KEGAWATDARURATAN

PADA ANAK DAN BAYI

Kepaniteraan Klinik Emergensi RSUP Fatmawati Jakarta

FKIK UIN Syarif Hidayatullah

ASSESSMENT OF
THE CRITICALLY ILL PATIENT

Applying the PAT

Appearance Work of
breathing

Circulation

Abnormal

Abnormal

Abnormal

Abnormal

Abnormal

Assessment
Respiratory distress
Shock
Primary CNS disfungtion/
Metabolic abnormality
Cadiopulmonary failure

Framework for assessing the critically ill patient

History

PHASE I

PHASE II

Initial contact-first minute

(primary survey)
What is the main physiological problem?

Subsequent reviews
(Secondary survey)
What is the underlying
cause?

Main features of circumsTances and environment

Witnesses, healthcare personel,
relatives
Main symptoms: pain, dyspnea,
faintness
Trauma?
Operative or nonoperative?
Medications/toxin

More detailed information

Present complaint
Past history, chronic
diseases, operations
Psychosocial & physical
Independence
Medications & allergies
Family history
Ethical or legal issues
System review

Examination

Look; Listen; Feel

Airway
Breathing & oxygenation
Circulation
Level of consciousness

Structured review of organ

system
Respiratory
Cardiovascular
Abdomen & GU tract
CNS, musculoskeletal sys
Endocrine, hematological

Chart review,
documentation

Essential physiology, vital

signs
Heart rate, rhythm
Blood pressure
Respiratory rate; pulse
oxymetry
Level of consciousness

Case records & note

keeping
Examine medical records if
available
Formulate specific diagnosis
Document current events

Investigations

Blood gas analysis (use

venous if arterias acces
difficult)
Blood glucose

Laboratory blood test

Radiology
ECG
Microbiology

Treatment

Proceeds in parallel with the

above
Oxygen
IV access + fluids
Assess response to immediate
resuscitation
CALL FOR MORE
EXPERIENCED ADVICE &
ASSISTANCE

Refine treatment, assess

responses, review trends
Provide specific organ
system support as required
Choose most appropriate site
for care
Obtain specialist advice /
assistance

Assessment of Airway & Breathing

AIR WAY
Causes of obstruction
blood, vomitus, foreign body, CNS depression, direct trauma,
infections

LOOK for
cyanosis, altered respiratory pattern & rate, use of accessory
muscles, tracheal tug, altered level of consciousness,
protective airway reflect (cough, gag)

LISTEN for
noisy breathing (grunting, stridor, wheezing, gurgling)
complete obstruction results in silence

FEEL for
decreased or absent air flow

BREATHING
Cause of inadequate breathing
Depressed respiratory drive: e.g CNS depression
Depressed respiratory effort: muscle weakness, nerve/spinal
cord damage, debilitation, chest wall abnormalities, pain
Pulmonary disorders: pneumo/hemothorax, aspiration, chronic
obstructive pulmonary disease, asthma, pulmonary
embolus, lung contusion, acute lung injury, ARDS,
pulmonary edema

LOOK for
cyanosis, altered respiratory pattern & rate, equality & depth of
respiration, sweating, JVP, use of accessory muscles,
tracheal tug, altered of consciousness, SaO 2

LISTEN for
dyspnea, inability to talk, noisy breathing, percussion,
ausculatation

FEEL for
precordial cardiac pulsation, pulses (central &
peripheral) assessing rate, quality, regularity,
symmetry

The Normal value of respiratory rate in children

Age

Rate (breath per min)

Newborn

30 60

Infant

30 40

2 4 yr

20 30

4 7 yr

20 30

7 12 yr

16 20

> 13 yr

12 - 16

Tachypnea : respiratory rate > N

Signs of Pulmonary Disease

1. Change in mentation neurologic deterioration
(blood gas abN)
2. Abnormality in respiratory rate tacypnea
3. Abnormal breathing pattern
4. Abnormality in the character of breathing
- conspicuous ventilatory movements
- diminished, barely chest
- asymetry of movement between both sides of
the chest or
- asymetry of movement between chest and abdomen

5.

