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8/17/2019 L1 Initial Assesment 2013
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PENILAIAN AWAL DAN
RESUSITASI PADAPENDERITA TRAUMA
(INITIAL ASSESMENT)
OlehRidlwan Kamaluddin, S.Kep., Ns,
M.Kep*
! "ead #$ Eme%&en'( Nu%sin& Depa%)men) Uns#ed
! Ins)%u)u% +T-LS Amulans /awa) Da%u%a) 0A/D1 2
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Men&apa Penan&anan T%auma
pen)in&...3333
4
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•Primary Survey
•Secondary
Survey
5
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elalu mulai dengan urvai
Primer
(mencari keadaan yang mengancam nyawa)• Primary Survey (KonsepATLS)
•A Airway dengan Proteksi servika
•B !reat"ing dengan #ksigenasi dan
$entiasi•
C %ircuation dengan KontroPerdara"an
•D &isa'iit keadaan Neuroo is
6
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7
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8
Bila ada penderita,
persiapan !!!!
+AAman &iri Aman
Lingkungan dan Aman
Pasien
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9
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2
!agaimana meniai penderita daam ,- detA/ak penderita 'er'icara 0
1espon 'aik menun/ukkan
A
Airway 'aik
B !reat"ing 'aik
C %ircuation mungkin
'aik D
&isa'iity mungkin'aik
!ia tidak ada respon 2 Primarysurvey
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:
Assess 2• Look • Listen
•
3ee
Airway & Prteksi
ervikal
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Tanda Trauma %ervica
;
• Lesi
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Ada )anda )%auma... Se&e%a pasan&
ne' '#lla%
4
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5
A
Airway wit" %4spine protection
5aan na6as di/aga manua 7 Suction (cairan 4 gurging) 7 %"in i6t 8 5aw T"rust (snoring) 5aan na6as sementara 7 #rop"aringea 7 Nasop"aryngea
!ia tidak 'er"asi 2 Airway de9niti6
B
A
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Tanda >%a)u% +asis -%anii
• O)#%%hea
• Rhin#%%hea
•
Ra''##n E(es• +a))le Si&n
6
!ia ada tanda diatas::: 5angan
LAK;KAN::::0000,:Suction dgn so6t cat"eter
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7
Asses
s 2• Look
•
Listen
•
3ee
Breat"ing &
#entilasi
B
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8
B
Breat"ing
!ia 'reat"ing terganggu 2
Seau #ksigen(,, LPM)
$entiasi('ia na6as tidak adekuat)
(dengan oksigenasi dan ventiasi)
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Peme%isaan
• Inspesi
• Ausul)asi
• Pe%usi
• Palpasi
9
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Inspesi
• Liha) ada ?e?as
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Ausul)asi
• Sua%a Na$as...0=esiule%
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Pe%usi• Pe%usi dada anan dan i%i• S#n#% N#%mal
•
"ipe%s#n#%
ada uda%a0pneum#)h#%a isa)ensi#n a)au #pen1
• Pea
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Palpasi
• Palpasi adan(a %epi)asia)au )ida
• K%epi)asi Cail 'hes)0pe%na$asan pa%ad#sal1
4
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44
B
!reat"ing 2 #penPneumot"ora
Sesak karena 'erna6as ewatu'ang toraks
Tutup 2 #pen %osed kasa + sisi
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O''lusi=e +anda&e.. 0Kassa 5 sisi1
45
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46
B
!reat"ing 2 Tension Pneumot"ora
&ekompresi 2 Tension #pen NeedeT"oracosintesis di I%S< mid cavicua
au mekanisme penti
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47
B !reat"ing 2 3ai c"est =
Kontusioparu
!ia ventiasi tidak adekuat 2
Assisted
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48
B
!reat"ing 2 Massive *ematot"ora
>?S&@ 'ia masi6 T"orakotom
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49
B
!reat"ing 2 Pemasangan %"est tu'
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42
Assess /an&&uanPe%$usi• A%al din&in• Ta'h('a%dia
• /an&&uan esada%an
• Ta'h(pneu
• "ip#)ensi
• Oli&u%ia
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5;
C
%ircuation 2 per'aikan voume
In6us 2 uyur 1L yang di"angatkan(/angan upa am'i sampe dara")
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5
C
%ircuation 2 kontroperdara"an
*aemorr"age %ontro 'ia eksterna 2&irect Pressure
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54
C
%ircuation 2 Kontro Perdara"anInterna
• Toraks 2 torakotomi .
• A'domen 2
aparotomi .
• Pevis 2 PAS urita
%4
%amp .
• Ekstremitas 2 !idai B
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55
C
%ircuation 2 Non"emorr"agic
S"ock Sesak (=) . 8 mungkinTensionPneumot"ora
Sesak (4) . 8 mungkin
Tamponade 5antung
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56
D
&isa'iity 2 Pemeriksaanminineuroogis
• %edera kepaa 'isa mati cepat 0
Niai %S
• Eye
• $er'a
• Motorik
,: Pupi
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57
E
Eposure and Environment %on
!uka2
• !uka pakaian 'asa"("ipotermi 0)
• Li"at cedera ain yangmengancam
nyawaTutup2
• 5angan sampai "ipot"ermi
!oe" og ro 'ia ada indikasi
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58
3oey %at"eter astric Tu'e
Periksa Ada kontra4indikasiCCC.
Tam'a"an pada PrimarySurvey
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59
Tam'a"an pada Primary Survey 2Monitor
• Pasang EK• Puse #ymeter
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5:
Ker/akan 'ia Sta'i 2 Secondary Surv
• Anamnesis engkap (Ampe
BKompak )• 3rom *ead To Toe ( !TLS )
• 3inger and Tu'e in every
ori9ce• Pemeriksaan tam'a"anainnya
ecndary urvey
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Secondary Survey
6;
-
A Aergy- MMedication
- P PostIness
- L LastMea
-
E Event
-K Keu"an-# #'at-M Makan-PPenyakit
-A Aergi-K
Ke/adian
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Secondary Survey
6
-! !entuk -T Trauma-L Lesi-S Sakit
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!ia suda" secondary
survey danpenderita sta'i 2Terapi de9niti6
• 5a"it
• 1awat ruangan
• I%;
• #K • 1u/uk ke 1S mampuF %ocok