I.

Skenario
Asmawati, 12 year old girl is brought to emergency room (ER) at 03.00 am

by her parent with a severe shortness of breath (SOB). Her mother tells the
attending doctor that Asmawati has been suffering from common cold for 2 days
and takes cold medicine from over the counter. She also tells the doctor that her
daughter is on her period. Asmawati has been suffering from intermittent SOB
since she was 3 year old usually triggered by physical exercise, but usually can be
controlled by salbutamol pills prescribed by her family doctor. This is first attack
that need hospitalization. On initial survey the doctor sees a pale breathless girl
gasping for air using her respiratory muscles, RR 38, BP 130/90, on auscultation
expiration is prolonged with fine rhonci and distinct expiratory wheezing. With a
diagnose of acute asthma exacerbation the doctor immediately put her on nebulizer
with salbutamol which relieves her malady after 10 minutes. Further anamnesis
reveals that her brother is allergic to dust, mother has allergic rhinitis, and father is
a heavy smoker.
II.

Klarifikasi Istilah
1. SOB (Shortness of Breath) : Dyspnea. Pernapasan yang sukar atau sesak
2. Severe : Parah
3. Common cold : Infeksi virus yang menyebabkan peradangan membran
mucosa di hidung dan tenggorokan, biasanya menyebabkan bersin dan sakit
tenggorokan
4. Intermittent SOB : Dyspnea yang ditandai oleh periode aktif dan tidak aktif
secara bergantian
5. Salbutamol : Albuterol. Agonis reseptor adrenergic beta II yang digunakan
dalam bentuk basa atau garam sulfat sebagai bronchodilator
6. Pale : Warna dari wajah yang mengindikasikan energi rendah, infeksi, dan
echo pattern

7. Gasping for air : Menarik napas dengan tiba-tiba dengan keadaan mulut
terbuka
8. Respiratory muscle : Otot-otot respirasi
9. Auscultation : Mendengarkan suara di dalam tubuh, terutama untuk
memastikan kondisi organ dalam thoraks atau abdomen
10.Expiration : Exhalation. Pengeluaran uap yang berair atau uap lain yang
dihembuskan keluar
11.Fine ronchi : Bunyi singkat, tidak kontinyu, tidak melodis, banyak terdengar
selama inspirasi
12.Expiratory wheezing : Bunyi bersiul dengan nada tinggi yang diperkirakan
merupakan akibat dari gas yang melalui jalur pernapasan yang mengecil pada
saat mengeluarkan napas
13.Acute asthma exacerbation : Serangan dyspnea proksimal berulang
(kambuhan), disertai kontraksi spasmodik bronchi yang menunjukkan gejala
yang berat dan perjalanan yang singkat dan berulang
14.Nebulizer : Suatu alat untuk menghantarkan obat dalam bentuk gas ke paruparu
15.Allergic rhinitis : Setiap reaksi alergi mucosa hidung, terjadi secara
perenial/musiman
Kesimpulan sementara : Asmawati mengidap asma akut karena faktor keturunan
yang timbul karena pemicu (debu, dll) yang masuk ke saluran pernapasan yang
menyebabkan hipersensitivitas, aktivitas fisik, dan ayahnya yang perokok berat
- Trigger : menstruasi, aktivitas yang berlebihan, cold
Triggers tersebut bereaksi pada saluran pernapasan
III.

Identifikasi Masalah
1. Asmawati, 12 year old girl is brought to emergency room (ER) at 03.00 am
by her parent with a severe shortness of breath (SOB)

