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BURN INJURY
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s/20/20L4
BURN INJURYRuby Riana A
FKUMM
T
I
FIRST AID . THERMAL BURN
Rescuing the victim from the buming pronises:
, STOP and DROP "polic-v" should be followed.
. Prcvent the victim frorn nmning which would only fan the flames andmake thern bum faster.
. Tbe victim should be insfiucted to lie down on the floor with thebuming side rrypcrmost.
The casualty should not bc rolld on the ground
If the victim is'mable to walk or is unconscious, make hir/her lie supine onflmr with both rpper limbs placed extended by tlrc side, above the head andthar drag the victim out of the rmm holding his/her legs.
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FIRST AID - THERMAL BURN
Put out the fire in an erpoditious rnanner: Stopping the buming process is rnaodatory toprevent firrther darnage
r The flarues should be doused with wzter. Smouldering clothing should be removed Ifwater is not available : Any other non-flammable "cleat" liquid such as mift, cameddrinkcan be used,
r The r,ictim should be put on the ground with the buming side uppermost and thenwrapped in a hearv cotton cloth (blankeVnrg/darilcoat or anli other heav_v fabric)
I Fire eKinguisbers are exhemely usefirl in putting out tbe fire.
e Don't throVapply mud"/sand over the victim's body to put out the fue
N{ale the victim lie suprne. Watch for the response and ass€ss for AI}C (Aima1,,Breathing, Circulation) If there is no response and there are no chest moveruents,cardiopulmonary resuscitation (CPR) should be instituted urgently.
FIRST AID . THERMAL BURN
a Cooling the bum: The first objective in the burn wound careis to dissipate the heat. The subcutaneous temperaturecontinues to rise for a while even after the heat soruce hasbeen removed. Thereafter, it takes about 3 minutes for thetissues to return to body temperature
a Immediate active cooling of burn wounds with cool tapwater (lavage, soaks, compress or immersion) is effective.Continuous cooling for the first l0 minutos dissipates heat,reduces pain, delays onset and minimises the extent of burnoedema by decreasing the histamine release from the skinmast cells
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Pembagian
r Berdasarkan kedalaman
r Berdasarkan luas
r Berdasa*an keparahan
BERDASARKAN KEDALAMAN
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TIDAK DIHITUNGDALAM PERHITUNGAN
LUAS LUKA BAKAR
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BERDASARKAN
BERDASARKAN KEPARAHAN
Parah - critical.
r Tingkat II 30% atau lebih
E TlngkatIlI tOo/o ataulebh
r Tingkat III pada tangan, kaki, muka
j Dengan adanya kornplikasi pemapasan, jantLlng, ft-aktur, soft tissr.€ yang luas.
Sedang - moderate.
E Tlngkat II 15-300,6
E -I]r€kat III 5-10%
Rir€an - minor.
! Tingkat Il kuGr€ 15oA
a Tingkat III kurar€ 106
s/20120L4
TATA LAKSANA
r Survai Primer :ABCDE
r Survai Sekunder
r Penreriksaan fisik
I Resusitasi cairan B terhitrng dari saat kejadian maka :
I Sjam | + %(4cc xkg BBx% LB) RL
r l6jam Il + %(4ccxkgBBx% LB) RL
r + 500-1000cc colloid.
r Selesai dalam 24 jam sejak kejadian
Di Surabaya formula B anak dimodi0kasi sbb :
I Replacenent 2 c/k f/o luka bahar
r DitarrbahKeb faal
1 Umur sampai I l0O cc/kgBB
r Umur 5-15 tahrm 50 cc,ftgtsB
r = cairan
Moncrief { lTl20Iftisaloid@L)+3/20Koloid an){ botolyang sarna
r dibagi 2 + dalam 8 jam dan 16 jmr berikutnya
s/20/2014
n Luka bakar listrik
o high voltage atau low voltage
r: awasi aritmia
o menunggu demarkasi jaringan
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AMERICAN BURN ASSOCIATION PRACTICEGUIDELINES FOR BURN SH(rcKRESUSCITATION
r Guidelines
inchil&en.
r ons
The addition of colloid-containing fluid following bum injury, ially
requir€ments.
avoid excessive a.
