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RESPIRASI
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Levitzky. Pulmonary physiology.
2007.
Bronchial Tree
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§ Ventilasi
§ Difusi
§ Perfusi
VENTILASI
Peristiwa perpindahan:
S O2 dari alveol ke kapiler dan
S CO2 dari kapiler ke alveol
www.medicinenet.com/
Perfusi
S Kegawatdaruratan respirasi:
S Haemoptisis
S Pneumotoraks
S Serangan asma
S Terapi oksigen
HEMOPTISIS
S
Istilah hemoptisis
Ekspektorasi darah:
S Perdarahan pada saluran napas di bawah laring,
atau
S Perdarahan yg keluar ke saluran napas di bawah
laring.
Etiologi
RSUP Persahabatan:
• Batuk darah < 600 mL/24 jam, tapi lebih dari 250 mL/24
jam, Hb < 10 g% dan masih terus berlangsung
• Batuk darah < 600 mL/24 jam, tapi lebih dari 250 mL/24
jam, Hb > 10 g% dalam 48 jam belum berhenti.
Diagnosis Hemoptisis
S Anamnesis teliti
Bedakan dengan hematemesis,
epistaksis dan perdarahan gusi
S Pemeriksaan Fisik
Selain toraks, periksa organ lain THT,
abdomen dll
Hemoptisis vs hematemesis
PH Basa Asam
LABORATORIUM
S Faal hemostasis
S Sitologi sputum
RADIOLOGIS
S CT Scan toraks
Manajemen hemoptisis
Tujuan:
Cegah asfiksia
Hentikan perdarahan
Terapi kausal
Batuk darah
Penatalaksanaan konservatif
Ro PA dan lateral
CT scan toraks (+ kontras)
Bronkial angiografi
Bronkoskop serat optik
Bronkoskop rigid
3 Terapi Spesifik
S
Pendahuluan
S Angka kematian
S laki-laki 1,26/juta/tahun
S perempuan 0,62/juta/tahun
Patofisiologi
Pecah
↓
Pneumotoraks
Ó Gejala pneumotoraks
Hidro/
piopneumotoraks
Suction
Light RW. Chest tubes. In: Light RW, ed. Pleural diseases. 2001.p.378-90.
Three bottle system
3 2 1
3 2 1
WSD
Selang WSD
Botol
WATER SEALED DRAINAGE (WSD)
S Undulasi
S Bubbles (gelembung)
S Produksi cairan
S Warna cairan
ASMA AKUT
S
Definisi
Is it asthma?
START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
WORSENING
Prednisolone: adults 1 mg/kg, max.
50 mg, children 1–2 mg/kg, max. 40 mg While waiting: give inhaled SABA
and ipratropium bromide, O2,
Controlled oxygen (if available): target systemic corticosteroid
saturation 93–95% (children: 94-98%)
IMPROVING
FOLLOW UP
Reliever: reduce to as-needed
Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending
on background to exacerbation
Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation,
including inhaler technique and adherence
Action plan: Is it understood? Was it used appropriately? Does it need modification?
Is it asthma?
ASSESS the PATIENT Risk factors for asthma-related death?
Severity of exacerbation?
LIFE-THREATENING
Drowsy, confused
or silent chest
URGENT
TRANSFER TO ACUTE
CARE FACILITY
While waiting: give inhaled SABA and
ipratropium bromide, O2, systemic
corticosteroid
Is it asthma?
ASSESS the PATIENT Risk factors for asthma-related death?
Severity of exacerbation?
TRANSFER TO ACUTE
CARE FACILITY
While waiting: give inhaled SABA and
ipratropium bromide, O2, systemic
corticosteroid
Is it asthma?
ASSESS the PATIENT Risk factors for asthma-related death?
Severity of exacerbation?
START TREATMENT
SABA 4–10 puffs by pMDI + spacer,
TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
WORSENING While waiting: give inhaled SABA and
Prednisolone: adults 1 mg/kg, max.
