LUKA BAKAR

Bobby Rianto 07120080099

INTRODUCTION

Definisi luka bakar

kerusakan pada jaringan tubuh disebabkan oleh panas, electricity, bahan kimia dan radiasi.

DETERMINANTS OF BURN
Causative agent Depth Extent/luasnya Location Age Concomitant injury Preexisting diseases

CAUSATIVE AGENT

Thermal
Flame Flash Scald Contact

Electrical Chemical Radiation

DEPTH

First-degree (Superficial)
Erythema Blanches on pressure Pain

Second-degree (Partial-thickness)
Red, shiny, wet Vesicles Swelling Very painful

DEPTH

Third-degree (Full-thickness)
Color : waxy white, gray Charred/terbakar hangus Leathery/strukturnya kasar Dry Brownish streaks Do not blanch on pressure Pain free Sunken appearance

DEPTH

DEPTH

First-degree (Superficial)

First-degree (Superficial)

Second-degree (Partial-thickness)

Second-degree (Partial-thickness)

Third-degree (Full-thickness)

Third-degree (Full-thickness)

EXTENT
Rule of nines The Lund and Browder chart The palmar surface of the adults hand 1% of the TBSA

Rule of Nines

The Lund and Browder Chart

LOCATION
Face Neck Hands Feet Joints Perineum Circumferential burn

neck, trunk, or extremities

BURN CLASSIFICATION (AMERICAN BURN ASSOCIATION)

Minor Burn Injury

Partial thickness :
<15% TBSA in adults <10% TBSA in children

Full thickness : <2% TBSA Does not involve special care areas (eyes, ears, face, hands, feet, perineum) Excludes electrical injury, inhalation injury, complicated injury (fracture), all poor-risk patients (extremes of age, intercurrent disease)

BURN CLASSIFICATION (AMERICAN BURN ASSOCIATION)

Moderate Uncomplicated Burn Injury

Partial thickness :
15-25% TBSA in adults 10-20% TBSA in children

Full thickness : <10% TBSA Does not involve special care areas Excludes electrical injury, inhalation injury, complicated injury, all poor-risk patients

BURN CLASSIFICATION (AMERICAN BURN ASSOCIATION)

Major Burn Injury

Partial thickness :
>25% TBSA in adults >20% TBSA in children

Full thickness : >10% TBSA Involve special care areas Includes electrical injury, inhalation injury, complicated injury, all poor-risk patients

GUIDELINES FOR BURN UNIT / CENTER HOSPITALIZATION

Second degree burns 15% TBSA Third degree burn 5% TBSA Burns of the face, hands, feet, & perineum Electrical injuries Inhalation injury, including smoke inhalation & carbon monoxide poisoning Chemical burns

GUIDELINES FOR BURN UNIT / CENTER HOSPITALIZATION

Burned patients with associated injuries, including fractures & major blunt & penetrating trauma Any burn in patients under the age of 10 years & over the age of 50 years Burns in patients with concomitant serious medical diseases (e.g. diabetes mellitus, chronic alcoholism, cirrhosis, heart disease, AIDS)

GUIDELINES FOR BURN UNIT / CENTER HOSPITALIZATION

All children suspected of being victims of child abuse or neglect Infected burns originally treated on an outpatient basis Small third degree burns best treated with early excision & grafting

GUIDELINES FOR BURN UNIT / CENTER HOSPITALIZATION

Smaller burns in patients not able to care for the burn, which if left unattended, pose a significant potential for development of burn infection :
Drug abusers Mentally ill Homeless Patients hospitalized at other institutions who experience a serious burn Unreliable home environment for small children

GUIDELINES FOR BURN UNIT / CENTER HOSPITALIZATION

Acute massive skin loss syndromes requiring burn center quality of care (e.g. Steven-Johnson syndrome / toxic epidermal necrolysis, large traumatic degloving injuries)

PATHOPHYSIOLOGY

Jacksons Thermal Wound Theory

Zone of Coagulation
Area nearest burn Cell membranes rupture, clotted blood and thrombosed vessels

Zone of Stasis
Area surrounding zone of coagulation Inflammation, decreased blood flow

Zone of Hyperemia
Peripheral area of burn Limited inflammation, increased blood flow

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY Systemic Responses to Burn Injury

PATHOPHYSIOLOGY Immune Response to Burn Injury

THERAPY
Initial : ABCs Special priority : stop burning process Airway control & ventilation

Inhalation injury should be suspected:

Being burned in a confined space Facial burn Carbon particles in the oropharynx Carbonaceous sputum Circumferential burn of the neck or trunk

THERAPY
Measurement of arterial blood gases & carbon monoxide level Indications for endotracheal intubation:
Supraglottic edema & inflammation on bronchoscopy Progressive hoarseness or air hunger Coma or respiratory depression Acute respiratory distress Full-thickness burns of face or perioral region Circumferential neck burns

THERAPY

Circulatory support & fluid resuscitation

Intravenous catheter Fluid resuscitation
Evans Brooke Baxter (Parkland Formula)

PARKLAND FORMULA

DAY 1 (Hour 0=time burn occurred) (Hours 0-24)

Lactated Ringers Soluton
Total volume for 24 hr = 4 cc / kg / % burn Give of total volume in 1st 8 hr Give of total volume in 2nd 16 hr

Adjust infusion rate as necessary to keep urine output:

Adults : 30 50 cc / hr Children : 1 cc / kg / hr

PARKLAND FORMULA

DAY 2 (Hours 25 48)

Change Lactated Ringers to D5W and adjust based on urine output as above Begin Colloid infusion: 5% Albumin at 0.3 1.0 cc / kg / % burn = cc 5% Albumin / hr 16 Do not vary based on urine output. Adjust crystalloid only.

DAY 3 (Hours 49+)

Change to maintenance IV or begin po intake and/or enteral feedings

THERAPY

Assessment parameters
Urine output : 30 50 cc / hr Cardiopulmonary factors
Blood pressure (systolic 90 100 mmHg) Pulse rate ( 100 / minute) Respiration (16 20 / minute)

Sensorium : alert & oriented to time, place Gastrointestinal function

Absence of ileus or nausea after first 24 hours

THERAPY

Burn wound care

Open or close Cold compresses Maintenance of body temperature Shielding the burn from air movement Topical antimicrobial treatment Dbridement, escharotomy, & escharectomy Skin graft

THERAPY

Other considerations
Nasogastric intubation Analgesia Systemic antibiotics Tetanus toxoid +/- hyperimmune human globulin

COMPLICATIONS
Organ system Respiratory Cardiovascular Major complications Inhalation injury, pulmonary edema, pneumonia, ARDS, embolism, sinusitis Myocardial infarction, endocarditis, pericarditis, arrhythmias, hypertension, septic thrombophlebitis, embolism, thrombosis, ruptured vessel wall Renal failure, hematuria,myoglobinuria DM, adrenal insufficiency, adrenal hemorrhage Encephalopathy, CO poisoning

Renal Endocrine Neurologic

KOMPLIKASI
Gastrointestinal Curling ulcer, hepatic dysfunction, paralytic ileus, acalculous cholecystitis, pancreatitis, mesenteric occlusion, superior mesenteric artery syndrome, peritonitis Hematologic Anemia, coagulopathies Immunologic Sepsis, immunodeficiency Metabolic-Nutritional Prolonged catabolism, starvation Musculoskeletal Contracture, loss of limb Skin Infection, hypertrophic scar, contracture