Ожог кипятком – разновидность термического ожога с повреждением кожи и нижележащих мягких тканей под воздействием горячей жидкости. Является частой травмой в быту, причем около трети пострадавших – маленькие дети. Схема лечения, восстановительный период и последствия ожога зависят от степени и площади повреждения, а также правильно оказанной первой помощи.
Фото 1. Неосторожное обращение с кипятком может дорого стоить ребенку. Источник: Flickr (CHILDREN AT RISK FOUNDATION).
Степени поражения кожи кипятком
Все термические травмы классифицируются в зависимости от глубины поражения тканей. Для ожогов кипящей жидкостью характерны 1-3 степени:
- I степень. Частично повреждается самый верхний слой кожных покровов. Возникают покраснение, незначительный отек и жгучая боль. Через несколько суток такой ожог заживает без следов.
- II степень. В данном случае поверхностный слой кожи полностью поврежден. На нем образуются небольшие волдыри с прозрачной жидкостью, при вскрытии которых видны эрозии ярко-красного цвета. Повреждение проходит максимум через две недели и тоже без рубцевания.
- III степень подразделяется на несколько подвидов. IIIА – полное повреждение верхних и частично – глубоких слоев кожи с образованием крупных пузырей с жидкостью и ожогового струпа (мягко белесой корки на ране). IIIБ – кожные покровы разрушены полностью, иногда затронута подкожная клетчатка. Болезненность на этой стадии умеренная, поскольку разрушаются нервные окончания.
- IV степень, с повреждением клетчатки, мышц, костей, для ожогов кипятком не характерна.
Имеет значение также площадь травмированной поверхности, поскольку даже наиболее легкая степень, затрагивающая более 10% тела, требует квалифицированной медпомощи.
Первая помощь при ожоге кипятком
От действий сразу после получения травмы зависят ее тяжесть, длительность лечения и риск развития осложнений.
Если повреждения незначительны, то обращаться в медучреждение не обязательно. Глубокие или обширные ожоги требуют квалифицированной медицинской помощи в стационаре.
Правила доврачебной помощи в домашних условиях
Что нужно сделать обязательно в случае ожога кипятком:
- Устранить травмирующий фактор (прекратить контакт с горячей жидкостью).
- Охладитьповрежденныйучасток кожи в течение 10-15 минут. Сделать это можно под струей воды, при помощи снега или льда. Охлаждение предотвращает нагревание неповрежденных тканей, окружающих область ожога, и уменьшает болевой синдром.
Это важно! Холод применяется только при 1 и 2 степенях травмы. Более тяжелые повреждения охлаждать не нужно.
- Наложить свободную стерильную повязку, освободив от одежды обожженный участок тела. Если ткань прилипла, обрезать ее по краям, ни в коем случае не пытаясь оторвать.
- Принять анальгетик. Подойдут 2 таблетки Парацетамола или Ибупрофена.
- Обратиться в медучреждение, если ожог легкий, но обширный, или вызвать бригаду скорой помощи в более тяжелых случаях. Незначительное повреждение можно обработать противоожоговыми средствами на основе пантенола и наложить повязку.
- Категорически нельзя: вскрывать волдыри, мазать ожог растительными или животными жирами, зеленкой и прочими подручными средствами.
Особенности оказания помощи детям
Первая помощь ребенку оказывается по аналогичной схеме.
Ожог нужно немедленно охладить, освободить от одежды, закрыть повязкой из стерильного бинта или ткани, дать обезболивающее с учетом возраста.
Подойдут такие препараты, как Панадол и Нурофен.
Если повреждение незначительное (покраснела кожа на небольшом участке) можно воспользоваться Пантенолом и к врачу не обращаться. Более серьезные ожоги (особенно лица) – повод для экстренной госпитализации.
Обратите внимание! При оценке степени тяжести и площади повреждения ожога у ребенка критерии снижаются в два раза. То есть травма 1 степени, занимающая более 5% поверхности тела требует обязательного обращения к врачу.
Правила помощи при образовании волдырей
Появляющиеся при ожогах 2 и 3 степени пузыри с жидкостью служат своеобразной защитой от инфицирования раны. Поэтому вскрывать их самостоятельно ни в коем случае нельзя. Крупные волдыри врач подрезает, чтобы удалить экссудат, после чего накладывает повязку с антисептиком. Мелкие трогать не нужно – через несколько дней они проходят сами.
Лечение ожога от кипятка
Легкие травмы 1 степени следует обработать противоожоговым средством и закрыть повязкой на пару дней (менять ее не нужно). При 2 степени травмы нужно накладывать повязки с бактерицидными мазями, меняя их раз в 2 суток. Более тяжелые и обширные повреждения лечатся в условиях стационара закрытым (под повязкой) способом или открытым – без нее. В случае некроза тканей они иссекаются.
Как лечить ожог в домашних условиях
Если ожог кипятком не требует помещения в стационар, назначается амбулаторное лечение. Оно направлено на ускорение регенерации тканей, обезболивание и предотвращение инфекционно-воспалительного процесса.
Обезболивающие лекарства
Ожоги первой степени характеризуются сильными болевыми ощущениями сразу после получения травмы, но в последующем обезболивания не требуют. Если амбулаторно лечится более значительное повреждение, то показан прием внутрь следующих препаратов:
- Анальгин
- Парацетомол
- Ибупрофен
- Панадол или Нурофен для детей.
Врач также может назначить повязки с растворами анальгетика. Обычно применяется Лидокаин.
Мази и другие медикаменты
Эти средства предназначены для профилактики инфицирования раны и ускорения ее заживления. Применяются только по назначению врача. Под повязку показаны следующие гели и мази:
- Левомеколь – противомикробное средство;
- Солкосерил – ускоряет процессы регенерации;
- Банеоцин – комбинированный антибиотик;
- Бепантен – ранозаживляющий крем.
С учетом особенностей травмы и состояния пациента могут назначаться и другие препараты, как для наружного применения, так и пероральные. Целесообразно принимать также витаминно-минеральные комплексы.
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