Download - Vascular Injury
Diagnosis dan Diagnosis dan PenanganannyaPenanganannya
TRAUMA VASKULER
PADA EXTREMITAS
PPENDAHULUANENDAHULUAN TRAUMA EXTREMITAS TRAUMA EXTREMITAS PASTIPASTI DISERTAI DISERTAI
TRAUMA VASKULERTRAUMA VASKULER
RINGAN SAMPAI BERATRINGAN SAMPAI BERAT
LIFE THREATENINGLIFE THREATENING
LIMB THREATENINGLIMB THREATENING
PPENDAHULUANENDAHULUAN MENGALIHKAN PERHATIANMENGALIHKAN PERHATIAN
PRIMARY SURVEYPRIMARY SURVEY
SECONDARY SURVEYSECONDARY SURVEY
EETIOLOGITIOLOGI LANGSUNG / DIRECTLANGSUNG / DIRECT
TIDAK LANGSUNG / INDIRECTTIDAK LANGSUNG / INDIRECT
KERUSAKAN ENDOTEL LOKALKERUSAKAN ENDOTEL LOKAL
EETIOLOGITIOLOGI : : DDIRECTIRECT
TRAUMA TUMPULTRAUMA TUMPUL
TRAUMA TAJAMTRAUMA TAJAM
EETIOLOGITIOLOGI : : IINDIRECTNDIRECT
TRAUMA TRAUMA KOMPRESSIKOMPRESSI
TRAUMA TARIKANTRAUMA TARIKAN
EETIOLOGITIOLOGI : : LOKAL LOKAL ENDOTEELENDOTEEL
OBAT-OBATAN ( DRUGs )OBAT-OBATAN ( DRUGs )
TRAUMA DINGIN TRAUMA DINGIN ( FREEZING )( FREEZING )
TTIPE IPE KKERUSAKANERUSAKAN KONTUSIKONTUSI
PERFORASIPERFORASI
LASERASILASERASI
TRANSEKSITRANSEKSI
DDIAGNOSISIAGNOSIS ANAMNESAANAMNESA
INSPEKSIINSPEKSI
PALPASIPALPASI
AUSKULTASIAUSKULTASI
DDIAGNOSISIAGNOSIS
MENGANCAM NYAWAMENGANCAM NYAWA
MENGANCAM EXTREMITASMENGANCAM EXTREMITAS HARD SIGNHARD SIGN
SOFT SIGNSOFT SIGN
HHARD ARD SSIGNIGN PERDARAHAN YANG PERDARAHAN YANG
BERDENYUTBERDENYUT ADANYA ARTERIAL THRILLADANYA ARTERIAL THRILL BRUIT DEKAT ARTERIBRUIT DEKAT ARTERI ISCHEMIA DISTALISCHEMIA DISTAL HEMATOMA YANG MEMBESARHEMATOMA YANG MEMBESAR
SOFT SIGNSOFT SIGN Anamnesa ada perdarahan Anamnesa ada perdarahan
banyakbanyak Menurunnya pulsasi arteriMenurunnya pulsasi arteri Adanya trauma tulang bagian Adanya trauma tulang bagian
proximal proximal Adanya kelainan neurologisAdanya kelainan neurologis
The Rule of Six - PThe Rule of Six - P PPAINAIN PPARASTHESIAARASTHESIA PPARALYSISARALYSIS PPALLORALLOR PPULSLESSNESSULSLESSNESS PPERISHINGLY COLD EXTREMITYERISHINGLY COLD EXTREMITY
GEJALA KLASIK GEJALA KLASIK MENGHILANGMENGHILANG
ADANYA SYOKADANYA SYOK
PEMBENGKAKAN, EDEM DAN PEMBENGKAKAN, EDEM DAN KONGESTI VENAKONGESTI VENA
PERSISTEN PULSES (25%)PERSISTEN PULSES (25%)
LABORATORISLABORATORIS DARAH LENGKAPDARAH LENGKAP TROMBOSIT CountTROMBOSIT Count BUN, S CREATININBUN, S CREATININ GOLONGAN DARAHGOLONGAN DARAH FAAL HEMOSTASISFAAL HEMOSTASIS
IMAGINGIMAGING
PLAIN X-RAYPLAIN X-RAY ARTERIOGRAFIARTERIOGRAFI
DUPLEX DOPPLERDUPLEX DOPPLER
MANAGEMENTMANAGEMENT LIFE TREATHENINGLIFE TREATHENING LIMB TREATHENINGLIMB TREATHENING HARD SIGNHARD SIGN SOFT SIGNSOFT SIGN
Management : Management : LIFE LIFE THREATENINGTHREATENING
MAJOR PELVIC DISRUPTION MAJOR PELVIC DISRUPTION WITH HEMORRAGEWITH HEMORRAGE
MAJOR HEMMORHAGEMAJOR HEMMORHAGE CRUSH SYNDROMECRUSH SYNDROME
