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7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
http://slidepdf.com/reader/full/ppt-syok-hipovolemik-ec-perdarahan-intra-abdomen 1/21
Penatalaksanaan Awal padaKasus Trauma Abdomen
dengan Syok Hipovolemik
Raja Ahmad Rusdan Musyawir Bin Raja
Abdul Malek
!"!"#!#
$%
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
http://slidepdf.com/reader/full/ppt-syok-hipovolemik-ec-perdarahan-intra-abdomen 2/21
R&M&SA' MASA(AH
(aki)laki %# tahun mengalamike*elakaan sepeda motor " jamyang lalu dan mempunyai gejala)
gejala syok+
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
http://slidepdf.com/reader/full/ppt-syok-hipovolemik-ec-perdarahan-intra-abdomen 3/21
H,P-T.S,S
(aki)laki tersebut menderita syokhipovolemik et *ausa perdarahanintra abdomen+
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
http://slidepdf.com/reader/full/ppt-syok-hipovolemik-ec-perdarahan-intra-abdomen 4/21
PR,MAR/ S&R0./ 1AB23.4
Airway Maintenan*e with 2ervi*alSpine 2ontrol
Breathing 5 0entilation
2ir*ulation 5 Hemorrhage 2ontrol
3isability 1'eurologi* ,njury4
.6posure 5 .nvironment
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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A,R7A/
Kontrol 5 proteksi 2)spine8 kolarservikal
Ajak bi*ara bi*ara jelas
kondisi baik-bstruksi8
◦ 9urgling
◦ Snoring◦ Stridor
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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A,R7A/
Tatalaksana8◦ Su*tion
◦ :aw thrust
◦ -PA;'PA◦ Krikotiroidotomi
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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BR.ATH,'9
,nspeksiPalpasi
Perkusi
Auskultasi
Assisted ventilation8
◦ Bag)valve mask
◦ 0entilator
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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2,R2&(AT,-'
Tanda)tanda syok8◦ takikardia<
◦ hipotensi<
◦ perubahan status mental◦ kulit teraba dingin
Keberhasilan resusitasi8
◦ Pulse pressure◦ 2entral venous pressure 120P4
◦ &rinary output
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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2,R2&(AT,-'
Resusitasi *airan8 Ringer laktatbolus "(
Trans=usi darah8 PR2 tipe - ;
whole blood Target8 tekanan darah sistolik
>!)!! mm Hg
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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3,SAB,(,T/ 1'.&R-,':&R/49lasgow 2oma S*ale 192S4Sai? dan reaksi pupil
terapi agresi= hipovolemia<
hipoksia 5 hiperkarbia hindarisecondary brain injury
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
http://slidepdf.com/reader/full/ppt-syok-hipovolemik-ec-perdarahan-intra-abdomen 11/21
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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.@P-S&R. 5
.'0,R-'M.'TSeluruh pakaian dibuka
evaluasi menyeluruh
Pakaikan selimut hangat<
ruangan hangat< *airan hangat2egah hipotermia koagulopati<
dis=ungsi jantung
pulse oximetry
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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A'AM'.S,S
◦ A 8 allergies
◦ M 8 medications currently beingtaken by patient
◦
P 8 past illness & operations◦ ( 8 last meal
◦ . 8 events & environment related tothe injury
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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P.M.R,KSAA' $,S,K 1khususabdomen4
,nspeksi8 luka< benda asing<distensi abdominal< dilatasigaster< ileus< 9rey Turner sign<
2ullen signPalpasi8 voluntary;involuntary
guarding< nyeri tekan
supersial;dalam;lepasPerkusi8 peritonitis< dilatasi
lambung< hemoperitoneum
Auskultasi8 suara usus
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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P.M.R,KSAA'P.'&':A'9HematokritHitung leukosit
.n?im pankreas
Tes =ungsi hati
&rinalisis
$oto Rntgen
2T)s*an
&S9 abdomen 1$AST4
3iagnosti* Peritoneal (avage 13P(4
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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3,A9'-S,S K.R:A
syok hipovolemik et causa perdarahan intra abdomen
T3 sistolik C! D !
'adi # E C! kali;menit=rekuensi na=as "#6;menit
Kuadran kiri atas8 bintik
perdarahan< hematom rupturlien
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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PAT-$,S,-(-9,
penurunan volume eritrositdan;atau plasma darah menurunkan volume akhir diastolik
ventrikel
stroke volume, cardiacoutput, tekanan nadi menurun peningkatan sympathetic outfow pada jantung dan organ lain peningkatan denyut nadi<vasokonstriksi< dan redistribusidarah menjauhi organ non)vital
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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TA'3A 5 9.:A(A K(,',S
Derajat hipovolemia Persentase darah yang hilang (%) Gejala dan Tanda
Ringan 20 Agitasi, gelisah, klit dingin, lem!a!,
hipotensi ortostatik, takikardia ringan
"edang 20#$0 Gelisah, agitasi, takirkadia, hipotensi
postral
erat &$0 Tekanan darah menrn, takikardia !erat,
oligria, somnolen
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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P.'ATA(AKSA'AA'
+ Pastikan jalan na=as 5 perna=asan pasiendalam kondisi baik+
"+ Posisikan kaki pasien lebih tinggi+
%+ Resusitasi *airan segera8 R( bolus ")F ("!)%! menit+
4. Monitoring
#+ Atasi ongoing bleeding
G+ Hb ! g;dl
Trans=usiI+ Hipovolemia berat 5 berkepanjangan
inotropik 1dopamin< vasopresin<dobutamin4
7/21/2019 Ppt Syok Hipovolemik Ec Perdarahan Intra Abdomen
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K.S,MP&(A'
(aki)laki %# tahun yangmengalami ke*elakaan sepedamotor tersebut menderita syok
hipovolemik et causa perdarahanintra abdomen+