ADVANCE TRAUMA &

CARDIOVASCULAR
LIFE SUPPORT SISWA SUSDOKBANGAN A-18

Anggota Kelompok 1 :
1. Lettu Kes dr. M. Zikri 6. Letda Kes dr. Rifqy S
2. Letda Kes dr. Ana F. Fitri 7. Letda Kes dr. Rizki N.D
3. Letda Kes dr. I Gusti Ayu A.N.W 8. Letda Kes dr. Rifwan H
4. Letda Kes dr. Kiagus M. Reza 9. Letda Kes dr. Angga N
5. Letda Kes dr. Bimo T.P 10. Letda Kes dr. Albertus N
 PENILAIAN PASIEN
1. Persiapan 6. Secondary survey (evaluasi head-to-toe
dan anamnesa)
2. Triage
7. Penunjang secondary survey
3. Primary survey (ABCDEs) dengan
resusitasi cepat pada pasien cedera 8. Lanjutan monitoring pasca-resusitasi
mengancam jiwa dan laksanakan evaluasi
4. Penunjang primary survey dan 9. Perawatan Definitif
resusitasi
5. Pertimbangkan kemungkinan pasien di
rujuk.

American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons Committee on Trauma;
2006.
Neugebauer EAM, Waydhas C, Lendemans S, et al. Clinical practice guideline: the treatment of patients with severe and multiple traumatic injuries. Dtsch Arztebl Int
2012;109(6):102–108. 2
PERSIAPAN
Selama fase prehospital petugas perlu menilai
dan mengawasi :

1. Minta Tolong

2. Pelihara keamanan jalan napas/ Airway

3. Kontrol perdarahan external dan shock

4. Immobilisasi pasien
5. R
Transport cepat untuk di ujuk ke fasilitas
kesehatan terdekat sesuai dengan kebutuhan
atau trauma center yang terverifikasi.
(beritahukan RS tujuan sebelum pasien tiba)
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS)
10th Edition. Chicago: American College of Surgeons
3
 TRIASE

Multiple
Mass Casualities
Casualities

TIDAK MELEBIHI MELEBIHI

kemampuan kemampuan
rumah sakit rumah sakit

Prioritas:
Prioritas: gawat Kemungkinan Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage,
darurat survival yang 2011. Morbidity and Mortality Weekly Report 2012;61:1–21.
terbesar 4
Davidson G, Rivara F, Mack C, et al. Validation of prehospital trauma triage criteria for motor vehicle collisions. J Trauma 2014; 76:755–766.6.
Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. Morbidity and Mortality Weekly Report 2012;61:1–21. 5
PRIMARY SURVEY WITH
SIMULTANEOUS
RESUSCITATION
1. A irway maintenance with restriction of cervical spine motion

2. Breathing and ventilation

3. Circulation with hemorrhage control
4. Disability(assessment of neurologic status)
5. Exposure/Environmental control

Penilaian klinis A,B,C dan D pada pasien trauma (10-second assessment) dengan cara mengidentifikasi dirinya lewat pertanyaan nama
pasien dan apa yang terjadi.

6
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
 PENGENALAN MASALAH
AIRWAY
Mempertahankan oksigenasi dan
mencegah hypercarbia sangat penting
dalam menangani pasien trauma, terutama
pasien dengan trauma kepala.

Arslan ZI, Yildiz T, Baykara ZN, et al. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA C Trach devices.
Anaesthesia 2009;64(12):1332–1336. Epub 2009; Oct 22. 5. Asai T, Shingu K. The laryngeal tube. Br J Anaesth 2005;95(6):729–736. 7
OBJECTIVE SIGNS OF AIRWAY
OBSTRUCTION
1. Agitasi (menandakan hypoxia)
2. Obtunded (menandakan Hypercarbia)
3. Cyanosis
4. Suara napas abnormal : Snoring, gurgling, dan crowing sounds (stridor) menujukkan partial
occlusion dari pharynx atau larynx. Hoarseness (dysphonia) menunjukkan gangguan fungsional
akibat laryngeal obstruction.
5. Evaluasi kebiasaan pasien

8
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of
Surgeons 9
 AIRWAY MAINTENANCE
TECHNIQUES

Manuver diatas dapat memperburuk c-spine injury, pastikan tidak terdapat pergerakan pada c-spine selama
melaksanakan prosedur tersebut.
10
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
 Airway Adjuncts :

