LAPORAN TUTORIAL SKENARIO D BLOK 24
DISUSUN OLEH : KELOMPOK 9 Tutor: dr.Syifa Alkaf ,Sp.O Aprilia Putri
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PENDIDIKAN DOKTER UMUM FAKULTAS AKULTAS KEDOKTERAN KEDOKTER AN UNIVERSITAS UNIVER SITAS SRIWIJAY SRI WIJAYA A 2018
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KATA PENGANTAR
Pui da( /yukur k*0adirat Tu0a( a() Ma0a Kua/a kar*(a ata/ 7*rkat, ra01at, da( karu(i karu(iaNy aNyaa la0 ka1i ka1i dapat dapat 1*yu/u 1*yu/u( ( lapora lapora( ( tutori tutorial al i(i /*/uai /*/uai d*()a( d*()a( +aktu +aktu ya() t*la0 t*la0 dit*(tuka(. Lapora( Lapora( i(i 1*rupaka( tu)a/ 0a/il k*)iata( tutorial tutorial Sk*(ario Sk*(ario 6 6lok &" P*(didika( P*(didika( Dokt*r U1u1 -akulta/ -akulta/ K*dokt*ra( K*dokt*ra( U(i;*r/ita/ U(i;*r/ita/ Sri+iaya Sri+iaya Ta0u( &!#$. Di/i(i Di/i(i ka1i 1*17a0a/ /*7ua0 ka/u/ k*1udia( dip*3a0ka( /*3ara k*lo1pok 7*rda/arka( /i/t*1atika(ya 1ulai dari klarifika/i i/tila0, id*(tifika/i 1a/ala0, 1*()a(ali/i/, 1*(i(au ula() da( 1*(yu/u( k*t*rkaita( a(tar 1a/ala0, /*rta 1*()id*(tifika/i topik p*17*laara(. 6a0a( lapora( lapora( i(i ka1i dapatka( dari 0a/il 0a/il di/ku/i di/ku/i a(tar a())ota k*lo1pok k*lo1pok da( 7a0a( aar dari do/*(do/*( p*17i17i(). Ak0ir kata, ka1i 1*()u3apka( t*ri1a ka/i0 /*7*/ar7*/ar(ya k*pada Tu0a( a() Ma0a Kua/a, ora() tua, tutor da( para a())ota k*lo1pok ya() t*la0 1*(duku() 7aik 1oril 1aupu( 1at*ril dala1 p*17uata( lapora( i(i. Ka1i 1*()akui dala1 p*(uli/a( lapora( i(i t*rdapat 7a(yak k*kura()a(. Ol*0 kar*(a itu, ka1i 1*1o0o( 1aaf da( 1*()0arapka( kritik /*rta /ara( dari p*17a3a d*1i k*/*1pur(aa( k*/*1pur(aa( lapora( ka1i di k*/*1pata( 1*(data(). S*1o)a lapora( i(i dapat 7*r1a(faat 7a)i para p*17a3a
Pal*17a(), #" -*7ruari &!#$
K*lo1pok 9
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DAFTAR ISI
Kata P*()a(tar P*()a(tar....... ............. ............. .............. ............. ............. .............. .............. ............. ............. .............. ............. ............. .............. .............. ............. .......... .... Daftar Daftar I/i....... I/i.............. .............. .............. ............. ............. .............. .............. ............. ............. .............. ............. ............. .............. .............. ............. ............. ............ ..... 6A6 I : P*(da0ulua( #.# #.# Lat Latar 6*l 6*laka( aka()< )<<< <<<< <<<< <<< <<<<< <<<<<< <<< <<<<< <<<<.. .... .. #.& Mak/ud da( da( Tu Tuua(< ua(<< <<<<<<<<<<<<<<<<< 6A6 II : P*17a0a/a( &.# Sk*(ari Sk*(ario.. o...... ....... ...<<< <<<<<< <<<<<< <<<<<< <<<<<< <<<<< <<<<< <<<.. .. &.& Klari Klarifik fika/i a/i I/til I/tila0.. a0..... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ...... &. Id*(tifika/ Id*(tifika/ii Ma/ala0..... Ma/ala0............ .............. ............. ............. .............. .............. ............. ............. .............. ............. ...... &." A(ali/ A(ali/i/ i/ Ma/ala Ma/ala0.. 0...... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ...... ... &.% L*ar(i L*ar(i() () I// I//u*.. u*..... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ..... .. &.' K*ra() K*ra()ka ka Ko(/*p Ko(/*p... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ...... ....... ....... ...... ....... ....... ....... ....... ...... ....... ....... ..... .. 6A6 III : P*(utup .# K*/i1pula( K*/i1pula( ............. .................... ............. ............. .............. .............. ............. ............. .............. ............. ............. ............. ...... DA-TA5 DA-TA5 PUSTAKA PUSTAKA .................................................. ...................................................
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BAB I PENDAHULUAN 1.1 Lata Lata B!"a#a$% B!"a#a
%$Pada k*/*1pata( i(i, dilakuka( dilakuka( tutorial tutorial /tudi ka/u/ /*7a)ai 7a0a( p*17*laara( p*17*laara( u(tuk 1*()0adapi tutorial ya() /*7*(ar(ya pada +aktu ya() aka( data(). P*(uli/ 1*1aparka( ka/u/ ya() di7*rika( 1*()*(ai 5*/piratory Di/tr*// Sy(dro1* pada 7ayi pr*1atur*. 1.2 Ma#&'( (a$ (a$ T')'a$ T')'a$
Adapu( 1ak/ud da( tuua( dari 1at*ri tutorial i(i, yaitu : #. S*7a)ai S*7a)ai lapora( lapora( tu)a/ tu)a/ k*lo1pok k*lo1pok tutorial tutorial ya() 1*rupak 1*rupaka( a( 7a)ia( dari /i/t*1 /i/t*1 p*17*laara( K6K di -akulta/ K*dokt*ra( U(i;*r/ita/ Sri+iaya Pal*17a(). &. Dapa Dapatt 1*(y 1*(y*l *l*/ */ai aika ka( ( ka/u ka/u// ya() ya() di7* di7*ri rika ka( ( pada pada /k*(a /k*(ari rio o d*()a d*()a( ( 1*to 1*tod* d* a(ali/i/ da( p*17*laara( di/ku/i k*lo1pok. . T*r3apai(ya *r3apai(ya tuua( tuua( dari 1*tod* 1*tod* p*17*laara( p*17*laara( tutoria tutoriall da( 1*1a0a1i 1*1a0a1i ko(/*p ko(/*p dari /k*(ario i(i. 1.* Data T't+,a"
a. Tutor Tutor 7. Mod*rator 3. S*k*rta S*k*rtari/ ri/ d. =aktu aktu
: dr. dr. Syifa Syifa Alkaf Alkaf ,Sp.O ,Sp.O : E2ra 5*i(0ard : Mu0a11 Mu0a11ad ad -a++a2 -a++a2ii Multa2 Multa2a1 a1 -ari Ir+i(/ya0 Ma(alu : S*(i(, S*(i(, #& -*7ruar -*7ruarii &!#$ Pukul #!.!! > #&.!! =I6 5a7u, #" -*7ruari &!#$ Pukul #!.!! > #&.!! =I6
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BAB II ISI 2.1 SKE SKENAR NARIO IO A (*+7or( 7a7y +a/ d*li;*r*d at pri;at* 3li(i3, a//i/t*d 7y 1id+if*. H* +a/
d*li;*r*d fro1 a ! y*ar/ old +o1a(, pri1i)ra;ida. Mr/. A(ita, t0* 7a7y?/ 1ot0*r 0ad pr*1atur* ruptur*d of 1*17ra(* % day/ a)o. T0* li@uor +a/ t0i3k, /1*lly a(d )r**(i/0. S0* al/o 0ad f*;*r /i(3* t+o day/ 7*for* d*li;*ry. T0* pr*)(a(3y +a/ full t*r1. T0* 7a7y +a/ (ot 3ri*d /po(ta(*ou/ly aft*r 7irt0. T0* 1id+if* 3l*ar*d t0* 7a7y?/ air+ay u/i() 1a(ual /u3tio( a(d /ti1ulat* t0* 7a7y 7y patti() 0i/ f**t, a(d t0*( 0* /tart*d to 3ry +*akly % 1i(ut*/ lat*r aft*r &0our/ o7/*r;atio( t0* 1id+if* /a+ t0* 7a7y /till 7r*at0i() u(*a/ily a(d 0ad )ru(ti(). T0* 7a7y +a/ r*f*r*d to Mo0 Ho*/i( Ho/pital. P0y/i3al *a1i(atio( r*;*al*d 7ody +*i)0t +a/ %!! )ra1/. 6ody l*()t0 %! 31/, 0*ad 3ir3u1f*r*(3* " 31/. H* look*d 0ypoa3ti;*, ta30yp(o*, r*/piratory rat* $' 7r*at0/ p*r1i(ut*, t0*r* +*r* 30*/t i(dra+i(), )ru(ti() 3ould 7* 0*ard u/i() /t*t0o/3op*, 7r*at0i() /ou(d +a/ (or1al, /aturatio( $!B u/i() (a/al oy)*(. Su3ki() r*fl* +a/ +*ak. H*art rat* +a/ #'$ 7*at/ p*r 1i(ut*. A7do1*( +a/ t*(d*r +it0 (or1al 7o+*l /ou(d. T0*r* +*r* (ot 1*3o(*(u1 /tai(i() at u17ili3al 3ord a(d /ki(. I$&t'-t,+$ A/ P +0at +ill you do to tr*at t0* 7a7y.
2.2 KLARIFIKASI ISTILAH
No. #. &.
I/tila0 Pri1i)ra;ida Pr*1 Pr*1at atur ur** 1*17ra(*
Klarifika/i S*ora() i7u ya() /*da() 0a1il u(tuk p*rta1a ruptu upturr*d
kali(ya. CU(i1u/ of K*tu7a( K*tu7a( p*3a0 di(i, p*3a0(ya k*tu7a( k*tu7a( /*7*lu1 /*7*lu1 fa/* aktif p*r/ali(a(. 5
.
ru(ti()
6u(yi p*r(apa/a( a7(or1al /aat *k/pira/i ya() 1*(u(uka( 7a0+a )lotti/ t*la0 1*(utup alira( udara dari paru, 7ia/a(ya u(tuk 1*(3*)a0 3olap/
". %.
6ody L*()t0 H*ad 4ir3u1f*r*(3*
paru. P*()ukura( tu7u0 dari pu(3ak k*pala /a1pai uu() tu1it /ala0 /atu kaki. P*()ukura( 1*li()kar pada k*pala ya() di1ulai da( diak0iri di )la7*lla da( 1*l*+ati protu7*r*(tia
'. 8. $. 9. #!.
Hypoa3ti;* 40*/t i(dra+i() Ta30yp(o* Su3ki() r*fl*
o33ipitali/. Tidak 7a(yak 7*r)*rak. 5*trak/i dada CDorla(d P*r(apa/a( ya() /a()at 3*pat. CDorla(d *raka( 1*()0i/ap ya() dapat dipi3u d*()a(
M*3o(*(u1 /tai(i()
1*(y*(tu0ka( /*7ua0 o7*k k*7i7ir 7ayi CDorla(d Ko(di/i di1a(a 1*3o(iu1 t*rd*po/it pada pla/*(ta, kulit, 1uko/a, da( p*r1ukaa( a(i( lai((ya.a() 1*(a(daka( f*tal di/tr*// da( 0aru/ dila0irka(. C1*di3alfo.3o1
2.* IDENTIFIKASI MASALAH
No. Ma/ala0 Priorita/ # Mr/,a(ita, ! ta0u(, pri1i)ra;ida, at*r1 1*()ala1i ;; k*tu7a( p*3a0 di(i d*()a( 3aira( a1(io( k*(tal, 7*r7au, da( 7*r+ar(a k*0iaua( % 0ari ya() lalu. &
Mr/.A(ita M*()ala1i d*1a1 /*ak & 0ari ya() lalu ;; 6ayi tidak la()/u() 1*(a()i/ /*t*la0 la0ir, % 1*(it ;;; /*t*la0 ti(daka( p*()0i/apa( 1a(ual ala( (apa/ da( /ti1ula/i 1*(*puk pada kaki 7ayi ol*0 7ida(, 7ayi
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1ulai 1*(a()i/ d*()a( l*1a0. S*t*la0 o7/*r;a/i & a1 7ayi 1a/i0 k*/ulita( 7*r(afa/ ;;;; 6
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da( 1*ri(ti0, 7ayi diruuk k* 5SMH. P0y/i3al *a1i(atio( r*;*al*d 7ody +*i)0t +a/ %!! ; )ra1/. 6ody l*()t0 %! 31/, 0*ad 3ir3u1f*r*(3* " 31/. H* look*d 0ypoa3ti;*, ta30yp(o*, r*/piratory rat* $' 7r*at0/ p*r1i(ut*, t0*r* +*r* 30*/t i(dra+i(), )ru(ti() 3ould 7* 0*ard u/i() /t*t0o/3op*, 7r*at0i() /ou(d +a/ (or1al, /aturatio( $!B u/i() (a/al oy)*(. Su3ki() r*fl* +a/ +*ak. H*art rat* +a/ #'$ 7*at/ p*r 1i(ut*. A7do1*( +a/ t*(d*r +it0 (or1al 7o+*l /ou(d. T0*r* +*r* (ot 1*3o(*(u1 /tai(i() at u17ili3al 3ord a(d /ki(.
