TRIAGE Kuliah Kepaniteraan Umum FKK Universitas Muhammadiyah Jakarta2014*Dr Mohammad Adib Khumaidi, SpOT

Kelinci >< Kura kura :Kelinci & Kura kura balap lari. Kelinci lari cpt, istirahat & Tertidur Kura kura menang. Moral Message : Kelinci Kompeten tp tdk Konsisten.

Kelinci >< Kura kura :Kelinci Sadar & menantang balap lari lg Menang. Moral Massage : Kelinci Kompeten & Konsisten

Kelinci >< Kura kura :Kura kura tdk puas & Menantang balap lari lagi dng rute lain. Kelinci lari cpt & sampai d sungai tptidak bs berenang Datang Kura kura berenang menyeberangisungai Kura kura menang krn memakaiotak.Moral Message : Be Smart

Kelinci & Kura kura duduk bersama & BERUNDING : Sepakat :Balapan lagi dng rute yg sama Kura kura digendong kelinci & lari cepat, sampai di sungai Kelinci naik Kura kura & berenang Kelinci & Kura kura sampai bersama samaMoral Message : Be Smart, Teamwork One System & One Command

TRIAGEAdalah tindakan memilah-milah penderita dalam suatu korban multipel atau massal, berdasarkan kegawatan penderita Pemilahan tergantung dari banyak faktor : ABCD; prognosis; tersedianya alat; waktu yang dibutuhkan dll Informasi/data terbatas; tetapi jangan ada yang tanpa keputusan akan diapakan

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PENDERITA GAWAT DARURATPrioritas Pertama (MERAH) : gangguan ABC Prioritas Sedang (KUNING) : tanpa gangguan AB tetapi dapat memburuk cepat Prioritas Rendah (HIJAU) : luka ringan Bukan prioritas (HITAM) : meninggal

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START Salah satu metode adalah START (Simple Triage and Rapid Treatment) 0. Awaln1. Airwayn2. Breathing n3.Circulation 4. Kesadaran

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AWALPanggil semua korban yang dapat berjalan, perintahkan pergi ke suatu tempat n Semua korban yang dapat berjalan dan mengikuti perintah ini, dapat kartu hijau n Sisanya periksa ABCD

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AIRWAYPenderita terdekat, masih bernapas? n Bernapas, penderita berikutnya n Tidak bernapas, buka airwayn Tetap tidak bernapas : bendera hitamn Bernapas : bendera merahn Bisa bernapas spontan, penderita berikut

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BREATHINGn Napas spontan : > 30 kali permenit : bendera merah < 30 kali permenit : tahap berikut n Tidak bernapas : bendera hitam

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CIRCULATION Periksa capillary refill / pengisian kembali kapiler tangan : > 2 detik : bendera merah < 2 detik : tahap berikut n Gelap, tidak terlihat pengisian kapiler Tidak teraba : bendera merah teraba : tahap berikut

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KESADARANTidak dapat mengikuti perintah : bendera merah n Dapat mengikuti perintah : bendera kuning

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TRIAGE TAGGING*

TRIAGE CASE STUDY

Case A 10 passenger bus crashes on a busy road hitting a family of 5 in another vehicle head on. The following are some of the victims from the scene that you are now the triage officer for. Triage these patients RED, GREEN, YELLOW and BLACK according to START criteria. Remember you have less then 60 seconds to assess each victim.

VICTIM 117 yo female with large bleeding laceration to legRespirations: 20Pulse: 65Mental Status: Screaming

Victim 251yo driver of the family vehicle, entrapped in wreckage with obvious head injury and brain matter protrudingRespirations: NONEPulse: NOT PALPABLEMental status: UNRESPONSIVE

Victim 365 yo male with complaint of painful breathing and bloody bruised left chestRespiration: 35Pulse: 120Mental Status: Intact

Victim 43 yo unconscious male in back seat of carRespirations: AbsentPulse: Weak and threadyMental Status: Diminished

Victim 526 yo female with mild bruising of abdomen, walking at the sceneRespirations: 24Pulse: 120Mental Status:Intact

Victim 66 yo male crying no apparent injuriesRespirations: 35Pulse: 110Mental Status: Intact

Victim 745 yo female complaining for left hand pain with obvious deformity of wrist with bone exposedRespiration: 30Pulse: Absent in wristMental Status: Intact

Victim 819 yo female unresponsive with bleeding from earsRespirations: NonePulse: No peripheral pulseMental Status: Unresponsive

Victim 930 yo male complaining of neck pain walking at the scene Respirations: 25Pulse: 95Mental Status: Intact

Victim 1060 yo male with complaining for chest painRespirations: 40Pulse: 110Mental Status: Intact

VICTIM 117 yo female with large bleeding laceration to legRespirations: 20Pulse: 65Mental Status: Screaming

YELLOWAPPLY PRESSURE DRESSING AND MOVE ON TO NEXT PERSON

Victim 251yo driver of the family vehicle, entrapped in wreckage with obvious head injury and brain matter protrudingRespirations: NONEPulse: NOT PALPABLEMental status: UNRESPONSIVE

BLACKMove to next victim

Victim 365 yo male with complaint of painful breathing and bloody bruised left chestRespiration: 35Pulse: 120Mental Status: IntactREDQuick exam reveals decreased breath sounds on left, needle decompression relieves the pneumothorax and respiration and pulse improve

Victim 46 yo unconscious male in back seat of carRespirations: AbsentPulse: Weak and threadyMental Status: Diminished

