Burn

Initial Assessment & Management

Iswinarno Doso Saputro

Burn Injury/ Thermal Injury/Combustio

Objectives :
n Identify components of primary and secondary
survey
n Apply the rule of nine to make an initial estimate of
burn extent
n Distinguish between partial thickness and full
thichness burn
n State of ABA reveral criteria
n Initial management of burn wound
2

PRIMARY SURVEY
A. Airway and cervical spine protection
B. Breathing and ventilation
C. Circulation and hemorrage control
D. Disability neorologic deficit
E. Exposure
4

Airway
n

Compromised airway:
1.
2.
3.

4.

Chin lift
Jaw thrust
Inserstion of an oral pharyngeal airway in the
unconscious patient
Endotracheal intubation

Breathing and ventilation

n
n
n

Listen to the chest and verify breath sounds

Assess adequacy of rate and depth of respiration
High flow oxygen is started on each patient at 15
L(100%), using non breathing mask
Circumferential full-thickness burn of the trunk may
impair ventilation and must be closely monitored

Circulation
Assess:
n Blood pressure
n pulse rate
n Skin color
n Inserting 2 large bore catheter into veins,begin
fluid administration.

Characteristics of Shock States

Hypovolemik or Traumatic Shock
Severe

Low-Output
Septic Shock

High Output
Septic Shock

Neurogenic
Shock

Pale

Pale

Pale

Pink

Pink

Normal

Low

Low

Low

Low

Low

Normal

Normal

High

High

High

Low

Low

Low

Low

Low

Cardiogenic
Shock

Mild

Moderate

Skin
perfusion

Pale

Pale

Urine
output

Low

Pulse rate

High

Blood
pressure

Normal

Normal

Normal

Mental
status

Anxious

Normal

Thirsty

Anxious

Anxious

Anxious

Anxious

Neck
veins

Distented

Flat

Flat

Flat

Flat

Flat

Flat

Oxygen
consumption

Low

Low

Low

Low

Low

Low

Low

Cardiac
index

Low

Low

Low

Low

Low

High

Low

Cardiac
filling
pressure

High

Low

Low

Low

Low

Low

Low

Systemic
vascular
resistance

High

High

High

High

High

Low

Low
8

Disability, neurologic deficit

AVPU method:
n A Alert
n V Respon to Verbal stimuli
n P - Respon only to Painful stimuli
n U - Unresponsive

Exposure/Environmental control
Remove all clothing and jewelry
n Maintaining the patients temperature
n Warmed intravenous fluid(37 - 40 oC)
n

10

II. SECONDARY SURVEY :

A. History / anamnesa
B. Physical examination/Pemeriksaan fisik

11

A. History
Circumstances of injury
n Flame
n Scald
n Chemical
n electric

12

Medical history
Factors of consider
AMPLE:
n A- Allergies
n M-Medication
n P-Previous illness
n L-Last meal or fluid intake
n E-Events/environment related to injury

13

B. Physical Examination
Head to Toe examination
n Head
n Maxillofacial
n Cervical spine and neck
n Chest
n Abdomen
n extremitas
n Perineum,genitalia
n Back and buttock
14

Diagnosis of a burn
Surface area of burn (luas luka bakar)
n Depth of burn (kedalaman luka)
n Other injury
n

15

Surface area of the burn

Estimated burn area :

Wallaces Rule of Nines

16

Surface area of the burn

Accurate
assessment : Lund
and Browder burn
charts

17

18

Simple erythema is ignored

n Area of the patients hand approximates to 1%
of the body surface area
n

19

20

Estimation of burn depth

21

Estimation of burn depth

n

1st degree burn

involves only the thinner epidermis
cutaneous erythema, mild pain

2nd degree burn

involves entire epidermis and portions of dermis
divided in superficial and deep
blister, extremely painful

3rd degree burn

involves the entire epidermis and dermis
lack of painful
22

Estimation of burn depth

n

Pinprick test with a sterile needle

partial-thickness : feels pain
full-thickness : no sensation

23

24

Classification of burn
minor
n Moderate
n severe
n

25

Classification: Minor Burns

Total involved BSA < 5%
n No significant involvement of hands, feet, face,
perineum
n No full thickness component
n No other complications
n May typically be treated as outpatients
n

