penatalaksanaan dini fraktur multiple
TRANSCRIPT
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PENATALAKSANAAPENATALAKSANAAN DINI FRAKTUR N DINI FRAKTUR
MULTIPLEMULTIPLE
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3 hal yang perlu tindakan segera pada 3 hal yang perlu tindakan segera pada trauma ekstremitas :trauma ekstremitas :
1.1. Fraktur terbukaFraktur terbuka
2.2. Fraktur tertutup dg gangguan NVDFraktur tertutup dg gangguan NVD
3.3. DislokasiDislokasi
““Goal” tindakan bedah ortopaedi adalah : Goal” tindakan bedah ortopaedi adalah : Maksimum rehabilitasi penderita secara Maksimum rehabilitasi penderita secara utuhutuh
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P3K pada kecelakaan tdd :P3K pada kecelakaan tdd :1. Basic life support 1. Basic life support → →
-Resusitasi kardiorespirasi -Resusitasi kardiorespirasi tindakan minimal yg dapat dikerjakan di tindakan minimal yg dapat dikerjakan di lapangan (prehospital)lapangan (prehospital)- Pada cedera muskuloskeletal - Pada cedera muskuloskeletal → → dilakukan splintingdilakukan splinting- Pada patah tulang terbuka → beri bebat - Pada patah tulang terbuka → beri bebat
tekan dg kain kasa bersih/steriltekan dg kain kasa bersih/steril
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P3KP3K
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2. ATLS (Advance Trauma Life Support)2. ATLS (Advance Trauma Life Support)
→ → termasuk primary & secondary survey :termasuk primary & secondary survey :
A : airwayA : airway
B : breathingB : breathing
C : circulationC : circulation
D : disabilityD : disability
E : exposureE : exposure
F : facility F : facility
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Pembuatan x-ray sebaiknya dilakukan Pembuatan x-ray sebaiknya dilakukan sesudah di psg bidai / splintingsesudah di psg bidai / splinting
→ → alasan :alasan :
- memudahkan transportasi- memudahkan transportasi
- mengurangi kerusakan lebih lanjut- mengurangi kerusakan lebih lanjut
- mengurangi rasa sakit- mengurangi rasa sakit
- mengurangi/menghentikan perdarahan- mengurangi/menghentikan perdarahan
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Pemasangan bidai / splintingPemasangan bidai / splinting
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DASAR DARI PENANGANAN DASAR DARI PENANGANAN FRAKTUR FRAKTUR
adalah : 4 Radalah : 4 R
1.1. Recognition = diagnosisRecognition = diagnosis
2.2. Reposition Reposition → → alignmentalignment
3.3. Retaining Retaining → fiksasi untuk mempertahankan → fiksasi untuk mempertahankan kedudukankedudukan
4.4. RehabilitationRehabilitation
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FRAKTUR TERTUTUPFRAKTUR TERTUTUP
Tx : Tx : - reposisi tertutup dalam - reposisi tertutup dalam narcose narcose- traksi- traksi- operasi- operasi
Acceptability ; yg dinilai :Acceptability ; yg dinilai :- AlignmentAlignment- RotasiRotasi- Kontak fragmenKontak fragmen- discrepency discrepency
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FRAKTUR TERBUKAFRAKTUR TERBUKA(in hospital)(in hospital)
Tindakan :Tindakan :
- DebridementDebridement
- Reposisi terbukaReposisi terbuka
- Imobilisasi atau fiksasi interna atau Imobilisasi atau fiksasi interna atau eksternaeksterna
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FRAKTUR TERTUTUP DG GANGGUAN FRAKTUR TERTUTUP DG GANGGUAN NEUROVASKULER ATAU NEUROVASKULER ATAU
KOMPARTEMEN SINDROMKOMPARTEMEN SINDROM
Fraktur Fraktur → perdarahan → tak bisa keluar → → perdarahan → tak bisa keluar → berada dlm komp otot → bengkak → berada dlm komp otot → bengkak → tekanan dlm komp ↑ → gangguan sirkulasi tekanan dlm komp ↑ → gangguan sirkulasi vena, arteri → bag distal non vital → vena, arteri → bag distal non vital → nekrosisnekrosis
*pemeriksaan NVD distal penting!*pemeriksaan NVD distal penting!
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KOMPARTEMEN KOMPARTEMEN SINDROMSINDROM
- Tindakan :Tindakan :
fasiotomi fasiotomi → luka → luka terbuka sajaterbuka saja
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DISLOKASIDISLOKASI
- Keadaan permukaan tulang yang membuat Keadaan permukaan tulang yang membuat persendian tidak bertemu atau bergeserpersendian tidak bertemu atau bergeser
TINDAKANTINDAKAN
- Reposisi SEGERAReposisi SEGERA
→ → mencegah “avascular necrosis”mencegah “avascular necrosis”
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KESIMPULANKESIMPULAN
3 Keadaan emergensi trauma orthopaedi :3 Keadaan emergensi trauma orthopaedi :1. fraktur terbuka1. fraktur terbuka2. fraktur tertutup dg gangguan NVD2. fraktur tertutup dg gangguan NVD3. dislokasi3. dislokasi
Multiple fraktur Multiple fraktur → patah tulang yang → patah tulang yang mengenai beberapa tulang , khususnya mengenai beberapa tulang , khususnya tulang panjang dan pelvistulang panjang dan pelvis
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Urutan penanganan pasien multiple trauma :Urutan penanganan pasien multiple trauma :
- Obtain accessObtain access- Establish an airway but protect the servical spineEstablish an airway but protect the servical spine- Ensure ventilationEnsure ventilation- Arrest haemorrhage and combat shockArrest haemorrhage and combat shock- Give analgesiaGive analgesia- ExtricateExtricate
- Splint fractureSplint fracture- Transport Transport
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PENANGANANPENANGANAN- On the scane On the scane
(prehospital)(prehospital)- In hospital In hospital IGD IGD
kamar opkamar op
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PEARLPEARL- Hypotension and tachycardia are present Hypotension and tachycardia are present
after a 30 to 40% loss of blood volumeafter a 30 to 40% loss of blood volume
- If a radial pulse is palpable the injured If a radial pulse is palpable the injured patient has a systolic pressure of at least patient has a systolic pressure of at least 80mm Hg. With a palpable carotid pulse the 80mm Hg. With a palpable carotid pulse the systolic pressure is at least 60mm Hgsystolic pressure is at least 60mm Hg
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