{\rtf1\ansi\ansicpg1252\uc1{\info{\title Document} {\author RSUP Dr Soetomo} {\comment PDF CreactiveX} {\creatim\yr2013\mo8\dy29\hr11\min21\sec17}} {\fonttbl{\f0 Times New Roman;}{\f1 Symbol;}} {\colortbl;\red0\green0\blue0;\red255\green255\blue255;\red255\green255\blue255;\red204\green204\blue204;\red177\green177\blue177;} \paperw12240\paperh15840 \margl0\margr0\margt0\margb0

\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 1 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b PENDAHULUAN\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma mencakup kepentingan lintas batas bangsa. Banyak negara yang sedang \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw0 \ql\fs24\cf1\f0 berkembang sudah memiliki banyak korban trauma dari jalan raya dan industri yang \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 mengenai kelompok usia muda. Morbiditas dan mortalitas yang terkait dengan trauma \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw0 \ql\fs24\cf1\f0 tersebut dapat dikurangi dengan intervensi medik yangefektif sejak dini. \par\pard\pvpg\phpg\posx1800\posy3482\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kursus Primary Trauma Care ini ditujukan untuk memberikan pengetahuan dasar dan \par\pard\pvpg\phpg\posx1800\posy3765\charscalex100\expndtw0 \ql\fs24\cf1\f0 ketrampilan yang diperlukan untuk identifikasi dan menangani korban trauma yaitu : \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw-1 \ql\fs24\cf1\f0 1. Penilaian cepat (rapid assessment) \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f0 2. Resusitasi \par\pard\pvpg\phpg\posx1800\posy4615\charscalex100\expndtw0 \ql\fs24\cf1\f0 3. Stabilisasi bagian / fungsi tubuh yang cedera.

\par\pard\pvpg\phpg\posx1800\posy5181\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kursus ini menekankan pentingnya diagnosa dini dan intervensi cepat pada setiap situasi \par\pard\pvpg\phpg\posx1800\posy5464\charscalex100\expndtw0 \ql\fs24\cf1\f0 yang mengancam jiwa. Materi diberikan melalui ceramahdan praktek skill station yang \par\pard\pvpg\phpg\posx1800\posy5748\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sesuai dengan kebutuhan pengelolaan korban trauma.Dokter dan para tenaga kesehatan \par\pard\pvpg\phpg\posx1800\posy6031\charscalex100\expndtw0 \ql\fs24\cf1\f0 dapat menggunakan landasan PTC ini untuk mengembangkan pengetahuan dan \par\pard\pvpg\phpg\posx1800\posy6314\charscalex100\expndtw0 \ql\fs24\cf1\f0 ketrampilan dalam menangani pasien trauma dengan peralatan yang minim, tanpa \par\pard\pvpg\phpg\posx1800\posy6597\charscalex100\expndtw0 \ql\fs24\cf1\f0 teknologi canggih. \par\pard\pvpg\phpg\posx1800\posy7164\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kita mengenal juga adanya kursus pengelolaan trauma yang lain seperti ATLS dari \par\pard\pvpg\phpg\posx1800\posy7447\charscalex100\expndtw0 \ql\fs24\cf1\f0 American College of Surgeons dan EMST dari Australia.Kursus-kursus tersebut \par\pard\pvpg\phpg\posx1800\posy7730\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ditujukan untuk tenaga kesehatan yang bekerja di rumah sakit dengan peralatan lengkap, \par\pard\pvpg\phpg\posx1800\posy8013\charscalex100\expndtw0 \ql\fs24\cf1\f0 oksigen, komunikasi, transport dan lain-lainnya dimana segala sesuatunya telah dirinci. \par\pard\pvpg\phpg\posx1800\posy8296\charscalex100\expndtw0 \ql\fs24\cf1\f0 Primary Trauma Care tidak dimaksudkan untuk menggantikursus-kursus tersebut tetapi \par\pard\pvpg\phpg\posx1800\posy8580\charscalex100\expndtw0 \ql\fs24\cf1\f0 memakai prinsip dan penekanan pada penanganan pokok yang sejak dini harus dilakukan \par\pard\pvpg\phpg\posx1800\posy8863\charscalex100\expndtw0 \ql\fs24\cf1\f0 dengan sarana yang minimal. \par\pard\pvpg\phpg\posx1800\posy9437\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Tujuan\b0

\par\pard\pvpg\phpg\posx1800\posy10048\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Setelah mengikuti kursus ini peserta akan :\b0 \par\pard\pvpg\phpg\posx1800\posy10610\charscalex100\expndtw0 \ql\fs24\cf1\f0 1. Memahami urutan prioritas pengelolaan korban trauma \par\pard\pvpg\phpg\posx1800\posy11176\charscalex100\expndtw0 \ql\fs24\cf1\f0 2. Mampu untuk dengan cepat dan tepat menentukan kebutuhan medik korban trauma \par\pard\pvpg\phpg\posx1800\posy11743\charscalex100\expndtw0 \ql\fs24\cf1\f0 3. Mampu untuk resusitasi dan stabilisasi korban trauma \par\pard\pvpg\phpg\posx1800\posy12309\charscalex100\expndtw0 \ql\fs24\cf1\f0 4. Mampu mengorganisir tata laksana medik dasar korban trauma di rumah sakit {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1776 \shpright10512 \shpbottom1776 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 2 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRAUMA DALAM PERSPEKTIF\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sebagian besar negara didunia mengalami epidemi trauma tetapi peningkatan jumlah \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw0 \ql\fs24\cf1\f0 yang tinggi terjadi di negara yang sedang berkembang.Penambahan jalan raya dan \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw-1 \ql\fs24\cf1\f0 penggunaan kendaraan bermotor menyebabkan laju jumlah korban dan kematian korban \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma. Banyak fasilitas kesehatan di perifer tidak mampu menangani banyak korban \par\pard\pvpg\phpg\posx1800\posy3199\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 sekaligus dari kecelakaan yang melibatkan bis penumpang atau bencana lainnya. Luka \par\pard\pvpg\phpg\posx1800\posy3482\charscalex100\expndtw-1 \ql\fs24\cf1\f0 bakar yang berat juga banyak dijumpai didaerah kota maupun diluarnya. \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Beberapa perbedaan besar antara negara-negara berpenghasilan tinggi dan yang rendah \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw-1 \ql\fs24\cf1\f0 mendesakkan adanya kursus Primary Trauma Care ini karena : \par\pard\pvpg\phpg\posx1800\posy4884\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy4912\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jauhnya jarak yang harus ditempuh korban untuk mencapai rumah sakit dengan \par\pard\pvpg\phpg\posx2071\posy5196\charscalex100\expndtw0 \ql\fs24\cf1\f0 fasilitasi medik yang memadai. \par\pard\pvpg\phpg\posx1800\posy5465\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy5493\charscalex100\expndtw0 \ql\fs24\cf1\f0 Lamanya waktu yang dibutuhkan korban untuk mencapai rumah sakit \par\pard\pvpg\phpg\posx1800\posy5763\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy5791\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tidak adanya peralatan canggih dan penyediaan obat-obat yang penting \par\pard\pvpg\phpg\posx1800\posy6060\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy6088\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tidak adanya tenaga kesehatan terdidik untuk menjalankan alat medik dan \par\pard\pvpg\phpg\posx2071\posy6372\charscalex100\expndtw0 \ql\fs24\cf1\f0 merawatnya. \par\pard\pvpg\phpg\posx1800\posy6943\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Tindakan pencegahan \b0 trauma sebenarnya adalah sarana yang paling murah dan paling \par\pard\pvpg\phpg\posx1800\posy7226\charscalex100\expndtw0 \ql\

fs24\cf1\f0 aman. Namun hal ini tergantung pada faktor : \par\pard\pvpg\phpg\posx1800\posy7779\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7807\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Budaya \par\pard\pvpg\phpg\posx1800\posy8076\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8104\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sumber daya manusia (manpower) \par\pard\pvpg\phpg\posx1800\posy8374\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8402\charscalex100\expndtw0 \ql\fs24\cf1\f0 Politik \par\pard\pvpg\phpg\posx1800\posy8672\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8700\charscalex100\expndtw0 \ql\fs24\cf1\f0 Anggaran keuangan untuk kesehatan \par\pard\pvpg\phpg\posx1800\posy8969\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8997\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pelatihan \par\pard\pvpg\phpg\posx1800\posy9564\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Setiap usaha harus dilakukan oleh tim medik traumauntuk mengarah kepada pencegahan \par\pard\pvpg\phpg\posx1800\posy9847\charscalex100\expndtw0 \ql\fs24\cf1\f0 terjadinya trauma. Walaupun hal ini berada diluar lingkup buku ini akan dibicarakan juga \par\pard\pvpg\phpg\posx1800\posy10130\charscalex100\expndtw0 \ql\fs24\cf1\f0 masalah-masalah yang ada di lingkungan saudara dankemungkinan untuk \par\pard\pvpg\phpg\posx1800\posy10413\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pencegahannya. {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1776 \shpright10224 \shpbottom1776 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 3 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b ABCDE DALAM TRAUMA\b0 \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pengelolaan trauma ganda yang berat memerlukan kejelasan dalam menetapkan prioritas. \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tujuannya adalah segera mengenali cedera yang mengancam jiwa dengan Survey \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw0 \ql\fs24\cf1\f0 Primer, seperti : \par\pard\pvpg\phpg\posx1800\posy3468\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Obstruksi jalan nafas \par\pard\pvpg\phpg\posx1800\posy3766\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3794\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera dada dengan kesukaran bernafas \par\pard\pvpg\phpg\posx1800\posy4064\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4092\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Perdarahan berat eksternal dan internal \par\pard\pvpg\phpg\posx1800\posy4361\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4389\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera abdomen \par\pard\pvpg\phpg\posx1800\posy4956\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika ditemukan lebih dari satu orang korban maka pengelolaan dilakukan berdasar \par\pard\pvpg\phpg\posx1800\posy5239\charscalex100\expndtw0 \ql\fs24\cf1\f0 prioritas (triage) Hal ini tergantung pada pengalamanpenolong dan fasilitas yang ada. \par\pard\pvpg\phpg\posx1800\posy5810\charscalex100\expndtw0 \ql\fs24\cf1\f0 Survei ABCDE \b (Airway, Breathing, Circulation, Disability, Exposure) \b0 ini disebut \par\pard\pvpg\phpg\posx1800\posy6098\charscalex100\expndtw0 \ql\

fs24\cf1\f0 survei primer yang harus selesai dilakukan \b dalam 2- 5 menit\b0 . \par\pard\pvpg\phpg\posx1800\posy6381\charscalex100\expndtw0 \ql\fs24\cf1\f0 Terapi dikerjakan serentak jika korban mengalami ancaman jiwa akibat banyak sistim \par\pard\pvpg\phpg\posx1800\posy6664\charscalex100\expndtw-1 \ql\fs24\cf1\f0 yang cedera : \par\pard\pvpg\phpg\posx1800\posy7236\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Airway\b0 \par\pard\pvpg\phpg\posx1800\posy7797\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menilai jalan nafas bebas. Apakah pasien dapat bicara dan bernafas dengan bebas ? \par\pard\pvpg\phpg\posx1800\posy8080\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika ada obstruksi maka lakukan : \par\pard\pvpg\phpg\posx1800\posy8633\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8661\charscalex100\expndtw0 \ql\fs24\cf1\f0 Chin lift / jaw thrust (lidah itu bertaut pada rahang bawah) \par\pard\pvpg\phpg\posx1800\posy8931\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8959\charscalex100\expndtw0 \ql\fs24\cf1\f0 Suction / hisap (jika alat tersedia) \par\pard\pvpg\phpg\posx1800\posy9228\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9256\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Guedel airway / nasopharyngeal airway \par\pard\pvpg\phpg\posx1800\posy9526\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9554\charscalex100\expndtw0 \ql\fs24\cf1\f0 Intubasi trakhea dengan leher di tahan (imobilisasi) pada posisi netral \par\pard\pvpg\phpg\posx1800\posy10125\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Breathing\b0 \par\pard\pvpg\phpg\posx1800\posy10687\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menilai pernafasan cukup. Sementara itu nilai ulang apakah jalan nafas bebas. \par\pard\pvpg\phpg\posx1800\posy10970\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika pernafasan tidak memadai maka lakukan :

\par\pard\pvpg\phpg\posx1800\posy11523\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11551\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dekompresi rongga pleura (pneumotoraks) \par\pard\pvpg\phpg\posx1800\posy11820\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11848\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tutuplah jika ada luka robek pada dinding dada \par\pard\pvpg\phpg\posx1800\posy12118\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12146\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pernafasan buatan \par\pard\pvpg\phpg\posx1800\posy12717\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Berikan oksigen jika ada\b0 \par\pard\pvpg\phpg\posx6089\posy13562\charscalex100\expndtw0 \ql\fs24\cf1\f0 . \par\pard\pvpg\phpg\posx2448\posy13845\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Penilaian ulang ABC harus dilakukan lagi jika kondisi pasien tidak stabil\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1920 \shpright10224 \shpbottom1920 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop13776 \shpright10082 \shpbottom14258 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 4 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Sirkulasi\b0 \par\pard\pvpg\phpg\posx1800\posy2018\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menilai sirkulasi / peredaran darah. Sementara itunilai ulang apakah jalan nafas bebas

\par\pard\pvpg\phpg\posx1800\posy2301\charscalex100\expndtw0 \ql\fs24\cf1\f0 dan pernafasan cukup. Jika sirkulasi tidak memadai maka lakukan : \par\pard\pvpg\phpg\posx1800\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2882\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hentikan perdarahan eksternal \par\pard\pvpg\phpg\posx1800\posy3152\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3180\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Segera pasang dua jalur infus dengan jarum besar (14 - 16 G) \par\pard\pvpg\phpg\posx1800\posy3449\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3477\charscalex100\expndtw0 \ql\fs24\cf1\f0 Berikan infus cairan \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Disability\b0 \par\pard\pvpg\phpg\posx1800\posy4610\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menilai kesadaran dengan cepat, apakah pasien sadar, hanya respons terhadap nyeri atau \par\pard\pvpg\phpg\posx1800\posy4893\charscalex100\expndtw0 \ql\fs24\cf1\f0 sama sekali tidak sadar. Tidak dianjurkan mengukur Glasgow Coma Scale \par\pard\pvpg\phpg\posx1800\posy5460\charscalex100\expndtw-1 \ql\fs24\cf1\f0 AWAKE \par\pard\pvpg\phpg\posx4680\posy5460\charscalex100\expndtw-1 \ql\fs24\cf1\f0 = A \par\pard\pvpg\phpg\posx1800\posy5743\charscalex100\expndtw0 \ql\fs24\cf1\f0 RESPONS BICARA (verbal) = V \par\pard\pvpg\phpg\posx1800\posy6026\charscalex100\expndtw-1 \ql\fs24\cf1\f0 RESPONS NYERI \par\pard\pvpg\phpg\posx4680\posy6026\charscalex100\expndtw-1 \ql\fs24\cf1\f0 = P \par\pard\pvpg\phpg\posx1800\posy6309\charscalex100\expndtw-1 \ql\fs24\cf1\f0 TAK ADA RESPONS \par\pard\pvpg\phpg\posx4679\posy6309\charscalex100\expndtw-1 \ql\fs24\cf1\f0 = U \par\pard\pvpg\phpg\posx1800\posy6876\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 Cara ini cukup jelas dan cepat. \par\pard\pvpg\phpg\posx1800\posy7447\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Eksposure\b0 \par\pard\pvpg\phpg\posx1800\posy8008\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Lepaskan baju dan penutup tubuh pasien agar dapat dicari semua cedera yang mungkin \par\pard\pvpg\phpg\posx1800\posy8292\charscalex100\expndtw0 \ql\fs24\cf1\f0 ada. Jika ada kecurigaan cedera leher atau tulang belakang, maka imobilisasi in-line harus \par\pard\pvpg\phpg\posx1800\posy8575\charscalex100\expndtw-1 \ql\fs24\cf1\f0 dikerjakan. \par\pard\page\par

\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 5 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b PENGELOLAAN JALAN NAFAS\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Prioritas pertama adalah membebaskan jalan nafas dan mempertahankannya agar tetap \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 bebas. \par\pard\pvpg\phpg\posx1800\posy2920\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 1. Bicara kepada pasien\b0 \par\pard\pvpg\phpg\posx1800\posy3482\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasien yang dapat menjawab dengan jelas adalah tanda bahwa jalan nafasnya bebas. \par\pard\pvpg\phpg\posx1800\posy3765\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasien yang tidak sadar mungkin memerlukan jalan nafas buatan dan bantuan pernafasan. \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyebab obstruksi pada pasien tidak sadar umumnya adalah jatuhnya pangkal lidah ke \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw-1 \ql\fs24\cf1\f0 belakang. Jika ada cedera kepala, leher atau dadamaka pada waktu intubasi trakhea \par\pard\pvpg\phpg\posx1800\posy4615\charscalex100\expndtw0 \ql\fs24\cf1\f0 tulang leher (cervical spine) harus dilindungi denganimobilisasi in-line.

\par\pard\pvpg\phpg\posx1800\posy5186\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 2. Berikan oksigen dengan sungkup muka (masker) atau kantung nafas ( self-\b0 \par\pard\pvpg\phpg\posx2071\posy5469\charscalex100\expndtw0 \ql\fs24\cf1\f0\b invlating)\b0 \par\pard\pvpg\phpg\posx1800\posy6036\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 3. Menilai jalan nafas\b0 \par\pard\pvpg\phpg\posx1800\posy6597\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tanda obstruksi jalan nafas antara lain : \par\pard\pvpg\phpg\posx1800\posy6867\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6895\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara berkumur \par\pard\pvpg\phpg\posx1800\posy7164\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7192\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara nafas abnormal (stridor, dsb) \par\pard\pvpg\phpg\posx1800\posy7462\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7490\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pasien gelisah karena hipoksia \par\pard\pvpg\phpg\posx1800\posy7760\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7788\charscalex100\expndtw0 \ql\fs24\cf1\f0 Bernafas menggunakan otot nafas tambahan / gerak dadaparadoks \par\pard\pvpg\phpg\posx1800\posy8057\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8085\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sianosis \par\pard\pvpg\phpg\posx1800\posy8652\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Waspada adanya benda asing di jalan nafas. Cara membebaskan jalan nafas diuraikan \par\pard\pvpg\phpg\posx1800\posy8935\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pada Appendix 1 \par\pard\pvpg\phpg\posx1800\posy9218\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jangan memberikan obat sedativa pada pasien seperti ini. \par\pard\pvpg\phpg\posx1800\posy9789\charscalex100\expndtw0 \ql\

fs24\cf1\f0\b 4. Menjaga stabilitas tulang leher\b0 \par\pard\pvpg\phpg\posx1800\posy10356\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 5. Pertimbangkan untuk memasang jalan nafas buatan\b0 \par\pard\pvpg\phpg\posx1800\posy10917\charscalex100\expndtw0 \ql\fs24\cf1\f0 Indikasi tindakan ini adalah : \par\pard\pvpg\phpg\posx1800\posy11187\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11215\charscalex100\expndtw0 \ql\fs24\cf1\f0 Obstruksi jalan nafas yang sukar diatasi \par\pard\pvpg\phpg\posx1800\posy11484\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11512\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Luka tembus leher dengan hematoma yang membesar \par\pard\pvpg\phpg\posx1800\posy11782\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11810\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Apnea \par\pard\pvpg\phpg\posx1800\posy12080\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12108\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hipoksia \par\pard\pvpg\phpg\posx1800\posy12377\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12405\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma kepala berat \par\pard\pvpg\phpg\posx1800\posy12675\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12703\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma dada \par\pard\pvpg\phpg\posx1800\posy12972\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy13000\charscalex100\expndtw0 \ql\fs24\cf1\f0 Trauma wajah / maxillo-facial \par\pard\pvpg\phpg\posx4025\posy13850\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Obstruksi jalan nafas harus segera diatasi\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1776 \shpright10224 \shpbottom1776 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn

lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop13680 \shpright10226 \shpbottom14258 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 6 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b PENGELOLAAN NAFAS (VENTILASI \b0 ) \par\pard\pvpg\phpg\posx1800\posy2076\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas kedua adalah memberikan ventilasi yang adekuat.\b0 \par\pard\pvpg\phpg\posx1800\posy2624\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2652\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Inspeksi / lihat frekwensi nafas (LOOK)\b0 \par\pard\pvpg\phpg\posx1800\posy2930\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Adakah hal-hal berikut : \par\pard\pvpg\phpg\posx1800\posy3213\charscalex100\expndtw0 \ql\fs24\cf1\f0 . Sianosis \par\pard\pvpg\phpg\posx1800\posy3496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . L \par\pard\pvpg\phpg\posx2062\posy3496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 uka tembus dada \par\pard\pvpg\phpg\posx1800\posy3780\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . Flail chest \par\pard\pvpg\phpg\posx1800\posy4063\charscalex100\expndtw0 \ql\fs24\cf1\f0 . Sucking wounds \par\pard\pvpg\phpg\posx1800\posy4346\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . Gerakan otot nafas tambahan \par\pard\pvpg\phpg\posx1800\posy4899\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4927\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Palpasi / raba (FEEL)\b0

