Macam-macam Luka Bakar

1. Luka Bakar Termal (Thermal Burn)

2. Luka Bakar Elektrik (Electrical Burn)
3. Luka Bakar Kimia (Chemical Burn)
4. Luka Bakar Eksplosif (Blast Burn)
 THERMAL BURNS
1. Flame Injuries (terkena api)
• Di negara maju, flame injuries paling sering
terjadi pada wanita (15–64 thn)
• Di negara berkembang, flame injuries paling
sering terjadi pada wanita 16–35 tahun
2. Scalds (Pelepuhan)
Scalds are frequently due to spilling of hot
drinks and liquids, and immersion in a hot or
shower. Scalding account for around 70% of
burns in children, although they are also
common in elderly people
3. Contact burns
Contact burns occur either when the skin
touches an extremely hot object (often seen
in industrial accidents) or when it touches a
less hot object for a very long time. The latter
may be seen in people who have lost
consciousness, such as those with epilepsy or
who misuse alcohol or drugs, or in elderly
people after a fall or blackout.
 ELECTRICAL BURNS
• Electrical burns occur when electricity flows
through the body from an entry point to an
exit point. The burn is caused by the heat
energy of the electric current damaging tissue
along its path of flow
Kerusakan jaringan ditentukan oleh besaran
tegangan listrik yang melewati tubuh korban :
• Listrik tegangan rendah (domestic current)
— Area luka sedikit, luka bakar yang dalam pada
titik sentu dan titik keluarnya listrik dari tubuh
• Listrik Tegangan tinggi
— Tegangan arus listrik yang > 1000 volt
mengakibatkan kerusakan yang sangat parah
pada jaringan,hingga dapat mengakibatkan
kehilangan organ tubuh. Tegangan arus listrik >
7000 volt biasanya mengakibatkan kematian.
Electrical burns dapat mengakibatkan serangan
jantung dan aritmia. Cardiac monitoring sangat
disarankan dalam penatalaksanaannya.
 CHEMICAL BURNS
Burn injuries from corrosive agents occur mainly
in industrial accidents, but they can also result
from products found in the home.

Chemical burns are caused by:

• Acids
• Alkalis/bases
• Organic products
• Chemical burns tend to cause deep dermal or
full thickness burns because the tissues
continue to be damaged until the chemical is
completely removed
 Explosions and Blast Injuries
Disaster response personnel must understand
the unique pathophysiology of injuries
associated with explosions and must be
prepared to assess and treat the people injured
by them
• Explosions can produce unique patterns of
injury .
• When they do occur, they have the potential
to inflict multi-system life-threatening
injuriseson many persons simultaneously.
• The injury patterns following such events are a
product of the composition and amount of the
materials involved
• the distance between the victim and the blast,
and any intervening protective barriers or
environmental hazards.
• blast-related injuries can present unique
triage, diagnostic, and managemet challenges
to providers of emergency care
• TRIAGE CONSIDERATIONS
• Unique patterns, multiple and occult injuries.
• Death is often a result of combined blast, ballistic, and thermal
effect injuries.
• Walking wounded and non-critical patients are time intensive.
• Hidden/internal injuries
• Overtriage can increase critical mortality – resulting from poor
patient distribution from scene and self-referrals to hospitals.
• Up to 75% of victims self-refer to hospital.
• Do patients require decontamination?

Initial triage, trauma resuscitation, and transport

should follow standard protocols for multiple
injured patients or mass casualties.
 FACTORS THAT CONTRIBUTE TO
BLAST INJURY SEVERITY
ENVIRONMENT Was The Bombing In An Open Or Closed
Space?

The effects of the blast wave are more

intense in a confined space such as a
building, bus or train.
AGENT
• Low-order Explosive • Device type – large (vehicle) or small
• High-order Explosive (suitcase)
• Delivery method
• Distance from device
• Protective barriers
PRIMARY INJURIES
Unique to high-order explosives; results from the impact
of the over-pressurization wave with body surfaces by the
blast wave.

