dr. Ifiq Budiyan Nazar

Luka Bakar

Severity Luka BakarDitentukan oleh: - derajat kedalaman - luas - critical areas yang terkena - medical condition atau trauma - umur pasien

Derajat Kedalaman (Grade) Luka Bakar:

Derajat kedalaman (Grade)Struktur yg terkenaGejala dan KeluhanGrade 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

DERMISEPIDERMISGr IGr IIAGr IIBGr III

Partial Thickness Burns

Full Thickness Burns

Luas Luka BakarDitentukan oleh percentage (%) dari body area yang terbakarTelapak tangan pasien + 1% rule of nines dari Wallace

Rule of nines of WallaceMembagi tubuh menjadi beberapa bagianDigunakan untuk mengkalkulasi % permukaan tubuh yang terbakar

Rule of NinesBODY PARTADULTCHILDHead & Neck 9 18Arms 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* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

Major BurnsModerate BurnsMinor BurnsLB 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 fungsiElectrical burnsLB disertai trauma inhalasiLB disertai underlying diseasesChemical burns LB disertai trauma penyerta lain

Usia 50th* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

Major BurnsModerate BurnsMinor BurnsLB 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

Emergency Medical Care Pasien DewasaStop the burning process & cegah cedera lbh lanjutBahan isolatorMonitor airway beri O2Cegah kontaminasi lebih lanjut

Luka BakarIndikasi MRS: semua derajat III Major Burns dan Moderate Burns

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

Emergency Medical CareSelimuti dengan bahan kering & steril No ointments, lotion, or antisepticDo not break blistersTransport ASAP

Emergency Medical CarePasien PediatrikGreater surface area in relationship to the total body sizeFluid and heat loss >>Risk of shock, airway and hypothermia Consider child abuse

Pasien PediatrikTransport - scoop and run

Luka Bakar Kimia Disebabkan karena adanya kontak kulit dengan bahan toksik

Luka Bakar KimiaDisebabkan oleh alkali, asam dan campuranProtect yourself from exposure or injury

Luka Bakar Kimia Emergency CareStop 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 eyesGently /continuously flushFor direct eye injury hold lids open and irrigate the eye

Dry chemicalsReaction with water can worsen burn (1) Brush - then flush(2) Remove victims clothing (shoes & socks)

Luka Bakar ListrikScene SafetyDo not contact high voltage wiresConsider all wires liveDo not handle down linesDo not come in contact with patient if the electrical source is live

Emergency Medical CareMay be more serious than it seemsEntry wound is usually a small burn areaLook for an extensive exit wound Possible tissue damage underneath (current spreads out as it travels through the body)

Emergency Medical Care cont:Possible Cardiac arrestPossible Respiratory arrestSplint possible fracturesTreat wounds with a dry, sterile dressingTransport

Electrical BurnsTreat any major complications first

Electrical InjuriesEntry wound on headExit wound on footLuka MasukLuka Keluar

Dressing and BandagingStop bleedingProtect wound from further damagePrevent further contamination and infection

Trauma InhalasiChemical fumesObvious fumes in the airInhaled fumes

Carbon Monoxide (CO)Deadly poison

Different than smoke inhalationOdorless TastelessNot an irritantCarbon Monoxide

Signs and symptoms a. Dyspnea (difficulty in breathing)b. Respiratory arrestc. Cherry red skin

CyanideSigns and SymptomsBurnt almondsDyspnea (difficulty in breathing)Respiratory arrest

Treatmenta. 100% oxygen through a non-rebreathing maskb. Be prepared to do basic life supportc. Transport

Resusitasi

Cairan intraselulerCairan Ekstraseluler40%15%5%Dextrose 5%RLNaCl 0,9% KoloidProtein plasmaDarah

Formula Cairan 24 jam pertama Kristaloid Pada 24 jam kedua Koloid Pada 24 jam kedua Parkland RL 4 ml / kg / %LB20-60% 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

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 lar. Saline, pantau output urine1 U fresh frozen plasma untuk tiap liter dari lar. saline yg digunakan + D5W dibutuhkan utk hipoglikemia.

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

Formula Evans-Brooke

Formula EvansForrnula Brooke1ml/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)

Formula Baxter/ParklandRL : 4ml / kgBB / % LB pemantauan jumlah diuresis antara 0,5 - 1 ml/kgBB/ jam

Resusitasi cairan pada syok Cairan kristaloid Tiga kali defisit cairan yg menyebabkan syok diberikan dlm 2 jam pertama Sisa jmlh cairan yg diperhitungkan menurut metode Baxter/ Parkland diberikan berdasarkan kebutuhan sampai dgn 24 jam.

Komplikasi

SIRS, MODS, Sikatriks, kontraktur

PrognosisTergantung dari beratnya derajat luka bakarTergantung Kecepatan dan Ketepatan Resusitasi