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BURN Tutorial

Dec 12, 2015

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Page 1: BURN Tutorial

ddr. r. Ifiq Budiyan NazarIfiq Budiyan Nazar

Luka Luka BakarBakar

Page 2: BURN Tutorial

SeveritySeverity Luka BakarLuka BakarDDitentukan oleh:itentukan oleh:

- derajat kedalaman- derajat kedalaman

- luas- luas

- - critical areas critical areas yang terkenayang terkena

- - medical condition medical condition atau traumaatau trauma

- umur pasien- umur pasien

Page 3: BURN Tutorial

DeDerajat Kedalaman (Grade) rajat Kedalaman (Grade) Luka BakarLuka Bakar::

Derajat kedalaman (Grade)

Struktur yg terkena Gejala dan Keluhan

Grade I(Superficial Burns)

Hanya mengenai lapisan atas kulit (epidermis)

-Hiperemi- Nyeri +- Bullae -

Grade II(Partial Thickness Burns)

Mengenai epidermis dan sebagian dermis

--lembab, mottled, kulit merah – memutih-- Nyeri ++--Bullae +

Grade III(Full Thickness Burns)

Mengenai seluruh lapisan kulit

--- kering--- putih/coklat tua/hitam---charred--- tdk nyeri

Page 4: BURN Tutorial

DERMIS

EPIDERMISGr I

Gr IIA

Gr IIB

Gr III

Page 5: BURN Tutorial

PartialPartial T Thickness hickness BBurnsurns

Page 6: BURN Tutorial

Full Full TThickness hickness BBurnsurns

Page 7: BURN Tutorial

Luas Luka BakarLuas Luka Bakar Ditentukan olehDitentukan oleh percentagepercentage (%) (%)

dari dari body areabody area yang terbakar yang terbakar Telapak tangan pasien Telapak tangan pasien ++ 1% 1% ‘‘rule of ninesrule of nines’ dari Wallace’ dari Wallace

Page 8: BURN Tutorial

Rule of nineRule of nines of s of WallaceWallace

Membagi tubuh menjadi beberapa Membagi tubuh menjadi beberapa bagianbagian

Digunakan untuk mengkalkulasiDigunakan untuk mengkalkulasi % % permukaan tubuh yang permukaan tubuh yang terbakarterbakar

Page 9: BURN Tutorial

Rule of NinesRule of NinesBODY PARTBODY PART ADULTADULT CHILDCHILD Head & NeckHead & Neck 9 9 18 18 ArmsArms 9 ( 9 (22)) 9 ( 9 (22)) Front & BackFront & Back 18 ( 18 (22)) 18 ( 18 (22)) LegsLegs 18 ( 18 (22)) 13.5 ( 13.5 (22)) GenitaliaGenitalia 1 1 1 1

Page 10: BURN Tutorial

Rule of Nines

(Wallace)

Page 11: BURN Tutorial

LoLokasi Luka Bakarkasi Luka Bakar MeliputiMeliputi critical areascritical areas

((wajahwajah, , upper airwayupper airway, , handshands, genitalia), genitalia)

Pre existing medicalPre existing medical c conditionsonditions

• DM

• py. Cardiopulmonum,

• gangguan psikiatrik, dll

Page 12: BURN Tutorial

Umur PasienUmur Pasien

< 10 tahun< 10 tahun > > 550 tahun0 tahun

Page 13: BURN Tutorial

SeveritySeverity Luka Bakar, Luka Bakar, dibagi menjadi:dibagi menjadi: major burnsmajor burns moderatemoderate burns burns minorminor burns burns

Page 14: BURN Tutorial

DewasaDewasaMajor Burns Moderate Burns Minor Burns

LB gr II>25%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

Page 15: BURN Tutorial

Usia <10 th dan > Usia <10 th dan > 50th50th

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 5 dewasa

* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

Page 16: BURN Tutorial

Emergency Medical Emergency Medical CareCare

Pasien DewasaPasien Dewasa Stop the burning process Stop the burning process && cegah cedera lbh lanjutcegah cedera lbh lanjut

Bahan isolatorBahan isolator Monitor Monitor airwayairway – – beri beri OO22 Cegah kontaminasi lebih lanjutCegah kontaminasi lebih lanjut

Page 17: BURN Tutorial

Luka BakarLuka Bakar Indikasi MRS:Indikasi MRS:

– semua derajat III – Major Burns dan Moderate Burns

Indikasi poliklinis (rawat jalan):Indikasi poliklinis (rawat jalan):–Minor Burns (kec. Derajat III)

