Thermal burns. Coding of a thermal burn in ICD ICD thermal burn of the radius

A burn is a local violation of the integrity of body tissues as a result of exposure to high temperature or chemical reagents. Depending on the etiology of the external factor, they are divided into thermal (temperature factor), chemical (alkalis, acids), radiation (sunstroke), electrical (lightning strike). According to WHO, thermal injuries account for about 6% of all injuries.

A burn according to ICD 10 is classified according to many criteria (nature of damage, severity of injury, location, area of ​​damage) to immediately determine the method of treatment and predict the outcome.

Clinical manifestations of thermal damage are based on the depth of damage to the skin layer. In the 1st degree, the burn looks like a hyperemic and edematous area. The pain persists for three days. Complete regeneration of the skin occurs without visible defects.

The presence of blisters is characteristic. There was a median lesion of the skin and swelling of the papillary dermis. Severe pain, limited redness, burning, and swelling appear in the damaged area up to the demarcation line.

The blisters easily become infected during the wound process. If you do not follow the rules of asepsis, a purulent-inflammatory focus may develop.

It is characterized by sharp pain, and a black scab forms on the body. Regeneration occurs slowly, with the formation of a scar.

With the 4th degree of damage, the formation of blisters, as well as a dark red scab, is characteristic.

Kinds

Thermal burns according to ICD-10 (International Classification of Diseases, 10th revision) have a range code from T20 to T-32. Each type has its own ICD 10 code, which is then indicated in the diagnosis in the medical history.

T20 – T25 Thermal and chemical burns of the external parts of the body, with a specific localization. The list indicates the stage of damage. Thermal burns according to ICD-10:

• T20. Heads and necks.
• T21. Mid body.
• T22. The upper free limb, excluding the wrist and phalanges of the fingers.
• T23. Wrists and hands.
• T24. The lower limb, except the ankle and plantar part of the foot.
• T25. Ankle and foot areas.
• T26. Limited to the periorbital zone.
• T27. .
• T28. All.
• T29. Several areas of the body.
• T30. Uncertain localization.

Classifiers with codes from T30 to T32 are compiled depending on the affected surface of the adult body. The burn code determines the class of disease.

Degrees

Classification according to the depth of tissue damage allows us to determine the level of development of the pathological process and predict further actions.

Degree of damage:

First degree. Occurs due to minor and short-term contact with a hot surface, liquid or steam. The lesion affects only the epidermis layer.

Second. Damage occurs to the layer of epithelial cells. Spherical protrusions form above the skin, containing blood plasma rich in leukocytes - a bubble.

Third. Typical skin necrosis. There are two stages:

• IIIa – necrosis at the level of epithelial cells and the superficial layer of the dermis;
• IIIb – necrosis at the level of the dermis up to the reticular layer inclusive, with destruction of the hair follicles; skin glands, with partial transition to the hypodermis.

Depending on the state of aggregation of the agent that has come into contact with the skin, wet burns and dry burns are distinguished. Occurs during prolonged, massive exposure to a thermal factor on the surface of the epithelium.

Fourth. The largest scale. May be fatal. All 3 layers of skin and underlying tissues undergo necrotic changes.

Diagnosis and degree determination

For reliable diagnosis, there is a special algorithm for collecting information.

1. Anamnesis is collected simultaneously with the necessary studies.

The medical history must indicate:

• time of receipt;
• place of receipt (open/closed premises);
• how it was received;
• than was received.

At this stage, the doctor determines the quality of first aid and collects a general medical history. Necessary for drawing up a subsequent treatment plan.

The general history includes:

• chronic pathologies;
• existing operations;
• presence of allergies;
• hereditary pathologies.

1. Based on the information received, the doctor conducts a general examination:

• Assess the area of ​​the lesion depending on the proportions of the body;
• Degree of damage (1-4);
• The area of ​​undamaged areas of the body is determined;
• The localization of thermal injury is determined (on the lower extremities as a whole, diffusely on the leg and foot);

The surgeon determines the indications for hospitalization and carries out the necessary treatment measures.

15-10-2012, 06:52

Description

SYNONYMS

Chemical, thermal, radiation damage to the eyes.

ICD-10 CODE

T26.0. Thermal burn of the eyelid and periorbital region.

T26.1. Thermal burn of the cornea and conjunctival sac.

T26.2. Thermal burn leading to rupture and destruction of the eyeball.

T26.3. Thermal burn of other parts of the eye and its adnexa.

T26.4. Thermal burn of the eye and its adnexa of unspecified localization.

