2. airway and breathing management 11

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Information about 2. airway and breathing management 11
Health & Medicine

Published on February 16, 2014

Author: bennygustian

Source: slideshare.net

AIRWAY  Prioritas Pertama dalam penanganan gawat darurat. Sumbatan total jalan napas pembunuh tercepat  Selalu imobilisasi servical  Servical control :     Multiple trauma Trauma Kapitis dengan penurunan kesadaran Luka diatas klavikula Biomekanik mendukung

MASALAH SUMBATAN (OBSTRUKSI)

SUMBATAN JALAN NAPAS  TOTAL  Chocking  tersedak benda asing  PARSIAL a. Cairan  Gurgling b. Pangkal lidah  Snoring c. Anatomis  Crowing

TANDA OBJEKTIF SUMBATAN JALAN NAPAS  Lihat (look) Penurunan kesadaran, cyanosis, retraksi, berontak, gelisah  Dengar (listen) Suara-suara abnormal : Snoring, gurgling, crowing  Rasakan (Feel) Rasakan adanya hembusan napas, raba posisi trakhea

Setiap pernapasan berbunyi, tanda sumbatan parsial jalan napas (Gurgling, Snoring, Crowing)

Setiap penderita yang bisa berbicara tanpa suara tambahan maka airway baik (Tidak ada sumbatan)

BASIC AIRWAY MANAGEMENT

CHOCKING MANAGEMENT TERSEDAK !!! >> Sumbatan Total Jalan Napas  Mendadak tidak bisa berbicara, batuk dan bernapas.  Berontak sambil memegangi leher  Sianosis  Mendadak tidak sadar

CHOCKING MANAGEMENT PENDERITA SADAR  Dewasa dan Anak Heimlich Maneuver > < Back Blow  Wanita hamil dan Orang gemuk Chest Thrust > < Back Blow

CHOCKING MANAGEMENT Heimlich Maneuver Back Blow Chest Thrust

CHOCKING MANAGEMENT PENDERITA TIDAK SADAR  Dewasa dan Anak Abdominal Thrust > < Finger Sweep  Wanita hamil dan Orang gemuk Chest Thrust > < Finger Sweep

CHOCKING MANAGEMENT Abdominal Thrust Chest Thrust Finger Sweep

CHOCKING MANAGEMENT PENANGANAN PADA BAYI  Dewasa dan Anak Abdominal Thrust > < Finger Sweep  Wanita hamil dan Orang gemuk Chest Thrust > < Finger Sweep

CHOCKING MANAGEMENT CHEST THRUST BACK BLOW

SUMBATAN PARSIAL CAIRAN   Darah, secret, air liur, muntah  Suctioning  Bila banyak miringkan kepala (trauma  Log Roll)  Tidak Berhasil Airway Definitif ++ Dewasa Max. 15 Detik ++ Anak Max. 5 Detik ++ Bayi Max. 3 Detik

SUMBATAN PANGKAL LIDAH Lidah jatuh menyumbat di hipofaring Pasien tidak sadar Tindakan mengangkat pangkal lidah

Manual Non Trauma   Head Tilt Chin Lift

Manual Trauma   CHIN LIFT

Manual Trauma   JAW THRUST

SUMBATAN PANGKAL LIDAH  ARTIFICIAL AIRWAY  Oropharyngeal Airway (OPA)  Nasopharyngeal Airway (NPA)

OroPharyngeal Airway  Menahan lidah pada bagian belakang faring  Untuk mempermudah proses suctioning faring  Untuk menghindari tergigitnya ETT  Digunakan pada pasien tidak sadar tanpa Gag Reflex

Oropharyngeal airway Complications :  Complete airway obstruction  Laringospasme  Vomiting

Oropharyngeal airway insertion

Nasopharyngeal airway  Digunakan pada pasien yang bernapas spontan, dan memiliki rangsangan batuk/muntah (gag reflex)

Nasopharyngeal Airway Complications  Nasal mucosa injury  Laryngospasm

Nasopharyngeal Airway Techniques

ADVANCE AIRWAY MANAGEMENT (AIRWAY DEFINITIF)

