Shock 3 : Handling Public Cause Combustio

Handling Public Combustio

1. Vital sign monitor
2. Rehidrasi
- Place infus two (2 channels / better) with the technique:
• Formula Baxter
RL:
4 CC x BB ( kg ) x % combustio
or
• Formula Evans
- BB (kg) x % combustio x 1 cc NaCl 0,9%
- BB (kg) x % combustiox 1 cc koloid solution ( ex: dextran ) + 2000 cc D5%
(amounting)

- Given the number 8 ½ hours pertma, other 16 ½ hours the next
- Day-2: ½ first the total number of days, Day 3: ½ the total number of second day, etc...

EXEMPLARY

BB 50 Kg patient, knowledgeable 20% burns. How much fluid needs?
1. Baxter
4 cc x 50 kg x 20 = 4000 cc RL
The first 8 hours: 2000 cc
Or: 2000 cc / 8x60 minutes = 4.167 cc / min
The next 16 hours: 2000 cc / 16x60 minutes = 2.083 cc / min

Day-2: 2000 cc / day
-3: 1000 cc / day, dst ...

2. Evans
NaCl 0.9% = 50 kg x 20% = 1000 cc
Dextran = 50 kg x 20% = 1000 cc
D5% = 2000 cc
The first 8 hours and 16 minutes following:
NaCl = 500 cc
Dextran = 500 cc
D5% = 1000 cc
Same way with the Baxter

3. Place kateter (evaluating urine output)
Good indication:
Adult: 30 ml / hr
Children: 1-2 ml / kgBB / hr

4. Listen to the Voice of breath
(Whether rehidrasi excess or udem pulmo? Etc.)

5. Inpatient if
- combustio II> 15% of adult
> 10% children
- combustio III> 10% of adult
- Trauma electrical / chemical
- Pain in the face, hands, genitoperineal
- roasted injury with other serious trauma
- Threatened edema laring

6. Heart Care
Degree I: compress, do not need specific treatment
Degree II: - washing with 500 cc NaCl + 5 cc savlon
- + Sufratul closed with a sterile verban thick
- Change verban 1 week later or if the serum from the wound wet
Degree III: - washing with 500 cc NaCl + 5 cc savlon every day
- Debridemen network is broken
- Can use silver sulfadiazin 1% (because bakteriostatik, large penetrating power, resistance and there is no secure)
- On the wound healed ≥ 3 days of suspected contract, if the extremity injuries and suspected the existence of a circle eskar characteristics:
a. painful
b. feeling numb, pins and
c. perfused less
then do escarektomi aft to carve with jaws loose
- The need to skin graft

7. Medicines
- Analgesic: morphine, pethidine
- Broad spectrum antibiotics: amox, bell
- Anti-stress Ulcer (H2 Blocker, antacid, PPI)
- ATS: 1500 μ (children) and 3000 μ (adults)
- Vitamin A: 10,000 μ / week
C: 500 mg / day
SF: 500 mg / day8.

8. Diet and rehabilitation