UTD-88261-REVIEW-YASTI.en.id.

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Ulus Travma Acil Cerrahi Derg, March 2015, Vol. 21, No. 2

Yastı et al. Guideline and Treatment Algorithm for Burn Injuries

79-89

manajemen awal pasien luka bakar sangat penting bagi morbiditas dan mortalitas di masa depan.

Menentukan Keparahan Luka Bakar

Menentukan keparahan luka bakar tergantung pada daerah yang terbakar, kedalaman luka bakar,
dan daerah tubuh yang terlibat.

1. Daerah yang terbakar

'Rumus 9' kira-kira bisa memperkirakan luka bakar pada dewasa (Gbr. 1a). Namun, diagram yang
lebih akurat yang tersedia untuk orang dewasa (Gambar. 1b) dan anak-anak (lihat diagram Lund
Browder), dan bentuk singkat dari diagram ditunjukkan pada Gambar. 2. Untuk perhitungan
praktis, telapak terentang dengan jari-jari bersama-sama dapat diterima 1% dari luas permukaan
tubuh bagi seorang individu (Gambar. 3).

2. Kedalaman luka bakar

Luka bakar diklasifikasikan sebagai dermal dangkal dan dalam. Dalam luka bakar dangkal, tidak
ada atau cedera dermal minimal. Ini adalah derajat pertama dan dangkal luka bakar derajat
kedua, dan biasanya sembuh dalam 3 minggu tanpa gejala sisa apapun. Dermis sebagian atau
seluruhnya terluka pada dalam kulit luka bakar. Mereka diklasifikasikan sebagai kedua
kedalaman, ketiga dan keempat derajat mengenai cidera dermal dan jaringan dalam yang
mendasari. Ini biasanya akan sembuh dalam lebih dari tiga minggu dan biasanya memerlukan
intervensi bedah.

Derajat pertama: Epidermis utuh, ada eritema, misalnya: kulit terbakar

Derajat dua: integritas epidermis rusak. Jika cedera terbatas pada lapisan atas dermis, itu adalah
dangkal derajat kedua; Namun, keterlibatan lapisan lebih dalam (reticular) mengarah ke dalam
luka bakar derajat kedua. Sementara dangkal jauh lebih menyakitkan, ada sedikit rasa sakit dan
tekanan perasaan tumpul di luka bakar.

Derajat ketiga: Semua lapisan dermis terlibat. Kulit keras, gelap, kering, tanpa rasa sakit,
trombosis dalam pembuluh darah, dan ada khas luka bakar yaitu eskar.

Derajat keempat: Semua lapisan kulit, jaringan lemak subkutan dan jaringan yang lebih dalam
(otot, tendon) terlibat, dan ada penampilan arang.

3. Daerah tubuh yang terbakar

Luka bakar di mata, telinga, wajah, tangan, kaki, dan alat kelamin yang 'area khusus luka bakar'
dan seharusnya dirawat di sebuah unit / pusat luka bakar yang berpengalaman.
Penanganan

1. Airway, Breathing, dan Circulation harus dinilai. Pada pasien multipel trauma, yang 'lupakan
luka bakar' prinsip yang valid dan pengelolaan cidera yang mengancam kehidupan memiliki
prioritas.

2. Menyelamatkan korban dari tempat kebakaran dan memadamkan api memiliki prioritas.

3. Dalam luka bakar ringan, area yang terbakar harus dijaga di bawah air keran selama 20 menit
dalam 15 menit pertama, dan luka bakar lebih lanjut harus dihentikan.

4. luka bakar air panas.

• Semua pakaian basah dilepas

5. Luka bakar api

• Pasien dipindahkan dari sumber panas dan pindah dari tempat kejadian ke udara terbuka;
Namun, jika tidak memungkinkan, api dipadamkan.

• Karbon monoksida atau keracunan asap diperiksa dan pasien diberikan 100% oksigen.

• Persyaratan untuk intubasi endotrakeal dievaluasi.

