LAPORAN KASUS
LUKA BAKAR
Disusun oleh: DINI NOVIANI PRATIWI 030.08.084
PEBIBIN!: D". BA#UAD#I S$.B
KEPANITERAAN KLINI ILMU BEDAH RSUD KOJA PERIODE 17 DESEMBER 2012- 23 FEBRUARI 2013 FAKULT FAKULTAS AS KEDOKTERAN UNIVERSITA UNIVERSI TAS S TRISAKTI TRI SAKTI JAKARTA 2012
0
BAB I LAPORAN KASUS
I.
IDENTITAS PASIEN
Nama
: An. S
U!a
: " #a$%n
J&n! K&'am!n
: P&(%m)%an
A'ama#
: *!'!n+!n,
A,ama
: I'am
S%%
: B&#a!
Nama /(an,#%a
:
P&&(aan /(an,#%a: Ma% RS
II.
: Ra% 1 D&&m&( 2012 )%%' 11.00
ANANESIS
D!'a%an &+a(a a%#/namn&! )a4a $a(! (a% #an,,a' 1 D&&m&( 2012 )%%' 11.00 5IB 4! P/'! K'!n! B&4a$ RSUD KOJA
Keluh%n u&%'%
K&4%a #%n,a! 4an a! m&'&)%$ 4an #&(aa n6&(! a(&na #&(&na '&4aan ,a &a 3 m!n,,% &&'%m ma% (%ma$ a!#.
Ri(%)%& $en)%*i& se*%"%n+
T!,a T!,a m!n,,% m!n,,% SMRS aa# )a!&n &4an, m&m)&(a!! m&m)&(a!! ,a 6an, (%a 4! a'a$ a#% (%ma$ maan. T!a-#!a #a%n, ,a #&(&%# m&'&4a 4an m&n6ama( &a(a$ a! )a!&n #&(&%#. K&m%4! K&m%4!an an )a!&n )a!&n &(%a &(%a$a $a &'%a( &'%a( am!' am!' &('a( &('a(!. !. Nam%n Nam%n )a!&n )a!&n #&#a) #&#a) #&(am #&(ama( a( a)! a'a%) a'a%)%n %n an,a# an,a# &&n#a &&n#a(. (. La'% La'% &m%4! &m%4!an an a)! 6an, 6an, m&n6am m&n6ama( a( 4!a,! 4!a,!an an a!n6 a!n6aa 4! )a4aman 4&n,an a!n aa$. T&(%(%n, T&(%(%n, 4a'am (%an,an -8 m&n,$!(%) aa) -8 &a na9a -8 #&(&n#%( 4! &)a'a -8 )!n,an -8 )%!n, -8 m%a' -8 m%n#a$ -8 Pa! Pa!&n &n &m% &m%4! 4!an an 4!a 4!aa a & '!n '!n! ! #&(4 #&(4& &a# a# 4an 4an 4!& 4!&(! (! )&(a )&(aa a#a #an n '%a '%a 4&n, 4&n,an an m&n,,%na m&n,,%naan an a'&) &m%4!an &m%4!an 4!(%% 4!(%% & RSUD K/a 4an 4!&(!an 4!&(!an )&(aa#an '%a 4an /a# %n#!. Pa+a &a4!an #&(&%# )a!&n %4a$ 2 a'! /n#(/' & )/'! '!n! &4a$ RSUD K/a %n#% 4!'a%an )&(aa#an '%a. Ri(%)%& $en)%*i& ,%hulu 1
A'&(,! /a# $!)&(#&n! DM 4an ama 4!an,a'.
Ri(%)%& $en)%*i& *elu%"+%
A'&(,! /a# $!)&(#&n! DM 4an ama 4!an,a'
III.
PEERIKSAAN -ISIK
K&a4a(an +/m)/ m&n#! P"i'%") su"e)
A : B&a B&a (am%# (am%# a#a% a#a% %'% %'% $!4%n, $!4%n, #!4a a4a 6an, 6an, #&(aa( #&(aa( B : S)/n#an S)/n#an 9(&%&n! 9(&%&n! na9a na9a 20;m&n 20;m&n!# !# (&,%'&( (&,%'&( &4a'ama &4a'aman n +%%) +%%) * : A(a' A(a' $an,a# $an,a# *RT *RT < 2= 2= #&anan #&anan 4a(a$ 100;>0 100;>0 mmH, mmH, 9(&%&n! 9(&%&n! na4! 112 112;m&n! ;m&n!# # %$% a9&(! D : ?*S 1@ E"MV@
Se/on,%") su"e)
K&)a'aaa$
: 4&9/(m!#a -8
Ma#a
: /n%n,#!Ca #!4a )%+a# '&(a #!4a !#&(!
L&$&(
: )&m&a(an K?B -8
THT
: &(&# -8
Da4a
: !m&#(! 4a'am 4!am 4an )&(,&(aan
Jan#%n Jan#%n, , : BJ I II n/(ma n/(ma' ' m%(m m%(m%( %( -8 -8 ,a''/ ,a''/) ) -8 Pa(%
: C& C&! !%'&( (/ (/n! -; -;- $&&!n !n, -; -;-
A4/ A4/m& m&n n
: 4a# 4a#a( a( '&ma '&ma NT -8 -8 #4 #4 #&(a #&(aaa ma maa a BU BU 8 8 n/( n/(ma ma' ' H;L H;L ## ##
E# E#(& (&m! m!#a #a
: '!$ '!$a# a# #a# #a#% % '/a '/a'! '!
S&%&us lo*%lis 2
K&)a'a 4an '&$&(
:0
T(%n% an#&(!/(
:0
T(%n% )/#&(!/(
:0
E#(&m!#a a#a anan
: 0
E#(&m!#a a#a !(!
:0
E#(&m!#a aa$ anan : E#(&m!#a aa$ !(!
:
?&n!#a'!a
:0
T/#a'
: 1>
E4&ma &m&(a$an '%a m&(a$ m%4a$ #am)a aa$ #am)a &)!#&'!a! 4an (&,&n&(a!
3
PEERIKSAAN PENUN#AN!
RUTIN
Da(a$;H
:
H&m/,'/!n
: 133 ,;4L
B!'!(%!n
:-
H&ma#/(!#
: "0
U(/!'!n/,&n
: 02
L&%/!#
: 1700;µL
N!#(!#
:-
T(/m/!#
: 3"3.000; µL
E#&(a& '&%/!#
:-
M*V
: 7 9'
M*H
: 27 ),
M*H*
: 3" ,;4L
KIMIA DARAH U(&%m
: 23 m,;4L
La+#a#&
: 27 mm/';L
*(&a#!n!n
: 0> m,;4L
PT
: 10> 4&#!
S?OT
: 21 U;L
PT /n#(/'
: 12 4&#!
S?PT
: 17 U;L
APTT
: 30> 4&#!
A'%m!n
: 3 ,(;4L
APTT /n#(/'
: 33@ 4&#! ?DS
: 10@ m,;4L
Na
: 1"" m&G;L
K
: "3 m&G;L
*'
: 10> m&G;L
URINALISIS S&4!m&n S&' &)!#&'
:
L&%/!#
: 1-2
E(!#(/!#
: 10-11
S!'!n4&(
:-
)H
: 73@
K(!#a'
:-
)*O2
: 3@2 mmH,
Ba#&(!
:-
)O2
: 103> mmH,
SO2
: 7
BE &+#
: -1 mm/';L
B&
: -"
SB*
: 20
H*O3
: 17 mm/';L
T*O2
: 207 mm/';L
B&(a# &n!
: 1.01@
)H
:@
P(/#&!n
:-
?'%/a
:-
K&#/n
:
ANALISA ?AS DARAH
4
DIA!NOSIS KER#A
L%a aa( ,(a4& II 1> &+. a)!
TATALAKSANA
-
P(/ (aa# !na) IVFD: H& Na+' 3
-
12
##;m&n!#
@00
m';2" am
V!#am!n * 21 ,( K&#/'/(a+ 330m, O(a'!# 2200 mL Raa# '%a 4&n,an ma4% 4an a'&) MEBO B&(!$an '%a &(! MEBO 4&n,an &#&a'an 0@ 1 mm 'a'% #%#%) &n/,(a9# 4an a'%# '%a 4&n,an aa. ?an#! a'%# #!a) $a(!.
PRO!NOSIS
%/ a4 V!#am
: B/nam
%/ a4 F%n+#!/nam
: B/nam
%/ a4 Sana+#!/nam : B/nam
5
BAB II TIN#AUAN PUSTAKA
ANATOI KULIT
K%'!# a4a'a$ %a#% /(,an )&m%n,% &'%(%$ )&(m%aan '%a( #%%$ m&(%)aan /(,an #&(&(a# 4an #&(&a( 4a(! #%%$. S&'%(%$ %'!# &(a#n6a &!#a( 1 &(a# #%%$ )a4a /(an, 4&aa &!#a( 27 3 , 4an '%an6a &!#a( 1@ 1 m&#&( )&(&,!. T&a'n6a %'!# &(Ca(!a! m%'a! 0@ mm am)a! mm #&(,an#%n, 4a(! '&#a %m%( 4an &n! &'am!n. K%'!# #!)! #&('&#a )a4a &'/)a ma#a )&n! 'a!%m m!n% 4an %'!# a,!an m&4!a' '&n,an a#a. S&4an,an %'!# #&a' #&(4a)a# )a4a #&'a)a #an,an #&'a)a a! )%n,,%n, a$% 4an //n,. S&+a(a &m(!/'/,! %'!# &(aa' 4a(! 4%a 'a)! 6an, &(&4a 'a)!an '%a( a4a'a$ &)!4&(m! 6an, m&(%)aan 'a)!an &)!#&' &(aa' 4a(! &+#/4&(m &4an,an 'a)!an 4a'am 6an, &(aa' 4a(! m&/4&(m a4a'a$ 4&(m! a#a% /(!%m 6an, m&(%)aan %a#% 'a)!an a(!n,an !a#. 1. EPIDERMIS E)!4&(m! a4a'a$ 'a)!an '%a( %'!# 6an, #!)! 4an aCa%'&(. T&(4!(! 4a(! &)!#&' &('a)! ,&)&n, &(#an4% m&n,an4%n, &' m&'an/!# Lan,&($an 4an m&(&'. T&a' &)!4&(m! &(&4a-&4a )a4a &(a,a! #&m)a# 4! #%%$ )a'!n, #&a' )a4a #&'a)a #an,an 4an a!. K&#&a'an &)!4&(m! $an6a &!#a( @ 4a(! &'%(%$ &#&a'an %'!#. T&(a4! (&,&n&(a! &#!a) "- m!n,,%. E)!4&(m! #&(4!(! a#a '!ma 'a)!an 4a(! 'a)!an 6an, )a'!n, a#a am)a! 6an, #&(4a'am8: 1. S#(a#%m K/(n&%m T&(4!(! 4a(! &' &(a#!n/!# 6an, !a m&n,&'%)a 4an &(,an#!. 2. S#(a#%m L%!4%m B&(%)a ,a(! #(an'%&n !aan6a #&(4a)a# )a4a %'!# #&a' #&'a)a a! 4an #&'a)a #an,an. T!4a #am)a )a4a %'!# #!)!. 3. S#(a#%m ?(an%'/%m D!#an4a! /'&$ 3-@ 'a)! &' )/'6,/na' ,&)&n, 6an, !n#!n6a 4!#&n,a$ 4an !#/)'ama #&(!! /'&$ ,(an%'a &(a#/$!a'!n 6an, m&n,an4%n, )(/#&!n a6a aan $!#!4!n. T&(4a)a# &' Lan,&($an. ". S#(a#%m S)!n/%m T&(4a)a# &(a-&(a 9!'am&n# 6an, 4!namaan #/n/9!(!' 4!an,,a) 9!'am&n-9!'am&n #&(&%# m&m&,an, )&(anan )&n#!n, %n#% m&m)&(#a$anan /$&! &' 4an m&'!n4%n,! 6
#&($a4a) &9& a(a!. E)!4&(m! )a4a #&m)a# 6an, #&(% m&n,a'am! ,&&an 4an #&anan m&m)%n6a! #(a#%m )!n/%m 4&n,an '&!$ an6a #/n/9!(!'. S#(a#%m aa'& 4an #(a#%m )!n/%m 4!&%# &a,a! 'a)!an Ma'9!,!. T&(4a)a# &' Lan,&($an. @. S#(a#%m Baa'& S#(a#%m ?&(m!na#!C%m8 T&(4a)a# a#!9!#a m!#/! 6an, $&a# 4an &(#an,,%n, aa 4a'am )&ma$a(%an &' &)!4&(m! &+a(a /n#an. E)!4&(m! 4!)&(a$a(%! &#!a) 2> $a(! %n#% m!,(a! & )&(m%aan $a' !n! #&(,an#%n, '&#a %!a 4an 9a#/( 'a!n. M&(%)aan a#% 'a)! &' 6an, m&n,an4%n, m&'an/!#. F%n,! E)!4&(m! : P(/#&! a(!&( /(,an!a! &' !n#&! C!#am!n D 4an !#/!n )&m&'a$an 4an m/!'!a! &' )!,m&n#a! m&'an/!#8 4an )&n,&na'an a'&(,&n &' Lan,&($an8. 2. DERMIS M&(%)aan a,!an 6an, )a'!n, )&n#!n, 4! %'!# 6an, &(!n, 4!an,,a) &a,a! T(%& S!n=. T&(4!(! a#a a(!n,an !a# 6an, m&n6//n, &)!4&(m! 4an m&n,$%%n,ann6a 4&n,an a(!n,an %%#!. T&a'n6a &(Ca(!a! 6an, )a'!n, #&a' )a4a #&'a)a a! &!#a( 3 mm. D&(m! #&(4!(! 4a(! 4%a 'a)!an :
La)!an )a)!'&( #!)! m&n,an4%n, a(!n,an !a# a(an,.
