STUDENTS SKILL LAB MANUAL BOOK

EMERGENCY AND TRAUMATOLOGY SYSTEM

EMERGENCY AND TRAUMATOLOGY SYSTEM

MEDICAL FACULTY
HASANUDDIN UNIVERSITY
MAKASSAR
2011
 AIRWAY MANAGEMENT
Definition: Freeing the airway to ensure the air exchanges normally both by manual or tools.
Learning Goals: after learning this manual the students are expected to have the ability to:
1. Identify the airways disturbance
2. Free or open airway without any tools
3. Free airway by using tools
4. Clean the airway
5. Deal with the obstruction of the airway for both partial and total obstruction
Media and the learning tools:
1. Students skill lab manual book emergency and traumatology system
2. Video and slide of the Airway Management Methods
3. Children and adult mannequin dolls
4. Oropharyng tubes in all size
5. Nasopharyng tubes in all size
6. Gloves
7. Dry Gauge
8. Suction
9. Stiff and flexible Suction tubes
Indication
1. It is done to the unconscious patients in any cause
2. It is done to the patients with partial or total airway obstruction

Learning Method
Procedures demonstration that is performed based on the manual

Airway Management Activities Description

Activity Time Description

1. Introduction
2. Short demonstration of the
airway management
technique by the instructor
3. Practicing Airway
management technique
4. Discussion
Total time
5 minutes 1. Introduction, manage the students sitting position
2. Brief explanation of the work procedures, students role,
and time allocation
10minutes 1. All students watch the airway management technique by
the instructor at the model
2. Brief discussion if there are problems that are less
understood
10minutes 1. One student as the assistant help to prepare all tools. One
student practices the airway management technique. Other
students observe attentively and correct if there are any
mistakes.
2. Instructor watches and guides the students if there any
mistakes in the practice.
3. Instructor goes around among the students and supervises
using the checklist.
10minutes 1. Discussion of the students impression toward the airway
management practice: what is easy, what is hard?
2. The students give advice or correction on the practice that
day. The instructor listens and gives answers.
3. The Instructor explains the general assessment on the
practice: whether it runs nicely, or whether some students
need more practice. If possible, announce each of the
students mark.
35minutes
 LEARNING MANUAL
AIRWAY MANAGEMENT SKILLS

Steps/Activity Information
Early Preparation
Check all tools
Diagnosis on airway disturbance Instructor explains and
demonstrates the techniques
1. Look of how to assess the signs of
Look at the breathing movement/ chest inflation and retraction airway disturbance
between the ribs
2. Listen
Listen to the breathing sound
3. Feel
Feel the airflow of breathing
Opening the airway without tools This technique is used to the
patient with airway
Head-tilt
obstruction because of the
Technique: back fall of the tongue
Put one hand on the patients forehead and push it so the head will be
upward and the tongue support will be raised to the front
Chin lift
Technique:
Use the middle and the point fingers to hold the patients chin bone,
then lift and push the bone to the front
Jaw thrust
Technique:
Push the angle of the left and right jaws to the front until all the
inferior teeth are in line with the superior teeth. Or enter the mother
finger in to the patients mouth and along with the other fingers pull
the chin to the front.
Airway management with tools
A. Oropharynx tube
Installation technique:
1. Wear the gloves
2. Open the mannequin/patients mouth with chin lift technique
or use the mother and point fingers
3. Prepare the oropharynx tube which has the right size
4. Clean and moist the tube to make the tube is easy to be
entered
5. Direct the curve facing the palatal
6. Enter half of the tube, turn the curve facing under the tongue
7. Push the tube slowly to the right position
8. Make sure the tongue is supported by the tube by looking at
the breathing pattern, feel and listen to the sound of breathing
after the installation.
B. Nasopharynx tube
1. Wear gloves
2. Evaluate the size of the nostrils with the tube that is going to be
entered.
 3. Evaluate the abnormality in the nasal cave.
4. Smear the tube and the nostril that is going to be entered with
gel. If its needed, give vasoconstrictor inside the nose.
5. Hold the tube with the position where the edge facing the ear.
6. Push the tube slowly until all of the tube enter the nose and
then evaluate the airflow in the tube.
7. Fix the tube with tape/plaster.

Clearing the airway Being done if there is any

1. Finger swab foreign things inside the

Techniques : mouth

a. Wear gloves
b. Open the patients mouth with jaw thrust technique and
push the chin downward
c. Use two fingers (the pointer and middle fingers) which
are clean or folded by gloves or gauge to clean and
pick all the foreign things inside the mouth.
2. With suction
Airway management in obstruction case by solid foreign
object
A. CHOKING
BACK BLOW / BACK SLAPS
Adult and conscious casualties

1. If the patient is totter, hold the patient from behind

2. One arm holding the body, the other arm does the
BACK- BLOW/ BACK SLAPS. Hold the patient and prevent
from falling

3. Give five hard blows/ slaps with your fist at the imaginary cross
lines of the vertebra and the scapula. If it fails, lay the patient slowly
in up position. Do the abdominal thrust.

ABDOMINAL THRUST
Standing/conscious adult patient

1. Hold the totter patient with your two arms from behind
2. Do the thrust, five times by pulling your two arms footing on
your two fists right at thrust point on the middle of the
umbilicus and the processus xyphoideus of the patient.
If it fails, lay the patient in up position slowly. Do the
abdominal thrust again.

ABDOMINAL THRUST
Lying/unconscious adult patient
1. If the patient is unconscious, lie the patient in up position.
2. The helper takes the position like riding horse on top of the
patients body or beside the patients hip.
3. Do pushing thrust five times by using your two arms footing
on the thrust point (epigastria area).
 Make sure the foreign object has moved or out by:
- Look inside the patients mouth, if its visible, take it
- If its not visible, blow air mouth to mouth while watch if
the air enters the lung. If the chest inflates, it means that
the airway has opened
- In the contrary, if the air doesnt enter it means that the
airway is still obstructed, do ABDOMINAL THRUST
AGAIN, and so on

If it fails, think to prepare cricothyroidotomy followed by

tracheotomy
.

Cricothyroidotomy
Definition
Performing puncture at cricothyroid membrane with large needle as a short cut for oxygenation
and ventilation on the breathing failure patient because of upper respiratory tract obstruction.
Learning Goals:
After this learning the students are expected to have the ability to:
1. Conduct puncture at the cricothyroid membrane
2. Prepare the equipments that are needed in cricothyroidotomy
3. Conduct the emergency airway management after the puncture of cricothyroid membrane
Learning media and tools:
1. Students skill lab manual book emergency and traumatology system
2. Video and slide of cricothyroidotomy
3. Mannequin dolls
4. Table or the place for instruments
5. Gloves
6. Disinfectant liquid (alcohol, povidon iodine) and cotton
7. Two Syringes of 12 cc
8. Lidocain 2 %
9. Jet insufflations equipment : Y form tube, where one of the wholes is connected to the
oxygen and the aqualung
10. Two IV polyurethane protective catheter sized 12 to 14
11. Sterile Gauge or sterile bandage
12. Antibiotic cream
13. Plaster or fabric tape
14. Washbasin for hand washing and antiseptic soap
Indications
1. If there is a significant upper airway obstruction
2. If the attempt to give ventilation with bag-valve-mask has failed
Learning Method
Procedures demonstration that is performed based on the manual
Cricothyroidotomy Activities Description
Activity Time Description
1. Introduction 5minutes 1. Introduction, arrange the students sitting position
2. Brief explanation of working procedures, the students
role, and time allocation
2. Short demonstration of 5minutes 1. All students watch the demonstration of
cricothyroidotomy by the cricothyroidotomy by the instructor on the model
instructor 2. Short discussion if there is something that is less
understood
3. Cricothyroidotomy 10minutes 1. One student as the assistant help preparing the
Practice cricothyroidotomy practice.
One student performs the cricothyroidotomy practice.
The other students observe attentively and correct if the
practice is not perfect
2. The instructor watches and guides the students in the
practice
3. The instructor goes around the students and supervise
using the checklist
4. Discussion 10minutes 1. Discussion of the students impression toward the
cricothyroidotomy practice: what is easy and what is
hard
2. The students give advice or correction toward the
practice on that day. The instructor listens and gives
answers
3. The instructor gives general explanation of the
cricothyroidotomy practice: is generally the practice
runs well, are there some students still need more
practice. If it is necessary announce the mark for each
students
Total time 30minutes

