DAFTAR DAFTAR ISI
Daftar Isi ........................................................................ ............................... 1 Lembar Pengesahan ........................................................ ............................. 2 BAB
I.
DEFINISI .............................................................. ............................... 3 BAB
II.
RUANG
LINGKUP LINGKUP .............................................................. ................ BAB
III.
!A!A
LAKSANA ............................................................. .................... " BAB
I#.
D$KU%EN! D$KU%EN!ASI ASI .................................................... ............................ 11
1
LEMBAR PENGESAHAN
PENGESAHAN DOKUMEN RS. JANTUNG HASNA MEDIKA NAMA
KETERANGAN
Pemb&at D'(&men A&th'ri+e, Pers'n
Dr. Umar Basri
Dire(t&r RS. -ant&ng asna %e,i(a
TANDA TANGAN
TANGGAL
1" Desember 2)1* 1" Desember 2)1* 1" Desember 2)1*
BAB I DEFINISI !riage a,a/ah sistem se/e(si 0asien ang ,atang ber'bat (e Insta/asi Gaat Dar&rat ,a/am (ea,aan seharihari ,an4ata& ,a/am (ea,aan ben5ana.Da/am ha/ ini ,a/am triage 6&ga me/i0&ti 5ara men,iagn'sis serta memi/ah 0en,erita ber,asar(an (eb&t&han tera0i ,an s&mber ,aa ang terse,ia. Kegiatan triage sangat ,i0er/&(an ,a/am 0e/aanan gaat ,ar&rat (arena Insta/asi Gaat Dar&rat sebagai 0&sat 0e/aanan (esehatan ang me/aani se/ama 2 6am 0en&h sehar&sna berf&ngsi &nt&( me/aani (esehatan
0a,a
0asien
ang
bersifat
gaat
,an
,ar&rat
serta
memb&t&h(an 0ert'/'ngan segera &nt&( menghin,ari 0er(embangan 0ena(it ang /ebih 0arah ,an ,a0at mengan5am 6ia 0asien. Nam&n ,a/am misi s'sia/na7 Insta/asi Gaat Dar&rat ti,a( ,i0er(enan(an &nt&( men'/a( 0asien ang ,atang ,an memb&t&h(an 0ert'/'ngan (esehatan7 mes(i0&n 0a,a (enataanna b&(an termas&( ,a/am (riteria gaat ,an4ata& ,ar&rat. Unt&( it& ,i0er/&(an tata /a(sana triase ang /ebih bai( sehingga 0e/aanan (esehatan &nt&( (as&s(as&s gaat ,an ,ar&rat ti,a( tergangg& '/eh 0e/aanan (as&s(as&s ang ti,a( gaat ,an4ata& ,ar&rat.
BAB II RUANG LINGKUP Pet&gas triage har&s ,a0at mene/e(si 0asien ses&ai ,engan ('n,isi (egaat,ar&ratanna sebagai 0ri'ritas 0ertama 0e/aanan (e0a,a 0asien ses&ai ,engan (etent&an ang a,a &nt&( 0e/aanan 0asien gaat ,ar&rat ang ber/a(& ,an ti,a( ber,asar(an &r&tan (e,atangan 0asien. Pasien ber,asar(an
ang
,atang
('n,isi
(e
Insta/asi
Gaat
(egaat,ar&ratanna
Dar&rat
,engan
,ise/e(si
mengg&na(an
