Translated from Indonesian to English - www.onlinedoctranslator.

com Group task

ISLAND DOCTOR BLOCK II
(Thursday 16 December 2021)

"Burns 27% (Grade 2)”

By:
Group 6

potentiator:
dr. Jimmy Pattinaja, Sp. KL

MEDICAL SCHOOL
PATTIMURA UNIVERSITY
AMBON
2021
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 COMPOSITOR: GROUP 6

1. Princess S. Surniah 201883161

2. Mitha Julfianti Barges 201883163
3. Tri Puspa Rini Dussun Kamoda 201983003
4. Sofia Angel Haumahu 201983006
5. Anna Beate Amanda Loupatty 201983007
6. Vithalya Selanno 201983008
7. Johan Weinand Lepertery 201983009
8. Nathaniel Armando Pelmelay 201983010
9. Satwika Tri Rahmadana 201983011
10. Glorya Agustin Bakarbessy 201983012

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 LIST OF CONTENTS

COMPOSITOR: GROUP 6..........................................................................................................................i

LIST OF CONTENTS.................................................................................................................................ii
FOREWORD..............................................................................................................................................iii
RESULTS AND DISCUSSION..................................................................................................................4
A. Definition of Grade 2 Burn (27%)...................................................................................................4
B. Treatment of Grade 2 Burns (27%)..................................................................................................4
CONCLUSIONS AND SUGGESTIONS....................................................................................................6
BIBLIOGRAPHY.....................................................................................................................................17

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 FOREWORD

With all praise and gratitude to God Almighty, who has given His love and grace so that
this paper entitled "Luka Bakar 27% (Grade 2)" can be completed properly. This paper was
prepared to fulfill one of the assignments for the Marine Medicine course.

On this occasion we would like to thank profusely to all those who have helped us in
completing this paper, to dr. Jimmy Pattinaja, Sp.KL as a Marine Science lecturer for his support
and motivation, as well as to friends who have contributed ideas and motivation to us to
complete this paper.

We realize that there are still many shortcomings in this paper, both in terms of material,
technical and presentation materials. Therefore, we expect constructive criticism and suggestions
to further improve the writing of this paper.

Finally, we hope that the writing of this paper can be useful for the readers.

Ambon, December 16, 2021

(Group 6)

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 RESULTS AND DISCUSSION

A. Definition of Grade 2 Burns

Burns are body skin damage caused by heat trauma or cold trauma (frost bite). The
causes are fire, hot water, electricity, chemicals, radiation and cold trauma (frost bite). This
damage can include subcutaneous tissue. The severity of the injury is usually characterized
by the extent of the skin involved, the anatomic location, the depth of the injury, the age of
the patient and the presence of comorbidities.

Table 1. Causes of burns in adults1,2

According to the American Burn Association, second-degree burns (partial thickness burns)
are burns whose depth reaches the dermis, usually painful, pale when pressed, and
characterized by bullae filled with fluid exudate that oozes out of the blood vessels due to
increased wall permeability.

B. Treatment of Grade 2 Burns (27%)

 First aid
1. Stop the burn process
Remove all sources of injury. Clothing should be removed because it can retain heat. In
electrical trauma, the electrical connection must be disconnected.1
2. Cool the burn
Effective in the first 20 minutes. Irrigation with 15oC water for 20 minutes. It helps
release harmful substances, reduce pain, and reduce edema by stabilizing mast cells and
releasing histamine. Do not use ice water because the vasoconstriction it causes can lead

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 to burn progression. However, cooling large areas of burned skin can cause hypothermia,
especially in children. Chemical burns can be irrigated with as much water as possible.1
3. Analgesic
NSAIDs such as ibuprofen can be given
4. Close the burn
It is better if the dressing used is flexible, soft, non-sticky, impermeable, and transparent.
It is recommended that the cover is only to cover the wound without completely
wrapping the wound. Blankets are good for keeping the patient warm. If there is no sticky
film, a sterile cotton pad can be used. Burns on the hands can be covered with clear
plastic clingwrap. Prevent the use of wet dressings.1
 Advanced treatment
1. Clean the wound
Clean with soap and water or an antibacterial liquid such as chlorhexine. If there are large
bullae, they should be removed from the base, dead skin should be removed with scissors
or a sterile needle. Small bullae should be left alone.1
- Second degree burn
 If there is an intact bulla, leave it because it helps wound healing
 When the bullae are open, remove all the dead skin
 Give a topical antibiotic, usually neomicyn bacitracin (Nebacatin®) cream or
MEBO® ointment twice daily and cover with a dry cover.1
 Superficial grade II usually heals in 10-14 days
2. Use cover
Ideally within 24 hours it is necessary to check dressings again. The first time the
dressing is changed after 48 hours then every 3-5 days thereafter. If the dressing wound is
painful, smells, is contaminated, there is excessive discharge, or there are signs of
infection such as fever, the dressing should be changed immediately. If the wound does
not heal within 3 weeks, immediately refer to a plastic surgeon who treats burns. Burn
scars will be dry and sensitive. During the healing period, it can be itchy. We recommend
giving a softening cream and keep it away from direct sunlight.1
3. Burns on the face

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 Should be referred to a specialist in plastic surgery. However, if it is only sunburn, the
wound should be cleaned twice a day with diluted chorohexidine solution. Preferably
coated with a cream such as liquid paraffin, every 1-4 hours to minimize crusting.
Patients should sleep with 2 pillows in the first 48 hours to prevent facial edema
 Treatment of burns in the first 24 hours

The principles of the Primary Survey and Secondary Survey on trauma (ATLS) and
simultaneous resuscitation should be applied.2

Before performing first aid, medical personnel are required to use personal protective
equipment (gloves, goggle glass, and special protective clothing) before handling patients.

