bls & survey primer 2003
TRANSCRIPT
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BASIC LIFE SUPORT
SURVEY PRIMER
Introduction
Pengenalan
Dr. Doso Sutiyono Sp.An.
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Pada saat kejadian
yang tewas belum 26
Sebagian tewas
1-4 jam kemudian
Sebagian tewas
beberapa hari
kemudian
Siapakah yang
menolong korban
pertama kali ?
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Korban bernafas tersengal-sengal
Nadi lemah, gelisah,
Cedera berdarah di dada dan punggung
Apatindakan
kita
seharusnya?
Apa
yang ditolong
lebih dulu?
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Korban tabrakan truk terjepit bak besi
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9U
sus terburai keluar, bahaya infeksi, peritonitis
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Pertolongan segera bukan pada usus yang terburai
tetapi A-B-C-D
Jaga jalan nafas
Beri O2Bantu nafas
Pasang infusi
Beri cairan
Atasi shock !!
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Mekanisme mati
A = Airway
B = Breathing
C = Circulation
D = Disability
Sumbatan 3-5¶
Henti nafas 3-5¶
Shock berat 1-2 jam
Coma 1 minggu
Gangguan mati dalam
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Doktrin Pertolongan Pasien Gawat :
TIME SAVING is LIFE SAVING
Waktu untuk bertindak: terbatas
Data dasar untuk bertindak: terbatas
Konsep berfikir sederhanaTindakan sistematik
Ketrampilan memadai
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trauma patients require different mindset
TIME SAVING is LIFE SAVING
Prognosis pasien trauma paling baik pada jam pertama
³the Golden Hour´
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Distribusi saat kematian korban trauma
05
10
15
20
25
30
35
40
45
50
0-1 jam 1- 4 jam 2-6 minggu
Kerusakan
SSP, jantung,
pemb darah besar
Perdarahan
banyak
Infeksi dan
gagal organ ganda
early
immediate
late
Int. Anesthesiol Clin 1987;25:1-18
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TRAUMA DI NEGARA BERK EMBANG
menghadapi kendala yang menyebabkan perbedaan konsep penanganan
Golden Hour ?
Silver Day ?
Bronze week ?
Jam emas ?
Hari Perak ?
Minggu Perunggu?
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Laringoskop
Tensimeter digital
Foto sinar-X
CT-scan
Penanganan trauma di negara maju
memakai banyak alat canggih
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Masker Oksigen
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Sistematika Pertolongan Trauma
TRI AGE
PRIM ARY SURVEY
SECONDARY SURVEY
ST ABILISATION
TR ANSFER
DEFINITIVE CARE
TRIASE
SURVEI PRIMER
SURVEI SEKUNDER
STABILISASI
RUJUKAN
TERAPI DEFINITIF
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Triage
RESUSIT ASI
& ST ABILISASI
Survei primer
Survei sekunder
Kamar Operasi
ICU
Hanya 50%
pasien trauma
perlu operasi
Terapi definitif
/ rujukan
Primary Trauma Care
RS lain
Derajat kegawatan
korban berbeda-beda
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Survei Primer
Periksa cepat berurutan
Selesai dalam 2 menit
Terapi segera apa yang ditemukan
( treat as you find )
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Mulai dengan Survei Primer
± Mencari dengan cepat gangguan fungsi vital di
sektor A-B-C-D
± Memberi terapi suportif dengan cepat pada
fungsi yang terganggu
Setelah fungsi vital stabilp Survei Sekunder
± Mencari gangguan fungsi vital dengan teliti ± Memberi terapi definitif pada fungsi yang
terganggu
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Survei Primer
A rw y
BreathingCirculation
Disability
Ex posure
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Sumbatan jalan nafas pasien tak sadar
paling sering disebabkan pangkal lidah
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Airwaymenilai jalan nafas
Kesadaran (bisa bicara?)
Look, Listen and Feel
Gerak dada
Gerak otot nafas tambahan
Warna kulit, mukosa, kuku
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Airwaymengatasi obstruksi / sumbatan jalan nafas
Lakukan chin lift / jaw thrust
Bersihkan rongga mulut (suction?)
