PAK - GETARAN ERWIN DN

DEFINISI PENYEBAB PATHOGENESIS DIAGNOSIS TERAPI PROGNOSIS PENCEGAHAN

PAK AKIBAT GETARAN Penyakit akibat getaran adalah penyakit atau gangguan kesehatan akibat getaran PAK akibat getaran : PAK akibat getaran seluruh tubuh PAK akibat getaran setempat (segmented vibration/ tool hand vibration)

Whole Body Vibration Getaran mekanaik yang disampaikan lewat tempat duduk (ex: alat berat) / lantai Getaraan dari alat berat  tempat duduk tulang belakang supir

WORKERS AT RISK Supir Traktor, truk, mobile crushers Fork-lifts Masnis, supir bus, taksi, motor boat, helikopter, pesawat Mesin / Alat berat (hammering and punching machinery) Orang yang bekerja di landasan yang bergetar

Vibrations

Vibration Exposure to vibration can occur while using power tools or while driving equipment. Vibration from power tools can place stress on the tissues of the fingers, hand and arms. Whole body vibration from driving puts stress on the spinal tissues.

Vibration Exposure Whole Body 4 s/d7 % pekerja di Eropa& USA terpapar WBV yang berbahaya bagi kesehatannya

Terdapat berbagai faktor yang perlu diperhatikan dalam menilai efek getaran pada manusia , yaitu: Karakteristik fisik dari frekuensi dan intensitas getaran Tipe dari sumber getaran Lamanya pemajanan Arah getaran Posisi tubuh Kerentanan individu Faktor lingkungan misalnya suhu udara, kebisingan, beban kerja dll.

Efek fisik getaran Pada otot skelet (4-12 Hz) Ujung tulang rawan & sendi Perubahan gerakan tl rawan & sendi (khususnya tl blk Sel tl. Rawan rusak Peradangan berulang menahun Kerusakan menahun pada sendi (arthritis)

Osteoarthritis

Osteoarthritis

Osteoarthritis

Osteoarthritis

Efek getaran dan frekuensi Frekuensi (Hz) Efek 4-12 Kerusakan sistem otot dan tulang 4-5 Kerusakan tulang belakang 5-20 (dg intensitas sangat tinggi Perdarahan paru

Frekuensi-efek Frekuensi (hz) efek < 10 Rongga dada dan perut >10 Organ dan jaringan perifer

EFEK PADA KESEHATAN WBV FREKUENSI(HZ) GANGGUAN KESEHATAN 4-12 -KERUSAKAN SEL TULANG RAWAN (ARTHRITIS PERMANEN) -SERUSAKAN SPINAL (HNPLBP) -ABDOMINAL PAIN -HEMATURIA -PERDARAHAN PARU (5-10 HZ; 5-15G) 3-9 DADA & PERUT 10 LEHER, KEPALA, PINGGUL, PERINEUM, OTOT, TULANG 13-15 PHARYNX 6-10 TEKANAN DARAH, DENYUT JANTUNG, IO2 MAX MENINGKAT

GANGGUAN KESEHATAN MENURUT FREKUENSI EFEK FREKUENSI (HZ) 0,1-1 1-10 10-100 100-1000 1000-10000 >10.000 MABUK GANGGUAN BICARA MATA KABUR GANGGUAN TUGAS SPINAL RUSAK*(KRONIS) GANGGUAN GI*(KRONIS) REYNOD D** ** THV *KRONIS

Respon fisiologis thd WBV yg masih dapat ditolerir o/ manusia adalah : Denyut jantung meningkat (10 – 15x/mnt) pada kondisi eksperimen yang normal, tanpa memperhatikan frekuensi  pajanan kontinyu pulih TD meningkat pd frek. ± 5 Hz menurun pd frek. ± 10 - 20 Hz

Tidal Volume : meningkat pada semua frekuensi (maks. Pd frek. 5 – 7 Hz) RR meningkat linier dg intensitas Pd 5-7Hz : VC menurun O2 Uptake meningkat.

Efek WBV pd ginjal , darah & endokrin : - Belum atau tidak terdapat bukti yg jelas Efek WBV pd keseimbangan : - tgt kerentanan individu.

Efek Getaran Pada Performance Ggn. Fgs. & ketajaman penglihatan  - sebanding dg amplitudo getaran - maksimum pd frek.10 -25 Hz. Penurunan performance pada tracking task (pekerjaan mengikuti jejak misalnya jejak satelit, pesawat udara dll) - sebanding dengan amplitudo getaran - maksimum pd frek. rendah (≤ 5 Hz)

HNP (Hernia Nucleus Pulposus) Tergelincirnya nukleus pulposus (anulus fibrosus)/slipped disc Pathogenesis: WBV  kerusakan tulang rawan  slipped disc  tekanan pada radiks dorsalis LBP

HERNIA NUCLEUS PULPOSUS (SLIP DISC)

Beberapa Faktor Risiko LBP sikap tubuh yg jelek & kurang OR - sikap berdiri yang membungkuk ke depan, - dada kempes - pungung lordosis - tidak tegap , - perut buncit  tekanan BB jatuh ke depan sbg kompensasi punggung hrs ditarik ke belakang -- hiperlordosis lumbal jk lama  kelelahan otot & rangsangan pd ligamen  nyeri.

