Upload
indah-lusiadi
View
226
Download
2
Embed Size (px)
DESCRIPTION
86483059 Luka Bakar Dr Adam
Citation preview
Dr. Adam Suyadi,SpB,MMBag Bedah FK UII Yogyakarta
Luka Bakar
Skin Anatomy
TIGA FAKTOR PENTING DALAM LUKA BAKAR1.ETIOLOGI / PENYEBAB2.KEDALAMAN LUKA BAKAR3.LUAS LUKA BAKAR
ETIOLOGI1.SUHU:PANAS ( API, UAP, AIR )DINGIN ( FROST BITE )2.LISTRIK3.KIMIA ASAM BASA 4.RADIASI5.LASER
KEDALAMAN LUKA BAKARDERAJAT SATU Superficial Skin BurnDERAJAT DUAPartial Thickness Skin BurnDERAJAT TIGAFull Thickness Skin Burn
Derajat 1
KEDALAMAN LUKA BAKARLuka Bakar Derajat Satu
Derajat 2
KEDALAMAN LUKA BAKARLuka Bakar Derajat Dua
Derajat 3
Luka Bakar Derajat Tiga
Luas Luka Bakar:Rule of Ninessurface of patient,s palm = 1% BSA
LUAS LUKA BAKARRule of Nines
Burns / Cold InjuriesManagement Principles Establish / maintain Airway Normal perfusion Fluid / electrolyte balance Normal body temperature
Inhalation InjuryClinical Indications Carbonaceous sputum Facial burns Hair singeing Carbon deposits Inflamed oropharynx History CO Hgb >10%
Life Saving Burn TreatmentRemove all Injurious material Clothing jewelry Prevent hypothermia Establish 2 large caliber IVS Initiate warmed ringer,s lactate solution
Burn AssessmentHistory Mechanism of injuryAssociated illnesses Allergies Tetanus status
Burn ManagementAirway Assess for injury Establish and maintain patent airway early
Burns ManagementBreathing Assume CO exposure Inhalation of toxic fumes, carbon particles Direct thermal injury Oxygenate/Ventilate Endotracheal intubation ABGs and CO levels
Burn ManagementCirculation Adequate venous access Monitor vital signs Hourly Urinary output Adult : 30-50 ML/hour Child : 1.0 ML/kg/hour
Burn ManagementCirculation : Estimate Fluid Needs 2-4 ml warmed ringer,s lactate Solution / kg / % BSA in 1st 24 hours in first 8 hours in next 16 hoursBased on time from injury Monitor heard rate and urinary output
PENANGANANRESUSITASIA - B - CB:Luka Bakar Pada Dinding Dada ESCHAROTOMYC:FORMULA BAXTERInfus RL: 4 cc x BB (Kg) x LUAS LB (%)
CONTOH KASUSPASIEN DENGAN BB 50 Kg LLB 20%Kebutuhan Cairan : 4 x 50 Kg x 20 % 4000 cc RL8 Jam pertama 2000 cc 62 tts/mnt16 Jam berikut 2000 cc 31 tts/mnt
Burn ManagementDevelop Treatment Plan Estimate burn size depth Identify associated injuries Weigh patient Baseline blood analyses and chest x-ray Document on flow sheet
Burn ManagementMaintain peripheral Circulation Remove All constricting devices Assess distal circulation Escharotomy : Surgical consult Fasciotomy/Escharotomy
Burn ManagementGastric Intubation Nausea vomiting , distentionBurns > 20% BSA MedicationsNarcotics : Minimal use IV only Antibiotics : Not indicated early
Burn ManagementWound Care Cover with clean linens Do not Break bisters Apply antiseptics Apply cold water
INDIKASI RAWAT INAPLB Derajat II > 15% Dewasa> 10% Anak / GeriatriLB Derajat III> 10% DewasaListrik / KimiaLB di daerah muka, tangan, genital, perinealLB dengan kelainan lain / trauma lain yang berat
PERAWATAN LUKADerajat Satu Derajat Dua Cuci NaCl + Savlon500 cc5 ccSofratulKassa Steril(Biarkan Satu Minggu)
Burn ManagementChemical Burns Duration, amount ,concentration Brush away dry chemicals Flush with copious amounts of water for 20-30 MinutesAlkali Burn
Burn ManagementElectrical BurnResult in damage to fascia and muscle, and may spare the overlying skin
Burn ManagementElectrical BurnABCDES Myoglobinuria Fluids : 100 ml urine / hourMannitol : 25 g IV Metabolic acidosisMaintain adequate perfusion Sodium bicarbonate
Burn Transfer Criteria2nd and 3rd Degree burn >10% BSA in ages 50 years >20% BSA To : Face Eyes Ears Hand Feet Genitalia Perineum Major joints
Burn Transfer Criteria
3rd degree burn > 5% BSA Electrical and chemical burns Inhalation injury Preexisting illnesses,associated injuries Children Special situations
Burn Transfer ProsedureCoordinate with burn center doctor Transfer withDocumentation/Information Laboratory results
Cold Injury FactureTemperatureDuration of exposure Environmental conditions Immobilization Moisture Vascular disease Open wounds
DefinitionFrostbite refers to the freezing of body tissue (usually skin), that results in loss of feeling and color in the tissue. It most commonly affects the feet and hands (which account for 90% of cases), the nose, or the ears.
There are three degrees of frostbitefrostnipsuperficial frostbitedeep frostbite
Most cases occur in adults between 30 and 49.
EtiologyFrostbite is caused by prolonged exposure to cold temperatures, particularly when accompanied by a low wind-chill factor or by briefer exposure to very cold temperatures
Cold ManagementDo not delay Remove clothing Warmed blankets Rewarm frozen partPreserve damaged tissue Prevent infection Elevate exposed partAnalgesics, tetanus, and antibiotics
Hypothermia : T < 35 Degrees
Rapid /slow drop in core temperature Elderly and Children at greater risk Low range thermometer required Clinical findings Depressed LOC Gray cyanotic Variable vital signs Absence of cardiorespiratory activity
HypothermiaManagement ABCDES, IV access Oxygenate and ventilate Prevent heat loss and rewarm Assess for associated disorders Blood analyses
HypothermiaManagement Passive external rewarming : Warmed environment, blankets, and IV fluids Active core rewarming Surgical rewarming techiniques Do not delay transfer Not dead until warm and dead
SummaryBurn InjuryRecognize and treat inhalation injury Fluid recuscitation Identify burns requiring transfer
SummaryCold injury Diagnose type History Clinical findings Measure core temperature Rewarming techniques Monitor and support vital functions