Entirely thoracic breathing (normal) or

entirely abdomen breathing (paralysis diaphragma)

6. Abnormality relative to phase of the respiratory cycle

- labored inspiration : retraction suprasternal,
supraclavicular, intercostal, substernal, nares flared
- labored expiration: asthma, ARDS
7. Stridor
8. Other signs:
Cyanosis (central or peripheral), Subcutaneus
emphysema, patient posture, pleural friction rub etc

Abnormal breathing patterns

1. Rapid with tidal volume

sympathetic nervous stimulation, chest complience, airway

resistance, pleuritic chest pain, trauma, elevated diaphragma

2. Rapid & deep (Kussmaul respirations)

metabolic acidosis, hysterical hyperventilation, infarction of midbrain or pons

3. Cheyne-Stokes respirations
brain damage, cardiogenic shock, uremia, drug induced resp.depress

1. Biots respirations (irregular resp. with long periods

of apnea)
brainstem dysfunction

Slow breathing
drug induced resp.depress, ICP, end-stege resp. muscle fatigue

Apnea punctuated by erregular, gasping breaths (agonal)

occurs just before death

Signs of Respiratory Distress and

Potential Respiratory Failure
Tachypnea,

tachycardia

Retractions
Nasal flaring
Grunting
Stridor or wheezing
Mottled color
Change in responsiveness
Hypoxemia, hypercarbia, decreased Hgb saturations
LATE : poor air entry, weak cry
apnea or gasping
deterioration in systemic perfusion
bradycardia

PULSE OXIMETRY
that estimates functional oxyhemoglobin saturation
Normal SpO2 96% - 99%

Poor signal detection:

- poor prob positioning
- motion
- intense vasocontriction and/or shock states (weakens pulse)
- sensor applied to tight

Factors that adversely SpO2

-neither a preinsertion nor an invivo calibration performed
-Light intensity calibration not performed at the time insertion
-Optics bent or broken
-Catheter tip close to or facing the pulmonary artery wall
-Increased carboxyhemoglobin or methemoglobin level
-Poor perfusion
-Anemia, hyperbilirubinemia, hypercapnia

Factors that adversely SpO2

-neither a preinsertion nor an invivo calibration performed
-Light intensity calibration not performed at the time
insertion
-Optics bent or broken
-Catheter tip close to or facing the pulmonary artery wall
-Increased carboxyhemoglobin or methemoglobin level
-Poor perfusion
-Anemia, hyperbilirubinemia, hypercapnia

CAPNOGRAPHY
To measure PaCO2 level
end tidal CO2 (ET-CO2) CO2 alveolar

Circulation
Causes of circulatory inadequacy
primay-directly involving the heart
ischemia, conduction defects, valvular disorders,
cardiomyopathy
secondary-pathology originating elsewhere
drugs, hypoxia, electrolyte disturbances, sepsis
LOOK for
reduced perpheral perfusion (palor, ), hemorrhage
(obvious concealed), altered level of conciousness,
dyspnea, urine output

LISTEN for
additional or altered heart sounds, carotid bruits
FEEL for
precordial cardiac pulsasion, pulses (central &
peripheral) assessing rate, quality, regularity,
symetry

Assessment of circulation:
pulses rate, cardiac pulsasion, quality & regularity,
skin temperature, & blood pressure

Heart Rate in Normal Children

Age (year)

Rate/minut

<1

110 160

12

100 150

25
5 12
> 12

95 140
80 120
60 - 100

Tachycardia: hypoxia, poor perfusion, febris, pain,

emotional
Bradycardia: sign of preterminal hypoxia
(decompensated stage), ischemia

Normal Blood Pressure in Children

Age (year)

Sistolic (mmHg)

