Transcript pak - getaran.2brppt

PAK - GETARAN
ERWIN DN
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DEFINISI
PENYEBAB
PATHOGENESIS
DIAGNOSIS
TERAPI
PROGNOSIS
PENCEGAHAN
PAK AKIBAT GETARAN
• Penyakit akibat getaran adalah penyakit
atau gangguan kesehatan akibat getaran
• PAK akibat getaran :
– PAK akibat getaran seluruh tubuh
– PAK akibat getaran setempat (segmented
vibration/ tool hand vibration)
Whole Body Vibration
• Getaran mekanaik yang disampaikan
lewat tempat duduk (ex: alat berat) / lantai
• Getaraan dari alat berat  tempat
duduk tulang belakang supir
WORKERS AT RISK
o Supir Traktor, truk, mobile crushers
o Fork-lifts
o Masinis, supir bus, taksi, motor boat,
helikopter, pesawat
o Mesin / Alat berat (hammering and
punching machinery)
o Orang yang bekerja di landasan yang
bergetar
Vibrations
Vibration
• Exposure to vibration can occur
while using power tools or while
driving equipment.
• Vibration from power tools can
place stress on the tissues of
the fingers, hand and arms.
• Whole body vibration from
driving puts stress on the spinal
tissues.
Vibration Exposure
Whole Body
4 s/d7 % pekerja di
Eropa& USA
terpapar WBV yang
berbahaya bagi
kesehatannya
Terdapat berbagai faktor yang perlu
diperhatikan dalam menilai efek getaran
pada manusia , yaitu:
• Karakteristik fisik dari frekuensi dan
intensitas getaran
• Tipe dari sumber getaran
• Lamanya pemajanan
• Arah getaran
• Posisi tubuh
• Kerentanan individu
• Faktor lingkungan misalnya suhu udara,
kebisingan, beban kerja dll.
Efek fisik getaran Pada otot
skelet (4-12 Hz)
• getaran
• Ujung tulang rawan & sendi
• Perubahan gerakan tl rawan & sendi
(khususnya tl blk
• Sel tl. Rawan rusak
• Peradangan berulang menahun
• Kerusakan menahun pada sendi (arthritis)
Osteoarthritis
Osteoarthritis
Osteoarthritis
Osteoarthritis
Efek getaran dan frekuensi
Frekuensi (Hz)
Efek
4-12
Kerusakan sistem otot dan tulang
4-5
Kerusakan tulang belakang
5-20 (dg
intensitas
sangat tinggi
Perdarahan paru
Frekuensi-efek
Frekuensi (hz)
< 10
>10
efek
Rongga dada dan perut
Organ dan jaringan perifer
EFEK PADA KESEHATAN WBV
FREKUEN
SI(HZ)
GANGGUAN KESEHATAN
4-12
-KERUSAKAN SEL TULANG RAWAN
(ARTHRITIS PERMANEN)
-SERUSAKAN SPINAL (HNPLBP)
-ABDOMINAL PAIN
-HEMATURIA
-PERDARAHAN PARU (5-10 HZ; 5-15G)
3-9
DADA & PERUT
10
LEHER, KEPALA, PINGGUL, PERINEUM, OTOT, TULANG
13-15
PHARYNX
6-10
TEKANAN DARAH, DENYUT JANTUNG, IO2 MAX
MENINGKAT
GANGGUAN KESEHATAN
MENURUT FREKUENSI
EFEK
FREKUENSI (HZ)
0,1-1
MABUK
GANGGUAN BICARA
MATA KABUR
GANGGUAN TUGAS
SPINAL RUSAK*(KRONIS)
GANGGUAN GI*(KRONIS)
REYNOD D**
1-10
10-100
100-1000
100010000
>10.000
Respon fisiologis thd WBV yg masih dapat
ditolerir o/ manusia adalah :
• Denyut jantung meningkat (10 – 15x/mnt) pada
kondisi eksperimen yang normal, tanpa
memperhatikan frekuensi  pajanan kontinyu
pulih
• TD meningkat pd frek. ± 5 Hz
menurun pd frek. ± 10 - 20 Hz
• Tidal Volume : meningkat pada semua frekuensi
(maks. Pd frek. 5 – 7 Hz)
• RR meningkat linier dg intensitas
• Pd 5-7Hz : VC menurun
O2 Uptake meningkat.
