First aid and treatment of chemical burns

First aid and treatment of chemical burns

Whether the first aid for a burn is timely and whether the evacuation is appropriate has important influence on the subsequent treatment and on the prognosis and outcome of the wounded. In particular, it is necessary to be cautious when dealing with batches.

( I ) First aid for burns

The principle of first aid is to promptly release the cause of injury, detach the wounded from the scene, and promptly give appropriate treatment and make preparations for the transfer.

1. "Fire extinguishing"

In general, the larger the burn area and the deeper the depth, the more difficult it is to treat and the worse the prognosis. Therefore, the first measure of first aid is to "fire", that is, remove the source of the injury and try to "burn less, burn shallow spots". Many burn processes, such as burning clothes, chemical burns, etc., at the time of a flame burn, all have certain time to injury, and the burn area and depth are often proportional to the time of injury. Therefore, if an effective fire extinguishing is carried out quickly, it can alleviate the injury. In addition to strengthening burn protection measures in peacetime, we should vigorously carry out mutual rescue and self-help education, be familiar with the use of various types of fire fighting equipment, learn how to use the surrounding materials to carry out fire fighting methods for all kinds of causes, and be prepared to face dangers and dangers. .

Category (1) chemical burn injury chemical substances very much, the general principles of fire and emergency following chemical burns.

1 All chemical burns should quickly remove clothes impregnated with chemicals.

2 The severity of chemical burns is related to the contact time, in addition to the nature and concentration of chemical substances. Therefore, no matter what kind of chemical burns, you should immediately rinse with plenty of clean water for at least 20 minutes. On the one hand, it can dilute and remove residual chemicals. On the other hand, as a way of cold therapy, it can reduce pain. Note that the initial water consumption should be large enough to quickly flush away the remaining chemicals from the wound surface.

3 There is no suitable neutralizer on the site. If it is available, it can be considered (for example, 5 % sodium bicarbonate can be used for phosphorus burn ) . However, you must not delay the flushing time because you wait for the neutralizer. It should be noted that the neutralization reactions that occur with the use of neutralizers can generate heat, sometimes deepen burns, and some neutralizers themselves can also be damaging. So the most practical method is to rinse with plenty of clean water immediately.

When the head and the face are burned, firstly pay attention to the eyes, especially the cornea, and give priority to washing. In particular, alkaline burns can cause activation and release of collagenases in the heel, causing progressive damage. While flushing with plenty of clean water, use collagenase inhibitors or subconjunctival injections of autologous serum if possible.

(2) Thermal burns include flames, steam, high-temperature liquids ( such as boiling water, boiling oil, etc. ) , and high-temperature metals, which are the most common cause of injury. The commonly used fire extinguishing methods are:

1 Remove the clothes impregnated with fire or boiling liquid as soon as possible, especially the clothes of chemical fiber fabrics. In order to prevent the hot liquid on clothes or clothing from continuing to act, the wounds will be deepened and deepened;

2 Use water to extinguish the fire, or jump into nearby pools and ditches;

3 After lying down quickly, slowly roll on the ground and smash the flame. It is forbidden for the casualty to stand or run for calls when the clothes are on fire to prevent head and face burns or inhalation injuries from increasing;

4 quickly leave the closed or poorly ventilated site to avoid inhalation injury and suffocation;

5 Use non-flammable materials such as blankets, raincoats ( non-plastic or tarpaulin ) , coats, quilts, etc., preferably flame-retardant materials, to quickly cover the fire and isolate it from the air;

6 When the napalm bombs explode and the oil drops, they should quickly cover or use clothing to cover the body, especially the exposed parts. After the oil is gone, the fire clothes will be quickly released, abandoned and quickly left the site. Fight flames to prevent hand burns ( phosphoryl napalm burns, fire extinguishing method with phosphorus burns ) ;

7 cold treatment. Timely cold treatment after thermal burn can prevent heat from continuing to act on the wound surface to deepen it, reduce pain and reduce exudation and edema. Therefore, if conditions permit, thermal burns and fire extinguishing should be performed as soon as possible. The sooner the effect is, the better. The method is to wash or immerse the burn wound in cold water under the tap (the water temperature can be tolerable to the wounded, usually 15 to 20 °C, and ice can be added to the water on hot days ) , or soaked in cold ( ice ) water. The towels, sand mats, etc. are applied to the wound surface. There is no clear limit to the time of treatment. Generally, there is no longer any severe pain after stopping cold therapy. It takes 0.5 to 1 hour. Cold therapy is generally suitable for small and medium burns.

Especially burns on the limbs. For large areas of burns, cold therapy is not completely contraindicated, but because of the extensive use of cold water bath, the wounded can not tolerate, especially in the cold season. In order to reduce cold stimulation, if there is no contraindication, sedatives such as morphine and pethidine may be properly applied.

