Resusitasi dan Terapi

Awal Luka Bakar dan

Trauma Inhalasi
• Muhammad Arethusa • Selvy Harianti
Ananta • Rani Septikasari
• Reza Khadafy Nugroho • Cahyono Yudianto
• Havez Kleib • Ayu Vidya Putri
• Teguh Setiawanto
• Andi Kusnawan
• Elizabeth Margareth
 DEFINISI
● Kerusakan kulit tubuh yang disebabkan oleh trauma panas atau trauma dingin

• Luka bakar saja

• Luka bakar + cedera lain yang tampak nyata
• Luka bakar + cedera lain yang “tersembunyi”  KLL, ledakan, listrik tegangan tinggi,
lompat dari tempat tinggi
 Burn Care
Team
Concept
Burn Unit
Burn Team

Pre-hospital Occupational
Nurses Dietitians
Clinicians Therapist

Emergency
Anesthesia Rehabilitation Psychosocial
Department

Intensive Speech
Surgeons Physiotherapist
Care Patologist

Australian and New Zealand Burn Association Emergency

Management of Severe Burns 18th edition
Jackson’s Burn Wound
Kedalaman Luka Bakar
1st Degree

2nd Degree

3rd Degree

Australian and New Zealand Burn Association Emergency

Management of Severe Burns 18th edition
 Klasifikasi Luka Bakar

Sedang /
Ringan / Minor Berat / Major
Moderate
• <10% TBSA • 10-20% TBSA pada • >20% TBSA pada dewasa
pada dewasa dewasa • >10% TBSA pada anak-anak
• <5% TBSA pada • 5-10% TBSA pada atau lansia
anak-anak atau anak-anak atau lansia • >5% TBSA pada full–thickness
lansia • 2-5% TBSA pada full- burn
• <2% TBSA pada thickness burn • High-voltage burn
full-thickness • Low-voltage burn, • Mengenai tangan, wajah,
burn curiga cedera inhalasi, telinga, mata, kaki, sendi besar,
luka bakar dan genetalia/perineum
RAWAT JALAN sirkumferensial, • Dengan cedera inhalasi, listrik,
dengan penyakit kimia disertai trauma lain
penyerta
American Burn Association Rawat di RS tipe B / A dengan ULB
Resusitasi dan
Terapi Awal
Luka Bakar
ONSITE / PRE HOSPITAL
First Aid Management of
Burns Your Picture Here

 Stop : hentikan proses

pembakaran
 Cooling : dinginkan lukanya Your Picture Here
 Cegah hypothermia

20 min, <3 hours

Your Picture Here
SANGAT PENTING &
MENENTUKAN
PROGNOSIS!
Australian and New Zealand Burn Association Emergency
Management of Severe Burns 18th edition
 Structure of EMSB
L A B C Infographic
D E Style Fluid A.M.P.L.E.
O i r i i x History
O r e r s p
K w a c a o Analgesia Head to Toe Exam
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Primary Survey First Aid Secondary Survey

 Burn Management (ER / Hospital)

Principles of Trauma:
• Primary Survey (ABCDE)

• Secondary Survey

EMERGENCY MANAGEMENT OF SEVERE BURNS OURSE. Australian and New Zealand Burn
Association Emergency Management of Severe Burns 18 th edition
 Primary Survey
1. AIRWAY & Cervical
Spine Control
5. EXPOSURE +
Environmental Control

2. BREATHING
&Ventilation

4. DISABILITY :
Neurological Status 3. CIRCULATION with
Hemorrhage control

Australian and New Zealand Burn Association Emergency

Management of Severe Burns 18th edition
Primary Survey
• Airway
• Jalan nafas paten
• Trauma inhalasi, KETIKA RAGU  Intubasi
Add
• C-spine stabilization Title
• Breathing
• Ekspos dada: adekuat & selaras
• 100% humidified O2 15 L/min via NRM
• Luka bakar melingkar dada full thickness  Add
eskarotomi Title

Add
T
• Circulation
• Cek nadi karotis, tekanan darah, CRT ≤2 detik
• 2 jalur IV berkaliber besar (16G (dewasa), 20G(anak)) + ambil
darah
• Perdarahan?  hentikan
• Luka bakar melingkar pada ekstremitas  elevasi

Gejala klinis awal menunjukkan syok  bukan karena luka bakarnya

Find it and treat it!
• Disability
• AVPU
• GCS
• Pupil (ukuran, isokor/anisokor, reflek direk/indirek)
• Enviroment
• Lepaskan semua pakaian dan perhiasan yang menempel
• Log roll + dokumentasi
• Selimuti pasien
• Hitung luas permukaan area menggunakan Wallace Rule of Nines
 Determination of Burn Extent