2. Her mother tells the attending doctor that Asmawati has been suffering from
common cold for 2 days and takes cold medicine from over the counter
3. She also tells the doctor that her daughter is on her period.
4. Asmawati has been suffering from intermittent SOB since she was 3 year
old usually triggered by physical exercise, but usually can be controlled by
salbutamol pills prescribed by her family doctor
5. On initial survey the doctor sees a pale breathless girl gasping for air using
her respiratory muscles, RR 38, BP 130/90, on auscultation expiration is
prolonged with fine rhonci and distinct expiratory wheezing.
6. With a diagnose of acute asthma exacerbation the doctor immediately put
her on nebulizer with salbutamol which relieves her malady after 10
minutes.
7. Further anamnesis reveals that her brother is allergic to dust, mother has
allergic rhinitis, and father is a heavy smoker.
IV. Analisis Masalah
1. Asmawati, 12 year old girl is brought to emergency room (ER) at 03.00 am
by her parent with a severe shortness of breath (SOB) 1,2
a. Apa saja faktor penyebab SOB?
b. Apakah saja tingkatan-tingkatan pada SOB?
c. Bagaimana mekanisme SOB pada kasus?
d. Hubungan kondisi umur dan jenis kelamin terhadap penyakit?
e. Hubungan udara pada pukul 03.00 dengan kasus?
2. Her mother tells the attending doctor that Asmawati has been suffering from
common cold for 2 days and takes cold medicine from over the counter 3,4
a. Apa hubungan antara pilek dengan kasus?
b. Apakah hubungan antara obat pilek bebas dengan kasus?
3. She also tells the doctor that her daughter is on her period. 3,4
a. Apakah hubungan antara menstruasi dengan kasus?
4. Asmawati has been suffering from intermittent SOB since she was 3 year
old usually triggered by physical exercise, but usually can be controlled by
salbutamol pills prescribed by her family doctor 5,6
a. Apakah penyebab intermittent SOB?
b. Kenapa kasus muncul pertama pada usia 3 tahun?
c. Bagaimana kegiatan fisik menjadi pemicu pada kasus?

d. Bagaimana cara kerja salbutamol dalam meredakan penyakit pada

kasus?
5. On initial survey the doctor sees a pale breathless girl gasping for air using
her respiratory muscles, RR 38, BP 130/90, on auscultation expiration is
prolonged with fine rhonci and distinct expiratory wheezing. 7,8
a. Bagaimana mekanisme bernapas normal?
b. Bagaimana patofisiologi pucat pada kasus?
c. Bagaimana patofisiologi sesak napas pada kasus?
d. Bagaimana anatomi dan fisiologi otot-otot pernapasan?
e. Mengapa RR dan BP tinggi pada kasus?
f. Mengapa bisa timbul fine rhonci dan distinct expiratory wheezing?
6. With a diagnose of acute asthma exacerbation the doctor immediately put
her on nebulizer with salbutamol which relieves her malady after 10
minutes. 9,10
a. Bagaimana patofisiologi acute asthma exacerbation?
b. Bagaimana cara kerja nebulizer?
c. Mengapa digunakan nebulizer pada kasus?
d. Mengapa penggunaan salbutamol dengan nebulizer dapat sembuh
setelah 10 menit?
7. Further anamnesis reveals that her brother is allergic to dust, mother has
allergic rhinitis, and father is a heavy smoker.
a. Bagaimana hubungan antara kasus dengan alergi debu yang diderita
saudaranya? 3,4
b. Bagaimana hubungan antara kasus dengan allergic rhinitis yang
diderita ibu? 5,6
c. Bagaimana hubungan antara kasus dengan ayahnya yang perokok
berat? 9,10
V.

Kerangka Konsep
Aktivitas
fisik

SOB

Common

Reaksi
hipersensitivi
tas

Acute
Asthma
Exacerbatio

Pale

Kenaikan
RR

VI.

Learning Issue

VI.1. Anatomi
- Saluran pernapasan 1,2
- Otot-otot pernapasan 3,4
VI.2 Histofisiologi sistem respirasi 5,6
VI.3. Imunitas Reaksi alergi 7,8
VI.4. Acute Asthma Exacerbation 9,10
Note :
1 Taufan

6 Archita

2 Fiani

7 Suci

3 Arma

8 Poppy

4 Brillia

9 Disa

5 Mareta

10 Dena

((Pembagiannya dianggap adil aja ya))