acute burn management bil
TRANSCRIPT
![Page 1: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/1.jpg)
ACUTE BURN MANAGEMENT
BILLY D. MESSAKH, MDGeneral surgeon
![Page 2: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/2.jpg)
DEFINISI LUKA BAKAR
Suatu trauma panas yang disebabkan oleh air / uap panas, arus listrik, bahan kimia, radiasi dan petir yang mengenai kulit, mukosa dan jaringan yang lebih dalam kerusakan/ kehilangan kulit
![Page 3: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/3.jpg)
ANGKA MORBIDITAS DAN MORTALITAS MASIH TINGGI
DI AMERIKA : 2 – 3 JUTA/TAHUNANGKA KEMATIAN : 5 – 6 RIBU / TAHUN
RSUP CIPTO MANGUNKUSUMO (1998)PENDERITA YANG DIRAWAT : 107ANGKA KEMATIAN : 37,78%
RSU DR. SOETOMO (JANUARI – DESEMBER 2000)PENDERITA YANG DIRAWAT : 106ANGKA KEMATIAN : 26,41%
MERUPAKAN TANTANGAN BAGI KITA
A B A (AMERICAN BURN ASSOCIATION) MENGADAKAN CONTINUING EDUCATION – A B L S
A L B I (ASOSIASI LUKA BAKAR INDONESIA) ???
![Page 4: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/4.jpg)
PENYEBAB LUKA BAKAR
1. API
2. AIR PANAS
3. BAHAN KIMIA
4. LISTRIK, PETIR, RADIASI
5. SENGATAN SINAR MATAHARI
6. LEDAKAN TUNGKU PANAS, UDARA PANAS
7. LEDAKAN BOM
![Page 5: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/5.jpg)
DERAJAT KEDALAMAN LUKA BAKAR
1. LUKA BAKAR DERAJAT I- EPIDERMIS
2. LUKA BAKAR DERAJAT II- DERAJAT IIA (SUPERFICIAL)- DERAJAT IIB (DEEP)
3. LUKA BAKAR DERAJAT III- SAMPAI OTOT / TULANG
![Page 6: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/6.jpg)
![Page 7: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/7.jpg)
![Page 8: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/8.jpg)
![Page 9: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/9.jpg)
![Page 10: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/10.jpg)
![Page 11: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/11.jpg)
![Page 12: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/12.jpg)
DERAJAT KEDALAMAN
KLINIS RASA 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
![Page 13: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/13.jpg)
LUAS LUKA BAKAR
WALLACE
RULE OF NINE Kepala leher 9% --------> 9%
Lengan 9% --------> 18%
Badan depan ---------------------> 18%
Badan belakang ------------------> 18%
Tungkai 18% -------> 36%
Genetalia/ perineum -------------> 1 %
Jumlah -----------------------------------> 100%
![Page 14: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/14.jpg)
DEWASA
![Page 15: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/15.jpg)
9
14
9 9
18 18
18 18
9 9
18 18
16 16
9
18 18
14
10 14 18
15 tahun 5 tahun 0 – 1 tahun
ANAK – ANAK
![Page 16: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/16.jpg)
![Page 17: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/17.jpg)
![Page 18: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/18.jpg)
KRITERIA BERAT RINGANNYA(AMERICAN BURN ASSOCIATION)
1. LUKA BAKAR RINGAN- LUKA BAKAR DERAJAT II < 15%- LUKA BAKAR DERAJAT II < 10% PADA ANAK-ANAK- LUKA BAKAR DERAJAT III < 1%
2. LUKA BAKAR SEDANG - LUKA BAKAR DERAJAT II 15-25% PADA ORANG DEWASA
- LUKA BAKAR DERAJAT II 10-20% PADA ANAK-ANAK - LUKA BAKAR DERAJAT III < 10%
![Page 19: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/19.jpg)
3. LUKA BAKAR BERAT
- LB. DERAJAT II 25% ATAU LEBIH PADA ORANG DEWASA
- LB. DERAJAT II 20% ATAU LEBIH PADA ANAK-ANAK
- LB. DERAJAT III 10% ATAU LEBIH
- LB. MENGENAI TANGAN, WAJAH, TELINGA, MATA, KAKI
DAN GENETALIA/PERINEUM.
