CLINICAL SCIENCE SESSION CARPAL TUNNEL SYNDROME

Preceptor : Dr. H. Djajang Suhana Sp.S !"#

D$%u%un o&eh :
1. 2. 3. #. ". !. 7. 8. .. Ocsyavina Indra Sandinirwan Arief Taufiqurroh an Sassi $a%a Su&ra ania Sa'ya Ta i%se%va (adia &in'i )ohd Sufian *on+ ,en ,in -e a%a'ha )unusa y An'ari (uray&an /i'ardiana 1301-1208-0187 1301-1208-0033 1301-1208-00!" 1301-1208-2228 1301-1208-213! 1301-1208-220" 1301-1208-2223 1301-1208-21"7 1301-1208-010#

'A(IAN ILMU PENYA"IT SARA) )A"ULTAS "EDO"TERAN UNI*ERSITAS PAD+AD+ARAN RS DR. HASAN SADI"IN 'ANDUN( ,--.

CARPAL TUNNEL SYNDROME

DE)INISI 0ar1a% Tunne% Syndro e 20TS3 ada%ah neuro1a'i 'e4anan a'au ceru'an 'erhada1 nervus edianus di da%a tunnel car1a% 1ada 1er+e%an+an 'an+an5 'e1a'nya di&awah f%e4sor re'ina4u%u . Tunnel 2'erowon+an3 car1a% 'erda1a' di&a+ian sen'ra% dari 1er+e%an+an 'an+an di ana 'u%an+ dan %i+a en'u e &en'u4 sua'u 'erowon+an se 1i' yan+ di%a%ui o%eh &e&era1a 'endon dan nervus edianus.

Tu%an+-'u%an+ 4ar1a%ia e &en'u4 dasar dan sisi-sisi 'erowon+an yan+ 4eras dan 4a4u. A'a1nya di&en'u4 o%eh f%e4sor re'ina4u%u 2tranverse carpal ligament dan palmar carpal ligament3 yan+ 4ua' dan e%en+4un+ dia'as 'u%an+-'u%an+ 4ar1a% 'erse&u'. Se'ia1 ada 1eru&ahan yan+ e 1erse 1i' 'erowon+an ini5 se1er'i 'er6adinya inf%a asi a4an enye&a&4an 'e4anan 1ada 1ada nervus edianus yan+ 'er%e'a4 dida%a nya. 78I97)IO:O/, Serin+ dida1a'4an 1ada ne+ara sedan+ &er4e &an+ 2 &anya4 4e is4inan5 4uran+ 1endidi4an5 6e%e4 nya sani'asi5 1e%ayanan 4eseha'an yan+ 4uran+3. Insidensi %a4i-%a4i : 1ere 1uan5 3-# : 1 . 8ada ne+ara &er4e &an+5 'e'anus serin+ en+enai 1ada -; neona'us5 ana42 < dewasa uda. 8ada ne+ara a6u5 'e'anus %e&ih &anya4 en+enai -; usia 'ua. 9i Afri4a Se%a'an : 300 4asus se'ia1 'ahun. 9i In++ris : 12-1" 4asus 'ia1 'ahun. 9i A eri4a : "0-70 4asus 'ia1 'ahun. *-O : 1.000.000 4e a'ian a4i&a' 'e'anus d se%uruh dunia5 1..2. 2 an+4a ini e%i1u'i "80.000 4e a'ian dari 'e'anus neona'oru 5 210.000 d asia 'en++ara5 1"2.000 d afri4a 3

FAKTOR RISIKO :u4a 'er&u4a a'au1un riwaya' %u4a se&e%u

%u4a yan+ 'er4on'a inasi o%eh 'anah 21ada 1e'ani3 'er%u4a o%eh &enda &er4ara'

