TRAUMA MUSKULOSKELETAL

Dr. Dudut Tanjung, M.Kep.Sp.KMB

 Definisi
Trauma muskuloskeletal:
Cedera yang menyebabkan kerusakan
jaringan muskuloskeleletal meliputi: tulang,
sendi, otot, ligamen, saraf dan pembuluh
darah
 Jenis
– Fraktur
– Dislokasi
– Sprain
– Strain
 Fraktur
Fraktur adalah patahan pada tulang
yang dapat disertai kerusakan
jaringan lunak sekitarnya
(Lemon & Burke, 2004; Brunner & Suddarth, 2009).
 Jenis fraktur

• Secara klinis:
fraktur tertutup dan fraktur terbuka
• Gustillo – derajat fraktur terbuka
1. Derajat I : luka < 1 cm, bersih
2. Derajat II: luka > 1cm, avulsi, memar, fraktur
sederhanaa
3. Derajat III: trauma tumpul yang hebat, fraktur
hebat disertai kerusakan jaringan yang luas +
gangguan neurovaskular
 Tanda dan Gejala Fraktur
• Deformitas
• Nyeri
• Edema
• Bone expose
• Gangguan neurovaskular perifer {pucat, dingin, sensasi
(-), motorik (-)}
• Pergerakan abnormal/Kehilangan fungsi
Deformitas
 X-ray

http://orthoanswer.org/images/anatomy/hip/xr-hip-nof-pt.jpg
 Traumatic Pelvic Fractures
• Pelvic fractures are important as a cause for
morbidity and mortality.
• The mortality can be 30% with unstable peivic ring
injuries, and 10-12% of this percentage alone is
due to blood loss.
• The unstable pelvic fracture can cause the most
damage and is life threatening.
 Nursing Management
• The nurse's primary role is to assess the patient and be
alert to the signs and symptoms of potential
complications by performing a careful examination.
• The nurse should be suspicious and aware that other
injuries could have occured.
• It is important to keep the patient's pain under control.
• The nurse needs to watch for the complications of a
normal postoperative patient and other complications
 Cedera Tulang Belakang
• Jika diduga terdapat cedera servikal segera
pemasangan neck collar + head immobilizer.
• Termasuk memperhatikan evakuasi & transportasi
--- Log roll, long spine board, scoop strecher, KED.
 DISLOKASI/ SUBLUKSASI
• Terputusnya ligamen/ robeknya simpai sendi
• Reposisi segera
• Mobilisasi setelah 2-3 minggu
 SPRAIN
Terjadi kerusakan pada jaringan ikat sendi (ligamen)
 STRAIN
• Terjadinya kerusakan pada otot atau tendon
 Pengkajian
ABCs (Airway, breathing, and circulations)
Pemeriksaan fisik
• Look: Luka/ Memar, Pucat/ Sianosis, Edema, Deformitas
• Feel: Nyeri, Krepitasi, Tenderness (nyeri tekan)
• Move: Tidak dapat digerakkan, Gerakan abnormal
 Talaksana
• Pertahankan Jalan Nafas
• Terapi Oksigen
• Hentikan Perdarahan, Tutup Luka
• Resusitasi Cairan
• Manajemen Nyeri
• RICE (Rest, Ice, Compression, Elevation)
• Imobilisasi Cedera -- Pembidaian
• Mencegah Komplikasi Akut (Kompartemen Syndron, Deep vein
Thrombosis)
 The 2008 British Thoracic Society
• Target oxygen saturation 94–98% or 88–94% (if risk of
type 2 respiratory failure)
• Saturations should be documented
• Delivery system should be documented
• In patients with chronic obstructive pulmonary disease
oxygen therapy should be started with a 24% Venturi
mask at 2–4 litres with an initial target saturation of 88–
92% pending blood gas results.
 Resuscitation beyond Advanced Trauma
Life Support: damage control
Delayed stabilization of long bone fractures is
associated with multi-organ dysfunction
syndrome and respiratory complications (ARDS,
pneumonia and fat embolism)
 Resuscitation beyond Advanced Trauma
Life Support: damage control
• Respiratory complications were mainly related to the
severity of injury overall rather than the timing of
fracture fixation.
• This becomes particularly relevant in patients with
associated head injuries when early definitive fixation
of fractures can add to secondary brain injury by
prolonging hypotension and hypoxia.
 Tourniquet
When to Apply a Tourniquet-prehospital setting?
• significant and active arterial bleeding;
• the patient is at risk for exsanguination and;
• there is suffiient limb remaining on which a
tourniquet can be applied (Lewis, 2013).

“Why”: Defining the Need for a Tourniquet

• Extreme life-threatening limb hemorrhage
• Limb bleeding not controlled by direct pressure
 Imobilisasi Fraktur

Fraktur diimobilisasi -- splinting, gips, traksi

mengurangi nyeri, mencegah meluasnya cedera,

Mempertahankan kesejajaran tulang

(Potter & Perry, 2009)

Imobilisasi Fraktur
 https://aotrauma.aofoundation.org/Structure/Pages/default.aspx

Traction Principle of 2
Splinting
Imobilisasi Fraktur
 Diagnosa Keperawatan
• Nyeri
• Gangguan mobilitas fisik
• Defisit perawatan diri
• Intoleransi aktivitas
• Gangguan integritas kulit
• Gangguan neurovaskular perifer
• Risiko jatuh
• Risiko cidera
• Perubahan eliminasi PERMENKES NOMOR 10 TAHUN 2015 TENTANG
STANDAR PELAYANAN KEPERAWATAN DI RS KHUSUS
 Masalah kolaborasi

• Perdarahan • Infeksi paru

• Syok hipovolemia • Infeksi Saluran Kemih (ISK)
• Autonomic dysreflexia • Atropi otot
• Dekubitus • Kontraktur sendi
• Deep Vein Trombosis (DVT) • Dislokasi sendi
• Kompartemen sindrom • Risiko tidak efektifnya
• Emboli lemak pemeliharan protese
• Dislokasi prostese • Respon pasca trauma
PERMENKES NOMOR 10 TAHUN 2015 TENTANG
STANDAR PELAYANAN KEPERAWATAN DI RS KHUSUS
 Tindakan Keperawatan
• Pembalutan pada pendarahan
• Pembidaian faktur ekstremitas
• Penanganan syok
• Pemasangan armsling.
• Pemberian terapi: obat, produk darah
• Manajemen nyeri (farmakologi dan non farmakologi).
• Restrain fisik.
• Pemasangan splint.
• Positioning
PERMENKES NOMOR 10 TAHUN 2015 TENTANG
STANDAR PELAYANAN KEPERAWATAN DI RS KHUSUS
GempaPidie Jaya, 11 Desember 2016
Thank you...
Terima Kasih...