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