PAK - GETARAN

ERWIN DN

• DEFINISI• PENYEBAB• PATHOGENESIS• DIAGNOSIS• TERAPI• PROGNOSIS• PENCEGAHAN

PAK AKIBAT GETARAN

• Penyakit akibat getaran adalah penyakit atau gangguan kesehatan akibat getaran

• PAK akibat getaran :– PAK akibat getaran seluruh tubuh– PAK akibat getaran setempat (segmented

vibration/ tool hand vibration)

Whole Body Vibration

• Getaran mekanaik yang disampaikan lewat tempat duduk (ex: alat berat) / lantai

• Getaraan dari alat berat tempat

duduk tulang belakang supir

WORKERS AT RISK

o Supir Traktor, truk, mobile crusherso Fork-liftso Masnis, supir bus, taksi, motor boat,

helikopter, pesawat o Mesin / Alat berat (hammering and

punching machinery)o Orang yang bekerja di landasan yang

bergetar

VibrationsVibrations

Vibration

• Exposure to vibration can occur while using power tools or while driving equipment.

• Vibration from power tools can place stress on the tissues of the fingers, hand and arms.

• Whole body vibration from driving puts stress on the spinal tissues.

Vibration ExposureVibration ExposureWhole BodyWhole Body

4 s/d7 % pekerja di Eropa& USA terpapar WBV yang berbahaya bagi kesehatannya

Terdapat berbagai faktor yang perlu diperhatikan dalam menilai efek getaran pada manusia , yaitu:

• Karakteristik fisik dari frekuensi dan intensitas getaran

• Tipe dari sumber getaran• Lamanya pemajanan• Arah getaran• Posisi tubuh• Kerentanan individu• Faktor lingkungan misalnya suhu udara,

kebisingan, beban kerja dll.

Efek fisik getaran Pada otot skelet (4-12 Hz)

Osteoarthritis

Osteoarthritis

Osteoarthritis

Osteoarthritis

Efek getaran dan frekuensi

Frekuensi (Hz) Efek4-12 Kerusakan sistem otot dan tulang

4-5 Kerusakan tulang belakang

5-20 (dg intensitas sangat tinggi

Perdarahan paru

Frekuensi-efek

Frekuensi (hz) efek< 10 Rongga dada dan perut>10 Organ dan jaringan perifer

EFEK PADA KESEHATAN WBV

FREKUENSI(HZ)

GANGGUAN KESEHATAN

4-12 -KERUSAKAN SEL TULANG RAWAN (ARTHRITIS PERMANEN)-SERUSAKAN SPINAL (HNPLBP)-ABDOMINAL PAIN-HEMATURIA-PERDARAHAN PARU (5-10 HZ; 5-15G)

3-9 DADA & PERUT10 LEHER, KEPALA, PINGGUL, PERINEUM, OTOT, TULANG

13-15 PHARYNX6-10 TEKANAN DARAH, DENYUT JANTUNG, IO2 MAX

MENINGKAT

GANGGUAN KESEHATAN MENURUT FREKUENSI

EFEK FREKUENSI (HZ)0,1-1 1-10 10-100 100-1000 1000-

10000>10.000

MABUKGANGGUAN BICARA

MATA KABUR

GANGGUAN TUGAS

SPINAL RUSAK*(KRONIS)

GANGGUAN GI*(KRONIS)

REYNOD D**

• Denyut jantung meningkat (10 – 15x/mnt) pada kondisi eksperimen yang normal, tanpa memperhatikan frekuensi pajanan kontinyu pulih

• TD meningkat pd frek. ± 5 Hz menurun pd frek. ± 10 - 20 Hz

Respon fisiologis thd WBV yg masih dapat ditolerir o/ manusia adalah :

• Tidal Volume : meningkat pada semua frekuensi (maks. Pd frek. 5 – 7 Hz)

• RR meningkat linier dg intensitas

• Pd 5-7Hz : VC menurun O2 Uptake meningkat.