- LB. DENGAN CEDERA INHALASI, LISTRIK, DISERTAI
TRAUMA LAIN
![Page 20: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/20.jpg)
FASE LUKA BAKAR1. FASE AKUT / FASE SYOK / FASE AWAL
- KEJADIAN / IRD- PROBLEM PERNAFASAN DAN CAIRAN- LUKA
2. FASE SUBAKUT- DALAM PERAWATAN- PROBLEM LUKA, INFEKSI, SEPSIS
3. FASE LANJUT- SETELAH BEROBAT JALAN- PROBLEM PARUT, KONTRAKTUR
![Page 21: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/21.jpg)
PENATALAKSANAANPENDERITA LUKA BAKAR
FASE AKUT
I. PRIMARY SURVEY :PEMERIKSAAN SEPERTI PADA TRAUMA YANG LAIN.
A. AIRWAY DAN CERVICAL SPINE PROTEKSI
B. BREATHING DAN VENTILASI
C. CIRCULASI DAN KONTROL PERDARAHAN
D. DISABILITY – PEMERIKSAAN NEUROLOGIS
E. EXPOSURE
![Page 22: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/22.jpg)
II. SECONDARY SURVEY :
A. HISTORY / ANAMNESA
B. PEMERIKSAAN FISIK / LENGKAP
MULAI KEPALA - KAKI
![Page 23: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/23.jpg)
PRINSIP PENANGANAN
1. HENTIKAN PROSES YANG MENYEBABKAN LUKA
BAKAR
2. UNIVERSAL PRECAUTION, HIV, HEPATITIS
3. FLUID RESUSCITATION : 2-4 CC RL X BB X LUAS
LB.
4. VITAL SIGN
5. PEMASANGAN NASOGASTRIC TUBE
6. PEMASANGAN URINE KATETER
![Page 24: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/24.jpg)
7. ASSESSMENT PERFUSI EKSTRIMITAS
8. CONTINUED VENTILATORY ASSESSMENT
9. PAINT MANAGEMENT
10. PSYCHOSOCIAL ASSESSMENT
11. PEMBERIAN TETANUS TOKSOID
12. TIMBANG BERAT BADAN
13. PENCUCIAN LUKA DI KAMAR OPERASI (BIUS TOTAL)
14. ESCHAROTOMY DAN FASCIOTOMY
![Page 25: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/25.jpg)
PENANGANAN RESUSITASI CAIRAN(FLUID RESUSCITATION)
FORMULA EVANS
FORMULA BROOKE
FORMULA PARKLAND
MODIFIKASI BROOKE
FORMULA MONAFO
![Page 26: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/26.jpg)
Formulas Used to Calculate fluid Needs in Burn ShockNAME AND YEAR
OF
INTRODUCTION1st 24 HOURS
SOLUTIONS, AMOUNTS,
AND RATES
2nd 24 HOURS
Harkins/
plasma
1941
(100 ml Plasma) (measured hematocrit-45)
Also add 25% of this calculated dose for each gram the serum protein is less than 6.0 gm/100 ml
----------------------------------------------------
1/3 given over first 2 hrs
1/3 given over next 4 hrs
1/3 given over next 6 hrs
Recalculate at 12 hrs
Cope/Moore
1947
75 ml Isotonic electrolyte/% BBSA
+
75 ml Plasma/% BBSA
+
2000 ml D5W
----------------------------------------------------
½ given over 1st 8 hrs
½ given over remaining 16 hrs
½ previously calculated isotonic electrolyte/plasma micture
+
D5W, 2000 ml
Evans
1952
1 ml 0.9% NaCl/% BBSA/kg
+
1 ml plasma/% BBSA/kg
+
2000 ml D5W
------------------------------------------------------
If greater than 50% BBSA, treat as 50%
![Page 27: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/27.jpg)
NAME AND YEAR OF
INTRODUCTION1st 24 HOURS
SOLUTIONS, AMOUNTS, AND RATES
2nd 24 HOURS
Brooke (old)
1953
1.5 ml Lactated Ringer’s/% BBSA/kg
+
0.5 Plasma/% BBSA/kg
+
2000 ml D5W
---------------------------------------------------------
½ given in first 8 hrs
½ given over next 16 hrs
---------------------------------------------------------
If greater than 50% BBSA, treat as if 50%
½ of previously calculated electrolyte and plasma mixture
+
D5W, 2000 ml
Moyer
1965
Lactated Ringer’s titrated to avoid shock
Sorenson
1968
Dexran 70, 6% in 0.9 NaCl 120 ml/% BBSA
Given over 48 hours with D5W, 50 cc/kg/hrs
Baxter/Parkland
1968
Lactated Ringer’s, 4 ml/% BBSA/kg½ given over first 8 hrs½ given over remaining 16 hrs
Dextran 40, 500-1000 mlBegin at 1st 18 hrs
![Page 28: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/28.jpg)
NAME AND YEAR OF
INTRODUCTION1st 24 HOURS
SOLUTIONS, AMOUNTS, AND RATES
2nd 24 HOURS
Monafo/hypertonic
Lactated saline
1970
1984
1970 : HLS
300 mEqNa+/L
200 mEq DL
Lactate/L
100 mEq Cl-/L
Given p.o./I.V, titrated to avoid shock
1984 : HLS
250 mEqNa+/L
100 mEq DL
150 mEq/Cl-/L
Haldane’s solution (1.33 NS)
p.o. Up to 3500 ml maximum
Free water p.o.