Bad posture

Obesitas & kehamilan trimester akhir  perpindahan tekanan BB ke depan >>> duduk  otot hamstring kaku & pendek d. Panjang tungkai yang tidak sama e. Sepatu tumit yang tinggi / pemendekan tendon achilles titik Berat bergeser ke depan

kelemahan otot dinding perut , gluteus maksimis & ileopsoas serta pemendekan otot-otot ekstensor punggug (otot yg penting u/ mempertahankan sudut lumbosacralis pd posisi optimal (30º ))  kelemahan = ”unstable back”. g. Merokok (blm jelas) - tekanan intra diskus meningkat (batuk kronis) - peregangan otot - nikotin h. Kesegaran jasmani IKJ Baik  < berisiko LBP i. Lama masa kerja semakin lama (dg beban berat) risiko semakin meningkat

ACGIH TLVs and BEIs Handbook Whole-Body Vibration Threshold Limit Values (TLV’s) ax, ay, az = acceleration in the directions of the x, y, z, axes x axis = back - to – chest y axis = right – to – left z axis = foot (or buttocks) - to - head X Y Z

Pencegahan Hindari paparan WBV > NAB  pilih peralatan/mesin yang anti getaran, pemeliharaan mesin, gunakan peredam, sepatu anti getaran Atur waktu kerja istirahat : 1 jam kerja-10 menit istirahat Istirahat : stretching, massaging, relaxing Terapi sesuai gejala Hindari faktor risiko Jaga badan tetap hangat

GETARAN SELURUH TUBUH Paparan menahun (f=) Paparan akut (F=) Gangguan aliran darah amplifikasi /resonansi Di daerah ginjal dan saluran kencing Kerusakan permanen pada sendi/tulang Arthritis Peradangan/inflamasi Slipped disc (L4-L5 atau L5 S1) Gangguan Fungsi Ginjal dan sal.Kencing, dg indicator: Hematuria HNP BUN Serum Creatini LBP Urea

PAK –GETARAN SETEMPAT

What is HAV (Hand-Arm Vibration)?   What is HAV (Hand-Arm Vibration)? transmitted from work processes into workers hands and arms. It can be caused by operating hand-held power tools such as : road breakers, hand-guided equipment (ex:s lawn mowers) holding materials being processed by machines such as pedestal grinders.

What injuries can HAV cause?   Regular exposure to HAV can cause a range of permanent injuries to your hands and arms that are known as hand-arm vibration syndrome (HAVS). The injuries can include damage to the following:

What injuries can HAV cause? o      Blood Circulatory System (vibration white finger) - >> tjd jika suhu tubuh/tangan dingin atau basah - tanda awal: ujung jari putih (kadang2) , baal , seperti terusuk jarum - akhir serangan: jari putih  berubah merah & sangat nyeri   Sensory Nerve Damage - kerusakan syaraf di jari rasa raba & rasa suhu berkurang  baal permanen, kesemutan di jari Damage to Muscle, Bones & Joints - kekuatan tangan hilang - nyeri di lengan & pergelangan tangan

Health Effects (bisanya setelah 3-5th) Hand Arm Vascular and circulation problems. Neurológical. Muscular disorders Others

Symptoms – Advanced Stages White or Blanched Finger Tips Aggravated by cold Mistaken for frostbite Few minutes initially With Continued Exposure Blanching spreads Attacks Increase in Frequency Intensity Duration

Symptoms – Latter stages Occur in all seasons On and off job Triggered by Cold Vibrating objects Nicotine Severe Cases Gangrene Amputation

Stockholm HAVS Classification System (Vascular Assessment) Stage Grade Description --------- No attacks 1V Mild Occasional attacks affecting only one or more fingers 2V Moderate Occasional attacks affecting distal and middle phalanges (rarely also proximal) of one or more fingers 3V Severe Frequent attacks affecting ALL phalanges of most fingers 4V Very Severe As in Stage 3, with trophic skin changes in the finger tips

Stockholm HAVS Classification System (Sensorineural Assessment) Stage Symptoms 0SN Exposed to vibration but no symptoms 1SN Intermittent numbness, with or without tingling 2SN Intermittent or persistent numbness, reducing sensory perception 3SN Intermittent or persistent numbness, reducing tactile discrimination and/or manipulative dexterity

Health Effects Vascular Disorders Muscle Normal Artery Damage Artery Normal flow Flow Restriction

Typical HAV Sources Fastening Tools Cutting Tools Finishing Tools Gardening Tools Compaction Tools Drilling/Boring Tools And More

Vibration Exposure Hand Arm

Vibration Exposure Hand Arm

Vibration Exposure Hand Arm

Hand Arm vibration exposure

What other factors can contribute to vibration injury? * How high the vibration levels * How long you use the tools and equipment * How awkward it is for you to use the equipment * How tightly you have to grip the equipment * How cold and wet you get when using the equipment Individual susceptibility - smokers are at a greater risk  

Upaya Pencegahan Jaga agar paparan tak melampaui NAB Atur waktu kera-istirahat (1 jam-10 mnt) Istirahat : massaging, swinging, shaking Pakai gloves (VIP) Jaga agar badan tetap hangat Hindari faktor risiko

Acceleration levels from Hand Arm Vibrations Hand-arm vibration acceleration level (m/sec2) Tool Type 1,183 Riveter, Caulker 424 Chipping Hammer 416 Motorcycle 339 Jack-Leg Drill 251 Grinder 195 Pavement Breaker 125 Pedestal Grinder 75 Chain Saw 59 Brush Saw 20 Hand Grinder

Tri-axial Measurements must be perform: Basicentric Measurement: Measurement of vibration directly from the tool.  Basicdynamic Measurement: Measurement of vibration indirectly over a knuckle.

2002/44/EC Directive 2002/44/EC of the European Parliament and of the Council 8-Hour Daily Exposure Limit Action Value Limit Value   Hand-Arm 2.5 m/s2 5 m/s2 Whole-Body 0.5 m/s2 1.15 m/s2 Whole-Body (vibration dose) 9.1 m/s1.75 21 m/s1.75

Vibrations on the Human body

QUESTIONS?