LEARNING MANUAL
CRICOTHYROIDOTOMY SKILL
Steps/Activities Annotation
Early preparation before installation
1. Check all the equipments
Connect oxygen hose with one of the Y tube whole and make
sure the oxygen flows properly through the hose
2. Place the IV catheter sized 14 to the 12 cc syringe
Cricothyroidotomy Procedures
3. Disinfect neck area with antiseptic
4. Palpate cricoids membrane, at the anterior between thyroid and
cricoids cartilage. Hold the trachea with your thumbs and
pointer finger so the trachea wont move to the lateral in the
procedure
5. With the other hand (right hand) puncture the skin at the
midline on top of cricoids membrane with big needle sized 12-14
which has been placed on a syringe. To easy the needle
penetration, you can make small incision at the puncture point
with knife sized 11
6. Direct the needle 45 degrees to the caudal, then carefully
penetrate the needle while sucking the syringe. If the air is
aspirated or there is bubble in the syringe which is filled with
aquadest it means that the needle has entered the trachea lumen
7. Release the syringe from the IV catheter, than pull the mandrin
and push the catheter gently downward
8. Connect the end of the catheter with one of the end of the
oxygen hose with Y form
9. Scheduled ventilation can be done by closing one end of the
opened Y hose with your thumb for one second and open it for 4
seconds. This procedure can last from 30 to 45 minutes

GIVING THE BREATHING AID

Definition: Giving the breathing aid with or without ant equipment to the breathing failure
patient in any cause.

Learning Goals: after this study the students are expected to have the ability to:
1. Prepare the equipments that are needed to give the breathing aid
2. Give the breathing aid to the breathing failure patient without any equipments
3. Give the breathing aid to the breathing failure patient with equipments

Learning Media and tools :

1. Skills lab students manual book of emergency and traumatology system
2. Video and slide of airway management
3. Mannequin dolls of adult and children intubation
4. Oropharyng tubes in any size
5. Orothracheal tubes in any size
6. Nasotracheal tube in any size
7. Bag-valve-mask
8. Oxygen hose and oxygen tank
9. Laryngoscope handle and battery
10. Laryngoscope leaves in any size and extra lamp
11. Plaster
12. Stethoscope
13. Endotracheal tube gel
14. Local anesthetic spray for nasal
15. Semi rigid cervical collar
16. Magill forceps
17. Stylet (introducer) endotracheal tube that is flexible
18. Tongue spatula
19. Hand gloves
20. Dry Gauge
21. Suction
22. Rigid and flexible suction tubes

Indication
It is done to the breathing failure patients

Learning Method
Procedures demonstration that is performed based on the manual
Activities descriptions of airway management

Activity Time Description

1. Introduction 5 minutes 1. Introduction, arrange the students sitting position
2. Brief explanation of working procedures, the students
role, and time allocation
2. Short demonstration 10 minutes 1. All students watch the demonstration of the
of the procedure of procedure of giving the breathing aid by the instructor on
giving the breathing aid the model
by the instructor 2. Short discussion if there is something that is less
understood
3. Practice the 10 minutes 1. One student as the assistant helps preparing the
procedure of giving the equipments.
breathing aid by the One student performs the procedure of giving the
instructor breathing aid. The other students observe attentively and
correct if the practice is not perfect
2. The instructor watches and guides the students in the
practice
3. The instructor goes around the students and supervise
using the checklist
4. Discussion 10 minutes 1. Discussion of the students impression toward the
giving the breathing aid practice: what is easy and what is
hard
2. The students give advice or correction toward the
practice on that day. The instructor listens and gives
answers
3. The instructor gives general explanation of the giving
the breathing aid practice: is generally the practice runs
well, are there some students still need more practice. If it
is necessary announce the mark for each students
Total time 35 minutes

LEARNING MANUAL
GIVING THE BREATHING AID SKILL

Steps/Activities Ket
Early Preparation
Check all the equipments
Bag-valve-mask Ventilation
1. Choose the mask size that is fit to the patients face
2. Connect the oxygen hose to the bag-valve-mask and set the oxygen flow up to
12 L/minutes
3. Make sure the patients airway is free and maintain it with the technique that has
been explain in the previous chapter
4. Install the oropharynx tube
5. The left hand hold the mask in the position where the mask tight to the face and
make sure there is no air that flow out from the mask when the bag is pumped.
The right hand holds the bag and pumps it until the patients (doll) chest looks
inflated.
6. For two helper : one helper hold the mask with two hands and the other helper
hold the bag and pump it with two hands
7. The ventilation adequacy is evaluated by watching the movement of the
patients (doll) chest
8. Ventilation is given in every 5 seconds
Orotracheal Intubation
1. Make sure that the airway is free and the oxygenation still goes on
2. If the patient is still given the breathing aid with bag-valve-mask, give enough
preoxygenation before performing the intubation
3. Pump up the endotracheal tube to make sure that the balloon is not leaked. If it is
not leaked, deflate the balloon
4. Connect the laryngoscope leave to the handle and check the lamp light
5. Hold the laryngoscope with the left hand
6. If the oropharynx tube is installed, put it of right away
7. Enter the laryngoscope at the right side of the patients mouth and push the
tongue to the left
8. Visually identify the epiglottis and then the vocal chord
9. Carefully enter the endotracheal tube in to the trachea without pressing the teeth
or the other tissue in the mouth
10. Pump up the balloon with the air from the syringe until there is no air is heard
from the interspaces of endotracheal tube and the trachea
11. Connect the endotracheal tube with the bag-valve and then pump it while
watching the chest inflation
12. Auscultate the left-right chest to check if the breathing sound is similar. The
abdominal auscultation to make sure the tube is correctly installed
13. Install the orotracheal tube and fixate the endotracheal tube to the mouth with
plaster

NEEDLE THORACOCENTHESIS

Definition
Performing puncture toward the chest wall at the second intercostals in order to expel the air in
the pleura in the tension pneumothorax cases

Learning Goals:
After this study the students are expected to have the ability to:
1. Perform the puncture at second intercostals
2. Prepare the equipments that are needed in performing the needle thoracocenthesis

Learning media and tools:

1. Skills lab students manual book of emergency and traumatology system
2. Video and slide of needle thoracocenthesis
3. Mannequin dolls
4. Table or the place for instruments
5. Gloves
6. Disinfectant liquid (alcohol, povidon iodine) and cotton
7. Two Syringes of 12 cc
8. Lidocain 2 %
9. Two IV polyurethane protective catheter sized 12 to 14
10. Sterile Gauge or sterile bandage
11. NaCl 0,9%
12. Washbasin for hand washing and antiseptic soap

