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DEFINITION
INTRODUCTION
BURN CAUSE COAGULATIVE NECROSIS OF EPIDEMIS AND UNDERLYING TISSUE THE DEPTH DEPENDING TEMPERATURE TIME EXPOSURE SPECIFIC HEAT FROM CAUSATIVE AGENT
BURN CLASSIFICATION
THERMAL ELECTRICITY CHEMICALS SCALD CONTACT RADIATION : DRY HEAT, MOIST HEAT, FLASH : CONDUCTION OF ELECTRIC CURRENT : NOXIOUS CHEMICALS : HOT LIQUID : HOT OR COLD SOLID MATERIAL : RADIOACTIVE AGENT / SUN BURN,
BURN CLASSIFICATION
FIRST DEGREE : LOCALIZED TO THE EPIDERMIS SUPERFICIAL SECOND DEGREE : EPIDERMIS AND SUPERFICIAL DERMIS DEEP SECOND DEGREE : EPIDERMIS AND DEEP INTO THE DERMIS THIRD DEGREE : INTO SUBCUTANEOUS FAT FOURTH DEGREE : INTO UNDERLYING MUSCLE OR BONE
Zone of Hipereremia: - Viable tissue - Vasodilatation capilare - Healing Process begin - Not risk further necrosis
ANATOMY OF SKIN
BURN DEPTH
THIRD DEGREE
FULL THICKNESS THROUGH EPIDERMIS AND DERMIS HARD, LEATHERY ESCHAR NO EPIDERMAL AND DERMAL APPENDAGES REMAIN MUST HEAL BY RE-EPITHELIALIZATION FROM THE WOUND EDGES
OTHER CHANGES
KIDNEYS STOMACH INTESTINE
SYSTEMIC CHANGES
INTEGUMENTARY SYSTEM RESPIRATORY SYSTEM CARDIOVASCULAR SYSTEM EFFECTS ON THE RENAL SYSTEM EFFECTS ON THE GASTROINTESTINAL SYSTEM EFFECTS ON THE IMMUNE SYSTEM MUSCULOSKELETAL SYSTEM CENTRAL NERVOUS SYSTEM INFLAMMATION & EDEMA HYPERMETABOLISM
Integumentary System
Thermal injury rapidly irreversible injury & cell death Epidermis dermis subcutaneous Skeletal muscle Burn injury extended deeper + inflammatory response
Integumentary System
Burn injury - Rapid loss of the intravascular fluid from the damaged capillaries - Neutrophils adhering to endothelium & to each other Obstruction of microvasculature Poor perfusion
Integumentary System
The presence and extent of infection Colonization proliferation extension (hair follicles) growth (necrotic tissue) Infection : bacterial, fungal Coagulum on the surface BURN ESCHAR Necrotic epidermis&dermis
Respiratory System
Direct thermal injury to the trachea and bronchi probably does NOT occur (except in the exposure to large quantities of steam)
Problems related to airways related to : Pneumothorax Interstitial emphysema Aspiration Pulmonary embolism Non specific pulmonary edema
Respiratory Infection
Patient with respiratory failure sterile lung tissue Patient with sepsis extensive infection of the lung (+)
Respiratory Infection
Bacteria & Fungi Angioinvasive Massive proliferation - The walls of pulmonary arteries - Ischemic necrosis of segments of lung tissue
Macrophages accumulate within alveoli Multiplication of alveolar type II cell SEVERE INTERSTITIAL FIBROSIS
Sistem Cardiovaskular
Umum terjadi takikardia dan peningkatan cardiac output pada pasien luka bakar Dilatasi cardiac dan kontraktilitas myocardial yang jelek terjadi pasien luka bakar Hipertropi jantung reaksi dari takikardi dan stimulasi catecolamine Bacterial endocarditis pasien dengan luka bakar dengan sepsis
Non bacterial thrombotic endocarditis (marantic endocarditis) peningkatan komplikasi embolik pada pasien dengan luka bakar luas dan sepsis karena spesies Acinetobacter
Myocardial injury contraction band necrosis Perfusi jelek dan kebutuhan metabolic tinggi pada episode hipotensi
Sistem Urin
Pasien luka bakar jika resusitasi pada jam pertama adequate fungsi ginjal normal Gagal ginjal bila resusitasi cairan tidak optimal dan sepsis Akut tubular nekrosis pada 80% kasus dan terdapat gagal ginjal Ciri morfologis : edema pada seluruh ginjal, peningkatan berat dan nekrosis sel tubular proximal dengan karyolisis, karyorrhexis dan peluruhan sel 48 jam regenerasi cell tubular yang selamat
Pembesaran hati terjadi 2-3 berat normal Hepatomegali kompromi ventilasi Lesi terlihat steatosis, deposition of large and small lipid droplets in hepatocytic dan congestion , centrilobular necrosis
Pankreatisis merupakan komplikasi yang sering Focal necrosis of pancreatic tissue Focal hemorrhage Focal fat necrosis
LYMPHOID SYSTEM
Depletion of Lymphocytes from lymphoid tissue Lymph nodes often lack germinal centre Gastrointestinal lymphoid tissue of the terminal ileum is generally atrophic Appendix often shows a striking lack of normal lymphoid tissue These abnormalities of lymphoid tissue correlate with the deficient immune responsiveness typical of patients with extensive burn injury
MUSCULOSKELETAL SYSTEM
Lesions of skeletal muscle are uncommon in burn patients Occasionally, direct thermal injury extends into deep muscle and can be so severe Electrical injury often associated with with extensive necrosis of muscle Atrophy of skeletal muscle occurs as part of the catabolic state of burn patients, and represent s a challenge for those involved in rehabilitative efforts
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