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Luka Bakar -- Refreshment Meeting

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Presentasi ini pernah saya sampaikan pada pertemuan dokter jaga IGD dan ruang rawat inap di RS Panti Rapih. Semoga bermanfaat.

Presentasi ini pernah saya sampaikan pada pertemuan dokter jaga IGD dan ruang rawat inap di RS Panti Rapih. Semoga bermanfaat.

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Luka Bakar -- Refreshment Meeting Luka Bakar -- Refreshment Meeting Presentation Transcript

  • http://i.treehugger.com/ B  U  R  N dr.  Robertus  Arian  D. IGD  RS  Panti  Rapih http://robertusarian.com;  @robertus_arian;  arian9677@gmail.comSaturday, January 26, 13
  • Etiology • scald • grease • flames • flash • contacts • electrical http://www.backgroundpictures.org • chemical agentsSaturday, January 26, 13
  • Diagnosis of Burn Wound depth of injury (temperature, heat capacity, duration of exposure, thickness of skin) size location possible complicationSaturday, January 26, 13
  • http://www.indiasurgeons.comSaturday, January 26, 13
  • Zone of Coagulation • burn eschar, 3-24 hours post burn • platelets and leucocyte adhesion on the surface of injured endothelial cells • local thrombosis, blood http://www.indiasurgeons.com clotting, fibrin plugSaturday, January 26, 13
  • Zone of Stasis • cells are viable, can easily be further damaged • capillary thrombosis from injured endothelium: ischemia- induced cell death • continued release of mediators: thrombosis, http://www.indiasurgeons.com vasoconstriction • impairment of blood flow: converts to dead escharSaturday, January 26, 13
  • Zone of Hyperemia • minimal cell injury • vasodilation: neighbouring inflammation http://www.indiasurgeons.comSaturday, January 26, 13
  • determining the depth of burns on initial presentation may prove difficult even for experienced burn specialistsSaturday, January 26, 13
  • Saturday, January 26, 13
  • First Degree Burn: • remains confined to the epidermis; • example: a nonblistering sunburn; • rarely are of medical consequence, heal rapidly, and are not included in burn size estimation Second Degree Burn: • extends into the dermis, example: blistering scald burn; • superficial partial thickness burn: only the superficial layer of the dermis involved, heal less than 21 days, generally do not require skin grafting; • deep partial thickness burn: deeper involvement in dermis (skin appendage), reepithelization more than 21 days, generally benefit from skin grafting Third Degree Burn: • involve the entire depth of the dermis and epidermis; • heal only by contraction from the edges over a prolonged period of time • skin grafting is requiredSaturday, January 26, 13
  • Saturday, January 26, 13
  • Saturday, January 26, 13
  • Management it is important for the patient to realize that this burn centre stay is only the first part of their recovery the management of burn STARTS at the scene of the accident reduce the AREA and the DEPTH of the burn STOP the burning process and COOL the burn woundSaturday, January 26, 13
  • First -aid at Scene • remove fom the source • take off clothes, rings, etc • irrigate in tap water 10-20 minutes • more than 10% tbsa ==> hospital • do NOT apply toothpaste, butter, etc... http://www.fotobank.ruSaturday, January 26, 13
  • Emergency Room • standard trauma care • fluid resuscitation • wound care after stabilization http://microgravity.grc.nasa.govSaturday, January 26, 13
  • Wound Care • open the blister, remove the fluid • do NOT remove the blister/skin • wash the wound with chlorhexidine 0,05% • painful: analgesics, consider narcose • apply topical dressingSaturday, January 26, 13
  • Aim of Dressing • moist and warm • migration of epithelium cell from peripheral to central • patient comfort • less pain • easy to monitorSaturday, January 26, 13
  • Traditional Dressing • tulle, moist gauze • has been used fo many years • cheap, easy • more colonization of bacteria • pain when changing dressing • eschar separation, difficult to excise • difficult to monitorSaturday, January 26, 13
  • Silversulphadiazine • has been used for many years • transient leucopenia, toxic to kidney • eschar separation maks difficult to excise and judge • kill keratinocytes, http://www.mountainside-medical.com/ impaired wound healingSaturday, January 26, 13
  • Transparent Dressing • practical • moist and warm • reepithelization • non sticky • easy to monitor • comfort, less pain when changing • early mobilization http://img.medscape.com/Saturday, January 26, 13
  • Prevent/Reduce Burn Wound Conversion • fluid resuscitation • nsaids • nutritional support • topical antibiotics • wound dressing • early surgical excision and grafting • correction of patient-dependent pathologic factorSaturday, January 26, 13
  • to Prevent Contractures, keep: • the neck in extension • the axilla in abduction • the elbows in extension • the wrists neutral or in extension • the metacarpophalangeal joints in flexion • the interphalangeal joints in extension • the knees in extension • the ankles in 90 degree dorsiflexionSaturday, January 26, 13
  • “Utamakan Keselamatan Pasien” Deklarasi Gerakan Keselamatan Pasien Rumah Sakit Panti Rapih; Rabu, 8 Desember 2010 selesaiSaturday, January 26, 13