Indication
In tension pneumothorax cases

Learning Method
Procedures demonstration that is performed based on the manual
Activities Description of Needle Thoracocenthesis
Activity Time Description
1. Introduction 5 minutes 1. Introduction, arrange the students sitting position
2. Brief explanation of working procedures, the
students role, and time allocation
2. Short demonstration 5 minutes 1. All students watch the demonstration of the
of the needle procedure of needle thoracocenthesis by the instructor
thoracocenthesis on the model
procedure by the 2. Short discussion if there is something that is less
instructor understood
3. Practice the needle 10 minutes 1. One student as the assistant helps preparing the
thoracocenthesis equipments for needle thoracocenthesis.
procedure by the One student performs the needle thoracocenthesis
instructor procedure. The other students observe attentively and
correct if the practice is not perfect
2. The instructor watches and guides the students in
the practice
3. The instructor goes around the students and
supervise using the checklist
4. Discussion 10 minutes 1. Discussion of the students impression toward the
needle thoracocenthesis practice: what is easy and
what is hard
2. The students give advice or correction toward the
practice on that day. The instructor listens and gives
answers
3. The instructor gives general explanation of the
needle thoracocenthesis practice: is generally the
practice runs well, are there some students still need
more practice. If it is necessary announce the mark for
each students
Total time 30 minutes

LEARNING MANUAL
NEEDLE THORACOCENTHESIS SKILL

Steps/Activities Annotation
Early preparation before installation
1. Check all equipments
2. Place IV catheter sized 14 to the 12 cc syringe that is filled with 5
ml water
Needle Thoracocenthesis Procedures
3. Disinfect the thorax area that is going to puncture with antiseptic
4. Identify the second intercostals area at the middle of clavicle. If the
patient is conscious inject the local anesthetic
5. Puncture the needle that is connected to the syringe at the upper part
of the third Costa until the air is expelled signed by the appearance of
the bubble at the syringe
6. Reevaluate the patient breathing if there is improvement or not
 CARDIO PULMONER RESCUCITATION

Definition: Performing external heart massage to manage the condition of breath stop and heart
stop
Learning Goals: after this study the students are expected to have the ability to:
1. Perform the resuscitation to the breath stop patient
2. Perform the external heart massage to the heart stop patient
Learning media and tools:
1. Skills lab students manual book of emergency and traumatology system
2. Video and slide of needle thoracocenthesis
3. Adult and children mannequin dolls
Indication
Being done to the breath stop and/or heart stop patient in any cause

Learning Method
Procedures demonstration that is performed based on the manual

CPR activities description

Activity Time Description
1. Introduction 5 minutes 1. Introduction, arrange the students sitting position
2. Brief explanation of working procedures, the
students role, and time allocation
2. Short demonstration 10 minutes 1. All students watch the demonstration of the CPR
of the CPR procedure by procedure by the instructor on the model
the instructor 2. Short discussion if there is something that s less
understood
3. Practice the CPR 10 minutes 1. One student as the assistant helps preparing the
procedure by the equipments for CPR.
instructor One student performs the CPR procedure. The other
students observe attentively and correct if the practice
is not perfect
2. The instructor watches and guides the students in
the practice
3. The instructor goes around the students and
supervise using the checklist
4. Discussion 10 minutes 1. Discussion of the students impression toward the
CPR practice: what is easy and what is hard
2. The students give advice or correction toward the
practice on that day. The instructor listens and gives
answers
3. The instructor gives general explanation of the CPR
practice: is generally the practice runs well, are there
some students still need more practice. If it is
necessary announce the mark for each students
Total time 35 minutes
 LEARNING MANUAL
CARDIOPULMONER RESCUCITATION
Steps/Activities Annotation
Early preparation
Check all equipments
Demonstration by one helper
1. Arrange the patients position and put the patient on the hard base
2. For the unconscious patient, make sure the patient is unconscious by calling, clapping
the patients back, shaking, or pinching the patient
3. Ask help immediately by shouting without leaving the patient
4. Check if the patient is breathing
5. If the patient is not breathing, open and free the airway
6. Recheck if the patient is breathing after opening the airway
7. If there is no breathing or the breathing is difficult, give two breathing aid, slow and
full while watching the chest inflation
8. Feel the carotid pulse
9. If you cant feel it, perform external heart massage 30 times at the base point which is
two fingers above the processus xyphoideus. Then continue with giving two blows of
breathing aid
10. Put one hand at the pressure point, the other hand is on top of the first hand
11. Both arms are straight and vertical at the sternum. Both of the helpers knee is close
to each other, and stick to the patients arm
12. Press downward 4-5 cm for adults, by dropping the weight to the patients sternum.
13. Compress rhythmically and regularly 100 times/minute. Evaluate at the breathing,
pulse, consciousness, and pupil reaction every end of the fifth cycle
14. If the breathing and the pulse are still cant be felt continue the CPR until the patient
is recover
Demonstration by two helper
1. Step 1-14 above are still performed by the first helper until the second helper comes
2. When the first helper makes the evaluation, the second helper takes the position for
heart massage
3. If the pulse is still cant be felt, the first helper gives two times breathing aid slowly
until the chest is inflated, followed by the second helper giving 30 times of heart
massage

PERIPHERAL VEIN CANULATION

Definition
Performing puncture at the superficial vein at the arms, feet, neck, or head using intravenous
catheter as indication
Learning Goals: after this learning the students are expected to have the ability to:
1. Know the indication of canulation intravenous catheter (infuse)
2. Explain the objectives of the canulation and the procedure to the patient
3. Prepare the equipments which are needed for canulation
4. Perform the vein canulation in the right way
5. Fixate the vein catheter in the right way
Learning media and tools:
1. Skills lab students manual book of emergency and traumatology system
2. Video and slide of vein canulation
3. Mannequin dolls and vein replacement kit and advanced vein puncture and injection
arm
4. Tourniquet
5. Gloves
6. Syringe of 1 cc
7. Lidocain 2 %
 8. Infuse set or transfuse set
9. IV polyurethane protective (in any size for adult and children)
10. Sterile Gauge or sterile bandage
11. Antibiotic cream
12. Plaster
13. Washbasin for hand washing and antiseptic soap

Indication
1. For giving fluid
2. As access for intravenous drugs
3. A part of resuscitation action
4. Plan for operation
5. Nutrition giving via peripheral parentheral

Learning Method
Procedures demonstration that is performed based on the manual
Peripheral vein canulations activities description
Activity Time Description
1. Introduction 5 1. Introduction, arrange the students sitting position
2. Brief explanation of working procedures, the students
minutes
role, and time allocation
2. Short demonstration of 5 1. All students watch the demonstration of the procedure
of peripheral vein canulation by the instructor on the model
the peripheral vein minutes
2. Short discussion if there is something that is less
canulation procedure by the understood
instructor
3. Practice the peripheral 15 1. One student as the assistant helps preparing the
equipments for peripheral vein canulation.
vein canulation procedure minutes
One student performs the peripheral vein canulation
by the instructor procedure. The other students observe attentively and
correct if the practice is not perfect
2. The instructor watches and guides the students in the
practice
3. The instructor goes around the students and supervise
using the checklist
4. Discussion 10 1. Discussion of the students impression toward the
peripheral vein canulation practice: what is easy and what
minutes
is hard
2. The students give advice or correction toward the
practice on that day. The instructor listens and gives
answers
3. The instructor gives general explanation of the
peripheral vein canulation practice: is generally the practice
runs well, are there some students still need more practice.
If it is necessary announce the mark for each students
Total time 35
minutes
 LEARNING MANUAL
PERIFER VEIN CANULATION
ACTIVITIES DESCRIPTION
Preparation
1. Check the patients medical record or status card (
search for diagnose, allergic histories, blood
abnormalities, etc.)
2. Check all of the equipments Check if the transfusion set is connected to the
solution bag
Make sure there is no air bubble in the
transfusion set
Provide 3 different catheter size intravenous )
that may match to the patient
3. Explain the procedure to the patient and his or her Create a pleasant atmosphere in the room by
making kind and friendly greetings, or either by
family
shaking hands and give a slight and friendly
touch to your patient if necessary. .
Intravenous catheter manual
4. Identify the veins that will be suitable to insert a Choose the most distal vein than the proximal
ones.
catheter
Better to choose extremities that are not
dominant
Search for dorsal manus area
Do not insert the catheter in antecubiti areas
5. Wash hands with antimicrobial soap
6. Use the handgloves
7. Insert the tourniquette If needed, an assistant will be helpful to
immobilize the patient.
Force the veins towards the distal direction or
set the patients arm in a position where the arm
is lower than the cardiac level. Place the
tourniquette in the middle part of the arm
between the wrist and elbow ) or either in the
lower part of the leg. Do not place the
tourniquette forcely or either too gently.
If rubber band is used as a tourniquette, not tie
it as a dead lock. The tie knot should be able
to be easily untied.
If the tourniquiette is already placed but veins
are not to be visible yet, a mild tapping on the
veins using your hands or placing a warm towel
would help to dilate the veins.