6. Luka bakar listrik

• penyedia layanan kesehatan harus menyadari bahwa pasien mungkin akan terluka dalam tiga
cara yang berbeda: cedera listrik nyata melalui arus listrik, busur luka bakar, dan api membakar
sebagai konsekuensi dari pengapian arus listrik.

• listrik dimatikan dan / atau pasien seharusnya dipindahkan dari sumber

• Kebutuhan untuk resusitasi jantung paru segera dievaluasi (terutama cedera tegangan rendah)
• tanda atau gejala multipel trauma, trauma tumpul atau penetrasi harus diperiksa

7. Luka bakar kimia

• bahan kimia kering pertama-tama disapu, dan kemudian, harus dibilas dengan air mengalir
sampai rasa sakit hilang (ini bisa memakan waktu 60 menit)

• agen yang menetralisir tidak dianjurkan (kontraindikasi mungkin menyebabkan panas lebih
lanjut)

Pemberian intravena diperlukan untuk setiap kasus luka bakar berat dan Ringer laktat
seharusnya menjadi pilihan resusitasi cairan. Resusitasi cairan harus dimulai jika luas permukaan
tubuh total yang terbakar adalah > 10% pada anak-anak dan > 20% pada orang dewasa. Kondisi
yang membutuhkan lebih banyak cairan : • pasien beralkohol, • cidera inhalasi, • onset lambat
atau tidak cukup resusitasi cairan, dehidrasi, • Luka bakar listrik. Sirkulasi, respirasi, dan output
urin diamati jika perlu. Target output urin adalah dewasa 30-50 mL/jam dan anak 1-2 mL/kg/jam.
Pada luka bakar listrik dan cidera inhalasi, output urin yang ditargetkan harus dua kali lipat dari
volume tersebut.
Luka bakar tidak harus ditutupi dengan obat-obatan, cukup membungkus luka bakar dengan kain
bersih. Untuk mencegah hipotermi sistemik, bagian tubuh yang tidak terbakar tertutup untuk
mempertahankan panas tubuh.

Luka bakar listrik, luka bakar zat kimia, dan luka bakar besar dan / atau dalam harus dirawat di
rumah sakit. elektrolit serum dan gas darah arteri, dan jika perlu, EKG harus diterapkan.

Pada kasus edema dan / atau pembentukan jaringan eschar, dada, perut, kaki, dan leher harus
dievaluasi untuk kebutuhan escharotomy atau fasciotomy.

Untuk pasien dengan luka bakar yang besar, profilaksis diterapkan sesuai dengan protokol
tetanus profilaksis umum.

Adanya infeksi atau eschar, dan luka bakar yang besar, 1% sulfadiazin perak dapat digunakan.

Indikasi rawat inap

 Pada semua umur, derajat kedua dan ketiga luka bakar

 Pasien dengan usia < 10 tahun atau > 50 tahun dengan luka bakar derajat kedua dan
ketiga
 Luka bakar pada wajah, telinga, tangan, dan kaki
 Luka bakar termasuk sendi utama
 Luka bakar alat kelamin dan perineum
 Luka bakar kimia
 Luka bakar listrik
 Sambaran Petir
 cidera inhalasi
 Kronis co-morbiditas (diabetes, hipertensi, penyakit jantung, defisiensi imun, gangguan
neurologis)
 Kehamilan
Alharbi et al. World Journal of Emergency Surgery 2012, 7:13 1-10