1. HEAD INJURIES
• May or may not include history of loss of consciousness
• Headache, seizures, dizziness, memory problems
• Gait/balance problems, nausea/vomiting, difficulty
concentrating.
• Visual disturbances, tinnitus, slurred speech.
• Disoriented, irritability, confusion.
• Extremity weakness or numbness.
2. TYMPANIC MEMBRANE – EAR INJURIES
• Evaluate and resuscitate per standing protocols.
• Impaired hearing may complicate triage process.
• Secondary evaluation and examination to identify all blast-
related injuries including perforated tympanic membranes.
• Serious blast injuries can occur in the absence or presence
of tympanic membrane rupture.
• Stable patients without signs and symptoms of significant
blast injury, may be discharged after 4 to 6 hours of
observation despite the presence of TM rupture.
• Patients should have urgent consultation and follow up care
with ENT specialist.
• Spontaneous healing occurs in 50-80% of all patients with
perforations.
3. ABDOMINAL INJURIES
• Treatment follows established protocols.
• Perforations can be delayed and develop 24 to
48 hours post blast. Manifestations of
peritonitis can occur hours or days after a
blast.
• There is the possibility of missed injury,
especially in semiconscious or unconscious
patients.
SECONDARY INJURIES
• Results from flying debris and bomb
fragments causing shrapnel wounds.
• Common injuries include:
Trauma to the head, neck, chest, abdomen,
and extremities in the form of penetrating and
blunt trauma.
Fractures
Soft tissue injuries
TERTIARY INJURIES
• Results from individuals being thrown by the
blast wind.
• Common injuries include:
Head injuries
Skull fractures
Bone fractures
 QUATERNARY INJURIES
• All explosion-related injuries, illnesses, or
diseases not due to primary, secondary, or
tertiary mechanisms.
• Common injuries include:
Burns
Head injuries
Exacerbation of pre-existing medical
conditions
COMBINED INJURIES
• avoid tunnel vision on one injury.
• Monitor fluid replacement amounts when
treating blast lung with another injury to avoid
fluid overload which can exacerbate blast lung
injury.
• Airway management and oxygenation/
ventilation are critical and performed with
standard techniques.
System Injury or Condition
Auditory TM rupture, ossicular disruption, cochlear damage, foreign
body
Eye, Orbit, Face Perforated globe, foreign body, air embolism, fractures
Respiratory Blast lung, hemothorax, pneumothorax, pulmonary
contusion and hemorrhage, A-V fistulas (source of air
embolism), airway, epithelial damage, a spiration
pneumonitis, sepsis
Digestive Bowel perforation, hemorrhage, ruptured liver or spleen,
sepsis, mesenteric ischemia from air embolism
Circulatory Cardiac contusion, myocardial infarction from air embolism,
shock, vasovagal hypotension, peripheral vascular injury, air
embolism-induced injury
CNS injury Concussion, closed and open brain injury, stroke, spinal cord
injury, air embolism-induced injury
Renal Injury Renal contusion, laceration, acute renal failure due to
rhabdomyolysis, hypotension, and hypovolemia
Extremity injury Traumatic amputation, fractures, crush injuries,
compartment
syndrome, burns, cuts, lacerations, acute arterial occlusion,
air embolism-induced injury
BURN/BLAST INJURY
• PREHOSPITAL
• Burn injury will require significant amounts of fluid
resuscitation while avoiding fluid overload to prevent
further pulmonary injury.
• Fluid resuscitation targeted to vital signs, to avoid
hypotension; judicious fluid administration to maintain
