INITIAL ASSESSMENT FOR

TRAUMA
By
Rossi M I Sebayang

PENDAHULUAN
KEMAJUAN LALU LINTAS
- PENGGUNA JALAN
- JUMLAH KENDARAAN
- JARINGAN JALAN
- KECEPATAN KENDARAAN

ANGKA KEJADIAN KECELAKAAN LALIN /

TRAUMA ME

KECELAKAAN / TRAUMA
-TAK DIKETAHUI
- KAPAN
- DIMANA
- KENAPA

PERLU PERTOLONGAN !!!

CEPAT

BENAR

-TEMUKAN PENDERITA GAWAT DARURAT

- MINTA PERTOLONGAN / TEAM
- KUALITAS PERTOLONGAN
- PRASARANA / PRASARANA

BASIC PRINCIPLES
TRAUMA

DEATH

MORBIDITY

PHASES OF TRAUMA CARE

PRE HOSPITAL
- Transport guidelines/protocolsOn-line
medical direction
- Mobilization of resources
- Periodic review of care

PHASES OF TRAUMA CARE

INHOSPITAL
- TRIAGE
- PRIMARY SURVEY
- RESUSCITATION
- SECONDARY SURVEY
- CONTINUED MONITORING
- DEFENITIVE TREATMENT

TRAUMA IN
CHILDREN
YOUNGER
ADULT
ELDERLY
PREGNANT WOMEN

PRIORITIES ARE THE SAME

OBJECTIVE
Identifikasi prioritas managemen
Aplikasi prinsip2 primary dan secondary survey
Lakukan resusitasi & monitoring
Perhatikan riwayat kejadian & biomekanik injury
Antisipasi bahaya/kesulitan2 yang tersembunyi

In general, trauma triage

and initial care is based on
a step-wide evaluation of
both anatomic injury and
physiologic stability.

PRIMARY SURVEY
Elderly, adult, younger, children,
pregnant women : Priorities are the
same
A : Airway + C-spine protection
B : Breathing
C : Circulation + hemorrhage control
D : Disability
E : Exposure/Environment

PRIMARY SURVEY
A = AIRWAY / C SPINE
JALAN NAFAS /TL BELAKANG CERVIKAL

PASTIKAN BAHWA JALAN NAFAS BERSIH

- BENDA ASING
- MANUVER
KASUS SPESIAL
IN LINE TRACTION = TRAKSI SEGARIS
RESIKO TINGGI CEDERANYA C SPINE
PITFALLS (HAL2 YG TERSEMBUNYI)

PRIMARY SURVEY
B = BREATHING AND VENTILATION
BERNAFAS DAN VENTILASI
BERSIHNYA JALAN NAFAS SAJA TDK
MENJAMIN VENTILASI YANG ADEKUAT
PASIEN TRAUMA MEMBUTUHKAN PERTUKARAN GAS
YANG ADEKUAT
EVALUASI DINDING DADA
AUSKULTASI PARU-PARU
PERKUSI ADANYA CAIRAN / DARAH

PRIMARY SURVEY
B = BREATHING AND VENTILATION

BERNAFAS DAN VENTILASI

MAJOR INJURIES :
TENSION PNEUMOTHORAX
FLAIL CHEST
MASSIVE HAEMOTHORAX
OPEN PNEUMOTHORAX
MINOR INJURIES :
RIB FRACTURES
SIMPLE HAEMO / PNEUMOTHORAX
PULMONARY CONTUSION

PRIMARY SURVEY
B = BREATHING AND VENTILATION
BERNAFAS DAN VENTILASI
THE PATIENT IS DYSPNOE,
TACHYPNOE RR = 35 X/i
YOU DECIDE TO INTUBATE /
VENTILATE

PRIMARY SURVEY
C = CIRCULATION AND CONTROL OF BLOOD LOSS
SIRKULASI DAN KONTROL PERDARAHAN

STATUS HAEMODYNAMIC PENDERITA

DI ASSESS SECARA CEPAT
HYPOTENSION YG MENYERTAI TRAUMA ADALAH
HYPOVOLEMIC KECUALI KENYATAAN SEBALIKNYA
HAEMORRHAGE ADALAH PENYEBAB KEMATIAN KE2 PASCA TRAUMA

