acute care surgery - total care des 2012( prof aryo)[1]a2013

8/18/2019 Acute Care Surgery - Total Care Des 2012( Prof Aryo)[1]a2013

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atient Safety

atient Safety

&

TOTAL CARE

OTAL CARE

Aryono D. usponegoro

ryono D. usponegoro

Kolegium Ilmu Bea! Inonesiaolegium Ilmu Bea! Inonesia



MENGAPA PERLU “PATIENTMENGAPA PERLU “PATIENTSAFETY “SAFETY “

??



Di Ruma! Sa"it #

$%anya"nya enis o%at'enis

pemeri"saan an proseur' serta

umla! pasien an staf Ruma! Sa"it

yang (u"up %esar' merupa"an !al yang

potensial %agi terainya

"esala!an.



KEADIA* TIDAK DI)ARAPKA* ,KTD-/KEADIA* TIDAK DI)ARAPKA* ,KTD-/

A0erse E0entA0erse E0ent

S#at# !ejadian yangS#at# !ejadian yangmenga"i%at"an

enga"i%at"an

(eeraeera yang tida! dihara$!an $adayang tida! dihara$!an $ada$asien !arena s#at# tinda!an$asien !arena s#at# tinda!an

''(ommission

ommission) ata# !arena tida!) ata# !arena tida!

"ertinda! '"ertinda! 'ommisionmmision

)* dan "#!an)* dan "#!an!arena “!arena “#nderlying disease#nderlying disease+ ata#+ ata#

!%ndisi $asien 'KKP(RS)&!%ndisi $asien 'KKP(RS)&



NYARIS CEDERA (NC)/ Near MissNYARIS CEDERA (NC)/ Near Miss S#at# !ejadian a!i"at ela!sana!an s#at#S#at# !ejadian a!i"at ela!sana!an s#at#

tinda!an ',%issi%n) ata# tida! enga"iltinda!an ',%issi%n) ata# tida! enga"iltinda!an yang sehar#snya dia"il '%issi%n)*tinda!an yang sehar#snya dia"il '%issi%n)*

yangyang da$at en,ederaida$at en,ederai $asien* teta$i ,edera$asien* teta$i ,edera

seri#s tida! terjadi* !arena -seri#s tida! terjadi* !arena -

““

!e"er#nt#ngan!e"er#nt#ngan

++

'is&*$asien teria s#at# %"at'is&*$asien teria s#at# %"at

!%ntra indi!asi teta$i tida! ti"#l rea!si %"at)*!%ntra indi!asi teta$i tida! ti"#l rea!si %"at)*

!arena!arena

““$en,egahan$en,egahan++ 's#at# %"at dengan %.erd%sis lethal's#at# %"at dengan %.erd%sis lethal

a!an di"eri!an* teta$i sta/ lain engetah#i dana!an di"eri!an* teta$i sta/ lain engetah#i dan

e"atal!annya se"el# %"at di"eri!an)* ata#e"atal!annya se"el# %"at di"eri!an)* ata#

““$eringanan$eringanan++ 's#at# %"at dengan %.er d%sis lethal's#at# %"at dengan %.er d%sis lethal

di"eri!an* di!etah#i se,ara dini lal# di"eri!andi"eri!an* di!etah#i se,ara dini lal# di"eri!an

antid%tenya)&'KKP(RS)antid%tenya)&'KKP(RS)



roses of Care

Error

Pasien

tidak cidera

Pasien

cidera

Near Miss

Aderse Eent

-!esalahan proses

"#pt dice$ah"%elaks %lan action

tdk komplit

"%akai %lan action y$

salah

"!rn berbuat : commission

"!rn tidak berbuat : omission

&NM'

&AE'

%roses of (are&Non Error' Aderse Eent

Pasien

cidera

&!)#*!e+adian )dk #iharapkan'

- #pt obat c.i.-, tdk timbul &chance'