2.4 ANALISIS MASALAH
#. Mr/,a(ita, ! ta0u(, pri1i)ra;ida, at*r1 1*()ala1i k*tu7a( p*3a0 di(i d*()a( 3aira( a1(io( k*(tal, 7*r7au, da( 7*r+ar(a k*0iaua( % 0ari ya() lalu. a. 6a)ai1a(a 0u7u()a( u/ia da( /tatu/ pri1i)ra;ida t*r0adap ka/u/ k*tu7a( p*3a0 di(i
Pada ka/u/, u/ia i7u t*r1a/uk tidak 7*ri/iko, yak(i ! ta0u(. U/ia /a()at 7*rp*()aru0 t*r0adap k*/iapa( i7u /*la1a k*0a1ila( 1aupu( 1*()0adapi p*r/ali(a(. U/ia u(tuk r*produk/i opti1al 7a)i /*ora() i7u adala0 a(tara u1ur &!% ta0u(. Di 7a+a0 atau di ata/ u/ia t*r/*7ut aka( 1*(i()katka( r*/iko k*0a1ila( da( p*r/ali(a( CD*pk*/, &!!. U/ia /*/*ora() /*d*1ikia( 7*/ar(ya
aka(
1*1p*()aru0i
/i/t*1 r*produk/i, kar*(a
or)a(or)a(
r*produk/i(ya /uda0 1ulai 7*rkura() k*1a1pua((ya da( k**la/ti/a((ya
dala1 1*(*ri1a k*0a1ila(. M*(urut 7*7*rapa p*(*litia(, +a(ita ya() t*la0 1*la0irka( 7*7*rapa kali da( p*r(a0 1*()ala1i KPD pada k*0a1ila( /*7*lu1(ya /*rta arak k*la0ira(
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ya() t*rla1pau d*kat diyaki(i l*7i0 7*r*/iko aka( 1*()ala1i KPD pada
k*0a1ila( 7*rikut(ya, (a1u( pada ka/u/ i(i 1a/i0 k*0a1ila( p*rta1a. -aktor 1ulti )ra;idita/, di1a(a pada k*0a1ila( ya() t*rlalu /*ri() aka( 1*1p*()aru0i pro/*/ *17ryo)*(*/i/ /*0i())a /*laput k*tu7a( ya() t*r7*(tuk aka( l*7i0 tipi/ ya() aka( 1*(y*7a7ka( /*laput k*tu7a( p*3a0 /*7*lu1 ada ta(data(da i(partu.
7. 6a)ai1a(a 1*ka(i/1* da( p*(y*7a7 k*tu7a( p*3a0 di(i 6a(yak t*ori, 1ulai dari d*f*3t kro1o/o1, k*lai(a( kola)*(, /a1pai i(f*k/i. Pada /*7a)ia( 7*/ar ka/u/ t*r(yata 7*r0u7u()a( d*()a( i(f*k/i C/a1pai '%B. Hi)0 ;irul*(/i 7*rupa 6a3t*roid*/ Lo+ ;irul*(/i, La3to7a3illu/ Kola)*( t*rdapat pada lapi/a( ko1pakta a1(io(, fi7ro7la/t, ari()a r*tikul*r korio( da( trofo7la/. Si(t*/i/ 1aupu( d*)rada/i ari()a( kola)*( diko(trol ol*0 /y/t*1 aktifita/ da( i(0i7i/i i(t*rl*uki( # CiL# da( pro/ta)la(di(. Fika ada i(f*k/i da( i(fla1a/i, t*radi p*(i()kata( aktifita/ iL# da( pro/ta)la(di(, 1*()0a/ilka( kola)*(a/* ari()a(, /*0i())a t*radi d*poli1*ra/i kola)*( pada /*laput korio(G a1(io(, 1*(y*7a7ka( k*tu7a( tipi/, l*1a0 da( 1uda0 p*3a0 /po(ta(. P*(y*7a7 dari pr*1atur* ruptur* of t0* 1*17ra(* CP5OM tidak atau 7*lu1 *la/, 1aka pr*;*(tif tidak dapat dilakuka(, k*3uali dala1 u/a0a 1*(*ka( i(f*k/i. M*(urut Ma(ua7a.I6 C&!!$, 0al.##9
p*(y*7a7 k*tu7a( p*3a0 di(i
/*7a)ai 7*rikut: a. S*r;ik i(ko1p*t*( 7. O;*rdi/t*(/i ut*ru/ 3. -aktor k*turu(a( Cio( 4u /*ru1 r*(da0, ;ita1i( 4 r*(da0, k*lai(a( )*(*ti3. d. P*()aru0 dari luar ya() 1*l*1a0ka( k*tu7a( Ci(f*k/i )*(italia, 1*(i()kat(ya *(2i1 prot*olitik. *. Ma/a i(t*r;al /*ak k*tu7a( p*3a0 /a1pai t*radi ko(trak/i di/*7ut fa/* lat*(. Maki( pa(a() fa/* lat*(, 1aki( ti())i k*1u()ki(a( i(f*k/i. Da( 1aki( 1uda k*0a1ila(, 1aki( /ulit upaya p*1*3a0a((ya ta(pa 1*(i17ulka( 1or7idita/ a(i(, /*0i())a ko1plika/i k*tu7a( p*3a0 di(i 1aki( 1*(i()kat.
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3. 6a)ai1a(a da1pak k*tu7a( p*3a0 di(i % 0ari ya() lalu t*r0adap a(i( Ko1plika/i ya() dapat ti17ul aki7at k*tu7a( p*3a0 di(i : #. P*r/ali(a( pr*1atur* S*t*la0 k*tu7a( p*3a0 7ia/a(ya diikuti d*()a( p*r/ali(a(. P*riod* lat*( t*r)a(tu() u1ur k*0a1ila(. Pada k*0a1ila( at*r1 9!B t*radi dala1 &" a1 /*t*la0 k*tu7a( p*3a0. &. I(f*k/i 5i/iko i(f*k/i i7u da( a(ak 1*(i()kat pada KPD. Pada i7u t*radi korioa1(io(iti/. Pada 7ayi dapat t*radi /*pti3*1ia, p(*u1o(ia, o1faliti/. U1u1(ya t*radi koria1(io(iti/ /*7*lu1 a(i( t*ri(f*k/i. Pada k*tu7a( p*3a0 di(i pr*t*r1 l*7i0 /*ri() t*radi i(f*k/i di7a(di()ka( d*()a( at*r1. S*3ara u1u1 i(/id*( i(f*k/i /*ku(d*r pada KPD 1*(i()kat /*7a(di() d*()a( la1a(ya p*riod* lat*(. -a3tor r*/iko korioa1(io(iti/ adala0 k*tu7a( p*3a0 la1a da( k*la0ira( pr*1atur*. Koria1(io(oti/ tidak /*lalu 1*(u(ukka( )*ala, 7*7*rpa )*ala ya() dapat ti17ul adala0 d*1a1, (adi 3*pat, 7*rk*ri()at, ut*ru/ t*ra7a l*17*k, da( 3aira( 7*r7au k*luar dari ;a)i(a. Dia)(o/i/ korioa1(io(iti/ dit*)akka( d*()a( p*1*rik/aa( fi/ik, )*ala, kultur dara0 da( 3aira( a1(io(. . Hipok/ia da( A/fik/ia D*()a( p*3a0(ya k*tu7a(, t*radi oli)o0idra1(io( ya() 1*(*ka( tali pu/at 0i())a t*radi a/fik/ia atau 0ipok/ia. T*rdapat 0u7u()a( a(tara t*radi(ya )a+at a(i( da( d*raat oli)o0idra1(io(. S*1aki( /*dikit k*tu7a(, /*1aki( )a+at k*adaa( a(i(. ". Si(dro1 D*for1ita/ Fa(i( KPD ya() t*radi t*rlalu di(i dapat 1*()0a17at p*rtu17u0a( a(i(, k*lai(a( di/*7a7ka( ko1pr*/i 1uka da( a())ota 7ada( a(i(, /*rta 0ipopla/i pul1o(al.
d. Apa /aa k*lai(a( ya() dapat 1*(y*7a7ka( 3aira( a1(io( k*(tal,7*r7au,0iau
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Air k*tu7a( ya() (or1al 7*r+ar(a ku(i() tra(/para(, a)ak k*ru0, ;olu1* pada 0a1il 3ukup 7ula( #!!!#%!! 1l 1*1pu(yai 7au ya() k0a/, a)ak a1i/, da( 1a(i/. S*da()ka( pada ka/u/: 6ad /1*ll li@uor 1*rupaka( 7au 7u/uk dari 3aira( a1(io(. Ko(di/i i(i 1*rupaka( /ala0 /atu krit*ria dari " krit*ria A1/*l pada 7a3t*rial ;a)i(o/i/ ya() 1*(a(daka( t*la0 t*radi kolo(i/a/i 1.o. pada 3aira( k*tu7a(. I(f*k/i ku1a( ya() /*ri() dit*1uka( adala0 Stap0ylo3o33u/ /p, Str*pto3o3u/ ;irida(/, Kl*7/i*lla p(*u1o(ia*, E(t*ro7a3t*r /p. -
=ar(a AK k*0iaua( atau k*3oklata( 1*(u(ukka( 7a0+a (*o(atu/ t*la0 1*()*luarka( 1*ko(iu1 Ckotora( ya() t*r7*(tuk /*7*lu1 la0ir, pada k*adaa( (or1al k*luar /*t*la0 la0ir /aat p*r)*raka( u/u/ ya() p*rta1a kali. Hal i(i dapat 1*(adi p*ta(da 7a0+a (*o(atu/ dala1 k*adaa( /tr*/. K*adaa( 0ipok/ia 1*(y*7a7ka( p*ri/taltik u/u/ da( r*lak/a/i otot /fi()t*r a(i, 1aka
-
1*ko(iu1 dapat k*luar 1*lalui a(u/ Air k*tu7a( dapat di(ilai k*k*ru0a(((ya d*()a( ;i/ual 7*r/ifat /u7*ktif dari p*(ilai Ckli(i/i 1*(adi t0i(, 1*diu1, t0i3k atau *(3*r, /*da() da( k*(tal. M*/kipu( p*(ilaia( /u7*ktif tidak 1*(i17ulka( 1a/ala0 /*riu/, 7a(yak p*(*litia( dilakuka( u(tuk 1*(ilai 1*ko(iu1 /*3ara o7*ktif. Di a(tara(ya p*1*rik/aa( /p*ktrofoto1*tri da( 1*3o(iu1 3rit. 6ayi d*()a( AKK k*(tal l*7i0 /*ri() 1*1pu(yai 1a/ala0 ya() l*7i0 7*/ar di7a(di() 7ayi d*()a( AKK ya() *(3*r
*. 6a)ai1a(a 3aira( a1(io( ya() (or1al 4aira( a1(io( pada k*adaa( (or1al 7*r+ar(a puti0 a)ak k*ru0 kar*(a ada(ya 3a1pura( partik*l /olid ya() t*rka(du() di dala1(ya ya() 7*ra/al dari la(u)o, /*l *pit*l, da( 1at*rial /*7a/*a. olu1* 3aira( a1(io( pada k*adaa( at*r1 adala0 /*kitar $!! 1l, atau a(tara "!! 1l #%!! 1l dala1 k*adaa( (or1al. Pada k*0a1ila( #! 1i())u ratarata ;olu1* adala0 ! 1l, da( k*0a1ila( &! 1i())u !! 1l, ! 1i())u '!! 1l. Pada k*0a1ila( ! 1i())u, 3aira( a1(io( l*7i0 1*(do1i(a/i di7a(di()ka( d*()a( a(i( /*(diri.