\par\pard\pvpg\phpg\posx1800\posy5205\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . P \par\pard\pvpg\phpg\posx2054\posy5205\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ergeseran letak trakhea \par\pard\pvpg\phpg\posx1800\posy5488\charscalex100\expndtw0 \ql\fs24\cf1\f0 . Patah tulang iga \par\pard\pvpg\phpg\posx1800\posy5772\charscalex100\expndtw0 \ql\fs24\cf1\f0 . Emfisema kulit \par\pard\pvpg\phpg\posx1800\posy6055\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . Dengan perkusi mencari hemotoraks dan atau pneumotoraks \par\pard\pvpg\phpg\posx1800\posy6608\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6636\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Auskultasi / dengar (LISTEN\b0 ) \par\pard\pvpg\phpg\posx1800\posy6919\charscalex100\expndtw0 \ql\fs24\cf1\f0 . Suara nafas, detak jantung, bising usus \par\pard\pvpg\phpg\posx1800\posy7202\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . Suara nafas menurun pada pneumotoraks \par\pard\pvpg\phpg\posx1800\posy7485\charscalex100\expndtw-1 \ql\fs24\cf1\f0 . Suara nafas tambahan / abnormal \par\pard\pvpg\phpg\posx1800\posy8038\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8066\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Tindakan Resusitasi\b0 \par\pard\pvpg\phpg\posx1800\posy8344\charscalex100\expndtw0 \ql\fs24\cf1\f0 Diuraikan lebih rinci pada Appendix 5 \par\pard\pvpg\phpg\posx1800\posy8628\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika ada distres nafas maka rongga pleura harus dikosongkan dari udara dan darah dengan \par\pard\pvpg\phpg\posx2160\posy8911\charscalex100\expndtw-1 \ql\fs24\cf1\f0 memasang drainage toraks segera tanpa menunggu pemeriksaan sinar X. \par\pard\pvpg\phpg\posx1800\posy9194\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika diperlukan intubasi trakhea tetapi sulit, maka kerjakan krikotiroidotomi. \par\pard\pvpg\phpg\posx1800\posy9765\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Catatan Khusus\b0 \par\pard\pvpg\phpg\posx1800\posy10030\charscalex100\expndtw0 \

ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10058\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika dimungkinkan, berikan oksigen hingga pasien menjadi stabil \par\pard\pvpg\phpg\posx1800\posy10328\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10356\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika diduga ada tension pneumotoraks, dekompresi harus segera dilakukan dengan \par\pard\pvpg\phpg\posx2160\posy10639\charscalex100\expndtw-1 \ql\fs24\cf1\f0 jarum besar yang ditusukkan menembus rongga pleurasisi yang cedera. Lakukan \par\pard\pvpg\phpg\posx2160\posy10922\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pada ruang sela iga kedua (ICS 2) di garis yang melalui tengah klavikula. Pertahankan \par\pard\pvpg\phpg\posx2160\posy11205\charscalex100\expndtw0 \ql\fs24\cf1\f0 posisi jarum hingga pemasangan drain toraks selesai. \par\pard\pvpg\phpg\posx1800\posy11475\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11503\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika intubasi trakhea dicoba satu atau dua kali gagal, maka kerjakan krikotiroidotomi. \par\pard\pvpg\phpg\posx2160\posy11786\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tentu hal ini juga tergantung pada kemampuan tenaga medis yang ada dan \par\pard\pvpg\phpg\posx2160\posy12069\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kelengkapan alat. \par\pard\pvpg\phpg\posx2791\posy12919\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Jangan terlalu lama mencoba intubasi tanpa memberikan ventilasi\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1656 \shptop12708 \shpright11306 \shpbottom13370 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1800 \shptop1786 \shpright11160 \shpbottom1786 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn

lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 7 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b PENGELOLAAN SIRKULASI\b0 \par\pard\pvpg\phpg\posx1800\posy2071\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas ketiga adalah perbaikan sirkulasi agar memadai.\b0 \par\pard\pvpg\phpg\posx1800\posy2637\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Syok \b0 adalah keadaan berkurangnya perfusi organ dan oksigenasi jaringan. Pada pasien \par\pard\pvpg\phpg\posx1800\posy2920\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma keadaan ini paling sering disebabkan oleh hipovolemia. \par\pard\pvpg\phpg\posx1800\posy3492\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Diagnosa syok \b0 didasarkan tanda-tanda klinis : \par\pard\pvpg\phpg\posx1800\posy3775\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hipotensi, takhikardia, takhipnea, hipothermi, pucat,ekstremitas dingin, melambatnya \par\pard\pvpg\phpg\posx1800\posy4058\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pengisian kapiler (capillary refill) dan penurunanproduksi urine. (lihat Appendix-3) \par\pard\pvpg\phpg\posx1800\posy4624\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jenis-jenis syok : \par\pard\pvpg\phpg\posx1800\posy5196\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Syok hemoragik (hipovolemik): \b0 disebabkan kehilangan akut dari darah atau cairan \par\pard\pvpg\phpg\posx1800\posy5479\charscalex100\expndtw0 \ql\fs24\cf1\f0 tubuh. Jumlah darah yang hilang akibat trauma sulit diukur dengan tepat bahkan pada \par\pard\pvpg\phpg\posx1800\posy5762\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma tumpul sering diperkirakan terlalu rendah. Ingat bahwa : \par\pard\pvpg\phpg\posx1800\posy6315\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy6343\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sejumlah besar darah dapat terkumpul dalam rongga perut dan pleura. \par\pard\pvpg\phpg\posx1800\posy6612\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6640\charscalex100\expndtw0 \ql\fs24\cf1\f0 Perdarahan patah tulang paha (femur shaft) dapat mencapai 2 (dua) liter. \par\pard\pvpg\phpg\posx1800\posy6910\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6938\charscalex100\expndtw0 \ql\fs24\cf1\f0 Perdarahan patah tulang panggul (pelvis) dapat melebihi 2 liter \par\pard\pvpg\phpg\posx1800\posy7509\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Syok kardiogenik : \b0 disebabkan berkurangnya fungsi jantung, antara lain akibat : \par\pard\pvpg\phpg\posx1800\posy8062\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8090\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kontusioo miokard \par\pard\pvpg\phpg\posx1800\posy8360\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8388\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tamponade jantung \par\pard\pvpg\phpg\posx1800\posy8657\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8685\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pneumotoraks tension \par\pard\pvpg\phpg\posx1800\posy8955\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8983\charscalex100\expndtw0 \ql\fs24\cf1\f0 Luka tembus jantung \par\pard\pvpg\phpg\posx1800\posy9252\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9280\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Infark miokard \par\pard\pvpg\phpg\posx1800\posy9847\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penilaian tekanan vena jugularis sangat penting dan sebaiknya ECG dapat direkam.

\par\pard\pvpg\phpg\posx1800\posy10418\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Syok neurogenik \b0 : ditimbulkan oleh hilangnyatonus simpatis akibat cedera sumsum \par\pard\pvpg\phpg\posx1800\posy10701\charscalex100\expndtw-1 \ql\fs24\cf1\f0 tulang belakang (spinal cord). Gambaran klasik adalah hipotensi tanpa diserta \par\pard\pvpg\phpg\posx1800\posy10984\charscalex100\expndtw-1 \ql\fs24\cf1\f0 takhikardiaa atau vasokonstriksi. \par\pard\pvpg\phpg\posx1800\posy11556\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Syok septik : \b0 Jarang ditemukan pada fase awal dari trauma, tetapi sering menjadi \par\pard\pvpg\phpg\posx1800\posy11839\charscalex100\expndtw0 \ql\fs24\cf1\f0 penyebab kematian beberapa minggu sesudah trauma (melalui gagal organ ganda). Paling \par\pard\pvpg\phpg\posx1800\posy12122\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sering dijumpai pada korban luka tembus abdomen dan luka bakar. \par\pard\pvpg\phpg\posx3382\posy13255\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Hipovolemia adalah keadaan darurat mengancam jiwa\b0\i0 \par\pard\pvpg\phpg\posx3785\posy13533\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Yang harus dikenali dan diatasi secara agresif\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1836 \shpright10224 \shpbottom1836{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop13162 \shpright10226 \shpbottom13884 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 8 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Langkah-langkah resusitasi sirkulasi\b0

\par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tujuan akhirnya adalah menormalkan kembali oksigenasijaringan. \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Karena penyebab gangguan ini adalah kehilangan darah maka resusitasi cairan merupakan \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 prioritas \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw-1 \ql\fs24\cf1\f0 1. Jalur intravena yang baik dan lancar harus segera dipasang. Gunakan kanula besar \par\pard\pvpg\phpg\posx2071\posy3199\charscalex100\expndtw-1 \ql\fs24\cf1\f0 (14 - 16 G). Dalam keadaan khusus mungkin perlu vena sectie \par\pard\pvpg\phpg\posx1800\posy3482\charscalex100\expndtw0 \ql\fs24\cf1\f0 2. Cairan infus (NaCL 0,9%) harus dihangatkan sampai suhu tubuh karena hipotermia \par\pard\pvpg\phpg\posx2071\posy3765\charscalex100\expndtw-1 \ql\fs24\cf1\f0 dapat menyababkan gangguan pembekuan darah. \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3. Hindari cairan yang mengandung glukose. \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f0 4. Ambil sampel darah secukupnya untuk pemeriksaan dan uji silang golongan darah. \par\pard\pvpg\phpg\posx1800\posy4903\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Urine\b0 \par\pard\pvpg\phpg\posx1800\posy5181\charscalex100\expndtw0 \ql\fs24\cf1\f0 Produksi urine menggambarkan normal atau tidaknya fungsi sirkulasi jumlah seharusnya \par\pard\pvpg\phpg\posx1800\posy5464\charscalex100\expndtw0 \ql\fs24\cf1\f0 adalah > 0.5 ml/kg/jam. Jika pasien tidak sadar dengan syok lama sebaiknya dipasang \par\pard\pvpg\phpg\posx1800\posy5748\charscalex100\expndtw0 \ql\fs24\cf1\f0 kateter urine. \par\pard\pvpg\phpg\posx1800\posy6319\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Transfusi darah\b0 \par\pard\pvpg\phpg\posx1800\posy6597\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyediaan darah donor mungkin sukar, disamping besarnya risiko ketidak sesuaian

\par\pard\pvpg\phpg\posx1800\posy6880\charscalex100\expndtw0 \ql\fs24\cf1\f0 golongan darah, hepatitis B dan C, HIV / AIDS. Risikopenularan penyakit juga ada \par\pard\pvpg\phpg\posx1800\posy7164\charscalex100\expndtw-1 \ql\fs24\cf1\f0 meski donornya adalah keluarga sendiri. \par\pard\pvpg\phpg\posx1800\posy7447\charscalex100\expndtw0 \ql\fs24\cf1\f0 Transfusi harus dipertimbangkan jika sirkulasi pasientidak stabil meskipun telah \par\pard\pvpg\phpg\posx1800\posy7730\charscalex100\expndtw0 \ql\fs24\cf1\f0 mendapat cukup koloid / kristaloid. Jika golongan darah donor yang sesuai tidak tersedia, \par\pard\pvpg\phpg\posx1800\posy8013\charscalex100\expndtw-1 \ql\fs24\cf1\f0 dapat digunakan darah golongan O (sebaiknya packred cel dan Rhesus negatif. \par\pard\pvpg\phpg\posx1800\posy8296\charscalex100\expndtw0 \ql\fs24\cf1\f0 Transfusi harus diberikan jika Hb dibawah 7g / dl jika pasien masih terus berdarah. \par\pard\pvpg\phpg\posx1800\posy8868\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas pertama : hentikan perdarahan\b0 \par\pard\pvpg\phpg\posx1800\posy9132\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9160\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera pada anggota gerak : \par\pard\pvpg\phpg\posx2160\posy9444\charscalex100\expndtw0 \ql\fs24\cf1\f0 Torniket tidak berguna. Disamping itu torniket menyebabkan sindroma reperfusi dan \par\pard\pvpg\phpg\posx2160\posy9727\charscalex100\expndtw0 \ql\fs24\cf1\f0 menambah berat kerusakan primer. Alternatif yang disebut bebat tekan itu sering \par\pard\pvpg\phpg\posx2160\posy10010\charscalex100\expndtw0 \ql\fs24\cf1\f0 disalah mengerti. Perdarahan hebat karena luka tusuk dan luka amputasi dapat \par\pard\pvpg\phpg\posx2160\posy10293\charscalex100\expndtw0 \ql\fs24\cf1\f0 dihentikan dengan pemasangan kasa padat subfascialditambah tekanan manual pada \par\pard\pvpg\phpg\posx2160\posy10576\charscalex100\expndtw0 \ql\fs24\cf1\f0 arteri disebelah proksimal ditambah bebat kompresif (tekan merata) diseluruh bagian \par\pard\pvpg\phpg\posx2160\posy10860\charscalex100\expndtw0 \

ql\fs24\cf1\f0 anggota gerak tersebut. \par\pard\pvpg\phpg\posx2098\posy12276\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Kehilangan darah adalah penyebab utama dari syok yang diderita pasien trauma\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1584 \shptop12113 \shpright10514 \shpbottom12838 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10320\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 9 \par\pard\pvpg\phpg\posx1800\posy1438\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy1466\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera dada \par\pard\pvpg\phpg\posx2160\posy1749\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Sumber perdarahan dari dinding dada umumnya adalaharteri. Pemasangan chest tube \par\pard\pvpg\phpg\posx2160\posy2032\charscalex100\expndtw0 \ql\fs24\cf1\f0 / pipa drain harus sedini mungkin. Hal ini jika di tambah dengan penghisapan berkala, \par\pard\pvpg\phpg\posx2160\posy2316\charscalex100\expndtw0 \ql\fs24\cf1\f0 ditambah analgesia yang efisien, memungkinkan paru berkembang kembali sekaligus \par\pard\pvpg\phpg\posx2160\posy2599\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menyumbat sumber perdarahan. Untuk analgesia digunakan ketamin I.V. \par\pard\pvpg\phpg\posx1800\posy2868\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2896\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera abdomen \par\pard\pvpg\phpg\posx2160\posy3180\charscalex100\expndtw0 \ql\fs24\cf1\f0 Damage control laparatomy harus segera dilakukan sedini mungkin bila resusitasi \par\pard\pvpg\phpg\posx2160\posy3463\charscalex100\expndtw0 \ql\fs24\cf1\f0 cairan tidak dapat mempertahankan tekanan sistolik

antara 80-90 mmHg. Pada waktu \par\pard\pvpg\phpg\posx2160\posy3746\charscalex100\expndtw0 \ql\fs24\cf1\f0 DC laparatomy, dilakukan pemasangan kasa besar untuk menekan dan menyumbat \par\pard\pvpg\phpg\posx2160\posy4034\charscalex100\expndtw0 \ql\fs24\cf1\f0 sumber perdarahan dari organ perut (\b abdominal packing\b0 ). Insisi pada garis tengah \par\pard\pvpg\phpg\posx2160\posy4317\charscalex100\expndtw0 \ql\fs24\cf1\f0 hendaknya sudah ditutup kembali dalam waktu 30 menit dengan menggunakan \par\pard\pvpg\phpg\posx2160\posy4600\charscalex100\expndtw0 \ql\fs24\cf1\f0 penjepit (towel clamps). Tindakan resusitasi ini hendaknya dikerjakan dengan \par\pard\pvpg\phpg\posx2160\posy4884\charscalex100\expndtw0 \ql\fs24\cf1\f0 anestesia ketamin oleh dokter yang terlatih (atau mungkin oleh perawat untuk rumah \par\pard\pvpg\phpg\posx2160\posy5167\charscalex100\expndtw0 \ql\fs24\cf1\f0 sakit yang lebih kecil). Jelas bahwa teknik ini harusdipelajari lebih dahulu namun \par\pard\pvpg\phpg\posx2160\posy5450\charscalex100\expndtw-1 \ql\fs24\cf1\f0 jika dikerjakan cukup baik pasti akan menyelamatkan nyawa. \par\pard\pvpg\phpg\posx1800\posy6021\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas kedua: Penggantian cairan, penghangatan, analgesia dengan ketamin\b0 . \par\pard\pvpg\phpg\posx1800\posy6574\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6602\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Infus cairan pengganti harus dihangatkan karena proses pembekuan darah \par\pard\pvpg\phpg\posx2160\posy6885\charscalex100\expndtw0 \ql\fs24\cf1\f0 berlangsung paling baik pada suuh 38,5 C. Hemostasis sukar berlangsung baik pada \par\pard\pvpg\phpg\posx2160\posy7168\charscalex100\expndtw-1 \ql\fs24\cf1\f0 suhu dibawah 35 C. Hipotermia pada pasien trauma sering terjadi jika evakuasi pra \par\pard\pvpg\phpg\posx2160\posy7452\charscalex100\expndtw-1 \ql\fs24\cf1\f0 rumah sakit berlangsung terlalu lama (bahkan juga di cuaca tropis). Pasien mudah

\par\pard\pvpg\phpg\posx2160\posy7735\charscalex100\expndtw0 \ql\fs24\cf1\f0 menjadi dingin tetapi sukar untuk dihangatkan kembali, karena itu pencegahan \par\pard\pvpg\phpg\posx2160\posy8018\charscalex100\expndtw0 \ql\fs24\cf1\f0 hipotermia sangat penting. Cairan oral maupun intravena harus dipanaskan 40-42 C. \par\pard\pvpg\phpg\posx2160\posy8301\charscalex100\expndtw0 \ql\fs24\cf1\f0 Cairan pada suku ruangan sama dengan pendinginan. \par\pard\pvpg\phpg\posx1800\posy8571\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8599\charscalex100\expndtw0 \ql\fs24\cf1\f0 Resusitasi cairan hipotensif : Pada kasus-kasus dimana penghentian perdarahan tidak \par\pard\pvpg\phpg\posx2160\posy8882\charscalex100\expndtw0 \ql\fs24\cf1\f0 definitive atau tidak meyakinkan volume diberikan dengan menjaga tekanan sistolik \par\pard\pvpg\phpg\posx2160\posy9165\charscalex100\expndtw-1 \ql\fs24\cf1\f0 antara 80 - 90 mmHg selama evakuasi. \par\pard\pvpg\phpg\posx1800\posy9435\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9463\charscalex100\expndtw0 \ql\fs24\cf1\f0 Cairan koloid keluar, cairan elektrolit masuk ! Hasilpenelitian terbaru dengan \par\pard\pvpg\phpg\posx2160\posy9746\charscalex100\expndtw0 \ql\fs24\cf1\f0 kelompok kontrol menemukan sedikit efek negatif dari penggunaan koloid \par\pard\pvpg\phpg\posx2160\posy10029\charscalex100\expndtw0 \ql\fs24\cf1\f0 dibandingkan elektrolit untuk resusitasi cairan. \par\pard\pvpg\phpg\posx1800\posy10299\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10327\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Resusitasi cairan lewat mulut (per-oral) cukup aman dan efisien jika pasien masih \par\pard\pvpg\phpg\posx2160\posy10610\charscalex100\expndtw0 \ql\fs24\cf1\f0 memiliki gag reflex dan tidak ada cedera perut. Cairan yang diminum harus rendah \par\pard\pvpg\phpg\posx2160\posy10893\charscalex100\expndtw-1 \ql\fs24\cf1\f0 gula dan garam. Cairan yang pekat akan menyebabkanpenarikan osmotik dari

\par\pard\pvpg\phpg\posx2160\posy11176\charscalex100\expndtw0 \ql\fs24\cf1\f0 mukosa usus sehingga timbullah efek negatif. Diluted cereal porridges yang \par\pard\pvpg\phpg\posx2160\posy11460\charscalex100\expndtw0 \ql\fs24\cf1\f0 menggunakan bahan dasar lokal/setempat sangat dianjurkan. \par\pard\pvpg\phpg\posx1800\posy11729\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11757\charscalex100\expndtw0 \ql\fs24\cf1\f0 Analgesia untuk pasien trauma dapat menggunakan ketamin dosis berulang 0,2 \par\pard\pvpg\phpg\posx2160\posy12040\charscalex100\expndtw0 \ql\fs24\cf1\f0 mg/kg. Obat ini mempunyai efek inotropik positif dan tidak mengurangi gag reflex, \par\pard\pvpg\phpg\posx2160\posy12324\charscalex100\expndtw0 \ql\fs24\cf1\f0 sehingga sesuai untuk evakuasi pasien trauma berat. \par\pard\pvpg\phpg\posx4442\posy13173\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Jagalah keamanan diri penolong.\b0\i0 \par\pard\pvpg\phpg\posx3466\posy13452\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Tenaga kesehatan yang terluka akan juga jadi pasien\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop12962 \shpright10514 \shpbottom13958 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 10 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b SURVEI SEKUNDER\b0 \par\pard\pvpg\phpg\posx1800\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Survei Sekunder hanya dilakukan bila ABC pasien sudah stabil\b0 \par\pard\pvpg\phpg\posx1800\posy2920\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Bila sewaktu survei sekunder kondisi pasien memburuk maka kita harus kembali\b0

\par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b mengulangi PRIMARY SURVEY\b0 . \par\pard\pvpg\phpg\posx1800\posy3487\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Semua prosedur yang dilakukan harus dicatat denganbaik. \par\pard\pvpg\phpg\posx1800\posy3770\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pemeriksaan dari kepala sampai ke jari kaki (head-to-toe examination) dilakukan dengan \par\pard\pvpg\phpg\posx1800\posy4053\charscalex100\expndtw-1 \ql\fs24\cf1\f0 perhatian utama : \par\pard\pvpg\phpg\posx1800\posy4624\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan kepala\b0 \par\pard\pvpg\phpg\posx1800\posy5172\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5200\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kelainan kulit kepala dan bola mata \par\pard\pvpg\phpg\posx1800\posy5470\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5498\charscalex100\expndtw0 \ql\fs24\cf1\f0 Telinga bagian luar dan membrana timpani \par\pard\pvpg\phpg\posx1800\posy5768\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5796\charscalex100\expndtw0 \ql\fs24\cf1\f0 Cedera jaringan lunak periorbital \par\pard\pvpg\phpg\posx1800\posy6367\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan leher\b0 \par\pard\pvpg\phpg\posx1800\posy6915\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6943\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Luka tembus leher \par\pard\pvpg\phpg\posx1800\posy7212\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7240\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Emfisema subkutan \par\pard\pvpg\phpg\posx1800\posy7510\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7538\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Deviasi trachea \par\pard\pvpg\phpg\posx1800\posy7808\charscalex100\expndtw0 \ql\

fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7836\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Vena leher yang mengembang \par\pard\pvpg\phpg\posx1800\posy8407\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan neurologis\b0 \par\pard\pvpg\phpg\posx1800\posy8955\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8983\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penilaian fungsi otak dengan Glasgow Coma Scale (GCS)\par\pard\pvpg\phpg\posx1800\posy9252\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9280\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penilaian fungsi medula spinalis dengan aktivitas motorik \par\pard\pvpg\phpg\posx1800\posy9550\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9578\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Penilaian rasa raba / sensasi dan refleks \par\pard\pvpg\phpg\posx1800\posy10149\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan dada\b0 \par\pard\pvpg\phpg\posx1800\posy10697\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10725\charscalex100\expndtw0 \ql\fs24\cf1\f0 Clavicula dan semua tulang iga \par\pard\pvpg\phpg\posx1800\posy10995\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11023\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara napas dan jantung \par\pard\pvpg\phpg\posx1800\posy11292\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11320\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pemantauan ECG (bila tersedia) \par\pard\pvpg\phpg\posx1992\posy12736\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Pasien trauma kepala harus dicurigai juga mengalami trauma tulang leher sampai\b0\i0 \par\pard\pvpg\phpg\posx4963\posy13015\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i terbukti tidak demikian\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1836 \shpright10368 \shpbottom1836

