DEFINITION
Burns are a form of tissue damage or loss caused by contact with heat sources such as fire, hot water, chemicals, electricity and radiation. Burns are a type of trauma with high morbidity and mortality. The cost required for handling is also high. In Indonesia, burns are still a serious problem.
Treatment and rehabilitation is still difficult and requires perseverance, expensive costs, trained and skilled personnel. Therefore, it is more appropriate to treat burns by a trauma team consisting of surgical specialists (children's surgery, plastic surgery, thoracic surgery, general surgery), intensifiers, internal medicine specialists, nutritionists, medical rehabilitation, psychiatry, and psychology.
The first result of burns is shock and pain. Capillaries exposed to high temperatures are damaged and their permeability increases. The blood cells in it are also damaged so that anemia can occur. The increased permeability causes edema and produces bullae that are rich in electrolytes. This causes a decrease in intravascular fluid volume. Skin damage from burns causes fluid loss due to excessive evaporation, ingress of fluid into the blisters that form in second degree burns and discharge from the scabs of third degree burns. If the burn area is less than 20%, usually the body's compensatory mechanisms can still handle it, but if it is more than 20%, hypovolemic shock will occur with typical symptoms, such as restlessness, paleness, chills, sweating, small pulse, and fast, decreased blood pressure , and reduced urine output. Swelling occurs slowly, maximum occurs after eight hours.
In a fire in a closed space or if the wound occurs on the face, damage to the airway mucosa can occur due to inhaled gas, smoke or steam. The resulting laryngeal edema can cause airway obstruction with symptoms of shortness of breath, tachypnea, stridor, hoarseness and dark colored sputum due to soot. CO poisoning can also be gas and other toxic gases. Carbon monoxide will bind tightly to hemoglobin so that hemoglobin is no longer able to bind oxygen. Signs of mild poisoning are weakness, confusion, dizziness, nausea and vomiting. In severe poisoning, coma ensues. Can be more than 60% of hemoglobin bound to CO, the patient can die. After 12-24 hours, capillary permeability begins to improve and mobilization and reabsorption of edema fluid into the blood vessels. This is marked by increasing diuresis.
ASSESSMENT OF DEGREE OF BURN
- Grade I burns
- Also called a superficial burn.
- Affects the outer layer of the epidermis, but not to the dermis. Often referred to as epidermal burn.
- The skin looks reddish, slightly edema, and feels.
- On the fourth day there will be desquamation of the epithelium (peeling).
- Grade II burns
A. Superficial partial thickness:
- The skin looks reddish, edema and pain is more severe than grade I burns.
- Marked by bullae that appear several hours after being injured.
- Burns involve the epidermis and upper layers of the dermis,
- If the bulla is removed, a wet pink wound will appear.
- The wound is very sensitive and will turn pale when exposed to pressure.
- Will heal by itself in 3 weeks (if not infected), but the skin color will not be the same as before.
B. Deep partial thickness :
- Burns include the epidermis and deep layers of the dermis.
- Also accompanied by a bull.
- The surface of the wound is mottled pink and white due to variations in blood vessel vascularization (the white part has only a few blood vessels and the pink part has some blood flow.
- Wounds will heal in 3-9 weeks.
- Grade III burns
- Causes permanent tissue damage.
- The pain is sometimes not felt too much because the nerve endings and blood vessels have been destroyed.
- Burns include skin, subcutis fat to the muscles and bones.
FIRST AID IN PATIENTS WITH BURNS
- Immediately avoid sources of fire and extinguish the fire on the body, for example by covering and covering the burning part to stop the supply of oxygen to the burning fire.
- Remove clothing, jewelery and other objects that create a tourniquet effect, as the affected tissue will soon become edematous.
- After removing the heat source, immerse the burn area in water or rinse it with running water for at least 20-30 minutes. The process of coagulation of cell proteins in tissues exposed to high temperatures continues after the fire has been extinguished so that the destruction continues to spread. This process can be stopped by cooling the burned area and maintaining this cool temperature for the first hour so that damage is shallower and minimized.
- However, this method cannot be used for more extensive burns because of the danger of ice should not be applied directly to any burn.
- Initial evaluation
- The principle of treating burns is the same as treating other traumatic wounds, namely ABC (Airway Breathing Circulation) followed by a special approach to the specific components of burns in the secondary survey.
- Seeking help
POST BURN PROBLEMS
After recovery from the wound, the next problem is scar tissue which can develop into severe disability. Skin contractures can impair function and cause joint stiffness or cause such disastrous esthetic defects that a psychologist is also needed to restore confidence. The problems that are feared in burns:
- Infection and sepsis
- Oliguria and anuria
- Pulmonary oedema
- ARDS (Adult Respiratory Distress Syndrome)
- Anemia
- Contracture
- Dead
Article written by dr. Puri Ambar Lestari, Sp.BP-RE (Plastic Surgery - Reconstruction and Aesthetics at EMC Cikarang Hospital).