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TRANSPORT OF THE CRITICALLY ILLPATIENTSDept/SMF Anestesiologi dan Terapi Intensif FK USU/RSUP H. Adam Malik Medan

TRANSPORT OF PATIENTS PRIMARY TRANSPORT SECONDARY TRANSPORT

PRIMARY TRANSPORTThe management and transport of a patient from an accident side to the closest available adequate medical facility.THE EARLIEST , THE BETTER

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SECONDARY TRANSPORTWhen the patient needs to be transferred to a second hospital or has to be moved within the same hospital to a different site (e.g. from the Intensive Care Unit to the Scanner Room)

PrimarySecondaryLocationPrehospital to HospitalInter or IntrahospitalPurposeInitial stabilization, evacuationStabilization, definitive careVehicleGround, HelicopterGround, Helicopter, PlanePatientPotentially unstableStabilizedTime factorShort response time criticalSpeed may be less criticalOrganizationEMS prehospitalEMS hospital -basedPrimary versus Secondary TransportEMS : Emergency Medical ServicesKEPUTUSAN MERUJUKKeputusan MedikIdealnya Dirujuk Ke RS Yang Lebih TinggiTahu Kemampuan RS TujuanDiusahakan Rujuk Ke RS TerdekatDilakukan Resusitasi Tanpa Menunggu Keputusan Dari RS RujukanPRINSIP UTAMA DALAM RUJUKAN JANGAN MEMBUAT CEDERA LEBIH LANJUT PADA PENDERITA

* DO NO FURTHER HARM *+++PasiengawatdaruratTransportasiPuskesmasPraktekswastaRuangresusitasiKamarbedahICUPra rumah sakitRumah sakitMODEL STRUKTUR SISKESNASRUJUKAN TERPADU RS. KLAS A / B

PERAN UTAMA TERAPI DEFENITIF BERAT PENGEMBANGAN SDM

RS. KLAS CRS. KLAS CRS. KLAS CPERAN RESUSITASI STABILISASI TERAPI DEFE- NITIF SEDANG

PUSKESMASPUSKESMASPUSKESMAS

PERAN : RESUSITASI / STABILISASI TERAPI DEFENITIF RINGAN+PENCEGAHANPENANGGULANGANMULTI DISIPLINANTARA LAIN SUMBER DAYA MANUSIAMULTI PROFESI- HELM YANG MEMBERI PERTOLONGANMULTI SEKTOR- SABUK AWAM UMUM PETUGAS DOKTER PENGAMAN AWAM KHUSUS AMBULANS PERAWAT TUJUAN MENCEGAHMASYARAKAT KOMUNIKASI - KEMATIANAMAN / - KECACADANSEJAHTERA(SAFE COMMUNITY)

PASIEN AMBULANS PUSKESMAS RS.KLAS C RS. KLAS A/B

PRA RS INTRA RS INTRA RS ANTAR RSPENDANAAN

TIME SAVING IS LIFE SAVING RESPONSE TIME DIUPAYAKAN SEPENDEK MUNGKIN MERUJUK THE RIGHT PATIENT, TO THE RIGHT PLACE AT THE RIGHT TIMESPGDT-S (Sistim Pelayanan Gawat Darurat Terpadu-Sehari2)TRANSPORTASI+20

Sampaikan data- fungsi vital- Tx yang sudah diberikanRS penerima dapatmenyiapkan fasilitasdan terapi lanjutan21JENIS TRANSPORTASIDaratjarak & lamapermukaan rata / kasar kemiringan dan arah trayekUdaraketinggian = tekanan udara, tekanan O222

G-force23

Pertahankan posisi korban tetap datarselama diangkut24

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Atap tinggiagar dapat bekerjadi dalamnya

Head-clearance tinggiPetugas dapat memberipertolongan lanjutanseraya ambulans jalan26

Airway, Intubation, SuctionNeck Collar, sandbags Oxygen, Ambu-bag, Ventilator BP, infusion, bandagesDrugs (vasopressor)EKG & DC shockStretcher, splint27Tanda klinis shockNafas cepatKulit dingin, pucat, basah, sianosisCapillary refill time > 2 detik

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Kalau ada ragu, kerjakan!In doubt, do

Jalan nafas intubasiPneumotoraks chest drain29

Bawa cadangan Oksigen, Cairan perjalanan bisa tertunda

Jalan jangan terlalu cepat

Bila jalan menurun atau mendaki panjang, sesuaikan letak kepala30Jalan menurunGravitasi ke kepalaAliran darah ke kepalaTekanan Intra Kranial naik31Jalan mendakigravitasi ke kakiAliran darah ke otak

Air Medivac33

Kabin bertekanan padapesawat komersial =tekanan udara pada tinggi 3000m= risiko hipoksia34

Dalam helikopterbanyak gangguan suaradan gelombang elektromagnetikPerubahan tekanan = risiko:- udara dalam botol infus- udara dalam pneumothorax- letak botol WSDTerbang ketinggian > 3000 mtanpa kabin bertekanan|risiko hipoksiaMinimum Equipment that shall be availableFor Airway and Ventilatory Management:Oxygen sourceSuction apparatus and CathetersCardiac Monitor/DefibrillatorBlood Pressure CuffPulse OxymetryMaterials for IV therapy: cannulas, solutions, tubing, needles and syringeDrugs for advanced Cardiac ResuscitationMonitoring during transportContinuous EKG monitoringIntermittent measurement of : Blood Pressure Respiratory RateContinuous monitoring by Pulse Oximetry is strongly recommendedIntubated patients receiving mechanical support of ventilation should have airway pressure monitoredStandard Resuscitation DrugsSulfas AtropineEpinephrineDobutaminLidocaineSodium BicarbonatMuscle RelaxantSedativeDexamethasoneRisk to the patient during transport can be minimized Careful PlanningUse of appropriately qualified PersonnelSelection of appropriate equipmentThe available equipment and skill level of the accompanying personnel must be equal to the interventions or anticipated for the patientPersonnel who accompany the patientA minimum of two people shall accompany the patient Physician Emergency & Critical Care NurseThe Basic Reason for Moving a Critically Ill Patient is The need for additional care Technology Specialists Nurse not available at the patients current locationSociety of Critical Care Medicine: Guidelines for the Transfer of Critically Ill Patients. Crit Care Med 1993 June,21(6):931-937

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