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Shinta Kharisma Dewi

405090066

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PATHOPHYSIOLOGY OF BURNS

Burncoagulative necrosis of the epidermis

and underlying tissues

depth depending

temperature to which the skin is exposed

duration of exposure

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BURN CLASIFICATION

Depths

First degree : Injury localized to the epidermis

Superficial second degree : to the epidermis and

superficial dermis Deep second degree : through the epidermis and

deep into the dermis

Third degree : full-thickness injury through the

epidermis and dermis into subcutaneous fat

Fourth degree : through the skin andsubcutaneous fat into underlying muscle or bone

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Zone of Tissue Damage

Zone of coagulationThe necrotic area of a

burn where cells have been disrupted is termed

(irreversibly damaged)

zone of stasisThe area surrounding the

necrotic zone with decreased tissue perfusion.

depending on the wound environment, can either

survive or progress to coagulative necrosis. associated with vascular damage and vessel

leakage

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BURN CLASIFICATION

Causes

Flame :damage from superheated, oxidized air

Scald : damage from contact with hot liquids

Flash : damage from explosion

Contact : damage from contact with hot or cold

solid materials

Chemicals : contact with noxious chemicals

Electricity : conduction of electrical current

through tissues

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FLAME BURNS

second most common mechanism of thermal

injury

e/: - smoking-related fires

- improper use of flammable liquids

- motor vehicle collisions

- ignition of clothing by stoves or space

heaters

Usually full-thickness burns

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SCALD BURNS

Most common

Usually from hot water

- (60C)deep partial-thickness or full-thickness

burn in 3 seconds

Scald burns from grease or hot oildeep

partial-thickness or full-thickness burns

Exposed areas of skin tend to be burned less

deeply than clothed areas

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FLASH BURNS

e/:

- Explosions of natural gas

- propane, butane, petroleum distillates, alcohols

- other combustible liquids

distribution over all exposed skin

deepest areas facing the source of ignition

typically epidermal or partial thicknessdepending on the amount and kind of fuelthat explodes

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CONTACT BURNS

e/:

- result from contact with hot metals, plastic, glass,

or hot coals

- irons, ovens, and wood-burning stoves

- exhaust pipes of motorcycles

usually limited in extent, but are invariably

deep

often fourth-degree burns

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ELECTRICAL BURNS

Electrical injury is unlike other burn injuries

the visible areas of tissue necrosis represent

only a small portion of the destroyed tissue.

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CLASSIFICATION

Injuries are divided into :

Low-voltage injury is similar to thermal burns

without transmission to deeper tissues; zones of

injury extend from the surface into the tissuecauses only local damage

High-voltage injury consists of varying degrees of

cutaneous burn at the entry and exit sites,

combined with hidden destruction of deep tissue

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PATHOPHYSIOLOGY

Electrical current enters a part of the bodyproceeds

through tissues with the lowest resistance to current

(bllod vesssels)Heat generated by the transfer of

electrical current

injures the tissues. Musclesustains the most damage.

Blood vesselsproceed to progressive thrombosis

the cells die or repair themselvestissue loss from

ischemia

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CHEMICAL BURNS

Chemicals cause their injury by protein

destruction, with denaturation, oxidation,

formation of protein esters, or desiccation of

the tissue

Alkali: potassium hydroxide, bleach, sodium

hydroxide

Acid: hydrofluoric acid, formic acid

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INITIAL TREATMENT OF BURNS

Prehospital

burned patients must be removed from the source ofinjury and the burning process stopped

Inhalation injury is always suspected

100% oxygengiven by facemask.

Burning clothing and all accessories is extinguishedand removed as soon as possible to prevent furtherinjury.

Room-temperature water can be poured on thewound within 15 minutes of injury to decrease thedepth of the wound

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Initial Assessment

divided into a primary and secondary survey.

Primary survey : immediately life-threatening

conditions are quickly identified and treated

Secondary survey : a more thorough head-to-toe

evaluation of the patient is undertaken

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Direct injury to the upper airway results in edema

Airway injury must be suspected with

facial burns

singed nasal hairs

carbonaceous sputum

Tachypnea

patient's respiratory status must be continuallymonitored to assess the need for airway control and

ventilatory support

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AIRWAY + BREATHING

hoarsenesssign of impending airway

obstruction endotracheal intubation needs to

be instituted early before edema distorts the

upper airway massive burns, who may appear to breathe

without problemsearly resuscitation (several

liters of volume are given to maintainhomeostasis and significant airway edema)

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Chest expansion and equal breath sounds with

CO2endotracheal tube

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CIRCULATION

monitors arterial pressure and urine output.

Explosioncervical collars to keep the head

immobilized until the condition can be

evaluated.

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WOUND CARE

Prehospital care of a burn woundclean dry

dressing or sheet to cover the involved part

diminishing pain

wrapped in a blanket to minimize heat loss andfor temperature control during transport.

IM or SC narcotic injections for pain are never

usedvasoconstriction

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Transport

uncontrolled transport of a burn victim is not a

priority

ground transportation and helicopter transport

greatest use For distances >150 miles, transport by fixed-wing

aircraft

Whatever the mode of transport, it needs to be of

appropriate size and have emergency equipment

available

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Resuscitation

IV accessis best attained through short

peripheral catheters in unburned skin

Saphenous vein cut-down is useful in patients

with difficult access and is used in preference

to central vein cannulationlower

complication rates.

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AdultRL without DX

Children < 2 yrRL + 5 % DX

burns greater than 10% TBSA

0.5 mL oftetanus toxoid.

If previous immunization is absent or unclear

or the last booster dose was given longer than

10 years ago250 units of tetanus IG

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RESUCITATION CRYSTALLOID !!!!!

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Escharotomies

The entire constricting eschar must be incised

longitudinally to completely relieve the impediment

to blood flow.

escharotomies are safest to restore perfusion to theunderlying nonburned tissues until formal excision is

performed

The most common complicationsblood loss and

transient hypotension