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Assessment
(Penilaian dan
Penanganan Survei
DepartemenPrimer)
Anestesiologi dan Terapi
Intensif
FK USU
2011
Emergency Medicine
TRIAGE
PRIMARY SURVEY
SECONDARY SURVEY
STABILISATION
TRANSFER
DEFINITIVE CARE
TRIASE
SURVEI PRIMER
SURVEI SEKUNDER
STABILISASI
RUJUKAN
TERAPI DEFINITIF
Concepts of Primary
Survey
Rapid Primary survey
Resuscitation
Adjuncts to primary survey
/resuscitation
Detailed secondary survey
Adjuncts to secondary survey
Reevaluation
Definitive care
Jangan terpukau
kelainan yang
jelas terlihat
Ikuti Sistematika A - B - C D
Derajat kegawatan
korban berbeda-beda
Triage Survei primer
Survei sekunder
Terapi definitif
/ rujukan
RS lain
RESUSITASI
& STABILISASI
Emergency Medicine
Kamar
Operasi
ICU
Hanya 50%
pasien trauma
perlu operasi
Triage
Sorting of patients
according to :
ABCDEs
Available resources
Multiple casualties
Mass casualties
ACS
Primary Survey
Primary survey
and resuscitation
of vital functions
are done
simultaneously
a team approach
Preparation
Prehospital System
Preparation
Inhospital
Preplanning essential
Equipment, personnel, services
Standard precautions
Transfer agreement
Standard Precautions
Cap
Gown
Gloves
Mask
Shoe covers
Goggles/face
Shields
Survei Primer
Survei Primer
Airway
Breathing
Circulation
Disability
Exposure
Jalan nafas
Pernafasan
Sirkulasi
Kesadaran
Pemapara
n
Resuscitation
Protect and secure airway
Ventilate and oxygenate
Stop the bleeding
Vigorous shock therapy
Protect from hypothermia
Survei Primer
Airway
Breathing
Circulation
Disability
Exposure
Airway
menilai jalan nafas
Airway
mengatasi obstruksi / sumbatan
jalan nafas
20
JN Nasopharynx
Jaw thrust
JN Oropharynx
JN Nasopharynx
21
Head tilt
Neck lift
Chin-lift
22
Airway
waspada
24
Primary Survey
Establish Patent Airway
C-spine injury
Pitfalls
Cautio
n
Equipment failure
Inability to intubate
Occult airway injury
Progressive loss of
airway
Primary Survey
Suspect C-Spine Injury
Spinal protection
C-spine X-ray when
appropriate
Survei Primer
Airway
Breathin
g
Circulation
Disability
Exposure
Breathing
menilai pernafasan
Frekwensi nafas
Gerak cuping hidung
Cekungan sela iga
Breathing
membantu
pernafasan
2.
1.
2.
29
Jejas di dada:
Breathing
waspada
- Pneumotoraks
tension
- Fr costa / Flail
chest
- Hemotoraks berat
- Kontusio paru
- Pneumotoraks
30
Survei Primer
Airway
Breathing
Circulati
on
Disability
Exposure
Circulation
mengatasi perdarahan
Hentikan perdarahan
Posisi shock
Pasang infus besar x 2
Ambil sampel darah
Circulation
mengatasi perdarahan
RL (Ringer Laktat)
NaCl 0.9% (Garam Fisiologis)
RA (Ringer Asetat)
Hypertonic Saline Dextran 250 ml
Shock ?
Perfusi :
pucat - dingin - basah
cap. refill time lambat (kuku, telapak)
Circulation
waspada & cari lokasi perdarahan
Cedera intra-abdominal
Cedera dada
Patah tulang panjang
Patah tulang pinggul
Luka tusuk / tembus
Luka kulit kepala
Primary Survey
Circulatory Management
Control hemorrhage
Restore volume
Reassess
Pitfalls
Elderly
Caution
Medication
Athletes
Children
Survei Primer
Airway
Breathing
Circulatio
n
Disability
Exposure
Disability
menilai kesadaran
P = responds to Pain
(ada reaksi
terhadap nyeri)
U = Unresponsive
A- V - P - U
Pupil
Primary Survey
Disability
Survei Primer
Airway
Breathing
Circulation
Disability
Exposure
Exposure
pemaparan
Primary Survey
Exposure / Environment
Completely undress the patient
Caution
hypothermia
Prevent
Survei Primer
Foto Dada sinar-X / Chest X-Ray ( jika ada)
Tulang leher / C Spine(lateral)
Panggul ( Pelvis )
Abdominal USG
Adjuncts to Primary
Survey
Vital sign
ECG
Urinary
ABGs
Adjuncts
Output
Pulse
oximeter
and CO
Urinary/gastric catheters
unless contraindicated
Adjuncts to Primary
Survey
Diagnostic Tools
Chest and pelvic
x-ray
DPL
Ultrasound
ACS
Adjuncts to Primary
Survey
Consider Early Transfer
Do not delay transfer for
diagnostic tests
Use time before transfer for
resuscitation
Special Considerations
Trauma in the Elderly
5th leading cause of death
Physiologic reserve
Comorbidities :
Diseases/medications
Survei Sekunder
Reevaluate
Proceed to Secondary Survey
After :
END
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