In the adult population, this phenomenon occurs when 15% or more of the skin is affected, and in children and the elderly it can occur at 5–10%. The state of shock instantly progresses and has several stages of development. Without emergency care, this process becomes irreversible.
Classification of burn shock
In burns, there are often no clear signs that characterize shock, and there are many clinical manifestations that make it difficult to classify to the satisfaction of clinicians. For convenience, the disease is divided into the following phases:
- erectile - seen within two hours of an accident;
- torpid - the first phase passes into it, six hours after the onset of the lesion;
- terminal - develops in case of failure to provide assistance to medical workers. Possible fatal outcome.
Taking into account the data of laboratory tests and the clinic of the course of the disease, it is customary to distinguish four degrees of shock according to the severity:
- mild - lesions make up to 20% of the dermis;
- medium - occurs when 20 to 40% of the skin surface area is damaged;
- severe - up to 60% affected area;
- extremely severe - occurs when more than 60% of the skin is affected.
Mild degrees of shock
This is the shock that occurs when a burn heals with conservative treatment. These include the following degrees of severity:
- The first one is easy. The patient retains a clear mind, has a pale skin color, blood pressure and body temperature are not elevated. There may be a slight tachycardia, tremors in the muscles and a feeling of thirst. Erythema (reddening of the skin), swelling and burning appear on the damaged area. The inflammation goes away after a few days. The patient's condition with the first degree of burn shock normalizes within a day, and healing occurs in a week.
- Second - medium. The surface layer of the epidermis is destroyed. Bubbles form with a yellowish liquid. The superficial layer is easily removed, under it there is a bright pink shade of the surface that causes pain. The patient experiences a strong overexcitation, which subsequently turns into lethargy. Shortness of breath begins, chills, skinturns pale, pressure goes down, but consciousness does not leave the patient. There is a malfunction of the extraction system. Healing lasts about two weeks. Pigmentation of the dermis lasts up to three weeks.
Severe shock
Occur in case of deep damage to the skin, associated with the death of the epithelium and requiring plastic surgery to restore. This group includes shock, the following severity:
- The third is heavy. The area of the affected surface makes up most of the body, while the entire thickness of the skin dies and a scab forms. With the rejection of the dead dermis, purulent foci appear. The victim is confused. There are muscle contractions, rapid pulse, shortness of breath, thirst. The skin becomes cold, acquiring a grayish tint. There is a malfunction of the kidneys. Burn wound healing takes up to six weeks.
- Fourth - an extremely severe degree of burn shock occurs when most of the skin is damaged. Muscles, tendons and bones are affected. A thick scab is formed with subsequent purulent complications. Events are developing very rapidly, the patient is losing consciousness, his condition is in danger. The skin acquires a pale cyanotic color, the temperature and pressure are lowered. The pulse becomes weak and cannot be felt. Severe shortness of breath begins, wet rales are heard. Kidney activity is disturbed, anuria is present. A positive prognosis is extremely rare, most often fatal.
Why is there a shock?
The main cause of burn shock is very strong pain sensations, which, when exposed to the nervous system, cause its disorder. Pain occurs as a result of damage to the skin.
There is an intense decrease in plasma in the blood, which dramatically reduces the volume of circulating blood. In addition, burn necrosis of tissues and toxins is added. All this adversely affects both the central nervous and circulatory and cardiovascular systems, and other organs. As a result, shock develops. This is a defensive reaction of the body. It reduces the pain of a person and frees up time for emergency care.
Pathogenesis
The mechanism of the origin and development of the disease begins after the receipt of a pain impulse in the central nervous system, when this happens:
- general overexertion caused by pain;
- intense emotional, speech and motor activity;
- intoxication of all body systems due to tissue damage;
- great loss of plasma causes dehydration and an increase in blood viscosity, leading to thrombosis;
- decrease in blood volume disrupts its circulation, reducing the supply of nutrients to internal organs;
- kidney damage due to poor circulation causes kidney failure.
Symptoms of burn disease
Primary signs of burn shock are as follows:
- strong excitability, restlessness;
- rapid heartbeat;
- fast intermittentbreath;
- pallor of the skin;
- body temperature is normal or slightly lower;
- discharge of cold sticky sweat;
- strong feeling of thirst;
- chills, muscle tremors.
With further development of burn shock, the following are observed:
- progression of the inhibited state;
- nausea and vomiting;
- increased tachycardia;
- poor urine flow;
- urine becomes darker, closer to black;
- increased pain.
If medical workers do not provide timely assistance, the patient's condition deteriorates rapidly, breathing slows down, the pulse capacity weakens, the skin turns blue, and consciousness is lost.
First aid for extensive burns
The development of burn shock depends on how quickly the victim was treated, so it is very important to follow these steps:
- Before the doctors arrive, release the victim from the damaging factor, get rid of the clothes, the damaged area of the dermis, cutting it with scissors.
- If the skin is intact, cool the surface with cold water for 20 minutes.
