PBL REPORT

TRAUMATOLOGY

RESPIRATORY FAILURE
GROUP 6
GROUP 6

• NURUL FITRIAH JUNAID 11020160046

• RESKY ASFIANI RAHMAN 11020160051
• RIDHA MARDHATILLAH 11020160048
• MUHAMMAD SYARIFULLAH
11020160042
• FIRMAWATI AR. 11020160171
• DEFINA BUDI 11020160036
• SITTI PUTRI SRIYANTI ASIS 11020160037
• MUHAMMAD FARID JAMAL 11020160049
• RIYSKA AMALIA 11020160027
• RESKY KARNITA DEWI 11020160072
SCENARIO

A 30 years old woman take to the

puskesmas after having a crash
accident an hour ago. On physical
examination, blood pressure 90/40
mmHg, pulse 100x/minute,
respiration 26x/minute, temperature
37○c, visible bruise on the left arm,
bruises on the left chest and visible
glass fragmnets in the left axilla.
During the observation in the
emergency suddenly the pastient
suffer from severe shorthness of
breath to cyanosis and decrease of
consciousness.
KEYWORDS

• A 30 years old woman take to the

puskesmas after having a crash accident an
hour ago
• blood pressure 90/40 mmHg 
hypotensiom
• pulse 100x/minute  normal
• respiration 26x/minute  hiperkapnia
• temperature 37○c  normal
• visible bruise on the left arm
• bruises on the left chest
• visible glass fragmnets in the left axilla
• suddenly the pastient suffer from severe
shorthness of breath to cyanosis and
decrease of consciousness
QUESTIONS

1. Explain about the primary survey and secondary

survey of the respiratory failure?
2. Explain the classification of respiratory failure?
3. Explain about the respiratory failure
pathomechanism?
4. How to maintenance or do stabilization the patient
with the respiratory failure that caused by
trauma?
5. What is possibly compication that may happen in
the early management and how to solve it?
6. Explain about the way of using emergency drugs?
7. How to do transportation and patient’s referral
with the respiratory failure?
8. Mention the perspective of Islam that fits the
scenario?
ANSWERS
The Primary Survey And
Secondary Survey Of The
Respiratory Failure
 Response

kualitatif kuantitatif

AVPU GCS

• A = Alert Green • Eye • Verbal • Motorik

• V = Verbal
Yellow 4 Open 5 : Oriented 6 : Obeys command
• P = Pain
Spontaneously
• U = Unrespond Red

Black 3 : Open to 4 : Confused 5 : Localising pain

verbal command

2 : Open to pain 3 : Inappropriate 4 : Withdrawal to pain

words

1 : No eye 2 : Incomprehensible 3 : Flexion from pain

opening sounds
1 : No verbal response 2 : Extension from pain

1 : No motor response
 Airway and C-Spinecontrol

Penilaian

Look

penilaian

Feel Listen

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
 Signs of airway obstruction :
• Snoring
• Gargling
• Crowing
• Flaring of the nostrils
• Tracheal retraction
• Thoracic retraction
• There is no sense of expiratory air

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
 Without tools

Head tilt/chin lift

maneuver Jaw Trhust Manuever

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
 Penanganan dengan alat
Oropharyngeal airway Nasopharyngeal airwayendotracheal tube (ETT)

Nasotracheal airway laryngeal mask airway

Suction

Oropharyngeal tube
 Breathing

Improve the function of ventilation by providing artificial respiration to ensure

the need for oxygen and CO2 emissions
Respiratory distress sign:
1. Nasal lobe movements
2. Straining muscles of breathing aids
3. Muscle pull between the ribs

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Circulation
Check:
a. The presence / absence of circulation,
the radial-cubitis-brachialis-femoral-
carotid pulsations
b. Calculate pulse frequency
c. Pulse regularity
d. Large pulse volume
e. Beating lift strength
f. Peripheral perfusion: warm, red, dry
g. Check for signs of head, chest,
abdominal, spinal and long bones
injuries
In the patient, the radial pulse was not
palpable and the patient looked
The possibility of the patient
experiencing shock, especially
hypovolemic shock.
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
• Shock position: Both legs are higher than the heart
• administration of fluids:
Initial treatment: RL as the first choice and
second choice NaCl. The liquid is warm up to 2 L
in adults IV bolus, then the patient's condition is
monitored and the dose is adjusted to the
patient's condition