" %lan, diket, dibatalkan &preention'" #pt obat c.i.-, diket, beri anti"nya

&miti$ation'

&!N(*!e+adian NA/I0 (I#E/A'



Dimana Kemung"inan Kesala!an BisaDimana Kemung"inan Kesala!an Bisa

Terai1Terai1

• 0iagn%sti! 0iagn%sti! Kesalahan ata# !eterla"atan diagn%seKesalahan ata# !eterla"atan diagn%se

Tida! enera$!an $eeri!saan yangTida! enera$!an $eeri!saan yangses#aises#ai

Mengg#na!an ,ara $eeri!saan yangMengg#na!an ,ara $eeri!saan yangs#dah tida! di$a!ais#dah tida! di$a!ai

Tida! "ertinda! atas hasil $eeri!saanTida! "ertinda! atas hasil $eeri!saanata# %"ser.asiata# %"ser.asi

• Peng%"atanPeng%"atan Kesalahan $ada $r%sed#r $eng%"atanKesalahan $ada $r%sed#r $eng%"atan Kesalahan $ada $ela!sanaan tera$iKesalahan $ada $ela!sanaan tera$i

Kesalahan et%de $engg#naan %"atKesalahan et%de $engg#naan %"at

Keterla"atan eres$%n hasilKeterla"atan eres$%n hasil$eeri!saan$eeri!saan



• Pre0enti0ePre0enti0e

Tia" mem%eri"an terapi profila"ti"Tia" mem%eri"an terapi profila"ti"

+onitor an follo2 up yang tia"+onitor an follo2 up yang tia"

ae"uatae"uat

Lain3lain # Lain3lain #

Kegagalan %er"omuni"asiKegagalan %er"omuni"asi

Kegagalan alatKegagalan alat Kegagalan sistem lainKegagalan sistem lain



4TO ERR IS )5+A*6 CORRI7A*' KO)* A*D DO*ALDSO*

5S ACADE+8 O9 SCIE*CES / I*STIT5TE O9 +EDICI*E'

:;;;

• <=>? *e2 8or"' :.=@ of amissions suffere an a0erse

e0ent' >@ of 2!i(! 2ere pre0enta%le

<==: Colorao an 5ta!' .@ of amissions suffere an

a0erse e0ent' @ of 2!i(! 2ere a0oia%le

O0er .+n 5S !ospital amissions pa' %et2een ??';;;

an =>';;; a0oia%le eat!s o((ur

>t! most freFuent (ause of eat!

a!ea of AIDS ,<'< eat!s pa-'

%reast (an(er ,?:':= eat!s pa- an

motor (ar a((ients ,?'?> eat!s pa-

Total (ost to t!e 5S e(onomy of a0oia%le eat!s ue to

!ealt!(are error G< 3 G:= Bn pa

)RRI' )ealt!(are Ris" Resour(es InternationalRRI' )ealt!(are Ris" Resour(es International



H)O

)O

3 Paa Horl )ealt! Assem%ly "e +ei :;;:

itetap"an suatu resolusi yang menorong ,urge-

negara untu" mem%eri"an per!atian "epaa

pro%lem Patient Safety mening"at"an

"eselamatan an sistem monitoring

O"t :;;? H)O an %er%agai lem%aga

meniri"an

4Horl Allian(e for Patient Safety6 gn tuuanmengang"at Patient Safety 7oal

49irst o no !arm6 an menurun"an mor%iitas'

(iera an "ematian yang ierita pasien



atient Safety i %er%agai negara

<. Ameri"a # A)R ,Agen(y for )ealt!(are

Resear(! an uality-' :;;<

:. Australia # Australian Coun(il for Safety an

uality in )ealt! Care' :;;;

. Inggeris # * SA

,*ational atient Safety Agen(y-' :;;<

?. Canaa # *SC S ,*ational Steering

Committee on atient Safety-J

C SI ,Canaian atient Safety Institute-' :;;

. +alaysia # atient Safety Coun(il' :;;?

