Asam format

Dari Wikipedia bahasa Indonesia, ensiklopedia bebas

Belum Diperiksa

Asam format

Nama IUPAC[sembunyikan]
Asam format[1]

Nama sistematis[sembunyikan]
Asam metanoat
Nama lain[sembunyikan]
Asam aminat; asam formilat, asam formiat, asam semut, asam hidrogen
karboksilat; hidroksimetanon, hidroksi(okso)metana, asam
metakarbonoat, asam oksokarbinat, oksometanol
Identifikasi
Nomor CAS

[64-18-6]

PubChem

284

DrugBank

DB01942

KEGG

C00058

ChEBI

30751

Nomor RTECS

LQ4900000

Kode ATC
SMILES

C(=O)O

InChI

1/CH2O2/c2-1-3/h1H,(H,2,3)

Sifat
Rumus kimia

CH2O2

Massa molar

46.03 g mol1

Penampilan

Cairan tak berwarna

Densitas

1.22 g/mL

Titik lebur
Titik didih
Kelarutan dalam air

Ya

Keasaman (pKa)

3.77 [2]

Viskositas

1.57 cP at 26 C
Struktur

Bentuk molekul

Planar

Momen dipol

1.41 D(gas)
Bahaya

MSDS

JT Baker

Bahaya utama

Korosif, iritasi;
sensitizer.

NFPA 704

2
3
1
Frasa-R

R10 R35

Frasa-S

(S1/2) S23 S26 S45

Titik nyala

69 C (156 F)
Senyawa terkait

Asam karboksilat terkait

Asam asetat
Asam propionat

Senyawa terkait

Formaldehid
Metanol

Kecuali dinyatakan sebaliknya, data di atas berlaku

pada temperatur dan tekanan standar (25C, 100 kPa)

Sangkalan dan referensi

Asam format atau asam formiat (nama sistematis: asam metanoat) adalah asam
karboksilat yang paling sederhana. Asam format secara alami antara lain terdapat pada
sengat lebah dan semut, sehingga dikenal pula sebagai asam semut. Asam format
merupakan senyawa antara yang penting dalam banyak sintesis bahan kimia. Rumus kimia
asam format dapat dituliskan sebagaiHCOOH atau CH2O2.
Di alam, asam format dihasilkan banyak serangga dari bangsa Hymenoptera, misalnya lebah
dan semut sebagai alat serang atau alat bertahan. Asam format juga merupakan hasil
pembakaran yang signifikan dari bahan bakar alternatif, yaitu
pembakaranmetanol (dan etanol yang tercampur air), jika dicampurkan dengan bensin. Nama
asam format berasal dari kata Latin formica yang berarti "semut". Pada awalnya, senyawa ini
diisolasi melalui distilasi semut. Semut menghasilkan asam ini pada kantung yang disebut
sebagai acidophore. Apabila semut "mengigit" (sebenarnya menjepit), ia juga menyemprotkan
asam format dari acidophoreuntuk memperkuat rasa sakit pada korbannya. Senyawa kimia
turunan asam format, misalnya kelompok garam dan ester,
dinamakan format atau metanoat. Ion format memiliki rumus kimia HCOO.

Referensi[sunting | sunting sumber]

1.

^ Templat:PubChem

2.

^ Brown, H. C. et al., in Braude, E. A. and Nachod, F. C., Determination of Organic

Structures by Physical Methods, Academic Press, New York, 1955.

http://www.healthline.com/health/chemical-burn-or-reaction#Overview1
http://www.emedicinehealth.com/chemical_burns/page4_em.htm

