SUMBATAN JALAN NAPAS.pptx

8/10/2019 SUMBATAN JALAN NAPAS.pptx

1/48


2/48

PRIMARY SURVEY


3/48


4/48

AVPU


5/48

Penyebab Obstruksi Jalan Nafas


6/48


7/48


8/48


9/48


10/48


11/48

Sumbatan saluran napas atas dapat dibagi menjadi 4 derajat

berdasarkan kriteria Jackson.

Jackson Iditandai dengan sesak, stridor inspirasi ringan, retraksi

suprasternal, tanpa sianosis.

Jackson IIadalah gejala sesuai Jackson I tetapi lebih berat yaitu disertai

retraksi supra dan infraklavikula, sianosis ringan, dan pasien tampak

mulai gelisah.

Jackson IIIadalah Jackson II yang bertambah berat disertai retraksi

interkostal, epigastrium, dan sianosis lebih jelas.

Jackson IVditandai dengan gejala Jackson III disertai wajah yang

tampak tegang, dan terkadang gagal napas.

(SUMBER : Kedaruratan Medik, Dr. Agus Purwadianto & Dr. Budi

Sampurna)


12/48

AIRWAY MANAGEMENT

AirwayManagement

Basic AirwayManagement

Triple airwaymanuver

Head Tilt

Chin Lift

Jaw Trust

Menggunakan

Alat

Airwaynasofaringeal

AirwayOrofaringeal

Definitif AirwayManagement

IntubasiEndotrakea

Orotracheal

Nasotracheal

Surgical

Krikotiroidotomi

Jet Insufflation


13/48

PRINSIP MANAGEMENT AIRWAY

Cervical tidak boleh ekstensi, fleksi,

rotasi

In line

Immobilsation

Curigai cedera servikal berdasarkanmekanisme trauma(Benturanfrontal,benturan belakang)

Cedera Cervical

Pemberian O2 harus dilakukansebelum dan segera setelahpengelolaan jalan napas

O2


14/48


15/48


16/48

HEAD TILT-CHIN LIFT

JAW TRUST


17/48

JAW TRUST


18/48

AIRWAY NASOFARINGEAL


19/48


20/48

N


21/48

A

I

RW

A

Y

N

A

S

O

F

A

R

I

N

G

E

A

L


22/48


23/48

INDIKASI PEMASANGAN AIRWAY

DEFINITIF


24/48

INTUBASI ENDOTRACHEA


25/48

INTUBASI ENDOTRACHEA


26/48


27/48


28/48


29/48


30/48

NEEDLE CRICOTHYROIDOTOMY


31/48

NEEDLE CRICOTHYROIDOTOMY


32/48


33/48

MENGAPA MENGELUARKAN BANYAK

DARAH? Mekanisme traumakepala terbentur

trotoar(benturan

frontal/samping/belakang)trauma

servikalperdarahanditandai dengan garglingdan rongga mulut mengeluarkan banyak darah


34/48

MENGAPA SIANOSIS

Syok Hemoragik dan obstruksi jalan nafas

BerkurangnyaSaO2berasal dari menurunnya PaO2Gangguan fungsi paruyang serius tidak terventilasi atau miskin ventilasi(hipoventilasi alveolar)penyebab sianosis sentral yangsering.

vasokonstriksi generalisataKetika cardiac output rendah,seperti pada gagal jantung kongestif berat atau syok,vasokonstriksi kulit terjadi sebagai mekanisme kompensasidarah dialirkan terutama ke daerah-daerah prioritas seperti

SSP dan jantung, dan terjadi sianosis yang berhubungandengan ekstremitas yang dingin. Walaupun saturasi daraharteri normal, volume darah yang mengalir ke kulit berkurangdan turunnya PO2pada ujung vena dari kapiler menyebabkan

sianosis.


35/48

TERAPI OKSIGEN

In immediately life threatening situations oxygen should be administered.

When to use oxygen therapy?

Hypoxia and or hypoxemia

Acute hypotension.

Breathing inadequacy.