perfusion without volume overload.
• Transfer to a facility with specific expertise in both trauma
and burn management, or at least the trauma
management.
• HOSPITAL
• Fluid resuscitation guided by urine output. Consider
monitoring central venous pressure, and systemic vascular
resistance when indicated.
 Trauma Inhalasi
Indikasi kecurigaan
 Sputum bercampur karbon
 Luka bakar di muka
 Bulu2 diwajah terbakar
 Sisa2 jelaga
 Hiperemis orofaring
 Riwayat didlm ruang tertutup
 CO Hgb >10%
 PATHOPHYSIOLOGY
The pathophysiology of burn wounds is a slowly
evolving process, unlike many other forms of
trauma. Whatever the mechanism, burn injuries
cause a local response and, in complex burns, a
systemic response.
Local response
The local response to a burn injury consists of
inflammation, regeneration and repair. A burn may
be divided into three zones.
1. Zone of coagulation/necrosis
— At the centre of the wound
— No tissue perfusion
— Irreversible tissue damage due to coagulation of
proteins
• Zone of stasis
— Surrounds the central zone of coagulation
— Decreased tissue perfusion
— Some chance of tissue recovery with optimal
management
• Zone of hyperaemia
— At the periphery of the wound
— Good tissue perfusion
— Tissue recovery likely.
These zones are dynamic environments. In the
superficial areas and around the edges, the
usual process of repair occurs (in growth of
capillaries and fibroblasts followed by formation
of granulation tissue and scar).
After 3–4 days, loss of tissue viability in the zone
of stasis (for example, due to delayed or
suboptimal management) will cause the burn
wound to become deeper and wider.
• Systemic response
In complex burns of more than 20–30% TBSA,
there is also a systemic response due to the
extensive release of inflammatory mediators at
the injury site. The effects are far reaching and
include systemic hypotension, broncho
constriction, a threefold increase in basal
metabolic rate and a reduced immune response.
 Penurunan Perfusi Jaringan
• GINJAL Akut Renal Failure
• GI ILEUS
• METAB ANAEROB ASIDOSIS
METABOLIK
• KERUSAKAN JARINGAN KULIT
• NEKROSIS
 Gangguan Organ Lain
1. Gangguan sel sel otak (edema serebri)
dan gangguan autoregulasi
2. Gangguan ginjal
3. Gangguan sel sel otot
4. Gangguan jantung dan hematologi
5. Gangguan elektrolit
6. Kontraktur dan parut hipertrofik
 Fase-Fase pada Luka Bakar
1. Fase awal
Masalah : pernafasan, sirkulasi
2. Fase sub akut
Masalah : proses inflamasi infeksi yang
menimbulkan sepsis proses
penguapan cairan tubuh di sertai
energi
3. Fase lanjut
Masalah : kontraktur,gangguan fungsi,
penampilan.
 Luka Bakar Derajat 1
kerusakan terbatas pada epidermis
kulit kering, hiperemik berupa eritema
tidak dijumpai bulae
nyeri
sembuh spontan
 Luka Bakar Derajat 2
 kerusakan meliputi epidermis dan dermis
 dijumpai bulae
 nyeri
 warna merah atau merah muda
 dibedakan menjadi dangkal dan dalam
 Luka Bakar Derajat 3
 Eskar melingkar di dada menghalangi
gerakan ekspansi rongga toraks
 Assessing Burn Area
1. Non-Complex Burn (Minor Burn)
• any partial thickness thermal burn covering <15% total
body surface area (TBSA) in adults or <10% in children
(<5% in children younger than 1 year) that does not
affect a critical area*. Includes deep dermal burns
covering 􀀩 1% of the body.
2. Complex Burn
• any thermal burn injury affecting a critical area* or
covering >15% TBSA in adults or >10% in children (>5%
in children younger than 1 year). All chemical and
electrical burns are considered complex.

