TATA LAKSANA ASMA SERANGAN SERANGAN BERAT PADA ANAK RONI NANING BAG.ILMU KESEHATAN ANAK FK UGM/RSUP DR SARDJITO YOGYAKA YOGYA KARTA RTA
Print document
SERANGAN ASMA : In order to print this document from Scribd, you'll first need to download it. Cancel
•
•
Download And Print
episode perburukan progresif gejala batuk, sesak napas, mengi, rasa dada tertekan atau kombinasi mencerminkan gagalnya tatalaksana jangka panjang atau adanya pajanan dengan pencetus
Print document
SERANGAN ASMA : In order to print this document from Scribd, you'll first need to download it. Cancel
•
•
Download And Print
episode perburukan progresif gejala batuk, sesak napas, mengi, rasa dada tertekan atau kombinasi mencerminkan gagalnya tatalaksana jangka panjang atau adanya pajanan dengan pencetus
Print document
Patofisologi serangan asma In order to print this document from Scribd, you'll first need to download it. Pencetus
Cancel Download And Print b.konstriksi, edem, sekresi
obstruksi jalan napas
atelektasis
ventilasi tidak seragam
hiperinflasi paru
ventilasi-perfusi tidak padu padan
gangguan
compliance
p surfaktan
hipovent.alv asidosis
v.konstriksi pulmonal
PaCO2
p kerja napas
PENILAIAN DERAJAT Print document SERANGAN ASMA
In order to print this document from Scribd, you'll first need to download it.
Parameter Aktivitas (bayi)
Ringan
Berat CancelSedang Download And Print
Bicara
Berjalan (menangis keras) Kalimat
Berbicara Istirahat (menangis (berhenti lemah) makan) Penggal klm. Kata-kata
Posisi
Bisa baring
Kesadaran
Mungkin teragitasi Tidak ada
Lebih suka duduk Biasanya teragitasi Tidak ada
Sianosis Mengi
Sedang, akhir eksp. Sesak napas Minimal
Duduk bertopang lgn. Biasanya teragitasi Ada
Nyaring, Terdengar eksp. + insp. tanpa steto. Sedang Berat
Ancaman gagal napas
Bingung
Sulit / tidak terdengar
Print document
Otot bantu napas Retraksi
Laju napas
Biasanya Biasanya ya Ya In order to print this document from Scribd, you'll tidak first need to download it. Dangkal, ret. Sedang, + Dalam, + interkostalCancelret.sup.stern Download Andnps.cpg.hdg Print Takipnu Takipnu Takipnu
Gerakan paradok Dangkal / hilang Menurun
Laju nadi
Normal
Bradikardi
Pulsus paradoksus PEF / FEV 1 -pra b.dilat. -pasca b.dil SaO2
Tidak ada Ada Ada (<10 mmHg) 10-20 mmHg >20 mmHg (% nilaiduga / % nilai ter- baik) >60% 40-60% <40% >80% 60-80% <60% >95% 91-95% <90%
PaO2
Normal
>60 mmHg
<60 mmHg
PaCO2
<45 mmHg
<45 mmHg
>45 mmHg
Takikardi
Takikardi
Tidak ada (Otot lelah)
Print document
PASIEN RISIKO TINGGI : In order to print this document from Scribd, you'll first need to download it.
•
And Print serangan asmaCancel yangDownload mengancam nyawa
•
intubasi karena serangan asma
•
pneumotoraks dan/atau pneumomediastinum
•
jangka waktu gejala yang lama
•
steroid sistemik (belum lama / baru lepas)
•
ke RS karena serangan asma dalam 1 tahun
•
pengobatan tidak teratur
•
berkurangnya persepsi tentang sesak napas
•
penyakit atau masalah psikososial
Print document
TUJUAN TATALAKSANA : In order to print this document from Scribd, you'll first need to download it. Cancel •
•
•
•
Download And Print
Meredakan penyempitan jalan napas secepatnya Mengurangi hipoksemia Mengembalikan faal paru normal secepatnya Re-evaluasi tatalaksana untuk mencegah kekambuhan
jenis obat
Print document In order to print this document from Scribd, you'll first need to download it.
•
AGONIS-BETA (ß) Cancel
•
Download And Print
•
S al b u t a m o l (a lb u t er o l )
•
Terbutalin
•
Fenoterol
•
Procaterol
•
Adrenalin
Antikolinergik •
Ip r at r o p i u m b r o m i d
Print document •
•
•
GOLONGAN SANTIN
In order to print this document from Scribd, you'll first need to download it.
•
AMINOFILIN Cancel Download And Print
•
TEOFILIN
KORTIKOSTEROID •
Prednison
•
Metil-prednisolon
•
Dexametason
•
Hidrokortison
MgSO4
Dosis obat
Print document
In order to print this document from Scribd, you'll first need to download it.