1. Nasopharyngeal Airway
2. Oropharyngeal Airway
3. Extraglottic and Supraglottic Devices

 Laryngeal Mask Airway and

Intubating LMA
 Laryngeal Tube Airway and
Intubating LTA

American Heart Association. (2016). Provider Manual: Advanced Cardiovascular Life Support. USA: American Heart Association.
11
 12
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American
College of Surgeons
KRITERIA DIPERLUKANNYA
DEFINITIVE AIRWAY :
 A — Ketidakmampuan untuk mempertahankan
kestabilan jalan napas. (e.g., inhalation injury, facial
fractures, atau retropharyngeal hematoma)
 B — Ketidakmampuan mempertahankan oksigen
adekuat meskipun menggunakan facemask oxygen
supplementation, atau riwayat apnea
 C — Obtundasi akibat cerebral hypoperfusi
 D — Obtundasi yang menunjukkan adanya cedera
kepala dan membutuhkan bantuan ventilasi( [GCS]
score ≤ 8), sustained seizure activity, dan bila
diperlukan perlindungan lower airway dari aspirasi
darah atau muntah.

13
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
 14
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
 SURGICAL AIRWAY

American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 15

10th Edition. Chicago: American College of Surgeons
 16
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
 17
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
PREDICTING DIFFICULT AIRWAY
MANAGEMENT
1. C-spine injury
2. Severe arthritis dari c-spine
3. Trauma pada maxillofacial atau mandibular yang signifikan
4. Limited mouth opening
5. Obesity
6. Variasi anatomi (e.g., receding chin, overbite, dan short-muscular neck)
7. Pasien anak

18
American College of Surgeons. (2018). Advanced Trauma Life Support (ATLS) 10th Edition. Chicago: American College of Surgeons
19
 OBJECTIVE SIGNS OF
BREATHING
 Look : Gerak dada, cuping hidung, sela iga
 Listen : Suara nafas, suara tambahan
 Feel : Udara nafas keluar hidung mulut
 Palpasi : Gerak dada, simetris ?
 Perkusi : Redup ? Hipersonor ? Simetris ?
 Auskultasi : Suara nafas ada? Simetris ?

American Heart Association. (2016). Provider Manual: Advanced Cardiovascular Life Support. USA: American
Heart Association. 5-10 DETIK 20
OBJECTIVE SIGNS OF
INADEQUATE VENTILATION
(DISTRESS
1. Nafas dangkal cepat
NAPAS)
2. Gerak cuping hidung
3. Tarikan sela iga / otot leher
4. Nadi cepat
5. Hipotensi
6. Vena leher distensi
7. Sianosis (tanda lambat)

American Heart Association. (2016). Provider Manual: Advanced Cardiovascular Life Support. USA: American Heart Association.
21
Dyer DS, Moore EE, Ilke DN, et al. Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.22
J Trauma 2000;48(4):673–82; discussion 682–683.
SIGNS AND SYMPTOMS TENSION
PNEUMOTHORAX : Chest pain
1.
2. Air hunger
3. Tachypnea
4. Respiratory distress
5. Tachycardia
6. Hypotension
7. Tracheal deviation ke arah yang
berlawanan dari sisi yang cedera
8. Unilateral absence of breath sounds
9. Elevated hemithorax tanpa pergerakan
napas.
10. Neck vein distention
11. Cyanosis (late manifestation)
23
24
25
26
 MENILAI SIRKULASI :
1. Denyut nadi
2. Tekanan darah
3. Warna akral
4. Capillary refill
5. Produksi urine

Cooper DJ, Walley KR, Wiggs BR, et al. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. Ann Intern Med 1990;112:492. 15. Cotton BA,
Au BK, Nunez TC, et al. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma 2009;66:41–49. 27
DIFERENSIAL DIAGNOSIS
SHOCK :
1. Hemorrhagic Shock
2. Non-hemorrhagic Shock
 Cardiogenic Shock
 Cardiac Tamponade
 Tension Pneumothorax
 Neurogenic Shock
 Septic Shock

28
TANDA KLINIS SHOCK :
1. Nafas cepat, kesadaran gelisah
sampai coma
2. Sistolik < 90mmHg
3. Kulit dingin, pucat, basah, sianosis
4. Capillary refill time > 2 detik
5. Produksi urine < 0,5 ml/kgbb/jam

29
HEMORRHAGIC SHOCK
Kendalikan Ganti darah Hentikan
perdarahan yang hilang perdarahan

 Class I : setara dengan orang yang mendonorkan 1 kantong darah.

