Lecture
Objective: to form students' understanding of the causes of accidents and their types; to study the types and degrees of skin damage from frostbite and burns, to familiarise them with types of first aid, to expand knowledge, forming students' skills and abilities in providing first aid for burns and frostbite.
People do not always follow safety regulations and, as a consequence, sustain injuries.
Problem situation:
-On a hike, one of your friends burned his fingers. He cried, waved his hands, shouted that it hurt. What should be done?
Introduction to the topic:
-What can happen during any fire?
1. Definition of a burn. Types of burns and their degrees of severity.
-The following types of burns are distinguished: thermal, electrical, chemical, radiation burns.
-Which of them are the most common?
Thermal burns are more common and people often sustain them as a result of fires.
-Name the causes of fires?
--What other objects do you know that can cause a fire? (candle, embers, iron, cigarette, etc.)
It is well known that a tiny flame can burn down a house, a street or even a city. Moscow, for example, burned down completely or partially about 60 times.
-Why did this happen?(there were many wooden houses)
-Now houses are made of stone, but they still burn just as quickly. Why?(flammable objects have appeared).
-What flammable objects do you know?
Often the cause of a fire is failure to comply with safety regulations.
Classification of burns is carried out according to the following criteria:
1). By depth of injury;
2). By the source of the damaging effect (type of injury).
Severity of a burn – the condition of the casualty, determined by the depth, extent of the burned surface and the anatomical region of its location.
Burns of any degree covering more than 30% of the body surface are life-threatening!
Determining the area of injury.
The depth as well as the area of the burn plays an important role in determining the severity of the injury. To approximately determine the area of injury as part of first aid, the palm rule or the rule of nines is used.
The size of the burned surface is expressed as a percentage of the total surface of the skin.
The palm rule.
A person's palm corresponds to approximately 0.78-1.2% of the skin surface, which allows it to be used as a unit for measuring the area of burns: however many palms fit into the burn area, that many percent makes up the burned surface of the casualty's body.
The rule of nines.
The rule is used if entire parts of the body are burned. In this case, it is assumed that the surfaces of different parts of the body make up approximately 9% each (or a multiple of this number) of the total body surface area: head and neck –9%; chest-9%; abdomen-9%; back surface of the body -18%; thighs-9% each; shins and feet –9% each;
In children these proportions are different.
This scheme is simple to use and in an emergency situation allows the affected body surface area to be quickly determined.
With extensive burns of II-III degree covering 10-15% of the body surface, a severe general disorder of the body occurs, burn disease, which is sometimes complicated by burn shock.
These injuries are classified according to the nature of the effect and the degree of injury. First aid for burns depends directly on these factors
Depending on the depth of skin and tissue damage, 4 degrees of burns are distinguished: mild (I), moderate (II), severe (III), extremely severe (IV).
1 degree - on the affected area redness and painful sensations, swelling of the skin occur. The burn damages only the top layer of skin. When providing aid, it is necessary to free the injured part of the body from clothing and hold the burned area under a stream of cold water for up to 10 minutes. Gauze moistened with a weak solution of potassium permanganate can be applied. Then a sterile dressing is applied to the burn site
2nd degree - blisters filled with tissue fluid appear at the burned site.
3rd degree - damage to the skin occurs and a scab forms (dense charred skin tissue). The burn engulfs the epidermis and partially the dermis. The sweat glands, sebaceous glands, hair follicles are preserved. This degree is characterised by tissue necrosis.
4th degree - not only the skin is charred, but also the underlying tissues: subcutaneous fat, muscles, tendons and even bones.
Burns of 2nd, 3rd, 4th degree must be treated only in a hospital.
Burn disease is characterised by: acute intoxication, disruption of the body's water and salt metabolism processes, often complicated by pneumonia, liver and kidney damage, acute ulcers of the gastrointestinal tract.
2. SCHEME OF PROVIDING AID FOR BURNS.
NEVER DO THE FOLLOWING!
1. Treat the injured surface with powders and alcohol-containing solutions.
2. Give alcohol.
3. Tear off clothing stuck to the burn wound.
4. Open blisters.
First aid for burns
Stop the action of the damaging factor.
For degree I, cool the burn site under a stream of cold water.
Free the burned area from clothing (if the clothing cannot be removed from some area, cut around the wound with scissors).
Apply a sterile napkin, an aseptic dressing to the wound
Carry out immobilisation of the limb with splints or a triangular bandage.
Apply an ice pack to the burn site.
Call «103» or hospitalise on a stretcher.
Give plenty of fluids. and provide pain relief (analgin, ketanov, ketolong, dexalgin, etc.)
