1.3. Pengelolaan Jalan Napas Dasar Dan Lanjut, FBAO Management (Dr. Prabowo)
1.3. Pengelolaan Jalan Napas Dasar Dan Lanjut, FBAO Management (Dr. Prabowo)
AND
FBAO
AIRWAY MANAGEMENT
Apa ke-khusus-an penanganan pasien gawat darurat ? 3
A = airway
LIFE SUPPORT
B = breathing
Resusitasi
C = circulation
Stabilisasi
D = disability
TERAPI DEFINITIF/
SPESIALISTIK
5
Life support
A ─B─ C─ D ─ E
Quick Diagnosis – Quick Treatment
Pasien obstruksi (A) atau apneu (B) akan mati dalam 3-5 menit
Pasien shock berat (C) akan mati dalam 1-2 jam
Pasien coma (D) akan mati dalam 1 minggu
6
Bagaimana mengamankan jalan nafas?
?
Bagaimana pendapat para ahli anestesiologi?
1.Intubasi oleh bukan ahli dapat timbulkan trauma
2.Resiko: hipoksia fatal/ secondary brain damage,
vagal reflex→ bradikardi berat, cardiac arrest
3.TIK naik hanya dapat dicegah dengan obat-obatan
4.Tidak semua fasilitas kesehatan dilengkapi peralatan untuk
intubasi trakea
7
1. Basic/ Manual
A. Chin Lift
B.Jaw Thrust
11
C. Combitube
Airway 15
Look
•Agitasi (hipoksia)/ tampak bodoh (hiperkarbia)
•Sianosis
•Retraksi
•Accessory respiratory muscle
16
Listen
•Snoring
•Gurgling
•Stridor
•Hoarness
Feel
•Trachea location
Patients talks clearly ? 17
Airway is adequate
Management: observation and selective intubation
Special consideration in :
•Maxillofacial injury
•Soft-tissue injury of the neck
•Facial or neck burns
Patient is hoarse ? 18
Laryngeal injury
Larngeal/ tracheal burn
Management: Evaluate and perform (if necessary):
•Intubation
•Surgical airway
Management :
Simple management manuevers:
•Suction
•Chin lift
•Jaw thrust
Intubation
DEFINITIVE
SURGICAL : Krikotiroidotomy
: Trakeostomy
NON DEFINITIVE
OROPHARYNGEAL AIRWAY
NASOPHARNGEAL AIRWAY
23
24
OBJECTIVE
Clear and protected airway
Oxygenation
Jangan Lakukan !!
Airway Dasar 29
NO: 0 1 2 3 4 5 6
How to measure the right size of 31
Oropharyngeal Airway
Komplikasi
Obstruksi total
Laringospasme
Muntah
Cara Pemasangan Oropharyngeal Airway
32
Dimasukkan mulut dg lengkungan menghadap palatum.
Setelah masuk separuh panjangnya, putar 180° hingga
lengkungan menempel pada lengkungan lidah.
1.
2.
3.
2. Nasopharyngeal Airway (NPA) 33
Nasopharyngeal Airway
Komplikasi
Kerusakan mukosa nasal
Laryngospasme
Cara Pemasangan Nasopharyngeal
Cara pemasangan: beri jelly pelicin, didorong memasuki
Airway 35
1.
2.
3.
3. Advanced Airway 36
Keuntungan :
Menjaga jalan nafas terbuka
Mengurangi risiko aspirasi
Sebagai fasilitas ‘suction’ trakea
Sebagai fasilitas pemberian oksigen
konsentrasi tinggi
37
Komplikasi
Endotrakeal Tube
Hipoksia
(ETT) Trauma
Muntah-aspirasi isi
lambung
Hipertensi
Disritmia jantung
Intubasi satu paru
Intubasi esofagus
Cardiac arrest akibat
vagal reflex
38
Persiapan Intubasi Endotrakeal
1. Alat:
A. Laryngoscope
Terdiri dari : Blade (bilah) dan Handle (gagang).
Pilih ukuran blade yg sesuai.
Dewasa : no 3 atau 4
Anak : no 2
Bayi : no 1
Pasang blade dengan handle
Cek lampu harus menyala terang.
Laryngoscope 39
Menyiapkan Laryngoscope
40
1. 2.