Pasang jalan nafas oro / nasopharynx
Lindungi tulang leher
Intubasi trachea
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MenilaiMenilai jalanjalan nafasnafas LIHAT - LOOK
Gerak dada & perut
Tanda distres nafas
Warna mukosa, kulit
Kesadaran
DENGAR - LISTEN
Gerak udara nafasdengan telinga
RABA - FEEL
Gerak udara nafasdengan pipi
28( Look - Listen - Feel )
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Walaupun tanpa intubasi
masih banyak
pasien dapat ditolong
JN OropharynxJN NasopharynxJaw thrust
JN Nasopharynx
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Ada 3 cara
membebaskan jalan nafas
Pasien tidak sadar,
paling baik di-intubasi
1.
2.
33.
Tet p 90% p s ed p t d tolo
de 2 c r
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Survei Primer
Airway
Bre thCirculation
Disability
Ex posure
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Breathingmenilai pernafasan
Adakah udara keluar masuk
± Look, Listen, Feel
Frekwensi nafas
Gerak cuping hidung
Cekungan sela iga
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Breathingmembantu pernafasan
1. Oksigen (jika ada)
2. Pernafasan buatan1.
2.
2.
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- Pneumotoraks tension
- Fr costa / Flail chest
- Hemotoraks berat
- Kontusio paru
- Pneumotoraks terbuka
Jejas di dada:
Breathing
waspada
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Survei Primer
Airway
BreathingC rc l t o
Disability
Ex posure
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Circulationmengatasi perdarahan
Beri infus cairan, 1000 ml cepat
± RL (Ringer Laktat) ± NaCl 0.9% (Garam Fisiologis)
± R A (Ringer Asetat)
± Hypertonic Saline Dextran 250 ml
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Shock ?
Perfusi :
± pucat - dingin - basah
± cap. refill time lambat (kuku, telapak)
Nadi > 100
Tekanan darah < 100 (atau 90) mmHg Nadi masih teraba di :
± radialis > 80 mmHg ± femoralis > 70 mmHg
± carotis > 60 mmHg
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Circulationwaspada & cari lokasi perdarahan
Cedera intra-abdominal
Cedera dada Patah tulang panjang
Patah tulang pinggul
Luka tusuk / tembus
Luka kulit kepala
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Survei Primer
Airway
BreathingCirculation
Dis bility
Ex posure
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Disabilitymenilai kesadaran
Periksa Pupil (besar, simetri, refleks cahaya)
Periksa kesadaran
± A = Awake (sadar penuh)
± V = responds to Verbal command
(ada reaksi terhadap perintah)
± P = responds to Pain
(ada reaksi terhadap nyeri) ± U = Unresponsive (tak ada reaksi)
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A- V - P - U
Pupil
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Survei Primer
foto sinar-X ( jika ada)
Tulang leher (lateral)
Dada
Panggul
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Survei Sekunder
Lanjutan dari survei primer
Hanya bila ABC sudah stabil
Teliti kepala sampai jari kaki
Kembali ulang survei primer jika pasien
tidak stabil / kondisi memburuk
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Jangan terpukaukelainan yang
jelas terlihat
Ikuti Sistematika A - B - C - D
Korban ledakan tabung elpiji
Muka hangus
Pneumotoraks (blast injury)Luka bakar luas
Fraktura betis kiri
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Siap berubah mindset
Mari kita mulai
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Life SupportResusitasi
Stabilisasi
Terapi Definitif /
Spesialistik
Pasien trauma
(gawat darurat lain)
A = A-irway
B = B-reathingC = C-irculation
D = D-isability
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Kebiasaan dulu : hentikan perdarahan segera !
miringkan kepala, cari arteria yang bocor klem
Cara ini berbahaya, jangan dilakukan
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A-irway & C-Spine
± Jaga jalan nafas,
intubasi ?
± Imobilisasi leher :
bantal pasir
B-reathing
± Berikan oksigen,nafas buatan ?
C-irculation
± Posisi shock,
± Pasang infus, ± Bebat tekan kepala
Setelah itu semua, baru eksplorasi luka !
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