Prehospital:

- Via telepon, cari info pasien

- Siapkan APD

Primary Survey
A. Airway and C-spine protection
1. Assessment
- Yakinkan patensi: look, listen, feel
- Assess obstruksi jalan napas:
agitated/obtundation? sianosis? retraksi? Pulse oxi?
Stridor? gurgling? snoring? serak? Trakea midline?
Palpasi sternoklavikular (dislok post kaput klav)
2. Management (proteksi C-spine dgn imobilisasi manual, lalu O2 sblm dan ssdh airway
manage)
- Chin-lift/jaw thrust
- Bersihkan korpal dari airway (rigid suction)
- Masukan OPA (ukurannya dari mulut ke ear lobe pasien)
- LEMON
- Definitif airway (intubasi or krikotiroidotomi surgical)
- gagal? smtra LTA/LMA/multilumen
- Describe jet insufflation of the airway, noting that it is only a temporary procedure
B. Breathing
1. Assessment
- Inspeksi dada & leher:
+ laju dan kedalaman respirasi
+ Deviasi trakea, pergerakan dinding dada uni/bi
+ penggunaan otot bantu pernapasan, tanda2 cedera
- Perkusi paru
- Auskultasi paru
2. Management
- O2, bag mask 11 Lpm
- Tension pneumo: needle decompression
- Open pneumo: seal 3 sisi
- Oksimeter
C. Circulation with hemorrhage control
1. Assessment:
- Cari penyebab perdarahan: blood on the floor and four more (thoraks, abd, pelvis, paha)
- Nadi: kualitas, rate, regularitas, paradoks
- Warna kulit
- TD bila sempat
2. Management
- Direct pressure eksternal
- Cari penyebab internal, konsul
- Dua IV cath kaliber besar
- ambil darah: hematologi, kimia darah, pregnancy test, crossmatch; ABC
- IV fluid hangat 1-2 L, or 20 cc/kg
- cegah hipotermia
D. Disability
- GCS, Pupil, lateralisasi
- Spine cord injury
E. Exposure/environment
F. Adjuncts:
- AGD, ventilatory rate
- monitor CO2 exhaled
- UO/NGT?
- CXR/pelvis?
- FAST/DPL?
G. Reassess ABCDE dan pertimbangkan utk transfer

Secondary Survey
Ketika primary survey selesai, usaha resusitatif sdg berlangsung, mulai nampak normalisasi
fungsi vital

A. An
1. AMPLE
Allergy
Medication
Past illness/pregnancy
Last meal
Event/environment
2. Injury-producing event, injury mechanisms
a. Tabrakan mobil dari depan
Bent steering wheel; knee imprint, dashboard, bull's eye fracture, wind-screen
- flail chest anterior, pneumotoraks
- Kontusio jantung, Disrupsi aorta traumatik
- Fraktur C-spine
- Ruptur limpa/liver
- Dislok/fraktur posterior hip dan/atau lutut
b. Tabrakan mobil dari samping
- Neck sprain kontralateral, fraktur c-spine
- Flail chest lateral, Pneumotoraks
- Disrupsi aorta traumatik
- Ruptur limpa/liver dan/atau ginjal (tergantung sisi impak)
- Fraktur pelvis or asetabulum
c. Tabrakan mobil dari belakang
- Cedera c-spine
- Cedera jaringan lunak leher
d. Terlempar dari kendaraan:
Tidak bisa diprediksi, but at greater risk
e. Tabrakan kendaraan dengan pejalan kaki:
- Cedera kepala
- Disrupsi aorta traumatik
- Cedera visera abdomen
- Fraktur ekstremitas bawah/pelvis
B. PF
0. Neuro: GCS, lateralisasi, pupil
1. Kep:
Assess: laserasi, kontusio, fraktur, luka termal
- pupil, perdarahan, luka tembus, Visus, dislok lensa, kontak lens
- n. kranial
- rinore, otore
- mulut: perdarahan dan CSS bocor, gigi goyang, ST trauma
- maksilofasial: deformitas, maloklusi, krepitasi
Manage:
- maintain airway, continue ventilation, oxygenation as indicated
- kontrol perdarahan
- cegah 2ndary brain injury (hipotensi, hipoksia, hiperkapnia, hipokapnia iatrogenik)
- lepas kontak lens
2. Cervical spine & Leher:
Assess
- ins: trauma, deviasi trakea, otot nafas tambahan
- palp: nyeri, deformitas, bengkak, emfisema subkutan, pulsasi
- aus: a. karotis -> murmur
- CT c-spine, or lateral cross table c-spine X-ray
Manage: maintain inline immobilization dan c-spine protection
3. Toraks
Assess
- ins trauma, otot nafas tambahan, perg dinding dada
- aus: sp, rh, wh, bising jantung
- palpasi: trauma, emfisema, nyeri tekan, krepitasi
- perkusi: hiperresonans/pekak
Manage:
- Needle decompretion or tube thoracostomy
- water seal drainage
- dress an open chest wound
- Pericardiosentesis kalo perlu
- Pindahkan pasien ke ruang operasi
4. Abd
Assess
- ins: trauma, perdarahan internal
- aus: BU
- palp: NT, defans, nyeri lepas, uterus hamil
- kompresi distraksi, pelebaran simfisis pubis (palpasi)
- Pelvic X-ray, DPL/FAST bila perlu, CT abd bila hemodinamik normal
Manage
- Transfer pasien ke rg op
- Wrap a sheet di pelvis/apply pelvic compression binder
5. Perineum/rektum/vagina
- Perineum: kontusio, hematoma, laserasi, perd. uretra
- Rektum: perd, RT, fragmen tulang
- Vagina: darah, laserasi
6. Muskulo:
Assess
- look, feel, movement
 - status distalis
- inspeksi dan palp v. torakalis, lumbalis: laserasi, deform, sensorik, NT
- Pelvic X-ray; X-ray of suspected fracture sites
Manage
- Splinting device (apply and/or readjust)
- Maintain imobilisasi spine torakal dan lumbar
- Wrap a sheet di pelvis/apply pelvic compression binder
- Splint utk imobilisasi cedera ekstremitas
- Imunisasi tetanus
- Administer medications as indicated/directed by specialist
- Pertimbangkan kompartemen sindrom
- cek neurovaskular ekstremitas

C. Adjuncts:
- X-ray spine
- CT kepala, dada, abdomen, dan/atau spine
- Urografi kontras
- Angiografi
- X-ray ekstremitas
- US transesofageal
- Bronkoskopi
- Esofagoskopi