Brooke (modified)
1970
2 ml Lactated Ringer’s/% BBSA/kg
½ given over first 8 hrs
½ given over next 16 hrs
Colloid 0.5 ml/% BBSA/kg
+
D5W maintenance
Odstock
1981
(7.5 ml) (kg)=plasma maximum dose for 36 hrs
1/3 given in first 8 hrs
1/3 given in next 12 hrs
1/3 given in next 16 hrs
P.O intake “as thirst demands”
![Page 29: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/29.jpg)
FORMULA BAXTER
RSU DR. SOETOMOHARI PERTAMA :
DEWASA :RL 4 CC X BB X % LUAS LB / 24 JAMANAK : RL : DEXTRAN = 17 : 3
2 CC X BB X % LUAS LB + KEBUTUHAN FAALI
KEBUTUHAN FAALI :< 1 TAHUN : BB X 100 CC1-3 TAHUN : BB X 75 CC3-5 TAHUN : BB X 50 CC
½ JUMLAH CAIRAN DIBERIKAN DALAM 8 JAM PERTAMA½ DIBERIKAN 16 JAM BERIKUTNYADEWASA : DEXTRAN 40, 500-1000 CC MULAI JAM KE 18
![Page 30: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/30.jpg)
HARI KEDUA :
DEWASA : DIBERI SESUAI KEBUTUHAN ALBUMIN (KP)
ANAK : DIBERI SESUAI KEBUTUHAN FAALI
![Page 31: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/31.jpg)
PEMERIKSAAN LABORATORIUMLUKA BAKAR DAPAT MENYEBABKAN GANGGUAN FUNGSI ORGAN. LABORATORIUM DASAR (BASELINE LABORATORY TEST)
1. HEMATOCRIT
2. DARAH LENGKAP (Hb)
3. ALBUMIN
4. RFT DAN LFT
5. ELEKTROLIT, Na, K, Cl, HCO3
6. BLOOD UREA NITROGEN
7. URINALYSIS
8. FOTO THORAK
9. ARTERIAL BLOOD GASES (TRAUMA INHALASI)
10. CARBOXY HEMOGLOBIN
11. ECG (TRAUMA LISTRIK)
![Page 32: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/32.jpg)
PERAWATAN LUKASECARA TERTUTUP
LUKA DICUCI, DEBRIDEMENT DAN DIDESINFEKSI
DENGAN SAVLON 1 : 30
TUTUP TULLE
TOPIKAL SILVER SULFADIAZINE (SSD)
TUTUP KASA STERIL TEBAL/ELASTIC VERBAN
LUKA DIBUKA HARI KE 5 KECUALI ADA TANDA INFEKSI
DILAKUKAN DENGAN PEMBIUSAN TOTAL DI KAMAR
OPERASI
![Page 33: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/33.jpg)
![Page 34: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/34.jpg)
![Page 35: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/35.jpg)
![Page 36: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/36.jpg)
