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Biasanya multitrauma
Penyebab
Trauma tumpul : falls, motorcycle or bicycle crashes,
sporting mishaps, and assaults. Compression causing a crush injury Shearing force causing tears of organs or vascular pedicles Sudden rise in intraabdominal pressure causing rupture of an intraabdominal viscus (Trauma Manual, 3rd edition) Trauma tembus -. Luka tembak -. Luka tusuk /impalement
Akibatnya
Syok hipovolemik
Shock should be regarded as present if any trauma patient presents with a systolic blood pressure less than 110 mmHg and a heart rate greater than 100 beats/min (Acute Care Surgery 2009)
Peritonitis
Abdominal examination after blunt trauma is often unreliable due to altered level of consciousness, spinal cord or other distracting injury, and medication or substance effects. (Trauma Manual, 3rd edition)
ruangan hangat Sering terjadi distensi lambung selama resusitasi pasang NGT
FAST
FAST
CT abdomen
for positive DPL 10 mL gross blood on aspiration > 100,000 red blood cells/mm3 >500 white blood cells/mm3 Bacteria. Bile Food particles
Trauma limpa
Trauma ginjal
Trauma usus
Gaster : debridement dan suture primer Usus halus :reseksi anastomosis, stoma Usus besar :
primary repair if minimal fecal spillage, no shock (defined as systolic blood pressure <90 mmHg), minimal associated intraabdominal injuries, <8-hour delay in diagnosis and treatment, and <1-L blood loss.
Rectum :
Bila dilakukan splenectomy imunisasi post op (pneumococ, h.influenzae, meningococ) Trauma ginjal : sering
to avoid the lethal triad of hypothermia (defined as a core body temperature of <35C), coagulopathy, and acidosis.
Three Step
1. Operating Room (Part I) Rapid control of hemorrhage Control or containment of contamination Restoration of vascular flow when required Intra-abdominal packing Temporary abdominal closure
2. Intensive Care Unit Core rewarming Optimization of hemodynamics Correction of coagulopathy Ventilatory support Secondary survey and injury identification
3. Operating Room (Part II) Pack removal Definitive repair of injuries Abdominal wall closure