Manajemen

Jalan Napas
Almayra N. Harahap 01073200091
dr. Irma Lusiana Tantri, Sp. An
 Manajemen Jalan Napas

Keputusan instrumentasi Keterampilan manajemen Masalah dan Resiko

Kegagalan ventilasi
Ketahui
Aspirasi
1. Kegagalan jalan napas Anatomi, fisiologi,
Hipoksia otak
patologi
2. Kegagalan ventilasi Kematian
3. Perlindungan jalan Kuasai
Alat dan Metode Gagal memahami
napas kondisi klinis pasien

Gagal bertindak tepat

Kenali waktu

Indikasi, kontraindikasi,
komplikasi
Anatomi Saluran Napas Atas
 Langkah Manajemen Jalan Napas

1. Airway assessment
2. Preparation and equipment
3. Patient positioning
4. Preoxygenation
5. Bag and Mask Ventilation (BMV)
6. Intubation
7. Confirmation of endotracheal tube placement
8. Intraoperative management and troubleshooting
9. Extubation
Airway Assessment
Rutin

1. Pembukaan mulut
2. Uji gigitan bibir atas
3. Jarak tiromental
4. Lingkar Leher
5. Mallampati
6. BMI
 Airway Assessment

Jalan Napas Sulit

a. Preoperative Endoscopic
Airway Examination
b. Pemeriksaan radiologi

grading Cormack-Lehane
 Equipment
Our accomplishments in 2021

S Scope Stetoskop, laringoskop

T Tubes Endotracheal tube

A Airway
Pipa orofaring (guedel)
Pipa nasofaring (nasi-tracheal airway)

T Tapes Mikropor

I Introducer Stylet / mandrin

C Connector Penyambung, magill

S Suction Suction
 Positioning
Sniffing Position
Preoxygenation

Suplementasi oksigen 100% sebelum induksi selama 3-5

menit

● Memberikan ‘safe apnea time’,

● Dinitrogenasi paru

Target reservasi O2 5-8 menit

FRC O2 paru 90%

 Bag and Mask Ventilation

Pengembangan dada

End tidal CO2 terdeteksi

Uap pada sungkup

 Intubation
Memasukan selang ke trakea

Tujuan Indikasi dan Kontraindikasi

Menjaga patensi dan Indikasi Kontraindikasi

Mempertahankan akses jalan
napas 1. Ketidakmampuan oksigenasi
2. Ketidakmampuan ventilasi
Oksigenasi dan ventilasi 3. Ketidakmampuan melindungi 1. Fraktur laring
jalan napas 2. Trauma servikal
4. Operasi kepala, leher, atau 3. Trauma maksilofasial masif
Sarana gas anestesi
rongga tubuh
5. Resiko aspirasi
 Laryngoscope

Jenis
Macintosh
Miller

Persiapan
Kunci bilah ke gagang
Uji lampu

Posisi
Sniffing position
 Endotracheal Tube
Bentuk dan rigiditas ETT dapat dibentuk sesuai
lekuk saluran napas atas
 Endotracheal Tube
Bentuk dan rigiditas ETT dapat dibentuk sesuai
lekuk saluran napas atas

Reguler / Double
Reguler
kingking lumen

Lumen
Armored/ Preformed
nonkinking
ganda / RAE
Endotracheal Tube Intubation

Bila intubasi gagal

● Reposisi pasien
● Kurangi ukuran pipa ETT
● Menambah ukuran stylet
● Pilih laringoskop berbeda
● Laringoskopi indirek (video)
● Coba rute hidung
● Alternatif (LMA)
 Laryngeal Mask Airway
Supraglottic Airway Device dapat menjadi alternatif untuk ETT

Indikasi dan Kontraindikasi

Indikasi Kontraindikasi

Absolut
1. Ventilasi elektif
1. Tidak bisa membuka mulut
2. Jalan napas sulit
2. Obstruksi jalan napas total
3. Gagal jantung NYHA kelas II
Relatif
4. Saluran intubasi
1. Resiko aspirasi
5. Manajeman jalan napas pra
2. Kelainan supraglotis
rumah sakit
3. Tekanan jalan napas tinggi
Laryngeal Mask Airway

Komplikasi

● Aspirasi isi lambung

● Iritasi lokal
● Trauma saluran napas atas
● Obstruksi, laryngospasme
● Edema paru, bronkokonstriksi
 Confirmation

Konfirmasi

● Pengembangan dada simetris

● Uap pada sungkup
● Auskultasi
 Extubation

1. Pemulihan adekuat dari neuromuscular blocking agents

2. Refleks batuk / menahan nafas
3. Gerakan membuka mata
4. Hemodinamik stabil
5. Efek analgesik adekuat
6. Pasien sudah sadar
Jalan Napas Sulit
Terima Kasih
 Year in review infographics
Growth in 2021