8. Cleanse the place of nsertiion with desinfektan ( After cleansing, no touch should be kept in
alcohol ) and let it dry by itself. mind.
9. Left arm should hold the area beneath the injection If the injection area is to be the dorsal manus
area, use the thumb to stabilize the veins and soft area, the patient can be asked to hold tight its
tissue. arm.
10. Do a local anesthetic injection in the injection area
using a small needle ( 30 gauge needle/1cc
disposable a local anesthetic cream If availabe in
advanced, a local anesthetic cream can be used
 (EMLA)
11. Place the bevel catheter i.v. in a upward position,
between the point finger and the thumb.
12. Hold the catheter in a 45 degree position, just above Approaches that can be done in penetrating the
the skin towards the vein but not yet penetrating vein :
the vein. Central : penetrate straight to the vein.
This is not a very good approach because
whenever the penetration is far too deep, it
could harm the tissue beneath the vein
causing extravacation.
Paraveins : penetrate the vein from its side
part first, then direct the needle intowards
the vein. This is the best way to penetrate
into the vein.
13. Place the catheter lower than or just as in one level
with the skin surface dan move the needle tip to
pass it althrough the vein.
14. Force the catheter slowly into the vein, make sure If there is a resistant sensation, and followed
there is a venous return flow quickly by a smooth penetration, it means that
the catheter is already placed inside the vein.
15. Force the catheter with its mandrin about 3-5 mm How far the force goes depends on the size and
into the vein to make sure the catheter in placed depth of the veins and the catheters size.
inside the veins lumen.
16. Pull the mandrin out, push the catheter till the end Do not re-insert the mandrin into the catheter
of the catheter touches the skin surface. because it could tear up the catheter.
17. Dispose the used mandrin using the catheters Be sure that the mandrin is wraped inside the
wrap/plastic wrap. catheter plastic bag/wrap until you hear a
click and dispose it carefully in a safe place
18. Release the tourniquette
19. Connect the catheter to the infuse/transfusion set If available, connect it with a three way stop
cock.
20. Let the saline fluid / i.v. fluid pass through, clean
any blood residuals and then dry it with a sterilized
gaus so the band aid will attach firmly.
I.V. Catheter Fixation
21. Attach one band aid 5mm in width, direct the ends Use two band aids, one for catheter fixation
to form the letter V just beneath the catheter intravenously, and the other to fixate the
origin so it would close the surface where the transfusion set. The length of the band aid is
catheter was inserted. about 15-20 cm long, not too wide nor too
narrow. ( width 0.5 mm ). Fixation should form
the letter V, in a way where it wouldnt
detached easily. -
22. Attach one band aid to fixate the infuse or transfuse Do not manipulate the transfusion pipe/set
set by forming the letter V before fixating it to the skin surface, for it may
cause difficulties whenever an injection through
the transfusion set is needed afterwards.

Post fixation
23. Immobilized the extremities wih ada board if there Do not use gause or any other material as a
is any indication. For example : when inserted in band in any insertion areas.
infants, children and joint areas
24. Instruction for patients :
Avoid any unnecessary movements.
Call for the nurse/doctor as soon as possible
whenever there is a swelling, pain or leakage
from the insertion.
25. Labelize the gause with date of insertion, size of
catheter and the inisial of the name who inserted it.
26. Write down in the patients medical record about :
Date of insertion
Catheter size
Initials of names who inserted the catheter
Place of insertion
Patients tolerance and respond to the
therapy
 PENUNTUN BELAJAR
KETERAMPILAN RESUSITASI PADA BAYI BARU LAHIR

