12. Luka Bakar-PPGD
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Transcript of 12. Luka Bakar-PPGD
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Luka BakarLuka Bakar
MAULANA HIDAYAT
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Pendahuluan
Di USA, 75.000 penderita luka bakar pertahun,mortalitas 10%
1/3 luka bakar disertai trauma lain
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Prehospital
A. Riwayat Saat kejadian Ruang terbuka/tertutup Penyebab : api, air panas, uap, kimia, ledakan Lama kontak Bahan beracun : plastik sianida Mekanisme trauma : kendaraan, terjatuh, loncat Jumlah cairan i.v yang diberikan
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PrehospitalB. Perawatan ditempat Penderita LB pdrt trauma pelayanan trauma Pindahkan pdrt dari tempat kejadian Periksa trauma yg mengancam jiwa Bersihkan LB dengan air Balut dng kasa kering Oksigen dan proteksi airway Segera transport ke RS
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Initial assessment and resuscitation
LB dapat mengaburkan injury lain Pasien mungkin stabil saat datang, dlm 24 jam
dpt kritis dng ventilator, gagal nafas dan sirkulasi Penting pain control ( 1.5 g morphine sulfate
setiap 5-30 menit ) Tinggikan suhu ruangan, menghindari heat loss Dekompresi lambung
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Airway Berikan oksigen suplemen
masalah : LB pada muka Kriteria intubasi
Apneu, gagal nafas, hipoksia LB pada muka Tanda inhalation injury
• LB ruang tertutup• Bulu & alis mata hangus• Deposit karbon di rongga mulut• Carbonaceous sputum• Wheezing• Apneu
Upper airway obstruction Intubasi endotracheal penting saat initial management
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Breathing
Jika intubasi, 100% oksigenPeriksa AGD
Foto thoraks : trauma lain, inhalation lung injury, posisi tubes
Bronchoscopy : inhalation lung injury
LB dada melingkar escharotomy
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Circulation
Infus dng catheter besar ( 14-16F)Akses sentral jika LB > 25%LPB
Resusitasi cairan Cairan kristaloid : RL Rumus Parkland : 4ml/kgBB/%LB
setengahnya diberikan dalam 8 jam pertama Urin output minimal 0.5 ml/kgBB/jam 24 jam II : kristaloid (RL) 1ml/kg/%LB/24jam
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CirculationRule of Nines
menghitung luas luka bakar
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Circulation
Colloid dianjurkan 8 jam sesudah LB, kec 0.5 ml/kg/%LB/24jam dilanjutkan dari 36-48 jam sesudah terbakar
Urin kemerahan : hemolysis, myoglobinuria urin output harus > 100ml/jamDpt diberikan manitol 12.5 gram dlm 1liter RL
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Initial wound assessment and management
A. Assessment LB >10% hitung dng Rule of Nines
LB << hitung dng telapak tangan = 1% Dalamnya LB
A. Superficial (derajat I)• Terbatas pd epidermis dng kerusakan jaringan
minimal• Erythema sedang, nyeri hilang dlm 48-72 jam• Epidermis dpt terkelupas tanpa meninggalkan scar
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Initial wound assessment and management
B. Partial thickness (derajat II)Seluruh epidermis dan sebagian dermis
1. Superficial Nyeri, kemerahan,
edematous, bula Sebagian besar
apendises kulit hidup Sembuh spontan 7-14
hari
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B. Partial thickness (derajat II)Seluruh epidermis dan sebagian dermis
2. Deep Kemerahan, basah, tanpa bula, kurang nyeri Sebagian kecil apendises kulit yang hidup Sembuh lebih lama,
meninggalkan scar
Initial wound assessment and management
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Initial wound assessment and management
C. Full thickness (derajat III) Seluruh lapisan epidermis
dan dermis rusak Relatif tidak nyeri, spt
kulit, spt lilin, dng pemb darah yg trombosis
Tidak sembuh tanpa eksisi dan grafting
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B. Pengelolaan luka bakar Bersihkan luka dng kasa yg direndam dalam NaCl atau
chlorhexidine 4% Buang kulit mati LB < 10% dapat diberikan topical agent LB lebih luas : debridement, analgesik, monitoring tanda
vital
Initial wound assessment and management
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