trauma maksilo fascial.ppt
TRANSCRIPT
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Maxillo-Facial Injuries
dr. Andriana Purnama, MM. SpB-KBD. FINACS
Sub Baian Beda! Dies"i# FK$P%&S'S
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(bjec"i)es
Ana"omi
Iden"i#i*asi +anuan Aira
Mene"a!ui e*ni* Menjaa Aira denan
Kon"rol Cer)ical
Mene"a!ui Perna#asan an Ade*ua"
inda*an Kon"rol Perdara!an inda*an Semen"ara dan inda*an De#ini"i#
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Anatomi
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Anatomi
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Klasifikasi Fraktur
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Dental Occlusion
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Penyebab trauma tersering
Kecelakaan Lalu Lintas
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Aira (bs"ruc"ion
Coma
Aspira"ion
Maxillo#acial
"rauma Nec* "rauma
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Pemeriksaan Awal
(Primary Survey)
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Primary Survey !esuscitation
Airway an" cervical s#ine control
$reat%ing
&irculation an" %emorr%age control Dysfunction of t%e central nervous system
'#osure an" environmental control
Secon"ary Survey
Definitive &are
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Airway &*s#ine control
&uriga ce"era c*s#ine+
,trauma "iatas klavikula
,benturan kece#atan tinggi
$ila #asien "itanya
,men-awab "g baik+ Airway baik.
,ti"ak men-awab+ keluarkan ben"a asing,a#neu+ ventilasi "g bag*valve mask
Angkat "agu/ "orong ra%ang ke "e#an
Primary Survey & Resuscitation
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Menjaa Aira
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De#ini"i)e Aira
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Surical Aira
Indica"ions/Inabili" "o in"uba"e "rac!ea
Maxillo#acial "rauma
Nec* injur Me"!ods
Needle crico"!roido"om i"! je"
insu##la"ion Surical crico"!roido"om
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Iden"i#i*asi +anuan Aira
0i!a"
+elisa! % Diam "a* berera*
&e"ra*si perna#asan
De#ormi"as
Aira debris
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Iden"i#i*asi +anuan Aira
Denar*an
Bicara Normal 1 ida* ada (bs"ru*si
Perna#asan adu! 1 (bs"ru*si
+urle
S"ridor 'oarseness
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Iden"i#i*asi +anuan Aira
Palpasi
Maxillo#acial % larneal Krepi"asi
rac!eal de)ia"ion
'ema"oma
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$reat%ing
Penyebab tersering gangguan ventilasi
,$ilateral
Obstruksi saluran nafas atas
Kebocoran antara wa-a% "g mask
,0nilateral
1ntubasi bronkus cabang kanan
Pneumotoraks
2ematotoraks
$en"a asing "i bronkus
Kontusio #aru
Primary Survey & Resuscitation
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Perna#asan ida* Ade*ua"
0i!a" Canosis
in men"al s"a"us C!es" asmme"r ac!pnea
Nec* )ein dis"en"ion Paralsis
Denar*an
2I can3" brea"!e 45
S"ridor, !ee6es
or absen" brea"!
sounds
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Perna#asan ida* Ade*ua"
Palpasi
Sub7. emp!sema
C!es" all
crepi"us % "enderness
rac!eal de)ia"ion
Penunjan
Pulse oxime"er
C(8de"ec"or
AB+s
C!es" x-ra
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&irculation %emorr%age
control 3an"a*tan"a S%ock
!es#irasi4menit
Denyut -antung4menit
3ekanan "ara%
3ekanan na"i
Kulit #ucat
Pengisian ka#iler
Pro"uksi urine
Kesa"aran
3era#i
, 1nfus cairan !L 5 liter
, $ila #erlu 5 -alur
, $ila #erlu 6ena seksi
, $ila #erlu v femoralis
7onitoring ketat
, Setela% 5 liter !L
membaik
mula membaik/ kemu"ian
memburuk
terus memburuk
Primary Survey & Resuscitation
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Dysfunction of
&entral 8ervous System
3ingkat kesa"aran "a#at "inilai "engan
sistim A6P0
,A9 Alert (Siaga)
,69 !es#orts to 6oice (7en-awab #ertanyaan),P9 !es#on"s to Pain ($ereaksi t%" nyeri)
,09 0nconscious (ti"ak sa"ar)
Primary Survey & Resuscitation
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'#osure
Seluru% #rimary survey tela% "ilakukan
Selimuti #asien "g selimut/ ruangan %arus
cuku# %angat 7onitoring teta# ketat
1nformasi untuk keluarga
Primary Survey & Resuscitation
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Secon"ary Survey
3u-uan Secon"ary Survey
,7emeriksa #asien "ari ke#ala sam#ai kaki/
"e#an "an belakang,Pengambilan riwayat #enyakit yg lengka#
,7enggabungkan seluru% %asil #emeriksaan
klinis/ laboratorium/ "an ra"iologis
,7embuat rencana #engelolaan selan-utnya
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Pemeriksaan Ke#ala
Ke#ala+ laserasi/ e"ema/ luka/ fraktur
Kea"aan neurologis+ :lasgow &oma Scale
$asis kranii+ %ematom
7ata+ #er"ara%an/ ben"a asing/ refleks
;a-a%+ asimetri/ "eformitas/ nyeri
Secondary Survey
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Pemeriksaan Le%er
Pasien "iangga# fraktur cervikal sam#ai
terbukti ti"ak a"a
,1mobilisasi le%er,!aba #rocesus s#inosus
,Pasien sa"ar+ nyeri