chapter 03 airway - breathing
TRANSCRIPT
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Airway & BreathingManagement
Ambulans Gawat Darurat 118
BT&CLS 118
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Diafragma
Nervusphrenicus
NerviIntercostales
Trakea
Larinks
ANATOMI
&
FISIOLOGI
Ambulans Gawat Darurat 118
BT&CLS 118
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Cara menilai pernafasan
Ambulans Gawat Darurat 118
BT&CLS 118
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Jenis pernafasan
Pernafasan
Reguler * otot interkostal * diafragma
Auksiler * otot tambahan(tambahan)
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BT&CLS 118
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Ambulans Gawat Darurat 118
BT&CLS 118
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Otot Tambahan utk Pernafasan
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Dada mengembang – Abd. keluar
Dada mengempis – Abd. masuk
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Mengapa kalau dada mengembang,
paru ikut mengembang ?
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BT&CLS 118
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Pleura Parietalis(melekat pada dd.dada)
Pleura viseralis(melekat pada paru)
Kavum pleura(tekanan negatif)
Sinus kosto-frenikus
Ambulans Gawat Darurat 118
BT&CLS 118
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Kontrol Pernafasan : Jalur eferen (turun)
1. M.Interkostalis : Th 1 - Th 12
Ambulans Gawat Darurat 118
BT&CLS 118
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Kontrol Pernafasan : Jalur eferen (turun)
2. Diafragma : C 3-4-5
Ambulans Gawat Darurat 118
BT&CLS 118
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Ambulans Gawat Darurat 118
BT&CLS 118
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Patofisiologi reflekspernafasan
Chemoreceptor
Pusat Pernafasan (MO)
Otot Pernafasan
Ventilasi
Ambulans Gawat Darurat 118
BT&CLS 118
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1 2
I E
Pernafasan Reguler
Inspirasi : kontraksi otot
1. Otot Diafragma C 3-4-5 2. Otot Interkostal Th 1-12
Ekspirasi : pasif (relaksasi otot)
Dewasa & Anak :Abdomino-torakal
Ambulans Gawat Darurat 118
BT&CLS 118
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AIRWAY OBSTRUCTION
Obstruksi : 1. Total = Akut = Perlahan
2. PartialAmbulans Gawat Darurat 118
BT&CLS 118
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AirwaySetiap usaha memperbaiki
Airway akan menggerakkan kepala
Pasien dicurigai fraktur servikal :• Multitrauma• Trauma kapitis + penurunan kesadaran• Luka kranial dari klavikula• Biomekanika Bila ada trauma selalu IMOBILISASI
LEHERAmbulans Gawat Darurat 118
BT&CLS 118
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Cara membuka jalan nafas pada pasien trauma
Chint Lift Jaw ThrustAmbulans Gawat Darurat 118
BT&CLS 118
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Gejala Obstruksi Airway
1. Sesak ! ! Dapat karena - Airway - Breathing
2. Pernafasan yang berbunyi pernafasan yang TERSUMBAT
Ambulans Gawat Darurat 118
BT&CLS 118
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1.Sesak Mengeluh sesak ( pasien sadar) Takipnea Retraksi ( suprasternal, infrasternal, antar iga )
2. Pernafasan berbunyi Gurgling (bunyi kumur-kumur) Cairan Snoring (mengorok) Lidah Stridor ( Crowing ) Sumbatan
Anatomis
Gejala obstruksi Airway
Ambulans Gawat Darurat 118
BT&CLS 118
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Penanggulangan obstruksi
3. Sumbatan anatomis (Stridor) : Trauma Edema laring pada
Luka bakar Fraktur laring
Non Trauma benda asing, difteri
Biasanya perlu Jalan Nafas Definitif
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Indikasi : 1. Proteksi Airway (A) Ancaman obstruksi Ancaman aspirasi 2. Perlu ventilasi (B)
Memasukkan pipa (Tube) dalam trakea (dengan Cuff )
Airway Definitif :
Ambulans Gawat Darurat 118
BT&CLS 118
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Airway Definitif
Kriko/Trakeostomi
Orotrakeal
Nasotrakeal
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1. Blind Naso-tracheal :
Sambil mendengar
pernafasan
Dorong saat
inspirasi Bila suara hilang kemungkinan
masuk esofagus
Hati-hati bila
fraktur
basis kranii
Airway Definitif
Ambulans Gawat Darurat 118
BT&CLS 118
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2. Oro-trakeal : Dapat tanpa / dengan pelemas otot Selalu persiapan yang baik (lampu, Cuff) Selalu bersiap untuk kriko – tiroidotomi
Airway Definitif
Intubasi oro-trakeal
Ambulans Gawat Darurat 118
BT&CLS 118
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Jangan dilakukan Hyperekstensi
pada kasus TRAUMA
Intubasi Oro-trakeal
Ambulans Gawat Darurat 118
BT&CLS 118
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3. Kriko-tiroidotomi : Dengan jarum Surgikal
Kartilago tiroid
Membrana
Kartilago krikoid Trakea
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BT&CLS 118
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Krikotirodotomi - jarum :
Ditusukkan lewat
membrana kriko-
tiroidea
Sambung dengan
oksigen,
1 detik tutup, 4
detik buka
Waktu ekstra 30-45
menit
Gunakan Jarum ukuran 14 G
Airway Definitif
Ambulans Gawat Darurat 118
BT&CLS 118
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Kriko-tiroidotomi surgikal
Airway Definitif
Ambulans Gawat Darurat 118
BT&CLS 118
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1. Penderita tidak sadar & gelisah atau gigi terkatup
Alternatif :
Berikan sedativa lalu intubasi lagi
Coba naso-trakeal (kontra indikasi ?)
Oro-trakeal memakai pelemas otot
Kriko-tirotomi dengan jarum sambil menunggu
dokter untuk melakukan krikotirodotomi surgikal
Penyulit penanggulangan Airway
2. Darah banyak dalam mulut (sering karena trauma maksilo-fasial) Tindakan Suction, bila tidak berhasil
Langsung krikotirotomiAmbulans Gawat Darurat 118
BT&CLS 118
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Gejala gangguan breathing :1. Frekuensi pernafasan 2. Dispnea3. Sianosis4. Pemeriksaan fisik ( Look -
listen – feel )5. Saturasi O2 dengan pulse
oxymeter (bila ada)
Dengan Oksigenasi & Ventilasi
Gangguan Breathing
Ambulans Gawat Darurat 118
BT&CLS 118
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OpenPneumotor
ax
TensionPneumotor
ax
Flail Chestdng
Kontusio Paru
MassiveHematotor
ax
Cedera toraks yang dapat dengan cepat
mengakibatkan Kematian Cepat
Beberapa keadaan penyebab gangguan breathing :
Gangguan Breathing
Ambulans Gawat Darurat 118
BT&CLS 118
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Ventilasi tambahan Mouth to Mouth Mouth to mask Bagging Ventilator
Selalu diberikan bila KU kurang baik
Pemberian oksigen
Ambulans Gawat Darurat 118
BT&CLS 118
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Bila Sat O2 < 95 % : Airway baik ? Ada sebab ? Atasi O2 face mask 11 LPM O2 non-rebreathing mask 11 LPM Assissted ventilation (sering perlu airway definitif) Bila ada sebab gangguan breathing atasi sesuai penyebab
Evaluasi Breathing
Ambulans Gawat Darurat 118
BT&CLS 118
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?
Ambulans Gawat Darurat 118
BT&CLS 118
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TERIMA KASIH
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BT&CLS 118