. Denmar" # 55 atient Safety' :;;

. Inonesia # KK 3RS' :;;



DI I*DO*ESIA 1DI I*DO*ESIA 1

3T!e 4T!e 4(o("roa(! t!eory(o("roa(! t!eory6 # 9or e0ery one you6 # 9or e0ery one you

see' !unres more are !iing in t!esee' !unres more are !iing in t!e2oo2or" 2oo2or"

344Our !ospital are 0ery safe an a (ouple ofOur !ospital are 0ery safe an a (ouple of

a((ientsM are a((epta%lea((ientsM are a((epta%le66

3 +asi! i aera! +asi! i aera! BlamingBlamingM yang sangatM yang sangat

(ostlyM an menau!"an pasien ari ruma!(ostlyM an menau!"an pasien ari ruma!sa"itsa"it

3 4Litigious So(iety63 4Litigious So(iety6 44efensi0e mei(ineefensi0e mei(ine66



Men$apa %atient 0afety

%rocess of care%rocess of care 1utcome1utcome0tructure0tructure : AE

Blamin$-

-)uduhan Malpraktek-&%id2%erd'"%roses Hukum:%olisi,%en$adilan

"Blo3"up Mass Media, 456

%ublikasi"opini ne$atif -%en$aduan, )untutan-%ertahanan /0- :

-%en$acara-/02#r : Asuransi-)untutan balik

" #sb

%atient 0afety

-Culture-Reporting

-Learning 2Analysis2/esearch

-K&R-based Standard-Guideline

-Implementasi,Monitor -Patient Inolement

(ostly

Kecurigaan meningkat

Kepercayaan meningkat

(ost: Insment

7uality 7uality 7uality

!ico "# Lumenta$KKP-RS



Patient Sa/ety

11Sa/e ,are is n%t an %$ti%n&

It is the right %/ e.ery $atient2h% entr#sts their ,are t% %#r3ealth,are systes11&&

Sir Lia 0%nalds%n* 4hair* 536 5%rld Allian,e /%r

Patient Sa/ety* F%r2ard Pr%grae* 7889:788;



Keselamatan asien

, atient safety-

Suatu sistem yang menorong ruma! sa"it

mem%uat asu!an pasien menai le%i! aman.

Sistem ini men(ega! terainya (eera yang

ise%a%"an ole! "esala!an a"i%at mela"sana"an

suatu tina"an atau tia" mengam%il tina"an

yang se!arusnya iam%il.

,KKP3RS-



PRIMUM, NON NOCEREPRIMUM, NON NOCERE

FIRST, DO NO HARMFIRST, DO NO HARM

HIPPOCRATES’ TENETHIPPOCRATES’ TENET

(460-! "C)(460-! "C)



Total Care

otal Care

#

#

I %anage !im ,I ma"e t!e%anage !im ,I m a"e t!e

2oun-' %ut 7O D !eale !im

oun-' %ut 7OD !eale !im

Am%roise

m%roise are

are

<?

?



Total Care

otal Care

#

Don let me on.

on let me on.

Dopamin.

opamin.

Terapi simptomati"

erapi simptomati"

Tana: 0ital 1111ana: 0ital 1111

Sel 1111

el 1111



Total Care

otal Care

#

#

rof. Samsu!iaat ,<=>-rof. Samsu!iaat ,<=>-

TOTAL CARE

OTAL CAR E



TOTAL CARE

OTAL CARE

#

atofisiologi.

atofisiologi.

Organrgan

AnatomiAnatomi

+a"ro sir"ulasi.

a"ro sir"ulasi.

Sel

el

+i"ro sir"ulasi.

+i"ro sir"ulasi.

Listenisten

To

o

H !at

!at

T!e

!e

Cells

ells

Say

ay



Total Care

otal Care

#

#

<;

;

Butir

utir

Total

otal

Care

are

#

<.

.

Triage

riage

1

:.

.

