понедельник, 27 июля 2009 г.

Перевод лекции РУС-АНГ. Медицина

Thermal Injuries

Physical properties of napalm. Napalm is a sticky mass, usually brown (colour depends on composition), lighter than water, that is why it can burn on its surface. During burning napalm rarefies, acquires fluidity and continues burning, gets into warlike equipment, refuges and houses through apertures. It sticks well to various walls, equipment, body surface. It burns for 3-5 minutes. Flame temperature reaches 1100-1200C. During burning there is a thick cloud of black smoke with release of much carbon oxide which causes intoxication.

Characteristics of burns caused by napalm. In 95% of burns these are mostly stage 3 and 4 burns. Open parts of the body, head, face, neck and bones are mostly affected. These burns are accompanied by severe forms of shock, it appears even in case of limited injuries (up to 10% of cutaneous covering) and if burn surface is 11-20% it happens in 84% of injured. In these cases severe forms of shock are caused by combination of psychic trauma with burn and quick development of toxemia. In about an hour after appearance of burn intoxicational effects caused by napalm develop: weakness, tachycardia, muscular adynamia, etc. burns caused by napalm are associated with high mortality, including death in the battlefield. Specific local changes in the region of napalm burn are: quick swelling and blisters near regions of primary necrosis of tissues. Burn injuries are often complicated by purulence, development of lymphangitis, lymphadenitis, thrombophlebitis. Cicatrization takes a long time, post-burn scars are characterized by massiveness, are keloid in their nature, are prone to ulcerations, deform the face, development of joint contracture.

Stages of burns:

Stage 1. Erythema.

Stage 2. Blisters.

Stage 3. Necrosis of dermal superficial layers.

Stage 3b. Necrosis of all dermal layers

Stage 4. Necrosis of skin and all subcutaneous tissues.

Stage 5. Establishment of depth and area of burn at RMS

Diagnostics of burn depth is based on anamnesis data, examination of burn injury and some diagnostic tests.

1. Anamnesis. Investigation of conditions of trauma, of character of the injurer. When it is steam or hot liquid burns are superficial, if it is flame burns are deep.

2. Colour of wound. In case of superficial burn wound is pink, if burn is deep colour is grey, buff, black.

3. When burn surface is damp burn is superficial, when surface is dry burn is deep.

4. Change of colour and pain reactions. If a finger is pressed against wound surface and it becomes white and the patient feels pain then burn is superficial. If colour does not change and tactile and painful sensation are absent then burn is deep.

Methods of establishment of area of burn:

1. Nine Rule (after Wallace). According to this rule area of cutaneous covering consists of: head and neck – 9% of body surface, chest – 9, abdomen – 9, back – 9, loin and buttocks – 9, each hand – 9, each hip – 9, each shin and foot – 9, perineum and genitals 1%.

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