La)!an (&#!%'&( #&a' #&(4!(! 4a(! a(!n,an !a# )a4a#. S&(a%#-&(a%#
/'a,&n
m&n&a' 4an !n#&a
/'a,&n
&(%(an,
4&n,an
&(#ama$n6a %!a. S&(a%# &'a#!n %m'a$n6a #&(% m&n!n,a# 4an m&n&a' an4%n,an &'a#!n %'!# man%!a m&n!n,a# !(a-!(a @ a'! 4a(! 9&#% am)a! 4&aa. Pa4a %!a 'an%# /'a,&n a'!n, &(!'an,an 4a'am %m'a$ &a( 4an &(a%# &'a#!n &(%(an, m&n6&aan %'!# #&(a4! &$!'an,an &'&maann6a 4an #am)a m&m)%n6a! an6a &(!)%#. D&(m! m&m)%n6a! an6a a(!n,an )&m%'%$ 4a(a$. D&(m! %,a m&n,an4%n, &&(a)a 4&(!Ca# &)!4&(m! 6a!#% 9/'!&' (am%# &'&na( &a&a 4an &'&na( &(!n,a#. K%a'!#a %'!# #&(,an#%n, an6a #!4an6a 4&(!Ca# &)!4&(m! 4! 4a'am 4&(m!. F%n,! D&(m! : #(%#%( )&n%nan, m&+$an!+a' #(&n,#$ %)'a! n%#(!! m&na$an $&a(!n, 9/(+& 4an (&)/n !n9'ama! 3. SUBKUTIS M&(%)aan 'a)!an 4! aa$ 4&(m! a#a% $!)/4&(m! 6an, #&(4!(! 4a(! 'a)!an '&ma. La)!an !n! #&(4a)a# a(!n,an !a# 6an, m&n,$%%n,an %'!# &+a(a '/n,,a( 4&n,an a(!n,an 4! aa$n6a. J%m'a$ 4an %%(ann6a &(&4a-&4a m&n%(%# 4a&(a$ 4! #%%$ 4an &a4aan n%#(!! !n4!C!4%. B&(9%n,! m&n%nan, %)'a! 4a(a$ & 4&(m! %n#% (&,&n&(a!. 7
F%n,! S%%#! F%n,! S%%#! ; $!)/4&(m! : m&'&a# & #(%#%( 4aa( !/'a! )ana +a4an,an a'/(! /n#(/' &n#% #%%$ 4an m&+$an!+a' $/+ a/(&(.
VASKULARISASI KULIT A(#&(! 6an, m&m&(! n%#(!! )a4a %'!# m&m&n#% )'&% #&('&#a an#a(a 'a)!an )a)!'&( 4an (&#!%'&( 4&(m! 4an &'a!n !#% an#a(a 4&(m! 4an a(!n,an %%#!. *aan, &+!' m&n!n,,a'an )'&% !n! m&m)&(4a(a$! )a)!''a 4&(m! #!a) )a)!''a 4&(m! )%n6a a#% a(#&(! a&n4&n 4an a#% +aan, C&na. Pa4a &)!4&(m! #!4a #&(4a)a# )&m%'%$ 4a(a$ #a)! m&n4a)a# n%#(!&n# 4a(! 4&(m! m&'a'%! m&m(an &)!4&(m!
-ISIOLO!I KULIT
K%'!# m&(%)aan /(,an 6an, &(9%n,! an,a# )&n#!n, a,! #%%$ 4!an#a(an6a a4a'a$ m&m%n,!nan &(#a$an 4a'am &(a,a! /n4!! '!n,%n,an &a,a! a(!&( !n9&! m&n,/n#(/' %$% #%%$ #&(m/(&,%'a!8 &na! &(&! 4an m&#a/'!m&. F%n,! )(/#&! %'!# a4a'a$ m&'!n4%n,! 4a(! &$!'an,an +a!(an 4a(! &'&#(/'!# #(a%ma m&an! %'#(aC!/'&# 4an &a,a! a(!&( 4a(! !nCa! m!(//(,an!m& )a#/,&n. S&na! #&'a$ 4!&#a$%! m&(%)aan a'a$ a#% 9%n,! %'!# 4a'am m&(&)/n (an,an, (aa a(&na an6an6a a$!(an a(a9 &)&(#! )a4a 4a&(a$ !!( )%#!n, 4an %%n, a(!. K%'!# &()&(an )a4a )&n,a#%(an %$% 4an &&!man,an +a!(an &'&#(/'!#. T&(m/(&,%'a! 4!/n#(/' /'&$ $!)/#$a'am%. T&m)&(a#%( )&(!9&( m&n,a'am! )(/& &&!man,an m&'a'%! &(!n,a# !n&!'& '/ 4a(! %'!# )a(% )a(% 4an m%/a %a'. T&m)&(a#%( %'!# 4!/n#(/' 4&n,an 4!'a#a! a#a% /n#(!! )&m%'%$ 4a(a$ %'!#. B!'a #&m)&(a#%( m&n!n,a# #&(a4! Ca/4!'a#a! )&m%'%$ 4a(a$ &m%4!an #%%$ aan m&n,%(an,! #&m)&(a#%( 4&n,an m&'&)a )ana 4a(! %'!# 4&n,an +a(a m&n,!(!m !n6a' !m!a 6an, 4a)a# m&n!n,a#an a'!(an 4a(a$ 4! %'!#. Pa4a #&m)&(a#%(
8
6an, m&n%(%n )&m%'%$ 4a(a$ %'!# aan Ca//n#(!! 6an, &m%4!an aan m&m)&(#a$anan )ana.
PEN1EBU2AN LUKA
P&n6&m%$an '%a a4a'a$ %a#% &n#% )(/& %a$a %n#% m&m)&(a!! &(%aan 6an, #&(a4!. K/m)/n&n %#ama 4a'am )(/& )&n6&m%$an '%a a4a'a$ /'a,&n 4!am)!n, &' &)!#&'. F!(/'a a4a'a$ &' 6an, &(#an,,%n, aa %n#% !n#&! /'a,&n. F!!/'/,! )&n6&m%$an '%a &+a(a a'am! aan m&n,a'am! 9a&-9a& &)&(#! 4!aa$ !n! : a. Fa& !n9'ama! Fa& !n! 4!m%'a! &a #&(a4!n6a '%a am)a! $a(! &'!ma. S&,&(a &#&'a$ #&(a4!n6a '%a )&m%'%$ 4a(a$ 6an, )%#% m&n,a'am! /n#(!! 4an (&#(a! 4!&(#a! (&a! $&m/#a! a(&na a,(&,a! #(/m/!# 6an, &(ama a'a 9!(!n m&m&%an 4a(a$. K/m)/n&n $&m/#a! !n! aan m&'&)aan 4an m&n,a#!9an !#/!n 6an, m&'!)%#! E)!4&(ma' ?(/#$ Fa+#/( E?F8 In%'!n-'!& ?(/#$ Fa+#/( I?F8 P'a#&'&4-4&(!C&4 ?(/#$ Fa+#/( PD?F8 4an T(an9/(m!n, ?(/#$ Fa+#/( &#a T?F-8 6an, &()&(an %n#% #&(a4!n6a &m/#a! n&#(/9!' ma(/9a, ma# &' &' &n4/#&'!a' 4an 9!(/'a. K&a4aan !n! 4!&%# 9a& !n9'ama!. Pa4a 9a& !n! &m%4!an #&(a4! Ca/4!'a#a! 4an a%m%'a! '&/!# P/'6m/()$/n%+'&a( PMN8. A,(&,a# #(/m/!# aan m&n,&'%a(an m&4!a#/( !n9'ama! T(an9/(m!n, ?(/#$ Fa+#/( &#a 1 T?F -18 6an, %,a 4!&'%a(an /'&$ ma(/9a,. A4an6a T?F 1 aan m&n,a#!Ca! 9!(/'a %n#% m&n!n#&! /'a,&n. . Fa& )(/'!9&(a! a#a% 9!(/)'a! Fa& !n! 4!&%# 9!(/)'a! a(&na )a4a maa !n! 9!(/'a an,a# m&n/n/' )&(ann6a. F!(/'a m&n,a'am! )(/'!9&(a! 4an m&n!n#&! /'a,&n. S&(a# /'a,&n 6an, #&(&n#% m&n6&aan a4an6a &%a#an %n#% &(#a%#n6a #&)! '%a. Pa4a 9a& !n! m%'a! #&(a4! ,(an%'a! /n#(a! '%a 4an &)!#&'!a'!a! +. Fa& (&m/4&'!n, a#a% ma#%(a! Fa& !n! m&(%)aan 9a& 6an, #&(a$!( 4an #&()anan, )a4a )(/& )&n6&m%$an '%a. T&(a4! )(/& 6an, 4!nam! &(%)a (&m/4&''!n, /'a,&n /n#(a! '%a 4an )&ma#an,an )a(%#. A#!C!#a !n#&! 4an 4&,(a4a! /'a,&n &(a4a 4a'am &&!man,an. Fa& !n! &('an,%n, m%'a! 3 m!n,,% am)a! 2 #a$%n . A$!( 4a(! )&n6&m%$an !n! 4!4a)a#an )a(%# '%a 6an, ma#an, 6an, m&m)%n6a! &%a#an >0 4a(! %'!# n/(ma' T!,a 9a& #&(&%# 4!a#a &(a'an n/(ma' &'ama #!4a a4a ,an,,%an a! 9a#/( '%a( ma%)%n 4a'am.
9
DE-INISI DAN ETIOLO!I
L%a aa( a4a'a$ %a#% &n#% &(%aan a#a% &$!'an,an a(!n,an 6an, 4!&aan /n#a 4&n,an %m&( )ana &)&(#! a)! a!( )ana a$an !m!a '!#(! 4an (a4!a!. L%a aa( m&(%)aan %a#% &n! #(a%ma 4&n,an m/(!4!#a 4an m/(#a'!#a #!n,,! 6an, m&m&('%an )&na#a'aanaan $%% &a aa' 9a& 6/8 am)a! 9a& 'an%#. L%a aa( 4a)a# 4!&aan /'&$ )a)a(an a)! a! &+a(a 'an,%n, ma%)%n #!4a 'an,%n, m!a' a!a# #&(!(am a!( )ana 6an, an6a #&(a4! )a4a &+&'aaan (%ma$ #an,,a. S&'a!n !#% )aanan %$% #!n,,! 4a(! ma#a$a(! '!#(! ma%)%n a$an !m!a %,a 4a)a# m&n6&aan '%a aa(. S&+a(a ,a(! &a( )&n6&a #&(a4!n6a '%a aa( 4a)a# 4!a,! m&na4!: •
Pa)a(an a)! o Flame: A!a# /n#a 'an,%n, an#a(a a(!n,an 4&n,an a)! #&(%a 4an m&n6&aan +&4&(a 'an,%n, & a(!n,an #&(&%#. A)! 4a)a# m&maa( )aa!an #&('&!$ 4a$%'% a(% m&n,&na! #%%$. S&(a# a'am! m&m!'!! &+&n4&(%n,an %n#% #&(aa( &4an,an &(a# !n#&#! +&n4&(%n, m&'&'&$ o
a#a% m&n6a'a 4an m&n!m%'an +&4&(a #ama$an &(%)a +&4&(a /n#a. B&n4a )ana /n#a8: T&(a4! a!a# /n#a 'an,%n, 4&n,an &n4a )ana. L%a aa( 6an, 4!$a!'an #&(a#a )a4a a(&a #%%$ 6an, m&n,a'am! /n#a. */n#/$n6a an#a(a 'a!n a4a'a$ '%a aa( a!a# (// 4an a'a#-a'a#
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&)&(#! /'4&( &! a#a% )&(a'a#an maa. Scalds a!( )ana8 T&(a4! a!a# /n#a 4&n,an a!( )ana. S&ma!n &n#a' +a!(an 4an &ma!n 'ama a#% /n#an6a &ma!n &a( &(%aan 6an, aan 4!#!m%'an. L%a 6an, 4!&n,aa a#a% a!a# &+&'aaan 4a)a# 4!&4aan &(4aa(an )/'a '%a aa(n6a. Pa4a a% &+&'aaan '%a %m%mn6a m&n%n%an )/'a )&(+!an 6an, a#% ama 'a!n 4!)!a$an /'&$ %'!# &$a#. S&4an,an )a4a a% 6an, 4!&n,aa '%a %m%mn6a m&'!a#an &&'%(%$an &#(&m!#a 4a'am )/'a !(%m9&(&n!a' 4&n,an
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,a(! 6an, m&nan4a! )&(m%aan +a!(an. Ua) )ana T&(%#ama 4!#&m%an 4! 4a&(a$ !n4%#(! a#a% a!a# &+&'aaan (a4!a#/( m/!'. Ua) )ana m&n!m%'an +&4&(a '%a a!a# a)a!#a )ana 6an, #!n,,! 4a(! %a) &(#a 4!)&(! /'&$ %a) &(#&anan #!n,,!. A)a!'a #&(a4! !n$a'a! %a) )ana 4a)a#
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m&n6&aan +&4&(a $!n,,a & a'%(an na)a 4!#a' 4! )a(%. ?a )ana In$a'a! m&n6&aan +&4&(a #$&(ma' )a4a a'%(an na9a a,!an a#a 4an /'%! a'an na9a a!a# &4&ma.
