Diagnosis dan Diagnosis dan PenanganannyaPenanganannya

TRAUMA VASKULER

PADA EXTREMITAS

PPENDAHULUANENDAHULUAN TRAUMA EXTREMITAS TRAUMA EXTREMITAS PASTIPASTI DISERTAI DISERTAI

TRAUMA VASKULERTRAUMA VASKULER

RINGAN SAMPAI BERATRINGAN SAMPAI BERAT

LIFE THREATENINGLIFE THREATENING

LIMB THREATENINGLIMB THREATENING

PPENDAHULUANENDAHULUAN MENGALIHKAN PERHATIANMENGALIHKAN PERHATIAN

PRIMARY SURVEYPRIMARY SURVEY

SECONDARY SURVEYSECONDARY SURVEY

EETIOLOGITIOLOGI LANGSUNG / DIRECTLANGSUNG / DIRECT

TIDAK LANGSUNG / INDIRECTTIDAK LANGSUNG / INDIRECT

KERUSAKAN ENDOTEL LOKALKERUSAKAN ENDOTEL LOKAL

EETIOLOGITIOLOGI : : DDIRECTIRECT

TRAUMA TUMPULTRAUMA TUMPUL

TRAUMA TAJAMTRAUMA TAJAM

EETIOLOGITIOLOGI : : IINDIRECTNDIRECT

TRAUMA TRAUMA KOMPRESSIKOMPRESSI

TRAUMA TARIKANTRAUMA TARIKAN

EETIOLOGITIOLOGI : : LOKAL LOKAL ENDOTEELENDOTEEL

OBAT-OBATAN ( DRUGs )OBAT-OBATAN ( DRUGs )

TRAUMA DINGIN TRAUMA DINGIN ( FREEZING )( FREEZING )

TTIPE IPE KKERUSAKANERUSAKAN KONTUSIKONTUSI

PERFORASIPERFORASI

LASERASILASERASI

TRANSEKSITRANSEKSI

DDIAGNOSISIAGNOSIS ANAMNESAANAMNESA

INSPEKSIINSPEKSI

PALPASIPALPASI

AUSKULTASIAUSKULTASI

DDIAGNOSISIAGNOSIS

MENGANCAM NYAWAMENGANCAM NYAWA

MENGANCAM EXTREMITASMENGANCAM EXTREMITAS HARD SIGNHARD SIGN

SOFT SIGNSOFT SIGN

HHARD ARD SSIGNIGN PERDARAHAN YANG PERDARAHAN YANG

BERDENYUTBERDENYUT ADANYA ARTERIAL THRILLADANYA ARTERIAL THRILL BRUIT DEKAT ARTERIBRUIT DEKAT ARTERI ISCHEMIA DISTALISCHEMIA DISTAL HEMATOMA YANG MEMBESARHEMATOMA YANG MEMBESAR

SOFT SIGNSOFT SIGN Anamnesa ada perdarahan Anamnesa ada perdarahan

banyakbanyak Menurunnya pulsasi arteriMenurunnya pulsasi arteri Adanya trauma tulang bagian Adanya trauma tulang bagian

proximal proximal Adanya kelainan neurologisAdanya kelainan neurologis

The Rule of Six - PThe Rule of Six - P PPAINAIN PPARASTHESIAARASTHESIA PPARALYSISARALYSIS PPALLORALLOR PPULSLESSNESSULSLESSNESS PPERISHINGLY COLD EXTREMITYERISHINGLY COLD EXTREMITY

GEJALA KLASIK GEJALA KLASIK MENGHILANGMENGHILANG

ADANYA SYOKADANYA SYOK

PEMBENGKAKAN, EDEM DAN PEMBENGKAKAN, EDEM DAN KONGESTI VENAKONGESTI VENA

PERSISTEN PULSES (25%)PERSISTEN PULSES (25%)

LABORATORISLABORATORIS DARAH LENGKAPDARAH LENGKAP TROMBOSIT CountTROMBOSIT Count BUN, S CREATININBUN, S CREATININ GOLONGAN DARAHGOLONGAN DARAH FAAL HEMOSTASISFAAL HEMOSTASIS

IMAGINGIMAGING

PLAIN X-RAYPLAIN X-RAY ARTERIOGRAFIARTERIOGRAFI

DUPLEX DOPPLERDUPLEX DOPPLER

MANAGEMENTMANAGEMENT LIFE TREATHENINGLIFE TREATHENING LIMB TREATHENINGLIMB TREATHENING HARD SIGNHARD SIGN SOFT SIGNSOFT SIGN