The main criteria for referral to a burn unit include

the following [2]: Kriteria utama untuk memindahkan ke unit luka bakar :
_ Second and third degree burns greater than 10%
TBSA in patients younger than 10 years and
older than 50 years. luka bakar derajat 2 dan 3 > 10 % TBSA pada pasien < 10 tahun dan > 50 tahun
_ Second and third degree burns greater than 20%. Luka bakar derajat 2 dan 3 > 20 %
_ Third degree burns greater than 5%. Luka bakar derajat 3 > 5 %
_ Burns to face, hands, feet, genitalia, perineum
and major joints. Luka bakar pada wajah, tangan, kaki, alat kelamin, perineum, dan sendi-sendi besar
_ Electrical burns (including lightning injury) Luka bakar listrik (termasuk tersambar petir)
_ Chemical burns Luka bakar zat kimia
_ Inhalation injury Cidera inhalasi
_ Patients with pre-existing conditions
_ Circumferential third degree burns to extremity
or chest Luka bakar derajat 3 pada ekstremitas / dada
_ Burns involving concomitant trauma with a great
risk of morbidity and mortality (i.e. explosion
trauma).

Airway: Early recognition of airway compromise

followed by prompt intubation can be live saving
[3]. If there is soot in the mouth consider early
intubation even if the patient is breathing normally.
Breathing: Determine if the patient is moving air or
not.
Circulation: Obtain appropriate vascular access and
a monitor device to control heart rate and blood
pressure.
Disability: Detect if there are any other
manifestations including fractures and deformities,
abdominal injury or neurological deficit.
Exposure: The patient should be completely
exposed and should be out of clothes. Exposure of
all orifices must be conducted in this part.

Fluid resuscitation: A mainstay in the treatment.

This point is discussed in the third question after
the calculation of the total burned surface area
(%TBSA) but the guidelines of Acute Trauma Life
Support (ATLS) should be followed in order to
maintain the circulation process.

Secondary survey is designed as a burn-specific

survey. It is performed during admission to the
burn unit. Full history should be approached
including:
_ Detection of the mechanism of injury.
_ Time of injury.
_ Consideration of abuse [4].
_ Height and weight.
_ Possibility of carbon monoxide intoxication
based on the history of burns in a closed area as
well as the presence of soot in mouth and nose
[5].
_ Facial burns.
Examination of the cornea is important as well as
the ear in case of explosion trauma. A systemic
overview should be performed in this phase
including a fast run on the abdomen, genital region,
lower and upper limbs (think: X-Ray C-Spine,
Thorax, and Pelvic). If the patient is a child, look for
signs of abuse.

First degree burns: typical redness and pain of the

affected skin. Minor epithelial damage occurs
without formation of blisters. Typically occurs with
sunburns. Luka bakar derajat 1 :kemerahan dan sakit pada kulit yang terkena. Kerusakan epitel kecil terjadi
tanpa pembentukan ....
Superficial second degree burns: complete epithelial
damage and only papillary dermal damage occurs.
This degree leaves no neurovascular damage. Thus, it causes pain, bleeds and presents with blisters.
Epithelial repair occurs within 14 days. It mostly
leaves no scars after healing. Sometimes
discoloration stays. Luka bakar derajat 2 superfisial : kerusakan epitel sempurna dan hanya terjadi kerusakan
dermal papillary. Tidak ada kerusakan neurovaskular. Nyeri dan berdarah. Sembuh dalam 14 hari. tidak
meninggalkan bekas luka setelah sembuh.
Deep second degree burns: complete epithelial
damage and damage of the reticular dermis present.
It results in neurovascular damage. Thus, it
generally presents without bleeding or sensation and
appears white in colour. Blisters can also be present
but are bigger than in superficial second degree
burns. Healing can occur but takes longer than
14 days and results in scars. Luka bakar derajat 2 dalam : kerusakan epitel sempurna dan adanya kerusakan
reticular dermis. Kerusakan neurovaskular. Tidak adanya perdarahan / sensasi. Penyembuhannya dapat terjadi >
14 hari dan meninggalkan bekas luka.
Third degree burns: involving the epidermis, dermis
and subcutaneous tissue. The skin appears leathery
consisting of thrombotic vessels (Figure 2). Luka bakar derajat 3 : termasuk epidermis, dermis, dan jaringan
subkutis.
Forth degree burns (debatable): it is a third degree
burn with involvement of the underlying fascia,
muscles and even bones.
_ Superficial burn injury (First degree).
_ Superficial partial-thickness burns (Superficial
second degree).
_ Deep partial-thickness burns (Deep second
degree).
_ Full-thickness burns (Third degree).
_ Fourth degree burns (debatable classification as
some references do not support this degree [1]).