10
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A'!(an '!#(! *&4&(a #!m%' a!a# a'!(an '!#(! 6an, '&a# m&n&m% a(!n,an #%%$. Um%mn6a '%a aa( m&n+a)a! %'!# a,!an 4a'am. L!#(! 6an, m&n6&aan )&(+!an a)!
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4an m&maa( )aa!an 4a)a# m&n6&aan '%a aa( #ama$an. a# !m!a aam a#a% aa8 Ra4!a! Sunburn !na( ma#a$a(! #&(a)! (a4!a!.
EPIDEIOLO!I L%a aa( a4a'a$ )&n6&a %#ama &4%a 4a(! +&4&(a &+&'aaan 4an &ma#!an
)a4a ana ana 4!aa$ %!a 1" #a$%n. L%a aa( 6an, 4!&aan /'&$ a,&n #&(ma' a4a'a$ '%a aa( 6an, )a'!n, &(!n, #&(a4! 4an %m%mn6a 4!4a)%( a#a% ama( man4!. L%a aa( a(&na '!#(! 4an a$an !m!a !aan6a #&(a4! )a4a &'/m)/ %!a ana #/4'&(. T!,a )&(&m)a# 4a(! &m%a '%a aa( 4!4%,a 4a)a# 4!+&,a$. B&# 200 8
KLASI-IKASI LUKA BAKAR
K&4a'aman '%a aa( 4!#&n#%an /'&$ #!n,,! %$% 'aman6a )aanan %$% #!n,,! a4&%a! (&%!#a! 4an a4an6a !n9&! )a4a '%a. S&'a!n a)! 6an, 'an,%n, m&n!'a# #%%$ a% 6an, !%# #&(aa( %,a m&m)&(4a'am '%a aa(. Ba$an a% 6an, )a'!n, aman a4a'a$ 6an, #&(%a# 4a(! %'% 4/ma /'8. Ba$an !n#&#! &)&(#! n!'/n 4an 4a(/n &'a!n m%4a$ #&(aa( %,a m%4a$ m&'&'&$ /'&$ %$% #!n,,! 'a'% m&na4! '&n,&# &$!n,,a m&m)&(&(a# &4a'aman '%a aa(. K&4a'aman '%a aa( 4!4&(!)!an 4a'am 4&(aa# '%a aa( 6a!#% '%a aa( 4&(aa# I II a#a% III:
D&(aa# I Paanan $an6a m&(%a &)!4&(m! &$!n,,a ma!$ m&n6!aan an6a a(!n,an %n#% 4a)a# m&'a%an (&,&n&(a!. L%a aa( 4&(aa# I !aan6a &m%$ 4a'am @7 $a(! 4an 4a)a# &m%$ &+a(a &m)%(na. L%a !aan6a #am)a &a,a! &(!#&ma 4an #!m%' 4&n,an &'%$an n6&(! 4an a#a% $!)&(&n!#!C!#a '/a'. */n#/$ '%a aa( 4&(aa# I a4a'a$ sunburn.
11
D&(aa# II L&! m&'!a#an &)!4&(m! 4an m&n+a)a! &4a'aman 4&(m! nam%n ma!$ #&(4a)a# &)!#&' C!#a' 6an, !a m&na4! 4aa( (&,&n&(a! 4an &)!#&'!a!. Ja(!n,an #&(&%# m!a'n6a &' &)!#&' aa' &'&na( &a&a &'&na( &(!n,a# 4an )an,a' (am%#. D&n,an a4an6a a(!n,an 6an, ma!$ &$a#= #&(&%# '%a 4a)a# &m%$ 4a'am 2-3 m!n,,%. ?ama(an '%a aa( &(%)a ,&'&m%n, a#a% %'a 6an, &(!! +a!(an &%4a# 4a(! )&m%'%$ 4a(a$ a(&na )&(%a$an )&(m&a!'!#a 4!n4!n,n6a 4!&(#a! (aa n6&(!. A)a!'a '%a aa( 4&(aa# II 6an, 4a'am #!4a 4!#an,an! 4&n,an a! 4a)a# #!m%' &4&ma 4an )&n%(%nan a'!(an 4a(a$ 4! a(!n,an &$!n,,a +&4&(a &(&man, m&na4! full-thickness burn a#a% '%a aa( 4&(aa# III. Superficial partial thickness: / L%a aa( m&'!)%#! &)!4&(m! 4an 'a)!an a#a 4a(! 4&(m! / K%'!# #am)a &m&(a$an /&4&m 4an (aa n6&(! '&!$ &(a# 4a(!)a4a '%a aa( ,(a4& I / D!#an4a! 4&n,an %'a 6an, m%n+%' &&(a)a am &#&'a$ #&(&na '%a / B!'a %'a 4!!n,!(an aan #&('!$a# '%a &a(na m&(a$ m%4a 6an, aa$ / L%a an,a# &n!#!C& 4an aan m&na4! '&!$ )%+a# !'a #&(&na #&anan / Aan &m%$ 4&n,an &n4!(!n6a 4a'am 3 m!n,,% !'a #!4a #&(&na !n9&! 8 #a)! a(na %'!# #!4a aan ama &)&(#! &&'%mn6a. Deep partial thickness / L%a aa( m&'!)%#! &)!4&(m! 4an 'a)!an 4a'am 4a(! 4&(m! / 4!&(#a! %,a 4&n,an %'a
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/ )&(m%aan '%a &(&+a m&(a$ m%4a 4an )%#!$ a(&na Ca(!a! 4a(! Ca%'a(!a! )&m%'%$ 4a(a$ a,!an 6an, )%#!$ )%n6a $an6a &4!!# )&m%'%$ 4a(a$ 4an 6an, m&(a$ m%4a m&m)%n6a! &&(a)a a'!(an 4a(a$ / '%a aan &m%$ 4a'am 3- m!n,,%.
D&(aa# III M&n,&na! &'%(%$ 'a)!an %'!# 4a(! %%#! $!n,,a m%n,!n /(,an a#a% a(!n,an 6an, '&!$ 4a'am. Pa4a &a4aan !n! #!4a #&(!a a(!n,an &)!#&' 6an, 4a)a# m&na4! 4aa( (&,&n&(a! &' )/n#an &$!n,,a %n#% m&n%m%$an &ma'! a(!n,an %'!# $a(% 4!'a%an +an,/ %'!#. ?&a'a 6an, m&n6&(#a! %#(% #an)a n6&(! ma%)%n %'a a(&na )a4a 4aa(n6a &'%(%$ a(!n,an %'!# 6an, m&m!'!! )&(a(a9an %4a$ #!4a !n#a.
13
BERAT DAN LUAS LUKA BAKAR
B&(a# '%a aa( &(,an#%n, )a4a 4a'am '%a 4an '&#a '%a. U!a 4an &&$a#an )a!&n &&'%mn6a aan an,a# m&m)&n,a(%$! )(/,n/!. A4an6a #(a%ma !n$a'a! %,a aan m&m)&n,a(%$! &(a# '%a aa(. Ja(!n,an '%na #%%$ aan #&(aa( !'a #&()a)a( )a4a %$% 4! a#a " /*. L%an6a &(%aan aan 4!#&n#%an /'&$ %$% )&(m%aan 4an 'aman6a /n#a. L%a aa( m&n6&aan /a,%'a! a(!n,an '%na. S&!(!n, 4&n,an )&n!n,a#an %$% a(!n,an '%na )&(m&a!'!#a a)!'&( %,a m&n!n,a# #&(a4! &$!'an,an +a!(an 4an C!/!#a )'ama m&n!n,a# 4&n,an (&%'#an )&m&n#%an m!(/#(/m%. H!'an,n6a
+a!(an 4a)a#
m&n6&aan $!)/C/'&m! 4an 6/ #&(,an#%n, an6an6a +a!(an 6an, $!'an, 4an (&)/n #&($a4a) (&%!#a!. L%a aa( %,a m&n6&aan )&n!n,a#an 'a% m&#a/'! 4an &n&(,! m&#a/'!m&. S&ma!n '%a )&(m%aan #%%$ 6an, #&('!a# m/(!4!#a 4an m/(#a'!#an6a m&n!n,a# 4an )&nan,anann6a %,a aan &ma!n /m)'&. L%a '%a aa( 4!n6a#aan 4a'am )&(&n #&($a4a) '%a &'%(%$ #%%$. A4a &&(a)a m&#/4& +&)a# %n#% m&n&n#%an '%a '%a aa( 6a!#%: • E#!ma! '%a '%a aa( m&n,,%naan '%a )&(m%aan )a'ma( )a!&n. L%a #&'a)a #an,an !n4!C!4% m&a!'! 1 '%a )&(m%aan #%%$. L%a '%a aa( $an6a 4!$!#%n, )a4a )a!&n 4&n,an 4&(aa# '%a II a#a% III. •
R%m% a#a% rule of nine %n#% /(an, 4&aa Pa4a 4&aa 4!,%naan (%m% 6a!#% '%a &)a'a 4an '&$&( 4a4a )%n,,%n, )!n,,an, 4an //n, &#(&m!#a a#a anan &#(&m!#a a#a !(! )a$a anan )a$a !(! #%n,a! 4an a! anan &(#a #%n,a! 4an a! !(! ma!n,-ma!n, . S!an6a 1 a4a'a$ 4a&(a$ ,&n!#a'!a. R%m% !n! m&man#% m&na!( '%an6a )&(m%aan #%%$ 6an, #&(aa( )a4a /(an, 4&aa.
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Pa4a ana 4an a6! 4!,%naan (%m% 'a!n a(&na '%a (&'a#!9 )&(m%aan &)a'a ana a%$ '&!$ &a( 4an '%a (&'a#!9 )&(m%aan a! '&!$ &+!'. Ka(&na )&(an4!n,an '%a )&(m%aan a,!an #%%$ ana &+!' &(&4a 4!&na' (%m% 10 %n#% a6! 4an (%m% 10-1@-20 %n#% ana.
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M&#/4& L%n4 4an B(/4&( M&#/4& 6an, 4!)&(&na'an %n#% /m)&na! &a(n6a )/(! maa #%%$ 4! &)a'a )a4a ana. M&#/4& !n! 4!,%naan %n#% &#!ma! &a(n6a '%a )&(m%aan
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)a4a ana. A)a!'a #!4a #&(&4!a #a&' #&(&%# )&(!(aan '%a )&(m%aan #%%$ )a4a ana 4a)a# m&n,,%naan R%m% 4an 4!&%a!an 4&n,an %!a: Pa4a ana 4! aa$ %!a 1 #a$%n: &)a'a 1> 4an #!a) #%n,a! 1". T/(/ o
o
4an '&n,an )&(&n#a&n6a ama 4&n,an 4&aa. Un#% #!a) )&(#ama$an %!a 1 #a$%n #ama$an 0.@ %n#% #!a) #%n,a! 4an #%(%nan )&(&n#a! &)a'a &&a( 1 $!n,,a #&(+a)a! n!'a! 4&aa.
Lund and Browder chart illustrating the method for calculating the percentage of body surface area affected by burns in children.