10
f. 6a)ai1a(a 1*ka(i/1* k*tu7a( p*3a0 di(i d*()a( 3aira( a1(io( 7*r7au, k*(tal, da( 7*r+ar(a 0iau
M*17ra( k0orioa1(io(itik t*rdiri dari ari()a( ;i/ko*la/tik. Apa7ila ari()a( i(i dipa3u ol*0 p*r/ali(a( atau i(f*k/i 1aka ari()a( aka( 1*(ipi/ da( /a()at
r*(ta( u(tuk p*3a0 di/*7a7ka( ada(ya akti;ita/ *(2i1 kola)*(olitik rup 6 /tr*pto3o33u/ 1ikroor)a(i/1* ya() /*ri() 1*(y*7a7ka( a1(io(iti/. S*lai( itu Bacteroides fragilis, Lactobacilli da( Staphylococcus epidermidis adala0 7akt*ri7akt*ri ya() /*ri() dit*1uka( pada 3aira( k*tu7a( pada
k*0a1ila( pr*t*r1. M*ka(i/1*: a. 6akt*ri 1*l*pa/ka( 1*diator i(fla1a/i J D*poli1*ra/i kola)*( pada /*laput korio(Ga1(io( J k*tu7a( tipi/, l*1a0, da( 1uda0 p*3a0 /po(ta( 7. 6akt*ri 1*l*pa/k*( 1*diator i(fla1a/i J Ko(trak/i ut*ru/ K*dua 0al i(i 1*(y*7a7ka( ada(ya p*ru7a0a( da( p*17ukaa( /*r;ik/,
da( p*3a0(ya /*laput k*tu7a( Air k*tu7a( ya() (or1al 7*r+ar(a ku(i() tra(/para(, a)ak k*ru0, ;olu1* pada 0a1il 3ukup 7ula( #!!!#%!! 1l 1*1pu(yai 7au ya() k0a/, a)ak
-
a1i/, da( 1a(i/. S*da()ka( pada ka/u/: 4aira( a1(io( ya() 7*r7au 1*(a(daka(
t*la0
t*radi
kolo(i/a/i
1ikroor)a(i/1* pada 3aira( k*tu7a(. I(f*k/i ku1a( ya() /*ri() dit*1uka( adala0 Stap0ylo3o33u/ /p, Str*pto3o3u/ ;irida(/, Kl*7/i*lla p(*u1o(ia*, -
E(t*ro7a3t*r /p. =ar(a k*0iaua( atau k*3oklata( 1*(u(ukka( 7a0+a (*o(atu/ t*la0 1*()*luarka( 1*ko(iu1 Ckotora( ya() t*r7*(tuk /*7*lu1 la0ir, pada k*adaa( (or1al k*luar /*t*la0 la0ir /aat p*r)*raka( u/u/ ya() p*rta1a kali. Hal i(i dapat 1*(adi p*ta(da 7a0+a (*o(atu/ dala1 k*adaa( /tr*/. K*adaa( 0ipok/ia 1*(y*7a7ka( p*ri/taltik u/u/ da( r*lak/a/i otot /fi()t*r a(i, 1aka 1*ko(iu1 dapat k*luar 1*lalui a(u/
). Apa 1ak(a kli(i/ 3aira( a1(io( 7*r7au, k*(tal, da( 7*r+ar(a 0iau
4aira( a1(io( ya() 7*r7au da( k*(tal 1*(a(daka( t*la0 t*radi(ya i(f*k/i di dala1 ra0i1
11
4aira( a1(io( ya() 7*r+ar(a 0iau 1*(a(daka( 3aira( a1(io( /uda0 7*r3a1pur 1*3o(iu1 ,1*3o(iu1 (or1al(ya dik*luarka( /*t*la0 (*o(atu/ la0ir.
0. 6a)ai1a(a kla/ifika/i k*tu7a( p*3a0 di(i KPD P!t!/
K*tu7a( p*3a0 di(i pr*t*r1 adala0 p*3a0 k*tu7a( ya() t*r7ukti d*()a( ;a)i(al pooli(), t*/ (itra2i( da(, t*/ f*r( atau I-6P# C pada u/ia 8 1i())u /*7*lu1 o(/*t p*r/ali(a(. KPD /a()at pr*t*r1 adala0 p*3a0 k*tu7a( /aat u1ur k*0a1ila( i7u a(tara &" /a1pai kura() dari " 1i())u, /*da()ka( KPD pr*t*r1 /aat u1ur k*0a1ila( i7u a(tara " 1i())u /a1pai kura() 8 1i())u. D*fi(i/i pr*t*r1 7*r;aria/i pada 7*r7a)ai k*pu/takaa(, (a1u( ya() pali() dit*ri1a da( t*r/*ri() di)u(aka( adala0 p*r/ali(a( kura() dari 8 1i())u CHarto(o, &!#'. KPD a(a K!a/,"a$ At!/
K*tu7a( p*3a0 di(iG pr*1atur* ruptur* of 1*17ra(*/ CP5OM adala0 p*3a0(ya k*tu7a( /*7*lu1 +aktu(ya ya() t*r7ukti d*()a( ;a)i(al pooli(), t*/ (itra2i( da( t*/ f*r( C, I-6P# C pada u/ia k*0a1ila( 8 1i())u
&. Mr/.A(ita M*()ala1i d*1a1 /*ak & 0ari ya() lalu a. 6a)ai1a(a 1*ka(i/1* da( p*(y*7a7 d*1a1 pada ka/u/ D*1a1 pada i7u di/*7a7ka( kar*(a t*radi(ya i(f*k/i aki7at k*tu7a( p*3a0 di(i ya() 1*l*7i0i &" a1. I7u 1*1iliki ri+ayat i(f*k/i C;a)i(a, /*r;i
t*radila0
r*ak/i 1*17ra( a(i(
da( d*/idua t*r0adap i(f*k/i d*()a( 1*1produk/i 1*diator CPro/ta)la(di(, IL # 5a()/a()
akti;ita/ 1atrik/ 1*taloprot*i(a/* CMMP d*)rada/i kola)*(
/*laput k*tu7a( tipi/, l*1a0, da( 1uda0 p*3a0
k*tu7a( p*3a0 di(i
p0
;a)i(a 7*ru7a0 dari a/a1 k* 7a/a 7akt*ri 7*rpi(da0 k* 30orio( da( a1(io( 30orioa1(io(iti/ C 3aira( k*tu7a( k*(tal, 7*r7au 7u/uk, 7*r+ar(a k*0iaua( /u0u 1*(i()kat Cd*1a1. 40orioa1(io(iti/ 7i/a 7*rla(ut 1*(adi /*p/i/, r*/piratory
di/tr*//.
Pada
ka/u/,
12
d*1a1
di/*7a7ka(
ol*0
t*radi(ya
korioa1(io(iti/ aki7at k*tu7a( p*3a0 di(i. D*1a1 aka( 7*rda1pak pada 7ayi, yaitu /*ptik*1ia, p(*u1o(ia, da( o1faliti/.
7. Apa 0u7u()a( d*1a1 d*()a( k*lu0a( 1r/.A(ita pada ka/u/ Etiolo)i: a)*( i(f*k/i CStr*ptokoku/ )rup 6, Stafilokoku/ aur*u/ da( Triko1o(a/ ;a)i(ali/, 1*diator i(fla1a/i
1o(o/itG1akrofa), /*l *(dot0*lial
pyo)*(ik 0ypot0ala1u/ a(t*rior
p*(i()kata( PE&
/itoki()
p*(i()kata(
/*t
poi(t 0ypot0ala1u/ r*)ula/i produk/i da( ko(/*r;a/i pa(a/ tu7u0 d*1a1.
3. 6a)ai1a(a da1pak d*1a1 pada i7u t*r0adap a(i( K*tu7a( p*3a0 di(i 1*(y*7a7ka( 0u7u()a( la()/u() a(tara du(ia luar da( rua()a( dala1 ra0i1, /*0i())a 1*1uda0ka( t*radi(ya i(f*k/i a/*(d*(. Da( /*1aki( la1a p*riod* lat*(, 1aki( 7*/ar k*1u()ki(a( i(f*k/i /*0i())a 1*(i()katka( k*adia( k*/akita( da( k*1atia( i7u da( 7ayi atau a(i( dala1 5a0i1.
d. I(f*k/i apa /aa ya() 1u()ki( t*radi pada ka/u/ k*tu7a( p*3a0 di(i 5i/iko i(f*k/i i7u da( a(ak 1*(i()kat pada k*tu7a( p*3a0 di(i. Pada i7u t*radi 30orioa1(io(iti/, *(do1*triti/, oli)o0idra1(io( C3aira( k*tu7a( t*rlalu /*dikit ya() aka( 1*(y*7a7ka( i(f*k/i pada a(i( 7a0ka( k*1atia( a(i(. Pada 7ayi dapat t*radi i(f*k/i po/tpartu1, /*ptik*1ia, p(*u1o(ia, o1faliti/.
Hu7u()a( I(f*k/i d*()a( K*tu7a( P*3a0 Di(i CS*3ara Mikro7iolo)i
13
. 6ayi tidak la()/u() 1*(a()i/ /*t*la0 la0ir, % 1*(it /*t*la0 ti(daka( p*()0i/apa( 1a(ual ala( (apa/ da( /ti1ula/i 1*(*puk pada kaki 7ayi ol*0 7ida(, 7ayi 1ulai 1*(a()i/ d*()a( l*1a0. a 6a)ai1a(a 1*ka(i/1* da( p*(y*7a7 7ayi tidak la()/u() 1*(a()i/ pada ka/u/ P*(y*7a7 7ayi tidak 1*(a()i/ /*3ara /po(ta( ada 7a(yak , /*p*rti : #. S*7*lu1 p*r/ali(a( Ko(di/i i7u /*7*lu1 p*r/ali(a( 7*rpot*(/i 1*(y*7a7ka( 7ayi 7aru la0ir tidak 7*r(apa/ da( tidak 1*(a()i/. Ko(di/i t*r/*7ut dia(tara(ya adala0: I7u 1*(d*rita p*(yakit Dia7*t*/ M*llitu/ > I7u d*()a( DM CDia7*t*/ /*1a/a k*0a1ila( "!B aka( 1*la0irka( 7ayi Makro/o1ia C7ayi 7*/ar 1*rupaka( /ala0 /atu ya() r*/iko ya() 1*(y*7a7ka( t*radi(ya trau1a la0ir, fraktur, a/fik/ia pada 7ayi 7aru la0ir, da( /i(dro1 )a+at (apa/ C5DS. I7u 1*1iliki pa())ul /*1pit >
Di/proportio /*falo p*l;ik Cpa())ul
/*1pit t*radi 7ila ukura( tula() p*l;i3 i7u tidak 3ukup da( 7*(tuk(ya tidak t*pat u(tuk 1*1u()ki(ka( 1*li(ta/(ya k*pala a(i(. Pada k*adaa( i(i, di1a(a k*pala 7*lu1 1a/uk pi(tu ata/ pa())ul 1aka p*17ukaa( 7*rla()/u() la1a da( 7*/ar k*1u()ki(a( air k*tu7a( p*3a0 /*7*lu1 +aktu(ya /*0i())a, k*pala tidak dapat 1*(*ka( /*r;ik/ k*3uali 7ayi /a()at kuat /*0i())a t*radi 1oula)* 0*7at. Ko(di/i i(i 7i/a 1*(y*7a7ka( ada(ya t*ka(a( pada a(i( atau po/i/i ya() tidak (or1al /*0i())a 1*17uat a(i( k*/ulita( 7*r(afa/. T*radi p*rdara0a( a(t*partu1 Cp*(dara0a( /*1a/a /*7*lu1 1*la0irka( > P*rdara0a( ya() t*radi /*1a/a /*7*lu1 1*la0irka( 7ia/a(ya di/*7a7ka( 14
ol*0 ada(ya k*lai(a( pla/*(ta, k*lai(a( i(/*r/i tali pu/at atau p*17ulu0 dara0 pada /*laput air k*tu7a( da( pla/*(ta ya() t*rl*pa/ dari p*rl*kata((ya /*7*lu1 7ayi la0ir C/olu/io pla/*(ta. I(f*k/i pada I7u > 1*()ala1i a(*1ia da( p*(yakitp*(yakit i(f*k/i ya() 1*()aki7atka( a(i( dala1 ka(du()a( 1*(d*rita 5*tarda/i P*rtu17u0a( dala1 5a0i1 CIU5 =ar(a air k*tu7a( 0iau > 6a0aya 7ayi 1i(u1 air k*tu7a( 0iau k*(tal atau 7*r3a1pur 1*ko(iu1 1u()ki( 7i/a t*radi I7u 1*(d*rita Pr**kla1/ia Ck*ra3u(a( k*0a1ila( > Hal i(i dita(dai d*()a(
p*(i()kata( t*ka(a(
dara0
p*17*()kaka(
da( t*radi(ya
prot*i(uria Cada(ya prot*i( di dala1 uri(. K*adaa( i(i 7*ri/iko 1*(y*7a7ka( /i(dro1 )a+at (apa/ pada a(i(, pr*1aturita/, k*1atia( a(i( i(traut*ri( CIU5 da( /*p/i/ Ci(f*k/i 7*rat. &. S*la1a p*r/ali(a( P*r/ali(a( 7ayi /u()/a(), p*r/ali(a( la1a, i7u d*()a( ala( la0ir ya() /*1pit, 1*17uat 7ayi 1*()ala1i k*/ulita( 7*r(apa/ da( tidak 1*(a()i/ k*tika dila0irka(. P*(*ka(a( tali pu/at ol*0 7a)ia( tu7u0 7ayi, 7ayi k*17ar, da( tu1or di ra0i1 u)a dapat 1*())a())u p*r(afa/aa( 7ayi. A/fik/ia u)a dapat t*radi ika pla/*(ta atau ariari l*pa/ l*7i0 t*rl*7i0 dulu da( 7ayi t*rlilit tali pu/at. . S*t*la0 p*r/ali(a( A/fik/ia (*o(atoru1 adala0 k*adaa( 7ayi ya() tidak dapat 7*r(apa/ /*3ara /po(ta( da( t*ratur, /*0i())a dapat 1*(uru(ka( ok/i)*(. Ko(di/i i(i u)a aka( 1*(i()katka(
kar7o(diok/ida ya() 1*(i17ulka(
aki7at 7uruk dala1
k*0idupa( l*7i0 la(ut. S*t*la0 p*r/ali(a(, a/fik/ia k*1u()ki(a( di/*7a7ka( ol*0 p*(yakit i(f*k/i akut atau kro(i/, k*ra3u(a( o7at 7iu/, ur*1ia da( tok/o1ia )ra;idaru1, a(*1ia 7*rat, 3a3at 7a+aa( atau trau1a, /*roti(u/ Ck*0a1ila( k*l*7i0a( 7ula(, da( k*kura()a( )i2i i7u 0a1il C1al(utri/i dala1 ka(du()a(.
