l2 initial assesment 2013
TRANSCRIPT
-
7/30/2019 L2 Initial Assesment 2013
1/45
PENILAIAN AWAL
DAN RESUSITASI
PADAPENDERITA
TRAUMA
(INITIAL ASSESMENT)
OlehRidlwan Kamaluddin, S.Kep., Ns,
M.Kep*
1
- Head of Emergency Nursing Department Unsoed
- Instruktur BT&CLS Ambulans Gawat Darurat (AGD) 118
-
7/30/2019 L2 Initial Assesment 2013
2/45
2
-
7/30/2019 L2 Initial Assesment 2013
3/45
3
-
7/30/2019 L2 Initial Assesment 2013
4/45
Mengapa Penanganan Trauma
penting...????
4
-
7/30/2019 L2 Initial Assesment 2013
5/45
Primary
Survey
SecondarySurvey5
-
7/30/2019 L2 Initial Assesment 2013
6/45
Selalu mulai dengan Survai Primer(mencari keadaan yang mengancam nyawa)
Primary Survey (Konsep ATLS)
A Airway dengan Proteksi servikal B Breathing dengan Oksigenasi dan Ventilasi C Circulation dengan Kontrol Perdarahan D Disability , keadaan Neurologis E Exposure dan Kontrol Hipothermia
6
-
7/30/2019 L2 Initial Assesment 2013
7/45
7
-
7/30/2019 L2 Initial Assesment 2013
8/45
8
Bila ada penderita, persiapan !!!!
3A
Aman Diri, Aman Lingkungan dan
Aman Pasien
-
7/30/2019 L2 Initial Assesment 2013
9/45
9
-
7/30/2019 L2 Initial Assesment 2013
10/45
10
Bagaimana menilai penderita dalam 10 detik ?
Ajak penderita berbicara !
Respon baik menunjukkan
A Airway baikB Breathing baikC Circulation mungkin baikD Disability mungkin baik
Bila tidak ada respon : Primary survey
-
7/30/2019 L2 Initial Assesment 2013
11/45
11
Assess :
Look
Listen
Feel
Airway & Proteksi ServikalA
-
7/30/2019 L2 Initial Assesment 2013
12/45
Tanda Trauma Cervical
12
Lesi/Luka dari Clavicula keatas
Cedera Kepala denganPenurunan Kesadaran
Multiple Trauma Biomekanika Trauma
-
7/30/2019 L2 Initial Assesment 2013
13/45
13
-
7/30/2019 L2 Initial Assesment 2013
14/45
Ada tanda trauma... Segera
pasang neck collar
14
-
7/30/2019 L2 Initial Assesment 2013
15/45
15
A Airway with C-spine protectionJalan nafas dijaga manual
* Suction (cairan - gurgling)
* Chin lift Jaw Thrust (snoring)
Jalan nafas sementara
* Oropharingeal
* Nasopharyngeal
Bila tidak berhasil : Airway definitif
BLS
ALS
-
7/30/2019 L2 Initial Assesment 2013
16/45
Tanda Fraktur Basis Cranii
Otorrhea
Rhinorrhea
Raccoon Eyes
Battle Sign
16
Bila ada tanda diatas... Jangan
LAKUKAN....!!!!1.Suction dgn soft catheter
2.Pemasangan NPA
-
7/30/2019 L2 Initial Assesment 2013
17/45
17
Assess :
Look
Listen
Feel
Breathing & VentilasiB
-
7/30/2019 L2 Initial Assesment 2013
18/45
18
B BreathingBila breathing terganggu :
Selalu Oksigen(11 LPM)
Ventilasi
(bila nafas tidak adekuat)
(dengan oksigenasi dan ventilasi)
-
7/30/2019 L2 Initial Assesment 2013
19/45
Pemeriksaan
Inspeksi
Auskultasi
Perkusi
Palpasi
19
-
7/30/2019 L2 Initial Assesment 2013
20/45
Inspeksi
Lihat ada jejas/luka/lesi
Ada luka tembak???? Luka tusuk???
Memar???
Pernafasan Paradoksal???
Kesimetrisan dinding dada
Deviasi trachea?
Peningkatan JVP?
20
-
7/30/2019 L2 Initial Assesment 2013
21/45
Auskultasi
Suara Nafas... (vesikuler/unvesikuler) Vesikuler normal
Unvesikuler gangguan...