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FASE SUBAKUT
r Fase setelah fase resusitasi.
r Rentang waKunya tidak selalu sama tergantung dari
r Jenis trauma
r Derajat luka bakar
r Keadaan umum pasien
r Komplikasi pada fase ini meliputi; SIRS, infeksi,
2t
PRINSIP PENANGANAN FASE
SUBAKUT
r Supportif sistemik, nreliputi
r Respintory rnaintenance
r lGseimbangan cainn dan elektolit
r Nubisi
r Wound care rnanagenrent
r Management BaKerial
r Managementjaringan nekrctik
r Skin coverage rnanagernent
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RESPI RATORY MAI NTENANCE
r Improve airway clearance; artifisial, pengencerandaha( terapi batuk, chest physical theraphy,washing
r Oksigenasi; nasal, masker, jacksen rees, ventilator.
r Improve respiratory muscle
KESEIMBANGAN CAIMNDAN ELEKTROLIT
rTotal cairan tubuh^,60olo BB
1. ICF Z|3TBW2. ECF U3 TBW
- Intravascular 1/q
- intertitial 3la
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PRI NSI P PE NATALAKSANMN
I lcseimbangenCairan
I inBrt = oriBlt
I outBJt = scnsiblc + inscnsiblc r,&rb6tI Evaporative wdter lod in mlJhour : [25 + % of TBS burned] x TBS in nu
r al in (>2.59/dL)
I tt4onltor nadl dan hkanan darah
! Monitor el€<tjdit dan kseimbangan asarrbasa
r l-lct- 30tO96
r CVPdi pertahankanT- 12 cm H2O
r l.ternpertatnnkanproduk5urin€
r Delv6a 0,t1 mutgifti
I
Aa"l< , t-2,,t1r,< /td-''
r Laki-laki 20 tahun dengan luka bakar 40o/o.Berat 50 kg, tinggi 150 cm, hari kedua postbaxter resuscitation. Berapa cairan yangdibutuhkan?
Keb fisiologis 30cc x 50 = 1500 ccIWL I 24 jam (25 + 40) x TBS x24 = 2350
ccTotal 3850 cc
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ELECTROLYTE IMBALANCE
Na 130-145mmo[L24 mq lkgldNa defisit : (0,6 x bw) x (130 - cunent Na)3olo NacUL : 513 mmol0,9olo Nacl/L : 154 mmolK 3,5 - 5,0 mmoUL1-2 meq/kg/dHypokalemia. 7,45o/o Kcl : I meqr 2040 meq/h diluted in 100-200 NSr given in 3-4 h, at rab 10 meq/hHyperkalemiar C: glukonas, D40, and insulin
mmol Na
NUTRISI
r Prinsip pemberian nutrisi
I "Go Slora/'
r Memperkirakan kebutuhan
r Memperkirakan kebutuhan
r Memperkirakan kebutuhan
r Memperkirakan kebutuhan
L4
sl2ol2oL4
KEBUTUHAN IGLORI
r Sutherland (1959)
Dewasa 20 kcal/kgBB + (70 kcal x luas LB)Anak 60 kcal/kgBB + (35 kcal x luas LB)
Curreri (1974)25 kcal/kgBB + (40 kcal x luas LB)
Perhitungan berdasarkan BMRdari Harris-Benedict (1919)
r TEE = Predicted BMR X injury factor X activity ftctor
Injury fuctor = 1 + [ 32+ (0,3xoloburn) - ( 0,4 x day post100
LB0-20o/o 1-1,5LB 20-404/o 1,5 - 1,8LB >,m% L8 - 2
Activity factor 1,25BMRMale: 66 + (13,7 x Vtff) + (5 x HT) - (6,8 x age)Female: 66 + (9,6 x VW) + (L,7 x Fff) - (4,7 x age)
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CONTOH
r Laki-laki 63 th mmbus 20olo. BB =75 kg,TB = L70 cm, beapakin-kin kalori png dibutuhkan?
BMR = 1500TEE = BMRx L,5xL,25
= 2700 kcal
WOUND CARE
r Manajemen eksudat dan baKeri
- Mandi/cuci luka 3-7 hari sekali (tergantungkondisi luka)
- Antibiotik Topical, SSD- Antibiotik sistemik sesuai kultur- Absorben dressing
Management nekrotik- Tangensial eksisi- autolitik atau enzimatik debridement
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SKIN COVERAGE
r Self epitelization
E Skin Grafting, bisa sebelum 4 hari atau setelah 2
minggu
r Kultur kulit
r Flap
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