7 Apaka0 ti(daka( ya() dilakuka( /uda0 t*pat 6a)ai1a(a ti(daka( ya() 0aru/(ya dilakuka( 7ila 7*lu1 t*pat 15
6ila 7ayi 7aru la0ir tidak 1*(a()i/ da( di/*rtai ap(*a, 1aka dokt*r dapat 1*lakuka( ti(daka( a+al /*p*rti : #. M*(a)a k*0a()ata( 7ayi d*()a( 3ara 1*()*ri()ka( da( 1*(y*li1uti tu7u0 7ayi. &. M*(*1patka( po/i/i k*pala 7ayi d*()a( 7*(ar da( 1*17*r/i0ka( ala( (apa/ dari l*(dir, dara0 da( air k*tu7a( Cya() kada()kada() 7*r3a1pur 1*ko(iu1 /*0i())a ala( (apa/ t*r7uka da( udara ya() 1*()a(du() O& dapat 1a/uk k* paruparu d*()a( 7aik. . Lakuka( ra()/a()a( taktil yak(i d*()a( 1*(*puk atau 1*(y*(til t*lapak kaki da( 1*())o/ok pu())u() 7ayi u(tuk 1*ra()/a() p*r(apa/a( 3 Apa 1ak(a kli(i/ 7ayi 7aru 1*(a()i/ l*1a0 /*t*la0 dilakuka( p*()0i/apa( 1a(ual ala( (apa/ da( /ti1ula/i 1*(*puk pada kaki 7ayi ol*0 7ida( Kar*(a /*7*lu1(ya ala( (apa/ t*r/u17at adi 7ayi tidak la()/u() 1*(a()i/. 5a()/a()a( taktil yak(i d*()a( 1*(*puk atau 1*(y*(til t*lapak kaki da( 1*())o/ok pu())u() 7ayi u(tuk 1*ra()/a() p*r(apa/a(.
d Apa 7ata/a( ti(daka( ya() 7ol*0 dilakuka( dokt*r u1u1 pada ka/u/ 7ayi ya() tidak 1*(a()i/ /po(ta(
16
* M*()apa /ti1ula/i dilakuka( pada kaki Sti1ula/i taktil pada 66L dapat dilakuka( d*()a( & 3ara: #. M*(*puk atau 1*(y*(til t*lapak kaki d*()a( 0ati0ati, &. M*())o/ok pu())u(), p*rut, dada, atau tu()kai 7ayi d*()a( t*lapak ta()a(.
". S*t*la0 o7/*r;a/i & a1 7ayi 1a/i0 k*/ulita( 7*r(afa/ da( 1*ri(ti0, 7ayi diruuk k* 5SMH.
17
a Apa /aa ya() dio7/*r;a/i pa/3a r*/u/ita/i pada 7ayi Pri(/ip /ta7ili/a/i (*o(atu/ dala1 STA6LE, t*rdiri dari: S Su)ar a(d Saf* 4ar* S (SUGAR AND SAFE CARE)
M*rupaka( la()ka0 u(tuk 1*(/ta7ilka( kadar )ula dara0 (*o(atu/. Pada a+al k*0idupa(, k*la()/u()a( pa/oka( (utri/i t*r0*(ti /*t*la0 p*1oto()a( tali pu/at. 6ayi 7aru la0ir 1*1*rluka( k*la()/u()a( (utri/i u(tuk 1*1p*rta0a(ka( a/upa( )luko/a. K*3ukupa( )luko/a dip*rluka( a)ar 1*ta7oli/1* /*l t*rtap 7*rla()/u() t*ruta1a /*l otak. Ada faktor ri/iko ya() 1*1p*()aru0i kadar )ula dara0: #. 4ada()a( )liko)*( t*r7ata/ &. Hip*ri(/uli(*1ia . P*(i()kata( p*())u(aa( )luko/a T T*1p*ratur* M*rupaka(u/a0a u(tuk 1*1p*rta0a(ka( /u0u (or1al 7ayi da( 1*(3*)a0 0ipot*r1ia. Pada 7ayi d*()a( 0ipot*r1i aka( t*radi ;a/oko(/trik/i p*17ulu0 dara0 /*0i())a 1*()aki7atka( k*tidak3ukupa( /irkula/i di ari()a( tu7u0. S*lai( itu ko(di/i 0ipot*r1ia dapat 1*(i()katka( 1*ta7oli/1 dala1 ra()ka u(tuk 1*(i()katka( kalori tu7u0, ko(di/i i(i aka( 1*(i()katka( k*7utu0a( tu7u0 t*r0adap ok/i)*(. D*()a( d*1ikia( /u0u)ula dara0ok/i)*( 1*1pu(yai k*t*rkaita( *rat. N*o(atu/ l*7i0 1uda0 1*()ala1i 0ipot*r1ia daripada 0ip*rt*r1ia. Li()ku()a( *k/traut*ri( 7*r7*da d*()a( li()ku()a( i(traut*ri(. Li()ku()a( *k/traut*ri( 1*(i()katka( ri/iko 0ipot*r1ia kar*(a li()ku()a( udara 7uka( 3aira( 0a()at, /*lai( itu u)a p*()aru0 ko(duk/i, ko(;*k/i, *;apora/i, da( radia/i. Su0u (or1al adala0 ',%!4 > 8,&G8,%!4. A Air+ay Ma/ala0 p*r(apa/a( 1*(adi 1or7idita/ ya() /*ri() diala1i 7ayi ya() 1*(dapat p*ra+ata( di NI4U. Saat r*/u/ita/i dilakuka( upaya 1*17uka al;*oli paru, pa/3a r*/u/ita/i al;*oli paru 7*lu1 /*p*(u0(ya t*r7uka. 6*7* rapa faktor pr*di/po/i/i :
Pr*1aturita/ P*r/ali(a( /*k/io 3*/aria 18
Si(dro1a a/pira/i 1*ko(*u1 CMAS Pro/*/ i(fla1a/i P(*u1otorak/: ko1plika/i, /po(ta( K*lai(a( 7a+aa( : 4DH, ki/ta paru, Ma/ala0 lai( di luar paru C0ipot*r1ia, 0ipo)lik*1ia, k*lai(a( a(tu(), dll Pro7l*1a /u17ata( ala( (apa/
D*t*k/i di(i k*)a+ata( (apa/ da( *;alua/i t*rapi, t*r1a/uk 1*(ilai pro)r*/ifita/ )a())ua( p*r(apa/a( /a()at p*(ti(). Sala0 /atu p*(ilaia( di(i )a())ua( p*r(apa/a( ya() 1uda0 adala0 1*())u(aka( Skor Do+(.
S*lai( 1*()a1ati ta(da k*)a+ata( p*r(apa/a(, p*(ti() u(tuk 1*(ilai:
K*7utu0a( ok/i)*( da( p*(i()kata( k*7utu0a( Ko1plika/i aki7at 0ipok/ia da( 0ip*rkar7ia
PPHN Cp*r7*daa( /atura/i O& pr* da( po/t duktal 19
P*rfu/i p*rif*r, t*ka(a( dara0
N*urolo)i/ : k*/adara(, aktifita/, ada tidak(ya k*a()
Produk/i uri(
Ta(data(da aka( t*radi k*)a)ala( p*r(apa/a(
P*r(apa/a( 1*)ap1*)ap
Tidak 7*r*/po(/ d*()a( p*17*ria( O&
6ila 1*1u()ki(ka( : a(ali/i/ )a/ dara0 Cdata p*(ti(): p4O& da( 6E 6 6lood pr*//ur* Syok t*radi aki7at ada(ya )a())ua( p*rfu/i da( ok/i)*(a/i or)a(. Ada *(i/ /yok, yaitu: Hipo;ol*1i Ct*r/*ri() pada (*o(atu/ Kardio)*(ik S*ptik P*(y*7a7 t*r/*ri() pada (*o(atu/ adala0: K*0ila()a( dara0 /aat i(traut*ri(Gp*r/ali(a( K*0ila()a( dara0 /*t*la0 la0ir D*0idra/i N*o(atu/ /*yo)ya(ya di3*)a0 a)ar a()a( /a1pai atu0 pada ko(di/i /yok. *ala
di(i )a())ua( /irkula/i pada (*o(atu/ l*7i0 /*ri() 7*rupa )a())ua( p*r(apa/a(. Takip(u K*ra (afa/ 1*(i()kat Takikardi Pada fa/* la(ut aka( t*radi: M*)ap1*)apGap(u 6radikardi Nadi p*rif*r l*1a0 Hipot*(/i Mottl* /i)( Cp*rfi/i p*rif*r 7uruk
L La7oratory Pada 7ayi ya() aka( diruuk, +ai7 dilakuka( p*1*rik/aa( la7oratoriu1 u(tuk k*1u()ki(a( i(f*k/i C7ila fa/ilita/ 1*1adai. P*rlu dilakuka( u)a pada 7ayi 7*ri/iko i(f*k/i. -aktor ri/iko t*r/*ri(): KPD J #$ a1 I7u d*()a( ri+ayat korioa1(io(iti/ I7u /akit Ci(f*k/i 1*(*la() p*r/ali(a(, 1i/al(ya k*puti0a(, diar*, /u0u i7u J $!4, p*r/ali(a( pr*1atur, 7ayi d*()a( ri+ayat )a+at a(i(. 20
E E1otio(al /upport K*la0ira( a(ak 1*rupaka( /aat ya() di(a(tika( da( 1*17a0a)iaka(. 6ila ko(di/i tidak /*p*rti ya() di0arapka( aka( 1*())a())u *1o/i. Ora()tua 7ia/a(ya aka( 1*1iliki p*ra/aa( 7*r/ala0, 1*(ya()kal, 1ara0, tidak p*r3aya, 1*ra/a )a)al, takut, /ali() 1*(yala0ka(, d*pr*/i. Duku()a( *1o/i t*r0adap ora()tua atau k*luar)a 7ayi /a()at p*(ti().
7 M*()apa 7ayi 1a/i0 1*()ala1i k*/ulita( 7*r(apa/ da( 1*ri(ti0 Ti(daka( ya() dilakuka( ol*0 7ida( 7*lu1 3ukup kar*(a 1a/ala0 uta1a(ya 7uka(la0 a/pira/i C3aira( a1(io( 1*lai(ka( i(f*k/i di paruparu 7ayi. 3 Apa i(dika/i ruuk pada ka/u/ I(dika/i ruuk (*o(atu/ pada ka/u/ i(i:
I(dika/i 1at*r(al Ck*0a1ila( i7u d*()a( k*la0ira( 7*r*/iko ti())i yaitu K*tu7a( p*3a0 di(i, 3aira( a1(io( t*r3*1ar 1*ko(iu1 da( i7u d*1a1 atau
/akit. I(dika/i 7ayi C7ayi r*/iko ti())i yaitu /*p/i/ da( )a())ua( (afa/ C5*/piratory di/tr*//
21
d 6a)ai1a(a p*r/iapa( ruuka( ya() 0aru/ dilakuka( pada 7ayi #. r*/u/ita/i
22
&. 7/*r;a/i ta(da k*)a+at darurata(
Buku saku pelayanan kesehatan anak di rumah sakit, Pedoman bagi rumah sakit rujukan tingkat pertama di kabupaten/kota.who: !!"
23
Buku saku pelayanan kesehatan anak di rumah sakit, Pedoman bagi rumah sakit rujukan tingkat pertama di kabupaten/kota.who: !!"
24
Buku saku pelayanan kesehatan anak di rumah sakit, Pedoman bagi rumah sakit rujukan tingkat pertama di kabupaten/kota.who: !!"
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25
a 6a)ai1a(a i(t*rpr*ta/i 7*rat 7ada( .% k) Nor1al, S*/uai d*()a( AACappropriat* for )*/tatio(al a)*
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k*ari()a( otot 1*(uru( 7ayita1pak 0ipoaktif KPD
faktor r*/iko i(f*k/i i(tra ut*ri(
t*rko(ta1i(a/i ku1a(
a1(io(
7ayi t*ra/pira/i 3aira( k*tu7a(
ya() t*ri(f*k/it*radi ascending infectiont*radi rada() pada al;*olu/ pada
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i)a
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t*rdapat
ada(ya u/a0a 1*(i()katka( ok/i)*( pada
)ru(ti()
7ayi
d*()a(
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Saturatio( $! Tar)*t B u/i() (a/al /atura/i oy)*(
#!
1*(it $%9% B 27
P*1*rik/aa( Su3ki() r*fl*
I(t*rpr*ta/i +a/ S*7a)ai /ala0 /atu )*ala u1u1
+*ak
/*p/i/. Tidak
ada(ya r*fl*k/ i(i dapat 1*1p*r7uruk k*adaa(
0ipoaktif pada 7ayi. H*art rat* +a/ #'$ K*tu7a( p*3a0 di(i t*radi p*ru7a0a( pH ;a)i(a 7*at/ p*r1i(ut*
dari a/a1 k* 7a/a
30orioa1(ioti/ i(f*k/i
7*rpi(da0(ya 7akt*ri ya() t*radi di paru
7ro(kop(*u1o(ia da( /*p/i/ o(/*t 3*pat di/tr*// p*r(apa/a(
Hipoaktif, 1*ri(ti0, Sulit
7*r(afa/, Tidak 1*(a()i/, H5 da( 55 1*(i()kat, Su3ki() r*fl* l*1a0, 5*trak/i di(di() dada A7do1*( +a/ t*(d*r Nor1al +it0
(or1al
7o+*l
/ou(d T0*r* +*r* 1*3o(iu1 M*ko(iu1 ya() dil*pa/ka( /aat 7ayi 1a/i0 dala1 /tai(i() at u17ili3al ka(du()a( aka( 7*r3a1pur d*()a( 3aira( k*tu7a( 3ord a(d /ki(
da( dapat 1*(*1p*l di kulit da( pla/*(ta 7ayi
* 6a)ai1a(a do+( /3or* pada ka/u/ S-+! R!&,at+: at! 3:a$+&,& A, !$t: G'$t R!ta-t,+$ N," ! '!G1i( Nor1al No(* Nil # '! I( roo1 M,"( A'&M,"( $!G1i( air 5,t &t!t+&-+! ;80
Skor pada ka/u/ =>
6*rda/arka( /kor do+(: !"
