LBM 1 KGD SUMBATAN JALAN NAPAS

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    Sumbatan Jalan Nafas

    STEP 1

    AVPU : untuk mengukur tingkat kesadarano Alert : mengetahui apakah sadarnya baik atau tidak

    o Verbal : respon kata2 baik atau tidak

    o Pain : rangsang nyeri

    o Unresponsive : responnya tidak baik

    Fraktur impresi : fraktur yg diakibatkan benturan oleh tenaga yg besar, yg langsung kena

    tulang kepala, sehingga menyebabkan penekanan atau bakan lasrasi ke lap. Duramater

    atau jaringan otak. Ada yg terbuka dan tertutup.

    Pulse oxymetri : suatu metode non invasive untuk memmonitoring O2 Saturasi (sp02) dr

    Hb. Dalam 1 HB ada 4 molekul O2. Dengan pulse oxymetri tdk bisa mlihat saturasi di

    semua tubuh hanya di jaringan yg tipis seperti di daun telinga. Triple airway manuvare : salah satu cara untuk mengelolaan jalan nafas,

    o Chin lift : dagu diangkat

    o Head tilf : kepala di kebelakangkan

    o Jaw trust : rahangnya agak di kedepankankhusus apabila ada cidera kepala.

    Definitive airway : suatu tindakan yang memasukkan pipa ke dalam trakea denga balon

    yg dikembangkan. Pipa tersebut di hub dngan alat bantu pernafasan yg kaya akan O2.

    Biasanya dilakukan apbila dgn maneuver sederhana tdk bereaksi. Indikasi : GCS =< 8

    Oropharyngeal airway : Teknik lanjutan dr Triple airway maneuver, alat untuk menekan

    lidah untuk membebaskan jalan nafas. Golongan non definitive airway. Tujuan : untuk

    menutupi lidah agar tdk menghalangi oropharing, dan mencegah agar lidah tdk tergigit,

    digunakan pd pasien yg tdk sadarkan diri.o Perbedaannya dgn definitve airway : DA melindungi jalan nafas dr muntahan,

    atau masuknya O2 dgn konsentrasi tinggi.

    Sp O2 :saturasi oksigen , normalnya 95-100% .

    STEP 2

    1. Jelaskan mengenai primary survey

    2. Mengapa pada pasien didapatkan RR meningkat ?

    3. Mengapa pasien mengeluarkan banyak darah dr ronga mulut dan hub dengan suara

    mengorok atau berkumur4. Mengapa setelah di lakukan TAM kondisi pasien tmbh memburuk ?

    5. Mengapa stlh dilakukan pemasangan oksigen rebreathing, saturasi menjadi turun ??

    6. Jelaskan tentang TAM, OPA, DA, dan NPA

    7. Identifikasi sumbatan jalan nafas, apa saja ?

    8. Jelaskan langkah2 menilai jalan nafas

    9. Mengapa didapatkan penurunan kesadaran dr pasien tsb dan sianosis pd pasien ?

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    accurately access the mental status. Utilize family and caregivers to obtain baseline

    information.

    3. Assess the patient's airway- Is the patient's airway open? If the patient is unresponsive

    stabilize the head and neck and use the jaw-thrust maneuver to ensure an open

    airway. If you do not suspect a spine injury use the head tilt, chin lift maneuver.

    4. Assess the patients breathing - Is the patient breathing adequately? With the airway

    open, place your ear over the patient's nose and mouth and watch for chestmovement,

    note symmetry or lack of symmetry in chest movement. Listen and feel for the

    presence of exhaled air. Listen to the quality of the breath sounds. Sporadic respirations

    are called agonal respirations and occur just prior to death.

    5. Assess the patient's circulation (pulse and bleeding)- Does the patient have an

    adequate pulse. Is there serious bleeding. Did the patient lose a large quantity of blood

    prior to your arrival?

    o

    If the patient is not breathing check the pulse at the neck (carotid).o If the patient is breathing you can check the carotid or the pulse at the wrist

    (radial)

    o If you document the presence of a carotid pulse but the radial pulse is absent

    this may represent a shock situation. A rapid or weak pulse may also represent a

    shock situation.

    o Although any uncontrolled bleeding may become life threatening, you are only

    concerned with profuse bleeding during the initial assessment

    o Blood that is bright red and spurting may be coming from an artery

    o Flowing blood that is darker in color typically reflects a venous origin

    o

    Your concern is for the total amount of blood lost, not just how fast or slow thebleeding is.

    o Assessment of circulation also includes checking skin signs - color, temperature,

    and moisture. Abnormal findings such as pale cool , moist skin could be

    indicative of shock

    Geriatric focus- The elderly often have an irregular pulse. This is rarely life threatening.

