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    Airways Dan Breathing Manajemen: by Yeniyulianti, S.Kep, NS, M.Kep

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    Mochadriyan
    This document discusses airway and breathing management. It covers anatomy and physiology of the airway and breathing, signs of airway and breathing problems in emergencies, techniques for maintaining the airway and providing oxygen support. It describes various types of breathing, airway techniques like head-tilt chin-lift, oral and nasal airways. Definitive airways like endotracheal intubation and criocothyrotomy are explained. Thoracic injuries affecting breathing like pneumothorax, flail chest and massive hemothorax are outlined along with their management. Oxygen administration and assisted ventilation techniques are also summarized.

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    Airways Dan Breathing Manajemen: by Yeniyulianti, S.Kep, NS, M.Kep

    Uploaded by

    Mochadriyan
    28 views51 pages
    This document discusses airway and breathing management. It covers anatomy and physiology of the airway and breathing, signs of airway and breathing problems in emergencies, techniques for maintaining the airway and providing oxygen support. It describes various types of breathing, airway techniques like head-tilt chin-lift, oral and nasal airways. Definitive airways like endotracheal intubation and criocothyrotomy are explained. Thoracic injuries affecting breathing like pneumothorax, flail chest and massive hemothorax are outlined along with their management. Oxygen administration and assisted ventilation techniques are also summarized.

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    This document discusses airway and breathing management. It covers anatomy and physiology of the airway and breathing, signs of airway and breathing problems in emergencies, techniques for maintaining the airway and providing oxygen support. It describes various types of breathing, airway techniques like head-tilt chin-lift, oral and nasal airways. Definitive airways like endotracheal intubation and criocothyrotomy are explained. Thoracic injuries affecting breathing like pneumothorax, flail chest and massive hemothorax are outlined along with their management. Oxygen administration and assisted ventilation techniques are also summarized.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views51 pages

    Airways Dan Breathing Manajemen: by Yeniyulianti, S.Kep, NS, M.Kep

    Uploaded by

    Mochadriyan
    This document discusses airway and breathing management. It covers anatomy and physiology of the airway and breathing, signs of airway and breathing problems in emergencies, techniques for maintaining the airway and providing oxygen support. It describes various types of breathing, airway techniques like head-tilt chin-lift, oral and nasal airways. Definitive airways like endotracheal intubation and criocothyrotomy are explained. Thoracic injuries affecting breathing like pneumothorax, flail chest and massive hemothorax are outlined along with their management. Oxygen administration and assisted ventilation techniques are also summarized.

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    AIRWAYS DAN BREATHING

    MANAJEMEN

    By YeniYulianti, S.Kep, Ns, M.Kep


    Tujuan :
    1. Dapat Menjelaskan Anatomi dan fisiologi
    Airway & Breathing
    2. Dapat Mengenali Tanda- tanda Gangguan
    Airway & Breathing pada Penderita
    Gawat Darurat
    3. Dapat melakukan tehnik-tehnik menjaga
    jalan napas dan memberi bantuan
    pernapasan
    4. Dapat memberikan oksigen pada
    penderita gawat darurat
    Jenis pernafasan

    Reguler * otot interkostal


    * diafragma
    Pernafasan

    Auksiler * otot tambahan


    (tambahan)
    Airway
    Pasien dicurigai fraktur servikal :

     Multi trauma
     Trauma kapitis + penurunan kesadaran
     Jejas dari klavikula ke arah kranial
     Biomekanika trauma mendukung

    Bila ada trauma selalu IMOBILISASI LEHER


    AIRWAY
    Masih dapat berbicara  baik
    Look – Listen – Feel

    Akut
    Berat
    / total
    insidious
    obstruksi
    Ringan
    / sebagian
    Obstruksi berat / total
    Nafas (-)

    Gambar : tersedak

    - Sadar :
    benda asing 
     Manuever heimlich
     Chest thrusts
    Obstruksi ringan / Partial

    Pernafasan yang berbunyi


    adalah
    pernafasan yang tersumbat
    parsial
    Obstruksi ringan /partial
    - Cairan gurgling suction
    (cairan)

