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    Trauma Vascular Perifer: What We Should Do?

    Uploaded by

    Nisrina Afifah
    This document discusses vascular trauma and management. It covers anatomy, types of vascular injuries, signs and symptoms of ischemia, assessment techniques like Doppler ultrasound and arteriography, and repair techniques like direct suture, patch, bypass grafting, and end-to-end anastomosis. The key is rapid assessment and intervention for "hard signs" of vascular injury to prevent limb loss from ischemia.

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    Download as PPTX, PDF, TXT or read online from Scribd

    Trauma Vascular Perifer: What We Should Do?

    Uploaded by

    Nisrina Afifah
    31 views56 pages
    This document discusses vascular trauma and management. It covers anatomy, types of vascular injuries, signs and symptoms of ischemia, assessment techniques like Doppler ultrasound and arteriography, and repair techniques like direct suture, patch, bypass grafting, and end-to-end anastomosis. The key is rapid assessment and intervention for "hard signs" of vascular injury to prevent limb loss from ischemia.

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    This document discusses vascular trauma and management. It covers anatomy, types of vascular injuries, signs and symptoms of ischemia, assessment techniques like Doppler ultrasound and arteriography, and repair techniques like direct suture, patch, bypass grafting, and end-to-end anastomosis. The key is rapid assessment and intervention for "hard signs" of vascular injury to prevent limb loss from ischemia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views56 pages

    Trauma Vascular Perifer: What We Should Do?

    Uploaded by

    Nisrina Afifah
    This document discusses vascular trauma and management. It covers anatomy, types of vascular injuries, signs and symptoms of ischemia, assessment techniques like Doppler ultrasound and arteriography, and repair techniques like direct suture, patch, bypass grafting, and end-to-end anastomosis. The key is rapid assessment and intervention for "hard signs" of vascular injury to prevent limb loss from ischemia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 56

    trauma

    vascular
    perifer
    What we should do?
    dr. Umar Usman, M.Ked,Klin Sp.BTKV
    justumarusman
    What we should do?
    What we should do?
    ANATO
    MI
    Tunika intima : endotel, membrane
    basement & jaringan konektif , kolagen,
    interna membrane elastic

    Tunika media; tunica muscularis,


    lapisan paling tebal

    Tunika adventisia, lapisan paling kuat

    justumarusman
    palpable artery
    carotis
    axillaris

    brachialis

    radio-ulnaris

    femoralis
    poplitera

    tibialis posterior
    dorsalis pedis
    justumarusman
    langsung
    trauma tidak langsung

    kasus vaskuler
    tumor
    nontrauma congenital
    infeksi
    ischemia
    justumarusman
    vaskular trauma

    trauma Langsung trauma tidak Langsung

    trauma Tajam spasme arteri


    trauma Tumpul peregangan arteri

    justumarusman
    US 2%
    inggris 4,4%
    afgan 12%

    Indonesia?
    vascular
    trauma
    incidence aussie 1%

    justumarusman
    50%

    vascular extremity
    30% trauma

    15%

    5%

    projectile stab handshot others


    justumarusman wound
    patologi

    justumarusman
    VASCULAR
    TRAUMA PATOFISIOLOGI
    Tajam VS Tumpul

    justumarusman
    Tajam VS Tumpul

    justumarusman
    Tajam VS Tumpul

    justumarusman
    status vaskular
    pulsasi

    justumarusman
    status vaskular
    pulsasi

    motorik

    0–1-3–4-5
    justumarusman
    status vaskular
    pulsasi

    motorik

    sensorik

    hipesthesia - anasthesia
    justumarusman
    status vaskular
    pulsasi

    motorik

    sensorik

    perabaan

    hangat - dingin
    setinggi apa?
    justumarusman
    status vaskular
    pulsasi

    motorik

    sensorik

    perabaan

    saturasi

    pulse oxymetry
    justumarusman
    status vaskular
    pulsasi

    motorik

    sensorik cut off 2 seconds

    perabaan

    saturasi

    capillary refill
    prick test
    justumarusman
    selalu
    membandingkan
    kanan dan kiri
    justumarusman
    justumarusman
    justumarusman
    Tanda tanda iskemia jaringan distal :
    • Pain • Pulseless
    • Pale • Paralysis
    • paresthesia • poikilothermia

    justumarusman
    6P
    justumarusman
    What Should do?
    Hard Sign Soft sign