26

Classification: Moderate Burns

Involvement of 5-15% BSA, OR any full
thickness component
n Involvement of hands, feet, face, or perineum
n Any complicating features (e.g., electrical or
chemical injury)
n Should be admitted to the hospital
n

27

Classification: Severe Burns

Total burn size >15% BSA
n Full thickness component >5% BSA
n Hypovolemia requiring central venous access for
resuscitation
n Presence of smoke inhalation or CO poisoning
n Should be admitted to an ICU
n

28

Indications for Admission

n

2nd degree burns > 10% BSA in patients < 10 or > 50

years old

2nd degree burns > 20% BSA in other groups

2nd degree burns that involve face, hands, feet,

genetalia, perineum, and major joints

3rd degree burns > 5% BSA in any age group

29

Indications for Admission

n

Electrical burns, including lightening injury

Inhalation injury with burns injury

Chemical burns with serious threat of functional or

cosmetic impairment

Any burn patient with concomitant trauma

30

Baseline Laboratory Test

1.
2.
3.
4.
5.
6.
7.
8.

Hematocrit
Darah lengkap (Hb)
Albumin
RFT dan LFT
Elektrolit, Na, K, Cl, HCO3
Blood urea nitrogen
Urinalysis
Foto thorak

31

Special circumstance
n
n
n
n

Arterial blood gases( Inhalation injury)

Carboxy hemoglobin
ECG (electric injury)
Glucose (in children) and Diabetic

32

Initial Management
{adjuncts to the secondary survey}
Stop the burn process
n Universal precaution
n Fluid resuscitation
n Vital sign
n Insertion of nasogastric tube
n Insertion of unnary catheter
n

33

{adjuncts to the secondary survey}

Stop the burn process
n Universal precaution
n Fluid resuscitation
n Vital sign
n Insertion of nasogastric
tube
n Insertion of unnary catheter
n

34

{adjuncts to the secondary survey}

Stop the burn process
n Universal precaution
n Fluid resuscitation
n Vital sign
n Insertion of nasogastric tube
n Insertion of unnary catheter
n

35

Resuscitation
Goal :
n Maintain tissue perfusion and organ function
n Avoiding complication

36

Fluid Resuscitation
Oral/enteral fluid replacement an option in
unextensive, uncomplicated burns
n In the field/pre-transfer, reasonable to begin IV
fluids (LR), at 20cc/kg/hour (for 1-2 hrs)
n

37

Fluid Resuscitation
n

Multiple formulas/approaches available

38

Formulas Used to Calculate fluid Needs in Burn Shock

NAME AND YEAR
OF
INTRODUCTION

Harkins/
plasma
1941

Cope/Moore
1947

Evans
1952

1st

24 HOURS

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

(100 ml Plasma) (measured hematocrit-45)

Also add 25% of this calculated dose for each
gram the serum protein is less than 6.0 gm/
100 ml
---------------------------------------------------1/3 given over first 2 hrs
1/3 given over next 4 hrs
1/3 given over next 6 hrs
Recalculate at 12 hrs
75 ml Isotonic electrolyte/% BBSA
+
75 ml Plasma/% BBSA
+
2000 ml D5W
--------------------------------------------------- given over 1st 8 hrs
given over remaining 16 hrs
1 ml 0.9% NaCl/% BBSA/kg
+
1 ml plasma/% BBSA/kg
+
2000 ml D5W
-----------------------------------------------------If greater than 50% BBSA, treat as 50%

previously calculated isotonic

electrolyte/plasma micture
+
D5W, 2000 ml

39

NAME AND YEAR

OF
INTRODUCTION

Brooke (old)
1953

Moyer
1965

1st

24 HOURS

1.5 ml Lactated Ringers/% BBSA/kg

+
0.5 Plasma/% BBSA/kg
+
2000 ml D5W
-------------------------------------------------------- given in first 8 hrs
given over next 16 hrs
--------------------------------------------------------If greater than 50% BBSA, treat as if 50%

of previously calculated
electrolyte and plasma
mixture
+
D5W, 2000 ml

Lactated Ringers titrated to avoid shock

Dexran 70, 6% in 0.9 NaCl 120

ml/% BBSA
Given over 48 hours with D5W,
50 cc/kg/hrs

Sorenson
1968
Baxter/
Parkland
1968

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

Lactated Ringers, 4 ml/% BBSA/kg

given over first 8 hrs

Dextran 40, 500-1000 ml

Begin at 1st 18 hrs

given over remaining 16 hrs

40

NAME AND YEAR

OF
INTRODUCTION

Monafo/
hypertonic
Lactated saline

1970
1984
Brooke
(modified)
1970
Odstock
1981

1st

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

24 HOURS

1970 : HLS
300 mEqNa+/L
200 mEq DL
Lactate/L
100 mEq Cl-/L
Given p.o./I.V, titrated to avoid shock
2 ml Lactated Ringers/% BBSA/kg
given over first 8 hrs
given over next 16 hrs

