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    Luka Bakar

    Uploaded by

    Akmal Sillivan Sods
    The document provides guidelines for the emergency management of severe burn injuries, including initial first aid, assessment of burn severity and size, fluid resuscitation guidelines, wound care, criteria for patient transfer, and a SBAR template for communicating patient information between healthcare facilities. Proper emergency management and resuscitation in the first few hours after injury are critical to prevent complications and ensure the best possible outcomes for patients with severe burns.

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    © All Rights Reserved
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    Luka Bakar

    Uploaded by

    Akmal Sillivan Sods
    1K views30 pages
    The document provides guidelines for the emergency management of severe burn injuries, including initial first aid, assessment of burn severity and size, fluid resuscitation guidelines, wound care, criteria for patient transfer, and a SBAR template for communicating patient information between healthcare facilities. Proper emergency management and resuscitation in the first few hours after injury are critical to prevent complications and ensure the best possible outcomes for patients with severe burns.

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    Luka bakar

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    Luka bakar

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    The document provides guidelines for the emergency management of severe burn injuries, including initial first aid, assessment of burn severity and size, fluid resuscitation guidelines, wound care, criteria for patient transfer, and a SBAR template for communicating patient information between healthcare facilities. Proper emergency management and resuscitation in the first few hours after injury are critical to prevent complications and ensure the best possible outcomes for patients with severe burns.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    1K views30 pages

    Luka Bakar

    Uploaded by

    Akmal Sillivan Sods
    The document provides guidelines for the emergency management of severe burn injuries, including initial first aid, assessment of burn severity and size, fluid resuscitation guidelines, wound care, criteria for patient transfer, and a SBAR template for communicating patient information between healthcare facilities. Proper emergency management and resuscitation in the first few hours after injury are critical to prevent complications and ensure the best possible outcomes for patients with severe burns.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    PENATALAKSANAAN LUKA BAKAR

    ~ EMSB – ANZBA
    (Emergency Management for Severe Burns Injury
    – Australia and New Zealand Burn Association)

    dr. Mirnasari Amirsyah, Sp.BP-RE


    Bagian Ilmu Bedah
    Divisi Bedah Plastik Rekonstruksi dan Estetik
    RSUDZA/FK1 UNSYIAH
    2017
    2
    *PENDAHULUAN
    tantangan
    Luka bakar ??? bagi tenaga kesehatan.

    *Perjalanan penyakit  trauma


    *Ketidaknyamanan yang nyata
    *Gangguan permanen pada penampilan
    *Gangguan fungsi  ketergantungan, pekerjaan ??? &
    masa depan ????
    ------------------------------------------------------------
    Masalah ??????
    Pasien Orang di sekitar
    Keluarga
    3 penderita
    Diagnosis dan penilaian emergency
    yang tepat
    Penanganan awal
    Resusitasi
    Rujukan

    ~ Emergency Management of severe Burns (EMSB)


    – Australia and New Zealand Burn Association)
    4
    5
    PERTOLONGAN PERTAMA
     Efektif dalam 3 jam pertama
    1. Hentikan proses pembakaran
     Lepaskan pakaian dan perhiasan yang terbakar
    2. Turunkan suhu luka
     Air mengalir suhu minimal 15°C (8-25°C) -- 20 mnt
    3. Cegah hipothermia

    Zone of Zone of
    Coagulation Stasis

    6
    ZONA LUKA BAKAR
    7
    *Airway
    * Compromised airway:
    1. Chin lift
    2. Jaw thrust
    3. Inserstion of an oral pharyngeal airway in the unconscious
    patient
    4. Endotracheal intubation

    8
    * Breathing and ventilation

    * Listen to the chest and verify breath sounds


    * Assess adequacy of rate and depth of respiration
    * High flow oxygen is started on each patient at 15 L(100%), using non
    rebreathing mask
    * Circumferential full-thickness burn of the trunk may impair
    ventilation and must be closely monitored

    9
    *Circulation
    Assess:
    * Blood pressure
    * pulse rate
    * Skin color
    * Inserting 2 large bore catheter into veins,begin fluid
    administration.

    10
    * Disability, neurologic deficit

    AVPU method:
    * A – Alert
    * V – Respon to Verbal stimuli
    * P - Respon only to Painful stimuli
    * U - Unresponsive

    11
    * Exposure/
    Environmental control
    * Remove all clothing and jewelry
    * Maintaining the patient’s temperature
    * Warmed intravenous fluid(37 - 40 oC)

    12
    SECONDARY SURVEY :
    History / anamnesa

    Penyebab ???

    Air panas Api kimia listrik

    AMPLE:
    A- Allergies
    M-Medication
    P-Previous illness
    13 L-Last meal or fluid intake
    E-Events/environment related to injury
    *Physical Examination

    Head to Toe examination


    *Head *Abdomen
    *Maxillofacial *extremitas
    *Cervical spine and neck *Perineum,genitalia
    14
    *Chest *Back and buttock
    *Perawatan Emergency Luka
    * Luka dicuci dengan air atau
    salin,dengan sabun atau larutan
    klorheksidin 0,1%.
    Antiseptik lain jangan digunakan

    * Luka dibungkus lembar plastik atau


    bahan kering (kain bersih) yang tidak
    melekat  atur prosedur evakuasi

    * Rujukan > 8 jam atau luka


    kontaminasi bersihkan luka & rawat
    dengan antimikroba krim silver
    sulfadiazin

    15
    *Perkiraan Luas Luka Bakar

    Wallace’s Rule of Nines :


