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 Struktur yg terkena Gejala dan Keluhan
(Grade)

Grade I Hanya mengenai lapisan -Hiperemi

(Superficial Burns) atas kulit (epidermis) - Nyeri +
- Bullae -

Grade II Mengenai epidermis dan --lembab, mottled, kulit

(Partial Thickness Burns) sebagian dermis merah memutih
-- Nyeri ++
--Bullae +
Grade III Mengenai seluruh lapisan --- kering
(Full Thickness Burns) kulit --- 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 ADULT CHILD
Head & Neck 9 18
Arms 9 (2) 9 (2)
Front & Back 18 (2) 18 (2)
Legs 18 (2) 13.5 (2)
Genitalia 1 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
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

Chemicalfumes
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