3. 4.
Memegang Laryngoscope
41
Memegang laryngoscope
selalu dengan tangan kiri
3. Pasien
Informed consent mengenai tujuan dan resiko tindakan.
LIDAH
VALEKULA
EPIGLOTIS
Trakea
Esofagus !!!
Sniffing Position
Mambantu Visualisasi laring
ELEVASI LARINGOSKOP 52
BURP MANUEVER
Menekan kartilago krikoid ke bawah, atas, kanan
(Back, Up, Right Pressure= BURP)
Membantu visualisasi plika vokalis
Dilakukan oleh asisten yg membantu intubator
ADAM’S APPLE
BURP
THYROID
CRICOID
INTUBASI TRAKEA 56
G. H.Intubasi endobronkhial
2
59
3
4
60
5
Teknik Nasal 61
1 2
62
4
63
5
64
MENCEGAH KOMPLIKASI
INTUBASI TRAKEA
Dilakukan oleh tenaga terlatih
Alat-alat intubasi lengkap : laryngoskop & pipa
trakea berbagai ukuran
Intubasi dilakukan < 30 detik
Dilakukan penekanan pada kartilago krikoid
(BURP Manuever)
Pilih pipa trakea ‘high volume low pressure
cuff’
RJP DENGAN PASIEN 65
TERPASANG ETT
Pasien dengan
intubasi trakhea,
bantuan ventilasi
tidak perlu sinkron
dengan kompresi
dada pada saat RJP
Intubation Movie 66
3. Advanced Airway 67
Keuntungan :
•Teknik pemasangan lebih mudah
•Trauma lebih sedikit
•Tidak membutuhkan laringoskop
Look for the Universal Sign of the victim's hand across their throat . . . . . . .
•if the victim is making sound or moving air, encourage them to cough.
•If the victim is not making sound, or is turning color, intervene.
•Announce to the victim that you know the Heimlich Manuver and can help!
•Have someone activate emergency medical system - CALL 911.
•Stand behind the victim with your arms wrapped around the 74
victims chest.
•Feel for the victim's xiphoid process with your right hand.
Make a fist with your left hand and place it (THUMB IN) below the right hand.
75
Look for the Universal Sign of the victim's hand across their throat.
•If the victim is making sound or moving air, encourage them to cough.
•If the victim is not making sound, or is turning color, intervene.
•Announce to the victim that you know the Heimlich Manuver and can help!
•Have someone activate emergency medical system - CALL 911.
•If you are alone, perform Heimlich Manuver first, then call 911, because 80children
need air !!!
•Stand behind the victim with your arms wrapped around the victims chest.
•Feel for the victim's xiphoid process with your left hand.
•Make a fist with your right hand and place it (THUMB IN)below the left hand.
81
•Place victim flat on his/her back with their head to your right, on
a hard surface.
With your left hand cupped in a "C" shape, grab the infant by the jaw
and rest the remainder of your arm across the infant's body. 85
•Lift the infant with your left hand and invert the victim so their body is resting across
the rescuer's left arm with the legs straddling your arm.
•Lower the victim's head.
•With the infant's back towards you, perform 5 back blows at the
level of the infant's shoulder blades with the heel of your right 86
hand.
•If no air goes in, reposition the head and try again.
•If no response after 1 minute, call emergency medical system dial-911
•Return to victim and continue the Heimlich Manuver.
3. Position the victim on his back and call “Help! Call 995”
5. Push chin down and check mouth for foreign body object
6. If foreign body is seen, If foreign body is seen, insert the index finger of
the other hand down along the inside of the cheek and deeply into the throat.
Use a hooking action to dislodge the foreign body and maneuver it out of
the mouth./ Take precaution not to force the foreign body deeper into the
throat. This maneuver is known as the finger sweep.
Finger Sweep 93
9. If the chest does not rise again, give 30 chest thrusts. The hand position
for chest thrusts is the same as chest compression performed in CPR.
10. Repeat S/N 4 to 8 until there are 2 successful ventilations, and check the
breathing.
95
2. If unsuccessful, the victim can also press the upper abdomen over any
firm surface such as the back of a chair, side of table, or porch railing.
Several thrusts may be needed to clear the airway.
Chest Thrust 96
Thank you.....