•
Salbutamol (albuterol) 0,1-0,15 mg/kgbb/kali atau 1 nebule/kali Terbutalin 0,05 mg/kbbb/kali Fenoterol 0,1 mg/kgbb/kali Cancel
•
•
•
Download And Print
Antikolinergik •
Ipratropium bromid 25 ug/kgbb/kali atau 0,1 ml/kgbb
……..dosis obat
Print document •
Aminofilin –
–
–
•
In order to print this document from Scribd, you'll first need to download it.
dosis inisial 4-6 mg/kgbb bolus dalam dextrose atau Cancel Download And Print garam fisiologis 20 ml dalam 20-30 menit Bila sudah mendapat aminofilin kurang dari 8 jam sebelumnya, dosis separuhnya dosis rumatan 0,5-1 mg/kgbb/jam
Steroid –
–
–
•
Metilprednisolon 1 mg/kgbb tiap 6-8 jam Hidrokortison 4 mg/kgbb tiap 6-8 jam Deksametason 1 mg/kgbb/hari
MgSO420-50 mg/kgbb setiap 4 jam atau 20 mg/kgbb/jam
Print document
TINDAKAN :
In order to print this document from Scribd, you'll first need to download it.
• •
Oksigen dengan kanul nasal 0,5-2 l/menit Cancel Download And Print Bronkodilator kerja cepat (salbutamol atau terbutalin) ditambahkan antikolinergik (Iptratropium bromide) inhalasi dengan nebulizer –
•
• • •
Aminofilin bolus dilanjutkan dengan rumatan
Cairan untuk mengatasi dehidrasi,kebutuhan 1,5 kali kebutuhan rumatan Steroid iv Analisis gas darah ( penilaian asidosis) Rontgen foto toraks ( kemungkinan adanya komplikasi spt atelektasis,pneumotoraks)
Print document •
•
• •
•
•
………TINDAKAN
In order to print this document from Scribd, you'll first need to download it.
Salbutamol + ipratropium bromid inhalasi diberikan tiap 1-2 jam, jika dalam 4-6 kali Cancel Download And Print pemberian terjadi perbaikan klinis inhalasi diperlebar tiap 4-6 jam Setelah perbaikan klinis nebulisasi diteruskan tiap 6 selama 24 jam Steroid dan aminofilin ganti peroral Bila dalam 24 jam, pasien bisa dipulangkan dengan dibekali obat beta 2 agonis (oral atau inhalasi)selama 24-48 jam Steroid dilanjutkan sampai 24-48 jam dan kontrol untuk reevaluasi tatalaksana Bila pasien menunjukkan tanda dan gejala ancaman henti napas langsung rawat di ICU
Print document
KRITERIA RAWAT ICU: In order to print this document from Scribd, you'll first need to download it.
•
And Print tatalaksana IGDDownloadtidak ada respons samasekali Cancel
•
perburukan cepat
•
tanda klinis ancaman henti napas
•
•
tatalaksana di ruang rawat inap tidak ada perbaikan dengan O2 tetap hipoksemia (PaO2 <60 &/ PaCO2 >45 mmHg)
Print document
Kasus kegagalan tindakan standar In order to print this document from Scribd, you'll first need to download it.
•
•
And Print Sekitar 15 % kasusDownload asma serangan berat Cancel
Dapat digunakan obat tambahan MgSO4 intra vena –
•
dosis 20-50 mg/kgbb/dosis atau 20 mg/kgbb/jam
Kadar MgSO4 diperiksa setiap jam infus titrasi, kadar dijaga antara 3,5 4,5 meq/dl –
Print document
Keadaan yang bisa menimbulkan respons terapi tidak baik In order to print this document from Scribd, you'll first need to download it. Cancel •
Dehidrasi
•
Asidosiss
•
•
Download And Print
Ada kompilkasi seperti atelektasis,pneumotoraks Ada penyakit penyerta
ALGORITMA SERANGAN ASMA Print document
In order to print this document from Scribd, you'll first need to download it.
Klinik / IGD NilaiCancel derajat serangan Download And Print Tatalaksana awal nebulisasi -agonis 3x, selang 20 menit nebulisasi ketiga + antikolinergik jika serangan berat, nebulisasi 1 x (+antikolinergik) •
•
•
Serangan ringan ( nebulisasi 1x, respons baik ) • •
obesrvasi 1-2 jam efek bertahan, boleh pulang
Serangan sedang ( nebulisasi 2-3x, •
•
•
repons parsial ) berikan O2
nilai ulang sedang Ruang Rawat Sehari pasang infus
• •
• •
Serangan berat ( nebulisasi 3x, respons buruk) O2 sejak awal nilai ulang berat, rawat inap foto Ro toraks pasang infus
Print document
Boleh pulang bekali -agonis (hirupan / oral) jika ada obat pengendal , teruskan inf.virus (+), steroid oral 24-48 jam kontrol proevaluasi
•
•
•
•
In order to print this document from Scribd, you'll first need to download it.