OPEN FRACTURE AND JOINT OPEN FRACTURE AND JOINT INJURIESINJURIES
COMPARTMENT SYNDROMECOMPARTMENT SYNDROME VASCULAR AND TRAUMATIC VASCULAR AND TRAUMATIC
AMPUTATIONAMPUTATION NEUROLOGIC INJURIESNEUROLOGIC INJURIES
Management : Management : LIMB LIMB THREATENINGTHREATENING
PENANGANAN TRAUMA PENANGANAN TRAUMA VASKULERVASKULER
PENDERITA STABILPENDERITA STABILHARD SIGN HARD SIGN
EXPLORASIEXPLORASISOFT SIGN SOFT SIGN
EVALUASIEVALUASI
MEDIKA MENTOSAMEDIKA MENTOSA
ANTIKOAGULAN PENTING UNTUK ANTIKOAGULAN PENTING UNTUK MENCEGAH THROMBOSISMENCEGAH THROMBOSIS
ANTI PLATELET DRUG MEMPUNYAI ANTI PLATELET DRUG MEMPUNYAI MANFAAT POST VASCULAR REPAIRMANFAAT POST VASCULAR REPAIR
TERAPI BEDAHTERAPI BEDAH
LIGASILIGASIREPAIRREPAIRREKONSTRUKSIREKONSTRUKSIREPLACEMENTREPLACEMENT
MANGLED EXTREMITYMANGLED EXTREMITY
DERAJAT KERUSAKANDERAJAT KERUSAKANISCHEMIAISCHEMIASYOKSYOKUMUR PENDERITAUMUR PENDERITA
CRUSH INJURYCRUSH INJURY
IVFDIVFD
CCOMPARTMENT OMPARTMENT SSYNDROMEYNDROME
TAMPAK TEGANGTAMPAK TEGANGADA GEJALA 6 PADA GEJALA 6 PBUKA SEMUA BALUTAN / SPLINTBUKA SEMUA BALUTAN / SPLINTEVALUASIEVALUASIFASCIOTOMYFASCIOTOMY
SUSPECTED VASCULAR INJURY
RESUSCITATE
HARD SIGN SOFT SIGN
API > 0.9 API<0.9
OBSERVE COLOUR FLOW DUPLEX ARTERIOGRAFI ULTRASONOGRAFI
CLINICAL FOLLOW UP
SURGICAL EXPLORATION ARTERIOGRAM CLINICAL FOLLOW UP
MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI
Komplikasi Komplikasi Prolonged ischemiaProlonged ischemia Secondary haemorrhageSecondary haemorrhage Fail reconstruction, recurrent ischemiaFail reconstruction, recurrent ischemia Vascular salvage of union functional Vascular salvage of union functional
limblimb Venous thromboembolismVenous thromboembolism Iatrogenic complicationIatrogenic complication
MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI
Kegagalan rekonstruksi vaskulerKegagalan rekonstruksi vaskuler Suture line tentionSuture line tention Missed intimal flapMissed intimal flap Missed proximal or distal Missed proximal or distal injuryinjury
Retained thrombosisRetained thrombosis
MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI Kegagalan rekonstruksi vaskulerKegagalan rekonstruksi vaskuler
Imperfect anatomosisImperfect anatomosis Lateral repair without patchLateral repair without patch Major venous ligation without repairMajor venous ligation without repair Inadequate excision of the damage Inadequate excision of the damage
vesselvessel Elevated compartment pressuresElevated compartment pressures InfectionInfection
PENUTUPPENUTUPPrimary SurveyPrimary SurveySecondary SurveySecondary SurveyHard SignHard SignSoft SignSoft SignMultiple Trauma --- TeamMultiple Trauma --- Team
T E R I M A K A S I H