Diagnosa 1

iagnosa 1

.

.

Kasus %ea! / %u"an 1

asus %ea! / %u"an 1

?.

.

+asala! yang apat tim%ul 1asala! yang apat tim%ul 1

.

.

enis op. / te"ni" op. ,

enis op. / te"ni" op. ,

S(!ool Of Surgery /

(!ool Of Surgery /

S(!ool Of Anest!esiology- 1

S(!ool Of Anest!esiology- 1

.

.

Timing

iming

operasi 1

perasi 1

..

+asala! pra%ea! 1asala! pra%ea! 1

>.

.

+asala! intra%ea! 1

asala! intra%ea! 1

=.

.

+asala! pas(a%ea! 1

asala! pas(a%ea! 1

<;.

;.

9ollo2 5p

ollo2 5 p

1

1

STRATE7IC

TRATE7IC

T)I*KI*7

)I*KI*7



Total Care

otal Care

#

#

<.

.

TRIA7E

RIA7E

1

rimary Sur0ey

r imary Sur0ey

#

#

A ,

,

Air2ay

ir2ay

-.

.

B , ,

Breat!ingreat!ing

-..

C ,

,

Cir(ulation

ir(ulation

-.

.

D ,

,

Disa%il ity

isa%ility

-.

.

E ,

,

ENposure

Nposure

)ipotermi-.

)ipotermi-.

Resusitasiesusitasi %ea!ea!

Stop

top

Bleeing

leeing

.

Stop

top

Contam ination

ontamination

.

Damage

amage

Control

ontrol

Surgery

urgery



Total Care

otal Care

#

:.

.

DIA7*OSA

IA7*OSA

#

#

Anamnesa

namnesa

+

+e(!. Of Inury

e(!. Of Inury

.

I

Inury Sustainenury Sustaine

.

S

Symptoms

ymptoms

T

T!erapy

!erapy

.

emeri"saan

emeri"saan

f

f

isi"

si"

Cari

Cari

Inury & Symptoms

nury & Symptoms

Ba(" To Basi(s

a(" To Basi(s

.

*utritional assessm ent ,Boy

utrit ional assessm ent ,Boy

(om position' Bio(!emi(al ata'om position' Bio(!em i(al ata'

Su%. 7lo%al Assessm ent 3 S7A -

u%. 7lo%al Assessm ent 3 S7A-

& S(reening.

S(reening.

La%oratorium

a%oratorium

+eta%olisme anaero% 1111

+eta%olisme anaero% 1111

Listen To H !at T!e C ells Say

isten To H !at T!e C ells Say

.

7iPi # Serum al%umin'

iPi # Serum al%umin'

Total lymp!

otal lym p!

(ount'

ount'

Serum transferin' Serumerum transferin' Serum

pre al%umin'

re al%umin'

Total iron %ining

otal iron %in ing

(apa(ity

apa(ity

' (!olesterol

(!olesterol

Imaing

maing

9oto polos' 5S7' CT S(an' +RI & +SCT ll.

oto polos' 5S7' CT S(an' +RI & +SCT ll.

Enos"opi

nos"opi

/

/

Laparos"opi

aparos"opi

D/ & A.

D/ & A.



Total Care #

otal Care #

.

.

Kasus

asus

%ea!

ea!

/

/

%u"an

u"an

1

1



Total Care

otal Care

#

#

?.

.

+ASALA) 87 D T TI+B5L

ASALA) 87 D T TI+B5L

1

1

Ota" 1

ta" 1

ernafasan 1

ernafasan 1

Kario0as"uler 1

ario0as"uler 1

)ati 1

ati 1

7inal 1

inal 1

an"reas 1an"reas 1

Con sum ption Coa gulopat!y'

onsum ption Coagulopat!y'

Surg . / *o n Surg. Bleeing 1

urg. / *on Surg . Bleeing 1

7u t 9ailure

ut 9ailure

1

1

Lam%ung / Ileus.