Langkah-langkah/Kegiatan Keterangan
Persiapan awal
Periksa semua kelengkapan alat
Langkah awal
1. Letakkan bayi di bawah pemancar panas yang telah dinyalakan
sebelumnya.
2. Letakkan bayi dengan kepala sedikit tengadah/sedikit ekstensi.
3. Hisap mulut kemudian hidung
4. Keringkan tubuh dan kepala dari cairan amnion
5. Singkirkan kain basah.
6. Perbaiki posisi kepala bayi agar leher agak tengadah.
Buka jalan napas
1. Bersihkan mulut dan hidung bayi dengan penghisap.
2. Posisikan bayi terlentang, kepala posisi tengadah jangan melakukan
ekstensi yang berlebihan
3. Berikan ganjal punggung dengan kain setebal 2.5 cm bila kepala
bayi besar atau occiputnya menonjol.
4. Jika pernapasan dangkal atau tersengal-sengal segera hisap lendir
mulai dari mulut kemudian hidung. Pengisapan jangan terlalu lama
(6 detik).
5. Evaluasi pernapasan, frekuensi jantung, dan warna kulit.
6. Jika ketuban keruh atau bercampur meconium kental bila bayi
menunjukkan usaha napas yang baik, tonus otot yang baik, dan
frekuensi jantung lebih dari 100 kali/menit, anda cukup
membersihkan sekret dan mekonium dari mulut dan hidung dengan
menggunakan balon penghisap yang biasa digunakan atau kateter
penghisap berukuran 12F atau 14F.
Rangsangan taktil
Cara rangsang taktil yang aman :
1. Menepuk / menyentil telapak kaki
2. Menggosok punggung/perut/dada/ekstremitas
Evaluasi kondisi bayi
1. Nilai pernapasan bayi dengan melihat pengembangan dada dan
warna kulit. Dengaran suara napas di seluruh lapangan paru
dengan stetoskop.
2. Nilai denyut jantung dengan mendengar irama jantung dengan
stetoskop. Hitung frekwensi denyut jantung
3. Nilai warna kulit apakah kemerahan/sianosis perifer atau sianosis
sentral.
Pemberian napas bantu
1. Jika pernapasan tetap tersengal atau apnu setelah rangsangan
singkat, segera berikan pernapasan buatan atau ventilasi tekanan
positif dengan oksigen 100 %.
2. Posisikan kepala bayi sedikit ekstensi atau ganjal bahu
3. Bersihkan sekret terlebih dahulu dan pastikan jalan napas bersih.
4. Pasang pipa orofaring
5. Letakkan sungkup di wajah bayi dengan rapat agar tidak bocor
melalui sisi sungkup
6. Berikan tekanan positip melalui bag-valve-mask (ambubag) dengan
lembut sambil melihat pengembangan dada bayi.
 7. Selanjutnya evaluasi lagi pernapasan dan denyut jantung secara
simultan.
8. Bila ventilasi tekanan positip tidak efektif dapat dilakukan intubasi
endotrakeal.
Pijat Jantung (penekanan dada)
1. Indikasi pijat jantung bila setelah 30 detik dilakukan VTP dengan
100% O2 , FJ tetap < 60 kali / menit
2. Diperlukan 2 orang : 1 orang yang melakukan pijat jantung dan 1
orang yang terus melanjutkan ventilasi.
Pelaksana kompresi : menilai dada & menempatkan posisi tangan
dengan benar
Pelaksana ventilasi : menempatkan sungkup wajah secara efektif &
memantau gerakan dada.
3. Penekanan dada dilakukan pada sepertiga bagian tengah sternum,
dibawah garis imajiner yang menghubungkan papilla mammae.
4. Teknik ibu jari :
1.Kedua ibu jari menekan tulang dada
2.Kedua tangan melingkari dada dan jari-jari tangan menopang bagian
belakang bayi
5. Teknik dua jari :
1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu tangan
digunakan untuk menekan tulang dada
2.Tangan yang lain digunakan untuk menopang bagian belakang bayi.
6. Lokasi untuk kompresi dada :
Gerakkan jari sepanjang tepi bawah iga sampai mendapatkan sifoid
Letakkan ibu jari atau jari-jari lain pada tulang dada, tepat diatas
sifoid dan pada garis yang menghubungkan kedua puting susu.
7. Tekanan saat kompresi dada :
Kedalaman + 1/3 diameter antero-posterior dada
Lama penekanan lebih singkat dari pada lama pelepasan
Jangan mengangkat ibu jari atau jari-jari tangan dari dada di antara
penekanan.
8. Frekuensi : satu-dua-tiga-pompa-...
Satu siklus kegiatan terdiri atas tiga kompresi + satu ventilasi.
Rasio 3 :1 1 siklus ( 2detik)
1 detik : 3 kompresi dada
detik : 1 ventilasi
90 kompresi + 30 ventilasi dalam 1 menit
9. Setelah 30 detik kompresi dada dan ventilasi , periksa frekuensi
jantung. Jika frekuensi jantung :
a. Lebih dari 60 kali/menit, hentikan kompresi dan lanjutkan
ventilasi dengan kecepatan 40-60 kali pompa/menit.
b. lebih dari 100 kali/menit, hentikan kompresi dada dan hentikan
ventilasi secara bertahap jika bayi bernapas spontan.
c. kurang dari 60 kali/menit, lakukan intubasi pada bayi jika belum
dilakukan, dan berikan epinefrin, lebih disukai dengan cara intravena.
Intubasi menyediakan cara yang lebih terpercaya untuk melanjutkan
ventilasi
 RESUSITASI BAYI DAN ANAK
Pengertian : Melakukan resusitasi bayi dan anak akibat gawat napas dan sirkulasi.
Tujuan pembelajaran : setelah pembelajaran ini mahasiswa diharapkan :
1. Mampu melakukan penilaian kegawatan napas dan sirkulasi
2. Mampu melakukan resusitasi bayi dan anak yang mengalami gangguan pernapasan yang
mengancam jiwa
3. Mampu membebaskan dan membersihkan jalan napas pada bayi dan anak.
4. Mampu memberikan napas bantu pada bayi dan anak yang tidak bisa bernapas/apnu.
5. Mampu melakukan pijatan jantung luar pada bayi dan anak yang mengalami henti
jantung.
Media dan alat pembelajaran:
1. Buku panduan peserta skill lab sistim emergensi dan traumatologi
2. Boneka manikin bayi dan anak.
3. Pipa orofaring ukuran bayi dan anak.
 4. Kateter penghisap
5. Masker resusitasi
6. Balon resusitasi tipe mengembang sendiri
7. Balon resusitasi tipe tidak mengembang sendiri
8. Pipa lambung (gastric tube)
9. Pipa endotrakeal no. 3.0 7,0
Indikasi
1. Dilakukan pada bayi dan anak yang mengalami sumbatan jalan napas
2. Dilakukan pada bayi dan anak yang tidak bernapas/apnu.
3. Dilakukan pada bayi dan anak yang mengalami henti jantung.

Metode Pembelajaran
Demonstrasi kompetensi sesuai dengan penuntun belajar

Deskripsi kegiatan resusitasi bayi dan anak.

Kegiatan Waktu Deskripsi
1. Pengantar 5 menit 1. Perkenalan, mengatur posisi duduk
mahasiswa
2. Penjelasan singkat tentang prosedur
kerja, peran masing-masing mahasiswa
dan alokasi waktu.
2. Demonstrasi singkat 10 menit 1. Seluruh mahasiswa melihat demonstrasi cara
resusitasi bayi dan anak oleh Instruktur pada
tentang cara resusitasi
model
bayi dan anak oleh 2. Diskusi singkat bila ada yang kurang
dimengerti.
instruktur.
3. Praktek cara resusitasi 10 menit 1. Satu orang mahasiswa mempraktekkan cara
resusitasi bayi dan anak. Mahasiswa lainnya
bayi dan anak.
menyimak dan mengoreksi bila ada yang kurang.
2. Instruktur memperhatikan dan memberikan
bimbingan bila mahasiswa kurang sempurna
melakukan praktek.
3. Instruktur berkeliling diantara mahasiswa
dan melakukan supervisi menggunakan
ceklis/daftar tilik.
4. Diskusi 10 menit 1. Diskusi tentang kesan mahasiswa terhadap
praktek cara resusitasi bayi dan anak: apa
yang dirasa mudah, apa yang sulit.
2. Mahasiswa memberikan saran atau koreksi
tentang jalannya praktek hari itu. Instruktur
mendengar dan memberikan jawaban.
3. Instruktur mejelaskan penilaian umum
tentang jalannya praktek resusitasi bayi dan anak :
apakah secara umum berjalan baik,
apakah ada sebagaian mahasiswa yang
masih kurang. Bila perlu mengumumkan
hasil masing-masing mahasiswa.
Total waktu 35 menit
 PENUNTUN BELAJAR
KETERAMPILAN RESUSITASI PADA BAYI DAN ANAK

Langkah-langkah/Kegiatan Keterangan
Persiapan awal
Periksa semua kelengkapan alat
RESUSITASI Instruktur menjelaskan dan

Pendekatan SAFE memperagakan bagaimana

menilai tanda-tanda adanya
Shout for help ( minta tolong)
gangguan sistem kardio
Approach with care (tangani dengan hati-hati)
vaskuler.
Free from danger (jauhkan dari bahaya)
Evaluate ABC (nilai jalan nafas, pernafasan, sirkulasi)

SAFE approach

Are you alright?

