BURNS

Thermal Injury / Combustion / Burn

Wound

Ishandono Dachlan
Division of Plastic Surgery, Department of Surgery
Faculty of Medicine, Gadjah Mada University
 BURNS
(Aston SJ et al., eds. Grabb and Smith’s Plastic Surgery. 5th ed.
Philadelphia: Lippincott-Raven Publishers, 1997)

A MAJOR BURN

 disruption of homeostasis

Loss of integrity of the skin

– Destroying the barrier between the

balance of inner environment and that
of the external
 BURNS

 Leading to the loss of:

• body temperature
• fluids
• proteins
• electrolytes
and allowing the ingress of foreign
materials and invasion by microbes
- Followed by:
Massive Systemic Response
 Leading to:
* fluid loss in uninjured tissues
* dysfunction of distant tissues and
organs
▼
Multi-organ Failure / Multi-organ
Dysfunction
▼
death
 EPIDEMIOLOGY
In the U.S.A.:
- 1.25 million / year sustain burn injury
- 51,000 requiring hospitalization
- annual mortality rate = 5,500
- long-term morbidity arising from:
• organ dysfunction
• mechanical dysfunction
• psychological
• cosmetic disability
THREE IMPORTANT
FACTORS IN BURNS

1. ETIOLOGY / CAUSE
2. BURN DEPTH
3. BURN SIZE / AREA
 ETIOLOGY / CAUSES

1. SCALD
2. FLAME
3. CONTACT
4. CHEMICALS
5. ELECTRICITY
Chemical Burn

 Duration, amount,
concentration
 Brush away dry
chemicals
 Flush with copious
amounts of water
for 20-30 minutes
Alkaline Burn
Electrical Burn

 Result in damage
to fascia and
muscle, and may
spare the overlying
skin

Fasciotomy
 BURN DEPTH

• 1st DEGREE
Superficial Skin Burn
• 2nd DEGREE
Partial-Thickness Skin Burn
• 3rd DEGREE
Full-Thickness Skin Burn
 BURN DEPTH

Superficial Skin Burn

 BURN DEPTH

1st degree
burn wound
 BURN DEPTH

Partial Thickness Skin Burn

 BURN DEPTH

2nd degree
burn wound
 BURN DEPTH

Full Thickness Skin Burn

 BURN DEPTH

3rd degree
burn wound
BURN SIZE / AREA

“Rule of Nines”
 BURN SIZE / AREA
EXTENT OF BURN WOUND
Age (Years)
Area 0-1 1-4 5-9 10-15
Head 19 17 13 10
Neck 2 2 2 2
Anterior trunk 13 13 13 13
LUND &
Posterior trunk 13 13 13 13 BROWDER
Buttock 5 5 5 5 CHART
Genitalia 1 1 1 1
Arm 4 4 4 4
Forearm 3 3 3 3
Hand 2½ 2½ 2½ 2½
Thigh 5½ 6½ 8½ 8½
Leg 5 5 5½ 6
Foot 3½ 3½ 3½ 3½
 TREATMENT

PRE-HOSPITAL
• STOP - DROP - ROLL
• Remove the heat source
(effective when less than 2
minutes)
 TREATMENT
RESUSCITATION A-B-C
A: When suspected of inhalation
injury
* closed-space smoke exposure
* facial burns; singed nasal
vibrissae
Endotracheal tube is better than
tracheostomy.
 TREATMENT

RESUSCITATION A-B-C
B: Burns of the chest area
 ESCHAROTOMY
C: Baxter Formula
Ringer’s lactate infusion:
4 cc x BW (kg) x burn area (%)
 AN EXAMPLE CASE
A patient with 50 kg of BW and 20% of
TBSA burn
Fluid amount needed
= 4 x 50 (kg BW) x 20 (%)
 4,000 mL of RL
1st 8 hours: 2,000 mL  62 drops/min
The next 16 hours: 2,000 mL  31
drops/min
 MONITORING

• Vital signs
• Urine output  Adult: 30 ml / h
Child: 1-2 ml / kg / h
• Breath sounds
INDICATIONS FOR ADMISSION /
TRANSFER CRITERIA
• 2nd and 3rd degree burns > 10% BSA in
patients < 10 or > 50 yrs old,
> 20% in the other age group
• 3rd degree burn > 5% in any age group
• electrical / chemical / inhalation burns
• burns involving: face, hands, feet, genitalia,
perineum, or major joints
• burns concomitant with other injuries / pre-
existing diseases
WOUND CARE
• 1st degree  no specific treatment
• 2nd degree  cleanse with
0.9% NaCl + Savlon
500 cc 5 cc
Sofratulle
Sterile gauze
(for 1 week)
WOUND CARE
3rd degree 
Cleanse with 0.9% NaCl (500 cc) +
Savlon (5 cc)
Daily debridement
Dermazin® / Burnazin® (1% Silver
Sulfadiazine cream) everyday
When necessary: Escharectomy +
Skin Grafting
Facilities of Dr. Sardjito Hospital
Burn Unit
6 beds with 2 isolation rooms
1 burn tank with a transporter
6 bedside monitors
2 ventilators
1 mobile X-ray
2 blanket rolls
1 nebulizer
1 getting dysinfectant
1 microwave
1 computer
Nurse Center
Burn Ward
Bedroom
Treatment Room
Burn Tank
Isolation Room
THANK YOU