Lam%ung / Ileus.

7iPi 1

iPi 1

*ormal'

*ormal'

+alnutrisi seang ,=@alnutrisi seang ,=@

"ompli"asi-'

ompli"asi-'

+alnutrisi %erat , ?:@ "ompli"asi-

alnutrisi %erat , ?:@ "ompli"asi-

Imunologi

munologi

SIRS' CARS' +ARS 1

IRS' CARS' +ARS 1

Strategi(

trategi(

T !in"ing

!in"ing



Total Care

otal Care

#

.

.

E*IS TI*DAKA* /

E*IS TI*DAKA* /

TEK*IK

EK*IK

O ERASI

ERASI

1

1

S(!ool of Su rgery 1

(!ool of Surgery 1

S(!oo l of Anest!esiology 1

(!ool of Anest!esiology 1

<' :' & ?

' :' & ?

Inform e Consent

nform e Consent

.

Communi(at ion

ommuni(at ion

S" ill

"ill



Total Care

otal Care

#

#

.

.

TI+I*7

I+I*7

O ERASI 1

O ERASI 1

7a2at Darurat 1

a2at Darurat 1

Segera 1egera 1

Tuna 1

una 1

Konser0atif 1

onser0atif 1

Ele"tif 1le"tif 1



Total Care

otal Care

#

#

.

.

+ASALA) RA BEDA) 1

ASALA) RA BEDA) 1

)ernia Strangulata !ari / < )ari 1

ernia Strangulata !ari / < )ari 1

+asala! A' B' C 1

asala! A' B' C 1

Resp Distress 1esp Distress 1

Compartment Synrom1

ompartment Synrom1

+eta%olisme' ele"trolit'

eta%olisme' ele"trolit'

asam3%asa1sam3%asa1

Toleransi operasi 111

oleransi operasi 111

Strategi %eru%a! trategi %eru%a!



Total Care #

otal Care #

>.

.

+ASALA) I*TRA BEDA)

ASALA) I*TRA BEDA)

1

1

9asilitas "mr operasi 1

asilitas "mr operasi 1

Te"ni" operasi 1

e"ni" operasi 1

+ampu"a! sayaampu"a! saya 111111

Te"ni" anestesi mana & ampa"nya 1

e"ni" anestesi mana & ampa"nya 1

)anya resusitasi %ea! / efinitif 1

anya resusitasi %ea! / efinitif 1

Op ele"tifp ele"tif

Triaria Off Deat!eat!

Dam age Control

am age Control

Surgery1

urgery1

*utrisi

utrisi

Te"ni" operasi ,9eeing

Te"ni" operasi ,9eeing

eunostomi 1-eunostomi 1-



Total Care #

otal Care #

=.

.

+ASALA) ASCA BEDA)

ASALA) ASCA BEDA)

1

1

E0aluasi %utir <

0aluasi %utir <

> 1

> 1

A1 B1 C1 D1 E

1 B1 C1 D1 E

,)ipotermi- 1)ipotermi- 1

Listen To H !at T! e Ce lls Say

isten To H !at T! e Ce lls Say

Ruangan %ea! 1

uangan %ea! 1

SIC5 / )C5 1IC5 / )C5 1

IC5 / ICC5 1

C5 / ICC5 1

+ASALA)

ASALA)

SEL

EL

111

111

+i"rosir"ulasi

i"rosir"ulasi

111

111



Total Care #

otal Care #

<;.

;.

9OLLOH 5

OLLOH 5

1

1

Di %angsal #

i %angsal #

A ,

A ,

Air2ay

ir2ay

- 1

1

B ,

,

Breating

reating

- 1

1

C , ,

Cir(ulationir(ulation

- 1 1

D ,

,

Disa%il ity

isa%ility

- 1

1

E ,)ipotermi- 1

,)ipotermi- 1

Listenisten Too H!at!at T!e!e Ce llsells Sayay

Di poli #

i poli #

Apa"a!

pa"a!

