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Dr. Dewi Haryanti K, SpBP Sub Bagian Bedah Plastik RSUD dr. Moewardi/ FK UNS Ska Luka Bakar.

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Presentasi berjudul: "Dr. Dewi Haryanti K, SpBP Sub Bagian Bedah Plastik RSUD dr. Moewardi/ FK UNS Ska Luka Bakar."— Transcript presentasi:

1 Dr. Dewi Haryanti K, SpBP Sub Bagian Bedah Plastik RSUD dr. Moewardi/ FK UNS Ska Luka Bakar

2 Tujuan: Menjelaskan prosedur penatalaksanaan luka bakar thermis, kimia dan listrik Menjelaskan prosedur penatalaksanaan luka bakar thermis, kimia dan listrik

3  Severity  Klasifikasi Luka Bakar  Emergency Medical Care  Luka Bakar Kimia  Luka Bakar Listrik  Dressing and Bandaging  Trauma Inhalasi Overview : Overview :

4 Severity Luka Bakar Ditentukan oleh: - derajat kedalaman - derajat kedalaman - luas - luas - critical areas yang terkena - critical areas yang terkena - medical condition atau trauma - medical condition atau trauma - umur pasien - umur pasien

5 Derajat Kedalaman (Grade) Luka Bakar: Derajat kedalaman (Grade) Struktur yg terkenaGejala dan Keluhan Grade I (Superficial Burns) Hanya mengenai lapisan atas kulit (epidermis) -Hiperemi - Nyeri + - Bullae - Grade II (Partial Thickness Burns) Mengenai epidermis dan sebagian dermis --lembab, mottled, kulit merah – memutih -- Nyeri ++ --Bullae + Grade III (Full Thickness Burns) Mengenai seluruh lapisan kulit --- kering --- putih/coklat tua/hitam ---charred --- tdk nyeri

6 DERMIS EPIDERMIS Gr I Gr IIA Gr IIB Gr III

7 Partial Thickness Burns

8 Full Thickness Burns

9 Luas Luka Bakar  Ditentukan oleh percentage (%) dari body area yang terbakar  Telapak tangan pasien + 1%  ‘rule of nines’ dari Wallace

10 Rule of nines of Wallace  Membagi tubuh menjadi beberapa bagian  Digunakan untuk mengkalkulasi % permukaan tubuh yang terbakar

11 Rule of Nines BODY PARTADULTCHILD  Head & Neck 9 18  Arms 9 (2) 9 (2)  Front & Back 18 (2) 18 (2)  Legs 18 (2) 13.5 (2)  Genitalia 1 1

12 Rule of Nines (Wallace)

13 Lokasi Luka Bakar  Meliputi critical areas (wajah, upper airway, hands, genitalia) (wajah, upper airway, hands, genitalia) Pre existing medical conditions DM py. Cardiopulmonum, gangguan psikiatrik, dll

14 Umur Pasien  < 10 tahun  > 50 tahun

15 Severity Luka Bakar, dibagi menjadi:  major burns  moderate burns  minor burns

16 Dewasa Major BurnsModerate BurnsMinor Burns LB gr II>25% LB gr II 15-25%LB gr II < 15% LB gr III>10%LB gr III 2-10% (*)LB gr III < 2% LB mengenai mata, telinga, wajah, tangan, kaki atau perineum yang mengakibatkan gangguan kosmetik atau fungsi Electrical burns LB disertai trauma inhalasi LB disertai ‘underlying diseases’ Chemical burns LB disertai trauma penyerta lain * Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

17 Usia 50th Major BurnsModerate BurnsMinor Burns LB gr II > 20%LB gr II 10-20%LB gr II < 10% LB gr III > 10%LB gr III 2-10% (*)LB gr III < 2% Lainnya ̴ dewasa * Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum

18 Emergency Medical Care  Pasien Dewasa  Stop the burning process & cegah cedera lbh lanjut  Bahan isolator  Monitor airway – beri O2  Cegah kontaminasi lebih lanjut