Possible equipment used: sterile napkins, bandage 5x10, bandage 7x14, ice pack, Kramer splints, triangular bandage, scissors, stretcher.
Chemical burns arise from exposure of the body to concentrated acids (hydrochloric, sulfuric, nitric, acetic) and alkalis (caustic potash and caustic soda, ammonia solution, quicklime), phosphorus and certain salts of heavy metals (silver nitrate, zinc chloride, etc.).
FIRST AID FOR CHEMICAL BURNS DEPENDS ON THE TYPE OF CHEMICAL SUBSTANCE.
1. Stop the action of the damaging factor.
Possible equipment used: sterile napkins, bandage 5x10, bandage 7x14, ice pack, 3% vinegar, baking soda, Kramer splints, triangular bandage, scissors, stretcher.
For burns caused by phosphorus, the burned part of the body must be immersed in water, and pieces of phosphorus removed under water with a stick, cotton wool, etc. Then the burn surface is covered with a sterile dry dressing.
4. Electrical burn.
These injuries occur as a result of contact with electrically conductive materials. This is a very serious injury. Electric current spreads extremely quickly through all tissues, via the blood, muscles, cerebrospinal fluid.
After the injury, a current mark is necessarily found on the patient's body - the so-called entry-exit point. The burn itself has a small area of damage. But it is very deep.
How to act in the case of an electrical burn? Such injuries are characterised by minor external damage. As noted above, this is the site of entry and exit of the current. However, despite the minor visual damage, the patient experiences extensive trauma to internal tissues and organs. The patient is usually diagnosed with a disturbed heart rhythm. Therefore all casualties, regardless of the area of injury, must necessarily be examined by doctors.
First aid for an electrical burn is based on the following measures: Immediately stop the effect of electric current on the casualty! The best method is switching off the power supply. If this cannot be done, the patient must be pushed away. For such purposes use any rubber or wooden object. It is strictly forbidden to touch such a person with bare hands! Do not approach them barefoot! Such actions will not only fail to help the casualty, but will also allow the current to spread to you. If the person is unconscious, and you do not feel their breathing, resuscitation measures must be undertaken immediately. Such patients must be observed for no less than a day. Since a disturbance of heart rhythm can occur not only during the injury, but also after it
5. Radiation burn.
Injuries can be caused by: Ultraviolet radiation. As a rule, they occur in summer. Such injuries are not deep, but have a large area of damage. Under the effect of ultraviolet, superficial burns of the 1st or 2nd degree form. Infrared radiation. Such exposure can cause damage to the skin and eyes (retina, cornea). The degree of damage depends on the intensity and duration of exposure to the body. Ionising radiation. Not only the skin can be affected, but also nearby tissues, organs. Burns are characterised by shallow damage.
6. Definition of the concept of frostbite. Causes.
Frostbite – this is damage to a part of the body caused by exposure to low temperatures.
Frostbite most often occurs in the cold winter season at ambient temperatures below -10oC - 20oC. With prolonged exposure outdoors, especially in high humidity and strong wind, frostbite can also be sustained in autumn and spring at air temperatures above zero.
Under the influence of cold, complex changes occur in tissues, the nature of which depends on the level and duration of the temperature drop. When exposed to temperatures below -30oC, the main factor in frostbite is the direct damaging effect of cold on the tissues, and cell death occurs. At temperatures of -10o to -20oC, at which most frostbite occurs, the leading role is played by vascular changes in the form of spasm of the smallest blood vessels. As a result, blood flow slows, and the action of tissue enzymes stops.
Frostbite in cold weather is caused by:
1. Tight and wet clothing and footwear;
2. Physical exhaustion;
3. Forced prolonged immobile and uncomfortable position;
4. Previous cold injury;
5. Weakening of the body as a result of illnesses suffered;
6. Hunger;
7. Sweaty feet;
9. Chronic diseases;
10. Smoking and other causes.
Statistics show that almost all severe frostbite cases leading to limb amputation occurred in a state of severe alcoholic intoxication!
7. Brief medical characterisation of frostbite and hypothermia. Degrees of frostbite and cooling.
Let us consider the degrees of frostbite. There are 4 degrees of frostbite:
Degree I (the mildest) – blanching of an area of skin occurs, which after warming turns into redness, the affected area goes numb, loses sensitivity, burning, itching, pains are possible.
By the end of the week after frostbite, slight peeling of the skin is sometimes observed. Complete recovery occurs by day 5-7 after frostbite.
Degree II - the symptoms are the same as for the first degree, but after a few days blisters appear on the affected area, healing occurs within 1-2 weeks.
