Pedoman Nasional Pelayanan Kedokteran 
         PENANGANAN LUKA BAKAR 
                          2016  
                        DAFTAR ISI 
        
       1. PENDAHULUAN ................................................................................................................. 6 
        1.1. Pengertian .................................................................................................................................. 6 
        1.2. Epidemiologi ............................................................................................................................. 6 
        1.3. Etiologi ....................................................................................................................................... 7 
        1.4. Indikasi dan Kriteria Rujuk ..................................................................................................... 7 
        1.5. Tim Luka Bakar ........................................................................................................................ 8 
       2. METODOLOGI ................................................................................................................... 10 
        2.1. Cara Penelusuran / Strategi ................................................................................................... 10 
        2.2. Kajian Praktis klinik ............................................................................................................... 10 
        2.3. Tingkat  Kesahihan  dan  Derajat  Rekomendasi  (Level  of  Evidence  –  Grade  of 
        Recommendation) .......................................................................................................................... 10 
       3. PENATALAKSANAAN ..................................................................................................... 12 
        3.1. Penatalaksanan 24 Jam Pertama ........................................................................................... 12 
         3.1.1. Primary Survey ....................................................................................................... 12 
         3.1.2. Secondary Survey ................................................................................................... 18 
          3.1.2.1. Riwayat Penyakit ............................................................................................. 18 
          3.1.2.2 Mekanisme Trauma .......................................................................................... 19 
          3.1.2.3. Pemeriksaan Survei Sekunder.......................................................................... 19 
          3.1.2.4 Eskarotomi ........................................................................................................ 19 
          3.1.2.5 Fasciotomi ......................................................................................................... 20 
          3.1.2.6 Dressing ............................................................................................................ 21 
          3.1.2.7. Dokumentasi .................................................................................................... 21 
          3.1.2.8. Re-Evaluasi ...................................................................................................... 21 
        3.2 Luka Bakar Listrik Dan Luka Bakar Kimia ......................................................................... 21 
         3.2.1 Luka Bakar Listrik ................................................................................................... 21 
         3.2.2. Luka Bakar Kimia .................................................................................................. 25 
          3.2.2.1. Proteksi ............................................................................................................ 25 
          3.2.2.2. Etiologi dan Klasifikasi.................................................................................... 25 
          3.2.2.3 Komplikasi Anatomi Khusus ............................................................................ 26 
          3.2.2.4 Pertolongan pertama ......................................................................................... 27 
        3.3 Luka Bakar Pada Anak ........................................................................................................... 27 
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         3.3.1 Pendahuluan............................................................................................................. 27 
         3.3.2 Epidemiologi ........................................................................................................... 27 
         3.3.3 Proporsi dan Ukuran Tubuh .................................................................................... 28 
         3.3.4 Kedalaman Luka Bakar ........................................................................................... 28 
         3.3.5 Pertolongan Pertama Luka Bakar pada Anak .......................................................... 28 
         3.3.6 Airway ..................................................................................................................... 29 
         3.3.7 Manajemen Cairan ................................................................................................... 29 
          3.3.7.1 Perbedaan antara Anak dan Dewasa ................................................................. 29 
          3.3.7.3 Urine Output ..................................................................................................... 29 
        3.4. Penanganan > 24 jam ............................................................................................................. 30 
         3.4.1. Kebutuhan Cairan ................................................................................................... 30 
          3.4.1.1. Rute untuk Resusitasi ....................................................................................... 31 
          3.4.1.2. Pemilihan Cairan .............................................................................................. 31 
          3.4.1.3. Formula Resusitasi Cairan ............................................................................... 32 
          3.4.1.4. Monitor Kecukupan Resusitasi ........................................................................ 32 
         3.4.2. Kebutuhan Nutrisi................................................................................................... 34 
         3.4.3. Penilaian Luas dan Kedalaman ............................................................................... 35 
          3.4.3.1. Penilaian Luas Luka Bakar .............................................................................. 35 
          3.4.3.2. Penilaian Kedalaman Luka Bakar .................................................................... 37 
           3.4.3.2.1 Luka Bakar Superficial............................................................................... 37 
           3.4.3.2.2 Luka Bakar Mid-Dermal ............................................................................ 38 
           3.3.3.2.3 Luka Bakar Deep ........................................................................................ 38 
         3.4.4. Perawatan Luka pada Luka Bakar .......................................................................... 39 
         3.4.5. Kontrol Infeksi ........................................................................................................ 41 
          3.4.5.1. Eksisi Tangensial ............................................................................................. 41 
          3.4.5.2 Split Thickness Skin Graft ................................................................................ 44 
          3.4.5.3. Penggunaan Antibiotik Sistemik...................................................................... 45 
         3.4.6 Rehabilitasi .............................................................................................................. 46 
          3.4.6.1 Parut dan Kontraktur ......................................................................................... 46 
           3.4.6.1.1 Parut Hipertrofi .......................................................................................... 46 
           3.4.6.1.2 Keloid ......................................................................................................... 47 
           3.4.6.1.3 Pencegahan ................................................................................................. 47 
           3.4.8.1.4 Manajemen Non Operatif ........................................................................... 48 
           3.4.6.1.5 Manajemen Operatif Keloid ....................................................................... 48 
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                              3.4.6.1.6 Balut Tekan (Pressure Garment) ................................................................ 48 
                           3.4.6.2 Kontraktur ......................................................................................................... 49 
                           3.4.6.3 Fisioterapi / Terapi Okupasi.............................................................................. 49 
                           3.4.6.4 Splinting ............................................................................................................ 50 
                           3.4.6.5 Psikoterapi......................................................................................................... 50 
                        3.4.7. Prognosis ................................................................................................................ 50 
                           3.4.7.1. ABSI (Abbreviated Burn Severity Index) Score ............................................. 50 
                        3.4.8 Critical Care ............................................................................................................. 51 
                           3.4.8.1 Ventilator .......................................................................................................... 51 
                              3.4.8.1.1. Intubasi Endotrakeal .................................................................................. 52 
                              3.4.8.1.2. Indikasi dan Teknik ................................................................................... 52 
                              3.4.8.1.3. Keuntungan dan Kekurangan Pemberian Ventilasi Mekanik ................... 52 
                              3.4.8.1.4. Setting Ventilator yang Optimal ............................................................... 53 
                              3.4.8.1.5. Sedasi saat Ventilasi Mekanik................................................................... 53 
                              3.4.8.1.6. Memonitor Ventilasi Mekanik .................................................................. 53 
                           3.4.8.2. Acute Kidney Injury (AKI) – Continous Veno Venous Hemofiltration (CVVH)
                           ....................................................................................................................................... 53 
                   4.   DAFTAR PUSTAKA ....................................................................................................... 56 
                    
                                                        
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