Primary Survey Assessment
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Primary Survey Assessment(Penilaian dan Penanganan
Survei Primer)Departemen Anestesiologi dan Terapi Intensif
FK – USU2011
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TRIAGEPRIMARY SURVEYSECONDARY SURVEYSTABILISATION TRANSFERDEFINITIVE CARE
TRIASESURVEI PRIMERSURVEI SEKUNDERSTABILISASI RUJUKANTERAPI DEFINITIF
Emergency Medicine
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Tujuan Survei Primer
• Secepat mungkin menemukan kelainan yang mengancam jiwa (cepat mematikan)– di sektor A - B - C - D
• Memberikan pertolongan yang memadai untuk menyelamatkan jiwa
• Pertolongan meliputi :– Resusitasi– Stabilisasi
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Concepts of Primary Survey Rapid Primary survey Resuscitation Adjuncts to primary survey /resuscitation Detailed secondary survey Adjuncts to secondary survey Reevaluation Definitive care
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Jangan terpukaukelainan yang jelas terlihat
Ikuti Sistematika A - B - C - D
Korban ledakan tabung elpiji
Muka hangusPneumotoraks (blast injury)
Luka bakar luasFraktura betis kiri
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Triage
RESUSITASI & STABILISASI
Survei primerSurvei sekunder
KamarOperasi
ICU
Hanya 50%pasien traumaperlu operasi
Terapi definitif/ rujukan
Emergency Medicine
RS lain
Derajat kegawatankorban berbeda-beda
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Triage
Sorting of patients according to :•ABCDEs•Available resources
Multiple casualties Mass casualties
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© ACS
Primary Survey
Primary survey and resuscitation of vital functions are done simultaneously –
a team approach
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Preparation
Prehospital System Transport guidelines /protocols On-line medical direction Mobilization of resources Periodic review of care Closest appropriate facility
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Preparation
Inhospital Preplanning essential Equipment, personnel, services Standard precautions Transfer agreement
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Standard Precautions
• Cap • Gown• Gloves• Mask• Shoe covers• Goggles/face • Shields
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Survei Primer
• Periksa cepat berurutan• Selesai dalam 2 menit• Terapi segera apa yang ditemukan
( treat as you
find )
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
Jalan nafasPernafasan SirkulasiKesadaran Pemaparan
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• Mulai dengan Survei Primer– Mencari dengan cepat gangguan fungsi vital di sektor A-B-C-D– Memberi terapi suportif dengan cepat pada fungsi yang
terganggu
• Setelah fungsi vital stabil Survei Sekunder– Mencari gangguan fungsi vital dengan teliti– Memberi terapi definitif pada fungsi yang terganggu
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Resuscitation Protect and secure airway Ventilate and oxygenate Stop the bleeding Vigorous shock therapy Protect from hypothermia
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
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Sumbatan jalan nafas pasien tak sadar paling sering disebabkan pangkal lidah
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Airwaymenilai jalan nafas
• Kesadaran (bisa bicara?) • Look, Listen and Feel• Gerak dada• Gerak otot nafas tambahan • Warna kulit, mukosa, kuku
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Airwaymengatasi obstruksi / sumbatan jalan nafas
• Lakukan chin lift / jaw thrust • Bersihkan rongga mulut (suction?)• Pasang jalan nafas oro / nasopharynx • Lindungi tulang leher• Intubasi trachea
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Walaupun tanpa intubasi masih banyakpasien dapat ditolong
JN OropharynxJN NasopharynxJaw thrust
JN Nasopharynx
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X
Neck lift
Head tilt
Chin-lift
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Airwaywaspada
• Obstruksi (sumbatan) jalan nafas• Cedera dada dengan gangguan
nafas• Cedera tulang leher
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Previously recommended hand positions for manual in-line stabilisation of the cervical spine.
Currently recommended hand positions for manual in-line stabilisation of the cervical spine.
