REFERAT ABORTUS
PEMBIMBING LETKOL (Kes) dr. Zakaria,Sp.OG
DISUSUN OLE !e""# $i%&'r# .**.+
KEPANITERAAN KEPANITERAAN KLINIK ILMU I LMU KEBIDANAN DAN KANDUNGAN RSPAU dr.ESNA!AN ANTARIKSA
FAKULTAS KEDOKTERAN UNI-ERSITAS KRISTEN KRIDA !AANA PERIODE MEI / 0ULI 0AKARTA
LEMBAR PENGESAAN
De"1a" 2'r"a&, Prese"&asi re3era& pada kepa"i&eraa" k4i"ik I456 Ke7ida"a" da" Ka"d6"1a" RSPAU dr. dr. ESNA! ESNA!AN AN ANTA ANTARIKSA RIKSA peri'de peri'de 5ei * * / 864i 864i * * de"1a de"1a" " 86d64 86d64 9ABORTUS:. Dis6s6" '4e2 ; Na5a
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Se7a1ai sa4a2 sa&6 s#ara& da4a5 5e"1ik6&i da" 5e"#e4esaika" kepa"i&eraa" I456 Ke7ida"a" da" Ka"d6"1a". Te4a2 dise&686i da" di&eri5a 2asi4 pe"#6s6"a"#a '4e2 #a"1 &er2'r5a& LETKOL (Kes) dr. Zakaria,Sp.OG.
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Ta"11a4
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0akar&a,
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LETKOL (kes) dr.Zakaria,Sp.OG
ABORTUS
LATAR BELAKANG A7'rsi 5er6paka" is&i4a2 #a"1 di16"aka" 6"&6k 5e"1ar&ika" se56a 7e"&6k pe"1ak2ira" ke2a5i4a", se4ai" i&6 is&i4a2 #a"1 4e7i2 6565 di16"aka" ada4a2 9ke1616ra": dide3i"isika" 6"&6k 5e"6"86ka" se56a 7e"&6k pe"1ak2ira" ke2a5i4a" se7e465 =ak&6"#a. Sa4a2 sa&6 k'5p4ikasi 6565 dari ke2a5i4a" ada4a2 a7'r&6s sp'"&a", #a"1 &er8adi pada ><>? ke2a5i4a".a7'r&6s sp'"&a" dika&e1'rika" 5e"8adi 5e"8adi a7'r&6s &era"%a5 (i5i"e"s), a7'r&6s seda"1 &er8adi (i"sipie"s), &idak 4e"1kap,4e"1kap, 5issed a7'r&i'",da" a7'r&6s 7er64a"1 (4e7i2 dari ka4i).
PATOFISIOLOGI Pa&'3isi'4'1i ke1616ra" sp'"&a" dapa& di7a1i 7erdasarka" =ak&6"#a. a%a& kr'5's'5 7iasa"#a pe"#e7a7 ke1616ra" sp'"&a", &er6&a5a #a"1 &er8adi se4a5a ke2a5i4a" +<@ 5i"116. Ti"1ka& 2'r5'" #a"1 &idak 5e"%6k6pi a&a6 7er4e7i2a" 7iasa"#a 5e"1aki7a&ka" ke1616ra" sp'"&a" se7e465 6sia ke2a5i4a" * 5i"116. Fak&'r i"3eksi, i56"'4'1i, da" 4i"1k6"1a" 6565"#a 5e"#e7a7ka" ke1616ra" di &ri5es&er per&a5a ke1616ra". Fak&'r<3ak&'r a"a&'5i 7iasa"#a 7er2676"1a" de"1a" &ri5es&er ked6a. De3isie"si 3ak&'r III da" de3isie"si 3i7ri"'1e" 4e"1kap a&a6 parsia4 7er2676"1a" de"1a" ke1616ra" sp'"&a" 7er64a"1. Ke1616ra" sp'"&a" ada4a2 se76a2 pr'ses #a"1 dapa& di7a1i 5e"8adi + &a2ap, se7a1ai 7erik6&; ke1616ra" &era"%a5 (i5i"e"s), ke1616ra" seda"1 &er8adi (i"sipie"s), &idak 4e"1kap, da" 4e"1kap. •
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Ke1616ra" &era"%a5 (i"sipie"s); perdara2a" $a1i"a, "#eri per6& pa"1164 a&a6 ked6a"#a se4a5a a=a4 ke2a5i4a" 5er6paka" %iri ke1616ra" &era"%a5. Sepere5pa& dari se56a =a"i&a 2a5i4 5e"1a4a5i 7e7erapa dera8a& perdara2a" per$a1i"a5 se4a5a &ri5es&er per&a5a. Seki&ar se&e"1a2 dari kas6s i"i 5e"8adi ke1616ra" ak&6a4. Perdara2a" da" rasa saki& #a"1 5e"#er&ai"#a, 7iasa"#a &idak &er4a46 i"&e"s. Ke1616ra" &era"%a5 8ara"1 di&a"dai de"1a" perdara2a" per$a1i"a5 #a"1 7era&. Pada pe5eriksaa" $a1i"a, ser$iks &er&6&6p da" &idak ada "#eri &eka" pada ser$iks a&a6p6" 8ari"1a" #a"1 di&e56ka". N#eri ra2i5 di36s, ke4e576&a" ad"eksa, a&a6 ked6a"#a dapa& di&e56ka". Ke1616ra" seda"1 &er8adi (i"sipie"s); perdara2a" per$a1i"a5 diser&ai de"1a" di4a&asi ka"a4is ser$ika4is. Pe"dara2a" 7iasa"#a 4e7i2 para2 di7a"di"1ka" de"1a" perdara2a" pada ke1616ra" &era"%a5 da" seri"1 diser&ai de"1a" "#eri per6& da" kra5. Ke1616ra" &idak 4e"1kap ; Pe"dara2a" per$a1i"a5 dapa& i"&e"s da" diser&ai "#eri per6&. ser$iks &er76ka de"1a" 2asi4 k'"sepsi #a"1 ke46ar. U4&ras'"'1ra3i di16"aka" 6"&6k 5e5as&ika" apaka2 5asi2 &ersisa 2asi4 k'"sepsi dida4a5 ra2i5.
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Ke1616ra" 4e"1kap ; Pasie" da&a"1 de"1a" ri=a#a& perdara2a" per$a1i"a5, saki& per6&, da" &erdapa& 7a1ia" 8ari"1a". Pada saa& ke1616ra" se4esai, perdara2a" da" "#eri 7iasa"#a aka" 5ereda. Pada pe5eriksaa" 64&ras'"'1ra3i &er4i2a& ra2i5 k's'"1. Dia1"'sis dapa& dipas&ika" de"1a" pe"1a5a&a" 8a"i" da" p4ase"&a di4a2irka" 4e"1kap, diper46ka" ke&e4i&ia" da4a5 5e576a& dia1"'sis i"i &a"pa 64&ras'"'1ra3i kare"a s64i& 6"&6k 5e"e"&6ka" apaka2 ke1616ra" &e4a2 4e"1kap a&a6 7e465.
