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  • Ringkasan Dosis Obat 7th Revised

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    Muhammad Ihsanuddin
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    Ringkasan dosis obat

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    Ringkasan dosis obat

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    142 просмотров38 страниц

    Ringkasan Dosis Obat 7th Revised

    Загружено:

    Muhammad Ihsanuddin
    Ringkasan dosis obat

    Авторское право:

    © All Rights Reserved
    Скачайте в формате PDF или читайте онлайн в Scribd
    Отметить как неприемлемый контент
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    Pavone a ene nod Benn a) pee) ST eres Ee ee rcoe Teo etl rs) rat core rl ST seme nett} Nee eee! rd pei er aero TT Poe CARA PENGHTTUNGAN DOSIS OBAT 1. Hitung dosis sesuai berat badan Dosis = dosis yg dipakai (W/kgBB/mnt) x kgBB Contoh : pasien BB 50 kg; dosis dobutamin S mcg/kgB8/mnt Dosis = 5 meg/kgBB/mntx 50 kg = 250 meg/rmnt 2. Hitung konsentrasi pengenceran obat Pengenceran =Sediaan obat ve dipakai (mg) x 1000 Volume pelarut (ml) Contoh: Sediaan dobutarin 1 vial 250 mg Diencerkandalam $0 mi cairan= 250 me x 1000 Som = 5000 meg/mL Diencerkan dalam 100 ml cairan = 250 mg x 1000 100 mL = 2500 meg/mL. Diencerkan dalam 500 mL cairan= 250 mg x 1000 ‘500 mL = 500 meg/mk 3. Hitung low rate untuk pemberian Syringe pum infussion pump = mi/jam Dosis yg) kg Smet (nema 1) Tetesan ins: ‘Seainanobat yg Gpatal ray 1000 Vouve paar id (romer 2) Contoh = (dosis pasien diatas dalam syringe pump 50 ml) 5 (wgymet 50 60 ment Tetesan infuse 0 15000 meg ae 250 gh 1000 50 id 5000 mg/m = 30 miyjam (lihat di tabel dobutamin) 4. Konversi pengenceran dari angka di tabel Semnua angka di tabel dengan pengenceran SO mL Jka pengenceran dengan larutan lebinbesar, kalikandengan Jjumiah cairan cibagi 50. Contoh: engenceran dobutamin dengan NS S00 mL Dosis obat diatas 30 mi Ghat di tabel dobutamin) x 500 50 = 30x 10=30 mi/jam Pengenceran dengan NS 500 mL dikalikan 10 NS 100 mi.dikalikan 2 5. Konversi dari dosis mi/jam ke tetes/menit 1 mL = 20 tetesmakrodkip = 18 tetes bloodset = 60 tetes rmikrocrip Infusmakrodti tete/menit) sess (iV) x20 = dsisxL coment) 3 Infusmikrotip tetes/menit)=asisiriljamx6 = dosisx 1. solment) Infusblondset crip (tetesymenit sess (rivjan) x18 = dosisx 3 amen) 10 1 (Lam) = 1/3 {tetes/menit) makrocrip = 1 tpmmikrocrip, = 3/10 tpmbloodset drip Cortoh: 30 mUjjam= 1/3 30 (tetes/mnt) mekrockip = 10 tom makro Pediatie Emergency Drugs and Defibrilation Remarks a Raeoane|oj-02 mote nr Snes rodeo [emote ive piv pou ax sige ose 120 iar doe 15 mp Bo Parone Joni o02 mote aces: 0° ro tax snge cose 08 m9 lesen Ieaazs mungor 20 mpkcine cose 220 meghginn 20 magia irae soares oo a sxe 10, act mange 0 Seater ceses 32 mag: ero mia Eaneprne loro ne suave or ous +-2mepiaiv perme rono per 30s emma rise 80 repo ion cose Pore fase [arnoamns fear 206 osum [meager ove Benne foro 2319 may oe gen? mo Tete soni, montero eer. ectenson [cariownen[ozetone Faun _fovoasnete Detwaaion [nae [Adult Emergency Drug brug [oose Remarks PRiaroane [Erg ow tees [ove apa caus man ‘ig ropntdore_| nga core 12m Favioiarom [isdegove 10 [rorpusdens VTE in totoweaby + | sta wit S00 mg 0 Imomntoretes, | tuson fRenasmpmin | ans dose: 22 pnt ere faropne fostone warvcaraam ome feed vey 35 [22a mapigion [Teas to senres tea loracen ozsrate Fetes v6 more foroweaoyos | APintar rat neconsty Epnepine [Epnepvie nian imagen taste Te mg repeat 3 rn enecotery Er 228g Weapon |2eengN ord [Oona sane frnsmayrepeat — | presen of pei 518 ng avery [terror unc 30 minrormacs [Oo zone Toeccana [cis ngngican |irmee 50 negnainn| rept evry 10 Smo ageaun | Bgow Sonn [usin Oe oar Teena pe aos Yirmae tou monterey sexe ony ANTIPLATELET 1. Aspirin: Low dose 80 mg > orset efek antiplatelet sth beberapa hari ‘Mediumdose 160-320 mg > onset efek antiplatelet dim 30 mt 2. Thyenopyridines/ ADP inhibitor: Clopidogrel 75 mg > onset efek maksiral antiplatelet setelah beberapa hari Dosis 300 - 600 rrg > onset dalam beberapajam 3. Glycoprotein ib/tlainhibitor : AMIODARONE Sediaan #1 amp =3mL = 150 mg; tablet 200 mg Oplosan : D5% atau NS Stabilitas : 24 jam dimDS% lebih balk digunakan segera setelah dilarutkan/ diencerkan dalamwaktu 12 jam. Carapemberian: 1, Awal bolus 150 mg amiodaron (3 ml) + 100 mL D5% hhabis dalarn30 menit (kec aju 200 mijam melalui syringe pup). 