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8/18/2019 Acute Care Surgery - Total Care Des 2012( Prof Aryo)[1]a2013
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atient Safety
atient Safety
&
TOTAL CARE
OTAL CARE
Aryono D. usponegoro
ryono D. usponegoro
Kolegium Ilmu Bea! Inonesiaolegium Ilmu Bea! Inonesia
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MENGAPA PERLU “PATIENTMENGAPA PERLU “PATIENTSAFETY “SAFETY “
??
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Di Ruma! Sa"it #
$%anya"nya enis o%at'enis
pemeri"saan an proseur' serta
umla! pasien an staf Ruma! Sa"it
yang (u"up %esar' merupa"an !al yang
potensial %agi terainya
"esala!an.
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KEADIA* TIDAK DI)ARAPKA* ,KTD-/KEADIA* TIDAK DI)ARAPKA* ,KTD-/
A0erse E0entA0erse E0ent
S#at# !ejadian yangS#at# !ejadian yangmenga"i%at"an
enga"i%at"an
(eeraeera yang tida! dihara$!an $adayang tida! dihara$!an $ada$asien !arena s#at# tinda!an$asien !arena s#at# tinda!an
''(ommission
ommission) ata# !arena tida!) ata# !arena tida!
"ertinda! '"ertinda! 'ommisionmmision
)* dan "#!an)* dan "#!an!arena “!arena “#nderlying disease#nderlying disease+ ata#+ ata#
!%ndisi $asien 'KKP(RS)&!%ndisi $asien 'KKP(RS)&
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NYARIS CEDERA (NC)/ Near MissNYARIS CEDERA (NC)/ Near Miss S#at# !ejadian a!i"at ela!sana!an s#at#S#at# !ejadian a!i"at ela!sana!an s#at#
tinda!an ',%issi%n) ata# tida! enga"iltinda!an ',%issi%n) ata# tida! enga"iltinda!an yang sehar#snya dia"il '%issi%n)*tinda!an yang sehar#snya dia"il '%issi%n)*
yangyang da$at en,ederaida$at en,ederai $asien* teta$i ,edera$asien* teta$i ,edera
seri#s tida! terjadi* !arena -seri#s tida! terjadi* !arena -
““
!e"er#nt#ngan!e"er#nt#ngan
++
'is&*$asien teria s#at# %"at'is&*$asien teria s#at# %"at
!%ntra indi!asi teta$i tida! ti"#l rea!si %"at)*!%ntra indi!asi teta$i tida! ti"#l rea!si %"at)*
!arena!arena
““$en,egahan$en,egahan++ 's#at# %"at dengan %.erd%sis lethal's#at# %"at dengan %.erd%sis lethal
a!an di"eri!an* teta$i sta/ lain engetah#i dana!an di"eri!an* teta$i sta/ lain engetah#i dan
e"atal!annya se"el# %"at di"eri!an)* ata#e"atal!annya se"el# %"at di"eri!an)* ata#
““$eringanan$eringanan++ 's#at# %"at dengan %.er d%sis lethal's#at# %"at dengan %.er d%sis lethal
di"eri!an* di!etah#i se,ara dini lal# di"eri!andi"eri!an* di!etah#i se,ara dini lal# di"eri!an
antid%tenya)&'KKP(RS)antid%tenya)&'KKP(RS)
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roses of Care
Error
Pasien
tidak cidera
Pasien
cidera
Near Miss
Aderse Eent
-!esalahan proses
"#pt dice$ah"%elaks %lan action
tdk komplit
"%akai %lan action y$
salah
"!rn berbuat : commission
"!rn tidak berbuat : omission
&NM'
&AE'
%roses of (are&Non Error' Aderse Eent
Pasien
cidera
&!)#*!e+adian )dk #iharapkan'
- #pt obat c.i.-, tdk timbul &chance'