    - Regio Facialis colli :9%
    - Regio Thoracoabdominal : 18 %
    - Regio Thoracolumbal : 18 %
    - Regio Extremitas Superior Dextra :9%
    - Regio Extremitas Superior Sinistra :9%
    - Regio Extremitas Inferior Dextra : 18 %
    - Regio Extremitas Inferior Sinistra : 18 %
    - Regio Genitalia Externa :1%
    TOTAL 100%

    16
    *Perkiraan Luas Luka Bakar
    Palmar Surface
     Small Burn

    17
    * Perkiraan Luas Luka Bakar
    Paediatric Rule of Nines ≥ 9 th /
    dewasa

    0-12 bln 1 th 2 th 8 th

    18
    19
    Kedalaman Luka Bakar

    DERAJAT KLINIS RASA


    KEDALAMAN NYERI
    DERAJAT I HYPEREMIS HYPER
    ESTESIA
    DERAJAT II A BULLA, MERAH HYPER
    ESTESIA
    DERAJAT II B BULLA, PUCAT HYPO
    ESTESIA
    DERAJAT III HITAM, KERING AN ESTESIA
    Depth Colour Blister Capillary Sensation Healing
    Refill

    Epidermal Red No Present Present Yes

    Superficial Dermal Pale pink Present Present Painful Yes

    Mid Dermal Dark Pink Present Sluggish +/- Usually

    Deep Dermal Blotchy red +/- Absent Absent No

    Full Thickness White No Absent Absent No

    21
    *Estimasi kebutuhan cairan
    Resusitasi cairan dengan Modified Parkland Formula

     Anak-anak > 10% TBSA


     Dewasa > 20% TBSA

    3 ml / Kg BB / % Luas luka bakar

    *8 jam I : 50% dari total resusitasi


    *16 jam berikutnya : 50% total resusitasi
    *Cairan crystalloid
    *Resusitasi cairan dihitung sejak kejadian luka bakar
    hingga 24 jam 23
    * Estimasi kebutuhan cairan
    pada anak-anak (0 - 24 jam)

    Anak –anak :
    Resusitasi Modifikasi Parkland Formula (crystalloid)

    +
    Cairan maintenance (0,9% NaCl + Dextrose 5%)

    Cairan maintenance “4:2:1 Rule”


    • 4 ml/jam untuk 10 kg pertama berat badan
    • 2 ml/jam untuk setiap kg BB >10Kg dan < 20 Kg
    • 1 ml/jam utuk setiap Kg BB >20 Kg
    24
    * Contoh Perhitungan Cairan Maintenance
    pada Anak-anak
    7 Kg 17 Kg

    Kg Rate Rule ml/ Kg Rate Rule ml/


    hour hour
    7 x 4 = 28 10 x 4 = 40
    2 7 x 2 = 14
    1 1
    TOTAL 28 ml/h TOTAL 54 ml/h

    Kg Rate Rule ml/ hour


    27 Kg
    10 x 4 = 40
    10 x 2 = 20
    7 x 1 = 7
    25
    TOTAL 67 ml/h
    *TARGET URIN

    Dewasa : 0,5 cc/KgBB/jam


    Anak-anak : 1 cc/KgBB/jam

    Urin output tidak adekuat


    Bolus cairan 5-10 cc/kgBB
    atau
    tingkatkan cairan 150% pada jam berikutnya
    26
    *Diagnosis Luka Bakar
    * Depth of burn
    (kedalaman luka bakar)

    * Surface area of burn


    (luas luka bakar)
    Contoh :
    * Trauma Lain - Regio Facialis colli : 4%
    - Regio Thoracoabdominal : 16 %
    - Regio Thoracolumbal : -
    - Regio Extremitas Superior Dextra : -
    - Regio Extremitas Superior Sinistra : 8%
    - Regio Extremitas Inferior Dextra : 5%
    - Regio Extremitas Inferior Sinistra : 5%
    - Regio Genitalia Externa : 1%

    27 Combustio Grade IIA IIB 39% ec api


    + Trauma Inhalasi
    *KRITERIA RUJUKAN
    SPAM
    SIZE PERSON AREA MECHANISM
    > 10% TBSA Penyakit Wajah/ tangan/ Kimia/ listrik
    (dewasa) penyerta kaki/ perineum/
    sendi besar
    > 5 % TBSA Hamil Melingkar Multiple
    (anak-anak) (extremitas trauma
    atau dada)
    > 5% TBSA Usia Paru-paru Non-
    (luka full extreme (trauma accidental
    thickness) inhalasi) (bunuh diri/
    child abuse)
    28
    *
    I-Identity Identitas pengirim (nama, pekerjaan,lokasi)
    Identitas penerima
    Identitas pasien (nama, usia, identitas RS)
    S – Situation Kondisi pasien
    Permasalahan trauma
    B – Background Burn injury :
    - Bagaimana /apa/dimana dan kapan terjadi luka bakar
    - “E” pada AMPLE
    Pasien :
    - “AMPL” pada AMPLE
    A – Assessment Primary & Secondary Survey
    Luas dan derajat kedalaman luka bakar
    Vital sign dan produksi urin
    R- Transfer ke burn unit
    Diskusi prosedur transfer Waktu , penanggung jawab (pengirim dan penerima
    Recommendation pasien)
    Anggota keluarga
    Treatment advice : resusitasi, perawatan luka, escarotomi
    Persiapan transfer :
    - Circulatory : akses iv dan cairan
    - Kateter urin
    - Analgetik
    - Gastric drainage
    - Pencucian luka, balutan dan anti tetanus
    CEGAH HIPOTERMIA 29
    IGD RSUZA : 0651 - 34571
    30

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