Abdoimnal Trauma   Abdoimnal Trauma   ABDOMINAL TRAUMA 6/3/2018

  6/3/2018

PRINSIP PENANGANAN TRAUMA A ; AIRWAY  BENDA ASING  FRAKTUR MANDIBULA  CIDERA TRACHEA  CIDERA LARYNG B ; BREATHING  PNEUMOTHORAX  HEMATOTHORAX  FLAIL CHEST 6/3/2018

 PERDARAHAN INTRA THORAX  FRAKTUR FEMUR  FRAKTUR PELVIS  DLL C ; CIRCULATION  PERDARAHAN INTRA ABD  PERDARAHAN INTRA THORAX  FRAKTUR FEMUR  FRAKTUR PELVIS  DLL D ; DISABILITY (NEUROLOGIC EVALUATION)  CIDERA KEPALA  GANGGUAN OXYGENASI  SYOK  ALKOHOLISM 6/3/2018

E ; EXPOSURE  BUKA SEMUA PAKAIAN PEND.  PERIKSA DARI UJUNG RAMBUT SAMPAI UJUNG KAKI (“HEAD TO TOE EXAMINATION”) SETIAP LUBANG HARUS DILIHAT DENGAN TELITI  HATI-HATI TERJADI HIPOTERMI  SELIMUTI PASIEN 6/3/2018

B6 PRIORITAS ? 1BREATHING 2. BRAIN 3. BLOOD 4. BOWEL 5. BLADDER 6. BONE B6 6/3/2018

SECARA ANATOMI ABDOMEN TERDIRI DARI TIGA RONGGA YAITU : 1. PERITONEAL CAVITY 2. RETROPERITONEAL CAVITY 3. PELVIS TRAUMA ABDOMEN ADA DUA : I. TRAUMA TUMPUL ABDOMEN - KLL - OLAH RAGA II. TRAUMA TAJAM ABDOMEN - TINDAKAN KRIMINAL (PISAU, TEMBAK) - BUNUH DIRI (JEPANG) The primary factor in assessing abd. trauma is not the accurate diagnosis of a specific type of injury, but rather the determination that an abdominal trauma injury exists 6/3/2018

PHYSICAL EXAMINATION INSPEKSI : - Penderita ditelanjangi (Fully Undressed) - Lihat seluruh bagian abdomen (luka lecet, memar, luka tusuk)  Bila perlu lakukan (Log Rolled) AUSKULTASI :  Untuk mengetahui ada/tidaknya bising usus  Darah, kontaminat dari isi usus  ileus PERKUSI :  Mencari muscle rigidity/defance muskular PALPASI :  Bisa menentukan lokasi nyeri  organ yang ruptur/rusak 6/3/2018

5. RECTAL TOUCHER (RT)  Leucocyt Alkohol  Mempunyai arti yang penting pada trauma abdomen karena :  Ada darah  ada perforasi usus  mengetahui tonus sphincter  Mendeteksi adanya fraktur tulang-tulang pelvis, ruptur urethra post LOBRATORIUM :  Hematocrit, Hb. (Haemoglobin)  Leucocyt  Amilase  Urinalysis Alkohol 6/3/2018

ROENTGEN ; SCREENING RO” : 1. CERVICAL LATERAL 2. CHEST X RAY (AP) 3. PELVIS  BOF : Dapat mengetahui adanya trauma abdomen (udara bebas dibawah diafragma), hilangnya bayangan M. illupsoas. CONTRAST STUDY : 1. IVP (Intra Vena Pyelography) 2. UPPER GIT. TRACT FOTO (Ba. Intake) 3. Ba. Inloop 4. Cystography 5. Uretrography 6/3/2018

SPECIAL DIAGNOSTIC : Diagnostic peritoneal lavage CT. Scan : - Dengan kontras - Tanpa kontras - Hanya dikerjakan pada pasien yang stabil 6/3/2018

INDIKASI CELIOTOMY (LAPAROTOMI) : Hypotensi dengan kecurigaan adanya kerusakan intra abdomen : - Luka tembak - Luka tusuk / stab wounds - Trauma tumpul dengan groos blood pada DPL Peritonitis Reccurent hypotensi setelah adekuat resusitasi Extra luminal air Injured Diaphragma Intraperitoneal perforation of urinary bladder 6/3/2018

7. CT. (Pancreas, Git. Tract, Liver Spleen, Kidney) 8. Positive Contrast Study of Upper and Lower Git. Tract. 9. Persistent Amylase Elevation With Abdominal Findings. 6/3/2018

ASSOCIATED INJURIES BONY INJURIES ASSOCITED INJURIES LOWER RIB FRACT LOWER THORACIC SPINE INJURIES LUMBAR TRANSVERSE PROCESS FRACTURES FELVIC FRACT ASSOCITED INJURIES LIVER AND/OR SPLEEN PANCREAS SMALL BOWEL ABDOMINAL VISCERA KIDNEY PELVIS ORGAN VESSEL RETRO PERITONEAL 6/3/2018

SURGICAL OPTIONS IN THE MANAGEMENT OF COLONIC INJURIES PRIMARY SUTURE WITHOUT COLOSTOMY PROXIMAL COLOSTOMY WITH OR WITHOUT REPAIR OR EXTERIORIZATION RESECTION AND ANASTOMOSIS EXTERIORIZED PRIMARY REPAIR 6/3/2018

CONTRAINDICATION TO PRIMARY CLOSURE SHOCK PREOPERATIVELY LAPSE OF 8 HOURS BEFORE REPAIR GROSS FECES IN THE PERITONEAL CAVITY PRESENCE OF MORE THAN 1000 ml BLOOD TWO OR MORE CONCOMITANT ORGAN INJURIES IN THE ABDOMEN COLON WOUND SO DESTRUCTIVE AS TO REQUIRE RESECTION EXTENSIVE LOSS OF ABDOMINAL WALL 6/3/2018