BEDAH

Question 1

Primary Survey

Answer 1

A (airway & C-spine control)
- Triple maneuver airway –> head tilt, chin lift + jaw thrust
- Definite airway (ETT)

B (Breathing) = RR, SpO2, PF
- terapi o2
- dekompresi (a/i)
- ventilator

C (Circulation) = TD, HR, CRT, Akral
- kontrol perdarahan = D-E-P-T
- resus cairan

D (Disability) = GCS, status neurologis

E (Exposure) = Buka baju pasien liat ada jejas/tdk
- Cegah hipotermia

Question 2

Gangguan airway
- gargling, tx?
- snoring, tx?
- crowing, tx?

Answer 2

• gargling –> tx = suction
• snoring (faring tertutup soft palate/epiglotis) = OPA
• crowing (e.c spasme laring e.c trauma inhalasi) tx = Intubasi

Question 3

Kelas syok hemoragik (I-IV)

Answer 3

WA

Kelas 3 = 30-40%
- volume darah = % x 50 cc
- HR (I-IV)= < 100, > 100, > 120, >140\
- RR (I-IV) –> angka I-III sesuai kelas
= I = 14 - 20
II = 20 - 30
III = 30 - 40
IV = > 35 (lain sendiri)

tx kelas 1-2 = kristaloid

tx kelas 3 - 4 = kristaloid + darah

Question 4

Macam-macam syok =

Answer 4

Hipovolemik (ADA LOSS = hemoragik, diare, dehidrasi)

Distributif (vasodilatasi sistemik = syok sepsis, syok anafilaktik, syok neurogenik)

Kardiogenik (ggn katup, listrik jantung, infark)

Obstruktif (tamponade, tension pneumothorax, emboli paru)

Question 5

Syok yang tidak terkompensasi dengan kulit HANGAT, KERING

Answer 5

Neurogenik (RR, HR, BP turun) –> masalah sist. saraf jdi tdk bsa kompensasi simpatisnya

Question 6

Syok yang UO meningkat

Answer 6

SYOK SEPSIS

Question 7

Sumbatan benda asing

Answer 7

• liat batuk efektif/tdk
• batuk efektif –> bantu korban batuk + awasi penkes
• Batuk tdk efektif
  1. Hamil/OBES (+) –> CHEST THRUST
  2. Anak - dewasa –> 5x back blow
  Bayi (< 1 thn) = Chest thrust
  > 1 thn = Abd thrust (Heimlich maneuver)
  dewasa = Abd thrust (Heimlich maneuver)

intinya ANAK - DEWASA = PUNGGUNG DULU –> Chest (anak), ABD (dewasa) = ulang terus

Penkes
- DEWASA = RJP
- ANAK = buka jalan napas -> 5x napas buatan -> rjp

Question 8

Trauma thorax (CEPAT MATI)

Answer 8

• tamponade jantung (beck’s triad)
• tension pneumothorax (perkusi = hipersonor)

trauma thorax lain
- hemothorax masif (perkusi = redup)
- flail chest (pernapasan paradoksal)
- obstruksi jalan napas (bunyi napas tambahan)

Question 9

Tx tension pneumothorax

Answer 9

A-B-C
- needle decomp @ ICS 4-5 linea axillaris anterior
- WSD

lokasi lama = ICS 2 Midklav

Question 10

pneumothorax yg plester 3 sisi

Answer 10

OPEN PNEUMOTHORAX

Question 11

tx simple Pneumothorax

Answer 11

langsung WSD

Question 12

e.c non-traumatik pneumothorax

Answer 12

primer (asthenic body habitus)

sekunder (komplikasi peny. paru)

Question 13

Tx hemothorax dan indikasi thoracotomy

Answer 13

• Primary survey
• WSD @ICS 4-5 linea axillaris anterior

indikasi thoracotomy (open chest)
- Volume awal > 1L (trauma tajam) / > 1,5 L (trauma tumpul)
- volume thoracostomy > 200 ml/jam (3 jam berturut2)
- jejas PD besar
- tamponade jantung
- open pneumothorax
- PERFORASI ESOFAGUS
- EMBOLI UDARA

Question 14

tx flail chest

Answer 14

• analgesik kuat (opioid/intercostal blocks) –> morfin 2 mg
• oksigen
• definitif = ORIF

tx DU = splinting

Question 15

temuan radiologis tamponae jantung + tx

Answer 15

water bottle sign (globuler shaped app)

tx = perikardiosentesis

cara
- Subxiphoid/Subcostal: The most common approach, below the xiphoid process (bottom tip of the breastbone), aiming towards the left shoulder.
- Guided by USG

Question 16

beda tension pneumo vs atelektasis

Answer 16

tension = trakea ke kontralateral (paru sehat)

atelektasis = deviasi trakea ipsilateral (paru sakit)