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8/18/2019 Mod 1b Airway Advanced
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1b_Airway_advanced 1
Setting Up Emergency Medical Service
Intensive Course & Workshop
Dr Sutomo Hospital
Dept Anesthesiology & eanimation!
Airlangga University! School o" Medicine Sura#aya Emergency Medicine & Disaster Management
Working $roup
Module
Day 1b
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1b_Airway_advanced 2
Introduction to Emergency Medical System
Why victims die and ho% %e can help
he A'CD approach o" (rimary Survey )*uick d+! *uick treatment,
Diagnosis and Understanding Air%ay Emergencies
reatment o" air%ay o#structions )manual methods,Use o" Air%ay Ad-uncts
Skills
Use o" Advanced Air%ay Ad-uncts
.+ygen and Drugs used in air%ay pro#lems
Skills
Day 1
/011
/021
/021
/011
/021
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Use o" Advanced Air%ay Ad-uncts.+ygen and Drugs used in air%ay pro#lems
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1.
2.
33.
90% pasiendapat ditolong
dengan cara #1 & #2
$old standard
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1b_Airway_advanced 5
Laringoskopi u/ intubasi trachea
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1b_Airway_advanced
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1b_Airway_advanced !
"#$%&A'" $(A)*+A
, -ilihan .ika caracara lain untuk Airway gagal, Ada kesukaran untuk 0e0beri naas buatan, Ada risiko besar ter.adi aspirasi ke paru, Mencegah p)2 naik cedera kepala4, )' ≤ 6
7 8arena pasti ada obstruksi 7 8arena pasti ada hipoventilasi p)2 naik4
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-asien dengan tracheal tube9 naas buatan
lebih eekti9 risiko aspirasi lebih kecil
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1b_Airway_advanced :
tetapi9 intubasi trachea
.uga 0e0bawa risiko besar
, *ipoksia karena spas0e pita suarasebelu0 +$$ berhasil 0asuk4
, $ekanan darah naik , Arit0ia9 bradikardia sa0pai asistole
, $ekanan "ntra 8ranial naik
, erakan leher 0e0perberat cedera cervical3 Seharusnya! intu#asi di#antu o#at anestesia
dan o#at pelumpuh otot )harus tenaga ahli,
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1b_Airway_advanced 1;
Laryngeal Mask Airwaydipasang tanpa laringoskopi
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1b_Airway_advanced 11
Me0bebaskan .alan naas
, 'u0batan pangkal lidah 7 .aw thrust
7 chin lit
7 .alan naas oropharyn
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'u0batan benda asing
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=inger sweep
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1b_Airway_advanced 1>
'uctioning
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(osisi #aring miring →
cairan akan mengalir keluar
karena ada risiko cedera leher
→ miringkan dengan cara log4roll
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1b_Airway_advanced 1
> orang
(em#eria#a4a#a
harus -elas
Logroll
Digulingkan serentak pelan4pelan
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1b_Airway_advanced 1!
Me0bebaskan .alan naas
, 'u0batan pangkal lidah 7 .aw thrust
7 chin lit 7 .alan naas oropharyn<
7 .alan naas nasopharyn<
7 intubasi trachea / LMA
, )airan di hypopharyn< 7 penghisap / suction
, 'u0batan di plica vocalis 7 cricothyroidoto0y
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)ricothyroidoto0y
3 (asien tidak dapat di#eri na"as #uatan dari atas
)mulut hidung, 5 #enda asing di laryn+
5 angioneurotic edema! laryn+ edema
3
6ika intu#asi gagal padahal -alan na"as masihtersum#at
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1b_Airway_advanced 1:
Alergi9 angioneurotic ede0a
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1b_Airway_advanced 2;
&A'"' )(A#""
atap nasopharyn<
tulang tipis 0udah patah
$%&+ nasopharyngeal
-lica
vocalis )ricothyroidoto0y
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1b_Airway_advanced 21
)ricothyroidoto0y
?alur darurat untuk oksigenasi
?aru0 besar9 1> atau .aru0 susuk 8& #orplant
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1b_Airway_advanced 22
O2
Alirkan 2 1;15 lp0 / 0aksi0al
$utup lubang dengan .e0pol9
biarkan 2 0asuk ke paru
&uka lubang agar gas keluar9 lalu
tutup lagi dst
&isa bertahan 1; 0enit9 2 bisa
0asuk tetapi )2 sukar keluar
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)spine protection
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1b_Airway_advanced 2>
Previously recommended hand
positions for manual in-line
stabilisation of the cervical
spine.
Currently recommended hand
positions for manual in-line
stabilisation of the cervical
spine.
Lindungi leher dari gerakan
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Immo#ilisasi leher se-ak tempat ke-adian
in4line immo#ilisation dan collar #race
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1b_Airway_advanced 2
#eck collar / )ollar brace
Dipasang tanpa menggerakkan leher )terlalu #anyak,
7epala harus dipegang 8in4line9
4ekanan intra4kranial #isa meningkat4 Air%ay #isa o#struksi
4 'ila muntah akan aspirasi
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1b_Airway_advanced 2!
-asien yang 0e0akai collar brace
, ?alan naasnya 0ungkin terganggu
7 tidak bisa buka 0ulut
3 mudah o#struksi -alan na"as partial
3 -ika muntah tidak mudah mengeluarkan
, $ekanan intracranial 0ungkin naik
7 akibat ha0batan aliran vena leher9 ?@- naik
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)ara lain untuk i00obilisasi leher tanpa 0enaikkan ")-
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1b_Airway_advanced 2:
)ara lain untuk i00obilisasi leher tanpa 0enaikkan ")-
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1b_Airway_advanced 3;
.+ygen and Drugs used in air%ay pro#lems
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Manaat oksigen pada pasien dengan
gangguan airway, Meningkatkan kadar oksigen di alveoli
7 @$ 5;; < 21 2 B 1;; cc 2 0urni
7 @$ 2;; < 21 2 B >; cc 2 0urni
7 @$ 2;; < ; 2 B 12; cc 2 0urni
, Meningkatkan .u0lah oksigen di =()
, Mengurangi dera.at hipokse0ia darah
, Dengan naas yang terbatas9 lebih banyak oksigen dapat0asuk ke alveoli
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)ara 0e0berikan oksigen
nasal prong :42 lpm
→ 21;
mask
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-asien gawat
, -erlu oksigen ;1;; 7 0ask
7 0ask C reservoir 7 bag C 0ask / ?ackson (eese
, Mungkin perlu segera naas buatan 7 bag C 0ask / ?ackson (eese 7 AM&% bag C reservoir4
?l t t
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1b_Airway_advanced 3>
(engatur tekanan tinggi dan
penun-uk tekanan ta#ung
?lo%meter pengatur
aliran oksigen
Humidi"ier! pelem#a#
Se#aiknya dikosongkan sa-a
)mudah -adi sarang kuman,
(ada %aktu transportdiperlukan oksigen tinggi!
air harus di#uang
krn mengham#at
aliran oksigen
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Airway skill >
optional4
, Laryngoscopy
, $racheal intubation, Laryngeal 0ask insertion4
0anikin9 airway trainer9 on table4
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1b_Airway_advanced 3!
Airway skill 5
, =inger sweep
, -haryngeal suction o liEuid, )ricothyroto0y
,
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1b Ai d d 36
Airway skill
, Applying collar brace
, Applying sandbags and i