D/F/50yo

80.75.98
 Chief complain : pain o/t (R) Arm
It has been suffered since 2 days before admitted to
Adam Malik Hospital. Initially, patient has traffic
accident while riding motorcycle then crashed with
truck from another direction. She brought a gallon of
gasoline and the gasoline was splashed on her right
arm and back. Her right arm was lacerated. History of
unconsciousness (+), seizure (-), vomiting (-). Patient
was brought to district hospital and her right arm was
performed primary suture. Then patient was referred
to Adam Malik Hospital the next day.
 Present State
• Sens : Alert
• BP : 110/70 mmHg
• HR : 88 x/i
• RR : 18 x/i
• Temp: 36,7oC
• VAS : 5
• BW : 80 kg
 Generalized State
• Head : no abnormality was found
• Neck : no abnormality was found
• Chest : no abnormality was found
• Back : In localized state
• Abdomen : no abnormality was found
• Genitalia : female, no abnormality was found
• Extremities : In localized state
 Localized State
Back:
• Look: chemical burn grade
II A-B 8 %, erythema (+),
CRT < 2”, bullae was
ruptured, necrotic tissue (+)
• Listen: vesicular on both
hemithorax
• Feel: sonor on both chest,
pain (-), step-off deformity
(-), sensory function was
impaired at the level of T4.
 Localized State
(R) Arm:
• Look: chemical burn grade II A-B
7 %, erythema (+), edema (+),
CRT < 2”, bullae (+), necrotic
tissue (+), deformity (-), sutured
wound (+) sized 35 cm o/t
forearm until dorsal hand, SpO2
of 1st-5th finger was 97-99%.
• Feel: Pain (-), decreased of
sensation (+), pulsation of radial,
ulnar and brachial artery was
difficult to assess d/t edema,
warm acral.
• Move: AROM decreased o/t wrist
and elbow joints d/t pain
 Laboratory finding
• Hb/Hct/WBC/Plt : 12.1/36/16.580/354.000
• Na/K/Cl : 136/3,7/101
• Random Blood Glucose: 129
Chest X-Ray
(R) Forearm X-Ray
Cervical X-Ray
FAST
 Working Diagnosis
Chemical Burn Superficial – Mid Dermal Thickness 15%
o/t Back and (R) Arm, + Lacerated wound o/t (R) Arm
Treatment in the Emergency room
• IVFD Crystalloid 20 drips/min
• Inj. Tetanus toxoid 0,5 cc IM
• Inj. HTIG 250 IU IM
• Inj. Antibiotic  Ceftriaxone 1 g IV
• Inj. Analgetic  Ketorolac 30 mg IV

• Patient prepared for debridement and wound

exploration
 At the operating theatre :
• In General Anesthesia,
supine position, aseptic
and antiseptic procedure
was performed.
• The wound was washed
repeatedly with normal
saline and clorhexidine,
the debris and non vital
tissue was removed.
 At the operating theatre :
• Suture was removed, wound
was explored, there was open
skin degloving sized 35x4x2cm,
muscle based, minimal
contamination, no active
bleeding
• Skin degloving was evaluated,
performed marginal excision
until 5 mm from bleeding point
• The wound was washed again
with normal saline until clean.
 At the operating theatre :
• The wound was
approximated with
nonabsorbable material 2.0
CB
• The rest of wound was
performed secondary healing
• The wound was dressed using
moist ointment, tule and
moist gauze, and dry gauze.
• The operation was done.