Trauma Epidemiology

Trauma is defined as injury that result

when energy is transferred from the
environment to human tissue(ENA,
2000)
Injuries are major cause of disability in
the United States, accounting for more
than 150.000 deaths annually
The number one killer of persons 1 to 34
years old

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Scene survey
Initial Assessment/primary survey
Rapid Trauma Survey or Focused
History and Physical Exam (Secondary
Survey)
Detailed Exam
Ongoing Exam

Take necessary body substance isolation

precautions
Evaluate scene hazard and assure scene
safety

Personal protection
Protection of the patient
Protection of bystander

Determine the mechanism of injury

Establish the number of patient
Ascertain the need for additional resources to
manage the scene and the patients

ALAT YANG DIPERLUKAN :

Long back board dan immobilisasi kepala

Cervical collar/immobilisasi leher
Oksigen dan alat bantu napas
Trauma box
Proteksi penolong

Form a general impression of the

patient
Assess the mental status
Assess the airway
Assess breathing
Assess the circulation
Establish patient priorities

Forming a general impression

Estimate the patient age

Note the patients sex
Determine if trauma or medical
patient
Obtain the patients chief complaint
Identify (and manage) immediate
life treats
Establish in-line stabilization
Position the patient for assessment

Life threats that require immediate

management as found

Airway
An airway that is compromise by blood,
vomitus, secretions, the tongue, teeth, or
other substances or objects.
Breathing

absence of breathing or inadequate breathing

open wound to the chest that may disrupt thoracic
pressure
injury to the chest that may do not allow for
adequate chest wall expansion

Circulation
Major bleeding

Assess The Mental Status

AVPU mnemonic for assessment of

mental status
A : Alert
V : responds to Verbal stimulus
P : responds to Painful stimulus
U : Unresponsive

AIRWAY
Buka jalan napas dengan head tilt/chin lift jika
tidak ada kecurigaan trauma spinal atau modified
jaw trus jika curiga adanya trauma spinal
Remove blood, vomitus, food, secretion, of foreign
objects
Pertahankan kepatenan jalan napas, tetap proteksi
cervical
Suction jika perlu
Pasang oropharingeal tube atau nasopharingeal jika
airway tidak bisa dipertahankan dengan posisi.
Nasopharingeal tube kontraindikasi pd fraktur
maxilofacial

BREATHING

Evaluasi pernapasanapakah pasien bernapas

spontan?apakah respirasi adekuat untuk kedalaman
dan ratenya?

Lihat :
Pergerakan dada
Paradoksal Movement
Retraksi intercosta
Ketidaksimetrisan dinding dada
Luka terbuka atau memar pada dada

Dengarkan :
- Suara udara pernafasan

Rasakan :
- Hangatnya hembusan udara pernafasan

Jika pernapasan tidak adekuat, berikan ventilasi

dengan bag valve mask dengan aliran tingggi
monitor distensi abdomen

Jika pernapasan sulit karena adanya injuri dada,-refer ke protokol management trauma dada
Jika pernapasan adekuat, berikan O2 aliran tinggi,
menggunakan nonrebreathing mask

CIRCULATION

Cek pulse, jika tidak ada lakukan CPR

Cek rate dan kualitas pulse
Inspeksi perdarahan
Observasi warna kulit, temperatur, untuk anak cek
cappilary refill
Kontrol hemoragi

TENTUKAN PRIORITAS PASIEN

Is this a critical situation?

Are there interventions that I must make
now?
Transfer ke fasilitas yang
memadai/trauma centre
Pemeriksaan dan penatalaksanaan
selanjutnya dilakukan dalam ambulance

Apakah Load and Go Pasien ini?

Tn Y 25 tahun, mengalami
penurunan kesadaran setelah jatuh
dari sepeda motor. Klien mengalami
cephal hematoma dg diameter 15
cm.

Apakah Load and Go Pasien ini?

Tn S 46 tahun, mengalami
kecelakaan kendaraan bermotor.
Setelah diperiksa ditemukan jejas
pada dada kanan, RR 34x/menit,
terdapat krepitasi pada dada kanan.

Apakah Load and Go Pasien ini?

Ny P 56 tahun, mengatakan kedua

kakinya sakit setelah terserempet
motor. Terdapat fraktur femur
bilateral, TD 100/60 mmHg, N
112x/menit

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Trauma kepala dengan penurunan kesadaran

Sumbatan jalan napas yang tidak dapat diatasi secara
mekanik
Keadaan yang membuat pernapasan tidak adekuat
a. Luka terbuka dinding dada
b. Flail chest
c. Tension Pneumothoraks
d. Trauma tumpul dada yang luas
1. Trauma dengan henti jantung dan
pernapasan
2. Syok

Initial Assessment

Dilakukan setelah scene aman

Pemeriksaan dilakukan secara cepat (<2
menit) dan lembut
Tidak ada yang dapat menghambat initial
assessment kecuali:

Sumbatan jalan nafas

Cardiac arrest

Karena kesulitan ekstrikasi total waktu

tidak boleh lebih 10 menit (Px kritis <5
menit)

Conduct a physical exam

Take baseline vital sign
Obtain a SAMPLE history
Disability
Make a transport decision

Deformities, Contusio, Abrations,

Penetrations, Paradoxal movement, Burn,
Tenderness, Laserations, Swelling (DCAPPBTLS)
Tenderness,Instability, Crepitation (TIC)

Pulse, Movement,Sensation (PMS)

Assess Vital Sign

Breathing
Pulse
Skins
Pupils
Blood pressure

SAMPLE history

S
A
M
P
L
E

:
:
:
:
:
:

Signs and Symptoms

Allergies
Medications
Past medical history
Last oral intake
Events leading to the injury

Disability

Level of Consciousness
Pupils
Motor (can the patient move the
finger and toes)
Sensation

Level of Consciousness

Perform detailed physical exam

Reassess the vital signs
Continue emergency care

Subjective changes
Mental status
Reassess ABCs
Assessment of identified injury
Check intervention
Ongoing assessment done at least
every 5 minute in the unstable
patient with critical injuries and
every 15 minute in stable patient

Check Intervention

Is the oxygen rate correct?

Is the oxygen tubing connected?
Is the open chest wound still sealed?
Are any of the dressing blood soaked?
Are the splinting in a good position?
Is the impaled object still well stabilized?
Is the pregnant patient tilted to the left?
Is the cardiac monitor attached and
working?
Is the pulse oximeter attached and working?

Summary

Patient assessment is the key to

trauma care.
Intervention required are not
dificult;their timing often is critical.
If you know what question to ask
and how to perform the exam, you
will know when to perform the
lifesaving intervention.