PEBA!IAN LUKA BAKAR
1. L%a aa( &(a# major burn8 a. D&(aa# II-III Q 20 )a4a )a!&n &(%!a 4! aa$ 10 #a$%n a#a% 4! a#a %!a @0 #a$%n . D&(aa# II-III Q 2@ )a4a &'/m)/ %!a &'a!n 4!&%#an )a4a %#!( )&(#ama +. L%a aa( )a4a m%a #&'!n,a #an,an a! 4an )&(!n&%m 4. A4an6a +&4&(a )a4a a'an na9a +&4&(a !n$a'a!8 #an)a m&m)&($!#%n,an '%a '%a aa( &. L%a aa( '!#(! #&,an,an #!n,,! 9. D!&(#a! #(a%ma 'a!nn6a
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,. Pa!&n-)a!&n 4&n,an (&!/ #!n,,! 2. L%a aa( &4an, moderate burn8 a. L%a aa( 4&n,an '%a 1@ 2@ )a4a 4&aa 4&n,an '%a aa( 4&(aa# III %(an, 4a(! 10 . L%a aa( 4&n,an '%a 10 20 )a4a ana %!a < 10 #a$%n a#a% 4&aa Q "0 #a$%n 4&n,an '%a aa( 4&(aa# III %(an, 4a(! 10 +. L%a aa( 4&n,an 4&(aa# III < 10 )a4a ana ma%)%n 4&aa 6an, #!4a m&n,&na! m%a #an,an a! 4an )&(!n&%m 3. L%a aa( (!n,an a. L%a aa( 4&n,an '%a < 1@ )a4a 4&aa . L%a aa( 4&n,an '%a < 10 )a4a ana 4an %!a 'an%# +. L%a aa( 4&n,an '%a < 2 )a4a &,a'a %!a #!4a m&n,&na! m%a #an,an a! 4an )&(!n&%m
PATO-ISIOLO!I LUKA BAKAR
A!a# )&(#ama '%a aa( a4a'a$ 6/ a(&na a,&# 4an &a!#an. P&m%'%$ a)!'&( 6an, #&()aan %$% #!n,,! (%a 4an )&(m&a!'!#a m&n!n,,!. S&' 4a(a$ 6an, a4a 4! 4a'amn6a !%# (%a &$!n,,a 4a)a# #&(a4! an&m!a. M&n!n,a#n6a )&(m&a!'!#a m&n6&aan &4&ma 4an m&n!m%'an %'a 6an, m&n,an4%n, an6a &'&#(/'!#. Ha' !#% m&n6&aan &(%(an,n6a C/'%m& +a!(an !n#(aCa%'&(. K&(%aan %'!# a!a# '%a aa( m&n6&aan &$!'an,an +a!(an a!a# )&n,%a)an 6an, &('&!$an ma%n6a +a!(an & %'a 6an, #&(&n#% )a4a '%a aa( 4&(aa# II 4an )&n,&'%a(an +a!(an 4a(! &(/)&n, '%a aa( 4&(aa# III. B!'a '%a '%a aa( %(an, 4a(! 20 !aan6a m&an!m& /m)&na! #%%$ ma!$ !a m&n,a#a!n6a #&#a)! !'a '&!$ 4a(! 20 aan #&(a4! 6/ $!)/C/'&m! 4&n,an ,&a'a 6an, $a &)&(#! ,&'!a$ )%+a# 4!n,!n &(&(!n,a# na4! &+!' 4an +&)a# #&anan 4a(a$ m&n%(%n 4an )(/4%! %(!n 6an, &(%(an,. P&m&n,aan #&(a4! )&'an-)&'an ma!ma' #&(a4! &#&'a$ 4&'a)an am. Pa4a &aa(an (%an, #&(#%#%) a#a% !'a '%a #&(a4! 4! aa$ 4a)a# #&(a4! &(%aan m%/a a'an na)a a(&na ,a aa) a#a% %a) )ana 6an, #&(!a). E4&ma 'a(!n, 6an, 4!#!m%'ann6a 4a)a# m&n6&aan $ama#an a'an na)a 4&n,an ,&a'a &a na)a #a!)n&a #(!4/( %a(a &(a 4an 4a$a &(a(na ,&'a) a!a# &'a,a. Da)a# %,a #&(a4! &(a+%nan ,a *O a#a% ,a &(a+%n 'a!nn6a. *O aan m&n,!a# $&m/,'/!n 4&n,an %a# &$!n,,a $&m/,'/!n #a mam)% 'a,! m&n,!a# /!,&n. Tan4a 17
&(a+%nan (!n,an a4a'a$ '&ma !n,%n, )%!n, m%a' 4an m%n#a$. Pa4a &(a+%nan 6an, &(a# #&(a4! /ma. B!'a '&!$ 4a(! 0 $&m/,'/!n #&(!a# *O )&n4&(!#a 4a)a# m&n!n,,a'. S&#&'a$ 12-2" am )&(m&a!'!#a a)!'&( m%'a! m&ma! 4an #&(a4! m/!'!a! &(#a )&n6&(a)an &ma'! +a!(an &4&ma & )&m%'%$ 4a(a$. In! 4!#an4a! 4&n,an m&n!n,a#n6a 4!%(&!. L%a aa( &(!n, #!4a #&(!'. K/n#am!na! )a4a %'!# ma#! 6an, m&(%)aan m&4!%m 6an, a! %n#% )&(#%m%$an %man aan m&m)&(m%4a$ !n9&!. In9&! !n! %'!# 4!a#a! a(&na 4a&(a$n6a #!4a #&(+a)a! /'&$ )&m%'%$ a)!'&( 6an, m&n,a'am! #(/m/!. Pa4a$a' )&m%'%$ !n! m&maa !#&m )&(#a$anan #%%$ a#a% an#!!/#!. K%man )&n6&a !n9&! )a4a '%a aa( &'a!n &(aa' 4a(! 4a(! %'!# )&n4&(!#a &n4!(! %,a 4a(! /n#am!na! %man a'%(an na)a a#a 4an /n#am!na! %man 4! '!n,%n,an (%ma$ a!#. In9&! n///m!a' !n! !aan6a an,a# &(a$a6a a(&na %mann6a an6a 6an, %4a$ (&!#&n #&($a4a) &(a,a! an#!!/#!. Pa4a aa'n6a !n9&! !aan6a 4!&aan /'&$ /% ?(am )/!#!9 6an, &(aa' 4a(! %'!# &n4!(! a#a% 4a(! a'%(an na)a #&#a)! &m%4!an 4a)a# #&(a4! !nCa! %man ?(am n&,a#!9 seudomonas aeruginosa 6an, 4a)a# m&n,$a!'an &/#/!n )(/#&a& 4a(! #/!n 'a!n 6an, &(a$a6a #&(&na' an,a# a,(&!9 4a'am !nCa!n6a )a4a '%a aa(. In9&! )&%4/m/na 4a)a# 4!'!$a# 4a(! a(na $!a% )a4a aa )&n%#%) '%a aa(. K%man m&m)(/4%! &n!m )&n,$an+%( &(/)&n, 6an, &(ama 4&n,an &%4a! /'&$ a(!n,an ,(an%'a! m&m&n#% nana$. In9&! (!n,an 4an n/n!nCa!9 4!#an4a! 4&n,an &(/)&n, 6an, m%4a$ #&('&)a 4&n,an nana$ 6an, an6a. In9&! 6an, !nCa!9 4!#an4a! 4&n,an &(/)&n, 6an, &(!n, 4&n,an )&(%a$an a(!n,an 4! #&)! &(/)&n, 6an, m%'a-m%'a &$a# m&na4! n&(/#! a!a#n6a '%a aa( 6an, m%'a-m%'a 4&(aa# II m&na4! 4&(aa# III. In9&! %man m&n!m%'an Ca%'!#! )a4a )&m%'%$ a)!'&( 4! a(!n,an 6an, #&(aa( 4an m&n!m%'an #(/m/! &$!n,,a a(!n,an 6an, 4!4a(a$!n6a nan#!. B!'a '%a aa( 4!!/)! 4an &%4a#n6a 4!!a !aan6a 4!#&m%an %man 4an #&('!$a# !nCa! %man #&(&%# & a(!n,an &&'!'!n,n6a. L%a aa( 4&m!!an 4!&%# '%a aa( &)#!. B!'a )&n6&an6a %man ?(am )/!#!9 &)&(#! #a9!'//% a#a% a!' ?(am n&,a#!9 'a!nn6a 4a)a# #&(a4! )&n6&a(an %man '&a# 4a(a$ a#&(&m!a8 6an, 4a)a# m&n!m%'an 9/% !n9&! 4! %%. S6/ &)! 4an &ma#!an 4a)a# #&(a4! a(&na #/!n %man 6an, m&n6&a( 4! 4a(a$. B!'a )&n4&(!#a 4a)a# m&n,a#a! !n9&! '%a aa( 4&(aa# II 4a)a# &m%$ 4&n,an m&n!n,,a'an +a+a# &(%)a )a(%#. P&n6&m%$an !n! 4!m%'a! 4a(! !a &'&m&n &)!#&' 6an, 18
ma!$ C!#a' m!a'n6a &' &'&na( &a&a &' aa' &' &'&na( &(!n,a# a#a% &' )an,a' (am%#. L%a aa( 4&(aa# II 6an, 4a'am m%n,!n m&n!n,,a'an )a(%# $!)&(#(/9! 6an, n6&(! ,a#a' a% 4an &+a(a &#&#! &'&. L%a aa( 4&(aa# III 6an, 4!!a(an &m%$ &n4!(! aan m&n,a'am! /n#(a#%(. B!'a #&(a4! 4! )&(&n4!an 9%n,! &n4! 4a)a# &(%(an, a#a% $!'an,. Pa4a '%a aa( &(a# 4a)a# 4!#&m%an !'&% )a(a'!#!. Pa4a 9a& a%# )&(!#a'! %% m&n%(%n a#a% &($&n#! a(&na 6/ &4an,an )a4a 9a& m/!'!a! )&(!#a'! 4a)a# m&n%(%n a(&na &%(an,an !/n a'!%m. S#(& a#a% a4an 9aa'! 6an, #&(a4! )a4a )&n4&(!#a '%a aa( &(a# 4a)a# m&n6&aan #&(a4!n6a #%a 4! m%/a 'am%n, a#a% 4%/4&n%m 4&n,an ,&a'a 6an, ama 4&n,an ,&a'a #%a )&)#!. K&'a!nan !n! 4!&na' &a,a! #%a !urling . Fa& )&(m%'aan '%a aa( m&(%)aan 9a& a#a/'!m& &$!n,,a &&!man,an )(/#&!n m&na4! n&,a#!9. P(/#&!n #%%$ an6a $!'an, a(&na &%4a! m&#a/'!m& #!n,,! 4an !n9&!. P&n,%a)an &('&!$an 4a(! %'!# 6an, (%a %,a m&m&('%a a'/(! #ama$an. T&na,a 6an, 4!)&('%an #%%$ )a4a 9a& !n! #&(%#ama 4!4a)a# 4a(! )&maa(an )(/#&!n 4a(! /#/# &'&#. O'&$ a(&na !#% )&n4&(!#a m&na4! an,a# %(% /#/# m&n,&+!' 4an &(a# a4an m&n%(%n. D&n,an 4&m!!an /(an '%a aa( m&n4&(!#a )&n6a!# &(a# 6an, 4!&%# )&n6a!# '%a aa(. B!'a '%a aa( m&n6&aan +a+a# #&(%#ama !'a '%a m&n,&na! aa$ &$!n,,a (%a &(a# )&n4&(!#a m%n,!n m&n,a'am! &an &!aan &(a#. Ja4! )(/,n/! '%a aa( 4!#&n#%an /'&$ '%an6a '%a aa(.
-ASE PADA LUKA BAKAR
Da'am )&(a'anan )&n6a!# 4a)a# 4!&4aan m&na4! #!,a 9a& )a4a '%a aa( 6a!#%: 1.
Fa& aa' 9a& a%# 9a& 6/ Pa4a 9a& !n! maa'a$ %#ama &(!a( )a4a ,an,,%an 6an, #&(a4! )a4a a'%(an na9a 6a!#% ,an,,%an m&an!m& &(na9a $a' !n! 4!a(&naan a4an6a &a( m&'!n,a( 4! 4a4a a#a% #(a%ma m%'#!)&' 4! (/n,,a #/(a 4an ,an,,%an !(%'a! &)&(#!
2.
&&!man,an +a!(an &'&#(/'!# 6/ $!)/C/'&m!a. Fa& &#&'a$ 6/ &(a$!( 9a& % a%# Maa'a$ %#ama )a4a 9a& !n! a4a'a$ Systemic "nflammatory #esponse Syndrome $S"#S% 4an &ulti-system 'rgan Dysfunction Syndrome $&'DS% 4an &)!. Ha' !n! m&(%)aan 4am)a 4an a#a% )&(&man,an maa'a$ 6an, #!m%' )a4a 9a& )&(#ama 4an maa'a$ 6an, &(m%'a 4a(! &(%aan a(!n,an '%a 4an &)! '%a8
19
3.