• Efek WBV pd ginjal , darah & endokrin :
- Belum atau tidak terdapat bukti yg jelas
• Efek WBV pd keseimbangan :
- tgt kerentanan individu.
Efek Getaran Pada Performance
• Ggn. Fgs. & ketajaman penglihatan 
- sebanding dg amplitudo getaran
- maksimum pd frek.10 -25 Hz.
• Penurunan performance pada tracking task
(pekerjaan mengikuti jejak misalnya jejak satelit,
pesawat udara dll)
- sebanding dengan amplitudo getaran
- maksimum pd frek. rendah (≤ 5 Hz)
HNP (Hernia Nucleus Pulposus)
• Tergelincirnya nukleus pulposus (anulus
fibrosus)/slipped disc
• Pathogenesis:
WBV  kerusakan tulang rawan  slipped
disc  tekanan pada radiks dorsalis
LBP
HERNIA NUCLEUS PULPOSUS
(SLIP DISC)
Beberapa Faktor Risiko LBP
a. sikap tubuh yg jelek & kurang OR
- sikap berdiri yang membungkuk ke depan,
- dada kempes
- pungung lordosis
- tidak tegap ,
- perut buncit
 tekanan BB jatuh ke depan sbg
kompensasi punggung hrs ditarik ke belakang - hiperlordosis lumbal jk lama  kelelahan
otot & rangsangan pd ligamen  nyeri.
Bad posture
b. Obesitas & kehamilan trimester akhir
 perpindahan tekanan BB ke depan
c. >>> duduk  otot hamstring kaku &
pendek
d. Panjang tungkai yang tidak sama
e. Sepatu tumit yang tinggi / pemendekan
tendon achilles titik Berat bergeser ke
depan
f. kelemahan otot dinding perut , gluteus maksimis &
ileopsoas serta pemendekan otot-otot ekstensor
punggug (otot yg penting u/ mempertahankan sudut
lumbosacralis pd posisi optimal (30º ))  kelemahan =
”unstable back”.
g. Merokok (blm jelas)
- tekanan intra diskus meningkat (batuk kronis)
- peregangan otot
- nikotin
h. Kesegaran jasmani
IKJ Baik  < berisiko LBP
i. Lama masa kerja
semakin lama (dg beban berat) risiko semakin
meningkat
ACGIH TLVs and BEIs Handbook
Whole-Body Vibration Threshold Limit
Values (TLV’s)
Y
X
Y
Y
X
X
Z
ax, ay, az = acceleration in the directions of the
x, y, z, axes
x axis = back - to – chest
y axis = right – to – left
z axis = foot (or buttocks) - to - head
Pencegahan
• Hindari paparan WBV > NAB  pilih
peralatan/mesin yang anti getaran,
pemeliharaan mesin, gunakan peredam, sepatu
anti getaran
• Atur waktu kerja istirahat : 1 jam kerja-10 menit
istirahat
• Istirahat : stretching, massaging, relaxing
• Terapi sesuai gejala
• Hindari faktor risiko
• Jaga badan tetap hangat
GETARAN SELURUH TUBUH
Paparan menahun (f=)
Gangguan aliran darah
Di daerah ginjal dan saluran kencing
Kerusakan permanen pada sendi/tulang
Arthritis
Slipped disc (L4-L5 atau L5 S1)
HNP
LBP
Paparan akut (F=)
amplifikasi /resonansi
Peradangan/inflamasi
Gangguan Fungsi
Ginjal dan
sal.Kencing, dg
indicator:
Hematuria
BUN
Serum Creatini
Urea
PAK –GETARAN SETEMPAT
What is HAV (Hand-Arm Vibration)?
What is HAV (Hand-Arm Vibration)?
- transmitted from work processes into workers hands and
arms.
- It can be caused by operating hand-held power tools such as
: road breakers,
hand-guided equipment (ex:s lawn mowers)
holding materials being processed by machines such as
pedestal grinders.
What injuries can HAV cause?
