Budhi Arifin Noor, Dion Ade Putra, Oktaviati, Ridho Ardhi Syaiful, Rizky Amaliah, Mursid
Areas of burn wounds are divided into three zones, which are coagulation zone, stasis zone and hyperemic zone.1,2
a. Coagulation zone
The tissue in this zone is irreversibly damaged during traumatic burn.
b. Stasis zone
There are moderate perfusion disturbances in the area surrounding the necrotic zone. In the stasis zone, there is vascular damage thus causes vascular leakage.
c. Hyperemic zone
The character of the hyperemic zone is vasodilatation due to
Burn Injury Phases5
- Acute Phase / shock phase. The patients may experience disturbance in the airway, breathing and circulation.
- Sub-acute phase, which takes place after the shock phase is resolved. Lost or damaged tissue resulting from contact with the heat source will cause inflammatory process with exudation of plasma protein and infection that can cause sepsis.
- Late Phase occurred after wound closure until maturation. The problem that arises during this phase are scarring, contractures and deformities due to the fragility of tissue or structured organ.
Table 1. Classification of Burn Wound Depth in United States.3
Table 2. Categorization of Burns.
- Acute/shock phase : to protect patient from the source of burn injury, ABC evaluation, evaluation of any other trauma, fluid resuscitation, urine catheter, nasogastric tube, vital sign and laboratory, pain management, tetanus prophylaxis, administration of antibiotics and wound care.
- Sub acute phase started when patient is hemodinamically stable. Management for acute phases: to prevent infection, wound care, and nutrition.
- Phase rehabilitation : to increase self-sufficiency through the achievement of improved full functionality.
- Baxter formula
The patients treatment was consist of fluid resuscitation with baxter formula (TBSA x body weight (kg) x 4 cc (RL) in 24 hours), in this case, patient was given 9300 cc for 24 hours, divided into 4650 cc or 50% in the first 8 hours, then 4650 cc or 50% in the next 16 hours. Urine production is needed to be monitored in the resuscitation fluid because it describes the circulation of the fluid and the adequacy of fluid given. Nomally, urine production is 0.5 cc / kg / hour. Installation of CVP is indicated to monitor systemic circulation of fluid resuscitation and to access other solution.
After seventh day (1)
After seventh day (2)
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- Herndon, David N. Total Burn Care 3rd edition. Saunders Elsevier.
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