Charles Baxter, MD, at

Parkland Hospital, Southwestern University Medical
Centre, designed in the 1960s [8,9] the Parkland
formula to calculate the fluid needs for the first
24 hours.

4 mL x Patient0s body weight x TBSA = Volume to be given in the first 24 hours

50% of this volume is infused in the first 8 hours,

starting from the time of injury, and the other 50%
is infused during the last 16 hours of the first day. 50 % dari volume ini diinfus dalam 8 jam pertama dimulai
dari waktu kejadian, dan 50 % lainnya diinfus selama 16 jam pada hari pertama

Lactated Ringer ringer laktat

balanced electrolyte solutions (Ringer-acetate) to prevent the high dose
administration of lactate. Safe option cairan ringer asetat untuk mencegah dosis tinggi laktat. Pilihan yang aman.

30-40% higher (close to

5.7 mL/kg/%TBSA)

Klein et al higher volumes equalled a

higher risk for complications, i.e. lungcomplications

urine output, blood pressure and

central venous pressure. the goal in fluid resuscitation is to
maintain a urine output of approximately 0.5 ml/kg/ h in adults and between 0.5 and 1.0 ml/kg/h in
patients weighing less than 30 kg. Urin output, tekanan darah, dan CVP. Hasil pada resusitasi cairan yaitu urin
output kira-kira 0,5 mL/kg/jam pada dewasa dan 0,5-1 mL/kg/jam pada pasien dengan BB < 30 kg.

Maintenance dose is provided after the first

24 hours.

100 ml/kg : for the first 10 kg

50 ml/kg : for the second 10 kg
20 ml/kg : every kilogram above 20 kg

for children:
Modified Parkland Formula
4 mL x Patient’s body weight x TBSA x Maintenance fluid = Volume to be given in the first 24 hours

Central venous catheter and

arterial line are indicated if the patient is
hemodynamically unstable or if frequent blood gas
analysis is required. CVC dan arteri line diindikasikan jika hemodinamik pasien tidak stabil.

nasogastric tube
and urinary catheter are indicated in patients with
20% TBSA or more. NGT dan kateter urine diindikasikan pada pasien dengan ≥ 20 % TBSA

Nasogastric tube will initiate

immediate feeding and decrease the possibility of
ileus or aspiration

the patient is
washed properly with warm water and then reevaluated
regarding the total burned surface area
(TBSA) as well as the degree of burns. Pasien disiram dengan air hangat dan lalu dievaluasi TBSA untuk
menentukan derajat luka bakar.

Basic laboratory tests include the following: Uji laboratorium dasar

_ Complete blood count (CBC) and Arterial blood
gas (ABG) analysis, AGD dan darah perifer lengkap
_ Urea and Electrolytes (U&E), elektrolit dan urea
_ Prothrombin time (PT) / Partial thrombin time
(PTT) and International Normalized Ration
(INR), PT, PTT, INR
_ Sputum Culture and Sensitivity, kultur sputum dan sensitivitas
_ Creatine Kinase (CK) and C-reactive protine
(CRP), creatinin, CRP
_ Blood glucose, GDS
_ Urine drug test,
_ Human chorionic gonadotropin (B-HCG): if the
patient is female, HCG
_ Albumin test. albumin
_ Thyroid values and myoglobin measures. tiroid

Burns occurring in closed areas and all burns that are

affecting the head are subjected to inhalation injury luka bakar yang terjadi disekitar area kepala dicurigai cidera
inhalasi