Regular exposure to HAV can cause a range of permanent
injuries to your hands and arms that are known as hand-arm
vibration syndrome (HAVS).
The injuries can include damage to the following:
What injuries can HAV
cause?
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Blood Circulatory System (vibration white finger)
- >> tjd jika suhu tubuh/tangan dingin atau basah
- tanda awal: ujung jari putih (kadang2) , baal , seperti terusuk
jarum
- akhir serangan: jari putih  berubah merah & sangat nyeri
o Sensory Nerve Damage
- kerusakan syaraf di jari rasa raba & rasa suhu berkurang  baal
permanen, kesemutan di jari
o Damage to Muscle, Bones & Joints
- kekuatan tangan hilang
- nyeri di lengan & pergelangan tangan
Health Effects (bisanya
setelah 3-5th)
Hand Arm
Vascular and circulation problems.
Neurológical.
Muscular disorders
Others
Symptoms – Advanced
Stages
• White or Blanched
Finger Tips
– Aggravated by cold
– Mistaken for frostbite
– Few minutes initially
• With Continued
Exposure
– Blanching spreads
– Attacks Increase in
• Frequency
• Intensity
• Duration
Symptoms – Latter stages
• Occur in all seasons
• On and off job
• Triggered by
– Cold
– Vibrating objects
– Nicotine
• Severe Cases
– Gangrene
– Amputation
Stockholm HAVS Classification
System (Vascular Assessment)
Stag
Grade
e
0 --------1V Mild
2V
Moderate
3V
Severe
4V
Very
Severe
Description
No attacks
Occasional attacks affecting only
one or more fingers
Occasional attacks affecting distal
and middle phalanges (rarely also
proximal) of one or more fingers
Frequent attacks affecting ALL
phalanges of most fingers
As in Stage 3, with trophic skin
changes in the finger tips
Stockholm HAVS Classification
System (Sensorineural
Assessment)
Stage
Symptoms
0SN Exposed to vibration but no symptoms
1SN
2SN
3SN
Intermittent numbness, with or without
tingling
Intermittent or persistent numbness,
reducing sensory perception
Intermittent or persistent numbness,
reducing tactile discrimination and/or
manipulative dexterity
Health Effects
Vascular Disorders
Muscle
Normal
Artery
Normal
flow
Damage
Artery
Flow
Restriction
Typical HAV Sources
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Fastening Tools
Cutting Tools
Finishing Tools
Gardening Tools
Compaction Tools
Drilling/Boring Tools
And More
Vibration Exposure
Hand Arm
Vibration Exposure
Hand Arm
Vibration Exposure
Hand Arm
Hand Arm vibration
exposure
What other factors can contribute to vibration injury?
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How high the vibration levels
o * How long you use the tools and equipment
o * How awkward it is for you to use the equipment
o * How tightly you have to grip the equipment
o * How cold and wet you get when using the equipment
o Individual susceptibility - smokers are at a greater risk
Upaya Pencegahan
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Jaga agar paparan tak melampaui NAB
Atur waktu kera-istirahat (1 jam-10 mnt)
Istirahat : massaging, swinging, shaking
Pakai gloves (VIP)
Jaga agar badan tetap hangat
Hindari faktor risiko
Acceleration levels from Hand Arm Vibrations
Hand-arm vibration acceleration level
(m/sec2)
Tool Type
1,183
Riveter, Caulker
424
Chipping Hammer
416
Motorcycle
339
Jack-Leg Drill
251
Grinder
195
Pavement Breaker
125
Pedestal Grinder
75
Chain Saw
59
Brush Saw
20
Hand Grinder
Tri-axial Measurements must be perform:
Basicentric Measurement: Measurement of vibration
directly from the tool.
Basicdynamic Measurement: Measurement of vibration
indirectly over a knuckle.
2002/44/EC
Directive 2002/44/EC of the European
Parliament and of the Council
8-Hour Daily Exposure Limit
Action Value
Limit Value
Hand-Arm
2.5 m/s2
5 m/s2
Whole-Body
0.5 m/s2
1.15 m/s2
Whole-Body (vibration dose)
9.1 m/s1.75
21 m/s1.75
Vibrations on the Human body
QUESTIONS?