Shinta Kharisma Dewi

405090066

PATHOPHYSIOLOGY OF BURNS
Burn coagulative necrosis of the epidermis
and underlying tissues
depth depending
temperature to which the skin is exposed
duration of exposure

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 and
subcutaneous fat into underlying muscle or bone

Zone of Tissue Damage

Zone of coagulation The necrotic area of a
burn where cells have been disrupted is termed
(irreversibly damaged)
zone of stasis The 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

 zone of hyperemia characterized by

vasodilation from inflammation surrounding
the burn wound.

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

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

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 oil deep

partial-thickness or full-thickness burns
Exposed areas of skin tend to be burned less
deeply than clothed areas

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 thickness
depending on the amount and kind of fuel
that explodes

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

ELECTRICAL BURNS
Electrical injury is unlike other burn injuries
the visible areas of tissue necrosis represent
only a small portion of the destroyed tissue.

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 tissue
causes 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

PATHOPHYSIOLOGY
Electrical current enters a part of the body proceeds
through tissues with the lowest resistance to current
(bllod vesssels) Heat generated by the transfer of
electrical current injures the tissues.
Muscle sustains the most damage.
Blood vessels proceed to progressive thrombosis
the cells die or repair themselves tissue loss from
ischemia

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

INITIAL TREATMENT OF BURNS

Prehospital
burned patients must be removed from the source of
injury and the burning process stopped
Inhalation injury is always suspected 100% oxygen
given by facemask.
Burning clothing and all accessories is extinguished
and removed as soon as possible to prevent further
injury.
Room-temperature water can be poured on the
wound within 15 minutes of injury to decrease the
depth of the wound

 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

 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 continually
monitored to assess the need for airway control and
ventilatory support

AIRWAY + BREATHING
hoarseness sign 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 problems early resuscitation (several
liters of volume are given to maintain
homeostasis and significant airway edema)

 Chest expansion and equal breath sounds with

CO2 endotracheal tube

CIRCULATION
monitors arterial pressure and urine output.
Explosion cervical collars to keep the head
immobilized until the condition can be
evaluated.

WOUND CARE
Prehospital care of a burn wound clean dry
dressing or sheet to cover the involved part
diminishing pain
wrapped in a blanket to minimize heat loss and
for temperature control during transport.
IM or SC narcotic injections for pain are never
used vasoconstriction

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

Resuscitation
IV access is 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 cannulation lower
complication rates.

 Adult RL without DX
Children < 2 yr RL + 5 % DX
burns greater than 10% TBSA 0.5 mL of
tetanus toxoid.
If previous immunization is absent or unclear
or the last booster dose was given longer than
10 years ago 250 units of tetanus IG

RESUCITATION CRYSTALLOID !!!!!

Escharotomies
The entire constricting eschar must be incised
longitudinally to completely relieve the impediment
to blood flow.
escharotomies are safest to restore perfusion to the
underlying nonburned tissues until formal excision is
performed
The most common complications blood loss and
transient hypotension