Fa& 'an%# Fa& !n! &('an,%n, &#&'a$ )&n%#%)an '%a am)a! #&(a4!n6a ma#%(a! a(!n,an. Maa'a$ 6an, 4!$a4a)! a4a'a$ )&n6%'!# 4a(! '%a aa( &)&(#! )a(%# $!)&(#(/9! /n#(a#%( 4an 4&9/(m!#a 'a!n 6an, #&(a4! a!a# &(a)%$an a(!n,an a#a% #(%#%( #&(#&n#% a!a# )(/& !n9'ama! 6an, $&a# 4an &('an,%n, 'ama
P&ma,!an /na &(%aan a(!n,an: 1. /na /a,%'a! /na n&(/! M&(%)aan 4a&(a$ 6an, 'an,%n, m&n,a'am! &(%aan /a,%'a! )(/#&!n8 a!a# )&n,a(%$ +&4&(a #&(m! $am)!( 4a)a# 4!)a#!an a(!n,an !n! m&n,a'am! n&(/! &&(a)a aa# &#&'a$ /n#a. O'&$ a(&na !#%'a$ 4!&%# %,a &a,a! /na n&(/!. 2. /na #a#! M&(%)aan 4a&(a$ 6an, 'an,%n, &(a4a 4! '%a(;4! &!#a( /na /a,%'a!. D! 4a&(a$ !n! #&(a4! &(%aan &n4/#&' )&m%'%$ 4a(a$ 4!&(#a! &(%aan #(/m/!# 4an '&%/!# &$!n,,a #&(a4! ,an,,%am )&(9%! n/ 9'/ )$&n/m&na8 4!!%#! )&(%a$an )&(m&a!'!#a a)!'a( 4an (&)/n !n9'ama! '/a'. P(/& !n! &('an,%n, &'ama 12-2" am )a+a +&4&(a 4an m%n,!n &(a$!( 4&n,an n&(/! a(!n,an. 3. /na $!)&(&m! M&(%)aan 4a&(a$ 4! '%a( /na #a#! !%# m&n,a'am! (&a! &(%)a Ca/4!'a#a! #an)a an6a m&'!a#an (&a! &'%'a(. T&(,an#%n, &a4aan %m%m 4an #&(a)! 6an, 4!&(!an /na &#!,a 4a)a# m&n,a'am! )&n6&m%$an )/n#an a#a% &(%a$ m&na4! /na &4%a a$an /na )&(#ama. INDIKASI RAWAT INAP PASIEN LUKA BAKAR
M&n%(%# (merican Burn (ssociation &/(an, )a!&n 4!!n4!a!an %n#% 4!(aa# !na) !'a: 1. L%a aa( 4&(aa# III Q @ 2. L%a aa( 4&(aa# II Q 10 3. L%a aa( 4&(aa# II a#a% III 6an, m&'!a#an a(&a (!#! aa$ #an,an a! ,&n!#a'!a )&(!n&%m %'!# 4! a#a &n4! %#ama8
(!!/
!,n!9!an %n#% maa'a$
/m&#! 4an &+a+a#an 9%n,! ". L%a aa( !(%m9&(&n!a' 4! #$/(a a#a% &#(&m!#a @. L%a aa( !,n!9!an a!a# a$an !m!a '!#(! )&#!( a4an6a #(a%ma ma6/( 'a!nn6a a#a% a4an6a /n4!! m&4! !,n!9!an 6an, #&'a$ a4a &&'%mn6a . A4an6a #(a%ma !n$a'a!
20
PEERIKSAAN PENUN#AN!
P&m&(!aan )&n%nan, 6an, 4!'a%an: 1. P&m&(!aan 4a(a$ (%#!n 4an !m!a 4a(a$ 2. U(!na'!! 3. P&m&(!aan &&!man,an &'&#(/'!# ". Ana'!! ,a 4a(a$ @. Ra4!/'/,! !a a4a !n4!a! ARDS . P&m&(!aan 'a!n 6an, 4!%#%$an %n#% m&n&,aan 4!a,n/! SIRS 4an MODS
PENATALAKSANAAN LUKA BAKAR
Pa!&n '%a aa( $a(% 4!&Ca'%a! &+a(a !#&ma#!. P(!/(!#a %#ama a4a'a$ m&m)&(#a$anan a'an na9a #&#a) )a#&n C&n#!'a! 6an, &9&#!9 4an m&n4%%n, !(%'a! !#&m!. In#%a! &n4/#(a&a 4!'a%an )a4a )a!&n 6an, m&n4&(!#a '%a aa( &(a# a#a% &+%(!,aan a4an6a &a !n$a'a! a#a% '%a aa( 4! a'an na9a a#a. In#%a! 4a)a# #!4a 4!'a%an !'a #&'a$ #&(a4! &4&ma '%a aa( a#a% )&m&(!an +a!(an (&%!#a! 6an, #&('am)a% an6a. Pa4a )a!&n '%a aa( !n#%a! /(/#(a&a 4an na/#(a&a '&!$ 4!)!'!$ 4a(!)a4a #(a&/#/m!. Pa!&n 4&n,an '%a aa( aa !aan6a $!)&(#&n!. A4an6a $!)/#&n! aa' 6an, #!4a 4a)a# 4!&'aan a#a% a4an6a #an4a-#an4a $!)/C/'&m!a !#&m! )a4a )a!&n '%a aa( m&n!m%'an &+%(!,aan a4an6a &a #&(&m%n6!. O'&$ a(&na !#% &#&'a$ m&m)&(#a$anan AB* )(!/(!#a &(!%#n6a a4a'a$ m&n4!a,n/! 4an m&na#a 'aana &a 'a!n #(a%ma #%m)%' a#a% #aam8 6an, m&n,an+am n6aa. R!a6a# #&(a4!n6a '%a &(man9aa# %n#% m&n+a(! #(a%ma #&(a!# 4an &m%n,!nan a4an6a &a !n$a'a!. In9/(ma! (!a6a# )&n6a!# 4a$%'% )&n,,%naan /a# 4an a'&(,! %,a )&n#!n, 4a'am &Ca'%a! aa'. Paa!an )a!&n 4!%a &m%a &m%a )&(m%aan #%%$ 4!n!'a!. P&m&(!aan (a4!/'/,! )a4a #%'an, &'aan, &(C!a' )&'C! 4an #/(a 4a)a# m&man#% m&n,&Ca'%a! a4an6a &m%n,!nan #(a%ma #%m)%'. S&#&'a$ m&n,&'%! &a !,n!9!an 'a!nn6a '%a aa( 4!&Ca'%a!. T&('&)a 4a(! '%an6a a(&a &a 4%a $a' 6an, $a(% 4!'a%an &&'%m 4!'a%an #(an9&( )a!&n a4a'a$ m&m)&(#a$anan C&n#!'a! a4&%a# 4an !a 4!!n4!a!an m&'&)a 4a(! &a( 6an, m&n,/n#(!!.
T%&%l%*s%n% "esusi&%si lu*% %*%" 21
a. Ta#a'aana (&%!#a! a'an na9a: 1. In#%a! T!n4aan !n#%a! 4!&(aan &&'%m &4&ma m%/a m&n!m%'an man!9&#a! /#(%!. T%%an !n#%a! m&m)&(#a$anan a'an na9a 4an &a,a! 9a!'!#a )&m&''!$a(aan a'an na9a. 2. K(!/#!(/!4/#/m! B&(#%%an ama 4&n,an !n#%a! $an6a aa 4!an,,a) #&('a'% a,(&!9 4an m&n!m%'an
m/(!4!#a
'&!$
&a(
4!an4!n,
!n#%a!.
K(!/#!(/!4/#/m!
m&m)&(&+!' 4&a4 )a+& m&m)&(&a( #!4a' C/'%m& '&!$ m%4a$ m&n,&(aan !'aan (/n/a'C&/'a( 4an )a!&n 4a)a# &(!+a(a !a 4!an4!n, 4&n,an !n#%a!. 3. P&m&(!an /!,&n 100 B&(#%%an %n#% m&n6&4!aan &%#%$an /!,&n !a #&(4a)a# )a#/'/,! a'an na9a 6an, m&n,$a'an,! %)'a! /!,&n. Ha#!-$a#! 4a'am )&m&(!an /!,&n 4/! &a( a(&na 4a)a# m&n!m%'an #(& /!4a#!9 &$!n,,a aan #&(&n#% (a4!a' &a 6an, &(!9a# Ca/4!'a#/( 4an m/4%'a#/( &)!. ". P&(aa#an a'an na9a @. P&n,$!a)an &(&# &+a(a &(a'a8 . P&m&(!an #&(a)! !n$a'a! B&(#%%an m&n,%)a6aan %aana %4a(a 6an, '&!$ a! 4!4a'am '%m&n a'an na9a 4an m&n+a!(an &(&# &n#a' &$!n,,a m%4a$ 4!&'%a(an. T&(a)! !n$a'a! %m%mn6a m&n,,%naan +a!(an 4aa( na#(!%m '/(!4a 0 4!#ama$ 4&n,an (/n/4!'a#/( !'a )&('%. S&'a!n !#% !a 4!#ama$an a#-a# 4&n,an $a!a# #&(#&n#% &)&(#! a#(/)!n %'9a# m&n%(%nan )(/4%! &( na#(!%m !a(/na# m&n,a#a! a!4/! &'%'&(8 4an #&(/!4 ma!$ /n#(/C&(!a'8 7. B!'aan (/n/a'C&/'a( >. P&(aa#an (&$a!'!#a#!9 %n#% (&)!(a! . Ea(/#/m! )a4a 4!n4!n, #/(a 6an, &(#%%an %n#% m&m)&(a!! /m)'!an! )a(%
. Ta#a'aana (&%!#a! +a!(an R&%!#a! +a!(an 4!&(!an 4&n,an #%%an )(&&(Ca! )&(9%! 6an, a4&%a# 4an &!man, 4! &'%(%$ )&m%'%$ 4a(a$ Ca%'a( (&,!/na' &$!n,,a !&m!a a(!n,an #!4a #&(a4! )a4a &#!a) /(,an !#&m!. S&'a!n !#% +a!(an 4!&(!an a,a( 4a)a# m&m!n!ma'!a! 4an &'!m!na! +a!(an &a 6an, #!4a 4!)&('%an /)#!ma'!a! #a#% C/'%m& 4an /m)/!! !n#(aCa%'a( %n#% m&nam!n %(C!Ca';ma!ma' 4a(! &'%(%$ 22
&' &(#a m&m!n!ma'!a! (&)/n !n9'ama! 4an $!)&(m&#a/'! 4&n,an m&n,,%naan &'&!$an 4an &%n#%n,an 4a(! &(a,a! ma+am +a!(an &)&(#! (!#a'/!4 $!)&(#/n! /'/!4 4an &a,a!n6a )a4a a#% 6an, #&)a#. D&n,an a4an6a (&%!#a! +a!(an 6an, #&)a# !#a 4a)a# m&n,%)a6aan #a!'!a! )a!&n &+&)a# m%n,!n &ma'! & /n4!! 9!!/'/,! 4a'am )&(!a)an m&n,$a4a)! !n#&(C&n! &4a$ &aa' m%n,!n. R&%!#a! +a!(an 4!'a%an 4&n,an m&m&(!an +a!(an )&n,,an#!. A4a &&(a)a +a(a %n#% m&n,$!#%n, &%#%$an +a!(an !n!:
*a(a ECan 1. L%a '%a aa( 8 BB ,8 m&na4! mL Na*' )&( 2" am 2. L%a '%a aa( 8 BB ,8 m&na4! mL )'ama )&( 2" am 3. 2.000 ++ ,'%/a @ )&( 2" am S&)a(%$ 4a(! %m'a$ 123 4!&(!an 4a'am > am )&(#ama. S!an6a 4!&(!an 4a'am 1 am &(!%#n6a. Pa4a $a(! &4%a 4!&(!an &#&n,a$ %m'a$ +a!(an $a(! )&(#ama. Pa4a $a(! &#!,a 4!&(!an &#&n,a$ %m'a$ +a!(an $a(! &4%a.
*a(a Ba#&( L%a '%a aa( 8 BB ,8 " mL S&)a(%$ 4a(! %m'a$ +a!(an 4!&(!an 4a'am > am )&(#ama. S!an6a 4!&(!an 4a'am 1 am &(!%#n6a. Pa4a $a(! &4%a 4!&(!an &#&n,a$ %m'a$ +a!(an $a(! )&(#ama. Pa4a $a(! &#!,a 4!&(!an &#&n,a$ %m'a$ +a!(an $a(! &4%a.
+.
R&%!#a! n%#(!! Pa4a )a!&n '%a aa( )&m&(!an n%#(!! &+a(a &n#&(a' &a!n6a 4!'a%an &a 4!n! 4an )a!&n #!4a )&('% 4!)%aaan. B!'a )a!&n #!4a a4a( maa )&m&(!an n%#(!! 4a)a# m&'a'%! naso-gastric tube N?T8. N%#(!! 6an, 4!&(!an &a!n6a m&n,an4%n, 10-1@ )(/#&!n @0-0 a(/$!4(a# 4an 2@-30 '&ma. P&m&(!an n%#(!! &a aa' !n! 4a)a# m&n!n,a#an 9%n,! &&a'an #%%$ 4an m&n+&,a$ #&(a4!n6a a#(/9! C!'! %%. D&n,an 4&m!!an 4!$a(a)an )&m&(!an n%#(!! &a aa' 4a)a# m&man#% m&n+&,a$ #&(a4!n6a SIRS 4an MODS.
