Advanced Trauma Life Support

Advanced Trauma Life Support

Manajemen Trauma

•Scene survey•Primary survey•Transport and critical interventions•Secondary survey•Reassessment survey•Definitive treatment

Persiapan

Scene Survey

Mekanisme Kejadian

Jumlah Korban

Lokasi aman?

Perlindungan Diri

•Essential equipment: universal precaution, trauma box, airway equipment, long back board

Primary Survey▫Dewasa, anak, wanita hamil memiliki prioritas

yang sama▫Mengidentifikasi kondisi yang mengancam

nyawa▫Maksimal dikerjakan dalam 2 menit▫Pemeriksaan dilakukan dari “neck to femur”

A

Menjaga patensi

jalan napas

B

Bernapas spontan dengan ventilasi adekuat

C

Sirkulasi dengan kontrol

perdarahan

D

Disability/ status

neurologis

E

Exposure/ kontrol

terhadap lingkungan

A (AIRWAY)

• Penyebab paling sering gangguan jalan napas: lidah, benda asing, pembengkakan lokal, trauma langsung pada jalan napas

• Tanda gangguan jalan napas: sesak, gangguan bicara, sianosis, napas iregular, stridor, gurgling, batuk

• Airway Maneuvers:▫ Head tilt chin lift (tak dilakukan pada cedera cervical)▫ Jaw thrust▫ Left lateral position▫ Heimlich▫ Artificial airways : oropharyngeal, nasopharyngeal

B (Breathing)

• Identifikasi : melihat, mendengar, merasakan

• Tanda pernapasan tidak adekuat: ▫ Napas abnormal (dari faktor frekuensi, kedalaman, kualitas)▫ Otot pernapasan tambahan▫ Pernapasan cuping hidung▫ Sianosis

• Bantuan napas spontan: Nasal cannula, face masks, rebreather and non-rebreather masks

• Alat bantu pada pasien tidak bernapas:Mouth to mask ventilation, Bag-Valve-Mask

C (Circulation)

• Menilai fungsi sirkulasi: nadi sentral-perifer, warna, kelembaban kulit

• Menilai perdarahan yang mengancam nyawa: Cepat, berasal dari arteri, jumlah masif

• Kontrol perdarahan: bebat tekan, splint and elevate, tourniquet

• Menilai internal hemorrhage +/-

D (Disability)

• Menilai tingkat kesadaran:AVPUP:A AlertV Respon terhadap rangsang verbalP Respon terhadap rangsang nyeriU UnresponsiveP Ukuran dan reaktifitas pupil

E (Exposure)

• Melepas baju pasien jika diperlukan

• Pertahankan suhu tubuh

• Log roll untuk identifikasi bagian belakang tubuh

RAPID ASSESSMENT “Neck to Knee”

• Inspeksi: DCAP – BLS, JVD• Palpasi: TIC, nyeri, deviasi trakea, tulang

leherLeher

• Inspeksi : DCAPP – BLS• Palpasi : TIC• Auskultasi suara napas• Perkusi

Dada

• Inspeksi : DCAP – BLS• Palpasi: TendernessAbdomen

• Inspeksi/palpasi: DCAP – BLS• Palpasi: TICPelvis

• Inspeksi/palpasi DCAP – BLS• Palpasi: TIC, PMS

Musculoskeletal (Femur)

Kriteria “Load and Go”

• Obstruksi jalan nafas yg tdk dpt diatasi scr mekanik(suction, forceps atau intubasi)

• Henti jantung karena trauma• Keadaan yg menimbulkan pernafasan tdk

adekuat (open pneumothotax, flail chest, tension pneumothorax, trauma dada luas)

• Shock• Trauma kepala tdk sadar, pupil

anisokor/penurunan kesadaran• Nyeri abdomen• Pelvis tdk stabil• Fraktur femur bilateral

SECONDARY SURVEY

• Anamnesis▫ S. Sign and simptoms ▫ A. Allergies▫ M. Medications currently used▫ P. Past illness / pregnancy▫ L. Last meal▫ E. Events / Environment related to injury

• Dilakukan pemeriksaan dari “head to toe”

• Pemeriksaan dikerjakan dalam 10 menit

HISTORYMechanisms of injury

• Blunt▫Automobile collisions

Seat belt usage Steering wheel deformation Direction of impact Ejection of passenger from the vehicle

• Burns and Cold injury▫ Inhalation injury and CO. intoxication in fire field

• Hazardous environment• Penetrate

▫Anatomy factors▫Energy transfer factor

Velocity and caliber of bullet Trajectory Distance

SECONDARY SURVEY

• Physical ExaminationHead and Maxillofacial Inspect and palpate head and face (DCAP – BLS, TIC)▫ Battle’s sign▫ Pupils and LOC▫ Raccoon eyes▫ Ears and nose for CSF▫ Mouth ▫ Skin : pale, cyanosis, diaphoresis

SECONDARY SURVEY

• Physical ExaminationC-spine and Neck

Inspect for signs of injury (DCAP – BLS), tracheal deviation- Palpate for tenderness, subcutaneous emphysema- Auscultate for carotid bruits

SECONDARY SURVEY

• Physical ExaminationChest

Inspect ant, lat and post chest for injury, use of accessory (DCAPP – BLS)- Palpate for TIC- Auscultate for breath sounds - Percussion

SECONDARY SURVEY

• Physical ExaminationAbdomen- Inspect for signs of injury or bleeding DCAP –

BLS- Palpate for tenderness- Auscultate for bowel sounds- Percuss

SECONDARY SURVEY

• Physical ExaminationMusculoskeletal

Inspect & Palpate extremities for signs of injury (DCAP – BLS, TIC, PMS)

Assess pelvis (DCAP – BLS, TIC)

SECONDARY SURVEY

• Physical ExaminationNeurologic

Determine GCS score Re-evaluate pupils Sensory / motor evaluation Maintain immobilization Prevent secondary CNS injury Early neurosurgical consultation

Tujuan:• Observasi perubahan kondisi yang terjadi pada pasien

• Dilakukan tiap 5 menit selama transportasi pasien atau setiap terjadi perubahan kondisi yang memburuk

Reassessment Survey

Reassessment Survey

• Tingkat kesadaran• Nilai ulang A B C • Leher, dada, abdomen, ekstremitas• Pemeriksaan lebih detail terhadap area luka • Pemeriksaan tindakan yang telah dilakukan, misal :

posisi pipa ETT, infus, aliran O2, balut-bidai, posisi cervical collar

TERIMA KASIH