s/20/20L4

BURN INJURY
Ruby Riana A
FKUMM

FIRST AID . THERMAL BURN

Rescuing the victim from the buming pronises:

STOP and DROP "polic-v" should be followed.

Prcvent the victim frorn nmning which would only fan the flames and
make thern bum faster.

Tbe victim should be insfiucted to lie down on the floor with the
buming side rrypcrmost.

The casualty should not bc

rolld

on the ground

I If the victim is'mable to walk or is unconscious, make hir/her lie supine on

flmr with both rpper limbs

placed extended by tlrc side, above the head and

thar drag the victim out of the rmm holding his/her legs.

s/20/20t4

FIRST AID - THERMAL BURN

Put out the fire in an erpoditious rnanner: Stopping the buming process is rnaodatory to
prevent firrther darnage

The flarues should be doused with wzter. Smouldering clothing should be removed If
water is not available : Any other non-flammable "cleat" liquid such as mift, camed
drinkcan be used,

The r,ictim should be put on the ground with the buming side uppermost and then
wrapped in a hearv cotton cloth (blankeVnrg/darilcoat or anli other heav_v fabric)

I
e

Fire eKinguisbers are exhemely usefirl in putting out tbe fire.

Don't throVapply

mud"/sand over the

victim's body to put out the fue

N{ale the victim lie suprne. Watch for the response and assss for AI}C (Aima1,,
Breathing, Circulation) If there is no response and there are no chest moveruents,
cardiopulmonary resuscitation (CPR) should be instituted urgently.

FIRST AID . THERMAL BURN

a

Cooling the bum: The first objective in the burn wound care
is to dissipate the heat. The subcutaneous temperature
continues to rise for a while even after the heat soruce has
been removed. Thereafter, it takes about 3 minutes for the
tissues to return to body temperature
Immediate active cooling of burn wounds with cool tap
water (lavage, soaks, compress or immersion) is effective.
Continuous cooling for the first l0 minutos dissipates heat,
reduces pain, delays onset and minimises the extent of burn
oedema by decreasing the histamine release from the skin
mast cells

s/20/20L4

Pembagian

r Berdasarkan kedalaman
r Berdasarkan luas
r Berdasa*an keparahan

BERDASARKAN KEDALAMAN

Hit-k bbS f ldgrrcrpom u led

Rrhrisdt brirl

sF[@ b

hoi

ti{ddrtEE

Mnd.d ra!

M{*r
BclE FeEl{
Faio m pr gri& iawly pnFdirnl h &dr
dLiut
Tu pqoniord n &pd ot borG: ]{l-fs &F

lfiei.. ielt

c leqr .+.8 . b lld

LqlFryqEq ht@q ttd'lillifi
C@rt[dnrbddhl
lsttsdEtErtdict}

s/20/20t4

TIDAK DIHITUNG
DALAM PERHITUNGAN
LUAS LUKA BAKAR

s/20/20L4

BERDASARKAN

BERDASARKAN KEPARAHAN
Parah

critical.

r Tingkat II 30% atau lebih

E TlngkatIlI tOo/o ataulebh
r Tingkat III pada tangan, kaki, muka
j Dengan adanya kornplikasi pemapasan,
Sedang

E
E

moderate.

-I]rkat

Riran

!
a

Tlngkat

II 15-300,6
III 5-10%

minor.

Tingkat
Tingkat

Il kuGr 15oA
III kurar 106

jantLlng, ft-aktur, soft tissr. yang luas.

s/20120L4

TATA LAKSANA
r

Survai Primer :ABCDE

r
r
I

Survai Sekunder
Penreriksaan

Resusitasi cairan

I
r
r
r

fisik

+ %(4cc xkg BBx% LB) RL

l6jam Il + %(4ccxkgBBx% LB) RL

Sjam |

+ 500-1000cc colloid.
Selesai dalam 24 jam sejak kejadian

B
I Replacenent 2 c/k
r DitarrbahKeb
1 Umur sampai I
Di

terhitrng dari saat kejadian maka

Surabaya formula

r
r =

anak dimodi0kasi sbb

f/o luka bahar

faal
l0O cc/kgBB

Umur 5-15 tahrm 50 cc,ftgtsB

cairan

{ lTl20Iftisaloid@L)+3/20Koloid an){
dan 16 jmr berikutnya
r dibagi 2 + dalam 8 jam
Moncrief

botolyang sarna

s/20/2014

n Luka bakar listrik

o high voltage atau low voltage
r: awasi aritmia

o menunggu demarkasi jaringan

sl20/20L4

AMERICAN BURN ASSOCIATION PRACTICE

GUIDELINES FOR BURN SH(rcK
RESUSCITATION
r

Guidelines

inchil&en.

ons
The addition of colloid-containing fluid following bum

injury,

ially

requirments.

avoid

excessive

a.