T26.5. Chemical burn of the eyelid and periorbital area.

T26.6. Chemical burn of the cornea and conjunctival sac.

T26.7. Chemical burn leading to rupture and destruction of the eyeball.

T26.8. Chemical burn to other parts of the eye and its adnexa.

T26.9. Chemical burn of the eye and its adnexa of unspecified localization.

T90.4. Consequence of eye injury in the periorbital region.

CLASSIFICATION

• I degree- hyperemia of various parts of the conjunctiva and limbus, superficial erosions of the cornea, as well as hyperemia of the skin of the eyelids and their swelling, slight swelling.
• II degree b - ischemia and superficial necrosis of the conjunctiva with the formation of easily removable whitish scabs, clouding of the cornea due to damage to the epithelium and superficial layers of the stroma, the formation of blisters on the skin of the eyelids.
• III degree- necrosis of the conjunctiva and cornea to the deep layers, but not more than half the surface area of ​​the eyeball. The color of the cornea is “matte” or “porcelain”. Changes in ophthalmotonus are noted in the form of a short-term increase in IOP or hypotension. Possible development of toxic cataracts and iridocyclitis.
• IV degree- deep damage, necrosis of all layers of the eyelids (up to charring). Damage and necrosis of the conjunctiva and sclera with vascular ischemia on the surface of more than half of the eyeball. The cornea is “porcelain”, a tissue defect of more than 1/3 of the surface area is possible, in some cases a perforation is possible. Secondary glaucoma and severe vascular disorders - anterior and posterior uveitis.

ETIOLOGY

Conventionally, chemical (Fig. 37-18-21), thermal (Fig. 37-22), thermochemical and radiation burns are distinguished.

CLINICAL PICTURE

Common signs of eye burns:

• the progressive nature of the burn process after the cessation of exposure to the damaging agent (due to metabolic disorders in the tissues of the eye, the formation of toxic products and the occurrence of an immunological conflict due to autointoxication and autosensitization to the post-burn period);
• tendency to relapse of the inflammatory process in the choroid at various times after receiving a burn;
• a tendency to the formation of synechiae, adhesions, the development of massive pathological vascularization of the cornea and conjunctiva.

• Stage I (up to 2 days) - rapid development of necrobiosis of affected tissues, excess hydration, swelling of the connective tissue elements of the cornea, dissociation of protein-polysaccharide complexes, redistribution of acidic polysaccharides;
• Stage II (2-18 days) - manifestation of pronounced trophic disorders due to fibrinoid swelling:
• Stage III (up to 2-3 months) - trophic disorders and vascularization of the cornea due to tissue hypoxia;
• Stage IV (from several months to several years) is a period of scarring, an increase in the amount of collagen proteins due to increased synthesis by corneal cells.

DIAGNOSTICS

The diagnosis is made based on the history and clinical picture.

TREATMENT

Basic principles of treating eye burns:

• provision of emergency care aimed at reducing the damaging effect of the burn agent on tissue;
• subsequent conservative and (if necessary) surgical treatment.

Washing is not carried out in case of a thermochemical burn if a penetrating wound is detected!

Planned surgical interventions on the eyelids and eyeball for the consequences of thermal burns are recommended to be carried out 12-24 months after the burn injury, since against the background of autosensitization of the body, allosensitization to the graft tissue occurs.

For severe burns, it is necessary to inject 1500-3000 IU of antitetanus serum subcutaneously.

Treatment of stage I eye burns

Long-term irrigation of the conjunctival cavity (for 15-30 minutes).

Chemical neutralizers are used in the first hours after a burn. Subsequent use of these drugs is inappropriate and can have a damaging effect on the burned tissue. The following means are used for chemical neutralization:

• alkali - 2% boric acid solution, or 5% citric acid solution, or 0.1% lactic acid solution, or 0.01% acetic acid:
• acid - 2% sodium bicarbonate solution.

NSAIDs

H1 receptor blockers: chloropyramine (orally 25 mg 3 times a day after meals for 7-10 days), or loratadine (orally 10 mg once a day after meals for 7-10 days), or fexofenadine (orally 120-180 mg once a day after meals for 7-10 days).

Antioxidants: methylethylpyridinol (1% solution, 1 ml intramuscularly or 0.5 ml parabulbarly once a day, for a course of 10-15 injections).

Analgesics: metamizole sodium (50%, 1-2 ml intramuscularly for pain) or ketorolac (1 ml intramuscularly for pain).

Preparations for instillation into the conjunctival cavity

In severe conditions and in the early postoperative period, the frequency of instillations can reach 6 times a day. As the inflammatory process decreases, the duration between instillations increases.

