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ADVANCED TRAUMA LIVESUPPORT
(ATLS)
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Program pelatihan untuk tenaga medis dalammenangani kasus trauma akut.
The point are:Menggunakan cara sederhana namun sesuaistandar dalam penilaian dan penanganan awalterhadap trauma pada korban guna meminimalisirkecacatan.
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GENERAL CATEGORIES OF TRAUMA
IMMEDIATELY LIFE TREATENINGAfect about 5% accou t !o" 5#%o! a$$ &o' ta$ t"au a *eat&'
URGENTCo " 'e' a "o+ ate$, about
-#.-5% o! a$$ at e t'/
NON.URGENTA "o+ ate$, 0#% o! a$$ 1u" e'
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STEPS:-/ P"e a"at o2/ T" a3e4/ P" a", 'u" e, (A6CDE')7/ Re'u'c tat o5/ A*1u ct' to " e", 'u" e, 8 "e'u'c tat o9/ Seco *a", 'u" e, (&ea* to toe e a$uat o 8
& 'to",):/ A*1u ct' to 'eco *a", 'u" e,0/ Co t ue* o't."e'u'c tat o o to" 3 8 "e.
e a$uat o;/ De< e ca"e
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•PRE HOSPITAL PHASE •IN HOSPITAL PHASE
Rece 3 &o' ta$' ot <e* <"'t
Se * to t&ec$o'e't=a "o " ate !ac $ t,
A* a ce* $a 3!o" t&e t"au a
Met&o* to 'u oe* ca$ tea
T"a '!e" a3"ee e t> t& e" <e* t"au a
ce te" e'tab$ '&e*P"otect !"oco u cab$e* 'ea'e
-/ PREPARATION
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2/ TRIAGE
T" a'e a"t ,a e $ &/P"o'e' '?" 3 'eca"a ce at u tu?e 3 *e t <?a' ?ea*aa ?o"ba a3a" *a at e be" ?a
e a 3a a ,a 3 te at /
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Priorities for the care of Adult , Pediatrics & Pregnancywomen are all the same.During the primary survey lifethreatening conditions are identified and management
is instituted SIMU !A"#$US %.A : Airway with cervical spine protect.
B : reathing
C : 'irculation ((control e)ternal *leeding.D : Disa*ility or neurological status
E : #)posure +undress & Environment +temp control
4/ PRIMARY SURVEY
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CONT. PRIMARY SURVEY
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B. Breathing & Ventilation
- Airway patency does not assure ade uate ventilation.C. Circulation with Hemorrhage Control.
/. lood 0olume & 'ardiac $utput
a. level of consciousness.
*. s1in color
c. Pulse.
2. leeding
-e)ternal *leeding is identified & controlled in theprimary survey.
-!ourni uets should not *e use.
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D. Disa*ility + "eurological #valuationSimple Mnemonic to descri*e level of consciousness
A 3 Alert
0 3 4esponds to 0ocal stimuli
P 3 4esponds to Painful stimuli
U 3 Unresponsive to all stimuli
"ot forget to use also 5lascow 'oma Scale.
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E. Exposure / Environmental ControlIt is the pt6s *ody temp that is most important,not he comfort of the health care provider.
Intravenous fluid should *e warm.
7arm environment +room tem should *e
maintained.early control of hemorrhage.
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A. Airway-definite airway if there is any dou*t a*out the pt6s a*ility to
maintain airway integrity.B. Breathing /Ventilation/ xygenation
-every in8ured pt should received supplement o)ygenC. Circulation
-control *leeding *y direct pressure or operative intervention- minimum of two large cali*er I0 should *e esta*lished-pregnancy test for all female of child *earing age.- actated 4inger is preferred & *etter if warm.
7/ RESUSCITATION
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A. Electro!car"iographic #onitoringB. $rinary & %astric Catheter /. Urinary catheter.
Urethral in8ury should *e suspected if- lood at the penile meatus
-Perineal ecchymosis
- lood in the scrotum -9igh riding or nonpalpa*le prostate -Pelvic fracture
. AD'$(C) ) *+,#A+- $+VE- & +E $ C,)A), (
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C. #onitoring
/. 0entilatory rate & A 5 2. Pulse o)imetry
does not measure ventilation or partial $2 pressure
:. lood pressure
poor measure of actual tissue perfusion. D. !+ay & Diagnostic tu"ies
'(spine, ';4, Pelvic film
#ssential )(ray should not *e avoid in pregnant pt.
000 Consi"er the nee" 1or patient trans1er.
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2. EC (DA+- $+VE-
Does not *egin until the primary survey +A 'D#s is completed, resuscitative effort are well esta*lished
& the pt is demonstrating normali<ation of vital sign.
- 9ead to !oe evaluation & reassessment of all vitalsigns.
- A complete neurological e)am is performed including a 5'S score.- Special procedure is order.
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9istoryA 3Allergies.
M 3# edication currently used.