A&stra/ian !riage S5a/e 8A!S9 sebagai beri(&t : 1. A!S 1 a,a/ah ('n,isi ang mengan5am 6ia 8ata& resi(' besar menga/ami (em&n,&ran9 ,an 0er/& inter;ensi ang 5e0at ,an agresif. 2. A!S 2 a,a/ah : a. 0asien ,engan ('n,isi ang 5&(&0 seri&s ata& menga/ami (emer's'tan se5ara 5e0at ang a0abi/a ti,a( ,itangani ,a/am 1) menit ,a0at mengan5am 6ia ata& menga(ibat(an (egaga/an 'rgan. b. 0asien ang ,engan 0emberian 'bat ang ,imana hasi/ ah(irna sangat tergant&ng ,ari sebera0a 5e0at 'bat it& ,iterima '/eh 0asien 8 misa/na : tr'mb'/isis7 antira5&n9 3. A!S 3 a,a/ah 0asien ang ,atang ,engan ('n,isi ang m&ng(in a(an be(embang men6a,i mengan5am nama ata& menimb&/(an (e5a5atan bi/a ti,a( ,itangani ,a/am a(t& 3) menit. . A!S a,a/ah 0asien ,engan ('n,isi
ang
,a0at
menga/ami
(emer's'tan ata& a(an menghasi/(an '&t5'me ang berbe,a bi/a ,a/am 1 6am 0asien be/&m ,itangani. *. A!S * a,a/ah ('n,isi 0asien ang s&,ah (r'nis ,engange6a/a ang min'r7 ,imana hasi/ ah(irna ti,a( a(an berbe,a bi/a 0enanganan ,it&n,a sam0ai 2 6am sete/ah (e,atangan. A,a0&n beri(&t ini a,a/ah berbagai ('n,isi ang ,a0at ,i(ateg'ri(an termas&( sebagai (as&s emergen57 antara /ain :
1. A!S 1 : enti -ant&ng enti Na0as Resi(' s&mbatan 6a/an na0as Fre(&ensi 0erna0asan 8RR9 < 1)=4menit Distress 4 Kes&(aran 0erna0asan ang sangat berat 8e=treme9 !e(anan ,arah < >) 8,easa9 ata& s'( 0a,a ana(4bai !i,a( res0'n ata& hana res0'n neri 8G?S < "9 Ke6ang ter&s mener&s ata& ber(e0an6angan $;er,'sis I# ,an ti,a( res0'nsif ata& hi0';enti/asi Gangg&an 0eri/a(& berat ,engan an5aman segera terha,a0 (e(erasan ang berbahaa 2. A!S 2 : Resi(' -a/an Na0as @ Stri,'r berat ata& 0r',&(si air /i&r ber/ebih
ang membahaa(an Distress 4 (es&(aran 0erna0asan berat Gangg&an Sir(&/asi : K&/it ber(eringat ata& ber&bah arna (arena 0erf&si ang b&r&( Deta( 6ant&ng < *) ata& 1*) 8,easa9 i0'tensi ,engan gangg&an hem',inami( Kehi/angan ,arah hebat Neri ,a,a (ar,ia( Neri sangat hebat @ a0a0&n 0enebabna Ka,ar G&/a Darah < 2 mm'/4/ %engant&(7 0en&r&nan res0'n 8G?S < 139 emi0aresis 4 ,isfasia a(&t Demam ,engan tan,atan,a /etargi 8sem&a &m&r9 !er(ena +at asam ata& basa 0a,a mata @ memb&t&h(an irigasi %&/titra&ma ma'r 8memb&t&h(an res0'n 5e0at ,ari tim • • • • • • • •
ter'rganisasi9 !ra&ma /'(a/ berat @ Fra(t&r ma'r7 am0&tasi Riaat 0ena(it resi(' tinggi K'ns&msi 'bat 0enenang ata& +at t'(si( /ainna se5ara signi(an En;en'mati'n 8tergigit hean bera5&n9 ang signi(an 4 berbahaa Neri hebat ang memberi (esan a,ana Pre e(/am0sia7 AAA 8Ab,'mina/ A'rti5 Ane&rsm9 4 Ane&risma A'rta Ab,'mina/is7 ata&
Kehami/an e(t'0i(. Peri/a(& 4 Psi(iatri(: Kasar ata& agresif An5aman /angs&ng terha,a0 ,iri sen,iri ata& 'rang /ain %emb&t&h(an 0enge(angan Agitasi ata& agresi berat • • • •
3. A!S 3 : i0ertensi berat Kehi/angan 5&(&0 bana( ,arah @ a0a0&n 0enebabna Sesa( na0as se,ang Sat&rasi $2 ") @ "* Ka,ar G&/a Darah 1C mm'/4/ Riaat (e6ang 8saat ini sa,ar9 Sem&a ,emam 0a,a 0asien im&n's&0resi misa/na 0asien 'n('/'gi7