{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1584 \shptop12631 \shpright10370 \shpbottom13498 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 11 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan rongga perut (abdomen)\b0 \par\pard\pvpg\phpg\posx1800\posy2004\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2032\charscalex100\expndtw0 \ql\fs24\cf1\f0 Luka tembus abdomen memerlukan eksplorasi bedah \par\pard\pvpg\phpg\posx1800\posy2302\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2330\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pasanglah pipa nasogastrik pada pasien trauma tumpul abdomen kecuali bila ada \par\pard\pvpg\phpg\posx2160\posy2613\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma wajah \par\pard\pvpg\phpg\posx1800\posy2883\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2911\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Periksa dubur (rectal toucher) \par\pard\pvpg\phpg\posx1800\posy3180\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3208\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasang kateter kandung seni jika tidak ada darah di meatus externus \par\pard\pvpg\phpg\posx1800\posy3780\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pelvis dan ekstremitas\b0 \par\pard\pvpg\phpg\posx1800\posy4328\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy4356\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cari adanya fraktura (pada kecurigaan fraktur pelvis jangan melakukan tes gerakan \par\pard\pvpg\phpg\posx2160\posy4639\charscalex100\expndtw-1 \ql\fs24\cf1\f0 apapun karena memperberat perdarahan) \par\pard\pvpg\phpg\posx1800\posy4908\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4936\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cari denyut nadi-nadi perifer pada daerah trauma \par\pard\pvpg\phpg\posx1800\posy5206\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5234\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cari luka, memar dan cedera lain \par\pard\pvpg\phpg\posx1800\posy5805\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan sinar-X (bila memungkinkan) untuk :\b0 \par\pard\pvpg\phpg\posx1800\posy6353\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6381\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Dada dan tulang leher (semua 7 ruas tulang leher harus nampak) \par\pard\pvpg\phpg\posx1800\posy6651\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6679\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pelvis dan tulang panjang \par\pard\pvpg\phpg\posx1800\posy6948\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6976\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tulang kepala untuk melihat adanya fraktura bila trauma kepala tidak disertai defisit \par\pard\pvpg\phpg\posx2160\posy7260\charscalex100\expndtw0 \ql\fs24\cf1\f0 neurologis fokal \par\pard\pvpg\phpg\posx1800\posy7543\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Foto atas daerah yang lain dilakukan secara selektif. \par\pard\pvpg\phpg\posx1800\posy7826\charscalex100\expndtw0 \ql\fs24\cf1\f0 Foto dada dan pelvis mungkin sudah diperlukan sewaktusurvei primer \par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 12 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs28\b TRAUMA DADA\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Seperempat dari jumlah kematian trauma terjadi akibatcedera dada. Kematian segera \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 terjadi jika kerusakan mengenai jantung dan pembuluh darah besar. Kematian pada fase \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw-1 \ql\fs24\cf1\f0 berikutnya disebabkan karena obstruksi jalan nafas, tamponade jantung atau aspirasi. \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Sebagian besar pasien trauma dada dapat dikelola dengan cara-cara sederhana\b0 \par\pard\pvpg\phpg\posx1800\posy3487\charscalex100\expndtw0 \ql\fs24\cf1\f0\b tanpa pembedahan.\b0 \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Distres nafas (sesak) dapat disebabkan oleh : \par\pard\pvpg\phpg\posx1800\posy4318\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4346\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fraktura iga / flail chest \par\pard\pvpg\phpg\posx1800\posy4616\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4644\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pneumotoraks \par\pard\pvpg\phpg\posx1800\posy4913\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4941\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pneumotoraks tension \par\pard\pvpg\phpg\posx1800\posy5211\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5239\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hemotoraks \par\pard\pvpg\phpg\posx1800\posy5508\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5536\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 Kontusioo paru \par\pard\pvpg\phpg\posx1800\posy5806\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5834\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Penumotoraks terbuka \par\pard\pvpg\phpg\posx1800\posy6104\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6132\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Aspirasi \par\pard\pvpg\phpg\posx1800\posy6698\charscalex100\expndtw0 \ql\fs24\cf1\f0 Syok akibat perdarahan dapat terjadi karena hemotoraks atau hemomediastinum \par\pard\pvpg\phpg\posx1800\posy7269\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Fraktura iga \b0 : \par\pard\pvpg\phpg\posx1800\posy7552\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dapat terjadi pada titik tumbuk dan menyebabkan kerusakan jaringan paru. Pada pasien \par\pard\pvpg\phpg\posx1800\posy7836\charscalex100\expndtw0 \ql\fs24\cf1\f0 tua trauma ringanpun dapat menyebabkan trauma iga. Potongan iga dapat stabil setelah \par\pard\pvpg\phpg\posx1800\posy8119\charscalex100\expndtw0 \ql\fs24\cf1\f0 10 - 14 hari. Penyembuhan yang sempurna dengan callustercapai setelah 6 minggu. \par\pard\pvpg\phpg\posx1800\posy8690\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Flail chest :\b0 \par\pard\pvpg\phpg\posx1800\posy8968\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Bagian / segmen yang tidak stabil bergerak sendiridan berlawanan dengan dinding dada \par\pard\pvpg\phpg\posx1800\posy9252\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pada saat bernafas. Hal ini menyebabkan distres nafas karena aliran udara didalam paru \par\pard\pvpg\phpg\posx1800\posy9535\charscalex100\expndtw0 \ql\fs24\cf1\f0 menjadi tidak efisien. \par\pard\pvpg\phpg\posx1800\posy10106\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pneumotoraks tension\b0 \par\pard\pvpg\phpg\posx1800\posy10384\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Keadaan yang berbahaya ini terjadi jika udara masuk kedalam rongga pleura tetapi tidak \par\pard\pvpg\phpg\posx1800\posy10668\charscalex100\expndtw0 \

ql\fs24\cf1\f0 dapat keluar lagi sehingga tekanan dalam dada meningkat tinggi dan mediastinum \par\pard\pvpg\phpg\posx1800\posy10951\charscalex100\expndtw0 \ql\fs24\cf1\f0 tergeser. Pasien menjadi sesak dan hipoksia. Trakhea yang terdorong kesisi yang sehat \par\pard\pvpg\phpg\posx1800\posy11234\charscalex100\expndtw0 \ql\fs24\cf1\f0 adalah tanda khas pneumotoraks yang sudah berjalanlanjut. \par\pard\pvpg\phpg\posx1800\posy11517\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Needle thoracostomy harus segera dikerjakan sebelum pemasangan drain toraks agar \par\pard\pvpg\phpg\posx1800\posy11800\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pasien dapat bernafas dengan baik. \par\pard\pvpg\phpg\posx2090\posy12933\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Derajad dan luasnya cedera di bagian dalam tubuh tidak dapat diperkirakan dari\b0\i0 \par\pard\pvpg\phpg\posx4980\posy13212\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i keadaan luka kulitnya.\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1584 \shptop12794 \shpright10514 \shpbottom13519 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1776 \shpright10080 \shpbottom1776 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 13 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Hemotoraks\b0 \par\pard\pvpg\phpg\posx1800\posy1735\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyulit ini lebih sering terjadi pada luka tembus / tusuk pada dada. Perdarahan yang \par\pard\pvpg\phpg\posx1800\posy2018\charscalex100\expndtw0 \ql\

fs24\cf1\f0 banyak menyebabkan pasien jatuh dalam syok hemoragikyang berat. Distres nafas juga \par\pard\pvpg\phpg\posx1800\posy2301\charscalex100\expndtw-1 \ql\fs24\cf1\f0 akan terjadi karena paru di sisi hemotoraks akan kolaps akibat tertekan volume darah. \par\pard\pvpg\phpg\posx1800\posy2584\charscalex100\expndtw0 \ql\fs24\cf1\f0 Terapi yang optimal adalah pemasangan pipa / chest tube ukuran besar. \par\pard\pvpg\phpg\posx1800\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2882\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hemotoraks 500 - 1500 ml yang berhenti setelah pemasangan pipa toraks cukup \par\pard\pvpg\phpg\posx2160\posy3165\charscalex100\expndtw0 \ql\fs24\cf1\f0 dilanjutkan dengan drain saja. \par\pard\pvpg\phpg\posx1800\posy3435\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3463\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hemotoraks lebih dari 1500 - 2000 ml atau yang perdarahannya berlanjut lebih dari \par\pard\pvpg\phpg\posx2160\posy3746\charscalex100\expndtw0 \ql\fs24\cf1\f0 200 - 300 ml/jam perlu diperiksa lebih lanjut atau perlu torakotomi. \par\pard\pvpg\phpg\posx1800\posy4317\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Kontusio paru\b0 \par\pard\pvpg\phpg\posx1800\posy4596\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyulit ini sering terjadi pada trauma dada dan potensial menyebabkan kematian. Proses, \par\pard\pvpg\phpg\posx1800\posy4879\charscalex100\expndtw0 \ql\fs24\cf1\f0 tanda dan gejala mungkin berjalan pelan dan makin memburuk dalam 24 jam pasca \par\pard\pvpg\phpg\posx1800\posy5162\charscalex100\expndtw-1 \ql\fs24\cf1\f0 trauma. Kontusio paru terjadi pada kecelakaan lalulintas dengan kecepatan tinggi, jatuh \par\pard\pvpg\phpg\posx1800\posy5445\charscalex100\expndtw0 \ql\fs24\cf1\f0 dari tempat yang tinggi dan luka tembak dengan pelurucepat (high velocity). \par\pard\pvpg\phpg\posx1800\posy5728\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tanda dan gejala :

\par\pard\pvpg\phpg\posx1800\posy5998\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6026\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Sesak nafas / dyspnea \par\pard\pvpg\phpg\posx1800\posy6296\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6324\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hipoksemia \par\pard\pvpg\phpg\posx1800\posy6593\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6621\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tachikardia \par\pard\pvpg\phpg\posx1800\posy6891\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6919\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara nafas berkurang atau tak terdengar di sisi kontusio \par\pard\pvpg\phpg\posx1800\posy7188\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7216\charscalex100\expndtw0 \ql\fs24\cf1\f0 Patah tulang iga \par\pard\pvpg\phpg\posx1800\posy7486\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7514\charscalex100\expndtw0 \ql\fs24\cf1\f0 Cyanosis \par\pard\pvpg\phpg\posx1800\posy8085\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Luka dada terbuka atau luka yang menghisap udara (sucking)\b0 \par\pard\pvpg\phpg\posx1800\posy8364\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Perlukaan pada dinding dada ini menyebabkan paru kolaps karena terpapar pada tekanan \par\pard\pvpg\phpg\posx1800\posy8647\charscalex100\expndtw0 \ql\fs24\cf1\f0 udara luar. Selanjutnya mediastinum akan terdorong kesisi yang sehat. Keadaan ini harus \par\pard\pvpg\phpg\posx1800\posy8930\charscalex100\expndtw-1 \ql\fs24\cf1\f0 segera ditolong karena cepat menyebabkan kematian.Gunakan selembar plastik yang \par\pard\pvpg\phpg\posx1800\posy9213\charscalex100\expndtw0 \ql\fs24\cf1\f0 diplester pada tiga sisinya untuk menutup luka

terbuka tersebut sebagai katup penahan \par\pard\pvpg\phpg\posx1800\posy9496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 udara masuk. \par\pard\pvpg\phpg\posx1800\posy9780\charscalex100\expndtw0 \ql\fs24\cf1\f0 Lakukan hal ini sampai korban tiba di rumah sakit. Selanjutnya dilakukan pemasangan \par\pard\pvpg\phpg\posx1800\posy10063\charscalex100\expndtw0 \ql\fs24\cf1\f0 pipa toraks, intubasi trakhea dan pernafasan buatan tekanan positif. \par\pard\pvpg\phpg\posx1800\posy10629\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera lain tersebut dibawah ini juga dapat terjadi pada trauma tetapi angka kematiannya \par\pard\pvpg\phpg\posx1800\posy10912\charscalex100\expndtw0 \ql\fs24\cf1\f0 sangat tinggi meskipun dikelola di pusat rujukan /rumah sakit dengan sarana lengkap. \par\pard\pvpg\phpg\posx1800\posy11196\charscalex100\expndtw0 \ql\fs24\cf1\f0 Uraian berikut hanya untuk tujuan pendidikan. \par\pard\pvpg\phpg\posx1800\posy11767\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Kontusio miokard\b0 \par\pard\pvpg\phpg\posx1800\posy12045\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyulit ini dapat menyebabkan kematian mendadak pasca trauma. Terjadi pada trauma \par\pard\pvpg\phpg\posx1800\posy12328\charscalex100\expndtw0 \ql\fs24\cf1\f0 tumpul dada yang disertai fraktur sternum atau iga. Diagnosa ditunjang oleh kelainan \par\pard\pvpg\phpg\posx1800\posy12612\charscalex100\expndtw0 \ql\fs24\cf1\f0 ECG dan peningkatan kadar serum enzim jantung padapemeriksaan serial. Kontusio \par\pard\pvpg\phpg\posx1800\posy12895\charscalex100\expndtw0 \ql\fs24\cf1\f0 miokard ini dapat menyerupai keadaan infark miokard. Perawatan pasien memerlukan \par\pard\pvpg\phpg\posx1800\posy13178\charscalex100\expndtw-1 \ql\fs24\cf1\f0 observasi dengan pemantauan ECG. \par\pard\pvpg\phpg\posx1898\posy14023\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Waspadalah, Kontusioo paru perlahan-lahan menyebabkan fungsi nafas memburuk.\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop13805 \shpright10370 \shpbottom14674

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 14 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Tamponade perikard\b0 \par\pard\pvpg\phpg\posx1800\posy1735\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Luka tembus / tusuk jantung adalah penyebab kematian utama pada daerah perkotaan. \par\pard\pvpg\phpg\posx1800\posy2018\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tamponade jarang terjadi akibat trauma tumpul. Terapinya adalah pericardio-centesis \par\pard\pvpg\phpg\posx1800\posy2301\charscalex100\expndtw0 \ql\fs24\cf1\f0 yang dikerjakan segera jika pasien menunjukkan : \par\pard\pvpg\phpg\posx1800\posy2571\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2599\charscalex100\expndtw0 \ql\fs24\cf1\f0 Syok \par\pard\pvpg\phpg\posx1800\posy2868\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2896\charscalex100\expndtw0 \ql\fs24\cf1\f0 Vena leher menggembung (distended) \par\pard\pvpg\phpg\posx1800\posy3166\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3194\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ekstretimas dingin tetapi tidak ada pneumotoraks \par\pard\pvpg\phpg\posx1800\posy3464\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3492\charscalex100\expndtw0 \ql\fs24\cf1\f0 Suara jantung lemah / sunyi \par\pard\pvpg\phpg\posx1800\posy4063\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Cedera pada pembuluh darah besar\b0 \par\pard\pvpg\phpg\posx1800\posy4341\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera pada vena atau arteria pulmonalis sering fatal dan merupakan penyebab utama \par\pard\pvpg\phpg\posx1800\posy4624\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 kematian korban di tempat kejadian. \par\pard\pvpg\phpg\posx1800\posy5196\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Ruptura trakhea atau bronkhus utama\b0 \par\pard\pvpg\phpg\posx1800\posy5474\charscalex100\expndtw0 \ql\fs24\cf1\f0 Angka kematian akibat penyulit ini adalah 50 %. Ruptura bronkhi 80% terjadi 2,5 cm di \par\pard\pvpg\phpg\posx1800\posy5757\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sekitar carina.Tanda-tanda : \par\pard\pvpg\phpg\posx1800\posy6027\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6055\charscalex100\expndtw0 \ql\fs24\cf1\f0 Batuk darah / hemoptysis \par\pard\pvpg\phpg\posx1800\posy6324\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6352\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Sesak nafas \par\pard\pvpg\phpg\posx1800\posy6622\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6650\charscalex100\expndtw0 \ql\fs24\cf1\f0 Emfisema subkutan dan mediastinum \par\pard\pvpg\phpg\posx1800\posy6920\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6948\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sianosis \par\pard\pvpg\phpg\posx1800\posy7519\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Trauma esofagus\b0 \par\pard\pvpg\phpg\posx1800\posy7797\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jarang terjadi pada trauma tumpul. Luka tusuk yangmerobek esofagus akan \par\pard\pvpg\phpg\posx1800\posy8080\charscalex100\expndtw0 \ql\fs24\cf1\f0 menyebabkan kematian karena mediastinitis. Keluhan pasien berupa nyeri tajam yang \par\pard\pvpg\phpg\posx1800\posy8364\charscalex100\expndtw0 \ql\fs24\cf1\f0 mendadak di epigastrium dan dada yang menjalar ke punggung. Sesak nafas, sianosis dan \par\pard\pvpg\phpg\posx1800\posy8647\charscalex100\expndtw0 \ql\fs24\cf1\f0 syok muncul pada fase yang sudah terlambat. \par\pard\pvpg\phpg\posx1800\posy9218\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Cedera diafragma\b0

\par\pard\pvpg\phpg\posx1800\posy9496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Terjadi cukup sering pada trauma tumpul dada. Diagnosis sering terlewat, karena itu \par\pard\pvpg\phpg\posx1800\posy9780\charscalex100\expndtw-1 \ql\fs24\cf1\f0 cedera diafragma harus dicurigai terjadi pada semua luka tusuk dada yang : \par\pard\pvpg\phpg\posx1800\posy10049\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10077\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dibawah ICS 4 anterior. \par\pard\pvpg\phpg\posx1800\posy10347\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10375\charscalex100\expndtw0 \ql\fs24\cf1\f0 Didaerah ICS 6 lateral \par\pard\pvpg\phpg\posx1800\posy10644\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10672\charscalex100\expndtw0 \ql\fs24\cf1\f0 Didaerah ICS 8 posterior \par\pard\pvpg\phpg\posx1800\posy10942\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10970\charscalex100\expndtw0 \ql\fs24\cf1\f0 Lebih sering terjadi pada sisi kiri \par\pard\pvpg\phpg\posx1800\posy11541\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Ruptura aorta thoracalis\b0 \par\pard\pvpg\phpg\posx1800\posy11820\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyulit ini dapat terjadi akibat gaya deselerasi yang besar seperti pada tabrakan mobil \par\pard\pvpg\phpg\posx1800\posy12103\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kecepatan tinggi atau jatuh dari tempat yang tinggi. Angka kematian yang tinggi dapat \par\pard\pvpg\phpg\posx1800\posy12386\charscalex100\expndtw0 \ql\fs24\cf1\f0 dimengerti karena cardiac output dewasa adalah 5 liter/menit dan jantung memompa 5 \par\pard\pvpg\phpg\posx1800\posy12669\charscalex100\expndtw0 \ql\fs24\cf1\f0 liter/menit \par\pard\pvpg\phpg\posx3348\posy13802\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Waspadailah tamponade perikard pada luka tusukdada\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 15 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRAUMA ABDOMINAL\b0 \par\pard\pvpg\phpg\posx1800\posy2112\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pada trauma ganda, abdomen merupakan bagian yang tersering mengalami cedera. Organ \par\pard\pvpg\phpg\posx1800\posy2395\charscalex100\expndtw-1 \ql\fs24\cf1\f0 yang tersering cedera pada trauma tembus adalah hepar/hati dan pada trauma tumpul \par\pard\pvpg\phpg\posx1800\posy2678\charscalex100\expndtw0 \ql\fs24\cf1\f0 adalah lien/limpa. \par\pard\pvpg\phpg\posx1800\posy3249\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Evaluasi awal terhadap pasien trauma abdominal harus menyertakan A (\i airway\b0\i0 \par\pard\pvpg\phpg\posx1800\posy3532\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i and C-spine\i0 ), B (\i breathing\i0 ), C (\i Circulation\i0 ), dan D (\i disability \i0 dan penilaian\b0 \par\pard\pvpg\phpg\posx1800\posy3816\charscalex100\expndtw0 \ql\fs24\cf1\f0\b neurologis) dan E (\i exposure\i0 ).\b0 \par\pard\pvpg\phpg\posx1800\posy4377\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Seorang pasien yang terlibat kecelakaan serius harus dianggap cedera abdominal sampai \par\pard\pvpg\phpg\posx1800\posy4660\charscalex100\expndtw0 \ql\fs24\cf1\f0 terbukti lain. Cedera abdominal yang tidak diketahuimasih merupakan sebab tersering \par\pard\pvpg\phpg\posx1800\posy4944\charscalex100\expndtw0 \ql\fs24\cf1\f0 dari kematian yang dapat dicegah (\i preventable death\i0 ) setelah trauma. \par\pard\pvpg\phpg\posx1800\posy5510\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Ada dua jenis dari trauma abdominal : \par\pard\pvpg\phpg\posx2160\posy5793\charscalex100\expndtw0 \ql\fs24\cf1\f0 I.