EPIDEMIOLOGI (A5erika Serika&) Ba"#ak"#a ke2a5i4a" #a"1 &idak 4a#ak, Me"6r6& perkiraa" >*? dari ke2a5i4a" di1616rka", ke1616ra" i"i 7iasa"#a &idak diak6i se%ara k4i"is. Ke1616ra" sp'"&a" dide3i"isika" se7a1ai ke2i4a"1a" ke2a5i4a" se%ara k4i"is #a"1 diak6i (&es dara2, &es 6ri"e, a&a6 64&ras'"'1ra3i) se7e465 6sia ke2a5i4a" * 5i"116. Seki&ar ><>? dari ke2a5i4a" didia1"'sis 5e"1aki7a&ka" ke1616ra" sp'"&a". (I"&er"asi'"a4) Be7erapa pe"e4i&i Er'pa 5e"e4i&i &i"1ka& ke1616ra" sp'"&a" &ere"da2 <>?. M'r&a4i&asM'r7idi&as Da&a s6r$ei4a"s 5e"6"86kka" 7a2=a ke1616ra" sp'"&a" da" i"d6ksi a7'rsi 5e"#e7a7ka" seki&ar +? dari ke5a&ia" #a"1 7er2676"1a" de"1a" ke2a5i4a" di A5erika Serika&. Ras Da&a s6r$ei4a"s 5e"#e76&ka" 6"&6k kas6s ke5a&ia" &erkai& ke2a5i4a" 5e"6"86kka" 4e7i2 7a"#ak ke5a&ia" aki7a& ke2a5i4a" ek&'pik, ke1616ra" sp'"&a", da" a7'rsi di ka4a"1a" =a"i&a A5erika A3rika di7a"di"1ka" pada =a"i&a k64i& p6&i2. De4apa" perse" dari ke5a&ia" #a"1 7er2676"1a" de"1a" ke2a5i4a" di a"&ara pere5p6a" k64i& 2i&a5 kare"a ke2a5i4a" ek&'pikC ? ada4a2 kare"a ke1616ra". Di a"&ara pere5p6a" k64i& p6&i2, da&a 5e"6"86kka" 7a2=a +? dari ke5a&ia" &erkai& ke2a5i4a" aki7a& ke2a5i4a" ek&'pik, +? ada4a2 kare"a ke1616ra". U56r U56r da" pari&as 5e"i"1ka& 5e5pe"1ar62i resik' se'ra"1 =a"i&a ke1616ra". Pada =a"i&a k6ra"1 dari * &a26", diperkiraka" ke1616ra" &er8adi ? dari ke2a5i4a". Pada =a"i&a 4e7i2 dari * &a26",diperkiraka" ke1616ra" &er8adi da4a5 ? dari ke2a5i4a". Ri=a#a&
Pasie" de"1a" ke1616ra" sp'"&a" 7iasa"#a da&a"1 ke r65a2 saki& de"1a" pe"dara2a" per$a1i"a5, "#eri per6& a&a6 ked6a"#a. Perdara2a" per$a1i"a5 dapa& 7er$ariasi dari 7er%ak ri"1a" sa5pai perdara2a" para2 #a"1 5e"1a"%a5 8i=a. A"a5"esis pasie" 2ar6s 5e"%ak6p 8654a2 pe57a46& a&a6 &a5p'" #a"1 di16"aka". asa" e& a4 5e"e56ka" 7a2=a perdara2a" 7era& pada &ri5es&er per&a5a, &er6&a5a 7i4a diser&ai de"1a" saki& per6&, &erkai& de"1a" risik' ke1616ra" 4e7i2 &i"11i •
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Bek6a" dara2 a&a6 8ari"1a" 5er6paka" &a"da pe"&i"1 #a"1 5e"6"86kka" perke57a"1a" dari ke1616ra" sp'"&a". N#eri per6& 7iasa"#a &er4e&ak di daera2 s6prap67ik, a&a6 disa4a2 sa&6 a&a6 ked6a k6adra" &ere"da2 N#eri 7isa 5e"#e7ar ke p6"116"1 7a=a2, pa"&a&, a4a& ke4a5i", da" peri"e65.
Ri=a#a& pasie" 861a 2ar6s 5e"%ak6p se7a1ai 7erik6&; ari per&a5a 2aid &erak2ir Perkiraa" 6sia ke2a5i4a" asi4 64&ras'"'1ra5 , 8ika se7e465"#a di4ak6ka" Ga"116a" perdara2a" • • • •
Ge8a4a 4ai" seper&i de5a5 a&a6 5e"11i1i4, 5er6paka" %iri ke1616ra" a&a6 a7'rsi sep&ik. Per2a&ika" se&iap =a"i&a 6sia s676r #a"1 2a5i4 de"1a" perdara2a" per$a1i"a5 sa5pai &er76k&i se7a4ik"#a.
Fisik
Ta"da<&a"da ke1616ra" &era"%a5 (i"sipie"s) Ta"da<&a"da $i&a4 2ar6s da4a5 re"&a"1 re3ere"si ke%6a4i &er8adi i"3eksi a&a6 perdara2a" &e4a2 5e"#e7a7ka" 2ip'$'4e5ia. A7d'5e" 7iasa"#a 4e576& da" &idak "#eri &eka". Ta"da<&a"da ke1616ra" &idak 4e"1kap; Ser$iks dapa& &a5pak 5e4e7ar a&a6 56"1ki" &er&6&6p. Pe5eriksaa" 7i5a"6a4 dapa& 5e"6"86ka" ra2i5 #a"1 5e57esar da" 4e576& Pada pe5eriksaa" pa"1164, 2asi4 k'"sepsi 56"1ki" se7a1ia" &erdapa& da4a5 ra2i5, dapa& 5e"'"8'4 dari 's&e65 eks&er"a4, a&a6 56"1ki" ada da4a5 $a1i"a. Pe"dara2a" da" kra5 7iasa"#a 7er&a2a" Ke1616ra" 4e"1kap ; Pada pe5eriksaa" pa"1164, 4e2er ra2i5 &er&6&6p. Missed a7r&6s ; Ta"da<&a"da $i&a4 7iasa"#a 7erada da4a5 re"&a"1 re3ere"si. Pe5eriksaa" a7d'5e" dapa& a&a6 &idak dapa& 5era7a ra2i5 . 0ika &era7a, 6&er6s 7iasa"#a 4e7i2 ke%i4 6"&6k 6sia ke2a5i4a" #a"1 di perkiraka". B6"#i 8a"&6"1 8a"i" &idak &erde"1ar a&a6 &idak &er4i2a& pada USG. Os&e65 ser$ika4is &er&6&6p pada pe5eriksaa" pa"1164. Ra2i5 aka" & erasa 4e576& da" 5e57esar. •
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PENYEBAB Pe"#e7a7 ke1616ra" pada &ri5es&er per&a5a da" &ri5es&er ked6a Ke4ai"a" e57ri' 5er6paka" @*<*? pe"#e7a7 pa4i"1 7a"#ak dari ke1616ra" &ri5es&er per&a5a.
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ke4ai"a" kr'5's'5 ada4a2 pe"#e7a7 pa4i"1 6565 dari ke1616ra" sp'"&a". Le7i2 dari *? dari ke4ai"a" %#&'1e"i% da" 5'r3'4'1i 5e"#e7a7ka" ke1616ra" sp'"&a". Ke4ai"a" kr'5's'5 &e4a2 di&e56ka" pe"#e7a7 4e7i2 dari >? dari 8a"i" #a"1 ke1616ra" pada &ri5es&er per&a5a Ti"1ka& ke"aika" ke4ai"a" kr'5's'5 7er2676"1a" de"1a" 6sia, pe"i"1ka&a" &a8a5 &er8adi pada =a"i&a 6sia 4e7i2 dari > &a26".
