initial assessment for trauma
DESCRIPTION
initial assessement for traumaTRANSCRIPT
INITIAL ASSESSMENT FOR TRAUMA
ByRossi M I Sebayang
PENDAHULUAN
KEMAJUAN LALU LINTAS - PENGGUNA JALAN- JUMLAH KENDARAAN- JARINGAN JALAN- KECEPATAN KENDARAAN
ANGKA KEJADIAN KECELAKAAN LALIN / TRAUMA ME ↑
KECELAKAAN / TRAUMA
-TAK DIKETAHUI
- KAPAN
- DIMANA
- KENAPA
PERLU PERTOLONGAN !!!
CEPAT BENAR
-TEMUKAN PENDERITA GAWAT DARURAT
- MINTA PERTOLONGAN / TEAM
- KUALITAS PERTOLONGAN
- PRASARANA / PRASARANA
BASIC PRINCIPLES
TRAUMA
DEATH MORBIDITY
PRE HOSPITAL
- Transport guidelines/protocolsOn-line
medical direction
- Mobilization of resources
- Periodic review of care
PHASES OF TRAUMA CARE
INHOSPITAL
- TRIAGE
- PRIMARY SURVEY
- RESUSCITATION
- SECONDARY SURVEY
- CONTINUED MONITORING
- DEFENITIVE TREATMENT
PHASES OF TRAUMA CARE
CHILDREN YOUNGER
ADULT ELDERLY
PREGNANT WOMEN
PRIORITIES ARE THE SAME
TRAUMA IN
OBJECTIVE
Identifikasi prioritas managemen
Aplikasi prinsip2 primary dan secondary survey
Lakukan resusitasi & monitoring
Perhatikan riwayat kejadian & biomekanik injury
Antisipasi bahaya/kesulitan2 yang tersembunyi
In general, trauma triage and initial care is based on a step-wide evaluation of both anatomic
injury and physiologic stability.
PRIMARY SURVEYElderly, adult, younger, children, pregnant women : Priorities are the same
A : Airway + C-spine protectionB : BreathingC : Circulation + hemorrhage controlD : DisabilityE : Exposure/Environment
PRIMARY SURVEY
A = AIRWAY / C – SPINE ≈ JALAN NAFAS /TL BELAKANG CERVIKAL• PASTIKAN BAHWA JALAN NAFAS BERSIH
- BENDA ASING- MANUVER
• KASUS SPESIAL• IN LINE TRACTION = TRAKSI SEGARIS• RESIKO TINGGI CEDERANYA C – SPINE • PITFALLS (HAL2 YG TERSEMBUNYI)
PRIMARY SURVEY
• B = BREATHING AND VENTILATION≈ BERNAFAS DAN VENTILASIBERSIHNYA JALAN NAFAS SAJA TDK MENJAMIN VENTILASI YANG ADEKUAT
PASIEN TRAUMA MEMBUTUHKAN PERTUKARAN GAS YANG ADEKUAT
EVALUASI DINDING DADAAUSKULTASI PARU-PARUPERKUSI ADANYA CAIRAN / DARAH
PRIMARY SURVEY
• B = BREATHING AND VENTILATION
≈ BERNAFAS DAN VENTILASIMAJOR INJURIES :
TENSION PNEUMOTHORAXFLAIL CHESTMASSIVE HAEMOTHORAXOPEN PNEUMOTHORAX
MINOR INJURIES : RIB FRACTURES
SIMPLE HAEMO / PNEUMOTHORAXPULMONARY CONTUSION
PRIMARY SURVEY
• B = BREATHING AND VENTILATION≈ BERNAFAS DAN VENTILASI
THE PATIENT IS DYSPNOE, TACHYPNOE RR = 35 X/i
YOU DECIDE TO INTUBATE / VENTILATE
PRIMARY SURVEY
• C = CIRCULATION AND CONTROL OF BLOOD LOSS≈ SIRKULASI DAN KONTROL PERDARAHAN
STATUS HAEMODYNAMIC PENDERITA DI ASSESS SECARA CEPAT
HYPOTENSION YG MENYERTAI TRAUMA ADALAH HYPOVOLEMIC KECUALI KENYATAAN SEBALIKNYA
HAEMORRHAGE ADALAH PENYEBAB KEMATIAN KE-2 PASCA TRAUMA
PRIMARY SURVEY
• C = CIRCULATION AND CONTROL OF BLOOD LOSS
CLINICALLY, ASSESS
1. LEVEL OF CONSCIOUSNESSBLOOD LOSS
C.V.P.
