shinta - kgd 2
TRANSCRIPT
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Shinta Kharisma Dewi
405090066
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PATHOPHYSIOLOGY OF BURNS
Burncoagulative necrosis of the epidermis
and underlying tissues
depth depending
temperature to which the skin is exposed
duration of exposure
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BURN CLASIFICATION
Depths
First degree : Injury localized to the epidermis
Superficial second degree : to the epidermis and
superficial dermis Deep second degree : through the epidermis and
deep into the dermis
Third degree : full-thickness injury through the
epidermis and dermis into subcutaneous fat
Fourth degree : through the skin andsubcutaneous fat into underlying muscle or bone
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Zone of Tissue Damage
Zone of coagulationThe necrotic area of a
burn where cells have been disrupted is termed
(irreversibly damaged)
zone of stasisThe area surrounding the
necrotic zone with decreased tissue perfusion.
depending on the wound environment, can either
survive or progress to coagulative necrosis. associated with vascular damage and vessel
leakage
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BURN CLASIFICATION
Causes
Flame :damage from superheated, oxidized air
Scald : damage from contact with hot liquids
Flash : damage from explosion
Contact : damage from contact with hot or cold
solid materials
Chemicals : contact with noxious chemicals
Electricity : conduction of electrical current
through tissues
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FLAME BURNS
second most common mechanism of thermal
injury
e/: - smoking-related fires
- improper use of flammable liquids
- motor vehicle collisions
- ignition of clothing by stoves or space
heaters
Usually full-thickness burns
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SCALD BURNS
Most common
Usually from hot water
- (60C)deep partial-thickness or full-thickness
burn in 3 seconds
Scald burns from grease or hot oildeep
partial-thickness or full-thickness burns
Exposed areas of skin tend to be burned less
deeply than clothed areas
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FLASH BURNS
e/:
- Explosions of natural gas
- propane, butane, petroleum distillates, alcohols
- other combustible liquids
distribution over all exposed skin
deepest areas facing the source of ignition
typically epidermal or partial thicknessdepending on the amount and kind of fuelthat explodes
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CONTACT BURNS
e/:
- result from contact with hot metals, plastic, glass,
or hot coals
- irons, ovens, and wood-burning stoves
- exhaust pipes of motorcycles
usually limited in extent, but are invariably
deep
often fourth-degree burns
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ELECTRICAL BURNS
Electrical injury is unlike other burn injuries
the visible areas of tissue necrosis represent
only a small portion of the destroyed tissue.
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CLASSIFICATION
Injuries are divided into :
Low-voltage injury is similar to thermal burns
without transmission to deeper tissues; zones of
injury extend from the surface into the tissuecauses only local damage
High-voltage injury consists of varying degrees of
cutaneous burn at the entry and exit sites,
combined with hidden destruction of deep tissue
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PATHOPHYSIOLOGY
Electrical current enters a part of the bodyproceeds
through tissues with the lowest resistance to current
(bllod vesssels)Heat generated by the transfer of
electrical current
injures the tissues. Musclesustains the most damage.
Blood vesselsproceed to progressive thrombosis
the cells die or repair themselvestissue loss from
ischemia
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CHEMICAL BURNS
Chemicals cause their injury by protein
destruction, with denaturation, oxidation,
formation of protein esters, or desiccation of
the tissue
Alkali: potassium hydroxide, bleach, sodium
hydroxide
Acid: hydrofluoric acid, formic acid
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INITIAL TREATMENT OF BURNS
Prehospital
burned patients must be removed from the source ofinjury and the burning process stopped
Inhalation injury is always suspected
100% oxygengiven by facemask.
Burning clothing and all accessories is extinguishedand removed as soon as possible to prevent furtherinjury.
Room-temperature water can be poured on thewound within 15 minutes of injury to decrease thedepth of the wound
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Initial Assessment
divided into a primary and secondary survey.
Primary survey : immediately life-threatening
conditions are quickly identified and treated
Secondary survey : a more thorough head-to-toe
evaluation of the patient is undertaken
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Direct injury to the upper airway results in edema
Airway injury must be suspected with
facial burns
singed nasal hairs
carbonaceous sputum
Tachypnea
patient's respiratory status must be continuallymonitored to assess the need for airway control and
ventilatory support
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AIRWAY + BREATHING
hoarsenesssign of impending airway
obstruction endotracheal intubation needs to
be instituted early before edema distorts the
upper airway massive burns, who may appear to breathe
without problemsearly resuscitation (several
liters of volume are given to maintainhomeostasis and significant airway edema)
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Chest expansion and equal breath sounds with
CO2endotracheal tube
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CIRCULATION
monitors arterial pressure and urine output.
Explosioncervical collars to keep the head
immobilized until the condition can be
evaluated.
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WOUND CARE
Prehospital care of a burn woundclean dry
dressing or sheet to cover the involved part
diminishing pain
wrapped in a blanket to minimize heat loss andfor temperature control during transport.
IM or SC narcotic injections for pain are never
usedvasoconstriction
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Transport
uncontrolled transport of a burn victim is not a
priority
ground transportation and helicopter transport
greatest use For distances >150 miles, transport by fixed-wing
aircraft
Whatever the mode of transport, it needs to be of
appropriate size and have emergency equipment
available
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Resuscitation
IV accessis best attained through short
peripheral catheters in unburned skin
Saphenous vein cut-down is useful in patients
with difficult access and is used in preference
to central vein cannulationlower
complication rates.
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AdultRL without DX
Children < 2 yrRL + 5 % DX
burns greater than 10% TBSA
0.5 mL oftetanus toxoid.
If previous immunization is absent or unclear
or the last booster dose was given longer than
10 years ago250 units of tetanus IG
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RESUCITATION CRYSTALLOID !!!!!
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Escharotomies
The entire constricting eschar must be incised
longitudinally to completely relieve the impediment
to blood flow.
escharotomies are safest to restore perfusion to theunderlying nonburned tissues until formal excision is
performed
The most common complicationsblood loss and
transient hypotension