1984 : HLS
250 mEqNa+/L
100 mEq DL
150 mEq/Cl-/L

Haldanes solution (1.33

NS)
p.o. Up to 3500 ml
maximum
Free water p.o.

Colloid 0.5 ml/% BBSA/kg

+
D5W maintenance

(7.5 ml) (kg)=plasma maximum dose for 36 hrs

1/3 given in first 8 hrs
1/3 given in next 12 hrs
1/3 given in next 16 hrs
P.O intake as thirst demands

41

Monitoring and observation should include:

-Measure of urine output hourly
-Frequent assessment of general condition
-Baseline determination of
hematocrit,Hb,SE,arterial blood gases.repeat
studies as indicated

42

43

44

45

{adjuncts to the secondary survey}

Stop the burn process
n Universal precaution
n Fluid resuscitation
n Vital sign
n Insertion of nasogastric tube
n Insertion of unnary catheter
n

46

{adjuncts to the secondary survey}

Stop the burn process
n Universal precaution
n Fluid resuscitation
n Vital sign
n Insertion of nasogastric tube
n Insertion of unnary catheter
n

47

{adjuncts to the secondary survey}

Assessment of extremity perfusion
n Continued ventilatory assessment
n Pain management
n Psychosocial assessment
n

48

Pain management
Entonox a self-administered nitrous oxide/
oxygen mixture to inhale on demand
n Morphine sulphate 0.1-0.2 mg/kg body weight
Never given intramuscularly or injected under the
skin
n Chlorpromazine 0.5 mg/kg complement and
potentiate the effect of the narcotics
n

49

Unsurvivable Burns
Palliative treatment concentrating on freedom from
pain and discomfort peaceful death within 6-18
hr
n Palliative treatment :
n

n Children

and young adults : full-thickness burns

>90% BSA
n Very elderly : full-thickness burns > 45% BSA

50

Initial care of the burn wound

Thermal burn
n Cover the burn area with a clean and dry sheet
n Ice never be applied directly to the burn

51

Initial care of the burn wound

Electric burn
n Event if the visible surface injury does not
appear serious,there may be occult severe,deep
tissue injury

52

Initial care of the burn wound

Chemical burns
n flushed with copious amount of water
n all contaminated clothing should be remove
n
team members proteced from chemical
exposure

53

WOUND MANAGEMENT

WOUND CLEANSING, DEBRIDEMENT, & DESINFECTION WITH

SAVLON 1 : 30

TULLE

TOPICAL SILVER SULFADIAZINE (SSD)

THICK STERILE GAUZE / ELASTIC BANDAGE

OPEN THE WOUND DRESSINGS AT DAY 5 UNLESS THERE IS

ANY SIGN OF INFECTION

PERFORM UNDER GENERAL ANAESTHESIA (IN THE

OPERATING THEATRE)
54

55

Burn Wound Management

56

57
57

58

Escharotomy
* Full-thickness burns girdling the chest wall
* Full-thickness burns constrict a limb or
digit

59

Burn unit RS dr soetomo

60

61

62

Summary
Burn = serious injury
n Health care provider must be able to assess the
injury rapidly and develop a priority based plan
of care
n Determined by the type,extent,and degree of
burn
n Must know the initial treatment and when to
refer,and method of transport
n

63

64

BUKU BACAAN
Principle And Practice Of Burn Management
(John A D Settle, 1996)
n Advance burn life support course-(American
Burn Association, 2001)
n Burn Surgery (Rajiv Sood,2006)
n

65

66

Shock and fluid resuscitation

Iswinarno Doso Saputro

67

Shock and fluid resuscitation

Objectives :
Participant will be able to
n Discuss post burn hemodynamic changes
n Identify post burn fluid requirements
n Describe physiologic monitoring of resuscitation
n List common complication of burn injury and
resuscitation therapy
n Identify patients requiring special fluid management
68

