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3rd Patient

A Female patient, 46 years old was admitted to ER with:

Chief Complain:
Burn injury at head, neck, trunk, both upper extremity and
thigh for 5 hours before admission

Primary Survey
A : hoarseness (+)
B : RR 22 x/minute, vesicular breathing sound right = left,
SpO2 99%
given O2 NRM, 10 l/min
C : HR 100x/minute, BP : 110/60 mmHg  rehidration
with baxter formula
D : Alert, GCS 15.
Secondary Survey
• Burn injury at head, neck, trunk, both upper extremity
and thigh for 5 hours before admission
• Patient was filling kerosene into stove in then kitchen,
then suddenly the fire spread, the fire burned patient’s
cloth. Then patient when out to outdoor and flash
with water.
• Hoarseness (+)
• Patiens was still consciuos after the accident
• There is no associated trauma in the other part
• Patient was delivered from district hospital with
IVFD RL 1 line, 1500 cc fluid was already
administered.
Physical Examination
• General Appearance : Severely illness
• Consiousness : GCS 15
• HR : 104 x/minute
• BP : 110/60 mmHg
• RR : 22 x/minute
• Temperature : 37,20 C
• VAS :6

Eyes : Conjungtive was not anemic


Locally State

Head and neck region


I : edema (+) at lip and face, eschar (+) at
whole face and neck, hair was burned,
total 5%

Trunk region
I : eschar (+), from whole chest and half of
abdomen to back, edema (+), total 15%
Locally State

Right upper extremity region


I : eschar (+), circular on humeral to antebrachii, bulae
on hand, SpO2 99% total 10%

Left upper extremity region


I : eschar (+), circular on humeral to antebrachii, bulae
on hand, SpO2 99%, total 10%

Right thigh region :


Eschar (+), Bulae (+) ±2%

Left thigh region :


Eschar (+), Bulae (+) ±2%
Locally State
5%

8%

10% 10%

2%
2%
8%
Working Diagnosis
Burns Injury grade II-III 45 % cause by fire
Inhalation injury
Impending compartement syndrome on both upper
extremity

Laboratorium:
Hb : 13,5 gr/dL GDS : 167 mg/dl
Ht : 41% Ureum : 52 mg/dl
Leukosit : 30.700/mm3 Kreatinin: 1,0 mg/dl
Patient was prepared at the pre operative room :
• Informed consent
• O2 10l/min NRM
• IVFD RL continue rehidration with baxter
formula
• Anti tetanus
• Antibiotic and analgetic
• Consult to anestesiologist

To the patient we performed :


• Insertion of ETT
• Escharotomy
Rehidration
Baxter formula:
4ccx 45 x 50 kg = 9000cc
First Day 1 st 8 hours = 4500 cc
2 nd 16 hours= 4500 cc
03/08-16 03/08-16 04/08-16 04/08-16
17.00 22.00 01.00 17.00

Arrive at M
Patient was Jamil Urine Urine
burned Hospital, 1cc/kgbw/ho 1cc/kgbw/ho
already got RL ur ur
1500 CC Given 4500 cc Given 4500 cc
Given 3000 cc RL for next 16 RL for next 24
RL for next 3 hours hours
hours
Operative report
• Supine position under general anesthesia
• Evaluation, trachea was edema, insertion ETT
• Disinfect operative field
• Performed escharotomy on both upper
extremity and finger
• Stop the bleeding
• Closed wound with dressing
Patient this morning:
• Patient was in ICU
S : patient on sedative
O : HR 92x/min, BP 100/70mmHg,
RR intubated
Right upper extremity region : SpO2 100%
Left upper extremity region : SpO2 100%
Urine : 0,5 cc/kgBW, clear yellow
In Patient

A male patient, 34 years old was admitted to


emergency room with:

Chief Complain :
Burn injury at face, both arm, and both leg for
3 days before admission
Present illness hystory
• Burn injury at face, both arm, and both leg for
3 days before admission
• Patient was cooking in the kitchen, then the gas
blew up and burn his body.
• Patient was still conscious after the accident.
• There was no associated trauma in the other
part
• Breathlessness (-)
• Patient was admitted to distric hospital then
referred to M Djamil hospital
Physical Examination
• General Appearance:Moderately illness
• Consiousness : GCS 15
• BP : 130/80 mmHg
• HR : 88 x/minute
• RR : 22 x/minute
• Temperature : 37,60 C
• VAS :6

Eyes : Conjunctive was not anemic


Locally State
3
%

5
%

4
%

6
%

7
%
Working diagnosed:
Burn Injury grade II-III 25 % caused by flame

Laboratorium :
HB : 13,4 gr%
WBC : 6.200/mm3
Ht : 46 %
Trombocyte : 225.000/mm3
Potasium : 132 mmol/L
Sodium : 3,3 mmol/L
RBG : 128 ng/dl
Ureum : 20 ng/dl
Creatinin : 0,8 ng/dl
Condition Patient this
Morning
Patient in Burn Unit
S/ Fever (-), breathlessness (-)
O/ BP HR RR
Temp VAS
120/80 mmHg 82x/’ 20x/’ 37,2
4

Urine production: 70 cc/hours,


bright yellow.