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Disability

( Neurologic Evaluation )
Evaluate using the AVPU method,
namely:
• A = Alert / Awake: fully aware
• V = Verbal stimulation: there is a
reaction to the command
• P = Pain stimulation: there is a
reaction to pain
• U = Unresponsive: not reacting

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
Exposure

Clean the patient's clothes, warm with a blanket, prevent

hypothermia, use appropriate clothing.

Initial Assesment dan Resusitasi dalam Advence trauma life Support (ATLS) Manual untuk Peserta Kursus. Jakarta :
American College of Surgeons. Ed-9. 2013
The Classification Of Respiratory
Failure
 Classification of the
respiratory failure

• oxygenation failure, arterial hypoxemia

• PaO2 <60 mmHg when inhaling ambient air.
Type I Respiratory
Failure

• ventilation failure: arterialhypercapnea

• PaCO2> 46 mmHg, and is followed simultaneously
Type II Respiratory by a decrease in PaO2 - PaO2 that remains
unchanged.
Failure
Respiratory failure can also be
distinguished based on the cause

Trauma Non Trauma

• Pneumothorax • Effusion
• Hemothorax, • Asthma
• Hydropneumothorax • Pneumonia
• Foreign body obstruction • Vascular disease
• Flail chest • Muscular dystrophy
• Brain infarction or bleeding • Polymyositis, and others.
The Respiratory Failure
Pathomechanism
Stabilization The Patient With The
Respiratory Failure That Caused By Trauma
Complication That May Happen In
The Early Management And How To
Solve It
1. Subcutaneous emphysema
Air in subcutaneous fat tissue is called subcutaneous emphysema. Air
can be from the outside, from the lungs penetrate the visceral and pa
rietal pleura into the subcutis or air from the lungs to the mediastinu
m and to the subcutis without pleural damage.
Suppression of blood vessels due to air entering the pericardial cavity
or in the blood vessels in the neck so that it blocks blood returning to
the heart.
Therapy : The first thing to do is to use a chest tube and make sure th
e chest tube is functioning properly (if the cause is a pneumothorax).
Installing a catheter or a small incision in the skin can help expel air fr
om subcutaneous tissue.
 2. Shock
Shock is an emergency caused by the failure of blood perfusion to the tiss
ues, resulting in impaired cell metabolism. Hypovolemic shock is shock ca
used by blood loss or hemorrhagic shock. that can caused by : trauma, gas
trointestinal bleeding, hematothorax etc.
The most common causes of hypovolemic shock are gastrointestinal muco
sal bleeding and severe trauma. Hemothorax can occur in traumatic pneu
mothorax so that intravenous access with a large cannula is required for fl
uid resuscitation if the patient experiences worsening to shock.
Management :
Manage Airway, breathing, circulation
Oxygen Therapy
Simple Aspirations
Thoracostomy Hose or Intercostal Catheter

Reference :
•American College of Surgeon. Thoracic trauma. In: Advanced Trauma Life Support, 10th ed. 2018: 65-8.
•Faculty of Medicine, University of Indonesia. 1999. Capita Selekta Medicine, Jakarta: Media Aesculapius.
•Faculty of Medicine, University of Indonesia. 1995. Collection of Surgery Studies, Jakarta: Binarupa Aksara
The Way Of Using
Emergency Drugs
EMERGENCY DRUGS

ADRENALIN
ATROPIN
CEDILANID
DOPAMIN
LIDOCAIN
EPHEDRIN
FUROSEMIDE
Transportation And
Patient’s Referral With The
Respiratory Failure
 Terms of transportation:

1. Stabilization

Is a process to maintain the condition and position of the patient / patient to remain
stable during the first aid

2. Transportation

Is a business process to move from one place to another without using tools.
Depending on the situation and conditions in the field.

