Thermal Injury

By: SUPRIADI, BSN, MHS

(Acute and chronic wound Specialist)
 THERMAL WOUND

Cause by:
1. Temperature  Hot
2. Chemistry (burn)
3. Electrical
4. Radiation  Cool

2
SKIN ANATOMY
P
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y
s
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o
l
o
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y
 Burn Degree

Grade 1 : Only epidermis

o Eritema
o Decreased Pain after 24
hour
Grade 2
• Epidermis and partial dermis
• Blister
• Burn healing with re-epitelisasi
Grade 3

• All Skin layers (epidermis to

dermis and fascia)
• Burn healing with scrape tissue
1
2

Grade 1 : epidermis
Grade 2 : dermis
Grade 3 : dermis to muscle
and organ in under layer
Depth of Burn
 BURN WIDE

Rule of
Nine for
Adult
 BURN WIDE

Rule of
Nine for
Child
 BURN MANAGEMENT

Primary Survey
A : Edema Glottis !
Be careful if:
- hair and eyebrow were
on fire
- Carbon in mouth or
faring
- Room Closed off
Then need:
Airway Definitive
 BURN MANAGEMENT

B : Intoksikation of CO
Be careful if “room closed off”
When need Bagging - O2
C : Excessive evaporation 
Dehidration
 BURN MANAGEMENT
C. Circulation
Intra Vena Fluid if burn wide is > 20 %
RL : 4 cc/Weight (kg)/% wide burn/24 hour
½  8 hour
½  16 hours
Always monitor of urine !
Adult: 30 – 50 cc/hour or 0.5 cc/Weight (kg)/hour
Anak : 1 cc/Weight (kg)/hour
Bayi : 2 cc/Weight (kg)/hour
 BURN MANAGEMENT

D : Head trauma

E : Open clothes of patient

 BURN MANAGEMENT
Secondary Survey
Assessment for :
- Injury by Trauma
- AMPLE
A : allergy
M : medication
P : Post illness
L : Last Meal
E : Environment / Events
 BURN MANAGEMENT
Surgical
Escharotomy
Excision of the Burn Wound
Skin Grafts

Non Surgical
Management of Infection
Management by Depth of Burn
Management by Depth of Burn

Superficial Thickness Burns

The care of a superficial-thickness burn is simple,

often requiring only the application of a moisturizer
on the wound. The goal is to provide an environment
that encourages reepithelialization of the wound.
Partial-Thickness Burns
The goal of wound management of partial thickness
burns is to prepare them for primary healing.

First, they should be cleansed.

It is generally felt that small, sturdy blisters can be
left intact, but large or fragile blisters should be
debrided. If there is a concern about infection, then
an antibacterial agent may also be applied to the
wound surface. The most common antimicrobial
agents used on partial-thickness wounds are
ointments or creams.
Full-Thickness Burns

Debridement of full-thickness burn wounds is

accomplished in the operating room as part of
surgical excision and skin grafting.
The clinician’s goal is therefore to prepare the
wound for surgical management by controlling
infection, rather than to promote primary healing.
Subdermal Burns
Subdermal burns are treated with moist wound
healing procedures as described until surgical
coverage of the wound is completed.

Burn Dressings, Ointments, and Creams

Hydrogels
Silver-impregnated gauze dressings.
Ointment; Bacitracin, Polymyxin B sulfate,
Neomycin.
Antimicrobial agents; Silver sulfadiazine,
Mafenide acetate 0.5% cream (Sulfamylon)
 BURN MANAGEMENT
Secondary Survey

• From head to toe

• Tube and finger in every orifice

 Definitive Therapy
Burn  Topical agent like silver
sulfadiazine.

Antibiotic : Wait to culture results

Antacid : If > 20 % burn wide  it
can gastritis erosive or curling ulcer
 Definitive Therapy
Don’t:
 Cool water splash
 Only 15 minute effect after
contact
 It can hypothermia
 Open the blister
 Cool Injury
 General
Hypothermia  < 35 ºC

Sub freezing
 Local (Trench foot)
Freezing (frost bite)
Cool Injury  Local

Frost Bite Trench foot

Management of Hypothermia

1. A, B, C, D & E
2. Warm :
•Warm water
•Blanket, aluminum Foil, blanket & Hair
Dryer
•Intra Vena fluid in condition of warm ,
Gastric Lavage of warm, Cliasma of
warm
•Oxygen
Management of Chemical Injury

Don’t move substance contamination to

Emergency room or Hospital.
We must do decontamination such as open
clothes & splash of water.

Strong Acid < Strong Lactic

Always splash 30’, Lactic >>

If powder  broom before

Management of Electrical Burn

Deviation of ECG

CPR, until the doctor talk of

death
Management of Electrical Burn

Disorder of tissue

Skin, Conduction <

Fat, Conduction >
Muscle, Conduction >>
 Injury by Weather Hot
1. Seizure
- Heat Cramps
- Deficit of electrolyte
2. Weakness
- Heat Exhaustion
- Dehydration
3. Stroke
- Heat Stroke
- Central (Brain trunk)