\par\pard\pvpg\phpg\posx2880\posy5793\charscalex100\expndtw0 \ql\fs24\cf1\f0 Trauma penetrasi dimana penting dilakukan konsultasi bedah sbb.: \par\pard\pvpg\phpg\posx2880\posy6076\charscalex100\expndtw-1 \ql\fs24\cf1\f0 A. Luka tembak \par\pard\pvpg\phpg\posx2880\posy6360\charscalex100\expndtw0 \ql\fs24\cf1\f0 B. \par\pard\pvpg\phpg\posx3600\posy6360\charscalex100\expndtw0 \ql\fs24\cf1\f0 Luka tusuk \par\pard\pvpg\phpg\posx2160\posy6926\charscalex100\expndtw0 \ql\fs24\cf1\f0 II. \par\pard\pvpg\phpg\posx2880\posy6926\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma non-penetrasi sbb.: \par\pard\pvpg\phpg\posx2880\posy7209\charscalex100\expndtw-1 \ql\fs24\cf1\f0 A. Kompresi \par\pard\pvpg\phpg\posx2880\posy7492\charscalex100\expndtw-1 \ql\fs24\cf1\f0 B. Hancur (crash) \par\pard\pvpg\phpg\posx2880\posy7776\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C. \par\pard\pvpg\phpg\posx3599\posy7776\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sabuk pengaman (seat belt) \par\pard\pvpg\phpg\posx2880\posy8059\charscalex100\expndtw-1 \ql\fs24\cf1\f0 D. \par\pard\pvpg\phpg\posx3600\posy8059\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cedera akselerasi / deselerasi. \par\pard\pvpg\phpg\posx1800\posy8625\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sekitar 20% dari pasien trauma dengan hemoperitoneum akut tidak menunjukkan tanda \par\pard\pvpg\phpg\posx1800\posy8908\charscalex100\expndtw-1 \ql\fs24\cf1\f0 dari rangsang peritoneum pada saat pemeriksaan pertama. Diagnosis baru ditemukan pada \par\pard\pvpg\phpg\posx1800\posy9196\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b SURVAI PRIMER ULANGAN.\b0 \par\pard\pvpg\phpg\posx1800\posy9758\charscalex100\expndtw0 \ql\fs24\cf1\f0 Trauma tumpul menjadi sulit dievaluasi bila pasien tidak sadar. Pasien ini mungkin \par\pard\pvpg\phpg\posx1800\posy10041\charscalex100\expndtw0 \ql\fs24\cf1\f0 memerlukan \b\i peritoneal lavage\b0\i0 . Laparatomi eksplorasi merupakan prosedur definitif

\par\pard\pvpg\phpg\posx1800\posy10324\charscalex100\expndtw0 \ql\fs24\cf1\f0 terbaik untuk menyingkirkan kemungkinan trauma abdominal. \par\pard\pvpg\phpg\posx1800\posy10896\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pemeriksaan fisik abdomen yang lengkap termasuk \bpemeriksaan rektum\b0 , menilai: \par\pard\pvpg\phpg\posx2160\posy11462\charscalex100\expndtw0 \ql\fs24\cf1\f0 I. \par\pard\pvpg\phpg\posx2880\posy11462\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tonus sfinkter anus \par\pard\pvpg\phpg\posx2160\posy11745\charscalex100\expndtw0 \ql\fs24\cf1\f0 II. \par\pard\pvpg\phpg\posx2880\posy11745\charscalex100\expndtw0 \ql\fs24\cf1\f0 Integritas dinding rektum \par\pard\pvpg\phpg\posx2160\posy12028\charscalex100\expndtw-6 \ql\fs24\cf1\f0 III. \par\pard\pvpg\phpg\posx2880\posy12028\charscalex100\expndtw0 \ql\fs24\cf1\f0 Darah dalam rektum \par\pard\pvpg\phpg\posx2160\posy12312\charscalex100\expndtw0 \ql\fs24\cf1\f0 IV. Posisi prostat. \par\pard\pvpg\phpg\posx1800\posy12878\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jangan lupa memeriksa apakah ada darah di meatus uretra eksterna. {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2160 \shptop13428 \shpright10262 \shpbottom13970 {\sp{\sn fillColor}{\sv 16777215}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx2431\posy13447\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Pemasangan kateter buli-buli adalah penting.(hati-hati pada cedera pelvis)\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1877 \shpright10224 \shpbottom1877 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 16 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw0 \ql\fs24\cf1\f0 Wanita harus dianggap \b hamil \b0 sampai terbukti lain. janin mungkin masih dapat \par\pard\pvpg\phpg\posx1800\posy1740\charscalex100\expndtw-1 \ql\fs24\cf1\f0 diselamatkan. Pengobatan terhadap fetus adalah melakukan resusitasi terhadap ibunya. \par\pard\pvpg\phpg\posx1800\posy2023\charscalex100\expndtw0 \ql\fs24\cf1\f0 Seorang ibu yang hamil cukup bulan (at term), biasanya baru dapat diresusitasi setelah \par\pard\pvpg\phpg\posx1800\posy2306\charscalex100\expndtw0 \ql\fs24\cf1\f0 bayinya dilahirkan. Situasi sulit ini harus dinilai pada saat itu. \par\pard\pvpg\phpg\posx1800\posy2877\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Diagnostic Peritoneal Lavage (DPL) \b0 dapat membantu menemukan adanya darah atau \par\pard\pvpg\phpg\posx1800\posy3160\charscalex100\expndtw0 \ql\fs24\cf1\f0 cairan usus dalam rongga perut. Hasilnya dapat amat membantu. Tetapi DPL ini hanya \par\pard\pvpg\phpg\posx1800\posy3444\charscalex100\expndtw-1 \ql\fs24\cf1\f0 alat diagnostik. Bila ada keraguan, kerjakan laparatomi (gold standard). \par\pard\pvpg\phpg\posx1800\posy4010\charscalex100\expndtw0 \ql\fs24\cf1\f0 Indikasi untuk melakukan DPL sbb.: \par\pard\pvpg\phpg\posx2160\posy4563\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy4591\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Nyeri abdomen yang tidak bisa diterangkan sebabnya\par\pard\pvpg\phpg\posx2160\posy4860\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy4888\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma pada bagian bawah dari dada \par\pard\pvpg\phpg\posx2160\posy5158\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy5186\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hipotensi, hematokrit turun tanpa alasan yang jelas \par\pard\pvpg\phpg\posx2160\posy5456\charscalex100\expndtw0 \ql\

fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy5484\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasien cedera abdominal dengan gangguan kesadaran (obat,alkohol, cedera otak) \par\pard\pvpg\phpg\posx2160\posy5753\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy5781\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasien cedera abdominal dan cedera medula spinalis (sumsum tulang belakang) \par\pard\pvpg\phpg\posx2160\posy6051\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy6079\charscalex100\expndtw0 \ql\fs24\cf1\f0 Patah tulang pelvis \par\pard\pvpg\phpg\posx1800\posy6645\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kontra indikasi relatif melakukan DPL sbb.: \par\pard\pvpg\phpg\posx2160\posy7198\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy7226\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hamil \par\pard\pvpg\phpg\posx2160\posy7496\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy7524\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pernah operasi abdominal \par\pard\pvpg\phpg\posx2160\posy7793\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy7821\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Operator tidak berpengalaman \par\pard\pvpg\phpg\posx2160\posy8091\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy8119\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Bila hasilnya tidak akan merubah penata-laksanaan \par\pard\pvpg\phpg\posx1800\posy8690\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Problem spesifik lain pada trauma abdominal :\b0 \par\pard\pvpg\phpg\posx1800\posy9252\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Patah tulang pelvis sering disertai cedera urologis dan perdarahan masif. \par\pard\pvpg\phpg\posx2160\posy9521\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy9549\charscalex100\expndtw0 \ql\

fs24\cf1\f0 Pemeriksaan rektum penting untuk mengetahui posisi prostat dan adanya darah \par\pard\pvpg\phpg\posx2520\posy9832\charscalex100\expndtw-1 \ql\fs24\cf1\f0 atau laserasi rektum atau perineum. \par\pard\pvpg\phpg\posx2160\posy10102\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy10130\charscalex100\expndtw0 \ql\fs24\cf1\f0 Foto ronsen pelvis ( bila diagnosaklinis sulit ditegakkan). \par\pard\pvpg\phpg\posx1800\posy10696\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penata-laksanaan patah tulang pelvis termasuk : \par\pard\pvpg\phpg\posx2160\posy11249\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy11277\charscalex100\expndtw0 \ql\fs24\cf1\f0 Resusitasi (ABC) \par\pard\pvpg\phpg\posx2160\posy11547\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy11575\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Transfusi \par\pard\pvpg\phpg\posx2160\posy11844\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy11872\charscalex100\expndtw0 \ql\fs24\cf1\f0 Imobilisasi dan penilaian untuk operasi \par\pard\pvpg\phpg\posx2160\posy12142\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy12170\charscalex100\expndtw0 \ql\fs24\cf1\f0 Analgesik {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2448 \shptop13392 \shpright9650 \shpbottom13970 {\sp{\sn fillColor}{\sv 16777215}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx3122\posy13411\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Patah tulang pelvis sering menyebabkan perdarahan masif\b0\i0 \par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 17 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRAUMA KEPALA\b0 \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Keterlambatan pengelolaan dini pasien trauma kepala sangat buruk akibatnya pada \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 kesembuhan. Hipoksia dan hipotensi menyebabkan angka kematian dua kali lebih \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw-1 \ql\fs24\cf1\f0 banyak. \par\pard\pvpg\phpg\posx1800\posy3199\charscalex100\expndtw0 \ql\fs24\cf1\f0 Keadaan-keadaan berikut ini sangat membahayakan jiwa tetapi sulit diatasi di rumah sakit \par\pard\pvpg\phpg\posx1800\posy3482\charscalex100\expndtw-1 \ql\fs24\cf1\f0 daerah. Kita harus menangani kasus dengan hati-hati dan disesuaikan dengan \par\pard\pvpg\phpg\posx1800\posy3765\charscalex100\expndtw0 \ql\fs24\cf1\f0 kemampuan, fasilitas dan jumlah korban. \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f0 Patologi berikut ini harus cepat di kenali dan dikelola dengan baik: \par\pard\pvpg\phpg\posx1800\posy4884\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4912\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Perdarahan ekstradural (epidural) akut \b0 - dengan tanda klasik sebagai berikut: \par\pard\pvpg\phpg\posx2160\posy5182\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy5210\charscalex100\expndtw-1 \ql\fs24\cf1\f0 hilangnya kesadaran (menurun dengan cepat) setelahsuatu masa bebas (lucid \par\pard\pvpg\phpg\posx2520\posy5493\charscalex100\expndtw0 \ql\fs24\cf1\f0 interval) \par\pard\pvpg\phpg\posx2160\posy5763\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy5791\charscalex100\expndtw-1 \ql\fs24\cf1\f0 perdarahan arteria meningea media dengan

peningkatan cepat dari tekanan \par\pard\pvpg\phpg\posx2520\posy6074\charscalex100\expndtw0 \ql\fs24\cf1\f0 intrakranial \par\pard\pvpg\phpg\posx2160\posy6344\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy6372\charscalex100\expndtw0 \ql\fs24\cf1\f0 timbulnya kelumpuhan (hemiparesis) pada sisi yang berlawanan dengan sisi \par\pard\pvpg\phpg\posx2520\posy6655\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma \par\pard\pvpg\phpg\posx2160\posy6924\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy6952\charscalex100\expndtw-1 \ql\fs24\cf1\f0 timbulnya pupil yang fixed (tidak ada reaksi cahaya) pada sisi yang sama dengan \par\pard\pvpg\phpg\posx2520\posy7236\charscalex100\expndtw0 \ql\fs24\cf1\f0 tempat trauma. \par\pard\pvpg\phpg\posx1800\posy7788\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7816\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Perdarahan subdural akut \b0 - terjadi akibat robeknya vena yang melintang antara \par\pard\pvpg\phpg\posx2160\posy8100\charscalex100\expndtw0 \ql\fs24\cf1\f0 korteks dan dura. Bekuan darah dalam rongga subdural disertai dengan Kontusio \par\pard\pvpg\phpg\posx2160\posy8383\charscalex100\expndtw0 \ql\fs24\cf1\f0 jaringan otak di bawahnya. \par\pard\pvpg\phpg\posx1800\posy8954\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Kedua keadaan tersebut diatas memerlukan pembedahandan harus diupayakan\b0 \par\pard\pvpg\phpg\posx1800\posy9237\charscalex100\expndtw0 \ql\fs24\cf1\f0\b dekompresi dengan burr-hole\b0 . \par\pard\pvpg\phpg\posx1800\posy9804\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Keadaan di bawah ini memerlukan pengelolaan medikkonservatif, karena pembedahan \par\pard\pvpg\phpg\posx1800\posy10087\charscalex100\expndtw0 \ql\fs24\cf1\f0 tidak akan membawa hasil lebih baik. \par\pard\pvpg\phpg\posx1800\posy10640\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy10668\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Fraktura basis cranii \b0 - ditandai adanya memar biru hitam pada kelopak mata \par\pard\pvpg\phpg\posx2160\posy10951\charscalex100\expndtw-1 \ql\fs24\cf1\f0 (Racoon eyes) atau memar diatas prosesus mastoid (Battle s sign) dan atau kebocoran \par\pard\pvpg\phpg\posx2160\posy11234\charscalex100\expndtw0 \ql\fs24\cf1\f0 cairan serebrospinalis yang menetes dari telinga atau hidung. \par\pard\pvpg\phpg\posx1800\posy11787\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11815\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Comotio cerebri \b0 - ditandai dengan gangguan kesadaran temporer \par\pard\pvpg\phpg\posx1800\posy12368\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12396\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Fraktura depresi tulang tengkorak \b0 - dimana mungkin ada pecahan tulang yang \par\pard\pvpg\phpg\posx2160\posy12679\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menembus dura dan jaringan otak \par\pard\pvpg\phpg\posx1800\posy13232\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy13260\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Hematoma intracerebral \b0 - dapat disebabkan oleh kerusakan akut atau progresif \par\pard\pvpg\phpg\posx2160\posy13543\charscalex100\expndtw0 \ql\fs24\cf1\f0 akibat contusio. {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1836 \shpright10224 \shpbottom1836 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 18 \par\pard\pvpg\phpg\posx1800\posy1452\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 Kesalahan yang sering terjadi pada waktu evaluasi trauma kepala dan resusitasi adalah: \par\pard\pvpg\phpg\posx1800\posy2004\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2032\charscalex100\expndtw0 \ql\fs24\cf1\f0 kegagalan melakukan ABC dan menetapkan prioritas pengelolaan \par\pard\pvpg\phpg\posx1800\posy2302\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2330\charscalex100\expndtw0 \ql\fs24\cf1\f0 kegagalan menemukan patologi lain disamping trauma kepala \par\pard\pvpg\phpg\posx1800\posy2600\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2628\charscalex100\expndtw0 \ql\fs24\cf1\f0 kegagalan menilai keadaan neurologis awal \par\pard\pvpg\phpg\posx1800\posy2897\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2925\charscalex100\expndtw0 \ql\fs24\cf1\f0 kegagalan evaluasi ulang kondisi pasien yang memburuk. \par\pard\pvpg\phpg\posx1800\posy3500\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Pengelolaan trauma kepala\b0 \par\pard\pvpg\phpg\posx1800\posy4106\charscalex100\expndtw0 \ql\fs24\cf1\f0 Stabilisasi jalan nafas, pernafasan dan sirkulasi harus segera dilakukan (usahakan \par\pard\pvpg\phpg\posx1800\posy4389\charscalex100\expndtw0 \ql\fs24\cf1\f0 imobilisasi tulang leher). Tanda-tanda fungsi vital dan derajad kesadaran (Glasgow Coma \par\pard\pvpg\phpg\posx1800\posy4672\charscalex100\expndtw0 \ql\fs24\cf1\f0 Score/GCS) harus dicatat berulang-ulang. Lihat Appendix 4. \par\pard\pvpg\phpg\posx1800\posy5239\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ingat: \par\pard\pvpg\phpg\posx1800\posy5508\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5536\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma kepala berat jika GCS \par\pard\pvpg\phpg\posx5054\posy5508\charscalex100\expndtw0 \ql\

fs24\cf1\f1 \u8804k \par\pard\pvpg\phpg\posx5246\posy5536\charscalex100\expndtw0 \ql\fs24\cf1\f0 8 \par\pard\pvpg\phpg\posx1800\posy5806\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5834\charscalex100\expndtw-1 \ql\fs24\cf1\f0 trauma kepala sedang jika GCS antara 9 dan 12 \par\pard\pvpg\phpg\posx1800\posy6104\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6132\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma kepala ringan jika GCS \par\pard\pvpg\phpg\posx5246\posy6104\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8805k \par\pard\pvpg\phpg\posx5438\posy6132\charscalex100\expndtw0 \ql\fs24\cf1\f0 13 \par\pard\pvpg\phpg\posx1800\posy6703\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Keadaan dapat memburuk akibat perdarahan\b0 \par\pard\pvpg\phpg\posx1800\posy7251\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7279\charscalex100\expndtw0 \ql\fs24\cf1\f0 pupil dilatasi atau anisokor menandakan peningkatan tekanan intrakranial \par\pard\pvpg\phpg\posx1800\posy7548\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7576\charscalex100\expndtw-1 \ql\fs24\cf1\f0 trauma kepala tidak pernah menyebabkan hipotensi pada pasien dewasa \par\pard\pvpg\phpg\posx1800\posy7846\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7874\charscalex100\expndtw0 \ql\fs24\cf1\f0 obat sedatif harus dihindari karena selain memperburuk derajat kesadaran juga \par\pard\pvpg\phpg\posx2160\posy8157\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menyebabkan hiperkarbia (nafas lambat dengan retensi CO2) \par\pard\pvpg\phpg\posx1800\posy8427\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8455\charscalex100\expndtw0 \ql\fs24\cf1\f0 peningkatan tekanan intrakranial yang fatal ditandai

respons Cushing yang spesifik \par\pard\pvpg\phpg\posx2160\posy8738\charscalex100\expndtw0 \ql\fs24\cf1\f0 yaitu : bradikardia, hipertensi dan nafas lambat \par\pard\pvpg\phpg\posx2160\posy9021\charscalex100\expndtw0 \ql\fs24\cf1\f0 Keadaan ini sudah sangat lambat dan prognosisnya jelek \par\pard\pvpg\phpg\posx1800\posy9592\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pengelolaan medik dasar untuk trauma kepala berat meliputi:\b0 \par\pard\pvpg\phpg\posx1800\posy10140\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10168\charscalex100\expndtw0 \ql\fs24\cf1\f0 intubasi dan hiperventilasi agar tercapai hipokapnia sedang (pCO2 33 -35 mmHg) \par\pard\pvpg\phpg\posx2160\posy10452\charscalex100\expndtw0 \ql\fs24\cf1\f0 hingga volume darah di otak menurun dan tekanan intrakranial juga menurun untuk \par\pard\pvpg\phpg\posx2160\posy10735\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sementara \par\pard\pvpg\phpg\posx1800\posy11004\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11032\charscalex100\expndtw0 \ql\fs24\cf1\f0 obat sedatif dan mungkin disertai obat pelumpuh otot \par\pard\pvpg\phpg\posx1800\posy11302\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11330\charscalex100\expndtw0 \ql\fs24\cf1\f0 cairan infus dibatasi, jangan sampai overload, kalau perlu diberikan diuretika. \par\pard\pvpg\phpg\posx1800\posy11601\charscalex100\expndtw-1 \ql\fs24\cf1\f1\fs32 \u8226k \par\pard\pvpg\phpg\posx2160\posy11709\charscalex100\expndtw0 \ql\fs24\cf1\f0 posisi head up 20 \par\pard\pvpg\phpg\posx3833\posy11681\charscalex100\expndtw0 \ql\fs24\cf1\f1 \par\pard\pvpg\phpg\posx1800\posy11980\charscalex100\expndtw-1 \ql\fs24\cf1\f1\fs32 \u8226k \par\pard\pvpg\phpg\posx2160\posy12088\charscalex100\expndtw-1 \ql\fs24\cf1\f0 cegah hipertermia