Pe"%(%&%n lu*% %*%"
Um%mn6a %n#% m&n,$!'an,an (aa n6&(! 4a(! '%a aa( 4!,%naan m/(9!n 4a'am 4/! &+!' &+a(a !n#(aC&na 4/! 4&aa aa' : 01-02 m,;, 4an maintenance @-20 m,;70 , &#!a) " am &4an,an 4/! ana-ana 00@-02 m,;, &#!a) " am8.
23
T&#a)! a4a %,a 6an, m&n6a#aan )&m&(!an m&#$a4/n& @-10 m, 4/! 4&aa8 &#!a) > am m&(%)aan #&(a)! )&n,$!'an, n6&(! (/n! 6an, a,% %n#% &m%a )a!&n '%a aa( 4&aa. J!a )a!&n ma!$ m&(aaan n6&(! a'a% 4&n,an )&m&(!an m/(9!n a#a% m&#$a4/n& 4a)a# %,a 4!&(!an &n/4!a&)!n& &a,a! #ama$an. T&(a)! )&m&4a$an )a4a '%a aa( 1. E!! 4!n! E!! 4!n! a4a'a$ #!n4aan )&m%an,an a(!n,an n&(/! 4an 4&(! debridement 8 6an, 4!'a%an 4a'am a#% %(an, 4a(! 7 $a(! !aan6a $a(! & @-78 )a+a +&4&(a #&(m!. Daa( 4a(! #!n4aan !n! a4a'a$: a.
M&n,%)a6aan )(/& )&n6&m%$an &('an,%n, '&!$ +&)a#. D&n,an 4!%an,n6a a(!n,an n&(/! 4&(! 4an &a( )(/& !n9'ama! #!4a aan &('an,%n, '&!$ 'ama 4an &,&(a 4!'an%#an )(/& 9!(/)'a!a. Pa4a 4a&(a$ &!#a( '%a aa( %m%mn6a #&(a4! &4&ma $a' !n! aan m&n,$ama# a'!(an 4a(a$ 4a(! a(#&(! 6an, 4a)a# m&n,a!a#an #&(a4!n6a !&m! )a4a a(!n,an #&(&%# a#a%)%n m&n,$ama# )(/& )&n6&m%$an 4a(! '%a #&(&%#. D&n,an &ma!n 'ama a#% #&('&)an6a &a( &ma!n 'ama %,a a#% 6an, 4!)&('%an %n#%
)&n6&m%$an. . M&m%#% (an#a! )(/& !n9'ama! 6an, 4a)a# &('an%# m&na4! /m)'!a! /m)'!a! '%a aa( &)&(#! SIRS8. Ha' !n! 4!4aa(an a#a a(!n,an n&(/! 6an, m&'&)aan burn to)ic= lipid protein comple)8 6an, m&n,!n4%! 4!'&)an6a m&4!a#/(-m&4!a#/( !n9'ama!. +. S&ma!n 'ama )&n%n4aan #!n4aan &!! &ma!n an6an6a )(/& an,!/,&n&! 6an, #&(a4! 4an Ca/4!'a#a! 4! &!#a( '%a. Ha' !n! m&n,a!a#an an6an6a 4a(a$ &'%a( aa# 4!'a%an #!n4aan /)&(a!. S&'a!n !#% )&n%n4aan &!! aan m&n!n,a#an (&!/ /'/n!a! m!(/ /(,an!m& )a#/,&n 6an, aan m&n,$ama# )&m%'!$an graft 4an %,a &a( 6an, m&'&m%# m&m%a# #!n4aan &!! &ma!n %'!#. T!n4aan !n! 4!&(#a! an&#&! a! '/a' ma%)%n ,&n&(a' 4an )&m&(!an +a!(an m&'a'%! !n9%. T!n4aan !n! 4!,%naan %n#% m&n,a#a! a% '%a aa( 4&(aa# II 4a'am 4an 4&(aa# III. T!n4aan !n! 4!!%#! #!n4aan $&m/#a! 4an %,a skin grafting = 4!an%(an split thickness skin grafting =8. T!n4aan !n! %,a #!4a aan m&n,%(an,! m/(#a'!#a )a4a )a!&n '%a aa( 6an, '%a. K(!#&(!a )&na#a'aanaan &!! 4!n! 4!#&n#%an /'&$ &&(a)a 9a#/( 6a!#%:
24
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Ka% '%a aa( 4a'am 6an, 4!)&(!(aan m&n,a'am! )&n6&m%$an '&!$ 4a(! 3 m!n,,%. K/n4!! 9!! 6an, m&m%n,!nan %n#% m&na'an! /)&(a! &a(. T!4a a4a maa'a$ 4&n,an )(/& )&m&%an 4a(a$. T&(&4!a 4/n/( 6an, +%%) %n#% m&n%#%)! )&(m%aan #&(%a 6an, #!m%'.
E!! 4!n! 4!%#amaan 4!'a%an )a4a 4a&(a$ '%a &!#a( a#an, #%%$ )/#&(!/(. E!! 4!n! #&(4!(! 4a(! &!! #an,&n!a' 4an &!! 9a!a'. E!! #an,&n!a' a4a'a$ %a#% #&n! 6an, m&n,&!! a(!n,an 6an, #&('%a 'a)! 4&m! 'a)! am)a! 4!%m)a! )&(m%aan 6an, m&n,&'%a(an 4a(a$ endpoint 8. A4a)%n a'a#-a'a# 6an, 4!,%naan 4a)a# &(ma+am-ma+am 6a!#% )!a% ?/%'!an a#a% H%m'6 6an, 4!,%naan )a4a '%a aa( 4&n,an '%a )&(m%aan '%a 6an, &+!' &4an,an )!a% 5a#/n ma%)%n m&!n 6an, 4a)a# m&m/#/n, a(!n,an %'!# )&('a)! 4&(ma#/m8 4!,%naan %n#% '%a aa( 6an, '%a. P&(m%aan %'!# 6an, 4!'a%an #!n4aan !n! #!4a /'&$ m&'&!$! 2@ 4a(! &'%(%$ '%a )&(m%aan #%%$. Un#% m&m)&(&+!' )&(4a(a$an 4a)a# 4!'a%an $&m/#a! 6a!#% 4&n,an tourni*uet &&'%m 4!'a%an &!! a#a% )&m&(!an 'a(%#an &)!n&)$(!n& 1:100.000 )a4a 4a&(a$ 6an, 4!&!!. S&#&'a$ 4!'a%an $a'-$a' #&(&%# a(% 4!'a%an skin graft =. K&%n#%n,an 4a(! #&n! !n! a4a'a$ 4!4a)a#n6a 9%n,! /)#!ma' 4a(! %'!# 4an &%n#%n,an 4a(! &,! /m&#!. K&(%,!an 4a(! #&n! a4a'a$ )&(4a(a$an 4&n,an %m'a$ 6an, an6a 4an endpoint &4a$ 6an, %'!# 4!#&n#%an. E!! 9a!a' a4a'a$ #&n! 6an, m&n,&!! a(!n,an 6an, #&('%a am)a! 'a)!an 9a+!a. T&n! !n! 4!,%naan )a4a a% '%a aa( 4&n,an &#&a'an )&n%$ full thickness8 6an, an,a# '%a a#a% '%a aa( 6an, an,a# 4a'am. A'a# 6an, 4!,%naan )a4a #&n! !n! a4a'a$ )!a% +a')&' m&!n )&m/#/n, electrocautery=. A4a)%n &%n#%n,an 4an &(%,!an 4a(! #&n! !n! a4a'a$: -
K&%n#%n,an : '&!$ m%4a$ 4!&(aan +&)a# )&(4a(a$an #!4a an6a
-
endpoint 6an, '&!$ m%4a$ 4!#&n#%an K&(%,!an : &(%,!an !4an, /m&#! )&n!n,a#an (&!/ +&4&(a )a4a a(a9a(a9 %)&(9!!a' 4an #&n4/n &!#a( &4&ma )a4a a,!an 4!#a' 4a(! &!!
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+. Skin grafting Skin grafting a4a'a$ m&#/4& )&n%#%)an '%a &4&($ana. T%%an 4a(! m&#/4& !n! a4a'a$: a. M&n,$&n#!an e,aporate heat loss . M&n,%)a6aan a,a( )(/& )&n6&m%$an #&(a4! &%a! 4&n,an a#% +. M&'!n4%n,! a(!n,an 6an, #&(%a
25
Skin grafting $a(% 4!'a%an &+&)a#n6a &#&'a$ 4!'a%an &!! )a4a '%a aa( )a!&n. K%'!# 6an, 4!,%naan 4a)a# &(%)a %'!# )(/4% !n#&! %'!# man%!a 6an, &(aa' 4a(! #%%$ man%!a 'a!n 6an, #&'a$ 4!)(/& ma%)%n &(aa' 4a(! )&(m%aan #%%$ 'a!n 4a(! )a!&n a%#/,(a9#8. Da&(a$ #%%$ 6an, !aa 4!,%naan &a,a! 4a&(a$ 4/n/( a%#/,(a9# a4a'a$ )a$a //n, 4an )&(%#. T&n! m&n4a)a#an %'!# )a!&n &+a(a a%#/,(a9# 4a)a# 4!'a%an &+a(a split thickness skin graft a#a% full thickness skin graft . B&4an6a 4a(! #&n! #&n! #&(&%# a4a'a$ 'a)!an-'a)!an %'!# 6an, 4!am!' &a,a! 4/n/(. Un#% m&ma!ma'an )&n,,%naan %'!# 4/n/( #&(&%# %'!# 4/n/( #&(&%# 4a)a# 4!(&n,,an,an 4an 4!%a# '%an, '%an, )a4a %'!# 4/n/( &)&(#! a(!n,-a(!n, 4&n,an )&(an4!n,an #&(#&n#% &!#a( 1 : 1 am)a! 1 : 8 4&n,an m&!n. M&#/4& !n! 4!&%# mess grafting . K&#&a'an 4a(! %'!# 4/n/( #&(,an#%n, 4a(! '/a! '%a 6an, aan 4!'a%an grafting %!a )a!&n &)a(a$an '%a 4an #&'a$ 4!'a%ann6a )&n,am!'an %'!# 4/n/( &&'%mn6a. P&n,am!'an %'!# 4/n/( !n! 4a)a# 4!'a%an 4&n,an m&!n dermatome a#a%)%n 4&n,an man%a' 4&n,an )!a% H%m'6 a#a% ?/%'!an.
S&&'%m 4!'a%an )&n,am!'an 4/n/( 4!&(!an %,a Ca//n#(!#/(
'a(%#an &)!n&9(!n8 4an %,a an&#&!. P(/&4%( /)&(a! skin grafting &(!n, m&n%m)a! maa'a$ 6an, 4!$a!'an 4a(! &!! '%a aa( )a!&n 4!mana #&(4a)a# )&(4a(a$an 4an $&ma#/m &#&'a$ 4!'a%an &!! &$!n,,a )&'&a#an %'!# 4/n/( %,a #&($ama#. O'&$ a(&nan6a )&n,&n4a'!an )&(4a(a$an
an,a#
4!)&('%an. A4a)%n &&(a)a
9a#/(
6an,
m&m)&n,a(%$!
