Sub Bagian Bedah Plastik RSUD dr. Moewardi/ FK UNS Ska

Presentasi berjudul: "Sub Bagian Bedah Plastik RSUD dr. Moewardi/ FK UNS Ska"— Transcript presentasi:

1 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

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

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

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

5 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

6 EPIDERMIS Gr I Gr IIA Gr IIB Gr III DERMIS

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 PART ADULT CHILD Head & Neck 9 18 Arms 9 (2) 9 (2)
Front & Back (2) (2) Legs (2) (2) Genitalia

12 Rule of Nines (Wallace)

13 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

14 Umur Pasien < 10 tahun > 50 tahun

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

16 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

17 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

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: Indikasi poliklinis (rawat jalan):
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 Masuk
Luka 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 Carbon Monoxide Different than smoke inhalation Odorless Tasteless
Not an irritant

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?