    However the speed of the pulse, both too fast and too slow can be life threatening.

    6.

    Make a decision on the priority or urgency of the patient for transport

    Special consideration for infants and children

    o Opening the airway of an infant involves moving the head into a neutral

    position, not tilting it back as with an adult. Opening the airway of a child

    requires only slight extension.

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    o Breathing and pulse rates are faster in infants and than in adults. The pulse to

    check in an infant or a small child is the brachial pulse

    o An additional part of checking an infant's or child's circulation is capillary refill.

    When the end of a child's fingernail is gently pressed, it turns white secondary to

    blood flow restriction. When the pressure is released, the nail turns pink again,

    usually in less than two seconds. If it takes longer than two seconds for the nailbed to become pink again or if it does not return to pink at all, there may be a

    problem with circulation such as shock or significant blood loss.

    Usually when an adult goes into shock they typically worsen gradually and the

    downward trend can be spotted in time to take appropriate actions. However,

    an infant's or child's body can compensate so well for a problem such as blood

    loss the he (she) may appear stable for some time, and then suddenly become

    much worse. Children can actually maintain their blood pressure up to the time

    when almost half of their total blood volume is loss. Therefore a normal blood

    pressure may not rule out the presence of shock. A delayed capillary refill time

    may be a more reliable indicator of circulatory compromise.

    Focused History and Physical Exam (Secondary Survey)

    A focused history and physical exam should be performed after the initial assessment. It is

    assumed that the life-threatening problems have been found and corrected. If you have apatient with a life-threatening problem that requires intervention (i.e. CPR) you may not get to

    this component. The main purpose of the focused history and physical is to discover and care

    for a patient's specific injuries or medical problems.

    Focused History and Physical Exam

    The focused history and physical exam includes a physical examination that focuses on a

    specific injury or medical complaint, or it may be a rapid examinationof the entire body.

    It also includes obtaining a patient history and vital signs.

    Patient History- A patient history includes any information relating to the current complaint or

    condition, as well as past medical problems that could be related. Utilize bystanders/family...

    when needed

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    Acronym to obtain a patient's history

    S- Signs/symptoms

    A- Allergies

    M- Medications

    P- Pertinent past medical historyL- Last oral intake

    E- Events leading to the illness or injury

    Rapid assessment - this a quick, less detailed head - to toe assessment of the most critical

    patients

    Focused assessment - This is an exam conducted on stable patients. It focuses on a specific

    injury or medical complaint.

    Vital signs- This include pulse, respirations, skin signs, pupils and blood pressure. This mayinclude documenting the oxygen saturation level (this is highly useful when dealing with

    chemical agent exposure).

    Pulse- Assess for rate, rhythm, and strength

    Respiration- Assess for rate, depth, sound, and ease of breathing

    Skin signs- Assess for color, temperature, and moisture

    Pupils- Check pupils for size, equality, and reaction to light. Constricted pupils in a mass

    casualty event are highly suggestive of nerve agent/organophosphate toxicity.

    Age-associated Vital Signs

    Age Blood pressure Pulse Respiratory rate

    Term Newborn (3 kg)

    Age 12 hours 50-70 / 25-45

    80-200 40-60

    Age 96 hours 60-90 / 20-60

    Age 7 days74 +/- 22 mmHg

    (Systolic BP)

    Age 42 days96 +/- 20 mmHg

    (Systolic BP)

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    Infant (6 months old) 87-105 / 53-66 80-180

    Toddler (2 years old) 95-105/53-66 80-180 24

    Schoolage (7 years old) 97-112/57-71 60-160

    Adolescent (15 years old) 112-128/66-80 60-160 12

    Head to Toe Examination of a Trauma Patient with Significant MOI - The physical examination

    of the patient should take no more than two to three minutes

    Neck- Examine the patient for point tenderness or deformity of the cervical spine. Any

    tenderness or deformity should be an indication of a possible spine injury. If the patient's C-

    spine has not been immobilized immobilize now prior to moving on with the rest of the exam.

    Check to see if the patient is a neck breather, check for tracheal deviation

    Head- Check the scalp for cuts, bruises, swellings, and other signs of injury . Examine the skull

    for deformities, depressions, and other signs of injury. Inspect the eyelids/eyes for impaled

    objects or other inju

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