If Carbon monoxide (CO) intoxication is

suspected, perform arterial blood gas (ABG) analysis to
detect carboxyhemoglobin (COHb), immediate supply
of 100% oxygen, chest X-Ray and discuss the
possibility of hyperbaric oxygen (HBO) therapy.
COHb higher than 20% or cases presented with
neurological deficits are absolute indications for HBO,
whereas COHb amounts of 10% and higher are seen
as relative indications for HBO

fiberoptic bronchoscopy

Indications of surgical debridement: Indikasi tindak bedah debridement

1. Deep second degree burns. Luka bakar derajat 2 dalam
2. Burns of any type, that are heavily contaminated Luka bakar semua tipe dengan kontaminasi yang berat
3. Third degree circumferential burns with
suspected compartment syndrome (think of:
Escharotomy) Luka bakar derajat 3 dengan curiga sindrom kompartemen
4. Circumferential burns around the wrist (think of:
Carpal tunnel release) Luka bakar disekitar pergelangan tangan

Benefits of surgical debridement: Manfaat tindak bedah debridement

1. To reduce the amount of necrotic tissue
(beneficial for prognosis) untuk mengurangi jumlah jaringan nekrotik (bermanfaat untuk prognosis)
2. To get a sample for diagnostic purposes
(if needed). untuk mendapatkan contoh guna diagnosis (jika perlu)

Complications of debridement:Komplikasi debridement

1. Pain. nyeri
2. Bleeding. perdarahan
3. Infection. infeksi
4. Risk of removal of healthy tissue. Risiko merusak jaringan yang sehat

Contraindications: kontraindikasi
1. Low body core temperature below 34°C. Suhu < 34 C
2. Cardiovascular and respiratory system
instability. Sistem kardiovaskular dan respirasi tidak stabil

Escharotomy: Indicated for third-degree and

second degree deep dermal circumferential
burns. This is used to prevent a soft tissue
compartment syndrome, due to swelling after
deep burn. An escharotomy is performed by
making an incision through the eschar to expose
the fatty tissue below. This can be illustrated in
Figure 3. Note that escharotomy lines on the
thumb and little finger, as an international
standard, should be always performed on the
radial side and not on the ulnar side.
Escharotomy incisions for the index finger,
middle finger and ring finger are performed
along the ulnar side. Eskarotomi : diindikasikan untuk luka bakar derajat 3 dan derajat 2 dalam. Ini digunakan
untuk mencegah sindrom kompartemen karena pembengkakan setelah luka bakar. Eskarotomi : insisi melalui
eskar untuk melihat jaringan lemak dibawahnya.
Fasciotomy: Fasciotomy is a limb-saving
procedure when used to treat acute
compartment syndrome. An incision is made in
the skin that extends into the fascia where it will
relieve pressure. Note that Carpal Tunnel
Syndrome (CTS) can result from the
circumferential burns around the wrist by
consecutive swelling.

Routine admission orders include:

_ Vital signs: Continuous monitoring of Heart rate,
Blood pressure, Pulse pressure, Respiratory rate,
Temperature and Central venous pressure.
_ Documentation of allergies
_ Diet: Nil per os (NPO) if burn more than 30%
during the first 24 hours. Nasogastric tube will
initiate immediate feeding and decrease the
possibility of ileus or aspiration.
_ I.V. fluids: follow the Parkland formula.
_ Decubitus precautions.
_ Consultation: Psychiatry or Psychology (only if
patient is awake).
_ Multivitamins and Traces: Vitamine C, ZnSo4,
Selenium and Vitamine E.
_ Tetanus prophylaxis.
_ Ulcer prophylaxis.
Analgesia: the choice is dependent on burn size, depth,
age and other trauma factor such as blunt trauma and
fractures.
_ Additional medications (for mechanically ventilated
adults with smoke inhalation injury): nebulized
heparin sulfate mixed in 3 ml normal saline every
4 hours and 3 ml 20% nebulized N-acetylcysteine plus
0.5 ml albuterol sulfate every 4 hours for 7 days [30].
Emergency Medicine International
The EmergencyManagement and Treatment of Severe
Burns
Melanie Stander and Lee AlanWallis
2011
1-5
Burn injury patients who should be referred to a burn unit
include the following: pasien luka bakar yang seharusnya dipindahkan ke unit lukabakar
(i) all burn patients less than 1 year of age; semua pasien luka bakar dengan usia < 1 tahun
(ii) all burn patients from 1 to 2 years of age with burns
>5% total body surface area (TBSA); semua pasien luka bakar dari usia 1-2 tahun dengan luka bakar > 5 %
TBSA
(iii) patients in any age group with third-degree burns of
any size; pasien pada semua usia dengan luka bakar derajat 3
(iv) patients older than 2 years with partial-thickness
burns greater than 10% TBSA;
(v) patients with burns of special areas—face, hands,
feet, genitalia, perineum or major joints;
(vi) patients with electrical burns, including lightning
burns;
(vii) chemical burn patients;
(viii) patients with inhalation injury resulting from fire or
scald burns;
(ix) patients with circumferential burns of the limbs or
chest;
(x) burn injury patients with preexisting medical disorders
that could complicate management, prolong
recovery, or affect mortality;
(xi) any patient with burns and concomitant trauma;
(xii) paediatric burn cases where child abuse is suspected;
(xiii) burn patients with treatment requirements exceeding
the capabilities of the referring centre;
(xiv) septic burn wound cases.

