LUKA BAKAR

Burn injury management principles * Establish / maintain

airway Normal perfusion Fluid / electrolit balance Normal body temp

Inhalation injuryClinical indication :Carbonaceous sputumFacial burnHair ?Carbon depositIn ? OropharynxHistoryCO Hb > 10 %

LIVE SAVING BURN TREATMENT Remote all : - injurious material - clothing, jewelry

Prevent hypothermiaEstablish 2 large caliber IV lineInitiate warmed RL sol

BURN assesment history Mechanism of injuryAssociated illnessAllergiesTetanus status

Rule of nine ADULT Posterior & anterior INFANT

Palm surface 1 % BSA

Illustrasi.

Depth of bur Illustrasi picture

Burn management airway Asses for injury Establish and maintain patent airway early

Burn management breathing Assume CO exposure Inhalation of toxic fumes, carbon particles Direct thermal injury Oxygenated / Ventilate ET intubation ABG s and CO level

Burn management circulation Adequate venous acces Monitor vital signs Hourly urinary output - adult : 30 50 cc / hour - child : 1,0 cc/ kg BB / hour

Burn management circulation Estimate fluid needs - 2 4 cc warmed RL so /kg BB / % BSA in first 24 hour in first 8 hour in next 16 hour

Based on time from injuryMonitor HR and urinary output

Burn management develop treatment plan

Estimate burn size / depth Identify associated injuries Weigh patient Baseline blood analyses and chest X ray Document on flow sheet

Burn management maintain peripheral circulation Remove all constricting devices

Asses distal circulation

Escharotomy : surgical consultation

Burn management gastric intubation Nausea, vomiting, distentionBurn > 20 % BSAMedication : - narcotis minimal use, IV only - antibiotics NOT indicated early

Burn management wound care Cover with clean linen Do not - break blister - apply antiseptic - apply cold water

Burn management chemical burn

Duration, concentration, amount Brush away dry chemicals Flush with copious amaount of water for 20 30 minutes

Burn management electrical burn * Result in damage to fascia and muscle and may spare the overlying skin

* Fasciotomy needs

* A B C D E s

* Myoglobinuria : fluid 100 cc urine / hour mannitol 25 gr I.V

* Metabolic acidosis : maintain adequate perfusion

sodium bicarbonate

Burn transfer criteria * II and III degree burn : - 10 % BSA in ages < 10 and > 50 years - > 20 % BSA - To face eyes ears hands feet genitalia perineum major joint

Burn transfer criteria

* III degree burn > 5 % BSA* Electric and chemical burn* Inhalation injury* Pre existing illness, associated injury* Children* Special situation

Burn transfer procedure * Coordinated with burn center doctor

* Transfer with : Documentation / information laboratory results