<1

70 90

12

80 90

25

80 100

5 12

90 110

> 12

100 - 120

The lower limits of systolic blood pressure :

70 mmHg + (2 x age in year)

Signs of Poor Systemic Perfusion

Tachycardia
Mottled color, pallor
Cool skin, prolonged capillary refill
Oliguria (urine volume < 1-2 ml/kg/hour)
Diminished intensity of peripheral pulses
Metabolic acidosis
Change in responsiveness
LATE : hypotension, bradycardia

Disability
to assess signs of neurologic compromise precede loss
of conscious

Decressing level of consciousness:

AVPU
Awake
Responsive to voice
Responsive to pain
Unresponsive

Modified Glasgow Coma Scale for Infant

Score
Eye Opening: Spontaeous
To verbal stimuli
To pain only
No response

4
3
2
1

Verbal response: Coos and babbies

Irritable cries
Cries to pain
Moans to pain
No respons

5
4
3
2
1

Motor response: Moves spntaneously and purposefully

Withdraws to touch
Withdraws in response to pain
Decorticate posturing (abnormal flexion) in response to pain
Decerebrate posturing (abnormal extension) in response to pain
No rensponse

6
5
4
3
2
1

Modified Glasgow Coma Scale for Children

Score
Eye Opening: Spontaeous
To verbal stimuli
To pain only
No response

4
3
2
1

Verbal response: Orriented, appropriate

Confuse
Inappropriate words
Incomprehensible words or nonspecific sounds
No response

5
4
3
2
1

Motor response: Obeys commands

Localizes painful stimulus
Withdraws in response to pain
Flexion in response to pain
Extension in rensponse to pain
No rensponse

6
5
4
3
2
1

Signs of Increased Intracranial Pressure

Decreased responsiveness (irritability, lethargy)
Inability to follow commands
Decreased spontaneous movement
Decreased response to painful stimulus
Pupil dilatation with decreased response to light
LATE : Hypertension
Change in heart rate (bradycardia)
Apne

Exposure
assessing the face, posture body & skin
rush, hematoma, temperature, etc

Triage of all sick children

EMERGENCY SIGNS
If any sign positive: give treatment(s), call for help, draw blood for emergency laboratory investigations
(glucose, malaria smear, Hb)
TREAT
1. ASSES:
AIRWAY AND
BREATHING

2. ASSES:
CIRCULATION

Obstructed breathing or
Central cyanosis or
Severe respiratory distress

C
Cold hands
with:
o
Capillary refill longer than
l
3 seconds, and
Weak and fast pulse

ANY SIGN
POSITIVE

IF FOREIGN BODY ASPIRATION

Manage airway in choking child
IF NO FOREIGN BODY ASPIRATION
Manage airway
Give oxygen
Make sure child is warm

Stop any bleeding

Give oxygen
Make sure child is warm
ANY SIGN
IF NO SEVERE MALNUTRITION:
POSITIVE
Check for severe Insert IV and begin giving fluids rapidly
malnutrition
If no able to insert peripheral IV, insert
an external jugular or intraosseous line
IF SEVERE MALNUTRITION:
If lethargic or unconscious:
Give IV glucose
Insert UV line and give fluids

If not lethargic or unconscious:

Give glucose orally or by NG tube
Proceed immediately to full
assessment and treatment
COMA
CONVULSING

Coma or
Convulsing (now)

IF COMA OR
CONVULSING

Manage airway
If convulsing, give diazepam or
paraldehyde rectally
Position the unconscious child (if head or
neck trauma is suspected, stabilize the
neck first)
Give IV glucose

Diarrhoea plus any two of these

SEVERE
DEHYDRATION Lethargy
(only in child with Sunken eyes
Diarrhoea)
Very slow skin pinch
d
I

DIARRHOEA
Plus TWO SIGNS
POSITIVE
Chedk for severe
malnutrition

Make sure child is warm

IF NO SEVERE MALNUTRITION:
Insert IV line and begin giving fluids
rapidly and diarrhoea treatment plan C
in hospital
IF SEVERE MALNUTRITION:
Do not insert IV
Proceed immediately to full assessment
and treatment

