Pp 3 1 Panduan Pelayanan Gawat Darurat Edit PDF

8/20/2019 Pp 3 1 Panduan Pelayanan Gawat Darurat Edit PDF

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RS PKU MUHAMMADIYAH YOGYAKARTA UNIT II

Jl.Wates Km 5,5 Gamping, Sleman, Yogyakarta – 55294

Telp. (024! "4990", #G$ (024! "499%%&'a. (024! "4992,e)mail*pk+oga2-yaoo./o.i

KEPUTUSAN DIREKTUR

RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II

Nomor : 0424/PS.1.2/IV/2015

Tentang

PANDUAN PELAYANAN PASIEN GAWAT DAUAT

DIE!TU U"A# SA!IT P!U "U#A""ADIYA# Y$GYA!ATA UNIT II

"en%m&ang : a. 'a()a *a+am ,-aa men%ngatan ,a+%ta *an

eamanan -e+aanan -a%en maa *%-er+,an a*ana

Pan*,an Pe+aanan Pa%en Ga)at Dar,rat *% ,ma(

Sa%t P!U ",(amma*%a( Yogaarta Un%t II.

&. 'a()a e,a% &,t%r a *%ata -er+, meneta-an !e-,t,an

D%ret,r ,ma( Sa%t P!U ",(amma*%a( Yogaarta

Un%t II tentang Pan*,an Pe+aanan Pa%en Ga)at

Dar,rat

"eng%ngat : 1. Un*angUn*ang I Nomor 3 Ta(,n 200 tentang

!ee(atan

2. Un*angUn*ang I Nomor 44 Ta(,n 200 tentang

,ma( Sa%t

3. Un*angUn*ang I Nomor 2 Ta(,n 2004 tentang

Prate !e*oteran

4. !e-,t,an "enter% !ee(atan I Nomor

115.A/"en!e/S!/6/2004 tentang !om%% Are*%ta%

,ma( Sa%t.

5. S,rat !e-,t,an 'a*an Pe+aana #ar%an ,ma( Sa%t

P!U ",(amma*%a( Yogaarta nomer 015/'II/'P#

II/6II/2013 tangga+ 12 Deem&er 2013 " tentang

S,,nan D%re% ,ma( Sa%t P!U ",(amma*%a(

Yogaarta Un%t II.


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M E M U T U S K A N

"eneta-an :

PETA"A !EPUTUSAN DIE!TUU"A# SA!IT P!U

"U#A""ADIYA# Y$GYA!ATA UNIT II

TENTANG PANDUAN PELAYANAN PASIEN GAWAT

DAUAT U"A# SA!IT P!U "U#A""ADIYA#Y$GYA!ATA UNIT II.

!EDUA : Pan*,an Pe+aanan Pa%en Ga)at Dar,rat *%ma,*an

e&aga%mana ter7ant,m *a+am Pan*,an *% !e-,t,an %n%.

!ETIGA : Pe+aanaan Pan*,an Pe+aanan Pa%en Ga)at Dar,rat

*%ma,*an ,nt, men%ngatan ,a+%ta *an eamanan

-e+aanan -a%en e&aga%mana *%ma,* *a+am D%t,m

eat,

!EE"PAT : !e-,t,an %n% &er+a, e8a tangga+ *%teta-an.

D%teta-an *% : S+eman

Pa*a Tangga+ : 4 A-r%+ 2015

D%ret,r

*r. #. A(ma* 9aeo+ S-. a* ". !e.

N'": .2


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!ATA PENGANTA

Sega+a -,8% (ana+a( &ag% A++a( S,&(ana(,)ata;a+a T,(an emeta a+am ang

te+a( mem&er%an %*+o *an Pet,n8, < Na e(%ngga Pan*,an Pe+aanan Pa%en

Ga)at Dar,rat %n% *a-at e+ea%an *an *a-at *%ter&%tan.

Pan*,an %n% *%&,at ,nt, men8a*% -an*,an er8a &ag% em,a ta= *a+am

mem&er%an -e+aanan ang tera%t -enanganan -a%en ga)at *ar,rat *% ,ma( Sa%t

P!U ",(amma*%a( Yogaarta ,n%t II.

Unt, -en%ngatan m,t, -e+aanan *%-er+,an -engem&angan e&%8aan

-e*oman -an*,an *an -roe*,r. Unt, t,8,an tere&,t -an*,an %n% aan am% e>a+,a%

et%*ana et%a- 2 ta(,n ea+%. "a,an r%t% *an aran ang ontr,t%= ,nt,

-engem&angan -an*,an %n% angat am% (ara-an *ar% -ara -em&a7a.

