Dr. Almahitta Cintami Putri Sp.

BP-RE (K)

Division of Plastic Reconstructive and Aesthetic Surgery

Department of Surgery Padjadjaran University/Dr. Hasan Sadikin General Hospital Bandung

ACUTE CARE SURGERY

2020
https://www.google.com/search?q=luka+bakar+knalpot&safe=strict&client=opera&sxsrf=ACYBGNSsgWRCmTa7mZKsrTOSvD_OqqRuGQ:1581227172152
&source=lnms&tbm=isch&sa=X&ved=2ahUKEwif4Z6f4sPnAhVaU30KHTEhDOEQ_AUoAXoECAwQAw&biw=1400&bih=832
Photos courtesy of Division of Plastic Surgery Hasan Sadikin Hospital
 is an injury to the skin or
other organic tissue

Thermal Electricity Chemicals Radiation

https://www.who.int/violence_injury_prevention/burns/en/
 Causes of Adult’s Burn Causes of Children’s Burn

Flame & explosion 44% Scald 57%

Scald 28% Contact 20%

Contact 14% Flame 11%

Chemical 6% Friction 9%

Friction 4% Chemical 1%

Electrical 2% Electrical 1%

Adults Place of Burning Children’s Place of Burning

Home 64% Home 84%

Work 16% Outdoors 8%

Outdoors 9% Roadway 3%

Roadway 7% Trade & service area 1%

Institutions 1% Institutions/School 1%

Other 3% Other 3%

ANZBA-EMSB course manual 2016

 An estimated 180 000 deaths occur each year from fires alone.

https://www.who.int/violence_injury_prevention/burns/en/; https://ourworldindata.org/grapher/fire-death-rates?country=TZA
Divisi Bedah Plastik RSHS
Stevy, Putra, Bagoes, Ita, Natasya, Almahitta-2018
 P S
Airway
R U Patency, Cervical spine control, Inhalation injury
I R
M V
Breathing
A E Mechanical restriction, Contusion, CO & Ventilation
R Y
Y
Circulation
Pulse, BP, Haemorrhage, Venous acces

Disability
AVPU/Glasgow Coma Scale, Pupils

Exposure & Environment

Examined including the back, Hypothermic

ANZBA-EMSB course manual 2016

  History of burn in
• Patency enclosed space
• Inhalation Injury   Facial burns
 Burned lips and nasal
hairs
 Soot in sputum
 Changed respiratory
mechanics
(hoarseness, coughing,
stridor)
 Dyspnoea
 Cyanosis
 Neurological deficits
• Consider need for intubation and secure (current or anamnestic
airway as required. unconsciousness,
vertigo, nausea,
• Maintain spinal precautions as required vomiting)
especially with explosion or electrical
burns.
Toon MH et al. Crit Care Resusc 2010; 12: 53–61
Photos courtesy of Division of Plastic Surgery Hasan Sadikin Hospital; Clarke JA. 1992. A Colour Atlas of Burn Injuries;
 Breathing
• Assess breathing and support as required.

• Assess adequacy of breathing where circumferential

burns on chest wall -consider escharotomy.

• Administer O2 100% high flow (15l/min) via non-

rebreather mask

ANZBA-EMSB course manual 2016

Sheridan RL. 2012. Burns A Practical Approach to Immediate Treatment and Long-Term Care ; Jeschke MG, La Kamolz LP, Shahrokhi S. 2013. Burn Care
and Treatment: A Practical Guide; McLaughlin ES, Paterson AO. 2012
ANZBA-EMSB course manual 2016
 Circulation
• Assess circulation: HR, BP, pulse, cap refill.
Insert 2 large bore peripheral IV lines. If
unable consider central.
• Haemorrhage control
• Elevate limbs where circumferential burns
present.
Assess perfusion distal to burn: capillary
refill, pulse, warmth, colour.
 Escharotomy/Fasciotomy

ANZBA-EMSB course manual 2016

Photos courtesy of Division of Plastic Surgery Hasan Sadikin Hospital
Clarke JA. 1992. A Colour Atlas of Burn Injuries
 Dissability  Eye Opening (E)
• 4 = spontaneous
• 3 = to sound
• Establish level of consciousness: • 2 = to pressure
• AVPU/Glassgow Coma Scale • 1 = none
 Verbal Response (V)
•
• 4
5 = orientated
4 = confused
• A-alert •
• 6
3 = words, but not coherent
2 = sounds, but no words
•
•
V-response to vocal stimuli
P-responds to painful stimuli
•

•
5
1 = none
Motor Response (M)
6 = obeys command
• U-unresponsive • 5 = localizing
• 4 = normal flexion
• 3 = abnormal flexion
• 2 = extension
• Check pupils • 1 = none

• Hypoxaemia and shock can decreased level

of consciousness

ANZBA-EMSB course manual 2016

https://en.wikipedia.org/wiki/Epidural_hematoma
 Exposure/Environment

• Assess extent of burn

using Rule of Nines
• Prevent hypothermia

ANZBA-EMSB course manual 2016

https://ameriburn.org/public-resources/burn-center-referral-criteria/
 Depth Colour Blisters Capillary Sensation
Refill
Epidermal Red No Present Present
Epidermal Superficial dermal
Superficial Pale Present Present Painful
Dermal pink

Mid Dark Present Sluggish +/-

Dermal pink
Deep Blotchy +/- Absent Absent Mid dermal Deep dermal
Dermal red
Full White/ No Absent Absent
thickness grey

Full thickness
ANZBA-EMSB course manual 2016
 ABA ANZBA

epidermal

superficial dermal
mid dermal
deep dermal

full thickness

McLaughlin ES, Paterson AO. 2012. Burns: Prevention, Causes and Treatment; ANZBA-EMSB course manual 2016
 Fluid Resuscitation
• Greater than 20%TBSA, child 10%TBSA
• RL 3ml/kgbw/%TBSA during the first 24 hr, child + maintenance

Analgesia
• Morphine 0,05-0,1 mg/kg

Tubes
• Urinary Catheter
• Nasogastic Tubes

Tests
• X-Ray, ECG
• Laboratory

First aid: cool running H2O -≥20 mins within 3 hours of burn injury
ANZBA-EMSB course manual 2016
 S
E
C
O A • Allergies

N
D M • Medications

A
R P • Past illnesses
Y

S
L • Last meal

U
R E • Events/environment

V Head To Toe
E Examination
Y

ANZBA-EMSB course manual 2016

 T I M E
• Tissue • Infection/Infla • Moisture • Epithelial
Management mmation Balance advancement/
• Clean: NS or Control • Paraffin/dry Edge
0.1% • Antibiotic gauze/Absorb • Healthy wound
Chlorhexidine cream (SSD) ent edge
• Remove all if delayed • Cling wrap if
loose dermis transfer immediate
• Debridement transfer

Halim AS, Khoo TL, and Saad AZ. Indian J Plast Surg. 2012 May-Aug; 45(2): 193–202.; ANZBA-EMSB course manual 2016
Neligan Plastic Surgery vol.4
 Documentation
Tetanus Support
& Transfer

ANZBA-EMSB course manual 2016

https://ameriburn.org/public-resources/burn-center-referral-criteria/
 Size Person Area Mechanism
>10% TBSA Pre-existing Face/Hands/Feet/Peri Chemical/Electrical
illness neum/Major joints

>5% TBSA child Pregnancy Circumferential (limb Major trauma

or chest)
>5% TBSA full- Extreme of age Lungs (inhalation) Non-accidental
thickness

ANZBA-EMSB course manual 2016