PRIORITY SIGNS These children need prompt assessment and treatment

Visible severe wasting

Oedema of both feet

Severe plmar palor
Any sick young infant (< 2 montha
of age)
Lethargy
ontinually irritable and restless
Major run
Any respiratory distress or
An urgent referral note from
another facility

Note If a child has trauma or other surgical

problems, get surgical help or follow
surgical guidelines

Check for head/neck trauma before treating childdo not move neck if cervical spine injury possible

NO- URGENT
Proceed with assessment and for treatment according to the childs priority

How to manage the airway in a choking child (foreign

body aspiration with increasing respiratory distress)
Infants
- Back slaps position: give 5 blows to the infants back with heel of hand
- if obstruction persist, give 5 Chest thrust with 2 fingers, one finger
breadth below nipple level in midline

- if obstruction persist, check infants mouth for any obstruction wich

can be removed
- if necessarry, repeat sequence with back slaps again

Children
Slapping the back to clear airway obstruction
Heimlich manoeuvre

if obstruction persist, check infants mouth for any

obstruction wich can be removed

if necessarry, repeat sequence with back slaps again

How to manage the airway in a child with obstructed

breathing (or who has just stopped breathing)
No neck trauma suspected
1.
2.
3.

Child conscious
Inspect mouth and remove foreign body, if present (neutral
position)
Clear secretions from throat
Let child assume position of maximal comfort

Child unconscious
1.
2.
3.
4.

Tilt the head as shown

Inspect mouth and remove foreign body, if present
Clear secretions from throat
Check the airway by looking for chest movements,
listening for breath sounds and feeling for breath

Look, listen and feel for breathing

Sniffing position to open the airway

 Neck trauma suspected (possible cervical spine injury)

1. Stabilize the neck, use jaw thrust without head tilt
2. Inspect mouth and remove foreign body if present
3. Clear secretions from throat
4. Check the airway by looking, listen and feel for breathing

If the child is still not breathing with carrying out the above,
ventilate with bag & mask

How to give oxygen

Give oxygen through nasal prongs or a nasal catheter
Start oxygen flow at 1-2 litres/minute

NASAL PRONGS
Place the prongs just inside
the nostrils and secure with tape

NASAL CATHETER
Use an 8F size tube
Measure the distance from the side
of the nostril to the inner eyebrow margin
with the catheter
Insert the catheter to this depth
Secure with tape

Start oxygen flow at 1-2 at 1-2 litres/minute

How to position the unconscious child

If neck trauma is not suspected:
- turn the child on the side to reduce risk of aspiration
- keep the neck slightly extended and stabilize by placing cheek
on one hand
- bend one leg to stabilize the body position

 If neck trauma is suspected:

- stabilize the childs neck an keep the child lying on the back
- prevent the neck from moving by supporting the childs head
- of vomiting, turn on the side, keeping the head in ling with the body

SYOK ADALAH SUATU SINDROMA AKUT

KARENA DISFUNGSI KARDIOVASKULAR
DAN KETIDAKMAMPUAN SISTEM SIRKULASI
MEMBERIKAN OKSIGEN DAN NUTRIEN
UNTUK MEMENUHI KEBUTUHAN ORGAN
VITAL

 SYOK

HIPOVOLEMIK: DEHIDRASI
PERDARAHAN
SYOK DISTRIBUTIF: SEPSIS, DSS,
ANAFILAKSIS
SYOK KARDIOGENIK: CHD,
KARDIOMIOPATI
SYOK OBSTRUKTIF: TAMPONADE
JANTUNG, TENSION
PNEUMOTHORAKS

 TAKHIKARDI
TAKHIPNEU
PENGISIAN KAPILER>>
IRITABILITAS RINGAN
TEKANAN NADI MENYEMPIT

 KULIT

DINGIN, LEMBAB, PUCAT,

SIANOSIS
PENGISIAN KAPILER >4 DETIK
HIPOTENSI (SANGAT KASIP)
OLIGURIA
DISTENSI ABDOMEN, BISING USUS
AGITASI, KONFUSI, HALUSINASI,
KOMA

TENTUKAN STATUS
KARDIOVASKULAR
2. TENTUKAN GANGGUAN
SIRKULASI TERHADAP
PERNAPASAN, TINGKAT
KESADARAN, PERFUSI, SUHU
DAN PRODUKSI URIN
1.

