8/3/2019 tbm untad

1/30

aristo

EMERGENCY NONTRAUMATOLOGI

8/3/2019 tbm untad

2/30

Kegawatdaruratan penyakitdalam

Respirasi : Asmabronkhial, hemoptisis Kardio : KrisisHipertensi,ACS

Endokrin : KAD, KHOHNK, Hipoglikemi

Gatro : Hematemesis melena, Diare akut

Infeksi : DSS, Syok septik

Immunologi : Intoksikasi opiat,Anafilaktik

http://smb//tmp/svcdd.tmp/SINDOMA%20KORONER%20AKUT.pptxhttp://smb//tmp/svcdd.tmp/SINDOMA%20KORONER%20AKUT.pptx

8/3/2019 tbm untad

3/30

Terima kasih

8/3/2019 tbm untad

4/30

8/3/2019 tbm untad

5/30

8/3/2019 tbm untad

6/30

8/3/2019 tbm untad

7/30

Asma brokhial

Obstruksi saluran yang napasreversibel

Inflamasi kronik sal. nafas

Hiperaktivitassaluran napas

Sundaru Heru IPD UI 2006; 245-250

http://smb//tmp/svcdd.tmp/patofis%20asma.pptxhttp://smb//tmp/svcdd.tmp/patofis%20asma.pptx

8/3/2019 tbm untad

8/30

Alergen + APC

H ip e rktiv ita s d a n in fla m a si

Im m u n o lo g i Ig E

S e lT h e lp e r

a u to n om

M o n o sit

M a kro fa gE o sin o fil

,to m b o sit

lim fo sit

-Sel plasma IgE

, , ,Histamin PG leukotrin PAF tromboxan

Inflamasi autonom

8/3/2019 tbm untad

9/30

Aktivasi mediator2 pro inflamasi

Perm. Vascularmeningkat

Infiltrasi sel radang Sekresi mukus

Fibrosis subepitelial

8/3/2019 tbm untad

10/30

diagnosa

Gejala klinis Episode batukMengi/ wheezing

Sesak nafasKadang disertai pilek, bersin

Riwayat atopi

8/3/2019 tbm untad

11/30

Goal Treatment

Menghilangkan obstruksi secepatmungkin

Menghilangkan hipoksemi

Mengembalikan faal paru ke normalsecepat mungkin

Mencegah kekambuhan

8/3/2019 tbm untad

12/30

8/3/2019 tbm untad

13/30

PENILAIAN AWAL

Subjektif

Pemeriksaan fisik

Analisis gas darah

Tentukan derajat berat serangan

8/3/2019 tbm untad

14/30

pengobatan

Hindari pencetus

Lebarkan saluran nafas

Kurangi respon inflamasi

8/3/2019 tbm untad

15/30

Pengobatan Awal

Inhalasi agonis -2 short acting 3x tiap20 menit atau

~ Injeksi Adrenalin 0,3 mg SC

~ Injeksi Terbutalin 0,25 mg SC

Bolus aminofilin 3 - 5 mg / kg BB

O2 saturasi oksigen > 90 %

8/3/2019 tbm untad

16/30

Kortikosteroid sistemik

ORAL Metilprednisolon atau prednison mulai 60 mg, 40 - 60 mg dalam

dosis terbagi

INTRAVENA

Metilprednisolon : 40 - 125 mg IV/6-8 jam

Hidrokortison : 2,0 mg/Kg BB IV/ 4jam

8/3/2019 tbm untad

17/30

Pemulangan pasien

Teruskan terapi inhalasi agonisbeta-2

Pertimbangkan kortikosteroid oral

Edukasi penderita :pakai obat dengan tepat

rencana jangka panjang

kontrol teratur

8/3/2019 tbm untad

18/30

ke m b a li

8/3/2019 tbm untad

19/30

8/3/2019 tbm untad

20/30

KRISIS HIPERTENSI

8/3/2019 tbm untad

21/30

8/3/2019 tbm untad

22/30

Severe hypertension

Blood pressure 180/110 Abscence of symptoms moderate headache

Without evidence of damage mmHg beyond

mild or acute target organ

Prim Care Clin Office Pract 2008; 35: 475487

8/3/2019 tbm untad

23/30

Hypertensive urgency

Blood pressure 180/110 mmHg

Presence of symptoms moderateheadache

Without evidence of damage beyondmild or acute target organ

Prim Care Clin Office Pract 2008; 35: 475487

8/3/2019 tbm untad

24/30

Hypertensive emergency

Very high blood pressure (often > 220/140mmHg)

Accompanied by evidence organ dysfunctio of

life-threatening

Prim Care Clin Office Pract 2008; 35: 475487

8/3/2019 tbm untad

25/30

8/3/2019 tbm untad

26/30

Patophysiology of ahypertensive crisis is not

well known.

8/3/2019 tbm untad

27/30

8/3/2019 tbm untad

28/30

Goal of Treatment

The goal of treatment in a hypertensiveemergencies is to restore bloodpressure to arange in which

autoregulatory forces may be re-established.

The treatment target is often not a

normal blood pressure, but insteadone that is only moderately lower, justsufficient to allow autoregulation to berestored.

8/3/2019 tbm untad

29/30

JNC-VII RECOMMENDATION

Reduce Mean Arterial BP no More than25 % over 2 hours then Reduce to160 / 100 mm Hg within 2-6 hours.

Avoid excessive falls in blood pressureWith the exception of patients withaortic dissectiotion, the BP should notbe reduce to normotensive and

especially hypotensive levels, astarget organhypoperfusion may results

Titrate with intravenous

antihypertensives.

8/3/2019 tbm untad

30/30

B a c k