9
8
7
6
Strong growth
5
4 Despite being red,
3 Mars is actually a
2 cold place
1
-1
-2 Weak growth
-3
-4
Venus is the second
planet from the Sun
-5
and is terribly hot
-6
-7
-8
-9
 Year in review infographics
Performance of different sectors in 2021

Agriculture Financial
Jupiter is a gas giant Mercury is the
and the biggest closest planet to the
planet of them all Sun and the smallest

Mining Human health

Neptune is the Venus is the second
farthest planet from planet from the Sun
the Sun and is terribly hot

Construction Technology
Despite being red, Saturn is composed
Follow the link in the graph to modify its Mars is actually a mostly of hydrogen
data and then paste the new one here. cold place and helium
For more info, click here
 Year in review infographics
Gross debt position

Advanced economies 2020 105%

Mercury is the closest planet to the
Sun and the smallest one in the
2021 125%
Solar System

Emerging market 2020 53%

Earth is the third planet from the
Sun and the only one that harbors
2021 62%
life in the Solar System

Low income developing countries 2020 43%

Saturn is a gas giant and has
several rings. It's composed mostly
2021 49%
of hydrogen and helium
 Year in review infographics
Company review

Work & assets Community Events Energy saved Forecasting

39M $400K 51M $171M 6,000

Jupiter Neptune Mars Mercury Venus

Jupiter is a gas Neptune is the Despite being red, Saturn is a gas Venus is the
giant and the farthest planet Mars is actually a giant and has second planet from
biggest planet from the Sun cold place several rings the Sun
 Year in review infographics

COVID-19 Wirecard scandal US elections

Jupiter is a gas giant Mercury is the Saturn is composed
and the biggest closest planet to the mostly of hydrogen
planet of them all Sun and the smallest and helium

January February May June August November

Australia bushfires George Floyd Belarus elections

Despite being red, Neptune is the Venus has a beautiful
Mars is actually a farthest planet from name, but also high
cold place the Sun temperatures
 Year in review infographics

Vital stats Social media growth Top 3 moments of 2021

45% Instagram followers New funding

Growth subscription revenue 10,143 Venus is the second
planet from the Sun
Neptune the farthest planet
from the Sun. It's also the
fourth-largest of them all
Twitter retweets Largest event
Mercury is the
3,006 smallest planet
87%
Customer retention rate
Facebook fans Official launch
Saturn is a gas giant and has
Jupiter is the biggest
several rings. It's composed
mostly of hydrogen and helium
11,607 planet of them all
 Year in review infographics

Post this year Key numbers

11,076 2,252
Subscribers Sales last month
Venus is the second Jupiter is the biggest
planet from the Sun planet of them all

New products launched

Video Photo
Article Podcast

Follow the link in the graph to modify its data

and then paste the new one here. For more Book Toolkit Course Mini-guide
info, click here
 Year in review infographics
Our accomplishments in 2021

Neptune is the farthest planet from the

1,000 New volunteers Sun. It's also the fourth-largest one

Saturn, the ringed planet, is composed

20,000 Holiday meals mostly of hydrogen and also helium

Venus is the second planet from the Sun

5,000 Care kits delivered and is Earth’s closest planetary neighbor

Mercury is the closest planet to the Sun

3,200 Clients enrolled and the smallest one in the Solar System
 Year in review infographics
Overall highlights from 2021

Official launch
Neptune is the farthest planet from
the Sun. It's also the fourth-largest
by diameter in the Solar System

Record sales Globalization Awards

Despite being red, Mars is Jupiter is a gas giant and Saturn is composed mostly
actually a cold place the biggest planet of hydrogen and helium
 Year in review infographics
Comparison of accomplishments

In 2020 In 2021

Growth subscription revenue Growth subscription revenue

28% 55%

Increase in employee base Increase in employee base

20% 35%

Customer retention rate Customer retention rate

40% 65%
Year in review infographics

Neptune is the
45% Growth revenue fourth-largest planet in
the Solar System

Earth is the third planet

300 Store training from the Sun and the only
one that harbors life

Venus has a beautiful

1,500 Content generated name and is the second
planet from the Sun

Despite being red, Mars is

2,000 Clients enrolled actually a cold place. It’s
full of iron oxide dust
 Year in review infographics
A review of the country’s economy

