Luka

Bakar
Dr. Dewi Haryanti K, SpBP
Sub Bagian Bedah Plastik
RSUD dr. Moewardi/ FK UNS Ska

Tujuan:
Menjelaskan prosedur
penatalaksanaan luka bakar
thermis, kimia dan listrik

Overview:

Severity
Klasifikasi Luka Bakar
Emergency Medical Care
Luka Bakar Kimia
Luka Bakar Listrik
Dressing and Bandaging
Trauma Inhalasi

Severity Luka Bakar

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

Derajat Kedalaman (Grade)

Luka Bakar:
Derajat kedalaman
(Grade)

Struktur yg terkena

Gejala dan Keluhan

Grade I
(Superficial Burns)

Hanya mengenai lapisan

atas kulit (epidermis)

-Hiperemi
- Nyeri +
- Bullae -

Grade II
(Partial Thickness Burns)

Mengenai epidermis dan

sebagian dermis

--lembab, mottled, kulit

merah memutih
-- Nyeri ++
--Bullae +

Grade III
(Full Thickness Burns)

Mengenai seluruh lapisan

kulit

--- kering
--- putih/coklat tua/hitam
---charred
--- tdk nyeri

EPIDERMIS
Gr I
Gr IIA
Gr IIB

Gr III

DERMIS

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
9
9 ( 2)
18 (2)
18 (2)
1

CHILD
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

Moderate Burns

Minor Burns

LB gr II>25%

LB gr II 15-25%

LB gr II < 15%

LB gr III>10%

LB gr III 2-10% (*)

LB gr III < 2%

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

Usia <10 th dan >

50th
Major Burns

Moderate Burns

Minor Burns

LB gr II > 20%

LB gr II 10-20%

LB gr II < 10%

LB gr III > 10%

LB gr III 2-10% (*)

LB gr III < 2%

Lainnya

dewasa

* 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
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

Entry wound on head

Exit wound on foot

Electrical Injuries

Luka Masuk

Luka Keluar

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 nonrebreathing 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