ETIOLOGY 0:OST=I9I>) T7TA(I Anero&i45 o'i%e5 &a'an+ +ra ?ve. Tida4 &erwarna dan &er&en'u4 ova% )e 1unyai 'er ina% &erisi s1ora %i4e @dru s'ic4A $e&anya4an di'e ui di 'anah5 feses hewan 24uda5 anusia3 9a%a 4eadaan anero& &eru&ah en6adi &en'u4 ve+e'a'ive. S1ora B &isa hidu1 da%a &en'u4 ve+e'a'ive &e&era1a 'ahun. =esis'an' 'erhada1 disinfec'an' Taha1 ve+e'a'ive ini &isa diina4'ivasi dn+an 1e &erian an'i&io'i4 2 e'ronidaCo%e5 1enisi%in3. - )en+hasi%4an 2 6enis e4so'o4sin : a3Te'ano%isin - rusa4 6arin+an se4i'ar infe4si - en+o1'i a%4an 4ondisi un'u4 u%'i1%i4asi &3Te'anos1as in - inhi&isi 1e &e&asan neuro'rans i'er - &a4'eria% 1ro'ease a4an enye&a&4an 'e'anos1as in e &en'u4 2 ran'ai yan+ dihu&un+4an o%h i4a'an disu%fida : a3=an'ai rin+an 2"049a3 - inhi&isi 'rans isi sina1'i4 &3=an'ai &era' 210049a3 - edia'or in'erna%isasi in'raneurona% PATHOGENESIS 0.'e'ani e asu4i 'u&uh e%a%ui %u4a. S1ora da1a' 'u &uh 1ada 4eadaan yan+ anaero&. Darin+an ne4rosis5 &enda asin+5 infe4si a4'if 6u+a eru1a4an 'e 1a' yan+ &ai4 un'u4 1er4e &an+an s1ora < 1er%e1asan 'o4sin. Te'ano1%as in eru1a4an suns'ansi asa a ino ran'ai 1o%i1e1'ida yan+ di%e1asi dida%a %u4a. To4sin 'eri4a' 1ada u6un+ 'er ina% o'or neuron 1erifer5 4e udian e asu4i a4son < di'rans1or secara re'ro+rad e%a%ui in'raneura%. To4sin ini &er4er6a 1ada sis'e saraf5 'er asu4 o'or end 1%a'e 1erifer5 edu%a s1ina%is5 o'a4 dan sis'e saraf o'ono . Se%ain i'u 'o4sin 6u+a da1a' enye&ar e%a%ui sis'e 1eredaran darah < %i fa'i4. Tetanop&a%/$n /engha/0at per&epa%an neuron $nh$0$tor 1ang 0er2ung%$ /engatur 3ontra3%$ otot. O'o' a4an &er4on'ra4si secara 'ida4 'er4on'ro% sehin++a en6adi 4a4u. (euron yan+ e%e1as4an neuro'rans i''er inhi&i'or a6or5 yai'u /AEA < +%isin a4an en6adi sensi'if 'erhada1 'e'ano1%as in sehin++a 'er6adi 4e+a+a%an inhi&isi 1ada res1on ref%e4s o'or 1ada s'i u%asi sensori4.

 8en+ha &a'an ini dese&a&4an 4erana 1e ecahan 1ro'ein yan+ &erfun+si 1ada 1er%e1asan vesi4a%5 yai'u syna1'o&revin. -a% ini en+uran+i fun+si inhi&isi < enin+4a'4an 4ece1a'an is'iraha' 1ada o'or neuron ser'a &er'an++un+6awa& 1ada ri+idi'as o'o'. Sehin++a 1ada saraf 1erifer 'er1ende4 a4an eni &u%4an +e6a%a awa% &eu1a dis'ursi wa6ah5 4e4a4uan 1un++un+ < %eher. Ia eru1a4an anifes'asi 4%inis 4has yan+ 'er6adi 4e'i4a 'oFin 'e'anus en+an++u 1er%e1asan neuro'rans i''er < en+ha &a' i 1u%se inhi&i'or. $eadaan ini en+a4i&a'4an 4on'ra4si < s1as e o'o'5 6u+a da1a' 'er6adi 4e6an+ < &ah4an en+enai sis'en saraf o'ono yan+ dise&a&4an inhi&isi 1ada neuron 1re+ana+%ion si 1a'is di su&s'an'ia +risea %a'era% edua%%a s1ina%is sehin++a en+ahsi%4an hy1era4'ifi'as si 1a'is. Te'ano1%as in da1a' en+ha &a' 1er%e1asan neuro'rans i''er 1ada neuro uscu%ar 6unc'ion yan+ a4an en+a4i&a'4an 4e%e ahan < 1ara%isis.