: Di/tr*// Napa/ 5i()a( 1*17utu0ka( O& (a/al atau 0*ad7o
"8
: Di/t/r*/ Napa/ S*da() 1*17utu0ka( Na/al 4PAP
J8
:
Di/tr*/ Napa/ 6*rat A(3a1a( a)al Napa/ 1*17utu0ka( I(tu7a/i
Cp*rlu dip*rik/a A(ali/a a/ Dara0GAD
f Apa 1ak(a kli(i/ dari dilakuka((ya 1*3o(*(u1 /tai(i() 28
M*li0at ada tidak(ya a/pira/i 1*3o(iu1 p*(y*7a7 t*r/*ri() dari p(*u1o(ia.
2.= LEARNING ISSUE A. KETUBAN PE3AH DINI 1. D,a%$+&,& Ba$(,
%$*ala da( ta(da ya() *ala da( ta(da ya() Dia)(o/i/ 1u()ki( /*lalu ada
kada() ada
K*luar 3aira( k*tu7a(
K*tu7a( p*3a0 ti7ati7a 4aira( ta1pak di i(troitu/ Tidak ada 0i/ dala1 # a1
4aira( ;a)i(a 7*r7au D*1a1G1*())i)il Ny*ri p*rut
5i+ayat k*luar air a1(io(iti/ Ut*ru/ 1*(y*1pit DFF 3*pat P*rdara0a( p*r;a)i(a1
KPD
/*dikit /*dikit
4aira( ;a)i(a 7*r7au atal, k*puti0a(, Tidak ada ri+ayat k*tu7a( p*rut, di/uria p*3a0
4aira( ;a)i(a 7*rdara0
(y*ri a)i(iti/G /*r;i/iti/
Ny*ri p*rut, )*rak a(i( P*rdara0a( a(t* partu1 7*rkura()
,
p*rdara0a(
7a(yak
2. A"%+,t/a D,a%$+&,& A. M*(*(tuka( p*3a0(ya /*laput k*tu7a( d*()a( ada(ya 3aira( k*tu7a( di
;a)i(a. 6. M*1*rik/a ada(ya 3aira( ya() 7*ri/i 1*ko(iu1, ;*r(ik ka/*o/a, ra17ut la(u)o da( kada()kada() 7au kalau ada i(f*k/i.
29
4. Dari p*1*rik/aa( i(/p*kulo t*rli0at k*luar 3aira( k*tu7a( dari 3aira( /*r;ikali/. D. T*/t (itra2i(Glak1u/, k*rta/ lak1u/ 1*ra0 7*ru7a0 1*(adi 7iru C7a/a 7ila k*tu7a( /uda0 p*3a0. E. P*1*rik/a( p*(u(a() d*()a( 1*())u(aka( US u(tuk 1*17a(tu dala1 1*(*(tuka( u/ia k*0a1ila(, l*tak a(i(, 7*rat a(i(, l*tak pla/*(ta /*rta u1la0 air k*tu7a(. P*1*rik/aa( air k*tu7a( d*()a( t*/ l*uko/it */t*ra/*, 7ila l*uko/it dara0 l*7i0 dari #%.!!!G11 k*1u()ki(a( ada(ya i(f*k/i. *. D!,$,&, K*tu7a( p*3a0 di(i CKPD did*fi(i/ika( /*7a)ai p*3a0(ya /*laput k*tu7a(
/*7*lu1 t*radi(ya p*r/ali(a(. K*tu7a( p*3a0 di(i dapat t*radi pada atau /*t*la0 u/ia )*/ta/i 8 1i())u da( di/*7ut KPD at*r1 atau pr*1atur* ruptur* of 1*17ra(*/ CP5OM da( /*7*lu1 u/ia )*/ta/i 8 1i())u atau KPD pr*t*r1 atau pr*t*r1 pr*1atur* ruptur* of 1*17ra(*/ CPP5OM CHarto(o, &!#'. 4. E,(!/,+"+%,
Ma/ala0
KPD
1*1*rluka(
p*r0atia(
ya()
l*7i0
7*/ar,
kar*(a
pr*;al*(/i(ya ya() 3ukup 7*/ar da( 3*(d*ru() 1*(i()kat. K*adia( KPD at*r1 t*radi pada /*kitar ',"'#%,'B k*0a1ila( at*r1 da( PP5OM t*radi pada t*radi pada /*kitar &B dari /*1ua k*0a1ila( tu())al da( 8,"B dari k*0a1ila( k*17ar. PP5OM 1*rupaka( ko1plika/i pada /*kitar #G dari /*1ua k*la0ira( pr*1atur, ya() t*la0 1*(i()kat /*7a(yak $B /*ak ta0u( #9$#. Dapat dipr*dik/i 7a0+a a0li o7/t*tri aka( p*r(a0 1*(*1uka( da( 1*lakuka( p*(a()a(a( ka/u/ KPD dala1 karir kli(ik(ya. K*adia( KPD pr*t*r1 7*r0u7u()a( d*()a( p*(i()kata( 1or7idita/ da( 1ortalita/ 1at*r(al 1aupu( p*ri(atal. S*kitar #G dari p*r*1pua( ya() 1*()ala1i KPD pr*t*r1 aka( 1*()ala1i i(f*k/i ya() 7*rpot*(/i 7*rat, 7a0ka( f*tu/G (*o(atu/ aka( 7*rada pada ri/iko 1or7idita/ da( 1ortalita/ t*rkait KPD pr*t*r1 ya() l*7i0 7*/ar di7a(di() i7u(ya, 0i())a "8,9B 7ayi 1*()ala1i k*1atia(. P*r/ali(a( pr*1atur d*()a( pot*(/i 1a/ala0 ya() 1u(3ul, i(f*k/i p*ri(atal, da( ko1pr*/i tali pu/at i( ut*ro 1*rupaka( ko1plika/i ya() u1u1 t*radi. KPD pr*t*r1
30
7*r0u7u()a( d*()a( /*kitar #$&!B k*1atia( p*ri(atal di A1*rika S*rikat CHarto(o, &!#'.
=. Et,+"+%,
P*(y*7a7 KPD 1*(urut Ma(ua7a, &!!9 da( Mor)a(, &!!9 1*liputi a(tara lai( C# S*r;ik/ i(ko1p*t*(, C& -aktor k*turu(a(, C p*()aru0 dari luar ya() 1*l*1a0ka( k*tu7a( Ci(f*k/i )*(*talia, C" o;*rdi/t*(/i ut*ru/ , C%1alpo/i/i atau 1alpr*/*(ta/* a(i(, C' faktor ya() 1*(y*7a7ka( k*ru/aka( /*r;ik/, C8 ri+ayat KPD /*7*lu1(ya dua kali atau l*7i0, C$ faktor ya() 7*r0u7u()a( d*()a( 7*rat 7ada( /*7*lu1 da( /*la1a 0a1il, C9 1*rokok /*la1a k*0a1ila(, C#! u/ia i7u ya() l*7i0 tua 1u()ki( 1*(y*7a7ka( k*tu7a( kura() kuat daripada u/ia 1uda, C## ri+ayat 0u7u()a( /*k/ual 7aru7aru i(i, C#& parita/, C# a(*1ia, C#" k*adaa( /o/ial *ko(o1i. S*7ua0 p*(*litia( ol*0 *ta0u( D, A(a(t0 dkk ta0u( &!!8 1*(y*7utka( 7a0+a a/1a 7i/a 1*1i3u t*radi(ya k*tu7a( p*3a0 di(i.
>. Fa#t+ R,&,#+
5i+ayat k*tu7a( p*3a0 di(i /*7*lu1(ya
I(f*k/i Traktu/ )*(ital /*3ara a/3*(di() C6akt*rial a)i(o/i/
Poly0idra1(io(
Multipl* */tatio(
P*rdara0a( A(t*partu1
M*rokok
Pro/*dur i(;a/i;* Ca1(io/i(t*/i/
I(/ufi/i*(/i /*r;ik/: 1*1iliki l*0*r ra0i1 ya() p*(d*k atau pr*1atur /*la1a k*0a1ila(
?.
Statu/ /o/io*ko(o1i r*(da0
6*rat 7ada( r*(da0
K"a&,,#a&,
31
K!t'6a$ !-a (,$, 7PROM9 p*3a0(ya /*laput a(i( /*tidak(ya # a1
/*7*lu1 o(/*t p*r/ali(a(, pada u/ia k*0a1ila( 8 1i())u. I(i t*radi pada #!#%B k*0a1ila( t*r1al, da( dikaitka( d*()a( ri/iko 1i(i1al pada i7u
da( a(i( kar*(a u/ia k*0a1ila( la(ut. K!t'6a$ !-a (,$, !/at' 7PPROM9 p*3a0(ya /*laput a(i( ya() t*radi pada u/ia )*/ta/i 8 1i())u. I(i t*radi pada &B k*0a1ila( da( 1*1iliki ti()kat ko1plika/i i7u da( a(i( ya() l*7i0 ti())i. Hal i(i t*rkait d*()a( "!B p*r/ali(a( pr*1atur.
PROM :a$% 6!#!a$)a$%a$: ka/u/ k*tu7a( p*3a0 di(i di1a(a l*7i0 dari
&" a1 t*la0 7*rlalu a(tara ruptur da( o(/*t p*r/ali(a(.
PPROM M,(t,/!&t! ata' P!@,a6"! PPROM : k*tu7a( p*3a0 di(i ya()
t*radi /*7*lu1 u/ia )*/ta/i &" 1i())u. S*7*lu1 u/ia i(i, a(i( tidak 7i/a 7*rta0a( di luar ka(du()a( i7u.
8.
Ma$,!&ta&, K",$,&
Pada k*tu7a( p*3a0 di(i, ri+ayat k0a/ adala0 p*3a0 k*tu7a( d*()a( +a(ita ya() 1*()ala1i /*(/a/i p*3a0 ya() tidak 1*(yakitka(, diikuti ol*0 /*)u1pal 3aira( *(3*r ya() 1*r*17*/ dari ;a)i(a. Na1u(, )*ala(ya /*ri()kali 7i/a l*7i0 tidak /p*/ifik, /*p*rti k*7o3ora( 3aira( 7*rair /*3ara 7*rta0ap dari ;a)i(a da( pakaia( dala1 l*17a7 G pad, atau p*ru7a0a( +ar(a atau ko(/i/t*(/i k*puti0a(. Pada p*1*rik/aa( /p*kulu1, dapat t*rli0at 3aira( 1*()*ri() dari /*r;ik/ da( t*r)*(a() pada for(ik/ ;a)i(a po/t*rior. U(tuk 1*1a/tika( p*1*rik/aa( ya() 1*1adai, +a(ita t*r/*7ut 0aru/ dipo/i/ika( di ka/ur
p*1*rik/aa(
/*tidak(ya /*la1a ! 1*(it. I(i aka( 1*1u()ki(ka( p*(u1puka( 3aira( a1(iotik ya() 7o3or di 7a)ia( ata/ ;a)i(a. S*lai( itu, kura()(ya k*puti0a( (or1al dapat 1*(u(ukka( ada(ya ruptur 1*17ra(. M*1i(ta +a(ita u(tuk 7atuk /aat p*1*rik/aa( 7i/a 1*(y*7a7ka( 3aira( k*tu7a( k*luar. P*1*rik/aa( d*()a( /p*kulu1 tidak dip*rluka( 7ila 3aira( k*tu7a( t*rli0at 1*r*17*/ la()/u() dari ;a)i(a. Aro1a air k*tu7a( 7*r7au a1i/ da( tidak /*p*rti 7au a1o(iak, 1u()ki( 3aira( t*r/*7ut 1a/i0 1*r*17*/ atau 1*(*t*/, d*()a( 3iri pu3at da( 7*r)ari/ 32
+ar(a dara0. 4aira( i(i tidak aka( 7*r0*(ti atau k*ri() kar*(a t*ru/ diproduk/i /a1pai k*la0ira(. D*1a1, 7*r3ak ;a)i(a ya() 7a(yak, (y*ri p*rut, d*(yut a(tu() a(i( 7*rta17a0 3*pat 1*rupaka( ta(data(da i(f*k/i ya() t*radi CMa(ua7a, &!!9.
