Thermal Injuries

• Thermal destruction of the skin

results in severe local and systemic
alterations
• This destruction can occur from
thermal energy from burns, chemical
reactions, electricity, or the response
to cold
• The management of the patient with a
major thermal injury diagnosis and
treatment not only of the local skin; the
hemodynamic, metabolic, nutritional,
immunological and psychologic,
homeostatic mechanisme
A.Pathophysiology
1.Amount of tissue destruction is based on
temperature and time of exposure
2.Three zones of injury within a major burn
a.zone of coagulation
cells irreversibly damaged
b.zone of stasis
cells injured and without specialized
treatment will die within 24-48 hours
c.zone of hyperemia
cells minimally injured and will recover
within 7 days
 Zone of Injury

Zone of Coagulation
Zone of
Zone of Hyperemia
Stasis
B.Diagnosis
1.Burn size
% of total body surface area (TBSA)
burned
2.Age
Burns at the extremes of age carry a
greater morbidity and mortality (beware
of patiets 3 or 60 years old
luas luka bakar
Lund and Browder chart
3.Depth
Very difficult to tell initially
a.History of etiologic agent and time of
exposure will helpful
b.Flame burns deeper than scald burns
c.Classification
1.First degree
2.Superficial partial thickness
3.Deep partial thickness
4.Full thickness
4.Location
5.Inhalation injury
Beware of closed quarter burne, burned
nasal hair, carbon particles in pharynx
Burn shock
1. Massive amount of fluid, electrolytes and
protein are lost to the circulation almost
immediately after burning
2. Two basic mechanisms account for fluid
loss and both the prevention and
treatment of burn shock depends upon
understanding these two mechanisms:
 a.Uptake of water and sodium ions by the
injured tissue in zone of stasis
b.Total body capillary permeability occurs
in patients with burns > 30 % TBSA
3.Resuscitation
Requires replacement of sodium ions and
water to restore plasma volume and
cardiac output
a.Many formulas have been reported to
effect resuscitation
1.This can be given by prescribing
4 cc ringer’s lactate/Kg/%TBSA burn
over the first 24 hours ( Baxter of
Parkland hospital formula)
Monitoring Resuscitation
1.Best guide
2.other guides to adequate resuscitation
Treatment of the burn woud
1.wound closure by patient’s own skin is the sine
qua non of treatment
a.By spontaneous healing or by autograft
b.Small ( < 15 % TBSA ) full thickness burn are
best treated by early excision and grafting
c.Larger burns need protection from infection
until necrotic tissue can be excised and
closure obtained
Terima Kasih