MONITORING RESUSCITATION/RESUSITASI CAIRAN
1. URINE PRODUKSI SETIAP JAM.
DEWASA: 0,5 CC/KG/JAM (30-50 CC/JAM)
ANAK : 1 CC/KG/JAM
2. OLIGO-URIA
BERHUBUNGAN DENGAN SYSTEMIK VASKULAR RESISTANCE
DAN REDUKSI CARDIAC OUTPUT)
3. HAEMOCHROMOGENURIA (RED PIGMENTED URINE)
4. BLOOD PRESSURE
5. HEART RATE
6. HEMATOCTRIT DAN HAEMOGLOBIN
![Page 37: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/37.jpg)
TRAUMA INHALASI
![Page 38: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/38.jpg)
PENANGANAN PERNAFASAN :
TRAUMA INHALASI TRAUMA PANAS LANGSUNG KERACUNAN ASAP GAS TOKSIK EFEK KARBON MONOKSIDA (CO)
KLINIS : 1. TERJEBAK RUANG TERTUTUP2. SPUTUM TERCAMPUR ARANG3. LUKA BAKAR PERIORAL4. PENURUNAN KESADARAN5. TERDAPAT DISTRESS NAFAS6. TACHIPNEA7. SESAK NAFAS
![Page 39: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/39.jpg)
PERNAFASAN
UDARA PANAS IRITASI UDEMA OBSTRUKSI GAGAL NAFAS
EFEK TOKSIK DARI ASAP :HCN, NO2, HCl, BENSIN IRITASI BRONKOKONSTRIKSI GAGAL NAFAS
CO HIPOKSIA
![Page 40: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/40.jpg)
TIPE TRAUMA INHALASI(ABLS)
1. KERACUNAN KARBON MONOKSIDA
2. TRAUMA INHALASI DIATAS GLOTTIS
3. TRAUMA INHALASI DIBAWAH GLOTTIS
![Page 41: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/41.jpg)
![Page 42: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/42.jpg)
![Page 43: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/43.jpg)
![Page 44: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/44.jpg)
![Page 45: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/45.jpg)
![Page 46: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/46.jpg)
PENATALAKSANAANTANPA DISTRES PERNAFASAN :1. INTUBASI (PEMASANGAN PIPA ENDOTRAKEA) TANPA
MENGGUNAKAN PELUMPUH OTOT DAN TANPA VENTILATOR
2. PEMBERIAN OKSIGEN 2-4 LITER/MENIT MELALUI PIPA ENDOTRAKEA
3. PENGHISAPAN SEKRET SECARA BERKALA4. HUMIDIFIKASI DENGAN PEMBERIAN NEBULIZER
MENGGUNAKAN SUNGKUP SETIAP 6 JAM.5. PEMBERIAN BRONKODILATOR (VENTOLIN® INHALASI)
DILAKUKAN BILA JELAS DIJUMPAI GEJALA DAN TANDA DISTRES PERNAFASAN
![Page 47: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/47.jpg)
6. PEMANTAUAN GEJALA / TANDA DISTRES PERNAFASAN :
A. GEJALA SUBYEKTIF : GELISAH, SESAK NAFAS
B. GEJALA OBYEKTIF : PENINGKATAN FREKUENSI PERNAFASAN
( > 30 KALI/MENIT), SIANOTIK, STRIDOR,
AKTIVITAS OTOT PERNAFASAN BERTAMBAH.
C. UNTUK PEMANTAUAN INI, MAKA DILAKUKAN PEMERIKSAAN :
i. ANALISA GAS DARAH
1. PADA PERTAMA KALI PENDERITA DITOLONG (SAAT RESUSITASI)
2. DALAM 8 JAM PERTAMA
3. DALAM 24 JAM PASCA CEDERA
4. SELANJUTNYA SESUAI KEBUTUHAN
ii. FOTO TORAK/PARU 24 JAM PASCA CEDERA.
![Page 48: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/48.jpg)
7. PEMERIKSAAN RADIOLOGIK (FOTO TORAK/PARU)
8. PENDERITA INI DIRAWAT PADA BED OBSERVASI,
DENGAN POSISI DUDUK ATAU SETENGAH DUDUK.
9. TINDAKAN INI DILAKUKAN SEBELUM TINDAKAN
RESUSITASI CAIRAN.
