Professional Documents
Culture Documents
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Pleurodynia
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Pneumotoraks tension
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Syndrome)
benda
asing
(Pulmonary
Aspiration
Foto toraks :
Penanganan :
Thoracentesis
Massive Atelectasis
Foto toraks :
Penanganan :
Klinis : Sesak nafas yang tiba-tiba dan berat, terasa berat/sakit di dada,
sianosis, takikardia, hipotensi, keringat besar-besar.
PD.
Inspeksi: Gerakan dada yang sakit bisa tertinggal
Palpasi: Stemfremitus lemah hilang pada sisi yang sakit
Perkusi: Hiper sonor - tympani
Auskultasi: Suara pernafasan hilang pada sisi yang sakit
Foto toraks :
Tampak hyperlucent dan corakan paru tidak ada
Tampak pleural line
Tampak gambaran paru kolaps
Trakhea terdorong ke sisi yang sehat
Mediastinum/jantung terdorong ke sisi yang sehat
Penanganan :
Segera diberik oksigen yang adekuat
Tusukkan abocat 14 18 di daerah sela iga 2 mid clavicularis ,lalu
hubungkan dengan infus set yang diletakkan di dalam air
Bila pasien sudah tenang (sesak berkurang) segera pasang WSD
Pada keadaan pasien yang life threatening jangan tunggu X-ray,
bila sudah dapat dipastikan ventil pneumothorax secara klinis .
Haemoptisis
Definisi : Adalah batuk-batuk yang disertai dengan dahak
yang bercampur darah.
Klasifikasi haemoptisis (Busroh 1978):
Haemoptisis masif :
Bila perdarahan kurang dari 600 cc tetapi lebih dari 250 cc/24
jam, akan tetapi Hb kurang dari 10g%
Etiologi
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Penanggulangan :
PENATALAKSANAAN SELANJUTNYA
Subcutenuous emphysema =
hammanss crunch
Penatalaksanaan
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PLEURODYNIA
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NEAR DROWNING
DEFINITION
Near drowning adalah bila seseorang
dapat bertahan hidup setelah
mengalami tenggelam dalam waktu 24
jam setelah peristiwa itu. Hal ini
secara tidak langsung juga
menerangkan bahwa recovery telah
terjadi. Istilah yang juga dipakai
dibeberapa artikel adalah submersion
injury atau submersion incident.
Edema paru
Meningkatnya shunt
Toksisitas langsung dari cairan teraspirasi
Inaktivasi surfactan
Hanyutnya surfaktan
Cidera pada membran alveolar
PENATALAKSANAAN
Airway Maneuvers
Hipoksia, ventilasi,bantuan nafas mouth-to-mouth
Resusitasi Kardiopulmoner (A,B,C)
Oksigen 100%, intubasi, suction, posisi miring ke
lateral.
Penanganan Hipoksia
PROGNOSIS
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O2
Intubation/mechanical ventilation
Bronchoscopy
FLAIL CHEST
Foreign body
Epiglottitis
Usually hemophilus influenzae type b, also
strep. pneumoniae. Treat with 3rd
generation cephalosporin, e.g. cefotaxime
2 g tds (adults). Children more likely to
require intubation, but if any concens over
airway then patient (adult or child) should
be monitored on ITU after anaesthetic
assessment.
Diptheria
Tumour obstruction
Collapse
Severe dyspnoea
Management
Priorities are
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PULMONARY EMBOLISM
PE is preceded by DVT, the factor
predisposing to two conditions are the
same and broadly fit Virchows triad of
venous stasis, injury to the vein wall and
coagulability of the blood .
PULMONARY EMBOLISM
TROMBOSIS VENA:
2. Polimerisasi fibrin
menstabilkan bekuan
3. Bekuan terbentuk
TROMBOSIS VENA
Emboli
Pulmonary embolism
Surgery1
Trauma2
Malignant disease1
Acute MI3,4
Acute infection3,4
Acute heart failure2
Acute respiratory failure3,4
Antiphospholipid syndrome1
Stroke2
Congestive heart failure2
Hypertension5
Myeloproliferative disorders1
Nephrotic syndrome2
Inflammatory bowel disease2
Obesity2
Varicose veins2
Immobility1
Long-distance travel6
Pregnancy and puerperium1
Previous venous thrombosis1
PULMONARY EMBOLISME
Serious Infections
Ischemis Cardiomyopathy
Non-ischemic cardiomyopathy
CHF Secondary to valvular Disease
Chronic idiopathic cardiomyopathy
CHF Secondary to arrythmias
Pneumonia
- Urinary Tract Infection
- Abdominal Infection
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Elderly Patients
All hospitalized elderly patients who are immobilized for 3 days or more and who have
serious underlying medical conditions known to be risk factor for DVT should be
considered for prophylaxis with Low Molekular Weight Heparin
Reference : Bosker G. Thrombosis Prophylaxis in Seriously ill Mediccal Patients : Evidence-Based Management, Patient Risk Stratification, and