2. Lanjutkanterapi maintenance : Dosis 900 me/24 jam, terbagl dalam (360mg 6 jam pertara + 540mg 18 jamkedua) > 6 ampul amiodarone dalam D5% S00 ce untuk pemakaian selamna 24 jam: ‘+6 jampertama dosis 1 mg/menit, 1 amp ‘amiodarone diencerkan drg D5% 100 mL Rumus = (dosisx 60 menit) = ? mi/jam Pengenceran Jadi > (11mg x 60 menit) Dome/S0OmL 18 Kecepitan pemberian 33.3 mi/jam dg infusion pump ,3mLjam © 18jamkeduadosis 05 me/mentt, kecepatan pemberian 16,7 mijjam. « Inisialterapi oral 800 ~ 1600 mg/hari 1 s/d3minggu; 600 - 800 me/hari 1 bulan 400 me/hari maintenance + Perhatian dan evaluasi rekaman ECG awasi bracikardi: ppelebaran gelombang 0; resiko hipotens + Terapi Atrial Fibrilasi © Bisoprolol/beta blocker pad AF stabil © Digoksin pada AF dergan hipotensi © Amiodaron pada paroksismal AF Table 9.4 Pharmacological treatments in acute AF. rae Administration Pamacologea cacoverson Fecainiée —2mg/hg V over 10 min (max 1507) (9r200-300me PO stat. Amiodsrone* 300m W ever 60min, then 1200m4/28 hours ‘400mg ts PO for 7-10 das. Provafenone mg/kg IV over 5-10%in ‘raB0-600mg PO sta Sota! 20-100 meV siow nection Rate-contro Digoxin (0.5-41mg Win 50m! seline over 4 hour (0 0.5mg PO 22 houry (2-9 doses) then 0.06250.25me day Metoorol _§-45m¢ stony (2 25100 mg 8 PO. Verepamii_Smgiv over 2 min repeats evry min upto 20m, (9740-120 ng a PO. ‘ALBUMIN Incikasi_:batas kadar minimal 25 gr/dl utk memeximalkan terapi antibiotik(terutama harus cikoreksi utksepsis) Sediaan : 20% & 25% dim 100 ri 5% dm 500 mL 25 gram albumin sediaan 100 mL» setara dergan 2 labu FFP(5O0cc) » setaradergan 2 labu WB Rumus — : Dosis = Alburin (target/3.5- pasier) x 880.8 Pemberian :tetesan pelan 100 mi dimé jam tidak boleh lebih dari 250 gran 48 jam BICARBONAT (BICNAT/MEYLON) Kekurargan Bicarbonat natricus dapat ilhat dari hasil AGD pada nila BE (Base Excess) NormalBE —_:-2sampai dergan +2 Sediaan £1 fles = 25 mL (25méq); 100ml (100 mEq) Pmberian koreksi — : Bolus atau drip infuse Rumus = 0.3xkg BEX hasilBE (mEq) 2 Koreksi Biknat = 1. ciberikan pada Asidosis Metabolik berat (ph <7.1), atau asidosis + gagalginjal 2. Koreksi Biknat diberikan Ye (setergahnya duu) bolus/infus cepat,larjut ¥ nya dalam infus lambat dalarn 24 jam 3. bikerbonat diberikan SO mEq s/o max 75 mEq dalam 105% 500ml (20 tom makro}; 2-5 mEq/kg lV infusion dalam 4-8 jar). Maximal 50 mEq IV dim 5 menit 4, Post Koreksi Biknat harus dievaluasi dengan periksa ‘Anaiisa Gas Darah ulang 4 jam kernudian eget PE & EPELEDEEE| © Anion Gap 28s $FE| eo E+ G gee Nat +K*-(CI-+HCO3) € ‘atau Na*- (Ct +HCO3) Normal = 8-12 £ SS ge ay Ariongenmenigat B BB BRE| — tdk bs dkoreksi dng = BICNAT NormallabBGA = & 3 ZeH | ° pH=7,35-7,45 = A pCO2= 35-45 pO, = 80 - 100 HCO = 21-28 BE =-35/d43 sO2=>95% seoumqunysig espg-ppry ods, ‘CALCIUM Ca Norra 277-8 mg/dl Sediaan CaGlukonas : 1 ampul adalah 100 me/ 10 mL Keadaan abnormal: HIPOCALCEMIA : Koreksi dgn Gluconas Cali 10% yg harus dierikan secara pelan-pelan untuk mencegah terjadinya hambatan listrik or Rodus sinus janturg dan hindari ekstravasasi yg depat ‘menimbukan nekrosis jaringan. 1. Tdkboleh diberiken secara intra musculer dan subcutan 2. KecepatanboluslV 1.5 -2ml/menit 3. KecepatanIV drip maximal 2:ml/merit HIPERCALCEMIA Koreksi perlu dipertimbangkan adarya koreksi kaliumbila adahiperkalemia. CRISTALOID 36 saline (513Na mmol/L) "Normal Saline / NS (154 Nammol/) Ringer's Lactate (130 Narmmol/t) Ye Normal Saline (77 Na mmol/.) [ mEq= mmolalensi. Eg. Ca?” 1 mEq = Yemmol; Not 1 mEq = 1 mmol] Normal : 130 mEq/ L150 mEq/L HIPONATREMIA (Sodium < 130 mEq) 1. Perrberiankoreksi * Larutan NaCl 3% (cairanhiipertonik) + Langsung maintenance NaC! 3% SOOmL/24 jam + Perrberian tidak boleh > 100 mi/jam (kecepatan laju) Hiponatremi akut 1 mecyjam, kronik 0,5 meqy/jm. « Bila terjadi syock hipovolemik,atasi dehidrasinya duu « Bila terjadi hipervolerik, lakukan restriksi cairan kalau perlu diberikan furosemica (lasix) + Awasi Central Pontine (osmotic) Myelinolisis jk koreksi hiporetremi terial cepat menjadi normo at hipernatremi 2. Rumus = (130~ Actual Na‘) x0.6 x kg88 HIPERNATREMIA (Soclium > 150 méq/titer) 1, Pemberian kareksi: * Berikan larutan NaCl0,45% dalam Dextrose 2.5% + Sebanyak 20 mL/kgbb/jam sampai syok teratasi + Penurunan tidak boleh lebih dari 10 poiry/24 jam AAkses IV line : vena central (CVC), bila diperifer dengan vverwlon no. 20 Effect of Adding One Litre Solution (Change in ECF |Change in ICF pw sat [667 mk 