Initial Assesment dan Triage

Safril
Balai Pelatihan Kesehatan
Banjarbaru, Kalimantan Selatan
NAMA : SAFRIL

TTL : BANJARMASIN, 6 APRIL 1971

INSTANSI : BAPELKES PROV KALSEL

ALAMAT : JL. PALEM (KARANGREJO) KOMPLEK

WIDYA CITRA GRAHA II NO. D5,

BANJARBARU

NO HP : 08125190138

EMAIL : safril.bapelkes@gmail.com

NO PIN BB : 57D4FA90
Tujuan Pembelajaran
A. Secara umum
Peserta mampu melakukan penilaian awal dan dapat menangani kasus
kegawatdaruratan secara cepat dan tepat.
B. Secara khusus
1. Mengetahui dan menjelaskan konsep penilaian awal yaitu primary
survey, resusitasi dan secondary survey.
2. Melakukan penanganan kegawatdaruratan dengan konsep penilaian
awal secara berurutan dan dilakukan secara simultan.
3. Mempersiapkan rujukan rumah sakit yang tepat untuk penanganan
definitif.
Agenda
1.Mengetahui dan menjelaskan konsep
penilaian awal yaitu primary survey,
resusitasi dan secondary survey.
2.Melakukan penanganan kegawatdaruratan
dengan konsep penilaian awal secara
berurutan dan dilakukan secara simultan.
3.Mempersiapkan rujukan rumah sakit yang
tepat untuk penanganan definitif.
I. Deskripsi Singkat
Kegawatdaruratan dapat terjadi
dimana-mana
Kejadiannya tidak dapat diperkirakan,
bersifat mendadak dan cepat,
Kejadian kasus kegawatdaruratan ini
bila tidak ditangani dengan baik, cepat
dan benar akan berdampak bukan pada
perbaikan keadaan penderita bahkan
dapat memperparah keadaan penderita.
I. Deskripsi Singkat

Kesiapsiagaan penolong / petugas perlu

ditingkatkan agar dapat melakukan
pertolongan dengan baik, cepat dan tepat
Prinsip pertolongan kegawatdaruratan
adalah do the right thing to the right patient
at the right time (melakukan dengan benar
pada penderita yang benar di saat yang
benar).
Tindakan yang benar ini dapat dilakukan
dengan melakukan penilaian awal (initial
assesment).
ACTION IN AN EMERGENCY
 Primary Survey (Initial assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid
 Reassess regularly
 Transport to health care facility
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)  D
 Provide first aid  R
 Reassess regularly  A
 Transport to health care facility
 B
 C
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help  Dangers (Trauma,
 Secondary Survey (assessment) Tenggelam, Keracunan,
 Provide first aid Luka)
 Reassess regularly R
 Transport to health care facility  A
B
C
 5

Kebakaran Tangki Penyimpanan

 PT. Asahimas Chemical – Tahun 2002 (Ethylene)
 PT. Tumindomas Bulk Terminal – Tahun 2002
(Aceton, Buthy Cellosolve, Buthyl Acetate, Iso Prophyl
Alcohol, Methyl Ethylene Ketone, Methyl Ethylene Glycol,
Vynil Acetate Monomer)
 PT. Petrokimia Nusantara Indonesia – Tahun 2001
(Hypochloride)
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)  Dangers (Aman
 diri,Lingkungan,Pasien)
Provide first aid
 Reassess regularly R
 Transport to health care facility  C
A
B
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)  Dangers (Aman
 diri,Lingkungan,Pasien)
Provide first aid
 Reassess regularly R
 Transport to health care facility  C
Sarung tangan
A
Kaca mata
Apron B
Sepatu
ACTION IN AN EMERGENCY
 Primary Survey (assessment)

 AVPU scale
 Dangers
 Alert and aware
 Response
 Responds to Verbal stimuli
 Responds to Painful stimuli
 C
 Unresponsive  A
 B
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)  Dangers
 Provide first aid  Response
 Reassess regularly
 Circulation
 Transport to health care facility
 Airway
 Breathing

DO NO FURTHER HARM
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help

 Dangers
Secondary Survey (assessment)
 Provide first aid  Response
 Reassess regularly  Airway
Look Listen Feel
 Transport to health care facility  Breathing Palpasi
 Circulation
Gurgling (sumbatan cairan, darah/sekret)
Curiga masalah airways:
Snoring (kesadaran menurun)
Stridor (Edema) Fraktur Cervical/Fr. Basis Cranii,
menghirup uap panas)
 ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help

 Dangers
Secondary Survey (assessment)
 Provide first aid  Response
 Reassess regularly  Circulation
 Transport to health care facility  Airway Look Listen Feel
Palpasi
 Breathing
Sirkulasi dinilai dengan melihat dan meraba:
Kesadaran, Warna kulit, akral dan nadi
Bila ada shock atau perdarahan, tangani sesuai
permasalahan
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help