 Class II : perdarahan tanpa komplikasi yang membutuhkan resusitasi cairan kristaloid.
 Class III
: complicated hemorrhagic yang membutuhkan resusitasi kritaloid dan
kemungkinan membutuhkan blood replacement.
 Class IV : preterminal hemorrhage; membutuhkan tindakan agresif atau pasien akan
meninggal dalam beberapa menit. Transfusi dibutuhkan.

30
RESPON
PASIEN
TERHADAP
INITIAL
FLUID
RESUSCITATI
ON ADALAH
KUNCI
UNTUK
MENENTUKA
N TERAPI
SELANJUTNY
A.

31
D
I
S
A
B
I
L
I
T
Y 32
33
EXPOSURE/ENVIRONMENTAL
1. Kateter urine.
2. Elektrokardiografi (EKG)
3. Pulse oxymetri
4. Nasogastric tube (NGT)
5. Foto rontgen

34
SECONDARY SURVEY
Dilaksanakan setelah primary survey

Keadaan klinis pasien dipastikan membaik

Alergi
Medikasi
Anamnesis AMPLE Past Illness/
Pregnancy
Last meal
Head to toe examinations Environment

Pemeriksaan diagnostic penunjang

35
 8 CEDERA YANG BERPOTENSI
MENGAKIBATKAN KEMATIAN, HARUS DI
IDENTIFIKASI SELAMA SECONDARY
SURVEY:
1. Simple pneumothorax 5. Blunt cardiac injury
2. Hemothorax 6. Traumatic aortic disruption
3. Flail chest 7. Traumatic diaphragmatic injury
4. Pulmonary contusion 8. Blunt esophageal rupture

36
 THE CHAIN OF SURVIVAL

Magid DJ, Aziz K, Cheng A, et al. Part 2: evidence evaluation and guidelines development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):In press.
Sawyer KN, Camp-Rogers TR, Kotini-Shah P, et al; for the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiovascular and Stroke Nursing;
Council on Genomic and Precision Medicine; Council on Quality of Care and Outcomes Research; and Stroke Council. Sudden cardiac arrest survivorship: a scientific statement from the37
American Heart Association. Circulation. 2020;141:e654-e685. doi: 10.1161/CIR.0000000000000747
 Kompresi : Ventilasi
3C Cek
30:2
kesadaran
KOMPRESI Kec 100-120 kali/mn
Lokasi dan kedalaman harus tepat
Cek Nadi Suara dibunyikan dan tidak disingkat

Call for help

VENTILASI, selalu cek pengembangan
(minta
tolong)
dada
38
39
40
 PENYEBAB TERSERING
CARDIAC ARREST
H’s T’s

 Hypovolemia  Tension pneumothorax

 Hypoxia  Tamponade (cardiac)
 Hydrogen ion (acidosis)  Toxins
 Hypo/Hyperkalemia  Thrombosis (pulmonary)
 Hypothermia  Thrombosis (coronary)

American Heart Association. (2016). Provider Manual: Advanced Cardiovascular Life Support. USA:

American Heart Association. 41
 NORMAL SINUS RHYTHM

www.heart.org/eccstudent
42
 43
American Heart Association. (2020). Highlight of the 2020 American Heart Association Guidelines Update for CPR and ECC. USA: AHA.
VENTRICULAR FIBRILLATION

www.heart.org/eccstudent
44
Pulseless Electrical Activity (PEA)

Agonal Rhythm / Asystole

www.heart.org/eccstudent
45
46
47
BRADYCARDIA

American Heart Association. (2020). Highlight of the 2020 American Heart Association Guidelines Update for CPR 48
and ECC. USA: AHA.
Sinus Bradycardia

us Bradycardia With Borderline First-degree AV Block

www.heart.org/eccstudent 49
 Second Degree Atrioventricular Block / Mobitz I Wenckebach

