2.

FALSAFAH
PENANGGULANGAN TRAUMA
R. Sjamsuhidajat
Definitive Surgical Trauma Care
Kolegium Ilmu Bedah Indonesia
2018
Referensi: Committee on Trauma, American
College of Surgeons (2011)
The TEAM Program
TRAUMA EVALUATION AND MANAGEMENT
(TEAM)

The ATLS Committee strongly encourages the

participation of ATLS instructors as they have
the knowledge of the philosophy, intent, and
content of the program.
The TEAM program provides a standardized
introductory course in the evaluation and
management of trauma for medical students
and multidisciplinary team members. The
ATLS Committee strongly encourages the
participation of ATLS instructors as they have
the knowledge of the philosophy, intent, and
content of the program.
Deaths from trauma show three peaks:
• immediate death;
• later death due to hemorrhage or direct organ
compromise;
• and delayed death due to complications and
organ failure.
Death may occur within seconds of the injury,
usually due to massive head injury, heart
injury, or aortic injury.
These deaths cannot be prevented.
A second peak in deaths begins an hour or two
after the injury. Deaths occurring in this
second peak are usually due to subdural and
epidural hematomas, hemo- or
pneumothorax, organ rupture, or blood loss.
These deaths are often preventable. This period
is called the “golden hour” during which
prompt intervention can save a life.
The third peak in deaths occurs many days after
the injury, and is usually due to sepsis or
multi-organ failure.
Prompt treatment of shock and hypoxemia
during the “golden hour” can reduce these
deaths.
The Philosophy of Trauma Care
In dealing with the trauma victim, the physician
must treat as he or she gathers information.
The approach cannot be routine “take a history,
do an exam, order some tests, make a
diagnosis, then treat the patient.”
Therapeutic interventions must be made “on the
fly,” before the full evaluation can be
completed.
For every possible injury, emergency physicians
and trauma surgeons have a “threshold of
action” — a point at which the physician will
aggressively intervene even without
traditional “proof” of the diagnosis.
For example, the combination of low blood
pressure, unilaterally decreased breath
sounds, and respiratory distress triggers a
response from the physician.
A chest tube is placed immediately, rather than
waiting until an x-ray can “prove” the
diagnosis.
As the trauma victim arrives, the physician
assesses vital functions (the ABCs) rapidly,
intervening when the patient’s status meets
the “threshold of action.”
The physician orders stabilization measures
such as IV and oxygen as the primary survey
is conducted.
 A Very Important Attitude:

• The management of the trauma victim should

NOT be viewed as a linear flow chart, with
one action following another.

• It should be viewed as a progression through

a series of loops.
The physician examines, takes action on a
positive finding, then “loops” back to examine
the effects of the action.
For example,
- weak air motion,
- place oral airway,
- recheck air motion.
.
If positive findings persist, the physician acts on
the abnormal finding again, and again checks
the effects.
After stabilizing the abnormality, the physician
progresses on to the next “loop.”
Some loops may reside inside other large loops
— for example, the physician may assess, take
action on, and reassess other problems while
waiting for the effects of fluid infusion.
When the physician is confident that the patient
is stable and adequately monitored, he
performs a full patient assessment (often
called the secondary survey).
As sufficient historical, examination, and
laboratory data becomes available, definitive
care is arranged.
HAVE A NICE DAY