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LUKA BAKAR

Definisi: Suatu bentuk kerusakan atau kehilangan jaringan yang disebabkan kontak dengan sumber panas Seperti api, air panas, bahan kimia, listrik dan radiasi

Severity Luka Bakar


Ditentukan oleh: - derajat kedalaman - luas - critical areas yang terkena - medical condition atau trauma - umur pasien

dalamnya luka bakar ANATOMI KULIT

Kedalaman kerusakan jaringan


LB derajat 1 LB derajat 2 Derajat 2A, Superficial
Terbatas pada edipermis Tidak ada bula, Nyeri Sembuh spontan 5-10 hr Epidermis dan sebagian dermis Ada bula, Nyeri Dasar luka kemerahan Apendices/biji kulit + Sembuh spontan 10-20hr

Derajat 2B, Deep LB derajat 3

Derajat Kedalaman (Grade) Luka Bakar:


Derajat kedalaman (Grade) Struktur yg terkena Gejala dan Keluhan

Grade I (Superficial Burns) Grade II (Partial Thickness Burns)

Hanya mengenai lapisan atas kulit (epidermis) Mengenai epidermis dan sebagian dermis

-Hiperemi - Nyeri + - Bullae --lembab, mottled, kulit merah memutih -- Nyeri ++ --Bullae + --- kering --- putih/coklat tua/hitam ---charred --- tdk nyeri

Grade III (Full Thickness Burns)

Mengenai seluruh lapisan kulit

Partial Thickness Burns

Full Thickness Burns

Luas Luka Bakar


Ditentukan oleh percentage (%) dari body area yang terbakar Telapak tangan pasien + 1% rule of nines dari Wallace

Rule of nines of Wallace


Membagi tubuh menjadi beberapa bagian Digunakan untuk mengkalkulasi % permukaan tubuh yang terbakar

Rule of Nines
BODY PART Head & Neck Arms Front & Back Legs Genitalia ADULT CHILD 9 9 (2) 18 (2) 18 (2) 1 18 9 (2) 18 (2) 13.5 (2) 1

Rule of Nines (Wallace)

Lokasi Luka Bakar


Meliputi critical areas (wajah, upper airway, hands, genitalia)

Pre existing medical conditions

DM py. Cardiopulmonum, gangguan psikiatrik, dll

Umur Pasien
< 10 tahun > 50 tahun

Severity Luka Bakar, dibagi menjadi:


major burns moderate burns minor burns

Dewasa
Major Burns LB gr II>25% LB gr III>10% LB mengenai mata, telinga, wajah, tangan, kaki atau perineum yang mengakibatkan gangguan kosmetik atau fungsi Electrical burns LB disertai trauma inhalasi LB disertai underlying diseases Chemical burns LB disertai trauma penyerta lain
* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

Moderate Burns LB gr II 15-25% LB gr III 2-10% (*)

Minor Burns LB gr II < 15% LB gr III < 2%

Usia <10 th dan > 50th


Major Burns LB gr II > 20% LB gr III > 10% Lainnya dewasa Moderate Burns LB gr II 10-20% LB gr III 2-10% (*) Minor Burns LB gr II < 10% LB gr III < 2%

* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

Emergency Medical Care


Pasien Dewasa
Stop

the burning process & cegah cedera lbh lanjut Bahan isolator Monitor airway beri O2 Cegah kontaminasi lebih lanjut

Luka Bakar
Indikasi MRS:
semua derajat III Major Burns dan Moderate Burns

Indikasi poliklinis (rawat jalan):


Minor Burns (kec. Derajat III)

Emergency Medical Care


Selimuti

dengan bahan kering &

steril No ointments, lotion, or antiseptic Do not break blisters Transport ASAP

Emergency Medical Care


Pasien Pediatrik
Greater surface area in relationship to the total body size Fluid and heat loss >> Risk of shock, airway and hypothermia Consider child abuse

Pasien Pediatrik
Transport - scoop and run

Luka Bakar Kimia


Disebabkan karena adanya kontak kulit dengan bahan toksik

Luka Bakar Kimia


Disebabkan oleh alkali, asam dan campuran Protect yourself from exposure or injury

Luka Bakar Kimia Emergency Care


Stop the burning process
(1)

Immediately flush with large amounts of water (2) Do not contaminate uninjured areas (3) Continue flushing while enroute to hospital

(4) Cover with dry sterile dressing or clean sheet (5) Special care of the eyes
Gently

/continuously flush For direct eye injury hold lids open and irrigate the eye

Dry chemicals
Reaction with water can worsen burn
(1)

Brush - then flush (2) Remove victims clothing (shoes & socks)

Luka Bakar Listrik


Scene Safety
Do

not contact high voltage wires Consider all wires live Do not handle down lines Do not come in contact with patient if the electrical source is live

Emergency Medical Care


May be more serious than it seems Entry wound is usually a small burn area Look for an extensive exit wound Possible tissue damage underneath (current spreads out as it travels through the body)

Emergency Medical Care cont:


Possible Cardiac arrest Possible Respiratory arrest Splint possible fractures Treat wounds with a dry, sterile dressing Transport

Electrical Burns
Treat any major complications first

Dressing and Bandaging


Stop bleeding Protect wound from further damage Prevent further contamination and infection

Trauma Inhalasi

Chemical fumes
Obvious

fumes in the air Inhaled fumes

Carbon Monoxide (CO)


Deadly poison

Carbon Monoxide
Different than smoke inhalation
Odorless Tasteless Not

an irritant

Signs and symptoms


a. Dyspnea (difficulty in breathing) b. Respiratory arrest c. Cherry red skin

Cyanide Signs and Symptoms


Burnt almonds Dyspnea (difficulty in breathing) Respiratory arrest

Treatment
a. 100% oxygen through a non-rebreathing mask b. Be prepared to do basic life support c. Transport

Pemberian cairan pada Luka Bakar


Formula Baxter
Dewasa 4cc x % luas LB x kg BB =.....cc lar. RL diberikan : bagian pada 8 jam I bagian pada16 jam berikutnya diberikan lar. koloid 500-1000cc pd jam ke 18-24

Pemberian cairan pada Luka Bakar


Formula (modifikasi) Baxter
Anak
2cc x % luas LB x kg BB=...cc lar. RL diberikan: bagian pada 8 jam I bagian pada 16 jam berikutnya larutan koloid 17:3 (sejak jam ke-0) Hari berikutnya diberikan cairan maintenance