DR Stefanus Nangoi, M.Biomed, SPB

Burn
dr Stefanus Nangoi, M.Biomed, SpB

Burn Epidemiology
•2,500,000/year
•100,000 hospitalized
•12,000 deaths
Second leading cause of trauma

deaths after motor vehicle accidents.
2
Skin Form & Function
• Organ terbesar
• Sebagai pelindung
• Fungsi:
• Sensasi
• Proteksi
• Temperature regulation
• Fluid retention
3
Skin Anatomy
• Skin Layers
• Epidermis
• Dermis
• Subcutaneous tissue
4
Major Concerns
Kehilangan cairan
Tidak dapat mempertahankan temperature tubuh
Infection
5
Superficial Burns
• Superficial (First degree)

• Involves only epidermis
• Red
• Painful
• Tender
• Blanches under pressure
• Possible swelling, no blisters
• Heal in ~7 days
7
Partial Thickness Burns
• Partial Thickness (Second

degree)
• Extends through epidermis
into dermis
• Salmon pink
• Moist, shiny
• Painful
• Blisters may be present
• Heal in ~7 to 21 days
8
Full Thickness Burns
• Full Thickness (Third degree)

• Through epidermis, dermis
into underlying structures
• Thick, dry
• Pearly gray or charred black
• May bleed from vessel
damage
• Painless
• Require grafting
9
Derajat Luka Bakar
• Susah ditentukan pada fase akut
• Infeksi lebih cenderung terjadi
• Bila ragu – Lebih baik over diagnosa
10
Burn Depth
11
Burn Depth
12
Burn Depth
13
Burn Depth
14
Burn Extent: Rule of Nines
15
Burn Extent: Rule of Thumb
• “Rule of Palm”
• Patient’s palm equals
1% of his body surface
area
17
Burn Severity
Depth
Extent
Location
Cause
Patient Age
Associated Factors
18
Critical Burns
• Full-thickness burns involving hands, feet, face,

upper airway, genitalia, or circumferential burns
of other areas
• Full-thickness burns covering more than 10% of
total body surface area
• Partial-thickness burns covering more than 30%
of total body surface area
• Burns associated with respiratory injury
19
Critical Burns, continued
• Burns complicated by fractures
• Burns on patients younger than 5 years old or older than 55 years old
that would be classified as moderate on young adults
20
Moderate Burns
• Full-thickness burns involving 2% to 10% of total body surface area
excluding hands, feet, face, upper airway, or genitalia
• Partial-thickness burns covering 15% to 30% of total body surface
area
• Superficial burns covering more than 50% of total body surface area
21
Minor Burns
• Full-thickness burns involving less than 2% of the total body surface
area
• Partial-thickness burns covering less than 15% of the total body
surface area
• Superficial burns covering less than 50% of the total body surface
area
22
Associated Factors
• Patient Age
• < 5 years old
• > 55 years old
• Burn Location
• Circumferential burns of chest, extremities
23
Kriteria Referal
• Second- and third-degree burns of greater than 10% TBSA
• Full-thickness burns in any age group
• Any burn involving the face, hands, feet, eyes, ears, or perineum that
may result in cosmetic or functional disability
• Electrical injury
• Inhalation injury or associated trauma
• Chemical burns
• Burns in patients with significant comorbid conditions (e.g., diabetes
mellitus, chronic obstructive pulmonary disease, cardiac disease)
Initial Assessment
• Scene Safety
• BSI
• Determine MOI/Severity
• Number of Patients
• Additional Resources
25
Stop Burning Process!
• Remove patient from source of

injury
• Remove clothing unless stuck to
burn
• Cut around clothing stuck to burn,
leave in place
26
Assess Airway/Breathing
• Start oxygen if:

• Moderate or critical burn
• Decreased level of consciousness
• Signs of respiratory involvement
• Burn occurred in closed space
• History of CO or smoke exposure
• Assist ventilations as needed
27
Assess Circulation
• Check for shock signs /symptoms
Early shock seldom results from effects of

burn itself.
Early shock = Another injury until proven
otherwise
28
Rapid Physical Exam
• Check for other injuries
• Rapidly estimate burned, unburned areas
• Remove constricting bands
30
Treat Burn Wound
• DO NOT apply ointments or creams
• Superficial Burn:
• Cool, moist dressings
• Protect from exposure to air
• Partial/Full Thickness Degree Burns:
• Cover with dry dressing (commercial burn sheets are acceptable)
31
Inhalation Injuries
…Beware the unseen injury!
32
Concerns:
• Hypoxia
• Carbon monoxide toxicity
• Upper airway burn
• Lower airway burn
33
Carbon Monoxide Poisoning
• Product of incomplete combustion

• Colorless, odorless, tasteless
• Binds to hemoglobin 200x stronger than oxygen
• Headache, nausea, vomiting, “roaring” in ears
• Exposure makes SpO2 useless!
34
Upper Airway Burn
• True Thermal Burn
• Danger Signs
• Neck, face burns
• Singing of nasal hairs, eyebrows
• Tachypnea, hoarseness, drooling
• Red, dry oral/nasal mucosa
35
Lower Airway Burns
• Chemical Injury
• Danger Signs:
• Loss of consciousness
• Burned in a closed space
• Tachypnea (+/-)
• Cough
• Rales, wheezes, rhonchi
• Carbonaceous sputum
36
Chemical Burns
37
Concerns:
• Damage to skin
• Absorption of chemical; systemic toxic
effects
• EMS personnel exposure
• Hazmat incident?
38
Management
• Remove chemical from skin
• Liquids
• Flush with water
• Dry chemicals
• Brush away
• Flush what remains with water
39
Chemical Burns
• Occur whenever a
toxic substance
contacts the body
• Eyes are most
vulnerable.
• Fumes can cause
burns.
• To prevent exposure,
wear appropriate
gloves and eye
protection.
40
Care for Chemical Burns
• Remove the
chemical from the
patient.
• If it is a powder
chemical, brush off
first.
• Remove all
contaminated
clothing.
41
Care for Chemical Burns, cont'd
• Flush burned area with

large amounts of water
for about 15 to 20
minutes.
• Transport quickly.
42
Electrical Burns
Current kills, not voltage!
43
Considerations:
• Intensity of current
• Duration of contact
• Kind of current (AC or DC)
• Width of current path
• Types of tissues exposed (resistance)
44
Electrical Burns
• Non-conductive injuries:
• Arc burns
• Ignition of clothing
• Conductive injuries:
• “Tip of Iceberg”
• Entrance/exit wounds may be small
• Massive tissue damage between entrance/exit
45
Electrical Entrance/Exit Wounds
46
Other Complications
• Cardiac arrest/arrhythmias
• Respiratory arrest
• Spinal fractures
• Long bone fractures
• Internal organ damage
47
Electrical Burn Management
• Make sure power is off
before touching
patient.
• Check ABCS
• Two wounds to
bandage.
• Transport patient and
be prepared to
administer CPR.
48
ALS Indicators
• Possible airway involvement including singed facial hair, soot in
mouth/nose, or hoarseness
• Burns with injuries: shock, fractures, or respiratory problems
• Partial or full thickness burns to the face
• Partial or full thickness burns > 20% BSA
• Severe pain (ALS pain control)
49
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DR Stefanus Nangoi, M.Biomed, SPB

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Burn

dr Stefanus Nangoi, M.Biomed, SpB

Second leading cause of trauma

Tidak dapat mempertahankan temperature tubuh

• Superficial (First degree)

• Partial Thickness (Second

• Full Thickness (Third degree)

• Full-thickness burns involving hands, feet, face,

• Remove patient from source of

• Start oxygen if:

• Check for shock signs /symptoms

Early shock seldom results from effects of

• Product of incomplete combustion

• Flush burned area with

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