Jurnal Luka Bakar Bedah

8/17/2019 Jurnal Luka Bakar Bedah

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BURN INJURY: GENERAL CONCEPTS AND

INVESTIGATION BASED ON ANTEMORTEM AND

POSTMORTEM OF CLINICAL INJURY

Yulia Ratna Sintia Dewi

Medical School - Udayana University

Abt!a"t

Burn injury is a condition which catastrophic consequences can affect the sufferer physically,

socially, as well as financially. Medicolegal aspect of a burn requires physicians to be able to

examine burn injuries on both the living and the dead. Burn injury is defined as tissue

damage due to contact with dry heat (fire), humid heat (vapor or hot liquid), chemicals

(corrosive agents), electrical devices (lamp or electrical current), friction, as well as

electromagnetic energy. Burn can be classified according to its breadth and degree. eath by

burn injuries can be classified into ! categories which are slow death and the fast one. "he

difference between antemortem and postmortem burn injury is that antemortem injury will

show several intravital signs in the bullae and vesicles while postmortem injury will have

none."hree main points exist in identifying antemortem and postmortem burn injuries,

namely redness lines, vesication, and reparative processes.

Keywords: burn injury, general concepts, antemortem, postmortem


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INTRODUCTION

Burns is one of the conditions that influence

catastrophic to the patient in terms of suffering, social life,

and about the limitations posed expenditure incurred for

pengobatannya.#,!,$ medicolegal aspects require a physician to perform

examination of a person who suffered burns both living

or who have mati.#,! addition, there are many instances where burns

happens to victims of violence, which require special s%ills to differentiate

whether the burns occurred while the victim was still alive (antemortem) or when the victim

is dead (postmortem) to cover the causes of death were sebenarnya.&

Burn injuries, especially burns deep and wide still

is a major cause of death and disability panjang.$,&,' term of hildren

and the elderly are at ris% for experiencing a deeper burns because

dermis s%in layer them over tipis.,* Between #++*!--! there were #* !$* children in

under ' years receiving treatment in the emergency department at #-- hospitals in meri%a./

0iven the scale of the impact caused by burns, incidence rates, and

mortality due to trauma of this type, we need a special literature for

peeling burns and overview of the concept in general. review of the literature

"his was made to help introduce medical practitioners against burns,

effects on multiple organ systems, classification according to the degree of extensive burns

surface, the main cause of death in burns, as well as how to

distinguish antemortem and postmortem wounds on the victim through clinical observation

short, clear, and easy to understand.

Aeti#$at%#&enei CUTS FUEL

1u%a is a state of body tissues due to disconnections

violence 2 trauma can be divided into mechanical trauma, physical trauma and

%imiawi.+,#-,## trauma burn is an injury to the tissue caused by

contact with dry heat (fire), moist heat (steam or hot liquids), chemical (

such, corrosive materials), electrical goods (electricity or light), friction,

or electromagnetic energy and radian.#! burn is a type of trauma

which has a high morbidity and mortality and require treatment

special start initial phase to phase ' lanjut.#$ "here etiology of burns,

ie fire, liquids, chemicals, electricity, or contact lainnya.#&


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Based on the course of their illness, burns are divided into acute phase, phase

subacute and late phase. 3n the acute phase of circulatory fluid balance disturbances

and electrolyte due to thermal injury that can lead to systemic

hypovolemic shoc%. 4ubacute phase ta%es place after the shoc% ends

characteri5ed by a state of hypermetabolism, sepsis and infection to inflammation in

form of 4364 (systemic inflammatory response syndrome). 7pen wounds due to damage

tissue (s%in and underlying tissue) cause inflammation, sepsis and

evaporation of body fluids with heat 2 energi.#$ problem that occurs is damage

or tissue loss due to contact heat source premises. 3njuries that occur

causing inflammation and infection processes, problems in wound closure wound bare

or not berepitel broad and or the structure or organ a functional organ, and

8urther hipermetabolisme.#-,#$ state phase ta%es place after the subacute phase up to

the patient recovered. omplications in this phase is a hypertrophic scar, %eloid, disruption

pigmentation, deformities and emergence %ontra%tur.#-

EFFECTS OF FUEL CUTS

3n burns 9!-:, usually compensatory mechanisms of the body can still be

overcome. Burns; !-: can lead to symptoms of hypovolemic shoc%

which %has.#' thermal burns in a confined space can cause inhalation

with the discovery of a dar% colored sputum caused by soot, burns on the face,

eyebrows and nose hair burning, oropharyngeal edema, changes such as a hoarse voice,

changes in consciousness, and stridor. 3n burns increased catabolism

so it becomes a negative protein balance. "herefore, the patient became

very thin, smaller muscle and decreased body weight.


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CLASSIFICATION OF CUTS FUEL

Burns can be classified by broad degree burns and wounds

grilled, and should obje%tif.' benchmar% that is still widely used and accepted is

follow the 6ules of >ines from ?allace. Burns that occurred in the face and

the nec% is much more dangerous than in the lower extremity burns, we must be very

guard against the onset of obstruction napas.*,#

Figure 1 Determination of Burn Area (Total Body Surface Area / TBSA)

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Based on the networ% it is damaged by the burns, burns

can be classified as grade 3, 33, 333 and 3@.* t # degree burns

(superficial burn), damage only occurs on the surface of the s%in. 4%in will appear

redness, no bull, little edema and pain, and will not cause

scar tissue after healing. !nd degree burns (partial thic%ness burn) on

portion of the thic%ness of the s%in that involves all of the epidermis and part of dermis.

