d d r. r. Ifiq Budiyan Nazar Ifiq Budiyan Nazar Luka Luka Bakar Bakar
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
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
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
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
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
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
SeveritySeverity Luka Bakar, Luka Bakar, dibagi menjadi:dibagi menjadi: major burnsmajor burns moderatemoderate burns burns minorminor burns burns
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
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
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
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)
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
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
Luka Bakar KimiaLuka Bakar Kimia
Disebabkan karena adanya Disebabkan karena adanya kontak kulit dengan bahan toksikkontak kulit dengan bahan toksik
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
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
(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
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)
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
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)
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
Electrical BurnsElectrical Burns Treat any major complications Treat any major complications
firstfirst
Electrical InjuriesElectrical Injuries
Entry wound on headEntry wound on head Exit wound on footExit wound on foot
Luka Masuk Luka Keluar
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
Trauma InhalasiTrauma Inhalasi
Chemical fumesChemical fumes Obvious fumes in the airObvious fumes in the air Inhaled fumesInhaled fumes
Different than smoke inhalationDifferent than smoke inhalation OdorlessOdorless
TastelessTasteless Not an irritantNot an irritant
Carbon MonoxideCarbon Monoxide
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
CyanideCyanideSigns and SymptomsSigns and Symptoms
Burnt almondsBurnt almonds Dyspnea (difficulty in breathing)Dyspnea (difficulty in breathing) Respiratory arrestRespiratory arrest
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
ResusitasiResusitasi
Cairan intraseluler Cairan Ekstraseluler
40% 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 / %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
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.
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-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)
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
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.