Iswinarno Doso Saputro

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 Definisi
 Luka bakar : suatu trauma
 Penyebab : - air/ uap/minyak panas,
- listrik
- bahan kimia
- radiasi/petir
 Menyebabkan : kerusakan atau kehilangan
jaringan kulit dan sekitarnya

Noer, 2006
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Etiologi

Api Air / minyakpanas Kesetrum Listrik Petir

Bahan Kimia dan Ledakan

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Epidemiology
Diagnosis
 Luas luka bakar : Total Body Surface
Area (TBSA) %

 Kedalaman luka bakar

 Co Morbid

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 Luas Luka Bakar
DEWASA

Rule of Nine menurut Wallace

American Burn Association, 2014
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 ANAK – ANAK
18 16 10

9 9 9 9 9 9

18 18 18 18 18 18

14 14 15 15 18 18

0-1 tahun 2 tahun 8 tahun

Setiap tambah umur,dikurangkan dari kepala, ditambahkan

ke kaki masing2 separohnya (ANZBA,2011)
Kedalaman Luka Bakar

(ANZBA,2011
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Kedalaman Luka Bakar
 Epidermal

Studyblue, 2016
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 Dermal:
 Superficial
 Mid
 deep :

Courtesy of Iswinarno DS
Courtesy of Iswinarno DS

dokumentasi tim combus, 2016

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Full Thickness

Courtesy of Iswinarno DS

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 Management
Pre Hospital Care
Hentikan proses terbakar.
Lepaskan pakaian dan perhiasan

Dinginkan luka bakar (efektif

selama 3 jam setelah kejadian)
air dingin suhu 8-25 derajat celcius
Minimal 20 menit
Management
 Management
PRIMARY SURVEY

 A : airway + C-spine control

 B : breathing + O2 15 L/ m
 C : circulation + bleeding control + I.V. line
 D : disability + AVPU + pupil
 E : exposure + environmental control

 Lepaskan semua pakaian dan perhiasan

 Dinginkan luka bakar dengan air mengalir
Noer, 2006
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Airway
 Apakah bebas?
 Crowing, wheezing atau gagling?
 Curiga trauma inhalasi?
 C-spine control
Terutama pada luka bakar dan
trauma
Jejas di atas clavicula,
penurunan kesadaran,
riwayat impact injury (jatuh, ledakan,
tabrakan)
Pasang bantal pasir/ collar brace

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 Trauma inhalasi
Trauma sistem pernafasan:

•Panas

•Iritan

•Toksik

Noer, 2006
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 Tanda Trauma Inhalasi
 Anamnesa  Riwayat dalam ruang
tertutup
 Riwayat kehilangan
kesadaran

 Tanda • Sputum jelaga

• Bulu hidung, alis, rambut
wajah terbakar

• Suara serak
 Gejala • Sesak nafas
• Tenggorokan kering
Noer, 2006
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 aTrManagement
aummalasi

cricothyroidotomy

tracheostomy

Tracheal intubation
Noer, 2006
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Breathing
 Pasang O2 masker
non rebreathing
15L/min
 Bagaimana
pergerakan dinding
dada:
 Simetris, adekuat?
 Adakah luka bakar
melingkar?
 Waspada pneumo/
hematothoraks
 Hitung RR

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Luka bakar melingkar

Luka bakar melingkar di dada

Gangguan ventilasi

Noer, 2006
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 Circulation
 Pasang IV line,masukan cairan
 Ambil sampel darah
 Hentikan perdarahan
 Cek status sirkulasi
 Tekanan darah
 Kualitas nadi
 Perfusi perifer
 Capillary refill time

Noer, 2006, Levitan R, 2008

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 Disability
 Cek kesadaran dengan
AVPU
 Alert
 Verbal
 Pain
 Unresponsive
 Cek kondisi kedua pupil

Noer, 2006, Levitan R, 2008

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Exposure

 Melepas semua
pakaian dan
perhiasan
 Menilai luas dan
kedalaman luka
bakar
 Menilai trauma
penyerta
 Log roll
 Menutupi tubuh dg
kain bersih hangat

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 FATT
 Fluid
 Analgesia
 Test
 Tube

ANZBA, 2013
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 Fluid
Resusitasi luka bakar
modifikasi Baxter/ Parkland

3cc x BB x %LB
Cara pemberian:
1. 8 jam pertama ½
2. 16 jam selanjutnya ½

8 jam 16 jam

Jam kejadian 8 jam 24 jam

Dr. Charles R Baxter
ABA, 2008, ANZBA, 2013
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  Cairan crystaloid
 Dipasang kateter urin untuk evaluasi
kecukupan cairan
 Prod. Urin normal:
 dewasa 0,5 cc/Kg BB/ jam
 Anak : 1 cc/kgBB/jam

ABA, 2008, ANZBA, 2013

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 Resusitasi anak-anak
 3 cc x BB x Luas luka bakar

 + Maintenance ( rumus 4:2:1)

 kg 10 kg pertama x 4
 kg 10 kg kedua x2
 kg 10 selanjutnya x1
 Cairan Na Cl
 Per jam selama 24 jam

ABA, 2008, ANZBA, 2013

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 RESUSITASI CAIRAN VERSI ANZBA

Dewasa : RL 3cc/kg BB/ % LB/ 24 jam

Anak : 3 cc x BB x luas Luka Bakar (%)/24 JAM
Cara pemberian:
1/2  8 jam pertama,1/2  16 jam berikutnya

Pada anak + maintanance(kebutuhan faali)