" %lan, diket, dibatalkan &preention'" #pt obat c.i.-, diket, beri anti"nya
&miti$ation'
&!N(*!e+adian NA/I0 (I#E/A'
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Dimana Kemung"inan Kesala!an BisaDimana Kemung"inan Kesala!an Bisa
Terai1Terai1
• 0iagn%sti! 0iagn%sti! Kesalahan ata# !eterla"atan diagn%seKesalahan ata# !eterla"atan diagn%se
Tida! enera$!an $eeri!saan yangTida! enera$!an $eeri!saan yangses#aises#ai
Mengg#na!an ,ara $eeri!saan yangMengg#na!an ,ara $eeri!saan yangs#dah tida! di$a!ais#dah tida! di$a!ai
Tida! "ertinda! atas hasil $eeri!saanTida! "ertinda! atas hasil $eeri!saanata# %"ser.asiata# %"ser.asi
• Peng%"atanPeng%"atan Kesalahan $ada $r%sed#r $eng%"atanKesalahan $ada $r%sed#r $eng%"atan Kesalahan $ada $ela!sanaan tera$iKesalahan $ada $ela!sanaan tera$i
Kesalahan et%de $engg#naan %"atKesalahan et%de $engg#naan %"at
Keterla"atan eres$%n hasilKeterla"atan eres$%n hasil$eeri!saan$eeri!saan
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• Pre0enti0ePre0enti0e
Tia" mem%eri"an terapi profila"ti"Tia" mem%eri"an terapi profila"ti"
+onitor an follo2 up yang tia"+onitor an follo2 up yang tia"
ae"uatae"uat
Lain3lain # Lain3lain #
Kegagalan %er"omuni"asiKegagalan %er"omuni"asi
Kegagalan alatKegagalan alat Kegagalan sistem lainKegagalan sistem lain
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4TO ERR IS )5+A*6 CORRI7A*' KO)* A*D DO*ALDSO*
5S ACADE+8 O9 SCIE*CES / I*STIT5TE O9 +EDICI*E'
:;;;
• <=>? *e2 8or"' :.=@ of amissions suffere an a0erse
e0ent' >@ of 2!i(! 2ere pre0enta%le
<==: Colorao an 5ta!' .@ of amissions suffere an
a0erse e0ent' @ of 2!i(! 2ere a0oia%le
O0er .+n 5S !ospital amissions pa' %et2een ??';;;
an =>';;; a0oia%le eat!s o((ur
>t! most freFuent (ause of eat!
a!ea of AIDS ,<'< eat!s pa-'
%reast (an(er ,?:':= eat!s pa- an
motor (ar a((ients ,?'?> eat!s pa-
Total (ost to t!e 5S e(onomy of a0oia%le eat!s ue to
!ealt!(are error G< 3 G:= Bn pa
)RRI' )ealt!(are Ris" Resour(es InternationalRRI' )ealt!(are Ris" Resour(es International
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H)O
)O
3 Paa Horl )ealt! Assem%ly "e +ei :;;:
itetap"an suatu resolusi yang menorong ,urge-
negara untu" mem%eri"an per!atian "epaa
pro%lem Patient Safety mening"at"an
"eselamatan an sistem monitoring
O"t :;;? H)O an %er%agai lem%aga
meniri"an
4Horl Allian(e for Patient Safety6 gn tuuanmengang"at Patient Safety 7oal
49irst o no !arm6 an menurun"an mor%iitas'
(iera an "ematian yang ierita pasien
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atient Safety i %er%agai negara
<. Ameri"a # A)R ,Agen(y for )ealt!(are
Resear(! an uality-' :;;<
:. Australia # Australian Coun(il for Safety an
uality in )ealt! Care' :;;;
. Inggeris # * SA
,*ational atient Safety Agen(y-' :;;<
?. Canaa # *SC S ,*ational Steering
Committee on atient Safety-J
C SI ,Canaian atient Safety Institute-' :;;
. +alaysia # atient Safety Coun(il' :;;?
