Burns cause loss of skin integrity and also cause systemic
effects are very complex. Burns
are usually expressed with a degree determined by the depth of burns. Severity of
injury depends on the deep, broad and location of the wound. In
addition to the burn severity, age and state of health of the patient before a
factor that greatly affects the prognosis.
CAUSE
Causes burns often are on fire directly, but it can be caused by burns scalded (generally a superficial burns, but also the entire thickness of the skin / degree three). Causes burns other is exposure to high temperature of the sun, electricity, or chemicals.
Pathophysiology
If skin burns or exposure to high temperatures, capillaries underneath, the surrounding area and the area that far away would be damaged and cause increased permeability. Tempers intrakapilar into the interstitial fluid leak resulting in edema and bullae that contain a lot of electrolytes. Damage to the skin from burns will result in the loss of function of the skin as a barrier and a barrier to evaporation.
Both of the above causes rapidly causing loss of intravascular fluid. On the extent of burns <20%, the compensation mechanism body could still handle. When the skin is burnt area (> 20%), hypovolemic shock can occur with typical symptoms, such as restlessness, pale, cold, sweaty, small and fast pulse, decreased blood pressure, and decreased urine production.
After 12-24 hours and the permeability of the capillaries begin to improve mobilization and re-absorption of fluid from the intravascular to the interstitial space characterized by an increased diuresis.
AREA BURN INJURY
Extensive burns widely expressed in gratuities for the entire body. In adults use formula 9 ", the broad head and neck, chest, back, abdomen, hips and buttocks, right upper extremity, left upper extremity, right thigh, left thigh, leg and right leg, and left leg and foot each respectively 9%, the remaining 1% is the genital area.
Also known formula for babies 10 and 10-15-20 for children.
For children, 15% of head and neck, front and rear body respectively 20%, right and left upper extremities respectively 10%, right and left lower extremities respectively of 15%.
For infants, the head and neck, as well as front and rear body respectively 20%, upper limb / lower left and right respectively of 10%.
DEGREE BURN INJURY
1. Only one degree burns on the epidermis and usually resolves in 5-7 days. Lika appears as erythema with complaints of pain or local hypersensitivity.
2. Degree burns two reached a depth of dermis, but there are still remaining healthy epithelial elements. Epithelial elements, such as the basal epithelial cells, sebaceous glands, sweat glands, and the base of the hair. With the existence of these epithelial cells, wounds can heal itself within 2 to 3 weeks. The symptoms are pain, bloat, or bullae.
3. Tigameliputi degree burns the entire depth of the skin and subcutaneous or organ may be deeper. Skin is pale gray or black abugelap, the lower surface of the healthy surrounding tissue. There is no bull and not feel pain.
CAUSE
Causes burns often are on fire directly, but it can be caused by burns scalded (generally a superficial burns, but also the entire thickness of the skin / degree three). Causes burns other is exposure to high temperature of the sun, electricity, or chemicals.
Pathophysiology
If skin burns or exposure to high temperatures, capillaries underneath, the surrounding area and the area that far away would be damaged and cause increased permeability. Tempers intrakapilar into the interstitial fluid leak resulting in edema and bullae that contain a lot of electrolytes. Damage to the skin from burns will result in the loss of function of the skin as a barrier and a barrier to evaporation.
Both of the above causes rapidly causing loss of intravascular fluid. On the extent of burns <20%, the compensation mechanism body could still handle. When the skin is burnt area (> 20%), hypovolemic shock can occur with typical symptoms, such as restlessness, pale, cold, sweaty, small and fast pulse, decreased blood pressure, and decreased urine production.
After 12-24 hours and the permeability of the capillaries begin to improve mobilization and re-absorption of fluid from the intravascular to the interstitial space characterized by an increased diuresis.
AREA BURN INJURY
Extensive burns widely expressed in gratuities for the entire body. In adults use formula 9 ", the broad head and neck, chest, back, abdomen, hips and buttocks, right upper extremity, left upper extremity, right thigh, left thigh, leg and right leg, and left leg and foot each respectively 9%, the remaining 1% is the genital area.
Also known formula for babies 10 and 10-15-20 for children.
For children, 15% of head and neck, front and rear body respectively 20%, right and left upper extremities respectively 10%, right and left lower extremities respectively of 15%.
