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Kegawatdaruratan 1
Fanny Indarto, dr. Sp.B
Sylabus
• Acute abdomen & strategi emergensi
• Trauma tumpul abdomen
• Luka bakar
• Fraktur & penanganan emergensi
Acute Abdomen
Schein's Common Sense, 2007
Acute abdomen & Strategi emergensi
• Laboratory : CBC, electrolytes,blood glucose,
renal function, amylase,lipase,lactate
• ECG
• Imaging : chest errect radiograph, plain
abdominal photo, USG, Abdominal CT
Trauma tumpul abdomen
General principles
• The physician evaluating the abdomen should answer two
questions: (a) Is there an intra-abdominal injury and (b)
does this injury require operative repair?
• While addressing these issues, two principles should not be
violated: (a) the ABCs should be adequately assessed
before focusing on the abdomen and (b) clinical
examination should be the most important element of the
evaluation.
• Clinical examination can determine the need for emergent
exploration following abdominal trauma by the presence of
one or both of two signs: (a) peritonitis and (b)
hemodynamic instability. In the absence of these two signs,
there is time for more detailed investigations.
Trauma Manual, 2008

Hemodynamic instability
• Hypotension may occur in the presence of
spinal cord injury without blood loss.
Hypertension may occur even in the presence
of blood loss due to increased intracranial
pressure and a Cushing's reflex.
Peritonitis
• A significant part of the trauma population is
simply nonevaluable because of associated head
injuries, spinal cord injuries, or intoxication. Such
patients receive the most benefit from additional
studies. Intoxication, unless profound, should not
be a reason to avoid clinical examination. Most
patients with mild or moderate intoxication will
manifest abdominal tenderness on careful
evaluation, if intra-abdominal structures are
injured and the reliability of clinical examination
is not impaired.8,9
• FAST : Focus of Abdominal Sonography for
Trauma
• Diagnostic Peritoneal Lavage
• Abdominal CT
• Diagnostic laparoscopy : left
thoracoabdominal injury
FAST
ACS 2007
Diagnostic Peritoneal Aspiration
Shock
Hemorrhagic Spinal
• Source : thoracic, • Source : spine fracture
abdominal/pelvic, femur • Hypotension, bradicardia
fractures • Urine output normal
• Hypotension, tachicardia,
tachipneu
• Low urine output
• Cold extremity, prolonged
capillary refill time
Blunt trauma
• If hemodynamic instability is caused by pelvic
retroperitoneal bleeding, long-bone fractures, blunt
myocardial contusion, spinal cord injury, or intrathoracic
trauma, an unnecessary laparotomy may be profoundly
detrimental.
• Along the same lines, unevaluable blunt trauma patients
need further diagnostic work-up before a decision for
laparotomy is made.
• The presence of a “sealbelt mark” sign is associated with
an incidence of about 20% of intraabdominal injuries.
These patients should be evaluated very carefully and the
threshold for laparotomy should be low
Management
• Spleen : splenectomy/splenoraphy
• Liver : suturing
• Bowel : resect and anastomotic, stoma
• Damage control surgery
Pelvic Wrapping
Luka bakar
• Location plays a major role in the risk for and
treatment of a burn.
Sabiston,2017
• Severe burns covering more than 20% TBSA in
adults and 40% TBSA in pediatric patients are
typically followed by a period of stress,
inflammation, and hypermetabolism,
characterized by a hyperdynamic circulatory
response with increased body temperature,
glycolysis, proteolysis, lipolysis, and futile
substrate cycling
• Burned patients must be removed from the
source of injury and the burning process stopped.
• Inhalation injury should always be suspected, and
100% oxygen should be given by face mask.
• All rings, watches, jewelry, and belts should be
removed because they retain heat and can
produce a tourniquet-like effect.
• Room temperature water can be poured on the
wound within 15 minutes of injury to decrease
the depth of the wound.
• Airway injury must be suspected with facial
burns, singed nasal hairs, carbonaceous sputum,
and tachypnea.
• Upper airway obstruction may develop rapidly,
and respiratory status must be continually
monitored to assess the need for airway control
and ventilatory support.
• Progressive hoarseness is a sign of impending
airway obstruction, and endotracheal intubation
should be instituted early before edema distorts
the upper airway anatomy.
• Small doses of intravenous morphine may be
given after complete assessment of the patient
and after it is determined to be safe by an
experienced practitioner.
• Lactated Ringer solution without dextrose is the
fluid of choice except in children younger than 2
years, who should receive 5% dextrose in lactated
Ringer solution.
• The initial rate can be rapidly estimated by
multiplying the TBSA burned by the patient’s
weight in kilograms and then dividing by 8.
• colloid solutions should not be used in the
first 24 hours until capillary permeability
returned closer to normal.
• All patients with burns of more than 10% TBSA
should receive 0.5 mL of tetanus toxoid.
• If prior immunization is absent or unclear or
the last booster dose was more than 10 years
ago, 250 units of tetanus immune globulin are
also given.
• When deep second- and third-degree burn
wounds encompass the circumference of an
extremity, peripheral circulation to the limb
can be compromised
• Each wound should be dressed with an appropriate
covering that serves several functions.
• First, it should protect the damaged epithelium,
minimize bacterial and fungal colonization, and provide
splinting action to maintain the desired position of
function.
• Second, the dressing should be occlusive to reduce
evaporative heat loss and to minimize cold stress.
• Third, the dressing should provide comfort over the
painful wound.
Fraktur & penanganan emergensi
• In the surgical management of
musculoskeletal injury, the priorities are (1) to
save the patient's life, (2) to save the
endangered limb, (3) to save the affected
joints, and (4) to restore function; these
priorities are pursued in accordance with
advanced trauma life support (ATLS)
guidelines
ACS 2007
Gustillo Anderson
Campbell 2007
• “Damage control orthopaedics,” in the form
of rapid immobilization of fractures with
external fixation to obtain stability and
recover length, while allowing full evaluation
of the extremity, is now standard care
ACS 2007
• Terima Kasih

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