Rumus 4:2:1. Misal BB 33 kg
10 pertama x 4 = 40
10 kedua x2 = 20
10 kg pertama : 4 cc/kg BB/jam
3 ketiga x1 = 3
10 kg kedua : 2 cc/kg BB/jam
Total = 63cc/jam
10 kg ketiga : 1 cc/kg BB/jam
Cairan maintenance: (D5 NS)
 Analgesia, Test and Tube
 Morfin I.V (0,05-0,1 mg/kg BB),atau
sejenisnya, titrasi
 Cek lab lengkap + cek kehamilan pada
wanita usia subur, HIV/Hepatitis
 Foto x-ray Thoraks dan cervical, dan
lainnya sesuai indikasi
 NGT.., Cateter urine

ANZBA, 2013
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 Penanganan Luka Bakar Fase Akut
SECONDARY SURVEY
 Riwayat (AMPLE)
 Allergies
 Medication
 Past illness
 Last meal
 Event/ Environtmental related injury
 Head to toe examination
 Tetanus
 Documentation and transfer

ANZBA, 2013
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Burn Wound Management
Emergency:
 Bulectomy
 Escharotomy /fasciotomy
 Necrotomy

Elective:
 Surgical Excision /Necrotomy burn wound
 Skin Graft /Flap
 Free flap
 Others

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Bulectomy

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Nekrotomi

Courtesy of Iswinarno DS

Courtesy of Iswinarno DS
Emergency:
Escharotomy /fasciotomy
* Full-thickness burns girdling the
chest wall
* Full-thickness burns constrict a
limb or digit

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 Burn Wound Management

Anti bakteri topikal ( silver sulfa diazine krim)

Courtesy of Iswinarno Doso Saputro

WOUND MANAGEMENT
 WOUND CLEANSING, DEBRIDEMENT, & DESINFECTION
( chlorhexidine acetat 0.05% )
 TULLE ( paravine gause, framicetine Tulle)
 TOPICAL SILVER SULFADIAZINE (SSD)/( Burnazin Plus)
 THICK STERILE GAUZE / ELASTIC BANDAGE
 OPEN THE WOUND DRESSINGS AT DAY 5-7 UNLESS THERE
IS ANY SIGN OF INFECTION
 PERFORM UNDER GENERAL ANAESTHESIA (IN THE
OPERATING THEATRE)

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Courtesy of Iswinarno DS 41
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Burn wound treatment

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H7
Burn Wound Management

Courtesy of Iswinarno Doso Saputro 43

Burn Dressing

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SPLINTS in BURN patient

 PREVENT CONTRACTURE
 PREVENT DEFORMITAS

 POSITION OF COMFORT=POSITION OF
CONTRACTURE
 APPLY PRESSURE/ STRETCH TO THE BURN
AREA
 ANTIDEFORMITY POSITION
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 Daftar Pustaka
 Thorne CH. Grabb & Smith’s Plastic Surgery, 6th eds, Lippincott Williams & Wilkins, 2007
 McGregor AD. Fundamental Techniques of Plastic Surgery, 10th eds, Churchill Livingstone, 2000
 https://plasticsurgerykey.com/154-non-accidental-injury-physical-abuse/
 Levitan R, http://epmonthly.com/article/strategies-for-maximizing-o2-delivery/2008
 McGregor AD. Fundamental Techniques of Plastic Surgery, 10th eds, Churchill Livingstone, 2000
 Settle JAD. Principles & Practice of Burns Management. Churchill Livongstone, 1996.
 ABLS Course Provider’s manual American Burn Association, 2001
 Martin JAJ. Acute Management of the Burn Patients. Philadelphia : WB Saunders Company;
1990.
 Marzoeki D. Pengelolaan Luka Bakar. Surabaya: Airlangga University Press; 1991.
 Moenajat Y. Luka Bakar Pengetahuan Klinis Praktis. Edisi II, Jakarta : Balai Penerbit UI; 2001.
 Standard Operating Procedure. Luka Bakar. Lab/SMF Ilmu Bedah Plastik FK Universitas
Airlangga-RSU Dr. Soetomo Surabaya.
 Still JM, Law EJ. Primary excision of the burn wound. Clin Plast Surg 2000
 Noer MS, Saputro ID, Perdanakusuma DS. Penanganan Luka Bakar. Surabaya, Airlangga
University Press, 2006.

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Preparation for surgery is based on three
main principles:

 Anesthetic evaluation

 Preparation of patients

 Preparation of operating romm

Preparation for Surgery

•Estabish burn size, depth and surgical plan

•Communicate with surgical team
•Establish expected physiological impact of surgery
•Asses airway, consider fiberoptic intubation
•Asses level of respiratory support
•Evaluate intraoperative requirement and make efforts to match
requirement during surgery
Preparation for Surgery

• Evaluate hemodynamic status and expected needs during surgery.

• Make a thorough and systematic evaluation of the patient.
• Detect any physiological derangements and pre-exiting condition
and correct them before patient is taken to the operating room
• Establis predicted blood loss and order blood products
• Order coagulation products if need
Preparation for surgery
Calculation of Expected Blood Loss
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Zona Luka Bakar – Jackson 1950
 Zona Koagulasi
 Tidak vital, nekrotik, putih, tanpa sirkulasi

 Zona Stasis (circulation sluggish)

 Full thickness, mottled red

 Zona Hiperemis
 Batas terluar, good blood flow, kemerahan
 Jackson’s Burn Model

Hiperemis
 Fase Luka Bakar

kejadian stabil sembuh

Akut Sub akut Lanjut

Noer, 2006
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