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 19 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRAUMA SPINAL (TULANG BELAKANG)\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kejadian kerusakan syaraf akibat trauma ganda ternyata lebih sering daripada yang \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 diperkirakan. Kerusakaan yang sering terjadi adalah pada syaraf jari, plexus brachialis \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 dan sumsum tulang belakang (medula spinalis). \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas pengelolaan selalu mengikuti Primary Survey serta urutan ABCDE :\b0 \par\pard\pvpg\phpg\posx1800\posy3468\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy3496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 A-Airway, membebaskan jalan nafas dengan melindungi tulang leher (cervical spine) \par\pard\pvpg\phpg\posx1800\posy3766\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy3794\charscalex100\expndtw-1 \ql\fs24\cf1\f0 B-Breathing, bantuan pernafasan \par\pard\pvpg\phpg\posx1800\posy4064\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy4092\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C-Circulation, bantuan untuk sirkulasi dan pemantauan tekanan darah \par\pard\pvpg\phpg\posx1800\posy4361\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy4389\charscalex100\expndtw0 \ql\fs24\cf1\f0 D-Disability, pemantauan kesadaran dan kerusakan syaraf pusat \par\pard\pvpg\phpg\posx1800\posy4659\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2071\posy4687\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 E-Exposure, melepas baju pasien untuk memeriksa secara lengkap semua kerusakan \par\pard\pvpg\phpg\posx2071\posy4970\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pada tubuh dan ekstremitas. \par\pard\pvpg\phpg\posx1800\posy5536\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pemeriksaan korban trauma tulang belakang harus dilakukan dalam posisi netral (tanpa \par\pard\pvpg\phpg\posx1800\posy5820\charscalex100\expndtw0 \ql\fs24\cf1\f0 melakukan fleksi, ekstensi dan rotasi pada tulang belakang). \par\pard\pvpg\phpg\posx1800\posy6372\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6400\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pasien hanya boleh dibalik atau dimiringkan dengan cara log-rolling \par\pard\pvpg\phpg\posx2160\posy6684\charscalex100\expndtw0 \ql\fs24\cf1\f0 Harus dilakukan imobilisasi sebaik-baiknya dengan cara in-line immobilization, \par\pard\pvpg\phpg\posx2160\posy6967\charscalex100\expndtw-1 \ql\fs24\cf1\f0 memasang stiff cervical collar dan bantal pasir dikiri kanan kepala. \par\pard\pvpg\phpg\posx1800\posy7236\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7264\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Transportasi korban dilakukan dalam posisi netral \par\pard\pvpg\phpg\posx1800\posy7831\charscalex100\expndtw0 \ql\fs24\cf1\f0 Bila terdapat trauma tulang belakang (yang mungkin disertai) kerusakan sumsum tulang \par\pard\pvpg\phpg\posx1800\posy8114\charscalex100\expndtw0 \ql\fs24\cf1\f0 belakang, periksalah : \par\pard\pvpg\phpg\posx1800\posy8667\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8695\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Apakah ada nyeri tekan. \par\pard\pvpg\phpg\posx1800\posy8964\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8992\charscalex100\expndtw0 \ql\fs24\cf1\f0 Deformitas dan tanda step-off posterior \par\pard\pvpg\phpg\posx1800\posy9262\charscalex100\expndtw0 \ql\

fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9290\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pembengkakan \par\pard\pvpg\phpg\posx1800\posy9856\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tanda klinis yang menyertai kerusakan akibat trauma tulang leher adalah : \par\pard\pvpg\phpg\posx1800\posy10409\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10437\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kesukaran bernafas (pola nafas diafragma, pola nafas paradoksal) \par\pard\pvpg\phpg\posx1800\posy10707\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10735\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kelumpuhan otot dan hilangnya refleks (periksa sfinkter ani) \par\pard\pvpg\phpg\posx1800\posy11004\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11032\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hipotensi dengan bradikardia. \par\pard\pvpg\phpg\posx1800\posy11599\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika tersedia alat sinar X maka foto tulang leherdilakukan pada posisi AP dan posisi \par\pard\pvpg\phpg\posx1800\posy11882\charscalex100\expndtw0 \ql\fs24\cf1\f0 lateral yang menampakkan sendi atlas-axis dan tujuh ruas tulang leher. \par\pard\pvpg\phpg\posx1800\posy12732\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Perhatian :\b0\i0 \par\pard\pvpg\phpg\posx1800\posy12996\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy13024\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Jangan memindahkan / membawa pasien dengan dugaan trauma tulang leher\b0\i0 \par\pard\pvpg\phpg\posx2160\posy13303\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i pada posisi duduk atau tengkurap\b0\i0 \par\pard\pvpg\phpg\posx1800\posy13568\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy13596\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Pastikan dulu pasien dalam kondisi stabil

sebelum transportasi\b0\i0 . {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1836 \shpright10224 \shpbottom1836 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop12554 \shpright10514 \shpbottom13997 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 20 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Evaluasi fungsi neurologis\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Untuk evaluasi berat dan luasnya cedera, jika pasien sadar tanyakan dengan jelas apa \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw-1 \ql\fs24\cf1\f0 yang dirasakan dan minta pasien untuk melakukan gerakan agar dapat dievaluasi fungsi \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 motorik dari ekstremitas atas dan bawah. \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Respons motorik\b0 \par\pard\pvpg\phpg\posx1800\posy3752\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3780\charscalex100\expndtw0 \ql\fs24\cf1\f0 Diafragma berfungsi normal \par\pard\pvpg\phpg\posx6844\posy3780\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C3, C4, C5 \par\pard\pvpg\phpg\posx1800\posy4049\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4077\charscalex100\expndtw0 \ql\fs24\cf1\f0 Mengangkat bahu \par\pard\pvpg\phpg\posx6842\posy4077\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 C4 \par\pard\pvpg\phpg\posx1800\posy4347\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4375\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fleksi siku (biceps) \par\pard\pvpg\phpg\posx6841\posy4375\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C5 \par\pard\pvpg\phpg\posx1800\posy4644\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4672\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Ekstensi pergelangan tangan \par\pard\pvpg\phpg\posx6841\posy4672\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C6 \par\pard\pvpg\phpg\posx1800\posy4942\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4970\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ekstensi siku \par\pard\pvpg\phpg\posx6840\posy4970\charscalex100\expndtw0 \ql\fs24\cf1\f0 C7 \par\pard\pvpg\phpg\posx1800\posy5240\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5268\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Fleksi pergelangan tangan \par\pard\pvpg\phpg\posx6841\posy5268\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C7 \par\pard\pvpg\phpg\posx1800\posy5537\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5565\charscalex100\expndtw0 \ql\fs24\cf1\f0 Abduksi jari tangan \par\pard\pvpg\phpg\posx6842\posy5565\charscalex100\expndtw0 \ql\fs24\cf1\f0 C8 \par\pard\pvpg\phpg\posx1800\posy5835\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5863\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Membusungkan dada \par\pard\pvpg\phpg\posx6840\posy5863\charscalex100\expndtw-1 \ql\fs24\cf1\f0 T1-T12 \par\pard\pvpg\phpg\posx1800\posy6132\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy6160\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fleksi panggul \par\pard\pvpg\phpg\posx6841\posy6160\charscalex100\expndtw0 \ql\fs24\cf1\f0 L2 \par\pard\pvpg\phpg\posx1800\posy6430\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6458\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ekstensi lutut \par\pard\pvpg\phpg\posx6840\posy6458\charscalex100\expndtw0 \ql\fs24\cf1\f0 L3-L4 \par\pard\pvpg\phpg\posx1800\posy6728\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6756\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fleksi dorsal pergelangan kaki \par\pard\pvpg\phpg\posx6842\posy6756\charscalex100\expndtw0 \ql\fs24\cf1\f0 L5-S 1 \par\pard\pvpg\phpg\posx1800\posy7025\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7053\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Fleksi plantar pergelangan kaki \par\pard\pvpg\phpg\posx6842\posy7053\charscalex100\expndtw-1 \ql\fs24\cf1\f0 S1-S2 \par\pard\pvpg\phpg\posx1800\posy7903\charscalex100\expndtw0 \ql\fs24\cf1\f0 Respons sensorik \par\pard\pvpg\phpg\posx1800\posy8456\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8484\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Paha anterior \par\pard\pvpg\phpg\posx6841\posy8484\charscalex100\expndtw-1 \ql\fs24\cf1\f0 L2 \par\pard\pvpg\phpg\posx1800\posy8753\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8781\charscalex100\expndtw0 \ql\fs24\cf1\f0 Lutut anterior \par\pard\pvpg\phpg\posx6840\posy8781\charscalex100\expndtw0 \ql\fs24\cf1\f0 L3 \par\pard\pvpg\phpg\posx1800\posy9051\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9079\charscalex100\expndtw0 \ql\

fs24\cf1\f0 Pergelangan kaki anterolateral \par\pard\pvpg\phpg\posx6841\posy9079\charscalex100\expndtw0 \ql\fs24\cf1\f0 L4 \par\pard\pvpg\phpg\posx1800\posy9348\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9376\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jempol kaki dan jari kedua dorsal \par\pard\pvpg\phpg\posx6122\posy9376\charscalex100\expndtw0 \ql\fs24\cf1\f0 L5 \par\pard\pvpg\phpg\posx1800\posy9646\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9674\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kaki lateral \par\pard\pvpg\phpg\posx6840\posy9674\charscalex100\expndtw0 \ql\fs24\cf1\f0 S1 \par\pard\pvpg\phpg\posx1800\posy9944\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9972\charscalex100\expndtw0 \ql\fs24\cf1\f0 Betis posterior \par\pard\pvpg\phpg\posx6841\posy9972\charscalex100\expndtw0 \ql\fs24\cf1\f0 S2 \par\pard\pvpg\phpg\posx1800\posy10241\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10269\charscalex100\expndtw0 \ql\fs24\cf1\f0 Perineum \par\pard\pvpg\phpg\posx6841\posy10269\charscalex100\expndtw0 \ql\fs24\cf1\f0 S2-S5 \par\pard\pvpg\phpg\posx1800\posy10836\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika fungsi motor dan sensor menunjukkan cedera total dari medula spinalis maka \par\pard\pvpg\phpg\posx1800\posy11119\charscalex100\expndtw0 \ql\fs24\cf1\f0 kemungkinan sembuh sangat kecil. \par\pard\pvpg\phpg\posx1973\posy12252\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Hilangnya fungsi otonomik pada cedera medula spinalis terjadi dengan cepat tetapi\b0\i0 \par\pard\pvpg\phpg\posx4337\posy12530\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i kembalinya sembuh sangat pelahan\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \

shptop12151 \shpright10370 \shpbottom13020 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 21 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRAUMA EKSTREMITAS (ANGGOTA GERAK)\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pemeriksaan harus meliputi : \par\pard\pvpg\phpg\posx1800\posy2619\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2647\charscalex100\expndtw-1 \ql\fs24\cf1\f0 warna dan suhu kulit \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2944\charscalex100\expndtw-1 \ql\fs24\cf1\f0 perabaan nadi distal \par\pard\pvpg\phpg\posx1800\posy3214\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3242\charscalex100\expndtw-1 \ql\fs24\cf1\f0 tempat-tempat yang berdarah \par\pard\pvpg\phpg\posx1800\posy3512\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3540\charscalex100\expndtw0 \ql\fs24\cf1\f0 deformitas ekstremitas \par\pard\pvpg\phpg\posx1800\posy3809\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3837\charscalex100\expndtw-1 \ql\fs24\cf1\f0 gerakan ekstremitas secara aktif dan pasif \par\pard\pvpg\phpg\posx1800\posy4107\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4135\charscalex100\expndtw0 \ql\fs24\cf1\f0 gerakan ekstremitas yang tak wajar dan adanya krepitasi \par\pard\pvpg\phpg\posx1800\posy4404\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy4432\charscalex100\expndtw-1 \ql\fs24\cf1\f0 derajat nyeri bagian yang cedera \par\pard\pvpg\phpg\posx1800\posy4999\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pengelolaan cedera ekstremitas harus ditujukan pada : \par\pard\pvpg\phpg\posx1800\posy5552\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5580\charscalex100\expndtw-1 \ql\fs24\cf1\f0 memelihara aliran darah ke jaringan perifer \par\pard\pvpg\phpg\posx1800\posy5849\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5877\charscalex100\expndtw0 \ql\fs24\cf1\f0 mencegah infeksi dan nekrosis kulit \par\pard\pvpg\phpg\posx1800\posy6147\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6175\charscalex100\expndtw-1 \ql\fs24\cf1\f0 mencegah kerusakan pada syaraf perifer \par\pard\pvpg\phpg\posx1800\posy6749\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Masalah-masalah khusus\b0 \par\pard\pvpg\phpg\posx1800\posy7342\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7370\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hentikan perdarahan aktif dengan cara menekan langsung pada bagian yang berdarah. \par\pard\pvpg\phpg\posx2160\posy7653\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pemakaian torniket lebih merugikan karena jika terlupa untuk melonggarkan akan \par\pard\pvpg\phpg\posx2160\posy7936\charscalex100\expndtw-1 \ql\fs24\cf1\f0 mengakibatkan ischemia yang merusak jaringan. \par\pard\pvpg\phpg\posx1800\posy8206\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8234\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fraktur terbuka. Setiap luka yang berada dekat fraktur harus dianggap sebagai \par\pard\pvpg\phpg\posx2160\posy8517\charscalex100\expndtw0 \ql\fs24\cf1\f0 luka-luka yang saling berhubungan. Prinsip pengobatan meliputi : \par\pard\pvpg\phpg\posx2520\posy8800\charscalex100\expndtw-1 \ql\fs24\cf1\f0 - m

\par\pard\pvpg\phpg\posx2847\posy8800\charscalex100\expndtw-1 \ql\fs24\cf1\f0 enghentikan perdarahan eksternal \par\pard\pvpg\phpg\posx2520\posy9084\charscalex100\expndtw0 \ql\fs24\cf1\f0 - \par\pard\pvpg\phpg\posx2659\posy9084\charscalex100\expndtw0 \ql\fs24\cf1\f0 immobilisasi dan mengatasi nyeri \par\pard\pvpg\phpg\posx1800\posy9353\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9381\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Sindroma kompartemen disebabkan oleh kenaikan tekanan internal pada \par\pard\pvpg\phpg\posx2160\posy9664\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kompartemen fascia. Tekanan ini mendesak / menekan pembuluh darah dan syaraf \par\pard\pvpg\phpg\posx2160\posy9948\charscalex100\expndtw0 \ql\fs24\cf1\f0 tepi. Perfusi menjadi kurang, serat syaraf rusak dan akhirnya terjadi iskemia atau \par\pard\pvpg\phpg\posx2160\posy10231\charscalex100\expndtw-1 \ql\fs24\cf1\f0 bahkan nekrosis otot. \par\pard\pvpg\phpg\posx1800\posy10500\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10528\charscalex100\expndtw0 \ql\fs24\cf1\f0 Bagian ekstremitas yang teramputasi harus ditutup kasa steril yang dibasahi \par\pard\pvpg\phpg\posx2160\posy10812\charscalex100\expndtw0 \ql\fs24\cf1\f0 NaCl 0,9% kemudian dibungkus dengan kantong plastik steril. Potongan ekstremitas \par\pard\pvpg\phpg\posx2160\posy11095\charscalex100\expndtw0 \ql\fs24\cf1\f0 ini dapat dipertahankan sampai 6 jam tanpa pendinginan, sedang jika didinginkan \par\pard\pvpg\phpg\posx2160\posy11378\charscalex100\expndtw-1 \ql\fs24\cf1\f0 dapat bertahan sampai 18 20 jam. \par\pard\pvpg\phpg\posx1819\posy12228\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Benda asing yang menembus tubuh sampai dalam, harus dibiarkan tetap ditempatnya\b0\i0 \par\pard\pvpg\phpg\posx3746\posy12506\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i sampai dilakukan eksplorasi di kamar bedah\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1836 \shpright10224 \shpbottom1836

{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop12082 \shpright10514 \shpbottom12950 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 22 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Terapi Pendukung untuk cedera ekstremitas : Fasciotomi dini\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Akibat dari sindroma kompartemen sering diabaikan: \par\pard\pvpg\phpg\posx1800\posy2619\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2647\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kerusakan jaringan akibat hipoksemia: Sindroma kompartemen dengan \par\pard\pvpg\phpg\posx2160\posy2930\charscalex100\expndtw0 \ql\fs24\cf1\f0 peningkatan tekanan intramuskuler (IM) dan kolaps aliran darah lokal sering \par\pard\pvpg\phpg\posx2160\posy3213\charscalex100\expndtw-1 \ql\fs24\cf1\f0 terjadi pada cedera dengan hematoma otot, cedera remuk (crushed), fraktur atau \par\pard\pvpg\phpg\posx2160\posy3496\charscalex100\expndtw0 \ql\fs24\cf1\f0 amputasi. Bila tekanan perfusi (tekanan darah sistolik) rendah, sedikit saja \par\pard\pvpg\phpg\posx2160\posy3780\charscalex100\expndtw0 \ql\fs24\cf1\f0 kenaikan tekanan IM dapat menyebabkan hipoperfusilokal. Pada pasien \par\pard\pvpg\phpg\posx2160\posy4063\charscalex100\expndtw0 \ql\fs24\cf1\f0 normotermik, shunting aliran darah mulai terjadi padatekanan sistolik sekitar 80 \par\pard\pvpg\phpg\posx2160\posy4346\charscalex100\expndtw0 \ql\

fs24\cf1\f0 mmHg. Sedang pada pasien hipotermik shunting terjadi pada tekanan darah lebih \par\pard\pvpg\phpg\posx2160\posy4629\charscalex100\expndtw0 \ql\fs24\cf1\f0 tinggi. \par\pard\pvpg\phpg\posx1800\posy4899\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4927\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kerusakan akibat reperfusi adalah lebih buruk : Jika hipoksemia lokal (tekanan IM \par\pard\pvpg\phpg\posx2160\posy5210\charscalex100\expndtw-1 \ql\fs24\cf1\f0 tinggi, tekanan darah rendah) berlangsung lebihdari 2 jam, reperfusi dapat \par\pard\pvpg\phpg\posx2160\posy5493\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menyebabkan kerusakan pembuluh darah yang ekstensif. Pada kasus-kasus \par\pard\pvpg\phpg\posx2160\posy5776\charscalex100\expndtw0 \ql\fs24\cf1\f0 ekstremitas dengan syok berkepanjangan, kerusakan akibat reperfusi sering lebih \par\pard\pvpg\phpg\posx2160\posy6060\charscalex100\expndtw-1 \ql\fs24\cf1\f0 buruk dibanding cedera primernya. Karena itu dekompresi harus dikerjakan lebih \par\pard\pvpg\phpg\posx2160\posy6343\charscalex100\expndtw-1 \ql\fs24\cf1\f0 awal, terutama kompartemen di lengan atas dan tungkai bagian bawah. \par\pard\pvpg\phpg\posx1800\posy6914\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika sumber perdarahan dapat dikuasai, kami menganjurkan \b fasciotomi untuk\b0 \par\pard\pvpg\phpg\posx1800\posy7202\charscalex100\expndtw0 \ql\fs24\cf1\f0\b kompartemen lengan atas dan tungkai bawah \b0 dikerjakan di lokasi kejadian jika \par\pard\pvpg\phpg\posx1800\posy7485\charscalex100\expndtw-1 \ql\fs24\cf1\f0 waktu untuk evakuasi mencapai 4 jam atau lebih.\par\pard\pvpg\phpg\posx1800\posy7768\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fasciotomi harus dapat dikerjakan oleh setiap dokter atau perawat terlatih dengan \par\pard\pvpg\phpg\posx1800\posy8052\charscalex100\expndtw-1 \ql\fs24\cf1\f0 anestesia ketamine. \par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 23 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b KASUS TRAUMA KHUSUS\b0 \par\pard\pvpg\phpg\posx1800\posy2074\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b Pasien Anak :\b0 \par\pard\pvpg\phpg\posx1800\posy2728\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma merupakan penyebab utama kematian pada anak-anak, terutama anak laki. Angka \par\pard\pvpg\phpg\posx1800\posy3012\charscalex100\expndtw0 \ql\fs24\cf1\f0 survival trauma berat sangat dipengaruhi oleh kualitas pertolongan pra rumah sakit dan \par\pard\pvpg\phpg\posx1800\posy3295\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kecepatan resusitasi. \par\pard\pvpg\phpg\posx1800\posy3861\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penilaian awal (Initial Assessment) pada pasien trauma anak sama seperti trauma dewasa. \par\pard\pvpg\phpg\posx1800\posy4144\charscalex100\expndtw0 \ql\fs24\cf1\f0 Prioritas utama adalah : Airway, Breathing, Circulation , Disability neurologis dan \par\pard\pvpg\phpg\posx1800\posy4428\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Exposure (pemeriksaan lengkap dari ujung kepala sampai ujung kaki). \par\pard\pvpg\phpg\posx1800\posy4711\charscalex100\expndtw0 \ql\fs24\cf1\f0 Selama pemeriksaan harus diwaspadai bahaya hipotermi. \par\pard\pvpg\phpg\posx1800\posy5282\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Masalah khusus pada resusitasi dan intubasi anak :\b0 \par\pard\pvpg\phpg\posx1800\posy5547\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5575\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Ukuran kepala, lubang hidung dan lidah yang relatif besar. \par\pard\pvpg\phpg\posx1800\posy5844\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5872\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Bayi kecil cenderung bernafas melalui hidung ( nose breather)

\par\pard\pvpg\phpg\posx1800\posy6142\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6170\charscalex100\expndtw0 \ql\fs24\cf1\f0 Sudut rahang bawah lebih besar, letak larynx lebih tinggi serta epiglottis yang lebih \par\pard\pvpg\phpg\posx2160\posy6453\charscalex100\expndtw-1 \ql\fs24\cf1\f0 besar dan berbentuk U. \par\pard\pvpg\phpg\posx1800\posy6723\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6751\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cricoid adalah bagian tersempit dari larynx yang menentukan ukuran ETT. Pada \par\pard\pvpg\phpg\posx2160\posy7034\charscalex100\expndtw-1 \ql\fs24\cf1\f0 orang dewasa, bagian tersempit adalah pita suara. \par\pard\pvpg\phpg\posx1800\posy7304\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7332\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Panjang trakea bayi aterm adalah 4 cm dan diameterETT yang sesuai adalah 2,5 - 3 \par\pard\pvpg\phpg\posx2160\posy7615\charscalex100\expndtw-1 \ql\fs24\cf1\f0 mm (panjang trakea dewasa sekitar 12 cm). \par\pard\pvpg\phpg\posx1800\posy7884\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7912\charscalex100\expndtw0 \ql\fs24\cf1\f0 Distensi lambung sering terjadi setelah resusitasi dan perlu dekompresi dengan \par\pard\pvpg\phpg\posx2160\posy8196\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pemasangan NGT (Naso-Gastric Tube). \par\pard\pvpg\phpg\posx1800\posy8762\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pada anak usia kurang dari 10 tahun, jangan menggunakan ETT dengan cuff (balon) \par\pard\pvpg\phpg\posx1800\posy9045\charscalex100\expndtw0 \ql\fs24\cf1\f0 untuk menghindari pembengkakan subglottis dan ulserasi. Pada bayi dan anak, intubasi \par\pard\pvpg\phpg\posx1800\posy9328\charscalex100\expndtw0 \ql\fs24\cf1\f0 oral lebih mudah dibandingkan intubasi nasal . \par\pard\pvpg\phpg\posx1800\posy9900\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Syok pada anak :\b0 \par\pard\pvpg\phpg\posx1800\posy10178\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 Perabaan denyut nadi anak mudah dilakukan pada daerah pelipatan paha (groin) untuk \par\pard\pvpg\phpg\posx1800\posy10461\charscalex100\expndtw0 \ql\fs24\cf1\f0 arteria femoralis dan pada daerah fossa antecubitiuntuk arteria brachialis. Jika denyut \par\pard\pvpg\phpg\posx1800\posy10744\charscalex100\expndtw0 \ql\fs24\cf1\f0 nadi tidak teraba maka resusitasi harus segera dimulai. \par\pard\pvpg\phpg\posx1800\posy11311\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tanda-tanda syok pada anak : \par\pard\pvpg\phpg\posx1800\posy11580\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11608\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Takhikardiaa. \par\pard\pvpg\phpg\posx1800\posy11878\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11906\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Denyut nadi perifer lemah atau tidak teraba. \par\pard\pvpg\phpg\posx1800\posy12176\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12204\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pengisian kapiler (capillary refill ) > 2 detik \par\pard\pvpg\phpg\posx3091\posy13336\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Prinsip pengelolaan pasien anak sama dengan orang dewasa\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1836 \shpright10224 \shpbottom1836{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop13226 \shpright10082 \shpbottom13807 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx1800\posy1438\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy1466\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Takhipnea. \par\pard\pvpg\phpg\posx1800\posy1736\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy1764\charscalex100\expndtw0 \ql\fs24\cf1\f0 Gelisah \par\pard\pvpg\phpg\posx1800\posy2033\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2061\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kesadaran menurun \par\pard\pvpg\phpg\posx1800\posy2331\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2359\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Produksi urine berkurang. \par\pard\pvpg\phpg\posx1800\posy2925\charscalex100\expndtw0 \ql\fs24\cf1\f0 Hipotensi sering merupakan tanda klinis yang terlambat, ketika syok sudah berat. \par\pard\pvpg\phpg\posx1800\posy3496\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Akses vaskuler \b0 dilakukan dengan kateter I.V.ukuran besar di dua vena yang terpisah \par\pard\pvpg\phpg\posx1800\posy3780\charscalex100\expndtw-1 \ql\fs24\cf1\f0 (v. saphena longus dan v. femoralis). Gunakan venaperifer lebih dahulu, hindari vena \par\pard\pvpg\phpg\posx1800\posy4063\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sentral \par\pard\pvpg\phpg\posx1800\posy4634\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Akses intraoseus \b0 adalah aman dan cukup efektif.Bila tidak tersedia jarum khusus \par\pard\pvpg\phpg\posx1800\posy4917\charscalex100\expndtw0 \ql\fs24\cf1\f0 intraoseus, dapat digunakan jarum spinal ukuran besar. Tempat pemasangan adalah \par\pard\pvpg\phpg\posx1800\posy5200\charscalex100\expndtw0 \ql\fs24\cf1\f0 daerah antero medial tibia dibawah tuberositas tibia.Hindari menusuk daerah epiphyseal \par\pard\pvpg\phpg\posx1800\posy5484\charscalex100\expndtw0 \ql\fs24\cf1\f0 growth plate. \par\pard\pvpg\phpg\posx1800\posy6055\charscalex100\expndtw-1 \

