Download - PAK - GETARAN
PAK - GETARAN
ERWIN DN
• DEFINISI• PENYEBAB• PATHOGENESIS• DIAGNOSIS• TERAPI• PROGNOSIS• PENCEGAHAN
PAK AKIBAT GETARAN
• Penyakit akibat getaran adalah penyakit atau gangguan kesehatan akibat getaran
• PAK akibat getaran :– PAK akibat getaran seluruh tubuh– PAK akibat getaran setempat (segmented
vibration/ tool hand vibration)
Whole Body Vibration
• Getaran mekanaik yang disampaikan lewat tempat duduk (ex: alat berat) / lantai
• Getaraan dari alat berat tempat
duduk tulang belakang supir
WORKERS AT RISK
o Supir Traktor, truk, mobile crusherso Fork-liftso Masnis, supir bus, taksi, motor boat,
helikopter, pesawat o Mesin / Alat berat (hammering and
punching machinery)o Orang yang bekerja di landasan yang
bergetar
VibrationsVibrations
Vibration
• Exposure to vibration can occur while using power tools or while driving equipment.
• Vibration from power tools can place stress on the tissues of the fingers, hand and arms.
• Whole body vibration from driving puts stress on the spinal tissues.
Vibration ExposureVibration ExposureWhole BodyWhole Body
4 s/d7 % pekerja di Eropa& USA terpapar WBV yang berbahaya bagi kesehatannya
Terdapat berbagai faktor yang perlu diperhatikan dalam menilai efek getaran pada manusia , yaitu:
• Karakteristik fisik dari frekuensi dan intensitas getaran
• Tipe dari sumber getaran• Lamanya pemajanan• Arah getaran• Posisi tubuh• Kerentanan individu• Faktor lingkungan misalnya suhu udara,
kebisingan, beban kerja dll.
Efek fisik getaran Pada otot skelet (4-12 Hz)
Osteoarthritis
Osteoarthritis
Osteoarthritis
Osteoarthritis
Efek getaran dan frekuensi
Frekuensi (Hz) Efek4-12 Kerusakan sistem otot dan tulang
4-5 Kerusakan tulang belakang
5-20 (dg intensitas sangat tinggi
Perdarahan paru
Frekuensi-efek
Frekuensi (hz) efek< 10 Rongga dada dan perut>10 Organ dan jaringan perifer
EFEK PADA KESEHATAN WBV
FREKUENSI(HZ)
GANGGUAN KESEHATAN
4-12 -KERUSAKAN SEL TULANG RAWAN (ARTHRITIS PERMANEN)-SERUSAKAN SPINAL (HNPLBP)-ABDOMINAL PAIN-HEMATURIA-PERDARAHAN PARU (5-10 HZ; 5-15G)
3-9 DADA & PERUT10 LEHER, KEPALA, PINGGUL, PERINEUM, OTOT, TULANG
13-15 PHARYNX6-10 TEKANAN DARAH, DENYUT JANTUNG, IO2 MAX
MENINGKAT
GANGGUAN KESEHATAN MENURUT FREKUENSI
EFEK FREKUENSI (HZ)0,1-1 1-10 10-100 100-1000 1000-
10000>10.000
MABUKGANGGUAN BICARA
MATA KABUR
GANGGUAN TUGAS
SPINAL RUSAK*(KRONIS)
GANGGUAN GI*(KRONIS)
REYNOD D**
• Denyut jantung meningkat (10 – 15x/mnt) pada kondisi eksperimen yang normal, tanpa memperhatikan frekuensi pajanan kontinyu pulih
• TD meningkat pd frek. ± 5 Hz menurun pd frek. ± 10 - 20 Hz
Respon fisiologis thd WBV yg masih dapat ditolerir o/ manusia adalah :
• Tidal Volume : meningkat pada semua frekuensi (maks. Pd frek. 5 – 7 Hz)
• RR meningkat linier dg intensitas
• Pd 5-7Hz : VC menurun O2 Uptake meningkat.