. Pat+,&,+"+%,
K*tu7a( p*3a0 di(i adala0 k*adaa( p*3a0(ya /*laput k*tu7a( /*7*lu1 p*r/ali(a(. Dala1 k*adaa( (or1al, $#!B p*r*1pua( 0a1il at*r1 aka( 1*()ala1i k*tu7a( p*3a0 di(i. P*3a0(ya k*tu7a( dala1 p*r/ali(a( /*3ara u1u1 di/*7a7ka( ol*0 ko(trak/i ut*ru/ da( p*r*)a()a( ula(). S*laput k*tu7a( p*3a0 kar*(a pada da*ra0 t*rt*(tu t*radi p*ru7a0a( 7ioki1ia ya() 1*(y*7a7ka( /*l*put k*tu7a( i(f*rior rapu0, 7uka( kar*(a /*luru0 /*laput k*tu7a(
rapu0. T*rdapat
k*/*i17a()a( a(tara /i(t*/i/ da( d*)rada/i
*k/tra/*lul*r 1atrik/. P*ru7a0a( /truktur, u1la0/ /*l, da( kata7oli/1* kola)*( 1*(y*7a7ka( akti;ita/ kola)*( 7*ru7a0 da( 1*(y*7a7ka( /*laput k*tu7a( p*3a0. D*)rada/i kola)*( di1*dia/i ol*0 1atrik/ 1*taloprot*i(a/* CMMP ya() di0a17at ol*0 i(0i7itor ari()a( /p*/ifik da( i(0i7itor prot*a/*. M*(d*kati +aktu p*r/ali(a(, k*/*i17a()a( a(tara MMP da( TIMP# 1*()ara0 pada d*)rada/i prot*olitik dari 1atrik/ *k/tra/*lul*r da( 1*17ra( a(i(. Akti;ita/ d*)rada/i i(i 1*(i()kat 1*(*la() p*r/ali(a(.
10. K+/",#a&,
Ko1plika/i 7ia/a(ya /*7a)ai 0a/il la()/u() dari p*(y*7ara( 7akt*ri dala1 ro())a t0ora C/*p*rti *fu/i pl*ura, *1pi*1a da( p*rikarditi/ atau p*(y*7ara( 7akt*r*1ia da( 0*1atolo)i. M*(i()iti/, artriti/ /upuratif, da( o/t*o1i*liti/
adala0
ko1plika/i ya() ara() dari p*(y*7ara(
0*1atolo)i.
11. Tata"a#&a$a Fa/a#+ (a$ N+$Fa/a#+
33
i(f*k/i
P*(atalak/a(aa( p(*u1o(ia k0u/u/(ya 7ro(kop(*u1o(ia pada a(ak t*rdiri dari & 1a3a1, yaitu p*(atalak/a(aa( u1u1 da( k0u/u/ CIDAI, &!#& 6radl*y *t.al., &!## : a.
P*(atalak/aa( U1u1 P*17*ria( ok/i)*( l*17a7 &" LG1*(it
7.
/a1pai /*/ak (afa/
0ila() atau PaO& pada a(ali/i/ )a/ dara0 '! torr. P*1a/a()a( i(fu/ u(tuk r*0idra/i da( kor*k/i *l*ktrolit. A/ido/i/ diata/i d*()a( p*17*ria( 7ikar7o(at i(tra;*(a.
P*(atalak/a(aa( K0u/u/ a. Mukolitik, *k/p*ktora( da( o7at p*(uru( pa(a/ /*7aik(ya tidak di7*rika( pada 8& a1 p*rta1a kar*(a aka( 1*()a7urka( i(t*rpr*ta/i r*ak/i a(ti7ioti a+al. 7. O7at p*(uru( pa(a/ di7*rika( 0a(ya pada p*(d*rita d*()a( /u0u ti())i, takikardi, atau p*(d*rita k*lai(a( a(tu() 3. P*17*ria( a(ti7iotika 7*rda/arka( 1ikroor)a(i/1* p*(y*7a7 da( 1a(if*/ta/i kli(i/. P(*u1o(ia ri()a(
a1ok/i/ili( #!&%
1)Gk)66Gdo/i/ Cdi +ilaya0 d*()a( a()ka r*/i/t*(/i p*(i/illi( ti())i do/i/ dapat di(aikka( 1*(adi $!9! 1)Gk)66G0ari. -aktor ya() p*rlu dip*rti17a()ka( dala1 p*1ili0a( t*rapi : Ku1a( ya() di3uri)ai ata/ da/a/ data kli(i/, *tiolo)i/ da( *pid*1iolo)i/ 6*rat ri()a( p*(yakit 5i+ayat p*()o7ata( /*la(ut(ya /*rta r*/po( kli(i/ Ada tidak(ya p*(yakit ya() 1*(da/ari
P*1ili0a( a(ti7iotik dala1 p*(a()a(a( p(*u1o(ia pada a(ak 0aru/ dip*rti17a()ka( 7*rda/aka( p*()ala1a( *1piri/, yaitu 7ila tidak ada ku1a( ya() di3uri)ai, 7*rika( a(ti7iotik a+al C&"8& a1 p*rta1a 1*(urut k*lo1pok u/ia. N*o(atu/ da( 7ayi 1uda C & 7ula( : a.
a1pi3illi( a1i(o)liko/id
7.
a1ok/i/illi( a/a1 kla;ula(at
3.
a1ok/i/illi( a1i(o)liko/id
d. /*falo/pori( )*(*ra/i k* 34
12. P!$-!%aa$ (a$ E('#a&,
P*(3*)a0a( KPD diuta1aka( d*()a( 1*()0i(dari faktor ri/iko(ya, /*p*rti: P*1*rik/aa( k*0a1ila( ya() t*ratur K*7ia/aa( 0idup /*0at, /*p*rti 1*()o(/u1/i 1aka(a( ya() /*0at, 1i(u1
3ukup, ola0ra)a t*ratur da( 7*r0*(ti 1*rokok. M*17ia/aka( diri 1*17*r/i0ka( da*ra0 k*1alua( d*()a( 7*(ar, yak(i
dari d*pa( k* 7*laka(), t*ruta1a /*t*la0 7*rk*1i0 atau 7ua() air 7*/ar. M*1*rik/aka( diri k* dokt*r 7ila ada /*/uatu ya() tidak (or1al di ad*ra0 k*1alua(, 1i/al(ya k*puti0a( ya() 7*r7au atau 7*r+ar(a tidak /*p*rti
7ia/a(ya. U(tuk /*1*(tara +aktu, 7*r0*(ti 1*lakuka( 0u7u()a( /*k/ual 7ila ada i(dika/i ya() 1*(y*7a7ka( k*tu7a( p*3a0 di(i, /*p*rti 1ulut ra0i1 ya()
l*1a0. M*()o(/u1/i #!! 1) ;ita1i( 4 /*3ara t*ratur /aat u/ia k*0a1ila( l*7i0 dari &! 1i())u P*(3*)a0a( /i(dro1 a/pira/i 1*ko(iu1 1*(3akup p*1a(taua( k*adaa(
dala1 ka(du()a( /*3ara /*k/a1a u(tuk 1*(3*)a0 a/fik/ia. Fika dit*1uka( 3aira( k*tu7a( 7*r3a1pur d*()a( 1*ko(iu1, dokt*r a0li k*7ida(a( 0aru/ 1*()0i/ap orofari() 7ayi /*7*lu1 1*la0irka( /i/a tu7u0 7ayi. Apa7ila 7ayi t*rli0at l*1a0d*()a( to(u/ ya() 7uruk, u/a0a (apa/ 1i(i1al, da( /ia(o/i/, orofari(() 7ayi 0aru/ dii/ap, pita /uara di;i/uali/a/i da( da*ra0 di 7a+a0 pita /uara dii/ap u(tuk 1*()*luarka( 1*ko(iu1 dari trak*a. Pro/*dur i(i dapat diula() dua /a1pai ti)a kali /*la1a1a/i0 t*rdapat 1*ko(iu1, /*7*lu1 1*(/ti1ula/i a7yi u(tuk 7*r(apa/ atau 1*1ulai 7a(tua( ;*(tila/i, i(fu/ /ali( k* dala1 3aira( k*tu7a( i(tra ut*ri( /*la1a p*/ali(a( dapat 1(*)ura()i i(/id*(/ a/pira/i p(*u1o(ia.
1*. P!/!,#&aa$ P!$'$)a
%$P*1*rik/aa( p*(u(a(): u(tuk 1*(*)aka( dia)(o/i/ dilakuka( p*1*rik/aa(:
35
A(ali/i/ )a/ dara0 1*rupaka( i(dikator d*fi(itif dari p*rtukara( )a/ u(tuk 1*(ilai )a)al (afa/ akut. M*/kipu( 1a(if*/ta/i kli(i/ ya() ada 1*1*rluka( ti(daka( i(tu7a/i /*)*ra da( p*())u(aa( ;*(tila/i 1*ka(i/, p*()a17ila( /a1p*l dara0 art*rial dip*rluka( u(tuk 1*()a(ali/i/ t*ka(a( )a/ dara0 CPaO&, Pa4O&, da( pH /a17il 1*lakuka( 1o(itori() d*()a( pul/* oy1*tri. P*1*rik/aa( p*(u(a() lai( ya() dip*rluka( /*7a)ai p*1*rik/aa( a+al pada pa/i*( ya() 1*()ala1i di/tr*// p*r(afa/a( a(tara lai(: ro(t)*( torak/ Cdapat dilakuka( /*t*la0 p*1a/a()a( ETT, p*1*rik/aa( dara0 u(tuk /kri(i() /*p/i/, t*r1a/uk p*1*rik/aa( dara0 ruti(, 0itu() *(i/, apu/ dara0 t*pi, 4r*a3ti;* prot*i(, kultur dara0, )luko/a dara0, da( *l*ktrolit. B. BRON3HOPNEUMONIA PADA NEONATUS 1. D,a%$+&,& Ba$(,
%$*alaGTa(da
6ro(kop(*
A/pira/i
TTN
PMH
u1o(ia
M*ko(iu1
C(ransient
CP*(yakit
(achypnea
of 1*17ra(
the )ewborn
0yali(*
At*r1Gpr*t*r1
Pr*t*r1
U/ia
At*r1Gpr*t
At*r1Gpo/t
K*0a1ila(
*r1
t*r1
O(/*t
6*7*rapa
6*7*rapa
6*7*rapa /aat S*)*ra
ti17ul(ya
/aat la0ir
/aat la0ir
la0ir
)*ala
Cpri1ary di/tr*//
36
ru(ti()
Sia(o/i/
G
G Cara()
P*r7aika(
M*17aik
S*1*(tara
M*17aik
S*1*(tara
d*()a( O&
d*()a( ok/i)*( /*1*(tara
Su3ki() 5*fl*
5*trak/i
G Cara()
Ada(ya
P*(y*17u0a(
5*trak/i
ya()
di(di()
1*(dadak
dada
di(di() dada *ala lai(
K0a/ Ada(ya ro(ki
da( 3aira(
l*uko/ito/i/
a1(io( ya() 7*r+ar(a k*0iaua( pada
/aat
k*la0ira( a17ara(
T*rdapat
T*rdapat
R/tar
7ur/t a17ara(
5o(t)*(
i(filtrat da( 7*rka/
7a(yak
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t*()a0
la//
da(
2. D,a%$+&,& K!)a 6ayi Ny A(ita k*la0ira( at*r1, 66 .% k), pa(a() tu7u0 %! 31, li()kar
k*pala " 31, 1*()ala1i r*/piratory di/tr*// /u/p*3t 7ro(30op(*u1o(ia d*()a( ri+ayat i7u 1*()ala1i KPD *.3 i(f*k/i i(traut*ri(*. *. A"%+,t/a (,a%$+&,&
37
N*o(atu/ d*()a( )a())ua( p*r(apa/a( C/ala0 /atu: p*r(apa/a( 3*pat, 7*ri/ik, atau /ulit ti()kat p*r(apa/a(J '! G 1*(it r*trak/i dada 7atuk 1*ri(ti0 ya() 1*1iliki: Ca kultur dara0 po/itif atau C7 dua atau l*7i0 p*()ikut:
-aktor pr*di/po/i/i D*1a1 i7u CJ $ 4 li@uor 7*r7au 7u/uk P*3a0a( 1*17ra( ya() 7*rk*pa(a()a( CJ &" a1 -
a17ara( kli(i/ /*p/i/ r*fl* 1i(u1 ya() 7uruk L*t0ar)y 5*fl*k/ ya() 7uruk Hipot*r1ia atau 0ip*rt*r1ia Di/t*(/i a7do1*( -
5adio)rafi ya() 1*(a(daka( p(*u1o(ia Ci(filtra/i pat30y atau (odular, ka7ut
C0a2y ya() difu/, 7ro(ko)ra1 udara, ko(/olida/i lo7ar atau /*)1*(tal P*ru7a0a( radiolo)i/ tidak 1*17aik dala1 +aktu "$ a1
Ha/il p*1*rik/aa( /*p/i/ ya() po/itif C/ala0 /atu dari 7*rikut i(i: 6a(d l*uko/it J &!B L*uko/it 1*(i()kat 4 r*aktif prot*i( 1*(i()kat P*(i()kata( lau /*di1*(ta/i *ritro/it CLED -
4. D!,$,&, P(*u1o(ia (*o(atal 1*rupaka( i(f*k/i par*(ki1 paru d*()a( t*radi(ya
/*ra()a( dala1 7*7*rapa a1 /*ak k*la0ira(, ya() dapat di/a1aka( d*()a( ku1pula( )*ala)*ala /*p/i/. I(f*k/i dapat ditularka( 1*lalui pla/*(ta, a/pira/i, atau dip*rol*0 /*t*la0 k*la0ira(. =. E,(!/,+"+%, 6ro(kop(*u1o(ia 1*rupaka( p*(y*7a7 uta1a 1or7idita/ da( 1ortalita/
a(ak 7*ru/ia di 7a+a0 % ta0u( C7alita. Dip*rkiraka( 0a1pir /*p*rli1a 38
k*1atia( a(ak di/*luru0 du(ia, l*7i0 kura() & uta a(ak 7alita 1*(i())al /*tiap ta0u( aki7at p(*u1o(ia, /*7a)ia( 7*/ar t*radi di Afrika da( A/ia T*())ara. I(/id*( p(*u1o(ia di (*)ara 7*rk*17a() yaitu ! "%B p*r #!!! a(ak di 7a+a0 u/ia % ta0u(, #' &&B p*r #!!! a(ak pada u/ia %9 ta0u(, da( 8 #'B p*r #!!! a(ak pada ya() l*7i0 tua. I(f*k/i /alura( (apa/ 7a+a0 1a/i0 t*tap 1*rupaka( 1a/ala0 uta1a dala1 7ida() k*/*0ata(, 7aik di (*)ara ya() /*da() 7*rk*17a() 0a1pir !B pada a(aka(ak di 7a+a0 u1ur % ta0u( d*()a( r*/iko k*1atia( ya() ti())i. 6*rda/arka( /ur;*i d*1o)rafi k*/*0ata( I(do(*/ia pr*;al*(/i p(*u1o(ia 7alita di I(do(*/ia 1*(i()kat dari 8,'B pada ta0u( &!!& 1*(adi ##,&B pada ta0u( &!!8. P*(y*7a7 uta1a ;iru/ p(*u1o(i pada a(ak adala0 5*/piratory Sy(3ytial iru/ C5S ya() 1*(3akup #%"!B ka/u/ diikuti ;iru/ i(fla1a/i A da( 6, parai(flu*(2a, 0u1a( 1*tap(*u1o;iru/ da( ad*(o;iru/. >. Et,+"+%,
Pada (*o(atu/ /*ri() t*radi p(*u1o(ia aki7at tra(/1i/i ;*rtikal i7u > a(ak ya() 7*r0u7u()a( d*()a( pro/*/ p*r/ali(a(. I(f*k/i t*radi aki7at ko(ta1i(a/i d*()a( /u17*r i(f*k/i dari i7u, 1i/al(ya 1*lalui a/pira/i 1*ko(*u1, 3aira( a1(io(, atau dari /*r;ik/ i7u. Sp*ktru1 1ikroor)a(i/1* p*(y*7a7 pada (*o(atu/ da( 7ayi k*3il 1*liputi Streptococcus )roup 6, *hlamydia trachomatis, da( 7akt*ri ra1 (*)atif /*p*rti +. coli, Pseudomonas sp, atau lebsiella sp. di/a1pi() 7akt*ri uta1a p*(y*7a7 p(*u1o(ia yaitu Streptococcus pneumoniae. I(f*k/i ol*0 *hlamydia trachomatis aki7at tra(/1i/i dari i7u /*la1a pro/*/ p*r/ali(a( /*ri() t*radi pada 7ayi di 7a+a0 & 7ula(. P*(ulara( tra(/pla/*(ta u)a dapat t*radi d*()a( 1ikroor)a(i/1* Tok/opla/1a, 5u7*la, ;iru/ Sito1*)alo, da( ;iru/ H*rp*/ /i1pl*k/ CTO54H, ari/*la > o/t*r, da( Listeria monocytogenes.
