21/01/2015

BURN & COLD

INJURY
Dr Djoni Darmadjaja, SpB,MARS
Konsultan Trauma PABI

RUANG LINGKUP

Thermal
Injuries

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THIRD DEGREE

CHEMICAL BURN

Flush with copious

amounts of water for
20 30 minutes

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ELECTRICAL BURN

Management of Electrical Burns

Fascia and muscle
damage; may spare
overlying skin
Myoglobinuria:
Increase fluids,
administer mannitol
Maintain adequate
perfusion
Sodium bicarbonate
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SASARAN KULIAH

Outline the principles of initial

assessment and treatment of thermal
injuries.
Discuss the importance of the size of
burn injury and associated injuries.
Identify special problems and methods of
treatment.
Specify criteria for transfer of
patients with burns.

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PRIORITAS

A B C D E

Assess the patients

patient s ABCs
AND
Stop the burning!

MANAGEMENT

Manage Airway and Breathing

Consider direct thermal or inhalation

injury.
Establish and maintain patent airway
early and consider early ET intubation.
Oxygenate and ventilate.
Obtain ABGs and CO levels.

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INHALATION TRAUMA
WANITA HAMIL

Carbonaceous sputum
Carbon deposits
CoHb > 10%
Face and neck burns
Hair singeing
Inflamed oropharynx
and hoarseness

SASARAN TERAPI

Maintain Organ Perfusion

Adequate venous access

Monitor vital signs
Hourly urine output
Adult: 0.5 1.0 mL / kg / hour
Child: 1.0 mL / kg / hour
Infant: 2.0 mL / kg / hour
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ESTIMASI DEWASA

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ANAK ANAK

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FLUID RESUCITATION

4 mL warmed balanced crystalloid

solution / kg / %BSA in first 24 hours
(global only)
Administer in first 8 hours
Administer in next 16 hours
Base calculations on time from injury
Monitor heart rate and urinary output

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COLD INJURY

Frostnip
Frostbite
Nonfreezing injury

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TREATMENT

How do I treat a local cold injury?

Do not delay Prevent infection
Remove clothing Elevate exposed
Warmed blankets part
Rewarm frozen part Analgesics,
Preserve damaged tetanus, and
tissue antibiotics

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HYPOTHERMIA

How do I recognize hypothermia?

Rapid or slow drop in core temperature
to < 35C
35 C
Elderly and children at greater risk
Low-
Low-range thermometer required

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TREATMENT

Treatment of Hypothermia
Passive external rewarming:
rewarming: Warmed
environment, blankets, and IV fluids
Active core rewarming: Surgical
rewarming techniques
Do not delay transfer
Not dead until warm and dead
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