3n the s%in there will be a bull, little edema, and severe pain. 3n the third degree burns (full

thic%ness burn), damage occurs in all layers of the s%in and no necrosis. lesions

s%in loo%s white and loses sensation, and will cause scarring

after the wound is healed. egree burns & called charring injury. 3n this burns


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s%in loo%s blac% li%e charcoal because of the burning tissue. amage throughout

s%in and subcutaneous tissues as well as the bones will burn.

4everity of burns based on the degree and extent of affected s%in and can

categori5ed into $ as mild, moderate and mild alled berat.#* if there

firstdegree burns covering 9#': or 0rade 33 area of 9!:. Burns is currently

firstdegree burns covering #-#': or stage 33 of '#-:. 4evere burns

a seconddegree burns covering; !-: or grade 333 covering; #-: or

on the face, hands feet, genital 2 armpit or around the joints due to the electric

high voltage (; #---@) or with complications of fractures 2 tissue damage

soft 2 airway disorders.

A" 7> 8CA1 C"4

"here are various causes of death in burns, including shoc%

neurogenic, hypovolemic, asphyxia, and sepsis.#/ eaths from burns can be in

divided into two, namely rapid death and death is rapid eath lambat.#-

deaths were seen according to the time in minutes until the number of hours of

accidents that may occur from neurogenic shoc% (very severe pain), wound

by heat (causing hypovolemia, shoc% and acute renal failure),

cuts on respiratory, etc..

4low death occurs as a result of several possible complications, among

nother ongoing fluid loss resulting in shoc% delayed or failed

renal, respiratory failure that occurs as a result of complications of damage

respiratory epithelium and acute respiratory distress syndrome (64), sepsis

occurs mainly due to pneumonia, and death due to pulmonary embolism as a result

long immobili5ation.

7M 78 430>4 > C"4 8CA1 intravital

postmortem

7n victims who are still alive when fire will reveal any matters between

intravital other signs in burns and bubbles are formed, the presence of

soot in the respiratory tract as well as carbon monoxide saturation above #-: in the blood

the victimDs blood. 3n victims of carbon monoxide poisoning if not the victimDs body

*

burn entirely bruised corpse will form a cherry red color. on the body

man who died when burned will not be colored red by the reaction


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"able # ifferences Burns antemortem and


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Fa%artaE


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LU)A BA)AR: )ONSEP UMUM DAN INVESTIGASI

BERBASIS )LINIS LU)A ANTEMORTEM DAN

POSTMORTEM

Yulia Ratna Sintia Dewi

Fakultas Kedokteran Universitas Udayana

Abt!a*


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1u%a ba%ar adalah %ondisi yang memili%i pengaruh yang %atastropi% terhadap

penderita dalam hal penderitaannya, %ehidupan sosialnya, %eterbatasan yang ditimbul%an dan

perihal %euangan yang di%eluar%an untu% pengobatannya. spe% medi%olegal menuntut

seorang do%ter untu% mela%u%an pemeri%saan terhadap seseorang yang mengalami lu%a

ba%ar bai% yang masih hidup ataupun yang telah mati. 1u%a ba%ar adalah cedera terhadap

jaringan yang disebab%an oleh %onta% dengan panas %ering (api), panas lembab (uap atau

cairan panas), %imiawi (seperti, bahanbahan %orosif), barangbarang ele%tri% (aliran listri%

atau lampu), fri%si, atau energi ele%tromagneti% dan radian. 1u%a ba%ar dapat di%lasifi%asi%an

berdasar%an luas lu%a ba%ar dan derajat lu%a ba%arnya. =ematian %arena lu%a ba%ar dapat di

bagi menjadi ! yaitu %ematian cepat dan %ematian lambat.


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membantu mengenal%an para pra%tisi medis terhadap lu%a ba%ar, efe%nya terhadap berbagai

sistem organ, %lasifi%asi derajat lu%a ba%ar menurut luas permu%aan, penyebab %ematian

utama pada lu%a ba%ar, serta bagaimana cara membeda%an lu%a antemortem dan postmortem

pada %orban melalui pengamatan %linis yang sing%at, jelas, dan mudah dimengerti.$

ETIOPATOGENESIS LU)A BA)AR

1u%a adalah suatu %eadaan %etida%sinambungan jaringan tubuh a%ibat

%e%erasan2trauma yang dapat dibeda%an menjadi trauma me%ani%, trauma fisi% serta trauma

%imiawi.+,#-,## 1u%a ba%ar adalah cedera terhadap jaringan yang disebab%an oleh %onta%

dengan panas %ering (api), panas lembab (uap atau cairan panas), %imiawi ( seperti, bahan

bahan %orosif), barangbarang ele%tri% (aliran listri% atau lampu), fri%si, atau energi

ele%tromagneti% dan radian.#! 1u%a ba%ar merupa%an suatu jenis trauma yang memili%i

morbiditas dan mortalitas yang tinggi sehingga memerlu%an perawatan yang %husus mulai

fase awal hingga fase lanjut.#$ da ' etiologi terjadinya lu%a ba%ar, yaitu %obaran api, cairan,

bahan %imia, listri%, maupun %onta% lainnya.#&

Berdasar%an perjalanan penya%itnya, lu%a ba%ar dibagi menjadi fase a%ut, fase

suba%ut dan fase lanjut.


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hidung yang terba%ar, edema orofaring, perubahan suara seperti sera%, perubahan %esadaran,

dan stridor.


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Ga(ba! ,-


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POSTMORTEM


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Tabel ,-


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&. 3dris, .M. 0uka "akar dalam +edoman Ilmu )edokteran *orensik 1disi pertama,

Fa%arta E ew Ior%E umana

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