Pathophysiology of Burn
1.Edema
n
n

Injured tissue: capillary permeability

Protein leakage: hypoproteinemia, and osmotic
pressure in burned tissue
Decreased cell membrane potential with inward
shift of Na+ and H2O, resulting in cellular swelling
Edema maximal at 24 hrs, usually resolved by 3-5
days; capillary leak normal at 24 hrs

69

2. Metabolic Responses
n

Mediators implicated:
n
n
n

cytokines: TNF, IL-1, IL-6

lipids: prostaglandins, thromboxane B2, PAF
stress hormones: catecholamines, steroids

Prostaglandins, IL-1, IL-6 implicated in:

n
n
n

increase in core temperature of 1-2oC

initiating acceleration of nitrogen catabolism
? inversion of T4/T8 ratios from 2:1 to 1:2

70

3. Cardiovasculer Responses
n

Cardiac output initially decreases

loss of intravascular volume, ed SVR
CVP and PCWP typically low-normal, even after
adequate volume resuscitation
Cardiac output usually normalizes before
intravascular volume completely restored

71

3. Cardiovasculer Responses
n
n

Systemic BP, CVP unreliable in this setting

Urine output: most useful single index of adequate
intravascular replacement
n optimal urine output=0.5-1.0 cc/kg/hour; output
<0.5 cc/kg/hr suggests inadequate volume
Diuretics rarely indicated in this setting
n exceptions: electrical, soft tissue, or muscle
injury, where myoglobinuria/ATN may occur

72

4. Fluid Resuscitation
Children with burns >15% BSA will require IV
resuscitation
n Children with burns >30% BSA will require
central line placement
n Resuscitation is with crystalloids initially, with
subsequent inclusion of colloids
n Kaliuresis is common, and K+ losses must be
supplemented
n

73

5. Renal Responses
n

Uncommon, but can result from:

n
n
n

prolonged hypotension due to hypovolemia

myoglobin release from damaged muscle/tissue
hemoglobinuria from heat-induced hemolysis

Early in the postburn period, decreased urinary Na

+ and ClK+ wasting in the urine is common (up to 200
mEq/liter), secondary to the intense adrenal
response to burn injury/stress
74

Hypertension in Burn Patients

n

May be common in pediatric patients

n up to 57% in one study
n 7-10 year old boys with >20% BSA affected
Hypertensive encephalopathy may result
n 7% of hypertensive pediatric burn patients

75

6. Pulmonary Responses
n

Pulmonary dysfunction etiologies in this setting:

shock, inhalational injury, aspiration, sepsis, CHF,
trauma

n
n

Circumferential thoracic eschar or edema may

contribute to restrictive lung disease
Inflammatory mediators released in burn injury
linked to evolution of ARDS
therefore, expect some degree of pulmonary capillary
leak, on a continuum from mild pulmonary edema, to
frank ARDS
76

7. Gastrointestinal Responses
n

Stress (curlings) ulcer

prophylaxis: antacids, H2 blockers, or sucralfate

Increased gut permeability in first 24 hours

n Acalculous cholecystitis
n

fever, abdominal distention, jaundice

n bacterial

seeding (ascending cholangitis)

n sterile, in patients with dehydration, ileus, or
pancreatitis

77

7. Gastrointestinal Responses
n

Superior Mesenteric Artery Syndrome

distal third of duodenum compressed between aorta and
SMA due to loss of retroperitoneal fat
n nausea, vomiting, abdominal pain
n

Acute pseudo-obstruction of the colon

n

massive colonic dilation without organic cause

Narcotic ileus
n

oral narcotic antagonists may be efficacious

78

8. Haematology Responses
n

Initially, shortened RBC survival with intravascular hemolysis/possible hemoglobinuria

n

typically resolves after the 1st week

Anemia is common, and to be expected;

may be masked initially by hemoconcentration
n may be exacerbated by fluid management, occult blood
loss
n typically persists until wound healing occur
n

n depressed

erythropoietin levels documented

79

8. Haematology Responses
n

n
n

Mild thrombocytopenia (sequestration) early, followed

by thrombocytosis (2-4x normal) by end of the first
week
Persistant thrombocytopenia associated with poor
prognosis--suspect sepsis
Fibrinogen elevated; concomitant in FSP
DIC with generalized bleeding can occur
shock, sepsis, hypoxia, reperfusion

