Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
INJURIES
FOOT • Since wet feet lose heat 25 times faster than dry, the body
uses vasoconstriction to shut down peripheral circulation
in the foot to prevent heat loss. Skin tissue begins to die
because of lack of oxygen and nutrients and due to
buildup of toxic products.
• reddened with numbness, tingling pain, and itching, then
becomes pale and mottled and finally dark purple, grey or
blue. The affected tissue generally dies and sloughs off.
• In severe cases trench foot can involve the toes, heels, or
the entire foot.
• If circulation is impaired for over 6 hours there will be
permanent damage to tissue.
• If circulation is impaired for over 24 hours the victim may
lose the entire foot.
TRENCH TATA LAKSANA
• gentle drying, elevation, and exposure of the extremity
FOOT feet regularly to see if they are wet. If feet get wet
(through sweating or immersion), stop and dry the feet
and wear dry socks. This applies especially to people
who sweat more than usual. Change socks at least once
a day and avoid sleeping with wet socks. Tight socks
can further impair peripheral circulation. Periodic air
drying, elevation, and massage will also help.
• Foot powder with aluminium hydroxide can help. High
altitude mountaineers put antiperspirant on their feet
for a week before the trip. The active ingredient,
aluminium hydroxide will keep the feet from sweating
for up to a month and there are no confirmed
contraindications for using antiperspirant.
FROSTBITE
FROSTBITE
Kondisi yang disebabkan oleh paparan berkepanjangan terhadap suhu dingin,
yang menyebabkan jaringan tubuh membeku dan mengalami kerusakan jaringan
ETIOLOGI
• Paparan berkepanjangan suhu < - 1 ºC
FAKTOR PREDISPOSISI
• Kegagalan aklimatisasi
• Gangguan sirkulasi/ penyakit vaskular (aterosklerosis, DM, Raynaud’s syndrome)
• Alkohol
• Nikotin
• Hipoksia
• Kulit basah
KLASIFIKASI
SUPERFICIAL FROSTBITE
• Epidermis – subkutan
• Area injuries berwarna putih spt lilin
• X capillary refill
• Saat pencairan area injury menjadi merah,
edema, nyeri, belang keunguan
• Blistering/ vesicle terbentuk dalam 24 jam,
pecah dalam 10 hari, (+) scar hitam
• Nyeri berdenyut & nyeri terbakar
KLASIFIKASI
DEEP FROSTBITE
• Injuri pada > jar. Subkutan (otot, tendon, struktur
neurovaskular)
• Bagian yang injury tetap biru/ kelabu setelah
pencairan
• Blister kadang terbentuk di jaringan yang masih
visible
• Edema biasanya 1 tubuh (generalisata) & butuh 1
bulan untuk recovery
GRADING • Terjadi pada orang-orang yang tinggal di lingkungan
dingin
GRADE I • Cedera mengakibatkan eritema setelah dihangatkan
kembali
• Kulit terasa kaku, namun jaringan dibawahnya masih
teraba lembut & hangat
• similar to mild chilblain with hyperemia, mild itching,
and edema. No blistering or peeling of skin occurs.
GRADING • Terjadi pembentukan blister / vesicle (clear-fluid filled)
& deskuamasi
GRADE II • Area injury ungu – biru, dikelilingi zona putih
GRADING • necrosis of skin and subcutaneous tissue with
ulceration.
GRADE III
GRADING • Involvement of deeper structure
• destruction of connective tissues and bone, with
GRADE IV gangrene.
• Blood-filled blisters
• Membentuk keropeng hitam setelah 2 minggu
PATHO
PHYSIOLOGY
TATA 1. RAPID EVACUATION
LAKSANA
2. Mengganti baju yang basah dan ketat dengan baju
longgar kering
1. FIELD MANAGEMENT
2. REWARMING
3. POSTREWARNING MANAGEMENT
4. PHARMACOLOGY
5. VESICLE TREATMENT
TATA • RAPID REWARMING: merendam ekstremitas di air
bersuhu 40-42 ºC sampai eritema, lembut
LAKSANA • ANTI SEPTIK: povidone-iodine
• AVOID MASSAGING & RUBBING
• THAWING
1. FIELD MANAGEMENT
– Superficial 20-40 mins
2. REWARMING
– Deep 1 jam
3. POSTREWARNING MANAGEMENT
4. PHARMACOLOGY
5. VESICLE TREATMENT
TATA • Once the skin is thawed…
• Lindungi area dari injuri berkelanjutan & reexposure
LAKSANA thdp dingin
• Elevasi area
• Monitoring infeksi sekunder
1. FIELD MANAGEMENT
2. REWARMING
3. POSTREWARNING MANAGEMENT
4. PHARMACOLOGY
5. VESICLE TREATMENT
TATA 1. Analgesik: ibuprofen saat & setelah rewarm
LAKSANA
2. Aloe vera cream setiap 6 jam
3. Imunisasi booster tetanus 0.5 mL IM
4. Antibiotik: Pencillin G 500.000 U setiap 6 jam, lanjut
72 jam
1. FIELD MANAGEMENT
5. Plasma expander: Dextran 40, 30 mL/kg setiap 24 jam
2. REWARMING (untuk mencegah penggumpalan darah)
3. POSTREWARNING MANAGEMENT 6. Aspirin 600 mg PO setiap 3 jam
4. PHARMACOLOGY
5. VESICLE TREATMENT
TATA 1. CLEAR/ MILKY VESICLE DEBRIDEMENT, ALOE
VERA
LAKSANA 2. HEMORRHAGIC VESICLE DO NOT
DEBRIDEMENT
1. FIELD MANAGEMENT
2. REWARMING
3. POSTREWARNING MANAGEMENT
4. PHARMACOLOGY
5. VESICLE TREATMENT
1. Menggunakan pakaian tipis namun berlapis banyak,
dibandingkan satu lapis tebal
2. Wear mittens, instead of gloves
3. Gunakan minimal 2 kaos kaki
4. Cover the face & head
5. Hindari pakaian ketat
6. Hindari baju basah, posisi stasis
7. Mengecek keadaan kulit tiap 10-20 menit
8. Hindari rokok (>> peripheral constriction)
PENCEGAHAN
COLD INJURIES
RE
• Cold Injuries, The Chill Within 2004
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC49230
33/pdf/main.pdf
REN
CE
THANK
YOU!