Rule of 9
 FATT (Fluid, Analgesia, Test, Tubes)
• Fluid
• Modified Parkland Formula
3 ml kristaloid x kgBB x TBSA
• ½ dosis - 8 jam pertama
• ½ dosis – 16 jam berikutnya
• Dihitung dari waktu terjadinya cedera
• Monitor: kateter urin (dewasa 0.5 ml/kg/hr, anak 1 ml/kg/hr)  2x lipat pada
luka bakar listrik
Monitor resusitasi: Urine output
• Pada anak-anak berikan maintenance:
• 4:2:1 (D5 NS)
 FATT (Fluid, Analgesia, Test, Tubes)
• Analgesia
• Luka bakar terasa sangat nyeri
• IV morfin 0.05 – 0.1 mg/kgBB
• Efek titrasi (tiap 3-5 menit)
• Test
• X-Ray: Lateral cervical spine, thoraks, pelvis
• Cek darah
• Darah lengkap, elektrolit, LFT, RFT, albumin, COHb, β-hCG,
cross match
• Tubes
• Endotracheal
• Nasogatric
• Kateter urin Pastikan first aid
 Secondary Survey
• A.M.P.L.E
• Allergy, Medication, Past Illness, Last Meal, Event
• Head to Toe Add
Title
• Tetanus
• Dokumentasi dan Transfer
• Support
Add
Title

Add
T
KRITERIA RUJUK
UKURAN ORANG AREA MEKANISME

>10% luas luka bakar Penyakit terdahulu Wajah / Tangan / Kimia / Listrik
dewasa yang diderita Kaki / Perineum .
Sendi Mayor

>5% luas luka bakar Kehamilan Sirkumferensial Trauma mayor

anak-anak (tungkai atau dada)

>5% luas luka bakar Usia Ekstrem Paru-paru (inhalasi) Cedera non
full-thickness kecelakaan

Australian and New Zealand Burn Association Emergency

Management of Severe Burns 18th edition
Resusitasi Awal
Trauma Inhalasi
Cedera saluran nafas akibat terhirupnya uap
panas atau produk pembakaran yang Definisi
menimbulkan kerusakan lokal maupun sistemik.

 Meningkatkan mortalitas dan pneumonia

 Prediktor mortalitas

Besarnya derajat kerusakan tergantung dari :

• Konsentrasi
• Sumber
• Durasi
api
pajanan
• Jarak
• Kelarutan
• Suhu
gas beracun
 Patofisiologi
• Cedera panas langsung 
gejala OBSTRUKSI
• Bronkospasm, fungsi proteksi
menurun
• Cedera jaringan akibat produk
pembakaran  gejala
OKSIGENASI
• Sloughing mukosa + terbentuknya
plugs & casts  inflamasi
meningkat + permeabilitas kapiler
meningkat  edema paru,
menurunnya compliance paru,
atelektasis
• Cedera sistemik: CO, HCN
(plastik atau lem)
Klasifikasi Trauma Inhalasi

• Edema akibat inhalasi gas

panas
Obstruksi • TBSA > 20% tanpa trauma
inhalasi
4-24 jam

Oksigenasi • Cedera parenkim paru

12 jam – 5 karena asam dan alkali
hasil pembakaran
hari • Eksudat, obstruksi
parenkim
Cedera sistemik (CO)
• CO memiliki afinitas 240x lebih kuat
terhadap Hb dibanding O2  Hipoksia intra
dan ekstraseluler
• Half life: 250 menit

Kadar COHb (%) Gejala

0-15 Normal/perokok
15-20 Sakit kepala, bingung
20-40 Mual, muntah, disorientasi, agitasi
40-60 Kejang, koma, ataksia
> 60 Kematian
 Diagnosis
• Anamnesis
• Mekanisme cedera: sumber api/panas, intensitas pajanan, riwayat
pingsan
• Pemeriksaan Fisik
• Luka bakar pada wajah Gold Standard
• Terbakarnya rambut di daerah wajah Direk Bronkoskopi
• Serak
• Batuk
• Dahak berjelaga
• Nasal flaring
• Retraksi iga
• Perubahan status mental Trakea normal Cedera gas panas Jelaga obstruktif
 Tatalaksana
• Patensi jalan napas: intubasi, trakeostomi
• When in doubt, intubate!
• Proteksi servikal
• Oksigenasi 100% via NRM 15L/menit
• IPPV (Intermittent Positive Pressure Ventilation)
• Eskarotomi bila perlu
• Elevasi kepala 30-450
• Pulmonary toilet
• Nutrisi
• Antibiotik
R • Traber DL, Herndon DN, Enkhbaatar P, Maybauer MO, Maybauer DM. The patohpysiology of inhalation injury.

e In: Herndon DN, editor. Total burn care, 3rd ed. Philadelphia: Elsevier-Saunders, 2007. p. 248

f • Klein MB. Thermal, chemical, and electrical injuries. Dalam: Thorne CH, Chung KC, Gosain AK, Gurtner GC,
Mehrara BJ, Rubin JP, Spear SL, editor. Grabb & Smith’s plastic surgery. Ed 7. Philadelphia: Lippincott

e
Williams & Wilkins, 2014. h. 133.

• Inhalation injury. The Education Committee of the Australian and New Zealand Burn Association Limited.

r Emergency management of severe burns (EMSB). Ed 17. Feb 2013.

e
• Steinstrasser L, Al-Benna S. Acute management of burn/electrical injuries. Dalam: Neligan PC, editor. Plastic
surgery. Ed 3. New York: Elsevier-Saunders, 2013. h. 407.

n
s
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THANK YOU