LUKA BAKAR

Burn injury management

principles
* Establish / maintain
airway
Normal perfusion
Fluid / electrolit balance
Normal body temp

Inhalation injury
Clinical indication :
Carbonaceous sputum
Facial burn
Hair ?
Carbon deposit
In ?
Oropharynx
History
CO Hb > 10 %

LIVE SAVING BURN TREATMENT

Remote all : - injurious material
- clothing, jewelry

Prevent hypothermia
Establish 2 large caliber IV line
Initiate warmed RL sol

BURN assesment history

Mechanism

of injury
Associated illness
Allergies
Tetanus status

Rule of nine
ADULT Posterior & anterior
INFANT
Palm surface 1 % BSA
Illustrasi.

Depth of bur
Illustrasi picture

Burn management airway

Asses for injury

Establish and maintain patent
airway early

Burn management breathing

Assume CO exposure
Inhalation of toxic fumes,
carbon particles
Direct thermal injury
Oxygenated / Ventilate
ET intubation
ABG s and CO level

Burn management circulation

Adequate venous acces
Monitor vital signs
Hourly urinary output
- adult
- child

:
:

30 50 cc / hour
1,0 cc/ kg BB / hour

Burn management circulation

Estimate fluid needs
- 2 4 cc warmed RL so /kg BB /
% BSA in first 24 hour
in first 8 hour
in next 16 hour
Based on time from injury
Monitor HR and urinary output

Burn management develop

treatment plan

Estimate burn size / depth

Identify associated injuries
Weigh patient
Baseline blood analyses and chest X ray
Document on flow sheet

Burn management maintain

peripheral circulation
Remove all constricting devices
Asses distal circulation
Escharotomy : surgical consultation

Burn management
gastric intubation
Nausea, vomiting, distention
Burn > 20 % BSA
Medication :
- narcotis minimal use, IV only
- antibiotics NOT indicated early

Burn management wound care

Cover with clean linen
Do not
- break blister
- apply antiseptic
- apply cold water

 Burn management chemical burn

Duration, concentration,
amount
Brush away dry chemicals
Flush with copious amaount of
water for 20 30 minutes

Burn management
electrical burn
* Result in damage to fascia and muscle and may spare the
overlying skin
* Fasciotomy needs
* A B C D E s
* Myoglobinuria : fluid

100 cc urine / hour mannitol 25 gr I.V

* Metabolic acidosis : maintain adequate perfusion

sodium bicarbonate

Burn transfer
criteria
* II and III degree burn :
- 10 % BSA in ages < 10 and > 50 years
- > 20 % BSA
- To face
eyes
ears
hands
feet
genitalia
perineum
major joint

Burn transfer criteria

*
*
*
*
*
*

III degree burn > 5 % BSA

Electric and chemical burn
Inhalation injury
Pre existing illness, associated injury
Children
Special situation

Burn transfer procedure

* Coordinated with burn center doctor
* Transfer with : Documentation / information
laboratory results