triage + playrole triage

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Page 1: TRIAGE + PLAYROLE TRIAGE

Triage / triase

TIM PELATIHAN KEGAWATDARURATAN

Anestesi dan Terapi Intensif

RSUD Saiful Anwar Malang/FK Univ.Brawijaya

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What is Triage?

• “Triage” sortir

• Evaluasi berdasarkan kebutuhan medis dan urgensi pada masing2 klien dalam waktu terbatas

Page 3: TRIAGE + PLAYROLE TRIAGE

Triage proses dinamik dan dilakukanlebih dari sekali

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Primary Disaster Triage

• Triage berdasarkan fisiologi pasien

–Kemampuan pasien dalammenghadapi /mengkompensasitrauma atau injuri

–Bila gagal prioritas tinggi

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Primary Disaster Triage

• Yang paling sering digunakan pada pasiendewasa di amerika dan kanada denganmenggunakan “START “ (Simple Triage and Rapid Treatment.

• Pada pasien anak dengan menggunakan“Jump START”.

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Label

• Pelengkap Triage

• Identifikasi pasiensecara cepat

• Berdasarkanwarna/code tertentu

• Dapat jugadigunakan pita berwarna sebagaipengganti label

Page 7: TRIAGE + PLAYROLE TRIAGE

Triage Categories

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NATO Guidelines• Merah

Obstruksi jalan nafas, gagal nafas, internal bleeding,shock,pneumothorak, luka bakarpada wajah / leher

• Kuning

Luka pada mata yang berat, fraktur, lukabakar pada abdomen dan ekstremitas

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NATO Guidelines• Hijau

Laserasi monor, kontusio, sprains, lukabakar parsial < 20% BSA

• Hitam

Cedera kepala GCS<8, luka bakar >85% BSA, multisistem trauma, tanda2 kematian (+)

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Sistem START

• Pertama kali pada thn 1980’s di Hoag

Hospital dan the Newport Beach CA Fire

Dept

• Assessment secara cepat

• Tidak lebih dari 15 detik

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Sistem START

Klasifikasi berdasarkan :

• Respirasi

• Perfusi

• Evaluasi status Mental

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Langkah pertama “START”

Apakah pasien dapat berjalan?

Ya tidak

Hijau

(Minor)

Evaluasi respirasi

(Step-2)

Page 16: TRIAGE + PLAYROLE TRIAGE

Langkah kedua “START”

Bernafas ?

YESNO

> 30/Min < 30/min

Evaluasi sirkulasi(Step-3)

Airway paten

bernafas?

tdk Ya

BlackRed/ Immediate

Red/ Immediate

Page 17: TRIAGE + PLAYROLE TRIAGE

Langkah ketiga “START”

sirkulasi

Pulsasi A.Radialis (-)

Control Hemorrhage

Pulsasi A.Radialis (+)

Evaluasi kesadaran

Red/ Immediate

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Langkah keempat “START”

Tidak dapat menuruti perintah sederhana

Level kesadaran

dapat menuruti perintah sederhana

Yellow/ DelayedRed/ Immediate

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Pasien Terkontaminasi

• Pasien yang terpapar (potensial atau

benar2 terpapar) diberi label BIRU

• Label biru terus berlangsung sampai

pasien dinyatakan dekontaminasi, dan

dilanjutkan dengan langkah2 START

• Beberapa merekomendasikan dengan

double label dengan biru dan warna

standar START

Page 20: TRIAGE + PLAYROLE TRIAGE

• Ingat RPM

• R- Respirasi- 30

• P- Perfusi- nadi Radialis

• M- Mental- mengikuti perintah

START-Overview

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The JumpSTART Field Pediatric Multicasualty Triage System ©

(Patients aged 1- 8 years)

Black = Deceased/expectantRed = ImmediateYellow = DelayedGreen = Minor/Ambulatory

Identify and direct all ambulatory patients to designatedGreen area for secondary triage and treatment. Beginassessment of nonambulatory patients as you come to them.

Proceed as below:

Spontaneous respirations?

NO

Open airway

Spontaneous respirations?

YES

IMMEDIATE

NO

DECEASED

YES

Peripheral pulse?

YES

Perform 15 sec.Mouth to MaskVentilations

Spontaneous respirations?

YES

IMMEDIATE

NO

DECEASED

NO

Check resp. rate

< 15/min or

> 40/minor irregular

IMMEDIATE

15 - 40/ min,regular

Peripheral pulse?

NO

IMMEDIATE

YES

Check mental status(AVPU)

AVP (appropriate)

DELAYED

P (inappropriate)U

IMMEDIATE

MINOR

© Lou Romig MD, FAAP, FACEP, 1995

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Skenario

• Terjadi ledakan pada saat pertandingan bola distadion gelora bung karno. Terdapat 200 orangterluka

• Berikan kriteria dan label pada pasien

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Pasien 1

• Apneu

• Pulsasi (-)

• Kesadaran (-)

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Pasien 2

• Terdapat eviserasi pada perut

• Multiple penetrasi pada dada dan kepala

• Tidak respon terhadap rangsangan nyeri

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Pasien 3

• Nyeri abdomen

• Peneterasi minor pada ekstremitas

• RR 24x/mnt

• Pulsasi a radialis kuat

• Kesadaran compos mentis

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Pasien 4

• Luka penetrasi multiple

• Darah keluar dari telinga

• Airway paten

• RR 20

• Pulsasi A.radialis kuat

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Pasien 5

• Fraktur ekstremitas

• Keluar darah dari telinga

• RR 26

• Pulsasi A radialis kuat

• Kesadaran compos mentis

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Pasien 6

• Anak2, berteriak

• Laserasi minor

• RR 30

• Masih dapat menggerakkan ektremitas

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Pasien 7

• Nyeri dada

• Penurunan kesadaran

• RR 34

• Pulsasi A radialis lemah

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