shinta - KGD 2

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    Shinta Kharisma Dewi

    405090066

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    PATHOPHYSIOLOGY OF BURNS

    Burncoagulative necrosis of the epidermis

    and underlying tissues

    depth depending

    temperature to which the skin is exposed

    duration of exposure

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    BURN CLASIFICATION

    Depths

    First degree : Injury localized to the epidermis

    Superficial second degree : to the epidermis and

    superficial dermis Deep second degree : through the epidermis and

    deep into the dermis

    Third degree : full-thickness injury through the

    epidermis and dermis into subcutaneous fat

    Fourth degree : through the skin andsubcutaneous fat into underlying muscle or bone

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    Zone of Tissue Damage

    Zone of coagulationThe necrotic area of a

    burn where cells have been disrupted is termed

    (irreversibly damaged)

    zone of stasisThe area surrounding the

    necrotic zone with decreased tissue perfusion.

    depending on the wound environment, can either

    survive or progress to coagulative necrosis. associated with vascular damage and vessel

    leakage

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    BURN CLASIFICATION

    Causes

    Flame :damage from superheated, oxidized air

    Scald : damage from contact with hot liquids

    Flash : damage from explosion

    Contact : damage from contact with hot or cold

    solid materials

    Chemicals : contact with noxious chemicals

    Electricity : conduction of electrical current

    through tissues

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    FLAME BURNS

    second most common mechanism of thermal

    injury

    e/: - smoking-related fires

    - improper use of flammable liquids

    - motor vehicle collisions

    - ignition of clothing by stoves or space

    heaters

    Usually full-thickness burns

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    SCALD BURNS

    Most common

    Usually from hot water

    - (60C)deep partial-thickness or full-thickness

    burn in 3 seconds

    Scald burns from grease or hot oildeep

    partial-thickness or full-thickness burns

    Exposed areas of skin tend to be burned less

    deeply than clothed areas

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    FLASH BURNS

    e/:

    - Explosions of natural gas

    - propane, butane, petroleum distillates, alcohols

    - other combustible liquids

    distribution over all exposed skin

    deepest areas facing the source of ignition

    typically epidermal or partial thicknessdepending on the amount and kind of fuelthat explodes

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    CONTACT BURNS

    e/:

    - result from contact with hot metals, plastic, glass,

    or hot coals

    - irons, ovens, and wood-burning stoves

    - exhaust pipes of motorcycles

    usually limited in extent, but are invariably

    deep

    often fourth-degree burns

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    ELECTRICAL BURNS

    Electrical injury is unlike other burn injuries

    the visible areas of tissue necrosis represent

    only a small portion of the destroyed tissue.

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    CLASSIFICATION

    Injuries are divided into :

    Low-voltage injury is similar to thermal burns

    without transmission to deeper tissues; zones of

    injury extend from the surface into the tissuecauses only local damage

    High-voltage injury consists of varying degrees of

    cutaneous burn at the entry and exit sites,

    combined with hidden destruction of deep tissue

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    PATHOPHYSIOLOGY

    Electrical current enters a part of the bodyproceeds

    through tissues with the lowest resistance to current

    (bllod vesssels)Heat generated by the transfer of

    electrical current

    injures the tissues. Musclesustains the most damage.

    Blood vesselsproceed to progressive thrombosis

    the cells die or repair themselvestissue loss from

    ischemia

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    CHEMICAL BURNS

    Chemicals cause their injury by protein

    destruction, with denaturation, oxidation,

    formation of protein esters, or desiccation of

    the tissue

    Alkali: potassium hydroxide, bleach, sodium

    hydroxide

    Acid: hydrofluoric acid, formic acid

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    INITIAL TREATMENT OF BURNS

    Prehospital

    burned patients must be removed from the source ofinjury and the burning process stopped

    Inhalation injury is always suspected

    100% oxygengiven by facemask.

    Burning clothing and all accessories is extinguishedand removed as soon as possible to prevent furtherinjury.

    Room-temperature water can be poured on thewound within 15 minutes of injury to decrease thedepth of the wound

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    Initial Assessment

    divided into a primary and secondary survey.

    Primary survey : immediately life-threatening

    conditions are quickly identified and treated

    Secondary survey : a more thorough head-to-toe

    evaluation of the patient is undertaken

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    Direct injury to the upper airway results in edema

    Airway injury must be suspected with

    facial burns

    singed nasal hairs

    carbonaceous sputum

    Tachypnea

    patient's respiratory status must be continuallymonitored to assess the need for airway control and

    ventilatory support

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    AIRWAY + BREATHING

    hoarsenesssign of impending airway

    obstruction endotracheal intubation needs to

    be instituted early before edema distorts the

    upper airway massive burns, who may appear to breathe

    without problemsearly resuscitation (several

    liters of volume are given to maintainhomeostasis and significant airway edema)

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    Chest expansion and equal breath sounds with

    CO2endotracheal tube

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    CIRCULATION

    monitors arterial pressure and urine output.

    Explosioncervical collars to keep the head

    immobilized until the condition can be

    evaluated.

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    WOUND CARE

    Prehospital care of a burn woundclean dry

    dressing or sheet to cover the involved part

    diminishing pain

    wrapped in a blanket to minimize heat loss andfor temperature control during transport.

    IM or SC narcotic injections for pain are never

    usedvasoconstriction

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    Transport

    uncontrolled transport of a burn victim is not a

    priority

    ground transportation and helicopter transport

    greatest use For distances >150 miles, transport by fixed-wing

    aircraft

    Whatever the mode of transport, it needs to be of

    appropriate size and have emergency equipment

    available

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    Resuscitation

    IV accessis best attained through short

    peripheral catheters in unburned skin

    Saphenous vein cut-down is useful in patients

    with difficult access and is used in preference

    to central vein cannulationlower

    complication rates.

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    AdultRL without DX

    Children < 2 yrRL + 5 % DX

    burns greater than 10% TBSA

    0.5 mL oftetanus toxoid.

    If previous immunization is absent or unclear

    or the last booster dose was given longer than

    10 years ago250 units of tetanus IG

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    RESUCITATION CRYSTALLOID !!!!!

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    Escharotomies

    The entire constricting eschar must be incised

    longitudinally to completely relieve the impediment

    to blood flow.

    escharotomies are safest to restore perfusion to theunderlying nonburned tissues until formal excision is

    performed

    The most common complicationsblood loss and

    transient hypotension