Morning Report

“Burn Trauma”
Stase Emergensi
Pembimbing: dr. Ranti Waluyan
Co-ass: Kevin Chikrista
NIM: I1011141053
Kasus
• Pasien datang dengan luka bakar akibat ledakan kabel listrik ± 30
menit SMRS.
Primary Survey
• Airway:
• Obstruction [-]:
• Snoring (-)
• Gurgling (-)
• Stridor (-)
• Choking (-)
Primary Survey
• Breathing:
• SPO2 : 98%
• Respiratory:
• Spontan (+)
• RR: 24 x/min
• Deviasi Trakea (-)
• Thorax: SND ves, rh (-/-), wh (-/-)
Primary Survey
• Circulation:
• Akral hangat
• CRT < 2
• PR: kuat angkat, 92 x/min
• BP: 130/90 mmHg
Primary Survey
• Disability
• GCS: E4M5V5
• Pupil: isokor | diameter OD/OS: 3 mm/3 mm | RCL (+/+) | RCTL (+\+)
Primary Survey
• Exposure
• Temp: 36.2˚C
• Expose and cover (if needed)
• Combustio a/r:
• Vertebralis
• Infrascapularis
• Lumbalis
• Brachii D, antebrachia D
Secondary Survey
Identitas Pasien
• Nama : Tn. B.
• Umur : 25 thn
• Jenis kelamin : Laki-laki
• Pekerjaan : pemasang baliho
• Agama : Islam
• BB : 60 kg
 Secondary Survey (AMPLE)
Keluhan Utama :
• Pasien datang dengan luka bakar akibat ledakan kabel listrik ± 30
menit SMRS.

• A (Alergy) : Tidak ada

• M (Medication) : Tidak ada

• P (Past Medical History): Hipertensi (-), Diabetes Melitus (-)

Secondary Survey
• L (Last Oral Intake)

• E (Event) : MOI  Pasien sedang memasang baliho dengan ketinggian

± 4 meter. Saat memasang baliho tidak memakai sendal, dibelakang
pasien terdapat kabel yang tiba-tiba korslet, menyebabkan terjadinya
ledakan pada kabel sampai mengenai tubuh pasien.
Secondary Survey
• Pemeriksaan Tanda Vital:
• KU: TSB
• Kesadaran: CM
• GCS E4V5M6
• BB: 60 kg
• Tensi: 130/90
• Nadi: 92 x/min
• Suhu: 36,2
• RR: 24 x/min
• SPO2: 98%
Secondary Survey
• Head to Toe (To make sure no other injuries have higher priority for
treatment.)
• Kepala: Normocephal
• Mata: CA (-/-), SI (-/-)
• Leher: Perbesaran KGB (-/-)
• Thorax: Simetris
• Paru: SND ves, Rh (-/-), Wh (-/-)
• Cor: S1S2 reg, m (-/-), g (-/-)
• Abd: x
• Ekstremitas: Akral hangat, CRT < 2,
• Combustio grade III a/r vertebra – lumbal dan brachii + antebrachia D
Secondary Survey
• Focused on Injury
• Combustio grade III
Burn Depth
Burn Depth
Emergency Medical Care
• Airway management:
• Intubation?
• Oxygen?
• Fluid Resuscitation:
• TSBA grade IIb or III burn > 20%  Fluid Resuscitation (don’t delay more than
2 hours)
• 18G IV catheter  2 IV line!
• Consensus Formula (Parkland / Baxter Formula)
• Urine output should be 0.5 – 1 ml/kg/h
Parkland Formula
• BB: 60 kg
• TBSA:
• Back  18%
• Brachii + Antebrachii  9%
• TOTAL = 27%
• Total Fluid Given = 4 x 27% x 60 kg = 6480 ml
• 1st ½ Total Fluid (1st 8 hours) = 3240 ml
• 2nd ½ Total Fluid (2nd 16 hours) = 3240 ml
• 1st ½ Total Fluid (1st 8 hours) = 3240 ml
• 3240 ml in 8 hours  405 ml/h  202.5 ml/h per IV line
• Macro drips  202.5/3 = 67.5 drips/min/IV line

• 2nd ½ Total Fluid (2nd 16 hours) = 3240 ml

• 3240 ml in 16 hours  202.5 ml/h  101.25 ml/h per IV line
• Macro drips  101.25/3 = 33.75 drips/min/IV line
Emergency Medical Care <continue>
• Laboratory Examination • Hb :17,2
• Blood • Leukosit : 17.400
• Complete Blood Count
• ABG  HbCO • Trombosit : 278.000
• Electrolytes • Hematokrit: 51,6
• Glucose
• X-ray (if there is indication) • Eritrosit : 6,17
• ECG
Emergency Medical Care <continue>
• Peripheral Circulation Assessment  find out Compartment
Syndrome
• Extremities: perfusion to muscle is the main concern!
• Pressure > 30 mmHg within compartment can lead to muscle necrosis; no
pulse  too late to save the muscle!
• Find out sign and symptoms of CS:  Escharotomy
• Pain greater than expected and out of proportion to the stimulus or injury
• Pain on passive stretch of the affected muscle
• Tense swelling of the affected compartment
• Paresthesia or altered sensation distal to the affected compartment
Escharotomy
Emergency Medical Care <continue>
• Narcotics, Analgetics and Sedatives
• Remove sign of hypoxemia or hypovolemia first before managing pain.
• Wound Care
• Protect from contamination
• Simply gently covering the burn with clean sheets to decrease pain!
• TBSA > 10%  do not apply cold water compression
• NO ICE COMPRESSION!!!
• Topical antimicrobials (for minor wound)
• 1% silver sulfadiazine (not for face!)
• Bacitracin
• Triple-antibiotic (neomycin, polymyxin B, bacitracin zinc)
Treatment IGD
• Resusitasi Baxter Formula
• Rawat luka bakar
• EKG
• Inj. Ketorolac 30 mg/8 jam
• Inj. Ceftriaxon 1 g/12 jam
• Pro ICU
• Pasang DC  monitor output
Terima Kasih