kegawatdaruratan airway
DESCRIPTION
Jalan nafas dan kegawatdaruratanTRANSCRIPT
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AIRWAY
TIM PELATIHAN KEGAWATDARURATAN
Anestesi dan Terapi Intensif
RSUD Saiful Anwar Malang/FK Univ.Brawijaya
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A: AIRWAY
(JALAN NAFAS)
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Jalan NafasAtas
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Jalan Nafas Atas
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Jalan Nafas Bawah
carina
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Jalan Nafas Bawah
Primary Bronchi
Hyoid Bone
Right Lung
Secondary Bronchi
Tracheal Ligament
Trachea
Larynx
Esophagus
Left Lung
Trachea
A
B
C
D
E
F
G
H
I
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Periksa
• Look (lihat) : Pergerakan dada
• Listen (dengar) : Hembusan nafas, suaratambahan
• Feel (Rasakan) : Hembusan hawa nafas
• Suara tambahan : Snoring (ngorok) karenapangkal lidah jatuh, Gargling karena cairan, Stridor karena edema plica vokalis
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Penyebab Utama Obstruksi
Airway
Pangkal lidah
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Tanda dan gejala obstruksi jalan nafas
gelisah (karena hipoksia)
gerak otot nafas tambahan(tracheal tug, retraksi sela iga)
gerak dada & perut paradoksal
sianosis (tanda lambat)
MAKINPARAH
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Membebaskan jalan nafas
• Sumbatan pangkal lidah (Suara mendengkur)
– chin lift
– jaw thrust
– jalan nafas oropharynx / nasopharynx
– jalan nafas intubasi trachea / LMA
• Cairan di hypopharynx (suara berkumur)
– penghisap / suction
• Sumbatan di plica vocalis (bervariasi)
– cricothyroidotomy
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CHIN LIFT
HEAD TILT
HEAD TILT never in trauma victims
PEMBEBASAN JALAN NAFAS TANPA ALAT
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Pasien tidak sadar → Lidah jatuh ke belakang
3 Cara Untuk mengatasi hal tersebut :
• Ekstensi Kepala, Angkat Leher ( tidak untuk trauma)
• Ekstensi Kepala, Angkat Dagu
• Ekstensi Kepala, Dorong Mandibula
– Bila diyakini jalan nafas baik, spontan, adekwat letakanpada Posisi Sisi Mantap untuk mencegah Aspirasi.
– Bila curiga trauma leher/ kepala pindahkan bila perlu saja
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Triple Airway Maneuvers
• HEAD TILT • CHIN LIFT
• JAW THRUST
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JAW THRUST
dianjurkan
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Membebaskan JalanNafas
head tilt
neck lift
Jangan untuk traumaHati-hati
neck lift
chin lift
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Membebaskan Jalan Nafas DenganAlat
• Suctioning
• Oropharyngeal Tube ( Mayo / Guedel )
• Nasopharyngeal Tube
• Laryngeal Mask Airway
• Intubasi Endotrakheal
• Krikothiroidotomi - Trakheostomi
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Oro-pharyngeal tube( GCS kurang 8 )
Reflek muntah (-)
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Cara mengukur oropharyngeal
• Dari tragus ke sudut bibir
• Dari angulus mandibula ke pertengahan bibir
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1 2
3 4
OROFARINGEALTUBE
( Dewasa – Sliding tehnik )
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Insersi pada anak
• Langsung ( non sliding )
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Naso-pharyngeal tube
Tidak merangsang muntahUkuran u/ dewasa 7 mm atau jari kelingking kanan
Nasopharyngeal tube( GCS lebih 8 )
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NASOFARINGEALTUBE
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Stridor ( edema plica )Kasus Alergi-Anafilaksis
• Oksigen Masker Bening 4 – 6 liter/mnt
• Beri injeksi Dexamethason 2 Ampul
• Suction bersih sekret (jangan melukai)
• Emergency: Konsul Intubasi, Siapkrikotiroidotomi
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Persiapan Airway Manajemen
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INTUBASI
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Airway definitif
Krikotirotomi - jarum 14 / 16:- Ditusukkan lewat membrana
kriko-tiroidea- Sambung dengan slang oksigen, 1 detik tutup, 4 detik buka
- Waktu ekstra hanya 30-45 menit
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Kriko-tiroidotomi
Kartilago tiroidMembrana
Kartilago krikoidTrakea
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Krikotiroidotomi jarum
Paling Besar 14 G
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Kriko-tiroidotomisurgikal
6
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Choking (tersedak benda asing)
• Pada chocking :
Back blows (pukul punggung)
Abdominal thrust (Heimlich manuver) (dorongperut)
Thoracal thrust ( dorong dada)
Cricothyroidotomy ( tusuk bawah jakun)
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Lima kali hentakanpada punggung,diantara dua scapula
CHOKING
Back blows
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CHOKING
HeimlichAbdominal trust
Dorong perut
Korban : sadar
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Korban : Tidak sadar
Heimlich Abdominal trust
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Posisi mantap / stabil / recovery
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Questions