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The Golden Hour: Is The Time in Which Resuscitation of Severely Injured Patients Must Begin To Achieve Maximal Survive
The Golden Hour: Is The Time in Which Resuscitation of Severely Injured Patients Must Begin To Achieve Maximal Survive
is the time in which resuscitation of severely injured patients must begin to achieve maximal survive
R. Adams Cowley, MD
The lethal factor in shock is inadequate cellular oxygen delivery, leads to irreversible anoxic cellullar injury that kills a critical mass of cells
25/07/2013
Hasanul, 2002
100
80
60 40 20 0
% survival
30
60
90
minutes
Hasanul, 2002
PRE-LOAD
CONTRACTILITY
AFTER-LOAD
STROKE VOLUME
HEART-RATE
CARDIAC OUTPUT
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BLOOD PRESSURE
Hasanul, 2003
PERDARAHAN
Hasanul, 2003
SHOCK
B1, B2,
HR , nadi halus cepat, TD. N/ Pulse-press. , perfusi dingin, pucat, basah, capill.refill > 2 det., lactic-acid
anxious, confused, lethargy urine out-put , <0.5 ml/kg/jam, pekat
B3, B4,
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Hasanul, 2003
Class II
750-1500 15-30% >100 Normal Decreased 20-30 20-30 Midly anxious
BV = 70 ml/kg
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Hasanul, 2003
7
Class IV
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Penderita datang dengan perdarahan Pasang infus jarum kaliber besar (16G, 18G), ambil sample darah Ukur tekanan darah, hitung nadi, nilai perfusi, produksi urine
Tentukan estimasi jumlah perdarahan, minta darah Guyur cepat Ringer Laktat atau NaCl 0.9% [hangat, 390C] 3x prakiraan lost-volume [1-2 liter]
evaluasi
9
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Management selanjutnya
Rapid response, perdarahan <20% Transient response, perdarahan 20-40% BV ongoing loss resusitasi tdk adekwat RL, NaCl 0.9%, Kolloid, Darah ? Minimal, no response Tindakan bedah segera Transfusi darah
Hasanul, 2003
10
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Vol. plasma
1000
1000 1000 700 1600 1300 1000
Vol. interstetial
-300 -260 -130 -
Vol.intrasel
-340 -170 -
Haes-steril-6%
Haes-steril-10%
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1000
1450
-450
Hasanul, 2003
11
KOLLOID
1:1
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12
Transfusi,
Target
Rule of - 5
7 - 9g%
ml Whole-Blood = 5 x delta Hb x BB
contoh:
Hasanul, 2003
= 4 bag [unit]
25/07/2013
14
Usia tua Ibu hamil Pasca bedah major (reseksianastomose) Varices esofagus Anak-anak
Plasmanate
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(1:1)
15
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16
4.4gr Human Albumin 0.6gr alfa dan beta globulin 0.05 gr gamma globulin Natrium 145mEq/L Kalium 0.25 mEq/l Chlorida 100 mEq/L
25/07/2013
Hasanul, 2002
17