Trauma Luka Bakar

8/9/2019 Trauma Luka Bakar

1/22

TRAUMA LUKA BAKAR

Stephanie Wirjomartani

406138166Pembimbing !r" Re##$ M"

So%ar& Sp"B


2/22

'()*+*T*,+

• B-rn i. !e%ne! a. an inj-r$ to the./in or other organi ti..-e primari#$a-.e! b$ therma# or other a-tetra-ma"


3/22

Pato%.io#ogi

angg-an .ir/-#a.i 2 $poo#emiaSho/

L-/a Ba/ar #-a. 579:2angg-an homeo.ta.i. airan&e#e/tro#it&

!an protein2 gan permeabi#ita. 5/ebooran:/api#er

2 gan per;-.i


4/22

=e!era termi.

•

Rea/.i *n>ama.i a/-tPermeabi#ita. /api##ar ? 2(/[email protected] airan intraa./-#er !an/ebooran

protein 2 e!ema inter.ti.ia#• Ker-.a/an perm-/aan

(apora.i? 5470/a#i:& hipoo#emia& hemo@/on.entra.i& /ebooran protein

Gangguan sirkulasi mikro → hipovolemia→ hipoksia jaringan


5/22

Gangguan sirkulasi mikro: cedera sel

S$o/ 5ggan per;-.i: ama.i

– A/tia.i protein ;a.e a/-t !an .i.tim /omp#emen


6/22

Gangguan sirkulasi makro: hipoperfusi

splangnikus

S$o/ ipoo#emia 2 Rea#o/a.i !i.trib-.iairan .ir/-#a.i

S$o/ipoo#emia

S*RS@M,'S =e!era

Se#


7/22

S$o/ ipoo#emia 2 Rea#o/a.i !i.trib-.i airan.ir/-#a.i

Per;-.i .ir/-#a.i peri;erC

• Rena# 5709: ATN-Renal failure

• Sp#angni/-. 57@309:

•

*./emia@!i.r-p.i m-/o.a – *nto#[email protected]!roma ma#ab.orp.i

– 'iare@entero/o#iti.

– Per!arahan .a# erna 5.tre.. ulcer)

–

Tran.#o/a.i ba/teri


8/22

Re.-.ita.i =airan


9/22

Prin.ip

•

Mengata.i .$o/

re.tora.i per;-.i

o#-me a!e/-at

• Mempertimbang/an Da/t- i./emi/ 5E4jam:

– Mani;e.ta.i .$o/ timb-# bi#a ter!apat !e%.itairan 79 o#-me .ir/-#a.i 5.$o/ !erajat **:

• Pemberian airan – Kri.ta#oi! 5RL:

– Ko#oi! +on@Protein

• =airan hangat menegah hipotermia


10/22


11/22

Prin.ip

•Bata.i pemberian /ri.ta#oi! ma.i;5e!ema inter.ti.ia# ma.i;& e!emapar- !an Ab!omina# =ompartment

S$n!rome:• Ko#oi! +on@Protein 5BM 700@300/':

– Sealing eect

–

Dilution eect, Plasma expander – Anti-inammatory eect

– ematological eect


12/22


13/22

Pemant-an Re.-.ita.i=airan

1" Pemanta-an per;-.i – ,/.igena.i g#oba#

– Ana#i.i. a. 'arah

– Metabo#i.me – ,/.igena.i regiona#

– Pem reten.i /-a#ita. !an /-antita. airan#amb-ng

– ,/.igena.i regiona#

– Pem reten.i /-a#ita. !an /-antita. airan#amb-ng


14/22

7" Fa.oa/ti;LoD 'o.e 'opamine 53GgH/gBBHjam:

titra.i .ete#ah pemberian o#-mea!e/-at

!" #luid treatment 5mengata.i !ampa/

re.-.ita.i /ri.ta#oi! ma.i;: – Sa#in hipertoni/ 3@I"9: -t/ e!ema .e#-#er

– Ko#oi!@protein -t/ e!ema inter.ti.ia#

$" Pac%ed Red &ell – 'uer protein

– Ko#oi!@Protein


15/22


16/22

" Ko#oi!@Protein – PR=

– ))P -nt-/ gangg-an /oag-#a.i

– A#b-min• Mempertahan/an te/anan on/oti/ 5o.moti/@

/o#oi!:

• Tran.porta.i@tran. membran 5#igan!:

beberapa .-b.tan.i tm./ obat@obatan


17/22

6" Re.-.ita.i .a#-ran erna – +-tri.i (ntera# 'ini

– Antio/.i!an

I" Manajemen #-/a – (ife saing* e./arotomi !an ;a.iotomi

– 'ebri!ement@ne/rotomi !an peraDatan#-/a #ainn$a

+" &ontinuous Renal ReplacementTerapy &RRT)


18/22

B-rn Wo-n! Management

1" 're..ing.

