BA Saluran Nafas
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Benda Asing Saluran Nafas
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BA endogen : gigi, sekret, clott, dll BA eksogen :
Organik : biji-bijian, kacang, dllAnorganik: paku, jarum, peniti ,dll
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Faktor predisposisi
Personal : Umur : < 3 th memasukkan sesuatu dlm mulutJenis kelamin : anak laki-laki > anak perempuan
↓ mekanisme proteksi normal: kesadaran ↓, tidur, epilepsi, alkohol,dll
Kelainan neurologis, fungsi menelan blm sempurna pada anak
Dental : gigi molar blm tumbuh / sudah tanggal
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Faktor kejiwaan : retardasi mental, psikosis Kecerobohan : menggigit jarum, peniti, dll
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PATOFISIOLOGI
Mekanisme pertahanan :- epiglotis & kart. aritenoid menutup jalan napas- spasme k. vokalis & pl. ventrikularis bila ada benda mendekati k. vokalis- refleks batuk impuls aferen pd laring, trakea, bronkus
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Saat Menelan Epiglottis Menunduk (Tutup Laring)
Tertawa, Menangis, Teriak, Terkejut
Inspirasi Kuat / DalamLaring Terbuka
Aspirasi
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Gejala dan tanda
Tergantung fase Derjat sumbatan tergantung letak, ukuran,
bentuk dan jenis BA.
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Terdapat 3 fase aspirasi1. Fase awal :
Pada saat BA terjepit di sfingter laring. Px tiba-tiba batuk-batuk bertubi-tubi (violent paroxixm of coughing), sesak nafas / tercekik (chocking), gagap (sputtering), wheezing, sianosis
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2.Bila benda asing masuk trakea atau bronkus: Kadang terjadi fase asimtomatis selama 24 jam / lebih (tergantung derajat sumbatan): BA terhenti, refleks batuk ↓, gejala iritatif ↓ sering tjd keterlambatan diagnosis
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3. Fase komplikasi: obstruksi, iritasi, infeksi batuk, hemoptisis, pneumonia, atelektasis, abses paru, dll
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B A Di Laring
Terjepit di glottis / subglottisGejala tgt ukuran dan bentuk obstruksi
total / parsial.Obstruksi total gawat darurat.Obstruksi parsial : parau, wheezing, stridor,
odinofagia, batuk, dll.BA sudah turun ke trakea/ bronkhus, tp
meninggalkan gejala sisa misalnya edema laring.
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Gejala spt B A di laring Patognomonis : audible slap, palpatory thud,
asmathoid wheeze (saat ekspirasi) Sesak nafas tgt ukuran & bentuk BA
B. B A Di Trakea
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BA Di Bronkhus
Bronkhus kanan lebih sering dp. kiriSering asimtomatis kecuali pada fase
komplikasiFase asimtomatis: foto toraks sering dalam
batas normal bila BA radiolusen.B A organik menimbulkan reaksi lebih hebat
dp anorganik
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Diagnosis Anamnesis: Pemeriksaan fisik
Bisa normalDidapat gejala dan tanda
Pemeriksaan penunjangFoto toraks AP / lateral:
• Bila BA radioopaque: segera foto• BA radiolusen : foto bila kejadian > 24 jam (<24 jam
tampak normal)Video fluoroskopiBronkogram: untuk BA radiolusen terutama di perifer
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Penatalaksanaan
A. BA di laring Emergensi : obstruksi total Pd anak: pegang posisi terbalik (kpl di
bawah) Punggung / tengkuk dipukul Diharapkan BA jatuh
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Cara lain: Heimlich(bila obstruksi total) Komplikasi Heimlich: trauma gaster, hepar,
costae
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Bila obstruksi parsial: Heimlich tdk bisa Ekstraksi dg laringoskop / bronkoskop Bila tidak tersedia alat: trakeotomi
sebelum rujuk(dg Trendelenburg)
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B. BA di trakea / bronkus -Rujuk untuk ekstraksi dengan bronkoskop-Bila fasilitas bronkoskopi tidak ada trakeotomi-Bila mungkin diekstraksi dengan cunam atau suction via trakeotomi.
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Antibiotik dan steroid tidak rutin Fisioterapi dada : pada kasus pneumoni,
bronkitis purulen dan atelektasis Px pulang 24 jam pasca tindakan bila
komplikasi (-)
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Radiograph of an adolescent with achewed pen cap in his mid-trachea (arrows).
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