• Efek WBV pd ginjal , darah & endokrin : - Belum atau tidak terdapat bukti yg jelas

• Efek WBV pd keseimbangan : - tgt kerentanan individu.

Efek Getaran Pada Performance

• Ggn. Fgs. & ketajaman penglihatan - sebanding dg amplitudo getaran - maksimum pd frek.10 -25 Hz.

• Penurunan performance pada tracking task (pekerjaan mengikuti jejak misalnya jejak satelit, pesawat udara dll)

- sebanding dengan amplitudo getaran - maksimum pd frek. rendah (≤ 5 Hz)

HNP (Hernia Nucleus Pulposus)

• Tergelincirnya nukleus pulposus (anulus fibrosus)/slipped disc

• Pathogenesis:WBV kerusakan tulang rawan slipped

disc tekanan pada radiks dorsalis LBP

HERNIA NUCLEUS PULPOSUS (SLIP DISC)

Beberapa Faktor Risiko LBPa. sikap tubuh yg jelek & kurang OR

- sikap berdiri yang membungkuk ke depan, - dada kempes - pungung lordosis - tidak tegap , - perut buncit

tekanan BB jatuh ke depan sbg kompensasi punggung hrs ditarik ke belakang -- hiperlordosis lumbal jk lama kelelahan otot & rangsangan pd ligamen nyeri.

Bad posture

b. Obesitas & kehamilan trimester akhir perpindahan tekanan BB ke depanc. >>> duduk otot hamstring kaku &

pendek d. Panjang tungkai yang tidak samae. Sepatu tumit yang tinggi / pemendekan

tendon achilles titik Berat bergeser ke

depan

f. kelemahan otot dinding perut , gluteus maksimis & ileopsoas serta pemendekan otot-otot ekstensor punggug (otot yg penting u/ mempertahankan sudut

lumbosacralis pd posisi optimal (30º )) kelemahan = ”unstable back”.

g. Merokok (blm jelas) - tekanan intra diskus meningkat (batuk kronis) - peregangan otot - nikotin

h. Kesegaran jasmani IKJ Baik < berisiko LBP

i. Lama masa kerja semakin lama (dg beban berat) risiko semakin meningkat

ACGIH TLVs and BEIs HandbookWhole-Body Vibration Threshold Limit

Values (TLV’s)

ax, ay, az = acceleration in the directions of the x, y, z, axesx axis = back - to – chesty axis = right – to – leftz axis = foot (or buttocks) - to - head

X

X

X

Y

YY

Z

Pencegahan• Hindari paparan WBV > NAB pilih

peralatan/mesin yang anti getaran, pemeliharaan mesin, gunakan peredam, sepatu anti getaran

• Atur waktu kerja istirahat : 1 jam kerja-10 menit istirahat

• Istirahat : stretching, massaging, relaxing• Terapi sesuai gejala• Hindari faktor risiko• Jaga badan tetap hangat

GETARAN SELURUH TUBUH

Paparan menahun (f=) Paparan akut (F=)Gangguan aliran darah amplifikasi /resonansi Di daerah ginjal dan saluran kencingKerusakan permanen pada sendi/tulang

Arthritis Peradangan/inflamasi

Slipped disc (L4-L5 atau L5 S1) Gangguan Fungsi Ginjal dan sal.Kencing, dg

indicator:Hematuria

HNP BUN Serum Creatini LBP Urea

PAK –GETARAN SETEMPAT

What is HAV (Hand-Arm Vibration)?

 

What is HAV (Hand-Arm Vibration)? -transmitted from work processes into workers hands and arms. - It can be caused by operating hand-held power tools such as : road breakers, hand-guided equipment (ex:s lawn mowers) holding materials being processed by machines such as pedestal grinders.

What injuries can HAV cause?

