patofisiologi luka bakar dan terapi nutrisi
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Patofisiologi Luka Bakar dan Terapi Nutrisi
dr. Rauza Sukma Rita, Ph.D
Definisi Luka Bakarsuatu bentuk kerusakan dan atau kehilangan
jaringan disebabkan kontak dengan sumber yang memiliki suhu sangat tinggi.
Kerusakan akut yang disebabkan panas, listrik, dan zat kimia
InsidenSekitar 310.000 orang di seluruh dunia meninggal
karena luka bakar30 % diantaranya berusia di bawah 20 tahun
ETIOLOGI• Paparan api
• Flame• Benda panas
(kontak)• Scalds (air panas)• Uap panas• Gas panas
• Aliran listrik• Zat kimia• Radiasi • Sunburn
panas
listrikZat kimia
Zat radioakif laser
petir
ledakan
Kehidupan sehari-hari
Klasifikasi Luka BakarBerdasarkan derajat dan kedalaman luka bakar 1. Superficial (first-degree) 2. Deep (second-degree) 3. Full thickness (third and fourth degree)
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SUPERFICIAL BURNS (FIRST DEGREE)
• Epidermal tissue only affected• Erythema, blanching on pressure, mild swelling no vesicles or blister initially• Not serious unless large areas involved• i.e. sunburn
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DEEP (SECOND DEGREE)*Involves the epidermis and deep layer of the
dermisFluid-filled vesicles –red, shiny, wet, severe painHospitalization required if over 25% of body
surface involvedi.e. tar burn, flame
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FULL THICKNESS (THIRD/FOURTH DEGREE)
• Destruction of all skin layers• Requires immediate hospitalization• Dry, waxy white, leathery, or hard skin, no pain• Exposure to flames, electricity or chemicals can
cause 3rd degree burns
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Perhitungan Luas Permukaan Tubuh yang Terkena1.Metode permukaan telapak tanganarea permukaan tangan pasien (termasuk jari
tangan) adalah sekitar 1% total luas permukaan tubuh.
Digunakan pada luka bakar kecil
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Metode Permukaan Telapak Tangan
Perhitungan Luas Permukaan Tubuh yang Terkena2. Metode rule of nine Metode yang baik dan cepat menilai luka bakar menengah dan berat pada penderita berusia di atas 10 tahun.
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RULES OF NINES• Head & Neck = 9%• Each upper extremity (Arms) = 9%• Each lower extremity (Legs) = 18%• Anterior trunk= 18%• Posterior trunk = 18%• Genitalia (perineum) = 1%
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3. Metode diagram oleh Lund and Browder Metode yang paling akurat pada anak bila digunakan dengan benar.
Perhitungan Luas Permukaan Tubuh yang Terkena
Lund Browder Chart used for determining Body Surface Area (BSA)
29Evans, 18.1, 2007)
Patofisiologi Luka BakarRespon LokalSegera setelah kontak permukaan kulit dengan sumber panas nekrosis kulit yang terkena.Tiga zona luka bakar :1. Koagulasi2. Stasis 3. Hiperemis
1. Zona Koagulasi Area yang terkena kontak erat dengan sumber panasSel pada area ini mengalami nekrosis koagulasi dan
tidak membaikKehilangan jaringan bersifat irreversibel
2. Zona StasisArea konsentris yang kerusakan jaringannya lebih
sedikitDitandai penurunan perfusi jaringanJaringan pada zona ini berpotensi untuk
diselamatkan
3. Zona HiperemisZona terluar di mana perfusi jaringan meningkatSel pada area ini mengalami trauma minimalPada sebagian besar kasus akan membaik dalam 7-
10 hari
Zona Luka Bakar Menurut Jackson
Patofisiologi Luka BakarRespon SistemikTergantung luas luka bakarLuka bakar > 20 % total permukaan tubuh respon sistemikDua fase pada penderita luka bakar :1. Fase ebb terjadi 24 jam pertama
hipometabolisme2. Fase flow setelah 24 jam
peningkatan konsentrasi hormon katabolikKondisi hipermetabolik menyebabkan perubahan metabolism karbohidrat, lemak dan protein
Gangguan metabolism karbohidratPeningkatan gluconeogenesisResistensi insulin