. Denmar" # 55 atient Safety' :;;
. Inonesia # KK 3RS' :;;
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DI I*DO*ESIA 1DI I*DO*ESIA 1
3T!e 4T!e 4(o("roa(! t!eory(o("roa(! t!eory6 # 9or e0ery one you6 # 9or e0ery one you
see' !unres more are !iing in t!esee' !unres more are !iing in t!e2oo2or" 2oo2or"
344Our !ospital are 0ery safe an a (ouple ofOur !ospital are 0ery safe an a (ouple of
a((ientsM are a((epta%lea((ientsM are a((epta%le66
3 +asi! i aera! +asi! i aera! BlamingBlamingM yang sangatM yang sangat
(ostlyM an menau!"an pasien ari ruma!(ostlyM an menau!"an pasien ari ruma!sa"itsa"it
3 4Litigious So(iety63 4Litigious So(iety6 44efensi0e mei(ineefensi0e mei(ine66
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Men$apa %atient 0afety
%rocess of care%rocess of care 1utcome1utcome0tructure0tructure : AE
Blamin$-
-)uduhan Malpraktek-&%id2%erd'"%roses Hukum:%olisi,%en$adilan
"Blo3"up Mass Media, 456
%ublikasi"opini ne$atif -%en$aduan, )untutan-%ertahanan /0- :
-%en$acara-/02#r : Asuransi-)untutan balik
" #sb
%atient 0afety
-Culture-Reporting
-Learning 2Analysis2/esearch
-K&R-based Standard-Guideline
-Implementasi,Monitor -Patient Inolement
(ostly
Kecurigaan meningkat
Kepercayaan meningkat
(ost: Insment
7uality 7uality 7uality
!ico "# Lumenta$KKP-RS
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Patient Sa/ety
11Sa/e ,are is n%t an %$ti%n&
It is the right %/ e.ery $atient2h% entr#sts their ,are t% %#r3ealth,are systes11&&
Sir Lia 0%nalds%n* 4hair* 536 5%rld Allian,e /%r
Patient Sa/ety* F%r2ard Pr%grae* 7889:788;
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Keselamatan asien
, atient safety-
Suatu sistem yang menorong ruma! sa"it
mem%uat asu!an pasien menai le%i! aman.
Sistem ini men(ega! terainya (eera yang
ise%a%"an ole! "esala!an a"i%at mela"sana"an
suatu tina"an atau tia" mengam%il tina"an
yang se!arusnya iam%il.
,KKP3RS-
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PRIMUM, NON NOCEREPRIMUM, NON NOCERE
FIRST, DO NO HARMFIRST, DO NO HARM
HIPPOCRATES’ TENETHIPPOCRATES’ TENET
(460-! "C)(460-! "C)
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Total Care
otal Care
#
#
I %anage !im ,I ma"e t!e%anage !im ,I m a"e t!e
2oun-' %ut 7O D !eale !im
oun-' %ut 7OD !eale !im
Am%roise
m%roise are
are
<?
?
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Total Care
otal Care
#
Don let me on.
on let me on.
Dopamin.
opamin.
Terapi simptomati"
erapi simptomati"
Tana: 0ital 1111ana: 0ital 1111
Sel 1111
el 1111
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Total Care
otal Care
#
#
rof. Samsu!iaat ,<=>-rof. Samsu!iaat ,<=>-
TOTAL CARE
OTAL CAR E
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TOTAL CARE
OTAL CARE
#
atofisiologi.
atofisiologi.
Organrgan
AnatomiAnatomi
+a"ro sir"ulasi.
a"ro sir"ulasi.
Sel
el
+i"ro sir"ulasi.
+i"ro sir"ulasi.
Listenisten
To
o
H !at
!at
T!e
!e
Cells
ells
Say
ay
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Total Care
otal Care
#
#
<;
;
Butir
utir
Total
otal
Care
are
#
<.
.
Triage
riage
1
:.
.