- To prevent dehydration, the victim should be given warm water to drink. Sweet tea, mineral alkaline water, and soda solution can also be used.
- Injured with burn shock with chills, cover with warm clothing or a blanket.
- Give sedatives.
- Inject intramuscularly for pain relief"Analgin" or "Paracetamol". When using drugs in tablets, it is better to crush them to speed up absorption.
- Apply sterile wipes moistened with hydrogen peroxide, chlorhexidine or furacilin to the burn surface.
- When receiving a chemical burn, it is necessary to wash the damaged skin surface well with water. This will help reduce the depth of the wound.
To determine the area of the lesion, apply a palm, considering that its area is 1% of the affected area. If necessary, make artificial respiration and chest compressions. After completing first aid, the patient is transported to the hospital for further treatment.
Emergency measures
In case of burn shock, emergency care is provided by qualified medical workers. They carry out resuscitation anti-shock therapy, during which they perform:
- Pain relief - carried out using analgesics or narcotic drugs. Often used: Morphine, Promedol, Analgin.
- Correction of BCC (volume of circulating blood) - the procedure is carried out at the location of the victim or in an ambulance. For therapy, drugs are used: "Hemodez", "Reogluman", "Polyglukin" or glucose solution.
- Restoration of breathing - done in case of damage to the respiratory tract. For this purpose, they give an oxygen mask, apply chest compressions and perform artificial respiration.
- Impact on damaged skin surfaces - with a cold jet of watercool the damaged areas for 20 minutes, then apply sterile dressings.
Burn shock: clinical guidelines for treatment
Treatment of a shock condition is carried out in a hospital under the supervision of a doctor.
A course of therapy is selected to help restore the disturbed volume of circulating blood in the vessels and normalize all metabolic processes. It includes the following activities:
- Removal of pain syndrome - it accompanies the patient until the damaged areas of the skin are restored. Strong painful sensations prevent a person from sleeping, resting calmly and recovering. Analgesics and antihistamines are prescribed intravenously to reduce suffering.
- Rebalancing metabolic processes - the lack of potassium and sodium is replenished by the introduction of solutions of s alts and minerals containing these elements through a dropper.
- In the treatment of burn shock, psychosomatic reactions are removed with sedative drugs with a hypnotic effect, which help to relax the nervous system.
- Decrease intoxication - occurs due to abundant drinking and saline solutions, which are administered intravenously using droppers.
- Monitoring the work of vital organs - to maintain the lungs, kidneys, brain and heart, use appropriate drugs. The vital activity of an unconscious patient is supported by special life support equipment.
- Restoration of vascular tone - carried outcorticosteroid drugs using Hydrocortisone and Prednisolone.
- Frequent wound dressing and dressings accelerate the regeneration of skin integuments.
Recovery of the victim after treatment of burn shock is determined by the following features:
- normalization of body temperature;
- restoring the level of red blood cells and hemoglobin;
- improving the movement of blood through the vessels;
- normal daily urine output.
Therapy of seriously ill patients takes a long period, very laborious and multi-stage. The time of treatment depends on the quality and timely provision of medical care. Its absence can cause death.
Features of the flow
Features of the course of burn shock due to the fact that the state of shock is established immediately after injury. In addition to severe pain, it is affected by a large loss of blood plasma released through the affected surfaces, and decay products of damaged tissues that poison the body. Only intensive therapy can save the patient, contributing to the correction of all important body functions. The duration of shock, with ongoing intensive therapy, is from two to three days. Features of burn shock, unlike others, are as follows:
- The duration of the erectile phase is one to two hours. The affected person is in an agitated state: talks and moves a lot, often tries to run.
- Blood pressure is normal or slightlyincreased. This is due to the release of a large amount of adrenaline into the blood.
- The rapid entry of potassium into the blood from damaged tissues and destroyed red blood cells clogs the renal tubules, and this develops kidney failure. Excess potassium in the blood leads to disruption of the heart muscle.
- Blood thickening occurs due to the large loss of plasma through the wound surfaces and can be up to 70% of the BCC. Thick blood circulates slowly and causes blood clots.
After the first phase of shock comes the second - torpid, characterized by inhibition of the cerebral cortex. It lasts from 2 to 3 days. Patients are conscious, but come into contact slowly, taciturn. They are often chilly, thirsty, may vomit and slow down the flow of urine to the bladder. If the upper respiratory tract is damaged, the course of shock is aggravated. The patient develops shortness of breath, hoarse voice, cough, sore throat. These burns most often occur indoors.
Conclusion
The shock of a burn occurs as a result of colossal thermal damage to the skin and tissues. It causes severe consequences associated with impaired blood circulation and metabolic processes in the body.
This situation requires the immediate provision of qualified medical care, otherwise the process may become irreversible. Therapy begins at the scene and in the ambulance. Urgent hospitalization in the thermal trauma unit is required. From hard-to-reach places the patientshipped using air transport.
