Primary Survey

Assessment
(Penilaian dan Penanganan
Survei Primer)
Departemen Anestesiologi dan Terapi Intensif
FK USU
2011

Emergency Medicine
TRIAGE
PRIMARY SURVEY
SECONDARY SURVEY
STABILISATION
TRANSFER
DEFINITIVE CARE

TRIASE
SURVEI PRIMER
SURVEI SEKUNDER
STABILISASI
RUJUKAN
TERAPI DEFINITIF

Tujuan Survei Primer

Secepat

mungkin menemukan
kelainan yang mengancam jiwa
(cepat mematikan)
di sektor A - B - C - D

Memberikan

pertolongan yang
memadai untuk menyelamatkan jiwa
Pertolongan meliputi :
Resusitasi
Stabilisasi

Concepts of Primary
Survey
Rapid Primary survey

Resuscitation

Adjuncts to primary survey

/resuscitation

Detailed secondary survey

Adjuncts to secondary survey

Reevaluation

Definitive care

Korban ledakan tabung elpiji

Muka hangus
Pneumotoraks (blast injury)
Luka bakar luas
Fraktura betis kiri

Jangan terpukau
kelainan yang
jelas terlihat

Ikuti Sistematika A - B - C D

Derajat kegawatan
korban berbeda-beda
Triage Survei primer
Survei sekunder

Terapi definitif
/ rujukan
RS lain

RESUSITASI
& STABILISASI

Emergency Medicine

Kamar
Operasi

ICU
Hanya 50%
pasien trauma
perlu operasi

Triage

Sorting of patients
according to :
ABCDEs
Available resources
Multiple casualties
Mass casualties

Primary Survey
Primary survey
and resuscitation
of vital functions
are done
simultaneously
a team approach

ACS

Preparation
Prehospital System
Transport guidelines /protocols
On-line medical direction
Mobilization of resources

Periodic review of care

Closest appropriate facility

Preparation
Inhospital
Preplanning essential

Equipment, personnel,
services
Standard precautions
Transfer agreement

Standard Precautions
Cap
Gown
Gloves
Mask
Shoe

covers
Goggles/face
Shields

Survei Primer
Periksa cepat berurutan
Selesai dalam 2 menit
Terapi segera apa yang ditemukan

( treat as you find )

Survei Primer
Airway
Breathing
Circulation
Disability
Exposure

Jalan nafas
Pernafasan
Sirkulasi
Kesadaran
Pemaparan

Mulai dengan Survei Primer

Mencari dengan cepat gangguan fungsi vital di

sektor A-B-C-D
Memberi terapi suportif dengan cepat pada fungsi
yang terganggu

Setelah fungsi vital stabil Survei Sekunder

Mencari gangguan fungsi vital dengan teliti

Memberi terapi definitif pada fungsi yang
terganggu

Resuscitation
Protect and secure airway
Ventilate and oxygenate
Stop the bleeding
Vigorous shock therapy
Protect from hypothermia

Survei Primer
Airway
Breathing
Circulatio
n
Disability
Exposure

Sumbatan jalan nafas pasien tak

sadar paling sering disebabkan
pangkal lidah

Airway

menilai jalan nafas

Kesadaran (bisa bicara?)
Look, Listen and Feel
Gerak dada
Gerak otot nafas tambahan
Warna kulit, mukosa, kuku

Airway

mengatasi obstruksi / sumbatan jalan

nafas

Lakukan chin lift / jaw thrust

Bersihkan rongga mulut (suction?)
Pasang jalan nafas oro /
nasopharynx
Lindungi tulang leher
Intubasi trachea

20

JN Nasopharynx
Jaw thrust

JN Oropharynx

Walaupun tanpa intubasi

masih banyak
pasien dapat ditolong

JN Nasopharynx
21

Head tilt

Neck lift

Chin-lift
22

Airway
waspada

Obstruksi (sumbatan) jalan

nafas
Cedera dada dengan gangguan
nafas
Cedera tulang leher

Lindungi leher dari gerakan

Previously recommended hand

positions for manual in-line
stabilisation of the cervical
spine.