Antibacterial agents: ciprofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or ofloxacin (eye drops 0.3%, 1-2 drops 3-6 times a day), or tobramycin 0.3% ( eye drops, 1-2 drops 3-6 times a day).

Antiseptics: picloxidine 0.05% 1 drop 2-6 times a day.

Glucocorticoids: dexamethasone 0.1% (eye drops, 1-2 drops 3-6 times a day), or hydrocortisone (eye ointment 0.5% for the lower eyelid 3-4 times a day), or prednisolone (eye drops 0.5% 1-2 drops 3-6 times a day).

NSAIDs: diclofenac (orally 50 mg 2-3 times a day before meals, course 7-10 days) or indomethacin (orally 25 mg 2-3 times a day after meals, course 10-14 days).

Midriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day) in combination with phenylephrine (eye drops 2 .5% 2-3 times a day for 7-10 days).

Stimulators of corneal regeneration: actovegin (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or solcoseryl (eye gel 20% for the lower eyelid, one drop 1-3 times a day), or dexpanthenol (eye gel 5% for the lower eyelid eyelid 1 drop 2-3 times a day).

Surgery: sectoral conjunctivotomy, corneal paracentesis, conjunctival and corneal necrectomy, genoplasty, corneal biocovering, eyelid plastic surgery, lamellar keratoplasty.

Treatment of stage II eye burns

Groups of drugs that stimulate immune processes, improve the body’s utilization of oxygen and reduce tissue hypoxia are added to the treatment.

Fibrinolysis inhibitors: aprotinin 10 ml intravenously, for a course of 25 injections; instillation of the solution into the eye 3-4 times a day.

Immunomodulators: levamisole 150 mg 1 time per day for 3 days (2-3 courses with a break of 7 days).

Enzyme preparations: systemic enzymes, 5 tablets 3 times a day, 30 minutes before meals, with 150-200 ml of water, the course of treatment is 2-3 weeks.

Antioxidants: methylethylpyridinol (1% solution, 0.5 ml parabulbarly, 1 time per day, for a course of 10-15 injections) or vitamin E (5% oil solution, 100 mg orally, 20-40 days).

Surgery: layered or penetrating keratoplasty.

Treatment of stage III eye burns

The following are added to the treatment described above.

Short-acting mydriatics: cyclopentolate (eye drops 1%, 1-2 drops 2-3 times a day) or tropicamide (eye drops 0.5-1%, 1-2 drops 2-3 times a day).

Antihypertensive drugs: betaxolol (0.5% eye drops, 2 times a day), or timolol (0.5% eye drops, 2 times a day), or dorzolamide (2% eye drops, 2 times a day).

Surgery: keratoplasty for emergency indications, antiglaucomatous operations.

Treatment of stage IV eye burns

The following are added to the treatment:

Glucocorticoids: dexamethasone (parabulbar or under the conjunctiva, 2-4 mg, for a course of 7-10 injections) or betamethasone (2 mg betamethasone disodium phosphate + 5 mg betamethasone dipropionate) parabulbar or under the conjunctiva 1 time per week 3-4 injections. Triamcinolone 20 mg once a week, 3-4 injections.

Enzyme preparations in the form of injections:

• fibrinolysin [human] (400 units parabulbar):
• collagenase 100 or 500 KE (the contents of the bottle are dissolved in 0.5% procaine solution, 0.9% sodium chloride solution or water for injection). Injected subconjunctivally (directly into the lesion: adhesions, scar, ST, etc. using electrophoresis, phonophoresis, and also applied cutaneously. Before use, check the sensitivity of the patient, for which 1 KU is injected under the conjunctiva of the diseased eye and observed for 48 hours. In the absence of an allergic reaction, treatment is carried out for 10 days.

Non-drug treatment

Physiotherapy, eyelid massage.

Approximate periods of incapacity for work

Depending on the severity of the lesion, it takes 14-28 days. Disability is possible if complications or loss of vision occur.

Further management

Observation by an ophthalmologist at your place of residence for several months (up to 1 year). Monitoring of ophthalmotonus, CT state, retina. If there is a persistent increase in IOP and there is no compensation with medication, antiglaucomatous surgery is possible. With the development of traumatic cataracts, removal of the cloudy lens is indicated.

FORECAST

Depends on the severity of the burn, the chemical nature of the damaging substance, the timing of the victim’s admission to the hospital, and the correctness of drug therapy.

Article from the book: .