• Efek WBV pd ginjal , darah & endokrin : - Belum atau tidak terdapat bukti yg jelas
• Efek WBV pd keseimbangan : - tgt kerentanan individu.
Efek Getaran Pada Performance
• Ggn. Fgs. & ketajaman penglihatan - sebanding dg amplitudo getaran - maksimum pd frek.10 -25 Hz.
• Penurunan performance pada tracking task (pekerjaan mengikuti jejak misalnya jejak satelit, pesawat udara dll)
- sebanding dengan amplitudo getaran - maksimum pd frek. rendah (≤ 5 Hz)
HNP (Hernia Nucleus Pulposus)
• Tergelincirnya nukleus pulposus (anulus fibrosus)/slipped disc
• Pathogenesis:WBV kerusakan tulang rawan slipped
disc tekanan pada radiks dorsalis LBP
HERNIA NUCLEUS PULPOSUS (SLIP DISC)
Beberapa Faktor Risiko LBPa. sikap tubuh yg jelek & kurang OR
- sikap berdiri yang membungkuk ke depan, - dada kempes - pungung lordosis - tidak tegap , - perut buncit
tekanan BB jatuh ke depan sbg kompensasi punggung hrs ditarik ke belakang -- hiperlordosis lumbal jk lama kelelahan otot & rangsangan pd ligamen nyeri.
Bad posture
b. Obesitas & kehamilan trimester akhir perpindahan tekanan BB ke depanc. >>> duduk otot hamstring kaku &
pendek d. Panjang tungkai yang tidak samae. Sepatu tumit yang tinggi / pemendekan
tendon achilles titik Berat bergeser ke
depan
f. kelemahan otot dinding perut , gluteus maksimis & ileopsoas serta pemendekan otot-otot ekstensor punggug (otot yg penting u/ mempertahankan sudut
lumbosacralis pd posisi optimal (30º )) kelemahan = ”unstable back”.
g. Merokok (blm jelas) - tekanan intra diskus meningkat (batuk kronis) - peregangan otot - nikotin
h. Kesegaran jasmani IKJ Baik < berisiko LBP
i. Lama masa kerja semakin lama (dg beban berat) risiko semakin meningkat
ACGIH TLVs and BEIs HandbookWhole-Body Vibration Threshold Limit
Values (TLV’s)
ax, ay, az = acceleration in the directions of the x, y, z, axesx axis = back - to – chesty axis = right – to – leftz axis = foot (or buttocks) - to - head
X
X
X
Y
YY
Z
Pencegahan• Hindari paparan WBV > NAB pilih
peralatan/mesin yang anti getaran, pemeliharaan mesin, gunakan peredam, sepatu anti getaran
• Atur waktu kerja istirahat : 1 jam kerja-10 menit istirahat
• Istirahat : stretching, massaging, relaxing• Terapi sesuai gejala• Hindari faktor risiko• Jaga badan tetap hangat
GETARAN SELURUH TUBUH
Paparan menahun (f=) Paparan akut (F=)Gangguan aliran darah amplifikasi /resonansi Di daerah ginjal dan saluran kencingKerusakan permanen pada sendi/tulang
Arthritis Peradangan/inflamasi
Slipped disc (L4-L5 atau L5 S1) Gangguan Fungsi Ginjal dan sal.Kencing, dg
indicator:Hematuria
HNP BUN Serum Creatini LBP Urea
PAK –GETARAN SETEMPAT
What is HAV (Hand-Arm Vibration)?
What is HAV (Hand-Arm Vibration)? -transmitted from work processes into workers hands and arms. - It can be caused by operating hand-held power tools such as : road breakers, hand-guided equipment (ex:s lawn mowers) holding materials being processed by machines such as pedestal grinders.
What injuries can HAV cause?