Stabilization Principle

• Maintain the patient so as not to move much in connection with the circumstances
experienced

• Maintaining the patient so that breathing remains stable

• Keep the bleeding from increasing

• Maintaining the patient's level of consciousness does not fall in an even worse state.

Soertidewi L. Penatalaksanaan Kedaruratan Cedera Kranio Serebral, UpdatesIn Neuroemergencies, Tjokronegoro A, Balai Penerbit KUI, Jakarta, 2002, 80
 • Effective Stabilization Unit:

- Rapid resuscitation

- stop bleeding & maintain resuscitation

- Immobilization if there is a fracture

- Analgesia

• Steps for stabilization:

-Pay attention and handle the airway

- Pay attention to bleeding & control bleeding if any, prevent immediately and

handle shock

- Look for and note the existence of injuries related to other disease

processes

- Pay attention to the heart's status (pulse, sound, flow, etc.)

Soertidewi L. Penatalaksanaan Kedaruratan Cedera Kranio Serebral, UpdatesIn Neuroemergencies, Tjokronegoro A, Balai Penerbit KUI, Jakarta, 2002, 80
 The patient to be referred must be examined and eligible to be
referred. The criteria for referred patients are if they meet one of:

1. The results of the physical examination can certainly not be overcome.

2. Results of physical examination with medical support examination turned

out to be unable to be overcome.

3. Requires a more complete medical support examination, but the

examination must be accompanied by the patient concerned.

4. If it has been treated and cared for, it requires examination, treatment and
care at health facilities that are more capable.

Aziz H.Pranoko, Duta Dhanabhalan. Sistem Rujukan Puskesmas Batealit Jepara [internet]. Semarang. 2012 [cited 2019 Sep 25] Tersedia di
:http://www.scribd.com/doc/115164565/protap-sistem-rujukan-puskesmas
 Reference Preparation

The preparations that must be made before referring are:

1. Preparation of health workers, make sure the patient and family are accompanied by a

minimum of two competent health workers (doctors and / or nurses).

2. Family preparation, inform the patient's family about the patient's latest condition, and

the reasons why need to be referred. Other family members must take the patient to

the place of referral.

3. Preparation of the letter, give a letter of introduction to the place of reference,

containing the patient's identity, reasons for the referral, actions and drugs that have

been given to the patient.

4. Equipment Preparation, bring necessary equipment and materials.

Aziz H.Pranoko, Duta Dhanabhalan. Sistem Rujukan Puskesmas Batealit Jepara [internet]. Semarang. 2012 [cited 2019 Sep 25] Tersedia di
:http://www.scribd.com/doc/115164565/protap-sistem-rujukan-puskesmas
 5. Medication preparation, carrying essential medicines needed during the

referral trip.

6. Vehicle Preparation, prepare a vehicle that is good enough, which allows

the patient to be in a comfortable condition and can reach the place of

referral as soon as possible. Complete the ambulance, tools and materials

needed.

7. Preparing money, remind the family to bring enough money to buy

medicines and health materials needed at the place of reference.

8. Donor preparation, prepare blood bags according to the blood type of the

patient or prospective blood donor from the family who are guarding

against possible cases that require blood donation

Aziz H.Pranoko, Duta Dhanabhalan. Sistem Rujukan Puskesmas Batealit Jepara [internet]. Semarang. 2012 [cited 2019 Sep 25] Tersedia di
:http://www.scribd.com/doc/115164565/protap-sistem-rujukan-puskesmas
Perspective Of Islam That
Fits The Scenario
 “And Let Not Those Of You Who
Possess Grace And Abundance Swear
Against Giving To The Near Of Kin And
Poor And Those Who Field’s In Allah’s
Way, And They Should Pardon And
Turn Away. Do You Not Love That
Allah Should Forgive You? And Allah Is
Forgiving, Merciful ”

An-nur : 22
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