• *Burns to hands, feet, face, perineum or genitalia,

burns crossing joints and circumferentialburns
 Assessing Burn Area

1. Wallace’s Rule of Nine

Tubuh dibagi menjadi zona 9 dan total keseluruhan area luka bakar
akan dikalkulasikan berdasarkan standar diagram
2.Lund and Browder Chart
Metode yang menghitung luas area luka dengan
variasi dari pertumbuhan tubuh manusia. Dapat
digunakan untuk anak-anak dan dewasa.
2. Palm Surface
Sebuah metode yang
menghitung area luka bakar
dengan telapak tangan, yang
merepresentasikan 1% dari
permukaan kulit.

Cara ini efektif untuk

menghitung area-area yang
kecil (<15%) atau luka yg luas
(>85%) dengan estimasi semua
permukaan tubuh adalah 100
%
 KATEGORI PASIEN DAN INDIKASI
RAWAT
Berat :
 Derajat II – III > 20% (usia < 10 thn atau > 50 thn)
 Derajat II – III > 25 % selain kelompok usia di atas
 Mengenai muka, telinga, tangan, kaki, perineum
 Cedera inhalasi
 Luka bakar listrik
 Disertai cedera lain
 Pasien resiko tinggi
2. Sedang
Luas 15 – 25% dengan derajat III < 10% pada
dewasa
Luas 10 – 20% (usia < 10 tahun atau > 50
tahun
dengan derajat III < 10 %
 Derajat III < 10% tidak mengenai muka,
tangan, kaki dan perineum pada anak dan
dewasa
3. Ringan
Luas < 15% pada dewasa
Luas < 10% pada anak dan usia lanjut
Derajat III < 2% pada segala usia, tidak
mengenai muka, tangan, kaki dan perineum
 Diagnosa Keperawatan
• Ggn pertukaran gas b.d keracunan gas CO,
inhalasi asap, dan obstruksi jln nfs atas
• Tdk efektif bersihan jln nfs b.d edema dan efek
inhalasi asap
• Defisit vol cairan b.d peningktn permeabilitas
kapiler
• Hypotermia b.d kehilangan mikrosirkulasi kulit
dan luka terbuka
• Nyeri b.d injuri jaringan dan syaraf
• Kecemasan b.d dampak emotional dr injury
Mengupayakan dan mempertahankan
• Jalan nafas
• Perfusi yang normal
• Keseimbangan cairan dan elektrolit
• Suhu tubuh : normal
 Prinsip2 Penatalaksanaan
Jalan nafas
 Penilaian adanya trauma inhalasi
 Mempertahankan patensi jalan nafas (intubasi
dgn ETT atau tracheostomi sedini mungkin)
Pernafasan
 Menilai kemungkinan keracunan CO
 Melakukan eskarotomi bila terdapat eskar
melingkar di dinding dada.
 Memberikan oksigen dan ventilasi : ALL major
burns or suspected inhalation injury are initially
administered 100 % oxygen
 Con’t
Sirkulasi
 Akses vena yang adekuat
 Monitoring tanda2 vital
 Monitor produksi urin tiap jam
• Dewasa : 30-50 mL/jam
• Anak2 : 1.0 ML/kg/jam
 Pemberian Cairan
Rumus Baxter
 4 ml warmed Ringer’s lactate
solution/kg/% BSA in 1st 24 hours
• ½ in first 8 hours
• ½ in next 16 hours
 Berdasar waktu mulai saat terjadi trauma.
 Evans Formula
• KOLOID: 1 ML X KG BB X %BSA
• Elektrolit / saline : 1 ml x BBx % BSA
• GLUKOSA 5%: 2000ml
– Hr 1 : ½ diberikan dl 8 jam; dipertahankn ½ lg
sampai 16 jam
– Hr 2 : koloid dan elektrolit
 Broke Army Formula
• Koloid : 0,5 ml x kg BB x % BSA
• Elektrolit (RL): 1,5 ml x kg BB x % BSA
• GLUKOSA 5 % : 2000 ML
• HR 1 : ½ DL 8 JAM; DILANJUT s.d 16 jam
• Hr 2 : ½ koloid, ½ elektrolit
 Penatalaksanaan Lanjutan
 Identifikasi adanya cedera ikutan
 Data dasar analisa gas darah dan foto thorax
 Dokumentasi data yang kontinyu (flow sheet).
 Perawatan Luka
• Jangan pecahkan bulae
• Jangan menyiram dengan air dingin
• Tutup dengan kain lembab yang bersih dan steril
• Penggunaan tulle atau krim antibiotika sesuai
dengan kebutuhan
• Penentuan untuk penutupan luka dengan
skingraft
• Kultur (pus,urin,tinja,sputum)
• Pemakaian balut tekan