Diagnosa 1
iagnosa 1
.
.
Kasus %ea! / %u"an 1
asus %ea! / %u"an 1
?.
.
+asala! yang apat tim%ul 1asala! yang apat tim%ul 1
.
.
enis op. / te"ni" op. ,
enis op. / te"ni" op. ,
S(!ool Of Surgery /
(!ool Of Surgery /
S(!ool Of Anest!esiology- 1
S(!ool Of Anest!esiology- 1
.
.
Timing
iming
operasi 1
perasi 1
..
+asala! pra%ea! 1asala! pra%ea! 1
>.
.
+asala! intra%ea! 1
asala! intra%ea! 1
=.
.
+asala! pas(a%ea! 1
asala! pas(a%ea! 1
<;.
;.
9ollo2 5p
ollo2 5 p
1
1
STRATE7IC
TRATE7IC
T)I*KI*7
)I*KI*7
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Total Care
otal Care
#
#
<.
.
TRIA7E
RIA7E
1
rimary Sur0ey
r imary Sur0ey
#
#
A ,
,
Air2ay
ir2ay
-.
.
B , ,
Breat!ingreat!ing
-..
C ,
,
Cir(ulation
ir(ulation
-.
.
D ,
,
Disa%il ity
isa%ility
-.
.
E ,
,
ENposure
Nposure
)ipotermi-.
)ipotermi-.
Resusitasiesusitasi %ea!ea!
Stop
top
Bleeing
leeing
.
Stop
top
Contam ination
ontamination
.
Damage
amage
Control
ontrol
Surgery
urgery
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Total Care
otal Care
#
:.
.
DIA7*OSA
IA7*OSA
#
#
Anamnesa
namnesa
+
+e(!. Of Inury
e(!. Of Inury
.
I
Inury Sustainenury Sustaine
.
S
Symptoms
ymptoms
T
T!erapy
!erapy
.
emeri"saan
emeri"saan
f
f
isi"
si"
Cari
Cari
Inury & Symptoms
nury & Symptoms
Ba(" To Basi(s
a(" To Basi(s
.
*utritional assessm ent ,Boy
utrit ional assessm ent ,Boy
(om position' Bio(!emi(al ata'om position' Bio(!em i(al ata'
Su%. 7lo%al Assessm ent 3 S7A -
u%. 7lo%al Assessm ent 3 S7A-
& S(reening.
S(reening.
La%oratorium
a%oratorium
+eta%olisme anaero% 1111
+eta%olisme anaero% 1111
Listen To H !at T!e C ells Say
isten To H !at T!e C ells Say
.
7iPi # Serum al%umin'
iPi # Serum al%umin'
Total lymp!
otal lym p!
(ount'
ount'
Serum transferin' Serumerum transferin' Serum
pre al%umin'
re al%umin'
Total iron %ining
otal iron %in ing
(apa(ity
apa(ity
' (!olesterol
(!olesterol
Imaing
maing
9oto polos' 5S7' CT S(an' +RI & +SCT ll.
oto polos' 5S7' CT S(an' +RI & +SCT ll.
Enos"opi
nos"opi
/
/
Laparos"opi
aparos"opi
D/ & A.
D/ & A.
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Total Care #
otal Care #
.
.
Kasus
asus
%ea!
ea!
/
/
%u"an
u"an
1
1
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Total Care
otal Care
#
#
?.
.
+ASALA) 87 D T TI+B5L
ASALA) 87 D T TI+B5L
1
1
Ota" 1
ta" 1
ernafasan 1
ernafasan 1
Kario0as"uler 1
ario0as"uler 1
)ati 1
ati 1
7inal 1
inal 1
an"reas 1an"reas 1
Con sum ption Coa gulopat!y'
onsum ption Coagulopat!y'
Surg . / *o n Surg. Bleeing 1
urg. / *on Surg . Bleeing 1
7u t 9ailure
ut 9ailure
1
1
Lam%ung / Ileus.
