Dr. Adam Suyadi,SpB,MMBag Bedah FK UII Yogyakarta

Luka Bakar

Skin Anatomy

TIGA FAKTOR PENTING DALAM LUKA BAKAR1.ETIOLOGI / PENYEBAB2.KEDALAMAN LUKA BAKAR3.LUAS LUKA BAKAR

ETIOLOGI1.SUHU:PANAS ( API, UAP, AIR )DINGIN ( FROST BITE )2.LISTRIK3.KIMIA ASAM BASA 4.RADIASI5.LASER

KEDALAMAN LUKA BAKARDERAJAT SATU Superficial Skin BurnDERAJAT DUAPartial Thickness Skin BurnDERAJAT TIGAFull Thickness Skin Burn

Derajat 1

KEDALAMAN LUKA BAKARLuka Bakar Derajat Satu

Derajat 2

KEDALAMAN LUKA BAKARLuka Bakar Derajat Dua

Derajat 3

Luka Bakar Derajat Tiga

Luas Luka Bakar:Rule of Ninessurface of patient,s palm = 1% BSA

LUAS LUKA BAKARRule of Nines

Burns / Cold InjuriesManagement Principles Establish / maintain Airway Normal perfusion Fluid / electrolyte balance Normal body temperature

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

Life Saving Burn TreatmentRemove all Injurious material Clothing jewelry Prevent hypothermia Establish 2 large caliber IVS Initiate warmed ringer,s lactate solution

Burn AssessmentHistory Mechanism of injuryAssociated illnesses Allergies Tetanus status

Burn ManagementAirway Assess for injury Establish and maintain patent airway early

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

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

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

PENANGANANRESUSITASIA - B - CB:Luka Bakar Pada Dinding Dada ESCHAROTOMYC:FORMULA BAXTERInfus RL: 4 cc x BB (Kg) x LUAS LB (%)

CONTOH KASUSPASIEN DENGAN BB 50 Kg LLB 20%Kebutuhan Cairan : 4 x 50 Kg x 20 % 4000 cc RL8 Jam pertama 2000 cc 62 tts/mnt16 Jam berikut 2000 cc 31 tts/mnt

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

Burn ManagementMaintain peripheral Circulation Remove All constricting devices Assess distal circulation Escharotomy : Surgical consult Fasciotomy/Escharotomy

Burn ManagementGastric Intubation Nausea vomiting , distentionBurns > 20% BSA MedicationsNarcotics : Minimal use IV only Antibiotics : Not indicated early

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

INDIKASI RAWAT INAPLB Derajat II > 15% Dewasa> 10% Anak / GeriatriLB Derajat III> 10% DewasaListrik / KimiaLB di daerah muka, tangan, genital, perinealLB dengan kelainan lain / trauma lain yang berat

PERAWATAN LUKADerajat Satu Derajat Dua Cuci NaCl + Savlon500 cc5 ccSofratulKassa Steril(Biarkan Satu Minggu)

Burn ManagementChemical Burns Duration, amount ,concentration Brush away dry chemicals Flush with copious amounts of water for 20-30 MinutesAlkali Burn

Burn ManagementElectrical BurnResult in damage to fascia and muscle, and may spare the overlying skin

Burn ManagementElectrical BurnABCDES Myoglobinuria Fluids : 100 ml urine / hourMannitol : 25 g IV Metabolic acidosisMaintain adequate perfusion Sodium bicarbonate

Burn Transfer Criteria2nd and 3rd Degree burn >10% BSA in ages 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 ProsedureCoordinate with burn center doctor Transfer withDocumentation/Information Laboratory results

Cold Injury FactureTemperatureDuration 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 frostbitefrostnipsuperficial frostbitedeep frostbite

Most cases occur in adults between 30 and 49.

EtiologyFrostbite 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 ManagementDo not delay Remove clothing Warmed blankets Rewarm frozen partPreserve damaged tissue Prevent infection Elevate exposed partAnalgesics, 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

HypothermiaManagement 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

SummaryBurn InjuryRecognize and treat inhalation injury Fluid recuscitation Identify burns requiring transfer

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