Thermal burn (ICD-10 code) is a skin injury that is distinguished according to the international classification of diseases. This system has been in effect since 1998 to this day. In the article we will analyze the degrees of thermal burns and methods of providing first aid.

Burning of the epithelium or deeper layers of skin that occurs upon contact with an open fire or heated objects is called a thermal burn. The impact emanating from solid, liquid and gaseous substances at high temperatures is taken into account.

The resulting injuries are dangerous and can cause death. Among thermal burns, ICD-10 code T20-30 are scalds, lightning strikes, radiation, friction, electric current and heating devices. This classification does not include diseases caused by ultraviolet radiation and erythema.

Causes of defeats:

• fire;
• boiling water or steam;
• touching hot objects.

Depending on the depth of the lesion and the type of damage, the severity of the patient’s condition is diagnosed. In advanced stages, this type of injury causes death.

The treatment is complex and lengthy, since overheating of the skin is accompanied by the destruction of proteins involved in tissue renewal and cellular construction.

Features of burns on different parts of the body according to the ICD

They are distinguished by the affected area on the human body:

1. Head and neck.
2. Torso.
3. Shoulder girdle and upper limbs.
4. Hands, wrists.
5. Hip area, shins, legs.
6. Ankles and feet.

Injuries to the head and neck include violation of the integrity of the ears, eyes, and scalp. Wounds limited to the area of ​​the eyes, mouth and pharynx are considered separately. Danger – proximity to the mucous membranes of the nose and eyes.

If the lateral or straight walls of the abdomen, back, chest, groin, genitals are damaged, then they are classified according to ICD-10 T21. Exceptions are the wounds of the scapular region and axillary areas, discussed in T22.

When the wound is distributed between zones or the severity of the lesion cannot be determined, it is classified as an unspecified location.

Thermal effects on the shoulders, forearms, hands and arms are classified as T22.

Burning the skin of the wrists, hands, including nails, palms is a separate item. T24 according to ICD-10 includes thermal burns of the thigh and limb injuries. Injuries to the foot and ankle - in point T25.

Degrees of thermal burns and their consequences

Under the influence of high temperature conditions, human skin is injured. If exposed to flame, it is difficult to remove the remains of burnt clothing during initial treatment of the wound. In the future, the cinders will cause infection.

Hot liquid entering the epidermis leads to the formation of a wound. When the burn is shallow, it often affects the respiratory tract. When touched by hot objects, the wound is clearly defined and deep, but when the source of exposure is removed, additional detachment often occurs. There are several degrees of thermal exposure according to ICD-10:

• epithelial soreness;
• bubble formation;
• burning of fiber;
• tissue death, charring of muscle and bone joints.

In the first degree, the turgor is damaged, redness and swelling appear. After two to three days, the area subjected to thermal burn heals. After the desquamation of the dermis is completed, traces from the outside disappear. A thermal burn of the foot or fingers according to ICD-10 at the second stage is less dangerous than damage to the face and chest. When burned to the germ layer, bubbles filled with sulfur are formed. Regeneration of the consequences lasts a month or more.

In the third degree, the epithelium and dermis are affected. The wound is a black or brown scab, pain sensitivity is lower. In the absence of infectious complications and secondary depressions, the cover is restored independently within six months. When bone tissue is destroyed, stage four is diagnosed.

Urgent help

Do not use oil ointments and fat. This will only worsen the condition, and subsequently you will have to remove the film from the oil, which will cause pain to the victim. Improper application of the bandage will worsen the patient's condition, leading to swelling and suppuration.

The damaging factor should be eliminated, and the burned area should be cooled under running water for half an hour if the integrity of the epidermis is not compromised.

Using a tourniquet unnecessarily will result in the loss of a limb. The most correct decision when receiving a burn is to go to a medical facility, where they will provide pain relief and treatment.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Thermal and chemical burns of unspecified location (T30)

general information

Short description

Thermal burns arise due to direct exposure of the skin to flame, steam, hot liquids and powerful thermal radiation.

Chemical burns occur as a result of exposure of the skin to aggressive substances, most often strong solutions of acids and alkalis, which can cause tissue necrosis within a short time.

