Luka Bakar
Dr. Dewi Haryanti K, SpBP
Sub Bagian Bedah Plastik
RSUD dr. Moewardi/ FK UNS Ska
Tujuan:
Menjelaskan prosedur
penatalaksanaan luka bakar
thermis, kimia dan listrik
Overview:







Severity
Klasifikasi Luka Bakar
Emergency Medical Care
Luka Bakar Kimia
Luka Bakar Listrik
Dressing and Bandaging
Trauma Inhalasi
Severity Luka Bakar
Ditentukan oleh:
- derajat kedalaman
- luas
- critical areas yang terkena
- medical condition atau trauma
- umur pasien
Derajat Kedalaman (Grade) Luka
Bakar:
Derajat kedalaman
(Grade)
Struktur yg terkena
Gejala dan Keluhan
Grade I
(Superficial Burns)
Hanya mengenai lapisan
atas kulit (epidermis)
-Hiperemi
- Nyeri +
- Bullae -
Grade II
(Partial Thickness Burns)
Mengenai epidermis dan
sebagian dermis
--lembab, mottled, kulit
merah – memutih
-- Nyeri ++
--Bullae +
Grade III
(Full Thickness Burns)
Mengenai seluruh lapisan
kulit
--- kering
--- putih/coklat tua/hitam
---charred
--- tdk nyeri
EPIDERMIS
Gr I
Gr IIA
Gr IIB
Gr III
DERMIS
Partial Thickness Burns
Full Thickness Burns
Luas Luka Bakar
 Ditentukan
oleh percentage (%)
dari body area yang terbakar
 Telapak tangan pasien + 1%
 ‘rule of nines’ dari Wallace
Rule of nines of Wallace
 Membagi
tubuh menjadi beberapa
bagian
 Digunakan untuk mengkalkulasi
% permukaan tubuh yang
terbakar
Rule of Nines
BODY PART
 Head & Neck
 Arms
 Front & Back
 Legs
 Genitalia
ADULT
9
9 (2)
18 (2)
18 (2)
1
CHILD
18
9 (2)
18 (2)
13.5 (2)
1
Rule of Nines
(Wallace)
Lokasi Luka Bakar

Meliputi critical areas
(wajah, upper airway, hands,
genitalia)
Pre existing medical
conditions
• DM
• py. Cardiopulmonum,
• gangguan psikiatrik, dll
Umur Pasien


< 10 tahun
> 50 tahun
Severity Luka Bakar, dibagi
menjadi:



major burns
moderate burns
minor burns
Dewasa
Major Burns
Moderate Burns
Minor Burns
LB gr II>25%
LB gr II 15-25%
LB gr II < 15%
LB gr III>10%
LB gr III 2-10% (*) LB gr III < 2%
LB mengenai mata, telinga, wajah,
tangan, kaki atau perineum yang
mengakibatkan gangguan kosmetik
atau fungsi
Electrical burns
LB disertai trauma inhalasi
LB disertai ‘underlying diseases’
Chemical burns
LB disertai trauma penyerta lain
* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau perineum
Usia <10 th dan > 50th
Major Burns
Moderate Burns
Minor Burns
LB gr II > 20%
LB gr II 10-20%
LB gr II < 10%
LB gr III > 10%
LB gr III 2-10% (*)
LB gr III < 2%
Lainnya ̴ dewasa
* Tanpa resiko ggn fungsi atau kosmetik pada mata, telinga, wajah, tangan, kaki atau
perineum
Emergency Medical Care

Pasien Dewasa
Stop the burning process &
cegah cedera lbh lanjut
Bahan isolator
Monitor airway – beri O2
Cegah kontaminasi lebih lanjut
Luka Bakar
 Indikasi
MRS:
– semua derajat III
– Major Burns dan Moderate Burns
 Indikasi
poliklinis (rawat jalan):
–Minor Burns (kec. Derajat III)
Emergency Medical Care
Selimuti
dengan bahan kering &
‘steril’
 No ointments, lotion, or
antiseptic
Do not break blisters
Transport ASAP
Emergency Medical Care
 Pasien
Pediatrik
–Greater surface area in relationship to the
total body size
–Fluid and heat loss >>
–Risk of shock, airway and hypothermia ↑
–Consider child abuse
Pasien Pediatrik
 Transport
- “scoop and run”
Luka Bakar Kimia

Disebabkan karena adanya
kontak kulit dengan bahan toksik
Luka Bakar Kimia
 Disebabkan
oleh alkali, asam dan
campuran
 Protect yourself from exposure or
injury
Luka Bakar Kimia
Emergency Care
 Stop
the burning process
(1) Immediately flush with large
amounts of water
(2) Do not contaminate
uninjured areas
(3) Continue flushing while
enroute to hospital
 (4)
Cover with dry sterile dressing
or clean sheet
 (5) Special care of the eyes
Gently /continuously flush
For direct eye injury hold lids
open and irrigate the eye
Dry chemicals
 Reaction
with water can worsen
burn
(1) “Brush - then flush”
(2) Remove victims clothing
(shoes & socks)
Luka Bakar Listrik
 Scene
Safety
Do not contact high voltage wires
Consider all wires live
Do not handle down lines
Do not come in contact with patient
if the electrical source is live
Emergency Medical Care
 May
be more serious than it
seems
 Entry wound is usually a small
burn area
 Look for an extensive exit wound
 Possible tissue damage
underneath (current spreads out
as it travels through the body)
Emergency Medical Care
cont:
 Possible
Cardiac arrest
 Possible Respiratory arrest
 Splint possible fractures
 Treat wounds with a dry, sterile
dressing
 Transport
Electrical Burns
 Treat
first
any major complications
 Entry
wound on head
 Exit wound on foot
Electrical Injuries
Luka Masuk
Luka Keluar
Dressing and Bandaging
 Stop
bleeding
 Protect wound from further
damage
 Prevent further contamination
and infection
Trauma Inhalasi
 Chemical
fumes
Obvious fumes in the air
Inhaled fumes
Carbon Monoxide (CO)
 Deadly
poison
Carbon Monoxide
 Different
than smoke inhalation
Odorless
Tasteless
Not an irritant
Signs and symptoms
 a.
Dyspnea (difficulty in
breathing)
 b. Respiratory arrest
 c. Cherry red skin
Cyanide
Signs and Symptoms
 Burnt
almonds
 Dyspnea (difficulty in breathing)
 Respiratory arrest
Treatment
 a.
100% oxygen through a nonrebreathing mask
 b. Be prepared to do basic life
support
 c. Transport
Pemberian cairan pada Luka
Bakar
 Formula
Baxter
– Dewasa
4cc x % luas LB x kg BB =.....cc lar. RL
diberikan : ½ bagian pada 8 jam I
½ bagian pada16 jam berikutnya
diberikan lar. koloid 500-1000cc pd jam ke 18-24
Pemberian cairan pada Luka
Bakar

Formula (modifikasi) Baxter
– Anak
2cc x % luas LB x kg BB=...cc lar. RL
diberikan: ½ bagian pada 8 jam I
½ bagian pada 16 jam berikutnya
larutan koloid 17:3 (sejak jam ke-0)
Hari berikutnya diberikan cairan maintenance