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 2000;26:251).Emergency Medicine: A Comprehensive Study Guide, Companion Handbook (September 1,

2001): by David M. Cline, John Ma, O. John Ma, Gabor Kelen, Steven Stapczynski By McGraw-Hill Education – EuropeDiaz, Steven E. 2006. Little Black Book of Emergency Medicine, The, 2nd Edition. Jones and Bartlett Publishers

Penyebab Luka Bakar

The Body’s 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.

Palmar surface

Wallace rule of nines

Lund and Browder chart

• 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 FEATURES1. 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

Hill, Paul. Lecture notes on Emergency Medicine. University of stellenbosch

• Chromic acid—Rinse with dilute sodium hyposulphite

• Dichromate salts—Rinse with dilute sodium hyposulphite

• Hydrofluoric acid—10% calcium gluconate applied topically as a gel or injected