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INFANT WITH

THERMAL BURN
PRESENTED BY :
H ANANI KUSUMAS ARI

G9 9152076

NADIRA ASAD G99161065


U TARI NUR ALIFAH

G99161100

Tutor : dr. Amru Sungkar, Sp. B, Sp.BP-RE


(K)

Patients Status
Name

: An. L

Age

: 5 months

Sex

: Female

Religion

: Islam

Ocupation : Address

: Mojogedang, Karanganyar

Admission date

: 08 Oktober 2016

Examination date : 10 Oktober 2016


MR number

: 01355548

Chief Complain
Thermal burn because of hot water

Present Ilness
The patient come with thermal burn as major complain
that occurred about 4 hours before enter hospital.
Patient played with her brother while their mother bring
a pot with hot boiled water. Unintentionally, her brother
pushed their mother and the pot dropped off then the
hot water splashed onto her face. Patient have a thermal
burn scar in face, body and left lower limb. Patient came
first to Karanganyar Hospital but due to unsupported
facility, they referred to dr. Moewardi Hospital.

Past History
Allergy

: denied

Hypertension

: denied

Diabetes Mellitus : denied


Heart Diseases
Past Trauma

: denied
: denied

Family History
Drug Allergy

: denied

Hypertension

: denied

Diabetes Mellitus : denied


Heart Diseases

: denied

Lifestyle History
Patients receive only breast milk due to exclusive
breastfeeding

Socioeconomic History
Patient is a BPJS insurance user

Systemic Anamnesis
Head : cephalgia (-), scar (+) in face
Eyes : Yellow eyes (-), eye redness (-)
Respiratory system

: shortness of breath (-), nasal voice (-),

Cardiovascular system

often choking (-)

: chest pain (-), dyspnea on exertion (-)

Gastrointestinal system : nausea (-), vomiting (-), abdominal pain (-), diarrhea
(-)
Genitourinary system : pain (-), urinated blood (-)
Upper Musculoskeletal system : oedem (-/-), scar (-/+), cold acral (-/-), pain (-/-)
Lower Musculoskeletal system : oedem (-/+). Scar (-/+), cold acral (-/-), pain (-/
+)

Physical Examination
1. Primary Survey
Airway

: Clear

Breathing : Thoracoabdominal, respiration rate 24x/min


Circulation: Heart Rate 124x/min, stable
Disability : GCS E4V5M6, isokor pupil (3mm/3mm)
Exposure : Body temperature 36,7C, lession (+) look at status localis

2. Secondary Survey
Head : mesocephal, scar (+) look at status localis
Eyes : pale conjunctiva (-/-), icteric sclera (-/-), isokor pupil (3mm/3mm),
light reflex (-/-), periorbital hematoma (-/-), diplopia (-/-)
Ears

: Secret (-/-), blood (-/-), mastoid pain (-/-), tragus pain (-/-)

Nose

: Symmetric, nasal flaring (-), secret (-), blood (-)

Lip : Gum bleeding (-), dirty tongue (-), lesion (-), malocclusion (-)
Neck : Thyroid enlargement (-), lymphonodes enlargement (-), pain (-),
normal JVP
Thorax : Normochest, lesion (-)

Cor
Inspection : ictus cordis not showed
Palpation : ictus cordis did not palpable
Percussion : heart enlargement (-)
Auscultation
: normal heart sound

Pulmo
Inspection : normal breath movement
Palpation : normal fremitus
Percussion : sonor/sonor
Auscultation
: vesicular sound normal

Abdomen
Inspection : distended abdomen (-)
Auscultation
: normal sound
Palpation : pain (-), muscular defense (-)
Percussion : tympanic sound
Genitourinaria : normal
Musculosceletal: pain (+), Range of Motion cant be examined
Extremety :
Cold acral

Edema

Status Localis
Regio Facialis
Inspection : combustion grade II 5%, bullae (+)

Regio Thorax Anterior


Inspection : combustion grade II 7%, bullae (+)

Regio Abdomen
Inspection

: combustion grade II 1%, bullae (+)

Regio Femur sinistra


Inspection

: combustion grade II 4%, bullae (+)

Regio Femur dextra


Inspection

: combustion grade I 1%, erythema(+)

Clinical Presentation

Assessment I
Combustion due to hot water grade I-II 18%

Planning I
Blood examination
RL Infussion 20 tpm
Ceftriaxon Injection 1 gr/12 hrs
Ketorolac Injection 1 amp/8 hrs
Check O2
Debridement

Literature Review

Definiton
Thermal Burn is a tissue damaging or loss due to extreme heat source, cold
source, electric source, chemical compounds, light, radiation, or friction.

Pathopysiology

Local response

Systemic Response

Measure the burn area

Degrees of burn

Severity of burn

Management of thermal burn

Nutritional management
Nutritional care for a patient in burns is adjusted to individual needs and
given in three stage :
Ebb phase/shock period : in the first 24 hours, responds to fluid resuscitation
Flow/recovery phase, resuscitation : characterized by gradual increases in cardiac
output, heart rate, oxygen consumption and supranormal increases of temperature
Anabolic phase/hypermetabolic hyperdinamic response : in 10-14 days after the
injury after which condition slowly recedes to normal as the burn wounds heal
naturally or surgically closed by applying skin grafting

Goals of Nutritional
Management
To promote optimal wound healing and rapid recovery from burn injuries
To minimise risk of complication including infection
To attain and maintain normal nutritional status
To minimise metabolic isturbances during the treatment process

Objectives of Nutritional
Management
Provide nutrition bia enteral route within 6-18 hours post burn injury
Maintain weight within 5-10% of pre burn weight
Prevent signs and symptoms of micronutrient deficiency
Minimize hyperglycaemia
Minimize hypertriglyceridaemia

Enteral feeding should be commenced early


Aggressive nutritional support is often required
Energy requirements are elevated by burn injury
Protein requirements are substantially increased
An increased requirement exist for nutrients associated with healing and
immune function

Mode of feeding
Enteral nutriton support with high protein, high carbohydrate diet. Feeding
started within 4-36 hours following injury appear. Enteral support can reduce
the burn related increase in secretion of catabolic hormones and help
maintain gut mucosal integrity.
Total parenteral nutriton is not recommended, due to its ineffectiveness in
preventing the catabolic response to burns.

Energy and Macronutrient


Support
Adults : 25 calories per kilogram plus 40 calories per each percent of burn
area
Children : 1800 calories plus 2200 calories per m2 of burn area

Nutritional management in
infant with burn trauma
Expressed Breast Milk (EBM)
Standard Infant Formula (e.g SMA Gold, C&G Premium)
Specialist Infant Formula (e.g Pregestimil, Neocate)
May be required in certain clinical conditions

High Energy Infant Formula (e.g Infatrini, SMA High Energy)


Infantri is not recommended for infants <3kg

Preterm Infant Formula


Can be used in the absence of EBM in infants weighing <2.5 kg