PATHOPHYSIOLOGY :u4a yan+ ne4rosis5 'er4on'a inasi o%eh 'anah5 'er%u4a O%eh &enda &er4ara' &enda asin+ Clostridium tetani -asi%4an To4sin 'e'anus asu4 Te'ano%isin 'e'anos1as in

I4a' 1ada rese1'or saraf 'er ina% 1ada o'o'-o'o' To4sin en+i4u' sera&u' saraf secara ascendin+ e%a%ui aFon edu%a s1ina%is enca1ai

Sa 1ai 4e se% &odi a%1ha o'or neuron 4e da%a 9an &a'an+ o'a4 To4sin 'e'anus se&eran+i ce%ah sina1s dan 'er ina% saraf inhi&isi 'o4sin 'eri4a' 1ada rese1'or

e &ran 1resina1'i4

inhi&isi neuro'rans i'er /AEA dan +%ycine 4on'ra4si o'o' a+onis dan an'a+onis secara &ersa aan 2seharusnya inhi&isi3 res'in+ firin+ ra'e 1ada a%1ha o'or neuron

Eisa efe4 1re+an+%ionic Si 1a'e'i4 neuron di %a'era% +ray a''er 1ada )edu%%a s1ina%is

SPASM
MANIFESTASI KLINIK )enye&a&4an si 1a'is hi1era4'ivi'i < uncu% se'e%ah ada riwaya' %u4a se&e%u nya- %u4a y+ ne4rosis5 'er4on'a inasi 1enin+4a'an sir4u%asi o%eh ca'echo%a ine - 'anah5 'er%u4a o%eh &enda &er4ara' a'au &enda asin+. - )asa in4u&asi : !-1# hari - Onse' : 1-7hari - /e6a%a u u : $e4a4uan o'o' 2ri+idi'as3 1. 'ris us 2%oc46aw3 B 4e4a4uan o'o' asse'er B &iasanya anifes'asi 1er'a a 2. risus sardonicus B 4on'ra4si &er'erusan dari o'o' wa6ah- +ri aceG sneer 3. 4e4a4uan o'o'-o'o' %eher yan+ eni &u%4an re'ra4si 4e1a%a #. 4e4a4uan o'o'-o'o' farin+ sehin++a 'i &u% disfa+ia ". 4e4a4uan o'o'-o'o' dada- +era4an nafas 'er&a'as-cyanosis dan 'hrea'en ven'i%a'ion. !. 1eru' 1a1an5 4on'ra4si o'o'-o'o' a&do en 7. o1i'o'onus- 4on'ra4si o'o'-o'o' 1un++un+ 1asien &isa fe&ri%e wa%au1un 'ida4 de a s1as e 24e6an+3 1. 4e6an+ 'oni4 yan+ 'i &u% secara e1isodi45 &isa dida1a'4an re'ra4si 4e1a%a5 o1is'o'onus yan+ en+he&a' dan f%e4si dari %en+an. 2. 'i &u% s1on'an a'au di1icu o%eh ran+san+an &eru1a ran+san+an sen'uhan5 audi'ori5 visua% a'au e osiona% +an++uan o'ono 2serin+ dida1a'4an 1ada 'e'anus dera6a' &era'3 1. 1enin+4a'an a4'ivi'as si 1a'is : sinus 'a4i4ardi ;1"0FG in5 4erin+a' yan+ &er%e&ihan5 1enin+4a'an 'e4anan darah sis'o%i4 dan dias'o%i4 ari' ia su1raven'ri4u%er 'ransien. 2. 1enin+4a'an a4'ivi'as 1arasi 1a'is : sa%ivasi &er%e&ihan51enin+4a'an 'onus va+a% yan+ &erefe4 4e sis'e 4ardiovas4u%er

RI(IDITY

DIAGNOSIS A(A)(7SA : =iwaya' %u4a se&e%u nya. H %u4a 21unc'u 5%aserasi < a&rasi3 en+a%a i ne4rosis5 'er4on'a inasi o%eh 'anah5 'er%u4a o%eh &enda &er4ara'G&enda asin+ /7DA:A $:I(IS : 1. $e4a4uan o'o' 2ri+idi'as3 Tris us =isus sardonicus

 $e4a4uan o'o' %eher $e4a4uan o'o' farin+ $e4a4uan o'o' dada 8eru' 1a1an O1i'o'onus 2. S1as e 3. /an++uan o'ono

KLASIFIKASI Secara 4%inis 'e'anus di&a+i da%a :