Fak&'r i76 pe"#e7a7 se7a1ia" 7esar ke1616ra" &ri5es&er ked6a Fak&'r pe"#aki& kr'"is i76 I76 i"s64i"
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I"3eksi (5isa4"#a, r67e44a, si&'5e1a4'$ir6s (M-) da" 5ik'p4as5a, 6reap4as5a4, 4is&eria4, i"3eksi &''p4as5a4 Tra65a o E5'si'"a4 o
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Fak&'r 4ai" #a"1 dapa& 5e"#e7a7ka" ke1616ra" Fak&'r eks'1e"; ' A4k'2'4 ' Te57aka6 ' K'kai" da" '7a& &er4ara"1 4ai""#a
Fak&'r<3ak&'r a"a&'5i; 3ak&'r<3ak&'r a"a&'5i a&a6 k'"1e"i&a4 di4ap'rka" &er8adi pada *<>? =a"i&a #a"1 5e"1a4a5i ke1616ra" sp'"&a" 7er64a"1. 4esi a"a&'5i k'"1e"i&a4 &er5as6k a"'5a4i d6k&6s 5644eria" (5isa4"#a, sep&a&e ra2i5, die&i4s&i47es&r'4 HDES #a"1 7er2676"1a" de"1a" a"'5a4i). Lesi Sa46ra" M644erii 7iasa"#a di&e56ka" pada ke1616ra" &ri5es&er ked6a A"'5a4i ar&eri ra2i5 de"1a" a4ira" dara2 ke e"d'5e&ri65 &er1a"116 5er6paka" ke4ai"a" 7a=aa". Pe"#aki& 4ai" a&a6 ke4ai"a" sis&e5 repr'd6ksi #a"1 dapa& 5e"1aki7a&ka" ke1616ra" 5e4ip6&i %a%a& 7a=aa" a&a6 di dapa& 5e4ip6&i 3i7r'id, i"k'5pe&e"si ser$iks, perke57a"1a" p4ase"&a a7"'r5a4, a&a6 564&ipari&as 7esar. •
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Fak&'r e"d'kri"; Fak&'r e"d'kri" 7erp'&e"si 5e"#e7a7ka" ke1616ra" 7er64a"1 pada *<*? kas6s I"s63isie"si 3ase 46&ea4 (#ai&6, 36"1si k'rp6s 46&e65 #a"1 &idak "'r5a4 de"1a" pr'd6ksi pr'1es&er'" #a"1 sediki&) 5er6paka" ke4ai"a" e"d'kri" #a"1 pa4i"1 6565 5e"#e7a7ka" ke1616ra" sp'"&a". ip'&ir'id, 2#p'pr'4a%&i"e5ia, k'"&r'4 dia7e&es #a"1 76r6k, da" si"dr'5 '$ari65 p'4ikis&ik 5er6paka" 3ak&'r k'"&ri76&i3 da4a5 ke1616ra" •
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Fak&'r I"3eksi Did61a pe"#e7a7 i"3eksi dapa& di&e56ka" pada >? kas6s I"3eksi 7ak&eri , $ir6s, parasi&, 8a56r, da" J''"'sis 5e"#e7a7ka" ke1616ra" sp'"&a" 7er64a"1. • •
Fak&'r I56"'4'1i Fak&'r Keke7a4a" 7erk'"&ri76si 2i"11a *? dari ke1616ra" sp'"&a" 7er64a"1. Si"dr'5 a"&i3's3'4ipid a"&i7'di 4e7i2 7erpe"1ar62 pada ke1616ra" &ri5es&er ked6a ke2a5i4a" di7a"di"1ka" ke1616ra" &ri5es&er per&a5a •
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DIAGNOSIS BANDING Rada"1 ak6& 6s6s 76"&6 Perdara2a" 6&er6s D#s5e"'rea E"d'5e&ri'sis Kis&a '$ari65 T'rsi '$ari65 Ke2a5i4a" ek&'pik Tra65a ke2a5i4a" I"3eksi sa46ra" ke5i2 $a1i"i&is LABORATORIUM • • •
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Pe5eriksaa" 6ri" k6a4i&a&i3 6"&6k 5e"1k'"3ir5asi ke2a5i4a" i&6"1 dara2 4e"1kap de"1a" di3ere"sia4 G'4'"1a" dara2 da" 3ak&'r R2 o G'4'"1a" dara2 2ar6s di%a&a& 6"&6k se&iap pasie" 2a5i4 de"1a" perdara2a" per$a1i"a5. e5'14'7i" da" 2e5a&'kri&; S&6di
PENCITRAAN U4&ras'"'1ra3i di16"aka" se%ara 46as da" 5er6paka" s&6di pe"%i&raa" pi4i2a". Ke6"&6"1a" 64&ras'"'1ra3i &er5as6k pe"116"aa" disa5pi"1 &e5pa& &id6r pe5eriksaa", ke&ersediaa", 7ia#a re"da2, da" "'"i"$asi$e"ess. Kek6ra"1a" &er1a"&6"1 'pera&'r #a"1 5e"8a4a"ka". U4&ras'"'1ra3i 7a"&6 5e"1ide"&i3ikasi 6"&6k 5e5per&a2a"ka" 2asi4 k'"sepsi, ke5a&ia" 8a"i", ke1616ra" &idak 4e"1kap, ke2a5i4a" ek&'pik, a&a6 ra2i5 k's'"1. Kare"a i&6, 5e57erika" k4asi3ikasi k4i"is #a"1 re4e$a" pada ke1616ra" . U4&ras'"'1ra3i ada4a2 5'da4i&as dia1"'s&ik #a"1 pa4i"1 ak6ra& da4a5 k'"3ir5asi ke2a5i4a" #a"1 4a#ak se4a5a &r i5es&er per&a5a.
I"dikasi 6"&6k di4ak6ka" 64&ras'"'1ra3i di r65a2 saki& 5e4ip6&i "#eri per6& a&a6 pa"1164, perdara2a" per$a1i"a5, di4a&asi ser$iks, ke4e576&a" 1erak ser$iks, per7edaa" a"&ara 6k6ra" ra2i5 da" 6sia ke2a5i4a". Se76a2 USG res'46si &i"11i dapa& 5e"de&eksi ke2a5i4a" pada 6sia ke2a5i4a" <+ 5i"116 da" ak&i$i&as 8a"&6"1 8a"i" pada 6sia > 5i"116.pe5eriksaa" ak&i$i&as 8a"&6"1 8a"i" pada =a"i&a de"1a" perdara2a" pada a=a4 ke2a5i4a" &e4a2 &er%a&a& 5e5i4iki se"si&i$i&as ? da" spesi3isi&as @? 6"&6k 8a"i" 7er&a2a" 2id6p pada ke2a5i4a" 5i"116 ke<* ke2a5i4a" . S&6di 8a"i" &er7a&as pada &ri5es&er per&a5a kare"a 6k6ra" 8a"i" ke%i4. U4&ras'"'1ra3i 7iasa"#a 5e"#ediaka" i"3'r5asi da4a5 7ida"1 6&a5a; 4'kasi ke2a5i4a", 6k6ra" ke2a5i4a", da" ada a&a6&idak"#a ke2adira" ak&i$i&as 8a"&6"1 8a"i".