    Urgent intervention!!! Observe – investigate


    justumarusman
    Sistem skoring pada trauma vaskular
    Mangled Extremity Severity Score (MESS)

    justumarusman
    ANKLE BRACHIAL INDEX (ABI)

    justumarusman
    Pemeriksaan penunjang

    USG DOPPLER

    justumarusman
    Pemeriksaan penunjang

    justumarusman ARTERIOGRAPHY MS CT SCAN


    ANGIOGRAPHY
    justumarusman

    MANAGEM
    prehospital
    medical gauze elastic bandage
    don’t be panic
    use tip of your finger
    to control bleeding
    surgical clamp
    initial assesment
    immediate treatment
    volume resuscitation
    volume resuscitation
    Tourniquette test
    • Bebaskan proksimal dan kalau
    perlu distal lesi  teugel
    • Heparinisasi 50 -100 IU/kgBB
    • Lakukan klem proximal dan
    distal
    • Eksplorasi vaskular
    • Evakuasi clot hematom jika
    perlu  lapangan operasi
    clear dan ekspose
    • Inspeksi lesi vaskular yang
    terjadi
    • Lakukan tindakan
    repair/rekonstruksi yang
    sesuai
    Teknik repair vascular
    • Direct suture
    • Patch
    • End to end anastomosis
    • Bypass dengan graft
    • Interposisi
    Direct suture

    Melintang

    Hati hati
    stenosis arteri

    memanjang
    Patch
    Menjahit dengan
    menempelkan segmen
    yang rusak dengan vena
    atau prothesis
    End to end
    anastomosis
    Syarat : gap tidak
    lebih dari 2 cm
    interposisi
    Mengganti segmen yang
    rusak dengan/defek
    dengan vena/ prothesis
    Bypass graft
    Melakukan pintas dari segmen yang
    rusak
    Bypass dengan graft
    seorang wanita 23 th datang ke IGD dengan memegang
    lengan kirinya yang tertutup kain yang berlumuran darah
    sampai menetes ke lantai IGD.
    pasien datang dengan kondisi lemah, pucat, tapi masih
    dapat berkomunikasi dengan dokter di IGD.
    pasien riwayat bertengkar dengan pacarnya. sejam yang
    lalu tidak melukai lengan kiri atasnya dengan pisau
    dapur. pasien datang dengan TD 90/60, RR 24x/mnt,
    HR 113x/mnt dengan suhu afebris. menurut keluarga
    terjadi perdarahan hebat sebelumnya kira kira sebanyak
    2 sarung penuh darah
    tindakan awal paling tepat yang dilakukan
    pada pasien tersebut adalah :
    a.membuka luka di lengan untuk mencari
    tau penyebab luka
    b.pasang Oksigen dan 2 jalur IV line
    c.memasang torniket dilengan pasien
    d.foto roentgen lengan kiri AP / lateral
    e.operasi repair pembuluh darah
    saat luka dibuka, ternyata perdarahan masih aktif,
    pulsasi areri radialis dan ulnaris tidak teraba, jari jari
    lebih dingin dengan kadar saturasi oksigen tidak terukur.
    melihat kejadian ini, maka dari pemeriksaan dapat
    disimpulkan pasien masuk kedalam kriteria
    a.soft sign
    b.hard sign
    c.tender sign
    d.iskemia sign
    e.shock sign
    tindakan yang harus segera dilakukan pada
    pasien tersebut adalah
    a.USG doppler
    b.Multiple Slice CT Scan angiography
    c.Arteriography
    d.masuk kamar operasi untuk repair
    pembuluh darah
    e.bukan salah satu diatas
    Teknik repair paling tepat untuk kasus
    diatas adalah
    a.end to end anastomosis
    b.bypass graft
    c.direct suture
    d.patch
    e.transposisi graft
    if you Fail to plan,
    you are planning to fail
    Benjamin Franklin

    lets discuss..

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