PEMERIKSAAN FISIK PADA

KEGAWATDARURATAN ANAK
PEMBIMBING : DR. EKA NURFITRI, SPA

KEPANITERAAN KLINIK EMERGENSI RSUP

FATMAWATI JAKARTA
FKIK UIN SYARIF HIDAYATULLAH JAKARTA

PEDIATRIC ASSESSMENT
TRIANGLE (PAT)
PAT : Mengevaluasi tanda vital pada pediatri.
Terdapat 3 komponen yang dinilai :
1)Appearance
2)Work of Breathing
3)Circulation to the skin

APPLYING THE PAT

Appearance

Work of
breathing

Circulation

Assessment

Abnormal

Abnormal

Abnormal

Primary CNS disfungtion/

Metabolic abnormality

Abnormal

Abnormal

Cardiopulmonary failure

Respiratory distress
Shock

ABCDES
Hand on assessment of ABCDEs :

Airway
- Manual airway opening maneuvers (Head tilt-chin

lift, jaw thrust)

- Age specific obstructed airway support
< 1 year : Back blow/chest thrust
> 1 year : Abdominal thrust
- Suction jika diperlukan

AIRWAY

Causes of obstruction
blood, vomitus, foreign body, CNS depression, direct trauma,
infections
LOOK for
cyanosis, altered respiratory pattern & rate, use of accessory
muscles, tracheal tug, altered level of consciousness,
protective airway reflect (cough, gag)
LISTEN for
noisy breathing (stridor, wheezing, gurgling)
complete obstruction results in silence
FEEL for
decreased or absent air flow

BREATHING
Cause of inadequate breathing
Depressed respiratory drive: e.g CNS depression
Depressed respiratory effort: muscle weakness, nerve/spinal
cord damage, chest wall abnormalities, pain
Pulmonary disorders: pneumo/hemothorax, aspiration, chronic
obstructive pulmonary disease, asthma, pulmonary
embolus, lung contusion, acute lung injury, ARDS,
pulmonary edema
LOOK for

cyanosis, altered respiratory pattern & rate, equality & depth of

respiration, sweating, JVP, use of accessory muscles,
tracheal tug, altered of consciousness.

LISTEN for
dyspnea, inability to talk, noisy breathing, percussion,
ausculatation

FEEL for

precordial cardiac pulsation, pulses (central &

peripheral) assessing rate, quality, regularity,
symmetry

BREATHING (AUSCULATION)
Breath Sound

Explanation

Stridor

Upper airway obstruction

Wheezing

Lower airway obstruction

Grunting

Poor oxgenation, pneumonia,

drowning, pulmonary contusion

Crackles

Fluid, mucus, blood in airway

Decrease/absent breath sound

Obstruction

CIRCULATION
Causes of circulatory inadequacy
primay-directly involving the heart
ischemia, conduction defects, valvular disorders,
cardiomyopathy
secondary-pathology originating elsewhere
drugs, hypoxia, electrolyte disturbances, sepsis
LOOK for
reduced perpheral perfusion (palor, ), hemorrhage
(obvious concealed), altered level of conciousness,
dyspnea, urine output

LISTEN for
additional or altered heart sounds, carotid bruits
FEEL for
precordial cardiac pulsasion, pulses (central &
peripheral) assessing rate, quality, regularity,
symetry

Assessment of circulation:
pulses rate, cardiac pulsasion, quality & regularity,
skin temperature, & blood pressure

Signs of Poor Systemic Perfusion

Tachycardia
Mottled color, pallor
Cool skin, prolonged capillary refill
Oliguria (urine volume < 1-2 ml/kg/hour)
Diminished intensity of peripheral pulses
Metabolic acidosis
Change in responsiveness
LATE : hypotension, bradycardia

DISSABILITY
Pemeriksaan Neurologis
AVPU Scale (Alert, Verbal, Painful, Unresponsive)
Pediatric Glasgow Coma Scale

EXPOSURE
Evaluasi fungsi fisiologis tubuh pada pasien pediatri
Maintenance lingkungan yang hangat dan
meminimalkan heat loss
Monitoring suhu tubuh
Monitoring IV fluids

