TRAUMATOLOGI

 
 
 
 
 
 
 
 
Bagian  Bedah  RSUD  Dr  Moewardi/FK  UNS  
2019  
 Trauma    

•  Remains   the   most   common   cause   of   death   for   all  

individuals  (1-­‐40  yo),  is  the  3rd  most  common  cause  of  
death  regardless  of  age  
•  Ini>al   management   ➔ Primary   Survey   (the   “ABCs”,  
Airway  +  Cervical  protec>on,  Breathing,  Circula>ons)  
•  The   goals   of   primary   survey   ➔ to   iden>fy   and   treat  
condi>ons  that  cons>tute  an  immediate  threat  of  live  
•  All  pa>ents  with  blunt  injury  should  be  assumed  to  
have  unstable  cervical  spine  injuries  un>l  proven  
otherwise  
➔ Maintain  cervical  spine  precau>ons  and  in-­‐line  
stabiliza>on  
•  Pa>ents  with  ongoing  hemodynamic  instability  (non  
responders  /  transient  responders)  require  prompt  
interven>on  
Four  categories  of  shock  :  
 
•  Hemoraghic    
•  Cardiogenik  
•  Neurogenic  
•  Sep>c  
 Abdominal  Trauma  

 
•  The  abdomen  is  a  diagnos)c  black  box  
•  Physical   examinaIon   +   Ultrasound   can   rapidly  
iden>fy  pa>ents  requiring  emergent  laparotomy  
•  CT   Scan   is   the   mainstay   of   evalua>on   in   the  
remaining   pa>ents   to   more   precisely   iden>fy   the  
site  and  magnitude  of  injury  
Abdominal  Compartement  Syndrome  
 
• Primary  (due  to  the  injury  of  abdominal  organs,  
bleeding  and  packing)  
 
• Secondary  (due  to  reperfusion  visceral  edema,  
retroperitoeal  edema,  ascites)  
 Derajat Iritasi Peritoneum
oleh cairan yg berada abnormal dlm rongga peritoneum (Lowenfels, 1975)

Cairan Lambung
Isi Usus Halus
Crn Pankreas
Empedu

Nanah
Darah

Urine

Iritasi Ringan Berat

PenetraIng  Abdominal  Injury  
Blunt  Abdominal  Injury  
Abdominal  Ultrasound  
The  Bloody  Vicious  Cycle  
Solid  Organ  (AAST  Grading)  
Liver  Injury  (Abdominal  CT  Scan)  
Splenic  Injury  (Abdominal  CT  Scan)  
Organ  Specific  Injuries  (Spleen)  

 
• Splenectomy  
• Splenorraphy  
• Par>al  Splenectomy  
Organ  Specific  Injuries  (Duodenum)  

R o u x -­‐ e n -­‐ Y  
duodenojejunostomy   is  
used   to   treat   duodenal  
i n j u r i e s   b e t w e e n   t h e  
p a p i l l a   o f   V a t e r   a n d  
s u p e r i o r   m e s e n t e r i c  
vessels   when   >ssue   loss  
precludes  primary  repair  
Organ  Specific  Injuries  (Pancreas)  

For  injuries  of  the  

pancrea>c  head  that  
involve  the  pancrea>c  duct  
but  spare  the  common  bile  
duct,  central  pancrea>c  
resec>on  with  Roux-­‐en-­‐Y  
pancrea>cojejunostomy  
p r e v e n t s   p a n c r e a > c  
insufficiency  
Organ  Specific  Injuries  (Colon  -­‐  Rectum)  

 
Bowel  repair  and  
anastomosis