2. SKIN COLOUR
3. PULSE
PRIMARY SURVEY
• CONTROL BLEEDING
DIRECT PRESSURE BEFORE
USING TOURNIQUETS
BEFORE USING CLAMPS
PRIMARY SURVEY• CONTROL BLEEDING
≈ KONTROL PERDARAHAN
THINK OF THE SITE THORAX
ABDOMEN
RETROPERITONEUM
FRACTURE SITE
PENETRATING THORAX
PRIMARY SURVEY
• PITFALLS REGARDING BLOOD LOSS
BEWARE OF THE ELDERLY AND CILDREN
BEWARE THOSE ON BETA – BLOCKERS
BEWARE FIT MALES (ATLIT)
The Lethal Triad
• SHOCK Prolonged hypotension
Coagulopathy
Metabolic Acidosis
Hypothermia
DEATH
Rotondo MF, Zonies DH. Surg Clin North Am 1997; 77(4): 761-777
PRIMARY SURVEY
• D = DISABILITY → NEUROLOGICAL EVALUATIONDONE AT THE END OF THE PRIMARY SURVEY
DROP IN LVL. OF CONSCIOUSNESSRE – EVALUATE OXYGENATION, VENTILATION, AND PERFUSIONIS IT A DIRECT CEREBRAL INJURY ?ARE THERE ALCOHOL OR DRUGS INVOLVED ?
AVPU GCS
PRIMARY SURVEY
E = EXPOSURE / ENVIRONMENT
EXPOSURE IS IMPORTANT
LOGROLL THE PATIENT
MAINTAIN THE CORE TEMPERATURE
THE RESUSCITATION PHASE
• AGGRESSIVELY RESUSCITATE PATIENTS TO INCREASE SURVIVAL
AIRWAY BERSIHKAN, BEBASKAN, LINDUNGI IF THE PATIENT CAN’T MAINTAIN AIRWAY INTEGRITY
PLACE A DEFINITIVE AIRWAYINTUBATE WITH CONTINUOUS C – SPINE PROTECTION !!!
THE RESUSCITATION PHASE• BERIKAN CAIRAN – CRYSTALLOID OR COLLOID ??
• ATASI HYPOVOLEMIA DAN HAEMORRHAGE !!!
• HAMPIR SEMUA SHOCK PD TRAUMA ADALAH HYPOVOLEMIC !!!!
• HENTIKAN PERDARAHAN, BUKAN BERIKAN CAIRAN
• PULIHKAN VOLUME INTRAVASCULAR
MONITORING DURING RESUSCITATION
• ECG MONITORING SINUS TACHYCARDIAST CHANGESATRIAL FIBRILLATIONPEA (Pulseless Electrical Activity) BRADYCARDIA
• TUBESURINARY CATHETERSNASOGASTRIC DECOMPRESSION
MONITORING DURING RESUSCITATION
• TUBES
INSTRUMENT THE UNCONSCIOUS PATIENT CAREFULLY
BEWARE OF URETHRAL TRANSECTION
MONITORING DURING RESUSCITATION
• MONITORINGRESUSITASI YG ADEKUAT DI ASSESS DENGAN PARAMETER FISIOLOGIS- HR- BP- PULSE PRESSURE- RR- ABG ANALYSIS- URINE OUTPUT
MONITORING DURING RESUSCITATION
RE – EVALUATE ALL PARAMETERS
ALL THE TIME
SECONDARY SURVEY
• JANGAN DIMULAI SAMPAI ABCDE’s (PRIMARY SURVEY) TERSELESAIKAN
• JANGAN DIMULAI SAMPAI KEADAAN PASIEN MEMBAIK
• JANGAN DIMULAI SAMPAI FASE RESUSITASI MEMBAIK
SECONDARY SURVEY
• HISTORY AMPLEMECHANISM OF INJURY
• FULL EXAMINATIONHEAD AND FACENECKCHESTABDOMENMUSCULOKELETALNEUROLOGICAL
• IMAGING
IMPORTANT POINTS IN TRAUMA
• FULL ASSESSMENT
• EVALUASI BERKELANJUTAN DAN SELALU
DIULANGI
• MULTIDISCIPLINARY APPROACH
IMPORTANT EXAM POINTS IN TRAUMA
• BERPEGANG PD BASIC PRINCIPLES
• SETIAP PERMASAALAHAN TRAUMA SECARA GLOBAL DI ASSESSMENT DENGAN MENGGUNAKAN ATLS / ACLS PROTOCOLS