Lindungi leher dari gerakan
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Primary Survey
C-spine injury Pitfalls
• Equipment failure• Inability to intubate • Occult airway injury• Progressive loss of airway
Establish Patent Airway
Caution
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Primary Survey
Suspect C-Spine InjurySpinal protection C-spine X-ray when appropriate
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
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Breathingmenilai pernafasan
• Adakah udara keluar masuk– Look, Listen, Feel
• Frekwensi nafas• Gerak cuping hidung• Cekungan sela iga
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Breathingmembantu pernafasan
• 1. Oksigen (jika ada)• 2. Pernafasan buatan 1.
2.2.
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- Pneumotoraks tension- Fr costa / Flail chest - Hemotoraks berat- Kontusio paru
- Pneumotoraks terbuka
Jejas di dada:
Breathingwaspada
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Dekompresi pneumotoraks (tension)harus dikerjakan dalam Primary Survey
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
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Circulationmengatasi perdarahan
• Hentikan perdarahan• Posisi shock• Pasang infus besar x 2• Ambil sampel darah
– u/ darah donor dan periksa Hb• Beri infus cairan, 1000 ml cepat
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Circulationmengatasi perdarahan
• Beri infus cairan, 1000 ml cepat – RL (Ringer Laktat)– NaCl 0.9% (Garam Fisiologis)– RA (Ringer Asetat)– Hypertonic Saline Dextran 250 ml
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Shock ?• Perfusi :
– pucat - dingin - basah– cap. refill time lambat (kuku, telapak)
• Nadi > 100• Tekanan darah < 100 (atau 90) mmHg Nadi masih
teraba di :– radialis > 80 mmHg – femoralis > 70 mmHg– carotis > 60 mmHg
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Circulationwaspada & cari lokasi perdarahan
• Cedera intra-abdominal• Cedera dada• Patah tulang panjang• Patah tulang pinggul• Luka tusuk / tembus • Luka kulit kepala
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Primary Survey
Circulatory Management Control hemorrhage Restore volume Reassess Pitfalls Elderly Children
Athletes Medication
Caution
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
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Disabilitymenilai kesadaran
• Periksa Pupil (besar, simetri, refleks cahaya)• Periksa kesadaran
– A = Awake (sadar penuh)– V = responds to Verbal command
(ada reaksi terhadap perintah)– P = responds to Pain
(ada reaksi terhadap nyeri)– U = Unresponsive (tak ada reaksi)
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A- V - P - U
Pupil
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Primary Survey
Disability Baseline neurologic evaluation
• GCS scoring • Pupillary response
Observe for neurologic
deterioration Caution
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Survei Primer
AirwayBreathingCirculationDisabilityExposure
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Exposurepemaparan
• Lepaskan semua pakaian untuk pemeriksaan teliti menyeluruh, ada jejas apa saja
• Periksa punggung!– miringkan pasien cara Log-roll
• Cegah hipotermia (kedinginan)
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Primary SurveyExposure / Environment • Completely undress the patient
Prevent hypothermiaCaution
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Survei Primer
Foto Dada sinar-X / Chest X-Ray ( jika ada)
Tulang leher / C - Spine(lateral)Panggul ( Pelvis )Abdominal USG
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Adjuncts to Primary SurveyVital sign
ECG ABGs Urinary Adjuncts Pulse Output oximeter
and CO₂
Urinary/gastric catheters unless contraindicated
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© ACS
Adjuncts to Primary Survey Diagnostic Tools• Chest and pelvic x-ray• DPL• Ultrasound
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Adjuncts to Primary Survey
Consider Early Transfer Do not delay transfer for diagnostic
tests Use time before transfer for
resuscitation
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Special Considerations
Trauma in the Elderly 5th leading cause of death ↓Physiologic reserve Comorbidities : Diseases/medications Outcome depends on early, aggressive
care
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Survei Sekunder
• Lanjutan dari survei primer• Hanya bila ABC sudah stabil• Teliti kepala sampai jari kaki• Kembali ulang survei primer jika pasien
tidak stabil / kondisi memburuk
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Reevaluate
Proceed to Secondary Survey After : Primary survey completed ABCD Es are reassessed Vital functions are returning to
normal
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