Page 18: BURN Tutorial

Emergency Medical Emergency Medical CareCare Selimuti dengan bahan kering & Selimuti dengan bahan kering & ‘steril’‘steril’

No No ointments, lotion, or ointments, lotion, or antisepticantiseptic

Do not break blistersDo not break blisters Transport Transport ASAPASAP

Page 19: BURN Tutorial

Emergency Medical Emergency Medical CareCare PPasien Pasien Pediatriediatrikk

–Greater surface area in relationship to the total body size

–Fluid and heat loss >>–Risk of shock, airway and hypothermia ↑–Consider child abuse

Page 20: BURN Tutorial

PPasien Pasien Pediatriediatrikk Transport - “Transport - “scoop and runscoop and run” ”

Page 21: BURN Tutorial

Luka Bakar KimiaLuka Bakar Kimia

Disebabkan karena adanya Disebabkan karena adanya kontak kulit dengan bahan toksikkontak kulit dengan bahan toksik

Page 22: BURN Tutorial

Luka Bakar KimiaLuka Bakar Kimia

Disebabkan olehDisebabkan oleh alkali alkali,, a asamsam dan dan campurancampuran

Protect yourself from exposure or Protect yourself from exposure or injuryinjury

Page 23: BURN Tutorial

Luka Bakar KimiaLuka Bakar Kimia Emergency CareEmergency Care

Stop the burning processStop the burning process (1) Immediately flush with large (1) Immediately flush with large amounts of wateramounts of water

(2) Do not contaminate (2) Do not contaminate uninjured areasuninjured areas

(3) Continue flushing while (3) Continue flushing while enroute to hospitalenroute to hospital

Page 24: BURN Tutorial

(4) (4) Cover with dry sterile dressing Cover with dry sterile dressing or clean sheetor clean sheet

(5)(5) Special care of the eyes Special care of the eyes Gently /continuously flushGently /continuously flush For direct eye injury hold lids For direct eye injury hold lids open and irrigate the eyeopen and irrigate the eye

Page 25: BURN Tutorial

Dry chemicalsDry chemicals Reaction with water can worsen Reaction with water can worsen

burn burn (1) “Brush - then flush”(1) “Brush - then flush” (2) Remove victims clothing (2) Remove victims clothing (shoes & socks)(shoes & socks)

Page 26: BURN Tutorial

Luka Bakar ListrikLuka Bakar Listrik Scene SafetyScene Safety

Do not contact high voltage wiresDo not contact high voltage wires Consider all wires liveConsider all wires live Do not handle down linesDo not handle down lines Do not come in contact with patient Do not come in contact with patient if the electrical source is liveif the electrical source is live

Page 27: BURN Tutorial

Emergency Medical Emergency Medical CareCare May be more serious than it seemsMay be more serious than it seems Entry wound is usually a small Entry wound is usually a small

burn areaburn area Look for an extensive exit wound Look for an extensive exit wound Possible tissue damage Possible tissue damage

underneath (current spreads out underneath (current spreads out as it travels through the body)as it travels through the body)

Page 28: BURN Tutorial

Emergency Medical Emergency Medical Care cont:Care cont:

Possible Cardiac arrestPossible Cardiac arrest Possible Respiratory arrestPossible Respiratory arrest Splint possible fracturesSplint possible fractures Treat wounds with a dry, sterile Treat wounds with a dry, sterile

dressingdressing TransportTransport

Page 29: BURN Tutorial

Electrical BurnsElectrical Burns Treat any major complications Treat any major complications

firstfirst

Page 30: BURN Tutorial

Electrical InjuriesElectrical Injuries

Entry wound on headEntry wound on head Exit wound on footExit wound on foot

Luka Masuk Luka Keluar

Page 31: BURN Tutorial

Dressing and Dressing and BandagingBandaging Stop bleedingStop bleeding Protect wound from further Protect wound from further

damagedamage Prevent further contamination Prevent further contamination

and infectionand infection

Page 32: BURN Tutorial

Trauma InhalasiTrauma Inhalasi

Chemical fumesChemical fumes Obvious fumes in the airObvious fumes in the air Inhaled fumesInhaled fumes

Page 33: BURN Tutorial

Carbon MonoxideCarbon Monoxide (CO)(CO)

Deadly poison Deadly poison

Page 34: BURN Tutorial

Different than smoke inhalationDifferent than smoke inhalation OdorlessOdorless

TastelessTasteless Not an irritantNot an irritant

Carbon MonoxideCarbon Monoxide

Page 35: BURN Tutorial

Signs and symptoms Signs and symptoms

a. Dyspnea (difficulty in a. Dyspnea (difficulty in breathing)breathing)

b. Respiratory arrestb. Respiratory arrest c. Cherry red skinc. Cherry red skin

Page 36: BURN Tutorial

CyanideCyanideSigns and SymptomsSigns and Symptoms

Burnt almondsBurnt almonds Dyspnea (difficulty in breathing)Dyspnea (difficulty in breathing) Respiratory arrestRespiratory arrest

