Primary Survey Assessment

(Penilaian dan Penanganan

Survei Primer)
Departemen Anestesiologi dan Reanimasi
FK – USU
2010
 Emergency Medicine
TRIAGE TRIASE
PRIMARY SURVEY SURVEI PRIMER
SECONDARY SURVEY SURVEI SEKUNDER
STABILISATION STABILISASI
TRANSFER RUJUKAN
DEFINITIVE CARE TERAPI DEFINITIF
 Tujuan Survei Primer
• Secepat mungkin menemukan kelainan yang
mengancam jiwa (cepat mematikan)
– di sektor A - B - C - D
• Memberikan pertolongan yang memadai untuk
menyelamatkan jiwa
• Pertolongan meliputi :
– Resusitasi
– Stabilisasi
Concepts of Primary Survey
 Rapid Primary survey
 Resuscitation
 Adjuncts to primary survey /resuscitation
 Detailed secondary survey
 Adjuncts to secondary survey
 Reevaluation
 Definitive care
 Korban ledakan tabung elpiji

Muka hangus
Pneumotoraks (blast injury)
Luka bakar luas
Fraktura betis kiri

Jangan terpukau
kelainan yang
jelas terlihat

Ikuti Sistematika A - B - C - D
Derajat kegawatan
korban berbeda-beda
Triage Survei primer Terapi definitif
Survei sekunder / rujukan

RS lain

Kamar
RESUSITASI Operasi
& STABILISASI
ICU

Hanya 50%
Emergency Medicine
pasien trauma
perlu operasi
Triage
 Sorting of patients according to :
•ABCDEs
•Available resources
 Multiple casualties

 Mass casualties
 © ACS

Primary Survey

Primary survey and

resuscitation of vital
functions are done
simultaneously –
a team approach
Preparation
Prehospital System
 Transport guidelines /protocols
 On-line medical direction
 Mobilization of resources
 Periodic review of care
 Closest appropriate facility
Preparation

Inhospital
 Preplanning essential
 Equipment, personnel, services
 Standard precautions
 Transfer agreement
Standard Precautions

• Cap
• Gown
• Gloves
• Mask
• Shoe covers
• Goggles/face
• Shields
 Survei Primer
• Periksa cepat berurutan
• Selesai dalam 2 menit
• Terapi segera apa yang ditemukan

( treat as you
find )
 Survei Primer

Airway Jalan nafas

Breathing Pernafasan
Circulation Sirkulasi
Disability Kesadaran
Exposure Pemaparan
• Mulai dengan Survei Primer
– Mencari dengan cepat gangguan fungsi vital di sektor A-B-C-D
– Memberi terapi suportif dengan cepat pada fungsi yang
terganggu

• Setelah fungsi vital stabil Survei Sekunder

– Mencari gangguan fungsi vital dengan teliti
– Memberi terapi definitif pada fungsi yang terganggu
Resuscitation

Protect and secure airway
 Ventilate and oxygenate

 Stop the bleeding

 Vigorous shock therapy

 Protect from hypothermia

Survei Primer

Airway
Breathing
Circulation
Disability
Exposure
Sumbatan jalan nafas pasien tak sadar
paling sering disebabkan pangkal lidah
 Airway
menilai jalan nafas

• Kesadaran (bisa bicara?)

• Look, Listen and Feel
• Gerak dada
• Gerak otot nafas tambahan
• Warna kulit, mukosa, kuku
 Airway
mengatasi obstruksi / sumbatan jalan nafas

• Lakukan chin lift / jaw thrust

• Bersihkan rongga mulut (suction?)
• Pasang jalan nafas oro / nasopharynx
• Lindungi tulang leher
• Intubasi trachea
20
JN NasopharynxJaw thrust JN Oropharynx

Walaupun tanpa intubasi

masih banyak
pasien dapat ditolong

JN Nasopharynx 21
 Head tilt

Neck lift Chin-lift 22

 Airway
waspada

• Obstruksi (sumbatan) jalan nafas

• Cedera dada dengan gangguan
nafas
• Cedera tulang leher
 Lindungi leher dari gerakan

Previously recommended hand Currently recommended hand

positions for manual in-line positions for manual in-line
stabilisation of the cervical stabilisation of the cervical
spine. spine. 24
Primary Survey
Establish Patent Airway
 C-spine injury
 Pitfalls
• Equipment failure
Caution • Inability to intubate
• Occult airway injury
• Progressive loss of airway
Primary Survey

Suspect C-Spine Injury

 Spinal protection

 C-spine X-ray when appropriate

Survei Primer

Airway
Breathing
Circulation
Disability
Exposure
 Breathing
menilai pernafasan

• Adakah udara keluar masuk

– Look, Listen, Feel
• Frekwensi nafas
• Gerak cuping hidung
• Cekungan sela iga
 Breathing
membantu pernafasan
• 1. Oksigen (jika ada)
• 2. Pernafasan buatan 1.