Airway opening manoeuver

Look, listen, feel

Up to 5 breaths

Check pulse

Start CPR
1 minute

Call emergency services

Tatacara meminta pertolongan:
1. Bila hanya 1 org penolong, lakukan bantuan hidup dasar
dulu, baru kemudian meminta bantuan
2. Bila penolong tidak dapat meminta pertolongan, teruskan
resusitasi sampai tiba penolong lain atau sampai kelelahan.
3. Bila ada 2 penolong, penolong pertama melakukan
resusitasi, penolong kedua mencari bantuan
4. Yang meminta bantuan menyebut lokasi, nomor telpon,
jenis kejadian, jumlah korban, pertolongan yg telah
diberikan dan informasi lain yg dibutuhkan.
Penilaian sistem kardiovaskuler
A. Airway = jalan nafas
 Dapat dipertahankan tanpa alat atau memerlukan alat
bantu jalan nafas
B. Breathing = Pernafasan
- Frekwensi
- Gerak nafas (retraksi, merintih, cuping hidung, otot bantu
nafas)
- Aliran udara pernafasan (pengembangan dada, suara nafas,
stridor, wheezing/mengi, gerakan paradoks)
Warna kulit (ada atau tidaknya sianosis)
C. Circulation = sirkulasi
- Frekwensi jantung, denyut sentral, denyut perifer
tekanan darah.
- Perfusi kulit (capillary refill time, suhu, warna kulit,
kulit berbercak (mottling)
- Perfusi SSP
- Reaksi Kesadaran (AVPU= Alert, Respon to Verbal,
Respon to Pain, Unresponsive) (mengenal org tua,
tonus otot, ukuran pupil, postur
(dekortikasi/deserebrasi)
Penilaian dilakukan tidak lebih dari 30 detik
JALAN NAFAS (AIRWAY)
1. Tentukan derajat kesadaran dan kesulitan nafas
a. Periksa tanda cedera kepala, leher, kesulitan pernafasan &
kesadaran. Bila ada cedera kepala jangan mengguncang
bayi atau anak karena dapat merusak medula spinalis.
b. Bila bayi dan anak tidak sadar tapi bernafas baik,
letakkan pada posisi pulih (recovery position)
c. Bayi dan anak sadar dengan kesulitan bernafas, letakkan
pada posisi senyaman mungkin yg memudahkan
bernafas.
2. Mintalah bantuan
3. Atur posisi korban
a. Letakkan dengan posisi terlentang diatas dasar yg rata
dan keras
b. Bila ada cedera kepala/leher pertahankan posis tubuh-
leher-kepala dalam satu garis. Hindari ekstensi, fleksi dan
rotasi kepala karena dapat mencederai medula spinalis.
c. Memindahkan ke tempat lain, posisi tubuh-leher-kepala,
 harus dalam satu garis kesatuan
4. Membuka jalan nafas
- Bila tidak ada cedera kepala dengan cara head tilt atau
chin lift
Head-tilt/chin lift
Cara melakukan:
1. Letakkan satu tangan pada dahi tekan perlahan ke posterior,
sehingga kemiringan kepala menjadi normal atau sedikit
ekstensi (hindari hiperekstensi karena dapat menyumbat
jalan napas).
2. Letakkan jari (bukan ibu jari) tangan yang lain pada tulang
rahang bawah tepat di ujung dagu dan dorong ke luar atas,
sambil mempertahankan cara 1.

- Bila tidak sadar dan ada cedera kepala dengan cara jaw
thrust
Cara melakukannya:
1. Posisi penolong di sisi atau di arah kepala
2. Letakkan 2-3 jari (tangan kiri dan kanan) pada masing-
masing sudut posterior bawah kemudian angkat dan dorong
keluar.
3. Bila posisi penolong diatas kepala. Kedua siku penolong
diletakkan pada lantai atau alas dimana korban diletakkan.
4. Bila upaya ini belum membuka jalan napas, kombinasi
dengan head tilt dan membuka mulut (metode gerak triple)
5. Untuk cedera kepala/ leher lakukan jaw thrust dengan
immobilisasi leher.
PERNAFASAN ( BREATHING)
1. Nilai usaha nafas dengan melihat gerak nafas, dengar desah
nafas, dan rasakan aliran udara pernafasan
2. Caranya
a. Pasang sungkup dengan ukuran sesuai umur sehingga
menutup mulut dan hidung, lalu rapatkan
b. Sambil mempertahankan posisi kepala (jalan nafas)
lakukan tiupan nafas buatan dengan mulut atau balon
(bag) resusitasi.
c. Bila dgn mulut, tarik nafas dalam, tiup dan liat
pengembangan dada. Bila tetap tdk mengambang
 kemungkinan obstruksi jalan nafas.
3. Frekuensi nafas buatan yg dilakukan:
- Bayi - < 8 thn : 20 kali permenit
- Neonatus : 30 60 kali permenit
SIRKULASI DARAH (Circulation)
Penilaian sirkulasi : setelah 2-5 kali nafas buatan
Tempat penilaian : bayi baru lahir : arteri umbilikus
bayi : arteri brakhialis
anak : arteri karotis
Indikasi pijat jantung : bradikardia ( <60x/m atau henti jantung )
Lokasi pemijatan : 1/2 bagian bawah tulang dada (sternum)
dengan kedalaman pijatan 1/3 tebal dada.
Cara :
- Bayi: pijatan dilakukan dengan teknik ibu jari atau dua jari
(telunjuk dan jari tengah)
Teknik ibu jari :
1.Kedua ibu jari menekan tulang dada
2.Kedua tangan melingkari dada dan jari-jari tangan
menopang bagian belakang bayi
Teknik dua jari :
1.Ujung jari tengah dan jari telunjuk atau jari manis dari satu
tangan digunakan untuk menekan tulang dada
2.Tangan yang lain digunakan untuk menopang bagian
belakang bayi.
- Anak < 8 tahun : dengan pangkal telapak tangan
- Anak > 8 tahun : pangkal telapak tangan terbuka dan dibantu
dengan tangan yang satu diatasnya.
Frekuensi pemijatan :
- Bayi dan anak : 100 kali permenit
- Neonatus : 120 kali permenit
Koordinasi antara pijat jantung dan nafas buatan:
- Neonatus : 3:1
- Anak : Dua penolong : 15 : 2
Satu penolong : 30 : 2
SUMBATAN JALAN NAFAS
Teknik ini digunakan pada
Teknik pukulan dan hentakan
penderita sumbatan jalan
Bayi dan anak kecil
napas akibat lidah yang jatuh
1. Letakkan bayi dengan posisi tertelungkup kepala lebih
ke belakang
rendah. Diatas lengan bawah, topang dagu dan leher dengan
lengan bawah dan lutut penolong.
2. Tangan lainnya melakukan pukulan punggung diantara
kedua tulang belikat secara hati-hati dan cepat sebanyak 5
kali pukulan.
3. Balikkan dan lakukan hentakan pada dada sebagaimana
melakukan pijat jantung luar sebanyak 5 kali.
4. Pada neonatus tidak boleh melakukan cara diatas, hanya
dilakukan dengan alat penghisap (suction)
Pada anak lebih besar :
1. Pukulan punggung dilakukan 5 kali dengan pangkal tangan
diatas tulang belakang diantara kedua tulang belikat. Jika
memungkinkan rendahkan kepala di bawah dada.
2. Hentakan perut (Heimlich maneuver dan abdominal thrust).
Cara: Penolong berdiri di belakang korban, lingkarkan
kedua lengan mengitari pinggang, peganglah satu sama lain
pergelangan atau kepalan tangan (penolong), letakkkan
kedua tangan (penolong) pada perut antara pusat dan
prosessus sifoideus, tekanlah ke arah abdomen atas dengan
hentakan cepat 3-5 kali. Hentakan perut tidak boleh
dilakukan pada neonatus dan bayi.
 Resume Resusitasi Anak
Maneuver Dewasa dan Anak kecil Bayi Neonatus CPR/Resc
anak besar Breathing
> 8 tahun 1-8 tahun < 1 tahun Bayi baru lahir
Airway Head tilt-chin Head tilt-chin Head tilt-chin Head tilt-chin Check responnya
lift (jika trauma lift (jika trauma lift (jika trauma lift (jika trauma Buka jalan nafas
jaw thrust) jaw thrust) jaw thrust) jaw thrust)
Breathing 2-5 nafas kira- 2-5 nafas kira- 2-5 nafas kira- 2-5 nafas kira-
kira 1 detik kira 1 detik kira 1 detik kira 1 detik Cek napas, jika
tiap nafas tiap nafas tiap nafas tiap nafas korban bernafas:
recovery position.
Jumlah nafas 12 kali/min 20 kali/min 20 kali/min 3060 kali/min Jika tidak ada
pengembangan
Obstruksi benda Abdominal Abdominal Back blows atau Suction (jangan dada : reposisi dan
asing thrusts atau thrusts atau chest thrust abdominal ulangi sampai 5
back blows back blows atau (jangan thrust atau kali
chest thrust abdominal back blows)
thrust)
Cek nadi Carotis Carotis Brachial Umbilical Nilai tanda
kehidupan, jika
Titik kompressi 1/2 bgn bawah 1/2 bgn bawah 1 jari dibawah 1 jari dibawah ada nadi tp napas
sternum sternum garis inter- garis inter- tidak ada: lakukan
mammary mammary tindakan bantu
napas, jika nadi <
Metode Pangkal telapak 1 pangkal 2 atau 3 jari 2 jari atau 50x/mnt dan
Kompressi tangan dan tgn telapak tangan teknik ibu jari perfusi jelek :
satu diatasnya kompresssi dada