    - Lidah snoring manual /


    (mengorok) airway
    sementara

    - Larinks/trachea crowing airway


    definitif
    (penyempitan) (stridor)
    Teknik Membuka Jalan Nafas

    Head-tilt Jaw thrust


    Chin lift
    1.Oropharyngeal Airway
     Size is measured from the corner of the
    mouth to the angle of the jaw
     Sizes range from 0-6
     It holds the tongue away from the
    posterior pharynx, but does not isolate
    the trachea
    Oral Airway continued
     The oral airway is
    inserted with the
    curve towards the
    side of the mouth
     Then rotated so that
    the curve of the
    airway matches the
    curve of the tongue
    2.Nasopharyngeal Airway
     Soft plastic or rubber tube that is designed to pass
    just inferior to the base of the tongue
     Passed through one of the nares and can be used in
    patients with an intact gag reflex
     CONTRAINDICATED in cases of suspected or
    possible basilar skull fracture
     Sizes range from 17-26 cm in length and 6-9 mm
    internal diameter
     Measured from tip of the nose to the corner of the
    patients ear
    Nasal Airway continued
     The nasal airway is
    lubricated with a water
    soluble lubricant
     The beveled tip is inserted
    directed towards the
    septum, with the airway
    directed perpendicular to
    the face
     If resistance is met, rotating
    the airway may help or the
    other nare may be used
    3.Laryngeal Mask Airway
     Sits over the glottic
    opening
     Available in different
    sizes
     Has a drain tube to aid
    in gastric suctioning
     With some versions an
    endotracheal tube may
    be passed through to
    aid in intubation
    LMA Positioning
    Airway Definitif :
    Memasukkan pipa (Tube) dalam trakea
    (dengan Cuff yang dikembangkan)

    Indikasi :
    1. Proteksi Airway (A)  Ancaman
    obstruksi
     Ancaman
    aspirasi

    2. Perlu ventilasi (B)


    PERLINDUNGAN DIRI SAAT INTUBASI
    PASIEN DICURIGAI COVID 19
     Pada prosedur intubasi pasien yang dicurigai atau
    sudah terkonfirmasi COVID-19, APD yang
    dikenakan oleh airway operator, airway assistant,
    dan team leader minimal meliputi :
    1. gaun lengan panjang atau coverall anti air sekali
    pakai
    2. topi operasi
    3. respirator facepiece class 3 (FFP3)/masker N95
    4. visor atau face shield yang menutupi seluruh
    wajah
    5. sarung tangan ganda
    Rekomendasi Ruangan :
     idealnya satu pasien ditempatkan dalam satu
    ruangan isolasi bertekanan negatif dengan
    pertukaran udara baik (>12 pertukaran per
    jam).
     Jika ruang isolasi negatif tidak tersedia, maka
    alternatifnya adalah ruangan bertekanan
    normal dengan pintu tertutup.
     Beberapa strategi untuk mengurangi
    kemungkinan transmisi adalah menggunakan
    filter high efficiency particulate air/HEPA
    atau negative air flow portable di ruangan
    isolasi biasa.
    Airway Definitif :
    Nasotrakeal
    Orotrakeal

    Kriko/Trakeostomi
    Airway Definitif :
    1. Blind Naso-tracheal :
    Sambil mendengar
    pernafasan
    Dorong saat inspirasi
    Bila suara hilang
    kemungkinan masuk
    esofagus
    Hati-hati bila fraktur
    basis kranii
    Airway Definitif :
    2. Oro-trakeal :
     Dapat tanpa/dengan
    pelemas otot
     Selalu persiapan yang
    baik (lampu, Cuff)
     Selalu bersiap untuk
    needle
    krikotiroidotomi

    Intubasi oro-trakeal
    Intubasi Oro-
    trakeal

    Jangan dilakukan
    Hyperekstensi
    pada kasus TRAUMA
    3. Kriko-
    tiroidotomi :
     Dengan jarum
     Surgikal

