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CURICULUM CURICU LUM VITA VITAE E Nama : Nanang Sukmana Gelar: Dr, SpPD-KAI Tgl/La!r : Su"ang, # Agu$%u$ &'() Pen* Pe n*!* !*!k !kan an : D+k%er Umum : KUI SpPD : KUI KAI : PA PAPDI PDI a"a%an : Angg+%a P. PERALMUNI

Nanang Sukmana

Subbagian Alergi-Imunologi Klinik Bagian Ilmu Penyakit Dalam, FKUI/RSUPN-CM akarta

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Nanang Sukmana

Subbagian Alergi-Imunologi Klinik Bagian Ilmu Penyakit Dalam, FKUI/RSUPN-CM akarta

Perjalanan Asma Akut 

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PELAYANAN AKUT

PERAWATAN

EKSASERBASI KRONIK

RUMAH SAKIT

AKUT

KUNJUNGAN KE GAWAT DARURAT KEMATIAN

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Mortalita! "-# $ %% &ari '( ka!u! bi!a &i)ega* Faktor-+aktor enyebab kematian   Diagno!i! ti&ak teat  Penilaian beratnya a!ma ti&ak akurat  Pengobatan kurang mema&ai

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Ringan Cancel Sesak Cara bicara Kesadaran Frekuensi napas Retraksi otot bantu napas

apat ber!a"an# berbaring $eberapa ka"iat Mungkin ge"isah Meningkat $iasan&a tidak ada

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1ebih suka duduk Satu ka"iat un&a ge"isah Meningkat $iasan&a ada

Mebungkuk Kata 5e"isah  6* 78enit ada

Mengi Ringan'sedang APE% terhadap standar  *'+*% (sesudah terapi) PO2 nora" (tes biasan&a tidak diper"ukan) PCO2 , -. /g

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keras , .*% (,4** "8enit) , 3* /g (ungkin sianosis)  -. /g (ungkin gaga" napas) , 0*%

 0.%

 3* /g , -. /g

Gagal napa !engan"a!

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I!tila* yg !ering &i.umai & enanggulangan a!ma In order to print this document from Scribd, you'll first need to download it. akut &i ruma* !akit, yaitu  Cancel

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1. Hospital Care, aktu yg &ierlukan untuk enatalak!anaan a!ma akut &i ruma* !akit 0 12 .am ob!er3a!i 2. Observational Stays 4Hospital Emergency Care5, aktu yg &ierlukan untuk enatalak!anaan akut a!ma 6 12 .am

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Penilaian Awal Cancel

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Riayat enyakit, emerik!aan +i!ik 4au!kulta!i, retrak!i otot bantu naa!, +rekuen!i na&i, +rekuen!i naa!, AP7 atau F78 ", !atura!i 91 &an te! lain !e!uai in&ika!i5

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order toInstalasi print this document from Scribd, you'll Tatalaksana Indi Gawat Darurat first need to download it.

Cancel Download And Print ": Pemberian ok!igen 4!atura!i 0 '($5 1: In*ala!i agoni! beta-1 &gn nebuli;er, tia &o!i! &t &iulang 1( menit untuk " .am ertama: Daat &iberikan ber!ama-!ama &gn antikolinergik 4iatroium bromi&a5 a&a a!ma &era.at berat #: Steroi& !i!temik &iberikan bila ti&ak a&a re!on! ter*a&a engobatan &gn nebula!i agoni! beta-1/bila a!ien tela* men&t !teroi& oral !ebelumnya/a!ien terma!uk a!ma akut &era.at berat 2: Bolu! amino+ilin intra3ena yg &ilan.utkan &gn &ri &t &iberikan a&a a!ien &gn !erangan a!ma akut &era.at berat

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": Se&ang / baru !a.a lea! &ari emakaian !teroi& !i!temik 1: Memunyai riayat raat ina &lm aktu "1 bulan terak*ir #: Riayat intuba!i karena a!ma 2: Memunyai ma!ala* !iko!o!ial atau !ikiatri =: Keti&aktaatan engobatan a!ma

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!e)ara in 3itro 

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": Penurunan roli+era!i otot olo! 1: Peningkatan / enurunan ro&uk!i +ibronektin otot olo! #: Penurunan !inte!i! !itokin otot olo! 2: Penurunan ek!re!i >
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!e)ara in 3itro 

