Luka Bakar

Dr. Adam Suyadi,SpB,MM Bag Bedah FK UII Yogyakarta

Skin Anatomy

TIGA FAKTOR PENTING DALAM LUKA BAKAR

1. ETIOLOGI / PENYEBAB

2. KEDALAMAN LUKA BAKAR

3. LUAS LUKA BAKAR

ETIOLOGI
1. SUHU:

2.

PANAS ( API, UAP, AIR )

DINGIN ( FROST BITE ) LISTRIK

3.
4. 5.

KIMIA ASAM BASA

RADIASI LASER

KEDALAMAN LUKA BAKAR

DERAJAT SATU
Superficial Skin Burn DERAJAT DUA Partial Thickness Skin Burn DERAJAT TIGA Full Thickness Skin Burn

Derajat 1
Superficial Skin Burn

KEDALAMAN LUKA BAKAR

Luka Bakar Derajat Satu

Derajat 2
Partial Thickness Skin Burn

KEDALAMAN LUKA BAKAR

Luka Bakar Derajat Dua

Derajat 3
Full Thickness Skin Burn

Luka Bakar Derajat Tiga

Luas Luka Bakar: Rule of Nines

surface of patient,s palm = 1% BSA

LUAS LUKA BAKAR

Rule of Nines

Burns / Cold Injuries

Management Principles Establish / maintain

Airway Normal perfusion Fluid / electrolyte balance Normal body temperature

Inhalation Injury
Clinical Indications Carbonaceous sputum Facial burns Hair singeing Carbon deposits Inflamed oropharynx History CO Hgb >10%

Life Saving Burn Treatment

Remove all Injurious material Clothing jewelry Prevent hypothermia Establish 2 large caliber IVS Initiate warmed ringer,s lactate solution

Burn Assessment
History Mechanism of injury Associated illnesses Allergies Tetanus status

Burn Management
Airway Assess for injury Establish and maintain patent airway early

Burns Management
Breathing Assume CO exposure Inhalation of toxic fumes, carbon particles Direct thermal injury Oxygenate/Ventilate Endotracheal intubation ABGs and CO levels

Burn Management
Circulation Adequate venous access Monitor vital signs Hourly Urinary output Adult : 30-50 ML/hour Child : 1.0 ML/kg/hour

Burn Management
Circulation : Estimate Fluid Needs 2-4 ml warmed ringer,s lactate Solution / kg / % BSA in 1st 24 hours in first 8 hours in next 16 hours Based on time from injury Monitor heard rate and urinary output

PENANGANAN
RESUSITASI A - B - C
B: Luka Bakar Pada Dinding Dada

ESCHAROTOMY
C: FORMULA BAXTER

Infus RL: 4 cc x BB (Kg) x LUAS LB (%)

CONTOH KASUS
PASIEN DENGAN BB 50 Kg LLB 20%
Kebutuhan Cairan : 4 x 50 Kg x 20 %

4000 cc RL
8 Jam pertama 2000 cc 62 tts/mnt

16 Jam berikut 2000 cc 31 tts/mnt

Burn Management
Develop Treatment Plan Estimate burn size depth Identify associated injuries Weigh patient Baseline blood analyses and chest x-ray Document on flow sheet

Burn Management
Maintain peripheral Circulation Remove All constricting devices Assess distal circulation Escharotomy : Surgical consult

Fasciotomy/Escharotomy

Burn Management
Gastric Intubation Nausea vomiting , distention Burns > 20% BSA Medications Narcotics : Minimal use IV only Antibiotics : Not indicated early

Burn Management
Wound Care Cover with clean linens Do not Break bisters Apply antiseptics Apply cold water

INDIKASI RAWAT INAP

LB Derajat II > 15% Dewasa
> 10% Anak / Geriatri LB Derajat III > 10% Dewasa

Listrik / Kimia
LB di daerah muka, tangan, genital, perineal

LB dengan kelainan lain / trauma lain yang berat

PERAWATAN LUKA
Derajat Satu
Derajat Dua Cuci NaCl + Savlon 500 cc Sofratul Kassa Steril (Biarkan Satu Minggu) 5 cc

Burn Management
Chemical Burns Duration, amount , concentration Brush away dry chemicals Flush with copious amounts of water for 20-30 Minutes Alkali Burn

Burn Management
Electrical Burn Result in damage to fascia and muscle, and may spare the overlying skin

Burn Management
Electrical Burn ABCDES Myoglobinuria Fluids : 100 ml urine / hour Mannitol : 25 g IV

Metabolic acidosis Maintain adequate perfusion Sodium bicarbonate

Burn Transfer Criteria

2nd and 3rd Degree burn >10% BSA in ages <10 and > 50 years >20% BSA To :

Face
Eyes Ears

Hand
Feet Genitalia

Perineum
Major joints

Burn Transfer Criteria

3rd degree burn > 5% BSA Electrical and chemical burns Inhalation injury Preexisting illnesses,associated injuries Children Special situations

Burn Transfer Prosedure

Coordinate with burn center doctor Transfer with Documentation/Infor mation Laboratory results

Cold Injury Facture

Temperature Duration of exposure Environmental conditions

Immobilization Moisture Vascular disease Open wounds

Definition
Frostbite refers to the freezing of body tissue (usually skin), that results in loss of feeling and color in the tissue. It most commonly affects the feet and hands (which account for 90% of cases), the nose, or the ears.

There are three degrees of frostbite

1. 2.

3.

frostnip superficial frostbite deep frostbite Most cases occur in adults between 30 and 49.

Etiology

Frostbite is caused by prolonged exposure to cold temperatures, particularly when accompanied by a low wind-chill factor or by briefer exposure to very cold temperatures

Cold Management
Do not delay Remove clothing Warmed blankets Rewarm frozen part

Preserve damaged tissue Prevent infection Elevate exposed part Analgesics, tetanus, and antibiotics

Hypothermia : T < 35 Degrees

Rapid /slow drop in core temperature Elderly and Children at greater risk Low range thermometer required Clinical findings Depressed LOC Gray cyanotic Variable vital signs Absence of cardiorespiratory activity

Hypothermia
Management ABCDES, IV access Oxygenate and ventilate Prevent heat loss and rewarm Assess for associated disorders Blood analyses

Hypothermia
Management Passive external rewarming : Warmed environment, blankets, and IV fluids Active core rewarming Surgical rewarming techiniques Do not delay transfer Not dead until warm and dead

Summary
Burn Injury Recognize and treat inhalation injury Fluid recuscitation Identify burns requiring transfer

Summary
Cold injury Diagnose type History Clinical findings Measure core temperature Rewarming techniques Monitor and support vital functions