Muskuloskeletal Emergency

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    KEDARURATAN

    MUSKULOSKELETALDisampaikan oleh:

    Indah PPada Kuliah Keperawatan Gawat Darurat 1

    Program S1 Keperawatan

    FIKESUMM

    2011

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    Learning Objectives

    Mengidentifikasi tanda-tanda fraktur

    Melakukan penatalaksanaan pada klien

    fraktur

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    Trauma Muskuloskeletal

    Sering terjadi,

    jarang mengancam

    jiwa

    Bisa merupakan

    bagian dari multi

    trauma

    Ingat ABC

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    Mekanisme Cedera

    Penting ditanyakan Petunjuk akan cedera yang mungkin diderita pasien

    Kesesuaian cerita dengan berat ringannya cedera Child abuse

    Terdapat gaya yang cukup untuk menyebabkankerusakan tulang atau jaringan lunak / fraktur ataudislokasi Orang tua/osteoporosis

    Ca metastase

    Gaya yang diperlukan

    lebih kecil

    }

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    Mekanisme Cedera

    Jatuh

    KLL

    Trauma olahraga Perkelahian

    Luka tusuk

    Luka tembak dll

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    Mekanisme cedera

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    Mekanisme cedera

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    Mekanisme cedera

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    Perdarahan pada trauma

    muskuloskeletal

    Mekanisme fisiologis tubuh :

    Mengaktifkan sistim pembekuan darah

    untuk mengurangi perdarahan Memperbaiki integritas membran sell dan

    kapiler untuk meningkatkan reabsorbsi

    cairan Meningkatkan aliran darah kolateral untuk

    merangsang penyembuhan

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    Cedera jaringan lunak

    Terganggunya integritas kulit tempatmasuknya mikro organisme

    Macam kerusakan jaringan lunak :

    Abrasi

    Avulsi

    Kontusi

    Laserasi Puncture

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    Cedera Pada Sendi

    Occult joint

    instability

    Subluksasi Dislokasi

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    Fraktur Femur

    Trauma mayor

    Pada orang tua : fraktur collum femur

    Fraktur femur tertutup : 1 1,5 liter

    Gambaran klinis : Nyeri, tidak dapat menahan BB

    Deformitas : pemendekan tungkai,

    exo/endorotasi Oedema

    Syok

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    Long Back Board

    June 12, 2014 14

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    Scoop stretcher

    June 12, 2014 15

    http://rds.yahoo.com/_ylt=A0S0207xNsRKmdUAWKWJzbkF;_ylu=X3oDMTBpaWhqZmNtBHBvcwMzBHNlYwNzcgR2dGlkAw--/SIG=1jkol9ah0/EXP=1254459505/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dscoop%252Bstretcher%2526ei%253Dutf-8%2526y%253DSearch%2526fr%253Dyfp-t-701%26w=353%26h=400%26imgurl=www.hkfsd.gov.hk%252Fhome%252Fimages%252Fequipment%252Fambulance%252Fimages%252Fphoto%252FScoop%252520Stretcher.jpg%26rurl=http%253A%252F%252Fwww.hkfsd.gov.hk%252Fhome%252Fimages%252Fequipment%252Fambulance%252F29_amb.html%26size=16k%26name=Scoop%2BStretcher%2B...%26p=scoop%2Bstretcher%26oid=2c63c6af7babd5e0%26fr2=%26no=3%26tt=189%26sigr=123fcqsjq%26sigi=12j8uigso%26sigb=12t9bl7ge
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    Illinois EMSC 16

    INJURY ASSESSMENT

    Initial Assessment - ABCs

    HistorySAMPLE

    Chief Complaint

    Mechanism of injury

    Onset of symptoms Focused Physical Assessment

    Observation

    Inspection

    Palpation

    5 Ps

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    Illinois EMSC 17

    INTERVENTIONS

    R - Rest/immobilize

    I - Ice

    C - Compression

    E - Elevation

    S - Support

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    Illinois EMSC 18

    SPLINTING INDICATIONS

    Prevention of further

    injury

    Decrease pain

    Decrease swelling

    Stabilize fracture or

    dislocation

    Relieve impairedneurological function or

    muscle spasms

    Reduce blood and fluidloss into tissues

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    Illinois EMSC 19

    IMMOBILIZATION/SPLINTING

    KEY POINTS Immobilize joint above and

    below injury

    Assess neurovascular statusdistal to injury prior to splint

    application and again rightafter splint application

    If angulation at fracture sitewithout neurovascularcompromise, immobilize aspresented

    Minimize movement of

    extremity during splinting

    Secure splint to provide

    support and compression

    Reassess/monitor

    neurovascular status every

    5-10 minutes

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    HIP DISLOCATION

    - ORTHOPEDIC EMERGENCY!

    - USUALLY CAUSED BY AUTO ACCIDENT

    - POSTERIOR DISLOCATION MOST COMMON

    -HIP FLEXED AND LEG ROTATED INTERNALLY

    - SEVERE PAIN ON ATTEMPT TO STRAIGHTEN

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    HIP DISLOCTION MANAGEMENT

    - SPLINT IN MOST COMFORTABLE POSITION

    - DOCUMENT SENSATION AND PULSE

    - PROMPT TRANSPORT

    - BE ALERT FOR ASSOCIATED KNEE INJURIES

    OR FRACTURES

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    Amputasi

    Dapat parsial atau total

    Life over limb Luka tajam lebih baik

    prognosanya untuk

    disambung kembali

    dibandingkan trauma avulsi

    Pikirkan kemungkinan

    replantasi

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    Amputasi

    Gambaran klinis :

    Hilangnya bagian tubuh

    Nyeri

    Perdarahan

    Syok

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    Crush Injuries

    Kerusakan jaringan lunakyang hebat

    Kerusakan seluler, vaskulerdan saraf

    Hancurnya tulang dan otot Syok hipovolemia

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    Crush Injuries

    Gambaran klinis :

    Pembengkakan pada pelvis atau

    extremitas yang terkena

    Nyeri

    Tanda-2 syok

    Gejala-gejala sindroma kompartemen Ganggguan neurovaskuler distal dari

    daerah cedera

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    Sindroma Kompartemen

    Akibat peningkatan tekanan dalam

    kompartemen

    Mengakibatkan gangguan aliran darah kapiler

    dan iskemia seluler Sering pada tungkai bawah dan lengan bawah

    Penyebab : internal (dari dalam) atau external

    Penekanan pada saraf, otot, pemb.darah

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    Sindroma Kompartemen

    Kompartemen padacruris

    Kompartemen padaantebrachi

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    Sindroma Kompartemen

    Gambaran klinis :

    Nyeri pada peregangan pasif

    Gangguan sensoris (paresthesi, tebal)

    Kelemahan otot progresif

    Oedema

    Peningkatan tekanan dalam kompartemen

    Hilangnya denyut nadi

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    SUMMARY

    NOTE MECHANISM OF INJURY

    REMEMBER PRIORITIES

    ABCs FIRST

    TREAT FOR HEMORRHAGIC SHOCK

    VISUALIZE INJURIES AREA

    CHEK AND RECORD PULSE AND SENSATION

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    SUMMARY

    CRITICAL PATIENTS

    DONT WASTE TIME ON MINOR SPLINTING

    IMMOBILZE SPINE

    IMMOBILIZE JOINT ABOVE AND BELOW

    IF DOUBT, SPLINT POTENTIAL FRACTURE

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