Dr.

Dadik Wahyu Wijaya SpAn

Departemen/SMF - Anestesi dan Terapi Intensif FK USU/RSUP H. Adam Malik Medan

TRANSPORT OF PATIENTS
PRIMARY TRANSPORT
SECONDARY TRANSPORT

AIR TRANSPORT
NEONATAL TRANSPORT

PEDIATRIC TRANSPORT

PRIMARY TRANSPORT
The management and transport of a patient from an accident side to the closest available adequate medical facility.

THE EARLIEST , THE BETTER

SECONDARY TRANSPORT
When 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)

Air Medivac

Primary versus Secondary Transport

Primary
Location Purpose Initial stabilization, evacuation

Secondary
Stabilization, definitive care Ground, Helicopter, Plane Stabilized Speed may be less critical EMS hospital -based

Prehospital to Hospital Inter or Intrahospital

Vehicle
Patient

Ground, Helicopter
Potentially unstable Short response time critical EMS prehospital

Time factor
Organization

EMS : Emergency Medical Services

Sampaikan data - fungsi vital - Tx yang sudah diberikan

RS penerima dapat menyiapkan fasilitas dan terapi lanjutan

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Transportasi
Gunakan spine-board atau brancard yang alasnya datar dan keras agar punggung tidak melengkung Tidak boleh pakai bantal dikepala Fixasi leher agar tidak banyak gerak Fixasi tubuh agar tidak terjatuh Usahakan posisi tubuh pasien selalu datar

Tatalaksana Transportasi
Pasien sesedikit mungkin digerakkan Semua extremitas dijaga lurus, gerakan sesedikit mungkin
Tenaga petugas sesedikit mungkin (posisi berlutut yang benar) Jangan mengangkat dengan punggung membungkuk (risiko HNP). Kerjakan dengan punggung lurus, dengan kekuatan otot paha

Pertahankan posisi korban tetap datar selama diangkut

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Cara mengangkat begini merusak tulang belakang yang cedera

JN Nasopharynx

Jaw thrust

Pipa Oropharynx

Untuk bebaskan jalan nafas pasangkan alat karena tidak bisa memegangi terus selama perjalanan

Pipa Nasopharynx

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JENIS TRANSPORTASI
Darat
jarak & lama permukaan rata / kasar kemiringan dan arah trayek

Udara
ketinggian = tekanan udara, tekanan O2
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Ambulance

Atap tinggi agar dapat bekerja di dalamnya

Head-clearance tinggi Petugas dapat memberi pertolongan lanjutan seraya ambulans jalan
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Airway, Intubation, Suction Neck Collar, sandbags Oxygen, Ambu-bag, Ventilator BP, infusion, bandages Drugs (vasopressor) EKG & DC shock Stretcher, splint

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G-force

Jangan berjalan cepat, max 60 kpj Jangan rem mendadak, belok mendadak

Jalan menurun Gravitasi ke kepala Aliran darah ke kepala Tekanan Intra Kranial naik

Jalan mendaki gravitasi ke kaki Aliran darah ke otak

Monitoring during transport

Continuous EKG monitoring Intermittent measurement of: Blood Pressure Respiratory Rate Continuous monitoring by Pulse Oximetry is strongly recommended Intubated patients receiving mechanical support of ventilation should have airway pressure monitored

Monitoring selama jalan SUKAR dikerjakan

-Auskultasi kacau akibat suara ribut -Tensimeter hanya palpasi atau elektronik -Dalam helikopter gangguan listrik banyak, monitor ECG tidak jalan

Diagnosis syok mungkin hanya dari gangguan perfusi

TANDA KLINIS SYOK

Nafas cepat Kulit dingin, pucat, basah, sianosis Capillary refill time > 2 detik
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Kalau ada ragu, kerjakan! In doubt, do

Jalan nafas intubasi Pneumotoraks chest drain

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Minimum Equipment that shall be available

For Airway and Ventilatory Management:
Oxygen source

Suction apparatus and Catheters Cardiac Monitor/Defibrillator Blood Pressure Cuff Pulse Oxymetry Materials for IV therapy: cannulas, solutions, tubing, needles and syringe Drugs for advanced Cardiac Resuscitation

Standard Resuscitation Drugs

Sulfas Atropine Epinephrine Dobutamin Lidocaine Sodium Bicarbonat Muscle Relaxant Sedative Dexamethasone

Bawa cadangan Oksigen, Cairan perjalanan bisa tertunda

Jalan jangan terlalu cepat Bila jalan menurun atau mendaki panjang, sesuaikan letak kepala
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Breathing harus terus dibantu, + Oksigen Infus harus tetap menetes, tidak boleh berhenti Jika perlu posisi shock, tetap dipertahankan selama di jalan

Dalam helikopter banyak gangguan suara dan gelombang elektromagnetik

Terbang ketinggian > 3000 m tanpa kabin bertekanan | risiko hipoksia

Perubahan tekanan = risiko: - udara dalam botol infus - udara dalam pneumothorax - letak botol WSD

Kabin bertekanan pada pesawat komersial = tekanan udara pada tinggi 3000m = risiko hipoksia

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Kabin bertekanan pada pesawat komersial = tekanan udara pada tinggi 3000m = risiko hipoksia
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Risk to the patient during transport can be minimized

Careful Planning Use of appropriately qualified Personnel Selection of appropriate equipment The available equipment and skill level of the accompanying personnel must be equal to the interventions or anticipated for the patient

Personnel who accompany the patient A minimum of two people shall accompany the patient : Physician Critical Care Nurse

The Basic Reason for Moving a Critically Ill Patient is :

The need for additional care Technology Specialists Nurse not available at the patients current location
Society of Critical Care Medicine: Guidelines for the Transfer of Critically Ill Patients. Crit Care Med 1993 June,21(6):931-937

Tulonnngggggggg Gue masih pengen Hidup . . . . . .

Thank you for your Attention