Klasifikasi Luka Bakar

A. Dalamnya Luka Bakar

Luka Bakar Tingkat I

Kedalaman : Ketebalan partial superfisial

Penyebab : Jilatan api, sinar ultra violet (terbakar oleh matahari).

Penampilan : Kering tidak ada gelembung, oedem minimal atau tidak ada, pucat bila ditekan dengan ujung jari, berisi kembali bila tekanan dilepas.

Warna : Bertambah merah.

Perasaan : Nyeri

Luka Bakar Tingkat II

Kedalaman : Lebih dalam dari ketebalan partial, superfisial, dalam.

Penyebab : Kontak dengan bahan air atau bahan padat, jilatan api kepada pakaian, jilatan langsung kimiawi, sinar ultra violet.

Penampilan : Blister besar dan lembab yang ukurannya bertambah besar, pucat bila ditekan dengan ujung jari, bila tekanan dilepas berisi kembali.

Warna : Berbintik-bintik yang kurang jelas, putih, coklat, pink, daerah merah coklat.

Perasaan : Sangat nyeri

Luka Bakar Tingkat III

Kedalaman : Ketebalan sepenuhnya

Penyebab : Kontak dengan bahan cair atau padat, nyala api, kimia, kontak dengan arus listrik.

Penampilan : Kering disertai kulit mengelupas, pembuluh darah seperti arang terlihat dibawah kulit yang mengelupas, gelembung jarang, dindingnya sangat tipis, tidak membesar, tidak pucat bila ditekan.

Warna : Putih, kering, hitam, coklat tua, hitam, merah.

Perasaan : Tidak sakit, sedikit sakit, rambut mudah lepas bila dicabut.

Derajat 1:  cedera dangkal yang hanya melibatkan lapisan luar kulit (epidermis),

misalnya karena berjemur di bawah terik matahari. Kulit memerah dan sangat

menyakitkan. Luka bakar akan sembuh sendiri tanpa jaringan parut dalam waktu dua

sampai lima hari.

Derajat 2: terjadi ketika kulit terbakar hingga lapisan kedua. Kulit tampak melepuh dan

lecet berwarna merah sehingga terlihat belang-belang dan terasa sangat perih

menyakitkan. Luka bakar derajat dua dianggap belum berbahaya jika melibatkan kurang

dari 15 persen dari permukaan tubuh pada orang dewasa dan kurang dari 10 persen pada

anak-anak. Bila ditangani dengan benar, luka bakar derajat dua akan sembuh tanpa

banyak menimbulkan jaringan parut. Penyembuhan biasanya memakan waktu hingga

tiga minggu.

Derajat 3: melibatkan semua lapisan kulit sehingga kulit rusak parah berwarna coklat,

kadang-kadang diselingi kelupasan putih atau hitam.  Luka bakar derajat tiga mungkin

sangat menyakitkan, namun beberapa pasien dapat sedikit atau tidak merasa sakit karena

ujung-ujung sarafnya telah hancur. Penyembuhan sempurna luka bakar derajat ini

mungkin memerlukan pencangkokan kulit.

Fluid resuscitation

Intravenous access may be obtained percutaneously or by cutdown, either peripherally or centrally. Peripheral access in an unburned area is preferred. Intraosseous (IO) infusion may be lifesaving in the severely burned patient if necessary.

Several burn resuscitation formulas can be used in pediatric burn care; the modified Parkland formula is most commonly used. Ringer lactate solution is initially used in pediatric patients of all ages at 3-4 mL/kg for each percent of BSA burned for the first 24 hours. One half of the calculated fluid needs are administered in the first 8 hours after the burn occurs, and the remaining half are administered over the following 16 hours. Maintenance fluids should be administered concomitantly (this represents the modification to the Parkland formula for pediatric patients).

Representative fluid resuscitation guidelines for pediatric burn patients with burns more than 15% TBSA are as follows:

Modified Parkland formula (Parkland formula plus maintenance fluids, used in patients who weigh less than 20 kg)

Resuscitation fluids - 3-4 mL Ringer lactate X weight (kg) X %TBSA burned (second-degree and third degree); half administered over the first 8 hours (from time of injury), remaining half administered over the next 16 hours

Maintenance fluids - Ringer lactate solution with 5% dextrose at 4 mL/kg/h for 0-10 kg, plus 2 mL/kg/h for 10-20 kg, plus 1 mL/kg/h for each kg more than 20 kg

Prehospital fluids must also be considered. If prehospital fluid resuscitation is inadequate, the fluid deficit must be added to the fluid rate calculated for the first 8 hours of resuscitation.

For patients with burns of 15% TBSA or less, the following are indicated:

Patients with burns 5-10% TBSA who are taking oral fluids well - Oral fluids only Patients with burns 5-10% TBSA who are not taking oral fluids well - Maintenance

fluids Patients with burns 10-15% TBSA - 150% maintenance fluids

The above recommendations are guidelines only. Patients with burns of more than 15% TBSA should have a urinary catheter placed. Desired urine output is 1 mL/kg/h for patients who weigh less than 30 kg and 30-50 mL/h for patients who weigh more than 30 kg. For major burns, fluid resuscitation needs to be reassessed hourly based on the patient's urine output.

Rates of fluid administration should be altered based on the patient's response. If a patient presents after some period of delay and has not been resuscitated properly during that time, adjustments should be made in the calculated fluid requirements to take these factors into account. Infants are at risk of developing hypoglycemia because of limited glycogen stores; therefore, glucose levels should be monitored, and Ringer lactate solution with 5% dextrose should be used for maintenance fluids. Assess response to fluid administration by measuring urine output via an indwelling urinary catheter. Monitoring sensorium, peripheral circulation, and blood pH is also helpful to assess the adequacy of resuscitation.