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