16 Jan 2009 Trakeostomi DON
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Transcript of 16 Jan 2009 Trakeostomi DON
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7 februari 2009Team :
EN, DLS, MA, DON, DND, KUL
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Lk,82 thn, 50 kg, KU : Tidak bisa BABTelaah: Hal ini dialami os sejak seminggu ini.
Nyeri perut menjalar disertai tegangan di perut (+), perut gembung (+), mual(+), muntah(+), demam(+). BAK sedikit (+), nyeri BAK (+), BAK keruh(+), rasa tidak puas BAK(+).MMT 2 hari yg lalu
RPT : -RPO : -
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TIME SEQUENCE
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Pemeriksaan Fisik B1 : Airway clear, snoring(-)gurgling(-)crowing
(-) RR 30 x/i, SP vesikuler mengeras, ST -/- . Riwayat asmatrakea medial, MP: I, GL : bebas.
B2 : A: H/M/K, TD 140/90 mmHg, HR 88 x/i T/V cukup reg , t axila 37,2oC, turgor baik, rasa haus (-), mata cekung (-)
B3 : Sens : CM, pupil isokor , RC +/+B4 : BAK (+) OUP 100/2 jam, warna kuning
jernih, riw. Hemodialisa 2xB5 : Abdomen soepel, damb contour (+),
distensi (+), peristaltik (-), MMT 2 hari yg lalu. B6 : oedem (-), Fraktur (-)
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LABORATORIUM (020209)- Hb : 12,5 gr/dl- Leu : 7.400 gr/dl- Ht : 37,8%- Trmb : 222.000/ul- Na/K/Cl : 142/4,1/97- Ur/Cr : 21/0,4- SGOT/SGPT: 43/80- EKG : Normo EKG - KGD ad random : 120 gr/dl
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AGDApH = 7,57pCO2 = 32,5
pO2 = 61,4Biknat = 29,6Tot CO2 = 30,6BE = 7,7Sat O2 = 94,7
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Diagnosa : Ileus obstruksi
Tindakan : LaparotomyPS ASA : 3-EAnestesi : GA-ETTPosisi : supine
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Teknik anestesi????
Pre-load cairan dgn RL 500ccPosisi supineIdentifikasi L3-L4 Desinfeksi dgn betadin
dan alkohol 70%Insersi Spinocan no 25,CSF (+),Barbotage
(+),inj Bupivacain 20 mgrKembalikan ke posisi supine, blok setinggi T5
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Durante OperasiTD : 130-160/90-100 mmHgHR : 80-100SpO2: 98 – 100 Perdarahan :
Kasa basah: 100 cc Kasa ½ basah : 70 cc Suction : 100 cc Handuk : 100 cc
penguapan : 6 x 50x 2 =600 Cairan :
Pre op : 500 cc Durante op : 1500 cc
Uop :
300cc/2jam
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Keadaan Post OperasiB1 : Airway : clear, RR: 20 x/i, SP: Vesikuler,
ST: -, Sat O2 100%B2 : Akral : H/M/K, HR : 94x/i, TD : 140/90
mmHg , temp 37,8CB3 : Sens : CM, RC +/+, Pupil: isokor Ø 3 mm.B4 : UOP : (+), warna :kuning jernih, vol :
±100 cc/jam B5 : Abdomen:soepel, perut bagian tengah
tertutup perban, Mual/muntah (-),Flatus/BAB (-)
B6 : Oedem / fraktur (-)
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Problem listPasien rehidrasi ringan resusitasi lambatPasien emergency puasa tidak cukup
pasang NGT suction aktif
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Post op di pasca bedahBed restO2 2l/iIVFD RL s/s D5% 60 gtt/iInj. Ketorolac 30 mg/8 jamInj. Ranitidine 1 amp/8 jamCaptopril 12,5 mg tab/8 jam
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T ERIMA KASIHKita jumpa lg ya...