2. airway and breathing management 11
TRANSCRIPT
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AIRWAY Prioritas Pertama dalam penanganan gawat
darurat.
Sumbatan total jalan napas pembunuh tercepat
Selalu imobilisasi servical Servical control : Multiple trauma
Trauma Kapitis dengan penurunan kesadaran
Luka diatas klavikula
Biomekanik mendukung
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MASALAH
SUMBATAN
(OBSTRUKSI)
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SUMBATAN JALAN NAPAS
TOTAL Chocking tersedak benda asing PARSIAL a. Cairan Gurgling b. Pangkal lidah Snoring c. Anatomis Crowing
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TANDA OBJEKTIF SUMBATAN JALAN NAPAS
Lihat (look) Penurunan kesadaran, cyanosis, retraksi,
berontak, gelisah Dengar (listen) Suara-suara abnormal : Snoring, gurgling,
crowing Rasakan (Feel) Rasakan adanya hembusan napas, raba posisi
trakhea
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Setiap pernapasan berbunyi,
tanda sumbatan parsial jalan napas
(Gurgling, Snoring, Crowing)
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Setiap penderita yang bisa berbicara tanpa suara
tambahan maka
airway baik
(Tidak ada sumbatan)
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BASIC
AIRWAY MANAGEMENT
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CHOCKING MANAGEMENT TERSEDAK !!!
>> Sumbatan Total Jalan Napas
Mendadak tidak bisa berbicara, batuk dan bernapas.
Berontak sambil memegangi leher
Sianosis
Mendadak tidak sadar
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CHOCKING MANAGEMENT
PENDERITA SADAR
Dewasa dan Anak
Heimlich Maneuver > < Back Blow
Wanita hamil dan Orang gemuk
Chest Thrust > < Back Blow
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CHOCKING MANAGEMENT
Heimlich
Maneuver Back Blow Chest Thrust
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CHOCKING MANAGEMENT
PENDERITA TIDAK SADAR
Dewasa dan Anak
Abdominal Thrust > < Finger
Sweep
Wanita hamil dan Orang gemuk
Chest Thrust > < Finger Sweep
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CHOCKING MANAGEMENT
Abdominal
Thrust
Chest
Thrust
Finger
Sweep
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CHOCKING MANAGEMENT
PENANGANAN PADA BAYI
Dewasa dan Anak
Abdominal Thrust > < Finger
Sweep
Wanita hamil dan Orang gemuk
Chest Thrust > < Finger Sweep
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CHOCKING MANAGEMENT
CHEST THRUST BACK BLOW
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SUMBATAN PARSIAL
CAIRAN Darah, secret, air liur, muntah
Suctioning Bila banyak miringkan kepala (trauma Log Roll) Tidak Berhasil Airway Definitif
++ Dewasa Max. 15 Detik ++ Anak Max. 5 Detik ++ Bayi Max. 3 Detik
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SUMBATAN PANGKAL LIDAH Lidah jatuh
menyumbat di hipofaring
Pasien tidak sadar
Tindakan mengangkat pangkal lidah
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Manual
Non Trauma Head Tilt Chin Lift
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Manual
Trauma CHIN LIFT
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Manual
Trauma JAW THRUST
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SUMBATAN PANGKAL LIDAH
ARTIFICIAL AIRWAY
Oropharyngeal Airway (OPA)
Nasopharyngeal Airway (NPA)
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OroPharyngeal Airway Menahan lidah pada
bagian belakang faring
Untuk mempermudah proses suctioning faring
Untuk menghindari tergigitnya ETT
Digunakan pada pasien tidak sadar tanpa Gag Reflex
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Oropharyngeal airway Complications :
Complete airway obstruction
Laringospasme
Vomiting
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Oropharyngeal airway insertion
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Nasopharyngeal airway
Digunakan pada pasien yang bernapas spontan, dan memiliki rangsangan batuk/muntah (gag reflex)
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Nasopharyngeal Airway Complications
Nasal mucosa injury
Laryngospasm
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Nasopharyngeal Airway Techniques
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ADVANCE AIRWAY
MANAGEMENT (AIRWAY DEFINITIF)
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ADVANCE AIRWAY
ENDOTRACHEAL INTUBATION
NEEDLE CRICOTHYROIDOTOMY
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INDIKASI AIRWAY DEFINITIF Adanya apnea
Ketidakmampuan mempertahankan airway dengan cara lain
Adanya resiko aspirasi darah / muntah
Ancaman segera / potensial sumbatan airway Cedera inhalasi, fraktur maksilofasial, hematoma retrofaringeal
Cedera kepala yang memerlukan bantuan napas (GCS < 8)
Ketidakmampuan mempertahankan oksigenasi dengan BVM
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ENDOTRACHEAL INTUBATION
NASOTRACHEAL INTUBATION
(Blind Intubation)
OROTRACHEAL INTUBATION
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Airway definitif
dengarkan
nafas
Blind Naso-tracheal :
- Sambil mendengar pernafasan
- Dorong saat inspirasi
- Bila suara hilang masuk Oesofagus
- Hati-hati bila fraktur basis kranii
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OROTRACHEAL INTUBATION Ventilasi dan oksiganisasi harus diberikan
sebelum memasukan laringoskop dan ETT.