2.
2.

29
Jejas di dada:

Breathing
waspada
- Pneumotoraks tension
- Fr costa / Flail chest
- Hemotoraks berat
- Kontusio paru

- Pneumotoraks terbuka

30
Dekompresi pneumotoraks (tension)
harus dikerjakan dalam Primary Survey
Survei Primer

Airway
Breathing
Circulation
Disability
Exposure
 Circulation
mengatasi perdarahan

• Hentikan perdarahan
• Posisi shock
• Pasang infus besar x 2
• Ambil sampel darah
– u/ darah donor dan periksa Hb
• Beri infus cairan, 1000 ml cepat
 Circulation
mengatasi perdarahan

• Beri infus cairan, 1000 ml cepat

– RL (Ringer Laktat)
– NaCl 0.9% (Garam Fisiologis)
– RA (Ringer Asetat)
– Hypertonic Saline Dextran 250 ml
 Shock ?
• Perfusi :
– pucat - dingin - basah
– cap. refill time lambat (kuku, telapak)
• Nadi > 100
• Tekanan darah < 100 (atau 90) mmHg Nadi masih teraba
di :
– radialis > 80 mmHg
– femoralis > 70 mmHg
– carotis > 60 mmHg
 Circulation
waspada & cari lokasi perdarahan

• Cedera intra-abdominal
• Cedera dada
• Patah tulang panjang
• Patah tulang pinggul
• Luka tusuk / tembus
• Luka kulit kepala
Primary Survey
Circulatory Management
 Control hemorrhage

 Restore volume

 Reassess

Pitfalls
Elderly Children

Caution Athletes Medication

Survei Primer

Airway
Breathing
Circulation
Disability
Exposure
 Disability
menilai kesadaran
• Periksa Pupil (besar, simetri, refleks cahaya)
• Periksa kesadaran
– A = Awake (sadar penuh)

– V = responds to Verbal command

(ada reaksi terhadap perintah)

– P = responds to Pain (ada reaksi
terhadap nyeri)
– U = Unresponsive (tak ada reaksi)
 A- V - P - U

Pupil
Primary Survey
Disability
 Baseline neurologic evaluation

• GCS scoring
• Pupillary response

Observe for neurologic

Caution deterioration
Survei Primer

Airway
Breathing
Circulation
Disability
Exposure
 Exposure
pemaparan

• Lepaskan semua pakaian untuk pemeriksaan

teliti menyeluruh, ada jejas apa saja
• Periksa punggung!
– miringkan pasien cara Log-roll
• Cegah hipotermia (kedinginan)
Primary Survey
Exposure / Environment
• Completely undress the patient

Prevent hypothermia
Caution
 Survei Primer
Foto Dada sinar-X / Chest X-Ray ( jika ada)

Tulang leher / C - Spine(lateral)

Panggul ( Pelvis )
Abdominal USG
Adjuncts to Primary Survey
Vital sign

ECG ABGs

Urinary Adjuncts Pulse

Output oximeter
and CO₂

Urinary/gastric catheters
unless contraindicated
Adjuncts to Primary Survey
Diagnostic Tools
• Chest and pelvic
x-ray
• DPL
• Ultrasound

© ACS
Adjuncts to Primary Survey
Consider Early Transfer
 Do not delay transfer for diagnostic

tests
 Use time before transfer for

resuscitation
Special Considerations

Trauma in the Elderly

 5th leading cause of death

 ↓Physiologic reserve

 Comorbidities : Diseases/medications

 Outcome depends on early, aggressive

care
 Survei Sekunder
• Lanjutan dari survei primer
• Hanya bila ABC sudah stabil
• Teliti kepala sampai jari kaki
• Kembali ulang survei primer jika pasien
tidak stabil / kondisi memburuk
Reevaluate
Proceed to Secondary Survey After :
 Primary survey completed
 ABCD Es are reassessed

 Vital functions are returning to

normal
END

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