Burn

Burn（Don't you think? the っ it does, the ょ う) With, the body chart organization which thermal chemical radiation and the like occurs with cause (mainly skin) Local damage. As for aliasBurn（Burn).

Classification

It is classified as follows by cause.

(Normality) burn

The hot water and the fire 焔, the damage the steam and the like with heat. The skin of the human 45 ℃ at heat above becomes the burn. When 45 ℃ is, when 1 hour, 70 ℃ is, destruction of organization starts in 1 second.

Chemical burn (chemical burn)

It is strong acid, it is strong alkali and the like by the chemical. Gradually over several hours organizationGangrene(Gangrene) Doing is a special feature.

Electric burn (electric burn)

electric current. To electric current resistance ℃ organization is destroyed at heat of extent. Even the lightning scar you say. The degree of serious illness voltage, is influenced by contact time to electric current and the conductor. interchange power source direct current power source. Muscle damage, blood vessel damage and heart stop (Cardiac ventricle small motion) There is a possibility, in addition after the severing relations can see progressive necrosis. Because deep organization is damaged mainly, it is difficult to decide the degree of serious illness in observation from the body chart.

Radiation burn (radiation burn)

radiation. The condition where the cell and the blood vessel which form the skin due to the radiation of the high dose are done, the injury resemble to the burn is displayed. sunburn strictly, it is the burn. It is included in the sunlight ultraviolet ray (UVA and UVB) it is bombed, destruction of skin organization happens. Though call the sunburn, it is not unable to become serious condition depending upon the circumstance of the irradiation time range.

Condition diagnosis

The degree of serious illness of the burn is decided in the depth and the area.

Burn depth

As for skinEpidermisWithCutisIt consists of, (Skin of personReference). Depth of the burn is displayed the damage has reached to some layer of the skin.

It is shallow, characteristic II degree (SDB) with characteristic II degree (DDB) about deeply

Shallow II, deeply when II ascertaining advances remedy, it becomes big turning point. Quickness is required from ascertaining, but there is also a case which it receives and distinguishes for the first time with lapse of scar rear several days. Usually, the affected part is pressed with the pincette and the like and when separating the pincette, the region which when becomes white returns to the origin, when shallow II degree, the blood style stagnates that way and is white it is deep II degree. In addition it is deep as a outline from II degree planting skin is examined, but decision is difficult, is also opposition of opinion between the doctor.

It is deep, characteristic II degree (DDB) with about III degree

Deeply there is also a case where it receives ascertaining II degree and scar rear several days, puts in place several weeks and distinguishes. As for this by the fact that you can say to also all depth decisions, as for decision there is also a case which is perplexed very much seriously even with the specialist.
In addition when III degree or more IV degree characteristic burns are named and V degree deeply separately, it is. It carbonizes those surfaces.

The naming in Japan was based on to the place where the Japanese burn academic society decides.

Burn area

Law below is well known as the method of measuring the burn area roughly.

• Law of 9: It applies to the adult

  The limb with respect to the limb right with respect to the head left respectively 9%, the trunk front & rear & left legs right legs 18%, the genital organs are calculated respectively with 1%.

• Law of 5: It applies to the infant

  In case of the infant, the head & trunk front & the rear 20%, the quarters are calculated respectively respectively with 10%.

  In case of the young child, the head 15%, the limb with respect to the limb right with respect to the left respectively 10%, the trunk front 20%, the trunk rear & left legs right legs are calculated respectively with 15%.

When the burn area of II degree or more becomes an adult, when 20%, it is the child, when it exceeds 10%, in order the to serious illness to convert, the disposal of the doctor must be received rapidly.

Finely the area is calculated, calculates) is applied the hand palm method (1% of the entire body with the area of the hand palm of the adult.

Windpipe burn

fire,Dizziness roadAndWindpipeThere are times when it owes the burn. The windpipe which owes the burn graduallyEdemaCausing, because it strangulates, breath becomes impossible, it is very dangerous. As for the burn of the windpipe being to be difficult to know from appearance, especially note is necessary. When there is a possibility of the windpipe burn, glance systemic state being good, because there are times when windpipe strangulation is caused from after there is a necessity of the 挿tube. After causing strangulation, the 挿tube is because it becomes difficult or impossible.

