TOTAL CARE

Aryono D. Pusponegoro
Bag. Bedah FKUI /
RSUPNCM

Total Care :

I bandaged him (I make the

wound), but GOD healed him

Ambroise Pare
1545

Total Care:
Don let me don.
Dopamin.

Terapi simptomatik
Tanda2 vital ????
Sel ????

Total Care :

Prof. Syamsuhidayat (1987)

TOTAL CARE

TOTAL CARE :
Patofisiologi.
Organ

Anatomi Makro
sirkulasi.
Sel Mikro sirkulasi.
Listen
To What The Cells Say !!!!

Total Care :
10 Butir Total Care :
1.
Triage ?
2.
Diagnosa ?
3.
Kasus bedah / bukan ?
4.
Masalah yang dapat timbul ?
5.
Jenis op. / teknik op. (School Of Surgery / School
Of Anesthesiology) ?
6.
Timing operasi ?
7.
Masalah prabedah ?
8.
Masalah intrabedah ?
9.
Masalah pascabedah ?
10. Follow Up ?
STRATEGIC THINKING !!!

Total Care :
Triage ?
Primary Survey :
A (Airway).
B (Breathing).
C (Circulation).
D (Disability).
E (Exposure Hipotermi).
Resusitasi bedah
Stop Bleeding.
Stop Contamination.
Damage Control !!!
1.

Total Care :
2. Diagnosa :
Anamnesa M Mech. Of Injury.
I Injury Sustained.
S Symptoms
T Therapy.
Pemeriksaan fisik Cari Injury & Symptoms
Back To Basics.
Nutritional assessment (Body
composition, Biochemical data,
Subjective Global Assessment - SGA)
& Screening.
Laboratorium
Metabolisme anaerob ????
Listen To What The Cells Say.
Gizi : Serum albumin, Total lymph count, Serum
transferin, Serum pre albumin, Total iron
binding capacity, Serum cholesterol.
Imajing Foto polos, USG, CT Scan & MRI dll.
Endoskopi / Laparoskopi D/ & PA.

Total Care :

3. Kasus bedah / bukan ?

Total care :
4. Masalah yg dpt timbul ?
Otak ?
Pernafasan ?
Kardiovaskuler ?
Hati ?
Ginjal ?
Pankreas ?
Consumption Coagulopathy, Surg./ Non Surg.
Bleeding ?
Gut Failure ? Lambung / Ileus.
Gizi ? Normal, Malnutrisi sedang (9% komplikasi),
Malnutrisi berat ( 42% komplikasi)
Imunologi SIRS, CARS, MARS ?
Strategic Thinking !!!

Total Care :
5. Jenis tindakan / teknik operasi ?
School of Surgery ?
School of Anesthesiology ?
1, 2, 3 & 4 Informed Consent.
Communication
Skill !!!

Total Care :
6. Timing operasi ?
Gawat Darurat ?
Segera ?
Tunda ?
Konservatif ?
Elektif ?

Total Care :
7. Masalah prabedah ?
Hernia inkarserata 3 hari / 1 Hari ?
Butir 4 : Geriatric Problem ?
Masalah A, B, C ?
Metabolism, elektrolit, asambasa ?
Toleransi operasi ???
Strategi berubah !!!

Total Care :
8. Masalah intrabedah ?
Fasilitas kmr operasi ?
Teknik operasi ?
Mampukah saya ???
Teknik anestesi mana &
dampaknya ?
Hanya resusitasi bedah / definitif ?
Op elektif Triad Of Death
Damage Control ?

Total Care :
9. Masalah pascabedah ?
Evaluasi butir 1 8 ?
A? B? C? D? Hipotermi ?
Listen To What The Cells Say
Ruangan bedah ?
SICU / HCU ?
ICU / ICCU ?
MASALAH SEL ???
Mikrosirkulasi ???

Total Care :
10. Follow Up ?
Di bangsal : A (Airway) ?
B (Breating) ?
C (Circulation) ?
D (Disability) ?
Listen To What The Cells Say !!!!
Di poli :
Apakah EQUILIBRIUM (Claude Bernard)
sdh dicapai ?