ql\fs24\cf1\f0\b Pemberian cairan \b0 ditujukan agar diuresis mencapai 1-2 ml/kg BB pada bayi dan 0,5 1 \par\pard\pvpg\phpg\posx1800\posy6338\charscalex100\expndtw0 \ql\fs24\cf1\f0 ml/kg BB pada anak/ remaja. \par\pard\pvpg\phpg\posx1800\posy6621\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dimulai dengan bolus NaCl 0,9% 20 ml/kg BB..Bila tidak ada respons, berikan bolus \par\pard\pvpg\phpg\posx1800\posy6904\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kedua dengan jumlah yang sama. Bila tetap tidak ada respons, berikan darah dari \par\pard\pvpg\phpg\posx1800\posy7188\charscalex100\expndtw0 \ql\fs24\cf1\f0 golongan yang sama atau PRC golongan O sebanyak 10 ml/kg BB.(sebaiknya Rh (-)) \par\pard\pvpg\phpg\posx1800\posy7759\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Hipothermi \b0 adalah masalah yang besar bagi anak.Kehilangan panas melalui daerah \par\pard\pvpg\phpg\posx1800\posy8042\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kepala cukup besar jumlahnya. Luas permukaan tubuhyang relatif lebih besar, \par\pard\pvpg\phpg\posx1800\posy8325\charscalex100\expndtw0 \ql\fs24\cf1\f0 meningkatkan risiko hipotermi. Segera setelah memeriksa sekujur tubuh pasien \par\pard\pvpg\phpg\posx1800\posy8608\charscalex100\expndtw0 \ql\fs24\cf1\f0 pasangkan selimut kembali. Infusi cairan harus dihangatkan. \par\pard\pvpg\phpg\posx3137\posy13140\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Anak harus dijaga tetap hangat dan dekat dengan keluarga.\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop12910 \shpright10370 \shpbottom13634 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 25 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\

fs24\cf1\f0\fs28\b Kehamilan\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Prioritas ABCDE bagi pasien hamil yang mengalami trauma adalah sama dengan pasien \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw0 \ql\fs24\cf1\f0 yang tidak hamil. \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ada beberapa perubahan anatomi dan fisiologi pada kehamilan yang sangat besar \par\pard\pvpg\phpg\posx1800\posy3199\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pengaruhnya pada pengelolaan trauma \par\pard\pvpg\phpg\posx1800\posy3770\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Perubahan anatomi\b0 \par\pard\pvpg\phpg\posx1800\posy4035\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4063\charscalex100\expndtw0 \ql\fs24\cf1\f0 Uterus yang membesar mudah mengalami kerusakan akibatbenturan dan tusukan \par\pard\pvpg\phpg\posx2160\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy4360\charscalex100\expndtw0 \ql\fs24\cf1\f0 pada kehamilan 12 minggu fundus uteri berada setinggisymphisis pubis \par\pard\pvpg\phpg\posx2160\posy4630\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy4658\charscalex100\expndtw0 \ql\fs24\cf1\f0 pada kehamilan 20 minggu fundus uteri berada setinggiumbilicus \par\pard\pvpg\phpg\posx2160\posy4928\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy4956\charscalex100\expndtw0 \ql\fs24\cf1\f0 pada kehamilan 36 minggu fundus uteri berada setinggixiphoid \par\pard\pvpg\phpg\posx1800\posy5225\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5253\charscalex100\expndtw0 \ql\fs24\cf1\f0 Janin dilindungi oleh ketebalan dinding uterus dan cairan amnion (air ketuban) \par\pard\pvpg\phpg\posx1800\posy5824\charscalex100\expndtw0 \ql\

fs24\cf1\f0\b Perubahan fisiologi\b0 \par\pard\pvpg\phpg\posx1800\posy6089\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6117\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kenaikan tidal volume dan respiratory alkalosis \par\pard\pvpg\phpg\posx1800\posy6387\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6415\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kenaikan denyut jantung \par\pard\pvpg\phpg\posx1800\posy6684\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6712\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kenaikan cardiac output 30% \par\pard\pvpg\phpg\posx1800\posy6982\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7010\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Penurunan tekanan darah 15% \par\pard\pvpg\phpg\posx1800\posy7280\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7308\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pada trimester ke III sering terjadi hipotensi pada waktu berbaring terlentang karena \par\pard\pvpg\phpg\posx2160\posy7591\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kompresi (penekanan) aortocaval. \par\pard\pvpg\phpg\posx1800\posy8162\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Catatan khusus\b0 \par\pard\pvpg\phpg\posx1800\posy8427\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8455\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Trauma tumpul akan berakibat: \par\pard\pvpg\phpg\posx2160\posy8724\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy8752\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kontraksi otot rahim dan terjadinya kelahiran prematur \par\pard\pvpg\phpg\posx2160\posy9022\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy9050\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ruptura uteri partial atau total

\par\pard\pvpg\phpg\posx2160\posy9320\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy9348\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Lepasnya placenta sebagian atau total (dapat terjadi sampai dengan 48jam) \par\pard\pvpg\phpg\posx2160\posy9617\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2520\posy9645\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jika ada fraktur pelvis perdarahannya akan sangat banyak \par\pard\pvpg\phpg\posx1800\posy10216\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Prioritas pengelolaannya\b0 \par\pard\pvpg\phpg\posx1800\posy10481\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10509\charscalex100\expndtw0 \ql\fs24\cf1\f0 Evaluasi ABCDE dari ibu \par\pard\pvpg\phpg\posx1800\posy10779\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10807\charscalex100\expndtw0 \ql\fs24\cf1\f0 Resusitasi ibu dengan posisi berbaring miring ke kiri (sisi kanan berada diatas) untuk \par\pard\pvpg\phpg\posx2160\posy11090\charscalex100\expndtw0 \ql\fs24\cf1\f0 menghindari kompresi aortocaval \par\pard\pvpg\phpg\posx1800\posy11360\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11388\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Cari sumber perdarahan vagina dengan pemeriksaan spekulum dan dilatasi cervix \par\pard\pvpg\phpg\posx1800\posy11657\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11685\charscalex100\expndtw0 \ql\fs24\cf1\f0 Periksa tinggi fundus uteri, apakah ada nyeri tekan dan pantau detak jantung janin \par\pard\pvpg\phpg\posx1800\posy12256\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Resusitasi \b0 pada ibu berarti menyelamatkan bayinya. Pada saat jiwa ibu dalam bahaya, \par\pard\pvpg\phpg\posx1800\posy12540\charscalex100\expndtw0 \ql\fs24\cf1\f0 janin dapat dikorbankan untuk menyelamatkan ibu. \par\pard\pvpg\phpg\posx2222\posy13672\charscalex100\expndtw0 \

ql\fs24\cf1\f0\b\i Resusitasi pasien hamil yang mengalami trauma harus menghindari kompresi\b0\i0 \par\pard\pvpg\phpg\posx3089\posy13951\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i aortocaval. Gunakan posisi left lateral tilt (sisi kanan diatas)\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop13507 \shpright10514 \shpbottom14374 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 26 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs28\b Luka bakar\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pasien luka bakar dikelola dengan urutan prioritas seperti pasien trauma lainnya. \par\pard\pvpg\phpg\posx1800\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Penilaian meliputi :\b0 \par\pard\pvpg\phpg\posx1800\posy2637\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Airway, Breathing (waspada terhisapnya gas panas / asap dan kerusakan jalan\b0 \par\pard\pvpg\phpg\posx1800\posy2920\charscalex100\expndtw0 \ql\fs24\cf1\f0\b nafas), Circulation (penggantian cairan), Disability (compartement syndrome),\b0 \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Exposure (persen luas luka bakar)\b0 \par\pard\pvpg\phpg\posx1800\posy3765\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Penyebab luka bakar perlu diketahui seperti api, air panas, parafin, minyak dsb.Luka \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw-1 \ql\fs24\cf1\f0 bakar akibat listrik sering lebih parah daripada penampakannya semula. Ingat bahwa \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f0 kerusakan kulit dan otot dapat menyebabkan gagal ginjal.

\par\pard\pvpg\phpg\posx1800\posy4903\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pengelolaan :\b0 \par\pard\pvpg\phpg\posx1800\posy5168\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5196\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hentikan proses kebakaran / pemanasan \par\pard\pvpg\phpg\posx1800\posy5465\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5493\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ABCDE dan tentukan luas luka bakar (rule of 9) \par\pard\pvpg\phpg\posx1800\posy5763\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5791\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasanglah jalur infus yang lancar pada vena besar untuk segera memberikan cairan. \par\pard\pvpg\phpg\posx1800\posy6362\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Hal-hal khusus pasien luka bakar\b0 \par\pard\pvpg\phpg\posx1800\posy6640\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hal-hal berikut adalah petunjuk adanya kemungkinancedera jalan nafas dan gangguan \par\pard\pvpg\phpg\posx1800\posy6924\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pernafasan : \par\pard\pvpg\phpg\posx1800\posy7193\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7221\charscalex100\expndtw0 \ql\fs24\cf1\f0 Luka bakar sekeliling mulut \par\pard\pvpg\phpg\posx1800\posy7491\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7519\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Luka bakar pada wajah atau adanya rambut / rambut hidung / alis yang terbakar \par\pard\pvpg\phpg\posx1800\posy7788\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7816\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara serak dan batuk \par\pard\pvpg\phpg\posx1800\posy8086\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8114\charscalex100\expndtw0 \ql\fs24\cf1\f0 Adanya edema glottis

\par\pard\pvpg\phpg\posx1800\posy8384\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8412\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Luka bakar yang dalam dan melingkar leher atau dada \par\pard\pvpg\phpg\posx1800\posy8978\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Intubasi naso tracheal atau endotracheal harus dilakukan terutama bila pasien \par\pard\pvpg\phpg\posx1800\posy9261\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menunjukkan tanda suara parau yang berat, kesulitan menelan ludah, nafas menjadi cepat \par\pard\pvpg\phpg\posx1800\posy9544\charscalex100\expndtw0 \ql\fs24\cf1\f0 setelah pasien mengalami inhalation injury (cedera inhalasi / asap) \par\pard\pvpg\phpg\posx1800\posy10111\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kebutuhan cairan elektrolit minimal 2 - 4 cc / kg BB / % luas luka bakar / 24 jam \par\pard\pvpg\phpg\posx1800\posy10394\charscalex100\expndtw0 \ql\fs24\cf1\f0 diperlukan untuk menjaga volume sirkulasi yang adekuat dan produksi urine cukup. \par\pard\pvpg\phpg\posx1800\posy10677\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Jumlah tersebut diatas diberikan dengan cara : \par\pard\pvpg\phpg\posx1800\posy10947\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy10975\charscalex100\expndtw-1 \ql\fs24\cf1\f0 50 % diberikan dalam 8 jam pertama pasca luka bakar \par\pard\pvpg\phpg\posx1800\posy11244\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy11272\charscalex100\expndtw0 \ql\fs24\cf1\f0 50 % sisanya diberikan dalam 24 jam agar tercapai urine 0.5 - 1.0 ml / kg / jam \par\pard\pvpg\phpg\posx1800\posy11839\charscalex100\expndtw0 \ql\fs24\cf1\f0 Berikan juga terapi berikut: \par\pard\pvpg\phpg\posx1800\posy12108\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12136\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Analgesia \par\pard\pvpg\phpg\posx1800\posy12406\charscalex100\expndtw0 \

ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12434\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kateter urine jika luas luaka bakar lebih dari 20 % \par\pard\pvpg\phpg\posx1800\posy12704\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy12732\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pipa nasogastrik \par\pard\pvpg\phpg\posx1800\posy13001\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy13029\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pencegahan tetanus. \par\pard\pvpg\phpg\posx2496\posy13596\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Manifestasi klinik cedera inhalasi mungkin belum muncul dalam 24 jam\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop13474 \shpright10226 \shpbottom14052 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 27 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs28\b TRANSPORTASI PASIEN KRITIS\b0 \par\pard\pvpg\phpg\posx1800\posy2066\charscalex100\expndtw0 \ql\fs24\cf1\f0 Transportasi pasien-pasien kritis ini berisiko tinggisehingga diperlukan komunikasi yang \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw0 \ql\fs24\cf1\f0 baik perencanaan dan tenaga-tenaga kesehatan yang sesuai. Pasien harus distabilisasi \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 lebih dulu sebelum diberangkatkan. Prinsipnya pasien hanya ditransportasi untuk \par\pard\pvpg\phpg\posx1800\posy2916\charscalex100\expndtw-1 \ql\fs24\cf1\f0 mendapat fasilitas yang lebih baik dan lebih tingggi di tempat tujuan.

\par\pard\pvpg\phpg\posx1800\posy3487\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Perencanaan dan persiapan meliputi :\b0 \par\pard\pvpg\phpg\posx1800\posy3752\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3780\charscalex100\expndtw0 \ql\fs24\cf1\f0 Menentukan jenis transportasi (mobil, perahu, pesawatterbang) \par\pard\pvpg\phpg\posx1800\posy4049\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4077\charscalex100\expndtw0 \ql\fs24\cf1\f0 Menentukan tenaga keshatan yang mendampingi pasien \par\pard\pvpg\phpg\posx1800\posy4347\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4375\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menentukan peralatan dan persediaan obat yang diperlukan selama perjalanan baik \par\pard\pvpg\phpg\posx2160\posy4658\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kebutuhan rutin maupun darurat \par\pard\pvpg\phpg\posx1800\posy4928\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4956\charscalex100\expndtw0 \ql\fs24\cf1\f0 Menentukan kemungkinan penyulit \par\pard\pvpg\phpg\posx1800\posy5225\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy5253\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menentukan pemantauan pasien selama transportasi \par\pard\pvpg\phpg\posx1800\posy5824\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Komunikasi yang efektif sangat penting untuk menghubungkan :\b0 \par\pard\pvpg\phpg\posx1800\posy6089\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6117\charscalex100\expndtw0 \ql\fs24\cf1\f0 Rumah sakit tujuan \par\pard\pvpg\phpg\posx1800\posy6387\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6415\charscalex100\expndtw0 \ql\fs24\cf1\f0 Penyelenggara transportasi \par\pard\pvpg\phpg\posx1800\posy6684\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy6712\charscalex100\expndtw0 \ql\fs24\cf1\f0 Petugas pendamping pasien \par\pard\pvpg\phpg\posx1800\posy6982\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7010\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Pasien dan keluarganya \par\pard\pvpg\phpg\posx1800\posy7581\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Untuk stabilisasi yang efektif diperlukan \b0 : \par\pard\pvpg\phpg\posx1800\posy7851\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7879\charscalex100\expndtw0 \ql\fs24\cf1\f0 Resusitasi yang cepat \par\pard\pvpg\phpg\posx1800\posy8148\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8176\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Menghentikan perdarahan dan menjaga sirkulasi \par\pard\pvpg\phpg\posx1800\posy8446\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8474\charscalex100\expndtw0 \ql\fs24\cf1\f0 Imobilisasi fraktur \par\pard\pvpg\phpg\posx1800\posy8744\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy8772\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Analgesia \par\pard\pvpg\phpg\posx1800\posy9343\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Ingat :\b0 \par\pard\pvpg\phpg\posx1800\posy9621\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika kondisi pasien memburuk lakukan evaluasi ulang dengan survey primer, berikan \par\pard\pvpg\phpg\posx1800\posy9904\charscalex100\expndtw0 \ql\fs24\cf1\f0 terapi yang adekuat untuk kondisi yang mengancam jiwadan nilailah kembali fungsi \par\pard\pvpg\phpg\posx1800\posy10188\charscalex100\expndtw0 \ql\fs24\cf1\f0 organ yang terganggu dengan lebih teliti. \par\pard\pvpg\phpg\posx2297\posy13586\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Be prepared : If anything can go wrong, it will, and at the worst possible time\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1877 \shpright10368 \shpbottom1877

{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2016 \shptop13454 \shpright10226 \shpbottom14035 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 28 \par\pard\pvpg\phpg\posx1800\posy1463\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs32\b Appendix 1 : Teknik Pengelolaan Jalan Nafas\b0\par\pard\pvpg\phpg\posx1800\posy2116\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Teknik Dasar\b0 \par\pard\pvpg\phpg\posx1800\posy2664\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2692\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Chin Lift dan Jaw Thrust\b0 \par\pard\pvpg\phpg\posx2160\posy2971\charscalex100\expndtw0 \ql\fs24\cf1\f0 Chin lift : Letakkan dua jari dibawah tulang dagu, kemudian hati-hati angkat keatas \par\pard\pvpg\phpg\posx2160\posy3254\charscalex100\expndtw-1 \ql\fs24\cf1\f0 hingga rahang bawah terangkat ke depan. Selama tindakan ini, perhatikan leher \par\pard\pvpg\phpg\posx2160\posy3537\charscalex100\expndtw-1 \ql\fs24\cf1\f0 jangan sampai menengadah berlebihan (hiper - ekstensi) \par\pard\pvpg\phpg\posx2160\posy3820\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jaw Thrust : doronglah sudut rahang bawah (angulus mandibulae) ke depan hingga \par\pard\pvpg\phpg\posx2160\posy4104\charscalex100\expndtw-1 \ql\fs24\cf1\f0 rahang bawah terdorong ke depan. Ingat bahwa keduatindakan tersebut diatas bukan \par\pard\pvpg\phpg\posx2160\posy4387\charscalex100\expndtw0 \ql\fs24\cf1\f0 jalan nafas definitif sehingga penyumbatan (obstruksi) ulang dapat terjadi.

\par\pard\pvpg\phpg\posx1800\posy4940\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4968\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pipa Orofarings\b0 \par\pard\pvpg\phpg\posx2160\posy5246\charscalex100\expndtw0 \ql\fs24\cf1\f0 Alat ini dimasukkan mulut agar ujungnya berada dibelakang lidah. Pertama alat \par\pard\pvpg\phpg\posx2160\posy5529\charscalex100\expndtw0 \ql\fs24\cf1\f0 dimasukkan dengan lengkungan menghadap ke langit-langit. Setelah masuk separuh \par\pard\pvpg\phpg\posx2160\posy5812\charscalex100\expndtw-1 \ql\fs24\cf1\f0 panjangnya, alat diputar 180 derajad hingga lengkungannya sekarang berada \par\pard\pvpg\phpg\posx2160\posy6096\charscalex100\expndtw0 \ql\fs24\cf1\f0 menempel lengkungan lidah. Tujuan : lidah tertahan tidak jatuh ke belakang \par\pard\pvpg\phpg\posx2160\posy6379\charscalex100\expndtw0 \ql\fs24\cf1\f0 menutupi hipofarings. \par\pard\pvpg\phpg\posx2160\posy6662\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Alat ini dapat merangsang muntah pada pasien yang sadar / setengah sadar. \par\pard\pvpg\phpg\posx2160\posy6945\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Hati-hati memasang alat ini pada anak karena dapatmelukai jaringan lunak. \par\pard\pvpg\phpg\posx1800\posy7498\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7526\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pipa Nasofarings\b0 \par\pard\pvpg\phpg\posx2160\posy7804\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pipa ini dipasang melalui lubang hidung (harus diberipelicin). Dorong hati-hati \par\pard\pvpg\phpg\posx2160\posy8088\charscalex100\expndtw0 \ql\fs24\cf1\f0 hingga ujung pipa terletak di orofarings. Alat ini lebih dapat diterima oleh pasien \par\pard\pvpg\phpg\posx2160\posy8371\charscalex100\expndtw-1 \ql\fs24\cf1\f0 daripada pipa orofarings. (Hati-hati memasang alatini jika ada fraktura basis cranii \par\pard\pvpg\phpg\posx2160\posy8654\charscalex100\expndtw-1 \ql\fs24\cf1\f0 sebab bisa salah arah masuk dasar tengkorak).