23D & 1/38 [$56 mL 444 ml Hat-nomal sane |[667 ml. (33 [Normal saline 1000 mL [0 mL. [Rage’sicate [900m [100m a Dex sr oa ene Sa SO HemREC AE ae as oy d aT sal |Qpejfoseom] (110mn)fosoon)) (LIPML19]] CLIOMHD|, NI) “omeN 19m —y ‘Stounos oWES Jo wopsodiwo) “289 Te ¢ poe 3 Yom» se YoU seo (ONTESY) IN TOR ¢ PEON SANE OONE onsMo, bir DIGOXIN Penghitungan total kaloriperhari pada} Sediaan :1 ampul =0,5 me dalam 2mL Kelori Basal Digitalisasi cepat 0,5 mg injeksi IV, sampai perubahan Lak lak BB idaman (kg) x 30 Kal/Kg rate/tyth, evaluesi jam kemuian Wanita x 25KalKg Setelah ituulangi 0,25 me jk masih ada AF Koreksi ‘Maintenance mex 0,03 me/kg88/ heii peru Umur >40 th % Altivitasringan :+103% Sedarg +208 DILTIAZEM (Herbesser) Berat — :+30% BB gemuk :-20% Sediaan = sediaan 10 mg, 25me & 50 mg / ampul lebih :-10% Oplosan —: NaCl 0.9% atau Dextrose 5% Kurang :+20% Perhatian = Gunakan dalamwakt 24 jam Stress metabolik : +(10-30%) Pgnceran : 100 mg Herbesser diencerkan dgn NaCl0.9% Harnil trimester & 1 jd 100 mL dengan infusion pur. Harn trimester I & laktasi Dosis Total kebutuhan «= Untuk SVT bolus dalam 10 menit dosis0.25/Kg8B, dliencerkan dalm 10 cc NSO,% £88 Idamen (Broca) = (TB ~ 100) ~ 10% BB ‘untuk hipertensi emergensi: mulai 5 meg/kgB8/menit, Kurang = <90% BBI nak tiap 5-10 menit 2.5 meg/kgBB/menit sampai dosis Normal = 90--110% Bet ‘maximal 15-20 meg/kg88/meni. Bilatarget tekanan darah sistole tercapai maka dosis dapat Lebih = 110 120% BBL dipertahankan/citururkan pelar-pelan tiap 2.5 meg Over => 120% B81 sarpai dergan dosis maintenance atau desis, pemeliharaan. lat :Syringepurn, spuit SOmL biasa, 1100 - 2400 kcal kgBB/cay ‘connecting/perfusor Diit Tinggi protein = 1,2- 1,5 gr/keBB/day Mline : Divenacertral (CVC), atau pembuluh darah perifer ‘drg venflon no. 20. Bila dipembuluh darah perifer, tidak boleh dicabarg. Indikasi : terminasi SVT, hipertensi emergency / berat pada asus neuro danjarturg. Pethatian_: Monitor kemungkinanterjadi tanda seperti socium bicarbonate krn akan mngendap, Efek samping : Menirgkatkan kontraktilitasjarturg, vvasoditatasiringan, perbaiki perfusi Splenknikus (pada dosis ringan maupundosis tinggi aman bagi jarturg) extravasasi vena/plebhitis. Dosis Kecepatan alan i . (regs mi/jam Efek sampirg : Tachyarrhytmia, hipertersi pada dosistingei. igo) mnt Doss an 5 [iz] ia iz [13 [2 [at [a3 oa Soa a7 aa [as [a Par [as Leauge non) eae 7s [ae [a s [sa [so 1 63 | 68 25 Tos] 75] 825| 9] 975] 105, 25 fae aL és Ss 5 v2] 735] 15[ 165| 18[ 195] 21 wee teetes Sas ee es ae 7s 1a | m2 [25 | 37 | 27 | 2925 | 3s 15 [7281 a3_[ toa [117 | 126 | 135 0 zfs six! =| a2 ins faa | 9s Tie | 126 | 137 | 147 | 158 as B75 [375] A125 | 45 | a7 | ws [96 | 708 jaz | tas 156 | 168 | 18 Beat | 40 | 48 5s [| 6 | 7 | 7 75 ise 255 9775) 63| 6625 | 735 i oo] 66 72] 78| o4 |) |m) 6 | 2 2 a 15 | aos 45] 495[ ssl asl 63 2 48 Berat Badan | 40 DOBUTAMINE (Dobuject) Sediaan #1 ampul = Smi = 250 mg = 250.000 meg COplosan : Nad 0,9% atau Dext 5% Stabiitas : Laruten harus digunaken dalam 24 jam Pengenceran : 250mg Dobuject diencerkan arg Nac 09% 4SmL menjadi 50 mL Dosis: Dosis awal 2 meg/kgB8/mnt naiktiap 15-30 menit, 2,5meg. Maximal dosis 15 ~20 meg (perhatixan. hemodinamik) Indikasi : Hipotensi akut/berat Perhatian Jangan dicampur dergan larutan alkali (basa), DOPAMIN Sediaan :1 arrpul = Sm = 200 mg = 200,000meg Oplosan : Nadi 0,9% atau Dext 5% Stabilitas : 24 jampadasuhy kama (setelah cllarutkan) Pethetian : Jangan dicampur dergan larutan alkali / sodium bicarbonate. Maximal kecepatan pemberian per infuse 50 meg/kgBB/mnt Pengenceran: 200mg dopamine diencerkan dengan Nad (0.9% 45m. menjacl 5O mL. Dosis: Dosis awal 2 megnaik icp 30 - 60 menit: 2mcg. Maximal dosis 15 - 20 mcg (perhatikan hemodinamik dan target tekanan darah systole) lat :Syringepumo, spuit 50 mi biasa, connecting/perfusor line: Divena central (CVC), atau perbuluh darah perifer dengan venvion no. 20. Bila di pembuluh darah perifer, tidak boleh dicabarg. Incikesi : Hipotensi akut/berat Efek sampirg : Dosis > 10 mcg : Tachicardia, hipertersi, extravasesi vena, vasokontriksi Dosis 4 ~ 10 meg :inotropikum Dosis 2 3mcg : efek perfusi ginjal dan inotropik ringan ime mL 7jam kg@9/mnt) 25 “IS 17 18 21 23 a4 26 28 5 30 34 38 41 45 49 53 6 75 45 51 56 62 68 73 79 84 @ 60 §8 75 83 30 98 i095 113 25 «7S 84 94 103 13 122 1B 141 1590 IG 113 128 135 146 158 169 7S 15 118 131 44 158 171 184 197 % 120-135 10 165 10 195 210 25 Brattain 4 5 