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%: Peningkatan ek!re!i S@PI 4secretory leukocyte protease inhibitor 5 ole* !el eitel : Pengurangan ek!re!i a&*e!i molekul ole* !el en&otel, +ibrobla!  !el eitel ': Rekon!titu!i !truktur eitel "(:Penurunan ro&uk!i muku! "": Penurunan ek!re!i !itokin  kemokin ole* berbagai !el

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": Serangan a!ma berat 1: In*ala!i agoni! beta-1 gagal memberikan erbaikan #: Serangan ma!i* ter.a&i me!kiun a!ien &lm terai kortiko!teroi& 2: Serangan a!ma !ebelumnya memerlukan kortiko!teroi& oral

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": Pemerik!aan +i!ik 1: AP7 #: Satura!i 91 2: >e! lain !e!uai in&ika!i

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 AP7

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?(-($ &ari re&ik!i

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 AP7

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6 ?( &ari re&ik!i  Pemerik!aan +i!ik  ge.ala berat !aat i!tira*at, retrak!i otot bantu naa!  Riayat enyakit  a!ien ri!iko tinggi  >i&ak a&a erbaikan !etela* terai aal  In*ala!i agoni! 1 tia .am atau teru!-meneru! in*ala!i antikolinergik  91  Kortiko!teroi& !i!temik  Pertimbangan enggunaan agoni! 1 !ubkutan, i:m/i:3

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": Re!on! yg ti&ak a&ekuat &lm "-1 .am terai 1: 9b!truk!i berat yg meneta 4AP7 6 2($ !tan&ar5 #: Riayat a!ma berat yg memerlukan eraatan 2: Kelomok ri!iko tinggi =:
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": Bila emakaian bronko&ilator aero!ol +rekuen!inya lebi* &ari tia 2 .am 1: Pa!ien mamu ber.alan !e)ara lelua!a #: Pa!ien t&k terbangun tenga* malam/agi *ari  memerlukan in*ala!i 2: Pemerik!aan .a!mani normal/men&ekati normal =: Nilai AP7/K8P" 4kaa!ita! 3ital ak!a &lm &etik ertama5 0 %($ &ari nilai !tan&ar !etela* terai agoni! beta-1 aero!ol ?: Pa!ien mema*ami )ara emakaian obat in*aler &gn benar %: Pa!ien membuat er.an.ian untuk kontrol

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 >eru!kan  Pa&a

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trai in*ala!i agoni!

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!ebagian be!ar ka!u! ertimbangkan

emberian tablet kortiko!teroi&  7&uka!i

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- Memakai obat !e)ara benar - Nilai kembali ren)ana engobatan - Follo-u teratur

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 In*ala!i

agoni!

 Kortiko!teroi&

1

in*ala!i antikolinergik

!i!temik

 91  Pertimbangkan  Monitor

amino+ilin intra3ena

AP7, !atura!i 9 1, na&i, teo+ilin

 Satura!i

91 0 '($ 4'=$ a&a anak5

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A&a kema.uan

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Diulangkan ika AP7 0 %($ &ari re&ik!i  teru!kan engobatan &gn tablet/in*ala!i

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Ma!uk ICU ika ti&ak a&a kema.uan &alam ?-"1 .am

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 In*ala!i

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in*ala!i antikolinergik

 kortiko!teroi&

intra3ena

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1

melalui

!ubkutan, i:m/i:3  91  Pertimbangkan  Bila

amino+ilin intra3ena

memungkinkan &ilakukan intuba!i &an

3entila!i mekanik


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 e*a(er+ation Emergen(y t&erapy o) t&e ast&ma Print document

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Clini)al 73aluation

A: 9ygen

Fir!t-@ine >*eray

A: Beta-1 agoni!t

B: Monitor

B: I8 Corti)o!teroi&

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Met*ylant*ine! 4Amino*ylline/>*eo*ylline5

A

C: 9btain

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C: Magne!ium Sul+ate

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PR9C77D FU>7R IN >7 S7>>IN< 9F PA>I7N> D7>7RI9RA>I9N D7SPI>7 MAEIMA@ M7DICA@ >7RAP

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