RESUSITASI
CAIRAN Kegawatan
&
ELKTROLIT
Kematian
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GANGGUAN TERSENDIRI
TERAPI BERBEDA
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• Tergantung : - Umur
- Jenis kelamin
Pria > Wanita (>> lemak)
Dinding Kapiler
(selapis endotel)
Mudah dilalui
Intraseluler InterstisialIntravaskuler Air & molekul kecil
40% 15% 5% tetapi
3L Tidak untuk
24 L 9 L
Molekul besar :
Koloid, protein plasma
& eritrosit
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DISTRIBUSI CAIRAN
RL
NaCl 0,9%
Koloid
40 % 15 % 5% Protein plasma
Darah
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Bila penderita 65 kg :
Kebutuhan cairan dalam 24 jam adalah
65 x 35 ml = 2.000 ml / 24 jam
Bila penderita febris tiap kenaikan suhu 1oC
kenaikan kebutuhan cairan sebanyak 10-15%
dari total kebutuhan
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Kebutuhan K + : K + x BB x 0,4
- Kecepatan pemberian max 20 mEq/jam
- atau 200 mEq / 24 jam
- Produksi urine 1 ml / Kg BB / jam
- 1 – 2 mEq / Kg BB / 24 jam
Kebutuhan Na + : Na + x BB x 0,6
- 2 – 3 mEq / Kg BB / 24 jam
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2. Cairan defisit
- Jumlah kekurangan cairan yang sebelum tindakan
- Dpt terjadi pd dehidrasi atau hipovolemik akibat
puasa, kombutsio, atau perdarahan akut.
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Lanjutan….
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DEHIDRASI
• Defisit cairan interstitiel dengan gejala :
- turgor kulit yang jelek
- mata cekung
- ubun-ubun cekung (bayi & anak)
- mukosa bibir dan kornea kering
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ETIOLOGI DEHIDRASI
• “Intake” kurang :
- Tidak minum & makan (puasa)
• “Output” banyak :
- Penguapan via kulit & paru-paru (febris atau
keringat >>>)
- Muntah-muntah
- Diare
- Translokasi air & elektrolit (ileus obstruksi
& peritonitis
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TANDA DEHIDRASI
DEHIDRASI RINGAN SEDANG BERAT
• CNS - Ngantuk, Apatis Refleks tendon
Respon lambat Stupor sp.
Anorexia Coma
Aktifitas turun
• Kardiovaskuer Takikardi Takikardi, Cianosis,
Hipotensi Hipotensi
ortostatik Akral dingin
Nadi lemah Nadi perifer tak
Vena kolaps teraba
Detak jantung
jauh
• Jaringan Mukosa lidah Lidah kecil, Atonia, mata
kering lunak, cowong
Turgor Turgor Turgor
• Urine Pekat Pekat, kurang Oligouria
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JENIS-JENIS DEHIDRASI
3. Dehidrasi isotonik
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24 9 3
+ 4 L crystalloids + 4 L colloids
+ 4 L dextrose
24 12 4 24 8 7
28 9 3
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PERDARAHAN
PERDARAHAN SYOK HIPOVOLEMIK
KONSEKUENSI
SHOCK TIME METABOLIK BI
OMLEKULER
RESUSITASI CAIRA
N
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AVAILABLE O2 = CO x CaO2
RUMUS NUNN-FREEMAN
CaO2 = (Hb x Saturasi O2 x 1,34) + (pO2 x 0,003)
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Normal Hb = 15 gr%
SaO2 = 100%
CO = 5 liter
Jadi Available = 50 x 15 x 1 x 1,34
= 1005 ml/menit
Kompensasi
Hb turun = 5 gr%
SaCO2 = tetap
CO = naik 3 kali
Jadi Available = 150 x 5 x 1 x 1,34
= 1005 ml/menit
Dulu Hb 10 gr%
Sekarang Hb 7-8 gr%
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PATOFISIOLOGI PERDARAHAN
PERDARAHAN
KEHILANGAN VOLUME
(gangguan curah jantung & perfusi)
dan
KEHILANGAN HEMOGLOBIN
(gangguan oksigenasi jaringan)
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• Resusitasi
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TERAPI CAIRAN
Resusitasi Rumatan
Air + Elektrolit +
Kristaloid Koloid Nutrisi
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Rumatan / Kg / Hari
AIR Na K NUTRISI
30-50 m 2-4 mEq 1-2 mEq
l
KALORI PROTEIN
20-30 KCal 0,5-1 gr
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Dewasa Anak-anak