You can list the adhesion of the smut of the buccal cavity nasal cavity as the sign which shows the possibility of the windpipe burn.

Remedy

Quick fix

Affected partEven in 1 second quick、With water、It coolsことが推奨される。 手近にあるコップの水でもお茶でもまずかけること。その後も流水（水道水）で冷やし続けることが望まれるが、それができないときは濡れタオルで冷やしても良い。15分ほど冷やしたら速やかに医師の診察を受けること。自己判断の治療（ジャガイモやアロエなど）は以後の治療の妨げになるので避ける。

• 衣服が肌に張り付いている場合は服の上から直接水をかける。無理に脱がそうとすると皮膚の損傷がひどくなる。
• 水疱（水ぶくれ）は破らないこと。破ると感染を起こしやすくなる。
• 乳幼児や老人は低体温を起こしやすいため、冷やしすぎに注意。ひととおり冷やしたらすぐに病院へ搬送する。
• 気道熱傷のおそれがある場合は直ちに救急搬送を依頼する。息ができなくなってからでは遅い！
• 電撃傷などで心肺停止状態にある場合は心肺蘇生が最優先される。冷却は二の次。
• 流水による冷却は感染症の危険を高めるため、自分で処置せずに、患部をそのままにしてラップ等で覆い、すぐ病院へ行くことが大切であるという意見もある。

局所治療

I度熱傷

原則的に治療の必要なし。数日で赤みがとれて治癒する。痛みが強い場合は軟膏を塗ることもある。

II度熱傷（SDB）

患部を湿潤環境で保護し、上皮化（皮膚の再生）を待つ。具体的にはハイドロコロイドなどの被覆材を貼る。ただし汚染創（感染創）はそのまま密封せず、デブリードマンとドレナージを確実に行う。

II度熱傷（DDB）

基本的にSDBと同じであるが、広範囲にわたる場合は植皮を考慮する。

III度熱傷

まず十分にデブリードマンを行う（壊死組織を除去する）。広範囲であれば植皮の適応となるが、小範囲であれば湿潤環境で保護し周囲からの上皮化を待つ。なお、全身状態が不安定な場合は広範囲の創処置は行わないが、その場合も焼痂（焼けて固形化した皮膚組織）で締め付けられないよう切開だけは加えておく。

全身管理

II度以上の熱傷面積が成人の場合20％、小児の場合10％を超えると全身状態が悪化するため、入院治療が必要である。

広範囲熱傷では体液が急速に喪失し、脱水による低容量性ショックが起こる。これに対し乳酸リンゲル液の大量輸液が行われる。輸液量はBaxterの公式で決定される。

• Baxter法

  輸液量(ml/day)＝熱傷面積(%)×体重(kg)×4

また、広範囲熱傷では全身性炎症反応症候群（SIRS）や創感染が起きやすく、遷延すると多臓器不全を引き起こすため、これらの制御を目標とした集中治療が行われる。

重度熱傷の生理的反応及び変化

• 急性期（acute stage）：受傷より48時間以内（72時間以内とする場合もある）。
  • 大量の体液の喪失。
  • 皮膚表面の細菌感染（infection）防御力喪失。
  • ショック（受傷後48時間はショック期とされている）。
  • 汗腺、皮膚腺の破壊。
  • 疼痛（pain）　等。
• 亜急性期（sudacute stage）：受傷より48時間以降、2週間以内。
  • 多臓器不全（MOF）。
  • 進行性壊死。
  • 合併症（conpication）　等。
  • 血液障害。
• 慢性期（chronic stage）：受傷より2週間以降、症状おおむね固定、生命の予後への懸念軽減。
  • 疼痛。
  • 精神的苦痛。
  • 瘢痕拘縮。
  • 栄養障害（malnutrition）　等。
• 回復期：リハビリ（rehabilitation）期とも。
  • 疼痛。
  • 精神的苦痛（リハビリが辛い、またはリハビリがはかどらないもどかしさ）など。

合併症

• 脱水
• 感染症
• Curling潰瘍
• 肥厚性瘢痕
• ケロイド
• 拘縮

診療科

• 形成外科
• 皮膚科

関連項目

• 日焼け
• 凍傷
• 創傷