App#$ !ai#$ !re..ing. to the Do-n!ontin-o-.#$ -nti# omp#ete hea#ing o-r.

or .-rgia# interention i. reJ-ire! ;or Do-n!#o.-re"

TDie@!ai#$ !re..ing hange. are .ti##in!iate! in patient. Dith Do-n!. that are orhae been in;ete! or tho.e Dith ee..ieamo-nt. o; e-!ate" A;ter Do-n! #ean.ing&oer the Do-n! Dith antibioti ream"


19/22

7" Topia# Antimirobia#.

Si#er .-#;a!iaine+itro;-raone

,#-..ie Do-n! !re..ing


20/22

SURGICAL TRAT!"T#$ %UR"S

scharo&om'• Defnition.—An e.harotom$ i. !e%ne! a. a .-rgia# ini.ion

thro-gh b-rn e.har 5neroti ./in:" Thi. proe!-re i. -.-a##$per;orme! Dithin the %r.t 74 ho-r. o; b-rn inj-r$" B-rn e.har ha.an -n$ie#!ing& #eather$ on.i.ten$ an! i. haraterie! b$!enat-re! protein. an! oag-#ate! e..e#. in the ./in& Dhih arethe re.-#t o; therma#& hemia# or e#etria# inj-r$"

• Purpose.—When the b-rn e.har ir-m;erentia##$ .-rro-n!. an$bo!$ .tr-t-re 5in#-!ing !igit.& etremitie.& ab!omen& he.t& orne/: the ti..-e. Dithin are .-bjet to inrea.ing inter.titia#

pre..-re. eaerbate! b$ ti..-e e!ema that !ee#op. !-ring thea-te pha.e o; b-rn re.-.itation in the %r.t 48 ho-r. a;ter inj-r$"A. the inter.titia# pre..-re ri.e. there i. initia##$ impairment o;eno-. o-t>oD ;o##oDe! b$ !imin-tion o; arteria# in>oD" Thi.on!ition& o;ten terme! ompartment .$n!romeN& Di## a-.e!$.;-ntion& i.hemia& or nero.i. Dithin or !i.ta# to that bo!$

.tr-t-re& o;ten Dithin ho-r."


21/22

• *n the #imb.& nere an! m-.#e !eath ma$ o-r a-.ing permanent;-ntiona# impairment or een the nee! ;or amp-tation" *n the ab!omen&the impaire! b#oo! .-pp#$ to the boDe#.& /i!ne$. an! other interna#organ. re.-#t. in the rapi! on.et o; hepati an! rena# ;ai#-re& inte.tina#i.hemia& an! re.trition o; !iaphragmati e-r.ion" =ompre..ion o; thehe.t b$ b-rn e.har Dor.en. p-#monar$ omp#iane a..oiate! Dith.mo/e inha#ation inj-r$"

• Technique.—Escharotomy 5ini.ion thro-gh the e.har: re#ea.e. theon.triting ti..-e a##oDing the bo!$ ti..-e. an! organ. to maintain theirnorma# per;-.ion an! ;-ntion" *n mo.t a.e. a .ing#e ini.ion i.ina!eJ-ate to proi!e re#ea.e o; the on.triting b-rn e.har"(.harotom$ ini.ion. are ro-tine#$ per;orme! on both .i!e. o; the tor.oor the me!ia# an! #atera# .i!e. o; eah aOete! #imb" )or the ab!omen

an! he.t& tran.er.e ini.ion. are o;ten reJ-ire! to permit re.toration o;re.pirator$ moement" The e.harotom$ proe!-re i. mo.t ommon#$per;orme! -.ing on.io-. .e!ation at the be!.i!e& in the emergen$room& h$!rotherap$ room& or inten.ie are -nit& b-t ma$ be !one in theoperating room i; genera# ane.the.ia i. reJ-ire!"


22/22

(e)ridemen& of %urn *ounds

• Defnition—Debridement i. the remoa# o; #oo.e& !eita#ie!& neroti&an!Hor ontaminate! ti..-e& ;oreign bo!ie.& an! other !ebri. on the Do-n!

-.ing mehania# or .harp tehniJ-e. 5.-h a. -retting& .raping&ronge-ring& or -tting:" The #ee# o; !ebri!ement i. !e%ne! b$ the #ee# o;

the ti..-e remoe!& not the #ee# epo.e! b$ the !ebri!ement proe.."

• Purpose—Wound hea#ing i. optimie! Dhen Do-n! .-r;ae. are #eanDith minima# mirobia# o#oniation an! neroti !ebri. pre.ent"

'ebri!ement #ean. the Do-n! an! a##oD. it to hea# more rapi!#$ Dithre!-e! ri./ o; in;etion" *n genera#& !ebri!ement i. per;orme! on .ha##oDb-rn. that are epete! to hea# Ditho-t the nee! ;or ./in gra;ting" *n

ontra.t to b-rn Do-n! ei.ion& the .-r;ae o; a !ebri!e! Do-n! i. not

rea!$ to .-pport imme!iate p#aement o; a permanent Do-n! oer"

• Technique—Debridement an be aomp#i.he! in a n-mber o; Da$.&o;ten -.ing the .ame .-rgia# in.tr-ment. -.e! ;or ei.ion" 5Thi. !oe. notin#-!e en$mati !ebri!ement o; Do-n!.":

Documents

Trauma Luka Bakar