P 3*ast illness= * regnancy. 33ast Meal
# 3 Events=Environment related to the in8ury.
-*lunt trauma=penetrating trauma=in8uries dueto cold & *urn=ha<ardous environment>
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P9%SI'A #;AMI"A!I$"4. Hea"
0isual acuity
Pupillary si<e
9emorrhage of con8unctiva and fundi
Penetrating in8ury
'ontact lenses+remove *efore edema occurs
Dislocation of lens
$cular movement
-@## -:
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5. #axillo1acial ,n6ury
no "5 tu*e, definite airway>7. Cervical pine & (ec8
-Pt with ma)illofacial or head trauma should *e presumedto have and unsta*le cervical spine.
9. Chest
-elderly pt are not tolerant of even relatively minorchest in8ury.
-'hildren often sustain significant in8ury to theintrathoracic structure without evidence of thoracic
s1eletal trauma.
-@## -0
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. A "omen
-e)cessive manipulation of the pelvic should *eavoided.
2. *erineum/rectum/vagina
;. #usculos8eletal<. (eurologic
- Protection of spinal cord is re uired at all times
until aspine in8ury e)cluded, especially when the pt istransfer.
-@## -;
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;. AD'$(C) ) )HE EC (DA+- $+VE- include additional )(ray and all other special procedure.
<. +E!EVA3$A), ( Adult urine output ?.@ml=1g=hr
Pediatric urine output /mg=1g=hr -Pain relief (( IM should *e avoid.
=. DE>,(,)E CA+E
-@## 2#
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,n"ication >or De1inite Airway
- Unconscious
- Severe ma)illo(facial fracture
- 4is1 for aspiration 3 leeding= vomiting- 4is1 for o*struction 3 nec1 hematoma=laryngeal,tracheal in8ury= stridor
- Apnea 3 "euromuscular paralysis=unconscious
- Inade uate respiratory effort3 tachypnea=hypo)ia=hypercapnia=cyanosis- Severe closed head in8ury need for hyperventilation
-@## 2-
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EVAKUASI
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I. Pertolongan 1 orang
a? a' e e 3 1a??a? e o$o 3
Pasien bisa jalan :
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Pasien tdk bisa jalan1) 2)
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Pasien tdk bisa jalan jarak jauh :
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Evak a!" kor#an t$k !a$ar $" $aera% #a%a&a :
Fireman.
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Po!"!" kor#an tengk ra' :1) 2)
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II. Pertolongan ( orang
Po!"!" tangan
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Po!"!" tangan
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Pe "n$a%an kor#an ke!tret*%er+$" lorong !e '"t ,
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Na"k+t r n tangga $ng k r!" :
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Pengangk tan $" lorong !e '"t :
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Evak a!" ( orang -arak -a % :
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III. Pertolongan orang/or#an t"$ak !a$ar
1) 2)
3)
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/or#an !a$ar t$k #"!a -alan :
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IV.Pengangk tan $engantan$ 1. Tan$ 0 rle&+/anva!+Stan$ar
Macam-macam tandu :
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(. Tan$ Pole /anva!
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. Tan$ S*oo'
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2. Tan$ Trolle&
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3. Tan$ 4a!ket
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Macam-macam tandu improvisasi :
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1. Tan$ #a # $ng tal" :
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B enis simpul !" di"unakan dlm tandu
bambu : S" ' l Pangkal
Jangkar
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(. Tan$ #a # $ng !el" t :
a) b)
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. Tan$ $ng ke e-a+-aket :
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2. Tan$ $ng ka"n !ar ng+kar ng:
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Me "n$a%kan kor#an ke ata!tan$62 'enolong) :
2.)
3.)
1.)
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(.)1)
Memindahkan korban ke atastandu (3 penolong) :
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1) 2)
eknik pemindahan korban keatas tandu di lorong sempit :
Pengangkatan kor#an $ng
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Pengangkatan kor#an $ngtan$ :
1) 2)
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Mel"nta! te #ok ,
1) 2)
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Men r n" tangga ge$ ng :
Posisi rata-rata air
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B Mel"nta! tana% t"$ak rata ,
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B Mel"nta! ! nga" ,
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V. Pengangk tan $ng
ken$araan ,
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VI.Evak a!" $" te 'atke#akaran :
1). Penolong $an kor#an !a$ar erangkak$" #a7a% ket"ngg"an !at eter ,
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(). Evak a!" kor#an t"$ak !a$ar$" areal ke#akaran ,
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) Evak a!" kor#an ke#akaran$ng engg nakan 8re #lanket ,
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2). Me #a7a kor#an en r n"tangga :
/or#an #era$a #era$a $" antara t # %'enolong $ng tangga/e$ a tangan 'enolong e eganganak tangga elal " ke$ a ket"ak
kor#an4erat #a$an kor#an #ert ' '$ ket"ak$" ke$ a tangan 'enolong $an#ergant"an #ert ' '$ !elangkangan$" ke$ a l t t 'enolongT r n !eta%a'9!eta%a' %"ngga $" #a7a%.
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