PROGRAM STUDI ILMU KEPERAWATAN (S1)

DASAR PENANGANAN
PENDERITA GAWAT 1

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Bagian UPF Ilmu Bedah
Fakultas Kedokteran Universitas Muhammadiyah Malang

Penderita Gawat Darurat

Penderita yang oleh karena suatu penyebab
(penyakit, tindakan, kecelakaan) bila tidak
segera ditolong akan cacat, kehilangan
anggota tubuh atau meninggal butuh
tindakan CEPAT dan TEPAT

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

SISTEM PELABELAN TRIAGE

MERAH Gawat + Darurat
ex: Multiple trauma + Syok Hemorragic
MERAH Gawat + tidak Darurat
ex: Ca Mamma Std IV (paru/hepar)

KUNING tidak Gawat + Darurat

ex: Fraktur tulang tertutup (simple)
HIJAU tidak Gawat + tidak Darurat
ex: Sakit Influenza
HITAM DOA (Death on Arrival)
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

HASIL SURVEY DI PROPINSI :

NTT, KALBAR, KALTENG, SUMUT, BENGKULU
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Trauma
Non trauma

Macam Kasus
Trauma / kecelakaan lalu lintas
Diare
Malaria panas kejang
ISPA batuk sesak
Stroke tidak sadar
TBC batuk darah sesak
Jantung hipertensi, infark
Obsgyn perdarahan, eklampsia
Intoksikasi gigitan ular - peptisida

% Kasus
20 %
17 %
15,6 %
12,2 %
8,6 %
7,7 %
7,6 %
6,4 %
4,9 %

: 25 %
: 75 %
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

BILA TERJADI HENTI NAFAS DAN HENTI JANTUNG

Keterlambatan

Kemungkinan berhasil

1 menit

98 / 100

4 menit

50 / 100

10 menit

1 / 100

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PENDERITA GAWAT DARURAT

HIPOKSEMIA
HIPERKARBIA

HENTI JANTUNG
HENTI NAFAS

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

CONCEPT
ABCDE approach to evaluation / treatment
Life support is very important
Definitive diagnosis not immediately important
Time is of the essence
Do no further harm

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

INITIAL ASSESSMENT / MANAGEMENT

Injury

Primary survey and adjuncts

Resuscitation
Reevaluation
Secondary survey and adjuncts
Reevaluation
Optimize patient status
Transfer

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Primary survey and resuscitation

Of vital functions are done
simultaneously a team approach

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PENANGANAN PASIEN TIDAK GAWAT

Anamnesis
Pemeriksaan fisik
Inspeksi
Palpasi
Perkusi
Auskultasi

Pemeriksaan penunjang
Diagnosis
Terapi
Supportif
Simtomatis
Definitif / Causatif

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PENANGANAN PASIEN GAWAT DARURAT

Pem. Fisik awal

(Primary survey)

(A-B-C-D)
+ Lab. Awal

Terapi suportif / resusitasi (life support)

Stabilisasi
Pem. Fisik sekunder (Secondary survey)
Anamnesis
Dari kepala s/d kaki (B1 s/d B6)
Pemeriksaan penunjang
Diagnosis

Terapi defenitif

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

KONSEP ATLS

Primary Survey
A : Airway with C-spine control
B : Breathing with ventilation
C : Circulation with hemorrhage control
D : Disability : neurologic status
E : Exposure/environment with temperature control
Resuscitation
Secondary Survey
Head to toe evaluation and history
Reevaluation

Definitive care
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

LIFE SUPPORT
A

: Airway Support

: Breathing Support

: Circulation Support

: Disability / Brain Support

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Dr. Bedah

Dr. Obgyn

Perdarahan
trauma

Perdarahan post partum

SHOCK
KARENA
PERDARAHAN

1
2

Dr. Penyakit
Dalam

Resusitasi
Stabilisasi

Dr.
Umum

Definitif terapi
awal
Definitif terapi
akhir

Dr.
Spesislias

Perdarahan
G.I.