5S) SDS FUROSEMIDA, Sedizan : 1 ampul= 20mg / 2mL Dosis :bolus iv 10-40 mg dlm3-5 menit Iinfussion 2- 10 me/jam ‘Atau 0,01 - 0,1 mL/kgB8/jaminfussion drip 0,5~ 1 mg per 6 - 24 jamoral, IM, IV (dalarn 20 mnt: ec 0,05 mg/KgB8/rin IV) Oplosan : NaCl0.9% Pethatian : Obat akan rusak bila cairan terkena largsung dengan cahaya, maka dibuturkan spuit & conecting/perfusor yang gelap/hitam + Bila tekanan darahsystole <90 mmig, pertimbangkan lagi untuk meneruskan pemberian lasix tersebut. ~ Jangan dicampur dengan larutan asam yang merriliki pH 5.Sseperti Dobutamine dan Dopamine, akan mengendap. + Kecepatan pemberian 4 mg/mnt pada dewasadan0.5 me/mnt pada anakanak Pengenceran : 100 mg lasic (5 arpui) dioplos dergan NaCl 440 mi menjadi pergenceran 2 mg/m 100 mg lasix (5 ampul dioplos dergan NaC!90 mL menjaci pergenceran 1 me/mi. Dosis + bila dibutuhkan drip dalam 24 jam maka litertukan 100 mg lasix (5 arnpul lasix) kecepatan laju ‘syringe pump 2ml/jam (4 me/jam) dapat dinaikkan ssampai dengan 4mi/am (8 me/jam). Bilatarget urine belum keluar maka dapat diberiextrabolus40 me/iv Alt : Syringe pump, spuit SOmi. ita, ‘connecting/perfusor hitamn NVline — :divena certral (CVC), atau pembuluh darah perifer dergan verwlon no. 20, Bila pembuluh darah perifer, tidak boleh dicabarg Incikasi ALO, urine kurarg daritarget pada kasus Jarturg, post operasi, cil Efek samping : Tuli, Tints = bilapemberian > 4rre/mnt terutama pada dosis tngat dan ketika dikombinasi dengan ‘bat ototoxic lain atau paca gangguan ginjal bert. HEPARIN Sediaan :1 vial = 5 mi = 5000 iu/mi. aPIT | Rebolus | Hold | Rate change | Repeat unit/agB_| infussion | (urit/Ag88/jam) | aPTT 8 Severe | Caution | Avoid [Avoid best, | 6oimae f= pr hour renal 5000) Insufisiency_ 30-49 | 30(max | - povt hr Increase | Neutra | Avoid Yes Yes 2500) bleeding 50-70 [No bolus _|~ nochange | 6he sk 71-95 | No bolus | - ‘by 2 hr Thrombo- | Worst | Better Better | Best 385 | Nobolus | 60min | \by3 hr Stee Dosis bons? taycah [Ye] Generay | Avoid [ye STEMI = max 5000 iu strategy avoid STEME = max 4000 iu (pada pasienyg sch streptokinase) Maintenance 2 - 5 hati drip 12 iw/kgB@/jam: max 1000, iu/jam = Target Heparinisasi = 1,5 - 2,5x Kontrol ee eee a KAUM (K*) Drip heparin: Dosis | 20.000iw/S00 | 20.000 iw/100 ivjam _| miNS rivjam | mL NS mi/jam 7000 | 25 5 950 24 a7 900 2 45 850 21 a2 800 20 4 750 19 37 700 1 35 650 16 32 600 15 3 Tabel Pemilihan Antikoagulan Kondisi UFH ( ind Normal Kalium :35~4.5mEq Sediaan £1 fles = 25 mL = 25 mEq (1 mL = 1 mEq) HIPOKALEMIA (Potassium <3.5 mEq) = 1. pemberian koreksi: €. Tidak boleh lebih dari 20 mEa/jar 'b. Oplosan dergan NS 500 mi. +29 més tidak boleh lebih pekat) . Kebutuanperhari dengan ketentuan perhiarl ‘maximum 40-80 meq (1-1.5 mEq/kg88/hari) 2. Incikasi koreksi a, Mutlak: - Kader K* <2; terapi digitalis: penurunan Kalium pada KAD; kelemahanotot nafas :insufisiensi Koroner otot jarturg: encephalopati . Sedang : Kader K'3-3,51re/L 3.Rumus — :0.3xkg bbx (DesireK+ - Actual K+) Dapat diberikan Ye-nyadulu 4, Perhatian : waspadaintoxikasi Kaliumn (parestesi pada ‘extermitas, lemas danrasa erat pada kaki, aritmi). Jangan dicarrpur dergan larutan Ringer Lactat Magnesium Sulfat dan Dobutamine, karena akan mengendap, 5.Akses di venacertral (VC), bila di periferdengan venvlon ukuran no. 20 6, Pemeriksaan laboratoriumiterutama Kalium secara periodik sesuai program. HIPERKALEMIA [Potassium >4.5 mEq) : 1. pemberian koreksi citujukan kepadaperyebabnya dan terganturg berat ringannya hiperkalemiadan per-bahan pada EKG 2. Bila kadar K’ > 6.5 mEq/L disertai perubahan paca EKG 24 jamakan terjaditoleransi Penggunaan infus set dari PVC akan mengurengi obat yg masuk, krn menempe! pada dinding botol. Pengenceran : 10 mg/TomL NTG diencerkan drg NaCI 0.9% 40 mL menjadi SO rr. > 10.000 meg : 50 = 200 mg/mL. ‘50 mg 10mL GTN encerkan 500 mi. > 100 meg/mi. Dosis: Dosis awal 5 mce/menit meningkat tian 5-10 menit ‘Smeg sampai dengan maximal 200 mcg. Bilatarget ‘tekanan darafsystoletercapai maka dosis depat dlipertahankan/iturunkan pelan-pelan tian Smeg sampai cdengan dosis mairtenance/pemeliharaan (hitungan dosis tidak pakai berat badar). Indikasi : ALO dengan Hipertersi, Hipertersi pada gangguan Jarturg dan par, Efek samping : Hipotensi, Tachicardia sampai dergan PAT, sakit kepala. Dosis mL/jam = meg/min (pengenceran) x 60 Ss pea pes pas] [sl a 1s [-9-| ss {33 | 95 [sf ast] 175 | 105 0 215 fs | fos | 63 vas | a7 | vas | int = [1s [| Pol 6s [| @ [im] 14 Daf as [as Piis| 9 [iss [93 | 195 [17 a0 28 Pa) [as Pan 7260 [95 [200 [120 Dass Oma/mL im Som Ta] mW] Dos] my} | Dos | mij | Oos | ml ] Bos | mi in| am | is | am | ic | am | ic | am | ic | am. Ss fas [iss [as [ass | r2s| 75 | 16s [29s a is as [ss | 55 | 95 | aes | 15] aos | 175 | 5, m6 foo] i fila [ral a2 [rol se 27S [6s | 19s [ios | ais [vas | ass | 19s | 85 a9 fay a pols pal as [iol 7 3s Tas Ps [mas Ps] sys | 1s | a6 | 195 | 8s a0|12 [99 [28 [120 | 35 1160 | 48 | 200-160. Doss SOmg/mi dim 500m ee ] iy [Boe] mij | Dos | mij | Dos | may | Dos] my NOREPINEPHRINE (RAIVAS / VASCON) Sediaan $1 arpul=4 mg / Ami = 4000 meg / 4 mL Pengenceran : 4 me/4 mL menjadi SO mL. Shg menjadi pergenceran 4000 meg : SO mL = 80 meg/ml Dosis: Mulai0,05 mcg/kgB8/mnt, meningkat tian 5-10 ‘menit 0,05 mcg sampal dosis maximal 1 meg. Bila target ‘tekanan darahsistole tercapai maka dosis pt dlipertahankarY/citurunkanpelar-pelan tia 0,05 meg samp cdergan dosis mairtenance atau dosis pemaliharaan, Incikasi : Hipotensi sistolik < 70 mmiig dansyok sepsis. Perhatian: Monitor kemungkinanterjaditanda extravasasi vvena/plebhitis. Kepekaan oplosan tidak boleh lebih deri 2 ‘ampul atau 160 meg/ml osis Kecepatan aliran (mcaykgB8 (mvjam) Tran) 00s | 15 [17] 19 [21 [23 | 3a [26 ‘al 30 | 34 [38 [ar] 45 | 49 | 53 iS | 45] 51 | 56 [62] 68 | 73 | 105 02 | 60 | 68 | 75 [83 | 90 | 98 | 105 025 | 75 | a4 | 94 [103] 113 | 122 | 131 03 | 90 [101] 113 | 124 | 135 | 146 | 158 035 | 105| 11.8 | 131 [144 | 158 [171 | 14 04 [120/135] 150 [165 | 180 | 195 | 21 04s | 135| 152 | 169 | 186 | 203 | 219 | 236 os [150 | 169] 188 | 205 | 25 | 244 | 53 0.55 | 16.5] 186 | 206 [227 | 248 | 268 | 289) oss [195] 21.9] 244 | 268 | 203 | 5.7 | BAT o7 [21.0 [236 | 253 | 289 | 315 | 41 | me ‘os [240 | 270 | 300 | 330 | 360 | 390 | a2 as | 255] a7 | 319 [351 | 383 | aia | a6 09 [270 4 | 338 | 37.1 | 405 | 439 | 473 095 | a5 | 321 | 356 [392] ze | 463 | 499 1 300 | 338 | 375 | 413 | 450 | 488 | 525 NICARDIPINE HCL (PERDIPINE) Hiperters pada permbedahan Hipertersi Emergensi —- 4 os Sedizan Perdipine® = 2me/2:mlurtuk penggunaan bolus (larutkandalam larutan 10cc) = 10 rrg/10 mi urtuk perggunaan dengan syringe purrp atau infus drip Pelarutar/cairan infus yang dapat digunakan: NaC10.9%, Dextrose 5%, PotacolR, Glucose 5%, Ringer Asetat, KN Solution 1A, KN Solution 18 Pelarut/cairan infus yang TIDAK dapat digunakan: Bikarborias Natrikus & Ringer Laktat Dosis Percipine®: = 3-15me/jam (0.5-1.Sampu Perdpine® 10 me/jam. dalam larttan infus 50-100) = Dosis maksimal 1Sme/jamatau 1.5 ampul Perdipine® 10, mefjam = Dosis ciberikan dengan caratitrasi sesuai petunjuk tabel. 6lug/kg BB/mnt) 10 Dosis : hipertensi emergency :0.5-6u/kg BB/mnt Hipertensi pada pembedahan : 2-10y/kg B8/mnt Volume cairan pelarut: (mi) larutan infus yang akan. dligunaken (100, 250, 500 mi) ‘Atau SO mi untuk Syringe Purp Sediaan Perdipine yang dipakai : 2 mg atau 10 mg ‘A. Untukpemberian dengan bolus iv + 10-30j/kg BB/kali pernberian + Pemakaian Perdipine® harts selalu disertai dengan monitor tekanan darah dan jantung ‘* Dosis awal hendakleh selalu dimuai dari dosis terendahy dosis dapat dinaikkan secara_bertahao untuk mendapatkan efek penurunan tekanan darah_yarg NCD 100 Ex: pasien sesak nafas Pas = 80 dng NRBM 8 Ipm, maka truly O> nya adalah 21, shg pasien ini sebenarrya mrp gagal nates tipe 2. PAO: ‘AaD0>: 13xFio, - pCOvO8 PAO; + 150 (persen oksigen yang dibututkan) 760 MET's Formula 35m xygend/kg®B/min ~ 1 MET Sleep ~ 0,9 MET Walk < 2mmph = <0,89rr/ak~ 2MET Walk 2Srrph = 1,11 m/atk ~ 3MET Walk mph = 1,78 nytk = 5 MET Peak Healthy person 10 22,9 MET ~ 35~ 80 mL axygervigBB/srin Toe a GET $ #2 58 1, Pay 1 SE sf ieuG 5 wid $3 pf by ree gf Gt 7: Vin & ii iq ik aig 23 a” 9 i PRES i ew é wee i ey vamupenen | netoes ECG Locatnaton of myeeardal intron vemenet Ineiy Haein nes Carn TE doses Stender Oreo VE Miatnormal EOS liner” 5 aan nde Gree Be add lca" lan nls Qe BG aT monn deen one ala te ss sr vmal PR = 0.12-0.20 sc (35 small bos Hiei” Garten dee Gowland tne andar * Normal QRS 5 0.10 sec (2.5 small boxes) fei Fal nee amici * imal QT half the ReR tv, fea rate nocmal feel "~"Saanion derGnne LHL AE VLA {ha fry TN wae VL wh Sin VET Kiteia St elevasi tac feminine Tce core SSS Ne aay ely casing weet Sted” _ ia SF xen ssion ite ret rear ice ViR eib ray urd n conuton oh nr accn, Thera ow bepreercGeery bows firm [New ST elevation atthe J point in 2 contiguous