First Aid :

Initial Assesment
Initial Assesment :
Proses penilaian pasien untuk melakukan penanganan
terhadap semua keadaan yang mengancam nyawa pasien yg
dimulai dari : Lokasi Kejadian, Primary Survey dan
Secondary Survey.

Standar Khusus Penilaian :

Pasien stabil
Mengindentifikasi tindakan
Mempersiapakan tindakan defenitif & cara menstanper pasien
dengan kondisi tsb.
 INITIAL PRIMARY
ASSESMENT SURVEY

Penilaian awal A Airway

yang dirancang untuk B Breathing
mendeteksi semua C Circulation
ancaman langsung D Disability
terhadap kehidupan E Exposure

• https://chemm.nlm.nih.gov/appendix8.htm#primary
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability,
Exposure (ABCDE) approach. International Journal of General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
Kapan initial
assessment ?
airway obstruction

head and cervical

spine injuries

chest injuries with

breathing difficulty

severe external or
internal
haemorrhage

abdominal injuries
• http://www.ichrc.org/chapter-1101-primary-survey-or-initial-assessment
 MENYELAMATKA
N JIWA

MENDETEKSI
ANCAMAN
MENCEGAH TUJUAN DENGAN SEGERA
KOMPLIKASI ABCDE DAN TELITI

MEMBERI PERTOLONGAN
PERTAMA YANG SESUAI DAN
SEGERA
• http://trauma.reach.vic.gov.au/guidelines/early-trauma-care/primary-survey
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing,
Circulation, Disability, Exposure (ABCDE) approach. International Journal of General Medicine. 2012;5:117-121.
doi:10.2147/IJGM.S28478..
AIRWAY
 Why do we check AIRWAY?
Lidah jatuh
Benda asing
›AIRWAY OBSTRUCTION Gigi
Darah
dll

• CARDIAC ARREST

• DEATH

• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 AIRWAY
• Suara jelas,
• Bisa berteriak, AIRWAY AMAN
• DENGARKA • tidak ada suara
N SUARA yang aneh dari
PASIEN pasien BUKA JALAN
• Tidak terlihat ada NAPAS
• AJAK sesuatu di jalan DAN BERSIHKAN
PASIEN napas JALAN NAPAS
BICARA

• PERIKSA • Suara tidak jelas,

SALURAN • Tidak ada suara,
NAPAS • Ada suara aneh AIRWAY
• Terlihat ada BERMASALAH
sesuatu di jalan
napas

• http://www.who.int/surgery/publications/s16382e.pdf
 AIRWAY
KONTRAINDIK
ASI
pada pasien yang
dicurigai
CIDERA
CERVICAL

Direkomendasikan
pada pasien yang
dicurigai cidera
cervical
Triple airway manoeuvre
• https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Triple%20airway%20manoeuvre.pdf
 AIRWAY DEVICES

• Gunakan jika pasien tidak sadar

• Gunakan ukuran yang benar, ukur dari depan telinga ke sudut
mulut
• Geser saluran udara di atas lidah
• Jika pasien menolak, mual atau muntah, segera lepaskan!
• http://www.who.int/surgery/publications/s16382e.pdf
• Becker DE, Rosenberg MB, Phero JC. Essentials of Airway Management, Oxygenation, and
Ventilation: Part 1: Basic Equipment and Devices. Anesthesia Progress. 2014;61(2):78-83.
doi:10.2344/0003-3006-61.2.78.
 AIRWAY DEVICES

• Lebih baik digunakan jika pasien setengah sadar

• Berikan pelumas dan masukan dengan baik ke satu lubang
hidung
• masukan langsung ke posterior, menuju tenggorokan
• http://www.who.int/surgery/publications/s16382e.pdf
• Becker DE, Rosenberg MB, Phero JC. Essentials of Airway Management, Oxygenation, and
Ventilation: Part 1: Basic Equipment and Devices. Anesthesia Progress. 2014;61(2):78-83.
doi:10.2344/0003-3006-61.2.78.
BREATHING
 BREATHING
LOOK

LISTEN

FEEL

PERCUSS

• http://www.who.int/surgery/publications/s16382e.pdf
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 LOOK

›Kesimetrisan dada
›Ada tidaknya sianosis
›Paradoximal movement
VIDEO
›Respiratory rate
›(semenit berapa kali dadanya naik turun)

• http://www.who.int/surgery/publications/s16382e.pdf
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 Dengakan udara yang keluar dari hidung dan
LISTEN mulut

Rasakan pergerakan udara dari hidung dan

FEEL mulut

PERCUSS Perkusi dada jika diperlukan

Look, listen, feel lakukan secara bersamaan. Lalu lakukan perkusi jika
diperlukan

