What Are the Most Common Causes of Burning Chest Pain?

The majority of burn shocks are secondary shocks, which usually occur in the first hours or more than ten hours after burns. They are hypovolemic shocks because a large amount of plasma fluid leaks from the capillaries to the wound and tissue space in the injured area , Resulting in reduced effective circulating blood volume.

Basic Information

English name: burn shock
Visiting department: Burn Plastic Surgery
Common causes: The role of humoral inflammatory mediators, enhanced capillary permeability, and extravasation of plasma-like fluid

Common symptoms: Increased pulse rate, decreased urine output, thirst, irritability, nausea and vomiting, poor peripheral circulation, changes in blood pressure and pulse pressure
Contagious: no

Causes of burn shock

Local and other parts of the burn caused by the role of receptor fluid inflammatory mediators, enhanced capillary permeability, a large amount of plasma-like fluid extravasation, some exuded from the wound, and some penetrated into the tissue space, causing tissue edema. This causes a reduction in blood volume, and if the reduction in blood volume exceeds the body's ability to compensate, it can cause hypovolemic shock. The exudation of plasma-like fluid was the sharpest at 2 to 3 hours after the injury, reached a peak at 8 hours, then gradually slowed down, and gradually recovered to 48 hours. The edema fluid exuding in the interstitial space began to absorb and the edema gradually subsided.

Clinical manifestations of burn shock

Burn shock is basically hypovolemic shock, so its clinical symptoms are similar to trauma or hemorrhagic shock, and its characteristics are as follows:

Pulse rate

The increased secretion of vasoactive substances after burns increases the ability of the myocardium to contract and increase the heart rate to compensate for the increased cardiac output. Therefore, heart rate increases in the early stage of burns, and severe burns can increase to more than 130 times per minute. If the heart rate is too fast, each time the cardiac output is reduced, and the peripheral vascular resistance is increased, the pulse is shown as weak weakness, and when the shock is severe, the pulse is weaker.

2. Reduced urine output

It is an early manifestation of burn shock. Generally can reflect the situation of tissue blood perfusion, but also can more sensitively reflect the severity of burn shock. The decrease in urine output in the early stage of burns is mainly due to insufficient effective blood volume and decreased renal blood flow, but it is also related to increased secretion of antidiuretic hormones and aldosterone, which limits the kidneys' discharge of water and sodium salts.

3. Thirst

It is an early manifestation of burn shock. It may be related to changes in intra- and extracellular osmotic pressure and insufficient blood volume, and it is also controlled by the hypothalamus-pituitary-adrenal cortex system.

4. restless

It is a manifestation of poor blood flow and hypoxia in brain cells. Symptoms appear earlier, can reflect the severity of burn shock, and are a more sensitive indicator of treatment response. When cerebral hypoxia is severe, delirium, mania, disturbance of consciousness, and even coma may occur. However, it needs to be distinguished from cerebral edema and early infection.

5. Nausea and Vomiting

Is one of the early symptoms of burn shock. A common cause is also cerebral hypoxia. The vomit is usually the contents of the stomach, and in severe shock, there may be brown or bloody vomits, suggesting that the mucosa of the digestive tract is severely congested, edema or erosion. Excessive vomiting should consider acute gastric dilatation or paralytic intestinal obstruction.

6. Poor peripheral circulation

In the early stage of burns, pale skin, cold limbs, and sometimes mild cyanosis at the ends, poor filling of superficial veins, and prolonged time to restore normal blood color after pressing nail beds and skin capillaries to make them pale.

7. Changes in blood pressure and pulse pressure

In the early stage of burns, blood vessels constrict, peripheral resistance increases, and blood pressure often increases, especially diastolic blood pressure, so pulse pressure becomes smaller. In the future, decompensation, capillary bed enlargement, blood stagnation, and effective circulating blood volume decrease, then blood pressure begins to drop. Prompt shock has been more serious. Among changes in blood pressure, pulse pressure becomes smaller earlier.

Burn shock examination

Laboratory inspection

The necessary laboratory tests are helpful for the early diagnosis of burn shock and the judgment of the progress of the disease. The changes in the laboratory tests of burns are mainly reflected in the following three aspects: The pituitary-adrenal stress response is manifested by eosinophils, lymphocytes and thrombocytopenia , Blood catecholamine content increased. The reflection of low blood volume, low blood flow, and tissue hypoxia are generally manifested as blood concentration, increased red blood cell count, increased hemoglobin volume and hematocrit, decreased central venous pressure, metabolic acidosis, and reduced partial pressure of arterial oxygen, The carbon dioxide partial pressure is normal or decreased, the arterial blood pH is normal or decreased, the venous blood carbon dioxide binding power is reduced, the blood buffering alkali and the remaining alkali are reduced, etc. In terms of metabolism, it is manifested as blood glucose, blood non-protein nitrogen, increased blood potassium, and blood sodium On the low side. The response of internal organ dysfunction varies with the degree of internal organ failure.