leads with the folowing ut points +201 Vin alleads excopt leads Vn men and women, + nleads VeVs, 202 mVin men 240 years and 20.25 mV in men < 40 years; + Infeaos Ves, 20.15 mV‘in women Kriteria non ST elevasi "New horizontal or down-soping SST segment depression = 0.05 mV in 2 contiguous leads, ‘Tinversion 2 0.1 mV in 2 contiguous leads with prominent R wave or RIS ralio> 1 ‘Sugsemental Leads - high suspen ef etuex arr occtuson Pesterrleads (recall spe, Vs) ‘Cutint> 0.05 iv ST-leaten nad Vig (Cuteint > 0,1 m(spectty nase) nen <0 90, ‘ST-depressinin¥, may be suggestive infra itarcen postr itaeton) Espa wh trina T wave pose (STsleaten equate) bower isis respect Inti itartion ad suspected igh errr inflaton Precordaleass VR and VR sha be recorded ‘STalevaton 2005 ni20,1 nVinmen< 300) kriteria Prior Myocard Infarction ‘Any Qwave » 0.02 sec or QS complex Inleads Vz, Qwave = 0.03 sec and? 0.1 mv deep (FOS complex in leads | I, aVL, AVF (oF V_-Vq mn any 2leade ofa contiguous ead grouping (1 aVL V-Ve Il VF), Ruwave = 0.04 seein Vi-V, and RIS2 1 witha concordant positive T wave SCORE AND CRITERIA IN CARDIOLOGY Perioperative Cardiology Risk Assesment, Cardiac Risk Index in Noncardiac surgery (Goldmanet.al.) GCRI story ‘Age >T0 yar (5 pols) Myocaalinfretion within 6 month 10 ports crdiae sam ‘Sign of CHF: vetcular gallop oF IVD (11 owt) ‘Sigiticant cone stenosis (3 points) Bectocatiograr ‘Athi ther than sinus or premature sal ‘comactons pois) ‘Sermore PYC's pr mine (7 poits) ‘ceneral Mees Condon P02 50 maa: Greatrine>3 mail; elevated SOOT, conic live ease; beatdden (3 pole) ‘peation Emergeny (4 pins) Intraperitoneal, invatoraci of aortic ponte ‘Aka: Lee's Revised Cardiac Risk Index criteria A. High Risk Surgery :1 Point A. Congestive Heart Failure: 1 Point ‘A. Cerebrovascular Disease: 1 Point ‘A. Diabetes Melts: 1 Point ‘A.Serum Creatinine >2mg/dl: 1 Point interpretation ‘A. Scoring 1. Points 0: Class Very Low (0.4% complications) 2. Points 1: Class Low (0.9% complications) 3, Points 2: Class ll Moderate (6.6% complications) 4, Points 3: Class IV High (>11% complications) Spans cast Te komplitas 6-12 points Cas 7% kompllk 43-25 points Cas It 4% komplkas 26:53 points Gasiv 7s komplica A. Scoring for Orthopedic Surgery 3. Points 2: A. Scoringfor Abdominal Surgery lass Il Moderate (2.39% complications) 's 3: Class IV High (4% complications) 1. Points 0: Class I Very Low (<1 % complications) ‘TIMI RISK SCORE for STEMI 2. Points 1: Class Il Low (<1 % complications) 3-Points 2: Cass Moderate (2.3% complications) a = | a ee 4, Points 3: Class IV High (8,1 % complications) a * o os burro 1 ‘ 2 mr es A. Complications predicted by above scoring “SBP < 100 mm 3 8 4 men : fod Epa : : a 1. Myocardial Infarction Weight <67kgG50I) 1 a 6 2. Pulmonary Embotismm PRESENTATION z 2 +3. Ventricular Fibrillation te me cd 6 4, Cardiac Arrest Grom papamere” | MENUS Tere 5. Complete Heart Block ro mene tea . savor nt HN ESC Cardiac Risk Assessment TIMI Rik Scare for UAINSTEMM? lk Se» Taal Pos 0-7) acer ene eres 1 ADRK i Krown eranary sterons2 OR | ASA se in prior days 5 Recon ere angina (24H) | lated eardac bomarers ‘ST deviaton 205 mm t nan A 2 5-2 ee | GEADS Sear = wan of nlik Sere Aled wake we eee ‘Table 5 Mortality in hospital and at 6 months in tow at 6 mont 5 Later Poti scenint Intermediate, andhihrisk in registry populations Cengertve Hear Faure vege ‘according tothe GRACE risk: ypenerion i ee Risk category GRACE sk n-hospltal deaths (2) geo sy 7 ys (teres) score ‘abet mali i os Low =108 a S Imermediate 19-4013 Friese 1 i oe hs os ee ae a or sao Rk category GRACE sk Post discharge to 6 months (terttes) score eaths (3) Low a 38 Canadian Cardiovascular Society grading of angina pectoris [Grade Daeription 5 or sweating) Kilip class L Klip class Killip Killip 1250 «22% 27 Morality rate was ound to be patients; 38%). 6% {curent 30 day mortally 2.8) 96/250 38% G2 Morality rate was found to be patients; 44%). 17% (cuent 30 day mortally 88) 26/250 10% (6.6- Morality rate was found to be patients; 14%). 