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Baca BTKV DR - Suhardi
Baca BTKV DR - Suhardi
tatalaksana
Trauma
Vaskular
Kegawatdaruratan yang Berpotensi
Irreducible
Open fracture Vascular injury
dislocations
Unstable pelvic
Compartment fracture/
Amputation
syndrome hemodynamic
instability
Displaced
Multiply-injured Spinal cord femoral neck
patient injury and talar neck
fractures
Gangguan
• Kehilangan darah Kerusakan
Trauma • Proses iskemik
ireversibel
vaskular • Sindroma
kompartemen setelah 6 jam
• Kematian jaringan
Kejadian trauma vaskular terus meningkat dipengaruhi oleh
dekatnya pembuluh darah terhadap tulang, tertambatnya
pembuluh darah pada sendi dan pembuluh darah yang
terletak pada daerah superfisial.
Arteri yang Sering Mengalami Trauma
Tibialshaftfx
• Tibialarteries
3%
Patah tulang panjang menyebabkan trauma
vaskular
38%
Fraktur dengan GSW menyebabkan trauma
vaskular
16-40%
Dislokasi lutut menyebabkan trauma
vaskular
Mekanisme Injuri
Iatrogenic
Blunt
trauma
Penetrating
• High energy
trauma • Low energy
• GSW
• Stab
Spasm
Intimal flaps
Tipe Subintimalhematoma
Trauma Laceration
Vaskular Transection
Thrombosis/Occlusion
A-V fistula
Efek Trauma Vaskular
Blood loss
Ischemia
Compartment syndrome
Tissue necrosis
Amputation
Death
Faktor yang Memengaruhi Prognosis
Level and type of vascular
injury
Collateral circulation
Shock/hypotension
Tissue damage (crush
injury)
Warm ischemia time
Patient factors/medical
conditions
Tatalaksana Awal
Resusitasi
cepat
Evaluasi
Tatalaksana
pembedahan
urgensi
Tatalaksana Lanjutan
Control bleeding
Cover wounds
Reduce
fractures/dislocations
Splint
Re-evaluate
Diagnosis
Exploration
Arteriogram
Duplex scanning
Doppler
pressure
(Ankle/brachial
systolic
pressure index
Physical (ABI))
exam
Pemeriksaan Fisik
Major
hemorrhage/hypotension
Injury to anatomically-
Arterial bleeding
related nerve
Temperature
differential between Expanding hematoma
extremities
Adanya aliran
darah arteri
Menentukan
Akses aliran tidak
ada/tidaknya
darah yang menghilangkan
aliran darah
adekuat kecurigaan
arteri
trauma
vaskular
Scan Duplex
Noninvasive
Safe
Rapid
• Injury to arteries
and veins
Reliable for
• A-V fistulas
• Pseudoaneurysms
Duplex vs Arteriography
Scan Duplex
Requires
technician and
scanner
availability
Not all
surgeons will
operate based
on duplex
information
alone
Angiografi
Locates site of
injury
Defines status
of vessels
proximal and
distal
May afford
Characterizes
therapeutic
injury
intervention
Angiografi
Expensive
Time-consuming
Procedural risks
• Renal burden from dye
• Possibility of anaphylaxis
• Injury to proximal vessels
CT Angiografi
Alternative to conventional
angiography
Rapid
Excellent for
detecting site
of injury
Eksplorasi Pembedahan
Cedera arteri
yang jelas pada
saat ujian
Tidak ada
Eksplorasi sinyal doppler
segera
diindikasikan
untuk: Tempat cedera
jelas terlihat
Waktu iskemia
hangat yang
lama
Evaluasi Lanjutan