Reaksi Anafilaksis (TRANSLATED)
-
Upload
robbysyahputra -
Category
Documents
-
view
239 -
download
1
Transcript of Reaksi Anafilaksis (TRANSLATED)
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 1/34
Raveinal
Division of Allergy and Clinical ImmunologyDepartment of Internal MedicineFKUA/RS M Jamil adang
Reaksi Anaphylaxis
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 2/34
Anaflaksis adalah berat , mengancam
kehidupan , umum atau sistemik reaksihipersensitivitas
Anaphylaxis
Allergic anaphylaxis Non-allergic anaphylaxis
IgE-mediated anafilaksis Non - IgE -mediated anafilaksis alergi
Johansson SGO et al! Allergy "##$%&'()$*-)"+
What is anaphylaxis?
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 3/34
Anafilaksis mer,pakan reaksi
alergi sistemik yang erat
dapat menyeakan kematian
ter.adi secara tia-tia
ses,dah terpapar oleh alergen
ata, pencet,s lainnya
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 4/34
Mechanisms underlying humananaphylaxis
/,man anaphylaxis
Imm,nologicIdiopathic
Non-Imm,nologic
IgE 0c1RIfoods, venoms,
latex, drugs
Other blood products,
immune aggregates,
drugs
2hysicalexercise, cold
Other drugs
Simon 0ER! J Allergy 3lin Imm,nol "##'%$$4(*'4-44
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 5/34
Mengapa kita harustahu ?Anafilaksis dapat berakibat fatal
Tak terduga dan tiba-tiba
Dapat terjadi di mana saja
Prevalensi meningkatMedico legal?
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 6/34
Epidemiology :
Prevalensi anafilaksis
1 : 2!"" peserta di #D di $% & 'te(art ) #(an *
1++,
.uma/ sakit anafilaksis debit 0*, 1""""" & 1++1-2 1"*2 1""""" & 1++-0 & '/eik ) Alves * 2""" 5
1!*2!" masuk untuk anafilaksis 1++"-2""" &
3upta * et al 2""! 21 kematian dikaitkan dengan anafilaksis di
4nggris 1++2-2""1 & Pump/re5 * 2""
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 7/34
Studi populasi dalam tahun :anaflaksis%ejadian & ta/unan : 21 per 1""""" orang - ta/un
1!! (arga 5ang mengalami 10 episode anafilaksis : -
11, (arga 1 episode
- 1! (arga 2 episode
- (arga ! episode0! 6 atopi
,7 6 alergen diidentifikasi : makanan * obat-obatan dan
sengatan serangga %onsultasi alergi 02 6
8 6 ra(at inap
1 pasien meninggal
Yocum, et al. JACI 1999;104:452-6
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 8/34
Anaphylaxis can be !atal
Dapat mengenali gejala-gejala
Ta/u dan meng/indari pemicu
Memiliki rencana tindakan darurat Mengobatin5a segera dan tepat
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 9/34
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 10/34
Anaphylaxis symptoms
M$9$T gatal pembengkakan bibir dan atau lida/
T#33;.;%A gatal * sesak * men5empit * suara
serak
%$94T gatal * gatal-gatal* kemera/an * bengkak
P#.$T munta/ * diare * kram
PA.$ sesak napas * batuk * mengi
<AT4 nadi lema/ * pusing* pingsan* 'akit kepala
#$.; * ke/ilangan pengli/atan * /ilangn5a
kesadaran * inkontinensia * kebingungan
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 11/34
&rekuensi ter*adinya tanda+tanda ge*ala anaflaksis - .
