LONG CASE

C O M B U T I O G RA D E I I I N C H I L D R E N

ANAMNESIS
Seorang anak perempuan berusia 2,8 tahun,
dibawa ke rumah sakit setelah tersiram dengan
air panas 10 jam SMRS pada kedua kaki dan
kemaluan, rewel +, kehausan +, BAK terakhir 4
jam SMRS.
RPD: alergi -, asma
RPK: alergi -, asma

PEMERIKSAAN FISIK
Vital sign
KU: sedang, CM
TD: N: 120 x/menit
T: 36,2oC
Status Generalis
BB: 16 kg
Mata: Ca -/-, SI -/-, mata cekung -/THT : sekret -, sianosis -,
Leher : pembesaran limfonodi -, deviasi trakea -,
Thorax : cor S1-S2 reguler +, mur-mur -, gallop
pulmo ves +/+ N, w -/-, R -/Abdomen: datar +, supel +, BU + N, NT , cubitan perut kembali cepat
Ekstremitas : CRT <2 , pucat -

STATUS LOKALIS
Pada kedua kaki dan genitalia terdapat luka
bakar, eritem, bula +

PEMERIKSAAN PENUNJANG
Hasil pemerikssaan laboratorium
Hb : 17,6
AL : 25, 6
Hmt : 54
AT : 542
GDS : 125

DIAGNOSIS
Combutio derajat II, 26%
ASA I

TERAPI

KaEN 2A 1300 cc/24jam

Cefotaxime 2 X 300mg
Novalgin 3 X 200mg
Rencana debridement, dengan general anastesi

LUKA BAKAR
Penyebab Luka Bakar
Burns and Scalds
Mortality from burns and scalds is low but morbidity (pain and scarring) is high.
Rates of injury are highest in the 12 to 24 month age group (44/100000/year)
Around half of these are scalds, almost all of which occur in the home.
Hot drinks, water on stoves, kettles and hot tap water are most commonly involved.
The severity of the burn is closely related to temperature of the liquid. Liquid at 60C will burn
children in less than 5 seconds, compared with 10 minutes if the liquid is at 49C.
Hot object burns also typically occur in the home and typically involve heaters, irons and ovens.
Electrical
Usually low voltage in children (<1000 volts), usually involve extension cords in young children.
Chemical
Ingested dishwasher powder (alkali) is the most common cause of chemical burns to children.
House fire
Admission rate following injury related to house fire is relatively low (around 4/100000).
Mortality from house fire is significant - accounting for 10 to 15% of child injury mortality.
Young children have the highest mortality when involved in house fires.

PERKIRAAN TBSA PADA ANAK

Area

Berdasrkan Usia
0

10

Head
(A/D)

10%

9%

7%

6%

Thigh
(B/E)

3%

3%

4%

5%

Leg
(C/F)

2%

3%

3%

3%

PERKIRAAN KEDALAMAN LUKA BAKAR

KAPAN LUKA BAKAR PERLU DI RAWAT DI

RS
Burns greater than 5-7% Total Body Surface Area (TBSA)
Burns to face, hands, feet, genitalia, perineum, major
joints
Full thickness burns
Electrical burns
Chemical burns
Inhalation injury
Circumferential burns
Burn injury inpatients with pre-existing medical disorders
Burns with associated trauma
Burn injury with suspicion of non-accidental injury refer
to Psychological Issues

PRIMARY SURVEY
Airway
Breathing: beware of inhalation and rapid airway
compromise
Circulation: fluid replacement
Disability: compartment syndrome
Exposure: percentage area of burn.

FLUID RESUSCITATION
Parklans formula: 3-4 ml/kgBB/%burned
cairan tersebut diberikan pada 8 jam pertama dan
kedua diberikan 1 jam berikutnya + maintenance
Monitoring: urine output merupakan indikator paling
akurat untuk mengetahui apakah resusitasi sudah
adekuat pada anak <2tahun 0.5ml/kgBB/jam;
>2tahun 1ml/kgBB/jam
Tanda under hydration: Oliguria, Poor peripheral colour
and return, Restlessness and confusion, Vomiting
Tanda over hydration: Excessive urine output,
Generalised oedema, Pulmonary oedema, Increased
blood pressure.

WOUND CARE
Pertolongan pertama
Lepaskan semua pakaian yang terkena air pada tubuh
pasien
Dinginkan luka bakar pada air mengalir
Apabila luka bakar luas, waspadai terjadinya hypothermia
Initial treatment
ATS profilaksis
Debridemen bula
Setelah debridement, bersihkan luka bakar dengan 0.25%
(2.5 g/litre) chlorhexidine solution, 0.1% (1 g/litre)
cetrimide solution, atau antiseptic lain
Antibiotic cream (silver sulfazidine)

MEDICATION FOR PAEDIATRIC BURN

PATIENTS >15% TBSA
Short term after initial burn (first 1 to 4 days)
intravenous morphine infusions or and regular
paracetamol (15mg/kg QID)
Apabila morphine tidak adequat tambahkan low
dose ketamine infusion
In PICU a midazolam infusion may also be required
Transition to oral analgesia
analgesia using continuous slow release agents eg
MSContin or Tramadol SR
analgesia using an immediate acting medication eg.
Oxycodone, tramadol

MEDICATION FOR PAEDIATRIC BURN

PATIENTS >15% TBSA
Vitamin
Multivitamins 0-3 years Pentavite infant 0.45ml daily
Over 3 years Pentavite mixture 5 ml daily
Iron supplement 0-30kg 2.5mg/kg (0.4ml/kg) daily
Ferroliquid (6mg elemental iron/ml) ,Over 30kg
Ferrogradumet 1 tablet (105mg) daily
Ascorbic Acid <2 years 250mg daily tablet crushed, >2
years 500mg daily 1 tablet crushed
Zinc Zinc Sulphate 1mg/kg/day (of elemental zinc) in 1-3
divided doses
Antibiotik
Diberikan apabila terdapat tanda infeksi dan tidak digunakan
sebagai profilaksis.