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TEHNIK
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TEHNIK
Sellick
Manouver
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Intubasi Orotracheal
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NEEDLE CRICOTHYROIDOTOMY
APABILA INTUBASI TIDAK BISA DILAKUKAN (Mis. Fraktur Maksilofasial berat)
Jet Insuflation / Jet Ventilation (30 – 45 Menit)
Menggunakan IV Cath. Paling besar Nomor 14
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Kriko-
tiroidotomi
Kartilago tiroid
Membrana
Kartilago krikoid
Trakea
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Airway definitif
Krikotirotomi - jarum :
- Ditusukkan lewat membrana
kriko-tiroidea
- Sambung dengan oksigen,
1 detik tutup, 4 detik buka
- Waktu ekstra 30-45 menit
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Needle Krikotiroidotomi
Paling
kecil 14 G
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Nedle Cricothyroidotomy
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BREATHING MANAGEMENT
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BREATHING
Oksigen
Selalu berikan bila keadaan umum (ku) pasien kurang baik
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RAPID ASSESMENT Look (lihat)
Pergerakan Dada
Listen (Dengar)
Suara Napas
Feel (Rasakan)
Hembusan Napas
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PEMERIKSAAN FISIK Inspeksi Rate, Ritme, Bentuk Pernapasan Simetris Dispnoe Auskultasi Bising Napas Vesikuler, Ronchi Perkusi Sonor Hipersonor
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OXYMETRI SATURASI
OKSIGEN
INTERPRETASI INTERVENSI
95% - 100% Normal O2 4 liter / menit – nasal canule
90% - <95% Hypoxia ringan - sedang
Face Mask 6 – 10 Liter / menit
85% - <90% Hypoxia sedang - berat Face Mask dengan resevoir 8 – 12 liter assisted ventilation
<85 % Hipoxia berat – mengancam nyawa
Assisted ventilation
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OKSIGENASI
ALAT FLOW RATE DELIVERY O2
Nasal Canule 1 Liter / Menit 21 % - 24 %
2 Liter / Menit 25 % - 28 %
3 Liter / Menit 29 % - 32 %
4 Liter / Menit 33 % - 36 %
5 Liter / Menit 37 % - 40 %
6 Liter / Menit 41 % - 44 %
Rebreathing Mask 6 – 10 Liter / Menit 35 % - 60 %
NonRebreathing Mask 6 Liter / Menit 60 %
7 Liter / Menit 70 %
8 Liter / Menit 80 %
9 Liter / Menit 90 %
10 - 15 Liter / Menit 95 % - 100 %
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Nasal Kanul Non Rebreating Mask
Rebreathing Mask
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VENTILASI
Ventilasi Buatan (Control Ventilation)
Ventilasi Bantuan (Assisted Ventilation)
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VENTILASI Mouth to mouth ventilation
Mouth to Mask ventilation
Bag Valve Mask
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MOUTH TO MOUTH MOUTH TO MASK BVM
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TERIMA KASIH