 Dangers
Secondary Survey (assessment)
 Provide first aid  Response
 Reassess regularly  Circulation
 Transport to health care facility  Airway Look Listen Feel
Palpasi
 Breathing
Masalah di Airways:
1.NPT/OPT/ETI NPT : Nasopharingeal Tube
OPT : Oropharingeal Tube
2.Oksigen ETI : Endotracheal Intubation
Difficult Airway
 ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help

 Dangers
Secondary Survey (assessment)
 Provide first aid  Response
 Reassess regularly  Circulation
 Transport to health care facility  Airway Look Listen Feel
Palpasi
 Breathing
3 masalah yang mengancam breathing:
1.Tension pneumothoraks.
2.Open pneumothoraks.
3.Haematotoraks.
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid
 Reassess regularly
 Transport to health care facility
ACTION IN AN EMERGENCY
 Indonesia 119
 Get help
 Health care facility
(0527-61479)

 What happened
 How many victims
 Where
 Who
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid  A
 Reassess regularly
 B
 Transport to health care facility
 C
 D
 E
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Airway
 B
 C
 Head tilt – chin lift method  D
 Jaw thrust method
 E
ACTION IN AN EMERGENCY

 Secondary Survey (assessment)

 Airway
 Rate
 Normal respiration 12 - 20  Breathing
 Bradypnea   C
 Tachypnea 
 Apnea  D
 Depth
 Ease
 E
 Noise
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid  Airway
 Reassess regularly  Breathing
 Transport to health care facility
 Circulation
 D
 E
ACTION IN AN EMERGENCY

 Secondary Survey (assessment)

 Rate  Airway
 Normal HR 60 - 90
 Bradycardia 
 Breathing
 Tachycardia   Circulation
 Strength
 Rhythm  D
 Arrythmia  E
 Skin colour
ACTION IN AN EMERGENCY

 Secondary Survey (assessment)

 Airway
 Systemic BP
 Breathing
 Normal BP 120–140 / 60-80  Circulation
 Hypertension   D
 Hypotension 
 E
 ACTION IN AN EMERGENCY

 Secondary Survey (assessment)

 Airway
 Breathing
Rapid assessment of hemodynamic status
Level of consciousness  Circulation
Skin color
Pulses in four extremities  D
Blood pressure and pulse pressure  E
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid  Airway
 Reassess regularly  Breathing
 Transport to health care facility
 Circulation
 Disability
 E
ACTION IN AN EMERGENCY
 Mental status
 Pupils
 Extremities

 Secondary Survey (assessment)

 Airway
 Breathing
 Circulation
 Disability
 E
 ACTION IN AN EMERGENCY
 Mental status: Glasgow Coma Scale  Eye opening
 Spontaneously 4
 Pupils  To Speach 3
 To Pain 2
 Extremities  None 1

 Secondary Survey (assessment)

 Verbal response
 Orientated 5
 Airway


Confused
Inappropriate words
4
3  Breathing
 Incomprehensible sounds 2
 None 1  Circulation
 Motor response
 Obeys verbal commands 6  Disability
 Localising pain 5


Withdraws
Flexing to pain
from pain stimuli 4
3
 E
 Extension to pain 2
 No response 1
ACTION IN AN EMERGENCY
 GCS
 Pupils
 Extremities

 Secondary Survey (assessment)

 Shape
 Airway
 Equality  Breathing
 Response to light
 Circulation
 PEARL  Disability
 Pupils Equal And Reacting to Light
 E
ACTION IN AN EMERGENCY
 GCS
 PEARL
 Extremities

 Secondary Survey (assessment)

 CSM
 Airway
 Circulation  Breathing
 Sensation
 Circulation
 Movement
 Disability
 E
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid  Airway
 Reassess regularly  Breathing
 Transport to health care facility
 Circulation
 Disability
 Exposure, Everything Else
ACTION IN AN EMERGENCY
 Physical exam
 Victim‘s chief complaint
 Head to toe examination
 Victim‘s history
 Secondary Survey (assessment)
 Airway
 Breathing
 Circulation
 Disability
 Exposure, Everything Else
ACTION IN AN EMERGENCY
 Physical exam
 Victim‘s chief complaint
 Head to toe examination
 Victim‘s history
 Secondary Survey (assessment)
 Airway
 Breathing
 DOTS
 Deformity  Circulation
 Open wounds
 Disability
 Tenderness
 Swelling  Exposure, Everything Else
ACTION IN AN EMERGENCY
 Physical exam
 Victim‘s chief complaint
 Head to toe examination
 Victim‘s history (AMPLE history)

 Secondary Survey (assessment)

 Airway
 Allergies  Breathing
 Medications
 Past medical history
 Circulation
 Last oral intake  Disability
 Events leading up to the illness or injury
 Exposure, Everything Else
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid
 Reassess regularly
 Transport to health care facility
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid
 Reassess regularly
 Transport to health care facility

 Recovery position
ACTION IN AN EMERGENCY
 Primary Survey (assessment)
 Get help
 Secondary Survey (assessment)
 Provide first aid
 Reassess regularly
 Transport to health care facility
 RESOURCES

 National Safety Council; FIRST AID AND CPR.