Signs 6 symptoms
yg erh,,ng dgn k,lit 7rtikaria 6 angioedema 2emilasan 2r,rit,s tanpa r,ampernafasan 8yspnea mengi Atas sal,ran napas angioedema rhinitis2,sing sinkop hipotensiper,t 9,al m,ntah diare kram nyeri
8:: Sakit kepala nyeri s,sternal serangan
;#<)&-;#<+&-&&<"-&<
+#-'#<+&-&#<&#-'#<$&-"#<*#-*&<
"&-*#<
&-)<+-'<$-"<
= On the asis of a compilation of $)'& patients reported in references $ thro,gh $+
> 2ercentages are approximations
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 12/34
3rading of anap/5lactic reactions according to severit5 of clinical s5mptoms
'5mptoms
3rade Dermal Abdominal .espirator5 =ardiovascular
I Pruritus
Flus!rticariaA"#io$ema
II PruritusFlus!rticaria
A"#io$ema %"otma"$ator&'
(auseaCram)i"#
*i"orroea+oarse"ess&s)"oea
ac&car$ia % 20 /)m'loo$ )ressure ca"#e %20 mm+# s&stolic'
Arr&tmia
III PruritusFlus!rticariaA"#io$ema %"ot
ma"$ator&'
omiti"#eecatio"iarroea
3ar&"#eal oe$emaro"cos)asmC&a"osis
oc
I PruritusFlus!rticariaA"#io$ema %"otma"$ator&'
omiti"#eecatio"iarroea
*es)irator& arrest Car$iac arrest
)m /eats )ermi"ute*i"# J, roco7 8 ere"$t. +istor& a"$ classiicatio" o a"a)&lais. I" A"a)&lais. (oartis Fou"$atio" 2004:12
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 13/34
/era*at berat reaksihipersensitivitas yang luas
Derajat 3ambaran klinik*i"#a" %a"&a ulit $a" <ari"#a"su/muosa'=
>ritema luas,e$ema )erior/ita,ataua"#ioe$ema
e$a"# %eterli/ata"
)er"a)asa", ar$ioasuler,atau#astroi"testi"al
esa, stri$or, me"#i, mual, mu"ta,
)usi"#, )resi"o) $iaoresis, rasatertea" $i $a$a atau te"##oro atausait )erut
erat %i)osia,i)ote"si,atau
$eisit "eurolo#i'
ia"osis, atau )?2 @ 92 )a$a tia)
ti"#at, i)ote"si %te sistoli @ 90 mm+# )$ $e7asa', /i"#u"# ola)s, ila"#esa$ara" atau i"o"ti"e"s
= *easi ri"#a" $a)at $i/a#i la#i, $isertai atau ti$a a$a a"#io$ema
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 14/34
0rading system !or generali1edreactions 2!rom 3ro4n 56678
3rade Defined b5.ingan & kulit dan jaringansubkutan saja >
eritema umum, urtiaria , e$ema)erior/ital atau a"#ioe$ema
'edang & fitur menunjukkan
pernapasan * keterlibatankardiovaskular ataugastrointestinal
&s)"oea, stri$or , me"#i , mual ,
mu"ta , )usi"# % )resi"o) '
erat & <ipoksia * /ipotensi
atau neurologisdikompromikan '
ia"osis atau )?2 B 92 , i)ote"si
% P @ 90 mm +# )a$a ora"#$e7asa ' , e/i"#u"#a" , ola)s , 3?Catau i"o"ti"e"sia
= 8elas ri"#a" ti$a me7aili a"ailasis me"urut I"stitut (asio"al Aler#i $a" Pe"&ait I"esi -
maa"a" Aler#i $a" A"ailasis Jari"#a" % (IAI - FAA( ' ei"isi % 8ota 2 ' , eila"#a"esa$ara" ; P , tea"a" $ara sistoli . ro7" A. JACI, 2004:114:DE1-6
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 15/34
#lisitor anafilaksis & termasuk reaksi anafilaktoid
narkoba
makanan
;bat dan makanan aditif@at kerja &misaln5a lateks
racun /e(an
aeroallergen
air mani
urticariogens kontakAgen fisik & colt * panas * radiasi ultraviolet
;la/raga
kista #c/inococcal
penjumla/an anafilaksis
pen5akit 5ang mendasari
aktor pelengkap kekurangan 1 - inaktivator
mastositosis sistemik
4diopatik & ?
*i"# J, roco7 8 ere"$t. +istor& a"$ classiicatio" o a"a)&lais. I" A"a)&lais. (oartis Fou"$atio" 2004:12
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 16/34
?he ca,ses of anaphylaxis
!olden D"K# atterns of anap$yla%is& Acute ' late p$ase features of allergic reactions( In Anap$yla%is(
)ovartis foundation *++,& -+.