Kedalaman 1/3 tebal dada 1/3 tebal dada 1/3 tebal dada 1/3 tebal dada
kompressi

Frekuensi 100/min 100/min 100/min 120/min

kompressi

Rasio Kompressi 15 : 2 (2rescuer) 15 : 2 (2rescuer) 15 : 2 (2rescuer) 3:1

ventilation 30:2 ( 1 rescuer) 30:2 ( 1 rescuer) 30:2 ( 1 rescuer)
 HEAD AND NECK TRAUMA
Examination and Management

Definition : To do first aid and secondary survey on patients with head and neck trauma

Aim :
After this study, each student are expected to :
1.1 Remove patients helmet in head and neck trauma cases, in a safe way and know how to
place a servical collar
1.2 Do physical examination on head and neckMenghitung Glasgow Coma Scale (GCS)
1.3. Identify normal head scan
1.1 Manage primary survey in a brief time
1.2 Count and estimate the GCS on the patient
1.3 Do secondary survey
1.4 Identify epidural hematoma on CT scan

1.1 Estimate and count the derivation of GCS

1.2 Manage severe head trauma
1.3 Demonstrate secondary survey on head and neck
1.4 Identify the possibility to consult to a neurosurgeon

Learning media and tools :

1. Skill guide books of emergency and traumatology system
2. Mr. Hurt manequin doll
3. Helmet
4. Cervical collar
5. Print out, of normal head scan, epidural, subdural dan contusion and intracranial
hematoma

Learning method:
Scenario by instructor, demonstrated by students

Activity Time Description

1. Introduction 5 minute 1. Scenario
2. Brief explanation about the scenario,
students role and time allocation

2. Remove helme dan put 10 minute 1. One student stands as the patient,
on the collar others as rescuers
2. Estimate GCS
3. Managemet of severe 5 minute 1. Estimate GCS
head trauma 2. Identify signs of high intracranial
pressure
4. Management of head 10 minute 1. Re-do primary survey
trauma that seems 2. Estimate GCS
worsening Differentiate the management
between severe head trauma and
worsening head trama
5. Mr. Hurt: 10 minute 1. Do secondary survey head and neck
6. CT scan 5 minute 1. Explanation about CT scan
 GLASGOW COMA SCALE
Variabel Nilai
Eye (E) response Spontaneous 4
To voices 3
To pain 2
None 1
Motoric (M) response Do as told 6
Localize the pain 5
Normal flexion (pull away from pain ) 4
Abnormal flexion (decortification) 3
Abnormal extension 2
None 1
Verbal (V) response Oriented 5
Confused speaking 4
Unarranged words 3
Unclear voice 2
None 1
Count GCS = (M + M + V ), Best score = 15, worse score = 3

LEARNING GUIDE
HEAD AND NECK TRAUMA

STEPS / Activities Description

Early preparation
Check for all tools
I. PRIMARY SURVEY
A. ABCDE
B. Immobilization and stabilized cervical
C. Brief neurological examination
1. Pupil light reflex
2. AVPU or GCS score

II. Secondary survey and Management

A. Inspect the head carefully, include face
1. Lacertion
2. Any CSS liquid from nose and ear
B. Palpate head thoroughly, include the face
1. Fractures
2. Lacerations and fractures
C. Inspeect all laserations on head skin
1. Brain tissure
2. Skull depressed fracture
3. Dirt / corpus alienum
4. CSS leakage
D. Minineurologis examination and scoring GCS
1. Eye response
2. Motoric response
3. Verbal response
4. Pupil light reflex
E. Cervical vertebrae examination
1. Palpate any pain and place on the semirigid collar if necessary
2. Examine cervical vertebrae X-rays on lateral projection if
necessary
 F. Judge the width of wound
Re-examine continously and observe any deteriorate signs :
1. Frequency
2. Parameters
3. Re-do ABCD

III. HOW TO REMOVE HELMET

Patient who use helmet and needs breathing aid management has to be
sured that its head and neck are in neutral positions.2 helpers are needed to
remove helmet.
One student lie down as the patient with the helmet on. Other students act
as helpers doing as follows :
1. One person stabilize the head and necks patient, with putting his hand
on the helmet, its fingers on the patinets mandibula while examining
and make sure that the airway is still open. This position prevent the
helmet to slip away
2. Second helper cuts the helmets belt on release it from the D-ring
3. Second helper stands on the right or the left side of patient with one
hand on the mandibule angulus, mother finger in one side and other
fingers on the other side. While the other hand makes a pressure under
the head on occipital regio. This way 2 helpers are immobilizing the
head and neck
4. First helper push the helmet to the lateral side to release both ears from
helmet and then remove the helmet slowy. If helmet has face mask,
this mask should be removed first. If the helmet has a very complete
mask, the nose could be wedged in and complicate the helmet removal.
To set free the nose, helmetshould be hold back and upward across the
nose
5. As this happens, second helper should maintain imobilizing position to
prevent the patients neck from moving
6. After the helmet is removed, straight immobilization mannual starts
from top, head and neck are saved from moving during the procedure
7. If by removing the helmet causes pain and parestesia, then it should be
removed by gips scissors.If there is any signs of cervical trauma on
Xrays, helmet should be removed by gips scissors. During the
procedure, head and neck are maintained immobilized and stabilized,
while the helmet is cut from the coronal passing through both ears.
External layer of the helmet can be easily remove, the internal layer
which made of spyrofoam can be cutted and removed from front. Head
and neck in neutral position
8. After the removal, immeadiately place the cervical collar followed by
primary surveySetelah helm dapat dilepaskan segera pasang cervical
collar.

