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Gangguan Sistem Pernapasan

Saat pelajaran biologi tadi, saya dan teman-teman melakukan presentasi tentang gangguan sistem pernapasan, dan di postingan ini saya ingin menambahkan sedikit dari yang kami presentasikan tadi. Alat-alat pernapasan merupakan organ tubuh yang sangat penting. Jika alat ini terganggu karena penyakit atau kelainan maka proses pernapasan akan terganggu, bahkan dapat menyebabkan kematian. Berikut akan diuraikan beberapa macam gangguan yang umum terjadi pada saluran pernapasan manusia. 1. Influenza (flu), penyakit yang disebabkan oleh virus influenza. Gejala yang ditimbulkan antara lain pilek, hidung tersumbat, bersin-bersin, dan tenggorokan terasa gatal. 2. Asma atau sesak napas, merupakan suatu penyakit penyumbatan saluran pernapasan yang disebabkan alergi terhadap rambut, bulu, debu, atau tekanan psikologis. Asma bersifat menurun. 3. Tuberkulosis (TBC), penyakit paru-paru yang diakibatkan serangan bakteri mycobacterium tuberculosis. Difusi oksigen akan terganggu karena adanya bintil-bintil atau peradangan pada dinding alveolus. Jika bagian paru-paru yang diserang meluas, sel-selnya mati dan paru-paru mengecil. Akibatnya napas penderita terengah-engah. 4. Macam-macam peradangan pada sistem pernapasan manusia: a. Rinitis, radang pada rongga hidung akibat infeksi oleh virus, missal virus influenza. Rinitis juga dapat terjadi karena reaksi alergi terhadap perubahan cuaca, serbuk sari, dan debu. Produksi lendir meningkat. b. Faringitis, radang pada faring akibat infeksi oleh bakteri Streptococcus. Tenggorokan sakit dan tampak berwarna merah. Penderita hendaknya istirahat dan diberi antibiotik. c. Laringitis, radng pada laring. Penderita serak atau kehilangan suara. Penyebabnya antara lain karena infeksi, terlalu banyak merokok, minum alkohol, dan terlalu banyak serak. d. Bronkitis, radang pada cabang tenggorokan akibat infeksi. Penderita mengalami demam dan banyak menghasilkan lendir yang menyumbat batang tenggorokan. e. Sinusitis, radang pada sinus. Sinus letaknya di daerah pipi kanan dan kiri batang hidung. Biasanya di dalam sinus terkumpul nanah yang harus dibuang melalui operasi. 5. Asfikasi, adalah gangguan pernapasan pada waktu pengangkutan dan penggunaan oksigen yang disebabkan oleh: tenggelam (akibat alveolus terisi air), pneumonia (akibatnya alveolus terisi cairan lendir dan cairan limfa), keracunan CO dan HCN, atau gangguan sitem sitokrom (enzim pernapasan). 6. Asidosis, adalah kenaikan adalah kenaikan kadar asam karbonat dan asam bikarbonat dalam darah, sehingga pernapasan terganggu. 7. Difteri, adalah penyumbatanpada rongga faring atau laring oloeh lendir yang dihasilkan kuman difteri. 8. Emfisema, adalah penyakit pembengkakan karena pembuluh darahnya kemasukan udara.

