DASAR PENANGANAN PENDERITA GAWAT

BASIC GENERAL EMERGENCY LIFE SUPPORT

Anestesiologi dan Reanimasi RSUD Tasikmalaya

TPU
Peserta mampu menangani penderita gawat darurat dengan baik dan benar

TPK
Peserta mampu : 1. Mengenal penderita gawat darurat 2. Mengetahui macam-macam penyebab kegawat daruratan 3. Memahami sistematika penanganan penderita gawat darurat 4. Mendiagnosa kegawatan jalan nafas / airway 5. Menangani kegawatan jalan nafas / airway 6. Mendiagnosa kegawatan nafas / breathing 7. Menangani kegawatan nafas / breathing 8. Memberikan terapi oksigen 9. Mendiagnosa gangguan sirkulasi 10. Menangani gangguan sirkulasi 11. Mendiagnosa gangguan kesadaran 12. Menangani gangguan kesadaran

Penderita Gawat Darurat Penderita yang oleh karena suatu penyebab (penyakit, tindakan, kecelakaan) bila tidak segera ditolong akan cacat, kehilangan anggota tubuh atau meninggal

SURVAI KESEHATAN RUMAH SAKIT (SKRT) 1986 DAN 1992 Kematian jantung Urutan 2 Kematian trauma Urutan 4 Kematian jantung di Jakarta 1991 2535 orang 1992 2746 orang 1993 2961 orang 1994 3255 orang 1995 1283 orang (sampai maret) Kematian kecelakaan lalu lintas di Indonesia 1991 10.621 orang 1992 9.819 orang 1993 10.038 orang 1994 11.004 orang 1995 9.251orang

USA : TRAUMA
Trauma penyebab kematian ketiga setelah cancer dan atheroselerosis

Usia 1- 44 tahun (produktif) penyebab kematian pertama

Jumlah kecelakaan : 60 juta / tahun 30 juta perlu perawatan medik 3,6 juta perlu MRS 9 juta cacat : 3000.000 permanen 8.700.000 temporer Kematian 145.000 / tahun Trauma related costs > $ 100 milyar / year

HASIL SURVEY DI PROPINSI : NTT, KALBAR, KALTENG, SUMUT, BENGKULU

No. 1. 2. 3. 4. 5. 6. 7. 8. 9.
Trauma Non trauma

Macam Kasus Trauma / kecelakaan lalu lintas Diare Malaria panas kejang ISPA batuk sesak Stroke tidak sadar TBC batuk darah sesak Jantung hipertensi, infark Obsgyn perdarahan, eklampsia Intoksikasi gigitan ular - peptisida
: 25 % : 75 %

% Kasus 20 % 17 % 15,6 % 12,2 % 8,6 % 7,7 % 7,6 % 6,4 % 4,9 %

BILA TERJADI HENTI NAFAS DAN HENTI JANTUNG

Keterlambatan 1 menit 4 menit 10 menit

Kemungkinan berhasil 98 / 100 50 / 100 1 / 100

CHAIN OF SURVIVAL Early Activation of EMS Early Basic of CPR

Early Defibrillation
Early Advanced Life Support

PENDERITA GAWAT DARURAT HIPOKSEMIA HIPERKARBIA

HENTI JANTUNG HENTI NAFAS

SINDROMA IWR

CONCEPT ABCDE approach to evaluation / treatment Treat greatest threat to life first Definitive diagnosis not immediately important

Time is of the essence

Do no further harm

INITIAL ASSESSMENT / MANAGEMENT Injury Primary survey and adjuncts Resuscitation Reevaluation Secondary survey and adjuncts Reevaluation Optimize patient status Transfer

Primary survey and resuscitation of vital functions are done simultaneously a team approach

PENANGANAN PASIEN TIDAK GAWAT Anamnesa Pemeriksaan fisik

Inspeksi Palpasi Perkusi Auskultasi

Pemeriksaan penunjang Diagnosa Terapi

Supportif Simtomatis Definitif / kausal

PENANGANAN PASIEN GAWAT DARURAT Pem. Fisik awal

(Primary survey)

(A-B-C-D) + Lab. Awal

Terapi suportif / resusitasi (life support) Stabilisasi Pem. Fisik sekunder (Secondary survey) Anamnesa Dari kepala s/d kaki (B1 s/d B6) Pemeriksaan penunjang Diagnosa Terapi defenitif

CPCR / RJPO (Peter Safar)

1. Basic life support emergency oxygenation A : Airway B : Breathe C : Circulate 2. Advanced life support Restoration of spontaneous circulation D : Drugs and Fluids E : EKG F : Fibrillations treatment 3. Prolonged life support post resuscitation brain oriented therapy G : Gauging H : Human mentation I : Intensive care

KONSEP ATLS Primary Survey A : Airway with C-spine control B : Breathing with ventilation C : Circulation with hemorrhage control D : Disability : neurologic status E : Exposure/environment with temperature control
Resuscitation Secondary Survey Head to toe evaluation and history

Reevaluation
Definitive care

KEY POINTS ACLS In the Primary Survey, focus on basic CPR and defibrillation

First A-B-C-D Airway

: Open the airway Breathing : Provide positive pressure ventilations Circulation : Give chest compressions Defibrillation: Shock ventricular fibrillation or pulseless ventricular tachycardia (VF/VT)

KEY POINTS ACLS

In the Secondary Survey, focus on intubation, intravenous (IV) access, and drugs and why the cardiorespiratory arrest occurred Second A-B-C-D Airway : Perform endotracheal intubation Breathing : Assess bilateral chest rise and ventilation Circulation : Gain IV access, determine rhythm, give appropriate agents Defibrillation Diagnosis (Think): Search for, find, and treat reversible causes

PENANGGULANGAN PENDERITA GAWAT DARURAT Basic General Emergency Life Support (GELS)
PPGD (Penanggulangan penderita gawat darurat) Dokter umum

PTC ACLS
ATLS HIGH RISK HIGH FREQUENCY HIGH SUCCESS PROCEDURE - PRIMARY PREVENTION - SECONDARY PREVENTION

BLS ALS PLS NLS OLS

BLS ALS ATLS ACLS NLS PLS OLS

LOCAL SPECIFIC - MALARIA - DHF - GE

PTC : Primary trauma care A : Airway B : Breathing C : Circulation Dsan: Dokter spesialis Anestesi

: Basic life support (A, B, C, BRAIN) : Advance life support : Advance trauma life support (Trauma oriented L.S) : Advance cardiac life support (Cardiac oriented L.S.) : Neonatal life support : Pediatric life support : Obstetric life support

LIFE SUPPORT A B C : Airway Support : Breathing Support : Circulation Support

: Disability / Brain Support

First responder Life saver Resusitasi stabilisasi

Airway Breathing Circulation Brain

Dr. Bedah Perdarahan trauma

SHOCK KARENA PERDARAHAN

Dr. Obgyn Perdarahan post partum 1 2 3

Resusitasi Stabilisasi Definitif terapi awal Definitif terapi akhir Dr. Spesislias Dr. Umum

Dr. Penyakit Dalam

Perdarahan G.I.

Pembagian Peran Dr. Umum Dr. Spesialis

PROTECTION FROM COMMUNICABLE DISEASE Water impermeable apron Gown Gloves Face mask Cap Eye protection / goggles Foot covers

To prevent contact with body fluids patients