Initial Management and Evaluation of Severely Injured Patients

“Prioritas utama dalam penanganan korban kritis di lapangan termasuk mempertahankan jalan nafas/airway, adequate ventilation, dan monitor perdarahan luar/ external bleeding”

Sebelum korban di bawa ke rumah sakit, trauma team di emergency departement terdekat/ tempat patient di tranfer harus di beritahu terlebih dahulu terutama mengenai seberapa kritis kondisi korban. Sehingga ED dapat mempersiapkan segala sesuatunya sebagai contoh peralatan ventilator pada intubated patient atau blood pada korban perdarahan. Atau bahkan bantuan petugas kesehatan jika korban dalam jumlah banyak.

Pasien yang gelisah, tidak kooperative dan not responding terhadap pemberian oxygen dapat di assumsikan bahwa pasien mengalami hypoxic sampai ada bukti hasil lab. Sehingga pasien membutuhkan endotracheal intubation untuk memberikan ventilasi yang adequate and menangani hypoxia.

Hal-hal yang di perlu di perhatikan pada penanganan pasien kritis :

• Pneumatic Antishock Garment (PASGs) ; Meskipun PASGs dapat membantu dalam immobilisasi fracture pada pelvic dan extremitas bawah dan juga dapat mengurangi kehilangan darah pada bleeding, peralatan ini tidak terlalu memberikan pengaruh pada pasien hypotensive. Perlu di ingat bahwa pemakaian peralatan ini juga dapat mungkin menyebabkan compartement syndromes terutama jika menggunakan tekanan yang tinggi dalam jangka waktu yg lama.
• Prehospital Intravenous Lines ; Pemberian dini intravenous fluids at the scene is counterproductive jika transit time to the hospital kurang dari 15 menit. Sesungguhnya, kelebihan cairan dapat menyebabkan kemungkinan perdarahan kembali pada luka yang sudah berhenti sementara.
• Establishing Intravenous Lines ; Jika pasien mengalami syock hypovolemik hebat yang menyebabkan vena collapse, atau ada riwayat penggunaan intravenous narcotic sebelumnya, mungkin akan sangat sulit mendapatkan vein access di peripheral. Sehingga pasien spt itu memerlukan subclavian veins untuk mendapatkan IV access yg tercepat. Percutaneous catheterization of internal jugular vein juga sangat bagus buat IV access terutama pada pasien yang indikasi memerlukan tindakan operative. Untuk perkiraan Pasien yang mengalami luka pada leher and dada atas membutuhkan minimal 1 venous access di lower extremitas, dan jika luka di perut di butuhkan 1 atau lebih IV lines terutama yang terdekat dengan vena cava superior.
• Cardiopulmonary Resuscitation ; Open thoracotomy mungkin dapat di pertimbangkan di emergency resuscitation room pada pasien yang mengalami luka tusuk di dada dan mengalami cardiac arrest ketika baru datang di ED. Walaupun demikian open cardiac massage di ED jarang berhasil pada pasien dengan cardiac arrest yang disebabkan oleh luka tembak/ gunshot wound, penetrating intra abdominal injuries, atau pada trauma tumpul yang hebat pada kepala or trunk.
• Control of External Bleeding ; Tourniquets jarang di gunakan tetapi jika diperlukan, pressure shoud be applied over the most proximal portion of the extrimity wound and cuff pressure should be well above the systolic pressure. karena jika pressure is slightly dibawah the systolic pressure, darah artery akan masih dapat mengalir ke extemitas sehingga menyebabkan increased venous bleeding.

Ref; Handbook of Trauma by Robert F. Wilson, 1999 Philadelphia

(artikel di link dari http://emergencyku.blogspot.com)

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bagus nih artikelnya

sharing pendapat yahh, sekarang ditempat kerja saya (afghanistan) sebagai alternatif pemasangan infus intravena kami lebih prefer ke Intraosseus dengan alat FAST. silahkan di googling aja pake keyword “FAST, intraosseus”. banyak koq artikel dan panduannya (salah satunya website dari australia juga). klo di kemasannya sih di refer ke www.pyng.com.

saya pernah ditraining sekali dan ternyata pemasangannya mudah dan simple. hanya perlu sedikit ‘nyali’ aja,hehehe.

ada bacaan tentang PASG juga,

SPECIAL NOTES:

1. May only be performed by Basic, Basic-IV, Intermediate 99 or Paramedic/RN personnel.

2. Head injury is not a contraindication.

3. The PASG should no longer be used for lower extremity long bone splinting. These injuries should be splinted using standard splinting devices or traction splints, when appropriate.

