prinsip triage dalam keperawatan gadar

5/24/2018 Prinsip Triage dalam keperawatan gadar

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PRINSIP TRIAGEpada Kasus Bencana Masal

Photousedwithperm

issionoftheEmergencyEducationCouncilofMarylandRegion5.


2/23

What is Triage?

Triage sortir

Evaluasi berdasarkan kebutuhan

medis dan urgensi pada masing2klien dalam waktu terbatas


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Triage is a dynamic process and is

usually done more than once.


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Primary Disaster Triage

Triage based on physiology

Kemampuan pasien dalam

menghadapi /mengkompensasi

trauma atau injuri

Bila gagalprioritas tinggi


5/23

Primary Disaster Triage

The most commonly used adult tool in

the US and Canada is the STARTtool.

The pediatric MCI primary triage tool

most commonly used in the US andCanada is Jump START.


6/23

The Best Tool?

No MCI

primary triage

tool has beenvalidated by

outcome data.

Wiseman DB, Ellenbogen R, Shaffrey CI. Triage for the

Neurosurgeon, Neurosurg Focus 12(3), 2002. Available on the

Internet at www.medscape.com/viewarticle/431314
http://www.medscape.com/viewarticle/431314http://www.medscape.com/viewarticle/431314


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Triage Categories


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NATO Guidelines

RedAirway obstruction, cardiorespiratoryfailure, significant external hemorrhage,shock, sucking chest wound, burns of face

or neck

Yellow

Open thoracic wound, penetratingabdominal wound, severe eye injury,avascular limb, fractures, significantburns other than face, neck or perineum


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NATO GuidelinesGreen

Minor lacerations, contusions, sprains,

superficial burns, partial-thickness

burns of < 20% BSA

Black

Head injury with GCS85%

BSA, multisystem trauma, signs of

impending death


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START: Step 1

Triage officer announces that all

patients that can walk should get up

and walk to a designated area for

eventual secondary triage.

All ambulatory patients are initiallytagged as Green.


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START: Step 2

Triage officer assesses patients in theorder in which they are encountered

Assess for presence or absence of

spontaneous respirations

If breathing, move to Step 3

If apneic, open airwayIf patient remains apneic, tag as Black

If patient starts breathing, tag as Red


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START: Step 3

Assess respiratory rate

If 30, proceed to Step 4If 30, tag patient as Red


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START: Step 4

Assess capillary refill

If 2 seconds, move to Step 5If 2 seconds, tag as Red


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START: Step 5

Assess mental status

If able to obey commands, tagas Yellow

If unable to obey commands,tag as Red


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Mnemonic

R

P

M

30

2

Can do


17/23

Photo used with permission of the Emergency Education Council of Maryland Region 5.


18/23

Whats your call?

An adult kneels at the side of the road,

shaking his head. He says hes too

dizzy to walk.

RR 20

CR 2 sec

Obeys commands


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Whats your call?

Adult female driver still in the bus,

trapped by her lower legs under caved-

in dash.

RR 24

Cap refill 4 sec

Moans with verbal stimulus


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Whats your call?

An adult male lies inside the bus.

Apneic

Remains apneic with jaw thrust


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Whats your call?

An adult male lies on the ground

RR 20

Good distal pulse

Obeys commands but cries that he

cant move his legs

OR


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Key Points about MCI Triage

MCI triage will never be logistically,intellectually, or emotionally easy

but we must be prepared to do itusing the best of our knowledge and

abilities.

FEMA Photo Library


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Key Points

The physiology of adults and childrendiffer; therefore different primarytriage systems should be used

Use JumpSTARTfor infants througholder children

Use STARTfor young adults and older

Primary triage is just the first look atan MCI victim, similar to theprimary/initial survey/assessment

prinsip triage dalam keperawatan gadar

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