Professional Documents
Culture Documents
Burn Wound Care
Burn Wound Care
Compiled by:
Dea Saufika Najmi G99142056
Riris Arizka Wahyu G99142065
Chendy Endriansa G99151012
Muhammad Al Amin G99121028
Supervisor:
Amru Sungkar, dr.,Sp.B,Sp. BP-RE
Introduction
Burns is an injury case often
faced by doctors, especially Burns cause loss of skin
in the ER. Severe burns can integrity and also raises very
cause severe morbidity and complex systemic effects
degree of disability is caused by contact with a
relatively high compared to heat source
other causes of injury
Wounds caused by
exposure to excessive
heat, chemicals, radiation,
or electricity leading to
damage of the tissue
ETIOLOGY
Thermal
exposure to flame or a hot object
Chemical
exposure to acid, alkali or organic substances
Electrical
result from the conversion of electrical energy into heat.
Radiation
result from radiant energy being transferred to the body
resulting in production of cellular toxins
4
CHEMICAL BURN
5
ELECTRICAL BURN
6
BURN INJURY CLASSIFICATIONS
Classified according to depth of injury and
extent of body surface area involved
Burn wounds differentiated depending on
the level of dermis and subcutaneous
tissue involved
1. superficial
2. deep
3. partial thickness
4. full thickness
7
4/1/2011
8
SUPERFICIAL BURNS
9
10
PARTIAL THICKNESS BURN
(Superficial)
13
14
FULL THICKNESS BURN
• Destruc tio n o f all skin layers
• Req uires im m ed iate ho sp italizatio n
• Dry, waxy white, leathery, o r hard
skin
• No p ain/ lo ss o f sensatio n
• Exp o sure to flam es, elec tric ity o r
c hem ic als c an c ause 3rd d egree
b urns
15
16
TOTAL BODY SURFACE AREA
(TBSA)
Superficial burns are not involved in the
calculation
Lund and Browder Chart is the most accurate
because it adjusts for age
Rule of nines divides the body – adequate for
initial assessment for adult burns
17
LUND BROWDER CHART USED FOR
DETERMINING BSA
18
Evans, 18.1, 2007)
RULES OF NINES
Head & Neck = 9%
Each upper extremity
(Arms) = 9%
Each lower extremity
(Legs) = 18%
Anterior trunk= 18%
Genitalia (perineum) =
1%
19
Local Response
THE THREE ZONES OF A BURN WOUND BY JACKSON
Zone of stasis
Zone of hyperemia
Zone of coagulation
central, by vaso- by
constriction vasodilation
most and ischemia.
severely resulting
The tissue is from the
damage initially release of
area. The viable, inflammatory
cells in however it mediators
this area may convert
to coagulation
from
are as a cutaneous
coagulated consequence cells. Tissue
or necrotic. of the in this zone
Tissue in development typically
this zone edema, remains
infection, and viable
must be 20
decreased
debrided. perfusion
Local response
21
SYSTEMIC CHANGES
• Decreased • Respiratory • Decreased or
cardiac output distress absent motility
syndrome • Curling’s ulcer
formation
• Increased of • Supression of
basal metabolic humoral and cell-
rate mediated
• Increase in core immune response
body temperature • Increased risk of
infection
Metabolic Immunologic 22
PHASES OF BURN INJURIES
23
Diagnosis
Physical Advanced
Anamnesis
Examination examination
• auto/alloanamnesis • Primary Survey • Laboratory studies
• Airway :CBC, serum
• Breathing electrolite,
albumine, ALP,
• Circulation
serum Carbon
• Disability Monoxide, urine
• exposure studies
• Secondary Surver • Chest X-Ray
(Head to toe) • CT-scan
• Local Status • ECG
• Renal function
(BUN and
creatinine)
• Bronchoscopy
Management
Acute Phase:
a. Avoid contact with source of burning injury
50% of this volume is infused in the first 8 hours, starting from the time of
injury, and the other 50% is infused during the last 16 hours of the first
day.
Cleansing and
debridement
Use mild soap and water or with
chlorhexadine/normal saline washes
Quantitative cultures to
diagnose wound invasion
best obtained by tissue
biopsy
First few hours colonized by gram-positive
bacteria
Colonized by gut flora by 5 days
- wound location
- cost
The goals in selecting the most appropriate
dressing :
• providing protection from contamination
(bacterial or otherwise) and from physical
damage
• allowing gas exchange and moisture retention
Anti-inflammatory Properties
Anti-oxidant Properties
Anti-viral Properties
Surgical:
Deep burns are also managed with surgical
excision and placement of xenograft, allograft,
autograft, or Cultured Skin Substitutes (CSS).
Most experienced burn surgeons Early wound
excision within the 1st to 7th day of injury
(attenuate the systemic inflammatory effects and
reduce the risk of sepsis)
Factors in appropriate timing for
burn wound excision and grafting
including:
- Age
- extent and depth of burn
- Comorbidities
- hospital resources
- physician preference
Other studies:
- Most studies have shown that excision within
24 to 48 h after injury is associated with
decreased blood loss, infection, length of
hospital stay and mortality, and increased
graft take
- Due to prevent infection, excising the eschar
and covering the wound as early as possible
are critical.
The standard for rapid and
permanent closure of full-
thickness burns is a split-
thickness skin graft from an
uninjured donor site on the
same patient (autograft)
sufficient coverage without risk
of rejection
Patients with more extensive burns often require
temporary coverage with :
allograft tissue taken from a living/deceased
human donor
xenograft taken from a different species
skin substitute
dermal analog
Allograft and Xenograft
Promote re-epithelialization and pre- pare the wound
bed for autograft, increasing the healing rate when
compared with traditional dressings
Xenograft superior choice for their increased safety
and reduced price
A cadaver allograft the best material for temporary
closure of excised wounds in extensive, life-threatening
burns and inadequate donor sites.
Allograft
Xenograft (pig origin)
Skin subtitutes and dermal analog