Ta"da<&a"da ke2a5i4a" dari pe5eriksaa" 64&ras'6"'1ra3i 5e4ip6&i ; ka"&6"1 ke2a5i4a" &idak 7era&6ra" Terdapa& 7a2a" 2#pere%2'i% a7"'r5a4 da4a5 r'"11a ra2i5, seper&i #a"1 di1a57arka" da4a5 s'"'1ra5 &a5pi4a" 5e5a"8a"1 e"d'$a1i"a4 5e"6"86kka" %aira" da4a5 ra2i5 . P6i"1
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Per&i57a"1ka" pe5eriksaa" de"1a" s'"'1ra3i pada ke1616ra" a=a4 ke2a5i4a" da4a5 2676"1a""#a de"1a" &a2ap perke57a"1a". S67k4i"is a&a6 ke1616ra" prak4i"is; i"i &er8adi da4a5 5i"116 per&a5a se&e4a2 k'"sepsi. B6k&i s'"'1ra3i ke2a5i4a" &idak ada pada &a2ap i"i. Ke1616ra" pada 5i"116 ke ><. Ke1616ra" pada &a2ap i"i didasarka" pada karak&eris&ik ka"&6"1 ke2a5i4a". Uk6ra" ka"&6"1 ke2a5i4a" a7"'r5a4 5er6paka" i"dikasi #a"1 pa4i"1 dapa& 5e"#e7a7ka" 2asi4 #a"1 a7"'r5a4 Ke1616ra" pada 5i"116 ke <@ ; 76k&i s'"'1ra3i didasarka" pada de5'"s&rasi dari e57ri' a7"'r5a4 a&a6 ka"&6"1 ke2a5i4a". Ke1616ra" pada 5i"116 ke <; dia1"'sis s'"'1ra3i dari ke5a&ia" e57ri' 7iasa"#a di76a& pada de5'"s&rasi dari 8a"i" #a"1 a7"'r5a4. B6k&i s'"'1ra3i 8a"i" k6ra"1 ak&i$i&as 8a"&6"1 ada4a2 i"dika&'r #a"1 pa4i"1 spesi3ik dari ke5a&ia" e57ri'. a4 i"i di1a57arka" da4a5 s'"'1ra5 di7a=a2.
64&ras'"'1ra5 e"d'$a1i"a4 5e"16"1kapka" s6a&6 64&ras'"'1ra5 irre164ar ,5e"16"1kapka" se76a2 ka"&6"1 ke2a5i4a" #a"1 &idak &era&6r de"1a" k6&67 8a"i" a5'rp2i%. Tidak ada ak&i$i&as 8a"&6"1 8a"i" di%a&a&. Ga57ar i"i 5er6paka" ke5a&ia" 8a"i" a&a6 5issed a7'r&i'" •
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Per2a&ia" dida4a5 dia1"'sis ke5a&ia" e57ri'. Pe"e"&6a" apaka2 s&r6k&6r e57ri' dapa& &er4i2a& sa"1a& pe"&i"1, kare"a &idak ada s&r6k&6r 5'r3'4'1is dike"a4 4ai""#a, se4ai" de&ak 8a"&6"1, ada pada &a2ap perke57a"1a". E57ri' 2ar6s dipi"dai se%ara 5e"#e46r62 6"&6k 76k&i de&ak 8a"&6"1. o Pe5eriksaa" s'"'1ra3i direk'5e"dasika" 6"&6k 5e"164a"1i s%a" da4a5 =ak&6 < 2ari 6"&6k 5e"e"&6ka" apaka2 perke57a"1a" "'r5a4 #a"1 &er8adi. Pada 3'44'=<6p, pe"6r6"a" 7e&a<2%1, ser&a perke57a"1a" 8a"i" #a"1 o a7"'r5a4, 5e"e1aska" ke5a&ia" e57ri'.
S'"'1ra3i dapa& 5e"1ide"&i3ikasi ada"#a 2e5a&'5a s67%2'ri'"i% a&a6 perdara2a" (5isa4"#a, perdara2a" a"&ara e"d'5e&ri65 da" ka"&6"1 ke2a5i4a").
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perdara2a" s67%2'ri'"i% ada4a2 s657er #a"1 pa4i"1 seri"1 diide"&i3ikasi pada perdara2a" &ri5es&er per&a5a, pada s'"'1ra3i &er4i2a& se7a1ai daera2 7er7e"&6k 764a" sa7i& 2#p'e%2'i% ka"&6"1 ke2a5i4a". perdara2a" s67%2'ri'"i% 5e"%ak6p spek&r65 &e56a" s'"'1ra3i. aira" S67%2'ri'"i% dapa& dik4asi3ikasika" da4a5 kai&a""#a de"1a" 6k6ra" ka"&6"1 ke2a5i4a" da" pa"8a"1 6sia ke2a5i4a". Perdara2a" S67%2'ri'"i% &er8adi ke&ika de"#6& %aira" s67%2'ri'"i% &er%a&a&. Uk6ra" perdara2a" s67%2'ri'"i% 2ar6s diper&i57a"1ka", seper&i 6k6ra" #a"1 4e7i2 7esar 7er2676"1a" de"1a" pe"i"1ka&a" risik' ke1616ra" sp'"&a". Se76a2 2e5a&'5a s67%2'ri'"i% 7esar (#ai&6, seki&ar 4e7i2 dari >*? dari ka"&6"1 ke2a5i4a") ada4a2 i"dika&'r pr'1"'sis #a"1 76r6k 6"&6k 2asi4 ke2a5i4a". Se76a2 perdara2a" s67%2'ri'"i% di1a57arka" di 7a=a2 i"i.
1a57ar 64&ras'"'1ra3i e"d'$a1i"a4 i"i 5e"6"86kka" perdara2a" s67%2'ri'"i% (S) k6ra"1 dari se&e"1a2 6k6ra" ka"&6"1 ke2a5i4a". Perdara2a" s67%2'ri'"ik dapa& diper4i2a&ka" 5e"116"aka" =ar"a D'pp4er i5a1e. ke1616ra" &idak 4e"1kap dapa& di&6"86ka" 7er7a1ai &e56a" pada s'"'1ra3i se7a1ai 7erik6&; ' ka"&6"1 ke2a5i4a" dapa& 5iss2aped a&a6 r6"&62, a&a6 56"1ki" 6&62, 5e"1a"d6"1 e57ri' &ak 2id6p. Se4ai" i&6, 5assa #a"1 k'5p4eks #a"1 &idak &era&6r da4a5 ka"a4 e"d'ser$iks e"d'5e&ri65ke56"1ki"a" &er4i2a&. S'"'1ra5 dari ke1616ra" &idak 4e"1kap di&a5pi4ka" di 7a=a2. o
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ke2a5i4a" 5'4a pada &ri5es&er per&a5a dapa& 5e"si564asika" s6a&6 ke1616ra" &idak 4e"1kap, de"1a" 5a&eri e%2'1e"i% da4a5 r'"11a e"d'5e&ri65 #a"1 &idak 5e5i4iki karak&eris&ik $esike4 a&a6 kis&a %aira" i"&ra6&eri" dapa& 5e=aki4i ka"&6"1 pse6d'1es&a&i'"a4 7iasa"#a di&e56ka" di ke2a5i4a" ek&'pik. S&6di 5e"6"86kka" &idak ada 2676"1a" s&a&is&ik #a"1 si1"i3ika" a"&ara ke2adira" a=a4 dari ka"&6"1 ke2a5i4a" a&a6 ke&e7a4a" e"d'5e&ri65 da" &i"1ka& ke7er2asi4a" 5a"a8e5e" 2a5i4.