Lam%ung / Ileus.
7iPi 1
iPi 1
*ormal'
*ormal'
+alnutrisi seang ,=@alnutrisi seang ,=@
"ompli"asi-'
ompli"asi-'
+alnutrisi %erat , ?:@ "ompli"asi-
alnutrisi %erat , ?:@ "ompli"asi-
Imunologi
munologi
SIRS' CARS' +ARS 1
IRS' CARS' +ARS 1
Strategi(
trategi(
T !in"ing
!in"ing
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Total Care
otal Care
#
.
.
E*IS TI*DAKA* /
E*IS TI*DAKA* /
TEK*IK
EK*IK
O ERASI
ERASI
1
1
S(!ool of Su rgery 1
(!ool of Surgery 1
S(!oo l of Anest!esiology 1
(!ool of Anest!esiology 1
<' :' & ?
' :' & ?
Inform e Consent
nform e Consent
.
Communi(at ion
ommuni(at ion
S" ill
"ill
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Total Care
otal Care
#
#
.
.
TI+I*7
I+I*7
O ERASI 1
O ERASI 1
7a2at Darurat 1
a2at Darurat 1
Segera 1egera 1
Tuna 1
una 1
Konser0atif 1
onser0atif 1
Ele"tif 1le"tif 1
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Total Care
otal Care
#
#
.
.
+ASALA) RA BEDA) 1
ASALA) RA BEDA) 1
)ernia Strangulata !ari / < )ari 1
ernia Strangulata !ari / < )ari 1
+asala! A' B' C 1
asala! A' B' C 1
Resp Distress 1esp Distress 1
Compartment Synrom1
ompartment Synrom1
+eta%olisme' ele"trolit'
eta%olisme' ele"trolit'
asam3%asa1sam3%asa1
Toleransi operasi 111
oleransi operasi 111
Strategi %eru%a! trategi %eru%a!
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Total Care #
otal Care #
>.
.
+ASALA) I*TRA BEDA)
ASALA) I*TRA BEDA)
1
1
9asilitas "mr operasi 1
asilitas "mr operasi 1
Te"ni" operasi 1
e"ni" operasi 1
+ampu"a! sayaampu"a! saya 111111
Te"ni" anestesi mana & ampa"nya 1
e"ni" anestesi mana & ampa"nya 1
)anya resusitasi %ea! / efinitif 1
anya resusitasi %ea! / efinitif 1
Op ele"tifp ele"tif
Triaria Off Deat!eat!
Dam age Control
am age Control
Surgery1
urgery1
*utrisi
utrisi
Te"ni" operasi ,9eeing
Te"ni" operasi ,9eeing
eunostomi 1-eunostomi 1-
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Total Care #
otal Care #
=.
.
+ASALA) ASCA BEDA)
ASALA) ASCA BEDA)
1
1
E0aluasi %utir <
0aluasi %utir <
> 1
> 1
A1 B1 C1 D1 E
1 B1 C1 D1 E
,)ipotermi- 1)ipotermi- 1
Listen To H !at T! e Ce lls Say
isten To H !at T! e Ce lls Say
Ruangan %ea! 1
uangan %ea! 1
SIC5 / )C5 1IC5 / )C5 1
IC5 / ICC5 1
C5 / ICC5 1
+ASALA)
ASALA)
SEL
EL
111
111
+i"rosir"ulasi
i"rosir"ulasi
111
111
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Total Care #
otal Care #
<;.
;.
9OLLOH 5
OLLOH 5
1
1
Di %angsal #
i %angsal #
A ,
A ,
Air2ay
ir2ay
- 1
1
B ,
,
Breating
reating
- 1
1
C , ,
Cir(ulationir(ulation
- 1 1
D ,
,
Disa%il ity
isa%ility
- 1
1
E ,)ipotermi- 1
,)ipotermi- 1
Listenisten Too H!at!at T!e!e Ce llsells Sayay
Di poli #
i poli #
Apa"a!
pa"a!