PEMERIKSAAN FISIK

PEMERIKSAAN FISIK
Pada umumnya anak sama dengan dewasa
Beda pendekatan
Anak lebih informal, dokter harus pandai membujuk
Inspeksi, Palpasi, Perkusi, Auskultasi

PEMERIKSAAN FISIK

STATUS PEMERIKSAAN FISIK

Keadaan umum: baik/ sedang /buruk

Keadaan sakit: tidak sakit/ sakit ringan/ sedang/berat
Sesak ada/tidak, sianosis ada/tidak, edema ada/tidak
Perkiraan umur, bentuk badan, cara berjalan berbaring, habitus
Kesadaran: compos mentis / apatis /somnolen / sopor /koma
Status gizi: baik/sedang/kurang/buruk
Tanda vital:
Nadi

: laju, irama, isi/kualitas, ekualitas

Tekanan darah
Nafas: laju, irama, kedalaman, tipe
Suhu

Antropometri

KULIT, RAMBUT, KGB

Kulit: warna, suhu, turgor, ikterus, dan efloresensi kulit
Rambut: warna, kelebatan, distribusi, mudah
dicabut/tidak
Kelenjar getah bening: teraba/ tidak, ukuran, bentuk,
konsistensi, mobilitas, tanda radang (diperiksa
bersamaan dengan pemeriksaan organ setempat)

KEPALA DAN LEHER

Kepala:
Bentuk dan ukuran, kontrol kepala, kraniotabes, rambut dan
kulit kepala, ubun-ubun
Wajah: simetris/tidak, edema, tanda radang, fasies
Mata
THT
Mulut: trismus, halitosis, bibir, mukosa, gusi, gigi palatum,
lidah

Leher:
Simetris/tidak, tortikolis, JVP, massa, kelenjar tiroid

TORAKS
Toraks: bentuk dan besar dada, simetris/tidak
statis/dinamis, deformitas, penonjolan, pembengkan,
kelainan lokal lain, sela iga, payudara
1. Garis midsternum
2. Garis sternum
3. Garis parasternum
4. Garis midklavikula
5. Garis aksilaris anterior dan post
6. Garis aksilaris medial

PARU
I : sama dengan toraks
P : simetri, fremitus, krepitasi
P : perkusi langsung/tak langsung, normal: sonor
A:
suara nafas dasar (vesikuler, bronkial, amforik, cog-wheel,
metamorphosing)
suara nafas tambahan ( ronkhi basah, ronkhi kering,
wheezing, krepitasi, friction rub, sukusio hipocrates)

JANTUNG
I+P: iktus kordis, detak pulmonal, thrill
P

: batas jantung

: BJ I-II normal/tidak, murmur?, gallop?

ABDOMEN
1. Inspeksi: ukuran, bentuk perut, dinding perut, gerakan
dinding perut
2. Auskultasi: peristaltik (bising usus), pembuluh, darah
3. Perkusi: perkusi umum, menentukan batas hati serta
massa intra abdomen, asites
4. Palpasi: ketegangan dinding perut, nyeri tekan,
palpasi organ intraabdominal (hati, lien, ginjal, vesica
urinaria), massa intraabdomen

ANOGENITAL
Anus-rektum: regio perianal (tumor, pertumbuhan
rambut fistula, abses) daerah anus (kelainan kongenital,
fistula, fisura, hemoroid, diaper rash), colok dubur (akut
abdomen)
Genitalia: laki-laki, perempuan (untuk menentukan
status pubertas)

EKSTREMITAS DAN TULANG

BELAKANG
Yang diperiksa:
Keadaan otot, tulang, sendi

Kelainan kongenital
Warna, perfusi perifer baik/buruk, capillary refill time <
3 detik
Clubbing finger?
Spine: postur dan posisi, gerakan tulang belakang,
kelainan kongenital, massa tulang belakang

NEUROLOGI
GCS
Kejang, tremor, twitching, korea, parese, paralisis
Rafleks patologis dan fisiologis
Tanda rangsang meningeal
Tonus dan kekuatan motorik
Sensibilitas
Nervus kranialis