4. The PASG should no longer be used as an air splint for an unstable pelvis. A longboard and padding should be used instead.

punya pengalaman dengan PASG ini? silahkan di share disini

salam,

www.diskusiperawat.co.cc

Nursing As A Profession

Posted in February 27th, 2008

by fefendi

Nursing is a highly regarded profession with high standards of honesty and ethics amongst various other professions. Nursing has emerged as the largest health care occupation with over 2.7 million jobs. With over 100,000 vacant positions and a ever-growing need for health care workers, the career outlook is excellent for the nursing field. National Center for Workforce Analysis, an agency of the U.S. Department of Health and Human Services predicts a shortage of 808,416 nurses by the year 2020. Such an analysis and prediction is backed by very strong reasoning and findings. Advancement in technology and medical field has resulted in an increased life span. Elderly population is now living longer and more of them will require care and nursing. With more elderly people in need of such care, demands rise for nursing force that can meet such needs. Also, the need for more skilled nurses is growing. With insurance companies stepping into the medical field to reduce the cost of health care expenditure, demand for nurses, outside the hospital setting has also risen. Not to forget that the current nursing workforce is aging and many are expected to retire over next 10-15 years only to create a void, adding to the shortage further. So, nurses with a BSN degree can expect a securer career and better job prospects.

Nurses blend knowledge of science and technology with the art of care and compassion. Nursing provides opportunity to save and improve lives, care for the sick and debilitated, educate patients and people towards achieving good health and above all, the feeling of helping someone in their hour of illness and need. There is no greater service than caring for the sick and needy. Nurses are required to deliver basic duties, which includes but is not limited to providing treatment, health education, emotional support, record maintenance, operating medical equipment in addition to counseling patient and their family about the management of their illness. Registered Nurses (RNs) also run general health screening and immunization clinics, organize public seminars, motivate blood donation drives, etc. Three out of five nurses in the United States work in hospitals. Most of the others work in clinics, home health, extended care settings, schools, colleges, universities, the public health services, and nonprofit agencies throughout the United States and many other countries. Nursing can be a challenging job with continuous exposure to grief and suffering, stress, work pressures, little or excessive patient contact and occupational hazards including but not limited to infectious diseases, radiation exposure, accidental needle sticks, chemicals, anesthesia, back injury and emotional stress. Role autonomy and independence, innovativeness, technical knowledge, and teamwork are characteristics of this job, in addition to personal satisfaction and professional rewards.

The nursing schools are a gateway to this profession and almost all of them require a high school diploma in addition to sound academic standing in English, Algebra, Biology, Chemistry, and Psychology with a GPA score of atleast 3. Computer experience is an asset. Leadership and organization skills are vital to this profession. Most schools shall still require you to clear the National League for Nursing (NLN) Pre-admission exam besides the SAT exam. Over 1,500 nursing programs in the US provide three different educational paths towards becoming a Registered Nurse (RN). Bachelor of Science in Nursing (BSN) is a four-year program offered at colleges and universities. An associate Degree in Nursing (ADN) is a two-year program offered at many community and junior colleges. Some hospital schools of nursing and universities offer an ADN degrees. Hospital Diploma is a two to three year program based in hospital settings. Many diploma schools are affiliated with junior colleges where students take basic science and English requirements. Opportunities are maximum with a BSN degree. BSN is a requirement for obtaining a master’s degree or becoming an Advanced Practice Nurse (APN). The American Association of Colleges of Nursing (AACN) recognizes the BSN degree as the minimum educational requirement for a professional nursing practice. Even though graduates can begin practice as an RN with an ADN or diploma, the BSN degree is a must for nurses seeking to assume roles as case-managers or supervisors or move across employment settings. Tuition fee depends on your college and state of residence, but financial aids and scholarships are available to take care of such needs. There are technical and vocational schools as well, which provide one-year course towards becoming a Practical Nurse or a Vocational Nurse. Once graduated, the next important thing is to obtain licensure for practice in the State of your preference. Eighteen states participate in the Nurse Licensure Compact Agreement (NCLA) which permits a licensed nurse to practice in any of the other seventeen states, if they have obtained license to practice in one of the states. License can be obtained by passing national licensing exam NCLEX-RN for becoming a Registered Nurse and NCLEX-PN for becoming Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) as in Texas, California. LPN and LCN provide care for sick, injured and disabled under direct supervision of physicians and RNs.

Nursing career is full of opportunities for those who want to specialize and pursue higher education. A few popular specialties are AIDS Care Nurse, Ambulatory Care Nurse, Cardiac Rehabilitation Nurse, Case Management, Correctional Nurse, Enterostomal Therapy Nurse, Gastroenterology/Endoscopy Nurse, Genetics Nurse, Infection Control Nurse, Intravenous Therapy Nurse, long-term Care Nurse, Managed Care Nurse, Nephrology Nurse and more, the list does not end here. Most of the specialties do welcome RNs with a BSN degree only. In addition, there is increasing demand for APNs. APNs are primary health care practitioners, working independently or in collaboration with physicians. In most states, they are permitted to prescribe medications. The four specializations for APNs include Clinical Nurse Specialist (CNS) providing expert consultation in any of the above mentioned specialties; Nurse Anesthetists (CRNA) administer anesthesia and monitor patient’s vital signs during surgery in addition to providing post-anesthesia care; Nurse Midwives (CNM) provide primary care to females covering aspects like family planning, prenatal care, neonatal care and assist delivery; and Nurse Practitioners (NP) who provide basic preventive health care to patient. NPs are primary as well as specialty care providers in medically underserved areas. APNs are lower cost primary care providers in comparison to physicians.