Currently recommended hand

positions for manual in-line
stabilisation of the cervical
spine.
24

Primary Survey
Establish Patent Airway
C-spine injury
Pitfalls

Cautio
n

Equipment failure
Inability to intubate
Occult airway injury
Progressive loss of
airway

Primary Survey

Suspect C-Spine Injury

Spinal protection
C-spine X-ray when
appropriate

Survei Primer
Airway
Breathin
g
Circulatio
n
Disability
Exposure

Breathing

menilai pernafasan

Adakah udara keluar masuk

Look, Listen, Feel

Frekwensi nafas
Gerak cuping hidung
Cekungan sela iga

Breathing
membantu
pernafasan

1. Oksigen (jika ada)

2. Pernafasan buatan

2.

1.

2.

29

Jejas di dada:

Breathing
waspada

- Pneumotoraks
tension
- Fr costa / Flail chest
- Hemotoraks berat
- Kontusio paru
- Pneumotoraks
terbuka
30

Dekompresi pneumotoraks (tension)

harus dikerjakan dalam Primary Survey

Survei Primer
Airway
Breathing
Circulati
on
Disability
Exposure

Circulation

mengatasi perdarahan
Hentikan perdarahan
Posisi shock
Pasang infus besar x 2
Ambil sampel darah

u/ darah donor dan periksa Hb

Beri infus cairan, 1000 ml cepat

Circulation

mengatasi perdarahan

Beri infus cairan, 1000 ml

cepat

RL (Ringer Laktat)
NaCl 0.9% (Garam Fisiologis)
RA (Ringer Asetat)
Hypertonic Saline Dextran 250 ml

Shock ?
Perfusi

pucat - dingin - basah

cap. refill time lambat (kuku, telapak)

Nadi > 100

Tekanan darah

< 100 (atau 90)

mmHg Nadi masih teraba di :

radialis > 80 mmHg
femoralis > 70 mmHg
carotis
> 60 mmHg

Circulation

waspada & cari lokasi perdarahan

Cedera intra-abdominal
Cedera dada
Patah tulang panjang
Patah tulang pinggul
Luka tusuk / tembus
Luka kulit kepala

Primary Survey
Circulatory Management

Control hemorrhage

Restore volume

Reassess
Pitfalls
Elderly

Caution
Medication

Athletes

Children

Survei Primer
Airway
Breathing
Circulatio
n
Disabilit
y
Exposure

Disability

menilai kesadaran

Periksa Pupil (besar, simetri, refleks

cahaya)
Periksa kesadaran
A = Awake (sadar penuh)
V = responds to Verbal command

(ada reaksi terhadap perintah)

P = responds to Pain
reaksi terhadap nyeri)

U = Unresponsive

(ada
(tak ada reaksi)

A- V - P - U
Pupil

Primary Survey
Disability
Baseline neurologic evaluation
GCS scoring
Pupillary response
Observe for
neurologic
Caution
deterioration

Survei Primer
Airway
Breathing
Circulatio
n
Disability
Exposure

Exposure
pemaparan

Lepaskan semua pakaian untuk

pemeriksaan teliti menyeluruh,
ada jejas apa saja
Periksa punggung!

miringkan pasien cara Log-roll

Cegah hipotermia (kedinginan)

Primary Survey
Exposure / Environment
Completely undress the
patient
Caution

hypothermia

Prevent

Survei Primer
Foto Dada sinar-X / Chest X-Ray ( jika ada)

Tulang leher / C Spine(lateral)

Panggul ( Pelvis )
Abdominal USG

Adjuncts to Primary
Survey
Vital sign
ECG
Urinary

ABGs
Adjuncts

Pulse

Output
oximeter
and CO
Urinary/gastric catheters
unless contraindicated

Adjuncts to Primary
Survey
Diagnostic Tools
Chest

and pelvic

x-ray
DPL
Ultrasound

ACS

Adjuncts to Primary
Survey

Consider Early Transfer

Do not delay transfer for
diagnostic tests
Use time before transfer for
resuscitation

Special Considerations
Trauma in the Elderly
5th leading cause of death
Physiologic reserve
Comorbidities :
Diseases/medications
Outcome depends on early,
aggressive care

Survei Sekunder
Lanjutan dari survei primer
Hanya bila ABC sudah stabil
Teliti kepala sampai jari kaki
Kembali ulang survei primer jika
pasien tidak stabil / kondisi
memburuk

Reevaluate
Proceed to Secondary Survey
After :

Primary survey completed

ABCD Es are reassessed
Vital functions are
returning to normal

END

52