• http://www.who.int/surgery/publications/s16382e.pdf
• https://www.nzrc.org.nz/assets/Guidelines/BLS/ANZCOR-Guideline-5-Breathing-Jan16.pdf
 Ganggua
n
breathing

oxygen delivery

assisted or
mechanical ventilation
tube thoracostomy
or chest tube
insertion.
Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
 Ganggua
n
breathin
g

oxygen delivery

assisted or
mechanical ventilation
tube thoracostomy
or chest tube
insertion.
Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
 Ganggua
n
breathing

oxygen delivery

assisted or
mechanical ventilation
tube thoracostomy
or chest tube
insertion.
Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
 Ganggua
n
breathing

oxygen delivery

assisted or
mechanical ventilation
tube thoracostomy
or chest tube
insertion.
Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
 CIRCULATION

http://www.mayo.edu/research/centers-programs/cardiovascular-research-center
 CARDIAC TRAUM SPINAL CORD
PROBLEMS INJURY
A
CARDIOGENIC NEUROGENIC
BLEEDING
SHOCK SHOCK

HEMORRAGE
SHOCK

GANGGUAN
CIRCULATION
CARDIOGENIC HEMORRAGE NEUROGENIC
AMAN AMAN
SHOCK SHOCK SHOCK
• Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
• Dave S, Cho JJ. Shock, Neurogenic. [Updated 2017 Oct 1]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459361/
 APA SAJA YANG DIPERIKSA ?
Nadi
WAJIB Bleeding
• Ada atau tidak
Lihat dan rasakan • Frekuensi • Internal bleeding
area kulit perifer • Kekuatan • External bleeding
(kuat / lemah)
• (sianosis / tidak) • Irama Capillary refill
• (dingin / hangat) (teratur / tidak)
JIKA
MEMUNGKINKA TEKANAN DARAH
N
AUSKULTASI
JANTUNG

AMATI URINE
OUTPUT
• https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
 NADI TIDAK NADI
TERABA TERABA

NON
CARDIOGENIC
CARDIOGENI
SHOCK
C SHOCK

Nilai Frekunsi,
RJP Kekuatan,
Irama

• Dave S, Cho JJ. Shock, Neurogenic. [Updated 2017 Oct 1]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2018 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459361/
• Setiati S, et al. Buku Ajar Ilmu Penyakit Dalam Ed. 6. Jakarta: Interna Publishing. 2014.
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway,
Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of General
Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 < 60 ATAU
> 2 DETIK > 100 KALI
/ MENIT

CAPILLARY CIRCULATIO HEART

REFILL RATE
N
60 - 100
< 2 DETIK KALI /
MENIT

• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
 Penanganan gangguan circulation
›Masukkan satu atau lebih kanula intravena besar (14
atau 16 G).
›Berikan 1 - 2 L cairan isotonik IV (dewasa)
›Berikan 20 ml/kgBB cairan isotonik IV (anak-anak)
›Pastikan pasien tetap hangat
›Menilai ulang tanda-tanda vital
›Jika tanda vital pasien belum membaik (sistol < 90
mmHg / HR > 110 bpm) , segera lakukan transfusi darah

• https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
• Wilson, Chad & Clebone, Anna. (2014). Initial Assessment and Management of the Trauma Patient.
Anesthesia for Trauma: New Evidence and New Challenges. 1-14. 10.1007/978-1-4939-0909-4_1.
• http://www.who.int/surgery/publications/s16382e.pdf
 DISABILITY

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024392/
 DISABILITY
WAJIB AVPU

Pastikan ABC telah

tuntas (pasien tidak GCS
hipoksia dan syok)
JIKA
CARI TAHU
MEMUNGKINKA
N
PENGGUNAAN Periksa pupil
OBAT PASIEN

CEK GULA
DARAH

• https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 PENANGANAN GANGGUAN DISABILITY
›Berikan antigonis obat yang mungkin menyebabkan kesadaran
pasien menurun
›Berikan glukosa baik oral maupun IV pada pasien hipoglikemi
›Pasien dengan gangguan kesadaran harus selalu dijaga ABCnya
›Posisikan pasien dalam recovery position jika pasien dalam pain
responsive atau unresponsive untuk menjaga ABCnya

• https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 RECOVERY
POSITION
• http://www.sja.org.uk/sja/first-aid-advice/first-aid-techniques/the-recovery-position.aspx
 RECOVERY POSITION
VS
CONTINUOUS HEAD TILT AND CHIN LIFT TECHNIQUE
The recovery position
• hindered breathing assessment,
• delayed breathing arrest identification and the initiation of cardiac
compressions,
• significantly increased the likelihood of not starting cardiopulmonary
resuscitation
When compared to the results shown when the continuous head tilt and
chin lift technique was used.
• Freire-Tellado M, et al. Does lying in the recovery position increase the likelihood of not delivering
cardiopulmonary resuscitation?. Resuscitation. 2017; 115: 173 – 177
• Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of
General Medicine. 2012;5:117-121. doi:10.2147/IJGM.S28478..
 EXPOSURE

• https://www.aic.cuhk.edu.hk/web8/log_roll.htm
TERIMA
KASIH