Occurs with more prolonged exposure to cold. In the initial period there is blanching, coldness, loss of sensitivity, but these phenomena are observed at all degrees of frostbite. Therefore the most characteristic sign is the formation of blisters filled with clear content in the first days after the injury. With degree II frostbite, after warming, the pain is more intense and prolonged than with degree I frostbite, skin itching and burning are troublesome.
Degree III – death of tissues, blisters filled with dark bloody content, such injuries heal in about a month, forming scars.
With degree III frostbite, the duration of the period of cold exposure and temperature decrease in the tissues increases. Blisters formed in the initial period are filled with bloody content, their base is blue-purple, insensitive to stimuli. Death of all elements of the skin occurs, resulting in the formation of granulation tissue and scars as an outcome of frostbite. Nails that have come off do not grow back, or grow back deformed.
Degree IV – blisters form on the least frostbitten areas of skin, the most affected area has a sharply cyanotic colour, swells strongly after warming. With degree IV frostbite, all soft tissues are affected, damage to joints and bones is possible.
Under conditions of prolonged exposure to low air temperature, not only local injuries are possible, but also general cooling of the body. General cooling of the body should be understood as the condition that occurs when body temperature drops below 34oC.
The onset of general cooling is promoted by the same factors as with frostbite: high air humidity, damp clothing, strong wind, physical exhaustion, psychological trauma, illnesses and injuries suffered.
Mild, moderate and severe degrees of general cooling are distinguished.
Mild degree: body temperature 32-34oC. The skin is pale or moderately cyanotic, <goose bumps> appear, chills, difficulty speaking. The pulse slows to 60-66 beats per minute. Blood pressure is normal or somewhat elevated. Breathing is not impaired. Degree I-II frostbite is possible.
Moderate degree: body temperature 29-32oC, characterised by sharp drowsiness, depressed consciousness, a vacant gaze. The skin is pale, cyanotic, sometimes with a marbled colouring, cold to the touch. The pulse slows to 50-60 beats per minute, of weak fullness. Blood pressure is slightly reduced. Breathing is infrequent - up to 8-12 per minute, shallow. Degree I-IV frostbite of the face and limbs is possible.
Severe degree: body temperature below 31C. Consciousness is absent, convulsions and vomiting are observed. The skin is pale, cyanotic, cold to the touch. The pulse slows to 36 beats per minute, of weak fullness, there is a marked decrease in blood pressure. Breathing is infrequent, shallow - up to 3-4 per minute. Severe and widespread frostbite is observed, up to the point of freezing.
8. First aid for frostbite.
Actions when providing first aid vary depending on the degree of frostbite.
First aid consists of stopping the cooling, warming the limb, restoring blood circulation in the cold-affected tissues and preventing the development of infection.
The first thing to do at the first signs of frostbite – bring the casualty to the nearest warm place, remove frozen footwear, socks, mittens. At the same time as carrying out first aid measures, a doctor or ambulance must be urgently called for medical assistance.
With degree I frostbite the cooled areas should be warmed to redness with warm hands, light massage, breathing, and then a cotton-gauze bandage applied. The teacher demonstrates on a student in practice the application of a cotton-gauze bandage: a layer of gauze, a thick layer of cotton wool, again a layer of gauze, and on top oilcloth or a plastic bag. Quilted jackets, padded jackets, woollen fabric, etc. can be used as thermal insulation material.
With degree II – IV frostbite rapid warming, massage or rubbing should not be done. Apply a thermally insulating dressing to the affected surface. Give the casualty hot drinks, hot food, a tablet of aspirin, analgin, «no-shpa».
Attention! Frostbitten areas of the body must not be smeared with fat or ointments, rubbed with snow, or placed in hot water.
Why should frozen areas of skin not be rubbed with snow?
The blood vessels of the hands and feet are very fragile and therefore may be damaged, and the resulting micro-abrasions on the skin promote the introduction of infection.
Rapid warming of frostbitten limbs by a campfire must not be used, nor should heating pads and similar heat sources be applied uncontrollably, since this worsens the course of the frostbite. Oils and fats must not be rubbed in, nor should alcohol be used for rubbing in cases of deep frostbite.
Why should a frostbitten limb not be warmed by an open fire, radiator, or heater? The sensitivity of such affected tissues is reduced. Additional skin damage is possible, but this time in the form of a thermal burn.
For mild general cooling a fairly effective method is warming the casualty in a warm bath at an initial water temperature of 24oC, which is raised to normal body temperature.
With moderate and severe general cooling accompanied by impaired breathing and circulation, the casualty must be delivered to a hospital as quickly as possible.
9."Iron" frostbite.
In practice, cold injuries also occur that arise on contact between warm skin and a cold metal object. If a curious little child grabs some piece of metal with a bare hand, or, worse still, licks it with the tongue, they will stick to it firmly. Freeing oneself from these bonds is possible only by tearing them away along with the skin.
