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SUMBATAN JALAN NAPAS

INSANIA CHUSNA ARIFAH


012116416
SGD 18

PRIMARY SURVEY

AIRWAY
Nilai Tanda Obstruksi Jalan Napas
LOOK

LISTEN

FEEL

Kesadaran

Snoring

Hembusan aliran
udara

Agitasi

Gurgling

Posisi trakea

Sianosis

Stridor

Nafas Cuping
hidung

Hoarseness

Retraksi dinding
dada

Afoni

Accesory
respiratory muscle

Crowing

Universal coughing
sign

Wheezing

AVPU

Penyebab Obstruksi Jalan Nafas

Sumbatan saluran napas atas dapat dibagi menjadi 4 derajat


berdasarkan kriteria Jackson.
Jackson I ditandai dengan sesak, stridor inspirasi ringan, retraksi
suprasternal, tanpa sianosis.
Jackson II adalah gejala sesuai Jackson I tetapi lebih berat yaitu disertai
retraksi supra dan infraklavikula, sianosis ringan, dan pasien tampak
mulai gelisah.
Jackson III adalah Jackson II yang bertambah berat disertai retraksi
interkostal, epigastrium, dan sianosis lebih jelas.

Jackson IV ditandai dengan gejala Jackson III disertai wajah yang


tampak tegang, dan terkadang gagal napas.
(SUMBER : Kedaruratan Medik, Dr. Agus Purwadianto & Dr. Budi
Sampurna)

AIRWAY MANAGEMENT

Head Tilt

Triple airway
manuver

Chin Lift

Jaw Trust

Basic Airway
Management

Menggunakan
Alat
Airway
Management

Airway
nasofaringeal
Airway
Orofaringeal

Orotracheal
Intubasi
Endotrakea
Nasotracheal
Definitif Airway
Management
Krikotiroidotomi
Surgical

Jet Insufflation

PRINSIP MANAGEMENT AIRWAY


In line
Immobilsation

Cervical tidak boleh ekstensi, fleksi,


rotasi

Cedera Cervical

Curigai cedera servikal berdasarkan


mekanisme trauma(Benturan
frontal,benturan belakang)

O2

Pemberian O2 harus dilakukan


sebelum dan segera setelah
pengelolaan jalan napas

HEAD TILT-CHIN LIFT

JAW TRUST

AIRWAY NASOFARINGEAL

A
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INDIKASI PEMASANGAN AIRWAY


DEFINITIF

INTUBASI ENDOTRACHEA

NEEDLE CRICOTHYROIDOTOMY

MENGAPA MENGELUARKAN BANYAK


DARAH?
Mekanisme traumakepala terbentur
trotoar(benturan
frontal/samping/belakang)trauma
servikalperdarahanditandai dengan gargling
dan rongga mulut mengeluarkan banyak darah

MENGAPA SIANOSIS
Syok Hemoragik dan obstruksi jalan nafas Berkurangnya
SaO2 berasal dari menurunnya PaO2 Gangguan fungsi paru
yang serius tidak terventilasi atau miskin ventilasi
(hipoventilasi alveolar) penyebab sianosis sentral yang
sering.
vasokonstriksi generalisata Ketika cardiac output rendah,
seperti pada gagal jantung kongestif berat atau syok,
vasokonstriksi kulit terjadi sebagai mekanisme kompensasi
darah dialirkan terutama ke daerah-daerah prioritas seperti
SSP dan jantung, dan terjadi sianosis yang berhubungan
dengan ekstremitas yang dingin. Walaupun saturasi darah
arteri normal, volume darah yang mengalir ke kulit berkurang
dan turunnya PO2 pada ujung vena dari kapiler menyebabkan
sianosis.

TERAPI OKSIGEN

In immediately life threatening situations oxygen should be administered.

When to use oxygen therapy?


Hypoxia and or hypoxemia
Acute hypotension.

Breathing inadequacy.
Trauma.
Acute illness.
CO poisoning.
Severe anaemia.
During the peri-operative period.

Tissue oxygen delivery depends upon:


Adequate function of cardiovascular (cardiac output and flow)

Hematological (hb and its affinity for oxygen)


Respiratory (arterial oxygen pressure) system.

Tissue hypoxia is not relieved by oxygen therapy alone, functioning of all the
three organ systems also needs to be improved

1. Nasal Cannulae (NC)


A thin tube with two small nozzels that protude into the patient nostrils.
Easy to use.
Well tolerated.
Comfortable for long periods.
Patient can eat and talk easily.
Possible to deliver oxygen concentrations of
24-40% at flow rates of 1-6 litres/min.
Flow rates in excess of 4 litres/min might cause discomfort and drying of
mucous membranes and are best avoided.