E5ILIBRI5+

5ILIBRI5+

,Claue Bernar-

Claue Bernar-

s! i(apai 1

! i(apai 1



"#AMIN$ %"#AMIN$ %



S&PPORTIN$%S&PPORTIN$%



)ypotensi0e)ypotensi0eResus(itation in t!eResus(itation in t!e

Pre )ospital & ERPre )ospital & ERP!aseP!aseAryono D.PusponegoroAryono D.Pusponegoro

Refferal #Refferal #

ATLSATLS

A(ute Care SurgeryA(ute Care Surgery

Peri Op Criti(al CarePeri Op Criti(al Care

Total CareTotal CarePusponegoro A.D.Pusponegoro A.D.



• QQ :> yrs Poli(e:> yrs Poli(e• A+ ta"en %y A+ ta"en %y

TaNi to Small )ospTaNi to Small )osp• Bleeing ,3-Bleeing ,3-• Alert' BP >;/Alert' BP >;/

Sta%leSta%le• PR =; / +inPR =; / +in• : L RL: L RL BleeingBleeing

,-,-

• S!o(" ,-S!o(" ,-• <:.;; Consulte to<:.;; Consulte to

SurgeonSurgeon Tria of Deat! ,-Tria of Deat! ,-

• Damage ControlDamage Control

SurgerySurgery• Re2armingRe2arming• <.;;<.;;



Dealy DoenDealy Doen # #

Let!al SiNLet!al SiN # #

<.<. Air2ay O%stru(tion Air2ay O%stru(tion

:.:. TensionTension

Pneumot!oraN Pneumot!oraN .. Caria(Caria(

Tamponae Tamponae

?.?. OpenOpen

Pneumot!oraN Pneumot!oraN

.. +asi0e+asi0e)emot!oraN )emot!oraN

.. 9lail C!est 9lail C!est

)ien SiN)ien SiN # #

<.<. T!oragi( AortaT!oragi( AortaDisruption Disruption

:.:.

Tra(!eo%ron(!ialTra(!eo%ron(!ialIn&ury In&ury

.. Blunt Caria(Blunt Caria(In&ury In&ury

?.?.

Diap!ragmati(Diap!ragmati(In&ury In&ury

.. Esop!ageal In&ury Esop!ageal In&ury

.. PulmonaryPulmonary

Contusion Contusion



ATLSATLS Sour(e of BleeingSour(e of Bleeing S!o(" #S!o(" #

<.<. T!oraNT!oraN

:.:. A%omenA%omen

.. Pel0isPel0is?.?. 9emur 9emur

.. Retro PeritonealRetro Peritoneal



Patient in )emor!agi( S!o("Patient in )emor!agi( S!o("

Resus(itate a((oring to Proto(alResus(itate a((oring to Proto(al

2it! :;;; (( RL2it! :;;; (( RL

S!o(" 111S!o(" 111ATLSATLS

<.<.Rapi ResponseRapi Response

:.:.Transient Response 111Transient Response 111..*o Response*o Response

H!y 111H!y 111



T!e Ameri(an College of

!e Ameri(an College of

Surgeons proto(ol for

urgeons proto(ol for

ATLS'TLS' re(ommens #e(ommens #

T)E TRADITIO*AL A ROAC)

)E TRADITIO*AL A ROAC)

of t!e emergen(y

of t!e emergen(y

p!ysi(ian an t!e trauma surgeon

!ysi(ian an t!e trauma surgeon

,(i0ilian

(i0ilian

setting-'etting-' !ypo0olemi( !ypotensionypo0olemi( !ypotension isis to (orre(tto (orre(t

any traumati( as rapily as possi%le.

ny traumati( as rapily as possi%le.