E5ILIBRI5+
5ILIBRI5+
,Claue Bernar-
Claue Bernar-
s! i(apai 1
! i(apai 1
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"#AMIN$ %"#AMIN$ %
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S&PPORTIN$%S&PPORTIN$%
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)ypotensi0e)ypotensi0eResus(itation in t!eResus(itation in t!e
Pre )ospital & ERPre )ospital & ERP!aseP!aseAryono D.PusponegoroAryono D.Pusponegoro
Refferal #Refferal #
ATLSATLS
A(ute Care SurgeryA(ute Care Surgery
Peri Op Criti(al CarePeri Op Criti(al Care
Total CareTotal CarePusponegoro A.D.Pusponegoro A.D.
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• QQ :> yrs Poli(e:> yrs Poli(e• A+ ta"en %y A+ ta"en %y
TaNi to Small )ospTaNi to Small )osp• Bleeing ,3-Bleeing ,3-• Alert' BP >;/Alert' BP >;/
Sta%leSta%le• PR =; / +inPR =; / +in• : L RL: L RL BleeingBleeing
,-,-
• S!o(" ,-S!o(" ,-• <:.;; Consulte to<:.;; Consulte to
SurgeonSurgeon Tria of Deat! ,-Tria of Deat! ,-
• Damage ControlDamage Control
SurgerySurgery• Re2armingRe2arming• <.;;<.;;
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Dealy DoenDealy Doen # #
Let!al SiNLet!al SiN # #
<.<. Air2ay O%stru(tion Air2ay O%stru(tion
:.:. TensionTension
Pneumot!oraN Pneumot!oraN .. Caria(Caria(
Tamponae Tamponae
?.?. OpenOpen
Pneumot!oraN Pneumot!oraN
.. +asi0e+asi0e)emot!oraN )emot!oraN
.. 9lail C!est 9lail C!est
)ien SiN)ien SiN # #
<.<. T!oragi( AortaT!oragi( AortaDisruption Disruption
:.:.
Tra(!eo%ron(!ialTra(!eo%ron(!ialIn&ury In&ury
.. Blunt Caria(Blunt Caria(In&ury In&ury
?.?.
Diap!ragmati(Diap!ragmati(In&ury In&ury
.. Esop!ageal In&ury Esop!ageal In&ury
.. PulmonaryPulmonary
Contusion Contusion
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ATLSATLS Sour(e of BleeingSour(e of Bleeing S!o(" #S!o(" #
<.<. T!oraNT!oraN
:.:. A%omenA%omen
.. Pel0isPel0is?.?. 9emur 9emur
.. Retro PeritonealRetro Peritoneal
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Patient in )emor!agi( S!o("Patient in )emor!agi( S!o("
Resus(itate a((oring to Proto(alResus(itate a((oring to Proto(al
2it! :;;; (( RL2it! :;;; (( RL
S!o(" 111S!o(" 111ATLSATLS
<.<.Rapi ResponseRapi Response
:.:.Transient Response 111Transient Response 111..*o Response*o Response
H!y 111H!y 111
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T!e Ameri(an College of
!e Ameri(an College of
Surgeons proto(ol for
urgeons proto(ol for
ATLS'TLS' re(ommens #e(ommens #
T)E TRADITIO*AL A ROAC)
)E TRADITIO*AL A ROAC)
of t!e emergen(y
of t!e emergen(y
p!ysi(ian an t!e trauma surgeon
!ysi(ian an t!e trauma surgeon
,(i0ilian
(i0ilian
setting-'etting-' !ypo0olemi( !ypotensionypo0olemi( !ypotension isis to (orre(tto (orre(t
any traumati( as rapily as possi%le.
ny traumati( as rapily as possi%le.
