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Trauma resuscitation and basic life support
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Trauma resuscitation and basic life support

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  • 1. DR LEE OI WAH PEGAWAI PERUBATAN UD 54
  • 2. KEPERLUAN Trauma merupakan penyebab kematian yang utama di kalangan yang berumur < 40 tahun. 3 pesakit mengalami kecacatan yang berkekalan untuk setiap mangsa yang mati. TLS merupakan bahasa perantaraan sedunia dalam perawatan.
  • 3. ATLS® Impacts 100% 50% 0% Immediate Deaths Early Deaths( FIRST 1 HR) Late Deaths % of Deaths
  • 4. Konsep ATLS ABCDE –pendekatan untuk evaluasi dan rawatan Rawat ancaman kepada nyawa terlebih dahulu (Treat greatest threat to life first) Diagnosa definitif BUKAN keutamaan utama. Masa itu emas! (Time is of the essence) Do no further harm ( Jangan membahayakan pesakit)
  • 5. Konsep Trauma Resuscitation A B C D E Airway with c-spine protection Breathing Circulation & Hemorrhage Control Disability / Neurologic status Exposure / Environment
  • 6. Initial Assessment Primary survey dan resuscitation adalah dijalankan serentak – Berpasukan
  • 7. Standard Precautions Cap Gown Gloves Mask Shoe covers Goggles / face shield
  • 8. Primary Survey  Orang dewasa, kanak-kanak dan perempuan mengandung KEUTAMAAN ADALAH SERUPA A B C D E Airway with c-spine protection Breathing & Ventilation Circulation & Hemorrhage Control Disability / Neurologic status Exposure / Environment
  • 9. Primary Survey Definisi Pemeriksaan pertama ke atas pesakit yang dilakukan secara sistematik dengan objektif untuk mengenalpasti keadaan yang mengancam nyawa dan merawat keadaan-keadaan tersebut serta- merta sebaik sahaja dikenalpasti.
  • 10. Primary Survey 1. Pemeriksaan yang cepat tan tepat untuk mengenalpasti keadaan dan status pesakit. 2. Mengambil keputusan untuk intervensi- intervensi kritikal dan masa untuk transportasi. TIDAK lebih daripada 2 minit TIDAK boleh diganggu kecuali tanda-tanda airway obstruction atau cardiac arrest
  • 11. Primary Survey I. PEMERHATIAN PERTAMA II. TINJAUAN KEADAAN/SUASANA III. KEDUDUKAN ATAU POSTUR IV. TAHAP KESEDARAN (AVPU) V. TATAKELAKUAN VI. KECEDERAAN YANG JELAS
  • 12. AIRWAY General Inspection * ANY LIFE THREATENINIG CONDITION DETECTED MUST BE CORRECTED SIMULTANEOUSLY *
  • 13. * ANY LIFE THREATENINIG CONDITION DETECTED MUST BE CORRECTED SIMULTANEOUSLY *
  • 14. Airway PASTIKAN SALUR UDARA PATEN C-spine injury Caution Pitfalls Kegagalan equipmen Tidak dapat intubate Kecederaan yang tidak dikenalpasti Progressive loss of airway
  • 15. Airway Suspect C-spine Injury Spinal protection ~ cervical collar C-spine x-ray when appropriate
  • 16. Airway Obstruction (penyumbatan salur udara) Penyebab: Lidah pesakit Cecair dan bendasing Kecacatan dan kecederaan termasuk kecederaan muka dan maxillofacial Salur udara yang bengkak. Laryngospasm
  • 17. AIRWAY MX OF LIFE THREATENING CONDITIONS  DARAH/BENDASING SUCTION LIDAH TERJATUH OROPHARYNGEL AIRWAY MAXILLOFACIAL INJURY ATTEMPT REDUCTION INTUBATION CRICOTHYROIDOTOMY MECHANICAL BLOCKADE – FINGER SWEEP & REMOVAL OF OBJECT PARTIALLY OBSTRUCTED AIRWAY  JAW THRUST CHIN LIFT
  • 18. PERLINDUNGAN C-spine Indikasi Anggap kecederaan C-spine Kecederaan di atas tulang klavikel Pesakit trauma yang tidak sedarkan diri Sakit tengkok Tanda neurologikal( kebas, lumpuh) Pemeriksaan tulang tengkok dilakukan bersama-sama manual immobilization. Cervical Collar yang bersaiz betul.
  • 19. Protection of the C-spineProtection of the C-spine MethodMethod
  • 20. Primary Survey Breathing & Ventilation(Pernafasan) Breathing Assess(perik sa) Oxygenate Ventilate Caution
  • 21. Primary Survey Sirkulasi dan kawalan pendarahan Circulatory Management  Kawal Pendarahan Kenalpasti dan kontrol pendarahan luaran  Restore volume  Look At Multiple Parameters NOT JUST BLOOD PRESSURE!!  Reassess Caution Pitfalls Elderly Athletes Children Medications
  • 22. Primary Survey Circulation & Hemorrhage Control Vascular Cannulation At LEAST TWO LARGE BORE CANNULA 20 mls BLOOD FOR X-MATCH, BUSE, FBC ABG Intravenous Fluid Correlate with clinical findings  TOO MUCH CAN BE DISASTROUS Warm Fluids PLEASE
  • 23. Primary Survey Circulation & Hemorrhage Control Assessment of Organ Perfusion Level of consciousness Skin color and temperature Pulse rate and character
  • 24. Primary Survey Disability Baseline neurologic evaluation AVPU (A ~ alert V~ respond to verbal P~ respond to pain U~ unresponsive) GCS scoring Pupillary response MONITOR THE CONSCIOUS LEVEL FREQUENTLY !!!….