Thermal Injury

Aditya Islami
Kepaniteraan Klinik Ilmu Bedah
Pembimbing: dr. Rantapina Kurnia Sari, Sp.B

Introduction
Thermal injuries are major causes of morbidity and
mortality. Attention to the basic principles of initial
trauma resuscitation and timely application of simple
emergency measures

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

Immediate Life Saving

Airway
Clinical indications of inhalation injury
include:

Face and/or neck burns

Singeing of the eyebrows and nasal vibrissae
Carbon deposits and acute inflammatory
changes in the oropharynx
Carbonaceous sputum
Hoarseness
Explosion with burn to head and torso
Carboxyhemoglobin level greater than 10%
on patient who was involved in a fire
Stridor Immediate Endotracheal Intubation

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

Immediate Life Saving

Stop the Burning Process
Remove all clothes
involved body-surface areas should be rinsed with
copious amounts of water
The patient then should be covered with warm, clean,
dry linens to prevent hypothermia.
Intravenous Access
Large Caliber

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

Assessment
History

Associated Injury
Explosions
Burns in Enclosed Space Inhalation Injury
Preexisting illnes, medication, allergy, drug sensitivity

Total Body Surface Area (TBSA)

Rule of Nine

Depth of Burns

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

Assessment Body Surface Area

The infant's or young

child's head larger
proportion of the
surface area, and the
lower extremities
smaller proportion
Infants head 2x
Adult

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

Assessment Depth of Burn

First Degree Burns (eg.

Sunburns) eritema, pain,
blisters (-)
Superficial and Depth
Partial Thickness/Second
Degree red mottled
appearence, swelling,
blisters, wet appearence,
painfully hipersensitive
Full Thickness/Third
Degree Dark & leathery.
Also Translucent, mottled,
waxy white. Painless,
generally dry

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,

William S. Norman et al. Bailey & Love's Short Practice of Surgery. Boca Raton. CRC Taylor & Francis Group.

William S. Norman et al. Bailey & Love's Short Practice of Surgery. Boca Raton. CRC Taylor & Francis Group.

Primary Survey & Resuscitation

Airway
Determine Inhalation Injury Upper Airway
Edema/Obstruction. Treatment Intubation

Breathing
Inhalation of Carbon Particles Chemical Tracheobroncitis,
Pneumonia
CO poisoning HbCO measurement
Treatment High-flow O2 via Non-Rebreathing Mask
Head-Chest Up 30o reduce neck & chest edema

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,
USA. 2008

Primary Survey & Resuscitation

Circulating Blood
Volume
Assess sign of Hypovolemic
Shock
Determine TBSA
Calculate first 24 hours fluid
replacement
Ringer Lactate is widely
used
Monitoring Urine Output
0,5-1 cc/kgBB

Fluid Replacement (ml) = 4 x TBSA

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,
USA. 2008

Secondary Survey & Related Adjuncts

Physical Examination
Documentation
Obtain samples for complete blood count,
carboxyhemoglobin, serum glucose, electrolytes,
arterial blood gas (measurement of HbCO). Chest x-ray
(find associated injuries)
Peripheral Circulation in Extremity Burns
Escharotomy & Fasciotomy
Gastric Tube Insertion
Narcotics, Analgesics, and Sedatives

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,
USA. 2008

Secondary Survey & Related Adjuncts

Wound Care
Cover burn with clean linen, dont break any blisters. Do not
apply cold water to patients with extensive burns (>10% TBSA)

Antibiotics
Tetanus Immunization

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,
USA. 2008

Treating the Burn Wound

Escharotomy
Circumferential fullthickness burn to limb
Dressing with
Nanocrystaline Silver

American Colleges of Surgeon. Advanced Trauma Life Support, Student Course Manual 8th Edition. Chicago,
USA. 2008

Thank You