Clinical Mentoring Terapi Cairan Pada Kasus Emergensi PDF
Clinical Mentoring Terapi Cairan Pada Kasus Emergensi PDF
Aries Perdana
Departemen Anestesiologi dan Terapi Intensif
FKUI-RSCM
Topik
1. Pendahuluan.
PENYEBAB TERSERING
USIA 45-84 TAHUN
Pneumonia, CHF,
COPD
SEPTIKEMIA
KEJANG
GANGGUAN TRAUMA
JANTUNG SYOK HIPOVOLEMIK
MANAJEMEN PASIEN
PADA KEDARURATAN
Kendala
TERAPI CAIRAN Diagnosis ?
Asesmen status cairan &
PENGETAHUAN STAF elektrolit ?
TERBATAS
Waktu terbatas
Relative High
Permeability Permeability
2. Vesikel plasmalemmal
Berbeda ;
Zat larut lemak.
Zat larut air.
DIFFERENT TYPES OF CAPILLARY IN ORGANS
Sistem Limfatik
Kristaloid
Kristaloid tidak
Cairan seimbang
NaCl 0.9% atau
Normal Saline
Parenteral
Albumin
Koloid Gelatins
Dextrans
Kristaloid Seimbang
• Mengandung Ca
Normal Saline (NaCl 0.9%)
TUJUAN PEMBERIAN
CAIRAN DI EMERGENSI
ADALAH MEMPERBAIKI
PERFUSI JARINGAN
AKSES INTRA VENA
RESUSITASI CAIRAN
• Tujuan:
• Memperbaiki tekanan darah
• Optimalisasi oksigenisasi jaringan
• Memastikan metabolisme selular adekuat
• Memperbaiki preload ventrikel kiri
• Meningkatkan curah jantung
CIRCULATORY SHOCK
DISTRIBUTIVE
Sepsis
OBSTRUCTIVE Neurogenic
Tamponade Anaphylaxis
Pneumothorax Drug induced
Embolus
Surviving Sepsis Campaign: International
Guidelines
A. INITIAL RESUSCITATION for Management of Sepsis and Septic
Shock:
• 1. Sepsis and 2016.
septic shock are medical emergencies, and we recommend that treatment and resuscitation
begin immediately .
• 2. We recommend that, in the resuscitation from sepsis- induced hypoperfusion, at least 30 mL/kg of IV
crystalloid fluid be given within the first 3 hours (strong recommendation, low quality of evidence
• 3. We recommend that, following initial Fluid resuscitation, additional fluids be guided by frequent
reassessment of hemodynamic status (BPS).
• 4. We recommend further hemodynamic assessment (such as assessing cardiac function) to determine the
type of shock if the clinical examination does not lead to a clear diagnosis (BPS).
• 5. We suggest that dynamic over static variables be used to predict fluid responsiveness, where available
(weak recommendation, low quality of evidence).
• 6. We recommend an initial target mean arterial pressure (MAP) of 65 mm Hg in patients with septic shock
requiring vasopressors (strong recommendation, moderate quality of evidence).
Surviving Sepsis Campaign: International
Guidelines for
F. Fluid Therapy.
Management of Sepsis and Septic
Shock: 2016.
1. Fluid challenge technique be applied where fluid administration is
continued as long as hemodynamic factors continue to improve
(Recommend).
2. Crystalloids as the fluid of choice for initial resuscitation and
subsequent intravascular volume replacement in patients with
sepsis and septic shock (strong recommendation, moderate quality
of evidence).
3. Suggest using either balanced crystalloids or saline for fluid
resuscitation of patients with sepsis or septic shock (weak
Early fluid resuscitation in severe trauma; Tim Harris,G O
Rhys Thomas,Karim Brohi. BMJ | 15 SEPTEMBER 2012 |
VOLUME 345.
• Prinsip Damage control resuscitation (DCR) ;
Dilakukan pada perdarahan mayor transfusi lebih dari 4
kantong darah pada 2-4 jam pertama
Permissive hypovolaemia (hypotension)
Compensatory Mechanism
Activation of norepinephrine Activation of Renin-Angiotensin- Increased myocardial contractility
Atrial natriuretic peptide Aldosterone Mechanism
MANAGEMENT OF
HEART FAILURE
SODIUM FLUID
INTAKE DIURETICS INTAKE
Terapi cairan pada CHF ; retriksi atau liberal
• AHA
• Bila kadar Na <135 meq/L dan tanpa bendungan restriksi cairan 1,5-2 L per
hari
• Pasien CHF dengan sepsis berat, syok sepsis, dan hipotensi yang tidak
mendapatkan cairan yang adekuat (<30 cc/kg) mortalitas dan
kemungkinan intubasi meningkat
Asesmen status volume dan respon pemberian cairan
• Tanda hipoperfusi berlanjut,
selain hipotensi:
• Hipervolemia ;
• Kulit dingin, lembab, • PND, ortopnea,
mottled dyspnea saat aktifitas
• Oliguria • Pemeriksaan fisik :
distensi vena
• Perubahan status jugularis, , edema
mental/kesadaran. ektremitas bawah,
rhonki di basal.
• Penunjang ;
• Rasio ureum/ nitrogen >
10:1