10. PELAKSANAANNYA DILAKUKAN DIRUANG
RESUSITASI INSTALASI GAWAT DARURAT.
![Page 49: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/49.jpg)
DENGAN DISTRES PERNAFASAN
1. DILAKUKAN TRAKEOSTOMI
2. PEMBERIAN OKSIGEN 2-4 LITER/MENIT MELALUI
TRAKEOSTOMI/PIPA ENDOTRAKEA
3. PEMBERSIHAN SALURAN NAFAS SECARA BERKALA, SERTA
BRONCHIAL WASHING.
4. HUMIDIFIKASI DENGAN NEBULIZER.
5. BRONKODILATOR (VENTOLIN @ INHALASI) SETIAP 6 JAM.
![Page 50: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/50.jpg)
6. PEMANTAUAN GEJALA DAN TANDA DISTRES PERNAFASAN :
A. GEJALA SUBYEKTIF : GELISAH, SESAK NAFAS.
B. GEJALA OBYEKTIF : FREKUENSI PERNAFASAN MENINGKAT
(> 30-40 KALI/MENIT).
7. PEMERIKSAAN RADIOLOGIK (FOTO TORAK/PARU)
8. KASUS INI DIRAWAT PADA BED OBSERVASI DENGAN POSISI
DUDUK ATAU SETENGAH DUDUK.
9. PELAKSANAANNYA DI RUANG RESUSITASI INSTALALASI GAWAT
DARURAT
![Page 51: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/51.jpg)
![Page 52: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/52.jpg)
LUKA BAKAR LISTRIK
![Page 53: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/53.jpg)
LUKA BAKAR LISTRIK
KERUSAKAN JARINGAN DISEBABKAN :
1. ALIRAN LISTRIK (ARUS BOLAK BALIK/AC)
MERUPAKAN ENERGI DALAM JUMLAH BESAR. KERUSAKAN DAPAT EKSTENSIF LOKAL MAUPUN SISTEMIK.
2. LONCATAN ENERGIDITIMBULKAN OLEH UDARA YANG BERUBAH MENJADI API
3. KERUSAKAN JARINGANAKIBAT KERUSAKAN SISTEM PEMBULUH DARAH SEPANJANG YANG DIALIRI LISTRIK (TROMBOSIS)
![Page 54: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/54.jpg)
![Page 55: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/55.jpg)
![Page 56: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/56.jpg)
![Page 57: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/57.jpg)
PENANGANAN LUKA BAKAR LISTRIK :
A. PRIMARY SURVEY
1. AIRWAY – CERVICAL SPINE
2. BREATHING
3. CIRCULATION
4. DISABILITY PEMERIKSAAN KESADARAN G C S DAN PERIKSA
PUPIL
![Page 58: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/58.jpg)
B. SECONDARY SURVEY
1. PEMERIKSAAN DARI KEPALA SAMPAI KAKI.
2. PAKAIAN DAN PERHIASAN DIBUKA. a. PERIKSA TITIK KONTAK
b. ESTIMASI LUAS LUKA BAKAR/DERAJAT LUKA BAKARNYA
c. PEMERIKSAAN NEUROLOGIS
d. PEMERIKSAAN TRAUMA LAIN, PATAH TULANG/DISLOKASI
e. KALAU PERLU PASANG ENDOTRAKEAL INTUBASI.
![Page 59: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/59.jpg)
C. RESUSITASI
1. BILA DIDAPATKAN LUKA BAKAR, DAPAT DIBERIKAN CAIRAN 2-4 CC/KG/LUAS LB.
2. KALAU DIDAPATKAN HAEMOCHROGENS (MYOGLOBIN), URINE OUT PUT DIPERTAHANKAN ANTARA 75-100 CC/JAM SAMPAI TAMPAK URINE MENJADI JERNIH.
3. SODIUM BICARBONAT DAPAT DITAMBAHKAN PADA RINGER’S LACTATE SAMPAI pH > 6.0.
4. MANITOL JARANG
![Page 60: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/60.jpg)
D. CARDIAC MONITORING
1. MONITORING ECG KONTINYU UNTUK DYSRHYTMIA
2. VENTRIKULAR FIBRILASI, ASYSTOLE DAN ARHYTMIA DITERAPI SESUAI ADVANCED CARDIAC LIVE SUPPORT
![Page 61: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/61.jpg)
LUKA BAKAR KIMIA
![Page 62: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/62.jpg)
LUKA BAKAR KIMIA
DI UNITED STATE TERDAPAT LEBIH 500.000 JENIS BAHAN KIMIA YANG BEREDAR. SEKITAR 30.000 JENIS YANG BERBAHAYA.