9. Pneumonia, adalah penyakit infeksi yang disebabkan oleh virus atau bakteri pada alveolus yang menyebabkan terjadinya radang paru-paru. 10. Wajah adenoid (kesan wajah bodoh), disebabkan adanya penyempitan saluran napas karena pembengkakan kelenjar limfa atau polip, pembengkakan di tekak atau amandel. 11. Kanker paru-paru, mempengaruhi pertukaran gas di paru-paru. Kanker paru-paru dapat menjalar ke seluruh tubuh. Kanker paru-paru sangat berhubungan dengan aktivitas yang sering merokok. Perokok pasif juga dapat menderita kanker paru-paru. Penyebab lainnya yang dapat menimbulkan kanker paru-paru adalah penderita menghirup debu asbes, radiasi ionasi, produk petroleum, dan kromium. Pengaruh Rokok Terhadap Kesehatan A. Kandungan Asap Rokok Asap rokok yang dihirup seorang perokok mengandung komponen gas dan partikel.komponen gas terdiri dari karbon monoksida, karbon dioksida, hydrogen sianida, amoniak, oksida dari nitrogen, dan senyawa hidrokarbon. Adapun komponen partikel terdiri dari tar, nikotin, benzopiren, fenol, dan kadmium. Asap yang dihembuskan para perokok dapat di bagi atas asap utama dan asap samping. Asap utama merupakan asap tembakau yang dihirup langsung oleh perokok, sedangkan asap samping merupakan asap tembakau yang disebarkan ke udara bebas, yang akan dihirup oleh orang lain atau perokok pasif. Terdapat 4000 jenis bahan kimia dalam rokok, dan 40 jenis di antaranya bersifat karsinogenik (dapat menyebabkan kanker), dimana bahan racun ini lebih banyak didapatkan pada asap samping. Misalnya karbon monoksida, 5 kali lipat lebih banyak ditemukan pada asap samping daripada asap utama , benzopiren 3 kali, dan ammonia 50 kali. Bahan bahan ini dapat bertahan di ruangan berjam jam lamanya. B. Penyakit Akibat Merokok Merokok dapat menyebabkan perubahan struktur dan fungsi saluran pernapasan dan jaringan paru-paru. Akibat perubahan anatomi saluran pernapasan tersebut, pada perokok akan timbul perubahan fungsi paru-paru. Merokok juga merupakan penyebab timbulnya penyakit obstruksi paru menahun, termasuk emfisema (pembengkakan paru-paru), bronkitis kronis. Dan asma. Merokok menjadi pemicu utama penyebab penyakit kanker paru-paru. Hubungan tersebut telah diteliti dan akhirnya secara tegas memang bahwa rokok sebagai penyebab utama kanker paru-paru. Dibandingkan dengan bukan seorang perokok, kemungkinan timbulnya kenker paru-paru pada perokok mencapai 10-30 kali lipat. Gangguan yang ditimbulkan akibat merokok antara lain sebagai berikut. 1. Jantung Koroner Merokok menjadi faktor utama penyebab penyakit pembuluh darah jantung koroner. Merokok juga berakibat buruk bagi pembuluh darah otak dan pembuluh darah perifer. 2. Stroke

Penyumbatan pembuluh darah otak yang bersifat mendadak sehingga pecah banyak dikaitkan dengan kegiatan merokok. Risiko stroke dan risiko kematian lebih tinggi pada perokok dibandingkan bukan perokok 3. Memudahkan Terjangkit AIDS Dalam penelitian yang banyak dilakukan di amerika serikat dan inggris, didapatkan kebiasaan merokok memperbesar kemungkinan timbulnya AIDS pada pengidap HIV. Pada kelompok perokok, AIDS timbul rata-rata dalam 8,17 bulan, sedangkan pada kelompok bukan perokok timbul setelah 14,5 bulan. Ternyata merokok menurunkan kekebalan tubuh sehingga lebih mudah terkena AIDS. 4. Gangguan Fisiologis Nikotin menyebabkan ketagihan. Selain itu, nikotin juga merangsang pelepasan andrenalin, meningkatan frekuensi jantung, tekanan darah, dan kebutuhan oksigen jantung. Nikotin juga mengganggu kerja saraf, otak, dan banyak bagian tubuh lainnya. Nikotin juga dapat mengaktifkan trombositsehingga terjadi adhesi (penempelan) trombosit ke dalam pembuluh darah. Karbon monoksida melarutkan hemoglobin, sehingga persediaan opksigen untuk jaringan tubuh menurun. CO menggantikan tempat oksigen di hemoglobin, mengganggu pelepasan oksigen, dan mempercepat aterosklerosis (pengapuran/penebalan dinding pembuluh darah). CO membuat darah mengental dan mudah menggumpal ( Sumber : poetoegauliptek ).

Kegagalan Sistem Pernafasan (Respiratory Failure)

Gambar menunjukkan topeng oksigen jenis Venturi yang amat persis. gambar dari: http://aftablifecare.com

Kegagalan sistem pernafasan terjadi apabila pertukaran gas oleh paru paru menjadi tidak cukup, menyebabkan hypoxia. Kegagalan pernafasan didefinisikan oleh PaO2 < 60 mmHg. Kegagalan sistem pernafasan dibahagikan kepada dua pecahan besar iaitu Jenis 1 dan Jenis 2, mengikut paras Karbon dioksida dalam darah PaCO2. Kegagalan Sistem Pernafasan Jenis 1 Didefinisikan oleh kurangnya paras oksigen dalam darah (PaO2 < 60 mmHg). Dalam kegagalan pernafasan Jenis 1, paras CO2 boleh jadi normal, ataupun sedikit rendah dari biasa. Biasanya, masalah kegagalan pernafasan Jenis 1 adalah disebabkan oleh ketidakseimbangan antara pernafasan dan aliran darah (V/Q mismatch). Antara yang menyebabkan masalah kegagalan sistem pernafasan Jenis 1 ialah:

