A 42 YEARS OLD MAN WITH FIRE

BURN WOUND IN BOTH LIMBS

Oleh :
I Kadek Ludi Junapati
G99142020
Krisnawati Intan S.
G99152095
Zakka Zayd
Z. J.
Pembimbing
: dr.
AmruG99152100
Sungkar, Sp. B,
Sp.BP-RE (K)

PATIENT STATUS
Identitas Pasien
Name: Mr. S
Age
: 42 years old
Gender : Male
Religion : Islam
Occupation : Farmer
Address : Madiun
Admission Date
: 24 March 2016
Examination Date
: 29 August 2016
MR Number: 01333865

CHIEF COMPLAIN
Fire Burn Wound in both limbs

PRESENT ILLNESS
5 hours before admissioned
the patient was burnt while
igniting diesel powered
machine in the ricefield. The
patient was concious, shortbreathness (-), vomitus (-).
The patient was brought to
Hospital in Madiun. Due to
the lack of facilites, the
patient was referred to

PAST HISTORY

Allergy
: denied
Hypertension
: denied
Diabetes Mellitus
: denied
Heart Diseases
: denied
Past Trauma
: denied

FAMILY HISTORY

Drug Allergy
: denied
: denied
Hypertension
: denied
Diabetes Mellitus
: denied
Heart Diseases

SYSTEMIC
ANAMNESIS
Eyes : Yellow eyes (-), eye redness (-)
Ears : blood (-), mucus (-), liquid (-), hearing loss (-)
Mouth: blood (-), bleeding gums (-), mouth sores (-), dry mouth
(-),
wobbly teeth (-), Malocclusion (-)
Nose : olfactory decrease (-), blood (-), secretions (-)
Respiratory system
: shortness of breath (-), nasal
voice (-),
often choking (-)
Cardiovascular system
: chest pain (-), dyspnea on exertion
(-)
Gastrointestinal system : nausea (-), vomiting (-), abdominal
pain
(-), diarrhea (-)
Musculoskeletal system : muscle pain (-), joint pain (-)
Genitourinary system
: pain (-), urinated blood (-)

PHYSICAL
EXAMINATION
I.

PRIMARY SURVEY

A. Airway: clear
B. Breathing 20 times / min
Palpation : crepitus (- / -)
Percussion : sonor / sonor
Auscultation : Vasicular sound (+ / +), Additional sound (/ -)
C. Circulation : blood pressure 140/90 mm Hg, pulse 100 x /
minute
D. Disability : GCS E4V5M6, light reflex (+/+), isochoric
pupil,
lateralization (-)
E. Exposure : temperature 36 C, injury (+) see local

II. SECONDARY SURVEY

Combustio
18%

Combustio
18%

Figure of Location Burn

Injury

Figure of Location Burn

Injury

DIAGNOSI
S
Fire Combustio grade II B
36%

PLANNING I

Complete blood check

Wound treatment using wound dress dan tulle
RL Infusion 20 tpm
Ceftriaxon Injection 1 gr/12 hrs
Ranitidin Injection 1 amp /12 hrs
Ketorolac Injection 1 amp/8 hrs
Mobilization to the left and right

LITERATURE
REVIEW

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

ETIOLOGI

Therm
al Burn
Electric
al Burn

Chemic
al Burn
Radiati
on
Burn

PATOPHYSIOLOGY
Burn Wound is
present because of
energy movement
from the source to
the body

Shock physiology in Burn

Wound is due to the fluid loss
from massive capillary
circulation.

Severity of Burn
Wound depends on
the cause factor, the
time length of heat
contact, and the area
of Burn Wound.
Burn Wound response will
increase the blood stream
to vital organ and reduce
the blood stream to
peripheral sites and nonvital organs.

Metabolic response in Burn Wound is

hypermetabolic since there are
metabolism and temperature
increase.

Burn Wound Area

rule of nine or rule of Wallace

Kepala dan leher

9%
Lengan kiri
9%
Lengan kanan
9%
Perut
9%
Bokong/pinggang 9%
Dada
9%
Punggung
9%
Tungkai atas kiri 9%
Tungkai atas kanan 9%
Tungkai bawah kiri 9%
Tungkai bawah kanan
9%
Genitalia
1%

Burn Wound Area referred to Lund and Browder :

Area luka bakar

0-1 Tahun

1-4 Tahun

5-9 Tahun

10-14 Tahun

15 Tahun

Kepala
Leher
Dada
Punggung
Lengan kanan atas
Lengan kiri atas
Lengan kanan bawah

19
2
13
13
4
4

17
2
13
13
4
4

13
2
13
13
4
4

11
2
13
13
4
4

9
2
13
13
4
4

Lengan kiri bawah

Tangan kanan
Tangan kiri
Genetalia
Bokong kanan
Bokong kiri
Paha kanan
Paha kiri
Tungkai kanan
Tungkai kiri
Kaki kanan
Kaki kiri