REDAs soon as a jaw thrust maneuver is performed respiration is restored and patient mental status improves

Victim 526 yo female with mild bruising of abdomen, walking at the sceneRespirations: 24Pulse: 120Mental Status:Intact

YELLOWMild bruising of the abdomen with elevated pulse could signify a serious injury

Victim 63 yo male crying no apparent injuriesRespirations: 35Pulse: 110Mental Status: Intact

GREENRespiratory rate for children in JUMPSTART is above 45 and below 15 Pulse is present and intact as is the mental status of the child

Victim 745 yo female complaining for left hand pain with obvious deformity of wrist with bone exposedRespiration: 30Pulse: Absent in wristMental Status: Intact

YELLOW Even though this is a limb threatening injury., it is not life threatening. If the patient is placed in a splint, they can wait to be fully evaluated

Victim 819 yo female unresponsive with bleeding from earsRespirations: NonePulse: No peripheral pulseMental Status: Unresponsive

BLACK

Victim 930 yo male complaining of neck pain walking at the scene Respirations: 25Pulse: 95Mental Status: Intact

YELLOWHe is walking and neurologically intact

Victim 1060 yo male with complaining for chest painRespirations: 40Pulse: 190Mental Status: Intact

REDHis respirations are above 35, he has a rapid pulse and is complaining of chest pain, so there is a high degree of suspicion for injury

QuestionsIn START triage an adult with respirations at a rate of 36 per minute is tagged as:RedYellowGreenBlack

QuestionsIn START triage, an adult with a fractured tibia, respirations of 20, and a palpable radial pulses and no mental impairment is taggedRedYellowGreenBlack

QuestionsThe Goal when triaging a patient is to spend less than _____ per patient10 seconds60 seconds120 seconds5 minutes

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STRUCTURAL DESIGN *

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ConclusionLearn triage classifications Apply the classifications in a timely mannerRemember that children are different from adults

*A 10 passenger bus crashes on a busy road hitting a family of 5 in another vehicle head on. The following are some of the victims from the scene that you are now the triage officer for. Triage these patients RED, GREEN, YELLOW and BLACK according to JUMP and JUMPSTART criteria. Remember you have less then 60 seconds to assess each victim.

*17 yo female with large bleeding laceration to legRespirations: 20Pulse: 65Mental Status: Screaming

What do you think she should be classified and why?*He was classified as BLACK because he has no respirations, no pulse, and is unresponsive. He is obviously dead.*65 yo female with complaint of painful breathing and bloody bruised left chestRespiration: 35Pulse: 120Mental Status: IntactWhat should she be classified and why?*6 yo unconscious male in back seat of carRespirations: AbsentPulse: Weak and threadyMental Status: Diminished What should he be classified and why?*26 yo female with mild bruising of abdomen, walking at the sceneRespirations: 24Pulse: 120Mental Status:IntactWhat should she be classified and why?*3 yo male crying no apparent injuriesRespirations: 35Pulse: 110Mental Status: IntactWhat should he be classified and why?*45 yo female complaining for left hand pain with obvious deformity of wrist with bone exposedRespiration: 30Pulse: Absent in wristMental Status: IntactWhat is her classification and why?*19 yo female unresponsive with bleeding from earsRespirations: NonePulse: No peripheral pulseMental Status: Unresponsive

What is her classification and why?*30 yo male complaining of neck pain walking at the scene Respirations: 25Pulse: 95Mental Status: IntactWhat is his classification and why?*60 yo male with complaining for chest painRespirations: 40Pulse: 110Mental Status: IntactWhat is his classification and why?*This victim was classified YELLOW her respirations are between 15 and 35, she has an intact pulse and has intact mental status. She should be given a pressure dressing and the examiner should move to the next victim.*He was classified as BLACK because he has no respirations, no pulse, and is unresponsive. He is obviously dead.*She should be classified as RED because a quick exam reveals decreased breath sounds on left, needle decompression relieves the pneumothorax and respiration and pulse improve and she could be easily treated.

*He is RED because as soon as a jaw thrust maneuver is performed respiration is restored and patient mental status improves. He should be transported quickly.*She is a YELLOW classification because mild bruising of the abdomen with elevated pulse could signify a serious injury, but she is not in shock yet and has some time. This type of patient if her condition worsens may be re-triaged and re-tagged a RED.*He is GREEN because remember that the respiratory rate for children in JUMPSTART is above 45 and below 15, his respirations of 35 are acceptable and his pulse is present and intact as is the mental status. He can wait for a full evaluation.*She is YELLOW because even though this is a limb threatening injury., it is not life threatening. If the patient is placed in a splint, they can wait to be fully evaluated.

*BLACK she is obviously dead.

* He is YELLOW because he is walking and neurologically intact.

*He is RED because his respirations are above 35, he has a rapid pulse and is complaining of chest pain, so there is a high degree of suspicion for injury

*Now let us do some quick questions.In START triage an adult with respirations at a rate of 36 per minute is tagged as:1.Red2.Yellow3.Green4.BlackThe answer is RED.

*In START triage, an adult with a fractured tibia, respirations of 20, and a palpable radial pulses and no mental impairment is taggedRedYellowGreenBlackThe answer is YELLOW.

*The Goal when triaging a patient is to spend less than _____ per patient10 seconds60 seconds120 seconds5 minutes

The answer is 60 Seconds.

*In conclusion, the students are encouraged to learn the triage classifications and to remember to apply the classifications in a timely manner. Also, remember that children are different from adults and have their own assessment criteria.