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COMBUSTIO
Dr.Dian Syahputra
PROBLEMS
4 stages acute management
1. 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.
Mass catastrophe :
-Bomb blast
-Bali 2002
-Marriot 2003
-Polonia Airplane
crash 1987
Prognosis :
100 Age + % BSA
Mental Psychosocial support
Sumatra :
NO BURN UNIT
DIAGNOSE
1.
2.
3.
4.
Ethiology
GRAde
SUrface area
LOcation
Grade
Deep : I, II, & III
% BSA
Specific areas
D : e-burn gr@sulo
ETHIOLOGY
Anamnesis :
SCALD
FLAME
ELECTRICAL
CHEMICAL
INHALATION
Grade/Severity
I & II
II & III
III
III
respiratory
GRADE
Erythema
Blister
Pinprick ( - )
ESTIMATION OF
BODY SURFACE AREA
9
9 9
BSA
1%
Rule of Nine
Hands Palm = 1%
LOCALIZATION
Special Area
: JOINT
HANDS
FACE
AURICLE
PERINEUM
Woman Breasts
PATHOPHYSIOLOGY
Fluid
Fluid
Electrolit Protein
Electrolit Protein
Increase
permeability
Interstitial tissue
Interstitial tissue
Haemoconsentration
HYPOVOLUMIC
SHOCK
SEVERITY OF BURN
Severe
Moderate
Mild
MANAGEMENT
1. General/Medical Treatment :
Fluid Resusitation
Prevention infection
2. Local : Topical Antibiotic
3. Surgery :
a. Debridement
b. Excharatomy
c. Excicion + Grafting
d. Granulating Tissue + Grafting
ESTIMATION OF
FLUID RESUSCITATION
Parkland 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
ATTENTION
Inhalation burn
face neck
Respiratory distress
first 24 hours & 1-5 days
Sistemic Antibiotic
Tetanus Prophylactic
Analgesic & Sedatives
Nutritional support :
Formula
TOPICAL ANTIBIOTIC
Silver Sulfadiazine
Cream in consentration of 1 %
Applied twice daily : open or
close
Effective Gram + & Gram
Silver Nitrat (0,5 % solution)
Sulfanylon
Debridement
Escharatomy
SURGERY
Prevention :
Position arm & leg
Thin
Grafting : STSG
Prompt
1 2 weeks Granulating
Moderate
Large : Electro Dermatome
MESH Graft
Scald Burn
Cemical Burn
Electrical Burn
Flame Burn
Upper Arm
Escharatomy
Granulating Tissue
1-2 weeks
Grafting
COMPLICATION
Pulmonary Oedema
Gastrointestinal
33% Curling Ulcer
Infection : - Septichemi
- UTI
- Auricular chondritis
Late Complication
6 months 2 years
1. Contracture
2. Keloid
Finger contracture
Ed Sept 2003