Luka Bakar

Alfreth langitan
FK UNTAD
RSUD UNDATA
PALU
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 : ½ bagian pada 8 jam I
½ 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: ½ bagian pada 8 jam I
½ bagian pada 16 jam berikutnya
larutan koloid 17:3 (sejak jam ke-0)
Hari berikutnya diberikan cairan maintenance