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Ke1616ra" 4e"1kap dapa& 5e57erika" &e56a" s'"'1ra3i 7erik6&; Se76a2 ra2i5 k's'"1 #s"1 &er4i2a& pada e"d'$a1i"a4 s'"'1ra5 5e"6"86kka" ke1616ra" #a"1 4e"1kap, "a56", dia1"'sis ke2a5i4a" ek&'pik 5e4ip6&i s'"'1ra3i da" ke2a5i4a" i"&ra6&eri" di"i. a&i<2a&i s%a""i"1 6"&6k 5assa ad"eksa, da" a&a6 %aira" disara"ka". •
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U4&ras'"'1ra3i &ra"sa7d'5i"a4 pa"1164 5e57erika" pa"da"1a" kese46r62a" dari s&r6k&6r pa"1164. Ka"d6"1 ke5i2 #a"1 pe"62 diper46ka" se7a1ai 8e"de4a s'"'1ra3i. E"d'$a1i"a4 64&ras'"'1ra3i 5e57erika" &a5pi4a" ri"%i dari e"d'5e&ri65 6&er6s, '$ari65, ad"eksa, da" %64
Dia1"'s&ik spesi3ik Ke1616ra" Tere4akka" T686a" dari pe"1'7a&a" ada4a2 e$ak6asi 6&er6s 6"&6k 5e"%e1a2 k'5p4ikasi (5isa4"#a, perdara2a" 4e7i2 4a"86&, i"3eksi). Ke1616ra" &idak 4e"1kap •
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0ika 8ari"1a",7ek6a" dara2, a&a6 pr'd6k dari k'"sepsi di&e56ka" di 's&e65 ser$iks, 5e"12ap6s"#a de"1a" 3'rsep %i"%i" 6"&6k 5e53asi4i&asi k'"&raksi ra2i5 da" 2e5's&asis. U"&6k a4asa" #a"1 sa5a, 5e"116"aka" 'ksi&'si" da4a5 kas6s pe"dara2a" para2 (*<* 5%1 L) Per&i57a"1ka" 2e5'&ra"s36si'" da4a5 kas6s pe"dara2a" para2, ke&idaks&a7i4a" 2e5'di"a5ik, a&a6 ked6a"#a. Per&i57a"1ka" pe"1'7a&a" de"1a" 5is'pr's&'4 6"&6k 5e53asi4i&asi pe"#e4esaia" ke1616ra".
Ke1616ra" 4e"1kap
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Pe"1'7a&a" pasie" #a"1 &e4a2 5e"1a4a5i ke1616ra" 4e"1kap 7er$ariasi &er1a"&6"1 pada dera8a& kepas&ia" dia1"'sis. Me"dia1"'sis ke1616ra" 4e"1kap di UGD 7isa s64i& 0ika pe5eriksaa" pa"1164 5e"12asi4ka" 8ari"1a" 8a"i" (a&a6 7a2a" pe"a5pi4a" ser6pa), kiri5ka" ke 4a7'ra&'ri65 6"&6k ide"&i3ikasi 2asi4 k'"sepsi.
Missed a7'r&i'" Pe"1'7a&a" dapa& 7er$ariasi &er1a"&6"1 pada 6sia ke2a5i4a" se7a1ai 7erik6&; ' &ri5es&er per&a5a Ke7a"#aka" pasie" ke2i4a"1a" 2asi4 k'"sepsi se%ara sp'"&a" a%a& K'a164asi sek6"der K6re&ase s6%&i'", a&a6 5is'pr's&'4 6"&6k pe"a"1a"a" 5edis ' o Tri5es&er ked6a Ra2i5 dik's'"1ka" '4e2 di4a&asi da" e$ak6asi. A&a6, ra2i5 dik's'"1ka" '4e2 i"d6ksi persa4i"a". •
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"s64&asi de"1a" d'k&er ka"d6"1a" 1i"ek'4'1 dii"dikasika" pada se56a pasie" de"1a" dia1"'sis ke1616ra" &idak 7isa di2i"dari a&a6 &idak 4e"1kapC pasie" de"1a" perdara2a" para2 a&a6 pasie" #a"1 5e5er46ka" k'"s64&asi 2e5'di"a5ik &idak s&a7i4 se1era 5e5er46ka" 7a"&6a" de"1a" pe"1'7a&a" de3i"i&i3. Pe"1'7a&a" de3i"i&i3 56"1ki" 6"&6k 5e"1e$ak6asi 2asi4 k'"sepsi dari 6&er6s de"1a" k6re&ase. Ter1a"&6"1 pada ke7i8aka" r65a2 saki&, k6re&ase dapa& di4ak6ka" di UGD de"1a" pe"1a5a&a" 4e7i2 4a"86& pasie" 6"&6k +< 8a5 se&e4a2 k6re&ase, a1ar ke56dia" &idak &er8adi k'5p4ikasi. K6re& 6565"#a di%ada"1ka" 6"&6k pasie" #a"1 7eresik' 6"&6k ke&idaks&a7i4a" 2e5'di"a5ik kare"a 7eresik' perdara2a" a&a6 7a1i 5ereka #a"1 e"d'5e&ri&is ada4a2 kek2a=a&ira". Na56", ke7a"#aka" pasie" de"1a" ke1616ra" seda"1 &er8asi a&a6 &idak 4e"1kap ada4a2 ka"dida& 6"&6k 5a"a8e5e" 5edis de"1a" 5is'pr's&'4. T686a" dari 3ar5ak'&erapi ada4a2 6"&6k 5e"%e1a2 k'5p4ikasi da" 5e"16ra"1i 5'r7idi&as
O#&'%i% a1e" i"i 5e5i4iki e3ek $as'pressi$e da" 5e"%e1a2 perdara2a" p's&par&65. Oksi&'si" (Pi&'%i", S#"&'%i"'") pr's&a14a"di" A1e" i"i 5e"#e7a7ka" k'"&raksi ra2i5. Mis'pr's&'4 (#&'&e%) Tidak dise&686i 6"&6k di16"aka" pada ke2a5i4a", "a56" ada4a2 '7a& #a"1 sa"1a& 7a"#ak di16"aka" 6"&6k i"d6ksi persa4i"a", da" se7a1ai a7'rsi 5edis. kea5a"a"
5e&'de pasi3 di4a&asi ser$iks da" 2ar6s diper&i57a"1ka" 6"&6k 3asi4i&asi dari 7a1ia" pr'd6k dari k'"sepsi da4a5 pe"1a&6ra" ke1616ra" &ak &ere4akka" a&a6 &idak 4e"1kap PROGNOSA Pr'1"'sis 6"&6k ke2a5i4a" #a"1 s6kses &er1a"&6"1 pada e&i'4'1i ke1616ra" sp'"&a" se7e465"#a, 6sia pasie", da" 1a57ara" s'"'1ra3i ke2a5i4a" &erse76& K'reksi ke4ai"a" e"d'kri" pada =a"i&a de"1a" ke1616ra" 7er64a"1 o 5e5i4iki pr'1"'sis &er7aik 6"&6k ke2a5i4a" #a"1 s6kses ( *?). o Pada =a"i&a de"1a" pe"#e7a7 ke1616ra" &idak dike&a26i pada ke2a5i4a" se7e465"#a, ke56"1ki"a" 5e"%apai ke2a5i4a" s6kses ada4a2 +*<@*?. o Ti"1ka& 2id6p<4a2ir se&e4a2 d'k65e"&asi dari ak&i$i&as 8a"&6"1 8a"i" pada 6sia ke2a5i4a" 5i"116 ke >< pada =a"i&a de"1a" a&a6 4e7i2 ke1616ra" sp'"&a" di8e4aska" ada4a2 seki&ar ?. o Ke&ika USG &ra"s$a1i"a4 pa"1164 dapa& 5e"6"86kka" 6sia e57ri' 5i"i5a4 @ 5i"116 da" ak&i$i&as 8a"&6"1, &i"1ka& ke1616ra" 6"&6k pasie" #a"1 4e7i2 56da dari > &a26" ada4a2 <>? da" 6"&6k 5ereka #a"1 4e7i2 &6a dari > &a26" ada4a2 @?. o i"dika&'r pr'1"'s&ik #a"1 &idak 5e"16"&6"1ka" s'"'1ra3i ada4a2 &ari3 ak&i$i&as 8a"i" 8a"&6"1 #a"1 4e7i2 4a57a& dari * de"#6& per 5e"i&, ke&idak "'r5a4a" 7e"&6k ka"&6"1 ke2a5i4a", 6k6ra", da" perdara2a" s67%2'ri'"i% 7esar o a"1ka ke1616ra" kese46r62a" 6"&6k pasie" #a"1 4e7i2 &6a dari > &a26" ada4a2 +? da" 6"&6k pasie" #a"1 4e7i2 56da dari > &a26" ada4a2 ?. •
Ed6kasi pasie" A"86rka" pasie" 6"&6k ke57a4i ke UGD se&e4a2 &er8adi"#a 1e8a4a seper&i 7erik6&; ' perdara2a" $a1i"a 7er4i5pa2 (4e7i2 dari pad 8a5) ' "#eri pa"1164 para2 ' S626 di a&as @ Pasie" 56"1ki" 5e"1a4a5i 5e"s&r6asi i"&er5i&e" seper&i a4ira" da" kra5 se4a5a 5i"116 7erik6&"#a. Peri'de 5e"s&r6asi 7erik6&"#a 7iasa"#a &er8adi da4a5 +<> 5i"116. Pasie" dapa& 5e4a"86&ka" ak&i$i&as seper&i 7iasa &e&api 2ar6s 5e"a2a" diri dari 2676"1a" se"11a5a 6"&6k seki&ar 5i"116.
