Luka Bakar Alfreth langitan FK UNTAD RSUD UNDATA
Luka Bakar Alfreth langitan FK UNTAD RSUD UNDATA PALU
Tujuan: Menjelaskan prosedur penatalaksanaan luka bakar thermis, kimia dan listrik
Overview: S S S Severity Klasifikasi Luka Bakar Emergency Medical Care Luka Bakar Kimia Luka Bakar Listrik Dressing and Bandaging Trauma Inhalasi
Severity Luka Bakar Ditentukan oleh: - derajat kedalaman - luas - critical areas yang terkena - medical condition atau trauma - umur pasien
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
EPIDERMIS Gr IIA Gr IIB Gr III DERMIS
Partial Thickness Burns
Full Thickness Burns
Luas Luka Bakar S Ditentukan oleh percentage (%) dari body area yang terbakar S Telapak tangan pasien + 1% S ‘rule of nines’ dari Wallace
Rule of nines of Wallace S Membagi tubuh menjadi beberapa bagian S Digunakan untuk mengkalkulasi % permukaan tubuh yang terbakar
Rule of Nines BODY PART S Head & Neck S Arms S Front & Back S Legs S Genitalia ADULT 9 9 ( 2) 18 (2) 1 CHILD 18 9 ( 2) 18 (2) 13. 5 (2) 1
Rule of Nines (Wallace)
Lokasi Luka Bakar S Meliputi critical areas (wajah, upper airway, hands, genitalia) Pre existing medical conditions • DM • py. Cardiopulmonum, • gangguan psikiatrik, dll
Umur Pasien S S < 10 tahun > 50 tahun
Severity Luka Bakar, dibagi menjadi: S S S major burns moderate burns minor burns
Dewasa Major Burns Moderate Burns Minor Burns 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 > 50 th 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 dewasa * Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum
Emergency Medical Care S Pasien Dewasa SStop the burning process & cegah cedera lbh lanjut SBahan isolator SMonitor airway – beri O 2 SCegah kontaminasi lebih lanjut
Luka Bakar S Indikasi MRS: – semua derajat III – Major Burns dan Moderate Burns S Indikasi poliklinis (rawat – Minor Burns (kec. Derajat III) jalan):
Emergency Medical Care SSelimuti dengan bahan kering & ‘steril’ S No ointments, lotion, or antiseptic SDo not break blisters STransport ASAP
Emergency Medical Care S Pasien Pediatrik – Greater surface area in relationship to the total body size – Fluid and heat loss >> – Risk of shock, airway and hypothermia ↑ – Consider child abuse
Pasien Pediatrik S Transport - “scoop and run”
Luka Bakar Kimia S Disebabkan karena adanya kontak kulit dengan bahan toksik
Luka Bakar Kimia S Disebabkan oleh alkali, asam dan campuran S Protect yourself from exposure or injury
Luka Bakar Kimia Emergency Care S Stop the burning process S(1) Immediately flush with large amounts of water S(2) Do not contaminate uninjured areas S(3) Continue flushing while enroute to hospital
S (4) Cover with dry sterile dressing or clean sheet S (5) Special care of the eyes SGently /continuously flush SFor direct eye injury hold lids open and irrigate the eye
Dry chemicals S Reaction with water can worsen burn S(1) “Brush - then flush” S(2) Remove victims clothing (shoes & socks)
Luka Bakar Listrik S Scene Safety SDo not contact high voltage wires SConsider all wires live SDo not handle down lines SDo not come in contact with patient if the electrical source is live
Emergency Medical Care S May be more serious than it seems S Entry wound is usually a small burn area S Look for an extensive exit wound S Possible tissue damage underneath (current spreads out as it travels through the body)
Emergency Medical Care cont: S Possible Cardiac arrest S Possible Respiratory arrest S Splint possible fractures S Treat wounds with a dry, sterile dressing S Transport
Electrical Burns S Treat first any major complications
S Entry wound on head S Exit wound on foot Electrical Injuries Luka Masuk Luka Keluar
Dressing and Bandaging S Stop bleeding S Protect wound from further damage S Prevent further contamination and infection
Trauma Inhalasi S Chemical fumes SObvious fumes in the air SInhaled fumes
Carbon Monoxide (CO) S Deadly poison
Carbon Monoxide S Different than smoke inhalation SOdorless STasteless SNot an irritant
Signs and symptoms S a. Dyspnea (difficulty in breathing) S b. Respiratory arrest S c. Cherry red skin
Cyanide Signs and Symptoms S Burnt almonds S Dyspnea (difficulty in breathing) S Respiratory arrest
Treatment S a. 100% oxygen through a nonrebreathing mask S b. Be prepared to do basic life support S c. Transport
Pemberian cairan pada Luka Bakar S Formula Baxter – Dewasa 4 cc x % luas LB x kg BB =. . . cc lar. RL diberikan : ½ bagian pada 8 jam I ½ bagian pada 16 jam berikutnya diberikan lar. koloid 500 -1000 cc pd jam ke 18 -24
Pemberian cairan pada Luka Bakar S Formula (modifikasi) Baxter – Anak 2 cc x % luas LB x kg BB=. . . cc lar. RL diberikan: ½ bagian pada 8 jam I ½ bagian pada 16 jam berikutnya larutan koloid 17: 3 (sejak jam ke-0) Hari berikutnya diberikan cairan maintenance
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