Advanced degrees available to nurses are masters (MSN), doctoral degree (Ph.D., EdD, DNS) and post-doctoral programmes. Doctoral degrees can provide placements as a senior policy analyst, researcher, health system executive and as a nursing school dean.

RNs may work as a staff nurse or become APNs. Also exisins are a few positions involving little or no direct patient contact. Such positions include Case Managers, Forensic Managers (applying knowledge of nursing for legal enforcement, like treating and investigating a victim of assault or abuse and similar), Infection Control Nurses, Legal Nurse Consultants (assist lawyers in medical cases by interviewing patient, organizing records, and educating lawyers about medical conditions), Nurse Administrators, Nurse Informatics, Health Care Consultants, Public Policy Advisors, Medical editors and writers.

Career and job prospects are bright as mentioned above and with increasing demand and difficulty to hold up nurses in hospitals, many hospitals and corporate sectors have now started offering incentives like signing bonuses, subsidized training, open shift bidding. Open shift bidding is an emerging concept where nurses can find vacant shifts at premium wages and bid for same online. This also reduces mandatory overtime that many nurses have to do otherwise. Many employers now provide family friendly work schedules and flexibility, again an indication of demand in such places.

RNs are earning anywhere from $37,300 to greater than $74,760 depending upon qualifications and experience, besides job locations. Median salary can be appreciated as $52,330 annually. Entry level RN can earn from $30,000 to $45,000 annually. All this comes with benefit packages including health insurance, holiday pay, college tuition reimbursement, childcare, pension plans and much more. Expected shortage of nurses over coming years is going to tilt the situation more in the favor of nurses and they can look forward to a securer future with brighter prospects and rewards.

Becoming a nurse is not just about money but dedicating your life to service mankind, caring for the sick and to be able to support them and their family in difficult times. The potential is enormous and specialization options aplenty. Nursing as a profession is full of personal satisfaction and professional rewards.

By: dave4

(the article was copied from http://indonesiannursing.com)

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artikel yang menantang. diawali dengan latar belakang permintaan masyarakat akan tenaga perawat hingga standard untuk dapat memenuhi kebutuhan tersebut.

perawat Indonesia diharapkan dapat bersaing dengan perawat2 dari luar negeri. dengan meningkatkan mutu perawat maka tentu tujuan diatas dapat tercapai.

percuma bila kita berkoar2 akan pentingnya tenaga perawat bila ternyata produk yang dihasilkan hanya cocok untuk ukuran ‘lokal’. pemerintah sudah tanggap dengan hal ini, mencoba memulai dengan Standarisasi profesi keperawatan. tapi ingat, dari perawat itu sendiri harus ada kemauan untuk maju.

ditambah dengan ketrampilan berkomunikasi (bahasa inggris, perancis, arab, mandarin, etc), maka dunia hanya ada di depan mata kita.

salam,

www.diskusiperawat.co.cc

Trauma Code

Arriving at The ER

“Trauma code, ETA 5 minutes.” My pulse always goes up a little bit with these radio notifications, but in this particular case it went up more than usual. The paramedic said it was a train versus pedestrian, no other information given. I could hear the siren in the background and a definite anxiousness in the paramedics voice. He didn’t have time to give us vital signs–not good.

I walked to the ambulance bay, opened the doors, and waited. The ambulance came in fast, the driver wasting no time backing up and throwing the back doors open.

“She had a pulse, and a blood pressure, I’ve got an IV started, but no airway, she was talking to us a few minutes ago,” the paramedic fired off.

We all helped pull the gurney into the resuscitation room, and I took a look. She was about 30, laying flat on her back, eyes closed, clearly not conscious. I couldn’t see any sign of trauma on her head, chest, abdomen or extremities, but there was quite a bit of blood coming from somewhere. It was pooling on the gurney.

I quickly put a plastic tube down her windpipe as the nurses tried to get vital signs, and started CPR. Her blood pressure was completely gone, no pulses at all. She had died. We rolled her on her side to examine her back, and found the problem. The back of her hips, pelvis and lower back were simply gone, somehow torn away from her body when she was hit by the train. What remained of her blood volume poured out of the wound, and onto the gurney and floor.

Later, we found out from a roomate that it was probably suicide, and that she had been fighting depression. She had stopped taking her medication. No one came to the hospital. No family, no friends.

I picked up the next patient’s chart and moved on. It was a 20 year old man with an ingrown toenail. He let me know he was very irritated to have been waiting for me.

(Sumber : http://www.yourerdoc.com/trauma-code)

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Temans, pernah punya pengalaman seperti ini?

Yahh, paling tidak kita bisa ambil pelajaran mengenai pentingnya melakukan secondary survey, mengecek bagian punggung pasien (atau bagian yang tidak kita exposed pada primary survey)