1. Te'anus %o4a% S1as e %o4a% y+ nyeri dise4i'ar %u4a H rin+an < hi%an+ sendiri 7'io : 6u %ah 'o4sin rendah G adanya i uni'as se&a+ian 'erhada1 'e'anos1as in 2. Te'anus sefa%i4 Te'anus %o4a% y+ en+enai o'o' y+ di1ersyarafi o%eh n.4rania% H 1arese fasia%5 disfa+ia 7'io : infe4si 'e%in+a G %u4a di daerah 4e1a%a 3. Te'anus neona'oru 7'io : 1roses 1e o'on+an 'a%i 1usar y+ 'd4 s'eri% H 'er6adi 1ada &ayi y+ i&unya 'd4 e i%i4i i uni'as 'erhada1 'e'anus /e6a%a 4%ini4 : 1. uncu% 1ada in++u 4edua se'e%ah %ahir 2. 4e%e ahan 3. 4e'ida4 a 1uan un'u4 en+hisa1 #. s1as e ". 4e4a4uan #. Te'anus u u 8a%in+ u u < serin+ 280I3 Eerasa% dari 'e'anus %o4a% H 'e'anus u u )anifes'asi 4%inis : 1. 'ris us 2. risus sardoni4us 3. o1is'o'onus #. 1eru' 1a1an ". 4on'ra4si 'oni4 dari o'o' y+ 'er6adi secara s1on'an au1un 'erhada1 res1on dari %uar DERAJAT TETANUS

2Eera' rin+annya dera6a' 1enya4i' 'e'anus da1a' di'en'u4an den+an &e&era1a cri'eria3 97=ADAT T7TA(>S )7(>=>T PATEL 4 +OA( $=IT7=IA 1 $=IT7=IA 2 $=IT7=IA 3 $=IT7=IA # $=IT7=IA " : 'ris us : s1as e : asa in4u&asi 7 hariG 4uran+ : 1eriode onse' #8 6a G 4uran+ : 4enai4an suhu rec'a% sa 1ai 100oJ G a4si%a sa 1ai ..oJ 2375!o03 1ada saa' K 2# 6a )=S E7=9ASA=$A( $=IT7=IA 9IATAS 9IE>AT S>AT> /=A9ASI 87(,A$IT : 97=ADAT 1 97=ADAT 2 97=ADAT 3 97=ADAT # 97=ADAT " : dida1a'4an 1 dari " 4ri'eria : dida1a'4an 2 dari " 4ri'eria5 or'a%i'as 10I : dida1a'4an 3 dari " 4ri'eria5 or'a%i'as 32I : dida1a'4an # dari " 4ri'eria5 or'a%i'as !0I : dida1a'4an " 4ri'eria5 or'a%i'as 8#I Se&a+ian &esar 'e'anus neona'oru < 'e'anus 1uer1eriu

97=ADAT T7TA(>S )7(>=>T A'IETT5S y+ di odifi4asi 97=ADAT 1 : )I:9 1. i%d 'o odera'e 'ris us 2. +enera% s1as'ici'y 3. no res1ira'ory e &arrass en' #. no s1as ". %i''%e G no disfa+ia 97=ADAT 2 : )O97=AT7 1. odera'e 'ris us 2. we%% ar4ed ri+idi'y 3. i%d 'o odera'e &u' shor' s1as #. odera'e res1ira'ory e &rass en' H == : ; 30 ". i%d dys1ha+ia 97=ADAT 3 : S7L7=7 1. severe 'ris us 2. +enera%iCed s1as'ici'y 3. ref%eF 1ro%on+ed s1as #. M == ; #0 ". a1noeic s1e%%s !. severe dys1ha+ia 7. 'achycardia : ; 120 97=ADAT # : L7=, S7L7=7 1. +rade 3 < vio%en' au'ono ic dis'ur&ance invo%vin+ cardiovascu%ar sys'e

