luka bakar
TRANSCRIPT
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LUKA BAKAR
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Burn injury management principles * Establish / maintain
airway Normal perfusion Fluid / electrolit balance Normal body temp
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Inhalation injuryClinical indication :Carbonaceous sputumFacial burnHair ?Carbon depositIn ? OropharynxHistoryCO Hb > 10 %
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LIVE SAVING BURN TREATMENT Remote all : - injurious material - clothing, jewelry
Prevent hypothermiaEstablish 2 large caliber IV lineInitiate warmed RL sol
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BURN assesment history Mechanism of injuryAssociated illnessAllergiesTetanus status
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Rule of nine ADULT Posterior & anterior INFANT
Palm surface 1 % BSA
Illustrasi.
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Depth of bur Illustrasi picture
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Burn management airway Asses for injury Establish and maintain patent airway early
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Burn management breathing Assume CO exposure Inhalation of toxic fumes, carbon particles Direct thermal injury Oxygenated / Ventilate ET intubation ABG s and CO level
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Burn management circulation Adequate venous acces Monitor vital signs Hourly urinary output - adult : 30 50 cc / hour - child : 1,0 cc/ kg BB / hour
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Burn management circulation Estimate fluid needs - 2 4 cc warmed RL so /kg BB / % BSA in first 24 hour in first 8 hour in next 16 hour
Based on time from injuryMonitor HR and urinary output
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Burn management develop treatment plan
Estimate burn size / depth Identify associated injuries Weigh patient Baseline blood analyses and chest X ray Document on flow sheet
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Burn management maintain peripheral circulation Remove all constricting devices
Asses distal circulation
Escharotomy : surgical consultation
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Burn management gastric intubation Nausea, vomiting, distentionBurn > 20 % BSAMedication : - narcotis minimal use, IV only - antibiotics NOT indicated early
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Burn management wound care Cover with clean linen Do not - break blister - apply antiseptic - apply cold water
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Burn management chemical burn
Duration, concentration, amount Brush away dry chemicals Flush with copious amaount of water for 20 30 minutes
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Burn management electrical burn * Result in damage to fascia and muscle and may spare the overlying skin
* Fasciotomy needs
* A B C D E s
* Myoglobinuria : fluid 100 cc urine / hour mannitol 25 gr I.V
* Metabolic acidosis : maintain adequate perfusion
sodium bicarbonate
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Burn transfer criteria * II and III degree burn : - 10 % BSA in ages < 10 and > 50 years - > 20 % BSA - To face eyes ears hands feet genitalia perineum major joint
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Burn transfer criteria
* III degree burn > 5 % BSA* Electric and chemical burn* Inhalation injury* Pre existing illness, associated injury* Children* Special situation
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Burn transfer procedure * Coordinated with burn center doctor
* Transfer with : Documentation / information laboratory results