PRIMARY SURVEY
C = CIRCULATION AND CONTROL OF BLOOD LOSS
CLINICALLY, ASSESS
1. LEVEL OF CONSCIOUSNESS
BLOOD LOSS

2. SKIN COLOUR
C.V.P.

3. PULSE

PRIMARY SURVEY
CONTROL BLEEDING
DIRECT PRESSURE BEFORE
USING TOURNIQUETS
BEFORE USING CLAMPS

PRIMARY SURVEY
CONTROL BLEEDING
KONTROL PERDARAHAN
THINK OF THE SITE

THORAX

ABDOMEN
RETROPERITONEUM
FRACTURE SITE
PENETRATING THORAX

PRIMARY SURVEY
PITFALLS REGARDING BLOOD LOSS
BEWARE OF THE ELDERLY AND CILDREN
BEWARE THOSE ON BETA BLOCKERS
BEWARE FIT MALES (ATLIT)

The Lethal Triad

SHOCK

Prolonged hypotension
Metabolic
Acidosis
DEAT
H

Coagulopath
Hypotherm
y
ia
Rotondo MF, Zonies DH. Surg Clin North Am 1997; 77(4): 761-777

PRIMARY SURVEY
D = DISABILITY NEUROLOGICAL EVALUATION
DONE AT THE END OF THE PRIMARY SURVEY

AVPU

GCS

DROP IN LVL. OF CONSCIOUSNESS

RE EVALUATE OXYGENATION, VENTILATION, AND
IS IT A DIRECT CEREBRAL INJURY ?
ARE THERE ALCOHOL OR DRUGS INVOLVED ?

PERFUSION

PRIMARY SURVEY
E = EXPOSURE / ENVIRONMENT
EXPOSURE IS IMPORTANT
LOGROLL THE PATIENT
MAINTAIN THE CORE TEMPERATURE

THE RESUSCITATION PHASE

AGGRESSIVELY RESUSCITATE PATIENTS TO
INCREASE SURVIVAL
AIRWAY BERSIHKAN, BEBASKAN, LINDUNGI
IF THE PATIENT CANT
MAINTAIN AIRWAY INTEGRITY
PLACE A
DEFINITIVE AIRWAY
INTUBATE WITH CONTINUOUS C SPINE
PROTECTION !!!

THE RESUSCITATION PHASE

BERIKAN CAIRAN CRYSTALLOID OR COLLOID ??

ATASI HYPOVOLEMIA DAN HAEMORRHAGE !!!

HAMPIR SEMUA SHOCK PD TRAUMA ADALAH

HYPOVOLEMIC !!!!

HENTIKAN PERDARAHAN, BUKAN BERIKAN CAIRAN

PULIHKAN VOLUME INTRAVASCULAR

MONITORING DURING
RESUSCITATION
ECG MONITORING SINUS TACHYCARDIA
ST CHANGES
ATRIAL FIBRILLATION
PEA (Pulseless Electrical
Activity)
BRADYCARDIA
TUBES
URINARY CATHETERS
NASOGASTRIC DECOMPRESSION

MONITORING DURING
RESUSCITATION
TUBES
INSTRUMENT THE UNCONSCIOUS PATIENT
CAREFULLY
BEWARE OF URETHRAL TRANSECTION

MONITORING DURING
RESUSCITATION
MONITORING
RESUSITASI YG ADEKUAT DI ASSESS DENGAN
PARAMETER FISIOLOGIS
- HR
- BP
- PULSE PRESSURE
- RR
- ABG ANALYSIS
- URINE OUTPUT

MONITORING DURING
RESUSCITATION

RE EVALUATE ALL
PARAMETERS
ALL THE TIME

SECONDARY SURVEY
JANGAN DIMULAI SAMPAI ABCDEs
(PRIMARY SURVEY) TERSELESAIKAN
JANGAN DIMULAI SAMPAI KEADAAN
PASIEN MEMBAIK
JANGAN DIMULAI SAMPAI FASE
RESUSITASI MEMBAIK

SECONDARY SURVEY

HISTORY

AMPLE
MECHANISM OF INJURY
FULL EXAMINATION
HEAD AND FACE
NECK
CHEST
ABDOMEN
MUSCULOKELETAL
NEUROLOGICAL
IMAGING

IMPORTANT POINTS IN TRAUMA

FULL ASSESSMENT
EVALUASI BERKELANJUTAN DAN
SELALU DIULANGI
MULTIDISCIPLINARY APPROACH

IMPORTANT EXAM POINTS IN

TRAUMA

BERPEGANG PD BASIC PRINCIPLES

SETIAP PERMASAALAHAN TRAUMA
SECARA GLOBAL DI ASSESSMENT
DENGAN MENGGUNAKAN ATLS /
ACLS PROTOCOLS