A 25 YEARS OLD MAN WITH VULNUS

GRANULOSUM ET CAUSA
ELECTRICAL BURN 53 % POST STSG

Elvia Rahmi M.P. G99152069

Gefaritza Rabbani G99161005

Supervisor :
dr. Amru Sungkar, Sp.B, Sp.BP(K)-RE
PATIENT IDENTITY

• Name : Mr. S
• Age : 45 yo
• Sex : Male
• Religion : Islam
• Occupation : enterpreneur
• Address : Kembangarum, Semarang
• MR number : 01361335
• Admission date : December, 2nd 2016
 CHIEF COMPLAIN

Electrical burn 9 days before admission

 PRESENT ILLNESS

Patients come with electrical burn complaints in the abdomen and legs
that have not healed since 8 months of SMRS. The wound is painful when
used for activity and reduced if rest. Patients experience limited activity
due to injury and can only lie in bed. Daily activities such as poop and
pee should be assisted by the family.
• In October 2017 patients were exposed to highway electricity while working in the
market. By the residents around the patient was rushed to RSDM. The patient suffered
burns in both hands, abdomen and both legs. Patients have also performed STSG
surgery. The wound in the hands has helaed but the stomach and leg sores still not
close. Patients routinely medication in RSDM every 5 days.
• Complaints of fever, spasms, nausea, vomiting are refuted. Poop and pee in normal
limits.
PAST HISTORY FAMILY HISTORY
Allergy : denied • Drug Allergy : denied

Hypertension : denied • Hypertension : denied

Diabetes Mellitus : denied • Diabetes Mellitus : denied
Heart Diseases : denied • Heart Diseases : denied
Past Trauma : denied
 PHYSICAL EXAMINATION

Primary Survey
Airway : Clear
Breathing : RR 20x/minutes, symetric.
Circulation : BP 120/70, Pulse 80x/minutes.
Dissability : GCS E4V5M6
Exposure : Temperature : 36.7oC, wound injury (see localized status)
 PHYSICAL EXAMINATION

Secondary Survey
Head : No abnormality Thorax : No Abnormality
Eye : No abnormality Abdomen : see localized status
Ear : No abnormality Genitourinaria : No Abnormality
Nose : No abnormality Superior extremity : healed scar
Mouth : No abnormality Inferior extremity : see localized status
Neck : No abnormality
LOCALIZED STATUS
Regio Abdomen Anterior
• Inspection : verban covered wound, leak (-)

Regio Ekstremitas Inferior

• Inspection : verban covered wound, leak (-)
 ASSESMENT I

• Vulnus Granulosum regio abdomen anterior, regio femur D/S, regio cruris D/S et
causa combustio listrik 53% post STSG
 PLANNING I

• Cek darah lengkap

• Medikasi luka
LITERATURE REVIEW
 DEFINITION

Burn Wound is a tissue damaging or loss due to extreme heat

source, cold source, electric source, chemical compounds, light,
radiation, or friction.
 ETIOLOGY

Electrical burns
• Electrical burns areclassified as high voltage
(≥1000V), low voltage (<1000V) and those
caused by lightning
• Low voltage: small partial thickness injury
• Hight voltage: large skin lessions with
necrosis at the contact point and even deeper
PATHOPHYSIOLOGY
 PATHOPHYSIOLOGY

Zone of coagulation

• Cells in the immediate area of contact die and the surrounding

tissue coagulates and denatures.
• No blood circulation in this area.

Zone of stasis

• Blood perfusion is decreased

• Increased damage could occur because of prolonged
hypoperfusion
 PATHOPHYSIOLOGY

Zone of hyperaemia

• This is the outermost zone; perfusion is

increased and tissue here will recover
unless there is another insult such as
sepsis or hypoperfusion
DEGREES OF BURN
 DEGREES OF BURN

Depth of wounds are categorized in four parts:

Superficial Deep partial

Epidermal Full thickness
partial thickness thickness
• only the • epidermis and • entire • the entire
epidermis is part of the epidermis and thickness of the
involved and papillary the papillary skin is lost,
sensation is still dermis is dermis is possibly with
intact damaged destroyed with deeper tissue
• Heal by itself for • Heal for about part of the • They don’t heal
about 7 days. 14 days. reticular spontaneously; a
• These take skin graft is
about 14–21 needed if depth
days to heal exceeds >1 cm.
DEGREES OF BURN
HOW TO ASSES THE DEGREE OF BURN ?
MANAGEMENT
 WOUND MANAGEMENT BASED ON
DEGREEOF BURNS
First degree

• Drench the burn thoroughly with cool water

• Topical antibiotik
• Analgesic: NSAID (Ibuprofen, Acetaminophen)

Second Degree (Superficial)

• Need routine care of the wound

• Dress with antibiotic and gauze
• Temporary coverage: allograft or xenograft

Second Degree (Deep) dan Third Grade

• Early exicision and grafting

THANK YOU