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