BURN

COMBUSTIO
Dr.Dian Syahputra

Division of Plastic Surgery, School of Medicine North Sumatra University

 Superficial Soft Tissue damage

due to :
- Dry and moist heat
- Electrical current
- Chemical fluid

PROBLEMS
4 stages acute management
1. Anticipation of shock/fluid resuscitation
and respiratory function disorder.
2. Prevention of secondary infection.
3. Proper management of burned tissue
with early grafting of deep burn skin loss.
4. Prevention of complication including late
complication contracture and keloid.

Mass catastrophe :
-Bomb blast
-Bali 2002
-Marriot 2003
-Polonia Airplane
crash 1987
Prognosis :
100 Age + % BSA
Mental Psychosocial support

Sumatra :
NO BURN UNIT

DIAGNOSE
1.
2.
3.
4.

Ethiology
GRAde
SUrface area
LOcation

Grade
Deep : I, II, & III
% BSA
Specific areas

D : e-burn gr@sulo

ETHIOLOGY

Anamnesis :
SCALD
FLAME
ELECTRICAL
CHEMICAL
INHALATION

Grade/Severity
I & II
II & III
III
III
respiratory

Time of injury fluid resusitation first 8 hours

GRADE
Erythema

Blister

Pinprick ( - )

ESTIMATION OF
BODY SURFACE AREA
9

9 9

BSA

1%

Rule of Nine

Hands Palm = 1%

Lund & Browder Chart

LOCALIZATION

Special Area

: JOINT

HANDS

FACE

AURICLE

PERINEUM

PALM & SOLE

Woman Breasts

PATHOPHYSIOLOGY
Fluid
Fluid

Electrolit Protein
Electrolit Protein

Increase
permeability
Interstitial tissue
Interstitial tissue
Haemoconsentration

HYPOVOLUMIC

SHOCK

SEVERITY OF BURN
Severe

Moderate

Mild

MANAGEMENT
1. General/Medical Treatment :
Fluid Resusitation
Prevention infection
2. Local : Topical Antibiotic
3. Surgery :
a. Debridement
b. Excharatomy
c. Excicion + Grafting
d. Granulating Tissue + Grafting

ESTIMATION OF
FLUID RESUSCITATION
Parkland Hospital Formula :
24 hours
4 ml Lact. Ringers x % BSA x Kg BW = X ml
X ml in first 24 hours
x ml in first 8 hours
24 48 Koloid

Foley catheter : urine out put / hours 1 ml / kg BW/ hours

Renal function
Serum electrolite level (K+)
Albumin / Globulin ratio

ATTENTION
Inhalation burn
face neck

Respiratory distress
first 24 hours & 1-5 days

 Sistemic Antibiotic
Tetanus Prophylactic
Analgesic & Sedatives
Nutritional support :
Formula

Curreri (24 hours caloric requirment)

Adult : 25 kilocal/kg BW + 40 kilocal % BSA

Child : 60-90 kilocal/kg BW + 35 kilocal % BSA

TOPICAL ANTIBIOTIC
Silver Sulfadiazine
Cream in consentration of 1 %
Applied twice daily : open or
close
Effective Gram + & Gram
Silver Nitrat (0,5 % solution)
Sulfanylon

 Debridement
Escharatomy

SURGERY
Prevention :
Position arm & leg

Thin

Grafting : STSG
Prompt
1 2 weeks Granulating

Moderate
Large : Electro Dermatome
MESH Graft

Scald Burn

Scald Burn with Pregnancy

Scald Burn in specific area

Flame Burn Suicide 40%

Flame Burn 30%

Cemical Burn

Electrical Burn

Flame Burn
Upper Arm

Escharatomy

Granulating Tissue
1-2 weeks

Grafting

COMPLICATION
Pulmonary Oedema
Gastrointestinal
33% Curling Ulcer
Infection : - Septichemi
- UTI
- Auricular chondritis
Late Complication
6 months 2 years
1. Contracture
2. Keloid

Late complication Keloid

Finger contracture

 Diagnose e-burn gr@sulo

Emergency
Mortality
life saving
Morbidity
live saving
Prevent infection & deformity

Ed Sept 2003