\par\pard\pvpg\phpg\posx1800\posy9225\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Tehnik Lanjutan\b0 \par\pard\pvpg\phpg\posx1800\posy9773\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy9801\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Intubasi orotrakhea\b0 \par\pard\pvpg\phpg\posx2160\posy10080\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Prosedur ini dapat mengakibatkan hiperekstensi leher. Pada pasien cedera tulang leher \par\pard\pvpg\phpg\posx2160\posy10363\charscalex100\expndtw-1 \ql\fs24\cf1\f0 diperlukan seorang untuk membantu memegangi kepalaagar leher dapat di \par\pard\pvpg\phpg\posx2160\posy10646\charscalex100\expndtw0 \ql\fs24\cf1\f0 pertahankan lurus (imobilisasi pada posisi in-line). \par\pard\pvpg\phpg\posx2160\posy10929\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Penekanan krikoid (cara Sellick) diperlukan pada kasus yang diduga lambungnya \par\pard\pvpg\phpg\posx2160\posy11212\charscalex100\expndtw0 \ql\fs24\cf1\f0 penuh. Segera setelah pipa masuk, cuff / balon harus segera ditiup. Kemudian segera \par\pard\pvpg\phpg\posx2160\posy11496\charscalex100\expndtw-1 \ql\fs24\cf1\f0 periksa apakah ujung pipa trakhea sudah tepat (diatas carina) dengan mendengarkan \par\pard\pvpg\phpg\posx2160\posy11779\charscalex100\expndtw-1 \ql\fs24\cf1\f0 adanya suara nafas yang simetris pada kedua sisi paru. \par\pard\pvpg\phpg\posx4226\posy12628\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i Ingat : pasien trauma muka dan leher\b0\i0 \par\pard\pvpg\phpg\posx4169\posy12907\charscalex100\expndtw0 \ql\fs24\cf1\f0\b\i sangat mudah mengalami sumbatan jalan nafas\b0\i0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2088 \shptop12499 \shpright11306 \shpbottom13370 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1800 \shptop1877 \shpright11160 \shpbottom1879 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn

lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 29 \par\pard\pvpg\phpg\posx1800\posy1456\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Intubasi Trakhea juga harus dilakukan agar :\b0 \par\pard\pvpg\phpg\posx1800\posy2004\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2032\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jalan nafas terjamin bebas dan terlindung dari aspirasi. \par\pard\pvpg\phpg\posx1800\posy2302\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2330\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Dapat diberikan oksigen kadar tinggi (tidak tercapai dengan cara masker / sungkup). \par\pard\pvpg\phpg\posx1800\posy2600\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy2628\charscalex100\expndtw0 \ql\fs24\cf1\f0 Ventilasi lebih baik dan mencegah hiperkarbia. \par\pard\pvpg\phpg\posx1800\posy3194\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jika usaha intubasi tidak berhasil setelah 30 detik, pasien harus diberi ventilasi oksigen \par\pard\pvpg\phpg\posx1800\posy3477\charscalex100\expndtw0 \ql\fs24\cf1\f0 (100%) dulu sebelum mencoba untuk intubasi lagi. \par\pard\pvpg\phpg\posx1800\posy4048\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Ingat : pasien meninggal karena hipoksia bukan karena tidak terpasangnya pipa\b0 \par\pard\pvpg\phpg\posx1800\posy4332\charscalex100\expndtw0 \ql\fs24\cf1\f0\b endotrakhea\b0 \par\pard\pvpg\phpg\posx1800\posy4880\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4908\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Krikotiroidotomi\b0 \par\pard\pvpg\phpg\posx1800\posy5469\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tindakan ini dilalukan jika pasien tidak dapat

diintubasi dan tidak dapat diberi ventilasi \par\pard\pvpg\phpg\posx1800\posy5752\charscalex100\expndtw0 \ql\fs24\cf1\f0 melalui mulut. Setelah membran krikotiroid dapat diraba, lakukan irisan pada kulit \par\pard\pvpg\phpg\posx1800\posy6036\charscalex100\expndtw0 \ql\fs24\cf1\f0 hingga menembus membran krikotiroid tersebut. Kemudian irisan dilebarkan dengan \par\pard\pvpg\phpg\posx1800\posy6319\charscalex100\expndtw-1 \ql\fs24\cf1\f0 forsep / klem arteria. \par\pard\pvpg\phpg\posx1800\posy6602\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Masukkan pipa endotrakeal kecil (4 - 6 mm) atau pipa trakheostomi kecil, lalu lakukan \par\pard\pvpg\phpg\posx1800\posy6885\charscalex100\expndtw-1 \ql\fs24\cf1\f0 fiksasi. \par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 30 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 2 : Nilai-nilai Fisiologis pada anak.\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2338 \shpright10469 \shpbottom2621 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Variabel\b0 \par\pard\pvpg\phpg\posx3960\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Neonatus\b0 \par\pard\pvpg\phpg\posx5400\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 6 Bulan\b0 \par\pard\pvpg\phpg\posx6839\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 12 Bulan\b0 \par\pard\pvpg\phpg\posx8279\posy2354\charscalex100\expndtw0 \ql\fs24\cf1\f0\b 5 Tahun Dewasa\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2621 \shpright10469 \shpbottom2856

{\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy2878\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Laju nafas RR/mnt \par\pard\pvpg\phpg\posx3960\posy2878\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx4061\posy2878\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4212\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx4371\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 10 \par\pard\pvpg\phpg\posx5400\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 30 \par\pard\pvpg\phpg\posx5652\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx5811\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx6840\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 24 \par\pard\pvpg\phpg\posx7092\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx7251\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx8280\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 23 \par\pard\pvpg\phpg\posx8532\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx8691\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx9720\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 12 \par\pard\pvpg\phpg\posx9972\posy2854\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx10131\posy2878\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx1800\posy3349\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Tidal Volume (ml) 21

\par\pard\pvpg\phpg\posx5400\posy3349\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 45 \par\pard\pvpg\phpg\posx6840\posy3349\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 78 \par\pard\pvpg\phpg\posx8279\posy3349\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 270 \par\pard\pvpg\phpg\posx9719\posy3349\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 575 \par\pard\pvpg\phpg\posx1800\posy3819\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Minute Vent (L/min) 1.05 \par\pard\pvpg\phpg\posx5400\posy3819\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1.35 \par\pard\pvpg\phpg\posx6840\posy3819\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1.78 \par\pard\pvpg\phpg\posx8279\posy3819\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5.5 \par\pard\pvpg\phpg\posx9719\posy3819\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6.4 \par\pard\pvpg\phpg\posx1800\posy4301\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Hematocrit \par\pard\pvpg\phpg\posx3960\posy4301\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 55 \par\pard\pvpg\phpg\posx4212\posy4277\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx4371\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 7 \par\pard\pvpg\phpg\posx5400\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 37 \par\pard\pvpg\phpg\posx5652\posy4277\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx5811\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx6840\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 35 \par\pard\pvpg\phpg\posx7092\posy4277\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx7251\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 2.5 \par\pard\pvpg\phpg\posx8280\posy4301\charscalex100\expndtw1 \ql\

fs24\cf1\f0\fs20 40 \par\pard\pvpg\phpg\posx8532\posy4277\charscalex100\expndtw0 \ql\fs24\cf1\f1\fs20 \par\pard\pvpg\phpg\posx8691\posy4301\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx9720\posy4301\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 43 - 48 \par\pard\pvpg\phpg\posx1800\posy4772\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Arterial pH \par\pard\pvpg\phpg\posx3960\posy4772\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 7.3 7.4 \par\pard\pvpg\phpg\posx6840\posy4772\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 7.35 7.45 \par\pard\pvpg\phpg\posx9391\posy4772\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 7.35 7.45 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop5515 \shpright10469 \shpbottom5798 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy5532\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Usia\b0 \par\pard\pvpg\phpg\posx3960\posy5532\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Denyut Jantung\b0 \par\pard\pvpg\phpg\posx7560\posy5532\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Tekanan Darah Sistolik\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop5798 \shpright10469 \shpbottom6082 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx4320\posy5815\charscalex100\expndtw0 \ql\fs24\cf1\f0\b (per menit)\b0 \par\pard\pvpg\phpg\posx8280\posy5815\charscalex100\expndtw0 \ql\fs24\cf1\f0\b (mmHg)\b0 \par\pard\pvpg\phpg\posx1800\posy6351\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0

\par\pard\pvpg\phpg\posx1950\posy6351\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 1 tahun \par\pard\pvpg\phpg\posx4464\posy6351\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 100- \par\pard\pvpg\phpg\posx4831\posy6351\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 160 \par\pard\pvpg\phpg\posx8276\posy6351\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 60- \par\pard\pvpg\phpg\posx8546\posy6351\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 90 \par\pard\pvpg\phpg\posx1800\posy6821\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx1950\posy6821\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 tahun \par\pard\pvpg\phpg\posx4464\posy6821\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 100- \par\pard\pvpg\phpg\posx4831\posy6821\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 170 \par\pard\pvpg\phpg\posx8276\posy6821\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 70- \par\pard\pvpg\phpg\posx8546\posy6821\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 90 \par\pard\pvpg\phpg\posx1800\posy7292\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx1951\posy7292\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 tahun \par\pard\pvpg\phpg\posx4677\posy7292\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 9 \par\pard\pvpg\phpg\posx4781\posy7292\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4882\posy7292\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 - \par\pard\pvpg\phpg\posx4946\posy7292\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 150 \par\pard\pvpg\phpg\posx8276\posy7292\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 80- \par\pard\pvpg\phpg\posx8546\posy7292\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 100 \par\pard\pvpg\phpg\posx1800\posy7762\charscalex100\expndtw0 \ql\

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\par\pard\pvpg\phpg\posx3430\posy10264\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Sistem Respirasi, Ukuran ETT dan Penempatannya.\b0 \par\pard\pvpg\phpg\posx1800\posy10826\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Umur \par\pard\pvpg\phpg\posx3240\posy10826\charscalex100\expndtw0 \ql\fs24\cf1\f0 Berat \par\pard\pvpg\phpg\posx4021\posy10826\charscalex100\expndtw0 \ql\fs24\cf1\f0 Laju Nafas \par\pard\pvpg\phpg\posx5402\posy10826\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Ukuran \par\pard\pvpg\phpg\posx6843\posy10826\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 ETT \par\pard\pvpg\phpg\posx8703\posy10826\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ETT \par\pard\pvpg\phpg\posx3240\posy11109\charscalex100\expndtw-1 \ql\fs24\cf1\f0 (Kg) \par\pard\pvpg\phpg\posx5401\posy11109\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ETT \par\pard\pvpg\phpg\posx6361\posy11109\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pada bibir (cm) pada hidung(cm) \par\pard\pvpg\phpg\posx1800\posy11674\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Neonatus \par\pard\pvpg\phpg\posx3240\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 1.0- \par\pard\pvpg\phpg\posx3557\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3.0 \par\pard\pvpg\phpg\posx4108\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 40- \par\pard\pvpg\phpg\posx4378\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 50 \par\pard\pvpg\phpg\posx5400\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3.0 \par\pard\pvpg\phpg\posx6840\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 5.5- \par\pard\pvpg\phpg\posx7157\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 8.5 \par\pard\pvpg\phpg\posx8280\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 7- \par\pard\pvpg\phpg\posx8445\posy11674\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 10.5 \par\pard\pvpg\phpg\posx1800\posy11909\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 Neonatus \par\pard\pvpg\phpg\posx3240\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3.5 \par\pard\pvpg\phpg\posx4108\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 40- \par\pard\pvpg\phpg\posx4378\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 50 \par\pard\pvpg\phpg\posx5400\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3.5

\par\pard\pvpg\phpg\posx6840\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 9 \par\pard\pvpg\phpg\posx8280\posy11909\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 11 \par\pard\pvpg\phpg\posx1800\posy12145\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 3 Bulan \par\pard\pvpg\phpg\posx3240\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 6.0 \par\pard\pvpg\phpg\posx4107\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 30- \par\pard\pvpg\phpg\posx4377\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 50 \par\pard\pvpg\phpg\posx5400\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 3.5 \par\pard\pvpg\phpg\posx6840\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 10 \par\pard\pvpg\phpg\posx8280\posy12145\charscalex100\expndtw1 \ql\fs24\cf1\f0\fs20 12 \par\pard\pvpg\phpg\posx1800\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx1950\posy12380\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx3341\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4107\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx4212\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy12380\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -3 \par\pard\pvpg\phpg\posx4478\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx5501\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy12380\charscalex100\expndtw0 \

ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx6840\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8280\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8381\posy12380\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx1800\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx1950\posy12615\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx3341\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx4107\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx4212\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy12615\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -3 \par\pard\pvpg\phpg\posx4478\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx5501\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx6840\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx8280\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8381\posy12615\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5

\par\pard\pvpg\phpg\posx1800\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx1950\posy12850\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx3341\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx4107\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx4212\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy12850\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -3 \par\pard\pvpg\phpg\posx4478\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx5501\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx6840\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx8280\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8381\posy12850\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx1800\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx1950\posy13085\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx3341\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx4107\posy13085\charscalex100\expndtw0 \

ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx4212\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx4313\posy13085\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -2 \par\pard\pvpg\phpg\posx4478\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx5400\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx5501\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx6840\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx8280\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8381\posy13085\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 7 \par\pard\pvpg\phpg\posx1800\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx1950\posy13321\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx3341\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4107\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx4212\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx4313\posy13321\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -2 \par\pard\pvpg\phpg\posx4478\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx5400\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5

\par\pard\pvpg\phpg\posx5501\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx6840\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx8280\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx8381\posy13321\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 9 \par\pard\pvpg\phpg\posx1800\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 8 \par\pard\pvpg\phpg\posx1950\posy13556\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx3341\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 4 \par\pard\pvpg\phpg\posx4107\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx4212\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy13556\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -2 \par\pard\pvpg\phpg\posx4478\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx5501\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx6840\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx8280\posy13556\charscalex100\expndtw0 \

ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx8381\posy13556\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx1800\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx1901\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx2051\posy13791\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx3341\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4107\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx4212\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy13791\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -2 \par\pard\pvpg\phpg\posx4478\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 6 \par\pard\pvpg\phpg\posx5501\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 5 \par\pard\pvpg\phpg\posx6840\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 7 \par\pard\pvpg\phpg\posx8280\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx8381\posy13791\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx1800\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx1901\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2

\par\pard\pvpg\phpg\posx2051\posy14026\charscalex100\expndtw-1 \ql\fs24\cf1\f0\fs20 Tahun \par\pard\pvpg\phpg\posx3240\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 3 \par\pard\pvpg\phpg\posx3341\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 8 \par\pard\pvpg\phpg\posx4107\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx4212\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx4313\posy14026\charscalex100\expndtw-2 \ql\fs24\cf1\f0\fs20 -2 \par\pard\pvpg\phpg\posx4478\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx5400\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 7 \par\pard\pvpg\phpg\posx5501\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 . \par\pard\pvpg\phpg\posx5551\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 0 \par\pard\pvpg\phpg\posx6840\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 1 \par\pard\pvpg\phpg\posx6941\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 8 \par\pard\pvpg\phpg\posx8280\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 \par\pard\pvpg\phpg\posx8381\posy14026\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs20 2 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1872 \shptop1831 \shpright10224 \shpbottom1834 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2263 \shpright10514 \shpbottom5146 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\

shpleft1728 \shptop2837 \shpright10368 \shpbottom2839 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 25400}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop3168 \shpright10080 \shpbottom3168 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop3593 \shpright10080 \shpbottom3595 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop4063 \shpright10080 \shpbottom4066 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop4546 \shpright10080 \shpbottom4548 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop5016 \shpright10080 \shpbottom5018

{\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop5424 \shpright10370 \shpbottom9850 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop6204 \shpright10368 \shpbottom6204 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop6581 \shpright10080 \shpbottom6581 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop7066 \shpright10080 \shpbottom7068 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop7536 \shpright10080 \shpbottom7538 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}}

{\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop8006 \shpright10080 \shpbottom8009 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop8477 \shpright10080 \shpbottom8479 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop8947 \shpright10080 \shpbottom8950 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1872 \shptop9418 \shpright10080 \shpbottom9420 {\sp{\sn geoRight}{\sv 8208}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8208,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop10174 \shpright10370 \shpbottom14602 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\

sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop10601 \shpright10368 \shpbottom10601 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 31 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 3 : Parameter Kardiovaskular\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2148 \shpright10469 \shpbottom2431 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2431 \shpright10469 \shpbottom2714 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy2443\charscalex100\expndtw0 \ql\fs24\cf1\f0 Kehilangan \par\pard\pvpg\phpg\posx3480\posy2443\charscalex100\expndtw0 \ql\fs24\cf1\f0 Denyut Tekanan \par\pard\pvpg\phpg\posx5580\posy2443\charscalex100\expndtw0 \ql\fs24\cf1\f0 Capill Nafas \par\pard\pvpg\phpg\posx7559\posy2443\charscalex100\expndtw0 \ql\fs24\cf1\f0 Urine Kesadaran {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2714 \shpright10469 \shpbottom2998 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy2726\charscalex100\expndtw0 \ql\

fs24\cf1\f0 Darah \par\pard\pvpg\phpg\posx3481\posy2726\charscalex100\expndtw0 \ql\fs24\cf1\f0 jantung darah \par\pard\pvpg\phpg\posx5581\posy2726\charscalex100\expndtw0 \ql\fs24\cf1\f0 refill \par\pard\pvpg\phpg\posx7620\posy2726\charscalex100\expndtw0 \ql\fs24\cf1\f0 ml/jam \par\pard\pvpg\phpg\posx1800\posy3292\charscalex100\expndtw0 \ql\fs24\cf1\f0 < 750 ml \par\pard\pvpg\phpg\posx3480\posy3292\charscalex100\expndtw0 \ql\fs24\cf1\f0 <100 normal \par\pard\pvpg\phpg\posx5521\posy3292\charscalex100\expndtw0 \ql\fs24\cf1\f0 normal normal >30 \par\pard\pvpg\phpg\posx9003\posy3292\charscalex100\expndtw0 \ql\fs24\cf1\f0 normal \par\pard\pvpg\phpg\posx1800\posy3859\charscalex100\expndtw0 \ql\fs24\cf1\f0 750-1500 ml \par\pard\pvpg\phpg\posx3480\posy3859\charscalex100\expndtw0 \ql\fs24\cf1\f0 >100 systolic lambat 20-30 20-30 menurun \par\pard\pvpg\phpg\posx4380\posy4142\charscalex100\expndtw0 \ql\fs24\cf1\f0 normal \par\pard\pvpg\phpg\posx1800\posy4708\charscalex100\expndtw0 \ql\fs24\cf1\f0 1500-2000 ml > 120 turun lambat 30-40 5-15 \par\pard\pvpg\phpg\posx9002\posy4708\charscalex100\expndtw0 \ql\fs24\cf1\f0 gelisah/ \par\pard\pvpg\phpg\posx9000\posy4992\charscalex100\expndtw0 \ql\fs24\cf1\f0 bingung \par\pard\pvpg\phpg\posx1800\posy5558\charscalex100\expndtw0 \ql\fs24\cf1\f0 > 2000 ml >140 turun lambat > 40 < 10 \par\pard\pvpg\phpg\posx9002\posy5558\charscalex100\expndtw0 \ql\fs24\cf1\f0 gelisah {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2119 \shpright10514 \shpbottom6444 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn

shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2988 \shpright10512 \shpbottom2988 {\sp{\sn geoRight}{\sv 8784}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8784,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop3845 \shpright10512 \shpbottom3845 {\sp{\sn geoRight}{\sv 8784}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8784,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop4702 \shpright10512 \shpbottom4704 {\sp{\sn geoRight}{\sv 8784}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8784,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop5254 \shpright10512 \shpbottom5254 {\sp{\sn geoRight}{\sv 8784}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8784,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop6132 \shpright10512 \shpbottom6134 {\sp{\sn geoRight}{\sv 8784}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8784,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 32 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 4 : Glasgow Coma Scale\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1771 \shptop2525\shpright10469 \shpbottom2808 {\sp{\sn fillColor}{\sv 13421772}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy2536\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fungsi \par\pard\pvpg\phpg\posx3960\posy2536\charscalex100\expndtw0 \ql\fs24\cf1\f0 Respons \par\pard\pvpg\phpg\posx8280\posy2536\charscalex100\expndtw0 \ql\fs24\cf1\f0 Skor \par\pard\pvpg\phpg\posx1800\posy3103\charscalex100\expndtw-1 \ql\fs24\cf1\f0 MATA (4) \par\pard\pvpg\phpg\posx3961\posy3103\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Buka spontan \par\pard\pvpg\phpg\posx8280\posy3103\charscalex100\expndtw-1 \ql\fs24\cf1\f0 4 \par\pard\pvpg\phpg\posx3960\posy3386\charscalex100\expndtw0 \ql\fs24\cf1\f0 Buka diperintah \par\pard\pvpg\phpg\posx8281\posy3386\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3 \par\pard\pvpg\phpg\posx3960\posy3669\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Buka dengan rangsang nyeri \par\pard\pvpg\phpg\posx8283\posy3669\charscalex100\expndtw-1 \ql\fs24\cf1\f0 2 \par\pard\pvpg\phpg\posx3960\posy3952\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tidak ada respons \par\pard\pvpg\phpg\posx8280\posy3952\charscalex100\expndtw-1 \ql\fs24\cf1\f0 1 \par\pard\pvpg\phpg\posx1800\posy4519\charscalex100\expndtw-1 \ql\fs24\cf1\f0 BICARA (5)