T!is emp!asis on immeiate post3inury flui
!is emp!asis on immeiate post3inury flui
resus(itation 2as %ase on early eNperimental
esus(itation 2as %ase on early eNperimental
ata s!o2ing t!at rapi restoration of %loo
ata s!o2ing t!at rapi restoration of %loo
0olume an pressureolume an pressure le to impro0ement of 0italle to impro0ement of 0ital
organ fun(tion an long term sur0i0al
rgan fun(tion an long term sur0i0al
' %y
%y
a0oiing t!e late seFuelae of !ypo0olemi( s!o(".
0oiing t!e late seFuelae of !ypo0olemi( s!o(".
ATLS Course promotes t!e
TLS Course promotes t!e
rapi infusion of
api infusion of
large 0olumes of (rystallois to !ypotensi0e
arge 0olumes of (rystallois to !ypotensi0e
trauma patients.
rauma patients.
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Opponents to T!e ATLS
pponents to T!e ATLS
(on(ept
on(ept
,<-
,<-
Solomono0 et al an KrauP et al
olomono0 et al an KrauP et al
,<==;-# Inepenently s!o2e'
,<==;-# Inepenently s!o2e'
t!at in an eNperimental s!eep!at in an eNperimental s!eep
moel of spleen inury' 2it!
oel of spleen inury' 2it!
un(ontrolle !emorr!age'
n(ontrolle !emorr!age'
0igorous infusion
igorous infusion
of isotoni(
of isotoni(
an !ypertoni( salinen !ypertoni( saline too
a(!ie0e a normal %loo
(!ie0e a normal %loo
pressure resulte in
ressure resulte in
in(rease
n(rease
%leeing an mortality.
leeing an mortality.
6$$%nents t% The ATLS6$$%nents t% The ATLS
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6$$%nents t% The ATLS6$$%nents t% The ATLS
,%n,e$t '7),%n,e$t '7)
Stern an (olleagues
tern an (olleagues
,<==- # s!o2e
,<==- # s!o2e
in a por(ine moel 2it! a%ominal
n a por(ine moel 2it! a%ominal
aorti( inury 2it! near fatal
orti( inury 2it! near fatal
!emorr!age' t!atemorr!age' t!at attempts to restorettempts to restore
%loo pressure 2it! rapi infusion of
loo pressure 2it! rapi infusion of
(rystallois
rystallois
le to in(rease %leeing
e to in(rease %leeing
an mortality.
n mortality.
Capone an asso(iatesapone an asso(iates # also# also
(onfirme t!is
onfirme t!is
a0erse result
a0erse result
in a
in a
murine moel' an s!o2e t!at
urine moel' an s!o2e t!at
ui(ious flui aministration impro0e
ui(ious flui aministration impro0e
s!ort3term sur0i0al.
!ort3term sur0i0al.
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Early 0s Delaye Resus(itationEarly 0s Delaye Resus(itation("i'e, N* E+* * .e 114)("i'e, N* E+* * .e 114)
Bi("ell note t!at
i("ell note t!at
rapily
apily
aministering La(tate RingerUs
ministering La(tate RingerUs
solution intra0enously
olution intra0enously
signifi(antlyignifi(antly in(reasesn(reases
!emorr!age an eat!
emorr!age an eat!
pV;.;.
pV;.;.
T!e
!e
in(rease 0olume of
n(rease 0olume of
!emorr!age in t!e resus(itate
emorr!age in t!e resus(itate
grouproup (oul !a0e resulte from(oul !a0e resulte from
eit!er a((entuation of an ongoing
it!er a((entuation of an ongoing
!emorr!age of
emorr!age of
reinitiating t!e
einitiating t!e
!emorr!age
emorr!age
after spontaneous
fter spontaneous
!emostasis !a o((urre.emostasis !a o((urre.
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5S5)S / 5niforme Ser0i(es
S5)S / 5niforme Ser0i(es
5ni0ersity of t!e )ealt!ni0ersity of t!e )ealt!
