ptc92 burn a9
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7/21/2019 Ptc92 Burn a9
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PRIMARY TRAUMA CARE
Luka bakar
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Luka bakar
• Prioritas sama dengan trauma: A!C"E
• #as$ada ada %edera &ain 'misa& $ada &edakan(
• #as$ada %edera &istrik
• )g na*as karena in+a&asi asa$ , udara $anas
• -+o%k karena ke+i&angan $&asma
• Luka bakar mengganggu regu&asi su+u
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/orban &edakan tabung gas e&$i0i
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/ematian &uka bakar
• /ematian dini
• /ematian &ambat
bstruksi 0a&an na*as
)aga& na*as
-+o%k ke+i&angan $&asma
)aga& gin0a&
-e$sis Mu&ti$&e organ *ai&ure
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Penanganan a5a&
• 6entikan $roses terbakar 'dan sisa $anasn7a( – siram air (jangan air es)
• A!C"E• Tentukan &uas &uka bakar
• !erikan in*us %airan 7ang %uku$ 'dua i8 &ine(
• Cega+ +i$otermia
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/eda&aman &uka bakar
• -u$er*i%ia& : n7eri er7t+ema tan$a bu&&ae• Partia& t+i%kness : n7eri %airan merembes
ada bu&&ae• ;u&& t+i%kness : tidak n7eri $uti+ atau ge&a$
se$erti ku&it '&eat+er7(
Pada resusitasi dini&uas &uka bakar &ebi+ $enting
dari$ada keda&amann7a
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Luas &uka bakar
RULE ; =I=E-
/e$a&a dan &e+er > ?
Ekstremitas atas > ?
Tubu+ de$an 1< ?
Punggung 1< ?
Ekstremitas ba5a+ > ?
Perineum 1 ?
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-irku&asi → +i$o8o&emia
%airan untuk 2. 0am $ertama
• RL , RA , =aC& @>?
• 2. m& , kg , ? &uka bakar
• 1,2 8o&ume da&am < 0am
• 1,2 8o&ume da&am 2. 0am berikutn7a
• 2. 0am di+itung dari saat terbakar
• $erta+ankan urine @1@ m&,kg,0am• re+idrasi ora& da$at diberikan u, &uka bakar ringan
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Luka bakar *u&& t+i%kness me&ingkar
• leher edema akan menjerat leher
– perlu intubasi trachea / tracheostomy
• dada restriksi gerak dada hipoventilasi
– perlu nafas buatan
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Luka bakar *u&& t+i%kness me&ingkar
• &e+er edema men0erat &e+er intubasi dini
• dada restriksi gerak dada
+i$o8enti&asi
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Cedera 0a&an na*as
• Api dalam ruang tertutup• Luka bakar daerah mulut,
ajah, rambut hidung
terbakar
• !uara serak, batuk, stridor • "ercak jelaga bersama
sputum
• #enghisap udara panas
(thermal injury)
• $istres nafas
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Ba&an na*as dan $erna*asan
$ertimbangkan intubasi dini 0ika
• -uara serak , $arau ↑
• /esu&itan mene&an &uda+
• "istres na*as ↑
Intubasi 0adi makin su&it 0ika ditunda
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In+a&ation T+erma& In0ur7
• Edema 0a&an na*as obstruksi tra%+ea
$er&u intubasi dini se0ak suara masi+ serak tra%+eostom7 bi&a obstruksi &ebi+ berat
• Edema bron%+ia& dan a&8eo&i destruksi
$er&u na*as buatan dengan oksigen tinggi
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Luka bakar derajat % / partial thickness
bullae yang pecah luka merembes plasma
Luka bakar di ajah dengan tanda smoke inhalation
intubasi dini dan nafas buatan
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Penanganan &an0ut
• Ana&gesia
• /ateter urine
• Pi$a nasogastrik
• Pro*i&aksis Tetanus
• Pertimbangkan es%+arotom7
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&scharotomy pada
luka bakar melingkar
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#+at ma7 go 5rong
• -moke
in+a&ation
• !ron%+ia&t+erma&
in0ur7
• -u**o%ation
=oti%e :
*a%ia& edema D
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