Dr. Dewi Haryanti K, SpBP

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Luka Bakar

• Dr. Dewi Haryanti K, SpBP
• Sub Bagian Bedah Plastik
• RSUD dr. Moewardi/ FK UNS Ska

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Tujuan

• Menjelaskan prosedur penatalaksanaan luka bakar
  thermis, kimia dan listrik

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Overview

• Severity
• Klasifikasi Luka Bakar
• Emergency Medical Care
• Luka Bakar Kimia
• Luka Bakar Listrik
• Dressing and Bandaging
• Trauma Inhalasi

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Severity Luka Bakar

• Ditentukan oleh
• - derajat kedalaman
• - luas
• - critical areas yang terkena
• - medical condition atau trauma
• - umur pasien

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Derajat Kedalaman (Grade) Luka 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
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EPIDERMIS
Gr I
Gr IIA
Gr IIB
Gr III
DERMIS
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Partial Thickness Burns
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Full Thickness Burns
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Luas Luka Bakar

• Ditentukan oleh percentage () dari body area
  yang terbakar
• Telapak tangan pasien 1
• rule of nines dari Wallace

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Rule of nines of Wallace

• Membagi tubuh menjadi beberapa bagian
• Digunakan untuk mengkalkulasi permukaan tubuh
  yang terbakar

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Rule of Nines

• BODY PART ADULT CHILD
• Head Neck 9 18
• Arms 9 (2) 9 (2)
• Front Back 18 (2) 18 (2)
• Legs 18 (2) 13.5 (2)
• Genitalia 1 1

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Rule of Nines (Wallace)
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Lokasi Luka Bakar

• Meliputi critical areas
• (wajah, upper airway, hands, genitalia)
• Pre existing medical conditions

• DM
• py. Cardiopulmonum,
• gangguan psikiatrik, dll

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Umur Pasien

• lt 10 tahun
• gt 50 tahun

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Severity Luka Bakar, dibagi menjadi

• major burns
• moderate burns
• minor burns

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Dewasa
Major Burns Moderate Burns Minor Burns
LB gr IIgt25 LB gr II 15-25 LB gr II lt 15
LB gr IIIgt10 LB gr III 2-10 () LB gr III lt 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
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Usia lt10 th dan gt 50th
Major Burns Moderate Burns Minor Burns
LB gr II gt 20 LB gr II 10-20 LB gr II lt 10
LB gr III gt 10 LB gr III 2-10 () LB gr III lt 2
Lainnya ? dewasa
Tanpa resiko ggn fungsi atau kosmetik pada
mata, telinga, wajah, tangan, kaki atau perineum
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Emergency Medical Care

• Pasien Dewasa
• Stop the burning process cegah cedera lbh
  lanjut
• Bahan isolator
• Monitor airway beri O2
• Cegah kontaminasi lebih lanjut

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Luka Bakar

• Indikasi MRS
• semua derajat III
• Major Burns dan Moderate Burns
• Indikasi poliklinis (rawat jalan)
• Minor Burns (kec. Derajat III)

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Emergency Medical Care

• Selimuti dengan bahan kering steril
• No ointments, lotion, or antiseptic
• Do not break blisters
• Transport ASAP

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Emergency Medical Care

• Pasien Pediatrik
• Greater surface area in relationship to the total
  body size
• Fluid and heat loss gtgt
• Risk of shock, airway and hypothermia ?
• Consider child abuse

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Pasien Pediatrik

• Transport - scoop and run

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Luka Bakar Kimia

• Disebabkan karena adanya kontak kulit dengan
  bahan toksik

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Luka Bakar Kimia

• Disebabkan oleh alkali, asam dan campuran
• Protect yourself from exposure or injury

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Luka Bakar Kimia Emergency Care

• Stop the burning process
• (1) Immediately flush with large amounts of
  water
• (2) Do not contaminate uninjured areas
• (3) Continue flushing while enroute to hospital

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• (4) Cover with dry sterile dressing or clean
  sheet
• (5) Special care of the eyes
• Gently /continuously flush
• For direct eye injury hold lids open and irrigate
  the eye

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Dry chemicals

• Reaction with water can worsen burn
• (1) Brush - then flush
• (2) Remove victims clothing (shoes socks)

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Luka Bakar Listrik

• Scene Safety
• Do not contact high voltage wires
• Consider all wires live
• Do not handle down lines
• Do not come in contact with patient if the
  electrical source is live

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Emergency Medical Care

• May be more serious than it seems
• Entry wound is usually a small burn area
• Look for an extensive exit wound
• Possible tissue damage underneath (current
  spreads out as it travels through the body)

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Emergency Medical Care cont

• Possible Cardiac arrest
• Possible Respiratory arrest
• Splint possible fractures
• Treat wounds with a dry, sterile dressing
• Transport

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Electrical Burns

• Treat any major complications first

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Electrical Injuries

• Entry wound on head
• Exit wound on foot

Luka Masuk
Luka Keluar
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Dressing and Bandaging

• Stop bleeding
• Protect wound from further damage
• Prevent further contamination and infection

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Trauma Inhalasi

• Chemical fumes
• Obvious fumes in the air
• Inhaled fumes

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Carbon Monoxide (CO)

• Deadly poison

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Carbon Monoxide

• Different than smoke inhalation
• Odorless
• Tasteless
• Not an irritant

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Signs and symptoms

• a. Dyspnea (difficulty in breathing)
• b. Respiratory arrest
• c. Cherry red skin

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CyanideSigns and Symptoms

• Burnt almonds
• Dyspnea (difficulty in breathing)
• Respiratory arrest

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Treatment

• a. 100 oxygen through a non-rebreathing mask
• b. Be prepared to do basic life support
• c. Transport

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Pemberian cairan pada Luka Bakar

• Formula Baxter
• Dewasa
• 4cc x luas LB x kg BB .....cc lar. RL
• diberikan ½ bagian pada 8 jam I
• ½ bagian pada16 jam
  berikutnya
• diberikan lar. koloid 500-1000cc pd jam ke 18-24

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Pemberian cairan pada Luka Bakar

• Formula (modifikasi) Baxter
• Anak
• 2cc x luas LB x kg BB...cc lar. RL
• diberikan ½ bagian pada 8 jam I
• ½ bagian pada 16 jam berikutnya
• larutan koloid 173 (sejak jam ke-0)
• Hari berikutnya diberikan cairan maintenance

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Summary

• Lesson Objective
• Describe the procedures to treat
• thermal, chemical and electrical burns.

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Summary

• Severity of Burns
• Depth of Burns
• Extent
• Location
• Pre existing conditions
• Patients age

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Summary

• Classification of Burns
• Critical
• Moderate burns
• Minor Burns
• Emergency Medical Care
• Adults
• Pediatrics
• Chemical Burns
• Electrical Burns

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Summary

• Scene Safety
• Emergency Medical Care
• Major complications
• Dressing and Bandaging
• Inhalation Injuries
• Chemical Fumes
• Carbon Monoxide
• Cyanide
• Treatment

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Questions?