2. Simple Face Mask


Easy to use.
Requires a good fit.
Between 6-12 lpm, concentration of oxygen 28-50%

3. Partial Rebreathing Mask


Based on a simple face mask, but featuring a reservoir bag which
increases the provided oxygen rate to 40-70% oxygen at 5 -15 lpm.

4. Non Rebreathing Mask

Draw oxygen from an attached reservoir bags, with one way valves
that direct exhaled air out of the mask.
When properly fitted and used at flow rates of 10-15 lpm, they deliver
close to 100% oxygen.
This type of mask is indicated for acute medical emergencies.

5. Venturi Mask
Also known as an air-entrainment mask is a a type of disposable face mask
used to deliver a controlled oxygen concentration to a patient, are considered
high-flow oxygen therapy devices.
The flow of 100 per cent oxygen through the mask draws in a controlled
amount of room air (21 per cent oxygen). Commonly available masks deliver
24, 28, 31, 35, or 40 per cent oxygen.
The kits usually include multiple jets in order to set the desired FiO2which are
usually color coded. The color of the device reflects the delivered oxygen
concentration, for example: blue = 24%; yellow = 28%; white = 31%; green =
35%; pink = 40%; orange = 50%.

Venturi Mask

When to stop oxygen therapy?


Patient becomes comfortable
Underlying disease stabilized
Blood pressure, pulse rate, respiratory rate and oxymetry are within
normal range

How to assess patient condition in 10 seconds?


1.Stimulate verbal response: good response = airway is clear, breathing
and ventilation adequate.

1.No response: Look, listen , feel


Look: chest movement, sign of hypoxia (cyanosis), accessory
respiratory muscle
Listen: snoring, gurgling, stridor, hoarness or no sound (apnea?)
Feel : air movement in front of nose.
3. Unconscious patient, Airway obstruction ?
Chin lift, jaw thrust (head tilt).
4. Spontaneous breathing or apnea (not breathing?)
Still breathing: give oxygen (NRM with 12 lpm)
Apnea : positive pressure ventilation with 100% oxygen (10-12 lpm).

A. Inisiasi dan Alur Kebutuhan Terapi Oksigen


Kebutuhan oksigen pada pasien dengan gangguan sirkulasi
/ nafas akut

Saturasi oksigen >95%


Hipoksemia ringan
(PaO2 60-79 mmHg dan SaO2 90-94%)

Hipoksemia berat
(PaO2 <40 mmHg dan
SaO2 < 75%)

Hipoksemia sedang (PaO2 40-60


mmHg, SaO2 75%-89%)

Metode Pemberian Oksigen


Sistem aliran rendah

Sistem aliran tinggi

Low concentration

Low concentration

Kanul binasal 1 6 L/menit


Sungkup ve nturi

High concentration

Head box

High concentration
24 44%
48
L/menit
Sungkup muka
sederhana

Sungkup muka
kantong rebreathing

SpO2 <93%
PCO2 <50
58
L/menit

40 60 %
FiO2

10 12
L/menit

Sungkup muka kantong


non rebreathing

Pertimbangkan
intubasi ET dan
ventilasi dibantu

PCO2 >50
6 10
L/menit

8 12
L/menit

95 100 % FiO2
40 60 % FiO2

95 100
% FiO2

GCS

Mengapa pasien tidak sadar?


Karena adanya hipoksia penimbunan asam
laktat penurunan suplay O2 ke otak
gangguan korteks serebri (bagian pengolah
kesadaran) penurunan kesadaran
Dapat pula Karena adanya trauma kepala
perdarahan intrakranial penekanan batang
otak penekanan ARAS (Ascending Reticular
Activating System bagian susunan penggalak
kewaspadaan) penurunan kesadaran
Terdapat pula kemungkinan fraktur cervical
penekanan pusat kesadaran penurunan
kesadaran

SUMBER
Emergency Care: A Textbook for Paramedics,Ian
Greaves, Keith Porter, Timothy J. Hodgetts, Malcolm
Woollard, Elsevier Health Sciences, 2006
Paramedic: Airway Management,Gregg S. Margolis,Jones &
Bartlett Learning, 1 Nov 2003 - 332 halaman
Harrisons Principles of Internal Medicine 16th Edition, page
209 - 211.
Harrisons Manual of Medicine 16th Edition, page 192 193
ATLS 8th edition
Toronto Notes : Emergency Medicine, 2008
Trauma:emergency resuscitation,preoperative
anesthesia,surgical management, volume 1,2007