Penanganan Pertama pada Luka Bakar

BY ADMIN APRIL 20, 2012 NO COMMENTS
KESEHATAN TAGGED: KESEHATAN, LUKA BAKAR, OBAT, PERTAMA

Dalam kehidupan kita sehari-hari,sering melihat atau

mengalami sendiri yang namanya luka bakar. Dan seringkali respon tindakan yang dilakukan oleh kita atau
masyarakat awam malah memperberat luka yang terjadi. Untuk itulah diperlukan pengetahuan yang baik dan
tepat sehingga tindakan atau ketrampilan yang dilakukan juga baik dan tepat, sehingga luka yang ditimbulkan
dapat segera sembuh.
Luka bakar merupakan salah satu jenis luka, kerusakan jaringan atau kehilangan jaringan yang diakibatkan
sumber panas ataupun suhu dingin yang tinggi. Penyebab dari terjadinya luka bakar dapat dikelompokkan dalam
beberapa jenis, yaitu :
1. Sumber panas seperti api, air panas dan uap panas.
2. Sumber listrik
3. Bahan kimiawi
4. Sinar matahari dan radiasi
Jenis luka dapat beraneka ragam dan memiliki penanganan yang berbeda tergantung jenis jaringan yang
terkena luka bakar, tingkat keparahan, dan komplikasi yang terjadi akibat luka tersebut. Luka bakar dapat
merusak jaringan otot, tulang, pembuluh darah dan jaringan epidermal yang mengakibatkan kerusakan yang
berada di tempat yang lebih dalam dari akhir sistem persarafan.
Seorang korban luka bakar dapat mengalami berbagai macam komplikasi yang fatal termasuk diantaranya
adalah kondisi shock, infeksi, ketidak seimbangan elektrolit (inbalance elektrolit) dan masalah distress
pernapasan.
Selain komplikasi yang berbentuk fisik, luka bakar dapat juga menyebabkan distress emosional (trauma) dan
psikologis yang berat dikarenakan cacat akibat luka bakar dan bekas luka (scar).
Berikut ini merupakan penangan pertama pada luka bakar dilihat berdasarkan dengan penyebabnya :
1. Luka bakar akibat sumber panas (api, air panas, uap panas)
Tahapan penanganan Pertama, luka bakar akibat air panas dan uap panas adalah pertama, jauhkan dari sumber
panas.
Kedua, jangan diolesi cairan seperti odol, minyak goreng, kecap, ataupun minyak tanah karena akan
memperdalam luka bakar.

Ketiga, buka keran air atau keran ledeng, lalu alirkan air tersebut ke arah bagian tubuh yang terkena luka bakar
selama 10-20 menit.
Ini dilakukan untuk menurunkan suhu panas yang diakibatkan luka bakar tersebut. Jangan memakai air es atau
es batu atau mencemplungkan diri dalam bak mandi, karena perubahan suhu yang tiba-tiba (antara panas dan
dingin), akan memperdalam luka bakar.
Penanganan luka bakar akibat api yaitu sebaiknya jangan merasa panik, dan berlari untuk mencari air. Hal ini
akan menyebabkan sebaliknya, yaitu akan memperbesar kobaran api karena tertiup oleh angin.
Oleh karena itu, segeralah hentikan (stop), jatuhkan (drop), dan gulingkan (roll) orang itu agar api segera padam.
Bila memiliki karung basah, segera gunakan air atau bahan kain basah untuk memadamkan apinya.
Apabila luka bakar yang dialami serius, seperti luka bakar yang dialami oleh korban ledakan gas elpiji, maka
yang harus dilakukan adalah : buka baju korban, lepaskan cincin, jam, atau barang apapun yang melekat pada
diri korban, selimuti tubuh korban dengan selimut bersih, lalu, bawa ke rumah sakit.
2. Luka bakar akibat sumber listrik
Pisahkan korban dari sumber listrik yaitu dengan segera mematikan sumber arus listrik. sebelum sumber listrik
dimatikan, penolong sebaiknya jangan dulu menyentuh korban, apalagi jika sumber listrik memiliki tegangan
tinggi.
Jika sumber arus tidak dapat dimatikan, gunakan benda-benda non-konduktor (tidak bersifat menghantarkan
listrik seperi sapu, kursi, karpet atau keset yang terbuat dari karet) untuk mendorong korban dari sumber listrik.
Jangan menggunakan benda-benda yang basah atau terbuat dari logam.
Jika memungkinkan, berdirilah di atas sesuatu yang kering dan bersifat non-konduktor (misalnya keset atau
kertas koran yang dilipat). Jangan coba-coba menolong korban yang berada dekat arus listrik bertegangan
tinggi.
Jika korban mengalami luka bakar, buka semua pakaian yang mudah dilepaskan dan siram bagian yang terbakar
dengan air dingin yang mengalir untuk mengurangi nyeri. Jika korban pingsan, tampak pucat atau menunjukkan
tanda-tanda syok, korban dibaringkan dengan kepala pada posisi yang lebih rendah dari badan dan kedua
tungkainya terangkat, selimuti korban dengan selimut atau jaket hangat.
Luka/cidera akibat listrik seringkali disertai dengan terlontarnya atau terjatuhnya korban sehingga terjadi cedera
traumatik tambahan, baik berupa luka luar yang tampak nyata maupun luka dalam yang tersembunyi.
Jangan memindahkan kepala atau leher korban jika diduga telah terjadi cedera tulang belakang. Setelah aman
dari sumber listrik, segera dilakukan pemeriksaan terhadap fungsi pernafasan dan denyut nadi. jika terjadi
gangguan fungsi pernafasan dan nadinya tidak teraba, segera lakukan resusitasi.
Sebaiknya dicari tanda-tanda patah tulang, dislokasi dan cedera tumpul maupun cedera tulang belakang. (halhal tersebut diatas sebaiknya dilakukan oleh tenaga medis).
3. Luka bakar akibat bahan kimiawi