3.

ESTIMASI BB, DAN BESARNYA

KEHILANGAN VOLUME:
BB (Kg) = 2 x ( umur dlm th + 4)
Estimasi volume darah = 80 mL/KgBB

1.
2.

3.

4.

BERIKAN 02 (FiO2 100%), BILA PERLU

VENTILATOR
CEPAT PASANG AKSES VASKULAR, BERIKAN
BOLUS 20mL/BB KRISTALOID SECEPAT
MUNGKIN DAPAT DIULANG 2-3 X HINGGA NADI
TERABA
NILAI RESPON APAKAH STATUS
KARDIOVASKULAR DAN PERFUSI MEMBAIK,
UKUR PRODUKSI URIN/JAM
BILA NADI BELUM TERABA PASANG KATETER
VENA SENTRAL (CVP) BERIKAN CAIRAN SESUAI
NILAI CVP

BILA HB<5 GR/Dl koreksi dg prc 10 cc/KGBB.

USAHAKAN HB>10gr/Dl atau Ht 40%
6. BILA HB<5 GR/Dl koreksi dg prc 10 cc/KGBB.
USAHAKAN HB>10gr/Dl atau Ht 40%
7. SETELAH KLINIS MEMBAIK PERIKSA
KEMUNGKINAN DISFUNGSI ORAGAN:
5.

UREUM, KREATININ
THORAKS FOTO
IRAMA JANTUNG?
PTT, aPTT, FDP, TROMBOSIT, D-DIMER
GANGGUAN SSP?

PADA BAYI DAN ANAK

MENGAKIBATKAN GANGGUAN
HEMODINAMIK, DEPRESI
MIOKARDIUM DAN AKTIVASI
KASKADE KOAGULASI

 PADA

AWALNYA TERJADI
HIPERPIREKSIA, HIPERVENTILASI,
TAKIKARDI, GANGGUAN KESADARAN,
DAN AKRAL YANG HANGAT
KOMPENSASI CURAH JANTUNG DAN
TAHANAN VASKULAR SISTEMIK

 STADIUM

DEKOMPENSASI
(COLD SHOCK)
JIKA TERAPI AWAL GAGAL DAN TUBUH
GAGAL MENGKOMPENSASI, TERJADI
HIPOTENSI, HIPOKSIA DAN METABOLISME
ANAEROB

1.

2.
3.

RESUSITASI CAIRAN, BILA TIDAK

BERHASIL BERIKAN INOTROPIK ATAU
VASOPRESOR, JIKA TERDAPAT
PENURUNAN TAHANAN VASKULAR
SISTEMIK PIKIRKAN VASODILATOR
PERIFER.
KOREKSI KETIDAKSEIMBANGAN
ASAM BASA, ELEKTROLIT.
ANTIBIOTIKA

 SYOK

TERJADI KARENA VASODILATASI

DAN KEHILANGAN CAIRAN KARENA
GANGGUAN PERMEABILITAS KAPILAR

HENTIKAN ALERGEN, BERIKAN ADRENALIN

PERTAHANKAN JALAN NAFAS DAN PERNAPASAN
ADEKUAT, BERIKAN NEBULASI ADRENALIN. BILA PERLU
INTUBASI, ATAU SURGICAL AIRWAY JIKA TERJADI
SUMBATAN JALAN NAFAS
3. BILA MASIH MENGI NEBULASI SALBUTAMOL BILA PERLU
HIDROKORTISON 4mg/BB IV ATAU DRIP AMINOFILIN
4. BILA SYOK LAKUKAN RESUSITASI CAIRAN KRISTALOID
ATAU KOLOID DILANJUTKAN OBAT INOTROPIK.
5. BILA HENTI JANTUNG, LAKUKAN RJP
1.
2.