  Regular exposure to HAV can cause a range of permanent injuries to your hands and arms that are known as hand-arm vibration syndrome (HAVS). The injuries can include damage to the following: 

What injuries can HAV cause? 

o      Blood Circulatory System (vibration white finger) - >> tjd jika suhu tubuh/tangan dingin atau basah - tanda awal: ujung jari putih (kadang2) , baal , seperti terusuk jarum - akhir serangan: jari putih berubah merah & sangat nyeri  oSensory Nerve Damage - kerusakan syaraf di jari rasa raba & rasa suhu berkurang baal permanen, kesemutan di jari oDamage to Muscle, Bones & Joints - kekuatan tangan hilang - nyeri di lengan & pergelangan tangan

Health Effects (bisanya Health Effects (bisanya setelah 3-5th)setelah 3-5th)

Hand ArmHand Arm

Vascular and circulation problems.Vascular and circulation problems.

Neurológical.Neurológical.

Muscular disordersMuscular disorders

OthersOthers

Symptoms – Advanced Stages

• White or Blanched Finger Tips– Aggravated by cold– Mistaken for frostbite– Few minutes initially

• With Continued Exposure– Blanching spreads– Attacks Increase in

• Frequency• Intensity• Duration

Symptoms – Latter stages• Occur in all seasons• On and off job• Triggered by

– Cold– Vibrating objects– Nicotine

• Severe Cases– Gangrene– Amputation

Stockholm HAVS Classification System (Vascular Assessment)

Stage

Grade Description

0 --------- No attacks1V Mild Occasional attacks affecting only

one or more fingers2V Moderate Occasional attacks affecting distal

and middle phalanges (rarely also proximal) of one or more fingers

3V Severe Frequent attacks affecting ALL phalanges of most fingers

4V Very Severe

As in Stage 3, with trophic skin changes in the finger tips

Stockholm HAVS Classification System (Sensorineural

Assessment)Stage Symptoms0SN Exposed to vibration but no symptoms

1SN Intermittent numbness, with or without tingling

2SN Intermittent or persistent numbness, reducing sensory perception

3SN Intermittent or persistent numbness, reducing tactile discrimination and/or manipulative dexterity

Normal Artery

Muscle

Normal flow

Damage Artery

Flow Restriction

Health EffectsHealth EffectsVascular DisordersVascular Disorders

Typical HAV Sources

• Fastening Tools• Cutting Tools• Finishing Tools• Gardening Tools• Compaction Tools• Drilling/Boring Tools• And More

Vibration ExposureVibration ExposureHand ArmHand Arm

Vibration ExposureVibration ExposureHand ArmHand Arm

Vibration ExposureVibration ExposureHand ArmHand Arm

Hand Arm vibration exposure

What other factors can contribute to vibration injury? 

 o     o* How high the vibration levels

o* How long you use the tools and equipment

o* How awkward it is for you to use the equipment

o* How tightly you have to grip the equipment

o* How cold and wet you get when using the equipmento Individual susceptibility - smokers are at a greater risk 

Upaya Pencegahan

• Jaga agar paparan tak melampaui NAB• Atur waktu kera-istirahat (1 jam-10 mnt)• Istirahat : massaging, swinging, shaking• Pakai gloves (VIP)• Jaga agar badan tetap hangat• Hindari faktor risiko

Acceleration levels from Hand Arm VibrationsHand-arm vibration acceleration level

(m/sec2)Tool Type

1,183 Riveter, Caulker

424 Chipping Hammer

416 Motorcycle

339 Jack-Leg Drill

251 Grinder

195 Pavement Breaker

125 Pedestal Grinder

75 Chain Saw

59 Brush Saw

20 Hand Grinder

Tri-axial Measurements must be perform:

Basicentric Measurement: Measurement of vibration directly from the tool. 

Basicdynamic Measurement: Measurement of vibration indirectly over a knuckle.

2002/44/ECDirective 2002/44/EC of the European

Parliament and of the Council8-Hour Daily Exposure Limit Action Value Limit Value 

Hand-Arm 2.5 m/s2 5 m/s2

 Whole-Body 0.5 m/s2 1.15 m/s2

 Whole-Body (vibration dose) 9.1 m/s1.75 21 m/s1.75

Vibrations on the Human body

QUESTIONS?