Co-Assistant:
Sasmiza 1161050078
Pembimbing :
dr. Christofel Panggabean, Sp.OG-KFM
Fakultas Kedokteran
Universitas Kristen Indonesia
MASALAH UTAMA
Perdarahan
Intermediate antepartum
Dan HDU
prematur
Sepsis
ICU
Gagal nafas
Postpartum akut
maternal
1%
0% dan 5%
8/1000
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Angka Morbiditas
4/1000 14/1000
Kanada
(1991-2001) (2003-2007)
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Terapi penuh atau
pasien post operasi
antepartum
KOMPLIKASI
<36 minggu
(31-32 minggu)
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Level ICU dewasa menurut The American College of Critical Care
Medicine (ACCM)
Level I :
RS pusat, komprehensif, perawatan khusus,
teknologi canggih (tabel peralatan &pendukung ICU)
Level II :
Komprehensif, spesialis kurang lengkap
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Peralatan dan pendukung ICU
Monitor ECG (99%) Beds removeable Capnography
Monitor tekanan Cahaya ruang yang Bronkoskopi fiberoptik
arteri (51%) cukup Monitor tekanan
Monitor tekanan vena Suction intrakranial
central Selimut Monitor EEG
Transcutaneous Timbangan Tekanan + dan ruang
oxygen/Pulse Alat pacu jantung isolasi
oximetry (33%) Alat pemantau suhu Akses informasi segera
Alat bantu nafas Montior tekanan arteri (buku petunujuk RS)
Alat ventilator pulmonalis
Alat resusitasi darurat Monitor cardiac output
Alat hemodinamik Dialisis dan ultrafiltrasi
pasien Dialisis peritoneal
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Observer per jam
u/:
o Input/output
o Vital signs
o Neurologi
Komplikasi:
Gagal nafas
e.c infeksi
saluran nafas
(ventilator)
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
The American College of Obstetricians and Gynecologists,
jointly with the Society for Maternal-Fetal Medicine tentang
Fasilitas Perawatan Maternal
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Tingkat Perawatan Critical Care
Menurut Kelompok Maternal
Tingkat Perawatan Contoh Maternal
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Parameter Objektif Kriteria Penerimaan ICU
Hasil Lab:
Sodium s: <110/>170 mEq/L ECG:
Radiologi:
Pottassium s: <2.0/>7.0 Komplek aritmia,
Perdarahan
mEq/L CHF/ hemodinamik
serebroaskular,
PaO2 : <50 mmHg tidak stabil
kontusio, atau SAH
pH : <7.1/>7,7 Ventricel
Viscus ruptur/
Kalsium s: >15 mg/dL takikardia/
varises esofagus
Glukosa s: >800 mg/dL ventrikel fibrilasi
d/ hemodinamik
Level toxic obat secara Complete heart tidak stabil
hemodinamik atau block
Diseksi aorta
neurologis
aneurisma
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Keterampilan petugas kesehatan dalam critical
care:
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
SEPUTAR SEPSIS OBSTETRI
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Seputar Sepsis Obstetri
Penyebab
1. Infeksi uteri
1. Infeksi genitalia20%
2. Korioamnionitis
2. ISK 34%
dan
endomiometritis 3. Infeksi saluran nafas 9%
3. Aborsi septik 4. Tidak diketahui 30%
4. Luka infeksi
5. invasif
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Sepsis
Gold standars
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Formulir Diagnostik Kriteria Sepsis
Infeksi, dokumentasi atau suspek dan disertai:
Variabel General:
Demam (>38,3C)
Hipotermia ( <36C)
HR > 90/m atau >2 SD angka normal
Takipnea
Penurunan kesadaran
Edema signifikan/ gangguan keseimbangan
cairan (>20 mL/kgBB/24 jam)
Hiperglikemia (>140 mg/dL)
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Variabel Inflamasi :
1. Leukositosis (WBC>12.000/uL)
2. Leukopenia (WBC<4.000/uL)
3. WBC normal dengan neutrofil > 10%
4. Protein plasma C-reaktif > 2 SD
5. Prokalsitonin plasma . 2SD
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
* Modifikasi pada kehamilan
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Klasifikasi dan Kriteria Terbaru Sepsis
(Sepsis-3)
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Tatalaksana Sepsis (2012)
Antimikroba spektrum luas 1 jam
(7-10 jam)
J
Antibiotik spektrum luas A
M
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Core Bundles for Management of Sepsis
(SSC)
resusitasi cairan vasopresor
Berghella Vincenzo. Maternal-Fetal Evidence Based Guidelines. Third Edition. CRC Press. Philadelphia. 2017. 349-363
Sindrom Distress Pernafasan Akut
3/10.000 postpartum