2. severe hy1er'ension < 'achycardia a%'erna'in+ wi'h re%a'ive hy1o'ension < &radycardia5 ei'her of which ay &e 1ersis'en' DIAGNOSIS BANDING 1. Tis us : 9en'a% a&scess5 1eri'onsi%ar a&scess5 1haryn+ea% di1h'heria5 fra4'ur andi&u%a5 dan u 1s 2. Ea4'eria% enin+i'is 3. Su&arachnoid hae orrha+in+ ". 0ere&ra% a%aria #. 71i%e1sy !. =a&ies N 8eneran+an : 2 < 3 - )e i%i4i 4e4a4uan o'o' %eher 'a1i +e6a%a %ain 'ida4 ada. # - 8asien 'ida4 sadar saa' 4e6an+5 ada riwaya' 4e6an+ &eru%an+ " - Ada +e6a%a de a yan+ 4has ! - -ydro1ho&ia5 +e6a%a +an++uan &a'an+ o'a45 saraf crania% da1a' 'er+an++u 6u+a MANAGEMENT 8rinsi1 'era1i un'u4 'e'anus : - )en+e%i inasi &a4'eri da%a 'u&uh un'u4 ence+ah 1en+e%uaran 'e'anos1as in %e&ih %an6u' - )ene'ra%isir 'e'anos1as in yan+ &eredar &e&as da%a sir4u%asi 2&e%u 'eri4a' den+an sis'e saraf 1usa'3 - )e ini a%isasi +e6a%a yan+ 'i &u% a4i&a' i4a'an 'e'anos1as in den+an sis'e saraf 1usa' - )en+o&a'i s1as e o'o' Tera1i u u un'u4 'e'anus : 9irawa' di ruan+an 'enan+ < di oni'or 4e'a'. 0airan infus 9" un'u4 ence+ah dehidrasi dan hi1o+%i4e i 9e&ride en' %u4a. Eeri4an hTI/ dan 'era1i an'i&io'i4a. O4si+enasi 9ie' 'in++i 4a%ori 'in++i 1ro'ein

Tera1i $husus un'u4 'e'anus : 1. Hu/an Tetanu% I/unog&o0u&$n 2hTI/ 3000-!000 I> i. 3 : un'u4 ene'ra%isir 'e'anos1as in &e&as. 9i&eri4an sece1a' un+4in se'e%ah

dia+nosis 4%inis 'e'anus di'e+a44an. 9osis efe4'if yan+ dire4o endasi4an ada%ah 3000-10.000 I> ivGi 5 den+an 4adar 1unca4 da%a darah dica1ai da%a #8-72 6a . Se&a+ai 1en+o&a'an secara a4'if 1"00-3000 I> diinfi%'rasi4an 1ada se4e%i%in+ %u4a. 9i Indonesia u u nya asih e a4ai An'i Te'anus Seru 5 'er asu4 6u+a di =S-S. -TI/ dian++a1 %e&ih &ai4 dari1ada equine an'iseru 4arena %e&ih sedi4i' eni &u%4an rea4si hi1ersen'ivi'as. 2. Seru/ ATS yan+ dian6ur4an 10.000 > i.v sa'u 4a%i. Se&e%u 1e &erian harus di%a4u4an s4in 'es. >n'u4 i unisasi a4'if di1a4ai TT. A1a&i%a %u4a 4eci%5 'ida4 'erinfe4si5 'e'a1i riwaya' i unisasi 'ida4 6e%as5 di&eri4an dosis TT 05" %. 9osis yan+ sa a u'%a4 di&eri4an a1a&i%a %u4a &esar5 'erinfe4si5 dan riwaya' i unisasi 'era4hir %ewa' " 'ahun. 3. Ant$0$ot$3 : un'u4 en+hi%an+4an su &er 'e'anos1as in. 9O0 : )e'ronidaCo%e "00 + 1.o 'ia1 ! 6a a'au 1+r 'ia1 12 6a se%a a 10-1# hari5 a4'if en+ha &a' 1er'u &uhan &a4'eri anaero& dan 1ro'oCoa. 8enici%%in 1ro4ain 152 6u'a uni' i. G! 6a se%a a 10 hari.2&i%a a%er+i 'erhada1 1enici%%in da1a' di&eri4an eri'ro isin dan 'e'rasi4%in.3 #. 'en6o7$a6ep$ne : un'u4 e ini a%isasi s1as e o'o' dan ri+idi'as 4arena &ersifa' /AEA enhancer. 9O0 : N9iaCe1a 4arena da1a' en+uran+i ansie'as5 enye&a&4an sedasi dan re%a4sasi o'o'. 9osis 1e &erian &erdasar4an dera6a' 4e1arahan s1as e o'o'. 8ada oran+ dewasa : S1as e rin+an : "-10 + 1.o 'ia1 #-! 6a S1as e sedan+ : "-10 + i.v S1as e &era' : "0-100 + da%a "00 % 9"5 infus4an den+an 4ece1a'an 10-1" +G6a Ei%a refra4'er 'erhada1 &enCodiaCe1ine5 &eri4an neuromuscular blocking agents 2vecuroniu 3 N)a+nesiu su%fa': di+una4an un'u4 en+on'ro% s1as e dan en+uran+i +an++uan o'ono . O&a' ini e i%i4i efe4 1e%e as o'o' yan+ 1o'en5 e i%i4i 4e a 1uan en+ha &a' 1e%e1asan 4a'e4o%a in neurona% dan adrena%5 enurun4an res1on rese1'or 'erhada1 4a'e4o%a in5 e i%i4i efe4 an'i4onvu%san dan &ersifa' vasodi%a'or.9osis 1e &erian: - dosis ua'an 70 +G4+&& se%a a 30 eni' di%an6u'4an dosis 1e e%iharaaan 2 +rG6a 2usia O !0'h3 a'au 1+rG6a 2usia ; !0'h3. - 9osis 'i'rasi sesuai 4e&u'uhan: 05"+rG6a 2usia O!0'h3 a'au 052"+rG6a 2usia ;!0'h3hin++a 'erca1ai dosis efe4'if ini u .