T!is emp!asis on immeiate post3inury flui

!is emp!asis on immeiate post3inury flui

resus(itation 2as %ase on early eNperimental

esus(itation 2as %ase on early eNperimental

ata s!o2ing t!at rapi restoration of %loo

ata s!o2ing t!at rapi restoration of %loo

0olume an pressureolume an pressure le to impro0ement of 0italle to impro0ement of 0ital

organ fun(tion an long term sur0i0al

rgan fun(tion an long term sur0i0al

' %y

%y

a0oiing t!e late seFuelae of !ypo0olemi( s!o(".

0oiing t!e late seFuelae of !ypo0olemi( s!o(".

ATLS Course promotes t!e

TLS Course promotes t!e

rapi infusion of

api infusion of

large 0olumes of (rystallois to !ypotensi0e

arge 0olumes of (rystallois to !ypotensi0e

trauma patients.

rauma patients.



Opponents to T!e ATLS

pponents to T!e ATLS

(on(ept

on(ept

,<-

,<-

Solomono0 et al an KrauP et al

olomono0 et al an KrauP et al

,<==;-# Inepenently s!o2e'

,<==;-# Inepenently s!o2e'

t!at in an eNperimental s!eep!at in an eNperimental s!eep

moel of spleen inury' 2it!

oel of spleen inury' 2it!

un(ontrolle !emorr!age'

n(ontrolle !emorr!age'

0igorous infusion

igorous infusion

of isotoni(

of isotoni(

an !ypertoni( salinen !ypertoni( saline too

a(!ie0e a normal %loo

(!ie0e a normal %loo

pressure resulte in

ressure resulte in

in(rease

n(rease

%leeing an mortality.

leeing an mortality.

6$$%nents t% The ATLS6$$%nents t% The ATLS



6$$%nents t% The ATLS6$$%nents t% The ATLS

,%n,e$t '7),%n,e$t '7)

Stern an (olleagues

tern an (olleagues

,<==- # s!o2e

,<==- # s!o2e

in a por(ine moel 2it! a%ominal

n a por(ine moel 2it! a%ominal

aorti( inury 2it! near fatal

orti( inury 2it! near fatal

!emorr!age' t!atemorr!age' t!at attempts to restorettempts to restore

%loo pressure 2it! rapi infusion of

loo pressure 2it! rapi infusion of

(rystallois

rystallois

le to in(rease %leeing

e to in(rease %leeing

an mortality.

n mortality.

Capone an asso(iatesapone an asso(iates # also# also

(onfirme t!is

onfirme t!is

a0erse result

a0erse result

in a

in a

murine moel' an s!o2e t!at

urine moel' an s!o2e t!at

ui(ious flui aministration impro0e

ui(ious flui aministration impro0e

s!ort3term sur0i0al.

!ort3term sur0i0al.



Early 0s Delaye Resus(itationEarly 0s Delaye Resus(itation("i'e, N* E+* * .e 114)("i'e, N* E+* * .e 114)

Bi("ell note t!at

i("ell note t!at

rapily

apily

aministering La(tate RingerUs

ministering La(tate RingerUs

solution intra0enously

olution intra0enously

signifi(antlyignifi(antly in(reasesn(reases

!emorr!age an eat!

emorr!age an eat!

pV;.;.

pV;.;.

T!e

!e

in(rease 0olume of

n(rease 0olume of

!emorr!age in t!e resus(itate

emorr!age in t!e resus(itate

grouproup (oul !a0e resulte from(oul !a0e resulte from

eit!er a((entuation of an ongoing

it!er a((entuation of an ongoing

!emorr!age of

emorr!age of

reinitiating t!e

einitiating t!e

!emorr!age

emorr!age

after spontaneous

fter spontaneous

!emostasis !a o((urre.emostasis !a o((urre.



5S5)S / 5niforme Ser0i(es

S5)S / 5niforme Ser0i(es

5ni0ersity of t!e )ealt!ni0ersity of t!e )ealt!

