LUKA BAKAR

Suatu trauma panas yang disebabkan oleh air / uap panas, arus listrik,
bahan kimia, radiasi dan petir
yang mengenai kulit, mukosa dan jaringan yang lebih dalam
kerusakan/ kehilangan kulit
Diagnosis
Penilaian dalam, luas dan berat ringan luka bakar
Dalamnya luka bakar tergantung:
* Tingginya panas
* Penyebab
* Lamanya kontak
BURN PHASES
1. ACUTE / SHOCK / EARLY PHASE
- IMMEDIATE / EMERGENCY ROOM
- AIRWAY & FLUID PROBLEM
- WOUND
2. SUBACUTE PHASE
- DURING ADMISSION
- WOUND, INFECTION, SEPSIS PROBLEM
3. LATE PHASE
- AFTER DISCHARGED
- SCAR & CONTRACTURE PROBLEMS
ETIOLOGY
1. FIRE
2. SCALD
3. CHEMICAL SUBSTANCES
4. ELECTRIC & RADIATION
5. SUNBURN
6. STOVE / GAS EXPLOSION
7. BOMB EXPLOSION
Burn

Capillary permeability and osmotic force change

Fluid and protein shift
Total blood volume have been lost
Burn shock

Derajat Kedalaman
Derajat I : Epidermis

 Derajat II : Dermis
A. Superfisial/ permukaan
B. Dalam
Derajat III : Seluruh tebal kulit/ lebih dalam sampai otot, tulang
DERAJAT I (DERAJAT ERYTEMA)
SANGAT RINGAN (ERYTEMA)
SEMBUH TANPA PERAWATAN KHUSUS
KLINIS, KULIT KEMERAHAN DAN NYERI HEBAT
TERAPI : ANALGETIK
BIASANYA DISEBABKAN SENGATAN MATAHARI
DERAJAT II (DERAJAT BULLOSA)
DIBAGI :
DERAJAT II A (DANGKAL)
DERAJAT II B (DALAM)
KLINIS :
- KERUSAKAN MENCAPAI DERMIS,
- TERDAPAT LEPUH (BULLA)
PADA DERAJAT II A, PENYEMBUHAN 2 MINGGU TANPA JARINGAN
PARUT (BILA TIDAK ADA INFEKSI)
PADA DERAJAT II B, PENYEMBUHAN AGAK LAMA, BILA LUAS PERLU SKIN
GRAFT
DERAJAT III
MENGENAI SELURUH TEBAL KULIT, OTOT DAN TULANG
KULIT NAMPAK HITAM DAN KERING

LUAS LUKA BAKAR

 Rule of nine
Rule of Wallace
Kepala leher
9% -------->
Lengan
9% -------->
18%
Badan depan
--------------------->
Badan belakang ------------------>
Tungkai
18% ------->
36%
Genetalia/ perineum ------------->
Jumlah -----------------------------------> 100%

JUVENILE - CHILDREN

9%
18%
18%
1%

SEVERITY CRITERIA
(AMERICAN BURN ASSOCIATION)
1. MILD
- 2nd DEGREE < 15%
- 2nd DEGREE < 10% IN JUVENILES
- 3rd DEGREE < 1%
2. MODERATE
- 2nd DEGREE 15-25% IN ADULTS
- 2nd DEGREE 10-20% IN JUVENILES
- 3rd DEGREE < 10%
1. SEVERE
- 2 DEGREE >25% IN ADULTS
- 2nd DEGREE >20% IN JUVENILES
- 3rd DEGREE >10%
- AFFECTED HANDS, FACE, EARS, EYES, FEET, AND
GENITAL / PERINEUM
- INHALATION INJURY, ELECTRICAL INJURY, OR ASSOCIATED WITH
OTHER TRAUMAS
nd

Indikasi Rawat
Luka bakar sedang
Luka bakar Grade II
1. Dewasa >20%
2. Anak / Orang tua > 15%
Luka Bakar Grade III

 Luka Bakar dengan komplikasi jantung, otak dll

Fase Luka Bakar
Fase Akut
Fase Sub Akut
Fase Lanjut
Manajemen Luka Bakar
Di tempat Kejadian :
Bebaskan dari sumber trauma panas
Jangan berdiri/berlari, karena api akan membesar
Api dipadamkan dengan disiram air, ditutup kain basah atau berguling
Penderita ditutup kain bersih dan dibawa ke RS
I.
PRIMARY SURVEY
II. SECONDARY SURVEY
III.INITIAL CARE OF THE BURN WOUND
IV. INITIAL LABORATORY STUDIES
V.
BURN CENTER REFERRAL
I.
PRIMARY SURVEY :
A. AIRWAY & CERVICAL SPINE PROTECTION
B. BREATHING & VENTILATION
C. CIRCULATION & HEMORRHAGE CONTROL
D. DISABILITY NEUROLOGICAL EXAMINATION
E. EXPOSURE
II.

SECONDARY SURVEY :
A. HISTORY TAKING
B. PHYSICAL EXAMINATION /
HEAD TO TOE EXAMINATION
C. PRINCIPALS :
1. STOP THE PROCESS CAUSING BURN WOUNDS
2. UNIVERSAL PRECAUTION, HIV, HEPATITIS
3. FLUID RESUSCITATION : 2-4 CC RL X KG BW X %WOUND
SURFACE
4. VITAL SIGN
5. NASOGASTRIC TUBE / IF NECESSARY
6. URINARY CATHETER / IF NECESSARY
7. PERFUSSION ASSESSMENT
8. CONTINUED VENTILATORY ASSESSMENT
9. PAIN MANAGEMENT
10.
PSYCHOSOCIAL ASSESSMENT

