Emergensi paru

What?

Kriteria Emergensi sesuai indikasi medis:• Kecelakaan/Ruda Paksa yang bukan kecelakaan kerja, contoh kasus: Trauma

kepala, patah tulang terbuka/tertutup, luka robekan/sayatan pada kulit/otot • Serangan jantung, contoh kasus: henti irama jantung, irama jantung yang

abnormal, nyeri dada akibat penyempitan/penutupan pembuluh darah jantung • Panas tinggi diatas 39 derajat Celsius atau disertai kejang demam, contoh kasus:

kejang demam • Perdarahan hebat, contoh diagnosis: Trauma dengan perdarahan hebat,

muntah/berak darah, abortus (keguguran) , Demam Berdarah Dengue Grade dengan komplikasi perdarahan

• Muntaber disertai Dehidrasi sedang s/d berat, contoh kasus: Kholera, Gastroenteritis akut dengan dehidrasi sedang/berat, mual dan muntah pada ibu hamil disertai dehidrasi sedang/berat

• Sesak Napas, contoh kasus: Asma sedang/berat dalam serangan, infeksi paru berat

• Kehilangan kesadaran, contoh kasus: Ayan/epilepsy, Syok/pingsan akibat kekurangan cairan, gangguan fungsi jantung, alergi berat, infeksi berat

• Nyeri kolik, contoh kasus: kolik abdomen, kolik renal, kolik ureter, kolik uretra• Keadaan gelisah pada penderita gangguan jiwa

Prosedur pelayanan emergensi (darurat) : • Pasien yang memenuhi kriteria emergensi atas indikasi medis dapat

berkunjung ke Unit Gawat Darurat (UGD) RS dan membawa KPK asli.

• Sementara pihak RS menangani pasien, keluarga mengurus administrasi di loket pendaftaran/dibagian Emergensi.

• Dokter UGD akan memeriksa pasien dan memberikan pertolongan pertama/melakukan tindakan medis serta memberikan resep minimum 1 (satu) hari dan maksimum 3 (tiga) hari

• Bila pasien belum sembuh, maka yang bersangkutan harus kembali ke PPK I yang ditunjuk/pilihan untuk mendapatkan pemeriksaan lebih lanjut atau PPK I akan merujuk ke dokter spesialis sesuai indikasi medis (bukan atas permintaan pasien sendiri). Pelayanan lanjutan tersebut harus mengikuti prosedur rawat jalan spesialis di PPK II/RS

• Bila pasien memerlukan perawatan setelah observasi di UGD, maka pihak Rumah Sakit akan mendaftarkan pasien sebagai pasien rawat inap

• Selanjutnya berlaku prosedur rawat inap

How?

• Resusitasi jantung paru bertujuan untuk mengembalikan fungsi pernafasan dan atau sirkulasi, dan penanganan akibat henti nafas (respiratory arrest) dan atau henti jantung (cardiac arrest), yang mana fungsi tersebut gagal total oleh sebab yang memungkinkan untuk hidup normal.

When ?

• Withholding resuscitation should be considered in cases of penetrating or blunt trauma victims who will obviously not survive.

• Standard resuscitation should be initiated in arrested patients who have not experienced a traumatic injury.

• Victims of lighting strike or drowning with significant hypothermia should be resuscitated.

• Children who showed signs of life before traumatic CPR should be taken immediately to the emergency room; CPR should be performed, the airway should be managed, and intravenous or intraosseous lines should be placed en route.

• In cases in which the trauma was not witnessed, it may be assumed that a longer period of hypoxia might have occurred and limiting CPR to 30 minutes or less may be considered.

• When the circumstances or timing of the traumatic event are in doubt, resuscitation can be initiated and continued until arrival at the hospital.

• Terminating resuscitation in children should be included in state protocols.

• unconscious • unresponsive • not breathing or not breathing normally (in

cardiac arrest, some people will take occasional gasping breaths – they still need CPR at this point. Don’t wait until they are not breathing at all)

http://www.betterhealth.vic.gov.au/bhcv

Resusitasi tidak dilakukan pada :§ Kematian normal, seperti yang biasa terjadi pada

penyakit akut atau kronik yang berat.§ Stadium terminal suatu penyakit yang tak dapat

disembuhkan lagi.§ Bila hampir dapat dipastikan bahwa fungsi

serebral tidak akan pulih, yaitu sesudah ½ – 1 jam terbukti tidak ada nadi pada normotermia tanpa RJP.

How ?

How?

1.airway

Posisi Perbaikan

• Emergency Needle DecompressionSuspicion of a tension pneumothorax

accompanied with alterations in ventilation or perfusion mandates immediate needle decompression.

• Chest Needle Decompression/The Procedure

• Gather Equipment-A large (14 gauge or larger) angiocath works well. It is imperative that you use at least a 2-2 ¼" needle. For the procedure to be effective you must be able to puncture into the pleural cavity. Some patients may have a thick (2-3cm) chest wall. You must use a needle with an adequate length. There are several commercial devices on the market that are specifically designed for needle thoracostomy. Most include a flutter valve or one-way valve device on them. These valves act to allow air to escape but not reenter the pleural cavity. A finger cut from a latex glove or a condom works also. Using a flutter valve on the needle is not as imperative as using a long enough needle. The likelihood of enough air reentering via the needle to really effect the patient is small.

• Identify Landmarks-You may use the 2nd intracostal (ICS) space at the midclavicular line or the 5th-6th ICS at the midaxillary line to perform the procedure. Take care to note the proper site and landmarks. The 5th ICS is roughly the nipple line. Pick your site and clean the area with alcohol or betadine.

• Insertion-Insert the needle on the superior aspect of the rib. Remember that a nerve, vein and artery run on the inferior aspect. You may puncture the skin holding the needle perpendicularly. If you hit a rib "tunnel" slightly to puncture over the superior aspect. As the needle enters the pleural space you should hear a hiss or rush of air as the air under tension is released. Secure the needle or device to the chest wall and if available attach a flutter valve. Anticipate placement of a chest tube as soon as qualified personnel and equipment are available.

• Follow-up-Continue to monitor the patient for dyspnea, or return/worsening of symptoms. If the patient deteriorates further consider repeating the procedure at another site. The in situ needle or device could have clotted off.