Luka Bakar

Ana Auliya A.
I11109038

 Approximately 1.25 million patients present to EDs

with burn injuries each year, and about 50,000 are
hospitalized. Risk of burns is highest in the 18 to
35 year old group
Annually, a minority of pts with massive (> 75% of
total body surface area) burns, approximately 3%
in children (Jama 2000;283:69). Major burns with
worse outcomes in infants and the elderly (Burns
2000;26:49). Scald burns of the perineum and
lower extremities are common and preventable
injuries in infants and the elderly (Burns
Emergency
Medicine: A Comprehensive Study Guide, Companion Handbook
2000;26:251).
(September 1, 2001): by David M. Cline, John Ma, O. John Ma, Gabor Kelen,
Steven Stapczynski By McGraw-Hill Education Europe
Diaz, Steven E. 2006. Little Black Book of Emergency Medicine, The, 2nd

Penyebab Luka Bakar

The Bodys Response to a

Burn
Local response
Zone of coagulation
Zone of stasis
Zone of hyperaemia

 Systemic response
Cardiovascular
changes
Respiratory
changes
Metabolic changes
Immunological
changes

Assessment of Burn Area

Burn size is quantified as a
percentage of body surface area
(BSA) involved.

 Luka bakar didefinisikan berdasar luas dan

kedalaman serta daerah yang terkena.
Burns are defined by their size and depth. Burn size
is quantified as a percentage of body surface area
(BSA) involved.
The most common method of approximating the
percentage of BSA burned is the rule of nines. A
more precise estimation, especially in infants and
children is to use a Lund Browder burn diagram (Fig.
121-1). Smaller burns can be estimated by using the
area of the back of the patient's hand as
approximately 1 percent of the BSA.

Burn depth is classified as superficial partial-thickness, deep

partial-thickness, and full-thickness.
Superficial partial-thickness burns have blistering exposed
dermis that is red and moist with intact capillary refill and are
very painful to touch. They heal in 14 to 21 days and scarring
is minimal.
Deep partial thickness burns extend into the deep dermis.
The exposed dermis is white to yellow and does not blemish.
Capillary refill and pain sensation are absent. Healing takes 3
weeks to 2 months, and scarring is common. Skin grafting
may be necessary.
Full-thickness burns involve the entire skin thickness. The
skin is charred, pale, painless, and leathery. Skin grafting is
necessary, and significant scarring results.

 Thermal (majority of burn unit

admissions), chemical (3-16% of burn
unit admissions) or electrical (3-4%
of burn unit admissions)

Pengertian

UPPER AIRWAYS BURNS

Thermal or caustic burns to the pharynx, larynx
or trachea.
Thermal Burns
Heated gases
pharyngeal, laryngeal, and tracheal burns are usually
the worse affected areas

Direct Flame
injuries usually confined to the face and lips

Caustic Burns
acid / alkali
intentional or accidental

 CLINICAL FEATURES
1. Thermal Burns
The initial physical findings are notoriously
unreliable at ruling out burns to the airway.
Suggestive findings are :
history of burns in an enclosed space
sore throat, painful swallowing
facial, nasal or oral burns
cough, stridor or voice changes
carbonaceous sputum or respiratory distress

2. Caustic Burns
associated with mucosal ulceration
and massive oedema
drooling
cough, stridor
ulceration of the mouth, tongue or
pharynx (may appear as white
plaques)
respiratory distress

Management
INITIAL STABILISATION
1. Airway
Complete Obstruction
summon help from the doctor most experienced in
airway management.
Use basic airway opening techniques (eg suction ,
head position, oropharyngeal airway, nasopharyngeal
airway) and attempt ventilation via bag valve mask
attached to oxygen
Attempt intubation without the use of muscle
relaxants initially
If unsuccessful, proceed to emergency surgical airway

 Partial Obstruction
Diagnosis based on the presence of stridor,
hoarse voice and/or respiratory distress.
Humidified oxygen
Notify anaesthetist/surgeon
Transfer to operating theatre accompanied
by skilled staff for examination under
anaesthetic/intubation or tracheostomy
Do not transfer the patient to another
institution until intubated

 Potential Obstruction
Diagnosis based on the presence of
sore throat, circumferential neck
burns, sooty sputum, burnt
mouth/tongue/nasal hairs or history
of fire or explosion in confined space.
Consider intubation.

2. Breathing
Measure respiratory rate, and if
inadequate, assist ventilation with bag
valve mask attached to oxygen.
Measure SaO2. If <95% and not
requiring assisted ventilation,
administer high flow oxygen ( 100%
O2 via non rebreather mask if carbon
monoxide poisoning is a possibility)

3. Circulation
Measure pulse rate, BP and capillary
refill
Attach to a cardiac monitor and
assess the rhythm
Insert IV cannula
Take blood for FBC, biochemistry

4. Disability
Record a GCS and pupil response.
Consider intubation (if this has not
already been done), if GCS 8 or below,
to protect the airway.
5. Monitor
- BP, ECG, SaO2
6. Summon
senior doctor with airway skills

aul. Lecture notes on Emergency Medicine. University of stellenbosch

 Chromic acidRinse with dilute

sodium hyposulphite
Dichromate saltsRinse with dilute
sodium hyposulphite
Hydrofluoric acid10% calcium
gluconate applied topically as a gel
or injected