S+eman 1 A-r%+ 2015

D%ret,r

1S K3 +ammaiya Yogyakarta

+nit II i


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DAFTAR ISI

#a+aman:

SUAT !EPUTUSAN DIE!TU

!ATA PENGANTA %

DA9TA ISI %%

A. DE9INISI. 1

'. UANG LING!UP. 1

?. TATA LA!SANA

1. Tr%age 2

2. Penanganan Pa%en.

a. Genera+ Im-re%on 2

&. Penga8%an Airway 3

7. Penga8%an Breathing @Perna=aan 3

*. Penga8%an Circulation 5

e. Penga8%an Level of Consciousness *an Disabilities

=. Expose Examine *an Evaluate

D. D$!U"ENTASI. B


+nit II ii


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LA"PIAN

!e-,t,an D%ret,r Nomor 0424/PS.1.2/IV/2015

Tentang Pan*,an Pe+aanan Pa%en Ga)at Dar,rat

PANDUAN PELAYANAN PASIEN GAWAT DAUAT

1. DE9INISI.

1. Penangg,+angan Pen*er%ta Ga)at Dar,rat @PPGD S,at, -erto+ongan

ang 7e-at *an te-at ,nt, men7ega( emat%an ma,-,n e7atatan.'eraa+ *ar% %t%+a( 7r%t%7a+ %++ -at%ent @-a%en r%t%/ga)at *an emergen7

-at%ent @-a%en *ar,rat.

2. Pen*er%ta Ga)at Dar,rat Pen*er%ta ang men*a*a &era*a *a+am

ea*aan ga)at *an teran7am na)ana ata, anggota &a*anna @aan

men8a*% 7a7at &%+a t%*a men*a-at -erto+ongan e7e-atna. ?onto( :

A"I 9rat,r ter&,a tra,ma e-a+a.

3. Pen*er%ta Ga)at T%*a Dar,rat Pen*er%ta ang memer+,an -erto+ongan

C egera teta-% t%*a teran7am 8%)ana/men%m&,+an e7a7atan &%+a

t%*a men*a-atan -erto+ongan egera m%a+na aner ta*%,m +an8,t.

4. Pen*er%ta Dar,rat T%*a Ga)at Pen*er%ta a%&at m,%&a( ang *atang

t%&at%&a teta-% t%*a mengan7am na)a *an anggota &a*anna m%ana

+,a aat *anga+.

5. Pa%en T%*a Ga)at T%*a Dar,rat Pen*er%ta ang men*er%ta -ena%t

ang t%*a mengan7am 8%)a/e7a7atan "%a+na -a%en *engan D"

terontro+ =+, maag *an e&aga%na.

2. UANG LING!UP.

?a,-an -e+aanan ee(atan ang -er+, *%em&angan me+%-,t%:

1. Penangg,+angan -en*er%ta *% tem-at e8a*%an

2. Tran-orta% -en*er%ta ga)at *ar,rat *an tem-at e8a*%an earana

ee(atan ang +e&%( mema*a%.

3. U-aa -ene*%aan arana om,n%a% ,nt, men,n8ang eg%atan

-enangg,+angan -en*er%ta ga)at *ar,rat.

1S K3 +ammaiya Yogyakarta+nit II %


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4. U-aa r,8,an %+m, -engeta(,an-a%en *an tenaga a(+%

5. U-aa -enangg,+angan -en*er%ta ga)at *ar,rat *% tem-at r,8,an @Un%tGa)at Dar,rat *an I?U.

3. TATA LA!SANA

1. Tr%age

T%n*aan mem%+a(m%+a( or&an e,a% *engan t%ngat ega)atanna

,nt, mem-ero+e( -r%or%ta t%n*aan. Pem&ag%an go+ongan -a*a m,%&a(

maa+/ &en7ana :

1. Ga)at *ar,rat < mera( !e+om-o -a%en ang t%&at%&a &era*a

*a+am ea*aan ga)at ata, aan men8a*% ga)at *an teran7am

na)ana ata, anggota &a*anna @aan men8a*% 7a7at &%+a t%*a

men*a-at -erto+ongan e7e-atna.