Management : Management : LIFE LIFE THREATENINGTHREATENING

MAJOR PELVIC DISRUPTION MAJOR PELVIC DISRUPTION WITH HEMORRAGEWITH HEMORRAGE

MAJOR HEMMORHAGEMAJOR HEMMORHAGE CRUSH SYNDROMECRUSH SYNDROME

OPEN FRACTURE AND JOINT OPEN FRACTURE AND JOINT INJURIESINJURIES

COMPARTMENT SYNDROMECOMPARTMENT SYNDROME VASCULAR AND TRAUMATIC VASCULAR AND TRAUMATIC

AMPUTATIONAMPUTATION NEUROLOGIC INJURIESNEUROLOGIC INJURIES

Management : Management : LIMB LIMB THREATENINGTHREATENING

PENANGANAN TRAUMA PENANGANAN TRAUMA VASKULERVASKULER

PENDERITA STABILPENDERITA STABILHARD SIGN HARD SIGN

EXPLORASIEXPLORASISOFT SIGN SOFT SIGN

EVALUASIEVALUASI

MEDIKA MENTOSAMEDIKA MENTOSA

ANTIKOAGULAN PENTING UNTUK ANTIKOAGULAN PENTING UNTUK MENCEGAH THROMBOSISMENCEGAH THROMBOSIS

ANTI PLATELET DRUG MEMPUNYAI ANTI PLATELET DRUG MEMPUNYAI MANFAAT POST VASCULAR REPAIRMANFAAT POST VASCULAR REPAIR

TERAPI BEDAHTERAPI BEDAH

LIGASILIGASIREPAIRREPAIRREKONSTRUKSIREKONSTRUKSIREPLACEMENTREPLACEMENT

MANGLED EXTREMITYMANGLED EXTREMITY

DERAJAT KERUSAKANDERAJAT KERUSAKANISCHEMIAISCHEMIASYOKSYOKUMUR PENDERITAUMUR PENDERITA

CRUSH INJURYCRUSH INJURY

IVFDIVFD

CCOMPARTMENT OMPARTMENT SSYNDROMEYNDROME

TAMPAK TEGANGTAMPAK TEGANGADA GEJALA 6 PADA GEJALA 6 PBUKA SEMUA BALUTAN / SPLINTBUKA SEMUA BALUTAN / SPLINTEVALUASIEVALUASIFASCIOTOMYFASCIOTOMY

SUSPECTED VASCULAR INJURY

RESUSCITATE

HARD SIGN SOFT SIGN

API > 0.9 API<0.9

OBSERVE COLOUR FLOW DUPLEX ARTERIOGRAFI ULTRASONOGRAFI

CLINICAL FOLLOW UP

SURGICAL EXPLORATION ARTERIOGRAM CLINICAL FOLLOW UP

MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI

Komplikasi Komplikasi Prolonged ischemiaProlonged ischemia Secondary haemorrhageSecondary haemorrhage Fail reconstruction, recurrent ischemiaFail reconstruction, recurrent ischemia Vascular salvage of union functional Vascular salvage of union functional

limblimb Venous thromboembolismVenous thromboembolism Iatrogenic complicationIatrogenic complication

MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI

Kegagalan rekonstruksi vaskulerKegagalan rekonstruksi vaskuler Suture line tentionSuture line tention Missed intimal flapMissed intimal flap Missed proximal or distal Missed proximal or distal injuryinjury

Retained thrombosisRetained thrombosis

MASALAH YANG MASALAH YANG DIHADAPIDIHADAPI Kegagalan rekonstruksi vaskulerKegagalan rekonstruksi vaskuler

Imperfect anatomosisImperfect anatomosis Lateral repair without patchLateral repair without patch Major venous ligation without repairMajor venous ligation without repair Inadequate excision of the damage Inadequate excision of the damage

vesselvessel Elevated compartment pressuresElevated compartment pressures InfectionInfection

PENUTUPPENUTUPPrimary SurveyPrimary SurveySecondary SurveySecondary SurveyHard SignHard SignSoft SignSoft SignMultiple Trauma --- TeamMultiple Trauma --- Team

T E R I M A K A S I H