PRINSIP PENATALAKSANAAN TERAPI

CAIRAN
TERAPI RUMATAN (MAINTENANCE)
2. PENGGANTIAN DEFISIT (DEFISIT)
3. ONGOING LOSSES
1.

How to give IV fluids rapidly for shock

(child not severely malnourished)
insert an IV line (and draw blood for emergency laboratory investigations)
infusion RL or normal saline 20 ml/kg as rapidly as possible
Age/weight

Volume of RL or normal
saline
(20 ml/kg)

2 month (<4 kg)

75 ml

2-<4month (4-<6 kg)

100 ml

4-12 month (6-<10 kg)

150 ml

1-<3years (10-14 kg)

250 ml

3-<5 years (14-19 kg)

350 ml

Reasses child after appropriate volume has run in

0 min
5 min

Recognize decrease mental status and perfusion. Maintain airway and

establish access according to PALS gidelines
Push 20 cc/kg isootonic saline or colloid boluses up to and over
60 cc/kg. Correct hypoglicemia, dan hypocalsemia

15 min

Fluid refractory shock

Fluid Responsive

Establish central venmous access, begin

dopamine therapy and arterial monitoring
Fluid refractory dopamine resistant shock

Observase
in PICU

Titrate epinefrin for cold shock, norepinefrine for warm shock

to normal MAP-CVP and SVC O2saturation >70%

Cathecholamine-resistant shock
At risk of adrenal insufficiency?
Not at risk?
Give hydrocortis
Do not Give hydrocortisone

60 menit
Normal Blood Pressure
Cold Shock
SVC O2 Saturation <70%
Add vasodilatoror
Type III PDE inhibitor
with volume loading

Low Blood Pressure

Cold Shock
SVC O2 Saturation <70%

Titrate volume
And Epinephrine

Low Blood Pressure

warm Shock

Titrate volume
and norepinephrine
Vasopresin or
angiotensin

PERSISTENT CATHECHOLAMINE-RESISTANT SHOCK

Place pulmonary artery catheter and direct fluid,
inotrope, vasopressor, vasolidator, and hormonal,
Therapies to attain normal MAP-CVP and
CI>3.3 and <6.0 L/mnt/m2

Refractory shock

ECMO
Recommnendation for stpewise management of hemodynamic support with
goals of normal perfusion and perfusion pressure (MAP-CVP) in infants and
children

How to give IV fluids for shock in a child with

severe malnutrition
Give this treatment only if the child has signs of shock
and is lethargic or has lost consciousness:
insert an IV line (& draw blood for emergency laboratory investigations)
& weight the child
IV fluid 15 ml/kg over 1 hour:
- RL with 5% glucose (dextrose) or
- half normal saline with 5% glucose (dextrose) or
- half-strength Darrows solution with 5% glucose (dextrose)
or if these are unavailable
- RL
measure the pulse & breathing rate at the start and every 5-10 minute

If there are signs of improvement (pulse & breathing rates fall):

give repeat IV 15 ml/kg over 15 hour; then

switch to oral or NGT rehydration with ReSoMal 10 ml/kg/h up to

10 hours
initiate refeeding with starter F-75

If the child fails to improve after the first 15 ml/kg iv,

assume the child has septic shock:
give maintenance iv fluid (4 ml/kg/h) while waiting for blood
when blood is available, transfuse FWB 10 ml/kg slowly over
3 hours
initiate refeeding with starter F-75

