dr.  Robertus  Arian  D.IGD  RS  Panti  RapihB  U  R  N

http://robertusarian.com;  @robertus_arian;  arian9677@gmail.com

http://i.treehugger.com/

Saturday, January 26, 13

Etiology

• scald

• grease

• flames

• flash

• contacts

• electrical

• chemical agentshttp://www.backgroundpictures.org

Saturday, January 26, 13

Diagnosis of Burn Wound

depth of injury (temperature, heat capacity, duration

of exposure, thickness of skin)size

locationpossible complication

Saturday, January 26, 13

http://www.indiasurgeons.com

Saturday, January 26, 13

Zone of Coagulation

• burn eschar, 3-24 hours post burn

• platelets and leucocyte adhesion on the surface of injured endothelial cells

• local thrombosis, blood clotting, fibrin plug

http://www.indiasurgeons.com

Saturday, January 26, 13

Zone of Stasis

• cells are viable, can easily be further damaged

• capillary thrombosis from injured endothelium: ischemia-induced cell death

• continued release of mediators: thrombosis, vasoconstriction

• impairment of blood flow: converts to dead eschar

http://www.indiasurgeons.com

Saturday, January 26, 13

Zone of Hyperemia

• minimal cell injury

• vasodilation: neighbouring inflammation

http://www.indiasurgeons.com

Saturday, January 26, 13

determining the depth of burns on initial presentation may prove difficult even for experienced burn

specialists

Saturday, January 26, 13

Saturday, January 26, 13

First Degree Burn:• remains confined to the epidermis;• example: a nonblistering sunburn;• rarely are of medical consequence, heal rapidly, and

are not included in burn size estimation

Second Degree Burn:• extends into the dermis, example: blistering scald burn;• superficial partial thickness burn: only the superficial layer of

the dermis involved, heal less than 21 days, generally do not require skin grafting;

• deep partial thickness burn: deeper involvement in dermis (skin appendage), reepithelization more than 21 days, generally benefit from skin grafting

Third Degree Burn:• involve the entire depth of the dermis and epidermis;• heal only by contraction from the edges over a

prolonged period of time• skin grafting is required

Saturday, January 26, 13

Saturday, January 26, 13

Saturday, January 26, 13

Managementit is important for the patient to realize that this burn

centre stay is only the first part of their recovery

the management of burn STARTS at the scene of the accident

reduce the AREA and the DEPTH of the burn

STOP the burning process and COOL the burn wound

Saturday, January 26, 13

First -aid at Scene

• remove fom the source

• take off clothes, rings, etc

• irrigate in tap water 10-20 minutes

• more than 10% tbsa ==> hospital

• do NOT apply toothpaste, butter, etc... http://www.fotobank.ru

Saturday, January 26, 13

Emergency Room

• standard trauma care

• fluid resuscitation

• wound care after stabilization

http://microgravity.grc.nasa.gov

Saturday, January 26, 13

Wound Care

• open the blister, remove the fluid

• do NOT remove the blister/skin

• wash the wound with chlorhexidine 0,05%

• painful: analgesics, consider narcose

• apply topical dressing

Saturday, January 26, 13

Aim of Dressing

• moist and warm

• migration of epithelium cell from peripheral to central

• patient comfort

• less pain

• easy to monitor

Saturday, January 26, 13

Traditional Dressing

• tulle, moist gauze

• has been used fo many years

• cheap, easy

• more colonization of bacteria

• pain when changing dressing

• eschar separation, difficult to excise

• difficult to monitor

Saturday, January 26, 13

Silversulphadiazine• has been used for many

years

• transient leucopenia, toxic to kidney

• eschar separation maks difficult to excise and judge

• kill keratinocytes, impaired wound healing http://www.mountainside-medical.com/

Saturday, January 26, 13

Transparent Dressing

• practical

• moist and warm

• reepithelization

• non sticky

• easy to monitor

• comfort, less pain when changing

• early mobilization http://img.medscape.com/

Saturday, January 26, 13

Prevent/Reduce Burn Wound Conversion

• fluid resuscitation

• nsaids

• nutritional support

• topical antibiotics

• wound dressing

• early surgical excision and grafting

• correction of patient-dependent pathologic factor

Saturday, January 26, 13

to Prevent Contractures, keep:

• the neck in extension

• the axilla in abduction

• the elbows in extension

• the wrists neutral or in extension

• the metacarpophalangeal joints in flexion

• the interphalangeal joints in extension

• the knees in extension

• the ankles in 90 degree dorsiflexion

Saturday, January 26, 13

“Utamakan Keselamatan Pasien” Deklarasi Gerakan Keselamatan Pasien

Rumah Sakit Panti Rapih; Rabu, 8 Desember 2010

selesaiSaturday, January 26, 13