Kedaruratan Paru-fk Umj
-
Upload
asiah-jelita -
Category
Documents
-
view
237 -
download
0
Transcript of Kedaruratan Paru-fk Umj
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 1/50
EGAWATDARURATAN
RESPIRASI
ERWIN ARIEFM. JUNUS PATAU
DIVISI PULMONOLOGIBAGIAN ILMU PENYAKIT DALAMFK UNHAS
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 2/50
ASMA EKSASERBASI (ASTHMA ATTACK)
PNEUMONIA ASPIRASI
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 3/50
ASMA EKSASERBASI(ASTHMA ATTACK)
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 4/50
Asthma exacerbation suatuepisode yg ditandai denganmeningkatnya keluhan sesak, batuk,
wheezing, chest tightness, ataukombinasi keluhan tersebut.
Ditandai penurunan aliran udara
ekspirasi (arus puncak ekspirasi/APEatau FEV1
Pencetus! in"eksi #irus $$, asap
rokok, polusi udara, dll.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 5/50
KLASIFIKASIKLASIFIKASI
Didasarkan pada :
Frekuensi
Night symptom %eterbatasan akti#itas
Faal paru (APE or FEV1
Variabilitas diurnal
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 6/50
SERANGAN ASMA
RINGAN
SERANGAN ASMA
RINGAN Sesak napas : Wak!" #e$%a&an
B'sa #e$#a$'n( Be$#')a$a : Ka&'*a!
Kesa+a$an : Ba'k
F$ek"ens' napas : , - /0*en'!
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 7/50
SERANGAN ASMA RINGANSERANGAN ASMA RINGAN
Pe*aka'an 1!1! #an!" napas0$e!$aks'
s"p$as!e$na&: !'+ak a+a
Men(' : $'n(anse+an(2 saa! ak3'$
eksp'$as'
Na+' : , 4 ka&'0*en'! P"&s"s pa$a+1ks"s: !+k a+a
5, 4**H(6
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 8/50
ASMA EKSASERBASI RINGANASMA EKSASERBASI RINGAN
APE ses"+a3 !e$ap' a7a& : 8 9
Pa O- : N1$*a&
Pa ;O- : , <= **H(
Sa!"$as' O- : 8 >=
5"+a$a #'asa6
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 9/50
ASMA EKSASERBASI
SEDANG
ASMA EKSASERBASI
SEDANG Sesak napas : Wak!" #e$#')a$a
Le#'3 s"ka +"+"k
Be$#')a$a : #e#e$apa ka!a
Kesa+a$an : #'asan?a a('!as'
F$ek"ens' napas : - @ /0*en'!
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 10/50
ASMA EKSASERBASISEDANG
ASMA EKSASERBASISEDANG
Pe*aka'an 1!1! #an!" napas $e!!$aks'
s"p$as!e$na&: #'asan?a a+a Men(' : ak3'$ eksp'$as'
Na+' : 4 4- ka&'0*en'!
P"&s"s pa$a+1ks"s : a+a 54-= **H(6
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 11/50
APE ses"+a3 !e$ap' a7a& : C 9
PaO-
: 8 C **H(
Pa;O- : , <= **H(
Sa!"$as' O- : >4 >= 5"+a$a #'asa6
ASMA EKSASERBASISEDANG
ASMA EKSASERBASISEDANG
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 12/50
ASMA EKSASERBASIBERAT
ASMA EKSASERBASIBERAT
Sesak napas : Saa! 's!'$a3a!
D"+"k *e*#"n(k"k
Be$#')a$a : ka!a +e*' ka!a Kesa+a$an : (e&'sa30a('!as'
F$ek"ens' napas : 8 / 0 *en'!
Pe*aka'an 1!1! #an!" napas: a+a Na+' : 8 4- ka&'0*en'!
