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Modification required
Immediate danger of death
Critical degree of ongoing danger that requires an intervention
within 1-2 minutes
Management
Emergency rescue
Reserved for immediate (within seconds) environmental threat to
life of victim or rescuer
Move to save area in manner that minimizes risk
Rapid extrication
Considered for medical conditions or situations that requires fast
intervention to prevent death
One or two minutes, but not seconds
Neutral alignment
Always monitor airway and breathing
Log roll
Single unit: spinal-column, head,
pelvis
Patient lying prone or supine
Modification required
Paint arm, leg, chest
Roll into uninjured side
Unstable fractures pelvis
Scoop stretcher
Lift carefully by four or more
rescuers
Special SMR Situations
Combative patient
Children
Altered mental status
Under influence
Special SMR Situations
Require side transport
Airway
Unconscious patient who are not
intubated
Pregnant
20 weeks or more
Vacuum board best
Special SMR Situantions
Closed-space rescue
Safety is first priority
In line with long axis
Water emergencies
Backboard floated under
Secure then remove
Special SMR Situantions
PEDIATRIC ELDERLY
Special SMR Situations
Prone, Seated or Standing
Minimize movement into supine position
Special SMR Situations
Protective gear
Motorcycle helmet: removal
Poorly fitted to patient
Significant neck flexion
Full face and open face
Note:
Remove to evaluate and manage airway
Special SMR Situations
Protective gear
Remove athletic helmet when
Face mask not removed timely
Airway cannot be controlled
Does not hold head securely
Note:
Cut chin strap: do not unhook
Special SMR Situations
Neck wounds
Caution: cervical collar
May prevent Ongoing Exam
Compromised airway with
subcutaneous air, expanding
hematomas, or mandible
fracture
Note:
May be needed to avoid
cervical collar; use manual
stabilization, head cushion
devices, blanket rolls
Diagnostik
Spinal X-Ray
CT-Scan Abnormalitas tulang
MRI Kerusakan pada medulla spinalis, edema, cedera kompresi,
hematom ekstradural spinal
Laktat Perfusion Monitoring
AGD Hipoksia
Emergency Management in ER
Prevent continuous spinal injury Supinasi
Aspirasi Suction
OPA / ET Tube
Monitoring Ventilation
SP02
AGD
Pasang Iv Line
Resusitasi cairan Kristaloid = Nadi radialis teraba
Hipotensi Syok Neurogenik Vasopressor MAP
Kateter Urine Output
Emergency Management in ER
NGT distensi ileus dan penurunan peristaltic
Prevent hipotermia
Sedasi Pasien Gelisah
Profilaksis tetanus, analgetik, dan antibiotic sesuai indikasi
Summary
Unstable or incomplete spinal damage is not completely
predictable
Unconscious trauma or dangerous mechanism affecting
head, neck should have SMR
Uncertain mechanisms may not require SMR
Special cases may require special techniques
Maintain neutral alignment specific for patient
Be prepared to manage airway compromise