Trendelenberg Posistion
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Transcript of Trendelenberg Posistion
7/23/2019 Trendelenberg Posistion
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Trendelenberg Posistion
ROBERT E SARAGIH SPJP,FIHA
SMF JANTUNG PEMBULUHDARAH RSU F UI
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Pengerti!n
• Posisi trendelenb"rg !d!l!# $osisitid"r $!sien d!l!% $osisi b!gi!n&e$!l! lebi# rend!# d!ri $!d! b!gi!n
&!&i'()*+- .
• Dil!&"&!n s!!t o$er!si !bdo%en"nt"& %endorong org!n $er"t &e !r!#
d!d!/• Seb!g!i ter!$i $!d! s#o0&'tet!$i tid!&
$!d! #e!d in1"r2./
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SEJARAH
• Friedrich Trendelenburg l!#ir diBerlin Born (344 d!n %eningg!l(564 ,seor!ng dr Bed!# d!n $endiri
!sosi!si Bed!# Jer%!n
• Pert!%! se&!li %engg"n!&!n $osisiini $!d! s!!t o$er!si 7is0er! t!#"n
(33(/
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Old des0ri$tion o8 t#e Trendelenb"rg $osition
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Trendelenb"rg $osition In S"rger2
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Tujuan
• Ag!r d!r!# lebi# b!n2!& %eng!lir &ed!er!# &e$!l!
• Unt"& %e%"d!#&!n o$er!si di b!gi!n
$er"t/• Unt"& %e%"d!#&!n $er!9!t!n d!n
$e%eri&s!!n
•
Seb!g!i $osisi $ertolong!n $ert!%! $!d!s2o&/
• Pertolong!n $!d! $en2el!% 2!ng 0ider! /
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HIPOTENSI
• P!sien deng!n #i$otensi 'lo9 blood $ress"re. "nt"&%ening&!t&!n $er8"si 0erebr!l &e ot!&/
• A 6) liter!t"re re7ie9 %eng!t!&!n "Literatureon the position was scarce, lacked strength,
and seemed to be guided by 'expert opinion/:;
• A 63 %et!*!n!l2sis %eng!t!&!n b!#9! !d!n2!resi&o 2!ng lebi# b"r"& deng!n Trendelenb"rg$osition ini, se#ingg! tid!& di!n1"r&!n l!gi /
• The passive leg raising test lebi# di!n1"r&!nseb!g!i 0!r! res"sit!si 0!ir!n d!n seb!g!i!"totr!ns8"si 2!ng lebi# e8e&ti8/
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Passive leg raising test
• Passive leg raising test adalah bedside test "nt"&%enge7!l"!si &eb"t"#!n 0!ir!n $!sien*$!sien 0riti0!ll2 ill /
• Tes ini %eng!ng&!t t"ng&!i $!sien se#ingg! g!2! gr!7it!si!&!n %endorong d!r!# d!ri t"ng&!i , se#ingg! ter1!di
$ening&!t!n 7ol"%e sir&"l!si &e 1!nt"ng '0!rdi!0 $relo!d.se&it!r ()*+ %illiliters, terg!nt"ng 1"%l!# reser7oir7en!/
• Re!l*ti%e e8e& n2! !d!l!# $!r!%eter #e%odin!%i& se$ertiblood $ress"re d!n #e!rt r!te di$!&!i seb!g!i t!nd!
!$!&!# $e%beri!n 0!ir!n %!si# di$erl"&!n !t!"%eng"nt"ng&!n/
• Assess%en ini !&!n lebi# %"d!# 1i&! %e%!&!i in7!si7e%onitoring 'se$erti !rteri!l 0!t#eter ./
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• M!n"7er ini se%!&in &"!t 1i&! $osisi bed $!siendir"b!# d!ri se%i*re0"%bent $osition &ere0"%bent $osition deng!n t"ng&!i ditinggi&!n
•
Teori %en2eb!b&!n !d!n2! t!%b!#!n$erger!&!n d!r!# d!ri sir&"l!si g!strointestin!l
• Beber!$! $eneliti!n %en2!t!&!n b!#9! 0!r!ini %er"$!&!n $redi&tor 2!ng lebi# b!i&
ter#!d!$ res$on $engisi!n 0!ir!n d!ri$!d!0!r! l!in se$erti 7!ri!si $ern!$!s!n /
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<!terbo!rding
• Posisi Trendelenb"rg dig"n!&!n s!!t<!terbo!rding "nt"& %en0eg!# !ir%!s"& &e $!r"*$!r", $!d! s!!t
interog!tor %e%beri&!n sens!sin2eri l"!r bi!s! $!d! t!#!n!n t!n$!!d! t!nd!6 &e&er!s!n /
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Pe%!s!ng!n =en! 0entr!l
• Posisi Trendelenb"rg%e%!&!i g!2!