ADVANCE AIRWAY  ENDOTRACHEAL INTUBATION  NEEDLE CRICOTHYROIDOTOMY

INDIKASI AIRWAY DEFINITIF  Adanya apnea  Ketidakmampuan mempertahankan airway dengan cara lain  Adanya resiko aspirasi  darah / muntah  Ancaman segera / potensial sumbatan airway  Cedera inhalasi, fraktur maksilofasial, hematoma retrofaringeal  Cedera kepala yang memerlukan bantuan napas (GCS < 8)  Ketidakmampuan mempertahankan oksigenasi dengan BVM

ENDOTRACHEAL INTUBATION  NASOTRACHEAL INTUBATION (Blind Intubation)  OROTRACHEAL INTUBATION

Airway definitif Blind Naso-tracheal : - Sambil mendengar pernafasan - Dorong saat inspirasi - Bila suara hilang masuk Oesofagus - Hati-hati bila fraktur basis kranii dengarkan nafas

OROTRACHEAL INTUBATION  Ventilasi dan oksiganisasi harus diberikan sebelum memasukan laringoskop dan ETT.

TEHNIK

TEHNIK Sellick Manouver

Intubasi Orotracheal

NEEDLE CRICOTHYROIDOTOMY APABILA INTUBASI TIDAK BISA DILAKUKAN (Mis. Fraktur Maksilofasial berat) Jet Insuflation / Jet Ventilation (30 – 45 Menit) Menggunakan IV Cath. Paling besar Nomor 14

Krikotiroidotomi Kartilago tiroid Membrana Kartilago krikoid Trakea

Airway definitif Krikotirotomi - jarum : - Ditusukkan lewat membrana kriko-tiroidea - Sambung dengan oksigen, 1 detik tutup, 4 detik buka - Waktu ekstra 30-45 menit

Needle Krikotiroidotomi Paling kecil 14 G

Nedle Cricothyroidotomy

BREATHING MANAGEMENT

BREATHING Oksigen  Selalu berikan bila keadaan umum (ku) pasien kurang baik

RAPID ASSESMENT  Look (lihat)  Pergerakan Dada  Listen (Dengar)  Suara Napas  Feel (Rasakan)  Hembusan Napas

PEMERIKSAAN FISIK  Inspeksi  Rate, Ritme, Bentuk Pernapasan  Simetris  Dispnoe  Auskultasi Bising Napas  Vesikuler, Ronchi  Perkusi  Sonor  Hipersonor

OXYMETRI SATURASI OKSIGEN INTERPRETASI INTERVENSI 95% - 100% Normal O2 4 liter / menit – nasal canule 90% - <95% Hypoxia ringan sedang Face Mask 6 – 10 Liter / menit 85% - <90% Hypoxia sedang - berat Face Mask dengan resevoir 8 – 12 liter  assisted ventilation <85 % Hipoxia berat – mengancam nyawa Assisted ventilation

OKSIGENASI ALAT Nasal Canule FLOW RATE DELIVERY O2 21 % - 24 % 2 Liter / Menit 25 % - 28 % 3 Liter / Menit 29 % - 32 % 4 Liter / Menit 33 % - 36 % 5 Liter / Menit 37 % - 40 % 6 Liter / Menit Rebreathing Mask 1 Liter / Menit 41 % - 44 % 6 – 10 Liter / Menit 35 % - 60 % NonRebreathing Mask 6 Liter / Menit 60 % 7 Liter / Menit 70 % 8 Liter / Menit 80 % 9 Liter / Menit 90 % 10 - 15 Liter / Menit 95 % - 100 %

Nasal Kanul Rebreathing Mask Non Rebreating Mask

VENTILASI  Ventilasi Buatan (Control Ventilation)  Ventilasi Bantuan (Assisted Ventilation)

VENTILASI  Mouth to mouth ventilation  Mouth to Mask ventilation  Bag Valve Mask

MOUTH TO MOUTH MOUTH TO MASK BVM

TERIMA KASIH

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