2. Ga)at t%*a *ar,rat < -,t%( !e+om-o -a%en &era*a *a+am ea*aan

ga)at teta-% t%*a memer+,an t%n*aan *ar,rat m%a+na aner

ta*%,m +an8,t.

3. T%*a ga)at *ar,rat < ,n%ng !e+om-o -a%en a%&at m,%&a(

ang *atang t%&at%&a teta-% t%*a mngan7am na)a *an anggota

&a*anna m%ana +,a aat *anga+.

4. T%*a ga)at t%*a *ar,rat < (%8a, !e+om-o -a%en ang t%*a +,a

*an t%*a memer+,an %nter>en% me*%7.

5. "en%ngga+ < (%tam

2. Penanganan Pa%en.

"e+a,an Pr%mar S,r>e tan-a *,,ngan a+at &ant, *%agnot%

em,*%an *%+an8,tan *engan Se7on*ar S,r>e

Primary survey mene*%aan e>a+,a% ang %temat% -en*ete%an *an

mana8emen egera ter(a*a- om-+%a% a%&at tra,ma -ara( ang

mengan7am e(%*,-an. T,8,an *ar% Primary survey a*a+a( ,nt,

meng%*ent%=%a% *an mem-er&a%% *engan egera maa+a( ang

mengan7am e(%*,-an. Pr%or%ta ang *%+a,an -a*a primary survey

antara +a%n @9,+*e 200 :

1S K3 +ammaiya Yogyakarta +nitII 2


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1) Airway maintenance *engan cervical spine protection

2) Breathing *an oxygenation3) Circulation *an ontro+ -er*ara(an eterna+

4) Disability-emer%aan ne,ro+og% %ngat

5) Exposure *engan ontro+ +%ng,ngan

Sangat -ent%ng ,nt, *%teanan -a*a )at, me+a,an primary survey

&a()a et%a- +anga( (ar, *%+a,an *a+am ,r,tan ang &enar *an

+anga( &er%,tna (ana *%+a,an 8%a +anga( e&e+,mna te+a(

e-en,(na *%n%+a% *an &er(a%+. Set%a- anggota t%m *a-at me+aanaan

t,ga e,a% ,r,tan e&aga% e&,a( t%m *an anggota ang te+a(

*%a+oa%an -eran tertent, e-ert% airway circulation *++ e(%ngga aan

e-en,(na mena*ar% mengena% -em&ag%an )at, *a+am eter+%&atan

merea @ American College of Surgeons 1.

Primary survey -er+, ter, *%+a,an &er,+ang,+ang -a*a e+,r,(

ta(a-an a)a+ mana8emen. !,n7% ,nt, -era)atan tra,ma ang &a%

a*a+a( -en%+a%an ang terara( em,*%an *%%,t% o+e( -em&er%an

%nter>en% ang te-at *an e,a% erta -enga8%an ,+ang me+a+,%

-en*eatan AI @assessment intervention reassessment .

Primary survey *%+a,an me+a+,% &e&era-a ta(a-an antara +a%n @G%+&ert.

D;So,Fa. P+etF 200 :

1. General Impressions

1) "emer%a on*%% ang mengan7am na)a e7ara ,m,m.

2) "enent,an e+,(an ,tama ata, mean%me 7e*era

3) "enent,an tat, menta+ *an or%enta% @)at, tem-at orang

2. Pengkajian Airway

T%n*aan -ertama a+% ang (ar, *%+a,an a*a+a( memer%a

re-on%>%ta -a%en *engan menga8a -a%en &er&%7ara ,nt,

memat%an a*a ata, t%*ana ,m&atan 8a+an na=a. Seorang -a%en

ang *a-at &er&%7ara *engan 8e+a maa 8a+an na=a -a%en ter&,a

@T(geron 2011. Pa%en ang t%*a a*ar m,ng%n memer+,an

&ant,an airway *an >ent%+a%. T,+ang &e+aang +e(er (ar, *%+%n*,ng%

1S K3 +ammaiya

Yogyakarta +nit II


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e+ama %nt,&a% en*otraea+ 8%a *%7,r%ga% ter8a*% 7e*era -a*a e-a+a

+e(er ata, *a*a. $&tr,% 8a+an na=a -a+%ng er%ng *%e&a&an o+e(o&tr,% +%*a( -a*a on*%% -a%en t%*a a*ar @W%+%non

S%nner 2000.