USIA
ETIOLOI AN SE5IN
ETIOLOI
6AKTE5I +. colli
FA5AN 6AKTE5I 6akt*ri a(a*ro7 39
AN
La0ir > &! 0ari
1i())u > 7ula(
" 7ula( > % ta0u(
% ta0u( >
Streptococcus group B Listeria monocytogenes
6AKTE5I *hlamydia trachomatis Streptococcus pneumoniae
Streptococcus group ' -aemophillus influen%ae Streptococcus pneumoniae reaplasma urealyticum I5US iru/ Sito1*)alo iru/ H*rp*/ /i1pl*k/ 6AKTE5I Bordetella pertussis -aemophillus influen%ae
I5US iru/ Ad*(o iru/ I(flu*(2a iru/ Parai(flu*(2a #, &, 1espitatory Syncytical 2irus 6AKTE5I *hlamydia pneumoniae
tip* 6 ora0ella catharalis Staphylococcus aureus reaplasma urealyticum I5US iru/ Sito1*)alo 6AKTE5I -aemophillus influen%ae
ycoplasma pneumoniae Streptococcus pneumoniae I5US iru/ Ad*(o iru/ I(flu*(2a iru/ Parai(flu*(2a iru/ 5i(o 1espiratory Synncytial 3irus 6AKTE5I *hlamydia pneumoniae ycoplasma pneumoniae Streptococcus pneumoniae
tipe B ora0ella catharalis )eisseria meningitidis Staphylococcus aureus I5US iru/ ari/*lao/t*r
6AKTE5I -aemophillus influen%ae r*1aa Legionella sp Staphylococcus aureus I5US iru/ Ad*(o iru/ Ep/t*i(6arr iru/ I(flu*(2a iru/ Parai(flu*(2a iru/ 5i(o 1espiratory Syncytial 2irus iru/ ari/*lao/t*r Ta7*l &.# Etiolo)i p(*u1o(ia pada a(ak /*/uai d*()a( k*lo1pok u/ia di (*)ara 1au.
40
?. Fa#t+ R,&,#+ P5OM # S*r;ik i(ko1p*t*( & O;*rdi/t*(/i ut*ru/ -aktor k*turu(a( Cio( 4u /*ru1 r*(da0, ;ita1i( 4 r*(da0, k*lai(a(
)*(*ti3. " P*()aru0 dari luar ya() 1*l*1a0ka( k*tu7a( Ci(f*k/i )*(italia, 1*(i()kat(ya *(2i1 prot*olitik. % Ma/a i(t*r;al /*ak k*tu7a( p*3a0 /a1pai t*radi ko(trak/i di/*7ut fa/* lat*(. Maki( pa(a() fa/* lat*(, 1aki( ti())i k*1u()ki(a( i(f*k/i. Da( 1aki( 1uda k*0a1ila(, 1aki( /ulit upaya p*1*3a0a((ya ta(pa 1*(i17ulka( 1or7idita/ a(i(, /*0i())a ko1plika/i k*tu7a( p*3a0 di(i 1aki( 1*(i()kat. MAS # K*0a1ila( fullt*r1po/tt*r1 & Hipok/ia Fa(i( 8. K"a&,,#a&,
P*17a)ia(
p(*u1o(ia
/*(diri pada da/ar(ya
tidak
ada
ya()
1*1ua/ka(, da( pada u1u1(ya p*17a)ia( 7*rda/arka( a(ato1i da( *tiolo)i.
6*7*rapa
a0li
t*la0
1*17uktika(
7a0+a
p*17a)ia(
p(*u1o(ia 7*rda/arka( *tiolo)i t*r7ukti /*3ara kli(i/ da( 1*17*rika( t*rapi ya() l*7i0 r*l*;a(. a. 6*rda/arka( loka/i l*/i di paru yaitu Pneumonia lobaris, Pneumonia interstitiali, Bronkopneumon. b. 6*rda/arka( a/al i(f*k/i yaitu Pneumonia ya() didapat dari 1a/yarakat Ccommunity ac4uired pneumonia 4AP. Pneumonia ya() didapat dari ru1a0 /akit Chospital5based pneumonia. c. 6*rda/arka( 1ikroor)a(i/1* p*(y*7a7 Pneumonia 7akt*ri Pneumonia ;iru/ Pneumonia 1ikopla/1a Pneumonia a1ur. d. 6*rda/arka( karakt*ri/tik p*(yakit yaitu Pneumonia tipikal P(*u1o(ia atipikal. e. 6*rda/arka( la1a
p*(yakit
Pneumonia p*r/i/t*(. .
Ma$,!&ta&, K",$,&
41
yaitu Pneumonia
akut
da(
Ma(if*/ta/i kli(i/ p(*u1o(ia pada 7ayi da( a(ak 7*r)a(tu() pada 7*rat ri()a((ya i(f*k/i, (a1u( /*3ara u1u1 adala0 )*ala i(f*k/i u1u1, yaitu d*1a1, /akit k*pala, )*li/a0, 1alai/*, p*(uru(a( (af/u 1aka(, k*lu0a( )a/troi(t*/ti(al /*p*rti 1ual, 1u(ta0 atau diar*. *ala )a())ua( r*/piratori yaitu 7atuk, /*/ak (apa/, (afa/ 3upi() 0idu(), 1*ri(ti0 da( /ia(o/i/. 10. Pat+,&,+"+%, 6ro(30op(*u1o(ia /*lalu dida0ului ol*0 i(f*k/i /alura( (afa/ 7a)ia( ata/
ya() di/*7a7ka( ol*0 7akt*ri /tap0ylo3o33u/, Ha*1op0ilu/ i(flu*(2a atau kar*(a a/pira/i 1aka(a( da( 1i(u1a(. Dari /alura( p*r(afa/a( d*()a( )a17ara( /*7a)ai 7*rikut: #. I(f*k/i /alura( (afa/ 7a)ia( 7a+a0 1*(y*7a7ka( ti)a 0al, yaitu dilata/i p*17ulu0 dara0 al;*oli, p*(i()kata( /u0u, da( *d*1a a(tara kapil*r da( al;*oli. &. Ek/pa(/i ku1a( 1*laui p*17ulu0 dara0 k*1udia( 1a/uk k*dala1 /alura( p*(3*r(aa( da1 1*()i(f*k/i(ya 1*()aki7atka( t*radi(ya p*(i()kata( flora (or1al dala1 u/u/, p*ri/talti3 1*(i()kat aki7at u/u/ 1*()ala1i 1ala7/or7/i da( k*1udia( t*radila0 diar* ya() 7*r*/iko t*r0adap )a())ua( k*/*i17a()a( 3aira( da( *l*ktrolit U1u1(ya 7akt*ri p*(y*7a7 t*r0i/ap k*paru p*rif*r 1*lalui /alura( (afa/. Mula1ula t*radi *d*1a kar*(a r*ak/i ari()a( ya() 1*1p*r1uda0 prolif*ra/i da( p*(y*7ara( ku1a( k* ari()a( /*kitar(ya. 6a)ia( paru ya() t*rk*(a 1*()ala1i ko(/olida/i yaitu t*radi /*r7uka( /*l poli1orfo(ukl*ar, fi7ri(, *ritro/it, 3aira( ud*1a da( dit*1uka((ya ku1a( di al;*oli. Stadiu1 i(i di/*7ut /tadiu1 0*pati/a/i 1*ra0. S*la(ut(ya t*radi d*po/i/i fi7ri( k* p*r1ukaa( pl*ura, t*rdapat(ya fi7ri( da( l*uko/it poli1orfo(ukl*ar di al;*oli da( t*radi(ya pro/*/ fa)o/ito/i/ ya() 3*pat. Stadiu1 i(i di/*7ut /tadiu1 0*pati/a/i k*la7u. Ak0ir(ya u1la0 /*l 1akrofa) di al;*oli 1*(i()kat, /*l aka( 7*rd*)*(*ra/i da( fi7ri( 1*(ipi/, ku1a( da( d*7ri/ 1*()0ila(). Si/t*1 7ro(kopul1o(*r ari()a( paru ya() tidak t*rk*(a aka( t*tap (or1al. A(tio7iotik ya() di7*rika( /*di(i 1u()ki( dapat 1*1oto() p*rala(a( p*(yakit 0i())a /tadiu1 k0a/ ya() diuraika( di ata/ tidak t*rli0at la)i. 42
6*7*rapa 7akt*ri t*rt*(tu l*7i0 /*ri() 1*(i17ulka( )*ala t*rt*(tu 7ila di7a(di()ka( d*()a( 7akt*ri lai(. D*1ikia( pula 7akt*ri t*rt*(tu l*7i0 /*ri() dit*1uka( pada k*lo1pok u1ur t*rt*(tu. Mi/al(ya Str*pto3o3u/ P(*1o(ia* 7ia/a(ya 7*r1a(if*/ta/i /*7a)ai 7*r3ak7*r3ak ko(/olida/i 1*rata di/*luru0 lapa()a( paru, (a1u( pada a(ak 7*/ar atau r*1aa dapat 7*rupa ko(/olida/i pada /atu lo7u/ Cp(*u1o(ia lo7ari/. P(*u1atok*l atau a7/*/a7/*/ k*3il /*ri() di/*7a7ka( ol*0 /tr*ptokoku/ aur*u/ pada (*o(atu/ atau 7ayi k*3il kar*(a /tr*ptokoku/ aur*u/ 1*()0a/ilka( 7*r7a)ai tok/i( da( *(2i1 /*p*rti 0*1oli2i(, l*uko/idi(, /tafiloki(a/*, da( koa)ula/*. Tok/i( da( *(i1 i(i 1*(y*7a7ka( (*kro/i/, p*rdara0a( da( ka;ita/i, koa)ula/* 7*ri(t*rak/i d*()a( faktor pla/1a da( 1*()0a/ilka( 7a0a( aktif ya() 1*()ko(;*r/i fi7ri(o)*( 1*(adi fi7ri( 0i())a t*radi *k/udat fi7ri(opurul*(. T*rdapat kor*la/i a(tara produk/i koa)ula/* da( ;irul*(/i ku1a( /tafilokoku/ ya() tidak 1*()0a/ilka( koa)ula/* ara() 1*(i17ulka( p*(yakit ya() /*riu/. P(*u1atok*l dapat 1*(*tap /a1pai 7*r 7ula(7ula( t*tapi 7ia/a(ya tidak 1*1*rluka( t*rapi l*7i0 la(ut.
