luka bakar dr adam
TRANSCRIPT
Dr. Adam Suyadi,SpB,MMDr. Adam Suyadi,SpB,MMBag Bedah FK UII YogyakartaBag Bedah FK UII Yogyakarta
Luka BakarLuka Bakar
Skin Anatomy
TIGA FAKTOR PENTING TIGA FAKTOR PENTING DALAM LUKA BAKARDALAM LUKA BAKAR
1. ETIOLOGI / PENYEBAB
2. KEDALAMAN LUKA BAKAR
3. LUAS LUKA BAKAR
ETIOLOGIETIOLOGI
1. SUHU:• PANAS ( API, UAP, AIR )• DINGIN ( FROST BITE )2. LISTRIK3. KIMIA ASAM – BASA 4. RADIASI5. LASER
KEDALAMAN LUKA BAKAR
• DERAJAT SATU
Superficial Skin Burn
• DERAJAT DUA
Partial Thickness Skin Burn
• DERAJAT TIGA
Full Thickness Skin Burn
Derajat 1Superficial Skin Burn
KEDALAMAN LUKA BAKAR
Luka Bakar Derajat Satu
Derajat 2Partial Thickness Skin Burn
KEDALAMAN LUKA BAKAR
Luka Bakar Derajat Dua
Derajat 3Full 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 Nine’s
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• ½ in first 8 hours• ½ 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 5 cc
Sofratul
Kassa Steril
(Biarkan Satu Minggu)
Burn ManagementChemical 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/
Information • Laboratory results
Cold Injury Facture
TemperatureDuration of
exposure Environmental
conditions
Immobilization Moisture Vascular disease Open wounds
DefinitionFrostbite 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 frostbite1. frostnip2. superficial frostbite3. 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 partAnalgesics, tetanus,
and antibiotics
Hypothermia : Tⅽ < 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
HypothermiaManagement 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