50 mg, children 1–2 mg/kg, max. 40 mg ipratropium bromide, O2, systemic
Controlled oxygen (if available): target corticosteroid
saturation 93–95% (children: 94-98%)
IMPROVING
IMPROVING
IMPROVING
FOLLOW UP
Reliever: reduce to as-needed
Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending
on background to exacerbation
Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation,
including inhaler technique and adherence
Action plan: Is it understood? Was it used appropriately? Does it need modification?
NO
YES
Further TRIAGE BY CLINICAL STATUS Consult ICU, start SABA and O2,
according to worst feature and prepare patient for intubation
NO
YES
Further TRIAGE BY CLINICAL STATUS Consult ICU, start SABA and O2,
according to worst feature and prepare patient for intubation
S
Terapi Oksigen
Dosis toksik
Lama pemberian
Indikasi
Jenis
Kontraindikasi
Efek samping
http://balabasnia.narod.ru/optimal/
Tujuan terapi oksigen
(Dosis)
Meningkatkan :
S Saturasi O2 > 90 %
S Koreksi hipoksemia
S Perbaikan oksigenasi
S Meningkatkan reabsorbsi pada rongga
badan.
S Absorption atelectasis
S Retrolental fibroplasia
Pierce LNB. Guide to: mechanical ventilation and intensive respiratory care. Philadelphia: WB Sauders;
1995.
Pemberian Terapi O2
S Rugi:
S Luka akibat tekanan
S Mukosa hidung kering &
iritasi
Pierce LNB. Guide to: mechanical ventilation and intensive respiratory care. Philadelphia: WB Sauders;
1995.
MASKER
& mulut
Masker Simpel
S Rugi:
S Tdk nyaman bagi
pembicara yg senang
menyingkirkan masker
S Sulit buang dahak dan
makan
S Tdk nyaman pd trauma
wajah
S Mata kering/iritasi
Pierce LNB. Guide to: mechanical ventilation and intensive respiratory care. Philadelphia: WB Sauders;
1995.
MASKER RESERVOIR
S Untung S Rugi
S Mata kering/iritasi
Pierce LNB. Guide to: mechanical
ventilation and intensive respiratory
care. Philadelphia: WB Sauders;
Tanpa klep
Tanpa klep
Masker Nonrebreathing
S Untung S Rugi
S FiO2 > 0,8 S Tdk nyaman
S Claustrophobia
S Tdk bisa makan, minum &
buang dahak
S Mata kering/iritasi
S Katup masker lengket
Klep 1 Klep 2
Reservoir
Selang O2
High flow devices
Venturi
S Konsentrasi oksigen à dalam masker dengan
udara didalamnya à oksigen diberikan
dengan angka pasti
S Alat digunakan nonaerosol à persen tetap
(24%, 28%, 31%, 36%, 40%, 50%)
Pemilihan jenis alat berdasarkan FiO2
No. Jenis alat Aliran (L/m) FiO2
1. Kanul hidung 1 0,24
2 0,28
3 0,32
4 0,36
5 0,40
6 0,44
2. Simple Mask 5-6 0,4
6-7 0,5
7-8 0,6
3. Rebreathing Mask 7 0,65
8-15 0,7-0,8
4. Nonrebreathing Mask Atur reservoir jgn 0,85-1,0
kempes
Pierce LNB. Guide to: mechanical ventilation and intensive respiratory care. Philadelphia: WB Sauders;
1995.
CONTINOUS POSITIVE AIRWAY
PRESSURE (CPAP)
1. Indikasi
3. Cara pemberian
4. Tehnik pemberian
Silinder
S Ringan
S Bila digunakan dengan kecepatan aliran 2
L/’ lama pemberian 7 hari
S Dapat dibawa sambil berjalan
S Harga > mahal
S Dapat diisi ulang
Konsentrator
AaDO2 = PA O2 - PaO2
PaO2
713
KONSENTRASI OKSIGEN
BERDASARKAN ALAT YANG DIGUNAKAN
lpm FIO2
1 0.24
2 0.28
3 0.32
4 0.36
5 0.40
6 0.44
Theoretical FIO2 Via Simple Mask, Partial
Rebreathing Mask and Nonrebreathing Mask
Partial ≥8 ≥ 0.60
Rebreathing
Non ≥ 10 ≥ 0.80
Rebreathing