Percentage Economic indicator

Venus is the second

-24.5% Retail sales planet from the Sun

Mercury is the
-20.5% Value of exports smallest planet

Despite being red,

-15.9% Industrial production Mars is a cold place

Jupiter is the biggest

-13% Services production planet of them all
 Year in review infographics

Growth & performance Open rate Engagement Automation

Revenue $100,000 $310,500 $54,000

Impressions 400,500 200,100 131,000

Followers 13,000 25,000 22,000

Conversions 700 830 5,500

Purchases growth +29% +22% +19%

 Year in review infographics

Revenue per country 2021 Social media stats

Instagram followers
2,500 Venus is the second
planet from the Sun

Twitter followers
3,040 Jupiter is the biggest
planet of them all

Facebook fans
300k Despite being red,
Mars is a cold place

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics
Average temperature in 2021

January 10°F
February 20°F
March 30°F
April
40°F
May
50°F
June
60°F
July
70°F
August
September 80°F

October 90°F
November 100°F
December 110°F
 Year in review infographics

Sector breakdown Offering breakdown

65% Real estate

20% Legal

4% Energy 68% 75%

4% Other

3% Financial

2% Software
Deal type Volumen transanted
1% Healthcare Venus is the second Despite being red,
1% Pharmaceutical planet from the Sun Mars is a cold place

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics

Company sales growth Key numbers

Subscription revenue
$1.8B Venus is the second
planet from the Sun

Conversion sales
$8M Despite being red,
Mars is a cold place

Largest investment
$1.9M Jupiter is the biggest
planet of them all

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics
Oil prices go negative

Dollars per barrel price

Neptune is the farthest
planet from the Sun. It's also
the fourth-largest one

Falling tendency
Saturn is a gas giant with an
average radius of about nine
times that on Earth

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics
2021 temperature stats

Highest daily temp Highest monthly temp

10°F
20°F
30°F
40°F
50°F
60°F
70°F
2021 2020 August July 80°F
90°F
Mercury is the closest planet to the Venus is the second planet from
Sun and the smallest of them all. It the Sun and is Earth’s closest 100°F
was named after a god planetary neighbor
110°F
 Year in review infographics
Comparison of costs

Costs A
Neptune is the farthest
planet from the Sun. It's also
the fourth-largest one

Costs B
Jupiter is a gas giant and the
biggest planet in the entire
Solar System

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics
Demonstrations by type in 2021

60%
Riots
Venus has a beautiful name
and is the second planet
from the Sun

40%
Protests
Neptune is the farthest
planet from the Sun. It's also
the fourth-largest planet
 Year in review infographics

Digital ad revenue growth comparison Sales by quarter (%)

71% Q1

53% Q2

64% Q3

75% Q4

2020 2021

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
 Year in review infographics

Best sale months ranking New 2021 country offices

December
1 $15,000 Venus is the second
planet from the Sun France

Sweden
June
2 $12,500 Despite being red,
Mars is a cold place
Poland

Austria

Romania
December
3 $10,000 Jupiter is the biggest
planet of them all
 Year in review infographics
Mobile year in review

Comparative usage How user discover new apps in 2021?

52% 27%
Friend and family Search engines
Neptune is the Venus has a beautiful
farthest planet from name, but also very
the Sun high temperatures

45% 24%
51% Mobile Browsing Company website
Saturn is composed Despite being red,
42% Desktop
mostly of hydrogen Mars is actually a cold
7% Tablet and helium place
 Year in review infographics
Comparison of inflation 2020-2021

United Kingdom Eurozone

2020 2021 2021 2020
1.9% 1.7% 1.7% 1.9%

United States Germany

2020 2021 2021 2020
2.4% 2.2% 1.4% 1.5%

China Japan
2020 2021 2021 2020
2.5% 2.6% 0.7% 1.0%
 Year in review infographics
Social media 2021 review

3,400 5,500 2,100 2,600

Facebook fans Instagram followers Twitter follower Youtube subscribers
Neptune is the Venus has a beautiful Saturn is composed Despite being red,
farthest planet from name, but also very mostly of hydrogen Mars is actually a cold
the Sun high temperatures and helium place
 Year in review infographics
Top 5 industries driving the U.S. economy in 2021 (percentage value-added)

Technology Retail
Neptune is the Venus has a beautiful
farthest planet from name, but also very
the Sun high temperatures

17.7% 10.6% 4.8%

12% 5.5%
Healthcare Construction Manufacturing
Despite being red, Saturn is composed The Sun is the star at
Mars is actually a mostly of hydrogen the center of the
cold place and helium Solar System
 Year in review infographics
Air travel plummeted in 2021

International market Revenue passenger kilometers

Africa -69.8%

Asia-Pacific -80.3%

Europe -73.7%

Latin America -71.8%

Middle East -72.9%

North America -75.4%

 Year in review infographics
Top 6 long-term investment choices in 2021

35% 21% 17% 16% 11%

Real Estate Stocks Savings Gold Bonds
Venus has a Neptune is far Jupiter is the Saturn is the Despite being red,
beautiful name away from us biggest planet ringed planet Mars is cold
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