1. THERMAL TRAUMA ( BURNS, ELECTRICAL TRAUMA, FROST BITE (FREEZING) )

2. Burns are he damage to tissues caused by their exposure to thermal, chemical, electrical, or radiation energy

3. CONSTRUCTION OF THE SKIN Epidermis Dermis Basal layer

5. THE REASONS OF THE BURNS THERMAL THERMAL: Hot liquids Steam Flame (fire) Hot hard solid RADIATION CHEMICAL Acids Alkalis ELECTRICAL

6. THE REASONS OF THE BURNS

8. CLASSIFICATION OF THE BURNS According to the depth of damage: DEGREE 1 DEGREE 2 DEGREE 3A DEGREE 3B DEGREE 4 According to the depth of damage: SUPERFICIAL DEEP

9. CLASSIFICATION OF THE BURNS

10. SUPERFICIAL BURNS DEGREE 1 DEGREE 1 – damage to only the epidermis. Skin in this areas reddened, with edema, sensory function is increased. Function of the tissues is intact. Treatment – application of alcohol. Heeling without crusts. DEGREE 2 DEGREE 2 – damage to the epithelium up to the basal layer. The pain is more severe, long fasting and there are blisters form, they are usually filled with light transparent contents. All types of sensation are kept. When the bare layer at the base of blister is touched the patient experiences severe pain. DEGREE 3A - epithelial necrosis with partial involvement of the basal layer; hair follicules, sweat and sebaceous glands are intact. All types of sensation are less. The blisters are filled with hemorrhagic contents. Epitelization and crust are formed from 3 to 4 weeks.

11. DEEP BURNS DEGREE 3B DEGREE 3B – complete necroses of the dermis, basal layer and part of subcutaneous layer. All types of sensation are lost. If blisters form, they are usually filled with hemorrhagic substance. When the blisters are opened violet-blush surface is not sensitive to skin prick or irritation by alcohol. There are the areas of necrosis DEGREE 4 – complete necrosis of the skin and underlying tissues.

12. DIFFERENTIATION BETWEEN DEGREE 3A AND DEGREE 3B PAIN SENSITIVITY THE CONTENS INTO THE BULLS THE FUNDUS OF THE BULLS BYOCHEMICAL REACTIONS

13. DETERMINATION OF THE AREA OF BURN THE “RULE OF NINE”

14. DETERMINATION OF THE AREA OF BURN Determination by Lund&Browders method THE “RULE OF PULM”

15. DETERMINATION OF THE AREA OF BURN IT IS THE MOST EXACT METHOD – WHIS HELP BY THE MILLIMETRE PAPER

16. EVALUATION OF SEVERITY OF BURNS THE RULE OF Baux (BO index): Age in years + general burns area in%: i 100 – poor prognosis 75-100 – doubtful prognosis j 75 – good prognosis FRANK’S INDEX: 1% of superficial burn equals one point, a deep burn equals three points to 30 – good prognosis 30-60 – relatively good prognosis 60-90 – doubtful prognosis; j 90 – poor prognosis

17. BURN DISEASE OCCURS WHITH A BURN AREA OF: Above 30% of body surface of the superficial burns in adults More then 10% of body surface of the deep burns in adults Above 5% of body surface of the superficial burns in children

18. BURN DISEASE The four periods of the disease are identified: Burn shock Burn shock (it is a result of the sharp pain, loss of large volume of blood plasma and intoxication of patient, local accumulation of vasoactive substances, injury the microcirculation; persistent from 48 till 72 hours). Acute burn toxaemia Acute burn toxaemia (it is outcome of the influence of toxic products and products of tissues decay; fever, tachycardia, dullness of heart sounds, anaemia, hypo-and dysproteinemia, abnormal hepatic and renal function; persist from the 3 till the 12-th day). Septicemia Septicemia (it is characterized by severe infection, may be fester of wound, general deterioration ( weight loss, dryness and pallor, muscular atrophy, bedsores; in this period proliferation of microbes is began with development of varied septic conditions: pneumonia, pressure sores, sepsis); complete skin regeneration is indicated of the end of the septicaemic period; it persists a few weeks). Recovery Recovery (it is the restoration of bodily function, after the full heeling of burn’s wounds, can persist for as long as 2-4 years after the trauma )

19. THE FIRST AID AFTER THE BURN 1.STOP THE ACTION OF THE THERMICAL AGENT 2.COOL THE BURN’S SURFACE.

20. THE FIRST AID AFTER THE BURN 3. APPLY THE ASEPTIC BANDAGE.

21. TREATMENT THE PLACE OF BURN 1.PRIMARY SURGICAL TREATMENT. 2.CLOSED METHOD OF TREATMENT. 3.OPENED METHOD OF TREATMENT.