For infants, the head and neck, as well as front and rear body respectively 20%, upper limb / lower left and right respectively of 10%.
DEGREE BURN INJURY
1. Only one degree burns on the epidermis and usually resolves in 5-7 days. Lika appears as erythema with complaints of pain or local hypersensitivity.
2. Degree burns two reached a depth of dermis, but there are still remaining healthy epithelial elements. Epithelial elements, such as the basal epithelial cells, sebaceous glands, sweat glands, and the base of the hair. With the existence of these epithelial cells, wounds can heal itself within 2 to 3 weeks. The symptoms are pain, bloat, or bullae.
3. Tigameliputi degree burns the entire depth of the skin and subcutaneous or organ may be deeper. Skin is pale gray or black abugelap, the lower surface of the healthy surrounding tissue. There is no bull and not feel pain.
HANDLING
The first effort is to turn off the fire as it burns on the body, After that soak the burn area in water or flush with running water for at least 15 minutes.
In minor burns, the main treatment principle is to cool the burned area with water, preventing infection and allowing the remains to proliferating epithelial cells, and close the wound surface. Wounds can be treated in a closed or open.
In the broad and deep burns, the patient should be immediately taken to the nearest hospital that has trained personnel and adequate burns unit for the treatment of burns. In the course of the patient was fitted with a drip and a clean cloth and cover ambulance or the like that could bring the patient in a sleeping position.
In severe burns, in addition to general handling as in minor burns, if necessary resuscitation immediately if the patient shows symptoms of shock. If the patient shows symptoms of airway burning, given the mixture of humid air and oxygen. In case of laryngeal edema, placed endotracheal tube or tracheostomy made. Tracheostomy to relieve airway function, reduce dead space, and ease of cleaning the airway of mucus or feces. When there are allegations kkeracunan CO, promptly given pure oxygen.
Local treatment is rubbing the wound with antiseptic and leave it open for an open or closed treatment with a sterile dressing for the treatment of sterility. If the patient needs to be bathed first.
Giving Intravenous Fluids
Before the infusion is given, the breadth and depth of burns must be determined carefully. Then the amount of fluids that will be given in the count. There are several ways to calculate this fluid needs.
How Baxter
Baxter formula, namely,
extensive burns in patients x B patients in Kg x 4 mL RL
Half of the amount of fluid administered in the first 8 hours, the rest are given in 16 hours. The first day is mainly given crystalloid solution RL. The second day is given the first half of the liquid.
Hydration status of patients with extensive burns should be monitored continuously. The success of the liquids can be seen from the normal diuresis is at least 1000-1500 mL / 24 hours or 1mL / kg / h and 3 mL / kg / hour in pediatric patients.
Drugs
Broad-spectrum systemic antibiotics are given to prevent infection. That are widely used classes of aminoglycosides effective against pseudomonas. If there is an infection, antibiotics are given based on the results of culture and sensitivity test germs.
To overcome opiate pain can be given through an IV in the lowest possible dose that can make adequate analgesika but without hypotension.
Furthermore, given the form of ATS and tetanus prevention or toxoid.
Currently, each burn unit has implemented the provision early enteral nutrition through a nasogastric tube to prevent ulcer curling and meet hipermetabolisme status that occur in the acute phase of burns. Enteral nutrition administered via a nasogastric tube which also functions to decompress the stomach. Patients who has stabilized the situation requires physiotherapy to improve blood circulation and prevent joint stiffness.
Handling Local
Degree burns that leave one and two epithelial elements such as sebaceous glands, sweat glands, or the base of the hair is expected to heal itself, as long maintained that the epithelial elements are not destroyed or damaged by infection. Therefore, the necessary infection prevention. In deeper wounds need to be sought as soon as possible rid of dead skin tissue and provide a powerful topical drugs through high until it reaches the base of dead tissue. Local treatment can be done in an open or closed.
There are several types of medications are recommended such as group Silver Sulfadiazine and MEBO (moist exposure burn ointment).
