“ INITIAL ASSESSMENT

“
 Initial Assessment :
Melakukan evaluasi secara cepat dan sistematis disertai tindakan resusitasi,
pada penderita gawat darurat
Initial Assessment :
◦ Pemeriksaan Primer ( Primary Survey )
◦ Pemeriksaan Sekunder ( Secondary Survey )
◦ Observasi
 PRINSIP :

mengancam jiwa
terlebih dahulu
Penderita dalam keadaan Pemeriksaan Primer
tidak stabil
Resusitasi - Stabilisasi

Penderita dalam keadaan Pemeriksaan Sekunder

sudah stabil
Diagnostik

Observasi

Pulang Tindakan Rawat Inap

segera
 Primary Survey
Adult, children, pregnant women – Priorities are the same !
A Airway with c-spine protection
B Breathing
C Circulation with hemorrhage control
D Disability (AVPU/GCS)
E Exposure/Environment
 AIRWAY
1. Nilai Airway (assess)
2. Bila ada kelainan →
atasi !
Primary
Survey
Suspect C-Spine Injury
➢ Spinal
protection
➢ C-spine X-ray
when
appropriate
Primary
Survey
Breathing
◆ Assess
◆ Oxygenate

◆ Ventilate
Primary Level of
Survey consciousness
Assessment of Organ
Perfusion

Skin color and

temperature

Pulse rate and

character
 Circulation
1. Nilai Circulation (assess)
2. Kontrol Perdarahan
3. Perbaikan volume
 1. Nilai Disability (assess):
1) Tingkat kesadaran (AVPU / GCS)
2) Pupil/tanda lateralisasi lain
Disability 2. Bila ada kelainan :
1) Cegah kerusakan
2) otak sekunder ! (perbaiki hipoksia-
hiperkarbia-hipovolemia)
Exposure
Buka pakaian penderita
• pakaian basah → Sepintas saja karena ini
hipotermia bukan secondary survey
• ada cedera lain !
yang mengancam
nyawa?

Selimuti penderita
supaya tidak hipotermia
Penderita stabil ?

(Re-evaluasi A-B-C-D)

Bila stabil →
secondary survey
Secondary
Survey

The complete
history and
physical
examination
Secondary
Survey
Key Components
History

Physical examination : Head-to-toe

“Tubes and finger in every orifice”
Complete neuro exam
Special diagnostic tests
Reevaluation
Secondary
Survey
History
A Allergies
M Medications
P Past Illnesses
L Last meal
E Events/Environment
Secondary
Survey
Head
◆ Complete neurologic examination
◆ GCS score determination
◆ Comprehensive eye/ear exam
Secondary
Survey
Maxillofacial
◆ Bony crepitus/stability

◆ Palpable deformity
Secondary
SurveySpine
Cervical
◆ Palpate for
tenderness
◆ Complete motor/
sensory exams
◆ Reflexes

◆ C-spine imaging
Secondary
Survey
Chest
◆ Inspect
◆ Palpate
◆ Percussion
◆ Auscultation
◆ X-ray
 Secondary
Survey
Abdomen
◆
Inspect, auscultate, palpate, and percuss
◆ Reevaluate frequently

◆ Special studies
◆ Pitfalls
• Hollow viscus and retroperitoneal injuries
• Excessive pelvic manipulation
 Secondary
Survey
Perineum Contusions, hematomas,
lacerations, urethral blood
Rectum

Sphincter tone , high –riding

prostate pelvic fracture,
Vagina rectal wall integrity, blood

Pitfalls Blood lacerations

Urethral injury in women,

Secondary
Survey
Musculoskeletal : Extremities
◆ Contusion , deformity

◆ Pain

◆ Perfusion

◆ Peripheral neurovascular status

◆ X- rays as needed

24
Secondary
Survey :
Musculoskeletal
Pelvis
◆ Pain on palpation
◆ Symphysis width ↑
◆ Leg length unequal
◆ Instability
◆ X-rays as needed

25
Definitive
Care
Local Facility??

Transfer agreements
?? Local resources ??
??

Trauma Specialty
Center Facility