\par\pard\pvpg\phpg\posx3961\posy4519\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Normal \par\pard\pvpg\phpg\posx8280\posy4519\charscalex100\expndtw-1 \ql\fs24\cf1\f0 5 \par\pard\pvpg\phpg\posx3960\posy4802\charscalex100\expndtw0 \ql\fs24\cf1\f0 Bingung \par\pard\pvpg\phpg\posx8280\posy4802\charscalex100\expndtw0 \ql\fs24\cf1\f0 4 \par\pard\pvpg\phpg\posx3960\posy5085\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Kata-kata kacau \par\pard\pvpg\phpg\posx8281\posy5085\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3 \par\pard\pvpg\phpg\posx3960\posy5368\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Suara tak menentu \par\pard\pvpg\phpg\posx8280\posy5368\charscalex100\expndtw-1 \ql\fs24\cf1\f0 2 \par\pard\pvpg\phpg\posx3960\posy5652\charscalex100\expndtw0 \ql\fs24\cf1\f0 Diam \par\pard\pvpg\phpg\posx8280\posy5652\charscalex100\expndtw0 \ql\fs24\cf1\f0 1 \par\pard\pvpg\phpg\posx1800\posy6218\charscalex100\expndtw0 \ql\fs24\cf1\f0 Motorik (6) \par\pard\pvpg\phpg\posx3960\posy6218\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dapat diperintah \par\pard\pvpg\phpg\posx8281\posy6218\charscalex100\expndtw-1 \ql\fs24\cf1\f0 6 \par\pard\pvpg\phpg\posx3960\posy6501\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dapat menunjuk tempat nyeri \par\pard\pvpg\phpg\posx8282\posy6501\charscalex100\expndtw-1 \ql\fs24\cf1\f0 5 \par\pard\pvpg\phpg\posx3960\posy6784\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fleksi normal terhadap nyeri \par\pard\pvpg\phpg\posx8283\posy6784\charscalex100\expndtw-1 \ql\fs24\cf1\f0 4 \par\pard\pvpg\phpg\posx3960\posy7068\charscalex100\expndtw0 \ql\fs24\cf1\f0 Fleksi abnormal terhadap nyeri \par\pard\pvpg\phpg\posx8283\posy7068\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3 \par\pard\pvpg\phpg\posx3960\posy7351\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 Ekstensi terhadap nyeri \par\pard\pvpg\phpg\posx8282\posy7351\charscalex100\expndtw-1 \ql\fs24\cf1\f0 2 \par\pard\pvpg\phpg\posx3960\posy7634\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tak ada respons \par\pard\pvpg\phpg\posx8281\posy7634\charscalex100\expndtw-1 \ql\fs24\cf1\f0 1 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1877 \shpright10368 \shpbottom1877{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2412 \shpright10514 \shpbottom8321 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2849 \shpright10368 \shpbottom2849 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop3415 \shpright10368 \shpbottom3415 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop3698 \shpright10368 \shpbottom3701 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn

fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop3982 \shpright10368 \shpbottom3984 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop4265 \shpright10368 \shpbottom4265 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 25400}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop4831 \shpright10368 \shpbottom4831 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop5114 \shpright10368 \shpbottom5117 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop5398 \shpright10368 \shpbottom5400 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn

shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop5681 \shpright10368 \shpbottom5681 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop5964 \shpright10368 \shpbottom5964 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 25400}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop6530 \shpright10368 \shpbottom6533 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 3}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,3)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop6814 \shpright10368 \shpbottom6816 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 2}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,2)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop7097 \shpright10368 \shpbottom7097 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop7380 \shpright10368 \shpbottom7380

{\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop7663 \shpright10368 \shpbottom7663 {\sp{\sn geoRight}{\sv 8640}}{\sp{\sn geoBottom}{\sv 0}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8640,0)}} {\sp{\sn pSegmentInfo}{\sv 2;5;16384;44032;1;44032;32768}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop7946 \shpright10368 \shpbottom7949 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 25400}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 33 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 5: Cardiac Life Support\b0 \par\pard\pvpg\phpg\posx1838\posy2071\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b PERTAMA SEKALI : PASTIKAN KESELAMATAN PASIEN & ANDA SENDIRI\b0 \par\pard\pvpg\phpg\posx6120\posy2632\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ADA \par\pard\pvpg\phpg\posx3240\posy3199\charscalex100\expndtw-1 \ql\fs24\cf1\f0 TIDAK \par\pard\pvpg\phpg\posx6120\posy4898\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ADA \par\pard\pvpg\phpg\posx3240\posy5464\charscalex100\expndtw-1 \ql\fs24\cf1\f0 TIDAK \par\pard\pvpg\phpg\posx6120\posy6880\charscalex100\expndtw-1 \ql\fs24\cf1\f0 ADA \par\pard\pvpg\phpg\posx3240\posy7730\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 TIDAK {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop2623 \shpright4754 \shpbottom2986 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx1759\posy2664\charscalex100\expndtw0 \ql\fs24\cf1\f0 PERIKSA RESPON PASIEN {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft7632 \shptop2623 \shpright10226 \shpbottom3202 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx8141\posy2664\charscalex100\expndtw-1 \ql\fs24\cf1\f0 PERIKSA DAN \par\pard\pvpg\phpg\posx8069\posy2947\charscalex100\expndtw0 \ql\fs24\cf1\f0 ATASI CEDERA {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop3636 \shpright5186 \shpbottom4282 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx1757\posy3674\charscalex100\expndtw-1 \ql\fs24\cf1\f0 A. BUKA JALAN NAPAS \par\pard\pvpg\phpg\posx1793\posy3957\charscalex100\expndtw0 \ql\fs24\cf1\f0 (JAW THRUST BILA? C-SPINE) {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop4896 \shpright4898 \shpbottom5376 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx1757\posy4936\charscalex100\expndtw-1 \ql\fs24\cf1\f0 B. PERIKSA PERNAPASAN {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft7632 \shptop4855 \shpright9794 \shpbottom5434

{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx7661\posy4893\charscalex100\expndtw0 \ql\fs24\cf1\f0 POSISI RECOVERY {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft3024 \shptop5429 \shpright3024 \shpbottom5911 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft2947 \shptop5906 \shpright3103 \shpbottom6010 {\sp{\sn shapeType}{\sv 75}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv{\pict\emfblip 010000006C000000830B0000121700001F0C00007A17000032960100122E0300B3AB0100683C030020454D46000001009401000015000000020000000000000000000000000000005605000000030000E20100000F010000000000000000000000000000665A070055220400270000001800000001000000000000000000000000000000250000000C00000001000000250000000C000000080000803B000000080000001B00000010000000830B0000121700003600000010000000D00B00007A17000036000000100000001F0C0000121700003600000010000000830B0000121700003C00000008000000130000000C000000010000003E00000018000000830B0000121700001F0C00007A170000130000000C00000001000000250000000C00000005000080250000000C000000070000801B00000010000000830B0000121700003600000010000000D00B00007A17000036000000100000001F0C0000121700003600000010000000830B000012170000250000000C000000010000000E00000014000000000000001000000014000000}}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop6007 \shpright4610 \shpbottom6586 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx2186\posy6045\charscalex100\expndtw-1 \ql\fs24\cf1\f0 BERI DUA NAPAS \par\pard\pvpg\phpg\posx2318\posy6328\charscalex100\expndtw-1 \ql\fs24\cf1\f0 YANG EFEKTIF {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft3024 \shptop6581 \shpright3024 \shpbottom6919

{\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft2947 \shptop6914 \shpright3103 \shpbottom7018 {\sp{\sn shapeType}{\sv 75}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv{\pict\emfblip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}}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1728 \shptop7015 \shpright4754 \shpbottom7584 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx1757\posy7053\charscalex100\expndtw-1 \ql\fs24\cf1\f0 C. PERIKSA SIRKULASI {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft4752 \shptop7517 \shpright7248 \shpbottom7517 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft7243 \shptop7440 \shpright7344 \shpbottom7596 {\sp{\sn shapeType}{\sv 75}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv{\pict\emfblip 010000006C0000004B1C0000101D0000B01C0000AC1D000055E603008301040041F403000417040020454D46000001009401000015000000020000000000000000

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\par\pard\pvpg\phpg\posx7992\posy7269\charscalex100\expndtw-1 \ql\fs24\cf1\f0 LANJUTKAN USAHA \par\pard\pvpg\phpg\posx7682\posy7552\charscalex100\expndtw-1 \ql\fs24\cf1\f0 PERNAPASAN 10 X/MENIT {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft7200 \shptop8381 \shpright11234 \shpbottom9679 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

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\par\pard\pvpg\phpg\posx2969\posy11229\charscalex100\expndtw-1 \ql\fs24\cf1\f0 VF/VT {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft8352 \shptop11191 \shpright10514 \shpbottom11890 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx8798\posy11229\charscalex100\expndtw-1 \ql\fs24\cf1\f0 NON VF/VT \par\pard\pvpg\phpg\posx8494\posy11512\charscalex100\expndtw0 \ql\fs24\cf1\f0 (ASISTOLE/EMD) {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2448 \shptop12199 \shpright4466 \shpbottom12910 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx2530\posy12237\charscalex100\expndtw-1 \ql\fs24\cf1\f0 DEFIBRILASI 3 X \par\pard\pvpg\phpg\posx2664\posy12520\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 sesuai keperluan {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft8352 \shptop12343 \shpright10370 \shpbottom12773 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx8630\posy12381\charscalex100\expndtw0 \ql\fs24\cf1\f0 RKP 3 MENIT {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft8352 \shptop13351 \shpright10370 \shpbottom13766 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx8597\posy13389\charscalex100\expndtw-1 \ql\fs24\cf1\f0 NILAI ULANG {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2448 \shptop13207 \shpright4466 \shpbottom13786 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx2726\posy13245\charscalex100\expndtw0 \ql\fs24\cf1\f0 RKP 1 MENIT {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft2448 \shptop14071 \shpright4466 \shpbottom14506 {\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\pvpg\phpg\posx2693\posy14109\charscalex100\expndtw-1 \ql\fs24\cf1\f0 NILAI ULANG {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft7488 \shptop10469 \shpright9216 \shpbottom10471 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\

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\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 34 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 6 : Respons Trauma\b0 \par\pard\pvpg\phpg\posx1800\posy2349\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jauh sebelum pasien trauma tiba di rumah sakit, peranmasing-masing anggota tim \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 trauma harus sudah jelas dan dimengerti. \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Anggota tim trauma (tergantung adanya dokter)\b0 \par\pard\pvpg\phpg\posx1800\posy3765\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Idealnya adalah : \par\pard\pvpg\phpg\posx1800\posy4318\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx1980\posy4346\charscalex100\expndtw0 \ql\fs24\cf1\f0 Dokter gawat darurat yang tugas jaga menjadi ketua tim (team leader) atau tenaga \par\pard\pvpg\phpg\posx1980\posy4629\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kesehatan lain yang berpengalaman. \par\pard\pvpg\phpg\posx1800\posy4899\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx1980\posy4927\charscalex100\expndtw0 \ql\fs24\cf1\f0 Perawat gawat darurat yang tugas jaga \par\pard\pvpg\phpg\posx1800\posy5196\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx1980\posy5224\charscalex100\expndtw-1 \ql\fs24\cf1\f0 1 sampai 2 orang tenaga kesehatan bantuan lainnya \par\pard\pvpg\phpg\posx1800\posy5791\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Ketika pasien datang evaluasi cepat harus segera dilakukan (TRIAGE). Triage ini \par\pard\pvpg\phpg\posx1800\posy6074\charscalex100\expndtw-1 \ql\fs24\cf1\f0 menetapkan prioritas penanganan pasien yang disesuaikan dengan keberadaan \par\pard\pvpg\phpg\posx1800\posy6344\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k

\par\pard\pvpg\phpg\posx2160\posy6372\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tenaga kesehatan \par\pard\pvpg\phpg\posx1800\posy6641\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6669\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Sarana kesehatan {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop7522 \shpright10440 \shpbottom7805 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop7805 \shpright10440 \shpbottom8088 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx4222\posy7821\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b PERAN ANGGOTA TIM TRAUMA\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop8088 \shpright10440 \shpbottom8371 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1699 \shptop7522 \shpright1800 \shpbottom8371 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft10440 \shptop7522 \shpright10541 \shpbottom8371 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop7507 \shpright10555 \shpbottom7527 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

{\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop7522 \shpright1705 \shpbottom8371 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft10541 \shptop7522 \shpright10561 \shpbottom8371 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop8386 \shpright6012 \shpbottom8669 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop8669 \shpright6012 \shpbottom8952 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy8685\charscalex100\expndtw0 \ql\fs24\cf1\f0\b KETUA TIM (DOKTER)\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1800 \shptop8952 \shpright6012 \shpbottom9235 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1699 \shptop8386 \shpright1800 \shpbottom9235 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6012 \shptop8386 \shpright6113 \shpbottom9235 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn

shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6228 \shptop8386 \shpright10440 \shpbottom8669 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6228 \shptop8669 \shpright10440 \shpbottom8952 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx6228\posy8685\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b (PERAWAT )\b0 {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6127 \shptop8386 \shpright6228 \shpbottom8952 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft10440 \shptop8386 \shpright10541 \shpbottom8952 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6127 \shptop8952 \shpright10541 \shpbottom9235 {\sp{\sn fillColor}{\sv 11645361}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop8371 \shpright10555 \shpbottom8391 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop8386 \shpright1705 \shpbottom9235 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6113 \

shptop8386 \shpright6133 \shpbottom9235 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft10541 \shptop8386 \shpright10561 \shpbottom9235 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

\par\pard\pvpg\phpg\posx1800\posy9544\charscalex100\expndtw0 \ql\fs24\cf1\f0 1. Koordinasi ABC \par\pard\pvpg\phpg\posx1800\posy9828\charscalex100\expndtw0 \ql\fs24\cf1\f0 2. Anamnesa pasien / keluarga \par\pard\pvpg\phpg\posx1800\posy10111\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3. Pemeriksaan sinar X (jika ada) \par\pard\pvpg\phpg\posx1800\posy10394\charscalex100\expndtw-1 \ql\fs24\cf1\f0 4. Survey Sekunder \par\pard\pvpg\phpg\posx1800\posy10677\charscalex100\expndtw0 \ql\fs24\cf1\f0 5. Mempertimbangkan pencegahan titanus \par\pard\pvpg\phpg\posx2071\posy10960\charscalex100\expndtw0 \ql\fs24\cf1\f0 dan pemberian antibiotika \par\pard\pvpg\phpg\posx1800\posy11244\charscalex100\expndtw-1 \ql\fs24\cf1\f0 6. Memeriksa ulang pasien berkala \par\pard\pvpg\phpg\posx1800\posy11527\charscalex100\expndtw0 \ql\fs24\cf1\f0 7. Menyiapkan transportasi pasien \par\pard\pvpg\phpg\posx1800\posy11810\charscalex100\expndtw0 \ql\fs24\cf1\f0 8. Melengkapi rekam medik \par\pard\pvpg\phpg\posx6228\posy9544\charscalex100\expndtw0 \ql\fs24\cf1\f0 1. Membantu koordinasi resusitasi \par\pard\pvpg\phpg\posx6228\posy9828\charscalex100\expndtw0 \ql\fs24\cf1\f0 2. Menjadi penghubung dengan keluarga \par\pard\pvpg\phpg\posx6391\posy10111\charscalex100\expndtw-1 \ql\fs24\cf1\f0 pasien \par\pard\pvpg\phpg\posx6228\posy10394\charscalex100\expndtw-1 \ql\fs24\cf1\f0 3. Memeriksa kelengkapan data : \par\pard\pvpg\phpg\posx6408\posy10677\charscalex100\expndtw0 \ql\fs24\cf1\f0 - Alergi \par\pard\pvpg\phpg\posx6408\posy10960\charscalex100\expndtw0 \ql\fs24\cf1\f0 - obat-obat yang dipakai

\par\pard\pvpg\phpg\posx6408\posy11244\charscalex100\expndtw0 \ql\fs24\cf1\f0 - riwayat penyakit sebelumnya \par\pard\pvpg\phpg\posx6408\posy11527\charscalex100\expndtw-1 \ql\fs24\cf1\f0 - makan minum terakhir \par\pard\pvpg\phpg\posx6408\posy11810\charscalex100\expndtw-1 \ql\fs24\cf1\f0 - kejadian trauma \par\pard\pvpg\phpg\posx6228\posy12093\charscalex100\expndtw0 \ql\fs24\cf1\f0 4. Memberitahu staf perawatan di ruangan \par\pard\pvpg\phpg\posx6391\posy12376\charscalex100\expndtw0 \ql\fs24\cf1\f0 lain. {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop9235 \shpright10555 \shpbottom9255 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1685 \shptop9250 \shpright1705 \shpbottom12946 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft1699 \shptop12931 \shpright6113 \shpbottom12951 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6113 \shptop9250 \shpright6133 \shpbottom12946 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft6127 \shptop12931 \shpright10541 \shpbottom12951 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}} {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}\shpleft10541 \shptop9250 \shpright10561 \shpbottom12946 {\sp{\sn fillColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 0}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}}}

{\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1872 \shpright10224 \shpbottom1872 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

\par\pard\page\par

\par\pard\pvpg\phpg\posx10200\posy14848\charscalex100\expndtw0 \ql\fs24\cf1\f0 35 \par\pard\pvpg\phpg\posx1800\posy1460\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Appendix 7: Rencana Aktivasi Tim Trauma\b0 \par\pard\pvpg\phpg\posx1800\posy2354\charscalex100\expndtw-1 \ql\fs24\cf1\f0\b Kriteria\b0 \par\pard\pvpg\phpg\posx1800\posy2632\charscalex100\expndtw0 \ql\fs24\cf1\f0 Pasien-pasien seperti berikut ini harus dievaluasi dengan lengkap : \par\pard\pvpg\phpg\posx1800\posy3204\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Riwayat penyakit:\b0 \par\pard\pvpg\phpg\posx1800\posy3468\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3496\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jatuh dari ketinggian > 3 meter \par\pard\pvpg\phpg\posx1800\posy3766\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy3794\charscalex100\expndtw-1 \ql\fs24\cf1\f0 kecelakaan lalu lintas dengan kecepatan > 30 km/jam \par\pard\pvpg\phpg\posx1800\posy4064\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4092\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Terlempar dari atau terperangkap dalam kendaraan bermotor \par\pard\pvpg\phpg\posx1800\posy4361\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4389\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Adanya korban lain yang meninggal dalam kecelakaantersebut \par\pard\pvpg\phpg\posx1800\posy4659\charscalex100\expndtw0 \ql\

fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy4687\charscalex100\expndtw0 \ql\fs24\cf1\f0 Tabrakan antara mobil dengan pejalan kaki / sepeda / mobil lain atau \par\pard\pvpg\phpg\posx2160\posy4970\charscalex100\expndtw0 \ql\fs24\cf1\f0 penumpang mobil tanpa mengenakan seat belt \par\pard\pvpg\phpg\posx1800\posy5541\charscalex100\expndtw0 \ql\fs24\cf1\f0\b Pemeriksaan :\b0 \par\pard\pvpg\phpg\posx1800\posy5820\charscalex100\expndtw0 \ql\fs24\cf1\f0 Jalan nafas atau adanya distres nafas \par\pard\pvpg\phpg\posx1800\posy6089\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6117\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Tekanan darah < 100 mmHg \par\pard\pvpg\phpg\posx1800\posy6387\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6415\charscalex100\expndtw0 \ql\fs24\cf1\f0 GCS < 13/15 \par\pard\pvpg\phpg\posx1800\posy6684\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy6712\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Lebih dari satu daerah yang terluka \par\pard\pvpg\phpg\posx1800\posy6982\charscalex100\expndtw0 \ql\fs24\cf1\f1 \u8226k \par\pard\pvpg\phpg\posx2160\posy7010\charscalex100\expndtw0 \ql\fs24\cf1\f0 Luka tusuk / tembus \par\pard\pvpg\phpg\posx1800\posy7585\charscalex100\expndtw0 \ql\fs24\cf1\f0\fs28\b Pengelolaan bencana\b0 \par\pard\pvpg\phpg\posx1800\posy7908\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Perencanaan pengelolaan medik pada bencana harus dilakukan dengan baik. Bencana \par\pard\pvpg\phpg\posx1800\posy8191\charscalex100\expndtw-1 \ql\fs24\cf1\f0 adalah suatu keadaan dimana jumlah dan keberadaan sarana kesehatan di tempat itu tidak \par\pard\pvpg\phpg\posx1800\posy8474\charscalex100\expndtw0 \ql\fs24\cf1\f0 lagi mampu mengatasi / mencukupi kebutuhan korban. \par\pard\pvpg\phpg\posx1800\posy9040\charscalex100\expndtw-1 \ql\fs24\cf1\f0 Rencana pengelolaan bencana harus meliputi : \par\pard\pvpg\phpg\posx1800\posy9324\charscalex100\expndtw-1 \

ql\fs24\cf1\f0 1. Pelatihan dengan berbagai skenario-skenario bencana \par\pard\pvpg\phpg\posx1800\posy9607\charscalex100\expndtw-1 \ql\fs24\cf1\f0 2. Protap pengelolaan bencana : \par\pard\pvpg\phpg\posx2040\posy9890\charscalex100\expndtw0 \ql\fs24\cf1\f0 a. Pengelolaan di tempat kejadian \par\pard\pvpg\phpg\posx2040\posy10173\charscalex100\expndtw0 \ql\fs24\cf1\f0 b. Cara identifikasi petugas pokok \par\pard\pvpg\phpg\posx2040\posy10456\charscalex100\expndtw0 \ql\fs24\cf1\f0 c. Triage trauma \par\pard\pvpg\phpg\posx1800\posy10740\charscalex100\expndtw0 \ql\fs24\cf1\f0 3. Protap pengiriman tim medik dari rumah sakit \par\pard\pvpg\phpg\posx1800\posy11023\charscalex100\expndtw-1 \ql\fs24\cf1\f0 4. Kesepakatan untuk pihak mana yang akan menangani / ikut berperan dalam bencana : \par\pard\pvpg\phpg\posx2040\posy11306\charscalex100\expndtw0 \ql\fs24\cf1\f0 a. Ambulans \par\pard\pvpg\phpg\posx2040\posy11589\charscalex100\expndtw0 \ql\fs24\cf1\f0 b. Polisi, tentara \par\pard\pvpg\phpg\posx2040\posy11872\charscalex100\expndtw-1 \ql\fs24\cf1\f0 c. Otoritas / kepala pemerintahan setempat / nasional / internasional \par\pard\pvpg\phpg\posx1800\posy12156\charscalex100\expndtw-1 \ql\fs24\cf1\f0 5. Protap prioritas evakuasi \par\pard\pvpg\phpg\posx1800\posy12439\charscalex100\expndtw0 \ql\fs24\cf1\f0 6. Fasilitas evakuasi \par\pard\pvpg\phpg\posx1800\posy12722\charscalex100\expndtw0 \ql\fs24\cf1\f0 7. Protap transportasi : jalan darat, jalan laut, terbang (heli, pesawat lain) \par\pard\pvpg\phpg\posx1800\posy13005\charscalex100\expndtw0 \ql\fs24\cf1\f0 8. Protap / strategi komunikasi {\shp{\*\shpinst\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpleft1728 \shptop1872 \shpright10224 \shpbottom1872 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn FFlipH}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineWidth}{\sv 12700}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fFilled}{\sv 0}}}}

}