The document discusses various types of environmental injuries including injuries from heat, cold, altitude changes, envenomation, dehydration, and burns. It provides information on the physiological changes that occur with these injuries and their typical signs and symptoms. Guidelines are given for assessment and management of these conditions, focusing on stabilization of vital functions and gradual rewarming or cooling as needed. Prevention strategies are also outlined, such as acclimatization procedures for altitude illness and rehydration for dehydration.
6. AMS & HACE
Acute Mountain Sickness
Nausea, vomiting, loss of appetite,
disturbed sleep, fatigue, dizziness
Paucity of physical finding
6-12 h after ascent
May progress to HACE
High Altitude Cerebral Edema
Hallmarks: ataxia & altered
consciousness
Diffuse cerebral involvement
Without focal neurologic deficit
7. HAPE
High Altitude Pulmonary
Edema
Onset: 2-4 days
Features:
• ↓ exercise tolerance
greater than expected
• Dry, persistent cough/
Blood-tinged sputum
• Tachypnea & tachycardia at
rest
• Crackles
• Hypoxemia & respiratory
alkalosis
9. PREVENTION
• Climb high, sleep low
• Above 3000m increase your altitude by 300m/day and
every 900m of elevation gained, take a rest day
• If begin to show symptoms don’t go higher until
symptoms decrease
• Keep hydrated
• Don’t over-exert yourself
• Avoid tobacco, alcohol, and other antidepressant drugs
• Eat a high carbohydrate diet while at altitude
• Medication (acetazolamide 24-48h before ascent and
continue for 48h at high altitude or longer,
dexamethasone)
14. TATALAKSANA HEAT STRESS/
CRAMPS
Move :
• Pindahkan korban ke tempat
yang jauh dari keramaian dan
teduh.
Assess :
• Identifikasi derajat serta jenis
heat injury. (perhatikan ABC)
Decide :
• Cool & Call. Panggil bantuan.
Kipas korban, lepaskan
segala sesuatu yang terlalu
mengikat (belt, dll) dan
berikan kompres dingin di 4
titik. Posisikan korban
dengan posisi
Trendelenberg. Jika korban
sadar beri minum.Jika tidak
sadar, jangan beri minum.
Evaluate :
• Evaluasi terus kondisi
korban, jangan langsung
ditinggal
Catatan :
4 tempat kompres =leher, aksila,
dahi, lipat paha
Jangan diberi minum jika korban
tidak sadar agar tidak tersedak!!!
15. TATALAKSANA HEAT
EXHAUSTION/ HEAT STROKE
DRHABC!!
1. Pindahkan pasien ketempat dingin, lepaskan pakaian dan lakukan
pendinginan eksternal :
• Konduktor dingin disisi dahi, kiri/kanan leher, aksila, dan
inguinal;
• Pendingin/ penyejuk ruangan
• Usapkan kulit dengan air suhu dingin
(target penurunan suhu ialah <39,4 oC pada rektal dan 30-33o C
pada kulit)
2. Posisikan pasien miring (recovery position) dan pastikan jalan
napas terbuka,
3. Berikan O2 4 L/menit. Upayakan agar saturasi selalu >90%.
4. Berikan cairan kristaloid isotonik untuk ekspansi volume
16. HIPOTERMIA
Core temperature < 35oC
Primary & Secondary hypothermia
Mild
(32oC – 35oC)
Moderate
(28oC – 32oC)
Severe
(<28oC)
17. 1. Hipotermia primer
• Produksi panas dalam tubuh tidak dapat
mengimbangi adanya stress dingin, terutama
bila cadangan energi dalam tubuh sedang
berkurang.
• Terjadi melalui radiasi (55-65%), konduksi
(10-15%), konveksi, respirasi, evaporasi.
2. Hipotermia sekunder
• Penyakit atau pengobatan tertentu yang
menyebabkan penurunan suhu.