Background T2e &er5 a7'r&i'" is %'55'"4# 6sed &' 5ea" a44 3'r5s '3 ear4# pre1"a"%# 4'ssC 2'=e$er, d6e &' &2e p'4ariJi"1 s'%ia4 s&i15a assi1"ed &' &2is &er5, &2e &er5 5is%arria1e is 6sed 2ere &' i"di%a&e a44 3'r5s '3 sp'"&a"e'6s ear4# pre1"a"%# 4'ss 'r p'&e"&ia4 4'ss. O"e '3 &2e %'55'" %'5p4i%a&i'"s '3 pre1"a"%# is sp'"&a"e'6s 5is%arria1e, =2i%2 '%%6rs i" a" es&i5a&ed ><>? '3 pre1"a"%ies. Sp'"&a"e'6s
5is%arria1es are %a&e1'riJed as &2rea&e"ed, i"e$i&a74e, i"%'5p4e&e, %'5p4e&e, 'r 5issed, a"d %a" 7e 36r&2er %4assi3ied as sp'radi% 'r re%6rre"& ( '%%6rre"%es). Pathoh!"#o$og! T2e pa&2'p2#si'4'1# '3 a sp'"&a"e'6s 5is%arria1e 5a# 7e s611es&ed 7# i&s &i5i"1. 2r'5's'5a4 de3e%&s are %'55'"4# see" i" sp'"&a"e'6s 5is%arria1es, espe%ia44# &2'se &2a& '%%6r d6ri"1 +<@ =eeks 1es&a&i'". Ge"e&i% e&i'4'1ies are %'55'" i" ear4# 3irs&<&ri5es&er 4'ss 76& 5a# 7e see" &2r'612'6& 1es&a&i'". Tris'5# %2r'5's'5es are &2e 5's& %'55'" %2r'5's'5a4 a"'5a4#. I"s633i%ie"& 'r e%essi$e 2'r5'"a4 4e$e4s 6s6a44# res64& i" sp'"&a"e'6s 5is%arria1e 7e3're * =eeks 1es&a&i'". I"3e%&i'6s, i556"'4'1i%, a"d e"$ir'"5e"&a4 3a%&'rs are 1e"era44# see" i" 3irs&<&ri5es&er pre1"a"%# 4'ss. A"a&'5i% 3a%&'rs are 6s6a44# ass'%ia&ed =i&2 se%'"d<&ri5es&er 4'ss. Fa%&'r III de3i%ie"%# a"d a %'5p4e&e 'r par&ia4 de3i%ie"%# '3 3i7ri"'1e" are ass'%ia&ed =i&2 re%6rre"& sp'"&a"e'6s 5is%arria1e.H A sp'"&a"e'6s 5is%arria1e is a pr'%ess &2a& %a" 7e di$ided i"&' + s&a1es, as 3'44'=s; &2rea&e"ed, i"e$i&a74e, i"%'5p4e&e, a"d %'5p4e&e. •
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A s67%2'ri'"i% 2e5'rr2a1e is &2e 5's& %'55'"4# ide"&i3ied s'6r%e '3 3irs&<&ri5es&er 74eedi"1, appeari"1 '" s'"'1rap2# as a %res%e"&< s2aped 2#p'e%2'i% area "e& &' &2e 1es&a&i'"a4 sa%. S67%2'ri'"i% 2e5'rr2a1e e"%'5passes a spe%&r65 '3 s'"'1rap2i% 3i"di"1s. S67%2'ri'"i% 346id %a" 7e %4assi3ied i" re4a&i'" &' 1es&a&i'"a4 sa% siJe a"d 4e"1&2 '3 1es&a&i'". S67%2'ri'"i% 74eedi"1 is prese"& =2e" p64sa&i'" '3 &2e s67%2'ri'"i% 346id is "'&ed. SiJe '3 &2e s67%2'ri'"i% 2e5'rr2a1e s2'64d 7e &ake" i"&' %'"sidera&i'", as 1rea&er siJe re4a&es &' a" i"%reased risk '3 sp'"&a"e'6s 5is%arria1e. A 4ar1e s67%2'ri'"i% 2e5a&'5a (ie, s6rr'6"di"1 1rea&er &2a" >*? '3 &2e 1es&a&i'"a4 sa%) is a p''r pr'1"'s&i% i"di%a&'r 3'r &2e pre1"a"%# '6&%'5e. A s67%2'ri'"i%
2e5'rr2a1e is depi%&ed 7e4'=. T2is e"d'$a1i"a4 64&ras'"'1rap2i% i5a1e de5'"s&ra&es a s67%2'ri'"i% 2e5'rr2a1e (S) 4ess &2a" 2a43 &2e 1es&a&i'"a4 sa% siJe. o
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S67%2'ri'"i% 74eedi"1 %a" 7e de5'"s&ra&ed 6si"1 %'4'r D'pp4er i5a1i"1. E"d'$a1i"a4 64&ras'"'1rap2# s2'64d 7e app4ied =2e"e$er p'ssi74e &' 4i5i& i5a1e dis&'r&i'" d6e &' pa&ie"& 2a7i&6s 'r a" '$erdis&e"ded 74adder.
A" i"%'5p4e&e 5is%arria1e 5a# de5'"s&ra&e a $arie&# '3 s'"'1rap2i% 3i"di"1s as 3'44'=s; o
T2e 1es&a&i'"a4 sa% 5a# 7e 5iss2aped 'r %'44apsed, 'r i & 5a# 7e i"&a%&, %'"&ai"i"1 a "'"4i$i"1 e57r#'. I" addi&i'", a" irre164ar %'5p4e 5ass =i&2i" &2e e"d'5e&ria4 'r e"d'%er$i%a4 %a"a4 5a# 7e prese"&. S'"'1ra5 '3 a" i"%'5p4e&e 5is%arria1e is s2'=" 7e4'=.
T2is i5a1e s2'=s a" e"d'$a1i"a4 4'"1i&6di"a4 $ie= '3 a 4'=<4#i"1 1es&a&i'"a4 sa% (GS) =i&2i" &2e 6&er6s (U&), represe"&i"1 a" i"%'5p4e&e 5is%arria1e. o
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E%2'1e"i% 5a&eria4 'r de7ris =i&2i" &2e e"d'5e&ria4 %a"a4 5a# represe"& re&ai"ed pr'd6%&s '3 %'"%ep&i'" 'r %4'&&ed 74''d. Firs&<&ri5es&er 5'4ar pre1"a"%ies 5a# si564a&e a" i"%'5p4e&e 5is%arria1e, =i&2 e%2'1e"i% 5a&eria4 =i&2i" &2e e"d'5e&ria4 %a$i&# &2a& 2as "' %2ara%&eris&i% $esi%4es 'r %#s&s. I"&ra6&eri"e 346id %'44e%&i'"s 5a# represe"& pse6d'1es&a&i'"a4 sa%s 3'6"d i" e%&'pi% pre1"a"%ies. S&6dies s611es& "' s&a&is&i%a44# si1"i3i%a"& re4a&i'"s2ip 7e&=ee" &2e i"i&ia4 prese"%e '3 a 1es&a&i'"a4 sa% 'r e"d'5e&ria4 &2i%k"ess a"d &2e s6%%ess ra&e '3 epe%&a"& 5a"a1e5e"&.
