TRIAGE + PLAYROLE TRIAGE
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Triage / triase
TIM PELATIHAN KEGAWATDARURATAN
Anestesi dan Terapi Intensif
RSUD Saiful Anwar Malang/FK Univ.Brawijaya
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What is Triage?
• “Triage” sortir
• Evaluasi berdasarkan kebutuhan medis dan urgensi pada masing2 klien dalam waktu terbatas
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Triage proses dinamik dan dilakukanlebih dari sekali
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Primary Disaster Triage
• Triage berdasarkan fisiologi pasien
–Kemampuan pasien dalammenghadapi /mengkompensasitrauma atau injuri
–Bila gagal prioritas tinggi
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Primary Disaster Triage
• Yang paling sering digunakan pada pasiendewasa di amerika dan kanada denganmenggunakan “START “ (Simple Triage and Rapid Treatment.
• Pada pasien anak dengan menggunakan“Jump START”.
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Label
• Pelengkap Triage
• Identifikasi pasiensecara cepat
• Berdasarkanwarna/code tertentu
• Dapat jugadigunakan pita berwarna sebagaipengganti label
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Triage Categories
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NATO Guidelines• Merah
Obstruksi jalan nafas, gagal nafas, internal bleeding,shock,pneumothorak, luka bakarpada wajah / leher
• Kuning
Luka pada mata yang berat, fraktur, lukabakar pada abdomen dan ekstremitas
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NATO Guidelines• Hijau
Laserasi monor, kontusio, sprains, lukabakar parsial < 20% BSA
• Hitam
Cedera kepala GCS<8, luka bakar >85% BSA, multisistem trauma, tanda2 kematian (+)
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Sistem START
• Pertama kali pada thn 1980’s di Hoag
Hospital dan the Newport Beach CA Fire
Dept
• Assessment secara cepat
• Tidak lebih dari 15 detik
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Sistem START
Klasifikasi berdasarkan :
• Respirasi
• Perfusi
• Evaluasi status Mental
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Langkah pertama “START”
Apakah pasien dapat berjalan?
Ya tidak
Hijau
(Minor)
Evaluasi respirasi
(Step-2)
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Langkah kedua “START”
Bernafas ?
YESNO
> 30/Min < 30/min
Evaluasi sirkulasi(Step-3)
Airway paten
bernafas?
tdk Ya
BlackRed/ Immediate
Red/ Immediate
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Langkah ketiga “START”
sirkulasi
Pulsasi A.Radialis (-)
Control Hemorrhage
Pulsasi A.Radialis (+)
Evaluasi kesadaran
Red/ Immediate
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Langkah keempat “START”
Tidak dapat menuruti perintah sederhana
Level kesadaran
dapat menuruti perintah sederhana
Yellow/ DelayedRed/ Immediate
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Pasien Terkontaminasi
• Pasien yang terpapar (potensial atau
benar2 terpapar) diberi label BIRU
• Label biru terus berlangsung sampai
pasien dinyatakan dekontaminasi, dan
dilanjutkan dengan langkah2 START
• Beberapa merekomendasikan dengan
double label dengan biru dan warna
standar START
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• Ingat RPM
• R- Respirasi- 30
• P- Perfusi- nadi Radialis
• M- Mental- mengikuti perintah
START-Overview
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The JumpSTART Field Pediatric Multicasualty Triage System ©
(Patients aged 1- 8 years)
Black = Deceased/expectantRed = ImmediateYellow = DelayedGreen = Minor/Ambulatory
Identify and direct all ambulatory patients to designatedGreen area for secondary triage and treatment. Beginassessment of nonambulatory patients as you come to them.
Proceed as below:
Spontaneous respirations?
NO
Open airway
Spontaneous respirations?
YES
IMMEDIATE
NO
DECEASED
YES
Peripheral pulse?
YES
Perform 15 sec.Mouth to MaskVentilations
Spontaneous respirations?
YES
IMMEDIATE
NO
DECEASED
NO
Check resp. rate
< 15/min or
> 40/minor irregular
IMMEDIATE
15 - 40/ min,regular
Peripheral pulse?
NO
IMMEDIATE
YES
Check mental status(AVPU)
AVP (appropriate)
DELAYED
P (inappropriate)U
IMMEDIATE
MINOR
© Lou Romig MD, FAAP, FACEP, 1995
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Skenario
• Terjadi ledakan pada saat pertandingan bola distadion gelora bung karno. Terdapat 200 orangterluka
• Berikan kriteria dan label pada pasien
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Pasien 1
• Apneu
• Pulsasi (-)
• Kesadaran (-)
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Pasien 2
• Terdapat eviserasi pada perut
• Multiple penetrasi pada dada dan kepala
• Tidak respon terhadap rangsangan nyeri
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Pasien 3
• Nyeri abdomen
• Peneterasi minor pada ekstremitas
• RR 24x/mnt
• Pulsasi a radialis kuat
• Kesadaran compos mentis
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Pasien 4
• Luka penetrasi multiple
• Darah keluar dari telinga
• Airway paten
• RR 20
• Pulsasi A.radialis kuat
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Pasien 5
• Fraktur ekstremitas
• Keluar darah dari telinga
• RR 26
• Pulsasi A radialis kuat
• Kesadaran compos mentis
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Pasien 6
• Anak2, berteriak
• Laserasi minor
• RR 30
• Masih dapat menggerakkan ektremitas
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Pasien 7
• Nyeri dada
• Penurunan kesadaran
• RR 34
• Pulsasi A radialis lemah
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