21. MANAGEMENT
• Do not attempt rewarming if there is a risk of refreezing
• Replace constricting, damp clothing with warm blankets
• Give the patient hot fluids by mouth (if able to drink)
• Place the injured part in circulating water at constant 40⁰C
until pink color and perfusion return (usually 20-30 min)
• Do not dry heat may cause injury due to skin insensation
• Rewarming can be extremely painful adequate analgesic
• Beware of the reperfusion synd. monitor patient’s cardiac
status and peripheral perfusion during rewarming
• Wound care (clean, and leave blisters intact for 7-10 days to
provide sterile biologic dressing to protect underlying
epithelization)
23. LUKA BAKAR
Penyebab utama morbiditas dan mortalitas:
• Penerapan prinsip dasar menurunkan angka morbiditas
dan mortalitas
Prinsip dasar:
• Curiga masalah airway
• Identifikasi dan penanganan cedera mekanis
• Resusitasi cairan
• Kontrol suhu
24. Luka bakar ekstravasasi plasma ke luka
edema, bullae hipovolemia
Jaringan terbakar mediator inflamasi lokal &
sistemik, hormon stress hiperpermeabilitas
vaskular, retensi natrium, vasokonstriksi
gangguan paru, jantung dan mikrosirkulasi
Komplikasi:
• Gagal ginjal akut
• Disfungsi organ akibat iskemia
• Kolaps kardiovaskular
• Asidosis metabolik
26. TANDA TRAUMA
INHALASI
• Luka bakar leher dan/atau wajah
• Alis atau bulu hidung terbakar
• Arang sputum / deposit karbon di
mulut/hidung
• Eritema orofaring
• Serak
• Riwayat terkurung
• Luka ledakan mengenai kepala dan
badan
• Kadar karboksihemoglobin > 10%
27. BURN AREA ASSESMENT
Palmar surface—The surface area of a patient's palm (including
fingers) is roughly 0.8% of total body surface area. Palmar surface
are can be used to estimate relatively small burns (< 15% of total
surface area) or very large burns (> 85%, when unburnt skin is
counted). For medium sized burns, it is inaccurate.
Wallace rule of nines—This is a good, quick way of estimating
medium to large burns in adults. The body is divided into areas of
9%, and the total burn area can be calculated. It is not accurate in
children.
32. What causes a superficial first-degree burn?
In most cases,superficial first-degree burns are caused by the
following:
Mild sunburn
Flash burn -- a sudden, brief burst of heat
33. What causes a second-degree burn?
In most cases, partial thickness second-degree burns are caused
by the following:
Scald injuries
Flames
Skin that briefly comes in contact with a hot object
Sunburn
Chemicals
Electricity
34. What causes a third-degree burn?
In most cases, full thickness, third-degree burns are caused by
the following:
A scalding liquid
Skin that comes in contact with a hot object for an extended
period of time
Flames from a fire
An electrical source
A chemical source
37. MANAGEMENT
DO
• DRABCDE
• Pressure immobilization
• Splint the bitten extremity
• Keep extremity at heart level
• Take digital photograph of the
snake
DON’T
• Incise
• Apply suction
• Apply ice/ electric shock
• Tourniquet
• Attempt to capture & transport
offending snake
41. BEES & WASPS
STINGS
• DRABCDE
• Remove the sting (by any means) ASAP
• Apply a cold compress to reduce pain & swelling
• Transport to hospital
• Monitor for signs of allergic reaction anaphylactic
shock injection of epinephrine / adrenaline
47. PENANGANAN
Oral Rehydration Therapy (ORT) untuk dehidrasi mild-moderate
Jika muntah-muntah, ORT bukan terapi yang tepat, namun rehidrasi
dilakukan secara intravena.
Jika ada tanda-tanda dehidrasi berat (HR meningkat, BP rendah), cairan
diberikan secara intravena.
Cairan intravena diberikan sebanyak 20-30 mL/ kg dari larutan
isotonik NaCl 0.9% selama 1-2 jam.
48. PENANGANAN (2)
Buatlah pasien menjadi lebih dingin, jika pasien mengalami kenaikan
temperatur atau setelah terpapar panas, dengan cara:
• Membuka pakaian berlebih dan kendorkan pakaian lain
• Dinginkan area di ruangan berAC merupakan cara terbaik untuk
membantu mengembalikan temperatur ke normal setelah
paparan panas
• Jika tidak ada AC, tingkatkan pendinginan dengan evaporasi
dengan meletakkan pasien dekat kipas angin, atau balut pasien
dengan handuk basah di sekitarnya
• Hindari pemberian paparan yang terlalu dingin (es)! Karena
mengakibatkan vasokonstriksi dan mengurangi pelepasan panas,
selain itu juga dapat mengakibatkan menggigil yang menaikkan
temperatur tubuh.
• Jika ada, semprot dengan spray air hangat di permukaan kulit
untuk membantu pendinginan dengan evaporasi