80

ADH
Aldosteron

Metabolic
acidosis

Myocardial
depression

Ht , Erytrocite damage
Stasis and impaired
microvascular

Shock

Cutaneus barrier
Insensible losses
Release
proinfl agent

permiability
local-distant

Hipoproteinemia
Starling forces
imbalance

Sodium pump
disfunction

Systemic vasc.
resistance

81

Renal
ARF

Pulmonary dysf
ARDS
Brain
Hypoxia

Haemopoitic syst:
Hemoconcentration
(sludging phenomen)

Hypovolemic
Shock

Haemolysis-Anaemia
thrombosis

Heart
COP

Splanchnic Vasoconstriction
Liver dysf.
Catabolic state
Detox disturb.

GIT
Curlings ulcer
Paralytic IIeus
82

Characteristics of Shock States

Hypovolemik or Traumatic Shock
Severe

Low-Output
Septic Shock

High Output
Septic Shock

Neurogenic
Shock

Pale

Pale

Pale

Pink

Pink

Normal

Low

Low

Low

Low

Low

Normal

Normal

High

High

High

Low

Low

Low

Low

Low

Cardiogenic
Shock

Mild

Moderate

Skin
perfusion

Pale

Pale

Urine
output

Low

Pulse rate

High

Blood
pressure

Normal

Normal

Normal

Mental
status

Anxious

Normal

Thirsty

Anxious

Anxious

Anxious

Anxious

Neck
veins

Distented

Flat

Flat

Flat

Flat

Flat

Flat

Oxygen
consumption

Low

Low

Low

Low

Low

Low

Low

Cardiac
index

Low

Low

Low

Low

Low

High

Low

Cardiac
filling
pressure

High

Low

Low

Low

Low

Low

Low

Systemic
vascular
resistance

High

High

High

High

High

Low

Low
83

Resuscitation
Goal :
n Maintain tissue perfusion and organ function
n Avoiding complication

84

Fluid Resuscitation
Oral/enteral fluid replacement an option in
unextensive, uncomplicated burns
n In the field/pre-transfer, reasonable to begin IV
fluids (LR), at 20cc/kg/hour (for 1-2 hrs)
n

85

Fluid Resuscitation
n

Multiple formulas/approaches available

86

Formulas Used to Calculate fluid Needs in Burn Shock

NAME AND YEAR
OF
INTRODUCTION

Harkins/
plasma
1941

Cope/Moore
1947

Evans
1952

1st

24 HOURS

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

(100 ml Plasma) (measured hematocrit-45)

Also add 25% of this calculated dose for each
gram the serum protein is less than 6.0 gm/
100 ml
---------------------------------------------------1/3 given over first 2 hrs
1/3 given over next 4 hrs
1/3 given over next 6 hrs
Recalculate at 12 hrs
75 ml Isotonic electrolyte/% BBSA
+
75 ml Plasma/% BBSA
+
2000 ml D5W
--------------------------------------------------- given over 1st 8 hrs
given over remaining 16 hrs
1 ml 0.9% NaCl/% BBSA/kg
+
1 ml plasma/% BBSA/kg
+
2000 ml D5W
-----------------------------------------------------If greater than 50% BBSA, treat as 50%

previously calculated isotonic

electrolyte/plasma micture
+
D5W, 2000 ml

87

NAME AND YEAR

OF
INTRODUCTION

Brooke (old)
1953

Moyer
1965

1st

24 HOURS

1.5 ml Lactated Ringers/% BBSA/kg

+
0.5 Plasma/% BBSA/kg
+
2000 ml D5W
-------------------------------------------------------- given in first 8 hrs
given over next 16 hrs
--------------------------------------------------------If greater than 50% BBSA, treat as if 50%

of previously calculated
electrolyte and plasma
mixture
+
D5W, 2000 ml

Lactated Ringers titrated to avoid shock

Dexran 70, 6% in 0.9 NaCl 120

ml/% BBSA
Given over 48 hours with D5W,
50 cc/kg/hrs

Sorenson
1968
Baxter/
Parkland
1968

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

Lactated Ringers, 4 ml/% BBSA/kg

given over first 8 hrs

Dextran 40, 500-1000 ml

Begin at 1st 18 hrs

given over remaining 16 hrs

88

NAME AND YEAR

OF
INTRODUCTION

Monafo/
hypertonic
Lactated saline

1970
1984
Brooke
(modified)
1970
Odstock
1981

1st

SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS

24 HOURS

1970 : HLS
300 mEqNa+/L
200 mEq DL
Lactate/L
100 mEq Cl-/L
Given p.o./I.V, titrated to avoid shock
2 ml Lactated Ringers/% BBSA/kg
given over first 8 hrs
given over next 16 hrs

1984 : HLS
250 mEqNa+/L
100 mEq DL
150 mEq/Cl-/L

Haldanes solution (1.33

NS)
p.o. Up to 3500 ml
maximum
Free water p.o.

