Post on 02-Jun-2018
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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