No Soal

57 Nilai PaCO2 darah normal adalah

a. 25-35
b. 35-45
c. 45-55
d.55-65
e.>80

58 Dosis induksi ketamin adalah

A. 0,25 mg/kg bb
B. 1 mg/kg bb
C. 3 mg/kg bb
D. 4 mg/kg bb

59 Cairan pilihan pertama yg digunakan untuk

mengatasi defisit cairan
a. D5%
B. NaCl 0.9%
C. Koloid
D. D5 1/4NS
E. RL

60 Volume kristaloid yg dibutuhkan pada

kehilangan cairan 750ml
A. 1500 ml
B. 2000 ml
C. 2500 ml
D. 2750 ml
E. 3000 ml
61 Pasien laki-laki usia 54th dtg ke IGd dg
keluhan sesak napas dan penurunan
kesadaran. Kesadaran somnolen, NCH(+), rr
44x/m, rhonki di seluruh lapang paru, akral
dingin. AGD PaO2 40 mmHg PaCO2 18 mmHg.
Terapi O2 yg tepat diberikan utk pasien ini
A. NRM
B. RM
C. Nasal kanul
D. ET ventilator
E. Non invasif ventilator

62 Operasi dimulai stadium

A. St 2
B. st 3 plana 1
C. St 3 plana 2
D. St 3 plana 3
E. St 4
63 Faktor yg memengaruhi osmolaritas
A. Hb
B. Ureum
C. Creatinin
D. Cl
E. Ht

64

Pasien datang ke IGD dengan keluhan sesak

nafas, gelisah, ketertinggalan gerak paru
kanan, trakea bersih
A. Pneumothorak
B. Fail chest
C. Tamponade jantung
D. Syok hemoragic
E. Edem Pulmo
Pembahasan

• pH : 7.35 – 7.45
• paO2 : 80 – 100 mmHg
Hipoksia ringan 60-80, sedang 40-60, berat <40
• paCO2 : 35 – 45 mmHg
• HCO3- : 22 – 26 mmol/L
• BB : 45 – 55 mmol/L
• BE : -2 – +2
• Anion gap : 8 – 16 mmol/L
• SaO2 : 95-98%
• PAO2 – PaO2 (selisih tek parsial oksigen alveolus – arteri) : 15 – 20 mmHg

DARI BUKU ANESTESIOLOGI UNDIP

Dosis ketamine:
Induksi: IV 0,5-2 mg/kgBB
IM 4-6 mg/kgBB
Analgesic: IV 0.2 – 0.8 mg/kgBB
IM 2-4 mg/kgbb

Larutan ringer laktat adalah cairan pilihan pertama, sedangkan NaCL fisiologis dapat diberikan sebagai pilihan
kedua. Larutan RL dapat diberikan dengan aman dalam jumlah besar kepada pasien dengan kondisi hipovolemia
dengan hiponatremia, hipokhloremiaatau alkalosis metabolik.(Ika Prasetya, 2009. Syok Hipovolemik dalam Buku
Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing)

DARI BUKU UNDIP

Kehilangan cairan 3- 4x
= 750 ml x 4
= 3000 ml
Kalau dilihat dari AGD:
PaO2 40 mmHg (turun  hipoksia)
PaCO2 18 mmHg (turun  hipokarbia)

Stage I (stage of analgesia or disorientation): from beginning of induction of general anesthesia to loss of
consciousness.
Stage II (stage of excitement or delirium): from loss of consciousness to onset of automatic breathing. Eyelash
reflex disappear but other reflexes remain intact and coughing, vomiting and struggling may occur; respiration
can be irregular with breath-holding.
Stage III (stage of surgical anesthesia): from onset of automatic respiration to respiratory paralysis. It is divided
into four planes:
• Plane I - from onset of automatic respiration to cessation of eyeball movements. Eyelid reflex is lost, swallowing
reflex disappears, marked eyeball movement may occur but conjunctival reflex is lost at the bottom of the plane
• Plane II - from cessation of eyeball movements to beginning of paralysis of intercostal muscles. Laryngeal reflex
is lost although inflammation of the upper respiratory tract increases reflex irritability, corneal reflex disappears,
secretion of tears increases (a useful sign of light anesthesia), respiration is automatic and regular, movement and
deep breathing as a response to skin stimulation disappears.
• Plane III - from beginning to completion of intercostal muscle paralysis. Diaphragmatic respiration persists but
there is progressive intercostal paralysis, pupils dilated and light reflex is abolished. The laryngeal reflex lost in
plane II can still be initiated by painful stimuli arising from the dilatation of anus or cervix. This was the desired
plane for surgery when muscle relaxants were not used.
• Plane IV - from complete intercostal paralysis to diaphragmatic paralysis (apnea).
Stage IV: from stoppage of respiration till death. Anesthetic overdose cause medullary paralysis with respiratory
arrest and vasomotor collapse. Pupils are widely dilated and muscles are relaxed.
Pneumothorak menurut Barmawi dan Budiono (2008), berdasarkan anamnesis, gejala-gejala yang sering muncul
adalah : a. inspeksi : dapat terjadi pencembungan dan pada waktu pergerakan nafas,
tertinggal pada sisi yang sakit b. sesak napas c. ateletaksis