BURN COMBUSTIO Dr.Dian Syahputra

Division of Plastic Surgery, School of Medicine North Sumatra University

Superficial Soft Tissue damage due to :- Dry and moist heat - Electrical current- Chemical fluid

PROBLEMS4 stages acute management1. Anticipation of shock/fluid resuscitation and respiratory function disorder.2. Prevention of secondary infection.3. Proper management of burned tissue with early grafting of deep burn skin loss. 4. Prevention of complication including late complication contracture and keloid.

Prognosis : 100 Age + % BSA Mental Psychosocial supportMass catastrophe :Bomb blastBali 2002Marriot 2003Polonia Airplane crash 1987Sumatra : NO BURN UNIT

DIAGNOSEEthiologyGRAdeSUrface areaLOcation { D : e-burn gr@sulo }GradeDeep : I, II, & III% BSASpecific areas

ETHIOLOGYAnamnesis : Grade/SeveritySCALDI & IIFLAME II & IIIELECTRICALIIICHEMICALIIIINHALATIONrespiratoryTime of injury fluid resusitation first 8 hours

GRADEErythema BlisterPinprick ( - )

ESTIMATION OF BODY SURFACE AREARule of NineHands Palm = 1%999999999991 %% BSA

Lund & Browder Chart

LOCALIZATIONSpecial Area : JOINT HANDSFACE AURICLEPERINEUM PALM & SOLE Woman Breasts

PATHOPHYSIOLOGYFluidElectrolitProteinIncrease permeability HaemoconsentrationHYPOVOLUMIC SHOCKInterstitial tissueFluidElectrolitProteinInterstitial tissue

SEVERITY OF BURNSevereModerateMild

MANAGEMENTGeneral/Medical Treatment :Fluid ResusitationPrevention infectionLocal : Topical AntibioticSurgery :a. Debridementb. Excharatomyc. Excicion + Graftingd. Granulating Tissue + Grafting

ESTIMATION OF FLUID RESUSCITATIONParkland Hospital Formula : 24 hours 4 ml Lact. Ringers x % BSA x Kg BW = X ml X ml in first 24 hours x ml in first 8 hours 24 48 Koloid

Foley catheter : urine out put / hours 1 ml / kg BW/ hoursRenal functionSerum electrolite level (K+)Albumin / Globulin ratio

ATTENTIONInhalation burn face neck

Respiratory distress first 24 hours & 1-5 days

Sistemic Antibiotic Tetanus ProphylacticAnalgesic & Sedatives Nutritional support : Formula Curreri (24 hours caloric requirment) Adult : 25 kilocal/kg BW + 40 kilocal % BSA Child : 60-90 kilocal/kg BW + 35 kilocal % BSA

TOPICAL ANTIBIOTICSilver SulfadiazineCream in consentration of 1 %Applied twice daily : open or closeEffective Gram + & Gram

Silver Nitrat (0,5 % solution)Sulfanylon

SURGERYDebridementEscharatomy Prevention : Position arm & leg

Grafting : STSG

ThinModeratePrompt1 2 weeks Granulating TissueLarge : Electro DermatomeMESH Graft

Scald Burn

Scald Burn with Pregnancy

Scald Burn in specific area

Flame Burn Suicide 40%

Flame Burn 30%

Cemical Burn

Electrical Burn

Flame Burn Upper ArmEscharatomy

Granulating Tissue 1-2 weeks Grafting

COMPLICATIONPulmonary OedemaGastrointestinal33% Curling UlcerInfection : - Septichemi - UTI - Auricular chondritisLate Complication6 months 2 years1. Contracture2. Keloid

Late complication Keloid

Finger contracture

Diagnose e-burn gr@suloEmergency life saving live saving Prevent infection & deformity

MortalityMorbidityEd Sept 2003

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