3. Treatment Protocol
3.1. Remove any Sources of Heat
(1) Remove any clothing that may be burned, covered
with chemicals, or that is constricting.
(2) Cool any burns less than 3 hours old with cold tap
water (18 degrees centigrade is adequate) for at least
30 minutes and then dry the patient.
(3) Cover the patient with a clean dry sheet or blanket to
prevent hypothermia.
(4) Use of Burnshield [18] is a very effective means of
cooling and dressing the injury for the first 24 hours.
(5) Rings and constricting garments must be removed.
3.2. Assess Airway/Breathing
(1) Careful airway assessment must be done where there
are flame or scald burns of the face and neck.
Intubation is generally only necessary in the case of
unconscious patients, hypoxic patients with severe
smoke inhalation, or patients with flame or flash
burns involving the face and neck. Indications for
airway assessment include the presence of pharyngeal
burns, air hunger, stridor, carbonaceous sputum, and
hoarseness.
(2) All patients with major burns must receive high-flow
oxygen for 24 hours.
(3) Always consider carbon monoxide poisoning in burn
patients. They may have the following symptoms:
restlessness, headache, nausea, poor co-ordination,
memory impairment, disorientation, or coma. Administer
100% oxygen via a non-rebreathing face
mask; if possible, measure blood gases including
carboxyhaemoglobin level.
(4) If breathing seems to be compromised because of
tight circumferential trunk burns, consult with the
burn centre surgeons immediately regarding the need
for escharotomy.
Circulation
(1) Stop any external bleeding.
(2) Identify potential sources of internal bleeding.
(3) Establish large-bore intravenous (IV) lines and provide
resuscitation bolus fluid as required in all compromised
patients, using standard ATLS protocols
[19]. Perfusion of potentially viable burn wounds is
critical.

(1) Patients with <10% TBSA burns can be resuscitated

orally (unless the patient has an electrical injury or
associated trauma). This needs ongoing evaluation
and the patient may still require an IV line.
(2) In the case of patients with burns 10–40% TBSA, secure
a large-bore IV line; add a second line if transportation
will take longer than 45 minutes.
(3) Burns >40% TBSA require 2 large-bore IV lines.
(4) If the transfer will take less than 30 minutes from the
time of call, do not delay transfer for an IV line.
(5) Initiate fluids for ongoing resuscitation and fluid
losses using the Parkland formula
4mL crystalloid × (kg of body weight)
× (%burn) = mL in first 24 hours,

Do not give dextrose solutions (except for maintenance

fluids in children) they may cause an osmotic diuresis. Ideally, use Ringer’s lactate or normal saline for
replacement
fluid and a 5% dextrose-balanced salt solution for the child’s
maintenance.

