kuliah gawat darurat
TRANSCRIPT
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DASAR-DASAR PENGELOLAAN
PENDERITA GAWAT DARURAT
dr. MH. Sudjito, SpAnLab/SMF Anestesiologi & ReanimasiFK UNS / RSUD Dr. Moewardi Surakarta
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Penderita gawat daruratPenderita yang oleh suatu penyebab (penyakit, trauma, kecelakaan, tindakan anestesi) jika tidak segera ditolong akan mengalami cacat, kehilangan organ tubuh atau meninggal
Time saving is life saving = waktu adalah nyawa
Tindakan pada menit-menit pertama menentukan hidup atau mati penderita
Tindakan yang harus tepat, cepat & cermat
PENDAHULUAN
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SISTEMATIKA DALAM PPGD
Triase
Survei primer + resusitasi
Survei sekunder
Stabilisasi
Rujukan / Terapi definitif
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• TRIASE• TRIASE•Survei primer dan resusitasi
(Quick Dx. - Quick Rx.)
Survei sekunder Stabilisasi
• Terapi definitif / rujukan
• RS. lain
• Kamar Operasi
• I C U
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Cara pemilahan penderita berdasarkan : Kebutuhan terapi Sumber daya yang tersedia
Terapi didasarkan pada kebutuhan :A : AirwayB : BreathingC : CirculationD : DisabilityE : Exposure
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Jumlah penderitaMasalah gawat darurat
Tidak melebihikemampuan RS
Melebihikemampuan RS
Yang gawat daruratdan multi trauma
Kemungkinan survivalyang terbesar
MUSIBAH MASSAL
PRIORITAS PRIORITAS
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Emergency A B C D EKasus Airway Breathing Circulation Disability Prioritas
1. + + + + 1
2. - - + - 3
3. + + + - 2
4. - - - - 4
5. Dst
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• Biru : gawat darurat sangat berat
• Merah : gawat darurat
• Kuning : tidak gawat, tetapi darurat
• Hijau : tidak gawat darurat
• Hitam : meninggal
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A = Airway ( + C Spine Controle )
B = Breathing
C = Circulation
D = Disability
E = Exposure
PENILAIANPENDERITA GAWAT DARURAT
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CARA MENILAI
Lihat ( Look )
Dengar ( Listen )
Raba ( Feel )
A = AIRWAY ( + C SPINE CONTROLLE )
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OBSTRUKSI JALAN NAPAS / TIDAK Agitasi Hipoksemia Penurunan kesadaran Hipercarbia Pergerakan dada - perut waktu bernafas
( See saw - Rocking respiration) Retraksi sela iga Sianosis : kuku, bibir
A :Airway I H A TL
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A :Airway D E N G A R
OBSTRUKSI JALAN NAPAS / TIDAK
•Suara napas normalBicara normal ------ tidak ada sumbatan
•Suara napas tambahan - obstruksi parsial- Snoring - Crowing / stridor- Gurgling - Suara parau ----- laring !
•Suara napas hilang - Obstruksi total - Henti napas
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R B AAA :Airway
OBSTRUKSI JALAN NAPAS/TIDAK
Meraba / merasakan hembusan hawa expirasi dari lubang hidung / mulut
Ada / tidaknya getaran di leher waktu bernapas - sumbatan parsial
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TABEL : OBSTRUKSI JALAN NAPAS
A :Airway
SUMBATAN
LIHATGERAK NAPAS
DENGARSUARA
TAMBAHAN
RABAHAWA
EKSPIRASI
Bebas Normal (-) (+)
Partial ringan
Normal (+) (-)
Parsial berat
See saw (++) (+)
Total See saw (-) (-)
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Lidah dan Epiglotis
Muntahan, darah, sekret dan benda asing
Trauma maksilofasial
SEBAB OBSTRUKSI JALAN NAPASA :
Airway
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A :Airway
PENGELOLAAN OBSTRUKSI JALAN NAPAS
MAINTENANCE AIRWAY
DENGAN ALAT1. Suction (cair)2. Oral airway3. Nasal airway
TANPA ALAT1. Jaw Thrust2. Oral Airway3. Nasal Airway
DEFINITIVE AIRWAY
1. Intubasi trakhea Oral Nasal
2. Crico thyroidectomy Needle Surgical
3. Trackheostomy
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2. PERIFER Airway Paru Rongga Pleura Otot napas Syaraf Jantung
1. SENTRAL Obat-obatan Radang otak Tumor Otak Trauma kepala Stroke
PENYEBAB GANGGUAN BREATHING
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L I H A TB :Breathing
Takhipnea
Perubahan status mental
Gerak napas
Sianosis
Distensi vena leher
Jejas di dada
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Keluhansesak (penderita sadar)
Suara napas- Normal ?
- Menurun ?- Hilang ?
Suara napas tambahan
B :Breathing E N G RD A
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Hawa ekspirasi
Emphysema sub cutis - pneumothorax
Krepitasi / nyeri tekan
Deviasi trakhea
B :Breathing R A B A
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Pulse Oximeter
CO2 detector, capnograf
Gas darah
Foto thorax
B :Breathing PEMERIKSAAN TAMBAHAN
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1. TERAPI SUPORTIF
Bantuan napas (ventilasi)- Tanpa alat : Mouth to mouth
Mouth to nose- Dengan alat : Bag-valve mask / tube
Tehnik : Napas buatan (Controlled respiratori) Napas bantuan (Assisted Respiratory)
Oksigenasi- Variable Performance System - Fixed Performance System
2. TERAPI CAUSAL
B :Breathing PENGELOLAAN
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Apakah penderita syok ? Tanda-tanda syok
Perfusi : - Perfusi perifer- Perfusi ke ginjal
Nadi : - Rate- Ritme- Pengisian
Tekanan darah
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JENIS SYOK TANDA KHAS TERAPI
Hipovolemik CVP rendah - Cairan 2-4 x kehilangan volume
- Bila Hb < 8 transfusi
Kardiogenik - CVP tinggi- Ada aritmia
- Diuretic- Digitalis- Beta mimetic- Obat-obat aritmia
Obstruktif - CVP tinggi Menghilangkan obstruksi
Distributif - Hiperdinamik dan hypodinamic stage
- Febris
- Suportif
- Antibiotika- Hilangkan fokus infeksi
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Apakah penderita henti jantung ?
Lakukan Bantuan Hidup Dasar (Napas buatan dan pijat jantung)
C :Circulation
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1. Bagaimana kesadaran penderita AVPU (paling cepat) Glasgow Coma Scale (EVM) Sadar, somnolent, sopor, coma
2. Tanda-tanda neurologis lain Mata : pupil, gerak, papil
Anggota gerak : Hemiplegia, paraplegia
Sistem saraf, tanda vital
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D :Disability
3. Penyebab gangguan kesadarana. Gangguan pernapasan
Hipoksemia Hipercarbia
b. Gangguan sirkulasi Syok Cardiac arrest CVA (perdarahan, thrombo emboli)
c. Trauma
d. Metabolik
e. Infeksi
f. Obat-obatan
g. Tumor
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Penderita harus dibuka pakaiannya
Penderita tidak boleh kedinginan
Selimut, ruang cukup hangat
Cairan infus yang sudah dihangatkan
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