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Burn Classifications

1st degree (Superficial burn)


Involves the epidermis
Characterized by dry & reddening
Tenderness and Pain
Increased warmth
Edema may occur, but no blistering (bullae)
Burn blanches under pressure
Example - sunburn
Usually heal in ~ 7 days
Burn Classifications

First Degree Burn


(Superficial Burn)
Burn Classifications
2nd degree (2)
Damage extends through the epidermis and
involves the dermis.
Moist, shiny appearance
Pink to red color
Painful
a. Superficial dermal burns (2a)
- Affect superficial dermis
- Adnexas are partially destroyed
- Heal spontaneously 10 14 days
b. Deep dermal burns (2b)
- Affect almost entire dermis
- Adnexas are almost entirely
destroyed
- Heal spontaneously 3 4 weeks,
or > 1 month
Burn Classifications

2nd Degree Burn


(Partial Thickness
Burn)
3rd degree
All layer
Dry
Black
Less or no pain
Impaired Distal Perfusion from Burn Tissue Compression

Sindrom kompartemen akibat escharectomy


adanya eschar yang melingkar
di ekstremitas, menyebabkan
perfusi ke distal terganggu
Diagnosis

Luka bakar derajat,luas,lokasi,penyebab,penyulit,


co-morbid atau cedera lain

Kategori luka bakar

Ringan Sedang Berat


Luka bakar berat/kritis
LB derajat II-III > 20 % pada pasien usia < 10 tahun atau > 50
tahun
LB derajat II-III > 25 % pada kelompok selain diatas
Luka bakar pada muka,tangan,kaki dan perineum
Adanya cedera jalan napas
Luka bakar listrik
Disertai trauma lain
Pasien dengan resiko tinggi
Luka bakar sedang (moderate)
Luka bakar dengan luas 15-25 % dengan luka
bakar derajat III kurang dari 10 %
Luka bakar seluas 10-15 % pada anak < 10 tahun
atau dewasa > 40 tahun dengan luka bakar derajat
III <10 %
Luka bakar derajat III < 10 % tanpa mengenai
muka,tangan,kaki dan perineum
Luka dicuci air bersih mengalir, keringkan dan
selimuti
Berikan profilaksis tetanus
Analgetik tidak nefrotoksik/hepatotoksik
Antibiotika spektrum luas, tidak
nefrotoksik/hepatotoksik (kontroversi)
Rujukan dilakukan dalam kondisi hemodinamik
stabil,pertimbangkan prognosis penderita
Pastikan fasilitas rujukan memiliki tempat,fasilitas dan
tenaga lebih baik (komunikasi)
Program resusitasi selama dalam perjalanan tetap
dilakukan
Dampingi oleh paramedis yang terlatih
Jelaskan tujuan, identitas,diagnosis,terapi yang telah
diberikan,kondisi saat dirujuk dan alasan
Burn Wound
Treatment
Low priority - After ABCs and initiation of IVs
Do not rupture blisters (controversial)
Topical antimicroba
Agent that promote healing
Cover with sterile dressings or left open
Agent Characteristics

Silver sulfadiazine Painless on application


Fair to poor eschar penetration
No metabolic side effects
Broad antibacterial spectrum

Mafenide acetate Painful on application


Excellent eschar penetration
Carbonic anhydrase inhibitor
Broad-spectrum antibacterial
Agent Characteristic

0.5% Silver nitrate Painless on application


Poor eschar penetration
Leaches electrolytes
Broad-spectrum
antibacterial & antifungal
Agent Characteristics

Antibiotic cream Painless on application


(Gentamicin) Good eschar penetration
Has little effect on gram (+)
Rapid development of resistant forms
Systemic toxicity

Povidone Iodine Painful on application


Failure on gram (-) control
High serum iodine levels
Wound closure
If possible, do it at the same time with
necrotomy (early excision)
Excision technique : Tangential excision
Use STSG/Split Thickness Skin Graft (autograft,
homograft, xenograft) or amnion sheet
If auto graft donor minimal : Tissue culture
Early wound excision was performed on full thickness burn areas

Tangential excision Fascia level excision


1. At 4~6 post burn day, cadaveric allograft skin was applied on the excised burn wound
and skin biopsy of 1 cm2 was obtained for keratinocyte culturing
2. Cadaveric allograft skin was grafted on excised areas
3. At the same time, a small skin biopsy(1cm2) was obtained for culturing CEAs

The CEAs were ready after 3 weeks


- Provided on top of petrolatum gauze.
1:6 meshed autograft Covered with CEAs
4th skin graft: 1:5 meshed autograft with CEA

PBD 62 PBD 128


Case M/26, Chemical Burn, 66%TBSA , CEA and fibrin sealant sprayed on the 1:6 autograft

14 days later 28 days later


Post op 9 day Post op 18 day

Post op 19 day Post op 21day


Pediatric Burns
Thin skin
increases severity of burning relative to adults
Large surface/volume ratio
rapid fluid loss
increased heat loss hypothermia
Delicate balance between dehydration and
over hydration
Commonly require fluid in excess of that
predicted by several formulae
Immature immunological response sepsis
Always consider possibility of child abuse
Geriatric Burns
Decreased myocardial reserve
fluid resuscitation difficulty
Peripheral vascular disease, diabetes
slow healing
COPD
increases complications of airway injury
Poor immunological response - Sepsis
% mortality ~= age + % BSA burned
Electrical Injury
Occurs when electricity is converted to heat as
it travels through tissue
Divided into:
High voltage greater than 1000 V
Low voltage less than 1000 V
Entrance wounds : Hands & wrists
Exit wounds : Feet are common
Adults in workplace, children at home
Severity of injury depends on:
Intensity of electrical current (voltage of
source and resistance of victim)
Pathway through victims body
Duration of the contact with the source
Immediate death may occur from:
1) Current-induced ventricular fibrillation
2) Asystole
3) Respiratory arrest secondary to:
Paralysis of the central respiratory control
system
Paralysis of the respiratory muscles
Principles of Electricity
Electricity: flow of electrons (negatively charged
outer particles of an atom) through a conductor
When the electrons flow away from this object
through a conductor they create an electric current:
amperes
Voltage: force that causes electrons to flow: volts
Anything that impedes the flow of electrons through
a conductor creates resistance: ohms
Electrical current exists in 2 forms:

1) AC: (Alternating Current): when electrons


flow back and forth through a conductor in a
cyclic fashion
- It is used in household and offices and
is standardized to a frequency of 60
cycles/sec (60 Hz)
2) DC: (Direct Current): when electrons flow
only in one direction
- Used in certain medical equipment:
defibrillators, pacemakers, electrical
scalpels
- AC is far more efficient and also more
dangerous than DC (~ 3 times): tetanic
muscle contractions that prolong the
contact of victim with source
Lightning is a form of DC
Occurs when electrical difference between a
thundercloud and the ground overcomes the
insulating properties of the surrounding air
Current rises to a peak in about 2 sec
Lasts for only 1-2 sec
Voltage >1,000,000 V
Currents of >200,000 A
Transformation of the electrical energy to heat
generated temperatures as high as 50,000F
Extremely short duration prevents from
melting