    Kartilago tiroid
    Membrana
    Kartilago krikoid
    Trakea
    Airway Sementara
    Krikotirodotomi - jarum
    :
    Ditusukkan lewat
    membrana kriko-tiroidea
     Sambung dengan oksigen,
    1 detik tutup, 4 detik buka
    Waktu ekstra 30-45 menit
    Airway Definitif
    Kriko-tiroidotomi surgikal

    Ambulans Gawat Darurat 118

    BT&CLS
    Cara Menilai Pernafasan
    Gangguan Breathing
    Dengan  Oksigenasi & Ventilasi

    Gejala gangguan breathing :


    1. Frekuensi pernafasan
    2. Dispnea
    3. Sianosis
    4. Pemeriksaan fisik (Inspeksi, Auskultasi, Perkusi,
    Palpasi )
    5. Saturasi O2 dengan pulse oxymeter (bila ada)
    Oksigenisasi
    Pemberian oksigen
    Selalu diberikan bila keadaan umum
    kurang baik
    Ventilasi tambahan
     Mouth to Mouth
     Mouth to mask
     Bagging
     Ventilator
    Gangguan Breathing
    Beberapa keadaan penyebab gangguan
    breathing :

    Open Tension Flail Chest Massive


    Pneumotorax Pneumotorax dng Hematotorax
    Kontusio Paru

    Cedera toraks yang dapat dengan cepat


    mengakibatkan Kematian Cepat
    Trauma Thorax yang mengancam
    nyawa/Primary Survey

    1. Obstruksi airway A
    2. Open pneumotoraks
    3. Tension pneumotoraks
    4. Flail Chest + kontusio paru
    B
    5. Masif hematotoraks 
    6. Tamponade jantung C
    2. Open Pneumo-thorax
    Manifestasi : Breathing
    !
    Udara pilih
    masuk lewat
    lubang
    (tahanan lebih
    kecil)

     Gangguan
    ventilasi
    2. Open Pneumo-thorax :
    Tindakan

    Occlusive dressing
    Tutup ! Segera Pasang Pipa toraks
    WSD ( Chestube )
    3.Tension Pneumo-thorax

    Pneumothorax  Tension ?
    3.Tension Pneumo-thorax
    Manifestasi :
    Breathing !
    Pneumothorax Tension Pneumothorak

    Insp. : Ekspansi #simetris Trakea terdorong


    Ausk. : Bs. Nafas satu sisi  Vena leher distensi

    Perk. : Hipersonor satu sisi Syok


    3.Tension Pneumo-thorax Tindakan :

    1. Dekompresi 2. Pipa Toraks


    4. Flail Chest + Kontusio Paru
    Manifestasi : Breathing !

    Pernafasan Paradoksal
    BT&CLS
    4. Flail Chest + Kontusio Paru
    Yang lebih penting : Kontusio Paru - nya

    Karena itu : Monitor A – B


    • Jaga Airway
    • Monitor pO2 dan pCO2
    • O2 100%
    • Ventilasi tambahan bila diperlukan
     Bagging
     Respirator
     adanya fraktur iga multipel berturutan ≥ 3 iga, dan
    memiliki garis fraktur ≥ 2 (segmented ) pada tiap
    iganya. Akibatnya adalah: terbentuk area “flail” yang
    akan bergerak paradoksal (kebalikan) dari gerakan
    mekanik pernapasan dinding dada. Area tersebut akan
    bergerak masuk saat inspirasi dan bergerak keluar
    pada ekspirasi.
    5. Massive
    Hematothorax
    Manifestasi : -
    Breathing
    -
    Circulation
    Bila : 1500 cc
    (initial)
    Bila > 200 cc/ Jam
    5. Massive Hematothorax

    Tindakan :
    • Chest Tube
    • Bila massive : Torakotomi
    Evaluasi Breathing
    Bila Sat O2 < 95 % :
     Airway baik ?
     Ada sebab ? Atasi
     O2 face mask 10 LPM
     O2 non-rebreathing mask 15 LPM
     Assissted ventilation (sering perlu
    airway definitif)
     Bila ada gangguan breathing atasi sesuai
    penyebab
    SELESAI ....................

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