Luka Bakar

Dr. Adam Suyadi,SpB,MM Bag Bedah FK UII Yogyakarta

Skin Anatomy

TIGA FAKTOR PENTING DALAM LUKA BAKAR
1. ETIOLOGI / PENYEBAB

2. KEDALAMAN LUKA BAKAR
3. LUAS LUKA BAKAR

ETIOLOGI
1. SUHU:

• 2.

PANAS ( API, UAP, AIR )
DINGIN ( FROST BITE ) LISTRIK

3.
4. 5.

KIMIA ASAM – BASA
RADIASI LASER

KEDALAMAN LUKA BAKAR • DERAJAT SATU Superficial Skin Burn • DERAJAT DUA Partial Thickness Skin Burn • DERAJAT TIGA Full Thickness Skin Burn .

Derajat 1 Superficial Skin Burn .

KEDALAMAN LUKA BAKAR Luka Bakar Derajat Satu .

Derajat 2 Partial Thickness Skin Burn .

KEDALAMAN LUKA BAKAR Luka Bakar Derajat Dua .

Derajat 3 Full Thickness Skin Burn .

Luka Bakar Derajat Tiga .

s palm = 1% BSA .Luas Luka Bakar: Rule of Nines surface of patient.

LUAS LUKA BAKAR Rule of Nine’s .

Burns / Cold Injuries Management Principles  Establish / maintain • • • • Airway Normal perfusion Fluid / electrolyte balance Normal body temperature .

Inhalation Injury Clinical Indications  Carbonaceous sputum  Facial burns  Hair singeing  Carbon deposits  Inflamed oropharynx  History  CO Hgb >10% .

Life Saving Burn Treatment     Remove all • Injurious material • Clothing jewelry Prevent hypothermia Establish 2 large – caliber IVS Initiate warmed ringer.s lactate solution .

Burn Assessment History  Mechanism of injury  Associated illnesses  Allergies  Tetanus status .

Burn Management Airway  Assess for injury  Establish and maintain patent airway early .

Burns Management Breathing  Assume CO exposure  Inhalation of toxic fumes. carbon particles  Direct thermal injury  Oxygenate/Ventilate  Endotracheal intubation  ABGs and CO levels .

0 ML/kg/hour .Burn Management Circulation  Adequate venous access  Monitor vital signs  Hourly Urinary output • Adult : 30-50 ML/hour • Child : 1.

Burn Management Circulation : Estimate Fluid Needs  2-4 ml warmed ringer.s lactate Solution / kg / % BSA in 1st 24 hours • ½ in first 8 hours • ½ in next 16 hours  Based on time from injury  Monitor heard rate and urinary output .

C B: Luka Bakar Pada Dinding Dada  ESCHAROTOMY C: FORMULA BAXTER Infus RL: 4 cc x BB (Kg) x LUAS LB (%) .B .PENANGANAN RESUSITASI A .

CONTOH KASUS PASIEN DENGAN BB 50 Kg LLB 20% Kebutuhan Cairan : 4 x 50 Kg x 20 %  4000 cc RL 8 Jam pertama 2000 cc  62 tts/mnt 16 Jam berikut 2000 cc  31 tts/mnt .

Burn Management Develop Treatment Plan  Estimate burn size depth  Identify associated injuries  Weigh patient  Baseline blood analyses and chest x-ray  Document on flow sheet .

Burn Management Maintain peripheral Circulation  Remove All constricting devices  Assess distal circulation  Escharotomy : Surgical consult Fasciotomy/Escharotomy .

distention  Burns > 20% BSA Medications  Narcotics : Minimal use IV only  Antibiotics : Not indicated early .Burn Management Gastric Intubation  Nausea vomiting .

Burn Management Wound Care  Cover with clean linens  Do not • Break bisters • Apply antiseptics • Apply cold water .

tangan.INDIKASI RAWAT INAP • LB Derajat II > 15% Dewasa > 10% Anak / Geriatri • LB Derajat III > 10% Dewasa • Listrik / Kimia • LB di daerah muka. genital. perineal • LB dengan kelainan lain / trauma lain yang berat .

PERAWATAN LUKA • Derajat Satu  • Derajat Dua  Cuci NaCl + Savlon 500 cc Sofratul Kassa Steril (Biarkan Satu Minggu) 5 cc .

Burn Management Chemical Burns  Duration. amount . concentration  Brush away dry chemicals  Flush with copious amounts of water for 20-30 Minutes Alkali Burn .

and may spare the overlying skin .Burn Management Electrical Burn  Result in damage to fascia and muscle.

Burn Management Electrical Burn  ABCDES  Myoglobinuria • Fluids ↑: 100 ml urine / hour • Mannitol : 25 g IV  Metabolic acidosis • Maintain adequate perfusion • Sodium bicarbonate .

Burn Transfer Criteria 2nd – and 3rd– Degree burn  >10% BSA in ages  <10 and > 50 years  >20% BSA  To : • Face • Eyes • Ears • Hand • Feet • Genitalia • Perineum • Major joints .

Burn Transfer Criteria       3rd degree burn > 5% BSA Electrical and chemical burns Inhalation injury Preexisting illnesses.associated injuries Children Special situations .

Burn Transfer Prosedure   Coordinate with burn center doctor Transfer with • Documentation/Infor mation • Laboratory results .

Cold Injury Facture Temperature  Duration of exposure  Environmental conditions  Immobilization  Moisture  Vascular disease  Open wounds  .

or the ears. the nose. It most commonly affects the feet and hands (which account for 90% of cases). .Definition Frostbite refers to the freezing of body tissue (usually skin). that results in loss of feeling and color in the tissue.

3. frostnip superficial frostbite deep frostbite Most cases occur in adults between 30 and 49. 2.There are three degrees of frostbite 1.  .

particularly when accompanied by a low wind-chill factor or by briefer exposure to very cold temperatures .Etiology  Frostbite is caused by prolonged exposure to cold temperatures.

Cold Management Do not delay  Remove clothing  Warmed blankets  Rewarm frozen part  Preserve damaged tissue  Prevent infection  Elevate exposed part  Analgesics. tetanus. and antibiotics  .

Hypothermia : Tⅽ < 35 Degrees     Rapid /slow drop in core temperature Elderly and Children at greater risk Low – range thermometer required Clinical findings • Depressed LOC • Gray cyanotic Variable vital signs • Absence of cardiorespiratory activity .

Hypothermia Management  ABCDES. IV access  Oxygenate and ventilate  Prevent heat loss and rewarm  Assess for associated disorders  Blood analyses .

blankets. and IV fluids  Active core rewarming • Surgical rewarming techiniques • Do not delay transfer  Not dead until warm and dead .Hypothermia Management  Passive external rewarming : Warmed environment.

Summary Burn Injury  Recognize and treat inhalation injury  Fluid recuscitation  Identify burns requiring transfer .

.

Summary Cold injury  Diagnose type • History • Clinical findings • Measure core temperature  Rewarming techniques  Monitor and support vital functions .

Sign up to vote on this title
UsefulNot useful