Sesuai berat badan
Cairan 30-50 cc / Kg BB
(4-2-1)
Natrium 2-3 mEq / Kg BB 2-4 mEq / Kg BB
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Rumatan Extra
Normal 30-50 ml / Kg
asupan
oral
Demam
IWL Kehilangan
abnormal
Normal
pengerluaran 0,5 ml / Kg
urine
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PILIHAN CAIRAN
1. Cairan kristaloid
a) NaCl 0,9%
b) Ringer laktat
c) Ringer asetat
2. Cairan koloid
Alami : plasma, albumin
Buatan : gelatin, strach
3. Cairan hipertonik + Dextran
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DEFISIT
5%
4% :: haus,
haus,mukosa
mukosa kering
kering
5-10% : turgor,
8% : turgor, tensi,
tensi, nadi
nadi
>10% : SHOCK, urine = 0
>12% : SHOCK, urine = 0
REHIDRASI
50% 50%
8 jam 50% 50%
16 jam
8 jam 16 jam
++ Maintenance
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1 2
Usus
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Infus
I II III
I = rehidrasi cepat
II = rehidrasi lambat
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Rehidrasi cepat
RL/NS cepat
Bolus 20 mL/kg dalam 30-60 menit
Kalau perlu diulang
Cairan
Intravaskuler
stabil
Tensi >100, nadi <100
Perfusi hangat kering
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Ileus
Peritonitis
Defisit cairan
ekstraseluler
Dextrose RL/NS
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Cairan hipertonik
Darah : transfusi
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ALGORITME PERDARAHAN
PENDERITA PERDARAHAN
TERUSKAN CAIRAN
Tekanan darah > 100, nadi < 10 2-4 X lost volume
0
Perfusi hangat, kering
Urine > ½ ml / kg / jam
HEMODINAMIK BAIK HEMODINAMIK BURUK
A
B C
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Bleeding
RL 2-4 x loss
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1. Pemeriksaan fisis
2. Evaluasi laboratorium
3. Pemantauan hemodinamik
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PEMERIKSAAN FISIS
Hipovolemik
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PEMERIKSAAN FISIS
Hipervolemik
Pitting Edema
Takhikardi
Ronchi Paru
Sekresi Jalan Napas yang Berbusa
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EVALUASI LABORATORIUM
Hipovolemik :
Ht meningkat
Asidosis metabolik progresif
BJ urine > 1,010
Na urine < 20 mEq/l
Osmolaritas urine > 450 mosm/kg
Hipernatremia
BUN : Kreatinin > 10 : 1
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CAIRAN INTRAVENA
Terdiri atas :
- Larutan Kristaloid
- Larutan Koloid
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KEBUTUHAN RUMATAN
• Dewasa : 35 – 40 ml / kgBB / 24 jam
• Anak :
Berat Dosis
10 kg pertama 4 ml / kgbb / jam
10 – 20 kg selanjutnya + 2 ml / kgbb / jam
> 20 kg + 1 ml / kgbb / jam
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Didapatkan dari :
Kebutuhan Rumatan x Lama Puasa
Defisit cairan :
Normal urine, GI, Insensible water lose
Abnormal perdarahan, muntah, dll.
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Kehilangan darah
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KEHILANGAN DARAH
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Redistribusi Internal :
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o Jenis cairan
Kristaloid: RL , Rasio 3 – 4 x Jumlah Darah yang hilang
Koloid : Rasio = 1 : 1
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LANJUTAN…
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LANJUTAN…
2. Perkirakan volume sel darah merah sebelum
operasi :
RBCV 35% = 5525 x 35% = 1934 ml
3. Perkirakan volume sel darah merah dgn Ht 30%
RBCV 30% = 5525 x 30% = 1657 ml
4. Hitung volume sel darah merah hilang
Jumlah kehilangan sel darah merah = 1934 – 1657
= 277 ml
5. Jumlah cairan darah hilang= RBCV x 3
= 277 x 3 ml
= 831 ml
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TERIMA
KASIH
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