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 17/34
2enyea did,ga kematian "$" reaksi
'ting 8 2+ (asp* bee* 1 unidentified
uts !2 2 almond* 2 braBil* 1 /aBel* 1" peanut* , (alnut* 11 miCed orunidentified
ood 1! 1 banana* 2 c/ickpea* 2 fis/* 0 milk* 2 crustacean* 1 snail
ood? 17 1 ?fis/* 0 during meal* 1 ?grape* ! ?milk* ! ?nut* 1 ?s/erbet*1 ?stra(berr5* 1 ?5east* 1 ?nectarine
Antibiotic 28 1 benB5penicillin* 1" aminopenicillin* 12 cep/alosporin* 1ciprofloCacin* 1 vancom5cin* 2 amp/otericin
Anest/etic !0 1+ suCamet/onium* 8 vecuronium* , attracurium* 8 at induction
;t/er drug 10 ! A=# in/ibitor* , 'A4D* 0 gelatines* 2 protamine* 2 vitamin %*
1 DiamoC &acetaBolamide* 1 etoposide* 1 pet/idine* 1 /eroin* 1kabikinase* 1 local anaest/etic
=ontrastmedia
11 + iodinated* 1 tec/netium* 1 fluorescein
;t/er ! 1 lateC* 1 /air d5e* 1 /5datid* 1 idiop/atic
ump$rey RS# Fatal anap$yla%is in t$e UK# -00*1*++-( In Anap$yla%is( )ovartis Foundation *++,&--2
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 18/34
9ode of death
Drug 'ting ood ood? Male emale
9o(er air(a5s 11 ! 2 11 21 2,
$pper lo(er air(a5s , 1! ! 0 1+
$pper air(a5s 8 7 0 ! 1, 12
'/ock asp/5Cia 21 2 12 10
'/ock !2 17 2 2! 2+
Disseminatedintravascular coagulation
0 1 1 2
ump$rey RS# Fatal anap$yla%is in t$e UK# -00*1*++-( In Anap$yla%is( )ovartis Foundation *++,&-*+
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 19/34
Interval from expos,re to first arrest! 8r,g reaction
@ere fastest mostly taking less than & min,tes
ump$rey RS# Fatal anap$yla%is in t$e UK# -00*1*++-( In Anap$yla%is( )ovartis Foundation *++,&-*-
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 20/34
/$A0%9S$S
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 21/34
riteria klinik diagnosisanaflaksis;
$! ?er.adinya ge.ala penyakit segera eerapa menit
sampai .amB yang meliatkan k,lit .aringan m,kosa
ata, ked,anya ,rtikaria yang merata pr,rit,sata,
kemerahan edema iir-lidah-,v,laB 8AN 2A:ING
SE8ICI? SA?7 8ARI DERIC7? INI (
a! Gangg,an pernapasan sesak mengi-
ronkospasme stridor pen,r,nan Ar,s 2,ncak
Ekspirasi A2EB hipoksemia!
! 2en,r,nan tekanan darah ata, erh,,ngandengan disf,ngsi organ hipotonia ata, kolaps
pingsan inkontinensB
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 22/34
riteria klinik diagnosisanaflaksis5
"! 8,a ata, leih dari petanda erik,t ini yang ter.adisegera setelah terpapar ser,pa alergen pada penderita
eerapa menit sampai .amB(
a!Ceterliatan k,lit-.aringan m,kosa ,rtikaria yang
merata pr,rit,s-kemerahan edema pada iir-
lidah-,v,laB
!Gangg,an pernapasan sesak mengi-
ronkospasme stidor pen,r,nan A2E hipoksemiaB
c!2en,r,nan tekanan darah ata, ge.ala yang
erh,,ngan hipotonia-kolaps pingsan
inkontinensB
d!Ge.ala gastrointestinal yang menetapkram per,t
sakit m,ntahB
i i kli ik di i
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 23/34
riteria klinik diagnosisanaflaksis<
*! 2en,r,nan tekanan darah segera setelah terpaparalergen eerapa menit sampai .amB
a! Dayi dan anak ( tekanan darah sistolik rendah
tgt ,m,rB ata, pen,r,nan leih dari *#<
tekanan darah sistolik!! 8e@asa ( tekanan darah sistolik k,rang dari ;#
mm /g ata, pen,r,nan leih dari *#< nilai asal
pasi
= ?ekanan darah sistolik rendah ,nt,k anak didifinisikan ila 4# mm/g antara $ ,lan sampai $ tah,n k,rang dari 4# mm /g F"x
,m,rB ,nt,k $ sampai $# tah,n dan k,rang dari ;# mm /g dari $$
sampai $4 tah,n!
