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MANAGEMENT
ALLEVIATE SUFFERING
ANY TIME
ANY ONE
Trimodal patterns
Donald Trunkey ATLS
50%
Death 30%
20%
%
sec hr days/week
Trauma Death
First Peak
Death that occurs at
impact or soon after the
accident
50 % death
Not preventable
severe head
laceration, massive
bleeding, heart injury
etc.
Prevention of accidents
enforcement,
education &
awareness
(pencegahan)
Trauma Death
Second Peak
Death within minutes
30 % of death
Life threatening
injuries involving
airway, breathing ,
circulation
Trauma Death
Airway
obstruction: tongue(lidah jatuh kebelakang
resuscitation
definitive therapy
Third peak
Third Peak
Death within days or week
after injury
20 % death
resuscitation, definitive
care, aggressive ICU care,
prevention of infection and
rehabilitation
INITIAL ASSESMENT
1. PRE-HOSPITAL PHASE
2. IN HOSPITAL PHASE
Kita suruh pihak rs untuk persiapkan
sblm pasien datang
PRE HOSPITAL
Ambulance Response
Time: Standard
50 % of all calls are
responded within 8
min. (harus direspon
cepat dlm 8 mnt)
95 % of calls within 14
min. (urban)
95 % of calls within 19
min. (rural )
Nolan JP, Pars. BJA
1997;79,226-240
Pre hospital Communication
Communication
Triage
Resuscitation Room
Activation of trauma
team
Trauma Team-work
Efficient method
Trained doctors & nurses
Variety of tasks taken
simultaneously(ngga perwat
dulu atau dokter dulu,
semua hrs kerja sma)
horizontal organization
saving procedure by 50
%
Trauma Team at Work
Managing trauma in a
smooth and efficient
manner
Do no further harm
3. The Primary Survey
Airway & cervical spine
control
Breathing & ventilation
Circulation & haemorrhage
control
Disability(kesadaran)
Exposure/Environment
Di ident, tanya
aja namanya, apa
yg terjadi kalo
bisa jawab, berati
airway klir, dan
breathing ga
masalah kalo dia
bisa bicara dia
cukup sadar(abcd
aman )
Airway & Cervical Spine Control
Difficult Airway
Goal
Keep airway patent
protect
compromised
airway
provide airway if
none( pasien
trauma muka ,
gamungkin napas ,
bikin jalan napas
midle ,
Cervical spine Fracture
Suspect:
Unconscious patients
Injury above clavicles
Neck pain
Weakness or
neurological deficit
History of fall > 6 m
Multipel trauma
Breathing & Ventilation
pressure/ ICP
Heart rate
Urine output
5. Secondary Survey
Not begin until the Primary Survey is completed
Maxillofacial
Chest( pneumothorak)
Abdomen (jejas)
Musculoskeletal
Neurologic
6. Definitive Care
Surgical intervention
Transfer to higher trauma center
Conclusion