11.
TETANUS TOXOID PROFILAXIS
12.
MEASURING BODY WEIGHT
13.
WOUND CLEANSING (OPERATING THEATRE, GENERAL
ANAESTHESIA)
14.
ESCHAROTOMY & FASCIOTOMY
FLUID RESUSCITATION
EVANS FORMULA
BROOKES FORMULA
PARKLANDS FORMULA
BROOKES MODIFICATION
MONAFOS FORMULA

DAY 2 :
ADULT
JUVENILE

: MAINTENANCE
ALBUMIN (IF NECESSARY)
: MAINTENANCE

MONITORING FLUID RESUSCITATION

1. URINARY PRODUCTION PER HOUR
ADULT
: 0,5 CC/BW/HR (30-50 CC/HR)
JUVENILE : 1 CC/BW/HR
2. OLIGURIA
ASSOCIATED WITH SYSTEMIC VASCULAR RESISTANCE & CARDIAC
OUTPUT RECUCTION
3. HAEMOCHROMOGENURIA (RED PIGMENTED URINE)
4. BLOOD PRESSURE

5. HEART RATE
6. HAEMATOCRITE & HAEMOGLOBIN
CLOSED WOUND MANAGEMENT
WOUND CLEANSING, DEBRIDEMENT, & DESINFECTION WITH SAVLON
1 : 30
TULLE
TOPICAL SILVER SULFADIAZINE (SSD)
THICK STERILE GAUZE / ELASTIC BANDAGE
OPEN THE WOUND DRESSINGS AT DAY 5 UNLESS THERE IS ANY SIGN
OF INFECTION
PERFORM UNDER GENERAL ANAESTHESIA (IN THE OPERATING
THEATRE)
III. LABORATORY EXAMINATION
1. HAEMATOCRITE
2. COMPLETE BLOOD COUNT (Hb)
3. ALBUMIN
4. RFT & LFT
5. ELECTROLITE, Na, K, Cl, HCO3
6. BLOOD UREA NITROGEN
7. URINALYSIS
8. CHEST X-RAY
9. ARTERIAL BLOOD GAS (INHALATION INJURY)
10.
CARBOXY HAEMOGLOBIN
11.
ECG (ELECTRIC INJURY)
SIRKULASI
Gangguan permeabilitas kapiler
Cairan dari Intravaskular Ekstravaskular Hipovolemia relatif
Syok ATN gagal Ginjal
PERNAFASAN
Udara panas Iritasi Udema Obstruksi Gagal Nafas
Efek Toksik dari Asap :
HCN, NO2, HCL, Bensin Iritasi Bronkokonstriksi Gagal nafas
CO Hipoksia
Perawatan Luka : Tertutup
Cuci Luka (Savlon: NaCl 0,9% = 1 : 30) + Buang jaringan nekrotik
Tulle
Silver Sulfadiazine tebal
Evaluasi 5 - 7 hari, kecuali balutan kotor
Eksisi Dini

Skin

Pada luka bakar derajat IIb dan III

Setelah keadaan Stabil ( hari 4-14)
Dengan cara tangensial eksisi (seperti mengambil STG )
Mempercepat penyembuhan luka
Kerugian sering terjadi perdarahan
grafting
Pada luka yang luas (>3 cm)
Sudah timbul granulasi
Mempercepat penyembuhan luka
Mengurangi kehilangan cairan dan infeksi

STAGES OF BURNS
Hypovolemic state
begins at the onset of burn and lasts for the first 48 hours - 72 hours
Rapid fluid shifts - from the vascular compartments into the
interstitial spaces
Capillary permeability with burns increases with
vasodilation
Fluid loss deep in wounds
Initially Sodium and H2O
Protein loss - hypoproteninemia
Hemoconcentration - Hct increases
Low blood volume, oliguria
Hyponatremia - loss of sodium with fluid
Hyperkalemia - damaged cells release K, oliguria
Metabolic acidosis
Diuretic Stage
begins 48 - 72 hours after burn injury:
Capillary membrane integrity returns
Edema fluid shifts back into vessels - blood volume
increases
Increase in renal blood flow - result in diuresis (unless renal
damage)
Hemodilution - low Hct, decreased potassium as it moves
back into the cell or is excreted in urine with the diuresis
Fluid overload can occur due to increased intravascular
volume
Metabolic acidosis - HCO3 loss in urine, increase in fat
metabolism
SIGNS OF ADEQUATE
FLUID RESUSCITATION :
Clear sensorium

Pulse < 120 beats per minute

Urine output for adults 30 - 50 cc/hour
Systolic blood pressure > 100 mm Hg
Blood pH within normal range 7.35 - 7.45

Organisms that usually infect burns are:

a. Staphylococcus aureus
b. Pseudomonas Infection is usually the cause of any deterioration
Signs of Sepsis:
a. Change in sensorium
b. Fever
c. Tachyapnea
d. Paralytic ileus
e. Abdominal distention
f. Oliguria
Ways to prevent infection:
a. Gowns, masks, gloves
b. Sterile linen
c. Persons with URI should not come in contact with patient
WOUND CARE PRINCIPLES
1. GOALS
1. close wound as soon as possible
2. prevent infection
3. reduce scarring and contractures
4. provide for comfort
2. Wound cleaning + closed technique
3. Debridement, mechanical, surgical, enzymatic
4. Topical antibacterial therapy mafenide (sulfonamide) sulfadiazine
5. Biological dressing
- Homograft (cadaver skin )
- Heterograft
- Autograft
IV. BURN CENTER REFERRAL
REFERRAL CRITERIA
1. 2nd degree >10%
2. Affecting face, hands, genital, perineum, & main joints
3. 3rd degree
4. Electric injury
5. Chemical injury
6. Inhalation injury
7. Juveniles
8. Associated with other traumas

ESCHAROTOMY
Fullthickness
circumferential
burns