(1) Insert a Foley catheter in patients with burns >15%

TBSA. Adequate urine output is 0.5mL/kg/h in
adults and 1.5 mL/kg/h in children.

Lasix and other diureticsmust not be given to improve

urine output; increase IV fluid rates to increase urine
output.

(2) Observe urine for burgundy colour (seen with massive

injuries or electrical burns). There is a high incidence
of renal failure associated with these injuries,
requiring prompt and aggressive intervention.

If the urine is red or brown consult a burn centre.

Insert a Nasogastric Tube. Insert a nasogastric tube in

any patient with burns >30% TBSA, or any patient who is
unresponsive, shocked, or with burns >20% if preparing for
air or long-distance transportation.

Medication
(1) Give tetanus immunisation.
(2) After fluid resuscitation has been started, pain medication
may be titrated in small intravenous doses (not
intramuscular). Blood pressure, pulse, respiratory
rate, and state of consciousness should be assessed
after each increment of IV morphine.

Wound Care
(1) Debridement and application of topical antimicrobials
are usually unnecessary. Initial wound care
needs to ensure that the burn is kept covered and
the patient is kept warm. Plastic food wrap (such as
Gladwrap) is ideal.
(2) Apply a thin layer of silver sulfadiazine to open areas
if transportation will be delayed for more than 12
hours.
(3) Use of Burnshield is a very effective means of cooling
and dressing the injury in the first 24 hours.

Special Considerations with Chemical Burns (Consult

Burn Centre)
(1) Remove all clothing.
(2) Brush powdered chemicals off the wound, then flush
chemical burns for a minimum of 30 minutes using
copious volumes of running water. Be careful to
protect yourself.
(3) Irrigate burned eyes using a gentle stream of saline.
Follow with an ophthalmology consultation if transportation
is not imminent.
(4) Determine what chemical (and what concentration)
caused the injury.

Special Considerations with Electrical Injuries (Consult

Burn Centre)
(1) Differentiate between low-voltage (<1000 v) and
high-voltage (>1000 v) injuries.
(2) Attach a cardiac monitor; treat life-threatening dysrhythmias
as needed.
(3) Assess for associated trauma; assess central and peripheral
neurological function.
(4) Administer Ringer’s lactate; titrate fluids to maintain
adequate urine output or to flush pigments through
the urinary tract (see urine output above). Useful laboratory
test: arterial blood gas levels with acid/base
balance.
(5) Using pillows, elevate burned extremities above the
level of the heart. Monitor distal pulses.
Nielson et al
Journal of Burn Care & Research
2017

Burns: Pathophysiology of Systemic Complications

and Current Management
469-481
Dextrose is the main calorie source used
and the recommended carbohydrate intake in adults

It should
be noted that this hyperdynamic circulation and
increased metabolic rate can continue up to 2 years
following burn injury in people

Treating burns requires the toxic eschar be

removed early, usually in the first 24 to 72 hours

Topical antimicrobial agents should be administered

after initial decontamination to prevent bacterial
colonization of the burn wound

the reduced vitamin C blood levels

seen in burn patients.

Vitamin A serum levels

have been shown to be reduced after thermal injury
and persist for over 30 days,

Parenteral high-dose vitamin

C inhibits endotoxin-induced endothelial dysfunction
and vasohyporeactivity and works to reverse
sepsis-induced suppression of microcirculatory control
in rodents.59,62,63 Parenteral high-dose vitamin C
also has been shown to significantly reduce required
resuscitation fluid volumes in both humans and animals.
62 The use of parenteral high dose vitamin C
has been recommended to reduce acute smoke inhalation
injury.64

burn patients were

treated with a dose of vitamin C 66 mg/kg/hr for
24 hours.

Administration of high-dose vitamin C

during the first 24 hours after thermal injury also significantly
reduced weight gain, wound edema, and a
decrease in the severity of respiratory dysfunction.

Insulin treatment has been effective at treating

post burn hyperglycemia.