Triase dan Pananganan Gawat Darurat Darurat Hendro Wartatmo PMPK – FK UGM
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Triase dan Pananganan GawatDaruratDarurat
Hendro Wartatmo
PMPK – FK UGM
Triase ( Triage ) … to sort
• “ Doing the greatest good for the greatest number of people using the available resources “using the available resources
• Chaotic situation ‐‐‐‐‐‐ a system that is simple and clear is most likely to succeed
• Triage should be a tool by which a seemingly unmanageable, overwhelming situation can be organized.
h ld b d d l• Triage should be a dynamic process carried out at several levels throughout the system.
• One of the goals of triage should be to diagnose criticalOne of the goals of triage should be to diagnose critical injuries requiring life saving treatment in the shortest possible time.
• To this end patients are categorized into groups to determine• To this end patients are categorized into groups to determine their priority for treatment and transport to definitive care facilities.
• "priority one," "emergency," or the color red indicates the need for immediate care;
• "priority two " "urgent " or the color yellow indicates that care• "priority two," "urgent," or the color yellow indicates that care may be delayed for a limited period of time without significant mortality;
• "priority three," "nonurgent," or the color green indicates that care may be delayed until the patients in the other categories have been dealt withhave been dealt with.
• A fourth group, described with the term "expectant" or the color black, has been advocated by some to denote patients who are dead or expected to die.
Trunkey’s curveTrunkey s curve
Trauma deaths
I di t
0 1 2 3 4 5 6 1 2 3 4
Immediatedeaths
Early deaths Late deaths
hours weeks
Single Triage ( SIT )Single Triage ( SIT )
• Untuk pasien yang datang satu persatuUntuk pasien yang datang satu persatu
• Sesuai situasi di UGD sehari‐hari
* Triage: Techniques and Applications in Decision Making .Katharyn Kennedy, MD Richard V Aghababian, MD Lucille Gans, MD C PhuliLewis, MDAnnals of Emergency Medicine. August 1996 • Volume 28 • Number 2
Luka Tdk ada20 Luka Lecet
CKR
Tdk adaTindakansegera
20
50
KORBANCKR
TriageOfficer
Paliatif15
-# femurtertutup
- # terbuka-Rupturhepar
TindakanLife saving
hepar-TensionPnthorax
-Multiple trauma dg
5
syok
Mening-gal
KmMayat 10
Luka Tdk ada20 Luka
Lecet
CKR
Tindakansegera
Paliatif
20
50
KORBANCKR
TriageOfficer
Paliatif15
TindakanIntensif
-Multiple t d1
-# femurtertutup
Tindakan
Intensiftrauma dg syok
4
1
tertutup- # terbuka-Rupturhepar
-Tension
Life saving4
Pnthorax
Mening-gal
KmMayat 10
Luka RawatLuka Lecet
CKR
RawatJalan
ObKORBAN CKR
TriageOfficer
Observasi
Ti d k-# femurtertutup
- # terbuka-Rupturhepar
Tindakan
Operasi
Operasi1000 0rang !! hepar-TensionPnthorax
CKB
Operasi
Operasi
1000 0rang !!
CKB
Mening
- CKBGCS = 3
- CKBGCS = 3 R.Khusus
Mening-gal
KmMayat
LukaLuka Lecet
CKR
Tertunda
PKORBAN CKR
TriageOfficer
Penampunganseadanya
A t i-# femurtertutup
- # terbuka-Rupturhepar
1000 0rang
Antri
Antri
Antrihepar-TensionPnthorax
M lti l
Antri
Antri
Mening
- Multiple trauma dg syok
TerlantarCHAOS !!Mening-gal
Penuh,Iden tifikasi ?
Luka DipulangkanLuka Lecet
CKR
Dipulangkan/ Pindahkan
R tKORBAN CKR
TriageOfficer
Ruang rwtYang layak
Ti d k-# femurtertutup
- # terbuka-Rupturhepar
Tindakan
Operasi-2
Operasi-31000 0rang hepar-TensionPnthorax
Operasi-3
Operasi-1
1000 0rang
- CKBGCS = 3
Ruang khusus
Mening-gal
KmMayat
Single Triage :
• Untuk pasien tunggal• Kategori pasien
– Immediate • ( AMI, Perdarahan dalam )
U t– Urgent • ( Stroke, Apendisitis )
– Non Urgent • ( Luka, Dislokasi, Fraktur )( , , )
Simple Triase And Rapid Transport ( START )( START )
• Proposes five categories.
• Using a color‐coded system, it includes a blue category for patients who are unlikely to survive or whose survival wouldpatients who are unlikely to survive or whose survival would depend on receiving extensive or complicated treatment rapidly. Patients in this category would receive treatment after priority one but before priority two cases, provided their numbers were not so large as to detract from the treatment of the urgent patients.g p
Re Triage !!Re Triage !!
Secondary Assessement for Victims EndpointSecondary Assessement for Victims Endpoint ( SAVE )
• Dilakukan bila jumlah korban luar biasa dan jauh melampaui• Dilakukan bila jumlah korban luar biasa dan jauh melampauikapasitas penolong.
• Kategori korban :– Yang akan selamat apapun tindakan yang dilakukan
– Yang akan tidak selamat apapun tindakan yang dilakukan
Yang tidak termasuk kedua golongan diatas keselamatannya sangat– Yang tidak termasuk kedua golongan diatas , keselamatannya sangattergantung intervensi yg dilakukan tim penolong
Medical Emergency ResponseMedical Emergency Response
Damagearea
TransportationTransfer
Hospitalisationarea area‐ Transferarea
Red Cross
Public
Hospital
Health Post
DamagedArea
Puskesmas
Field Hospital
Regional ResponseRegional Responseof Health Sector
Terima Kasih
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