". -adrenergik blocking agents 2:a&e'o%o% 052"-1 +G eni' e%a%ui infus i.v se'e%ah di'i'rasi3 un'u4 en+on'ro% disfun+si o'ono yan+ dido inasi a4'ivi'as si 1a'is5 ya4ni enurun4an 'e4anan darah 'an1a e 1er&era' 'a4i4ardi. !. Intu0a%$ en7otra3ea& atau tra3eo%to/$ 1ada 'e'anus &era' 2s'adiu III-IL3 un'u4 a'asi +an++uan na1as. -enda4nya 'ra4eos'o i di%a4u4an 1ada 1asien yan+ e er%u4an in'u&asi %e&ih dari 10 hari5 disa 1in+ i'u 'ra4eos'o i 6u+a dire4o endasi4an se'e%ah onse' 4e6an+ u u yan+ 1er'a a. 7. *a%au1un $/un$%a%$ a4'if 'ida4 100I efe4'if ence+ah 'e'anus5 na un i unisasi 'e'anus 'e%ah e 1er%iha'4an se&a+ai sa%ah sa'u yan+ 1a%in+ efe4'if se&a+ai 1ence+ahan 'erhada1 4e6adian 'e'anus. 8e &erian i unisasi dan 1enan+anan %u4a yan+ &ai4 di4e'ahui eru1a4an 4o 1onen yan+ 1en'in+ da%a ence+ah 1enya4i' ini. 8ada 1asien den+an 'e'anus5 i unisasi a4'if den+an TT harus u%ai di&eri4an a'au di%an6u'4an sese+era un+4in se'e%ah 4ondisi 1asien s'a&i%. *a3%$na%$ 'e'anus den+an 'e'anus 'oFoid di&eri4an 1ada se ua 1asien 1ada asa 1enye &uhan.&oos'er di&eri4an #-! in++u sesudahnya5 dosis 4e'i+a di&eria4n # in++u sesudah dosis 4edua. 8. In7u3%$ para&1%$% 21ancuroniu 2# + a'au vencuroniu diser'ai 1en++unaan 8ent$&ator di I0>. !-8 +G6a 3

.. Tera1i s'andar 1asien 'e'anus di =S-S: - ATS 10.000 I> i. - TT 05" cc i. diu%an+ 1 &u%an 4e udian - Te'rasi4%in 2 +Ghari dan e'ronidaCo%e 1"00 +Ghr - 9iaCe1a 10 + i.v - 8e asan+an (/T5 'ra4eos'o i5 1erawa'an %u4a5 d%% - )asu4 I0> a'as indi4asi: a1a&i%a s1as e 'ida4 da1a' dia'asi a'au 'er6adi diso'ono ia KOMPLIKASI 8ada 1asien 'e'anus5 4o 1%i4asi yan+ 'er6adi da1a' en+enai ha 1ir se ua or+an 'u&uh5 den+an yan+ 1a%in+ serin+ en+enai sis'e res1irasi5 4ardiovas4u%ar5 dan sis'e o'ono 5 ser'a 4o 1%i4asi sis'e i4 %ain. Eody sys'e Airway 0o 1%ica'ion As1ira'ionN :aryn+os1as Go&s'ruc'ionN Seda'ive associa'ed o&s'ruc'ionN A1noeaN