Mikro7akt*riu1
P(*u1o(ia*
1*(i17ulka(
p*rada()a(
d*()a(
)a17ara( 7ara)a1 pada paru da( l*7i0 /*ri() 1*()*(ai a(ak u/ia /*kola0 atau r*1aa. Mikro7akt*riu1 p(*u1o(ia* 3*(d*ru() 7*rk*17a() 7iak pada p*r1ukaa( /*l 1uko/a /alura( (afa/. Aki7at t*r7*(tuk(ya H&O& pada 1*ta7oli/1*(ya 1aka ya() t*radi adala0 d*/kua1a/i da( ul/*ra/i lapi/a( 1uko/a, ud*1a di(di() 7ro(ku/ da( ti17ul(ya /*kr*t ya() 1*1*(u0i /alura( (afa/ da( al;*oli. K*ru/aka( i(i ti17ul dala1 +aktu r*latif /i()kat a(tara &" > &$ a1 da( dapat t*radi pada 7a)ia( paru ya() 3ukup lua/.
43
11.
Pat+%!$!&,& S*ak 1a/a k*0a1ila( /a1pai k*tu7a( p*3a0, a(i( r*latif t*rli(du()i dari
flora 1ikro7a i7u ol*0 1*17ra(Gdi(di() korioa1(iotik, pla/*(ta, da( faktor a(ti7akt*ria dala1 air k*tu7a(. 6*7*rapa ti(daka( 1*di/ ya() 1*())a())u i(t*)rita/ i/i ra0i1 /*p*rti a1(io/i(t*/i/, 3*r;i3al 3*r3la)*, p*()a17ila( 3o(to0 ;ili koriali/ tra(//*r;ikal, atau p*()a17ila(
3o(to0 dara0
p*rkuta(*u/, dapat 1*1uda0ka( or)a(i/1* (or1al kulit atau ;a)i(a 1a/uk /*0i())a 1*(y*7a7ka( a1(io(iti/ da( i(f*k/i /*ku(d*r pada a(i(. 6ila k*tu7a( p*3a0 l*7i0 dari &" a1, 7akt*ri ;a)i(a dapat 7*r)*rak (aik da( pada 7*7*rapa ka/u/ 1*(y*7a7ka( i(fla1a/i pada 1*17ra( a(i(, tali pu/at, da( pla/*(ta. I(f*k/i pada a(i( dapat di/*7a7ka( ol*0 a/pira/i air k*tu7a( ya() t*ri(f*k/i, dapat 1*()aki7atka( (*o(atu/ la0ir 1ati, p*r/ali(a( kura() 7ula(, atau /*p/i/ (*o(atal. 44
Or)a(i/1* ya() pali() /*ri() dit*1uka( dari air k*tu7a( ya() t*ri(f*k/i adala0 7akt*ri a(a*ro7ik, /tr*ptokoku/ k*lo1pok 6, E/30*ri3ia 3oli, da( 1ikopla/1a da*ra0 )*(ital. I(f*k/i pada i7u /aat pro/*/ k*la0ira( t*ruta1a i(f*k/i )*(ital adala0 alur uta1a tra(/1i/i 1at*r(al da( dapat 7*rp*ra( p*(ti() pada k*adia( i(f*k/i (*o(atal. I(f*k/i 0*1ato)*( tra(/pla/*(tal /*la1a atau /*)*ra /*7*lu1 p*r/ali(a( Ct*r1a/uk /aat p*l*pa/a( pla/*(ta dapat t*radi +alau i(f*k/i l*7i0 1u()ki( t*radi /aat (*o(atu/ 1*l*+ati ala( la0ir.
12.
K+/",#a&, Ko1plika/i 7ro(kop(*u1o(ia pada (*o(atu/ dapat t*radi kar*(a 0a/il
la()/u() dari p*(y*7ara( 7akt*ri dala1 ro())a t0ora atau p*(y*7ara(
7akt*r*1ia da( 0*1atolo)i. Ko1plika/i dari p*(y*7ara( i(f*k/i 0*1atolo)i adala0: M*(i()iti/ Artriti/ /upuratif O/t*o1i*liti/
1*. Tata"a#&a$a Fa/a#+ (a$ N+$Fa/a#+ 1. P!$ata"a#&aa$ U/'/
45
a. P*17*ria( ok/i)*( l*17a7 &" LG1*(it /a1pai /*/ak (afa/ 0ila() atau PaO& pada a(ali/i/ )a/ dara0 '! torr. 7. P*1a/a()a( i(fu/ u(tuk r*0idra/i da( kor*k/i *l*ktrolit. 3. A/ido/i/ diata/i d*()a( p*17*ria( 7ikar7o(at i(tra;*(a. 2. P!$ata"a#&a$aa$ K'&'& a. Mukolitik, *k/p*ktora( da( o7at p*(uru( pa(a/ /*7aik(ya tidak di7*rika(
pada 8& a1 p*rta1a kar*(a aka( 1*()a7urka( i(t*rpr*ta/i r*ak/i a(ti7ioti a+al. 7. O7at p*(uru( pa(a/ di7*rika( 0a(ya pada p*(d*rita d*()a( /u0u ti())i, takikardi, atau p*(d*rita k*lai(a( a(tu() 3. P*17*ria( a(ti7iotika 7*rda/arka( 1ikroor)a(i/1*
p*(y*7a7
da(
1a(if*/ta/i kli(i/. P(*u1o(ia ri()a( a1ok/i/ili( #!&% 1)Gk)66Gdo/i/ Cdi +ilaya0 d*()a( a()ka r*/i/t*(/i p*(i/illi( ti())i do/i/ dapat di(aikka( 1*(adi $!9! 1)Gk)66G0ari. P*1ili0a( a(ti7iotik dala1 p*(a()a(a( p(*u1o(ia pada a(ak 0aru/ dip*rti17a()ka( 7*rda/aka( p*()ala1a( *1piri/, yaitu 7ila tidak ada ku1a( ya()di3uri)ai, 7*rika( a(ti7iotik a+al C&"8& a1 p*rta1a 1*(urut k*lo1pok u/ia. #. N*o(atu/ da( 7ayi 1uda C & 7ula( : a. a1pi3illi( a1i(o)liko/id 7. a1ok/i/illi( a/a1 kla;ula(at 3. a1ok/i/illi( a1i(o)liko/id d. /*falo/pori( )*(*ra/i k* &. 6ayi da( a(ak u/ia pra /*kola0 C& 7l% t0( a. 7*ta lakta1 a1ok/i/illi( 7. a1ok/i/illi(a/a1 kla;ula(at 3. )olo()a( /*falo/pori( d. kotri1ok/a2ol *. 1akrolid C*ritro1i/i( . A(ak u/ia /*kola0 CJ % t0( a. a1ok/i/illi(G1akrolid C*ritro1i/i(, klaritro1i/i(, a2itro1i/i( 7. t*tra/ikli( Cpada a(ak u/ia J $ ta0u( Kar*(a da/ar a(ti7iotik a+al di ata/ adala0 3o7a3o7a Ctrial and error 1aka 0aru/ dilak/a(aka( d*()a( p*1a(taua( ya() k*tat, 1i(i1al tiap &" a1 /*kali /a1pai 0ari k*ti)a.6ila
p*(yakit 7*rta17a0
1*(u(ukka( p*r7aika( ya() (yata dala1 &"8& a1
7*rat
atau tidak
)a(ti d*()a(
a(ti7iotik lai( ya() l*7i0 t*pat /*/uai d*()a( ku1a( p*(y*7a7 ya() didu)a 46
C/*7*lu1(ya p*rlu diyaki(ka( dulu ada tidak(ya p*(yulit /*p*rti *1py*1a, a7/*/ paru ya() 1*(y*7a7ka( /*ola0ola0 a(ti7iotik tidak *f*ktif. 14. P!$-!%aa$ (a$ E('#a&,
P*1*rik/aa( k*0a1ila( ya() t*ratur K*7ia/aa( 0idup /*0at, /*p*rti 1*()o(/u1/i 1aka(a( ya() /*0at da( 3ukup (utri/i, 1i(u1 3ukup, ola0ra)a t*ratur da( 7*r0*(ti 1*rokok. M*17ia/aka( diri 1*17*r/i0ka( da*ra0 k*1alua( d*()a( 7*(ar, yak(i dari d*pa( k* 7*laka(), t*ruta1a /*t*la0 7*rk*1i0 atau 7ua() air 7*/ar. M*1*rik/aka( diri k* dokt*r 7ila ada /*/uatu ya() tidak (or1al di ad*ra0 k*1alua(, 1i/al(ya k*puti0a( ya() 7*r7au atau 7*r+ar(a tidak /*p*rti 7ia/a(ya. 1=. P!/!,#&aa$ P!$'$)a
%$A(ali/i/ )a/ dara0 1*rupaka( i(dikator d*fi(itif dari p*rtukara( )a/ u(tuk 1*(ilai )a)al (afa/ akut. M*/kipu( 1a(if*/ta/i kli(i/ ya() ada 1*1*rluka( ti(daka( i(tu7a/i /*)*ra da( p*())u(aa( ;*(tila/i 1*ka(i/, p*()a17ila( /a1p*l dara0 art*rial dip*rluka( u(tuk 1*()a(ali/i/ t*ka(a( )a/ dara0 CPaO&, Pa4O&, da( pH /a17il 1*lakuka( 1o(itori() d*()a( pul/* oy1*tri. P*1*rik/aa( p*(u(a() lai( ya() dip*rluka( /*7a)ai p*1*rik/aa( a+al pada pa/i*( ya() 1*()ala1i di/tr*// p*r(afa/a( a(tara lai(: ro(t)*( torak/ Cdapat dilakuka( /*t*la0 p*1a/a()a( ETT, p*1*rik/aa( dara0 u(tuk /kri(i() /*p/i/,
47
t*r1a/uk p*1*rik/aa( dara0 ruti(, 0itu() *(i/, apu/ dara0 t*pi, 4r*a3ti;* prot*i(, kultur dara0, )luko/a dara0, da( *l*ktrolit. 1>. P+%$+&,& o o o
Vuo ad ;ita1 : du7ia ad 7o(a1 Vuo ad fu()/io(a1: du7ia ad 7o(a1 Vuo ad /a(atio(a1 : du7ia ad 7o(a1
1?. S#(, B+$#+$!'/+$,a 4A Lulu/a( dokt*r 1a1pu 1*17uat dia)(o/i/ kli(ik da( 1*lakuka( p*(atalak/a(aa(
p*(yakit t*r/*7ut /*3ara 1a(diri da( tu(ta/ . B+$#+$!'/+$,a (!$%a$ &!&,& *B Ma1pu 1*17uat dia)(o/i/ kli(ik 7*rda/arka( p*1*rik/aa( fi/ik da( p*1*rik/aa( p*1*rik/aa( ta17a0a( ya() di1i(ta ol*0 dokt*r 1i/al(ya p*1*rik/aa( la7 atau ray. Dokt*r dapat 1*1utu/ka( da( 1*17*ri t*rapi p*(da0ulua(, /*rta 1*ruuk k* /p*/iali/ ya() r*l*;a( Cka/u/ )a+at darurat.
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KERANGKA KONSEP
48
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%)$in! taia$(i (an tai#n)" *t$"i Di,"n&i "$,atan n)"%ni *.1 KESIMPULAN $)t$ai (in(in (a(a at"$ai %)n"$"n /aan na,a i%iai
6ayi Ny A(ita k*la0ira( at*r1, 66 .% k), pa(a() tu7u0 %! 31, li()kar k*pala " 31, 1*()ala1i r*/piratory di/tr*// /u/p*3t 7ro(30op(*u1o(ia d*()a( ri+ayat i7u 1*()ala1i KPD *.3 i(f*k/i i(traut*ri(.
49
DAFTAR PUSTAKA
Alata/ H, Ha/a( 5 C*d, &!!$. Buku uliah 6 7lmu esehatan #nak , P*r3*taka( I(fo1*dika, Fakarta. Ar;i(, 6.K. dit*r*1a0ka( ol*0 Sa1ik +a0a7. )elson : 7lmu esehatan #nak. ol. # Edi/i #%. E4 : Fakarta. &!!!. 0. '!!'!#. Beckmann, *harles 8!&!9. bstetrics and $ynecology, ;e. Baltimore, ': Lippincott &;. 7SB) ?@A5
!@A&@AA!@; .
*r*i)*, 5. S. da( P. M. Lauf*r. &!#. P(*u1o(ia. Pediatrics in 1e3iew. "C#!: "$"%% r**(, 5. F. da( F. M. Kol7*r). &!#'. N*o(atal p(*u1o(ia i( /u7Sa0ara( Afri3a. P(*u1o(ia. $C: #'. Harto(o, Po*do. &!#'. P*do1a( Na/io(al P*laya(a( K*dokt*ra( K*tu7a( P*3a0 Di(i. P*rku1pula( O7/t*tri da( i(*kolo)i I(do(*/ia Hi1pu(a( K*dokt*ra( -*to Mat*r(al. Ma(ua7a C&!!9. 6uku aar patolo)i o7/t*tri u(tuk 1a0a/i/+a k*7ida(a(. Fakarta: E4. Mor)a(. *ri. C&!!9. O7/t*tri *(*kolo)i Praktik. Edi/i II. Fakarta: P*(*r7it 6uku Kodokt*ra(, E4. 5a(it S. A3ut* r*/piratory failur* a(d oy)*( t0*rapy. I(dia( F P*diatr &!!#. &!!#'$C:&"9%%. 50