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 13/50
ASMA EKSASERBASIBERAT
ASMA EKSASERBASIBERAT
Men(' : eksp'$as' 'nsp'$as' P"&s"s pa$a+1ks"s : se$'n( a+a
8 -= **H( APE : , C 5, 4 L0*en'!6 PaO- : , C **H(2 #'sa +'se$!a'
s'an1s's Pa;O- : 8 <= **H(
Sa!"$as' O- : , > 5"+a$a #'asa6
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 14/50
SERANGAN ASMA
MENGANCAM JIWA
SERANGAN ASMAMENGANCAM JIWA
Kesa+a$an : T'+ak #e('!" sa+a$
Pe*aka'an 1!1! #an!" napas : pe$(e$akan!1$ak1a#+1*'na& ?an( pa$a+1ksa&
Men(' : T'+ak a+a Na+' : B$a+'ka$+' P"&s"s pa$a+1ks"s : T'+ak a+a 51&e3 ka$ena
ke&e&a3an 1!1! pe$napasan6
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 15/50
TUJUAN PENGOBATANEKSASEBAS! AS"A
&E')*+A'%A' -0%* A+0A''APA E2EPA &'%*'
&E'AA* )*P%E&*A &E&+*)%A' F'* PA0 E2EPA
&'%*' &E'2EA) %E%A&-)A' -E0*%'3A &E'2EA) PE0+A''A' +E-*)
-E0A/ &E'2EA) %E&A*A'.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 16/50
Assesment A#a$:i#a%at Pen%akit& P' (a)sk)$tasi& otot bant)
napas&*&& APE ata) 'E+,& sat O-& AGD.Terapi A#a$:
O- & t)/)an: Sat O- 0 123 (anak- 143.!nha$asi 56- a7onist ker/a cepat secara kontin%) da$am, /am
G$)kokortikosteroid sistemik /ika tidak ada respon&ata) pasien te$ah mendapat 7$)kokortikosteroid ora$&ata) episode beratObat sedati8: kontraindikasi9
Peni$aian U$an7 sete$ah , /amP'& APE& Sat O- dan pemeriksaan $ain (bi$aper$).
Episode -eratEpisode edang
A$7oritme Tata$aksana AsmaEksaserbasi
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 17/50
Kriteria Episode Berati#a%at 8aktor risiko near8ata$ asma
APE ;2 3 prediksiP': ke$)han berat saatistirahat& retraksi dindin7dadaTidak ada perbaikan st$h
terapi a#a$Terapi:O-!nha$asi 56- a7onist dananti6koiner7ik G$)kokortikosteroidsistemik
"a7nesi)m !+
Kriteria Episode Sedan7APE ;26<23 prediksiP': ke$)han sedan7&
pen77)naan otot bant)napasTerapi:O-!nha$asi 56- a7onist dan
inha$asi anti6ko$iner7iksetiap ;2 mntG$)kokortikosteroid ora$Terapi diter)skan sampai ,6= /am
Peni$aian U$an7 sete$ah ,6- /am
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 18/50
0espon -aikesponmenetap ;2
mnt sete$ahterapi terakhirP' norma$& tdkada distres
APE > ?23Sat O- 0 123(143 pd anak.
0espon *nkomplitisiko near
fatal asma
P': 7e/a$arin7an @sedan7APE ;23
Sat O- tidakmembaik Penan7ananUnit Pera#atanAk)tO-!nha$asi 56-a7onist anti6ko$iner7ik
G$)kokortikost
0espon -urukisiko near
fatal asma
P': ke$)hanberat&dro#siness&con8)sion
APE =23PO- > C4mm*7PO- ;2mm*7Penan7anan!U:O-!nha$asi 56-
a7onist Peni$aian U$an7
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 19/50
&embaik! kriteriara4at rumah
APE > ;2 3 prediksi"embaik d7n terapiora$Hinha$asi
Terapi di r)mah:Ian/)tkan inha$asi56- a7onistPertimban7kan7$)kokortikosteroid
ora$Pertimban7kanmenambah inha$erkombinasi
Ed)kasi pasien :
espon B)r)k ($ihatdi atas.:
Penan7anan !U espon !nkomp$itda$am ;6,- /am ($ihatdi atas.Pertimban7kan
penan7an7an !U /ikatidak ada perbaikanda$am ;6,- /am
&embaik (lihat di
sebelah
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 20/50
USING NEBULIZER
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 21/50
PNEUMONIA ASPIRASI
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 22/50
%onsekuensi pd paru akibat masuknya ! cairan, substansi padat/partikel, atau
sekret endogen 3g berasal dari )pper air#a%s atau7astric contents.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 23/50
0isiko aspirasi ! gangguan mekanismetubuh
yang melindungi saluran napas ba4ah, antara lain!
gangguan penutupan glottis, terganggunya re5eks batuk, atau mekanisme permbersihan (clearance
mechanism lainnya.
&aterial yang teraspirasi proses
in5amasi
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 24/50
Faktor risiko! ransient (anestesi umum,intoksikasi, drug abuse
Persistent (gangguanneuromuskular/sei6ure, akalasia
Flora normal rongga mulut (ginggi#al
cre#ice in"eksi paru anaerob
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 25/50
Fulminating anaerobic pneumonia, a 778year8old 4oman 4ith onset o" pneumonia 9 days be"oreadmission. A. Day of admission. Patchy consolidation in right lower lung eld and behind the
cardiac silhouette. B. ne day a"ter admission! E:tensi#e patchy al#eolar in;ltrates bilaterally 4ithareas o" rare"action on right suggesti#e o" ca#itation.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 26/50
<<angrene= o" the lung a"ter aspiration,anteroposterior ( A) and lateral (B ) iews. !"tensiecaitation
"ollo4ing necroti6ing pneumonia.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 28/50
"ani8estasi k$inis: Pasien umumnya dgn "aktor risikoaspirasi
*n"eksi pada ginggi#a (ginggi#al
cre#ice -atuk dgn sputum berbau busuk %ecenderungan komplikasi supurati"
pada kasus8kasus lan>ut.
