TRAUMA VASKULER

PADA EXTREMITAS
Diagnosis dan Penanganannya

PENDAHULUAN
TRAUMA EXTREMITAS

PASTI DISERTAI

TRAUMA VASKULER
RINGAN SAMPAI BERAT
LIFE THREATENING

LIMB THREATENING

PENDAHULUAN
MENGALIHKAN PERHATIAN
PRIMARY SURVEY
SECONDARY SURVEY

ETIOLOGI
LANGSUNG / DIRECT
TIDAK LANGSUNG / INDIRECT
KERUSAKAN ENDOTEL LOKAL

ETIOLOGI : DIRECT
TRAUMA TUMPUL
TRAUMA TAJAM

ETIOLOGI : INDIRECT
TRAUMA

KOMPRESSI

TRAUMA

TARIKAN

ETIOLOGI : LOKAL ENDOTEEL

OBAT-OBATAN ( DRUGs )
TRAUMA DINGIN ( FREEZING )

TIPE KERUSAKAN
KONTUSI
PERFORASI
LASERASI
TRANSEKSI

DIAGNOSIS
ANAMNESA

INSPEKSI
PALPASI
AUSKULTASI

DIAGNOSIS
MENGANCAM NYAWA

MENGANCAM EXTREMITAS
HARD SIGN
SOFT SIGN

HARD SIGN
PERDARAHAN YANG BERDENYUT
ADANYA ARTERIAL THRILL
BRUIT DEKAT ARTERI
ISCHEMIA DISTAL
HEMATOMA YANG MEMBESAR

SOFT SIGN
Anamnesa ada perdarahan banyak
Menurunnya pulsasi arteri

Adanya trauma tulang bagian

proximal
Adanya kelainan neurologis

The Rule of Six - P

PAIN
PARASTHESIA
PARALYSIS
PALLOR
PULSLESSNESS
PERISHINGLY COLD EXTREMITY

GEJALA KLASIK MENGHILANG

ADANYA SYOK

PEMBENGKAKAN, EDEM DAN KONGESTI VENA

PERSISTEN PULSES (25%)

LABORATORIS
DARAH LENGKAP
TROMBOSIT Count
BUN, S CREATININ
GOLONGAN DARAH
FAAL HEMOSTASIS

IMAGING
PLAIN X-RAY
ARTERIOGRAFI
DUPLEX DOPPLER

MANAGEMENT
LIFE TREATHENING
LIMB TREATHENING
HARD SIGN
SOFT SIGN

Management : LIFE THREATENING

MAJOR PELVIC DISRUPTION WITH

HEMORRAGE
MAJOR HEMMORHAGE
CRUSH SYNDROME

Management : LIMB THREATENING

OPEN FRACTURE AND JOINT INJURIES
COMPARTMENT SYNDROME

VASCULAR AND TRAUMATIC AMPUTATION

NEUROLOGIC INJURIES

PENANGANAN TRAUMA VASKULER

PENDERITA STABIL
HARD SIGN
SOFT SIGN

EXPLORASI
EVALUASI

MEDIKA MENTOSA
ANTIKOAGULAN PENTING UNTUK MENCEGAH

THROMBOSIS
ANTI PLATELET DRUG MEMPUNYAI MANFAAT

POST VASCULAR REPAIR

TERAPI BEDAH
LIGASI

REPAIR
REKONSTRUKSI
REPLACEMENT

MANGLED EXTREMITY
DERAJAT KERUSAKAN
ISCHEMIA
SYOK
UMUR PENDERITA

CRUSH INJURY
IVFD

COMPARTMENT
SYNDROME
TAMPAK TEGANG
ADA GEJALA 6 P
BUKA SEMUA BALUTAN / SPLINT
EVALUASI
FASCIOTOMY

SUSPECTED VASCULAR INJURY

RESUSCITATE

HARD SIGN

SOFT SIGN

API > 0.9

OBSERVE

API<0.9

COLOUR FLOW DUPLEX

ULTRASONOGRAFI

ARTERIOGRAFI

CLINICAL FOLLOW UP
SURGICAL EXPLORATION

ARTERIOGRAM

CLINICAL FOLLOW UP

MASALAH YANG DIHADAPI

Komplikasi

Prolonged ischemia
Secondary haemorrhage
Fail reconstruction, recurrent ischemia
Vascular salvage of union functional limb
Venous thromboembolism
Iatrogenic complication

MASALAH YANG DIHADAPI

Kegagalan rekonstruksi vaskuler

Suture line tention

Missed intimal flap
Missed proximal or distal injury
Retained thrombosis

MASALAH YANG DIHADAPI

Kegagalan rekonstruksi vaskuler

Imperfect anatomosis
Lateral repair without patch
Major venous ligation without repair
Inadequate excision of the damage vessel
Elevated compartment pressures
Infection

PENUTUP
Primary Survey
Secondary Survey
Hard Sign
Soft Sign
Multiple Trauma --- Team

TE R I MA KAS I H