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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) Grade I (Superficial Burns) Grade II (Partial Thickness Burns) Struktur yg terkena Gejala dan Keluhan 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

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 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%

Minor Burns LB gr II < 15%

LB gr III 2-10% (*) 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

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

dengan bahan kering &

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

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