S(ien(es

(ien(es ''&SA&SA 788<)788<) I

Conferen(e of 5S5)S'

Conferen(e of 5S5)S'

Re(ommene #Re(ommene #

Consensus ofConsensus of resus(itation enpointsresus(itation enpoints

i.

.

a palpa%le raial pulse'

palpa%le raial pulse'

ii.

i.

a%ility to mentate' an

%ility to mentate' an

iii.ii.

sustaine a systoli( %looustaine a systoli( %loo

pressure >3=; mm)g

ressure >3=; mm)g ,if,ifsp!ygmomanometry 2assp!ygmomanometry 2asa0aila%le-.a0aila%le-.



)8 OTE*SIWE RES5SCITATIO*

8 OTE*SIWE RES5SCITATIO*

T!is te(!niFue (alls

!is te(!niFue (alls

for flui

or flui

aministration' enpoint #

ministration' enpoint #

i.

.

+A

A

,mean arterial pressure- of

mean arterial pressure- of

;

;

mm )g

m )g

or'

or'

ii.

i.

SB

B

,systoli( %loo pressure- of

systoli( %loo pressure- of

=;

;

mm )g'

m )g'

t!e

!e

minimum pressure ne(essary to

inimum pressure ne(essary to

maintain 0ital organ perfusion.

aintain 0ital organ perfusion.

)ypotensi0e resus(itation !as %een

ypotensi0e resus(itation !as %een

a0o(ate in orer

0o(ate in orer

to pre0ent t!e

o pre0ent t!e

resus(itation

esus(itation

re3%leeing

e3%leeing

inury

nury

mentione a%o0e.

entione a%o0e.



Bloo Pressure at 2!i(! Re%leeingBloo Pressure at 2!i(! Re%leeing

O((urs after Resus(itation in S2ine 2it!O((urs after Resus(itation in S2ine 2it!

Aorti( InuryAorti( Inury(S2+ee+, Tra3.a 00 52 !4)(S2+ee+, Tra3.a 00 52 !4)

T!ere 2asT!ere 2as a reprou(i%le pressurea reprou(i%le pressure atat

2!i(!2!i(! re%leeing o((ursre%leeing o((urs

T!e re%leeing o((urs 2as not affe(te %y time ,3

!e re%leeing o((urs 2as not affe(te %y time ,3

<- minute or %y t!e rate ,<;; 0s ;; ml/minute-' %ut

- minute or %y t!e rate ,<;; 0s ;; ml/minute-' %ut

#

T!e

!e

a0erage pressure at t!e re%leeing

0erage pressure at t!e re%leeing

2as

2as

+A ?A ? : mm)g: mm)gSystoli( =?

ystoli( =?

mm)g

mm)g

Diastoli( ?

iastoli( ?

: mm)g

: mm)g

Con(lusions #

on(lusions #

T!e optimal enpoint of

!e optimal enpoint of

resus(itation for un(ontrolle

esus(itation for un(ontrolle

%leeing s!oul %e %elo2 t!e

leeing s!oul %e %elo2 t!e

re%leeing pressuree%leeing pressure



During TransportDuring Transport Keep t!e Keep t!ePatient )ypotensi0e uner t!ePatient )ypotensi0e uner t!eRe%leeing PointRe%leeing Point

IfIf Surgeon ,3-Surgeon ,3-

Keep t!e PTKeep t!e PT)ypotensi0e until t!e Surgeon)ypotensi0e until t!e Surgeonarri0esarri0es

Arri0al in t!e ERArri0al in t!e ER 7o Straig!t7o Straig!tto t!e Operating Room or Do an ERto t!e Operating Room or Do an ERLaparotomy / T!ora(otomy toLaparotomy / T!ora(otomy to StopStopt!e Bleeingt!e Bleeing t!en Resus(itatet!en Resus(itate

DonMt 2aste your timeDonMt 2aste your time in t!ein t!eResus(itation Room 2it! 9luis Resus(itation Room 2it! 9luis

acute care surgery - total care des 2012( prof aryo)[1]a2013

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