Radang paru paru Paru paru berair (Pulmonary oedema) PE Asma/semput Emphysema (lubang dalam paru paru) Fibrosing alveolitis ARDS (Acute Respiratory Distress Syndrome)

Kegagalan Sistem Pernafasan Jenis 2 Didefinisikan oleh kurangnya paras oksigen dalam darah (PaO2 < 60mmHg) dengan disertai oleh peningkatan paras karbon dioksida (PaCO2 > 45mmHg). Masalah ini adalah berpunca daripada kurangnya kerja bernafas. Antara penyebab masalah ini termasuk:

Penyakit paru paru: o Asma o Masalah rokok COPD (Chronic Obstructive Pulmonary Disease) o Radang paru paru (pneumonia) o Pulmonary fibrosis o Masalah terjaga dari tidur akibat salur pernafasan tersumbat (sleep apnoea)

Kurangnya dorongan untuk bernafas: o Ubat penenang dapat menyebabkan pernafasan menjadi terganggu sekiranya diambil secara berlebihan o Tumor Saraf tunjang (CNS) Penyakit Otot dan saraf o Kerosakan saraf servikal (menjejaskan pernafasan) o Lumpuh saraf diafragma (diaphragmatic paralysis) o poliomyelitis (penyakit yang menyebabkan lumpuh, dan kaki bengkok dalam kanak kanak) o myesthenia gravis (penyakit yang menyebabkan rasa amat penat terutamanya bahagian mata dan muka) o sindrom Guillain Barre (masalah saraf sengal pada tangan dan kaki dan diakhiri dengan masalah pernafasan) Masalah dada: o tulang rusuk patah (flail chest) o bongkok atau scoliosis (kyphoscoliosis)

Gambar menunjukkan ubat penenang (sedative) Gambar dari: Wikipedia

Tanda dan simptom klinikal:

Simptom paras oksigen rendah (hypoxia): o Sesak nafas o Konfius o Muka biru Simptom paras Karbon dioksida tinggi (hypercapnia): o Salur darah mengembang di periferi (periphery vasodilation) o Denyutan darah yang jelas pada arteri (bounding pulse) o Tangan terketar o Degupan jantung laju o Rasa mengantuk

Sakit kepala

Apakah rawatan terbaik untuk pesakit pesakit ini? Rawatan terhadap pesakit Jenis 1

Berikan bantuan oksigen 40-60% (FiO2) dengan topeng oksigen Sekiranya masih teruk (pesakit menunjukkan paras oksigen dibawah PaO2<60mmHg), pesakit akan diberikan bantuan mesin pernafasan (ventilatory machine)

Rawatan terhadap pesakit Jenis 2


Punca penyakit dikenalpasti dan dirawat Disebabkan pesakit Jenis 2 mempunyai paras Karbon dioksida yang tinggi (PaCO2>45mmHg), maka oksigen harus diberikan dengan berhati hati kerana Oksigen yang tinggi akan merencatkan pernafasan. Walaubagaimanapun, rawatan oksigen tidak dapat diabaikan. Maka Oksigen paras rendah (24% FiO2) harus diberikan untuk permulaan rawatan. Selepas 20 minit memberikan rawatan Oksigen 24%, sekiranya pesakit menunjukkan bacaan Karbon dioksida yang sama atau kurang daripada yang asal (petanda baik), maka rawatan oksigen boleh dipertingkatkan dengan memberikan pesakit oksigen 28%. Sekiranya pesakit menunjukkan paras Karbon dioksida yang meningkat, maka ini menunjukkan pesakit mengalami kekurangan kerja pernafasan. Ubat untuk meningkatkan kadar pernafasan harus diberikan supaya kadar pernafasan seminit dapat ditingkatkan dan masalah peningkatan paras Karbon dioksida dapat diselesaikan. Ubat yang amat popular untuk tujuan ini ialah Doxopram. Sekiranya masih gagal, maka bantuan pernafasan mekanikal harus diberikan.