&&($a!'an )&n6a#%an %'!# 4/n/( 4&n,an a(!n,an 6an, ma% 4!'a%an grafting a4a'a$: -
K%'!# 4/n/( &#!)! m%n,!n Pa#!an /n#a an#a(a %'!# 4/n/( 4&n,an &4 a(!n,an 6an, 4!'a%an ,(a9#!n,8 $a' !n! 4a)a# 4!'a%an 4&n,an +a(a : *&,a$ ,&(aan ,&&( a! 4&n,an )&ma'%# &'a#! a'%# #&an8 o o D(a!na& 6an, a! o ?%naan aa a4/(&n
KOPLIKASI Sistemic Inflammatory Response Syndrome SIRS56 Multi-system Organ Dysfunction Syndrome (MODS),,%n Se$sis
P&n4a$%'%an
26
SIRS a4a'a$ %a#% &n#% (&)/n '!n! 6an, &(!9a# !#&m! #&($a4a) &(a,a! #!m%'% '!n! &(a# a!a# !n9&! a#a%)%n n/n!n9&! &)&(#! #(a%ma '%a aa( (&a! a%#/!m%n !(/! )an(&a#!#! 4''. R&)/n !n! m&(%)aan 4am)a 4a(! )&'&)aan m&4!a#/(-m&4!a#/( !n9'ama! )(/!n9'ama!8 6an, m%'an6a &(!9a# 9!!/'/,! 4a'am )(/& )&n6&m%$an '%a nam%n /'&$ a(&na )&n,a(%$ &&(a)a 9a#/( )(&4!)/!! 4an 9a#/( )&n+&#% (&)/n !n! &(%a$ &+a(a &('&!$an m&n,a'am! &a,(&,a!8 4an m&n6&aan &(%aan )a4a /(,an-/(,an !#&m! m&n6&aan 4!9%n,! 4an &(a$!( 4&n,an &,a,a'an /(,an #&(&na m&na'anan 9%n,!n6a MODS &ulti-system 'rgan Disfunction Syndrome8 a$an am)a! &,a,a'an &(a,a! /(,an &ulti-system 'rgan Failure;MOF8. SIRS 4an MODS m&(%)aan )&n6&a %#ama #!n,,!n6a an,a m/(#a'!#a )a4a )a!&n '%a aa( ma%)%n #(a%ma &(a# 'a!nn6a. Da'am )&n&'!#!an 4!'a)/(an SIRS 4an MODS &4%an6a m&na4! )&n6&a >1 &ma#!an )a+a #(a%ma 4an 4a)a# 4!%#!an )%'a a$a SIRS &n4!(! m&n,an#a(an )a!&n )a4a MODS. A4a @ $a' 6an, !a m&na4! a#!Ca#/( #!m%'n6a SIRS 6a!#% infection injury inflamation inade*uate blood flow 4an ischemia-reperfusion injury. K(!#&(!a '!n! 6an, 4!,%naan m&n,!%#! $a!' /n&n% (merican !ollege of !hest phycisians 4an the Society of !ritical !are &edicine #a$%n 11 6a!#% !'a 4!%m)a! 2 a#a% '&!$ m&n!9&#a! &(!%# &'ama &&(a)a $a(! 6a!#%: -
H!)&(#&(m!a %$% Q 3>*8 a#a% $!)/#&(m!a %$% < 3*8
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Ta!a(4! 9(&%&n! na4! Q 0;m&n!#8
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Ta!)n&% 9(&%&n! na9a Q 20;m&n!#8 a#a% #&anan )a(!a' *O2 (&n4a$ Pa*O2 < 32 mmH,8 L&%/!#/! %m'a$ '&/!# Q 12.000 &';mm38 '&%/)&n! < "000
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&';mm38 a#a% 4!%m)a! Q 10 n&#(/9!' 4a'am &n#% !ma#%( band 8. B!'a 4!)&(/'&$ %#! a$a !n9&! &a,a! )&n6&a 4a(! $a!' %'#%( 4a(a$;a#&(&m!a8 maa SIRS 4!&%# &a,a! &)!. SIRS aan &'a'% &(a!#an 4&n,an MODS a(&na MODS m&(%)aan a$!( 4a(! SIRS. Pa4a 4aa(n6a MODS a4a'a$ %m)%'an ,&a'a 4&n,an a4an6a ,an,,%an 9%n,! /(,an )a4a )a!&n a%# &4&m!!an (%)a &$!n,,a $/m&/#a! #!4a 4a)a# 4!)&(#a$anan #an)a !n#&(C&n!. B!'a 4!#&'%%(! '&!$ 'an%# SIRS &a,a! %a#% )(/& 6an, &(&!nam%n,an &$!n,,a 4a)a# 4!m&n,&(#! a$a MODS m&n,,ama(an /n4!! '&!$ &(a# 4an m&(%)aan a,!an a$!( 4a(! )&#(%m &a4aan 6an, &(aa' 4a(! SIRS. Pa#/9!!/'/,! 27
P&(a'anan SIRS 4!&'aan m&n%(%# #&/(! 6an, 4!&man,an /'&$ Bone 4a'am &&(a)a #a$a). ahap " R&)/n !n9'ama! !#&m! 4!4a$%'%! /'&$ %a#% )&n6&a m!a'n6a '%a aa( a#a% #(a%ma &(a# 'a!nn6a. K&(%aan '/a' m&(an,an, )&'&)aan &(a,a! m&4!a#/( )(/!n9'ama! &)&(#! !#/!n 6an, &'a!n m&man,!#an (&)/n !n9'ama! %,a &()&(an )a4a )(/& )&n6&m%$an '%a 4an m&n,&(a$an &'-&' (&#!%'/&n4/#&'!a'. S!#/!n a4a'a$ )&maa )&an 9!!/'/,! 4a(! (&)/n !n9'ama!. M/'&%' %#aman6a m&'!)%#! umor ecroti/ing Factor TNF8 !n#&('&%!n IL 1 IL8 !n#&(9&(/n !olony Stimulating Factor *SF8 4an 'a!n-'a!n. E9&#/( &'%'a( (&)/n !n9'ama! a4a'a$ &'-&' PMN m/n/!# ma(/9a, 4an &'-&' &n4/#&'. S&'-&' %n#% !#/!n 4an m&4!a#/( !n9'ama! &%n4&( &)&(#! )(/#a,'an4!n '&%/#(!&n thrombo)ane latelet (cti,ating Factor PAF8 (a4!a' &a /!4a n!#(!# 4an )(/#&a&. En4/#&' #&(a#!Ca! 4an '!n,%n,an 6an, a6a !#/!n m&n,a#!9an aa4& /a,%'a! &$!n,,a #&(a4! #(/m/! '/a'. Ha' !n! m&n,%(an,! &$!'an,an 4a(a$ m&'a'%! '%a nam%n 4!am)!n, !#% #!m%' &9& )&ma#aan walling off 8 a(!n,an +&4&(a &$!n,,a &+a(a 9!!/'/,! 4a&(a$ !n9'ama! #&(!/'a!. ahap "" S&%m'a$ &+!' !#/!n 6an, 4!'&)aan & 4a'am !(%'a! %#(% m&n!n,a#an (&)/n '/a'. T&(a4! )&(,&(aan ma(/9a, #(/m/!# 4an #!m%'a! )(/4%! 9a#/( )&(#%m%$an 0rowth Factor ; ?F8. S&'an%#n6a 4!m%'a!'a$ (&)/n 9a& a%# 6an, #&(/n#(/' &+a(a !m%'#an m&'a'%! )&n%(%nan a4a( m&4!a#/( )(/!n9'ama! 4an )&'&)aan an#a,/n! &n4/,&n an#a,/n! (&&)#/( IL1 4an m&4!a#/(-m&4!a#/( an#!-!n9'ama! 'a!n &)&(#! IL" IL10 IL11 (&&)#/( #&('a(%# TNF ransforming 0rowth Factor ;T?F8. D&n,an 4&m!!an m&4!a#/(-m&4!a#/( #&(&%# m&na,a (&)/n !n9'ama! aa' 6an, 4!&n4a'!an 4&n,an a! /'&$ down regulating cytokine production 4an &9& an#a,/n! #&($a4a) !#/!n 6an, #&'a$ 4!'&)aan. K&a4aan !n! &('an,%n, $!n,,a $/m&/#a! #&(a,a. ahap """ J!a $/m&/#a! #!4a 4a)a# 4!&ma'!an &(&man, #a$a) III SIRS8 #&(a4! (&a! !#&m! ma!9. E9& )(&4/m!nan 4a(! !#/!n &(%a$ m&na4! 4&#(%#!9. S!(%'a! 4!an!(! m&4!a#/(-m&4!a#/( !n9'ama! &$!n,,a !n#&,(!#a 4!n4!n, a)!'&( (%a. S!#/!n m&(ama$ & 4a'am &(a,a! /(,an 4an m&n,a!a#an &(%aan. R&)/n 4&#(%#!9 (&,!/na' 4an !#&m! #&(a4! )&n!n,a#an Ca/4!'a#a! )&(!9&( ,an,,%an )&(m&a!'!#a m!(/Ca%'a( a&'&(a! #(/m/! m!(/Ca%'a( a#!Ca! &' '&%/!#-&n4/#&'8 6an, m&n,a!a#an )&(%a$an-)&(%a$an )a#/'/,! 4! &(a,a! /(,an. J!a (&a! !n9'ama! 28
#!4a 4a)a# 4!&n4a'!an #&(a4! 6/ &)#! Disseminated "ntra,ascular !oagulation DI*8 ARDS MODS 4an &ma#!an. MODS m&(%)aan a,!an a$!( 4a(! )&#(%m '!n! SIRS. Pa4a )a!&n '%a aa( 4a)a# 4!%m)a! &+a(a aa( 30 a% m&n,a'am! MODS. A4a 3 #&/(! 6an, m&n&'aan #!m%'n6a SIRS MODS 4an &)! 6an, mana &#!,an6a #&(a4! &+a(a !m%'#an. T&/(! )&(#ama m&n6&%#an a$a 6/ 6an, #&(a4! m&n6&aan )&n%(%nan )&n%(%nan !(%'a! 4! 4a&(a$ )'an,n!% )&(9%! & a(!n,an %% #&(,an,,% m&n6&aan 4!(%)! m%/a a'%(an +&(na. D!(%)! m%/a m&n6&aan 9%n,! m%/a &a,a! barrier &(%(an,;$!'an, 4an m&m)&(m%4a$ #&(a4!n6a #(an'/a! a#&(!. Ba#&(! 6an, m&n,a'am! #(an'/a! %m%mn6a 9'/(a n/(ma' %% 6an, &(!9a# /m&na' &(%a$ m&na4! /)/(#%n!#! $%%n6a a!a# )&(%a$an %aana 4! 4a'am '%m&n %% )%aa )&m&(!an an#a!4a 4an &&(a)a &n! an#!!/#!a8. S&'a!n &$!'an,an 9%n,! &a,a! barrier #&($a4a) %man 4a6a !m%n!#a %,a &(%(an, %'!# m%/a8 &$!n,,a m%4a$ 4!(%a /'&$ #/!n 6an, &(aa' 4a(! %man &n4/ a#a% &n#&(/#/!n8. Pa4a /n4!! 4!(%)! !'a )a!&n 4!)%aaan maa )(/& 4&,&n&(a! m%/a %#(% &('an%# m&na4! a#(/9! m%/a %% 6an, 4a)a# m&m)&(&(a# &a4aan. ?an,,%an !(%'a! & &(a,a! /(,an m&n6&aan /n4!!-/n4!! 6an, m&m!+% SIRS. ?an,,%an !(%'a! &(&(a' m&n6&aan 4!9%n,! a(&na ,an,,%an !#&m a%#/(&,%'a! &(&(a' 6an, m&m&(! 4am)a !#&m! &n&9&'/)a#!8. ?an,,%an !(%'a! & ,!na' m&n6&aan !&m! ,!na' $%%n6a #%%'% &('an%# 4&n,an (cute ubular ecrosis ATN8 6an, &(a$!( 4&n,an ,a,a' ,!na' (cute #enal Failure;ARF8. ?an,,%an !(%'a! )&(!9&( m&n6&aan !&m! /#/#-/#/# 4&n,an 4am)a )&m&+a$an ,'!/)(/#&!n 6an, m&n!n,a#an )(/4%! itric ')ide NO8 NO !n! &()&(an &a,a! m/4%'a#/( &)!. ?an,,%an !(%'a! & %'!# 4an !#&m !n#&,%m&n m&n6&aan #&(%#ama ,an,,%an !#!m !m%n a(&na )&n%(%nan )(/4%! '!m9/!# 4an )&n%(%nan 9%n,! barrier %'!#. T&/(! &4%a m&n&'aan )&'&)aan Lipid rotein !omple) LP*8 6an, &&'%mn6a 4!&na' 4&n,an burn to)in 4a(! a(!n,an n&(/! a!a# +&4&(a #&(m!. LP* m&m!'!! #/!!#a (!%an a'! 4! a#a &n4/#/!n 4a'am m&(an,an, )&'&)aan m&4!a#/( )(/!n9'ama! nam%n )&'&)aan LP* !n! #!4a a4a $%%n,ann6a 4&n,an !n9&!. R&)/n 6an, #!m%' m%'an6a &(!9a# '/a' #&(a#a )a4a 4a&(a$ +&4&(a &m%4!an &(&man, m&na4! %a#% &n#% (&)/n !#&m!. T&/(! &#!,a m&n&'aan &a+a%an !#&m m&#a/'!m& $!)/m&#a/'! )a4a 9a& a%# 4!'an%#an $!)&(m&#a/'! )a4a 9a& &'an%#n6a8 6an, m&n,%(a &'%(%$ m/4a'!#a #%%$ $%%n6a !#!m !m%n/'/,!. M&4!a#/(-m&4!a#/( )(/-!n9'ama! 6an, 4!'&)a & 29
!(%'a! &a,a! (&)/n #&($a4a) %a#% +&4&(a #!4a $an6a m&n6&(an, &n4a a!n, a#a% #/!n 6an, a4a #&#a)! %,a m&n!m%'an &(%aan )a4a a(!n,an /(,an !#&m!. K/n4!! !n! 4!m%n,!nan a(&na '%a aa( m&(%)aan %a#% &n#% #(a%ma 6an, &(!9a# !m%n/%)(&!9.