Demam Fe#er +eukositosis esak na as leuritic chest ain
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 29/50
"etode mence7ah aspirasi
a. emirecumbent position atau posisi tegak.b. &engurangi #olume/isi lambung
(metoklopramide atau pipa nasogastrik
c. 2egah ter>adinya regurgitasid. 'etralisasi asam lambung dengan )?
blockers atau antasida.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 30/50
PENATALA SANAAN
Penanganan di"okuskan pada!
erapi antimikroba optimal Drainase >ika terdapat abses atau empyema
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 31/50
Terapi Antimokrobia$
@ika memungkinkan! pengambilanspesimen untuk pemeriksaanmikrobiologik (dari paru atau darah
bat standar! Penicillin Alternati"! clindamycin, metronida6ole
penicillin, beta8lactam anti beta8lactamase inhibitor (ticarcillin8cla#ulanate,
ampicillin8sulbactam, amo:icillin8cla#ulanate, piperacillin8ta6obactam,chloramphenicol, imipenem ataumeropenem, and ?nd generation
cephalosporins seperti ce"o:itin atau
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 32/50
Durasi th/B tergantung klinis C20 pasien
erapi dilan>utkan sampai setidaknyademam, purulensi sputum dan cairanabses berkurang/menghilang.
Direkomendasikan minimal ? 8
antibiotika.
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 33/50
ARDS
(Acute Respiratory Distress
Syndrome)
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 34/50
ARDS :Gangguan fungsi paru akiba
k!rusakan a"#!$"i %g &ifus %g
'!n%!babkan !&!'a a"#!$"i %ang&is!rai &gn ip$ks!'ia
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 35/50
riteria diagnosis menurut
AECC (199!"
Ons! aku
In&!ks $ksig!nasi (PaO*+,iO*) - *..''Hg
,$$ $raks infi"ra a"#!$"ar bi"a!ra"
PA/P - 01 ''Hg aau i&ak a&a bukik"inis HT ariu' kiri
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 36/50
PENYEBAB ARDS
I . LANGSUNGII. TIDAK LANGSUNG
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 37/50
Langsung AspirasiTenggelam
Inhalasi asap aau !ahan"imia #"si"
K#nusi# paruKera$unan #"sigen%neum#nia
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 38/50
Ti&a" langsung '
S(#" !eraSepsis%an"reaiisEm!#li lema"
Trans)usi !erle!ihan%as$a ransplanasi paru
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 39/50
%AT*GENESISBelum &i"eahui &engan
pasi &i&uga "elainann(aerlea" pa&a mem!ran
al+e#lar,"apiler
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 40/50
#er$agai se$a$ ARDS
mem$ran a%&eo%o'a)i%er
)ermea$i%itas
a%iran *airan dari intra e
estra &asu%er
edema
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 41/50
Patogenesis ARDS secara
umum:
1.Edema paru
2.Shunting dalam darah paru3.Fibrosis pada jar. paru
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 42/50
ambaran !linisDispnea " ta#ipnea
$ipo#semia dgn sianosis %angmenetap
!repitasi %g luas pada #edua paru
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 43/50
&aboratorium
Analisa gas darah
hipo#semia Pa'2 ( )*
mm$g
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 44/50
Radiologi :
+n,iltrat paru di,us edema bilateral-snow storm appearance
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 46/50
PE/A0A&A!SA/AA/
0erapi sangat #omple#s
1. 0erapi suporti,
2. 0erapi pen%a#it dasarn%a
0 i S i,
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 47/50
0erapi Suporti,
a. entilasi me#ani# mening#at#an
o#sigenasi %ang ade#uat
b. Perubahan posisi mengeluar#an
se#ret ,isioterapi
c. /itrat o#sida memperbai#i
o#sigenasi arteri paru danmenurun#an resistensi as#uler paru
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 48/50
d. Sur,a#tan
e. !orti#osteroid
7/23/2019 Kedaruratan Paru-fk Umj
http://slidepdf.com/reader/full/kedaruratan-paru-fk-umj 49/50
PR'/'S+S
Prognosis buruk oleh karena :Gegala dini sulit dikenaliMekanisme tidak diketahuiPatofisiologinya kompleksGejala klinis yang bervariasi
Proses progresifKorelasi antara th/ & hasilnya tidak
memuaskan