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 24/34
')EA'ME%'
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 25/34
=enatalaksanaan anaflaksis
1. +e"tia" )e"cetus, "ilai /erat"&a $a" /eria" tera)i &a"# sesuai
i"ta /a"tua"
A$re"ali" i.m %)aa lateral' 0.01m#G# /ole sam)ai 0.5m#
Pasa"# i"useer/ari"# rataG ti"##ia" )osisi ai /ila /ias
eria" osi#e" alira" ti"##i,alat /a"tu "a)asGe"tilasi /ila $i)erlua"
I3A +IP?>(I
Ases i..tam/aa" %<arum 14 atau 16 )a$a ora"# $e7asa' ut
i"us (aCl isiolo#is. (aCl isiolo#is /olus atau i"us 20 m3G#
$i/eria" sece)at"&a /ila )erlu $e"#a" tea"a"
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 26/34
=enatalaksanaan anaflaksis2 ila respons tidak adekuat* keadaan mengancam ke/idupan* atau memburuk:
Pertimbangkan /al-/al berikut
• <ipotensio $langi infuse a=l fisiologis 1"-2" mlkg dapat mencapai 0" mlkg dalam !" menito iv atropine ""2 mgkg bila bradikardi berat dosis minimum "1 mgo iv vasopresor untuk mengatasi vasodilatasi Pada /enti jantung adrenalin dapat
ditingkatkan menjadi !-0 mg setiap 2-! menit mungkin efektifo iv glucagons pada pasien 5ang memakai obat pen5ekat beta Dosis orang de(asa
1-0 mg diikuti 0-10 ugmnt• ronkospasme
o 4n/alasi salbutamol secara kontin5uo iv /idrokortison 0mgkg diikuti prednisone 1mgkg maksimal &0" mg selama /ari
• ;bstruksi saluran napas bagian ataso Adrenalin in/alasi &0 mg atau 0 ml sediaan adrenalin 1E1""" mungkin membantuo
Persiapkan tindakan beda/
ulai $e"#a" infuse adrenalin sesuai $e"#a" )a"$ua"G)rotocol ruma sait
AA!
!la"# a$re"ali" i.m setia) D-5 me"it
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 27/34
=enatalaksanaan anaflaksis
D . 9ama observasi dan tindak lanjut1 ;bservasi paling tidak jam setela/ semua gejala dan tanda
meng/ilang• ila memungkinkan periksa kadar triptase serum saat dating* 1 jam
stela/n5a* dan sebelum dipulangkan• Pada kasus 5ang berat pasien dira(at semalam* terutama pasien
5ang mempun5ai ri(a5at reaksi 5ang berat atau asma 5ang tidak
terkontrol dan pasien 5ang datang pada malam /ari
2 'ebelum dipulangkan pasien diberikan penjelasan mengenai alergen
tersangka dan upa5a peng/indarann5a
'etela/ dipulangkan pasien dirujuk ke a/li alergi terutama pada kasus
5ang sedang F berat* dan 5ang ringan karena alergi makanan 5angdisertai asma
D Di negara maju setela/ dibekali penjelasan dan pelati/an sebagian
pasien di berikan #piPen 5aitu adrenalin "! atau "10 mg 5ang siap
pakai
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 28/34
=harmacology o! epinephrine
Epinephrine
$-receptor "-receptor $-adrenergic
receptor
"-adrenergic
receptor
↑
vasoconstriction
↑
peripheral vasc,lar resistance↓
m,cosal edema
↓ ins,lin release
↓ neropinephrine release
↑
inotropy
↑
chronotropy
↑ ronchodilation
↑
vasodilation↑
glycogenolysis
↓
m,cosal edema
Estelle 0ER! J Allergy 3lin Imm,nol "##+%$$*()*4-++
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 29/34
Absorption o! epinephrine is !astera!ter intramuscular in*ection than
a!ter subcutaneous in*ection
Estelle 0ER! J Allergy 3lin Imm,nol "##+%$$*()*4-++
*+ ± $+ &-$"#B min,tes
p #!#&
& $# $& "# "& *# *&
)±
" min,tes
?ime to 3max after infection min,tesB
Intram,sc,lar
epinephrine
EpipenHB
S,c,taneo,s
epinephrine
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 30/34
=)E>E%'$9%
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 31/34
Education o! anaphylaxis
4ndividu dan keluarga mereka pengasu/
%asus kese/atan profesional & dokter* pera(at
responden pertama 9a5anan medis darurat
3uru pelati/ * pen5edia pera(atan anak
4ndustri makanan * restoran * pembuat /ukum
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 32/34
Mengapa menindak lan*uti
diperlukan ? Anafilaksis dapat terjadi berulang kali
Pemicun5a perlu dikonfirmasi
'trategi pencega/an jangka panjang perludilaksanakan
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 33/34
Sample "he! "ard?o the 3hef(
ARNING I am allergic to pean,ts! In order to avoid a life-threateningreaction I m,st avoid the follo@ing ingredients(
Artificial n,ts
Deer n,ts
3old pressed expelled or extr,ded pean,t oil
Gro,nd n,ts
9andelonas
9ixed n,ts
9onkey n,ts
N,t pieces
2ean,t
2ean,t ,tter 2ean,t flo,r
2lease ens,re any ,tensils 6 eK,ipment ,sed to prepare my meal as
@ell as prep s,rfaces are thoro,ghly cleaned prior to ,se! ?hanks for
yo,r cooperation
9,noL! Anaphylaxis "##+! iley 3hichester! 2! "'&-4&
7/23/2019 Reaksi Anafilaksis (TRANSLATED)
http://slidepdf.com/reader/full/reaksi-anafilaksis-translated 34/34
THANK YOU