Bahan kimiawi yang dapat menyebabkan luka bakar adalah asam kuat atau basa kuat. Luka bakar akibat bahan
kimia umumnya disebabkan karena sifat kimiawi bahan tersebut yang tajam dan dapat membakar kulit, seperti
[sodium hidroksida], silver nitrate, dan bahan kimia berbahaya lainnya (seperti asam sulfur ataupun asam nitrat).
Untuk penanganannya segera basuh menggunakan air bersih dan jauhkan dari sumber bahan kimia, lalu, bawa
ke rumah sakit segera untuk penanganan selanjutnya.
4. Akibat sengatan sinar matahari dan radiasi
Sengatan sinar matahari (sunburn) umumnya terjadi karena paparan sinar ultraviolet yang berlebihan yang
dipancarkan oleh matahari. Paparan yang berlebihan dalam waktu cukup lama dapat mengakibatkan
peradangan kulit akut. Sebenarnya, definisi sunburn tidak terbatas pada sinar ultraviolet dari matahari, tetapi
juga termasuk luka bakar akibat paparan sinar ultraviolet dari sumber lain seperti lampu ultraviolet.
Penanganan sunburn dapat dilakukan antara lain dengan cara : mendinginkan daerah yang terkena dengan
kompres dingin atau berendam di air dingin, menjaga bagian yang mengalami luka bakar tetap lembab, misalnya
dengan mengoleskan krim pelembab, membiarkan luka lepuh tetap utuh.
Jangan mencoba untuk memecahkannya karena akan memperlambat proses penyembuhan dan meningkatkan
risiko infeksi, jika timbul nyeri, dapat dikurangi dengan mengkonsumsi obat pereda nyeri misalnya parasetamol
atau ibupropen, jika kulit mulai mengelupas, rawat dengan hati-hati dan kalau perlu oleskan krim pelembab.
Semua penangan diatas hanya merupakan penangan pertama yang didapat dilakukan dalam keadaan darurat,
penangan selanjutnya terutama pada kasus-kasus yang gawat tentunya memerlukan penanganan lebih lanjut
dengan segera di rumah sakit.
oleh : dr. H. Yahmin Setiawan, MARS (Direktur LKC Dompet Dhuafa) dan Putri Halley Sari
Hadi(Mahasiswa FKUI Kelas Internasional Semester 13 Yang Magang di LKC )

http://www.lkc.or.id/2012/04/20/penanganan-pertama-pada-luka-bakar/

General Information

After a chemical mass casualty incident, trauma with or without burns is expected to
be common.

Burn therapy adds significant logistical requirements and complexity to the medical
response in a chemical mass casualty incident.

Burns complicating physical injury and/or chemical injury decrease the likelihood of
survival.

Health care providers with burn expertise are needed to optimize burn care.

Consultation with American Burn Association Verified Burn Centers is recommended

top of page

Diagnosis of Burns

Definition: A burn is the partial or complete destruction of skin caused by some form
of energy, usually thermal energy.