Yang -er+, *%-er(at%an *a+am -enga8%an airway -a*a -a%en antara

+a%n:

1) !a8% e-atenan 8a+an na=a -a%en. A-aa( -a%en *a-at

&er&%7ara ata, &erna=a *engan &e&aH

2) Tan*atan*a ter8a*%na o&tr,% 8a+an na=a -a*a -a%en antara

+a%n:

1 A!anya snoring ata, gurgling

2 Str%*or ata, ,ara na-a t%*a norma+

3 Ag%ta% @(%-o%a

4 Pengg,naan otot &ant, -erna=aan / para!oxical chest

movements

5 S%ano%

Loo" *an listen &,t% a*ana maa+a( -a*a a+,ran na-a &ag%an

ata *an -oten%a+ -ene&a& o&tr,% :

1 ",nta(an

2 Per*ara(an

3 G%g% +e-a ata, (%+ang

4 G%g% -a+,

5 Tra,ma )a8a(

3) J%a ter8a*% o&tr,% 8a+an na=a maa -at%an 8a+an na=a

-a%en ter&,a.

1) L%n*,ng% t,+ang &e+aang *ar% geraan ang t%*a -er+,

-a*a -a%en ang &er%%o ,nt, menga+am% 7e*era t,+ang

&e+aang.

2) G,naan &er&aga% a+at &ant, ,nt, mem-atenan 8a+an

na=a -a%en e,a% %n*%a% :

Chin lift / #aw thrust 1S K3 +ammaiya

Yogyakarta +nit II 4


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1 La,an ,7t%on @8%a tere*%a

2 $ropharyngeal airway/nasopharyngeal airway Laryngeal $as" Airway

3 La,an %nt,&a%

3. Pengkajian Breathing Perna!asan"

Penga8%an -a*a -erna=aan *%+a,an ,nt, men%+a% e-atenan 8a+an

na=a *an ea*e,atan -erna=aan -a*a -a%en. J%a -erna=aan -a*a

-a%en t%*a mema*a% maa +anga(+anga( ang (ar,

*%-ert%m&angan a*a+a(: *eom-re% *an *ra%nae ten%on

-ne,mot(oraK/(aemot(oraK closure of open chest in#ury *an

>ent%+a% &,atan @W%+%non S%nner 2000.

Yang -er+, *%-er(at%an *a+am -enga8%an breathing -a*a -a%en

antara +a%n :

1) Loo" listen *an feel +a,an -en%+a%an ter(a*a- >ent%+a% *an

o%gena% -a%en.

1) In-e% *ar% t%ngat -erna-aan angat -ent%ng. A-aa( a*a

tan*atan*a e&aga% &er%,t : 7ano% penetrating in#ury

flail chest suc"ing chest woun!s *an -engg,naan otot &ant,

-erna=aan.

2) Pa+-a% ,nt, a*ana : -ergeeran traea =rat,r r,+%ng %ga

subcutaneous emphysema -er,% &erg,na ,nt, *%agno%

haemothorax *an pneumotora"s.

3) A,,+ta% ,nt, a*ana : ,ara a&norma+ -a*a *a*a.

2) ',a *a*a -a%en *an o&er>a% -ergeraan *%n*%ng *a*a -a%en

8%a -er+,.

3) Tent,an +a8, *an t%ngat e*a+aman na=a -a%en a8% +e&%(

+an8,t mengena% arater *an ,a+%ta -erna=aan -a%en.

4) Pen%+a%an em&a+% tat, menta+ -a%en.

5) Da-atan &a7aan pulse o"simetri 8%a *%-er+,an

6) Pem&er%an %nter>en% ,nt, >ent%+a% ang t%*a a*e,at *an /

ata, o%gena%:

1S K3 +ammaiya

Yogyakarta +nit II 5


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1) Pem&er%an tera-% o%gen

2) 'agVa+>e "aer3) Int,&a% @en*otraea+ ata, nasal *engan on=%rma%

-enem-atan ang &enar 8%a *%%n*%a%an

4) ?atatan: *e=%&r%+a% t%*a &o+e( *%t,n*a ,nt, a!vance!

airway proce!ures

7) !a8% a*ana maa+a( -erna-aan ang mengan7am 8%)a +a%nna

*an &er%an tera-% e,a% e&,t,(an.