R= Ster'i, %&ntah ter&s mener&s Dehi,rasi ?e,era (e0a/a ,engan (ehi/angan (esa,aran ang sing(at @ saat ini
sa,ar Neri
se,ang
sam0ai
berat
@
a0a0&n
0enebabna7
ang
memb&t&h(an ana/gesi5 Neri ,a,a n'n(ar,ia( ,engan ting(at (e0arahan se,ang Neri 0er&t tan0a 5iri5iri resi(' tinggi @ ting(at (e0arahan se,ang
ata& 0asien &sia C* tah&n !ra&ma e(stremitas se,ang @ ,ef'rmitas7 /aserasi ang 0arah7 E(stremitas @ Per&bahan sensasi7 ti,a( a,a 0&/sasi !ra&ma @ Riaat 0ena(it resi(' tinggi tan0a resi(' tinggi /ainna Ne'nat&s stabi/ Ana( beresi(' Peri/a(& 4 Psi(iatri(: Sangat terte(an7 resi(' mena(iti ,iri sen,iri Psi('ti( a(&t ata& gangg&an 0i(iran Krisis sit&asi'na/7 senga6a mena(iti ,iri sen,iri Agitasi 4 menari( ,iri 4 ber0'tensi agresif . A!S : Per,arahan ringan As0irasi ben,a asing7 tan0a ,istress 0erna0asan ?e,era ,a,a tan0a neri 0a,a t&/ang iga ata& ,istress 0erna0asan Kes&/itan mene/an7 tan0a ,istress 0erna0asan ?e,era (e0a/a ringan7 ti,a( (ehi/angan (esa,aran Neri se,ang7 ,engan bebera0a fa(t'r resi(' %&ntah ata& ,iare tan0a ,ehi,rasi Inamasi ata& ben,a asing 0a,a mata @ 0eng/ihatan n'rma/ !ra&ma e(stremitas min'r @ 0erge/angan (a(i ter(i/ir7 (em&ng(inan • • • •
0atah t&/ang7 /aserasi ti,a( ter('m0/i(asi ang memb&t&h(an in;estigasi ata& inter;ensi @ tan,a ;ita/ n'rma/7 neri ringan 4
se,ang Gi0s ter/a/& (etat7 tan0a (er&sa(an ne&r';as(&/er
Sen,i beng(a( ,an 0anas Neri 0er&t ti,a( s0esi( Peri/a(& 4 Psi(iatri( : %asa/ah (esehatan menta/ semi&rgent Da/am 'bser;asi ,an4ata& ti,a( a,a resi(' /angs&ng terha,a0 ,iri •
sen,iri ma&0&n 'rang /ain *. A!S * :
Neri minima/ tan0a 5iri5iri beresi(' tinggi
Riaat 0ena(it resi(' ren,ah ,an saat ini asimt'mati(
Ge6a/a min'r ,ari 0ena(it stabi/ ang a,a
Ge6a/a min'r ,ari ('n,isi ,engan resi(' ren,ah
L&(a min'r @ /e5et (e5i/7 /aserasi ringan 8ti,a( memb&t&h(an 6ahitan9
Di6a,a/(an ('ntr'/ misa/na 0a,a ('ntr'/ /&(a7 0erban ('m0/e(s
Im&nisasi
Peri/a(& 4 Psi(iatri( : Pasien ang ,i(ena/ ,engan ge6a/a (r'nis Krisis s'sia/7 0asien bai( se5ara (/inis. Unt&( 0asien ana(ana( ,ig&na(an stan,ar, ang berbe,a7 (arena
('n,isi 0a,a ana( 6a&h /ebih berbahaa ,ari0a,a ,easa. TRIASE ANAK < 6 BULAN
Pemberian ma(anan Ar'&sa/ 4 !ing(at
RESIKO TINGGI < n'rma/ Sering mengant&(
(eas0a,aan 8SSP9
Pen&r&nan a(ti;itas
RESIKO SEDANG 142 243 n'rma/ Ka,ang mengant&(
K'n;&/si Perna0asan Sir(&/asi $&t0&t 5airan
!angisan /emah A0nea ata& Sian'sis K&/it 0&5at ,an 0anas %&ntah (ehi6a&an
Sesa( nafas K&/it 0&5at * = m&ntah ,a/am 2
< = 0'0'( basah 4 6am hari
Ken5ing (&rang ,ari biasana
Feses
!in6a ber,arah
BAB III TATA LAKSANA Insta/asi
Gaat
mene/enggara(an
Dar&rat
0e/aanan
RS.
