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  Syok dapat diklasifikasikan menjadi 4 macam, yaitu: 1)   Syok hipovolemik Syok hipovolemik disebabkan oleh volume darah yang rendah (SV turun) yang disebabkan oleh perdarahan atau dehidrasi 2)   Syok kardiogenik Syok kardiogenik disebabkan oleh penurunan kontraktilitas jantung (SV turun), yang  biasanya disebabkan oleh infark miokardium (MI) masif 3)   Syok distributif Syok distributive disebabkan oleh hilangnya tonus arteri yang normal (PVR turun) sehingga darah tidak dapat terdistribusi ke seluruh tubuh (misalnya, sepsis, anafilaksis, transeksi medulla spinalis, overdosis obat, defisiensi endokrin) 4)   Syok obstruktif Syok obstruktif disebabkan oleh obstruksi sirkulasi sentral (SV turun; misalnya, embolus  paru masif, tamponade perikardium, pneumotoraks tegang, tension pneumothorax, atau diseksi aorta thorakalis, yang menurunkan “SV” efektif di sebelah distal tempat diseksi)  Sumber : Bresler, JM. Manual Kedokteran Darurat. Ed. 6. Jakarta: EGC, 2006 Tatalaksana perdarahan internal :    Stabilkan kondisi pasien (ABC-nya distabilkan)    Setelah stabil, periksa dengan benar apakah terdapat perdarahan internal atau tidak dengan melihat ada atau tidaknya tanda dan gejala dari adanya perdarahan internal (lakukan juga CT scan untuk memastikan sekali lagi apakah terdapat  perdarahan internal atau tidak)    Setelah mendapat kepastian adanya perdarahan internal, tindakan selanjutnya adalah operasi. Operasi dilakukan segera atau tidak tergantung dari seberapa  parah perdarahan internal yang diderita korban atau pasien.  Catatan buat Indri : ini kesimpulan yang ak dapat habis baca tentang tatalaksana internal bleeding di emedicine. Kalo ada kesalahan bisa ditambahkan ini ak sertakan copas dr webnya. Di bawah catatan ini ni ada tanda dan gejala kalo kena internal bleeding. Alamat webnya jug a udh ak sertakan dibawah… maaf ngerepotin ndri, tapi ini yang ak sampaikan di dk kmrn :’)      Abdominal pain and/or swelling can be caused by Internal bleeding from trauma in the liver  or  spleen. These symptoms get worse as the bleeding continues.    Light-headedness, dizziness, or  fainting can result from any source of internal bleeding once enough blood is lost.    A large area of deeply purple skin (called ecchymosis) can result from bleeding into the skin and soft tissues.    Swelling, tightness, and pain in the leg can result from internal bleeding in the thigh. Most often, this is caused by a fracture of the thighbone.    Headache and loss of consciousness could be the result of Internal bleeding in the brain.  Treatments for Internal Bleeding Due to Trauma Internal bleeding damages the body both from the loss of blood and from the pressure the misplaced blood puts on other organs and tissues. Treatment usually takes place in a hospital's emergency department. Intravenous fluids and blood transfusions may be given to prevent or correct an unsafe drop in  blood pressure.  Imaging tests (usually an ultrasound, CT scan, or both) can identify whether internal bleeding is  present. Doctors consider the amount of internal bleeding along with the injured person's blood  pressure and severity of injuries to decide on the best initial treatment -- surgery or observation. When internal bleeding is slower or delayed, observation may be appropriate at first. Often, internal bleeding from trauma stops on its own. Ongoing or severe internal bleeding due to trauma requires surgery to correct the problem. When internal bleeding is severe, emergency surgery may take place within minutes after arrival at the hospital.  The type of surgery used will depend on the location of the injury and bleeding:    Exploratory laparotomy: A surgeon makes a large incision in the skin of theabdomen and carefully explores the abdomen. The surgeon will seal the ends of any leaking blood vessels with a heat probe or suture material.    Thoracotomy: For bleeding around the heart or lungs, a surgeon makes an incision along the rib cage or the breastbone. Gaining access to the chest, the surgeon can identify and stop the  bleeding and protect the heart and lungs from pressure caused by excess blood.    Craniotomy: For bleeding due to traumatic brain injuries, a surgeon may create a hole in the skull. This can relieve pressure and reducing further injury to the brain.    Fasciotomy: Internal bleeding into an area such as the thigh can create high pressure and prevent  blood flow to the rest of the leg. A surgeon can cut deeply into the thigh to relieve pressure and gain access to stop the bleeding. Some people have additional risk factors for internal bleeding due to trauma. These include:    Use of blood thinner  medications, such as clopidogrel (Plavix), warfarin(Coumadin), and dabigatran (Pradaxa)    Severe liver disease or  cirrhosis     Inherited conditions that interfere with blood clotting ability, such as von Willebrand's disease or  hemophilia  People with internal bleeding due to trauma who have these risk factors may receive additional treatments to help their   blood clot  properly. Medical Treatment Initial treatment of internal bleeding will include stabilizing the patient, meaning that the ABCs of resuscitation take priority for the care provider.    A: Airway.  Patients with altered or decreased mental status may not be awake enough to  breathe on their own.     B: Breathing. Even if the airway is open, the lungs may not adequately be functioning and may need assistive care to allow oxygen to be transferred from the lung to the bloodstream.    C: Circulation.  The body requires blood to circulate to all its cells to provide oxygen and nutrients and to remove waste products. Treatment is aimed to maintain blood pressure and circulation. Often intravenous fluids only are required. Sometimes blood transfusion is needed. A few patients will require immediate transfusions with universal donor blood (type O negative blood). Specific treatment for internal bleeding depends upon the source of the bleeding. The common goal for treatment is to find the source of bleeding and stop it. At the same time, treatment will  be directed to repair or stabilize any damage that the bleeding caused. Once the acute situation has resolved, treatment will try to correct the underlying cause of  bleeding to prevent future episodes. Sumber: http://www.emedicinehealth.com/internal_bleeding/page8_em.htm#medical_treatment Darurat adalah suatu keadaan yang tidak terduga yang mana membutuhkan pertolongan segera Sumber : KBBI Tanda dan gejala fraktur tulang :    Riwayat trauma    Adanya nyeri lokal dan semakin bertambah dengan adanya gerakan    Hilangnya fungsi anggota gerak dan persendian yang terdekat    Terdapat perubahan bentuk (deformitas)    Adanya nyeri tekan, nyeri ketok, atau nyeri sumbu    Gerakan abnormal    Pemeriksaan keadaan neurovascular di bagian distal dan garis fraktur
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