LUKA BAKAR

LUKA BAKAR

• Cedera yang mengakibatkan hilangnya

atau rusaknya jaringan
• Penyebabnya dapat berupa: paparan
terhadap panas, listrik, kimia,dan radiasi
• residential fires, motor vehicle crashes,
scalds (wet heat), or electrical and
chemical sources.
Patofisiologi
• Heat Induced Injury
– Paparan dengan durasi tertentu pada suhu diatas 40 – 44 C
malfungsi enzim dan denaturasi protein merusak jaringan
– Durasi yang lebih lama menyebabkan nekrosis dan koagulasi
protein
• Inflammatory Mediator Injury (hr 1 -3)
– Aktivasi mediator inflamasi toksik
– Kelebihan produksi meditor khususnya oxidant dan protease
menyebabkan kerusakan lanjut pada endotel kapiler dan sel
kulit.
• Ischemia Induced Injury
– Terjadinya trombosis vaskuler cepat disekitar sel yang mati dan
jaringan dibawahnya menyebabkan iskemia dan nekrosis lanjut
CONTINUING BURN WOUND INJURY

• ongoing inflammation caused by

- necrotic tissue
- bacteria on surface
- caustic topical agents
- surface exudate
• hipotmia
• gangguan bergerak
• gangguan pernapasan
• kehilangan banyak cairan
Karakteristik luka bakar
berdasarkan kedalaman
Area permukaan tubuh yang
cedera
• Rule of nine
• Lund and browder
• Palmer method
Lund and Browder
Local Effects
1) Tissue damage - Heating af tissue results in cell
necrosis, damage to the peripheral microcirculation.
2) Inflammation –
• In the area least damaged by burning is manifested by erythema
due to neurovascular response to trauma.
• In prolonged inflammatory response, macrophages produce
inflammatory mediators and cytokines and phagocytose necrotic
cells. Neutrophils protects against infection.
• Damaged tissue separates by a process called desloughing
which completes by 3 weeks.

3) Infection - The damaged and dead tissue acts as a nidus

for infection. Burn wounds will almost always be infected
by micro-organisms within 24 to 48 hours.
• Perawatan LB harus direncanakan
menurut luas dan dalamnya luka bakar,
perawatan dilakukan melalui 3 fase:
• 1. fase darurat/ resusitasi
• 2. fase akut/ intermediate
• 3. fase rehabilitasi
Sistemic effects

• Gangguan kardiovaskular
• Gangguan cairan dan elektrolit
• Gangguan pernafasan
• Gangguan renal
• Gangguan Imunologis
• Gangguan termoregulasi
• Gangguan gastrointestinal
Gangguan kardiovaskular

• Hypovolemia  decreased perfusion and oxygen

delivery.
• Cardiac output decreases  blood pressure drops.
• The sympathetic nervous system releases
catecholamines vasoconstriction and an increase in
pulse rate.
• Anemia from damaged red blood cells, Blood losses
sustained during surgical procedures, wound care, and
diagnostic studies and ongoing hemolysis
• Hematocrit may be elevated due to plasma loss.
• Abnormalities in coagulation, including thrombocytopenia
and prolonged clotting and prothrombin times

Penatalaksanaan: fluid resuscitation, Blood transfusions

Gangguan cairan dan elektrolit
• Edema caused by increased perfusion to the injured
area and is reflective of the amount of vascular and
lymphatic damage to the tissue, loss of capillary integrity
• massive systemic edema
• act like a tourniquet, especially if the burn is
circumferential
• evaporative fluid loss through the burn wound may reach
3 to 5 L or more over a 24-hour period until the burn
surfaces are covered
• Hiponatremia (perpindahan dr intestisial ke vaskuker),
hiperkalemia (destruksi sel yg masif), hipokalemia
(perpindahan cairan dan asupan cairan yg kurang)
• Penatalaksanaan: avoiding excessive fluid
administration during the early postburn period
Gangguan pernafasan
• Inhalation Injury - The inhalation of hot gases cause thermal burn to
the upper airway. This is manifested early by stridor, hoarseness,
cough and respiratory obstruction .
• Inhalation of product of combustion causes a chemical burn to the
bronchial tree and lungs. This is manifested by hypoxia, Acute
Respiratory Distress Syndrome (ARDS) and respiratory failure.
Carbon monoxide displaces oxygen from haemoglobin to form
carboxyhaemoglobin thus reducing oxygen carring capacity of
blood.
• ARDS terjadi kalau derajat gg ventilasi dan pertukaran sudah
mengancam jiwa --> intubasi dan ventilasi mekanik.
• Bronchoconstriction (caused by release of histamine, serotonin, and
thromboxane, a powerful vasoconstrictor) and chest constriction
secondary to circumferential full-thickness chest burns cause this
deterioration
• The pulmonary surfactant is reduced, resulting in atelectasis
(collapse of alveoli)
Gangguan renal

• Mioglobinuria
• Penurunan GFR
• GGA
• destruksi sel-sel darah merah akan menghasilkan Hb
bebas dlm urin.
• kerusakan otot, mioglobin akan dilepaskan dr sel-sel otot
dan disekresikan oleh ginal--> mioglobinuria
• penurunan aliran darah, Hb dan mioglobin akan
menyumbat tubulus renal--> nekrosis akut tubuler-->
GGA
Gangguan imunologis
Gangguan termoregulasi

• Hipotermia
Gangguan gastrointestinal

• Kembung
• Infeksi saluran pencernaan sampai sepsis
• Ileus paralitik
Manajemen Luka bakar
• Emergensi/resusitasi
– Di tempat
• Matikan api
• Dinginkan luka
• Hilangkan benda-benda yang mengekang
• Tutup luka
• Irigasi luka bakar kimia
• Pertahankan ABC
– Manajemen medis
• Transfer ke unit LB
• Manajemen kehilangan cairan dan syok
• Terapi pengganti cairan
• Kebutuhan cairan
• Indications for referral to burn units are -
1. Burn requiring fluid resuscitation.
2. Burn of face, hand, feet, perenium and
genitalia.
3. Full thickness burn > 5% of total body surface
area.
4. Circumferential limb or chest burn.
5. Electric burn.
6. Chemical burn.
7. Burn in children and elderly.
8. Associated medical condition or pregnancy.
9. Associated other trauma.
Manajemen keperawatan

• 1. A - Airway.
2. B - Breathing and ventilation.
3. C - Circulation.
4. D - Disability - neurological status.
5. E - Environmental control - keep warm.
6. F - Fluid resuscitation.
Resusitasi cairan
Akut/intermediate
– Manajemen medis
• Pencegahan infeksi
• Perawatan luka: Hidroterapi
• Terapi antibakteri topikal
• Balutan
• Debridemen luka: natural, mekanikal, kemikal, surgical
• Woud graft
• Manajemen nyeri
• Support nutrisi
– Manajemen keperawatan
• Pengembalian keseimbangan cairan normal
• Pencegahan infeksi
• Mempertahankan nutrisi adekuat
• Mempertahankan integritas kulit
• Menghilangkan nyeri dan ketidaknyamanan
• Mempertahkankan mobilitas fisik
• Memperkuat strategi koping
• Dukungan pasien dan proses keluarga
• Monitoring dan manajemen potensial komplikasi
• Rehabilitasi
– Dukungan psikososial
– Hyperthropic scarring
– Kontraktur
– Splinting