A %'5p4e&e 5is%arria1e 5a# de5'"s&ra&e &2e 3'44'=i"1 s'"'1rap2i% 3i"di"1s; o
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A" e5p&# 6&er6s "'&ed '" e"d'$a1i"a4 s'"'1ra5 s611es&s a %'5p4e&e 5is%arria1eC 2'=e$er, s'"'1rap2i% dia1"'sis i"%46des e%&'pi% pre1"a"%# a"d ear4# i"&ra6&eri"e pre1"a"%#. are364 s%a""i"1 3'r ad"ea4 5asses a"d'r 3ree 346id is ad$ised.
N' si"14e 64&ras'"'1rap2i% 5eas6re5e"& '3 &2e di33ere"& a"a&'5i%a4 3ea&6res i" &2e 3irs& &ri5es&er 2as de5'"s&ra&ed a 2i12 predi%&i$e $a46e 3'r de&er5i"i"1 ear4# pre1"a"%# '6&%'5e. Re%e"& resear%2 s611es&s &2e 3i"di"1 '3 74''d 34'= i" &2e i"&er$i44'6s spa%e i" %ases '3 3irs&<&ri5es&er 5is%arria1e 6si"1 %'4'r D'pp4er 64&ras'"'1rap2# as 6se364 i" &2e predi%&i'" '3 s6%%ess364 epe%&a"& 5a"a1e5e"&. Mis%arria1es =i&2 i"&er$i44'6s spa%e 74''d 34'= =ere + &i5es 5're 4ike4# &' %'5p4e&e =i&2 epe%&a"& 5a"a1e5e"&. Proc%dur%" •
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Tra"sa7d'5i"a4 64&ras'"'1rap2# '3 &2e pe4$is pr'$ides a" '$era44 $ie= '3 &2e pe4$i% s&r6%&6res. A 3644 74adder is re6ired as a s'"'1rap2i% =i"d'=. E"d'$a1i"a4 64&ras'"'1rap2# 1i$es a de&ai4ed $ie= '3 &2e e"d'5e&ri65 '3 &2e 6&er6s, '$aries, ad"ea, a"d %64
Pr%ho"#ta$ Car% •
Mai"&ai" r'6&i"e 6"i$ersa4 pre%a6&i'"s i" $ie= '3 p'&e"&ia44# 2ea$# $a1i"a4 74eedi"1. E5er1e"%# 5edi%a4 ser$i%es (EMS) pers'""e4 s2'64d 7e a=are '3 &2e p'&e"&ia4 3'r 2e5'rr2a1i% s2'%k a"d s2'64d &rea& a" # 2e5'd#"a5i% i"s&a7i4i&#. o
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O7&ai" $i&a4 si1"s a"d es&a74is2 a" i"&ra$e"'6s 4i"e i" a44 pre1"a"& pa&ie"&s =2' 2a$e a7d'5i"a4 pai" a"d $a1i"a4 74eedi"1. I3 &2e pa&ie"& is 2#p'&e"si$e, a" i"&ra$e"'6s 7'46s '3 "'r5a4 sa4i"e (NS) is i"di%a&ed 3'r 2e5'd#"a5i% s&a7i4iJa&i'". Ad5i"is&er '#1e".
E"%'6ra1e &2e pa&ie"& &' 7ri"1 a"# passed &iss6e &' &2e 2'spi&a4 3'r e$a46a&i'".
E&%rg%nc! D%art&%nt Car% Tr%at a$$ at#%nt" -#th .ag#na$ )$%%d#ng o+ an! %t#o$og! a" +o$$o-"/ •
De&er5i"e 2e5'd#"a5i% s&a7i4i&# a"d &rea& i"s&a7i4i&#. I3 &2e pa&ie"& is i" 2e5'rr2a1i% s2'%k, &rea&5e"& i"%46des &2e Tre"de4e"76r1 p'si&i'", '#1e", a11ressi$e 346id res6s%i&a&i'" (a& 4eas& 4ar1e<7're I- 4i"es =i&2 4a%&a&ed Ri"1er HLR s'46&i'" 'r "'r5a4 sa4i"e, =ide 'pe"), a"d 2e5'&ra"s36si'".
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De&er5i"e pre1"a"%# s&a&6s (6a4i&a&i$e a"d 6a"&i&a&i$e).
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Make 4a7'ra&'r# de&er5i"a&i'" '3 2e5a&'%ri& (%&) 4e$e4 a"d R2 s&a&6s.
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Per3'r5 a pe4$i% ea5i"a&i'" &' de&er5i"e &2e ra&e '3 74eedi"1C prese"%e '3 74''d %4'&s 'r pr'd6%&s '3 %'"%ep&i'"C a"d %'"di&i'" '3 %er$i%a4 's, %er$i, 6&er6s, a"d ad"ea. Per3'r5 pe4$i% 64&ras'"'1rap2# &' de&er5i"e i"&ra6&eri"e a"d'r e&ra6&eri"e %'"&e"&s (3e&a4 2ear& a%&i$i&#) a"d'r &' %4i"i%a44# %4assi3# sp'"&a"e'6s 5is%arria1e.
D#agno"t#c "%c#+#c &anag%&%nt I"e$i&a74e 5is%arria1e •
T2e 1'a4 '3 &rea&5e"& is e$a%6a&i'" '3 &2e 6&er6s &' pre$e"& %'5p4i%a&i'"s (e1, 36r&2er 2e5'rr2a1e, i"3e%&i'").
I"%'5p4e&e 5is%arria1e
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I3 &iss6e, 74''d %4'&s, 'r pr'd6%&s '3 %'"%ep&i'" are 3'6"d i" &2e %er$i%a4 's, re5'$e &2e5 =i&2 ri"1 3'r%eps &' 3a%i4i&a&e 6&eri"e %'"&ra%&i'"s a"d 2e5's&asis. F'r &2e sa5e reas'", 6se '#&'%i" i" %ases '3 se$ere 74eedi"1 (*<* 5%1L '3 NS, =ide 'pe"). Ad5i"is&er R2'GAM &' a 1ra$id pa&ie"& =2' is R2<"e1a&i$e a"d is eperie"%i"1 $a1i"a4 74eedi"1. '"sider 2e5'&ra"s36si'" i" &2e %ase '3 se$ere 74eedi"1, 2e5'd#"a5i% i"s&a7i4i&#, 'r 7'&2. '"sider &rea&5e"& =i&2 5is'pr's&'4 &' 3a%i4i&a&e %'5p4e&i'" '3 &2e 5is%arria1e.
'5p4e&e 5is%arria1e •
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Trea&5e"& '3 a pa&ie"& =2' 2as 2ad a %'5p4e&e 5is%arria1e $aries depe"di"1 '" &2e de1ree '3 %er&ai"&# '3 &2e dia1"'sis. Dia1"'si"1 %'5p4e&e 5is%arria1e i" &2e ED %a" 7e di33i%64&, 6"4ess a" i"&a%& 1es&a&i'"a4 sa% =as epe44ed. I3 pe4$i% ea5i"a&i'" pr'd6%es 3e&a4 &iss6e ('r 5a&eria4 '3 si5i4ar appeara"%e), se"d i& &' &2e 4a7'ra&'r# 3'r ide"&i3i%a&i'" '3 p'ssi74e pr'd6%&s '3 %'"%ep&i'".