gr!7it!si "nt"&%en!%b!# $engisi!nd!n distensi d!ri"$$er 0entr!l 7eins
s!!t $e%!s!ng!n0entr!l line di intern!l 1"g"l!r !t!"s"b0l!7i!n 7eins
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Manuver Valsava
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• D!l!% il%" &edo&ter!n, manuver Valsava dil!&"&!n deng!n e&s$ir!si $!&s! deng!n %en"t"$bibir d!n %en"t"$ #id"ng/
• H!l ini !&!n %endes!& "d!r! %!s"& &e teling!
d!l!% &eti&! s!l"r!n E"st!0#i terb"&!/• Dig"n!&!n %eng"1i 8"ngsi 1!nt"ng d!n &ontrol s!r!8
otono% 1!nt"ng !t!" "nt"& %en2!%!&!n te&!n!n did!l!% teling! &eti&! ter1!di $erbed!!n te&!n!n
$!d! ol!#r!g! sel!% d!n dirg!nt!r!/• Te&ni& ini d!ri n!%!> Antonio M!ri! =!ls!7!, seor!ng
do&ter d!n !#li !n!to%i ber&eb!ngs!!n It!li!/
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• Te&!n!n d!r!# 'sistoli& d!n di!stoli&.d!n &e0e$!t!n det!& sel!%! res$onnor%!l ter#!d!$ %!n"7er =!ls!7!/
• Te&!n!n 4 %%Hg ter1!di $!d! )deti& d!n %en"r"n sel!%! 6 deti&/
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• Res$ons ?siologis ter#!d!$ %!n"7er=!ls!7! dib!gi &e d!l!% 4 8!se>
1. Kenaikan tekanan inisial: P!d! s!!t
$e%b"!ng!n n!$!s deng!n $!&s!!n,te&!n!n di d!l!% d!d! %eninggi d!n%e%!&s! d!r!# "nt"& &el"!r d!ri $!r"*$!r" 'siste% $ern!$!s!n. %en"1" ser!%bi
&iri 'LA. /H!l ini %en2eb!b&!n &en!i&!n sedi&it$!d! te&!n!n d!r!#/
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2. Pengembalian darah vena yang tereduksi dankomensasi: e%b!lin2! d!r!# &e 1!nt"ng di#!%b!tdeng!n te&!n!n di d!l!% d!d!/
Men2eb!b&!n d!r!# d!ri 1!nt"ng ber&"r!ng !t!"
tered"&si, 2!ng %en2eb!b&!n te&!n!n d!r!# t"r"n/ Ter1!di se&it!r ) *(4 deti&/
Ber&"r!ngn2! te&!n!n d!r!#, se0!r! re@e&s,%en2eb!b&!n $e%b"l"# d!r!# %en2e%$it ber&onstri&sid!n d!$!t %en!i&&!n te&!n!n d!r!# '() *6 deti&./
o%$ens!si ini dit!nd!i deng!n te&!n!n 2!ng &e%b!li%ende&!ti nil!i nor%!l !t!" b!#&!n di !t!s nil!i nor%!l,n!%"n &el"!r!n 1!nt"ng d!n !lir!n d!r!# %!si# sedi&it/
P!d! 9!&t" ini, 1!nt"ng berden2"t lebi# &en0!ng/
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!. Peleasan tekanan:
Te&!n!n $!d! d!d! dile$!s&!n/
Pe%b"l"# d!r!# $!r"*$!r" d!n !ort! d!$!t
%eleb!r, %en2eb!b&!n te&!n!n d!r!#sedi&it %en"r"n '6 * 6+ deti&. &!ren!ber&"r!ngn2! d!r!# 2!ng &e%b!li &e ser!%bi&iri'LA. d!n %en!i&&!n 7ol"%e !ort!/
D!r!# 7en! d!$!t %!s"& &e d!d! d!n 1!nt"ng/
el"!r!n 1!nt"ng %"l!i %ening&!t/
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". Keluaran jantung kembali normal:
D!r!# 2!ng d!$!t &e%b!li &e 1!nt"ngse%!&in %ening&!t, %en2eb!b&!n
&el"!r!n 2!ng se%!&in b!n2!& d!nte&!n!n d!r!# %ening&!t/
Te&!n!n d!r!# bi!s!n2! !&!n sedi&it di!t!s nor%!l d!#"l", b!r" &e%"di!n %!s"&
&e nil!i nor%!l/Deng!n &e%b!lin2! te&!n!n d!r!# nor%!l,den2"t 1!nt"ng 1"g! &e%b!li nor%!l/
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• Bil! terd!$!t $erbed!!n deng!n $ol!res$ons d!$!t %en!nd!&!n !d!n2!8"ngsi 1!nt"ng 2!ng tid!& nor%!l
'G!g!l J!nt"ng.,!t!" $!d! &ontrols!r!8 otono% 1!nt"ng/
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TERIMAASIH