10

sl2a/20t4

FASE SUBAKUT

r
r

Fase setelah fase resusitasi.

Rentang waKunya tidak selalu sama tergantung dari

r Jenis trauma

r Derajat luka bakar

r Keadaan umum pasien
r

Komplikasi pada fase ini meliputi; SIRS, infeksi,

2t

PRINSIP PENANGANAN FASE

SUBAKUT
r

Supportif sistemik, nreliputi

r
r
r
r

Respintory rnaintenance
lGseimbangan cainn dan elektolit
Nubisi

Wound care rnanagenrent

r
r
r

Management BaKerial

Managementjaringan nekrctik
Skin coverage rnanagernent

11

sl20/20L4

RESPI RATORY MAI NTENANCE

Improve airway clearance; artifisial, pengenceran

daha( terapi batuk, chest physical theraphy,
washing

r Oksigenasi; nasal, masker, jacksen rees, ventilator.

r Improve respiratory muscle

KESEIMBANGAN CAIMN
DAN ELEKTROLIT
rTotal cairan tubuh^,60olo
1. ICF Z|3TBW
2. ECF U3 TBW
- Intravascular

BB

1/q

- intertitial 3la

L2

sl20/20L4

PRI NSI P PE NATALAKSANMN

lcseimbangenCairan

I inBrt = oriBlt
I outBJt = scnsiblc + inscnsiblc r,&rb6t
I Evaporative wdter lod in mlJhour : [25 + % of TBS burned]
r al in (>2.59/dL)
I tt4onltor nadl dan hkanan darah
! Monitor el<tjdit dan kseimbangan asarrbasa
r l-lct- 30tO96
r CVPdi pertahankanT- 12 cm H2O
r l.ternpertatnnkanproduk5urin
r Delv6a 0,t1 mutgifti

x TBS in nu

Aa"l< , t-2,,t1r,< /t
d-''

r Laki-laki 20 tahun dengan luka bakar 40o/o.

Berat 50 kg, tinggi 150 cm, hari kedua post
baxter resuscitation. Berapa cairan yang
dibutuhkan?

50

Keb fisiologis 30cc x

= 1500 cc
IWL I 24 jam (25 + 40) x TBS x24 = 2350
cc
Total 3850 cc

13

sl2o/20L4

ELECTROLYTE IMBALANCE
Na 130-145mmo[L

24 mq lkgld
Na defisit

3olo

: (0,6 x bw) x (130

NacUL

0,9olo
K 3,5

: 513 mmol

cunent Na)

mmol Na

Nacl/L : 154 mmol

- 5,0 mmoUL

1-2 meq/kg/d
Hypokalemia
7,45o/o Kcl :

.
I meq
r 2040 meq/h diluted in 100-200 NS
r given in 3-4 h, at rab 10 meq/h
Hyperkalemia
r C: glukonas, D40, and insulin

NUTRISI
r

Prinsip pemberian nutrisi

I
r
r
r
r

"Go

Slora/'

Memperkirakan kebutuhan
Memperkirakan kebutuhan
Memperkirakan kebutuhan
Memperkirakan kebutuhan

L4

sl2ol2oL4

KEBUTUHAN IGLORI

Sutherland (1959)

Dewasa

Anak

20 kcal/kgBB + (70 kcal x luas LB)

60 kcal/kgBB + (35 kcal x luas LB)

Curreri (1974)
25 kcal/kgBB + (40 kcal x luas LB)

Perhitungan berdasarkan BMR

dari Harris-Benedict (1919)
r

TEE = Predicted BMR X injury factor X activity ftctor

Injury fuctor = 1 + [ 32+ (0,3xoloburn)

( 0,4 x day post

100

LB0-20o/o

1-1,5
LB 20-404/o 1,5 - 1,8
LB

>,m%

L8

Activity factor 1,25

BMR

Male:

66 + (13,7 x Vtff) + (5 x HT) - (6,8 x age)

Female: 66 + (9,6 x VW) + (L,7 x Fff) - (4,7 x age)

15

sl20/20L4

CONTOH

Laki-laki 63 th mmbus 20olo. BB =75 kg,TB

kin-kin kalori png dibutuhkan?
BMR

TEE

L70 cm, beapa

= 1500
= BMRx L,5xL,25
= 2700 kcal

WOUND CARE
r

Manajemen eksudat dan baKeri

- Mandi/cuci luka 3-7 hari sekali (tergantung

kondisi luka)
- Antibiotik Topical, SSD
- Antibiotik sistemik sesuai kultur
- Absorben dressing
Management nekrotik
- Tangensial eksisi
- autolitik atau enzimatik debridement

15

s/20/20L4

SKIN COVERAGE

r Self epitelization
E Skin Grafting, bisa sebelum 4 hari atau setelah
minggu

Kultur kulit

Flap

17

s/20/2014

16#8#2005'

2(#8#

18

s/20l2oL4

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