Gangguan metabolism proteinTerjadi proteolysis yang bisa berlangsung 40-90
hari paska luka bakarPenurunan lean body mass hingga setahun paska
luka bakar
Patofisiologi Luka Bakar
Gangguan metabolism lemakPeningkatan lipolysis
Gangguan makronutrien Penurunan zat besi, seng, selenium, vitamin C,
tokoferol, retinol, dan vitamin A
Patofisiologi Luka Bakar
Respon metabolik terhadap luka bakar
Manifestasi Klinis Luka Bakar• Reaksi Lokal KemerahanBengkakNyeriPerubahan sensasi
Manifestasi Klinis Luka Bakar• Reaksi Sistemik pada luka bakar yang luasSyok hipovolemik luka bakar > 25 % luas
permukaan tubuhHipotermiaPerubahan metabolik
Terapi Luka Bakar1.Pertolongan emergency remove heat source avoid re-damage lessen contamination control pain manage combined injury
cold therapy
Terapi Luka Bakar2.Terapi Umum(1. Correct burn shock 2. Prevention and treatment of systemic infection 3. Nutritional support
(1) Correct burn shock ★ ◨ choice of fluid: water, crystalloid, colloid ◨ route for fluid administration: peripheral, central vein ◨ volume and rate of infusion: 24h volume = 1.5ml×%burn×weight (kg)
(2) Prevention and treatment of systemic infection ·control of wound infection ·systemic antibiotics ·support therapy
(3) Nutritional support in burned patients
• Burns are a tissue injury resulting in protein denaturation edema loss of intravascular fluid volume caused by chemical, thermal, radiation, or
electrical contact.
• There are three important reactions of the body to a burn injury, which include
Metabolic HormonalImmune Response
Nutrition in burned patients (cont.)
Feeding the burned patient • The first 24-48 hours of nutritional intervention
replaces lost fluid and electrolytes. • Initiation of feeding is recommended within 4-12
hours of hospitalization.
Nutrition in burned patients (cont.)
Calculation of energy needs • is usually based on the Curreri method:24 kcal × kg usual body weight + 40 kcal × % TBSA (with a maximum of 50% TBSA)• Adults are often calculated to need 35-40
kcal/kg/day.
Nutrition in burned patients (cont.)
Nutritional Requirements• CHO: Glucose administration at a rate of 5
mg/kg/min is optimum for adults. The child glucose requirement is 5-7 mg/kg/min.
• Lipid: 15% of energy requirements is sufficient.
Nutrition in burned patients (cont.)
• Protein: approximately 25% of total energy should come from protein.
• Adults : 1g protein /kg + 3g x % burn.• Children : 3g protein/kg + 1g x % burn.
Nutrition in burned patients (cont.)
Arginine• Is one amino acid important in the healing of burn wounds associated with:Reduced hospital stay & infection rate. It is also a precursor to nitric oxide, which increases blood flow to the wound and causes vasodilatation.
Glutamine• Another important amino acid has been shown
to Preserve integrity of the intestinal mucosa,Reduce infection and maintain immune
function in burn patientsDecrease the translocation of bacteria and
bacterial survival in animals.• Ornithine α-ketoglutarate, a precursor of
glutamate and glutamine, has been shown to be beneficial when administered to burn patients.
Vitamin requirements :•Vitamin A, which is important in proper immune function and epithelialization, in the amount of 10,000 IU/day and 5,000 IU/day in children under three years old.
•Vitamin C supplementation are 250 mg twice daily for children under 10 years old and 500 mg twice daily for adult.
Nutrition in burned patients (cont.)
Minerals • Are also important to monitor in the nutritional care
of burn patients. Supplementation of zinc, copper, and selenium during the first week.
• Calcium, phosphorus, magnesium, sodium, and potassium levels monitored cautiously.
Nutrition in burned patients (cont.)
Prevention:
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