Burn severity is dictated by:

o

Percent total body surface area (TBSA) involvement

Burns >20-25% TBSA require IV fluid resuscitation

Burns >30-40% TBSA may be fatal without treatment

In adults: "Rule of Nines" is used as a rough indicator of % TBSA

Rule of Nines for Establishing Extent of Body Surface Burned

Anatomic Surface

% of total body surface

Head and neck

9%

Anterior trunk

18%

Posterior trunk

18%

Arms, including hands

Legs, including feet
Genitalia

9% each
18% each
1%

In children, adjust percents because they have proportionally larger

heads (up to 20%) and smaller legs (13% in infants) than adults

Lund-Browder diagrams improve the accuracy of the % TBSA

for children.

Palmar hand surface is approximately 1% TBSA

Estimating Percent Total Body Surface Area in Children Affected

by Burns

(A) Rule of "nines"

(B) Lund-Browder diagram for estimating extent of burns
(Adapted from The Treatment of Burns, edition 2, Artz CP and Moncrief
JA, Philadelphia, WB Saunders Company, 1969)
o

Depth of burn injury (deeper burns are more severe)

Superficial burns (first-degree and superficial second-degree burns)

First-degree burns

Damage above basal layer of epidermis

Dry, red, painful ("sunburn")

Second-degree burns

Damage into dermis

Skin adnexa (hair follicles, oil glands, etc,) remain

Heal by re-epithelialization from skin adnexa

The deeper the second-degree burn, the slower the

healing (fewer adnexa for re-epithelialization)

Moist, red, blanching, blisters, extremely painful

Superficial burns heal by re-epithelialization and usually do not

scar if healed within 2 weeks

Deep burns (deep second-degree to fourth-degree burns)

Deep second-degree burns (deep partial-thickness)

Damage to deeper dermis

Less moist, less blanching, less pain

Heal by scar deposition, contraction and limited reepithelialization

Third-degree burns (full-thickness)

Entire thickness of skin destroyed (into fat)

Any color (white, black, red, brown), dry, less painful

(dermal plexus of nerves destroyed)

Heal by contraction and scar deposition (no epithelium

left in middle of wound)

Fourth-degree burns

Burn into muscle, tendon, bone

Need specialized care (grafts will not work)

Deep burns usually need skin grafts to optimize results and

lead to hypertrophic (raised) scars if not grafted

Age

Mortality for any given burn size increases with age

Children/young adults can survive massive burns

Delay increases fluid requirements

Need for escharotomies and fasciotomies

Other trauma increases severity of injury

Delay in resuscitation

Smoke inhalation injury doubles the mortality relative to burn size

Associated injuries

Elderly may die from small (<15% TBSA) burns

Smoke inhalation injury

Children require more fluid per TBSA burns

Increases fluid requirements

Use of alcohol or drugs (especially methamphetamine)

Makes resuscitation more difficult

top of page

American Burn Association Burn Unit Referral Criteria

*Criteria not established for very large mass casualty incidents (MCI)
Summary of Burn Unit Referral Criteria (PDF - 7 KB) (American Burn Association)
1. Second- and third-degree burns greater than 10% TBSA in patients under 10 or over
50 years of age
2. Second- and third-degree burns greater than 20% TBSA in other age groups
3. Second- and third-degree burns that involve the face, hands, feet, genitalia,
perineum, and major joints
4. Third-degree burns greater than 5% TBSA in any age group
5. Electrical burns, including lightning injury
6. Chemical burns
7. Inhalation injury
8. Burn injury in patients with pre-existing medical disorders that could complicate
management, prolong recovery, or affect mortality (e.g., significant chemical
exposure)
9. Any patients with burns and concomitant trauma (e.g., fractures, blast injury) where
burn injury poses the greatest risk of morbidity or mortality. In such cases, if the
trauma poses the greater immediate risk, the patient may be treated initially in a
trauma center until stable before being transferred to a burn center. Physician
judgment will be necessary in such situations and should be in concert with the
regional medical control plan and triage protocols appropriate for the incident
10. Hospitals without qualified personnel or equipment for the care of children should
transfer children with burns to a Verified Burn Center with these capabilities

11. Burn injury in children who will require special social/emotional and/or long-term
rehabilitative support, including cases involving suspected child abuse or substance
abuse
top of page

Treatment

General information
o

All burn patients should initially be treated with the principles of Advanced
Burn and/or Trauma Life Support

The ABC's (airway, breathing, circulation) of trauma take precedent

over caring for the burn

Search for other signs of trauma

Verified Burn Centers provide advanced support for complex cases

o

Certified by the American College of Surgeons (ACS) Committee on Trauma

and the American Burn Association (ABA)