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 Primary survey
Immediately identify life-threatening conditions and perform emergency management.2
a. Airway: Airway management and cervical trauma management
b. Breathing: Breathing and ventilation
c. Circulation: Circulation with bleeding control
d. Disability : Neurogenic status
e. Exposure : Exposure and Environmental Control

 Secondary survey
It is a thorough examination from head to toe. Examinations are carried out after life-
threatening conditions are believed to be absent or have been resolved.2
The ultimate goal is to establish the correct diagnosis.2
a. Disease history
Information that must be obtained regarding the patient's medical history before the
trauma occurred:
A (Allergies): History of allergies

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 M (Medications): Drugs that are consumed
P (Past illness): Illness before the trauma
L (Last meal): Last meal
E (Events): Events that occur during trauma
b. Trauma mechanism
Information that must be obtained regarding the interaction between the patient and the
environment:
1. Burns :
a. Exposure duration
b. Type of clothes used
c. Water temperature and condition, if the cause of burns is hot water
d. Adequacy of first aid measures
2. Sharp trauma:
a. Projectile speed
b. Distance
c. The direction of movement of the patient during trauma
d. Blade length, inserted distance, direction
3. Blunt trauma:
a. Impact speed and direction
b. Use of seat belts
c. Number of passenger compartment damage
d. Ejection (ejected)
e. Falling from a height
f. Type of explosion or explosion and distance of blow
c. Secondary survey check
1. Perform a head to toe examination referring to a secondary examination of the ATLS
course (advanced trauma life support)
2. Monitoring / Chart / Recorded resuscitation results
3. Prepare transfer documents

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 Emergency surgical management
a. Escharotomy
An eschar incision that encircles the chest or extremity
Goal:2
1) Prevent breathing disorders.
2) Prevent pressure on important structures in the extremities (blood vessels, nerves).
Escharotomy is performed when indicated.
Indications: In burns that affect the entire thickness of the dermis, causing edema that can
pinch blood vessels, for example circular burns in the extremities and chest.
Procedure:2
1. Diagnosis:
a. Eskar wrapped around the chest and extremities.
b. Eschars: white/pale structures that are painless and generally harden.
c. Signs of respiratory distress: increased respiratory rate.
d. Signs of compression of important structures: numbness of the fingers, pain,
paleness, coldness, immobility.
2. Tools preparation:
a. Blade No. 15
b. Betadine
c. Cauter
d. sterile gauze
e. Elastic Bandage
f. Plaster
3. Action
a. Asepsis and antisepsis were performed.
b. An escharotomy incision is made:
On the chest: in the midaxillary line bilaterally.

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 In the antebrachie: in the midulnar and midradial lines.
On the crus: in the medial and lateral lines.

On the dorsum manus and dorsum pedis: generally 3 fan-shaped incisions.

c. Perform hemostasis.
d. Cover with sterile gauze and elastic bandages on the extremities and bandages on
the chest.

CONCLUSIONS AND SUGGESTIONS

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 Burn injuries are an under-appreciated trauma that can affect anyone, anytime and
anywhere. The injuries can be caused by friction, cold, heat, radiation, chemical or electric
sources, but the majority of burn injuries are caused by heat from hot liquids, solids or fire.
In second-degree burns, there will be damage to the epidermis and part of the dermis.
Second-degree burns are divided into two, including:
1. Superficial damage that affects the surface of the dermis such as hair, sweat glands,
which usually heals in 10-14 days
2. Deep damage throughout the dermis layer and heal longer than one month

Early treatment for patients with burn injuries:

1. Stop the burn process (Ex : burns due to electrical trauma, the electricity must be cut off)
2. Irrigite/ rehydration
3. Analgesics to relieve the pain
4. Dressing (cover the burn area with a soft cloth)
5. Check the airway, beating and circulation (follow up treatment)

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 BIBLIOGRAPHY
.
1. RI MK. NATIONAL GUIDELINES FOR MEDICAL SERVICES FOR BURN
MANAGEMENT. Ministerial Regulation. 2019;1–9p
2. Kurniawan SW, Susianti. Burns Degree II-III 90% due to fire in a 22-year-old man in the
surgical department of the Abdoel Moeloek Regional General Hospital, Lampung. J
Unila medulla. 2017;Volume 7,(2):140.
3. Mansjoer, Arif et al. Capita Selecta Medicine Volume 1. 4th Edition. Jakarta: Media
Aesculapius, 2014. pp. 253-255.

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