LBM 4

LBM 4KUITKU MEEPUH DAN TERASA PANASSTEP 1 STEP 21. Mengapa didapatkan bulla ?2. Mengapa setelah diberi infus NaCL 30 tetes produksi urin hanya 5 cc dan berwarna kemerahan ?3. Mengapa pada vital sign didapatkan RR 24 dan TD 100/70 , nadi 100x/menit ?4. Klasifikasi luka bakar ?5. Penanganan pertama pada luka bakar ?6. Kenapa didapatkan lengan kiri gosong dan paha kanan bengkak , hematom pada pelipis kanan?7. Bagaimana terapi cairan pada pasien tersebut ?8. Mengapa luka dibersihkan dengan povidon iodin ? benar atau tidak ?9. Bagaimana patofisiologi luka bakar ?10. Apa komplikasi luka bakar ?

STEP 71. Bagaimana patofisiologi luka bakar ?

Jawab: Anatomi kulit

The bodys response to a burnBurn injuries result in both local and systemic responses.Local responseThe three zones of a burn were described by Jackson in 1947.Zone of coagulationThis occurs at the point of maximumdamage. In this zone there is irreversible tissue loss due tocoagulation of the constituent proteins.Zone of stasisThe surrounding zone of stasis ischaracterised by decreased tissue perfusion. The tissue in thiszone is potentially salvageable. The main aim of burnsresuscitation is to increase tissue perfusion here and preventany damage becoming irreversible. Additional insultssuch asprolonged hypotension, infection, or oedemacan convert thiszone into an area of complete tissue loss.Zone of hyperaemiaIn this outermost zone tissue perfusion isincreased. The tissue here will invariably recover unless there issevere sepsis or prolonged hypoperfusion.These three zones of a burn are three dimensional, and lossof tissue in the zone of stasis will lead to the wound deepeningas well as widening.

Electrical injury

Specific causes of electrical injuries are classifiedas:a. Low-voltage injuries- also called low-tensioninjuries; low-voltage burns are caused by voltageless than 1000 V. This group includes mostinjuries caused by household current; the childwho bites into the cord producing lip, face andtongue injuries as well as occupational injuriesresulting from the use of small power tools, orthose who become grounded while touching anobject that is energized.

Fig. 1: Low-voltage injury. Representative electric fieldlines and isopotential lines established in the lower faceduring oral contact with a home power cord.B. High-voltage injuries- these burns are alsoknown as high-tension injuries, and they are aresult of exposure to 1000 V or more. Theseinjuries are often the result of occupationalexposure to outside power lines and the mostcommonly occur when a conductive objecttouches an overhead high voltage power line.Rarely, patients get into electrical switchingequipment and directly touch energized component.

Fig. 2: High-voltage injury. Approximate electric field lineswhen current path extends from hand to hand.

C. Lightning injuries- involve voltages higher thanthose of the other injuries, and are usuallycategorized separately. The typical lightninginjury involves energy with high voltage and highamperage but extremely short duration. Lightningis usually a unidirectional massive currentimpulse and is best understood as a currentrather than a voltage phenomenon. The largestflow of current tends to jump to the ground beforemuch of it passes through the body. Lightning injuries occur when the patient is part of or nearthe lightning bolt, and generally, the patient wasthe tallest object around or near a tall object,such as a tree

PathophysiologyCertain properties of electricity and tissue illustratethe mechanisms of electrical injury and the abilityto predict patients outcomes. These properties includevoltage, current, resistance, and conductance.Voltage is the electromotive force or the difference inthe electrical potential. The current is the flow ofelectricity. The resistance of a material is its oppositionto the passage of an electric current through it, andits conductance is its ability to transmit a current. Inaddition, electricity can also form arcs and result in thecreation of plasma. The three major mechanisms (5, 6)of electricity-induced injury are as follows:1. Electrical energy causing direct tissue damage,altering cell membrane resting potential,and eliciting tetany.2. Conversion of electrical energy into thermalenergy, causing massive tissue destructionand coagulation necrosis.3. Mechanical injury with direct trauma resultingfrom falls or violent muscle contraction.Factors that determine the degree of injuryinclude the magnitude of energy delivered, resistanceencountered current, current pathway, and duration ofcontact. Systemic effects and tissue damage aredirectly proportional magnitude of current delivered tothe victim. Current flow (amperage) is directly relatedto voltage and inversed resistance, as dictated by Ohmlaw (I=V/R; where I=current, V=voltage, R=resistance).Electrical current is categorized as direct current (DC)or alternating current (AC). Direct current, such ascurrent generated by batteries, flows in the samedirection constantly. Alternating current, such as currentavailable through household wall sockets, changesdirection periodically. Alternating current, which isused in most households, is more dangerous than direct current. Direct current tends to cause a singlemuscle contraction often strong enough to force theperson away from the currents source. Alternatingcurrent causes a continuing muscle contraction, oftenpreventing people from releasing their grip on thecurrents source. As a result, exposure may be prolonged;even a small amount of alternating currentbarelyenough to be felt as a mild shock- may causea persons grip to freeze. Slightly more alternatingcurrent can cause the chest muscles to contract,making breathing impossible. Still more current cancause deadly heart rhythms (6, 7).High voltage (>1000 V) current causes moresevere injuries than low voltage (