Trauma.

Acute illness.

CO poisoning.

Severe anaemia.

During the peri-operative period.


36/48

Tissue oxygen delivery depends upon:

Adequate function of cardiovascular (cardiac output and flow)

Hematological (hb and its affinity for oxygen)

Respiratory (arterial oxygen pressure) system.

Tissue hypoxia is not relieved by oxygen therapy alone, functioning of all the

three organ systems also needs to be improved


37/48

1. Nasal Cannulae (NC)

A thin tube with two small nozzels that protude into the patient nostrils.

Easy to use.

Well tolerated.

Comfortable for long periods.

Patient can eat and talk easily.Possible to deliver oxygen concentrations of

24-40% at flow rates of 1-6 litres/min.

Flow rates in excess of 4 litres/min might cause discomfort and drying of

mucous membranes and are best avoided.


38/48

2. Simple Face Mask

Easy to use.

Requires a good fit.

Between 6-12 lpm, concentration of oxygen 28-50%


39/48

3. Partial Rebreathing Mask

Based on a simple face mask, but featuring a reservoir bag which

increases the provided oxygen rate to 40-70% oxygen at 5 -15 lpm.


40/48


41/48

5. Venturi Mask

Also known as an air-entrainment mask is a a type of disposable face mask

used to deliver a controlled oxygen concentration to a patient, are considered

high-flow oxygen therapy devices.The flow of 100 per cent oxygen through the mask draws in a controlled

amount of room air (21 per cent oxygen). Commonly available masks deliver

24, 28, 31, 35, or 40 per cent oxygen.

The kits usually include multiple jets in order to set the desired F iO2which are

usually color coded. The color of the device reflects the delivered oxygen

concentration, for example: blue = 24%; yellow = 28%; white = 31%; green =

35%; pink = 40%; orange = 50%.


42/48

Venturi Mask


43/48

When to stop oxygen therapy?

Patient becomes comfortable

Underlying disease stabilized

Blood pressure, pulse rate, respiratory rate and oxymetry are withinnormal range

How to assess patient condition in 10 seconds?1.Stimulate verbal response: good response = airway is clear, breathing

and ventilation adequate.

1.No response: Look, listen , feel

Look: chest movement, sign of hypoxia (cyanosis), accessory

respiratory muscle

Listen: snoring, gurgling, stridor, hoarness or no sound (apnea?)

Feel : air movement in front of nose.

3. Unconscious patient, Airway obstruction ?

Chin lift, jaw thrust (head tilt).

4. Spontaneous breathing or apnea (not breathing?)

Still breathing: give oxygen (NRM with 12 lpm)

Apnea : positive pressure ventilation with 100% oxygen (10-12 lpm).


44/48


45/48

GCS


46/48

Karena adanya hipoksiapenimbunan asam

laktatpenurunan suplay O2 ke otakgangguan korteks serebri (bagian pengolahkesadaran)penurunan kesadaran

Dapat pula Karena adanya trauma kepala

perdarahan intrakranialpenekanan batangotakpenekanan ARAS (Ascending ReticularActivating Systembagian susunan penggalakkewaspadaan)penurunan kesadaran

Terdapat pula kemungkinan fraktur cervicalpenekanan pusat kesadaranpenurunankesadaran

Mengapa pasien tidak sadar


47/48


48/48

SUMBER

Emergency Care: A Textbook for Paramedics,IanGreaves, Keith Porter, Timothy J. Hodgetts, MalcolmWoollard, Elsevier Health Sciences, 2006

Paramedic: Airway Management,Gregg S. Margolis,Jones &Bartlett Learning, 1 Nov 2003 - 332 halaman

Harrisons Principles of Internal Medicine 16thEdition, page209 - 211.

Harrisons Manual of Medicine 16thEdition, page 192193

ATLS 8th edition

Toronto Notes : Emergency Medicine, 2008 Trauma:emergency resuscitation,preoperative

anesthesia,surgical management, volume 1,2007

Documents

SUMBATAN JALAN NAPAS.pptx