In Traumatic Cases

DR. Med . Dr. Untung Widodo, SpAn.KIC.

Dept. of Anesthesiology & Reanimation
Faculty of Medicine, Gadjah Mada University
Yogyakarta, 2014
I. Introduction
 Before all of examinations should be known :
Death or Alive
 In CPR (Cardio Pulmonary Resuscitation) :
Step 1 : I (Initial Assessment)
 If the Patient is Death :
DNR (Do not Resuscitate)
 If the Patient is Alive :
Help, examine and treatment : A B C D E F G H I
II. Examination
 Like all of the patients examination :
Anamnesis and Physical Examination
 Step 1 : Initial Assessment : the patient looks like
unconscious and no movement with or without
traumatic bleeding wound
Ax. : Are you okey ? !
Pak ?! Bu ?!
Bapak ? Bapak ? ! Bapak?! Ibu ?! Ibu ?! Ibu?!
Bang ! Bang ! Bang !
Mbak ! Mbak! Mbak ! , Mas ! Mas ! Mas !
Dik ! Dik ! Dik!
e t c.
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 Examine : Airway – Breathing
. Look the Thoracal-Abdominal Breathing Movement
Feel the Air Movement on Nose and Mouth

 If breathing movement +, air movement - , continue

with srept A (make free the airway)
 If both are positif, mean Alife, then continue the
next examination
 If both are negative, mean probably Death, then cont.
to the next examination
Examine the Circulation

Carotic Arteria Palpation, don’t more than 10 second

 If no pulsation : continue with Chest Compresion
. If puksation + , check Blood pressure
if BP < 90 mmHg, continue the Resuscitation with
stept D ( Drugs and Fluids )
III. Brain Stem Death
 MBO (Mati Batang Otak)
 Diagnostic procedures for Brain Stem Death :
Test the Function of Brain Stem as the Center of Nervi
Craniales Reflexes
- pupil with light reflex
- Gag reflex
- Doll eyes reflex
Should be negative by two independent physicians
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IV. Next Step
 Alive : Continue Resuscitation
 Death :
- Withdrawing and Withholding the medical treatment
- information to the family
- standard procedure of the hospital
- cultural perform for the patients
V. Coclussion
 When the Patient become unconscious and
unresponsive,
do the diagnostic procedures for Alive or Death
 If Alive : continue to resuscitation
 If Death : Stop the medical treatment
Alhamdulillahi robbil’alamiin