Académique Documents
Professionnel Documents
Culture Documents
BURN
MANAGEMENT
: 5 6 Thousand/year
BURN PHASES
1.
2.
SUBACUTE PHASE
- DURING ADMISSION
- WOUND, INFECTION, SEPSIS PROBLEM
3.
LATE PHASE
- AFTER DISCHARGED
- SCAR & CONTRACTURE PROBLEMS
3
ETIOLOGY
1.
FIRE
2.
SCALD
3.
CHEMICAL SUBSTANCES
4.
5.
SUNBURN
6.
7.
BOMB EXPLOSION
4
DEPTH ASSESSMENT
1. 1st DEGREE
- EPIDERMIS
2. 2nd DEGREE
- SUPERFICIAL
- DEEP
3. 3rd DEGREE
- EXTENSION TO
MUSCLE / BONE
11
Second A
caused; hot liquid or
solid
appearance; red,
moist blebs
surface; wet,
sensation; very painful
Second B
caused; hot liquid,
flash flame to clothing
appearance; red,
blebs, edematous
surface; wet
sensation; hipoesthesi
12
13
14
15
WOUND EXTENT
WALLACE
RULE OF NINE
Head & neck
----------9%
Upper extremities 9%
---------- 18%
---------- 18%
---------- 18%
-----------36%
Genital / perineum
-----------1 %
Total
---------- 100%
17
ADULT
ANAK ANAK
10
9
14
9
18 18
18
18 18
18
15 tahun
18
16
18 18
16
5 tahun
14
14
0 1 tahun
SEVERITY CRITERIA
(AMERICAN BURN ASSOCIATION)
1. MILD
- 2nd DEGREE < 15%
- 2nd DEGREE < 10% IN JUVENILES
- 3rd DEGREE < 1%
20
2. MODERATE
- 2nd DEGREE 15-25% IN ADULTS
- 2nd DEGREE 10-20% IN JUVENILES
- 3rd DEGREE < 10%
21
3. SEVERE
- 2nd Degree >25% IN ADULTS
- 2nd Degree >20% IN JUVENILES
- 3rd Degree >10%
- Affected hands, face, ears, eyes, feet, and genital/perineum
- Inhalation injury, electrical injury, or associated with other traumas
22
I.
PRIMARY SURVEY
II.
SECONDARY SURVEY
I.
PRIMARY SURVEY :
Like any other trauma
24
2.
3.
4.
Vital sign
5.
6.
7. Perfussion assesment
8. Continoued ventilatory assesment
9. Pain management
10. Psychosocial assesment
11. Tetanus toxoid profilaxis
12. Measuring body weight
13. Wound cleansing (operating theatre, general anaesthesia)
14. Escaharotomy & fasciotomy
FLUID RESUSCITATION
EVANS FORMULA
BROOKES FORMULA
PARKLANDS FORMULA
BROOKES MODIFICATION
MONAFOS FORMULA
27
BAXTERS FORMULA
DAY 1 :
ADULT:
ANAK :
RL : DEXTRAN = 17 : 3
2 CC X KG BW X %WOUND SURFACE + MAINTENANCE
MAINTENANCE :
< 1 YR : BW X 100 CC
1-3 YRS : BW X 75 CC
3-5 YRS : BW X 50 CC
IN FIRST 8 HRS
NEXT 16 HRS
DAY 2 :
ADULT
: MAINTENANCE
ALBUMIN (IF NECESSARY)
JUVENILE
: MAINTENANCE
2.
JUVENILE
: 1 CC/BW/HR
OLIGURIA
ASSOCIATED WITH SYSTEMIC VASCULAR RESISTANCE & CARDIAC OUTPUT
RECUCTION
3.
4.
BLOOD PRESSURE
5.
HEART RATE
6.
30
31
HAEMATOCRITE
COMPLETE BLOOD COUNT (Hb)
ALBUMIN
RFT & LFT
Heat regulation
Sensory preception
Excretion
Vitamin D production
Expression
important with body image - fear of disfigurement
34
STAGES OF BURNS
Hypovolemic state
begins at the onset of burn and lasts for the first 48 hours - 72
hours
Rapid fluid shifts - from the vascular compartments into the
interstitial spaces
Capillary permeability with burns increases with vasodilation
Fluid loss deep in wounds
Initially Sodium and H2O
Protein loss - hypoproteninemia
35
STAGES OF BURNS
Diuretic Stage
begins 48 - 72 hours after burn injury:
Capillary membrane integrity returns
Edema fluid shifts back into vessels - blood volume increases
Increase in renal blood flow - result in diuresis (unless renal
damage)
Hemodilution - low Hct, decreased potassium as it moves back
into the cell or is excreted in urine with the diuresis
Fluid overload can occur due to increased intravascular volume
Metabolic acidosis - HCO3 loss in urine, increase in fat metabolism
36
SIGNS OF ADEQUATE
FLUID RESUSCITATION
Clear sensorium
Pulse < 120 beats per minute
Urine output for adults 30 - 50 cc/hour
Systolic blood pressure > 100 mm Hg
Blood pH within normal range 7.35 - 7.45
37
38
Signs of Sepsis:
a.
b.
c.
d.
e.
f.
Change in sensorium
Fever
Tachyapnea
Paralytic ileus
Abdominal distention
Oliguria
39
GOALS
1.
2.
3.
4.
2.
3.
4.
5.
41
REFERRAL CRITERIA
1.
2.
3.
4.
5.
6.
7.
8.
42
43
45
Scene
Survey
Patient
Assessmt
Critical
Interventn
Oxygen
Cooling
Stop Bleeding
Ventolin nebulization if pt is wheezing
Identify
LOAD &
GO
Inhalational injury
>= 20% BSA second degree burns
Send to burns centre
NOTIFY
Secondary
Survey
IV Fluids
Wound care
Analgesia
62
63
64
CLINITRON BED
65
66
THANK
YOU