Outcome Optimizing Pharmacological Management. Internal Medicine Consensus Reports. Juni 1, 2001: 1-8
Tanpa gejala
Tachypnea, rales
Suara jantung sekunder accentuated
Tachycardia (heart rate >100/min)
Fever/demam (temperature >37.8 C)
Diaphoresis (-)
S3 atau S4 gallop
Thrombophlebitis
Edema ekstrimitas bawah
Cardiac murmur
Cyanosis
Pleuritis
Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM, Program Director, Associate Professor, Department of Internal
Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Manitoba; Site Director of Respiratory
Medicine, St Boniface General Hospital, June 2006
DIAGNOSTIC SUPPORT
Clinical sign and Symptom
CXR
D-dimer
Venous Ultrasonography
Echocardiography
Spiral CT
Ventilation Perfution Scan
Pulmonary Arteriography
Penatalaksanaan
I. Penanganan pada fase akut
- bed rest & elevasi kaki
- mobilisasi dini
II. Terapi PE
a. Antikoagulan:
- Heparin pemantauan aPTT 1,5-2,5 kali
nilai normal
- LMWH
- Dilanjutkan dengan antikoagulan oral (warfarin)
b. Thrombolityc Therapy
c. Inferior Vena Cava Interuption
d. Pulmonary Embolectomy
e. Supportive Care
CLASSIFICATION OF ASTHMA
SEVERITY
INTERMITTENT
Symptoms less than once a week
Brief exacerbations
Nocturnal symptoms not more than twice
a month
FEV1 or PEF > 80% predicted
PEF or FEV1 variability < 20%
MILD PERSISTENT
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MODERATE PERSISTENT
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Symptoms daily
Exacerbations may affect activity and sleep
Nocturnal symptoms more than once a week
Daily use of inhaled short acting B2-agonist
FEV1 or PEF 60-80% predicted
PEF or FEV1 variability >30%
SEVERE PERSISTENT
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Symptoms daily
Frequent exacerbations
Frequent nocturnal asthma symptoms
Limitation of physical activities
FEV1 or PEF < 60% predicted
PEF or FEV1 variability > 30%
SEVERE OR LIFE-THREATENING
ASTHMA
Severe airway obstruction
Exhaustion
Bradycardia or arrhythmia
Ventilation-Perfusion mismatch
Cyanosis
Hypoxia
Ventilatory failure
Rising Pa Co2
Confusion or coma
Acute severe asthma
Inability to complete sentences in one breath
Respiratory rate > 25x/min
Tachycardia (HR > 100/min
PEF 30-50 % predicted
Managemen
Initial treatment
Sit the patient up in bed
Oxygen 15L/min (least 60 % )
Nebulized bronchodilator : Salbutamol 5
mg or terbutalin 10 mg every 15-30
minutes
Add ipratropium bromida 0,5 mg 4-6
hourly if response to B2-agonists is poor
Indication to ICU
Hypoxia ( PaO2 < 60 mmHg,FiO2 60% )
Rising PaCO2
Exhaustion,drowsiness or coma
Respiratory arrest
Failure to improve despite adequate
therapy
CAUSES
Infective exacerbation (no new CXR
changes):Typically H.influenzae,
S.pneumoniae,Moraxella catarrhalis. Commonly
viral
Community acquired pneumonia (new CXR
changes)
Exposure to known allergen
Pneumothorax
Expansion of large bullae
Sputum retention with lobar or segmental
collapse (atelectasis)
Myocardial ischaemia,pulmonary oedema,cor
pulmonale,pulmonary embolism
MANAGEMENT
TREAT HYPOXIA AND RESPIRATORY
FAILURE
- Oxygen therapy
- Arterial blood gases
- NIV (non invasive ventilation)
- Mechanical ventilation
- Respiratory stimulants (doxapram)
SEPTIC SHOCK
BAHAN PENYEBAB
Tabel Beberapa inhalan toksik dan mekanisme
kerjanya
Tipe
Gas iritan
Penyebab asfiksia
Inhalan
Sumber
Mekanisme
Amonia
Klorin
Sulfur dioksida
Nitrogen dioksida
Karbon monoksida*
napas
Hidrogen
sianida
Pembakaran
polyurethane, Asfiksia jaringan dengan menghambat
nitrocellulose (sik, nilon, wool) aktiviti cytochrome axidase intrasel,
menghamabt produksi ATP, meningkatkan
anoksia sel
Hidrogen sulfida
Hidrokarbon
Penyalahgunaan
inhalan
(toluene, benzena, freon),
aerosol, lem, bahan bakar
kendaraan,
pembersih
pewarna kuku, bensin, cairan
pembersih
Organofosfat
Asap metal
Toksin sistemik
Endothelial injury
Disturbed capillary
Blood flow
Macrophages
Neutrophyls
Pulmonary
microcirculation
Injury to alveolar
capillary membrane
Microvaskular permeability
Mediators
Intertitial and alveolar
Damage, Edema
ARDS
DIAGNOSTIC SUPPORT
TATA LAKSANA
SUPORTIF
Tanda vital tetap stabil, paparan zat
toksik, eliminasi zat toksik
Nyaman, lifes saving A,B,C.. segera
Resusitasi, sistim respirasi,patensi sal
napas, ventilasi, oksigenisasi
Monitor, hemodinamik
Cegah kerusakan organ lain
Rawat intensif
KHUSUS
Monitor 4-12 jam
Kembali ke RS, bila perburukan setelah
24-48jam
Progresivitas gawat napas intubasi
ventilator
Bronkial toilet
Kasus akut : steroid, bronkodilator
Atasi infeksi sekunder segera
Antidotum
Oksigenisasi adekuat