Regular exposure to HAV can cause a range of permanent injuries to your hands and arms that are known as hand-arm vibration syndrome (HAVS). The injuries can include damage to the following:
What injuries can HAV cause?
o Blood Circulatory System (vibration white finger) - >> tjd jika suhu tubuh/tangan dingin atau basah - tanda awal: ujung jari putih (kadang2) , baal , seperti terusuk jarum - akhir serangan: jari putih berubah merah & sangat nyeri oSensory Nerve Damage - kerusakan syaraf di jari rasa raba & rasa suhu berkurang baal permanen, kesemutan di jari oDamage to Muscle, Bones & Joints - kekuatan tangan hilang - nyeri di lengan & pergelangan tangan
Health Effects (bisanya Health Effects (bisanya setelah 3-5th)setelah 3-5th)
Hand ArmHand Arm
Vascular and circulation problems.Vascular and circulation problems.
Neurológical.Neurológical.
Muscular disordersMuscular disorders
OthersOthers
Symptoms – Advanced Stages
• White or Blanched Finger Tips– Aggravated by cold– Mistaken for frostbite– Few minutes initially
• With Continued Exposure– Blanching spreads– Attacks Increase in
• Frequency• Intensity• Duration
Symptoms – Latter stages• Occur in all seasons• On and off job• Triggered by
– Cold– Vibrating objects– Nicotine
• Severe Cases– Gangrene– Amputation
Stockholm HAVS Classification System (Vascular Assessment)
Stage
Grade Description
0 --------- No attacks1V Mild Occasional attacks affecting only
one or more fingers2V Moderate Occasional attacks affecting distal
and middle phalanges (rarely also proximal) of one or more fingers
3V Severe Frequent attacks affecting ALL phalanges of most fingers
4V Very Severe
As in Stage 3, with trophic skin changes in the finger tips
Stockholm HAVS Classification System (Sensorineural
Assessment)Stage Symptoms0SN Exposed to vibration but no symptoms
1SN Intermittent numbness, with or without tingling
2SN Intermittent or persistent numbness, reducing sensory perception
3SN Intermittent or persistent numbness, reducing tactile discrimination and/or manipulative dexterity
Normal Artery
Muscle
Normal flow
Damage Artery
Flow Restriction
Health EffectsHealth EffectsVascular DisordersVascular Disorders
Typical HAV Sources
• Fastening Tools• Cutting Tools• Finishing Tools• Gardening Tools• Compaction Tools• Drilling/Boring Tools• And More
Vibration ExposureVibration ExposureHand ArmHand Arm
Vibration ExposureVibration ExposureHand ArmHand Arm
Vibration ExposureVibration ExposureHand ArmHand Arm
Hand Arm vibration exposure
What other factors can contribute to vibration injury?
o o* How high the vibration levels
o* How long you use the tools and equipment
o* How awkward it is for you to use the equipment
o* How tightly you have to grip the equipment
o* How cold and wet you get when using the equipmento Individual susceptibility - smokers are at a greater risk
Upaya Pencegahan
• Jaga agar paparan tak melampaui NAB• Atur waktu kera-istirahat (1 jam-10 mnt)• Istirahat : massaging, swinging, shaking• Pakai gloves (VIP)• Jaga agar badan tetap hangat• Hindari faktor risiko
Acceleration levels from Hand Arm VibrationsHand-arm vibration acceleration level
(m/sec2)Tool Type
1,183 Riveter, Caulker
424 Chipping Hammer
416 Motorcycle
339 Jack-Leg Drill
251 Grinder
195 Pavement Breaker
125 Pedestal Grinder
75 Chain Saw
59 Brush Saw
20 Hand Grinder
Tri-axial Measurements must be perform:
Basicentric Measurement: Measurement of vibration directly from the tool.
Basicdynamic Measurement: Measurement of vibration indirectly over a knuckle.
2002/44/ECDirective 2002/44/EC of the European
Parliament and of the Council8-Hour Daily Exposure Limit Action Value Limit Value
Hand-Arm 2.5 m/s2 5 m/s2
Whole-Body 0.5 m/s2 1.15 m/s2
Whole-Body (vibration dose) 9.1 m/s1.75 21 m/s1.75
Vibrations on the Human body
QUESTIONS?