3
2,5
2,5
1
2,5
2,5
5,5
5,5
5
5
3,5
3,5

3
2,5
2,5
1
2,5
2,5
6,5
6,5
5
5
3,5
3,5

3
2,5
2,5
1
2,5
2,5
8
8
5,5
5,5
3,5
3,5

3
2,5
2,5
1
2,5
2,5
8,5
8,5
6
6
3,5
3,5

3
2,5
2,5
1
2,5
2,5
9
9
6,5
6,5
3,5
3,5

BURN WOUND DEGREE

MANAGEMENT

Acute Phase
Death because of inhalation
damage will be present in 8
24 hours after trauma.
Endotracheal pipe and/or
cricothyrotomy is a
compulsory measure in
inhalation damage suspect.
Following therapy after the
life-saving procedure
(Inhalation theraphy,
Airway clearance, patient
positioning, physiotheraphy
as soon as possible.
Shock management,
especially hypovolemic
shock.

Subacute Phase

Clothing
Cooling
Cleaning
Covering Comforting

Burn wound inpatient indication:

Second Degree (Adult > 30 %, Children > 20 %).

Third Degree> 10%

Burn Wound with respiratory tract, fracture, and severe soft tissue trauma
complications.

Electric burn wound

Third Degree in critical body parts such as face, hands, feet, eyes, ears, ears, and
anogenital.

Shock or Shock threatened patiens if the burn wound > 10% in children or > 15%
in adults

Larynx edema threatening due to somke or warm air inhalation

The wound location could lead to severe disabilities such as in face, eyes, hands,
feet, or perineum.

The burn wound location in face, hands, genital, or feet.

The patient is unable to treat the wound well in home.

The patient is <2 years old or >70 yeaars old.

Burn wound in internal organs.

Two wound treatment :

Exposure method
Occlusive dressing method

PROCESS THE WOUND HEALING OF

BURN INJURY
The wound healing is divided into two: Acute and Chronic. An acute wound is
the wound that would be healed in 2 3 weeks.Chronic wound is the wound
that would be healed in/ more than 4 6 weeks.

Inflammatory Phase
This phase is going
immediately after
the wound is present
and is finished in 3
4 days. Consisted of
two main processes:
hemostasis and
phagocytosis.
The wound area is
reddish and swelling.

Proliferative Phase
This phase is going
from the 4th day to
21st day.
Granulation tissue is
formed, consisting
fibroblast,
inflammation cell,
new vascular,
fibronectin, and
hyaluronic acid.

Maturation Phase
This phase is going
from 21st day for 1
2 years.
The wound area
would be shrinking,
elasticity would be
decreasing, and the
white line would be
formed.
There is wound
remodelling
Fibrous tissue is
formed with strength
of 5080%
compared to the

MAJOR BURN INJURY

2nd grade more than 25%

3rd grade more than 10% or there are at
face, legs and hands
Burn injury with Inhalation trauma/ wide
soft tissue or fracture
Burn injury cause of electric

Limited Donor

Relationship with treatment of burn

injury as skin graft
Limited skin graft located in the body
such as inguinal, supraclavicula or
infraclavicula
Total body surface area as resipien of
skin graft need to much impared donor
of skin graft

Contracture

Contraction is an active biological process by which an

area of skin loss in an open wound is decreased due to
concentric reduction in the size of the wound. The
reduction in size of wound causes lesser degree of
connective tissue deposition and the amount of
epithelialisation needed is decreased.
Wound contraction involves an interaction of
fibroblasts, myofibroblasts and collagen deposition and
is a satisfactory mechanism when the tissue loss is
small, in a non-critical area and surrounded by loose
skin.
Scar contracture, on the other hand, is the end result of
the process of contraction.

The Hypermetabolic Response to

Burn Injury

Severe burn injury is followed by a profound hypermetabolic

response that persists up to 24 months after injury. It is
mediated by up to 50-fold elevations in plasma
catecholamines, cortisol and inflammatory cells that lead to
whole body catabolism, elevated resting energy
expenditures and multi-organ dysfunction.
All of these metabolic and physiologic derangements
prevent full rehabilitation and acclimatization of burn
survivors back into society.
Modulation of the response by early excision and grafting of
burn wounds, thermoregulation, early and continuous
enteral feeding with high proteinhigh carbohydrate feedings
and pharmacologic treatments have markedly decreased
morbidity.

THANK YOU