=es1ira'ory

-y1oFiaN Ty1e IN 2a'e%ec'asis5 as1ira'ion5 1neu onia3 and Ty1e IIN res1ira'ory fai%ure 2%aryn+ea% s1as 5 1ro%on+ed 'runca% s1as 5 eFcessive seda'ion3 A=9SN 0o 1%ica'ion of 1ro%on+ed assis'ed ven'i%a'ion 2e.+. 1neu onia3 0ardiovascu%ar TachycardiaN5 hy1er'ensionN5 ischae iaN -y1o'ensionN5 &radycardiaN Tachyarrhy'h ias5 &radyarrhy'h iasN Asys'o%eN 0ardiac fai%ureN =ena% -i+h ou'1u' rena% fai%ureN O%i+uric rena% fai%ureN >rinary s'asis and infec'ion /as'roin'es'ina% /as'ric s'asis I%eus 9iarrhoea )isce%%aneous -ae orrha+eN *ei+h' %ossN Thro &oe &o%usN Se1sis and u'i1%e or+an fai%ureN Jrac'ures of ver'e&rae durin+ s1as s Tendon avu%sions durin+ s1as s N $o 1%i4asi yan+ en+anca 6iwa

PENATALAKSANAAN KOMPLIKASI $o 1%i4asi =es1irasi $eadaan hi1o4sia5 hi1oven'i%asi da1a' dice+ah dan dia'asi den+an 1e &erian o4si+en dan 1en++unaan ven'i%a'or. 9i 'e 1a' yan+ 'ida4 e i%i4i ven'i%a'or5 harus di&eri4an O2 se&anya4 !-8 %i'erG eni'. Ei%a adanya 1neu onia a4i&a' as1irasi se4re' da1a' dia'asi den+an an'i&io'i4a yan+ 'e1a'5 dan &i%a ada s1as e %arin+ da1a' dia'asi den+an 1e &erian ch%or1ro aCine "0 + iv a'au diaCe1a 10-20 + iv. $o 1%i4asi $ardiovas4u%ar o'ono >n'u4 4eadaan hi1ersi 1a'is da1a' di1er+una4an 1en+ha &a' P dan Q5 yai'u %a&e'o%o%5 a'au 1en+ha &a' Q 21ro1ano%o dan es o%o%3 dan a+nesiu su%fa' $o 1%i4asi o'ono %ain

A4'ivi'as 1arasi 1a'is yan+ &er%e&ihan 2se4resi sa%iva5 'ra4eo&ron4ia% &er%e&ihan a'au &ro4os1as e3 da1a' di4on'ro% den+an &o%us a'ro1in in'ravena na un harus di1an'au a+ar denyu' 6anu'n+ 'ida4 e%e&ihi 1"0-170FG eni' 1ada ana4-ana4 a'au 120-130F. eni' 1ada dewasa $o 1%i4asi sis'e i4 %ain Sepsis5 da1a' di&eri4an an'i&io'i4 4o &inasi sefa%os1orin +enerasi 4e-35 a ino+%i4osid5 van4o isin5 dan e'ronidaCo% Rhobdomiolisis5 da1a' enye&a&4an 'er6adinya +a+a% +in6a% a4u'5 &i%a 4adar 0$ ; "000 >G%' a'au dide'e4si io+%o&in da%a urin5 harus di%a4u4an hidrasi den+an (a0% 05.I dan a%4a%inisasi urin den+an (a &i4ar&ona' Komplikasi saluran cerna5 serin+ di6u 1ai 1erdarahan sa%uran cerna &a+ian a'as sehin++a dian6ur4an 1e &erian an'asida secara re+u%er a'au da1a' di&eri4an an'ihis'a in 2 an'a+onis.

PENCEGAHAN TETANUS I unisasi a4'if : - I unisasi a4'if ini 1er%u di&eri4an 1ada an4-ana4 se6a4 dini dan 6u+a 1ada i&u ha i%. Se6a4 &ayi se&ai4nya sudah di&eri4an i unisasi den+an 6adwa% se1er'i 1ada 'a&e% 1. (a un 6i4a &e%u dii unisasi5 ana4-ana4 R 7 'ahun da1a' 1u%a dii unisasi den+an in'erva% se1er'i 1ada 'a&e% 2. TAE7: 1: I unisasi 8ri er 1 8ri er 2 8ri er 3 8ri er # Eoos'er Eoos'er Ta &ahan TAE7: 2: I unisasi 8ri er 1 8ri er 2 8ri er 3 Eoos'er >sia GIn'erva% 1e &erian R ! in++u #-8 in++u se'e%ah 1ri er 1 #-8 in++u se'e%ah 1ri er 2 !-12 in++u se'e%ah 1ri er 3 #-! 'ahun Se'ia1 10 'ahun se'e%ah &oos'er 'era4hir 8rodu4 98T 98T 98T 98T 98T Td

