Tabel 5.8 Penyebab Utama Penurunan SJO2 dan Terapinya Penyebab PaO2 CBF Kondisi Kimia !

ipo"semia #nemia !ipotensi !iper$entilasi !ipertensi intra%ranial !ipertermia Sei&ure Terapi Kore"si !ipo"semia Trans'usi dara( )n'us %airan* inotropi" dan $asopresor Kore"si PaCO2 Mannitol* 'urosemid* barbiturate* propo'ol +in,in"an Barbiturat* propo'ol

CM O2

7ui%" #ssessment o' t(e patient

#ir8ay mana,ement Tra%(eal )ntubation

Fluid resus%itation Maintain mean BP 0 93 mm!,

)CP Monitori n, -.S /O )CP 0 15 mm!,

/O

PaCO2 at 23 mm!, :o8 dose iso'lurane5des'lurane Supplement 8it( 'entanyl

-.S

PaCO2 at 23 mm!, )so'lurane or des'lurane Fentanyl prn

!ead up PaCO2 25423 mm!, T(iopental bolus5in'usion 'entanyl prn Mannitol 6 'urosemide

#%ute brain in;ury +isturbed (ypot(alami% 'un%tion Massi$e alp(a4adrener,i% dis%(ar,e Pulmonary $aso%onstri%tion )n%reased pulmonary $enous pressure Systemi% $aso%onstri%tion )n%reased aorti% and systemi% arterial presure +e%reased le't $entri%ular %omplian%e )n%reased le't atrial pressure

S(i't o' blood 'rom systemi% to pulmonary %ir%ulation

Transient massi$e )n%rease )n pulmonary %apillary pressure Unbalan%ed starlin, 'or%es Transiently in%reased pulmonary blood Stru%tural pulmonary 'lo8 $as%ular in;ury #ltered pulmonary %apillary permeability Pulmonary4edema 'luid 8it( persistenly (i,( protein %on%entration

#%ute pulmonary edema

Pulmonary (emorr(a, es