CONTEMPORARY TREATMENT OF BURNS IN USSR

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81-00280R000200210018-4
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 11
• Document Creation Date: December 22, 2016
• Document Release Date: April 11, 2011
• Sequence Number: 18
• Publication Date: November 27, 1956
• Content Type: REPORT

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C0YgI' 0RARY TkEATMENT' OF BURNS IN USSR
Klinicheska Meditsina, No 8
Aug 1y , pp 3-12
Prof N. N. Yelanskiy (Moscow)
Honorary Worker of Science
The problem of the treatment of burns, especially third-degree burns ac-
companied by necrosis of all layers of the skin, is a difficult one. The seri-
ousness of burn injury is determined not only by the degree, i.e., the depth of
the affection, but also by its extent on the body surface, the localization,
the age of the patient, the general condition at the moment of injury, and the
subsequent course of the burn.
An understanding of the essentials of the pathological and physiological
processes in burn patients is necessary for successful treatment. Injuries
caused by the action of high temperature on an area greater than 10% of the
bodily surface are considered serious. They are accompanied by significant
changes in the functions of all organs and systems; such changes serve as a
basis for speaking of burn sickness.
The course of burn sickness is especially serious in elderly persons.
The condition of the heart, the respiratory organs, the liver, and the excre-
tory system are especially important in this case. Even comparatively small
burns are poorly borne if accompanied by disturbances in the function of these
organs. Patients more than 60 years old suffer from the long period spent in
bed; bed sores, pneumonia, and sepsis often result. Children cope with burns
somewhat better, but various infective processes and complications of metabol-
ism also develop easily in them. Deep burns of the face, wrists, and genitalia,
even when a small area is affected, are in the serious category, inasmuch as
their healing is associated with considerable disfigurement and functional dis-
turbances. Especially serious functional disturbances are observed in burns of
the joint areas or of their flexural surfaces.
The nature of the thermal agent has great significance. The mildest de-
grees of burn result from the action of boiling water or hot steam, although
the external appearance of the burned surface and the severe pain in the region
of the burn sometimes lead to an exaggerated evaluation of the seriousness of
the injury. These burns usually heal, by all methods of treatment, within 8-10
days, since only the surface layer of the epidermis is injured. Deeper burns
are caused by burning clothing, buildings,or flammable liquids, as gasoline,
kerosene, ether, alcohol, which have burst into flame. Especially deep burns
are caused by combustible mixtures of the napalm type or mixtures containing
phosphorus. The burns resulting from the action of high temperature during
the atomic explosion at Hiroshima and Nagasb?-_i were classified as second degree
in 90% of the cases and as third degree in only 5% of the cases. This is ex-
plained by the fact that the more serious third-degree burns caused by the
explosion of the atomic bomb were included with radiation and mechanical in-
juries. Such cases did not come under medical observation and, therefore,
were not taken into account. Burns were observed in 80-85% of those injured
by the atomic explosion at Hiroshima and Nagasaki.
Shock may develop in all burn cases with a burn area greater than 1% of
the body surface. Shock development in burns is the same as in traumatic shock.
A high ambient temperature is an extremely strong stimulant of the receptor ap-
paratus on a large area of the body surface.
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These stimuli are accompanied by a stream of impulses which cause stimula-
tory and inhibitory phenomena in the central nervous system, leading to exhaus-
tion of the nerve cells and the onset of a state of shock characterized by- deep-
seated disturbances of the activity of the cardiovascular, respiratory, diges-
tive, and excretory systems.
In the first period of burn shock (the erectile period), a spasm of the
vascular vessels and an increase in arterial pressure is observed; this is fol-
lowed by paralysis of the vasomotors and dilatation of the blood vessels (tor-
pid sta~.;e). The fluid past of the blood passes from the vascular stream into
the tissues, and edema develops. A sudden drop in arterial pressure is observed
in this stage.
Owing to the peculiar nature of burn trauma, shock associated with it is
accompanied by loss of plasma; this does not occur in traumatic shock. Nor7m,31v
the total volume of circulatin; blood is 8%. and the e:tracellular fluid
is Plasma loss occurs at the expense of the passage of the fluid part of
the circulatin.? blood and depletion of the fluid of the extracellular space. A
redistribution of the body fluids occurs in extensive burns as a result of the
paralysis of the vasomotors in the burn area. The edema of the tissues in the
region of the burn and the plasma loss lead to a sudden depletion o the organ-
ism's proteins and electrolytes and to a decrease in the total volume of cir-
culatin,, blood. Plasma loss during shock is sometimes very great. Burned
patients lose per day 3-5 liters of edema fluid rich e proteins and electrolytes.
