PEMICU 1 KGD

SITI SURYANI
 THERMAL BURNS
• Injuries to the skin resulting from contact with
heat, electrical current, radiation, or chemical
agents
• Less than 44oC  well tolerated
• Above 60oC  denaturation of protein

Rosen’s Emergency Medicine 7th Ed

 PATHOPHYSIOLOGY
• Three concentric zone
– Zone of irreversible coagulative necrosis
– Zone of ischemia
– Zone of hyperemia
• Regeneration comes from
– Basal layer of cells
– Dermal skin appendages (hair follicles and
sebaceous glands)

Rosen’s Emergency Medicine 7th Ed

 PATHOPHYSIOLOGY
• Clotting  inflammatory cells recruitment (B2-
integrins, CD11b, CD18)  cells marginate to vessel
walls (ICAM-1)  release of mediators and
cytokines (cytotoxic reactive oxygen and nitrogen species) 
lipid peroxidation  accumulation of
leukocytes, RBC, platelet  microthrombi 
reduce local perfusion

Rosen’s Emergency Medicine 7th Ed

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www.aafp.org
www.aafp.org
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www.aafp.org
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http://www.protectorfiresafety.com/10704-thickbox_default/first-aid-for-chemical-burn.jpg
 Inhalation injury
– Caused by steam, aldehydes, oxides of sulfur and nitrogen, PVC,
Hydrochloric Acid, CO
– Airway edema & de-epithelization of injured mucosa  necrotic
lining  pseudomembranous cast  airway obstruction
– Edema & congestion of pulmonary parenchyma  bronchospasm,
inflammation, destruction  decreased lung compliance 
microatelectasis  progressive hypoxemia  ARDS

Rosen’s Emergency Medicine 7th Ed

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 MANAGEMENT
– Inhalation Injury
• Fiberoptic laryngoscope & bronchoscopy  soot,
charring, inflammation, edema, necrosis
• Injury to parenchyma  xenon ventilation (RARE)
• Other : CO and cyanides
• Treatment : mechanical ventilation, aleveolar lavage,
PO2 >92%, airway pressure <35cm H2O, pH >7,25
• Bronchospasm  bronchodilators + suctioning
• N-acetylsistein with/without heparin aerosolized 
breakdown thick mucous

Rosen’s Emergency Medicine 7th Ed

https://s-media-cache-ak0.pinimg.com/originals/b2/4a/60/b24a609d69f9945931478b5abc1dc1bd.jpg
http://r1.emsworld.com/files/base/image/EMSR/2009/04/16x9/640x360/1242402277713_10320436.jpg
 http://www.ferne.org/
(Joshua Broder, MD, FACEP, Assistant Clinical Professor of Surgery, Division of Emergency Medicine, Duke University
Medical Center, Durham, North Carolina)
 http://www.ferne.org/
(Joshua Broder, MD, FACEP, Assistant Clinical Professor of Surgery, Division of Emergency Medicine, Duke
University Medical Center, Durham, North Carolina)
 http://www.ferne.org/
(Joshua Broder, MD, FACEP, Assistant Clinical Professor of Surgery, Division of
Emergency Medicine, Duke University Medical Center, Durham, North Carolina)
http://image.slidesharecdn.com/spinalcordinjurysci-rhaiene-160224022558/95/spinal-cord-injury-sci-15-638.jpg?cb=1456280996
http://www.lyslaw.com/Spine-Injury-Traumatic-Brain-Injury-Support/Symptoms-Spinal-Cord-Injury.aspx
http://www.lyslaw.com/Spine-Injury-Traumatic-Brain-Injury-Support/Symptoms-Spinal-Cord-Injury.aspx
Current Diagnosis & Treatment Emergency Medicine 7th Ed.
Current Diagnosis & Treatment Emergency Medicine 7th Ed.
http://www.lyslaw.com/Spine-Injury-Traumatic-Brain-Injury-Support/Symptoms-Spinal-Cord-Injury.aspx
ATLS 9th Ed.
ATLS 9th Ed.
ATLS 9th Ed.
ATLS 9th Ed.
ATLS 9th Ed.