Protocol code: E-023 "Thermal and chemical burns of the external surfaces of the body"
Profile: emergency

Purpose of the stage: stabilization of vital body functions

Code(s) according to ICD-10-10: T20-T25 Thermal burns of the external surfaces of the body, specified by their location

Included: thermal and chemical burns:

First degree [erythema]

Second degree [blisters] [loss of epidermis]

Third degree [deep necrosis of the underlying tissues] [loss of all layers of skin]

T20 Thermal and chemical burns of the head and neck

Included:

Eyes and other areas of the face, head and neck

Viska (regions)

Scalp (any area)

Nose (septum)

Ear (any part)

Limited to the area of ​​the eye and its adnexa (T26.-)

Mouth and pharynx (T28.-)

T20.0 Thermal burn of head and neck, unspecified degree

T20.1 Thermal burn of the head and neck, first degree

T20.2 Thermal burn of the head and neck, second degree

T20.3 Third degree thermal burn of head and neck

T20.4 Chemical burn of head and neck, unspecified degree

T20.5 Chemical burn of the head and neck, first degree

T20.6 Chemical burn of the head and neck, second degree

T20.7 Chemical burn of the head and neck, third degree

T21 Thermal and chemical burns of the torso

Included:

Lateral abdominal wall

Anus

Interscapular region

Mammary gland

Groin area

Penis

Labia (major) (minor)

Crotch

Back (any part)

Chest walls

Abdominal walls

Gluteal region

Excluded: thermal and chemical burns:

Scapular region (T22.-)

Armpit (T22.-)

T21.0 Thermal burn of the torso, unspecified degree

T21.1 Thermal burn of the torso, first degree

T21.2 Thermal burn of the torso, second degree

T21.3 Third degree thermal burn of torso

T21.4 Chemical burn of the torso, unspecified degree

T21.5 Chemical burn of the torso, first degree

T21.6 Chemical burn of the torso, second degree

T21.7 Chemical burn of the torso, third degree

T22 Thermal and chemical burns of the shoulder girdle and upper limb, excluding the wrist and hand

Included:

Scapular region

Axillary region

Arms (any part other than just the wrist and hand)

Excluded: thermal and chemical burns:

Interscapular region (T21.-)

Wrists and hands only (T23.-)

T22.0 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, unspecified degree

T22.1 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, first degree

T22.2 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, second degree

T22.3 Thermal burn of the shoulder girdle and upper limb, excluding the wrist and hand, third degree

T22.4 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, unspecified degree

T22.5 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, first degree

T22.6 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, second degree

T22.7 Chemical burn of the shoulder girdle and upper limb, excluding the wrist and hand, third degree

T23 Thermal and chemical burns of the wrist and hand

Included:

Thumb (nail)

Finger (nail)

T23.0 Thermal burn of wrist and hand, unspecified degree

T23.1 Thermal burn of the wrist and hand, first degree

T23.2 Thermal burn of the wrist and hand, second degree

T23.3 Third degree thermal burn of wrist and hand

T23.4 Chemical burn of wrist and hand, unspecified degree

T23.5 Chemical burn of wrist and hand, first degree

T23.6 Chemical burn of the wrist and hand, second degree

T23.7 Chemical burn of the wrist and hand, third degree

T24 Thermal and chemical burns of the hip joint and lower limb, excluding the ankle and foot

Included: legs (any part excluding ankle and foot)

Excludes: thermal and chemical burns of the ankle and foot only (T25.-)

T24.0 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, unspecified degree

T24.1 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, first degree

T24.2 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, second degree

T24.3 Thermal burn of the hip joint and lower limb, excluding the ankle and foot, third degree

T24.4 Chemical burn of the hip joint and lower limb, excluding ankle and foot, unspecified degree

T24.5 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, first degree

T24.6 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, second degree

T24.7 Chemical burn of the hip joint and lower limb, excluding the ankle and foot, third degree

T25 Thermal and chemical burns of the ankle and foot area

Included: toe(s)

T25.0 Thermal burn of the ankle and foot area, unspecified degree

T25.1 Thermal burn of the ankle and foot area, first degree

T25.2 Thermal burn of the ankle and foot area, second degree

T25.3 Thermal burn of the ankle and foot area, third degree

T25.4 Chemical burn of the ankle and foot area, unspecified

T25.5 Chemical burn of the ankle and foot area, first degree

T25.6 Chemical burn of the ankle and foot area, second degree

T25.7 Chemical burn of the ankle and foot area, third degree

THERMAL AND CHEMICAL BURNS OF MULTIPLE AND UNSPECIFIED LOCALIZATION (T29-T32)

T29 Thermal and chemical burns to multiple areas of the body

Includes: thermal and chemical burns classified in more than one of T20-T28

T29.0 Thermal burns of several areas of the body, unspecified degree

T29.1 Thermal burns of multiple areas of the body, indicating no more than first degree burns

T29.2 Thermal burns of multiple areas of the body, indicating no more than second degree burns

