DEFINITION OF BURN AND BURN MANAGEMENT

Skin is the most extensive organ in the human body, consisting of 2 (two) layers. The outer layer that is visible on the surface is called the Epidermis.

The epidermis is the boundary between the body and the environment. Beneath the thin layer of the epidermis is a collagenous connective tissue called the dermis. This layer contains the nervous system and also supports structures such as hair follicles, sweat glands and oil glands.

The skin has very important functions, one of which is a barrier between the body and the outside environment, keeping fluids in the body, preventing bacteria and other microorganisms from entering the body.

The skin is also a sensory organ that captures stimuli that will be conveyed to the brain, especially body temperature regulation. If there is damage to the skin, then all of these functions cannot function and cause the body to experience dangerous problems.

Skin burns occur when heat or chemicals come in contact with or penetrate the skin and damage the cells of the skin components. Apart from the actual response of tissue damage, the body also experiences an inflammatory reaction which can increase the severity of the burn.

The part of the skin that experiences necrosis due to burns is called the irreversible coagulation zone. The area around the coagulation zone is called the stasis zone (little blood flow, the tissue will be necrotic if this situation lasts a long time). This condition can be seen deeper in areas of partial-thickness burns and can be treated with good burn care and fluid resuscitation.

TYPES OF BURNS AND THEIR TREATMENT

1. Chemical burns.

Chemical (chemical) burns are caused by contact of skin tissue with strong acids or bases. The concentration of the chemical, the duration of contact and the amount of tissue exposed determines the extent of injury due to this chemical. Problems with chemical burns can occur due to contact with cleaning agents used for household purposes and various chemicals used in industry, agriculture and the military. Chemical burns occur when the skin comes in contact with various chemicals.

1) The procedure for cleaning chemicals on burns

a. Use personal protective equipment such as glasses, gloves, special masks. Under certain conditions, it is necessary to wear chemical protective clothing.

b. Remove all patient clothing. Store in a plastic bag to minimize contact.

c. Flush the chemical from the patient's body using running water. If the chemical is dry (powder), it must be cleaned by brushing before irrigation.

d. Remove all objects attached to the patient's body by examining all parts of the patient's body.

2. Electrical burns.

Electrical burns are caused by heat generated by electrical energy being passed through the body. The severity of the wound is affected by the duration of contact, the high voltage and the way the electric waves reach the body. The degree of tissue damage in electrical burns depends on the flow involved and the duration of exposure. Electrical burns can cause cardiac arrest, and cardiopulmonary resuscitation (CPR) may be needed to treat them.

There are three types of electrical injury.

1.) Electrical burns from direct contact. The electric current flowing through the tissue causes extensive necrosis along the length of the tissue through which the current flows. The skin often looks burnt and even in some cases can become scattered. In this type of burn, you can find entry and exit wounds, which are small wounds on the surface of the skin.

2.) Burns caused by sparks/jumps of electric sparks. In this case it will cause a real burn on the skin.

3.) Electrical burns. This can happen if the patient is too close to an open electrical source, causing burns due to hot temperatures. Generally occurs in patients who are near the power source and do not protect their skin with special clothing.

3. Radiation burns.

Radiation burns are caused by exposure to a radioactive source. This type of injury is often associated with the use of ionizing radiation in industry or from radiation sources for therapeutic purposes in medicine. Sunburn due to prolonged exposure is also a type of radiation burn.

Factors that affect the severity of burns include:

1. Into the burn.

2. Extent of burns.

3. Affected location.

4. Health condition of the patient.

5. Mechanism of injury.

6. Age of the patient.

The depth of the burn is categorized based on the depth of the burn and response, as superficial (degree I), partial thickness (degree II), full thickness (degree III)

1. Superfiicial / degree I has the following characteristics:

a. Only affects the epidermis layer.

b. Wounds appear bright pink to red (mild to severe erythema)

c. The skin turns pale when pressed.

d. Minimal edema.

e. No blisters

f. Warm/dry skin

g. Pain/hyperetetic.

h. Discomfort ends approximately within 48 hours.

i. Can recover spontaneously within 3-7 days.

2. Partial thickness / degree II has the following characteristics:

a. Partial thickness is grouped into two, namely superpartial thickness and deep partial thickness.

b. Concerning the epidermis and dermis.

c. The wound looks red to pink.

d. Blisters are formed.

e. Edema

f. Sensitive to cold air.

g. Wound healing for superpartial thickness 14 – 21 days and deep partial thickness 21 – 28 days.

However, the healing varies depending on the depth and presence or absence of infection.

3. Full thickness (derajat III).

a. Affects all layers of skin, subcutaneous fat, and may involve surface muscles and innervation and blood vessels.

b. The sores appear variable and can be white, red and brown or black in color.

c. No blisters.

d. Dry wound surface with a rough/hard texture.

e. Little pain or no pain.

f. Spontaneous wound healing is unlikely.

g. Need skin graft.

h. Hypertrophic scars and contractures can occur if preventive measures are not taken.

EXTENSIVE BURN

There are several methods for determining the extent of burns including,

1. Rule of nine

2. Lund and browder.

3. Hand palm.

The size of the burn can be determined using one of these methods. The size of the burn is determined by the percentage of the body surface affected by the burn. The accuracy of the calculation varies according to the method used and the person's experience in determining the extent of the burn. The rule of nine method was introduced in the 1940s as a rapid assessment tool to determine the approximate size/extent of burns. The basis of this method is that the body is divided into anatomic parts where all parts represent 9% except the genital area 1%.

MANAGEMENT OF BURN WOUNDS

The initial assessment must be carried out especially at the scene of the incident, namely the rescuer's security situation. Things that threaten the patient and rescuers must be identified immediately. Helpers may not provide assistance if the firefighters have not declared it safe to provide assistance. If the patient has been brought to a safe place, the burning process must be stopped immediately to prevent further injury and to reduce tissue damage (Stop The Burning Process).

In the primary assessment, the greatest attention is paid to the airway, including identifying signs of inhalation, such as:

a. Burns that affect the face and or neck.

b. Eyebrows and nose hair scorched.

c. Presence of carbon deposits and signs of acute inflammation of the oropharynx.

d. Sputum containing carbon / charcoal.

e. Hoarseness/stridor.

f. History of chewing disorder and/or confinement to fire.

g. Head and body burns from the explosion.

h. Carbohismoglobin level is more than 10% after burning.

The possibility of smoke poisoning, CO poisoning, and respiratory tract injury must be considered if these incidents occur in an enclosed space.

In patients with thermal trauma, the likelihood of inadequate oxygenation and poor circulation is high. For this reason, the patient, whether conscious or unconscious, must be given oxygen with a high fraction and monitor the airway and breathing continuously. The response of CO and cyanide to high fractional oxygen is almost 100%. Stable patients with good gag reflex and a free airway should be given oxygen and should be monitored. Definitive airway action can be performed if needed based on the indications.

In a patient with a charred appearance over the entire chest, the ability to expand the chest wall may be severely limited. This limitation may be due to reduced elasticity of the burned tissue, resulting in inadequate tidal and minute respiratory volumes. A small proportion of patients who experience this require an incision (escharotomy) performed by a trained person; if the person is not trained to do this, then administration of high concentration oxygen should be done. After that immediately do fluid resuscitation.

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