38% (cument 30 day mortally 14.4) 471250 19% (14 Mortality rate was found to be 67%, class IV: pationts; 24%). “The New York Heart Assocation (NYHA) Functional Cassiiaion ‘Cardiac disease, but no symptoms and no limitation in ‘otcinary physical activity, e.. shortness of breath when waking, climbing stairs et. TT | tile symptoms (mild shonness of reath andlor angina) and Slight imitation during ordinary acti THT | Marked limitation inactivity due to symptoms, even during less thar-ordinary activity, e.g, waking shor distances (20- +100 m) Comfortable only atest TV _| ‘Severe initatons. Experiences sympioms even while atvest. Mostly bedbound patients, Grade | oranay physical att dons rot cause angha such os waking ‘anécimng ars, Argos wih srenuovscrrepd or rolanges ‘ierionat wok or eaeton Grade! | sig iiaton of eroary seit, Waking or cimbing as ‘any, waking whl waling Osa cling ater meal, 20 ‘2, on wna order ercenal sess oly dring the ew hours afer enskeing Wabirg more tanto lcs on ve and ciming more thn one fig cfc sta a oma pace andin noel eontions (Grace | Marks tation rina physi acy. Waking oe oF 40 books on teal ad iting oe fight stars inrorma rion and at arma pac8 ‘Grade | inabity to cary on any physi activ witout econ anghalsycrme maybe presen are Killipcrteria Class 1 Tndludes individuals with no clinical signs of heart failure ‘Classil__| includes individuals with rales or crackles In the lungs, an S), and elevated jugular venous pressure Class iit | describes individuals with frank acute pulmonary edema ClassIV___| describes individuals in cardiogenic shock or hypotension (measured as systolic blood pressure lower than 90 mmtig), and evidence of peripheral vasoconstriction (ligula, cyanosi CARDIAC CYCLES: Infark Related Artery at hg — ots 7a ae e a Vena ava ee = ti ees iota eres pe ere fight Coronary — aes osces ol a a cs ae ne nen ee ‘ight Marginal Figure A : Anterior Aspect of Coronary Circulation Epigastric pain withradiation to neck > right coronary diss. Epigastric pain withno radiation > left circumflex disease Chest pain radiating down the right arm > Inferior infarct ea ay ea Obl Vin of Aun) unt Brac of Lc Aiea ‘Natal ey Ota tt Ht S Conary Ss inthe ff i ra — Y ena Candiac Vein ie dean RCA 4 ide Ci Ven Figure B : Posterior Aspect of Coronary Circulation (Cerda ees TA I Tee XK Coin kine Give Chewdar soweyne AST Agprate wanamnate LDH Laue seehopease Figure 2. Groh of be pernc of crduc miter ibe ode oe ch Pgh dar 1 mcs aaa eb ara sopra ene gra ern pemacn tom WAR ca (999) Ce INC7 Blood pressure classification Ceegery «SP tig) BP rth Normal 70 AND Fretnpenanion 1io.1i9 08 Suge ypetenion "45-109 OR Sige Hyperion" Siu ico Fog 8 xn yt AV aL Yr 8p ED Box 1.16 Suggested inital energies for DC shock for elective cardioversion ‘ Sesmined monomorphic VT 200) biphasic Synchronized 1 Atal fbrilaton 50-200) Sjochronized Atal fuer 50) Sjochronzed © Other VTS 50) Sjnchronted the intl shocks unsucessu increase the energy (50.100, 200,360) and repeat. + sul unsuccessful consider changing pale postion and ty 200] ann ECG Hemiblok Peon Infor Mma, eA Ateroseptal V4, wo Aateroapical I uo (sal) ‘Antelateral, (Vy La, cy Posterior lL Rave, not wave) RA “PabologleQ waves in al of an exensive anterior ME" usualy associated wih 2 proximal et coronary arty occksion. (CH, ht cleuartex coronary arariondescendieg covocary ary ALA, ight coroeary arty. Ptneccr Senne! Burn inent rt. Sgarbosa utk MC apabila dterrukan pada cukup 1 lead saja ECG BundleBranch Block ‘iran Banc Book or vr + + sere ORS TASH inv, Patorears) "Prominent Sn att Sih ur vt < vr Vv ‘wees FS fag; obec nV ‘beer and pomnett ‘envy ECGVentrikular Hipertrofi cngeteertin “remodyaamic in or acute heart failure No Ne STS ratio < — 0.25 No Serial ECGs etal epee “neverve2.0mme Bedside echocardiogram 7 : pation Primary PCL Coronary or fibrinolyties angiography Diognosis ond wioge algorithm for pationts with sus ‘ond 1BBB. i : ‘Table 1.1 Lock foran undoing cause fo pulmonary edema ‘endpaper Manuea rtooraeaee ues «pect pean septate Ane rei + Let anal opm ii veined chemi Geacicgresre 5 reps ‘merce dese Cedoayeputy + Uncorwalehyporandon 1 Parad consncson 1 Fadovetoad 1 Eheupun ms sama, yom, Paget revere AV) fate Beer) + Rovere deme 1 Pumansnyvensue + Loe Ratu (og. VED) remire 1 Vere este dae Neogene 1 invamalbororhars 1 Geet ome Ponca pate alone increased pimomy 10min 1 Dyspnea on ray exarion + Decrease in al apuy by 1 Henan | oeced Th ie pes HF (9) Th ploy Sher ree Fane Sy [hn Co atl LAA. Cope Ese 3 ‘was Ae ON ‘sweitopuon oy in sis ayo onting oso ens on some yn canppiaeaieg alla i | 2 e < : i i L s roumeg vo euion, revoe vet em 0 piace ume odedopey nya lpm _Feanpa lewoung aentojprmwen wai enBopie eemOya MH eA YH Nea SFeORY TORE Box 444 Duke criteria Definite endocardiis Direct evitence of endocaris Fam his ‘lope er