Luka bakar listrik
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Transcript of Luka bakar listrik
![Page 1: Luka bakar listrik](https://reader036.fdocuments.net/reader036/viewer/2022081422/5571f93049795991698f01e1/html5/thumbnails/1.jpg)
Oleh :Sulandri (SUL)
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Luka bakar listrik
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PENDAHULUAN
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+ 20% dari total px luka bakar di RSDS (2006)
Distribusi:- anak-anak- pekerja bangunan
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Faktor yang mempengaruhi kerusakan jaringan
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Jenis arus (AC/DC)Resistensi jaringanKuat arus VoltageAliran listrik mengenai tubuhLama kontakFaktor lingkungan
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JENIS ARUS
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Arus searah (DC):Arus searah (DC):- spasme otot sesaat- px dapat terlempar- durasi kontak singkat- trauma tumpul
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Arus bolak-balik (AC):Arus bolak-balik (AC):- 3x lebih bahaya- kontraksi otot kontinu / tetani
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RESISTENSI JARINGAN
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Paling konduktif hingga paling resisten:- saraf- pembuluh darah- otot- kulit basah- kulit kering- tendon- lemak- tulang
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VOLTAGE
Voltage Voltage merupakan merupakan faktor yang faktor yang
paling paling menentukamenentuka
nn
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Voltage rendahVoltage rendah: p.u menimbulkan destruksi lokal tanpa gangguan sistemik
Voltage tinggiVoltage tinggi (>1000 V): bisa mengakibatkan kerusakan jaringan yang ekstensif
- luka masuk & keluar p.u <10% TBSA, namun kedalaman luka bakar sulit
diperkirakan- kerusakan yang dalam disebabkan
aliran listrik yang melalui jaringan- waspada trauma lain yang menyertai
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ALIRAN LISTRIK
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Luas kerusakan jaringan tergantung aliran listrik mengenai tubuh
Melalui dada → aritmia, kerusakan jantungMelalui kepala → kejang, kerusakan otak,
paralisisDekat mata → katarak
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MEKANISME TRAUMA LISTRIK
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Kontak langsung:Kontak langsung: luka masuk / keluar memiliki 3 area
Kehitaman di tengahKehitaman di tengahKehitaman di tengahKehitaman di tengah
Abu-abu, Abu-abu, nekrosis nekrosis koagulankoagulan
Abu-abu, Abu-abu, nekrosis nekrosis koagulankoagulan
Kerusakan jaringan Kerusakan jaringan parsialparsial
Kerusakan jaringan Kerusakan jaringan parsialparsial
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Luka masuk Luka keluar
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Electrical arc:Electrical arc:- penyebab kerusakan jaringan terparah akibat kontak tak langsung- loncatan listrik melalui udara yang terionisasi menuju tubuh
Flash burn:Flash burn:campuran luka bakar superfisial dan dalam
TermalTermal
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Trauma tumpul:Trauma tumpul:- jatuh dari ketinggian- Arus AC → kejang → fraktur & dislokasi
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MANIFESTASI ORGAN SPESIFIK
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JantungCNSKulitEkstremitasMataGinjalPembuluh darah
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Jantung
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Nekrosis otot jantung secara langsungDisritmia → VF, AF, asistol, aritmia, dllArus AC lebih berbahaya
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CNS
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AkutAkutDepresi nafas, kejang, perubahan status
mental, koma, amnesia, kuadriplegia, parese lokal, neuropati perifer
Aliran listrik melalui kepala koagulasi parenkim otak, EDH, SDH, IVH
Fase lanjutFase lanjutAscending paralysis, transverse myelitis,
amyotrophic lateral sclerosis
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EkstremitasLuka bakar pada area
pelipatan fleksor:akibat lompatan electrical arc
Fraktur / dislokasiCompartment syndrome
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Mata
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Katarak:- p.u >1000 V- terjadi 1-12 bulan kemudian
Lesi kornea, uveitis, iridosiklitis, perdarahan vitreus, ablasio retina, atrofi papil, korioretinitis
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Ginjal
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MyoglobinuriaGagal ginjal akut
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Pembuluh darah
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Akibat langsung dari aliran listrikSekunder akibat kerusakan jaringan sekitar
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PENANGANAN TRAUMA LISTRIK
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Pastikan aliran listrik telah berhenti sebelum menolong px
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PRIMARY SURVEY
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Airway & C-spine controlBreathingCirculation
Monitor EKG 24 jam → disritmiaDisability
GCS, pupil
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SECONDARY SURVEY
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Head to toe examinationLuka masuk & luka keluarEstimasi luas dan derajat luka bakarPemeriksaan neurologisPemeriksaan adanya trauma lainProfilaksis anti tetanus bila perlu
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Kriteria MRS
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Henti jantungLuka bakar beratEKG abnormalLuka bakar pada komisura bibirKehilangan kesadaranHipoksiaMyoglobinuria / peningkatan CPK signifikanHigh voltage
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RESUSITASI
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Luka bakar yang luas → cairan 2-4 cc/kg BB/luas luka bakar
Myoglobinuria → pertahankan urine output 75-100 cc/jam hingga urine jernih
Manitol / Nabic
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PENANGANAN LUKA
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Waspada compartment syndrome → fasiotomi
Myonekrosis p.u baru dapat dideteksi setelah 3-5 hari pasca trauma → debridement + penutupan luka definitif
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