STABILISATION AND TRANSPORTATION

Definition : 1. Prepare safe transportation for patients
2. Give first aid and secondary survey on patients with medulla spinalis
trauma
Aim:
Students are expected to :
1. Demonstrate the techniques of examination to check patients with medulla spinalis trauma
2. Discuss the principals of immobilization and log roll on patients with neck trauma/medulla
spinalis trauma and indications to remove protections aid.
3. Do neurological examination and estimate the level of trauma
4. Decide whether transferring to other hospital is needed and how to immobilize patient
correctly when transfering.
5. Limitize patients risk to worsen with doing the right mobilizaiton
6. Prepare safe transportation for the patient
Learning media and tools :
1. Skill guide book of emergency and traumatology system
2. Video and slide
3. Patient models (students may role as patient)
4. Semirigid cervical collar
5. Desk or stretcher or bed.
6. Folded towel to support .
7. Blanket
8. Bandage
9. Scoop stretcher
10. Long spine board.
11. Vacuum mattress
12. KED (Kendrick Extrication Device)

Learning method :
Scenario by the instructor, demonstrated by students

Activity description :
Activity Time Description
1. Introduction 5 minue 1. Tools introduction
2. Primary and secondary survey
scenario judgement
2. Scenario I 10 minute 1. Give help on spot using long spine
board and cervical collar only
2. Log Roll
3. Scenario II 10 minute 1. Help patient on spot, using
cervical collar, scoop stretcher,
and long spine board
4. Scenario III 10 minute 1. Evacuate patient using vacuum
matras
5. Scenario IV 10 mintue 1. Extrict patient with KED

LEARNING GUIDE
STABILIZATION AND TRANSPORTATION SKILLS

STEPS/Activity Descriptin
Preparation
Check list all tools
I. PRIMARY SURVEY RESUSCITATION SPINAL CHORD
TRAUMA JUDGEMENT
II. Airway
Judge the airway while positioning the cervical spine. Open and clean up
the airway, do the jaw thrust, place oropharynx tube, and do intubation if
necessary
A. Breathing
Judge and give adequate oxygen, and ventilation if necessary
B. Circulation
a. Judge the circulation by checking pulsations, blood pressure
and perifer perfusion. If hypotension occurs, it has to be
differiated by hypovolemic shock ( decreased blood
pressure, increased heart rate and cold extremities)
C. Solution to correct hypovolemia
 D. Disability- brief neuorological examination
a. Judge the conciousness and pupil.
b. Decide whether to use AVPU or GCS to judge patients
conciousness
c. Identify paralysis or paresis
d.
II. SECONDARY SURVEY NEUROLOGICAL
JUDGEMENT
A. AMPLE History Taking
1. History and mechanism of trauma
2. Medical record
B. Identify and write down any medication given to the patient
before, during, and after treatment
C. Re-examine conciousness and
D. Re-examine GCS score
E. Examine spinal chord
1. Palpation
Palpate the whole posterior spinal chord by doing log roll
carefully
Examine ::
a. Any deformities/ swelling
b. Crepity
c. Increasing pain when palpated
d. Contusion and laceration.
2. Pain, paralyze and paresthesia
a. Yes/No
b. Location
c. Neurological level

3. Sensation
Pinprick tes to estimate sensation, is performed in all dermatoms
and write down the most caudal dermatom which gives
sensation
4. Motoric Sensation

III. PRINCIPALS IN IMMOBILIZING THE SPINAL CHORD AND

LOG ROLL
A. Log roll:
1. One person hold the head and neck to maintain the
immobilization in one line.
2. One person stand by on the side to hold the patients body (
pelvis and hips )
3. Another person hold the pelvis and limb. With the command
from the person on the head, move the patient in an angle
position carefully
4. The 4th person check on the spine chord and place the long
spine board
B. Placing the ong spine board
1. Maintain the head and neck in one line when the second person holds
the patient on its shoulders and wrists. Third person holds the patient;s
hand ad hips with one hand, the other hand holds the bandage that
cords patients ankles pergelangan kaki.
2. With the commandments from the rescuers whose holding the patients
head and neck, perfrorm log roll as a unit towards the other
persons/rescuer whose beside the patient. It only needs a minimal
rotation to place the spine board underneath the patient. Maintain the
 one line principal of the head and neck in this procedure
3. Spine board is placed underneath the patient, afterwards perform log
roll towards the spine board.
4. Long spine board with its rope/band is inserted to the thoracal regio,
above crista iliaca, thighs and ankles. Band or bandage is used to fixate
the head and neck to attach to the spine board
5. Perform inline immobilisation of the head and neck manualy, then
place the semirigid collar
6. Straighten the arms and place it beside the patients body
7. Straighten the limbs carefully and place it in one line with the spine
chord.Both ankles are tied together with a bandage
8. Place a pillow/support under the patients neck to avoid any
overextended movements and to comfort the patient
9. Pillow, blanket or any other supports is place on the right and left side
of the patients neck, while the head is tied, attached to the long board
10. Place a bandage above the cervical collar to guarantee there is no
movement of the head and neck.
C. Scoop Stretcher
1. Prepare scoop stretcher
2. Open the lock to divide in two
3. Arrange the scoop to match patients height
4. Place scoop under the patient
5.Scoop stretcher is not for immobilizing the patient.
6.Scoop stretcher not a transport device, do not lift scoop on the edges
because it could fold on the middle and will lose the straightnes of the
vertebrae

Splint/spalk Installation ( Immobilization of the extremities ) and

Musculoskeletal Management.
Definition : To give first aid to musculoskeletal trauma patients

Aim of study : After this study, students are expected to be able :

1. To do quick examination on patients with musculoskeletal trauma

2. To recognise life and limb threatening problems in musculoskeletal trauma
3. To install a spalk/splint correctly.

Learning media and tools :

1. Skill guide book
2. Living models ( students can role as patients )
3. Leg traction splint
4. Air splint
5. Spalk
6. Gloves

Learning method :
Scenario by the instructor, demonstrated by students
 LEARNING GUIDE
MUSKULOSKELETAL SKILL

EXTREMITIES IMMOBILISATION PRINCIPLES

Check the ABCDE and treat conditions which are life threatening first.
1. Loose all clothes thoroughly, including on the extremities
2. Loose watches, rings, necklace and all things that might clamp
3. Check neurovasculars before setting the spalk/splint. Check external bleeding
pulsation that has to be stopped, and check also the sensoric and motoric function of
the extremities.
4. If there are wounds, close it with sterilized bandage
5. Choose kinds and sizes of spalk that matches the traumatized extremities
6. The spalk setting should also cover joints below and above the traumatized
extremities.
7. Place a pillow bag above the bone protrusion
8. Support the extremities with spalk/splint in a position where there is a distal
pulsation. If there is not any distal pulsation, try to straighten the extremitis. Make a
traction carefully and maintain it until splint is settled.
9. Splint/spalks are settled onto extremities that are straight, if not, try to straighten it.

MASS DISASTER MANAGEMENT

Definition : To carry out triage principles in whenever patients outnumbered rescuers

Aim of study : After this study, students are expected to :

1. Define triage
2. Understood and able to explain principles and factors that effects and includes
in the proses of triage

Learning media and tools :

1. Slides of guidlines to do triage scenario
2. Triage scenario booklet

Learning methods :
Roles play
Activity description :
Activity
1. Introduction
2. Role play (1)
Time Description
10 minutes 1. Triage scenario slide presentation
2. Brief explanation about the scenario,
students roles and time allocation
10 minutes 1. All students have put priorities on which
patients they will handle
2. Each student give their suggestions on why
they put their priorities on specific patients

Role play (2) 10 minutes 1. All students have put priorities on which
Fire followed by patient they will handle
explosion in settlements 2. Each student give their suggestions on why
they put their priorities on specific patients

Role play (3) 10 minutes 3. All students have put priorities on which
Car crash patient they will handle
1. Each student give their suggestions on why
they put their priorities on specific patients

Role play (4) 10 minutes 1. All students have to determine which criteria
A football stadium is used to identify patients and what
collapsed priorities should be done
2. All students propose the clues and signs that
were given by the patient which could help
in the triage procces
3. All students propose what can be done
before and after the paramedics and
ambulance arrives.
4. All students should propose which victims
has to go first to the hospital and which type
of hospital should the victim goes to.