DILAPORKAN 2-6% KEJADIAN LUKA BAKAR KARENA BAHAN KIMIA.
![Page 63: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/63.jpg)
KLASIFIKASI BAHAN KIMIA :1. ALKALIS / BASA
HYDROXIDES, CAUSTIC SODAS, POTASSIUM AMMONIUM, LITHIUM, BARIUM, CALCIUM.BAHAN-BAHAN PEMBERSIH.MENYEBABKAN LIQUAFACTION NECROSIS DAN PROTEIN DENATURATION
2. ACIDS / ASAMHYDROCHLORIC ACID, OXALIC ACID, SULFURIC ACIDPEMBERSIH KAMAR MANDI, KOLAM RENANG.MENYEBABKAN KERUSAKAN COAGULATION NECROSIS
3. ORGANIC COMPOUNDSPHENOL, CREOSOTE, PETROLEUM.SEBAGAI DESINFECTANS KIMIA.MENYEBABKAN KERUSAKAN CUTANEUS, EFEK TOKSIS TERHADAP GINJAL DAN LIVER
![Page 64: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/64.jpg)
BERAT/RINGANNYA TRAUMA TERGANTUNG :
1. BAHAN / AGENT
2. KONSENTRASI
3. VOLUME
4. LAMA KONTAK
5. MEKANISME TRAUMA
![Page 65: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/65.jpg)
PENATALAKSANAAN :
1. BEBASKAN PAKAIAN YANG TERKENA.
2. IRIGASI DENGAN AIR YANG KONTINYU
3. HILANGKAN RASA NYERI
4. PERHATIKAN AIRWAY, BREATHING DAN CIRCULATION
5. IDENTIFIKASI BAHAN PENYEBAB
6. PERHATIKAN BILA MENGENAI MATA
7. PENANGANAN SELANJUTNYA SAMA SEPERTI
PENANGANAN LUKA BAKAR.
![Page 66: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/66.jpg)
LUKA BAKAR DANKEHAMILAN
![Page 67: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/67.jpg)
LUKA BAKAR DAN KEHAMILAN
HATI-HATI TERHADAP KOMPLIKASI.
KOMPLIKASI PADA IBU DAN JANIN.
PADA LUKA BAKAR 60% ATAU LEBIH
MENIMBULKAN SPONTAN TERMINASI DARI
KEHAMILAN.
![Page 68: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/68.jpg)
PENATALAKSANAAN
1. SEGERA DILAKUKAN STABILISASI AIRWAY. KALAU PERLU DILAKUKAN ENDOTRACHEAL INTUBASI. HIPOKSIA DAPAT TERJADI PADA IBU DAN JANIN.
2. RESPIRATORY DISTRESS DAN HYPOKSIA DAPAT MENIMBULKAN RESISTAN VASKULER PADA UTERUS, MENGURANGI UTERUS BLOOD FLOW DAN OKSIGEN KE JANIN MENURUN.
3. MONITORING JANIN
4. KONSULTASI DENGAN SPESIALIS KANDUNGAN.
![Page 69: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/69.jpg)
KOMPLIKASI
1. TERMINASI KEHAMILAN AKIBAT HYPOTENSI, HYPOKSIA SERTA ADANYA GANGGUAN CAIRAN DAN ELEKTROLIT
2. PERSALINAN PREMATUR
3. KEMATIAN JANIN INTRA UTERINE
![Page 70: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/70.jpg)
![Page 71: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/71.jpg)
![Page 72: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/72.jpg)
![Page 73: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/73.jpg)
![Page 74: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/74.jpg)
![Page 75: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/75.jpg)
CLINITRON BED
![Page 76: Acute Burn Management BIL](https://reader033.vdocuments.mx/reader033/viewer/2022061107/544b817caf79599c438b523b/html5/thumbnails/76.jpg)