Ruang Rawat Inap
Rng. Rawat Sehari •
Oksigen teruskan
•
•
Cancel Download steroid oral And Print
•
• •
•
nebulisasi / 2 jam 8-12 jam klinis stabil boleh pulang 12 jam tetap belum
baik
rawat inap
•
• •
•
•
Catatan: Bila belum ada alatnya, nebulisasi awal dapat diganti dengan adrenalin sk. 0,01 ml/kgBB/kali, maksimal 0,3 ml/kali.
•
Oksigen teruskan atasi dehidrasi & asidosis jika ada steroid IV tiap 6-8 jam nebulisasi/1-2 jam aminofilin IV awal, lanjutkan rumatan nebulisasi 4-6x baik, interval 4-6 j 24 jam stabil boleh pulang dengan steroid & aminofilin IV tetap tidak baik ICU
Print document
Monitoring
In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Tanda vital : kesadaran, Laju napas, nadi dan suhu
•
Sianosis, retraksi, wheezing
•
Status hidrasi, asam basa, elektrolit
•
Tanda komplikasi : pneumotoraks, atelektasis, enselopati
Print document
Penggunaan salbutamol inhalasi secara kontinyu pada asma serangan berat adalah aman, perbaikan fungsi paru dan menurunkan rawat inap (EVIDENCE A) In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
( Cam argo et al. The Co c h rane lib rary , Is s u e 2004)
Print document
Penggunaan salbutamol MDI + Spaser sama efektif dengan menggunakan nebulizer In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
(E v i d e n c e A ) ( - S ch u h e t al . J P ed i at r 1 999 L avers b a et al. J Pediatr 2000 - T h e C o c h r a n e l i b r a r y , Is s u e 3,2 00 2)
Print document
PENGGUNA A N IPRA TROPIUM (A n t i k o l in er g i k i n h al as i ) In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Penggunaan salbtumaol + ipratropium pada asma serangan berat meningkatkan fungsi paru dan menurunkan rawat inap (EVIDENCE A ) (P lo t n i c k & D u c h am e The Coc h rane lib rary , Iss u e 2, 2004)
Print document
PENGGUNA A N STEROID In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Penggunaan Steroid pada asma serangan akan menurunkan angka kekambuhan, mengurangi penggunaan beta-agonis (EVIDENCE A ) (R o w e et a l.P lo t n i c k & D u c h a m e The Coc h rane lib rary , Iss u e 1, 2004)
Print document
PENGGUNA A N STEROID In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Penggunaan steroid inhalasi dosis tinggi pada asma serangan berat dapat sebagai alternatif pemberian. (EVIDENCE B )
( N u g h o g l u et al . A n n A l l er g y A s t h m a Im m u n o l 2 00 1 )
Print document
PENGGUNA A N A MINOFIL IN In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Penggunaan aminofilin pada asma serangan berat dapat mengurangi rawat inap,meningkatkan saturasi oksigen,lama penggunaan oksigen dan intubasi/ventlasi mekanik (EVIDENCE B ) ( Y u n g e t al . A r c h D i s C h i l d 1 9 98 )
Print document
PENGGUNA A N MA GNESIUM SULFAT In order to print this document from Scribd, you'll first need to download it. Cancel
•
Download And Print
Penggunaan magnesium sulfat pada asma serangan sedang dan berat dapat mengurangi rawat, meningkatkan FEV1 dan PEFR (EVIDENCE A ) ( C h e u x e t . A r c h D i s C h i l d 2 0 05 )
A S M A 1
4
Serangan Asma Print document
Pencetus
In order to print this document from Scribd, you'll first need to download it.
2
Serangan teratasi Cancel Download And Print (Tenang)
Tentukan derajat dan Atasi segera
3
Tentukan klasifikasi
Episodik jarang
5
6
Episodik sering
Persisten
PENGHINDARAN (AVOIDANCE)
Reliever (+)
7
Reliever (+)
8
Reliever (+)
Print document In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Nebulizer
Print document
In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Inhaling through a loose-fitting face-mask
Print document In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Lung deposition of 0.1%
Inhaling through a loose-fitting face-mask
Print document
In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Screaming during inhalation
Print document
In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Lung deposition of 1%
Screaming during inhalation
Print document In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Quietly inhaling
Print document
In order to print this document from Scribd, you'll first need to download it. Cancel
Download And Print
Quietly inhaling
Lung deposition of 5%