Gambar menunjukkan mesin pernafasan mekanikal Gambar dari: biomedicalism.blogspot.com

Respiratory System: The respiratory system provides the means for gas exchange required in living cells. Examples: Carbon Dioxide and Oxygen. When you inhale you are bringing oxygen to the lungs. When you exhale you are getting rid of carbon dioxide. When you hold your breath, does your body start saying breath I need oxygen or does it say help the carbon dioxide levels that are out of whack? If you said carbon dioxide levels you are correct. Let's take a look now at what the respiratory system consists. There are 2 tracts of the respiratory system: - Upper respiratory system. - Lower respiratory system It also can be divided into a conducting portion and respiratory function. Conducting portion: Nose, Nasal cavity, pharynx, larynx, trachea and the smaller progressively airways (primary bronchi to terminal bronchioles). Respiratory portion: is composed of small airways called respiratory branchioles, alveolar ducts and alveoli (air sacs).

Respiratory System

Respiratory System Anatomy

Some of Respiratory System main Functions: Pulmonary Ventilation: Inhalation: bringing gas into the lungs. Exhalation: letting gas flow out of the lungs. Gas exchange: Oxygen is drawn in by inhalation and is transported to the body cells from the lungs by blood circulation. The body uses the oxygen to generate carbon dioxide as a waste product which is then transported to the lungs and is then exhaled. Gas Conditioning: Gases entering the body are "modified" before reaching the gas exchange surfaces. These gases are warmed to body temperature, filtered of any harmful particles and humidified by contact of the respiratory epithelium and the sticky mucus covering in the winding pathways in the nasal cavity and the paranasal sinuses. Some Ventilation Concepts: Negative-pressure ventilation: where air is essentially sucked into the lungs. Positive pressure ventilation: where air (or another gas mix) is pushed into the trachea. When physicians use a ventilator? Medical Ventilator is a machine designed to mechanically assist in moving breathable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently. Ventilator mainly in its simplest form, a modern positive pressure ventilator consists of: - A compressible air reservoir or turbine,

- Air and oxygen supplies, - A set of valves and tubes, A disposable

or

reusable

"patient

circuit",

The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When overpressure is released, the patient will exhale passively due to the lungs' elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold. The oxygen content of the inspired gas can be set from 21 percent (ambient air) to 100 percent (pure oxygen). Pressure and flow characteristics can be set mechanically or electronically. Ventilators may also be equipped with monitoring and alarm systems for patientrelated parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, and mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computercontrolled turbo pump. Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient's needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Germany, Canada, and the United States, respiratory therapists are responsible for tuning these settings while biomedical technologists are responsible for the maintenance. The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive. Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods

require intubation, which for long-term ventilator dependence will normally be a tracheotomy cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Setup of Ventilator in hospital ICU room: The illustration shows a standard setup for a ventilator in a hospital room. The ventilator pushes warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the patient.

Some expressions: Minute Volume: is the volume of air (oxygen) inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a persons lungs in one minute (5 -40 L/min). Tidal Volume (Vt): the volume of air (oxygen) what is given to patient in one breathe (0.1-2 L). Flow: volume/time (5-35 L/min). BPM: Breathe Per Minute (2-60) Ti: Inspiration time. Te: Expiration time. I:E: Inspiration to Expiration ratio. Respiratory Cycle:

Relation between Tidal Volume, Inspiration time and Flow:

How to work on ventilator? The classification of ventilators refers to the following elements:

1- Control: How the ventilator knows how much flow to deliver Volume Controlled (volume limited, volume targeted) and Pressure Variable. Pressure Controlled (pressure limited, pressure targeted) and Volume Variable. Dual Controlled (volume targeted (guaranteed) pressure limited). 2- Cycling: how the ventilator switches from inspiration to expiration: the flow has been delivered to the volume or pressure target - how long does it stay there? Time cycled such in pressure controlled ventilation. Flow cycled such as in pressure support. Volume cycled the ventilator cycles to expiration once a set tidal volume has been delivered: this occurs in volume controlled ventilation. If an inspiratory pause is added, then the breath is both volume and time cycled . 3- Triggering: what causes the ventilator to cycle to inspiration. Ventilators may be time triggered, pressure triggered or flow triggered. Time: the ventilator cycles at a set frequency as determined by the controlled rate. Pressure: the ventilator senses the patient's inspiratory effort by way of a decrease in the baseline pressure. Flow: modern ventilators deliver a constant flow around the circuit throughout the respiratory cycle (flow-by). A deflection in this flow by patient inspiration is monitored by the ventilator and it delivers a breath. This mechanism requires less work by the patient than pressure triggering. 4- Breaths are either: what causes the ventilator to cycle from inspiration Mandatory (controlled) - which is determined by the respiratory rate. Assisted (as in assist control, synchronized intermittent mandatory ventilation, pressure support) Spontaneous (no additional assistance in inspiration, as in CPAP) 5- Flow pattern: Sinusoidal: this is the flow pattern seen in spontaneous breathing and CPAP Decelerating: the flow pattern seen in pressure targeted ventilation: inspiration slows down as alveolar pressure increases (there is a high initial flow). Most intensives and respiratory therapists use this pattern in volume targeted ventilation also, as it results in a lower peak airway pressure than constant and accelerating flow, and better distribution characteristics. Constant: flow continues at a constant rate until the set tidal volume is delivered. Accelerating: flow increases progressively as the breath is delivered. This should not be used in clinical practice. 6- Mode or Breath Pattern: Continuous Mandatory Ventilation (CMV): In which ventilator provides a mechanical breath on a preset timing, without allowances for spontaneous breathing from patient side. This is usually only used in an unconscious patient. It may also be used in infants who often quickly adapt their breathing pattern to the ventilator timing. Assist-Control: That minimizes patient effort by providing full mechanical support with every breath. This is often the initial mode chosen for adults because it provides the greatest degree of support. Intermittent Mandatory Ventilation (IMV): It mixes controlled breaths and spontaneous breaths, as the ventilator provides a preset mechanical breath (volume

limited) every specified number of seconds (determined by dividing the respiratory rate into 60 seconds, thus a respiratory rate of 12 results in a 5 second cycle time). Within that cycle time the ventilator waits for the patient to initiate a breath using either a pressure or flow sensor. When the ventilator senses the first patient breathing attempt within the cycle, it delivers the preset ventilator breath. If the patient fails to initiate a breath, the ventilator delivers a mechanical breath at the end of the breath cycle. Additional spontaneous breaths after the first one within the breath cycle do not trigger another SIMV breath. However. SIMV is frequently employed as a method of decreasing ventilatory support (weaning) by turning down the rate, which requires the patient to take additional breaths beyond the SIMV triggered breath. Pressure Support: Where the patient has control over all aspects of his breath except the pressure limit. Continuous Positive Airway Pressure (CPAP): A continuous level of elevated pressure is provided through the patient circuit to maintain adequate oxygenation, decrease the work of breathing, and decrease the work of the heart (such as in leftsided heart failure CHF). Note that no cycling of ventilator pressures occurs and the patient must initiate all breaths. In addition, no additional pressure above the CPAP pressure is provided during those breaths Synchronized Intermittent Mandatory Ventilation (SIMV): In which ventilator provides a preset pressure limited mechanical breath every specified number of seconds SIMV is frequently employed as a method of decreasing ventilatory support (weaning) by turning down the rate, which requires the patient to take additional breaths beyond the SIMV triggered breath. Positive End Expiratory Pressure (PEEP): may or may not be employed to prevent atelectasis in adult patients. It is almost always used for pediatric and neonatal patients due to their increased tendency for atelectasis. Drger Company:

As an international leader in medical and safety technology, Drger develops innovative equipment and solutions people the world over trust when livesare on the line and Technology for Life is their guiding principle and mission.

And we invited "Drger International Co." agent company in Egypt "Life care Technology Co." and their representative Eng. Shawkat Ahmed (Service Supervisor of Co.) who welcomed the invitation and spent about three hours illustrating the Medical Ventilation Machines to SBME's and bring one of their most advanced models of their Ventilators Evita XL (which is shown among their products below). Drgers range of Ventilators Products:

Drager - Evita 2 dura

Drager - Savina

Drager - Evita XL

Drager - Oxylog 1000

Drager - Oxylog 2000 We enable professional caregivers turn the ICU into a healing environment Stefan Draeger.

References: The Respiratory System handout (downloadablefile) Anatowiki Fundamentals of Mechanical Ventilation Draeger Medical Operation Manual of Evita XL Medical Ventilation through Medical Ventilators through Weaning patient from mechanical What To Expect While on a Modes of Mechanical Ventilation

Ventilation Ventilator Wikipedia Wikipedia ventilator Ventilator?