TRAUMA MANAGEMENT
Hendy Satrya Kurniawan
PENDAHULUAN
PENDAHULUAN
Number of Incidents by Age
40,000
35,000
Number of Incidents
30,000
25,000
20,000
15,000
10,000
5,000
0
1 8 15 22 29 36 43 50 57 64 71 78 85 92 99 106
Age (years)
Number of Incidents by Age and Gender
30,000
25,000
Number of Incidents
20,000
Males
15,000
Females
10,000
5,000
0
0
6
12
18
24
30
36
42
48
54
60
66
72
78
84
90
96
102
Age (years)
Case Fatality Rate by Age
10.0
9.0
8.0
7.0
Case Fatality Rate
6.0
5.0
4.0
3.0
2.0
1.0
0.0
0 10 20 30 40 50 60 70 80
Age (years)
PERSIAPAN
Fase Pre Hospital
Fase Hospital
PRE HOSPITAL PHASE
• Koordinasi dengan RS dan Trauma team
• Airway management
• Kontrol perdarahan eksternal dan syok
• Imobilisasi penderita
• Transport penderita
Field Triage Decision Scheme
HOSPITAL PHASE
Aspek penting persiapan di RS :
• Ruang resusitasi
• Perlengkapan airway definitif
• Cairan resusitasi (warmed) dan monitor
• Laboratorium dan radiologi
INITIAL ASSESMENT
PRIMARY SURVEY
• Advanced Trauma Life Support
Assess and address life threatening injuries in
order
• “ABCDE of trauma”
– Airway
– Breathing
– Circulation
– Disability / Neurologic “deficit”
– Exposure & Environment of patient
AIRWAY MANAGEMENT
AIRWAY
–Identikasi obstruksi jalan nafas
– Mempertahankan imobilisasi cervical spine
– Definitif airway
• Orotracheal intubation
• Blind nasotracheal intubation
• Cricothyroidotomy
• Tracheotomy
Luka bakar wajah
Trauma maxilofacial
TEKNIK MEMPERTAHANKAN AIRWAY
Chin-lift
Jaw-thrust
Nasopharyngeal / Oropharyngeal airway
LMA
LTA
Extraglottic and Supraglottic Devices
DEFINITIVE AIRWAYS
Surgical Airway
Needle & surgical cricothyroidotomy
BREATHING MANAGEMENT
BREATHING
– Identifikasi kelainan yang menyebabkan gangguan
ventilasi
• Simple pneumothorax
• Tension pneumothorax
• Massive hemothorax
• Open pneumothorax (“sucking chest wound”)
• Flail chest
Tension Pneumothorax
Open Pneumothorax
Hematothorax Masif
Flail Chest
Hernia Diafragmatika
CIRCULATION MANAGEMENT
CIRCULATION
• Identifikasi tanda syok
Syok – gangguan perfusi organ
• Penyebab syok
– Hemoragik
– Non Hemoragik
PATOFISIOLOGI SYOK
SYOK NON HEMORAGIK
• Syok kardiogenik
• Syok septik
• Syok neurogenik
• Tamponade jantung
• Tension pneumothorak
SYOK HEMORAGIK
SYOK HEMORAGIK
PENATALAKSANAAN SYOK
HEMORAGIK
• A-B-C-D-E
• Dekompresi lambung
• Kateter urin
• Initial 1 liter bolus cairan kristaloid / 20
cc/KgBB untuk anak <40 kg
• Definitive management untuk kasus
perdarahan yang masih berlangsung
DISABILITY / NEUROLOGIC
“DEFICIT”
DISABILITY /
NEUROLOGIC “DEFICIT”
• Assessmen cepat status neurologi untuk
mendeteksi kelainan yang mengancam jiwa
– Ukuran dan respon pupil
– Glascow coma scale
– Pemeriksaan motorik dan sensorik
Glascow Coma Scale
• 3 – 15 poin untuk menentukan status mental
penderita
• Skala dimodifikasi untuk penderita anak2
• GCS ≤ 8 “coma” perlu penanganan airway
definitif
KOMPONEN MATA
KOMPONEN VERBAL
KOMPONEN MOTORIK
Infants Coma Scale
Eye
Spontaneous 4
To speech 3
To pain 2
None 1
Verbal
Coos, babbles 5
Irritable cry 4
Cries to pain only 3
Moans to pain 2
None 1
Motor
Normal spontaneous movements 6
Withdraws to touch 5
Withdraws to pain 4
Abnormal flexion 3
Abnormal extension 2
None 1
EXPOSURE
EXPOSURE
Head to toe examination pada pasien trauma
• Pitfalls
– Maintenance of spine precautions
– Prevention of heat loss
– Under cervical collar
– Back and flanks
