Basic Emergency Medicine

Basic Emergency Medicine

Dr Ugi Sugiri SpEM Emergency & Accident Dept Fatmawati General Hospital

ABCD

Physiology
Basic unit of life = cell  Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose)  No oxygen, no energy  No energy, no life


O2

Ventilasi paru

Airway breathing difusi

O2

Distribusi  sirkulasi darah arteri

CO2
CO2
jantung

O2

MAKROSIRKULASI

cair ginjal ekskresi

MIKROSIRKULASI
vena

Formula Explains the whole of Cardiovascular and Respiratory System


DO2 = [1.39 x Hb x SaO2 + (0.002 x PaO2)] x CO

Cardiac Output = Heart rate x Stroke Volume  Heart rate is controlled by the autonomic nervous system.  Stroke volume is determined by Preload, Afterload and Contractility;


darah arteriole

Elektrolit + Plasma

Saluran lymphe

MIKROSIRKULASI

Eritrosit mitochondria O2 Na+ K+

perfusi
ATP Na+ K+ Clperfusi Na+ K+ ClATP Na+ K+ Cl-

CO2
sel

Cl-

End-venule Saluran lymphe Saluran lymphe

Oxygen Delivery


Increasing pulse mean ,compensation mechanism to maintain adequacy oxygen delivery, thus DO2 tend to decrease Hypoxia.

Fisiologis

penyebab kematian pasien

Respiratory Rate

Nadi Tensi (volume darah Hypoxia systemic Akral Hypoxia sistemik di vaskuler) akibat gangguan Kesadaran Hypoksia sentral Airway, breathing Pulse pressure + Mean Arterial Pressure Respiratory rate Menurun kelainan syaraf Sentral Perifer Ventilasi  oksigenasi Meningkat kelainan airway kelainan breathing
(serat syaraf)

Paru ddg dada diafragma abdomen

fraktur vertebrae cervical

Nadi Systemik Akral

Hypoxia
(Fisiologis) Sentral kesadaran

Aliran darah sistemik S-D Tensi (Circulation) D+1/3 (S-D)

aliran darah sentral Pulse pressure (<40-60)~ stroke volume

Mean Arterial Pressure~aliran darah (MAP) jantung (>70- 130<) ke ginjal (>70-130<) (Otak (>80- …)

Circulation

Jantung jugular vein pressure (JVP) Dinding pembuluh darah pemb.drh besar perdrhan end arteriole LIRS SIRS

Isi

Volume darah

Tensi : - Pulse Pressure - Mean Arterial Pressure Produksi urine warna jumlah



Kenyataan sehari-hari
- MOD
tak dapat diketahui - MOF Tindakan (resusitasi) - Oxygen dipenuhi - Jalan oxygen diperbaiki dianggap MOD

EVALUASI



Pasien datang

dicari kelainan fisiologi

-Nadi, akral,

kesadaran
- Tensi - Respiatory Rate Lakukan resusitasi : - Oxygenasi - Jalan oxygen diperbaiki Evaluasi (fisiologi) Hypoxia hilang Hypoxia tetap Resusitasi lanjut Stabilisasi k/p Surgical resusitasi



Pasien non trauma

dicari kelainan fisiologis Resusitasi Evaluasi Stabilisasi

Tindakan definitif

Symptom + Sign



Pasien trauma

dicari kelainan Fisiologis Resusitasi Evaluasi Stabilisasi

Tindakan definitif

dicari kelainan anatomis yang tinggal



Pengertian Resusitasi

Pemenuhan oxygen sel (mikrosirkulasi)

Cara : - Pemberian oxygen tambahan - Perbaikan Airway - Perbaikan Breathing - Perbaikan Circulation Pengertian Stabilisasi Cara : usaha agar kelainan fisiologis tak terjadi lagi

menjaga - supplay oxygen - kondisi Airway tetap paten - kondisi Breathing tetap baik - kondisi Circulation tetap baik - volume darah - penghentian perdarahan - menjaga jantung



Evaluasi Cara :

penilaian kembali kelainan Fisiologis setelah Resusitasi menilai pasien berdasar - Nadi, akral hypoxya systemik - kesadaran hypoxya sentral - Tensi - Pulse Pressure Volume darah - Mean Arterial Pressure - Urine : - Warna Volume darah - Jumlah - Respiratory Rate Ventilasi