merebilepeal nang fom surgkal or autopsy specimens. Cina dlagnesisrequres 2 aor erteria major Sand} minge enter, oF 3 minor eters Fondings tha ll shere of deft endcirdts but are not rected Reuires 1 major and 1 2 minor cloves) entess or) minor cote Firm alternate diagnos or sustaned resoliton ef cna fates with <+ dys lf aroote tery Posts endecardice Rejected dagnosts Major eriteria « Postave blcod culture + ype microorgess for I frm two separate Hood cules + Serstenty postive bleed ature + Single pastne blood culture or ter for © fever + Enidence of endocardal rvobement 1 Poutive aenocarsegram Decking ntrcardin mass (vgezation) — Aas —Now partal dchicerce of prosthetic vale «Fler ve regurgtason Minor ertera «Precept enducn or V cru use 3 Foerosee = {Vat phenome atari enol. septic pukrenary acs esr eran recat and cng havea Poe « frerelepal phenomena: gomerlnechrts, ile’ nodes, Rot spot rcuratid ctor «Poste ood atures not meeting mar entra Duke Criteria for infective Endocarditis Defic xdocrds request rr a3 miro Sia ern jor rte Postwe ood care fowrcict Fabaceae ieee Vesa greene arr embol epic pulrorary wi cre navn eed cd hearths eay er Iemnologe ST ar de Roth ot eum fcr ‘Box 4.1 Diagnostic criteria for rheumatic fever (Jones criteria) idence of group A streptococelpharmgts Eider a poslive throat culture or rep streptococal antigen test. (ran elevated or ring sreptococeal antibody ter (sles ak weeks spar). «© Plus wo major or one major and two minor Jones emer: Majer itor ‘Minor ertena = Fever 2 Artal 5 Prong renal Blsated ESR and CRP : i Active cancer restmert ongoir, withn6 mots, or palliative) Paralysis, press orrecert plaster immobilisation ofthe lower extrertios Recertly bec iddenfor 3 days or moreor malo suney Within 12 weeks requiring general or regional anaesthesia] Tocalisedtencerness alorg the dstrbuton of the deep vernussystem Titireleg swollen, Calf sweling at least 3 cmlarger than asymptomatic sce Piling cedkrra corfined tothe symprorratic le ‘Colateral superficial veins (non-varicose) Previously docurnerted DVT ‘Analterrative diagnosisis atleast astikey as DVT Table 12 Risk actors for DVT rocoapiane ater Conger ‘egited FeV ae Malan dora (5%) ‘Arateombnl decency Anathosholed some Proten Ceecency Meleroterave dorces ProtemS decency Onl cantrcepie pepe wh Sagar Vimar) [Nepios drome a enl ATHL Honocstna Parga nocumal hemoglobin Wes ais Imerobiy (eg tng jourers) Recent srgey Pvc natt Pregnancy er recent cidbrh Seer ebay Macstancous Hrperiscosty reomes Provo VT or PE Fay etary of OPE Dut ikely FET Tablo:1. Chsifiation of penpheral artery dsease (PAD) Dut unlikely T point or Tess Fenaine Ratherord Segeineal Gaegoy Ces Toroomee ° Aayrerenst li Mid pan en vain 1 . Mid daudasos Ws Medarte osorsepan I Moderate Some fuerte — cme) es =. Wichome estou W.Vierion or rgene Il s mos Ieegen rea A Reena one Tene pera Fe we “Samy Coma CHADS, -> CHA,DS,VASc [CHA2DS2-VASe ‘Score: Hypertension | 1 — aes Risk ‘Abnormal Renal & Liver 1-2 ee J lerronvers | funtion fon sircke i oe +] [Prvesenson i Bless 1 ron 2 ‘abil INR 1 > Elderly (>65y0.) 1 pe 8 7b : ‘Drugs or Alcohol 1-2 abs +) seme! 2 wax rewoa = [ewer 7 Tia | ee igh isk ja total 3 ee pao 4 a ESS ee 1 Box 1.1 Causes of acute mitral regurgitation CHADS, -> CHA;DS,VASc « Ifecne endocardeis Prplary masle dysfunction or rupure (pos: M0 1 Rupture of chordae tendrae (eg. nfecuon, mxomatous degeneration, yumi ps eyiatons LE) «Trauma (oleate. papilary morc, or chords) CHADS? | Patients |Auawa] Nase” | "Srsoa\"| “Stone ‘ Prosthetic vale malnction (eg. secondary to ifetion) seo | (nets) | “state | | Sore = sfetaralranema joe coe 4 Colsgen sass Seorder (eg, Mar’) a} fas u cs 1 Caner sve duces (age tnd mediums arts) ta | = | 2 [aso [a2 «| we | ae eae | [weer 7 [8 oe 7] ea 7 | oan =e 2 ATP Ill classification of LDL, eotal, and HDL cholesterol Framingham risk scoring system for men ‘LDL cholesterol, mg/dl (mmollL) fe_____Duhews; _Soeoperty 100256) Opera — 0-1 258-33) Her or oe oot opr 1i0-1891036-410) Ferdi igh = 10-18 4-408) He 1 2101401) ver hth a Toil chlor ma noo a $200 (8.17 Desirable a 20-29 (5.7418 Barre igh ‘ 2240 (420) yh 5 OL chlor ml ret) eo seo Low , HOU) wih Jone ATP Ill criteria for diagnosis of the metabolic syndrome. a Sool ctra ube sted er dps ca Varable Trresheld = ‘Waite ireumerence >a Men 2. ee nee MOE 2B Ferg gcse Sib rid oo ood prea > tides nb si Hiok elena

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