Download - Politrauma Br Update
![Page 1: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/1.jpg)
POLITRAUMA: PATOFISIOLOGI, PRIORITAS DAN MANAJEMEN
Pembimbing: dr.Zulkarnaini, Sp.OT
![Page 2: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/2.jpg)
Rangkaian Rx.Trauma Sistemik
Trauma Multipel melebihi sebuah
kekerasan
Disfungsi Organ-Fungsi Vital yg tidak
terkena langsung
DEFINISI
![Page 3: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/3.jpg)
Multipel Trauma Case
![Page 4: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/4.jpg)
FRACTURE
SOFT-TISSUE INJURY
BONE INJURY
STRESS, PAIN, HEMORRHAGE
INFECTION & COMPARTEMEN SYNDROME
![Page 5: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/5.jpg)
PATOFISIOLOGI
FRAKTUR
FOKUS INFLAMASI
SIST. P. LOKAL
SIST. P. SISTEMIK
SEL IMUNOKOMPETEN
KTMNS
TR. RI
DARAH
SIRS
MOF
MODS
![Page 6: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/6.jpg)
Algoritma of Initial Assesment
“Primary Survey”
Basic Imaging
RescucitationOxygenation,
perfusion
Life-saving surgery
Delayed Primary Surgery
EvaluationVital
function?Respon?
Damage Control
Scoring
ICU
“Secondary Survey”
?
-+
![Page 7: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/7.jpg)
Physiological StatusSurgical
InterventionTiming
Response to
Resuscitation
- Life-saving
surgery
Day 1? Damage control
+ Delayed primary
surgery
Hyper-
inflammation
“Second-look”-
only! Day 2-3
Window of
Opportunity
Scheduled
definitive surgery Day 5-10
Immunosuppressio
n
No Surgery!!!
Recovery
Secondary
reconstructive
surgeryWeek 3
Prioritas dan Timing
![Page 8: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/8.jpg)
Kontrol Perdarahan
Debridement
Intensive Care
Tangani Nyeri
Cegah Trauma Reperfusi-
Iskemik
Kontrol Kontaminasi
TUJUAN UMUM MANAJEMEN FRAKTUR
![Page 9: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/9.jpg)
CARA HITUNG SKOR ISS
Masing-masing trauma digolongkan terlebih dahulu dalam Abbreviated Injury Scale (AIS) yang dialokasikan
pada satu dari 6 bagian besar tubuh.
Hanya nilai AIS tertinggi pada masing-masing regio tubuh yang dipakai.
Tiga regio yang mengalami trauma terberat nilainya di kuadratkan dan dijumlahkan satu sama lain, dan itulah nilai ISS.
![Page 10: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/10.jpg)
Injury AIS Score
1 Minor
2 Moderate
3 Serious
4 Severe
5 Critical
6 Unsurvivable
Abbreviated Injury Scoring (AIS)
![Page 11: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/11.jpg)
Region Injury description AIS Square top
Three
Head & Neck Cerebral Contusion 3 9
Face No Injury 0
Chest Flail Chest 4 16
Abdomen Minor Contusion of Liver
Complex Rupture Spleen
2
5 25
Extremity Fractured Femur 3
External No Injury 0
Total ISS 50
#Contoh INJURY SEVERITY SCORING (ISS) Skor 0-75
![Page 12: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/12.jpg)
•Biomechanical Choice
•Intramedullary Canal
•Efek Samping: Emboli Paru
Nailing
•Pembedahan Besar
•Mudah Kontrol Perdarahan
•Dapat dilakukan Debridement & Fasciotomi
Plating
Penanganan Fraktur dengan Metode Fiksasi
![Page 13: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/13.jpg)
•Cepat, Mudah, Minimalisir Comp.Syndrome
•Kurang Stabil Sebagai Terapi Definitif
•Pin-Tract Infections
•Prosedur Bedah Plastik Sulit Dilakukan
Ext.Fiksasi
![Page 14: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/14.jpg)
Perdarahan Masif
FrakturPelvis
Resusitasi cairan
Reduksi atau fiksasi
pelvis
Ext.Fiksasi
Kompresi Pelvis
Hemodinamik
Tidak Stabil
Stabil
Rekons. Pelvis Laparotomy
EmergensiIntensive care
Recovery
Manajemen Fraktur pada Kondisi tertentu
![Page 15: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/15.jpg)
Manajemen Fraktur pada Cedera Kepala Berat
Cegah Kerusakan
Jar.Otak, ec:HipotensiHipoksemi
Optimalisasi Perfusi Otak
Tatalaksana Cedera
Kepala (Life-Saving)
Respon Baik Resusitasi
(Hemodinamik Stabil,
O2 Adekuat)
Fiksasi dan Rekosntruksi
Fraktur
![Page 16: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/16.jpg)
Cegah
Emboli
Paru
Eksternal Fiksa
si
Manajemen Fraktur pada Trauma Dada
![Page 17: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/17.jpg)
Menyelamatkan
• Teknik Bedah Mikro
• Debridement• Revaskularisasi• Fasciotomy• Fiksasi Fraktur• Debridement
Ulang• Rekonstruksi
Jaringan
Amputasi
• Guillotin Teknik dikombinasi dengan Primary Open Wound
Menyelamatkan Ekstremitas vs Amputasi
![Page 18: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/18.jpg)
Politrauma=Kasus Sistemik Bedah
Pahami Patofisiologi, Resusitasi, Triase, Timing, Plan Perawatan
yang Benar = BERHASIL
Fiksasi Segera Pada Fraktur Mayor=PENTING
Kesimpulan
![Page 19: Politrauma Br Update](https://reader031.vdokumen.com/reader031/viewer/2022013102/5572115e497959fc0b8edd3b/html5/thumbnails/19.jpg)
TERIMA KASIH