T29.3 Thermal burns of multiple areas of the body, indicating at least one third degree burn

T29.4 Chemical burns of multiple areas of the body, unspecified degree

T29.5 Chemical burns of multiple areas of the body, indicating no more than first degree chemical burns

T29.6 Chemical burns of multiple areas of the body, indicating no more than second degree chemical burns

T29.7 Chemical burns to multiple areas of the body, indicating at least one third-degree chemical burn

T30 Thermal and chemical burns of unspecified location

Excluded: thermal and chemical burns with a specified area affected

Body surfaces (T31-T32)

T30.0 Thermal burn of unspecified degree, unspecified localization

T30.1 First degree thermal burn, unspecified location

T30.2 Thermal burn of second degree, unspecified location

T30.3 Third degree thermal burn, unspecified location

T30.4 Chemical burn of unspecified degree, unspecified location

T30.5 First degree chemical burn, unspecified location

T30.6 Chemical burn of second degree, unspecified location

T30.7 Third degree chemical burn, unspecified location

T31 Thermal burns classified according to body surface area affected

Note: this category should be used for primary statistical development only in cases where the location of the thermal burn is not specified; if the localization is clarified, this rubric, if necessary, can be used as an additional code with rubrics T20-T29

T31.0 Thermal burn of less than 10% of body surface

T31.1 Thermal burn of 10-19% body surface

T31.2 Thermal burn of 20-29% body surface

T31.3 Thermal burn of 30-39% body surface

T31.4 Thermal burn of 40-49% body surface

T31.5 Thermal burn of 50-59% body surface

T31.6 Thermal burn of 60-69% body surface

T31.7 Thermal burn of 70-79% body surface

T31.8 Thermal burn of 80-89% body surface

T31.9 Thermal burn of 90% or more of the body surface

T32 Chemical burns classified according to body surface area affected

Note: this category should be used for primary development statistics only in cases where the location of the chemical burn is not specified; if the localization is clarified, this rubric, if necessary, can be used as an additional code with rubrics T20-T29

T32.0 Chemical burn of less than 10% of body surface

T32.1 Chemical burn of 10-19% body surface

T32.2 Chemical burn of 20-29% of body surface

T32.3 Chemical burn of 30-39% of body surface

T32.4 Chemical burn of 40-49% body surface

T32.5 Chemical burn of 50-59% body surface

T32.6 Chemical burn of 60-69% body surface

T32.7 Chemical burn of 70-79% body surface

T31.8 Chemical burn of 80-89% body surface

T32.9 Chemical burn of 90% or more of the body surface

Classification

The severity of local and general manifestations of burns depends on the depth of tissue damage and the area of ​​the affected surface.

The following degrees of burns are distinguished:

First degree burns - persistent hyperemia and infiltration of the skin.

Second degree burns - peeling of the epidermis and formation of blisters.

IIIa degree burns - partial necrosis of the skin with preservation of the deeper layers of the dermis and its derivatives.

IIIb degree burns - death of all skin structures (epidermis and dermis).

IV degree burns - necrosis of the skin and underlying tissues.

Determination of burn area:

1. "Rule of nine."

2. Head - 9%.

3. One upper limb - 9%.

4. One bottom surface - 18%.

5. Front and back surfaces of the body - 18% each.

6. Genitals and perineum - 1%.

7. The “palm” rule is conditional, the area of ​​the palm is approximately 1% of the total surface area of ​​the body.

Risk factors and groups

1. Nature of the agent.

2. Conditions for getting a burn.

3. Agent exposure time.

4. The size of the burn surface.

5. Multifactorial damage.

6. Ambient temperature.

Diagnostics

Diagnostic criteria

The depth of the burn injury is determined based on the following clinical signs.

First degree burns manifested by hyperemia and swelling of the skin, as well as a burning sensation and pain. Inflammatory changes subside within a few days, the superficial layers of the epidermis peel off, and healing begins by the end of the first week.

Second degree burns are accompanied by severe swelling and hyperemia of the skin with the formation of blisters filled with yellowish exudate. Under the epidermis, which is easily removed, there is a bright pink, painful wound surface. For chemical burns of the second degree, the formation of blisters is not typical, since the epidermis is destroyed, forming a thin necrotic film, or is completely rejected.

For third degree burns At first, either a dry light brown scab is formed (from flame burns) or a whitish-gray wet scab (exposure to steam, hot water). Sometimes thick-walled blisters filled with exudate form.

For IIIb degree burns dead tissue forms a scab: for flame burns - dry, dense, dark brown; for burns with hot liquids and steam - pale gray, soft, doughy consistency.