(3) Electric burns Burns due to arcing or clothing fire are similar to ordinary fire burns. Generally referred to as electrical burns are electrical contact burns, that is, electrical currents directly through the body caused by burns. Not only does it burn deeper, it can sometimes charring large tissues or limbs and even immediately endangering the wounded. When emergency, immediately cut off the power, pull the switch or open the power with non-conductive items ( sticks, bamboo, etc. ) and extinguish the fire. Before the power is cut off, the emergency person must remember not to touch the injured person to avoid electric shock. After the fire is extinguished, if the wounded person's breathing and heartbeat are stopped, an extracorporeal heart massage and mouth-to-mouth resuscitation should be performed immediately. After the heartbeat and respiration are restored, they should be promptly transferred to the nearest hospital for further treatment; or while the cardiopulmonary resuscitation continues, the wounded shall be injured. Transfer to the nearest medical unit for processing.

2. Treatment after fire extinguishing

Emergency treatment after fire extinguishing depends on the size and severity of burns, and whether there are complex injuries or poisoning. Generally should be handled in the following order.

(1) Inspection First, check the conditions that can immediately jeopardize the lives of the wounded. If there is major bleeding, asphyxia, open pneumothorax, severe poisoning, etc., it should be promptly handled and rescued. Regardless of any cause of cardiac arrest, respiratory arrest in patients should be immediately on the site chest cardiac massage and artificial respiration at the same time, the patient evacuated from the scene ( mainly out of oxygen environment ) to be recovered after the evacuation; or transferred to Close to the medical unit.

(2) After leaving the site, the general wounded was quickly detached from the site after being extinguished and moved to a safe area or nearby medical facility.

(3) Judging the initial estimate of the extent of the injury and the depth of the burn to determine the injury, should pay attention to the presence of inhalation injury. Complex injury or poisoning.

(4) After sedation pain burns, the patient has varying degrees of pain and irritability and should be given sedation pain. For mild burns, oral pain relief tablets or intramuscular injection of pethidine can be given. For large areas of burns, due to poor peripheral circulation and tissue edema, intramuscular injection is often not easy to absorb, and it can be diluted by intravenous infusion of pethidine, and it is usually combined with phenazine. However, for frail, infants, infants with combined inhalation injury or brain injury should be used with caution or try not to pethidine or morphine, so as not to inhibit breathing, can use luminal or phenazine. Avoid long-term application of analgesic sedative drugs, so as not to cause respiratory depression.

(5) Maintaining airway patency For those who have difficulty breathing due to inhalation injuries or facial burns, use a trachea to intubate or incise as appropriate and breathe oxygen. If there are signs of CO poisoning, give a high concentration of oxygen for inhalation within a short period of time.

(6) After the wound has been treated and extinguished, it should be started to prevent the contamination of the wound. It can be used for bandaging with burn-type dressings or other first-aid triangles, or simple protection with materials such as clean sheets, clothes, etc. to avoid re-contamination. At the same time, it also protects the wound during handling and prevents further damage. When the first-aid dressing was done, it was confirmed that the fire-extinguishing clothes could not be taken off and the pollution could be reduced. If it is a chemical burn, the soaked clothes must be taken off. Keep warm in the cold season.

(7) processing a composite fracture injury should be fixed; severe trauma, brain, abdominal and other active while rescue, priority should be given to the nearest medical treatment units; Fair wound bandage.

(8) Rehydration therapy Because the emergency site does not have infusion conditions, the wounded person may orally take appropriate burn oral beverages ( each tablet contains sodium chloride 0.3g , sodium bicarbonate 0.15g , sugar amount. Each serving one tablet , serving water 100ml , or containing Salt drinks, such as salted hot tea, rice soup, soy milk, etc., but should not simply drink plenty of water, so as to avoid water poisoning.Experimental studies in dogs show that 30 % of shallow second-degree burns early oral burns drink, after injury and bumps (In the case of simulated evacuation ) , none of the experimental dogs suffered from shock. Clinically, it was also found that most of the young people with superficial second-degree burns were treated with oral rehydration during the first half of the year.

Grams. However, for severe burns, children with superficial second-degree burns exceeding 1 % of the age or age, those who have shock signs or gastrointestinal disorders ( bloating, vomiting, etc. ) should be treated with intravenous fluids ( Isotonic saline, if available). 5 % glucose saline, balanced salt solution, dextran and / or plasma, etc. ) .

(9) The use of antibiotics should be given as soon as possible oral or ( muscular ) injections of broad-spectrum antibiotics for burn victims .

(10) Record and fill out medical forms in time for reference for follow-up treatment.

3. First aid precautions

(1) The on-site rescue, especially the on-site rescue of a group of burned patients is a stressful task. The rescue personnel must be calm and calm, work in an organized manner, and must not be confused.

(2) When the clothes are on fire, it is necessary to stop the wounded from running and calling in order to avoid supporting combustion and inhaling the flames, and to allow the wounded to quickly leave the closed and poorly ventilated site. Inhalation of smoke and hot air to prevent inhalation injury.