22. OPENED METHOD OF TREATMENT OF BURNS

23. CLOSED METHOD OF TREATMENT OF BURNS

24. COVERING OF THE BURN’S SURFACE USE OF THE XENOTRANSPLENTANT ALLOWS: - TO DECREASE THE LOOSING OF PLASMA; - TO PREVENT THE DEVELOPMENT OF INFECTION AND INTOXICATION; - TO STIMULATE OF THE REPARATION OF SKIN; - TO DECREASE THE TIME OF TREATMENT INTO THE HOSPITAL.

25. TREATMENT OF BURN’S DESEASES BURN SHOCK: TREATMENT OF HYPOVOLEMIA AND TOXEMIA, ANALGETICS, ANTYBIOTICS, TREATMENT OF SYMPTOMS ACUTE BURN TOXEMIA: KORRECTION OF WATER-ELECTROLITIC BALANS, NETRALIZATION AND EXTRACTION OF TOXINS, STIMULATION OF THE HOMEOSTASIS, ANALGETICS, PREVENT OF DEVELOPMENT OF INFECTION SEPTICEMIA ANTYBIOTICS, IMMUNOSTIMULATION, PARENTERAL EATING.

26. CHEMICAL BURNS ACIDS – coagulation necrosis ALKALI– colliquative necrosis

27. RADIATION BURNS IT IS PRESENT ON A BASE OF THE RADIATION DEEASES AND IT’S TREATMENT IS VERY DIFFICULT

28. ELECTRICAL TRAUMA IT IS NECESSARY TO PAY GREAT ATTENTION TO: Power and stress of current, resistance of skin, time of action, kind of current (constantly, chaining), the way of the spreading of current across the body, conditions during the trauma.

29. ELECTRICAL TRAUMA CLINICAL SYMPTOMS: General Local

30. FIRST AID AFTER THE ELECTRICAL TRAUMA 1. STOP THE ACTION OF CURRENT. 2. CARDIAL-LUNG REANIMATION. 3. ASEPTIC BANDAGE.

31. LOCAL TREATMENT OF THE PLACE OF CURRENTS ACTION 1.NECRECTOMIA. 2.AMPUTATION. 3.REPLACMENT OF SKIN. 4.RECONSTRACTIVE OPERATIONS.

32. FROST BITE (FREESING)

34. CLASSIFICATION OF THE FROST BITE (FREESING) 1.ACUTE: -LOCAL FREESING -GENERAL HYPOTERMIA 2. CHRONICAL.

35. CLASSIFICATION OF THE FROST BITE (FREESING) ACCORDING TO THE LEVEL OF TEMPERATURE: -FREESING AFTER THE 0°C -FREESING AFTER THE TEMPERATURE LESS THAN 20°C -CONTACT FREESING

36. PERIODS OF FROSBITE - LATENT (PRE-REACTIVE) - REACTIVE

37. DEPTH OF FROSTBITE

39. DEGREE 1 DEGREE 2

40. DEPTH OF FROSTBITE DEGREE 4 DEGREE 3

41. DIFFERENT TYPES OF FROSTBITE

42. CHANGINGS INTO THE PATIENT’S BODY 1.IN PRE-REACTIVE PERIOD - IT IS MINIMAL). 2.IN REACTIVE PERIOD: -DISTROY THE MICROCIRCULATION INTO THE KIDNIES -DEVELOPMENT OF THE TOXEMIA -DESTROY THE FUNCTION OF CNS, CVS, LUNGS.

43. GENERAL HYPOTERMIA

44. THERE ARE 4 PERIODS: 1. COMPENSATION (t° is the 37°) 2. ADYNAMIC (decrease t° of body on to 1-2°) 3. AVERAGE (STUPOR FORM) - (decrease t° of body till the 26-27°) 4. CONVULSIVE FORM (fall in the body temperature as low as 26°)

45. FIRST AID AFTER THE FROSTBITE

47. FIRST AID AFTER THE GENERAL HYPOTERMIA

48. TREATMENT OF FROSTBITE

49. CONCERVATIVE TREATMENT 1.ANTICOAGULATIVE AND ANTIAGREGANT THERAPY. 2.SPASMOLITICS. 3.DESENSIBILIZATTION. 4.DETOXICATION. 5.ANTIINFLAMMATORY THERAPY. 6.SIMPTOMATHYC THERAPY.

50. SURGICAL TREATMENT NECROTOMIA NECRECTOMIA

51. SURGICAL TREATMENT AMPUTATION