Pembagian Peran Dr. Umum Dr. Spesialis

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PROTECTION FROM COMMUNICABLE DISEASE

Water impermeable apron

Gown
Gloves
Face mask
Cap
Eye protection / goggles
Foot covers

To prevent contact with body fluids patients

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PRIORITAS UTAMA
Airway
Bebas dan terjaga
Breathing / ventilation
Adekuat
Supplemen O2
Adekuat

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PRIMARY SURVEY

Establish patent airway

Caution sign Cervical spine injury

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PRIMARY SURVEY

Assume C-Spine Injury

Multisystem trauma
Altered level of consciousness
Blunt injury above clavicle
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

SUMBATAN JALAN NAFAS

Penyebab
Pe kesadaran

Tindakan anestesi
Koma
Trauma kepala
Radang otak
Obat / alkohol
dll

Suatu penyakit
Laringitis
Edema laring

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

sumbatan jalan nafas

Trauma / Kecelakaan
Maksilofacial
Jalan nafas
dll

Benda asing
Darah
Muntahan
Makanan
dll

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

sumbatan jalan nafas

Macam
Parsial
Ringan
Berat

Total

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

TRAUMA / NONTRAUMA
PENDERITA
TAK SADAR

RELAKSASI
OTOT

HILANG REFLEKS
PERLINDUNGAN

LIDAH

KLEP

SUMBATAN
JALAN NAFAS

MUNTAH
REGURGITASI

ASPIRASI
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

SUMBATAN JALAN NAFAS

Look / Lihat
Perubahan Status Mental
Agitasi / gelisah Hipoksemia
Obtundasi / teler Hiperkarbia
Gerak Nafas
Normal
See saw / rocking
Retraksi
Deformitas
Debris
Darah / sekret
Muntahan
Gigi
Sianosis
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

SUMBATAN JALAN NAFAS

Listen / Dengar
Bicara normal Tak ada sumbatan
Ada suara tambahan
Snoring Lidah
Gurgling Cairan
Stridor / crowing Penyempitan
Suara parau (hoarseness / dysphonia)
Feel / Raba
Hawa nafas
Krepitasi / fraktur (maxillofacial / laryngeal)
Deviasi trakhea
Hematoma
Getaran di leher
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

MACAM SUMBATAN
LOOK

LISTEN

FEEL

SUMBATAN

GERAK
NAFAS

BEBAS

NORMAL

PARSIAL RINGAN

NORMAL

PARSIAL BERAT

SEE SAW

TOTAL

SEE SAW

SUARA
HAWA
TAMBAHAN EKSHALASI

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PENGELOLAAN PERLU :

CEPAT, TEPAT, CERMAT

Sumbatan Total :

FRC (Functional Residual Capacity) : 2500 ml

Kadar O2 15% x 2500 ml

: 375 ml

Kebutuhan O2 permenit

: 250 ml

Sumbatan total O2 dalam paru habis dalam 1,5 menit

(375 / 250)

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PENYEBAB SUMBATAN
Lidah
Epiglotis
Benda asing / muntahan / darah / sekret
Trauma jalan nafas

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PEMBEBASAN JALAN NAFAS

PENYEBAB LIDAH
Manual :
- Non trauma :
Head tilt
Neck lift
Chin lift
Jaw thrust
- Trauma :
Chin lift
Jaw thrust
Dengan in-line manual immobilization / pasang cervical collar
Bantuan Alat
- Oropharyngeal airway
- Nasopharyngeal airway
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

head tilt

neck lift

chin lift

Dont do

Be careful
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

OROFARINGEAL TUBE

Perhatikan ukuran

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

OROFARINGEAL TUBE

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Nasopharyngeal tube

Tidak merangsang muntah

Ukuran u/ dewasa 7 mm / jari kelingking kanan
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

PEMBEBASAN JALAN NAFAS

PENYEBAB BENDA ASING
Manual
Penghisap

Definitive airway

Pada choking :
Back blows
Abdominal thrust (Heimlich manuver)
Thoracal thrust
Cricothyroidotomy
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

CHOKING
Back blows
5x hentakan pada punggung,
diantara dua scapula

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

CHOKING
Heimlich
Abdominal trust

Korban : sadar
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Heimlich Abdominal trust

Korban : Tidak sadar

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

dr. Mochamad Aleq Sander, Sp.B., M.Kes.

DEFINITIVE AIRWAY
Cuffed tube in trachea

Secure airway
Ventilation
Types :
* Endotracheal intubation
* Surgical airway: - Cricothyrotomy
- Tracheotomy
dr. Mochamad Aleq Sander, Sp.B., M.Kes.

Membrana cricothyroid

Pada keadaan gawat darurat

- Tempat injeksi transtracheal
obat emergency
- Tempat untuk needle dan

surgical cricothyroidotomi

dr. Mochamad Aleq Sander, Sp.B., M.Kes.