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
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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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