-ant&ng
gaat
asna
,ar&rat
%e,i(a
se/ama
2
ang 6am
me/a(sana(an (egiatan triage ang ,it&6&(an &nt&( mene/e(si ,an me/aani 0asien ber,asar(an ('n,isi (egaatan ,ar&ratanna ,an b&(an ber,asar(an &r&tan (e,atangan 0asien ses&ai ,engan 0r'se,&r. !riase har&s ,i/a(&(an aa/ se6a( 0asien tiba ,i IGD '/eh se'rang 0et&gas ang ter/atih ,an ber0enga/aman. Pet&gas ini har&s memasti(an a,ana 0eni/aian &/ang terha,a0 0asien ang men&ngg& ,an a0abi/a (ea,aan ber&bah7 ,a0at me/a(&(an triase &/ang. Area !riase har&s/ah m&,ah ,i6ang(a& ,an bertan,a 6e/as. Unt&( &(&ran tem0at har&s mem&ng(in(an &nt&( memeri(sa 0asien7 memberi 0ri;asi ,an ,a0at ,engan 6e/as me/ihat (e arah 0int& mas&(7 se/ain it&
6&ga
aman
bagi
0et&gas.
Setia0
,i/a(&(an
triase
har&s
a,a
,'(&mentasina. Pen5atatan ini men5a(&0 : a. b. 5. ,.
!angga/ ,an 6am 0emeri(saan Nama 0et&gas triase Pr'b/em &tama ang a,a Riaat 0ena(it ang berh&b&ngan ,engan 0r'b/em ang a,a
se(arang e. A/'(asi ber,asar (ateg'ri triase f. a(t& ,an a/asan ,i/a(&(an retriase &/ang g. Pemeri(saan 0en&n6ang ang ,i/a(&(an : Sete/ah ,ise/e(si7 ,i/a(&(an tin,a(an sebagai beri(&t : •
Ditangani ,i tem0at 0eri(sa4tem0at tin,a(an ses&ai ,engan
•
('n,isi (/inisna 8be,ah4n'nbe,ah4'bstetrigine('/'gi9 -i(a ,i,a0at(an (egaat,ar&ratan angmengarah 0a,a ('n,isi 5ar,ia5 arrest ,an4ata& res0irat'r arrest segera ,itangani ,i
•
r&ang res&sitasi. -i(a 0asien ang ,atang termas&( A!S ,an A!S * ,atang 0a,a 6am (er6a ma(a ,iarah(an (e Insta/asi Raat -a/an &nt&( men,a0at(an 0enanganan ses&ai ,engan ('n,isi (/inisna ,an bi/amana 0er/& ,ian6&r(an &nt&( men,a0at(an 0emeri(saan '/eh ,'(ter s0esia/is. -i(a 0asien ,atang ,i /&ar 6am (er6a ma(a ,i/a(&(an 0enanganan ses&ai ,engan ('n,isi (/inisna sete/ah
•
(as&s(as&s gaat ,ar&rat ter/aani Pasien ,atang ,a/am (ea,aan s&,ah meningga/ ,&nia 8,eath 'n arri;a/9. Di0asti(an ter/ebih ,ah&/& baha 0asien memang s&,ah meningga/ ,&nia7 &nt&( (em&,ian bi/amana 0er/& ,ibaa (e (amar 6ena+ah.
Kateg'ri A!S 1 A!S 2 A!S 3 A!S A!S *
a(t& res0'n ma=im&m Segera 1) menit 3) menit C) menit 12) menit
BAB IV DOKUMENTASI Kegiatan triage ,i Insta/asi Gaat Dar&rat RS. -ant&ng asna %e,i(a ,i,'(&mentasi(an setia0 hari ,i,a/am b&(& register 0e/aanan Insta/asi Gaat Dar&rat ang se5ara 0eri',i5 ,i/a0'r(an setia0 sat& mingg& se(a/i ,a/am ra0at manager ,an 6&ga se5ara a(&m&/atif ,i/a0'r(an sat& b&/an se(a/i ,a/am ra0at (er6a.