2. Blood pressure measurement

The measurement of central venous pressure is helpful for judging the condition of kidneys. When burns are caused by hypovolemic shock, the CVP (central venous pressure) value is often lower than normal except that the pulmonary arterial pressure is increased due to pulmonary microembolism. It can be 0 or even negative. After the infusion is sufficient, the central venous pressure can return to normal. If the vasospasm has been relieved at this time, the urine volume will increase to 35ml / h, which means that there is no major damage to the kidney. If urine or anuria is present, there may be renal tubular injury, and the possibility of acute renal failure should be considered to be very high.

Burn shock diagnosis

The diagnosis of this disease is not difficult, and shock caused by burns has a history of large-scale burns.

Burn shock treatment

Burn shock is low-volume shock. Severe cases are accompanied by shock lung and other organ damage, and some patients are accompanied by inhalation injury. Therefore, there are obstacles to the circulation and respiratory system. Therefore, the general principles of resuscitation in early burn resuscitation must be followed. Keep airway unobstructed, maintain respiratory function, and maintain cardiovascular function. The reasons for the difficulty of early shock recovery are more complicated, often due to multiple factors. It is important to understand the situation at the time of injury in detail and to examine it carefully.

Fluid replacement

Rehydration is an effective measure to prevent burn shock, and venous channels should be established in time to ensure smooth rehydration.

2. Maintain good breathing function

During shock, especially with inhalation injury, gas exchange function is mostly inhibited, and severe cases may be complicated by acute respiratory failure. Therefore, maintaining good respiratory function is an important measure to prevent burn shock. Mainly to keep the airway open.

3. Application of sedative and analgesic drugs

Severe pain after burns and patient fear are strong stimuli to the central nervous system, so sedation and analgesia have a certain effect on the prevention and treatment of shock. Dulodine or morphine is generally used.

4. Cardiac function adjuvant therapy

During the treatment of severe burns, attention should be paid to improving myocardial ischemia and myocardial energy metabolism, reducing myocardial damage, and actively preventing and treating heart dysfunction.

5. Reduce peripheral vascular resistance

The use of alpha-adrenergic blockers can improve microcirculation blood flow and enhance tissue perfusion. Blood volume should be monitored before medication to prevent the vascular bed from expanding, causing or exacerbating relative hypovolemia, and appropriately correcting metabolic acidosis.

6. Adjuvant renal function treatment

Severe large-scale burn shock, hemoglobinuria or myoglobinuria after deep burns or electric burns, fluid overload, inhalation injury, and combined brain and brain trauma caused by pulmonary edema and brain edema, inorganic phosphorus and other chemical poisoning Causes renal damage, all need good renal function to facilitate urination or excrete poison. After necessary rehydration and diuretic treatment, if you still cannot urinate or the urine output is not satisfactory, artificial kidney replacement therapy can be used in time.

7. Correct acid-base disorders

Metabolic acidosis is caused by increased lactic acid production due to hypoxic metabolism during shock. In the early stages of burns, respiratory alkalosis is often caused by hyperventilation due to tension, pain, shock and inhalation injury and hypoxia. All aspects directly or indirectly affect the balance of acid and alkali in the body and interfere with the stability of blood pH.

8. Hormone therapy

Most are only used when patients have difficulty resuscitation or adrenal insufficiency. For patients with difficult resuscitation, the dosage should be large and the time should be early.

9. Application of oxygen free radical scavenger

In severe burns, the white blood cells in the blood vessels of the burn tissue are activated, and the oxidase on the cell membrane is activated, which enhances the metabolism of the pentose phosphate pathway and generates oxygen free radicals, causing the cells to suffer more severe damage. The use of oxygen free radical scavengers can reduce the damage of various internal organs or tissue cells caused by shock, thereby improving the survival rate of burns.

10. Shock exchange plasma therapy

Using a blood cell continuous separator or a blood cell continuous adder, while removing the patient's plasma, the same amount of frozen fresh plasma is replaced.