Colloid 0.5 ml/% BBSA/kg

+
D5W maintenance

(7.5 ml) (kg)=plasma maximum dose for 36 hrs

1/3 given in first 8 hrs
1/3 given in next 12 hrs
1/3 given in next 16 hrs
P.O intake as thirst demands

89

FORMULA BAXTER
n

RSU DR. SOETOMO digunakan formula baxter untuk dewasa .

untuk anak digunakan formula Moncrief (modifikasi)

Dewasa

n
n
n
n
n
n
n

RL 4 CC X BB X % Luas LB / 24 jam
+ dektran 500-1000 setelah jam ke 18
Anak
:
RL : DEXTRAN = 17 : 3
2 CC X BB X % Luas LB + Kebutuhan Faali
< 10 kg
: BB X 100 CC
10-30 kg
: BB X 75 CC
> 30 kg
: BB X 50 CC
Jumlah cairan diberikan dalam 8 jam pertama
Diberikan 16 jam berikutnya
90

Contoh perhitungan cairan

n
n
n
n
n
n
n

Luka bakar 20 % BB 60 kg
Kejadian jam 06.00 , Datang di UGD jam 09.00
Cairan resusitasi=4x20x60=4800 cc RL
8 jam pertama( dari 06.00 jam 14.00)=2400 cc
16 jam berikutnya(jam 14.00-06.00)=2400 cc
Yang penting monitor produksi urine
Setelah 18 jam diberikan dextran (40%)500 1000 cc

91

Summary
Goal of resuscitation are to maintain tissue
perfusion and organ function,avoiding the
complication
n Monitoring and observation should include:
-Measure of urine output hourly
-Frequent assessment of general condition
-Baseline determination of
hematocrit,Hb,SE,arterial blood gases.repeat
studies as indicated
n

92

Summary
Goal of resuscitation are to maintain tissue
perfusion and organ function,avoiding the
complication
n Monitoring and observation should include:
-Measure of urine output hourly
-Frequent assessment of general condition
-Baseline determination of
hematocrit,Hb,SE,arterial blood gases.repeat
studies as indicated
n

93

iNk

94

Classification: Minor Burns

Total involved BSA < 5%
n No significant involvement of hands, feet, face,
perineum
n No full thickness component
n No other complications
n May typically be treated as outpatients
n

95

Classification: Moderate Burns

Involvement of 5-15% BSA, OR any full
thickness component
n Involvement of hands, feet, face, or perineum
n Any complicating features (e.g., electrical or
chemical injury)
n Should be admitted to the hospital
n

96

KRITERIA BERAT RINGANNYA

(AMERICAN BURN ASSOCIATION)
1.

LUKA BAKAR RINGAN

- Luka Bakar Derajat II < 15%
- Luka Bakar Derajat II < 10% pada anak-anak
- Luka Bakar Derajat III < 1%

2.

LUKA BAKAR SEDANG

- Luka Bakar Derajat II 15-25% pada orang dewasa
- Luka Bakar Derajat II 10-20% pada anak-anak
- Luka Bakar Derajat III < 10%
97

3.

LUKA BAKAR BERAT

- Luka bakar derajat II 25% atau lebih pada orang dewasa

- Luka bakar derajat II 20% atau lebih pada anak-anak
- luka bakar derajat III > 10%
- Luka bakar mengenai tangan, wajah, telinga, mata, kaki
dan genetalia/perineum.
- Luka bakar dengan cedera inhalasi, listrik, disertai trauma lain

98

99

Burn center referal

A. burn center characteristics
B. referal criteria
- greater than 10% TBSA
- involve the face,hands,feet,genitalia,perineum
- electric,chemical,inhalation injury

100

Burn wound Zone

Zone of
Coagulation
Zone o
f

Hyper
aemia

Zone of
Stasis

Jackson 1953
101
101

102