How to give diazepam

rectally for convulsions
Give diazepam rectally
Draw up the dose from an ampoule of diazepam into
a tuberculin (1 ml) syringe, base the dose
on the weight of the child, where possible,
then remove the needle
Insert the syringe into the rectum 4-5 cm
and inject the diazepam solution
Hold buttock together for a few minutes

Seizures

Diazepam 0,3-0,5 mg/BW iv

or
Diazepam rectally Body weight < 10 : O,5 mg/BW
> 10 : 0,3 mg/BW
or
Diazepam rectally BW < 10 mg ; 5 mg
BW > 10 ; 10 mg

5-10 min

Seizures
Yes

Diazepam 0,3-0,5 mg/BW iv

or
Diazepam rectally 0,2-0,5 mg/BW
Hypoglycemia : D25% 2 ml/BW

No

STOP

5-10 min
prolonged seizure

Seizures
Yes

Airway-breathing-circulation
sign : trauma, infection, paresis
Vein access
Laboratorium : Blood :Glucose, electrolyte

Fenitoin 15-20 mg/BW iv bolus

1mg/BW/min

No

STOP

Seizures
Yes

Status of Convulsions

Fenobarbital 10-20 nmg/BW im

No

12 hours later
fenitoin 5-7 mg/BW iv

Seizures
Yes

PICU, Intubation

Midazolam 0,03 mg/BW bolus,

and maintenance,
if needed : ventilator

No

12 hours later
fenitoin 5-7 mg/BW iv
+ fenitoin 5-7 mg/kg

How to treat severe dehydration

in an emergency setting

RAPID IV FLUID REPLACEMENT IN severe dehydration.

BABY (< 1YRS)
70 ML/KB/1 HR
30 ML/KB/5 HR
CHILDREN
70 ML/KG/0.5 HR
30 ML/KG/2.5 HR

SLOWER IN DKA AND MENINGITIS, MUCH SLOWER IN

HYPERNATREMIA STATE (REHYDRATED OVER 48 HOURS,
SERUM SODIUM SHOULD NOT FALL BY > 1 MMOL/L/HR

PENANGANAN
EKSASERBASI AKUT
ASMA PADA BAYI DAN
ANAK

BERVARIASI INTER-/INTRA INDIVIDU

DALAM HAL:
GEJALA DAN TANDA
DERAJAT BERATNYA
LAMA SERANGAN
KOMPLIKASI
RESPON TERHADAP OBAT
PENANGANAN KASUS PER
KASUSDISESUAIKAN DENGAN KLASIFIKASI DAN
RESPON

PATHOPHYSIOLOGY
Chemical mediators
Bronchoconstriction, mucosal edema, exes.secret
Airway obstruction
Atelectasis

Hyperinflation
Acidosis
Pulmonary
vasoconstriction

Nonuniform
ventilation

Hyperinflation

Mismatching V/P

Decreased
compliance

Alveolar
Hypoventilation

PaCO2
PaO2

Increased work
of breathing

KLASIFIKASI EKSASERBASI
RINGAN

SEDANG

BERAT

ANCAMAN
HENTI NAPAS

PARAMETER YANG DIJADIKAN

DASAR:
I.
KLINIS: AKTIFITAS, KEMAMPUAN
BICARA, POSISI, KESADARAN,
SIANOSIS, WHEEZING, SESAK,
OTOT BANTU, RETRAKSI,
FREKUENSI NAPAS, NADI DAN
PULSUS PARADOKSUS
II.
HASIL SPIROMETRIK (FEV1) DAN
FLOWMETER (PEFR)
III. GAS DARAH: SATURASI O2; Pa
O2; Pa CO2

LANJUTAN

LANJUTAN

1.
2.
3.
4.

MEREDAKAN OBSTRUKSI
MENGURANGI HIPOKSEMIA
MENORMALKAN FAAL PARU
MERENCANAKAN
PENANGANAN JANGKA
PANJANG SESUAI KLASIFIKASI
PENYAKIT

LANJUTAN

LANJUTAN

LANJUTAN