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

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

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

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

Derajat Kedalaman (Grade) Luka Bakar: Struktur yg terkena Gejala 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

EPIDERMIS Gr I Gr IIA Gr IIB Gr III DERMIS

Partial Thickness Burns

Full Thickness Burns

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

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

Rule of Nines BODY PART ADULT CHILD Head & Neck 9 18 Arms 9 (2) 9 (2) Front & Back 18 (2) 18 (2) Legs 18 (2) 13.5 (2) Genitalia 1 1

Rule of Nines (Wallace)

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

Umur Pasien < 10 tahun > 50 tahun

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

Dewasa Major Burns Moderate Burns Minor Burns LB gr II>25% 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

Usia <10 th dan > 50th Major Burns Moderate Burns Minor 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

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

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

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

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

Pasien Pediatrik Transport - “scoop and run”

Luka Bakar Kimia Disebabkan karena adanya kontak kulit dengan bahan toksik

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

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

(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

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

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

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)

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

Electrical Burns Treat any major complications first

Electrical Injuries Entry wound on head Exit wound on foot Luka Masuk Luka Keluar

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

Trauma Inhalasi Chemical fumes Obvious fumes in the air Inhaled fumes

Carbon Monoxide (CO) Deadly poison

Carbon Monoxide Different than smoke inhalation Odorless Tasteless Not an irritant

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

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

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

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 500-1000cc pd jam ke 18-24

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

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

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

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

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

Questions?