19 Luka Bakar  Indikasi MRS: – semua derajat III – Major Burns dan Moderate Burns  Indikasi poliklinis (rawat jalan): –Minor Burns (kec. Derajat III)

20 Emergency Medical Care  Selimuti dengan bahan kering & ‘steril’  No ointments, lotion, or antiseptic  Do not break blisters  Transport ASAP

21 Emergency Medical Care  Pasien Pediatrik –Greater surface area in relationship to the total body size –Fluid and heat loss >> –Risk of shock, airway and hypothermia ↑ –Consider child abuse

22 Pasien Pediatrik  Transport - “scoop and run”

23 Luka Bakar Kimia  Disebabkan karena adanya kontak kulit dengan bahan toksik

24 Luka Bakar Kimia  Disebabkan oleh alkali, asam dan campuran  Protect yourself from exposure or injury

25 Luka Bakar Kimia Emergency Care  Stop the burning process  (1) Immediately flush with large amounts of water  (2) Do not contaminate uninjured areas  (3) Continue flushing while enroute to hospital

26  (4) Cover with dry sterile dressing or clean sheet  (5) Special care of the eyes  Gently /continuously flush  For direct eye injury hold lids open and irrigate the eye

27 Dry chemicals  Reaction with water can worsen burn  (1) “Brush - then flush”  (2) Remove victims clothing (shoes & socks)

28 Luka Bakar Listrik  Scene Safety  Do not contact high voltage wires  Consider all wires live  Do not handle down lines  Do not come in contact with patient if the electrical source is live

29 Emergency Medical Care  May be more serious than it seems  Entry wound is usually a small burn area  Look for an extensive exit wound  Possible tissue damage underneath (current spreads out as it travels through the body)

30 Emergency Medical Care cont:  Possible Cardiac arrest  Possible Respiratory arrest  Splint possible fractures  Treat wounds with a dry, sterile dressing  Transport

31 Electrical Burns  Treat any major complications first

32 Electrical Injuries  Entry wound on head  Exit wound on foot Luka MasukLuka Keluar

33 Dressing and Bandaging  Stop bleeding  Protect wound from further damage  Prevent further contamination and infection

34 Trauma Inhalasi  Chemical fumes  Obvious fumes in the air  Inhaled fumes

35 Carbon Monoxide (CO)  Deadly poison

36  Different than smoke inhalation  Odorless  Tasteless  Not an irritant Carbon Monoxide

37 Signs and symptoms  a. Dyspnea (difficulty in breathing)  b. Respiratory arrest  c. Cherry red skin

38 Cyanide Signs and Symptoms  Burnt almonds  Dyspnea (difficulty in breathing)  Respiratory arrest

39 Treatment  a. 100% oxygen through a non- rebreathing mask  b. Be prepared to do basic life support  c. Transport

40 Pemberian cairan pada Luka Bakar  Formula Baxter – Dewasa 4cc x % luas LB x kg BB =.....cc lar. RL diberikan : ½ bagian pada 8 jam I ½ bagian pada16 jam berikutnya diberikan lar. koloid cc pd jam ke 18-24

41 Pemberian cairan pada Luka Bakar  Formula (modifikasi) Baxter – Anak 2cc x % luas LB x kg BB=...cc lar. RL diberikan: ½ bagian pada 8 jam I ½ bagian pada 16 jam berikutnya larutan koloid 17:3 (sejak jam ke-0) Hari berikutnya diberikan cairan maintenance

42 Summary Lesson Objective: Describe the procedures to treat thermal, chemical and electrical burns.

43 Summary  Severity of Burns  Depth of Burns  Extent  Location  Pre existing conditions  Patients age

44 Summary  Classification of Burns  Critical  Moderate burns  Minor Burns  Emergency Medical Care  Adults  Pediatrics  Chemical Burns  Electrical Burns

45 Summary  Scene Safety  Emergency Medical Care  Major complications  Dressing and Bandaging  Inhalation Injuries  Chemical Fumes  Carbon Monoxide  Cyanide  Treatment

46 Questions?


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