Trauma

Pre-Test
• A 20-year-old man presents to the ED with multiple stab wounds to
his chest. His BP is 85/50 mm Hg and HR is 123 beats per minute.
Two large-bore IVs (intravenous) are established and running wide
open. On examination, the patient is mumbling incomprehensibly,
has good air entry on lung examination, and you notice jugular
venous distension. As you are listening to his heart, the nurse calls
out that the patient has lost his pulse and that she cannot get a BP
reading. Which of the following is the most appropriate next step in
management?

• a. Atropine
• b. Epinephrine
• c. Bilateral chest tubes
• d. ED thoracotomy
• e. Pericardiocentesis
 Pre-Test
• A 19-year-old man is brought into the trauma room by EMS after a
head on cycling accident. The patient was not wearing a helmet.
Upon presentation his BP is 125/75 mm Hg, HR is 105 beats per
minute, RR is 19 breaths per minute, and oxygen saturation is 100%
on mask. His eyes are closed, but open to command. He can move
his arms and legs on command. When you ask him questions, he is
disoriented but able to converse. What is this patient’s GCS score?

• 11
• 12
• 13
• 14
• 15
?
Trauma Approach
P
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 Level of Counciousness/
Tingkat Kesadaran
A —Alert (awake, oriented, and obeys commands)
V — Responds to Verbal stimuli (awake but
confused, or unconscious but responds
in some way to verbal stimuli)
P —Responds to Pain (unconscious but responds
in some way to touch or painful stimuli)
U —Unresponsive (no gag or cough reflex)
Stabilisasi Leher
Airway
Nasopharyngeal and Oropharyngeal
Airway
Airway?
Breathing
Breathing
Circulation
Pemeriksaan Leher
Pemasangan Cervical Collar
Cervical Collar
Pemeriksaan Dada
Tension Pneumothorax
 Needle
Decompression
Flail Chest
Cardiac Tamponade
Massive Hemothorax
Pemeriksaan Abdomen
Pemeriksaan Pelvis
Load and Go?

Evakuasi Segera ?
Load and Go
Persiapkan Pasien untuk Ditransport
O
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s
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v
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Secondary Survey in Ambulance
S
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s
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 SAMPLE History
• S — Symptoms
• A — Allergies
• M — Medications
• P — Past medical history (Other illnesses?)
• L — Last oral intake (When was the last time
there was any solid or liquid intake?)
• E — Events preceding the incident
(Why did it happen?)
Immobilization
Periksa Tanda-tanda Pasang Akses
Vital Intravena
Klasifikasi Syok Akibat Perdarahan
 Saat di
Ambulans
Rumah Sakit
Tim Trauma
Stabilisasi
Pemeriksaan Penunjang
 X
Ray
 CT
Scan
U
S
G
Perawatan
Definitif
Outcome
Mencegah lebih baik
daripada mengobati
Kecelakaan
Ambulans
 Post Test
• A 25-year-old man is brought into the trauma resuscitation room
after his motorcycle is struck by another vehicle. EMS reports that
the patient was found 20 ft away from his motorcycle, which was
badly damaged. His vital signs include a BP of 90/60 mm Hg, HR of
115 beats per minute, RR of 22 breaths per minute, and pulse
oxygenation of 100% on facemask. Which of the following is the
smallest amount of blood loss that produces a decrease in the
systolic BP in adults?

• a. Loss of 5% of blood volume

• b. Loss of 10% of blood volume
• c. Loss of 15% to 30% of blood volume
• d. Loss of 30% to 40% of blood volume
• e. Loss of greater than 40% of blood volume
 Daftar Pustaka
• Block, J. et.al. The Atlas of Emergency
Radiology. Mc.GrawHill Companies.
• Campbell, J. 2012. International Trauma Life
Support for Emergency Care Provider. Pearson
Education.
• Knoop, KJ. et.al. 2010. Atlas of Emergency
Medicine, 3rd Ed. Mc.GrawHill Companies.
• Mistovich, JJ. Karen, KJ. 2010. Prehospital
Emergency Care, 9th ed. Pearson Education.
 Daftar Pustaka
• O’Keefe, MF., Limmer, D. 2012. Brady Emergency
Care. 12th ed. Pearson Education.
• Schwartz, DT. 2008. Emergency Radiology Case
Studies. Mc.GrawHill Companies.
• Wolfson, AB. 2015. Harwood-nuss’ Clinical
Practice of Emergency Medicine, 6th ed. Wolters
Kluwer .