Second Degree Atrioventricular Block / Mobitz II Block

50
www.heart.org/eccstudent
degree Atrioventricular Block
lete AV Block with a Ventricular Escape Pacemaker (Wide QRS : 0.12 To 0.14 Second)

egree AV Block with a Junctional Escape Pacemaker (Narrow QRS : Less Than 0.12 To 0.14 Second

www.heart.org/eccstudent 51
TACHYCARDIA

52
 53
American Heart Association. (2020). Highlight of the 2020 American Heart Association Guidelines Update for CPR and ECC. USA: AHA.
 Sinus Tachycardia

Atrial Fibrillation

Atrial Flutter

54
www.heart.org/eccstudent
 Supraventricular Tachycardia

www.heart.org/eccstudent 55
56
 57
American Heart Association. (2020). Highlight of the 2020 American Heart Association Guidelines Update for CPR and ECC. USA: AHA.
TERI
MA
KASIH
58
*MATERI TAMBAHAN
Boulanger BR, Milzman D, Mitchell K, et al.. Body habitus as a predictor of injury pattern after blunt trauma. J Trauma 1992;33:228–232.
Boyle EM, Maier RV, Salazar JD, et al. Diagnosis of injuries after stab wounds to the back and flank. J Trauma 1997;42(2):260–265 60
BLUNT

PENETRATING

61
PELVIC FRACTURES AND
ASSOCIATED INJURIES

62
63
64
65
66
67
 68

X-RAY
EXAMINATION
69
Post AF, Boro T, Eckland JM: Injury to the Brain In: Mattox KL, Feliciano DV, Moore EE, eds. Trauma. 7th ed. New York, NY: McGraw-Hill; 2013:356–376. 70
 Perbedaan yang sangat signifikan antara
burns dengan injury lainnya adalah luka
bakar dapat secara langsung
mengakibatkan inflamasi luas terhadap
cedera.
 Obstruksi pada airway tidak hanya dapat
terjadi akibat cedera langsung (e.g.,
inhalation injury, tapi juga dapat terjadi
akibat edema massif jalan napas
karena respon inflamasi dari luka bakar.
 Cedera thermal dapat menimbulkan 3
masalah utama pernapasan, yaitu :

1. Hypoxia
2. Keracunan CO2
3. Smoke inhalation injury

71
72
THE
RUL
E OF
NINE
S

73
THE
RULE
OF
NINES
74
 DEPTH OF BURN
 Derajat 1 : Luka bakar superficial (e.g., sunburn)yang ditandai dengan erythema dan nyeri,
namun tidak melepuh.
 Derajat 2 : Luka bakar partial.
 2a : Superficial partial-thickness burns lembab, menimbulkan rasa nyeri yang sangat
hipersensitif (bahkan terhadap hembusan udara), melepuh, dan warna pink merata yang memudar
bila di tekan.
 2b : Deep partial-thickness burns kering, tidak terlalu nyeri, melepuh, warna merah atau
berbintik-bitnik yang tidak memudar bila di tekan.
 Derajat 3 : Full-thickness burns. Kulit tampak bening atau putih seperti lilin, kering, dan tidak
nyeri bila di sentuh. Semakin dalam luka bakar, semakin tidak elastis sehingga pada derajat ini
tidak terlalu bengkak.

75
FIGURE 9-5 Depth of Burns.
A. Schematic of superficial partial-thickness burn injury
B. Schematic of deep partial-thickness burn
C. Photograph of deep partial-thickness burn
D. Photograph of full-thickness burn.

76
PEDIATRIC EMERGENCY CARE APPLIED RESEARCH
NETWORK (PECARN) CRITERIA FOR HEAD CT FOR
CHILDREN YOUNGER THAN 2 YEARS

77
PEDIATRIC EMERGENCY CARE APPLIED RESEARCH
NETWORK (PECARN) CRITERIA FOR HEAD CT FOR
THOSE AGED 2 YEARS AND OLDER

78
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80
 THE STROKE CHAIN OF
SURVIVAL

Fassbender, K., Balucani, K., Walter, S., Levine, SR., Haass, A., Grotta, J. 2013.
Streamlining Of Prehospital Stroke Management: The Golden Hour. Lancet Neurol; 12: 81
585–96.
FK Universitas Kristen Duta Wacana ; RS. Bethesda. 2016. Neurona Vol. 33 No. 3 juni 2016. Reliability of Kurashiki Indonesian Version of Prehospital Stroke Scale Score and 82
it’s Association with Acute Ischemic Stroke Patient Disability. Yogyakarta.
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