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Resusitasi Dan Terapi Awal Luka Bakar Dan Trauma Inhalasi
Resusitasi Dan Terapi Awal Luka Bakar Dan Trauma Inhalasi
Resusitasi Dan Terapi Awal Luka Bakar Dan Trauma Inhalasi
Pre-hospital Occupational
Nurses Dietitians
Clinicians Therapist
Emergency
Anesthesia Rehabilitation Psychosocial
Department
Intensive Speech
Surgeons Physiotherapist
Care Patologist
2nd Degree
3rd Degree
Sedang /
Ringan / Minor Berat / Major
Moderate
• <10% TBSA • 10-20% TBSA pada • >20% TBSA pada dewasa
pada dewasa dewasa • >10% TBSA pada anak-anak
• <5% TBSA pada • 5-10% TBSA pada atau lansia
anak-anak atau anak-anak atau lansia • >5% TBSA pada full–thickness
lansia • 2-5% TBSA pada full- burn
• <2% TBSA pada thickness burn • High-voltage burn
full-thickness • Low-voltage burn, • Mengenai tangan, wajah,
burn curiga cedera inhalasi, telinga, mata, kaki, sendi besar,
luka bakar dan genetalia/perineum
RAWAT JALAN sirkumferensial, • Dengan cedera inhalasi, listrik,
dengan penyakit kimia disertai trauma lain
penyerta
American Burn Association Rawat di RS tipe B / A dengan ULB
Resusitasi dan
Terapi Awal
Luka Bakar
ONSITE / PRE HOSPITAL
First Aid Management of
Burns Your Picture Here
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Principles of Trauma:
• Primary Survey (ABCDE)
• Secondary Survey
EMERGENCY MANAGEMENT OF SEVERE BURNS OURSE. Australian and New Zealand Burn
Association Emergency Management of Severe Burns 18 th edition
Primary Survey
1. AIRWAY & Cervical
Spine Control
5. EXPOSURE +
Environmental Control
2. BREATHING
&Ventilation
4. DISABILITY :
Neurological Status 3. CIRCULATION with
Hemorrhage control
Add
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• Circulation
• Cek nadi karotis, tekanan darah, CRT ≤2 detik
• 2 jalur IV berkaliber besar (16G (dewasa), 20G(anak)) + ambil
darah
• Perdarahan? hentikan
• Luka bakar melingkar pada ekstremitas elevasi
Rule of 9
FATT (Fluid, Analgesia, Test, Tubes)
• Fluid
• Modified Parkland Formula
3 ml kristaloid x kgBB x TBSA
• ½ dosis - 8 jam pertama
• ½ dosis – 16 jam berikutnya
• Dihitung dari waktu terjadinya cedera
• Monitor: kateter urin (dewasa 0.5 ml/kg/hr, anak 1 ml/kg/hr) 2x lipat pada
luka bakar listrik
Monitor resusitasi: Urine output
• Pada anak-anak berikan maintenance:
• 4:2:1 (D5 NS)
FATT (Fluid, Analgesia, Test, Tubes)
• Analgesia
• Luka bakar terasa sangat nyeri
• IV morfin 0.05 – 0.1 mg/kgBB
• Efek titrasi (tiap 3-5 menit)
• Test
• X-Ray: Lateral cervical spine, thoraks, pelvis
• Cek darah
• Darah lengkap, elektrolit, LFT, RFT, albumin, COHb, β-hCG,
cross match
• Tubes
• Endotracheal
• Nasogatric
• Kateter urin Pastikan first aid
Secondary Survey
• A.M.P.L.E
• Allergy, Medication, Past Illness, Last Meal, Event
• Head to Toe Add
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• Tetanus
• Dokumentasi dan Transfer
• Support
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KRITERIA RUJUK
UKURAN ORANG AREA MEKANISME
>10% luas luka bakar Penyakit terdahulu Wajah / Tangan / Kimia / Listrik
dewasa yang diderita Kaki / Perineum .
Sendi Mayor
>5% luas luka bakar Usia Ekstrem Paru-paru (inhalasi) Cedera non
full-thickness kecelakaan
• Konsentrasi
• Sumber
• Durasi
api
pajanan
• Jarak
• Kelarutan
• Suhu
gas beracun
Patofisiologi
• Cedera panas langsung
gejala OBSTRUKSI
• Bronkospasm, fungsi proteksi
menurun
• Cedera jaringan akibat produk
pembakaran gejala
OKSIGENASI
• Sloughing mukosa + terbentuknya
plugs & casts inflamasi
meningkat + permeabilitas kapiler
meningkat edema paru,
menurunnya compliance paru,
atelektasis
• Cedera sistemik: CO, HCN
(plastik atau lem)
Klasifikasi Trauma Inhalasi
e In: Herndon DN, editor. Total burn care, 3rd ed. Philadelphia: Elsevier-Saunders, 2007. p. 248
f • Klein MB. Thermal, chemical, and electrical injuries. Dalam: Thorne CH, Chung KC, Gosain AK, Gurtner GC,
Mehrara BJ, Rubin JP, Spear SL, editor. Grabb & Smith’s plastic surgery. Ed 7. Philadelphia: Lippincott
e
Williams & Wilkins, 2014. h. 133.
• Inhalation injury. The Education Committee of the Australian and New Zealand Burn Association Limited.
e
• Steinstrasser L, Al-Benna S. Acute management of burn/electrical injuries. Dalam: Neligan PC, editor. Plastic
surgery. Ed 3. New York: Elsevier-Saunders, 2013. h. 407.
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