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Combustio
Definition of Burn Injuries (combustio)
Burns (combustio) is tissue damage or loss caused by contact with heat sources such as fire, hot water, chemicals, electricity, and radiation (Moenajat, 2001).
Etiology of Burn Injury
Burn a High Temperature (Thermal Burn)
Burn Injuries of Chemicals (Chemical Burn)
Burn Electrical Shock (Electrical Burn)
Radiation Burn Injuries (Radiation Injury)
Burn Phase
A. The acute phase
Known as the initial phase or phases of shock. In the initial phase the patient will experience the threat of disruption airway (airway), brething (breathing mechanism), and circulation (circulation). Airway disorders can not only occur immediately or shortly after the fire, but still can occur due to obstruction of the respiratory tract inhalation injury within 48-72 hours post trauma. Inhalation injury is the leading cause of death in the acute phase penderiat.
In the acute phase of common disorders of fluid and electrolyte balance due to thermal injury with systemic impact.
B. Sub-acute phase
Takes place after the phase of shock is resolved. The problem that happens is damage to or loss of tissue due to contact heat source premises. Injuries that occur to cause:
1. The process of inflammation and infection.
2. Problem closing the wound with point of concern in the wound epithelium naked or dressed in broad and or the structure or organ - a functional organ.
3. Hipermetabolisme circumstances.
C. Phase information.
Next phase will last until the maturation of scarring from injuries and recovery functions of the organs functional. Problems that appear in this phase are complications in the form of hypertrophic scars, keloids, pigmentation disorders, deformities and contractures.
Classification of Burns
A. Burn it
Classification combustio
Burn Level I
Depth: Superficial partial thickness
Cause: flares, ultraviolet light (burnt by the sun).
Appearance: Dry there is no bubble, edema, minimal or absent, pale when pressed with a fingertip, contains back when pressure is released.
Color: Increased red.
Feeling: Pain
Burn Rate II
Depth: Deeper than the thickness of the partial, superficial, deep.
Cause: Contact with water or solid materials, flames on clothing, licking directly chemical, ultra violet rays.
Appearance: Blister large and growing larger in size moist, pale when pressed with a fingertip, when the pressure is released contains the return.
Color: Spotted-spots that are less clear, white, brown, pink, red-brown areas.
Feeling: Very sore
Burn Level III
Depth: Thickness completely.
Cause: Contact with liquid or solid material, flames, chemicals, contact with electric current.
Appearance: Dry with skin peeling, such as charcoal visible blood vessels under the skin is peeling, bubbles rarely, the walls are very thin, not enlarged, not pale when pressed.
Colors: White, dry, black, dark brown, black, red.
Feelings: No pain, little pain, hair easily separated when removed.
B. Area of Burn
Wallace divides the body above the 9% or multiples of 9 are known by the name of the rule of nine or rule of Wallace are:
1. Head and neck: 9%
2. Each arm 9%: 18%
3. Agency for the next 18%, 18% rear weight: 36%
4. Each leg 18%: 36%
5. Genetalia / perineum: 1%
Total: 100%
C. Burn severity
To assess the severity of the burn should consider several factors, among others:
1) The percentage area (extent) on the body surface burns.
2) The depth of the burn.
3) Anatomical location of burns.
4) Age of clients.
5) history of past treatment.
6) trauma that accompanies or concurrently.
American College of Surgeon divided in:
A. Severe - Critical:
a) Level II: 30% or more.
b) Level III: 10% or more.
c) Level III on the hands, feet and face.
d) With the penafasan complications, heart disease, fractures, extensive soft tissue.
B. Medium - moderate:
a) Level II: 15-30%
b) Level III: 10-10%
C. Lightweight - minor:
a) Level II: less 15%
b) Level III: less than 1%
Indication of Inpatient Burn
A. Grade II burns:
1. Adults> 20%
2. Child / parent> 15%
B. Grade III burns.
C. Burns with complications: heart, brain etc..
Management
A. Resuscitation A, B, C.
1) Respiratory:
• Hot air, mucosal damage, edema, obstruction.
• The toxic effects of smoke: HCN, NO2, HCL, Petrol irritation Bronkho kontriksi obstruction failed breath.
2) Circulation:
Impaired capillary permeability: intra-vascular fluid from moving into the extra vascular relative hypovolemia shock ATN renal failure.
B. Intravenous lines, catheters, CVP, oxygen, lab, wound cultures.
C. Baxter fluid resuscitation.
Adults: Baxter.
RL 4 cc x BW x% LB/24 hours.
Children: + the number needs resuscitation physiology:
RL: dextran = 17: 3
2 cc x BW x% LB.
Needs of physiology:
<1 year: BB x 100 cc
1-3 years: BB x 75 cc
3-5 years: BB x 50 cc
À ½ awarded the first 8 hours
½ Ã given 16 hours later.
Day two:
Adults: dextran 500 - 2000 + D5% / albumin.
Children: Given as needed physiology.
D. Monitor urine and CVP.
E. Topical and close wounds.
• Wash the wound with savlon: NaCl 0.9% (1: 30) + dispose of necrotic tissue.
• Tulle.
• Silver sulfa diazin thick.
• Close the thick gauze.
• Evaluate 5-7 days, except for dirty bandage.
F. Drugs - drugs:
• Antibiotics: not given when a patient comes in <6 hours since the incident.
• If necessary give antibiotics according to the pattern of germs and the corresponding culture results.
• Analgesic: strong (morphine, petidine).
• Antacids: if necessary.
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