IV degree burns are accompanied by the death of tissues located under their own fascia (muscles, tendons, bones). The scab is thick, dense, sometimes with signs of charring.

At deep acid burns usually a dry, dense scab is formed (coagulative necrosis), and when affected by alkali, the scab is soft for the first 2-3 days (colliquation necrosis), gray in color, and later it undergoes purulent melting or dries out.

Electrical burns They are almost always deep (IIIb-IV degrees). Tissues are damaged at the points of entry and exit of current, on the contacting surfaces of the body along the path of the shortest passage of current, sometimes in the grounding zone, the so-called “current marks”, which look like whitish or brown spots, in place of which a dense scab is formed, as if pressed in relation to to surrounding intact skin.

Electrical burns are often combined with thermal burns, caused by an electric arc flash or ignition of clothing.

List of main diagnostic measures:

1. Collection of complaints and general therapeutic anamnesis.

2. General therapeutic visual examination.

3. Measurement of blood pressure in peripheral arteries.

4. Pulse examination.

5. Heart rate measurement.

6. Respiration rate measurement.

7. General therapeutic palpation.

8. General therapeutic percussion.

9. General therapeutic auscultation.

List of additional diagnostic measures:

1. Pulse oximetry.

2. Registration, interpretation and description of the electrocardiogram.

Differential diagnosis

Differential diagnosis is based on assessment of local clinical signs. It is quite difficult to determine the depth of the lesion, especially in the first minutes and hours after the burn, when there is an external similarity of different degrees of burn. The nature of the agent and the conditions under which the injury occurred must be taken into account. Absence of pain reaction when pricked with a needle, pulling out hair, touching the burned surface with an alcohol swab; the disappearance of the “play of capillaries” after short-term finger pressure indicates that the lesion is no less than grade IIIb. If a pattern of subcutaneous thrombosed veins can be seen under the dry scab, then the burn is reliably deep (IV degree).

With chemical burns, the boundaries of the lesion are usually clear, and streaks often form - narrow strips of affected skin extending from the periphery of the main lesion. The appearance of the burn area depends on the type of chemical. In case of burns with sulfuric acid, the scab is brown or black, with nitric acid it is yellow-green, and with hydrochloric acid it is light yellow. In the early stages, the smell of the substance that caused the burn may also be felt.

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Treatment

Treatment tactics

The goal of treatment is to stabilize the vital functions of the body.First of all, it is necessary to stop the action of the damaging agent and removevictim from the area of ​​exposure to thermal radiation, smoke, toxic productscombustion. This is usually already done before the ambulance arrives. Soaked in hotliquid, clothing must be removed immediately.

Local hypothermia (cooling) of burned tissues immediately after cessationaction of the thermal agent contributes to the rapid reduction of interstitialtemperature, which weakens its damaging effect. For this there may bewater, ice, snow, special cooling packs were used, especially whenlimited area burns.

For chemical burns after removing clothing soaked in chemicalssubstance, and abundant washing for 10-15 minutes (if applied late, do notless than 30-40 minutes) the affected area with a large amount of running coldwater, begin to use chemical neutralizers that increaseeffectiveness of first aid. Then a dry cloth is applied to the affected areas.aseptic dressing.

In case of thermal damage, clothing from burned areas is not removed, but cut and carefully removed. After this, a bandage is applied, and if it is missing, use any clean cloth. Do not clean the dressing before applying it.burnt surface from stuck clothing, remove (pierce) blisters.

To relieve pain, especially with extensive burns, for victimsSedatives must be administered - diazepam* 10 mg-2.0 ml IV (Seduxen, Elenium, Relanium,sibazon, valium), painkillers - narcotic analgesics (promedol(trimepyridine hydrochloride) 1%-2.0 ml, morphine 1%-2.0 ml, fentanyl 0.005%-1.0 ml IV),and in their absence - any painkillers (baralgin 5.0 ml IV, analgin 50% -2.0 IV, ketamine 5% - 2.0* ml IV) and antihistamines - diphenhydramine 1% -1.0ml* IV (diphenhydramine, diprazine, suprastin).

If the patient does not have nausea, vomiting, even if he does not have thirst, it is necessarypersuade to drink 0.5-1.0 liters of liquid.

Seriously ill patients with burns covering a total area of ​​more than 20% of the body surface,immediately begin infusion therapy: intravenous stream of glucose-saltsolutions (0.9% sodium chloride solution*, trisol*, 5-10% glucose solution*), in volume,ensuring stabilization of hemodynamic parameters.

