Sie sind auf Seite 1von 40

Secondary Survey Assessment

( Penilaian dan Penanganan


Survei Sekunder )

Departemen Anestesiologi dan


Reanimasi
FK USU
2010

Sistematika Emergency
Medicine
TRIASE
SURVEI PRIMER
SURVEI SEKUNDER
STABILISASI
RUJUKAN
TERAPI DEFINITIF

Survei sekunder

Mencari cedera yang mengancam jiwa


atau cacad ekstremitas (life or limb)
Pemeriksaan teliti dari kepala sampai kaki
Dikerjakan setelah survei primer selesai
Dikerjakan jika ABC sudah stabil
Segera kembali ke survei primer jika ABC
memburuk lagi

Pemeriksaan kepala

Kulit kepala (robekan, memar, laserasi)


Tengkorak (nyeri tekan, depresi tulang)
Mata (pupil, fundus, lensa, conjunctiva)
Cairan CSF / darah dari telinga,
hidung, mulut

Ada darah mengalir, tetapi dari mana ?

Periksa kesadaran dan syaraf

Glasgow Coma Score


Pupil

ukuran, simetri, refleks cahaya

Fungsi motorik
Fungsi sensorik
Refleks-refleks

Secondary Survey
Head

Complete neurologic examination

GCS score determination

Comprehensive eye/ear exam


Pitfalls

Unconscious patient

Periorbital edema

Occluded auditory canal

Secondary Survey

The
complete

history and
physical
examination

Secondary Survey
Key Components

History

Physical examination : Head-to-toe

Tubes and finger in every orifice

Complete neuro exam

Special diagnostic tests

Reevaluation

Secondary Survey
History
A Allergies
M Medications
P Past Illnesses
L Last meal
E Events/Environment

Secondary Survey
Mechanisms of Injury

ACS

Pemeriksaan leher (1)

Lihat / inspeksi
Palpasi (nyeri tekan,
deformitas)
Anggap leher cedera
Imobilisasi pada posisi netral

Pemeriksaan leher (2)

Cari Luka tembus


Cari Emfisema subkutis
Apakah trachea ditengah ?

raba di supra-sternal notch

Apakah Vena leher distended ?

Periksa posisi trachea: palpasi di suprasternal not

Secondary Survey
Cervical Spine

Pitfalls

Palpate for
Altered LOC for
tenderness
any reason

Complete motor/
Other severe ,
sensory exams
painful injury

Reflexes

C-spine imaging

Secondary Survey
Neck (soft tissues)
Mechanism : Blunt
vs penetrating
Symptoms : Airway
obstruction ,
hoarseness
Findings :Crepitus
hematoma ,stridor
bruit

Pitfalls
Delayed
symptoms
and signs
Progressive airway
obstruction
Occult injuries

Secondary Survey
Maxillofacial

Bony crepitus/stability

Palpable deformity
Pitfalls

Potential airway obstruction


Cribriform plate fracture
Frequently missed injury

Pemeriksaan dada
mencari ulang kerusakan

Lihat / inspeksi
Palpasi
Perkusi
Auskultasi
Foto sinar-X dada (jika
ada)
ECG ( jika ada)

Secondary Survey
Chest

Inspect

Palpate

Percuss

Auscultate

X-ray

Pitfalls
Elderly
Children

Pemeriksaan perut (1)

Cari perdarahan tersembunyi


(Internal hemorrhage)

ketegangan otot perut


nyeri tekan
cairan bebas (USG / DPL)

Inspeksi / palpasi / auskultasi


Jangan test gerakan panggul bila
diduga ada fr. pelvis
Periksa rektum (rectal toucher)

Perlukaan organ padat / pemb darah besar


Perlukaan organ berongga (usus)

Pemeriksaan perut (2)

Trauma tembus = pembedahan eksplorasi


Trauma tumpul = pasang pipa naso/
orogastric dan observasi lanjut
Pasang kateter buli jika tak ada darah di
meatus ext.
Periksa ulang berkali-kali

Secondary Survey
Abdominal Evaluation

Blunt trauma

Penetrating trauma

Secondary Survey
Abdomen

Inspect, auscultate, palpate, and


percuss

Reevaluate frequently

Special studies
Pitfalls
Hollow viscus and retroperitoneal injuries
Excessive pelvic manipulation

Secondary Survey
Perineum

Contusions, hematomas,
lacerations, urethral blood

Rectum

Sphincter tone , high riding


prostate pelvic fracture,
rectal wall integrity, blood

Vagina
Pitfalls

Blood lacerations
Urethral injury in women,
pregnancy

Ekstremitas / anggota gerak

Inspeksi

deformitas, robekan, memar, laserasi

Palpasi
Palpasi nadi arteria distal
Ingat compartment syndrome
Jangan lupa periksa punggung
Log-roll

Log-roll
Cari luka, robekan, memar, nyeri tekan,
deformitas tulang belakang

4 orang

Digulingkan serentak pelan-pelan

Pemberi
komando
instruksi
yang jelas

Foto sinar-x

Dikerjakan waktu survei sekunder


Dada
Tulang leher - 7 segmen vertebra
Pelvis / panggul
Lokasi lain sesuai indikasi
(misal fr tulang paha dll)

Secondary Survey
Musculoskeletal : Extreminities

Contusion , deformity

Pain

Perfusion

Peripheral neurovascular status

X- rays as needed

Secondary Survey
Musculoskeletal : Pelvis

Pain on palpation

Symphysis width

Leg length unequal

Instability

X-rays as needed

Secondary Survey
Musculoskeletal

Pitfalls
Potential blood loos
Missed fractures
Soft-tissue or ligamentous injury
Occult compartement syndrome
(especially with altered LOC /
hypotension)

Secondary Survey
Neurologic
Spine / Cord
CNS
Complete motor
Frequent
and sensory exams
reevaluation
Imaging as
Prefent
indicated
secondary brain
Reflexes
injury
Early neurosurgical
consultation

Adjuncts to Secondary
Survey

Special diagnostic test as


indicated
Pitfalls
Patient deterioration
Delay of transfer

Secondary Survey
Neurologic
Pitfalls
Incomplete immobilization
Suble in ICP with
manipulation
Rapid deterioration

Reevaluation
Minimizing Missed Injuries
High index of suspicion
Frequent reeveluation and
monitoring

Reevaluation
Pain Management
Relief of pain /anxiety as
appropriate
Administer intravenously
Careful monitoring is
essential

Definitive Care
Local Facility
??
Transfer agreements
?? Local resources ??
??
Trauma
Specialty
Center Facility

Record , Legal
Considerations
Concise, chronologic
documentation
Consent for treatment
Forensic evidence

40