The amount of urine discharged diopL~ abruptly. The blood thickens. The eryth-
rocyte count may reach 3 million, and the hemoglobin, 16096. Thinning of the
blood occurs within 3. days, and anemia develops as a result o" the erythrocyte
disturbance. The body loses up to 150 grams o:' proteins per day with the edema
fluid. The average loss of nitrogen in extensive burns is as much as 25.6 ,;rams
per day. In addition, hyperglycemia, hyperadrenalinemia, and a reduction in the
blood alkali reserve are noted in burn patients.
Casts, proteins, and leached erythrocytes are identified in the urine.
The amount of urine secreted decreases suddenly. The seriousness of the pa-
tient's condition is determined by the amount of urinary secretion per hour. If
less than 50 ml of urine is secreted per hour this is evidence of a disturbance
in the filtering function of the kidneys. The hematocrit readings, the leel of the
blood alkali reserve, and the amount of urinary secretion per hour serve, to a
certain extent, as criteria of the seriousness of' the circulatory disorders anc
the disturbance in the secretory function and metabolic processes of' the organ-
ism.
The pain syndrome, the plasma loss, and the loss of proteins, electrolytes,
and fluids are fundamental factors in the pathogenesis of burn shock in the
first days of burn sickness. The second or third day after the burn, when the
shock symptoms become less prominent, symptoms of toxemia, due to the absorp-
tion of the protein-breakdown products of the extensive burned area appear in
burn patients. S%ri;torn, of toxemia may also be due to a disturbance in the
secretory function of the skin ar.u the poisoning of the or?canism by products of
metabolism which should t'e seorPted through the skin. Toxemia in burns charac-
terized by nigh temperature. chills, confused mental state, rapid pulse and res-
piration. low L'inary secretion, and 'astri(- symptoms, such as nausea and some-
tines vomiting with blood. But it is very difficult to separate toxemia from
septicemia. because at. this time the infection developing or, the burn surface
be-comes prominent. The hi ?,h temperatures with chills, occasionally hectic fever
with a rise in temperature o:'-'-~o, the suppurative process in the wound, the
positive blood cultures, and the high leukocytosis provide a basis for speaking
c'' septicemia in patients with burns covering large areas o' the body.
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Burns of the upper respiratory passages with subsequent development of
edema of the pharynx and trachea and difficulty in breathing may also be ob-
served in facial burns from a hot flame. The course of these burns is often
serious or fatal.
To determine the seriousness of a burn, the
and the depth of the burn must be known. The
easily from tables prepared by B. N. Postnikov.
the area of the separate regions of the body and
to the total.area of the body.
percent of the body area burned
area burned is determined most
in these tables is calculated
their percentage relationship
B. N. Postnikov proposed a simple method for the exact determination of
the area of a burn with the. aid of a cellophane or washed X-ray film., The
film is placed on the burn, and a solution of methylene blue is used to outline
its contours. The cellophane is then placed on a centimeter Grid by means of
which the area of the burn can be calculated. The size of the lesion can also
be determined by the rule of "nines," proposed by "TTenison" and "Rulaski."
According to.this rule, the surface of the head and neck comprises 9% of the,
total surface of the body; the surface of the upper extremities, 9% each; and
the front and back surfaces of the torso and each of the lower extremities,
18% each, for a total of 90,%. The genitalia and the perineum occupy the remain-
ing area.
Burns are divided according to depth into three, four, and five degrees.
According to the most prevalent classification, the three-degree system, the
first degree is characterized by erythema. in this instance, only the epidermis
is affected. The pain, which is usually severe at first, subsides rapidly
after the application of cold, moist bandages treated with a solution of potas-
sium penman ;anate, alcohol, and other substances. Healing be;_,ins after 2-5 days.
Second-degree burns are accompanied by severe hyperemia, the formation of blis-
ters, hyperesthesia, and acute pain. The pain is due to the fact that the
nerve endings situated in the papillary layer remain intact. In second-degree
burns coverin small areas, healing begins after -10 days. First- or second-
degree burns covering extensive areas may be accompanied by several .