In'era% 8e &erian # in++u !-12 in++u Se'ia1 10 'ahun se'e%ah &oos'er 'era4hir

8rodu4 Td Td Td Td

- 8ada i&u ha i% da1a' di&eri4an 2 4a%i in6e4si Td 'oFoid 1ada 'ri es'er 4e-2 a'au 4e-3. I unisasi Td 'oFoid 1ada i&u ha i% ini di1er%u4an un'u4 ence+ah 'er6adinya 'e'anus neona'oru . Se%ain i'u 1ersa%inan yan+ &ersih 6u+a &er1eran 1en'in+ da%a 1ence+ahan 'e'anus neona'oru .

I unisasi se'e%ah

en+a%a i %u4a :

- 8ada seseoran+ yan+ en+a%a i %u4a5 da1a' di%a4u4an 1ence+ahan 'e'anus den+an e &ersih4an %u4a 2iri+asi35 en+hi%an+4an &enda asin+ yan+ ada5 de&ride en'5 1en++unaan an'i&io'i4 6i4a di1er%u4an. 2a3 8ada %u4a inor5 'ida4 'erinfe4si -9i&eri4an TT den+an dosis " :f 205" cc3 1ada 1enderi'a den+an indi4asi: s'a'us i unisasi yan+ 'ida4 di4e'ahui5 &e%u 1ernah dii unisasi a'au 'eri unisasi 1arsia%5 %e&ih dari 10 'ahun 'ida4 enda1a' &oos'er. 2&3 8ada %u4a ayor5 'erinfe4si -Indi4asi 1e &erian TT sa a se1er'i 1ada %u4a inor5 na un den+an dosis &oos'er TT. 9i&eri4an i unisasi 1asif 1ada 1enderi'a 'erse&u'5 &ai4 den+an -TI/ 2"0-"00 > i. a'au1un den+an ATS "000 >. TAE7: 3: :u4a =en'an Te'anus :u4a Tida4 =en'an Te'anus ; ! 6a O ! 6a $eda%a an 2; 1 c 3 Su1erfisia% 2O 1 c 3 Ter4on'a inasi Eersih S'e%%a'e5 avu%si5 re u4 :iner5 'a1i 'a6a 9enervasi5 is4e i4 SarafGvas4u%er in'a4 Infe4si se4under 2?3 Infe4si se4under 2-3 9ia &i% dari >dwadia J.7.5 Te'anus5 Eo &ay 1..# PROGNOSIS 8ro+nosis < or'a%i'as 'er+an'un+ dari &era'nya +e6a%a 4%ini4. 8en++unaan cara indu4si 1ara%isis den+an 1e a4aian L' diser'ai 1enan+anan in'ensive care yan+ 1ri a 'er&u4'i %e&ih un++u% di&andin+ 1e a4aian seda'ive < o&a' re%a4sasi o'o' da%a 1enurunan an+4a 4e a'ian. Ja4'or2 yan+ e 1en+aruhi an+4a 4e a'ian ada%ah : 2a3 asa in4u&asi < wa4'u onse' B se a4in 1ende4 asa in4u&asi dan 1eriod onse'5 se a4in 'in++i an+4a 4e a'ian 2&3 &era' +e6a%a 4%ini4 B an+4a 4e a'ian 'in++i 1ada 1enderi'a 'e'anus &era'. 2 +e6a%a 4%ini4 yan+ &er1eran da%a 1ro+nosis ada%ah s1as e < diso'ono ia. Se a4in &era' dan 4ua' s1as e o'o' dan diso'ono ia5 se a4in &uru4 1ro+nosis. 2c3 usia B 1ro+nosis &uru4 dan an+4a 4e a'ian 'in++i 1ada neona'us dan 1enderi'a yan+ &erusia ;"0 'ahun. 2d3 +iCi &uru4 B 1ro+nosis 4uran+ &ai4 1ada 1enderi'a 'e'anus d+n +iCi &uru4. 8enye &uhan a4an %e&ih &ai4 dan ce1a' a1a&i%a di&eri die' 4a%ori 'in++i 23"00#0004a%Ghari3 2e3 8enan+anan 4o 1%i4asi B a1a&i%a 4o 1%i4asi 'e'anus yan+ 'i &u% di'an+ani den+an o1'i a%5 a4a an+4a 4e a'ian rendah.