Resources will give advice or assist with care

Burn Unit Referral Criteria (PDF - 7 KB) (American Burn Association)

Airway
o

Extensive burns may lead to massive edema

Obstruction may result from upper airway swelling

Risk of upper airway obstruction increases with

Massive burns

All patients with deep burns >35-40% TBSA should be

endotracheally intubated

Burns to the head

Burns inside the mouth

Intubate early if massive burn or signs of obstruction

Intubate if patients require prolonged transport and any concern with

potential for obstruction

If any concerns about the airway, it is safer to intubate earlier than

when the patient is decompensating

Signs of airway obstruction

Hoarseness or change in voice

Use of accessory respiratory muscles

High anxiety

Tracheostomies not needed during resuscitation period

Remember: Intubation can lead to complications, so do not intubate if not

needed

Breathing
o

Hypoxia

Fire consumes oxygen so people may suffer from hypoxia as a result of

flame injuries

Carbon monoxide (CO)

Byproduct of incomplete combustion

Binds hemoglobin with 200 times the affinity of oxygen

Leads to inadequate oxygenation

Diagnosis of CO poisoning

Nondiagnostic

PaO2 (partial pressure of O2 dissolved in serum)

Oximeter (difference in oxy- and deoxyhemoglobin)

Patient color ("cherry red" with poisoning)

Diagnostic

Carboxyhemoglobin levels

<10% is normal

>40% is severe intoxication

Treatment

Remove source

100% oxygen until CO levels are <10%

Smoke inhalation injury

Pathophysiology

Smoke particles settle in distal bronchioles

Mucosal cells are die

Sloughing and distal atelectasis

Increase risk for pneumonia

Diagnosis

History of being in a smoke-filled enclosed space

Bronchoscopy

Soot beneath the glottis

Airway edema, erythema, ulceration

Nondiagnostic clinical tests

Early chest x-ray

Early blood gases

Nondiagnostic clinical findings

Soot in sputum or saliva

Singed facial hair

Treatment

Supportive pulmonary management

Aggressive respiratory therapy

Circulation
o

Obtain IV access anywhere possible

Unburned areas preferred

Burned areas acceptable

Central access more reliable if proficient

Cut-downs are last resort

Resuscitation in burn shock (first 24 hours)

Massive capillary leak occurs after major burns

Fluids shift from intravascular space to interstitial space

Fluid requirements increase with greater severity of burn (larger %

TBSA, increase depth, inhalation injury, associate injuries - see above)

Fluid requirements decrease with less severe burn (may be less than
calculated rate)

IV fluid rate dependent on physiologic response

Place Foley catheter to monitor urine output

Goal for adults: urine output of 0.5 ml/kg/hour

Goal for children: urine output of 1 ml/kg/hour

If urine output below these levels, increase fluid rate

Preferred fluid: Lactated Ringer's Solution

Isotonic

Cheap

Easily stored

Resuscitation formulas are just a guide for initiating resuscitation

Resuscitation formulas:

Parkland formula most commonly used

IV fluid - Lactated Ringer's Solution

Fluid calculation

4 x weight in kg x %TBSA burn

Give 1/2 of that volume in the first 8

hours

Give other 1/2 in next 16 hours

Warning: Despite the formula suggesting

cutting the fluid rate in half at 8 hours,
the fluid rate should be gradually
reduced throughout the resuscitation to
maintain the targeted urine output, i.e.,
do not follow the second part of the
formula that says to reduce the rate at 8
hours, adjust the rate based on the urine
output.

Example of fluid calculation

100-kg man with 80% TBSA burn

Parkland formula:

4 x 100 x 80 = 32,000 ml

Give 1/2 in first 8 hours = 16,000 ml in

first 8 hours

Starting rate = 2,000 ml/hour

Adjust fluid rate to maintain urine output of 50

ml/hr

Albumin may be added toward end of 24 hours if

not adequate response

Resuscitation endpoint: maintenance rate

When maintenance rate is reached (approximately 24 hours),

change fluids to D50.5NS with 20 mEq KCl at maintenance level

Maintenance fluid rate = basal requirements + evaporative losses

Basal fluid rate

Adult basal fluid rate = 1500 x body surface area (BSA)

(for 24 hrs)