Page 37: BURN Tutorial

TreatmentTreatment a. 100% oxygen through a non-a. 100% oxygen through a non-

rebreathing maskrebreathing mask b. Be prepared to do basic life b. Be prepared to do basic life

supportsupport c. Transportc. Transport

Page 38: BURN Tutorial

ResusitasiResusitasi

Cairan intraseluler Cairan Ekstraseluler

40% 15% 5% Dextrose 5%

RLNaCl 0,9%

KoloidProtein plasmaDarah

Page 39: BURN Tutorial

Formula Cairan 24 jam pertama

Kristaloid Pada 24 jam kedua

Koloid Pada 24 jam kedua

Parkland RL 4 ml / kg / %LB

20-60% estimate plasma volume

Pemantauan output urine 30 ml/jam

Evans (Yowler, 2000)

Larutan saline 1 ml/kg/%LB, 2000 ml D5W*, dan koloid 1 ml/ kg / %LB

50% volume cairan 24 jam pertama + 2000 ml D5W

50% volume cairan 24 jam pertama

Slater (Yowler, 2000)

RL 2 L/24 jam + fresh frozen plasma 75 ml/kg/24 jam

Page 40: BURN Tutorial

Brooke (Yowler, 2000)

RL 1.5 ml / kg / %LB, koloid 0.5 ml / kg/ %LB, dan 2000 ml D5W

50% volume cairan 24 jam pertama + 2000 ml D5W

50% volume cairan 24 jam pertama

Modified Brooke RL 2 ml / kg / %LB

MetroHealth (Cleveland)

RL + 50 mEq sodium bicarbonate per liter, 4 ml / kg / %LB

½ lar. Saline, pantau output urine

1 U fresh frozen plasma untuk tiap liter dari ½ lar. saline yg digunakan + D5W dibutuhkan utk hipoglikemia.

Page 41: BURN Tutorial

Monafo hypertonic Demling

250 mEq/L saline pantau output urine 30 ml/jam, dextran 40 dalam lar. saline 2 ml/kg/jam untuk 8 jam, RL pantau output urine 30 ml/jam, dan fresh frozen plasma 0.5 ml/jam untuk 18 jam dimulai 8 jam setelah terbakar.

1/3 lar. Saline, pantau output urine

Page 42: BURN Tutorial

Formula Evans-Formula Evans-BrookeBrooke

Formula Evans Forrnula Brooke

1ml/kgBB/ %LB koloid (darah)lml/kgBB / %LB larutan saline(elektrolit)2000ml glukosaPemantauan :

Diuresis (>50 ml/jam)

0.5ml/kgBB/%LB koloid (darah) 1.5ml/kgBB/%LB larutan saline (elektrolit)2000ml glukosaPemantauan : Diuresis (30-50 ml/jam)

Page 43: BURN Tutorial

Formula Formula Baxter/ParklandBaxter/Parkland RL : 4ml / kgBB / % LB RL : 4ml / kgBB / % LB pemantauan jumlah diuresis pemantauan jumlah diuresis

antara 0,5antara 0,5 -- 1 1 ml/kgBB/ jam ml/kgBB/ jam

Page 44: BURN Tutorial

Resusitasi cairan Resusitasi cairan pada syok pada syok CCairanairan kristaloid kristaloid Tiga kali defisit cairan yg Tiga kali defisit cairan yg

menyebabkan syok diberikan dlm 2 menyebabkan syok diberikan dlm 2 jam pertamajam pertama

Sisa jmlh cairan yg diperhitungkan Sisa jmlh cairan yg diperhitungkan menurut metode Baxter/ Parkland menurut metode Baxter/ Parkland diberikan berdasarkan kebutuhan diberikan berdasarkan kebutuhan ssaampmpaai dgn 24 jam.i dgn 24 jam.

Page 45: BURN Tutorial

KomplikasiKomplikasi

SIRS, SIRS, MODS, MODS, SikatSikatrrikikss, , kontrakturkontraktur

Page 46: BURN Tutorial

PrognosisPrognosis Tergantung dari beratnya derTergantung dari beratnya deraajat jat

luka bakarluka bakar Tergantung Kecepatan dan Tergantung Kecepatan dan

Ketepatan ResusitasiKetepatan Resusitasi