Fortunately, an "iron" wound is rarely deep, but it still needs to be disinfected urgently. First rinse it with warm water, and then with hydrogen peroxide. The oxygen bubbles released will remove any dirt that has gotten inside. After this, try to stop the bleeding. A haemostatic sponge applied to the wound helps well, but a sterile bandage folded several times can also be used, which should be pressed firmly and held until the bleeding stops completely. But if the wound is very large, a doctor must be consulted urgently.
10. Prevention of frostbite and hypothermia:
There are several simple rules that will allow you to avoid frostbite in severe cold:
1. Do not drink alcohol – alcohol intoxication actually causes greater heat loss, while at the same time creating an illusion of warmth.
2. Do not smoke in cold weather – smoking reduces blood circulation, thereby making the limbs most vulnerable.
3. Wear loose clothing – this promotes normal blood circulation. Dress like «cabbage» - this way there are always layers of air between the layers of clothing, which retain heat excellently.
4. Tight footwear, absence of an insole, damp dirty socks often serve as a primary precondition for frostbite.
5. Do not go out in the cold without mittens, a hat and a scarf.
6. Do not wear metal jewellery in the cold – rings, earrings, etc. metal cools much faster than the body, as a result of which it may «stick» to the skin with painful sensations.
7. Use the help of a friend – watch your friend's face, especially the ears, nose and cheeks, for any changes in colour, and they will watch yours.
8. Do not allow a frostbitten area to freeze again – this will cause far more severe skin damage.
9. Do not remove footwear from frostbitten limbs in the cold – they will swell and you will not be able to put the footwear back on. It is necessary to reach a warm place as quickly as possible. If your hands are frozen – try to warm them under your armpits. Hide from the wind, the likelihood of frostbite is significantly higher in wind.
10.Before going out into the frost you should eat – you will need energy.
It should be taken into account that in children the body's thermoregulation is not yet fully established, while in elderly people and in some illnesses this function may be impaired. These groups are more prone to hypothermia and frostbite, and this should be taken into account when planning a walk. When letting a child go for a walk in frosty weather, remember that it is advisable for them to come back into the warmth every 15-20 minutes to warm up.
Finally, remember that the best way out of an unpleasant situation is not to get into it in the first place. If you do not like extreme sensations, in severe frost try not to leave the house without a particular need.
Knowledge check:
Give answers to the questions:
1.Why do frostbites occur and what are they characterised by?
2.How to prevent the occurrence of frostbite?
3.What does the severity of the condition and the depth of tissue damage in frostbite depend on?
4.Name the main principles of providing first medical and pre-medical aid in cases of exposure to low temperatures.
1.Complete the sentences written on the board:
If a person is still shivering with cold, it means things…(are not so bad).
A frozen person must not be seated…(close to the fire).
Survival at low temperatures depends on the condition…(of clothing and footwear).
Working with the instruction card: Fill in the missing words.
The following degrees of thermal burns are distinguished:
1st degree -…, swelling, a feeling of … .
2nd degree – formation of …, which contain a clear liquid, with … around them, a burning sensation.
3rd degree – skin of a dark or grey colour, extensive …, superficial partial charring of … .
4th degree – charring not only of the skin, but also of the tissues and muscles located beneath it,
(pain, burning, blisters, swelling, redness, skin, bone)
Consider the situations:
Situation No. 1
Spilled hot tea on the hand, redness, no blisters. What are your actions? What degree of burn is this?
Choose the correct answer. Demonstration on a doll.
1.Put the hand under water, hold for 10-15 minutes.
2.Treat with «Panthenol» spray.
Situation No. 2
Burn from a hot iron. Redness of the skin, swelling, blisters have appeared. What degree of burn is this? What are your actions? Demonstration on a doll.
Choose the correct answer.
1.Apply a loose bandage.
2. Apply ice on the bandage or water in a bag.
3. Seek medical attention.
Situation No. 3
A person ended up in a fire zone. There are bloody blisters on the skin, damage to the tissue under the skin, muscles, bones. What degree of burn is this? What are your actions? Demonstration on a doll.
Choose the correct answer.
What must not be done?
Situation No. 4.
A person spent a long time outside in tight, cold footwear while remaining largely immobile; the air temperature was 10-15 degrees Celsius. At home the body temperature rose, and chills appeared; significant pain arose in the feet. The feet are of a purplish-cyanotic colour, swollen, and the swelling spreads to the shins; on the dorsal surface of the feet there are blisters filled with a white liquid. Sensitivity of the feet is sharply reduced. What is the nature of the injury? What is the first medical aid (PMP)?
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