2. LB: Injuri / kerusakan jaringan kulit & jaringan tubuh
yang disebabkan trauma thermal.
Penyebab:
Api, Air panas, Zat kimia, Listrik, Petir,
Ledakan dan Radiasi.
MORBIDITAS & MORTALITAS: 1. Penyebab dan Lama kontak.
2. Sudah terjadi sejak fase awal LB.
2
14. “Indeterminate”
• Unsure as to whether
PT or FT
• Observe for
conversion b/t days
3-7
• May or may not
require E&G
• Can unpredictably
increase LOS
15. Calculate burn size
• Estimate %TBSA
Palmar surface of pts hand = 1% TBSA
Age-appropriate diagrams (e.g.- Berkow)
Rule of Nines
16. The Rule of Nines and Lund–Browder Charts
Orgill D. N Engl J Med 2009;360:893-
901
18. Disability
(from other injuries)
• Primary & secondary surveys are
important!!!
• R/O non-thermal trauma … ~5% have
concomitant non-thermal injury
• Management of non-thermal trauma
typically supercedes burn management,
except for the resuscitation.
19. Everything else
• Vascular access: PIV is preferable
• Analgesia = IV opiates
• Conservative & judicious sedatives, prn only
• Wood’s lamp eye exam for flash burns to face
• Escharotomies
• Early enteral nutrition (≥ 20% TBSA)
21. Indications
• Circumferential FT extremity burns with
threatened distal tissue
Diminished or absent distal pulses via doppler
Any S/S of compartment syndrome.
• Circumferential FT thoracic burn (Breathing
disturbance)
Elevated PIP or Pplateau
Worsening oxygenation or ventilation
23. ELECTRICAL INJURY
• Zeus, the ruler of the ancient
Greek gods, was
characteristically depicted
holding thunderbolts,which he
used as warning or punishment
against those who disobeyed
him.
• The first electrical fatality
recorded in France in 1879
24. 24
Shock Severity
• Severity of the shock depends on:
Path of current through the
body
Amount of current flowing
through the body (amps)
Duration of the shocking
current through the body,
• LOW VOLTAGE DOES NOT
MEAN LOW HAZARD
25. PRINCIPLES OF ELECTRICITY
• Electricity is the flow of electrons (the negatively
charged outer particles of an atom) through a
conductor.
• when the electrons flow away from this object
through a conductor, they create an electric
current, which is measured in Amperes (I).
• The force that causes the electrons to flow is the
voltage, and it is measured in Volts (V).
• Anything that impedes the flow of electrons
through a conductor creates resistance, which is
measured in Ohms (R).
28. Resistance of Body Tissues
Least
• Nerves
• Blood
• Mucous membranes
• Muscle
Intermediate
• Dry skin
Most
• Tendon
• Fat
• Bone
29. • Power lines range from:
– Low: < 600 volts
– Ultrahigh: > 1 million volts
• Most homes in US & Canada have a 120/240 V
other countries (Europe, Asia..): 220 V
30. Immediate death may occur from:
1) Current-induced ventricular fibrillation
2) Asystole
3) Respiratory arrest secondary to:
– Paralysis of the central respiratory control
system
– Paralysis of the respiratory muscles
31.
32. • Electrical current exists in 2 forms:
1) AC: (Alternating Current): when
electrons flow back and forth through a
conductor in a cyclic fashion
• It is used in household and offices and is
standardized to a frequency of 60
cycles/sec (60 Hz)
33. 2) DC: (Direct Current): when electrons
flow only in one direction
• Used in certain medical equipment:
defibrillators, pacemakers, electrical
scalpels
• AC is far more efficient and also more
dangerous than DC (~ 3 times): tetanic
muscle contractions that prolong the
contact of victim with source
34. Cutaneous Injuries & Burns
• Extensive flash and flame burns
• Hemodynamic, autonomic,
cardiopulmonary, renal, metabolic and
neuroendocrine responses
35. LIGHTNING
• Lightning is a form of DC
• Occurs when electrical
difference between a
thundercloud and the
ground overcomes the
insulating properties of the
surrounding air
• Current rises to a peak in
about 2 µsec
• Lasts for only 1-2 sec
36. • Voltage >1,000,000 V
• Currents of >200,000 A
• Transformation of the electrical energy to
heat generated temperatures as high as
50,000ºF.
37.
38. Pathway of the current through the body:
– Vertical pathway parallel to the axis of the
body is the most dangerous. It involves all the
vital organs; central nervous system, heart,
respiratory muscles, in pregnant women the
uterus and fetus
– Horizontal pathway from hand to hand: the
heart, respiratory muscles and spinal cord
– Pathway through the lower part of the body:
local damage
39.
40. Nervous System
• Loss of conciousness, confusion & impaired recall
• Peripheral motor & sensory nerves : motor & sensory
deficits
• Seizures, visual disturbances & deafness
• Hemiplegia, quadriplegia, spinal cord injury
• Transient paralysis, autonomic instability
hypertension, peripheral vasospasm due to lightning
from massive release of catecholamines
41. Management of Electrical and
Lightning Injuries
Overall fluid management should be
judicious unless: SIADH
42. Patient Monitoring
• Most severe cardiac complications present
acutely
• Very unlikely for a patient to develop a
serious or life-threatening dysrhythmia
hours or days later
• Asymptomatic normal ECG do not need
cardiac monitoring
43. • Preexisting heart disease: monitor such
patients for 24 hrs after the injury
• Criteria for cardiac monitoring:
– Exposure to high voltage
– Loss of consciousness
– Abnormal ECG at admission
44. Electric Shock:
What Should You Do?
The victim:
Felt the current
pass through
his/her body
The current
passed through
the heart
Was held by the
source of the
electric current
Lost
consciousness
Yes
No No
No
1 second
or more
Yes
No
Yes
Cardiac Monitoring
24 hours
Touched a voltage
source of more
than 1 000 volts
Yes
No
Yes
45. Electric Shock:
What Should You Do?
Page 2.
Touched a voltage
source of more
than 1 000 volts
Cardiac Monitoring
24 hours
Has burn marks
on his/her
skin
The current
passed through
the heart
Yes
No
Yes
Yes
Evaluate and treat burns
(surgical evaluation,
look for myogolbinuria, etc.)
No
Was thrown from
the source
Evaluate trauma
No
Is pregnant
Evaluate fetal
activity
No
Yes
Yes
No
BENIGN SHOCK
Reassure and discharge
Direction Services de Sante
Hydro Quebec, 1995
46. Kriteria Rujukan Pasien LB
46
Grade 2–3
Luas LB>10% BSA pd semua umur.
Umur <10 and > 50 thn
Luas LB >20% BSA
Mengenai area :
• Face
• Eyes
• Ears
• Hand
• Feet
• Genitalia
• Perineum
• Sendi2 utama (Major
joints)
47. Kriteria Rujukan Pasien LB
Grd 3 dg Luas LB> 5% BSA
LB listrik, petir & Zat Kimia
Trauma Inhalasi
Tdp Penyakit atau trauma penyerta
47
48. Kriteria Rujukan Pasien LB
Koordinasi dg dokter Pusat Rujukan.
Dirujuk dg:
• Dokumentasi/ informasi yg
lengkap.
• Hasil Laboratorium.
48