4. Pengkajian Circulation

S(o7 *%*e=%n%%an e&aga% t%*a a*e,atna -er=,% organ *an

o%gena% 8ar%ngan. #%-o>o+em%a a*a+a( -ene&a& o -a+%ng

,m,m -a*a tra,ma. D%agno% (o7 *%*aaran -a*a tem,an +%n%:

(%-oten% ta%ar*%a ta%-nea (%-oterm%a -,7at etrem%ta *%ng%n

-en,r,nan capillary refill *an -en,r,nan -ro*,% ,r%n. $+e( arena

%t, *engan a*ana tan*atan*a (%-oten% mer,-aan a+a( at,

a+aan ang 7,,- aman ,nt, menga,m%an te+a( ter8a*%

-er*ara(an *an +ang,ng mengara(an t%m ,nt, me+a,an ,-aa

meng(ent%an -en*ara(an. Pene&a& +a%n ang m,ng%n

mem&,t,(an -er(at%an egera a*a+a(: tension pneumothorax%

car!iac tampona!e% car!iac spinal shoc" *an anaphylaxis. Sem,a

-er*ara(an eterna+ ang nata (ar, *%%*ent%=%a% me+a+,% -a-aran

-a*a -a%en e7ara mema*a% *an *%e+o+a *engan &a% @W%+%non

S%nner 2000..

Langa(+anga( *a+am -enga8%an ter(a*a- tat, %r,+a% -a%en

antara +a%n :

1) ?e na*% *an m,+a% +a,an ?P 8%a *%-er+,an.

2) ?P (ar, ter, *%+a,an am-a% *e=%&r%+a% %a- ,nt,

*%g,naan.

3) !ontro+ -er*ara(an ang *a-at mengan7am e(%*,-an *engan

-em&er%an -eneanan e7ara +ang,ng.

4) Pa+-a% na*% ra*%a+ 8%a *%-er+,an:1S K3 +ammaiya

Yogyakarta +nit II "


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1) "enent,an a*a ata, t%*ana

2) "en%+a% ,a+%ta e7ara ,m,m @,at/+ema(3) I*ent%=%a% rate @+am&at norma+ ata, 7e-at

4) egularity

5) !a8% ,+%t ,nt, me+%(at a*ana tan*atan*a (%-o-er=,% ata,

(%-o%a @capillary refill .

6) La,an treatment ter(a*a- (%-o-er=,%

5. Pengkajian Level of Consciousness #an Disabilities

Pa*a primary survey !isability *%a8% *engan mengg,naan a+a

AVPU :

A alert a%t, mere-on ,ara *engan te-at m%a+na memat,(%

-er%nta( ang *%&er%an

$ vocalises m,ng%n t%*a e,a% ata, menge+,aran ,ara ang

t%*a &%a *%mengert%

P respon!s to pain only @(ar, *%n%+a% em,a eem-at t,nga% 8%a

etrem%ta a)a+ ang *%g,naan ,nt, menga8% gaga+ ,nt,

mere-on

U unresponsive to pain 8%a -a%en t%*a mere-on &a% t%m,+,

ner% ma,-,n t%m,+, >er&a+.

6. Expose% Examine #an Evaluate

"enangga+an -aa%an -a%en *an memer%a 7e*era -a*a -a%en.

J%a -a%en *%*,ga mem%+%% 7e*era +e(er ata, t,+ang &e+aang

%mo&%+%a% %n+%ne -ent%ng ,nt, *%+a,an. La,an log roll et%a

me+a,an -emer%aan -a*a -,ngg,ng -a%en. Yang -er+,

*%-er(at%an *a+am me+a,an -emer%aan -a*a -a%en a*a+a(

menge-o -a%en (ana e+ama -emer%aan eterna+. Sete+a(

em,a -emer%aan te+a( e+ea% *%+a,an t,t,- -a%en *engan

e+%m,t (angat *an 8aga -r%>a% -a%en e7,a+% 8%a *%-er+,an

-emer%aan ,+ang @T(geron 2011.

1S K3 +ammaiya

Yogyakarta +nit II


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Da+am %t,a% ang *%*,ga te+a( ter8a*% mean%me tra,ma ang

mengan7am 8%)a maa api! &rauma Assessment (ar, egera*%+a,an:

1 La,an -emer%aan e-a+a +e(er *an etrem%ta -a*a

-a%en

2 Per+a,an et%a- tem,an +,a &ar, ang *a-at mengan7am

na)a -a%en +,a *an m,+a% me+a,an tran-orta% -a*a -a%en

ang &er-oten% t%*a ta&%+ ata, r%t%.

4. D$!U"ENTASI.


+nit II &

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