Pediatric basal fluid rate (<20kg) = 2000 x BSA (for 24

hrs)

May use

100 ml/kg for 1st 10 kg

0 ml/kg for 2nd 10 kg

20 ml/kg for remaining kg for 24 hrs

Evaporative fluid loss

Adult: (25 + % TBSA burn) x (BSA) = ml/hr

Pediatric (<20kg): (35 + % TBSA burn) x (BSA) =

ml/hr

Complications of over-resuscitation

Compartment syndromes

Best dealt with at Verified Burn Centers

If unable to obtain assistance, compartment syndromes may

require management

Limb compartments

Symptoms of severe pain (worse with movement),

numbness, cool extremity, tight feeling compartments

Distal pulses may remain palpable despite ongoing

compartment syndrome (pulse is lost when pressure >
systolic pressure)

Compartment pressure >30 mmHg may compromise

muscle/nerves

Measure compartment pressures with arterial line

monitor (place needle into compartment)

Escharotomies may save limbs

Performed laterally and medially throughout

entire limb

Performed with arms supinated

Hemostasis is required

Fasciotomies may be needed if pressure does not drop

to <30 mmHg

Requires surgical expertise

Hemostasis is required

Chest Compartment Syndrome

Increased peak inspiratory pressure (PIP) due to

circumferential trunk burns

Escharotomies through mid-axillary line, horizontally

across chest/abdominal junction

Abdominal Compartment Syndrome

Pressure in peritoneal cavity > 30 mmHg

Measure through Foley catheter

Signs: increased PIP, decreased urine output despite

massive fluids, hemodynamic instability, tight abdomen

Treatment

Abdominal escharotomy

NG tube

Possible placement of peritoneal catheter to

drain fluid

Laparotomy as last resort

Acute Respiratory Distress Syndrome (ARDS)

Increased risk and severity if over-resuscitation

Treatment supportive

Wound Care
o

During initial or emergent care, wound care is of secondary importance

Advanced Burn Life Support recommendations

Cover wound with clean, dry sheet or dressing. NO WET DRESSINGS.

Simple dressing if being transported to burn center (they will

need to see the wound)

Sterile dressings are preferred but not necessary

Covering wounds improves pain

Elevate burned extremities

Maintain patient's temperature (keep patient warm)

While cooling may make a small wound more comfortable,

cooling any wound >5% TBSA will cool the patient

If providing prolonged care

Wash wounds with soap and water (sterility is not necessary)

Maintain temperature

Topical antimicrobials help prevent infection but do not eliminate

bacteria

Silver sulfadiazine for deep burns

Bacitracin and nonsticky dressings for more superficial burns

Skin grafting

Deep burns require skin grafting

Grafting may not be necessary for days

Preferable to refer patients with need for grafting to Verified Burn

Centers or, if not available, others trained in surgical techniques

Grafting of extensive areas may require significant amounts of

blood

Patient's temperature must be watched

Anesthesia requires extra attention

Medications
o

All pain meds should be given IV

Tetanus prophylaxis should be given as appropriate

Prophylactic antibiotics are contraindicated

Systemic antibiotics are only given to treat infections

top of page

Special Burns

General information
o

Often require specialized care

Calling a Verified Burn Center is advised

Electrical injuries
o

Extent of injury may not be apparent

Damage occurs deep within tissues

Damage frequently progresses

Electricity contracts muscles, so watch for associated injuries

Cardiac arrhythmias may occur

If arrhythmia present, patient needs monitoring

CPR may be lifesaving

Myoglobinuria may be present

Color best indicator of severity

If urine is dark (black, red), myoglobinuria needs to be treated

Increase fluids to induce urine output of 75-100 ml/hr in adults

In children, target urine output of 2 ml/kg/hour

Alkalinize urine (give NaHCOi3)

Check for compartment syndromes

Mannitol as last resort

Compartment syndromes are common

Long-term neuro-psychiatric problems may result

Chemical Burns
o

Brush off powder

Prolonged irrigation required

Do not seek antidote

Delays treatment

May result in heat production

Special chemical burns require contacting a Verified Burn Center, for example:

Hydrofluoric acid burn

http://chemm.nlm.nih.gov/burns.htm
http://pact.esicm.org/media/Burns_Injury_3_Dec_2012_final.pdf