• Charles University in Prague, 1st Faculty of Medicine,
Institute of Theory and Practice of Nursing
 Chapleau, W., Pons, P. (2007) EMERGENCY MEDICAL
TECHNICIAN. St. Louis: Elsevier
 Caroline, N. (2007) EMERGENCY CARE IN THE
STREET. 6th ed. London: Jones and Bartlett
 YAGD 118, BT&CLS, 2012, Jakarta
 American college of surgeon, community of trauma, ATLS,
TRIAGE
Sejarah triage, konsep dan
kategorisasi

Training comittee
 Sejarah Triage

• Definisi : Dari kata Perancis “Trier”

membagi dalam 3 group
• Dikembangkan di medan pertempuran
• Konsep ini digunakan bila terjadi bencana
• Dilaksanakan di ruang gawat darurat dari
1950 / 1960 karena 2 alasan :
- kunjungan
- penggunaan utk non urgen

Triage 46
 Triage
• Suatu proses yg mana pasien
digolongkan menurut tipe dan tingkat
kegawatan kondisinya
• Hal itu di atur untuk mendapatkan :
 pasien yg benar ke
 tempat yg benar pada
 waktu yg benar dengan
 tersedianya perawatan yg
benar

Triage 47
Triage 48
 Sistem Triage

• Nondisaster: Untuk menyediakan perawatan sebaik

mungkin bagi setiap individu pasien
• Disaster: Untuk menyediakan perawatan yg lebih
efektif untuk pasien dalam jumlah banyak

Triage 49
 Jenis triage
• 1. Triage harian
Triage harian digunakan untuk memilah
mana pasien yang paling sakit dan
mana yang kurang sakit.
Terapi diberikan sesuai urutan prioritas
berdasarkan tingkat kesakitan.
Intensitas perawatan yang diberikan
dilakukan berdasarkan seberapa serius
masalah pasien, bukan berdasarkan
peluang keselamatan.
Triage 50
• 2. Insidental triage
Insidental triage terjadi pada situasi
dimana sejumlah besar pasien datang
ke UGD secara bersamaan, namun
UGD masih mampu untuk menyediakan
perawatan pada semua korban.
Pada situasi ini, UGD mungkin
memerlukan bantuan dari unit lain.
Perawatan secara intensif masih
dilakukan berdasarkan seberapa serius
masalah yang dialami pasien.
Triage 51
• 3. Disaster Triage
Pada kondisi bencana, tujuan utama triage
adalah mencari sebanyak mungkin mana
pasien yang mempunyai peluang hidup
paling besar dengan perawatan seminimal
mungkin.

Triage 52
Gambar 6.4.1: Pembagian Triage

Triage 53
 Skala Kegawat - daruratan dalam Triage

• Secara umum, kita mengenal pembagian triage

dalam 2 skala, 3 skala, 4 skala dan 5 skala.
• Pembagian triage kedalam 5 skala mempunyai
nilai presisi dan reliabilitas yang lebih tinggi
daripada pembagian dengan 2, 3 dan 4 skala.
• Secara internasional,pembagian triage menjadi
5 skala juga lebih banyak dipakai.

Triage 54
 Konsep Triage

• Tujuan utama adalah utk mengidentifikasi kondisi

mengancam nyawa
• Tujuan kedua adalah utk memprioritaskan pasien
menurut keakutannya
• Pengkategorian mungkin ditentukan sewaktu-waktu
• Jika ragu, pilih prioritas yg > tinggi utk
menghindari penurunan triage

Triage 55
 Kode Warna International Dalam
Triage
• Hitam – Priority 0
(dead)
• Merah – Priority 1
• Jingga – Priority 2
• Hijau – Priority 3

Triage 56
Prioritas 1- Kasus berat
• Masalah Airway, Breathing, Circulation
• Perdarahan berat
• Asfiksia, cervikal, cedera pada maxilla
• Trauma kepala dgn koma dan proses shock yg cepat
• Fr. Terbuka & Fr. Compound
• Luka bakar > 30 % / Extensive burn
• Crush injury
• Shock tipe apapun

Triage 57
 Prioritas 2 - Kasus sedang
• Trauma thorax Non asfiksia
• Fr. Tertutup pada tulang panjang
• Luka bakar terbatas ( < 30 % dari Luas
Permukaan Tubuh)
• Cedera pada bagian / jaringan lunak

Triage 58
Prioritas 3 - Kasus ringan

• Minor injuries
• Seluruh kasus - kasus ambulant / jalan

Triage 59
 Prioritas 0 - Kasus meninggal

• Tdk ada respon pada semua rangsangan

• Tdk ada respirasi spontan
• Tdk ada bukti aktivitas jantung
• Tdk ada respon pupil terhadap cahaya

Triage 60
Noji
Nojiet
etal,
al,NEJM
NEJM
TERIMA KASIH

Triage 62