Indications for hospitalization:
- first degree burns of more than 15-20% of the body surface;

Second degree burns on an area of ​​more than 10% of the body surface;
- IIIa degree burns on the areamore than 3-5% of body surface;
- burns of IIIb-IV degree;
- burns of the face, hands, feet,perineum;
- chemical burns, electrical trauma and electrical burns.

All victims who are in a state of burn shock with severehemodynamic disturbances (weak and rapid pulse, sudden and persistent hypotension,chills, thirst, vomiting), with inhalation damage to the respiratory tract, with poisoningcarbon monoxide, with general hyperthermia, heart rhythm disturbances needproviding emergency resuscitation assistance. During transportation like this

11. * Trisol - 400.0 ml, fl.

* - drugs included in the list of essential (vital) medicines.

Information

Sources and literature

1. Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
   1. 1. Clinical recommendations based on evidence-based medicine: Trans. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. -2nd ed., revised - M.: GEOTAR-MED, 2002. - 1248 p.: ill. 2. Guide for emergency physicians / Ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, revised and expanded - SPb.: BINOM. Knowledge Laboratory, 2005.-704p. 3. Management tactics and emergency medical care in emergency conditions. Guide for doctors./ A.L. Vertkin - Astana, 2004.-392 p. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and diagnostic and treatment protocols taking into account modern requirements. Guidelines. Almaty, 2006, 44 p. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines.” 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On introducing amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines.”

Information

Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; candidate of medical sciences, associate professor Dyusembayev B.K.; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

Attached files

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Coding of thermal burns in the ICD

Burns are a fairly common type of injury to human skin, so a whole section is devoted to them in the 10th revision of the International Classification of Diseases document. Therefore, according to ICD 10, a thermal burn has a code that corresponds to the scale and location of the affected skin area.

• Classification
• Definition of pathology

Classification

Thermal damage to the body surface of specified localization has a code in the range T20-T25. Characteristic lesions in multiple forms and unspecified localization are coded as T29-T30, depending on the extent of the lesion. Code T31-T32 is usually used as an addition to the rubrics T20-T29 in determining the extent of skin lesions on the human body as a percentage. For example, a thermal burn of 70-79% of the surface of the entire body has the code T31.7, which can further characterize any code from the T20-T29 heading.

In burn centers, such data from global nosology provide enormous assistance in determining the extent of diagnostic and therapeutic measures, as well as prognosis.

For many years, highly qualified specialists have successfully applied in practice local protocols for providing first aid and managing patients with burn lesions of the skin of the body of any location and stage of the lesion.

Definition of pathology

In ICD 10, a thermal burn is formed due to exposure of the skin to hot liquids, steam, flame or a strong stream of hot air. A chemical burn occurs when aggressive chemical solutions, such as acids and alkalis, come into contact with the skin. They are capable of causing tissue necrosis of even deep layers of skin in a short period of time.

The burn surface is distinguished and classified according to the degree of spread and damage to the skin and subcutaneous tissues as follows:

• redness and thickening of the skin area (1st degree);
• blister formation (grade 2);
• necrosis of the upper layers of skin (grade 3);
• complete necrosis of the epidermis and dermis (grade 4);
• lesions in which all layers of the skin die and subcutaneous tissues are involved in the necrotic process (grade 5).

The code for a thermal burn of the foot, arm, abdomen or back depends on determining the extent of the process, according to the recommendations of local protocols in ICD 10.

The affected area is determined using the “rule of nine,” that is, each part of the body corresponds to a certain percentage of the entire surface.

So the head and arm make up 9% each, the front (stomach and chest), back surface of the body (back) and leg 18% each, 1% is allocated to the perineum and genitals. Experts can also use the palm, the area of ​​which is roughly equal to approximately 1% of the area of ​​the entire human body.

For example, a thermal burn to the hand, face or foot will account for 2% of the burn surface. When establishing the extent of the process, doctors take into account the conditions under which the tissue injury occurred. Important aspects are: determination of the nature of the agent, the time of its exposure, ambient temperature and the presence of aggravating factors in the form of clothing.

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Thermal and chemical burns of the torso

ICD-10 → S00-T98 → T20-T32 → T20-T25 → T21.0

Thermal burn of the torso, unspecified degree

First degree thermal burn to the torso

Second degree thermal burn to the torso

Third degree thermal burn to the torso

Chemical burn of the torso, unspecified degree

First degree chemical burn to the torso

Second degree chemical burn to the torso

Third degree chemical burn to the torso

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International statistical classification of diseases and related health problems. 10th revision.

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