(3) In chemical burns, thermal burns and poisoning are common at the same time. Rescue workers should fully consider and deal with them. Be sure to understand the nature of the chemical substance. When rinsing, it takes more water and the time is long enough to be thorough. If you suspect there is a possibility of systemic poisoning, it should be dealt with as soon as possible.

(4) When extinguishing, strive to use the materials or tools around you as quickly as possible. Generally no water or sediment out the fire, in order to reduce contamination of the wound, but if indeed when no other available materials, sand or water can also be applied, do not burn and therefore the deeper area increased.

(5) Burned clothes that have been extinguished but not removed, especially cotton or sweaters, must be carefully checked for the persistence of extinction so as not to cause further burns, or to increase the severity of burns, especially for those with unconsciousness or coma. .

(6) The wounded person with inhalation injury should be closely observed and promptly sent to a nearby medical unit for further treatment.

(7) Except for a small area of ​​superficial burn, the wound should not be coated with colored drugs or grease dressings, so as not to affect the further estimation and treatment of wound depth ( debridement, etc. ) . In general, dressings can be used to wrap or clean sheets and other wraps to protect the wound. Do not break the water blister nor tore away the skin to reduce the chance of contamination on the wound surface.

(8) We must pay attention to the entry of records and various medical forms. In addition to recording burn area, depth, complex injuries and poisoning, etc., fire extinguishing methods, on-site first aid and treatment measures should be indicated, and initial injury classification should be made, especially when batch burns, should be divided into light, heavy, slow, Urgent, easy to send and further treatment reference.

( II ) On-site processing

Whether in peacetime or in wartime, after the on-site rescue, the injured must first be promptly moved to the nearest medical unit for preliminary treatment, and then further processed according to circumstances. The incidence of shock in severe burn patients is high, and improper delivery may increase the occurrence and development of shock or accelerated shock, as well as the occurrence of complications, and even lead to death. Therefore, for a specific casualty, the choice of evacuation, evacuation timing and evacuation tools, and what issues to pay attention to during the evacuation must be carefully planned. It is necessary to take into account the manpower and material conditions at that time, and it is even more necessary to consider the specific conditions of the wounded. We will elaborate on the following issues.

In situ treatment

Severely burned wounded people were transported after long-distance transport, jolted and repeatedly moved, and the treatment on the way was not timely, etc. Shock increased significantly, wound infections also significantly increased, and some wounded even died in the after-delivery. Even after arriving at the destination, although actively rescued, it is difficult for some to rescue them from severe shock; or even though they barely overcome shocks, the long duration of ischemia and lack of oxygen in the body and the resistance have been severely low. Outbreaks of systemic infection or / and severe visceral complications or even organ failure result in difficulty in handling and high mortality. If possible, try to create conditions that allow early treatment on the spot (in the vicinity of the site ) .

The following matters should be noted when performing in-situ therapy.

(1) There should be leadership and organization; leaders, medical personnel, and the masses should be combined. All relevant departments cooperate with each other and make full use of all available conditions. The personnel participating in the rescue must brave the heavy burden and serve the wounded with all their heart and soul.

(2) Overcome all difficulties, because it is simple, adjust measures to local conditions, and actively create conditions to rescue the wounded. Such as sterile isolation, insulation, etc., can be drawn on the spot, relying on the wisdom of the masses to solve.

(3) In batches, they should be organized carefully to prevent rush. There must be division of labor and cooperation.

(4) Hospitals or medical institutions that have burn wards or have a study on the prevention and treatment of burns should usually be prepared so that they can be dispatched at any time to assist their fraternal units in conducting on-site treatment.

1 staff preparation. According to the hospital's size and technical strength, professionals can be divided into several rescue teams. Usually one group includes doctors and 2 to 3 nurses . Each team is on duty. After receiving the rescue mission, they can immediately go to the scene of the accident to assist in the rescue. The number of departures can be increased or decreased according to the number of injuries and the number of wounded.

2 material preparation. Including first aid kits and first aid kits. Each first aid kit can be used for emergency treatment of a severely burned person ( see Table 3 - 4) . Backpack-style first-aid kit is easy to carry. The content of the first aid kit is basically the same as that of the first aid kit, but it is expanded by five times and it can provide emergency care for 5 to 6 burned wounded people. Further, additional equipment, a simple blood together, cut gas tube (or cannula) a package, sterilizing a skillet, a 50ml empty needle, and urinometer litmus paper. The amount of cargo can be determined based on the site emergency personnel and material conditions. As the local medical institutions, is mainly to support the power of technology, material and required emergency treatment can be resolved by the local hospital.

3 thought preparation. On-duty rescue personnel on duty must be mentally prepared. Once they have tasks, they can start immediately.

The information in this article comes from the Internet and was reorganized and edited by China Rescue Equipment Network.