Penilaian kegawatan pada anak

LENY AMBARWATIPenilaian kegawatan pada anak

Tindakan yang tepatPrognosis baikPENILAIAN UMUMIndentifikasiIntervensi EvaluasiSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Pediatric Assesment TRIANGLE (PAT)

APPEARANCE METODE TICLS Karakteristik Hal yang dinilai ToneApakah anak bergerak aktif atau menolak pemeriksaan. Apakah tonus ototnya baik/lumpuhInteractivenessBagaimana kesadarannya, apakah suara mempengaruhinya, apakah ia mau bermain, anak tidak bersemangat berinteraksi dengan orang tua/pengasuh atau pemeriksa ConsolabilityApakah anak dapat ditenangkan, anak menangis terusLook/GazeApakah ia memfokuskan penglihatan pada muka atau pandangan kosongSpeech/cryApakah anak berbicara atau menangis kuat, lemah atau parauWORK OF BREATHINGKarakteristik Hal yang dinilai Suara napas yang tidak normalMengorok, parau, stridor, merintih, mengiPosisi tubuh yang tidak normal Tripoding, menolak berbaringRetraksiSupraklavikula, interkostal, substernalCuping hidung Head bobbingPernapasan cuping hidung CIRULATION TO THE SKINKarakteristik Hal yang dinilai PucatKulit atau mukosa tampak kurang merah karena aliran darah yang kurangMottling Kulit berbercak kebiruan akibat vasokonstriksiSianosisKulit dan mukosa tampak biru Pediatric Assesment TRIANGLE (PAT)

NN(+)Distress PernafasanPediatric Assesment TRIANGLE (PAT)

(+)N(+)Gagal NafasPediatric Assesment TRIANGLE (PAT)

(+)(+)NSyokPediatric Assesment TRIANGLE (PAT)

(+)NNGangguan metabolisme /SSPPediatric Assesment TRIANGLE (PAT)

Menilai pasien < 1 menitPENILAIAN PRIMER A = AirwayB = BreathingC = CirculationD = DisabilityE = ExposureSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.AIRWAYSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Tindakan sederhanaPosisi yang nyaman Head tilt chin lift Isap lenderMenghilangkan obstruksi bila anak masih sadarUsia < 1 tahun : menepuk punggung (back sleps/blow) dan pijat dada (chest trusts)Usia > 1 tahun : abdominal trusts Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.

Abdominal ThrustTindakan /intervensi lanjut :Intubasi endotrakheal (ET)Menghilangkan benda asing, intervansi ini memerlukan alat direct laryngoscopyMemerlukan alat continuous positive airway pressure (CPAP)Cricotyrotomy (penusukan membrane cricothyroid menggunakan jarum)

Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.BREATHINGFrekuensi pernapasanUpaya pernapasan, Suara napasSaturasi oksigen dengan pulse oxymetrySystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Respirasi rate normal sesuai usiaUsiaFrekuensi Tiap MenitNeonatus 1 tahun30-601 3 tahun24-403 12 tahun20-30> 12 tahun12-30Pediatric fundamental critical care support. United State of America: Society of Crititical Care Medicine; 2008.Takipneu ( Nafas cepat > nilai normal sesuai usia)Demam, kecemasan dan rasa nyeri, penyakit respirasi, asidosis metabolik, dehidrasi, sepsis, gagal jantung, anemia berat, penyakit jantung sianotik, efek samping obatBradipneu ( Nafas lambat < nilai normal sesuai usia )Kelelahan bernafas, infeksi atau trauma susunan saraf pusat, hipotermia, obat-obatan yang menekan pusat nafas., severe sepsis, kelainan metabolicUPAYA PERNAFASanRetraksiPernafasan cuping hidungHead bobbingSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Suara nafasSura nafas tambahan : stridor, grunting, wheezing, cracles.

Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Saturasi oksigen > 94% room air oksigenasi adekuat< 94 % room air oksigenasi tambahan< 90% dgn oksigen 100% intervensi tambahanSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.C = Circulation

Frekuensi denyut jantung Irama jantung, Nadi, Capillary refill time, Warna kulit dan suhu, Tekanan darah

Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Frekuensi Denyut Jantung Normal Berdasarkan UsiaUmurSaat BangunRata-rataSaat Tertidur Bayi baru lahir 3 bulan 85-20514080-1603 bulan 2 tahun 100-19013075-1602 tahun 10 tahun 60-1408060-90> 10 tahun 60-1007550-90Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Tekanan darah sistolik berdasarkan usiaUsiaTekanan Darah Sistolik (mmHg)Neonates 60< 1 tahun701 10 tahun70 + (usia dalam tahun x 2)> 10 tahun90Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.DISABILITYPenilaian Kesadaran :APVUGCSSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.EXPOSUREPemeriksaan menyeluruhSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Penilaian sekunderS = sign and symptomA = Allergies M = Medications P = Past medical history L = Last meal E = Events Systematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Penilaian tersierPemeriksaan tambahan/ pemeriksaan penunjang untuk mengetahui derajat keparahan penyakit dan menentukan terapiSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.triaseA = Immediate ResuscitationB = EmergencyC = UrgenD = RoutineSystematic approach to the seriously ii or injured child. In: Chameides L, Samson R, Schexnayder S, Hazinzki M, editors. Pediatric advance life support United State of America: American Heart Assosiation; 2011.Penerapan triase rshsP1 gangguan respirasiP2 gangguan sirkulasiP3 sebab lainP4 tidak ada ancaman kematiansimpulanPengenalan kegawatan penting untuk tindakan segeraSemakin cepat dilakukan tindakan yang tepat, prognosis semakin baikTERIMAKASIH