Bunyi Jantung S1 dan S2 (jelas ataumenjauh)
Terdengar normal
Menjauh kemungkinan tamponadejantung
21
-
7/30/2019 L2 Initial Assesment 2013
22/45
Perkusi
Perkusi dada kanan dan kiri
Sonor Normal
Hipersonor ada udara
(pneumothorak bisa tension atauopen)
Pekak/Redup ada cairan/massa
kemungkinan hematothorax
22
-
7/30/2019 L2 Initial Assesment 2013
23/45
Palpasi
Palpasi adanya krepitasi atau tidak
Krepitasi flail chest (pernafasan
paradoksal)
23
-
7/30/2019 L2 Initial Assesment 2013
24/45
24
B Breathing : Open Pneumothorax
Sesak karena bernafas lewat lubang toraks
Tutup : Open Closed , kasa 3 sisi
-
7/30/2019 L2 Initial Assesment 2013
25/45
Occlusive Bandage.. (Kassa 3
sisi)
25
-
7/30/2019 L2 Initial Assesment 2013
26/45
26
B Breathing : Tension Pneumothorax
Dekompresi : Tension Open, NeedleThoracosintesis di ICS2 mid clavicula lalumekanisme pentil
-
7/30/2019 L2 Initial Assesment 2013
27/45
27
B Breathing : Flail chest +Kontusio paru
Bila ventilasi tidak adekuat : Assisted
-
7/30/2019 L2 Initial Assesment 2013
28/45
28
B Breathing : Massive Hematothorax
WSD, bila masifThorakotomi
-
7/30/2019 L2 Initial Assesment 2013
29/45
29
B Breathing : Pemasangan Chest tube
-
7/30/2019 L2 Initial Assesment 2013
30/45
30
Assess : Gangguan Perfusi Akral dingin
Tachycardia
Gangguan kesadaran
Tachypneu
Hipotensi
Oliguria/anuria
C CirculationKontrol Perdarahan
-
7/30/2019 L2 Initial Assesment 2013
31/45
31
C CirculationKenali Syok :
akral dingin takikardi
Kontrol Perdarahan
Perbaikan volume
-
7/30/2019 L2 Initial Assesment 2013
32/45
32
C Circulation : perbaikan volume
Infus : Guyur, RL yang dihangatkan(jangan lupa ambil sampel darah)
-
7/30/2019 L2 Initial Assesment 2013
33/45
33
C Circulation : kontrol perdarahan
Haemorrhage Control bila eksternal :
Direct Pressure
-
7/30/2019 L2 Initial Assesment 2013
34/45
34
C Circulation : Kontrol PerdarahanInternal
Toraks : torakotomi ?
Abdomen : laparotomi ?
Pelvis : PASG, Gurita, C-Clamp ?
Ekstremitas : Bidai / Spalk
-
7/30/2019 L2 Initial Assesment 2013
35/45
35
C Circulation : Non hemorrhagicShock
Sesak (+) ? mungkin Tension
Pneumothorax
Sesak (-) ? mungkinTamponade
Jantung
-
7/30/2019 L2 Initial Assesment 2013
36/45
36
D Disability : Pemeriksaan minineurologis Cedera kepala bisa mati cepat !
Nilai GCS
Eye
Verbal
Motorik
1. Pupil 2. GCS 3. Tanda lateralisasi
lainnya
-
7/30/2019 L2 Initial Assesment 2013
37/45
37
E Exposure and Environment ControlBuka :
Buka pakaian basah (hipotermi !)
Lihat cedera lain yang mengancam
nyawa
Tutup : Jangan sampai hipothermia
Boleh log roll bila ada indikasi
-
7/30/2019 L2 Initial Assesment 2013
38/45
38
Foley Catheter Gastric Tube
Periksa Ada kontra-indikasi ?
Tambahan pada Primary Survey
-
7/30/2019 L2 Initial Assesment 2013
39/45
39
Tambahan pada Primary Survey : Monitor
Pasang EKG
Pulse Oxymeter
-
7/30/2019 L2 Initial Assesment 2013
40/45
40
Tambahan pada Primary Survey : X-ray
X-Toraks X- PelvisX-Servikal
-
7/30/2019 L2 Initial Assesment 2013
41/45
41
Kerjakan bila Stabil : Secondary Survey
Anamnesis lengkap (Ample /Kompak )
From Head To Toe ( BTLS )
Finger and Tube in every orifice
Pemeriksaan tambahan lainnya
Secondary Survey
-
7/30/2019 L2 Initial Assesment 2013
42/45
Secondary Survey
42
- A Allergy
- M Medication
- P Post
Illness
- L Last Meal- E Event
-K Keluhan
-O Obat
-M Makan
-P Penyakit
-A Alergi-K Kejadian
-
7/30/2019 L2 Initial Assesment 2013
43/45
Secondary Survey
43
-B Bentuk
-T Trauma
-L Lesi
-S Sakit
-
7/30/2019 L2 Initial Assesment 2013
44/45
44
Bila sudah secondary survey, dan
penderita stabil :
Terapi definitif
Jahit Rawat ruangan
ICU
OK
Rujuk ke RS >>>> mampu & Cocok
-
7/30/2019 L2 Initial Assesment 2013
45/45