trauma pd anak
TRANSCRIPT
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PPGD Fakultas Kedokteran Unissula
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• Anak : fisik dan psikis berbeda dg dewasa
• Anatomi belum berkembang sempurna• Trauma penyebab : keelakaan lalulintas!
diruma"! disekola"! ola" raga
• Anak yg mengalami trauma epatmemburuk
• Dapat merupakan trauma disenga#a : "ild
abuse
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$% Ukuran keil & tenaga yg diserap banyak kerusakan "ebat
& letak organ berdekatan kerusakan multi
organ
'% Tulang belum tumbu" sempurna & trauma t"oraks : kerusakan paru "ebat
meski tdk ada fraktur iga
& kerusakan pusat pertumbu"an pendek
(% )fek psikologis trauma psikis berke*
pan#angan+% Peralatan menolong anak sering tdk
tersedia di ruma" sakit
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• ,ama spt dewasa : airway prioritas
pertama
• Proporsi kepala lebi" besar
• Posisi #alan napas bebas posisi
mengisap (sniffing position)
• -antal pada ba"u . badan agar #alan
napas tidak tertekuk
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• Faring masi" rapu"! pemasangan /PA"arus "ati*"ati 0dg spatula lida"1
• 2aring pendek! sekret terakumulasi
• 2ama mengisap . suction #angan lebi" dari3 detik
• Trak"ea pendek! sewaktu memasang
intubasi #angan masuk ke bronk"us• Pipa intubasi tidak memakai balon
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• Frekwensi pernapasan +4 5 64 kali
permenit
• Trauma t"oraks menyebabkan kontusio
paru berat meski tidak ada fraktur iga
• 7ati*"ati memakai ambu-bag
• Tension pneumot"ora8! "emot"ora8 masif
yg menganam nyawa ditangani samaseperti penderita dewasa
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• 9esere fisiologis ukup besar
perdara"an (4; dpt ditoleransi dg baik
• 2ewat (4; perburukan ter#adi epat
• Tekanan dara" sistolik < =4 > 0' 8 umuranak dlm ta"un1
• Tekanan dara" diastolik < '.( tekanan
sistolik• Tak"ikardi pada anak sesuai umur
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• ?olume dara" anak < @4 ml . kg --
• 9esusitasi dimulai dg '4 ml . kg --
diulang ( kali
• P9 diberikan $4 ml. kg --
• Kesulitan akses ena perifer
• Anak B 6 ta"un dengan infus intra*osseous
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• Trauma multipel : @; melibatkan t"oraks• '.( trauma t"oraks akan mengenai organ
lain
• Kebanyakan trauma tumpul• Kontusio paru tanpa fraktur iga
• Trauma t"oraks mengakibatkan gangguan
pernapasan dan sirkulasi lebi" berat padanak dibanding dewasa
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• Terbanyak trauma tumpul• Pemeriksaan fisik sulit dilakukan
• ,ering ter#adi edera multi organ
• Penanganan seperti pada penderita
dewasa
• -eberapa keadaan spt ruptur lien dapat
ditangani seara konseratif . non*operatif
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• /tak masi" keil! tulang tengkorak elastis
• Tekanan intrakranial meninggi masi" bisadikompensasi bila tidak berat
• Anak rentan ter"dp "ipoksia! "ipoolemia
trauma otak sekunder lebi" sering
• Pemeriksaan G, memerlukan modifikasi
pada komponen erbal :
& senyum 3! menangis ttp dpt di"entikan + & iritabel persisten (! agitasi '
& tidak ada respons $
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• -elum sempurnanya pertumbu"an tulang!
periost tebal! epifisis belum menutup• Didapati fraktur k"as pada anak : buckle
dan greenstick fracture
• )pifisis belum menutup : sulit interpretasifoto buat perbandingan kanan*kiri
• Trauma yg mengenai pusat pertumbu"an
pertumbu"an terganggu tulang lebi"pendek
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,enga#a dilakukan kerabat dekat
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• Trauma yg dilakukan dengan senga#a ole"orang terdekat
• Angka pasti di Cndonesia
• Pi"ak UGD . ruma" sakit sering tidakmenatat dan memper"atikan
• Petugas tidak waspada . tidak memikirkan
tela" ter#adi kekerasan pd penderita anakyg datang berobat
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U9CGAC K)K)9A,AE
$% Adanya ketidak sesuaian anamnesis dan
pemeriksaan fisik
'% aktu meminta pertolongan yg lama
(% 9iwayat trauma berulang
+% 9espons orang tua yg tidak sesuai
3% Anamnesis yg beruba"*uba"
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P))9CK,AAE FC,CK
$% ,ubdural "ematom multipel
'% Perdara"an retina
(% Trauma sekitar mulut+% Trauma genital . perianal krn kekerasan
seksual
3% -anyak #aringan parut yg sd" sembu"6% Gigitan! bekas tali! sundutan rokok
=% 2uka bakar pd daera" yg tidak laHim