Luka Bakar
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Penanganan Emergensi Luka Bakar terkini
Dr.Ulfa Elfiah,M.Kes,SpBP-REFakultas Kedoteran Universitas Jember
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PENDAHULUAN
Angka kejadian luka bakar:
• USA 0,5%, Australia1%
• Asia27% berkonstribusi terhadap kematian luka bakar di dunia
• Soetomo ,surabaya106 kasus (thn 2000)
• Kariadi, semarang250 kasus ( thn 2010)
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Faktor Resiko
Sosial EkonomiStatus
KesehatanUsiaAnak-anak+
Wanita dewasa muda
Jenis Kelamin
Wanita>Pria
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Patofisiologi
Respon Sistemik
Respon Lokal
-Zona nekrotik
-Zona Statis-Zona
Hiperemi
- Sirkulasihipovolemi- Respirasi ARDS
- Hipertabolik- Gangguan barrier usus
- Sistem imun imunosupresi
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Penanganan Luka Bakar
HospitalFFase Luka
Bakar
Akut Subakut Kronik
Pre-Hospital
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Pertolongan Pertama
Menghentikan proses
Menurunkan suhu
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Penanganan Fase Akut
Primary survey
AAirway
Breathing
Circulation
Exposure
Disability
Hipoventilasi
Hipovolemi
Hipotermi
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Penanganan Fase Akut
Secondary
survey
AAnamnesis waktu kejadian, penyebab,
Penanganan sebelumnya
Penilaian Luka
Pemberian cairan
Evaluasi & rujukan
Perawatan luka
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Penilaian Luka Bakar
KedalamanKlinis
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Penilaian Luka Bakar9
14
9 9
18 18
18 18
9 9
18 18
16 16
9
18 18
14
10 14 18
15 tahun 5 tahun 0 – 1 tahun
Luas-Rule of Nine
- Rule Of palm
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Penilaian Luka Bakar
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Luka Bakar derajat I
Luka Bakar derajat III
Luka Bakar derajat IIb
Luka Bakar derajat IIa
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Pemberian Cairan- Berbeda antara dewasa & anak
- Ditentukan oleh luas luka bakarjalur intravena
- TBSA ≥ 20% pada dewasa- TBSA ≥ 10% pada anak
- Waktu Pemberian 2 jam stelah kejadian menurunkan angka
morbiditas & mortalitas
- Komposisi cairan cairan fisiologis (RL) + Koloid
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Pemberian Cairan
Dewasa
Modifikasi Moncrief2ml x BSA(%) x weight
(kg)
Pemberian koloid pada jam ke-18 500-1000ml
dextran
Cairan ditambah kebutuhan faali
Cairan Rl:Koloid=17:3diberikan bersama
anak
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Evaluasi Resusitasi Cairan
Produksi Urin
Anak : 1-2 ml/kg bbDewasa:
0,5-1ml/kgbb
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Perawatan Luka Emergensi
Tidak perlu perawatan dengan balutan modern
Setelah evaluasi segera tutup dengan pembalut + antimikroba
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Perawatan Luka
Evaluasi tanda-tanda kompartemen
sindrommelingkar &melibatkan keseluruhan
kedalaman kulit
Escharotomi/Fasciotomi oleh
orang yang kompeten + fasilitas
memadai Escharotomi
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Perawatan Luka
• Perawatan Luka Secara Tertutup– Luka dicuci, debridement dan didesinfeksi
dengan savlon 1 : 30–Tutup tulle–Topikal Silver Sulfadiazine (SSD)–Tutup kasa steril tebal/elastic verban– Luka dibuka hari ke 5 kecuali ada tanda
infeksi
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Luka Bakar derajat IIa
1. cuci, debridemant dgn savlon, bula dipecah dibawah pain management
2. Tutul betadin+ silversulfadiazin
Tutup tulle
Prosedur perawatan
Tutup dressing sekunder + pertahankan selama 5
hari
Epitelisasi
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Pemberian Obat-obatan- Analgetikmengatasi nyeri
- Pemberian profilaksis anti tetanus & antibiotik bila ada
tanda infeksi Pertimbangkan bila luka >8jam & bila luka kotor
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Perawatan Definitif
Perawatan Spesialistik
Unit Luka Bakar
u
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Indikasi Rujukan
Ditentukan setelah penilaian primary
dan secondary survey
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Terima Kasih