Missed 5is%arria1e •
Trea&5e"& 5a# $ar# depe"di"1 '" 1es&a&i'"a4 a1e as 3'44'=s; o
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Firs& &ri5es&er
M's& pa&ie"&s pass &2e pr'd6%&s '3 %'"%ep&i'" sp'"&a"e'6s4#.
'a164a&i'" de3e%&s se%'"dar# &' a dead 3e&6s are rare.
Epe%&a"& 5a"a1e5e"&,H@ s6%&i'" %6re&&a1e, 'r 5is'pr's&'4 3'r 5edi%a4 5a"a1e5e"& &' 3a%i4i&a&e passa1e '3 pr'd6%&s '3 %'"%ep&i'" 5a# 7e per3'r5ed.
Se%'"d &ri5es&er
T2e 6&er6s is e5p&ied 7# di4a&a&i'" a"d e$a%6a&i'". A4&er"a&i$e4#, &2e 6&er6s is e5p&ied 7# i"d6%&i'" '3 4a7'r.
Con"u$tat#on" '"s64&a&i'" =i&2 a" '7s&e&ri%ia"1#"e%'4'1is& is i"di%a&ed i" a44 pa&ie"&s =i&2 &2e dia1"'sis '3 i"e$i&a74e 'r i"%'5p4e&e 5is%arria1eC pa&ie"&s =i&2 se$ere 2e5'rr2a1e 'r pa&ie"&s =2' are 2e5'd#"a5i%a44# 6"s&a74e re6ire i55edia&e %'"s64&a&i'" 3'r
assis&a"%e =i&2 de3i"i&i$e &rea&5e"&. De3i"i&i$e &rea&5e"& 5a# 7e &' e$a%6a&e &2e pr'd6%&s '3 %'"%ep&i'" 3r'5 &2e 6&er6s =i&2 %6re&&a1e. Depe"di"1 '" 2'spi&a4 p'4i%#, %6re&&a1e 5a# 7e per3'r5ed i" &2e ED =i&2 s67se6e"& '7ser$a&i'" '3 pa&ie"&s 3'r +< 2'6rs a3&er %6re&&a1e, a"d &2e" dis%2ar1e i3 "' %'5p4i%a&i'"s '%%6r. 6re&&a1e is 1e"era44# reser$ed 3'r &2'se pa&ie"&s =2' are a& risk 3'r 2e5'd#"a5i% i"s&a7i4i&# d6e &' &2e 7risk"ess '3 74eedi"1 'r 3'r &2'se i" =2'5 e"d'5e&ri&is is a %'"%er". '=e$er, 5's& pa&ie"&s =i&2 i"e$i&a74e 'r i"%'5p4e&e 5is%arria1e are %a"dida&es 3'r 5edi%a4 5a"a1e5e"& =i&2 5is'pr's&'4.H, *, , M%d#cat#on Su&&ar! T2e 1'a4s '3 p2ar5a%'&2erap# are &' pre$e"& %'5p4i%a&i'"s a"d &' red6%e 5'r7idi&#. O0!toc#c Ag%nt T2is a1e"& 2as $as'pressi$e e33e%&s a"d pre$e"&s p's&par&65 74eedi"1. O0!toc#n 1P#toc#n2 S!ntoc#non3 Pr'd6%es 2#&25i% 6&eri"e %'"&ra%&i'"s a"d %a" %'"&r'4 p's&par&65 74eedi"1 'r 2e5'rr2a1e. Pro"tag$and#n T2ese a1e"&s i"d6%e 6&eri"e %'"&ra%&i'"s. M#"oro"to$ 1C!tot%c3 N'& appr'$ed 3'r 6se i" pre1"a"%#, #e& is a" i"$a46a74e 5edi%a&i'" =ide4# 6sed 3'r %er$i%a4 prepara&i'" 3'r 5is%arria1e, 4a7'r i"d6%&i'", a"d as a 5edi%a4 a7'r&i3a%ie"&. Pr'$ides sa3e, passi$e 5e&2'd '3 %er$i%a4 di4a&a&i'" a"d s2'64d 7e %'"sidered 3'r 3a%i4i&a&i'" '3 passa1e '3 pr'd6%&s '3 %'"%ep&i'" i" &2e se&&i"1 '3 i"e$i&a74e 'r i"%'5p4e&e 5is%arria1e Progno"#" •
T2e pr'1"'sis 3'r a s6%%ess364 pre1"a"%# depe"ds 6p'" &2e e&i'4'1# '3 pre$i'6s sp'"&a"e'6s 5is%arria1es, &2e a1e '3 &2e pa&ie"&, a"d &2e s'"'1rap2i% appeara"%e '3 &2e 1es&a&i'". o
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'rre%&i'" '3 a" e"d'%ri"e a7"'r5a4i&# i" ='5e" =i&2 re%6rre"& 5is%arria1e 2as &2e 7es& pr'1"'sis 3'r a s6%%ess364 pre1"a"%# (*?). I" ='5e" =i&2 a" 6"k"'=" e&i'4'1# '3 pri'r pre1"a"%# 4'ss, &2e pr'7a7i4i&# '3 a%2ie$i"1 s6%%ess364 pre1"a"%ies is +*<@*?. T2e 4i$e<7ir&2 ra&e a3&er d'%65e"&a&i'" '3 3e&a4 %ardia% a%&i$i&# a& >< =eeks '3 1es&a&i'" i" ='5e" =i&2 'r 5're 6"ep4ai"ed sp'"&a"e'6s 5is%arria1es is appr'i5a&e4# ?.
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!2e" &2e &ra"s$a1i"a4 pe4$i% s'"'1ra5 s2'=s a" e57r#' '3 a& 4eas& @ =eeks es&i5a&ed 1es&a&i'"a4 a1e (EGA) a"d %ardia% a%&i$i&#, &2e 5is%arria1e ra&e 3'r pa&ie"&s #'6"1er &2a" > #ears is <>? a"d 3'r &2'se '4der &2a" > #ears is @?. U"3a$'ra74e s'"'1rap2i% pr'1"'s&i% i"di%a&'rs are a 3e&a4 %ardia% a%&i$i&# ra&e &2a& is s4'=er &2a" * 7ea&s per 5i"6&e, a" a7"'r5a44# s2aped 'r siJed 1es&a&i'"a4 sa%, a"d a 4ar1e s67%2'ri'"i% 2e5'rr2a1e. T2e '$era44 5is%arria1e ra&e 3'r pa&ie"&s '4der &2a" > #ears is +? a"d 3'r pa&ie"&s #'6"1er &2a" > #ears is ?.
Pat#%nt Educat#on •
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Ad$ise pa&ie"&s &' re&6r" &' &2e ED 6p'" '%%6rre"%e '3 s#5p&'5s s6%2 as &2e 3'44'=i"1; o
Pr'36se $a1i"a4 74eedi"1 (5're &2a" pad2'6r)
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Se$ere pe4$i% pai"
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Te5pera&6re a7'$e @ (**.+F)
Pa&ie"&s 5a# eperie"%e i"&er5i&&e"& 5e"s&r6a4<4ike 34'= a"d %ra5ps d6ri"1 &2e 3'44'=i"1 =eek. T2e "e& 5e"s&r6a4 peri'd 6s6a44# '%%6rs i" +<> =eeks. Pa&ie"&s %a" res65e re164ar a%&i$i&ies =2e" a74e &' 76& s2'64d re3rai" 3r'5 i"&er%'6rse a"d d'6%2i"1 3'r appr'i5a&e4# =eeks. .
