Post on 19-Apr-2015
description
INITIAL ASSESSMENT
Pelatihan Penanganan Gawat Darurat Mahasiswa F.K. UNDIP
PREPARATION
• Pre-hospital: • Patient preparation for transport• Inhospital:• Personnel & equipment preparation
based on information of patients condition
• Self protection
Initial Assessment
1. Preparation2. Triage3. Primary Survey (ABCDEs)4. Resuscitation5. Adjunct to primary survey & resuscitation6. Secondary survey (Head to toe evaluation &
history)7. Adjunct to secondary survey8. Continued post resuscitation monitoring and
reevaluation9. Definitive care
TRIAGE
• Is sorting of patients based on the need for treatment and the available resources to provide that treatment (based on ABC priorities)
• Field Triage: Triage in the scene • Hospital Triage: Triage in the certain
room of Emergency Department.
PRIMARY SURVEY & RESUSCITATION
SCENARIO CASE 1
• In emergency dept. of District Hospital, you as a GP on duty received man 25 years, traffic accident, riding motor car strucked bus. RR= 44/mnt, BP: 180/100 mmHg, PR: 64/mnt, gurgling (+), suprasternal retraction, mandible and maxilla deformity and bluish around the eye.
Problem Sign & Symptom
Alternatives Management
Monitoring
A (Air Way & C.Spine Stabilization)Cause Obstr:- solid- liquid- tissue destruction
• Gurgling• Snoring• Retraction• Increase
RR• Central
cyanosis
• Cervical collar• Oxygenation• Air way clearing:• Chin lift• Jaw thrust• Suction• Oropharyngeal
tube• Nasopharyngeal
tube• Endotracheal
tube• Crycothyroidost
omi (puncture,open)
• Respiratory Rate
• Retraction• Gurgling• Snoring• Oxygen
Saturation
AIR WAY PROBLEM & C-SPINE STABILIZATION
SCENARIO CASE 2
• In emergency dept. of District Hospital, you as a GP on duty received man 21 years, after traffic accident, cyanotic, speak confusely with short frequent breath (RR 44/mnt), BP: 80/60 mmHg, PR: 124/mnt, yugular vein enlargement, right tracheal deviation, skin abrasions on the left chest and tympanic on percussion.
Problem Sign & Symptom AlternativesManagement
Monitoring
B (Breathing)• Tension
pneumothorax• Massive
Hematothorax• Flail Chest• Open Chest
wound
• Increase RR• Central
cyanosis• YVE• Tracheal
deviation• Change on
percussion• Change on
auscultation• Paradoxal
movement• Decrese BP
• Oxygenation• Close open chest
wound• Puncture
thoracocentesis• Thoracic tube• Ventilation• Thoracotomy
• RR• Oxygen
saturation• Yugular Vein• Trachea• Percusion• Auscultation• WSD
BREATHING PROBLEM & VENTILATION
SCENARIO CASE 3
• In emergency dept. of District Hospital, you as a GP on duty received bar woman. She said she got stab wound. Wound on the left chest in the 3rd intercostal space. RR 36/mnt, PR 136/mnt, BP 80/60 mmHg, yugular vein enlargement, no tracheal deviation, muffled heart tone (+) and hypersonor on percussion of the left chest.
SCENARIO CASE 4
• In emergency dept. of District Hospital, you as a GP on duty received man 45 years old a driver Daihatsu Zebra head on collision with truck. He answer all question, RR 30/mnt, PR 108/mnt, BP 110/85 mmHg, cold extremities, bruises of the left lower chest and upper abdomen, percussion and auscultation equal left & right chest, abdomen pain on palpation and slight rebound tenderness.
Problem Sign & Symptom
Alternatives Management
Monitoring
C(Circulate & bleeding controlled)Syok;• Central • Neurogenic• Hemorrha-
gic
• BPdecrease• Pulse
rate increase/ decrease• Pulse
pressure decrease• YVE
• IV line, warm RL• Oxygenation• Identification the
cause of bleeding:• Clinically• DPL• USG• CTScan• Pericardiocentesis• Urine catheter• Stop Bleeding
• BP• Pulse pressure• Oxygen
Saturation• ECG• Oxygen
saturation• Urine
production
Circulate problem & bleeding controlled