BURN MANAGMENT

Ns Hamka, M.Kep., RN., WOC(ET)N

The BURNS patient has the same priorities as all other
TRAUMA patients
 Resusitasi cairan
•  DEWASA (BAXTER
FORMULA) •  Anak2 modifikasi
4 CC X % LBB X Kg BB baxter.
= ….Lar.RL 2 CC x % LLB x Kg
Diberikan : BB = …lar.RL
-  ½ bagian 8 jam pertama Diberikan :
-  ½ bagian 16 jam -  ½ bagian 8 jam
berikutnya. pertama
-  Berikan lar.koloid -  ½ bagian 16 jam
500-1000 cc pd jam ke berikutnya
18-24
WOUND ASSESMENT
1.  Tentukan luasnya luka bakar : Wallace à “Rule of Nines”
2.  Tentukan stadium / derajat luka bakar dengan cara :
•  Klinis : Partial thickness or Full thickness
•  Tusukan jarum / pinprick test : Stage I,II,III,IV
3.  Tentukan penyebab
•  Chemical
•  Electrical
•  Radiation
•  Scalding ( hot water
4.  Laboratorium : Hb, hematokrit, elektrolit
 ZONES OF INJURY

Zone of Zone of Zone of Hyperaemia

Coagulation Stasis

Jackson 1953
 Post-surgical healing issues
Ø  Elbows-elbow flexi on
contracture,loss of supination,
ulnar nerve compression and
heterotopic
ossification...position in
extension and supination
Ø  Wrists-flexi on
contracture...support wrists in
neutral position with splints /
pillows
Ø  Hands-Edema,claw hand
deformity,decreased first web
space...elevation, resting hand
splints, dynamic flexion or
extension splints, thumb splints
 Post-surgical healing issues
Ø  Hips
Flexi on contracture...position
flat,use trochanter rolls at hips
to prevent external rotation
Ø  Knees
Flexi on contracture,peroneal
nerve palsy...elevate, avoid
tight dressing, ace wraps for
vascular support for ambulation
Ø  Ankles
Plantar flexion
contracture...foot splints
 Cleansing And Debridement
•  A new burn is essentially
•  Topical wound
sterile and it is important to
irrigation solutions
keep it clean and moist to
containing topical
promote the development of
antiseptics (e.g.
healthy granulation tissue.
polyhexamethylene
•  Irrigation is the preferred biguanide [PHMB]) can
method for cleansing be considered to maintain a
wounds, and various low bacterial load, reducing
solutions can be used, the risk of infection
including normal saline or
warm tap water. Mild soap
may also be used.
 Next..

•  Debridement of the
wound and wound
edges to remove
necrotic tissue can
reduce the risk of
infection and
encourage
epithelialisation. This
may be a one-off
debridement or
ongoing for
 Managing Blisters

•  The general consensus is

that blisters greater than
1cm2 should be
deroofed, while smaller
blisters should be left
intact
•  Blisters on the palm of
the hand should be left
intact (as deroofing is
painful here) unless they
restrict movement
 Burn Wound Dressig
The characteristics of a good burn
wound dressing have been described :
•  Maintains a moist wound
environment
•  Contours easily
Non-adherent to protect delicate skin
•  Retains close contact with the
wound bed
•  Easy to apply and remove
•  Painless on application and removal
•  Protects against infection
Cost-effective.
 Dressing Change
•  The first dressing change should be
48 hours after injury and then
every 3–5 days there after,
depending on how healing is
progressing.
•  Where possible, dressings that
have a tendency to adhere to the
skin — such as alginate and paraffin
gauze (Jelonet®) dressings — should
be avoided and mod- ern
alternatives such as a soft silicone
wound contact layer and foam
dressing should be used to ensure
atraumatic and pain-free removal.
APLICATION Wound
Dressing
(

4
BURN WITH
DM
KOMPOR MINYAK
Cleansing – debridement –
moist - T
IME
ME
AIR PANAS

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PEDIATRIC BURN (courtesy by
Edy M)
PEDIATRIC BURN (courtesy by Edy M)
PEDIATRIC BURN (courtesy by Edy M)