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Diterbitkan olehEmmanuel Dumas Telah diubah "5 tahun yang lalu
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Luka Bakar Alfreth langitan FK UNTAD RSUD UNDATA PALU
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Tujuan: Menjelaskan prosedur penatalaksanaan luka bakar thermis, kimia dan listrik
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Overview: Severity Klasifikasi Luka Bakar Emergency Medical Care
Luka Bakar Kimia Luka Bakar Listrik Dressing and Bandaging Trauma Inhalasi
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Severity Luka Bakar Ditentukan oleh: - derajat kedalaman - luas
- critical areas yang terkena - medical condition atau trauma - umur pasien
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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
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EPIDERMIS Gr I Gr IIA Gr IIB Gr III DERMIS
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Partial Thickness Burns
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Full Thickness Burns
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Luas Luka Bakar Ditentukan oleh percentage (%) dari body area yang terbakar Telapak tangan pasien + 1% ‘rule of nines’ dari Wallace
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Rule of nines of Wallace
Membagi tubuh menjadi beberapa bagian Digunakan untuk mengkalkulasi % permukaan tubuh yang terbakar
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Rule of Nines BODY PART ADULT CHILD Head & Neck 9 18 Arms 9 (2) 9 (2)
Front & Back (2) (2) Legs (2) (2) Genitalia
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Rule of Nines (Wallace)
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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
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Umur Pasien < 10 tahun > 50 tahun
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Severity Luka Bakar, dibagi menjadi:
major burns moderate burns minor burns
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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
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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
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Emergency Medical Care
Pasien Dewasa Stop the burning process & cegah cedera lbh lanjut Bahan isolator Monitor airway – beri O2 Cegah kontaminasi lebih lanjut
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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)
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Emergency Medical Care
Selimuti dengan bahan kering & ‘steril’ No ointments, lotion, or antiseptic Do not break blisters Transport ASAP
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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
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Pasien Pediatrik Transport - “scoop and run”
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Luka Bakar Kimia Disebabkan karena adanya kontak kulit dengan bahan toksik
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Luka Bakar Kimia Disebabkan oleh alkali, asam dan campuran
Protect yourself from exposure or injury
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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
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(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
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Dry chemicals Reaction with water can worsen burn
(1) “Brush - then flush” (2) Remove victims clothing (shoes & socks)
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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
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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)
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Emergency Medical Care cont:
Possible Cardiac arrest Possible Respiratory arrest Splint possible fractures Treat wounds with a dry, sterile dressing Transport
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Electrical Burns Treat any major complications first
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Electrical Injuries Entry wound on head Exit wound on foot Luka Masuk
Luka Keluar
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Dressing and Bandaging
Stop bleeding Protect wound from further damage Prevent further contamination and infection
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Trauma Inhalasi Chemical fumes Obvious fumes in the air Inhaled fumes
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Carbon Monoxide (CO) Deadly poison
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Carbon Monoxide Different than smoke inhalation Odorless Tasteless
Not an irritant
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Signs and symptoms a. Dyspnea (difficulty in breathing)
b. Respiratory arrest c. Cherry red skin
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Cyanide Signs and Symptoms
Burnt almonds Dyspnea (difficulty in breathing) Respiratory arrest
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Treatment a. 100% oxygen through a non-rebreathing mask
b. Be prepared to do basic life support c. Transport
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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
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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
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