trauma vascular (malang)

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    Diagnosis dan Penanganannya

    TRAUMA VASKULER

    PADA EXTREMITAS

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    PENDAHULUAN

    TRAUMA EXTREMITAS PASTI DISERTAI

    TRAUMA VASKULER

    RINGAN SAMPAI BERAT

    LIFE THREATENING

    LIMB THREATENING

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    PENDAHULUAN

    MENGALIHKAN PERHATIAN

    PRIMARY SURVEY

    SECONDARY SURVEY

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    ETIOLOGI

    LANGSUNG / DIRECT

    TIDAK LANGSUNG / INDIRECT

    KERUSAKAN ENDOTEL LOKAL

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    ETIOLOGI: DIRECT

    TRAUMA TUMPUL

    TRAUMA TAJAM

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    ETIOLOGI: INDIRECT

    TRAUMA KOMPRESSI

    TRAUMA TARIKAN

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    ETIOLOGI: LOKAL ENDOTEEL

    OBAT-OBATAN ( DRUGs )

    TRAUMA DINGIN ( FREEZING )

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    TIPE KERUSAKAN

    KONTUSI

    PERFORASI

    LASERASI

    TRANSEKSI

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    DIAGNOSIS

    ANAMNESA

    INSPEKSI

    PALPASI

    AUSKULTASI

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    DIAGNOSIS

    MENGANCAM NYAWA

    MENGANCAM EXTREMITAS

    HARD SIGN

    SOFT SIGN

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    HARD SIGN

    PERDARAHAN YANG BERDENYUT

    ADANYA ARTERIAL THRILLBRUIT DEKAT ARTERI

    ISCHEMIA DISTAL

    HEMATOMA YANG MEMBESAR

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    SOFT SIGN

    Anamnesa ada perdarahan banyak

    Menurunnya pulsasi arteriAdanya trauma tulang bagian

    proximal

    Adanya kelainan neurologis

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    The Rule of Six - P

    PAIN

    PARASTHESIAPARALYSIS

    PALLOR

    PULSLESSNESS

    PERISHINGLY COLD EXTREMITY

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    GEJALA KLASIK MENGHILANG

    ADANYA SYOK

    PEMBENGKAKAN, EDEM DAN KONGESTI VENA

    PERSISTEN PULSES (25%)

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    LABORATORIS

    DARAH LENGKAP

    TROMBOSIT Count

    BUN, S CREATININ

    GOLONGAN DARAH

    FAAL HEMOSTASIS

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    IMAGING

    PLAIN X-RAY

    ARTERIOGRAFI

    DUPLEX DOPPLER

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    MANAGEMENT

    LIFE TREATHENING

    LIMB TREATHENING

    HARD SIGN

    SOFT SIGN

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    Management : LIFE THREATENING

    MAJOR PELVIC DISRUPTION WITH

    HEMORRAGEMAJOR HEMMORHAGE

    CRUSH SYNDROME

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    OPEN FRACTURE AND JOINT INJURIES

    COMPARTMENT SYNDROMEVASCULAR AND TRAUMATIC AMPUTATION

    NEUROLOGIC INJURIES

    Management : LIMB THREATENING

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    PENANGANAN TRAUMA VASKULER

    PENDERITA STABIL

    HARD SIGN EXPLORASI

    SOFT SIGN EVALUASI

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    MEDIKA MENTOSA

    ANTIKOAGULAN PENTING UNTUK MENCEGAH

    THROMBOSIS

    ANTI PLATELET DRUG MEMPUNYAI MANFAAT

    POST VASCULAR REPAIR

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    TERAPI BEDAH

    LIGASI

    REPAIR

    REKONSTRUKSIREPLACEMENT

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    MANGLED EXTREMITY

    DERAJAT KERUSAKAN

    ISCHEMIA

    SYOK

    UMUR PENDERITA

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    CRUSH INJURY

    IVFD

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    SYNDROME

    TAMPAK TEGANG

    ADA GEJALA 6 P

    BUKA SEMUA BALUTAN / SPLINT

    EVALUASIFASCIOTOMY

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    SUSPECTED VASCULAR INJURY

    RESUSCITATE

    HARD SIGN SOFT SIGN

    API > 0.9 API

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    MASALAH YANG DIHADAPI

    Komplikasi Prolonged ischemia

    Secondary haemorrhage

    Fail reconstruction, recurrent ischemia

    Vascular salvage of union functional limb

    Venous thromboembolism

    Iatrogenic complication

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    MASALAH YANG DIHADAPI

    Kegagalan rekonstruksi vaskuler

    Suture line tentionMissed intimal flap

    Missed proximal or distal injury

    Retained thrombosis

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    MASALAH YANG DIHADAPI

    Kegagalan rekonstruksi vaskuler

    Imperfect anatomosis

    Lateral repair without patch

    Major venous ligation without repair

    Inadequate excision of the damage vessel

    Elevated compartment pressures

    Infection

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    PENUTUP

    Primary Survey

    Secondary SurveyHard Sign

    Soft SignMultiple Trauma --- Team

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    T E R I M A K A S I H