Ta#a'aana P&na#a'aanaan '%a aa( &(!9a# '&!$ a,(&!9 4an &(#%%an m&n+&,a$ )&(&man,an SIRS MODS 4an &)!. P&m&(!an N%#(!! En#&(a' D!n! NED8 m&'a'%! )!)a na/,a#(! 4a'am > am )&(#ama )a+a +&4&(a. S&'a!n &(#%%an m&n+&,a$ #&(a4!n6a a#(/9! m%/a %% )&m&(!an NED !n! &(#!#! #/'a m&n+&,a$ 4an m&n,a#a! /n4!! $!)/m&#a/'! )a4a 9a& a%# ; 6/ 4an m&n,&n4a'!an #a#% $!)&(a#a/'!m& 6an, #&(a4! )a4a 9a& flow. P&m&(!an an#a!4a 4an an#!!/#!a #!4a 4!&na(an a(&na aan m&(%a$ )/'a ; $a!#a# %man 6an, m&n,,an,,% &&!man,an 9'/(a %%. Ja(!n,an n&(/! ma%)%n a(!n,an n/n C!#a' 'a!nn6a 6an, 4!&aan +&4&(a #&(m! $a(% &,&(a 4!'a%an n&(/#/m! 4an debridement 4an 4!'a%an &4!n! m%n,!n &!! 4!n! $a(! &#!,a-&&m)a# )a+a +&4&(a '%a aa( &4an, $a(! &#%%$-&4&'a)an )a4a '%a aa( &(a#8 a$an !'a m&m%n,!nan 4!'a%an )&n%#%)an &,&(a immediate skin grafting 8 %n#% m&n,a#a! &(a,a! maa'a$ a!a# &$!'an,an %'!# &a,a! )&n%#%) m&n+&,a$ e,aporati,e heat loss 6an, m&n!m%'an ,an,,%an m&#a/'!m&8 barrier #&($a4a) %man 4an )(/& !n9'ama! &(&)anan,an 6an, m&m)&n,a(%$! )(/& )&n6&m%$an #!4a m&n%n,,% a(!n,an ,(an%'a! 6an, 4a'am $a' !n! m&n,%'%( a#% 4an m&m)&(&(a# #(& m&#a/'!m&. P&m&(!an /a#-/a#an 6an, &(!9a# an#! !n9'ama! &)&(#! an#!$!#am!n 4!an,,a) #!4a &(man9aa#. P&m&(!an #&(/!4 &&'%mn6a 4!an,,a) &(man9aa# nam%n $a(% 4!!n,a# aa# )&m&(!an &(#a &9& am)!n,n6a. P&m&(!an a# 6an, m&n!n,a#an !m%n/'/,! &)&(#! Om&,a-3 aan m&n!naan '&%/#(!&n LTB" 6an, &(!9a# ma'!,na8 4&n,an +a(a m&m)&n,a(%$! lypo)ygenase pathway )a4a m&#a/'!m& aam a(a$!4/na# &$!n,,a m&n,$a!'an '&%/#(!&n 6an, '&!$ &n!,na. P&m&(!an Om&,a- m&m!'!! &9& )a4a cyclo-o)ygenase pathway aam a(a$!4/na# &$!n,,a m&n,$a!'an #(/m/an 6an, '&!$ &n!,na m&n,,an#!an #(/m/an hrombo)aneA28 6an, &(!9a# ma'!,na.
K/m)'!a! 30
K/m)'!a! SIRS &(Ca(!a! #&(,an#%n, &#!/'/,!. K/m)'!a! 6an, m%n,!n #&(a4! )a4a SIRS a4a'a$ ,a,a' na)a (cute #espiratory Distress Syndrome ARDS8 4an )n&%m/n!a n///m!a' ,a,a' ,!na' )&(4a(a$an a'%(an +&(na 4an #(& ,a#(!#! an&m!a T(/m/! C&na 4a'am Deep 1ein hrombosis;DVT8 $!)&(,'!&m!a 4an Disseminated intra,ascular coagulation DI*8
PRO!NOSIS
P(/,n/! 4an )&nan,anan '%a aa( #&(%#ama #&(,an#%n, )a4a 4a'am 4an '%an6a )&(m%aan '%a aa( 4an )&nan,anan &a aa' $!n,,a )&n6&m%$an. S&'a!n !#% 9a#/( '&#a 4a&(a$ 6an, #&(aa( %!a 4an &a4aan &&$a#an )&n4&(!#a %,a #%(%# m&n&n#%an &+&)a#an )&n6&m%$an. P&n6%'!# %,a m&m)&n,a(%$! )(/,/n/! )a!&n. P&n6%'!# 6an, #!m%' )a4a '%a aa( an#a(a 'a!n ,a,a' ,!na' a%# &4&ma )a(% SIRS !n9&! 4an &)! &(#a )a(%# $!)&(#(/9! 4an /n#(a#%(.
BAB III PEBA2ASAN KASUS
Tn.SS %!a 32 #a$%n 4a#an, 4&n,an &'%$an &4%a #%n,a! 4an a! m&'&)%$ 4!&(#a! n6&(! a(&na #&(&na a)! &a 3 m!n,,% &&'%m ma% (%ma$ a!#. K%'!# 6an, m&'&)%$ 4!a!a#an /'&$ #a%n, ,a 6an, #!a-#!a m&'&4a. Pa!&n #!4a #&(%(%n, 4a'am (%an,an. T!4a a4a &'%$an &a na9a )%!n, m%a' ma%)%n m%n#a$. Pa!&n 4a#an, 4a'am &a4aan %4a$ m&'&a#! 9a& a%# '%a aa(. Maa )&('% 4!)&($a#!an AB*D 4a(! )a!&n. Da(! )&m&(!aan %m%m #!4a 4!#&m%an %'% $!4%n, 6an, #&(aa(. Ha' !n! 4a)a# m&n6!n,!(an a4an6a +&4&(a !n$a'a!. P&(na)aan n/(ma' 4an #!4a a4a &a( m&'!n,a( 6an, 4a)a# m&n,$a'an,! )&(,&(aan )&(na)aan. T&anan 4a(a$ 31
)a!&n &4!!# m&n%(%n 6a!#% 100;>0 mmH, 4&n,an 9(&%&n! na4! 6an, m&n!n,a# 6a!#% 112;m&n!#. Ha' !n! 4a)a# m&n%n%an a4an6a ,an,,%an )a4a !#&m a(4!/Ca%'a( a!a# #&(a4!n6a $!)/C/'&m! 6an, 4!a!a#an )&n,%a)an &('&!$ 4an &'%a(n6a +a!(an !n#(aCa%'a(. Pa4a #%%$ 4!#&m%an '%a aa( 4! #%n,a! 4an a! !(! 8 &(#a #%n,a! 4an a! anan 8. L%a '%a 4!#&n#%an m&n%(%# 4!a,(am rules of nine 4a(! 5a''a+&. T/#a' '%a '%a aa( m&n+a)a! 1> 4&n,an &4a'aman 4&(aa# II. L%a aa( )a4a )a!&n !n! 4!,/'/n,an 4&(aa# II &a &(%aan m&'!)%#! &)!4&(m! 4an &a,!an 4&(m! 6an, #&('!$a# 4a(! (&a! !n9'ama! a%# 4an )(/& &%4a! )a4a maa a%# 4!#&m%an %'a nam%n &a(an, %'a %4a$ $!'an, 4an 4!,an#!a '%a a(n& m&(a$ m%4a 6an, #am)a aa$ 4aa( '%a &(a(na m&(a$ a#a% )%+a# 4an n6&(! a!a# !(!#a! %%n, a(a9 &n/(!. L%a aa( )a4a )a!&n #!4a 4!,/'/n,an 4a'am 4&(aa# I &a )a4a '%a aa( 4&(aa# I &'a!nann6a $an6a &(%)a &(!#&ma %'!# &(!n, n6&(! #an)a 4!&(#a! &%4a!. L%a aa( %,a #!4a 4!,/'/n,an 4a'am 4&(aa# III &a )a4a '%a aa( 4&(aa# III 4!%m)a! %'!# #&(aa( &(a(na a%-a% 4an )%+a# '&#an6a '&!$ (&n4a$ +&%n,8 4!an4!n,an %'!# &!#a( 4an #!4a 4!%m)a! (aa n6&(!;$!'an, &na! a!a# &(%aan #/#a' %%n, &(a%# a(a9 &n/(!. Da(! )&m&(!aan 'a/(a#/(!%m 4a(a$ #&)! 4!#&m%an )&n!n,a#an '&%/!#. P&n!n,a#an '&%/!# !n! 4!&aan /'&$ (&a! !n9'ama! )a4a 9a& a%# '%a aa(. Pa4a )&m&(!aan %(!n 4!#&m%an an6a &(!#(/!#. D!#&m%an )%'a )&n!n,a#an 'a#a#. Ha' !n! )&('% 4!)an#a% %n#% 4&#&! 4!n! a(&na $a' !n! 4a)a# m&n6&aan &(%aan #%%'% ,!na' 6an, )&(man&n. P&na#a'aanaan 6an, 4!'a%an a4a'a$ (&%!#a! +a!(an. D&n,an +a(a Ba#&( 4a)a# 4!$!#%n, &%#%$an +a!(an )a!&n 6a!#%: " BB '%a aa( " 0 1> ".320 mL ; 2" am Saa# 9a& a%# '%a aa( )a4a > am )&(#ama )a!&n 4!&(!an 2.10 mL. K&m%4!an )a4a 1 am &m%4!an 4!&(!an +a!(an &an6a 2.10 mL. Pa4a $a(! &4%a 4!&(!an +a!(an &an6a &#&n,a$ +a!(an )&(#ama 6a!#% 2.10 mL;2" am. Pa4a $a(! &#!,a %m'a$ +a!(an &ma'! 4!%(an,! &#&n,a$n6a m&na4! 1.0>0 mL;2" am. J%m'a$ +a!(an 4a)a# 4!%(an,! a$an 4!$&n#!an !'a 4!%(&! )a!&n m&m%aan 4an )a!&n 4a)a# m!n%m #an)a &%'!#an. S&#&'a$ !#% 4!'a%an )&(aa#an '%a aa(. L%a aa( 4!&(!$an 4&n,an a!( $an,a# 6an, m&n,a'!(. Ha' !n! m&(%)aan +a(a #&(a! %n#% m&n%(%nan %$% 4! 4a&(a$ +&4&(a &$!n,,a 4a)a# m&n,$&n#!an )(/& /m%!/ )a4a a(!n,an. Un#% m&n%#%) 32
'%a 4!,%naan aa '&ma #&(!' m&n,,%naan +a!(an RL a#a% a'&) %n#% m&n+&,a$ )&n,%a)an. Ba'%#an 4!n!'a! 4a'am a#% 2"-"> am. B%'a 6an, '%a 4&n,an a%m%'a! #(an%4a# aan m&n6&aan )&na(!an +a!(an & 4a'am %'a &$!n,,a m&n6&aan ,an,,%an &&!man,an +a!(an. O'&$ a(&na !#% )&('% 4!'a%an !n!!. In!! !n! &(#%%an %n#% m&n,&'%a(an +a!(an #(an%4a# #an)a m&m%an, &)!4&(m! 6an, #&('&)a. K&m%4!an &)!4&(m! 6an, #&('&)a !n! 4!a4!an )&n%#%) '%a biological dressing 8 &)&(#! split thickness skin graft $SS0%. S&#&'a$ !#% 4!'&#aan tulle 4! a#a graft #&(&%# 4an m&m%n,%n6a 4&n,an aa '&ma &'ama 2-3 $a(! &m%4!an 4!&(!an a'&) an#!!/#! am)a! #&(a4!n6a &)!#&'!a!. Pa4a %'a-%'a 6an, &+!' +%%) 4!'a%an a)!(a! m&n,,%naan &m)(!# 4an 4!'a%an &a,a!mana )a4a %'a 6an, '%a. P(/,n/! a4 C!#am )a4a )a!&n !n! a4a'a$ /nam a(&na )&n6a!# !n! %4a$ 4!4!a,n/! 4an aa# !n! #!4a m&n,an+am n6aa. P(/,n/! a4 9%n+#!/nam )a4a )a!&n !n! a4a'a$ /nam a(&na &%a! 4&n,an '%a 4an &4a'aman '%a )&n6&m%$an 4a)a# #&(a4! &+a(a )/n#an 4an #&'a$ 4!'a%an #&(a)! )&n,/a#an 6an, a4&%a# #&($a4a) '%a aa(. P(/,n/! a4 ana+#!/nam )a4a )a!&n !n! a4a'a$ /nam a(&na 9a#/( )&n6&a 4a)a# 4!$!n4a(! 4an #!4a a4a an,a (&%(&n!.
DA-TAR PUSTAKA
1.
A$ma46a$ I P(a/n/ TOH. L%a. Da'am: Sam%$!4aa# R 4& J/n, 5 &4!#/(. B%% aa( !'m% &4a$. E4!! 2. Jaa(#a: P&n&(!# B%% K&4/#&(an E?* 200@. $. 73-@.
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