S(ien(es
(ien(es ''&SA&SA 788<)788<) I
Conferen(e of 5S5)S'
Conferen(e of 5S5)S'
Re(ommene #Re(ommene #
Consensus ofConsensus of resus(itation enpointsresus(itation enpoints
i.
.
a palpa%le raial pulse'
palpa%le raial pulse'
ii.
i.
a%ility to mentate' an
%ility to mentate' an
iii.ii.
sustaine a systoli( %looustaine a systoli( %loo
pressure >3=; mm)g
ressure >3=; mm)g ,if,ifsp!ygmomanometry 2assp!ygmomanometry 2asa0aila%le-.a0aila%le-.
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)8 OTE*SIWE RES5SCITATIO*
8 OTE*SIWE RES5SCITATIO*
T!is te(!niFue (alls
!is te(!niFue (alls
for flui
or flui
aministration' enpoint #
ministration' enpoint #
i.
.
+A
A
,mean arterial pressure- of
mean arterial pressure- of
;
;
mm )g
m )g
or'
or'
ii.
i.
SB
B
,systoli( %loo pressure- of
systoli( %loo pressure- of
=;
;
mm )g'
m )g'
t!e
!e
minimum pressure ne(essary to
inimum pressure ne(essary to
maintain 0ital organ perfusion.
aintain 0ital organ perfusion.
)ypotensi0e resus(itation !as %een
ypotensi0e resus(itation !as %een
a0o(ate in orer
0o(ate in orer
to pre0ent t!e
o pre0ent t!e
resus(itation
esus(itation
re3%leeing
e3%leeing
inury
nury
mentione a%o0e.
entione a%o0e.
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Bloo Pressure at 2!i(! Re%leeingBloo Pressure at 2!i(! Re%leeing
O((urs after Resus(itation in S2ine 2it!O((urs after Resus(itation in S2ine 2it!
Aorti( InuryAorti( Inury(S2+ee+, Tra3.a 00 52 !4)(S2+ee+, Tra3.a 00 52 !4)
T!ere 2asT!ere 2as a reprou(i%le pressurea reprou(i%le pressure atat
2!i(!2!i(! re%leeing o((ursre%leeing o((urs
T!e re%leeing o((urs 2as not affe(te %y time ,3
!e re%leeing o((urs 2as not affe(te %y time ,3
<- minute or %y t!e rate ,<;; 0s ;; ml/minute-' %ut
- minute or %y t!e rate ,<;; 0s ;; ml/minute-' %ut
#
T!e
!e
a0erage pressure at t!e re%leeing
0erage pressure at t!e re%leeing
2as
2as
+A ?A ? : mm)g: mm)gSystoli( =?
ystoli( =?
mm)g
mm)g
Diastoli( ?
iastoli( ?
: mm)g
: mm)g
Con(lusions #
on(lusions #
T!e optimal enpoint of
!e optimal enpoint of
resus(itation for un(ontrolle
esus(itation for un(ontrolle
%leeing s!oul %e %elo2 t!e
leeing s!oul %e %elo2 t!e
re%leeing pressuree%leeing pressure
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During TransportDuring Transport Keep t!e Keep t!ePatient )ypotensi0e uner t!ePatient )ypotensi0e uner t!eRe%leeing PointRe%leeing Point
IfIf Surgeon ,3-Surgeon ,3-
Keep t!e PTKeep t!e PT)ypotensi0e until t!e Surgeon)ypotensi0e until t!e Surgeonarri0esarri0es
Arri0al in t!e ERArri0al in t!e ER 7o Straig!t7o Straig!tto t!e Operating Room or Do an ERto t!e Operating Room or Do an ERLaparotomy / T!ora(otomy toLaparotomy / T!ora(otomy to StopStopt!e Bleeingt!e Bleeing t!en Resus(itatet!en Resus(itate
DonMt 2aste your timeDonMt 2aste your time in t!ein t!eResus(itation Room 2it! 9luis Resus(itation Room 2it! 9luis
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