Presentasi ini pernah saya sampaikan pada pertemuan dokter jaga IGD dan ruang rawat inap di RS Panti Rapih. Semoga bermanfaat.

1. dr.
Robertus
Arian
D.
IGD
RS
Panti
RapihB
U
R
Nhttp://robertusarian.com;
@robertus_arian;
arian9677@gmail.com
http://i.treehugger.com/
Saturday, January 26, 13

2. Etiology
• scald
• grease
• flames
• flash
• contacts
• electrical
• chemical agents
http://www.backgroundpictures.org
Saturday, January 26, 13

3. Diagnosis of
Burn Wound
depth of injury
(temperature, heat capacity, duration
of exposure, thickness of skin)
size
location
possible complication
Saturday, January 26, 13

4. http://www.indiasurgeons.com
Saturday, January 26, 13

5. Zone of Coagulation
• burn eschar, 3-24 hours
post burn
• platelets and leucocyte
adhesion on the surface
of injured endothelial
cells
• local thrombosis, blood
clotting, fibrin plug
http://www.indiasurgeons.com
Saturday, January 26, 13

6. Zone of Stasis
• cells are viable, can easily
be further damaged
• capillary thrombosis
from injured
endothelium: ischemia-
induced cell death
• continued release of
mediators: thrombosis,
vasoconstriction
• impairment of blood
flow: converts to dead
eschar
http://www.indiasurgeons.com
Saturday, January 26, 13

7. Zone of Hyperemia
• minimal cell injury
• vasodilation:
neighbouring
inflammation
http://www.indiasurgeons.com
Saturday, January 26, 13

8. determining the depth of burns on initial presentation
may prove difficult even for experienced burn
specialists
Saturday, January 26, 13

9. Saturday, January 26, 13

10. First Degree Burn:
• remains confined to the epidermis;
• example: a nonblistering sunburn;
• rarely are of medical consequence, heal rapidly, and
are not included in burn size estimation
Second Degree Burn:
• extends into the dermis, example: blistering scald burn;
• superficial partial thickness burn: only the superficial layer of
the dermis involved, heal less than 21 days, generally do not
require skin grafting;
• deep partial thickness burn: deeper involvement in dermis
(skin appendage), reepithelization more than 21 days,
generally benefit from skin grafting
Third Degree Burn:
• involve the entire depth of the dermis and epidermis;
• heal only by contraction from the edges over a
prolonged period of time
• skin grafting is required
Saturday, January 26, 13

11. Saturday, January 26, 13

12. Saturday, January 26, 13

13. Management
it is important for the patient to realize that this burn
centre stay is only the first part of their recovery
the management of burn STARTS at the scene of the
accident
reduce the AREA and the DEPTH of the burn
STOP the burning process and COOL the burn wound
Saturday, January 26, 13

14. First -aid at Scene
• remove fom the source
• take off clothes, rings,
etc
• irrigate in tap water
10-20 minutes
• more than 10% tbsa ==>
hospital
• do NOT apply
toothpaste, butter, etc... http://www.fotobank.ru
Saturday, January 26, 13

15. Emergency Room
• standard trauma care
• fluid resuscitation
• wound care after
stabilization
http://microgravity.grc.nasa.gov
Saturday, January 26, 13

16. Wound Care
• open the blister, remove
the fluid
• do NOT remove the
blister/skin
• wash the wound with
chlorhexidine 0,05%
• painful: analgesics,
consider narcose
• apply topical dressing
Saturday, January 26, 13

17. Aim of Dressing
• moist and warm
• migration of epithelium cell from peripheral
to central
• patient comfort
• less pain
• easy to monitor
Saturday, January 26, 13

18. Traditional Dressing
• tulle, moist gauze
• has been used fo many years
• cheap, easy
• more colonization of bacteria
• pain when changing dressing
• eschar separation, difficult to excise
• difficult to monitor
Saturday, January 26, 13

19. Silversulphadiazine
• has been used for many
years
• transient leucopenia,
toxic to kidney
• eschar separation maks
difficult to excise and
judge
• kill keratinocytes,
impaired wound healing
http://www.mountainside-medical.com/
Saturday, January 26, 13

20. Transparent Dressing
• practical
• moist and warm
• reepithelization
• non sticky
• easy to monitor
• comfort, less pain when
changing
• early mobilization http://img.medscape.com/
Saturday, January 26, 13

21. Prevent/Reduce Burn Wound
Conversion
• fluid resuscitation
• nsaids
• nutritional support
• topical antibiotics
• wound dressing
• early surgical excision and grafting
• correction of patient-dependent pathologic
factor
Saturday, January 26, 13

22. to Prevent Contractures, keep:
• the neck in extension
• the axilla in abduction
• the elbows in extension
• the wrists neutral or in extension
• the metacarpophalangeal joints in flexion
• the interphalangeal joints in extension
• the knees in extension
• the ankles in 90 degree dorsiflexion
Saturday, January 26, 13

23. “Utamakan Keselamatan Pasien”
Deklarasi Gerakan Keselamatan Pasien
Rumah Sakit Panti Rapih; Rabu, 8 Desember 2010
selesai
Saturday, January 26, 13