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THERMAL BURN
PRESENTED BY :
H ANANI KUSUMAS ARI
G9 9152076
G99161100
Patients Status
Name
: An. L
Age
: 5 months
Sex
: Female
Religion
: Islam
Ocupation : Address
: Mojogedang, Karanganyar
Admission date
: 08 Oktober 2016
: 01355548
Chief Complain
Thermal burn because of hot water
Present Ilness
The patient come with thermal burn as major complain
that occurred about 4 hours before enter hospital.
Patient played with her brother while their mother bring
a pot with hot boiled water. Unintentionally, her brother
pushed their mother and the pot dropped off then the
hot water splashed onto her face. Patient have a thermal
burn scar in face, body and left lower limb. Patient came
first to Karanganyar Hospital but due to unsupported
facility, they referred to dr. Moewardi Hospital.
Past History
Allergy
: denied
Hypertension
: denied
: denied
: denied
Family History
Drug Allergy
: denied
Hypertension
: denied
: denied
Lifestyle History
Patients receive only breast milk due to exclusive
breastfeeding
Socioeconomic History
Patient is a BPJS insurance user
Systemic Anamnesis
Head : cephalgia (-), scar (+) in face
Eyes : Yellow eyes (-), eye redness (-)
Respiratory system
Cardiovascular system
Gastrointestinal system : nausea (-), vomiting (-), abdominal pain (-), diarrhea
(-)
Genitourinary system : pain (-), urinated blood (-)
Upper Musculoskeletal system : oedem (-/-), scar (-/+), cold acral (-/-), pain (-/-)
Lower Musculoskeletal system : oedem (-/+). Scar (-/+), cold acral (-/-), pain (-/
+)
Physical Examination
1. Primary Survey
Airway
: Clear
2. Secondary Survey
Head : mesocephal, scar (+) look at status localis
Eyes : pale conjunctiva (-/-), icteric sclera (-/-), isokor pupil (3mm/3mm),
light reflex (-/-), periorbital hematoma (-/-), diplopia (-/-)
Ears
: Secret (-/-), blood (-/-), mastoid pain (-/-), tragus pain (-/-)
Nose
Lip : Gum bleeding (-), dirty tongue (-), lesion (-), malocclusion (-)
Neck : Thyroid enlargement (-), lymphonodes enlargement (-), pain (-),
normal JVP
Thorax : Normochest, lesion (-)
Cor
Inspection : ictus cordis not showed
Palpation : ictus cordis did not palpable
Percussion : heart enlargement (-)
Auscultation
: normal heart sound
Pulmo
Inspection : normal breath movement
Palpation : normal fremitus
Percussion : sonor/sonor
Auscultation
: vesicular sound normal
Abdomen
Inspection : distended abdomen (-)
Auscultation
: normal sound
Palpation : pain (-), muscular defense (-)
Percussion : tympanic sound
Genitourinaria : normal
Musculosceletal: pain (+), Range of Motion cant be examined
Extremety :
Cold acral
Edema
Status Localis
Regio Facialis
Inspection : combustion grade II 5%, bullae (+)
Regio Abdomen
Inspection
Clinical Presentation
Assessment I
Combustion due to hot water grade I-II 18%
Planning I
Blood examination
RL Infussion 20 tpm
Ceftriaxon Injection 1 gr/12 hrs
Ketorolac Injection 1 amp/8 hrs
Check O2
Debridement
Literature Review
Definiton
Thermal Burn is a tissue damaging or loss due to extreme heat source, cold
source, electric source, chemical compounds, light, radiation, or friction.
Pathopysiology
Local response
Systemic Response
Degrees of burn
Severity of burn
Nutritional management
Nutritional care for a patient in burns is adjusted to individual needs and
given in three stage :
Ebb phase/shock period : in the first 24 hours, responds to fluid resuscitation
Flow/recovery phase, resuscitation : characterized by gradual increases in cardiac
output, heart rate, oxygen consumption and supranormal increases of temperature
Anabolic phase/hypermetabolic hyperdinamic response : in 10-14 days after the
injury after which condition slowly recedes to normal as the burn wounds heal
naturally or surgically closed by applying skin grafting
Goals of Nutritional
Management
To promote optimal wound healing and rapid recovery from burn injuries
To minimise risk of complication including infection
To attain and maintain normal nutritional status
To minimise metabolic isturbances during the treatment process
Objectives of Nutritional
Management
Provide nutrition bia enteral route within 6-18 hours post burn injury
Maintain weight within 5-10% of pre burn weight
Prevent signs and symptoms of micronutrient deficiency
Minimize hyperglycaemia
Minimize hypertriglyceridaemia
Mode of feeding
Enteral nutriton support with high protein, high carbohydrate diet. Feeding
started within 4-36 hours following injury appear. Enteral support can reduce
the burn related increase in secretion of catabolic hormones and help
maintain gut mucosal integrity.
Total parenteral nutriton is not recommended, due to its ineffectiveness in
preventing the catabolic response to burns.
Nutritional management in
infant with burn trauma
Expressed Breast Milk (EBM)
Standard Infant Formula (e.g SMA Gold, C&G Premium)
Specialist Infant Formula (e.g Pregestimil, Neocate)
May be required in certain clinical conditions