Manajemen Suportif Perdarahan Intra Abdomen

Time is of the essence in caring for patients with multiple injuries. To emphasize the time-
sensitive nature of this care, the critical period immediately following injury was historically
termed the golden hour. The golden hour is no longer sacred, as we know that patient
outcome is directly related to the time from injury to definitive care.1
In order to save time, the initial assessment and management should follow a systematic
approach that can be easily learned and practiced. This approach is the foundation for the
Advanced Trauma Life Support (ATLS) course. Lack of a systematic approach to the initial
assessment can result in errors from which the resuscitation team, and ultimately the patient, do
not recover.2
When specific criteria suggesting a possible serious injury are met, the trauma team is activated
through a trauma alert system. The entire team responds immediately. In addition, the triage
officer may activate the trauma alert system at his/her own discretion for any reason.3

- Ideally, the team arrives before the patient. The trauma surgery attending physician is the team
leader. Each team member must understand their role. Communication is essential, and
discussion of potential scenarios prior to the arrival of the patient can be very useful.
- The operating room should be notified and made aware of a possible emergent case.
- The radiology team should be ready and waiting for patients arrival.
Protecting the Trauma Team
- Needlesticks and splashes are endemic in acute trauma management.
- Universal precautions are probably more important here than in any other part of the hospital,
given the patient population, use of sharp instruments and needles, number of staff, and
accelerated pace of trauma assessment.
- Be careful of unexpected sharps such as broken ribs and retained missiles or foreign bodies.
The team leader is responsible for keeping the resuscitation smooth and calm.

Initial assessment and management includes the following2:

All trauma patients are assessed by a primary survey, resuscitation, secondary
survey, and definitive care.
The goals of these phases are as follows:
- Primary survey : Identify injuries that may be life threatening immediately or within minutes
- Resuscitation: Stabilize and/or treat these immediately lethal injuries
- Secondary survey: Identify injuries that are less rapidly fatal, but still potentially lethal, as well
as all other injuries
- Definitive care: Treatment (surgical or otherwise) of identified injuries
- The more drastic the situation, the more closely this template should be followed. In actual
practice many steps will likely proceed simultaneously (i.e., primary survey and resuscitation).
Preparation
The hospital phase of preparation is initiated with advance notice of the arrival of the injured
patient. There is a tiered response in place at every trauma center. Depending on the severity of
injury, a level of activation is initiated. For example, patients who are hypotensive (systolic
blood pressure 90 mm Hg), bradycardic or tachycardic (heart rate [HR] 50 beats/min or 130
beat/min), or intubated in the field or with respiratory compromise.1
- Ideally, the team arrives before the patient. The trauma surgery attending physician is the team
leader. Each team member must understand their role. Communication is essential, and
discussion of potential scenarios prior to the arrival of the patient can be very useful.
- The operating room should be notified and made aware of a possible emergent case.
- The radiology team should be ready and waiting for patients arrival.
Protecting the Trauma Team
- Needlesticks and splashes are endemic in acute trauma management.
- Universal precautions are probably more important here than in any other part of the hospital,
given the patient population, use of sharp instruments and needles, number of staff, and
accelerated pace of trauma assessment.
- Be careful of unexpected sharps such as broken ribs and retained missiles or foreign bodies.
The team leader is responsible for keeping the resuscitation smooth and calm.
Primary Survey
Evaluation of all trauma patients begins with the ABCs:
A: Airway. Establish a patent airway while avoiding cervical spine injury
B: Breathing. Ensure effective ventilation
C: Circulation. Identify shock and life threatening hemorrhage
D: Disability. Briefly assess neurologic status
E: Exposure/Environment. Remove all clothing. Keep patient warm.

Airway
Maintenance of the airway is the most important priority in caring for the trauma patient.
Inadequate ventilation leads to hypoxia and inadequate oxygen delivery to tissues.1