Topical drugs used in the form of a solution, ointment, or cream. Antibiotics may be given in a dosage form netting (tulle). Antiseptic is used povidone iodine or nitras-Argenti 0.5%. Compress nitras-Argenti were always soaked every 2 hours effective as bacteriostatic for all the germs. The drug is precipitated as sulphide or chloride salts that give black enough to contaminate all the fabric. Silver sulfadiazine cream 1% is very useful because it is bacteriostatic, has enough penetrating power, effective against all bacteria, not cause resistance, and safe. Cream applied without pads, and can be cleaned and replaced every day.
Reference:
Textbook of Surgery 3rd edition de Jong, EGC. Jakarta: 2010
The first effort is to turn off the fire as it burns on the body, After that soak the burn area in water or flush with running water for at least 15 minutes.
In minor burns, the main treatment principle is to cool the burned area with water, preventing infection and allowing the remains to proliferating epithelial cells, and close the wound surface. Wounds can be treated in a closed or open.
In the broad and deep burns, the patient should be immediately taken to the nearest hospital that has trained personnel and adequate burns unit for the treatment of burns. In the course of the patient was fitted with a drip and a clean cloth and cover ambulance or the like that could bring the patient in a sleeping position.
In severe burns, in addition to general handling as in minor burns, if necessary resuscitation immediately if the patient shows symptoms of shock. If the patient shows symptoms of airway burning, given the mixture of humid air and oxygen. In case of laryngeal edema, placed endotracheal tube or tracheostomy made. Tracheostomy to relieve airway function, reduce dead space, and ease of cleaning the airway of mucus or feces. When there are allegations kkeracunan CO, promptly given pure oxygen.
Local treatment is rubbing the wound with antiseptic and leave it open for an open or closed treatment with a sterile dressing for the treatment of sterility. If the patient needs to be bathed first.
Giving Intravenous Fluids
Before the infusion is given, the breadth and depth of burns must be determined carefully. Then the amount of fluids that will be given in the count. There are several ways to calculate this fluid needs.
How Baxter
Baxter formula, namely,
extensive burns in patients x B patients in Kg x 4 mL RL
Half of the amount of fluid administered in the first 8 hours, the rest are given in 16 hours. The first day is mainly given crystalloid solution RL. The second day is given the first half of the liquid.
Hydration status of patients with extensive burns should be monitored continuously. The success of the liquids can be seen from the normal diuresis is at least 1000-1500 mL / 24 hours or 1mL / kg / h and 3 mL / kg / hour in pediatric patients.
Drugs
Broad-spectrum systemic antibiotics are given to prevent infection. That are widely used classes of aminoglycosides effective against pseudomonas. If there is an infection, antibiotics are given based on the results of culture and sensitivity test germs.
To overcome opiate pain can be given through an IV in the lowest possible dose that can make adequate analgesika but without hypotension.
Furthermore, given the form of ATS and tetanus prevention or toxoid.
Currently, each burn unit has implemented the provision early enteral nutrition through a nasogastric tube to prevent ulcer curling and meet hipermetabolisme status that occur in the acute phase of burns. Enteral nutrition administered via a nasogastric tube which also functions to decompress the stomach. Patients who has stabilized the situation requires physiotherapy to improve blood circulation and prevent joint stiffness.
Handling Local
Degree burns that leave one and two epithelial elements such as sebaceous glands, sweat glands, or the base of the hair is expected to heal itself, as long maintained that the epithelial elements are not destroyed or damaged by infection. Therefore, the necessary infection prevention. In deeper wounds need to be sought as soon as possible rid of dead skin tissue and provide a powerful topical drugs through high until it reaches the base of dead tissue. Local treatment can be done in an open or closed.
There are several types of medications are recommended such as group Silver Sulfadiazine and MEBO (moist exposure burn ointment).
Topical drugs used in the form of a solution, ointment, or cream. Antibiotics may be given in a dosage form netting (tulle). Antiseptic is used povidone iodine or nitras-Argenti 0.5%. Compress nitras-Argenti were always soaked every 2 hours effective as bacteriostatic for all the germs. The drug is precipitated as sulphide or chloride salts that give black enough to contaminate all the fabric. Silver sulfadiazine cream 1% is very useful because it is bacteriostatic, has enough penetrating power, effective against all bacteria, not cause resistance, and safe. Cream applied without pads, and can be cleaned and replaced every day.
Reference:
Textbook of Surgery 3rd edition de Jong, EGC. Jakarta: 2010
