Emergency Troley

Manfaat

Manfaat:
Reaksi cepat dalam kondisi darurat

Meyakinkan kelengkapan tersedia

Kemudahan akses dan transportasi

1. Oxygen

2. Drugs for cardiac disorders

3. Drugs for poisoning

4. Drugs for shock

5. Drugs for hypertensive crisis and pulmonary edema

Beberapa Obat Obatan Dalam Ruang OK

Sediaan : 50mg/cc, 1 ampul isi 2 cc

PETHIDIN Pengenceran : 2 cc + 8 cc NaCl o,9%
10 cc = tiap cc pengenceran
mengandung 10 mg
Dosis : 0,5-1 mg/kgBB

Sediaan : 0,05mg/cc, 1 ampul isi 2 cc

FENTANYL Pengenceran : 2 cc + 8 cc NaCl o,9%
10 cc = tiap cc pengenceran
mengandung 10 mcg
Dosis : 0,5-1 mg/kgBB
Sediaan : 10mg/cc, 1 ampul isi 20 cc
PROPOFOL Pengenceran : Tanpa pengenceran
20 cc = tiap 1 cc mengandung
10 mg
2,25 mg/kgBB
Dosis :
Beberapa Obat Obatan Dalam Ruang OK

PETHIDIN Sediaan : 50mg/cc, 1 ampul isi 2 cc

Pengenceran : 2 cc + 8 cc NaCl o,9%
10 cc = tiap cc pengenceran
mengandung 10 mg
Dosis : 0,5-1 mg/kgBB

FENTANYL Sediaan : 0,05mg/cc, 1 ampul isi 2 cc

Pengenceran : 2 cc + 8 cc NaCl o,9%
10 cc = tiap cc pengenceran
mengandung 10 mcg
Dosis : 0,5-1 mg/kgBB
PROPOFOL Sediaan : 10mg/cc, 1 ampul isi 20 cc
Pengenceran : Tanpa pengenceran
20 cc = tiap 1 cc mengandung
10 mg
2,25 mg/kgBB
Dosis :
 Tanpa O2 dalam 6 mnt ; Brain death

 Tanpa O2 dalam 6 - 8 mnt ; mati klinis

 Tanpa O2 dalam 8 - 10 mnt ; mati biologis

 Untuk mengukur saturasi O2 ; Pulse oximeter

 What’s the ideal O2 saturation ? 95%

WAKTU DAN KERUSAKAN PADA OTAK
Butuh O2
 TATA CARA PEMBERIAN OKSIGEN

Pemberian oksigen selalu diberikan pada pasien dengan

penyakit jantung akut ataupun distress pernapasan.

Cara pemberian oksigen :

 Suplay osigen (dinding maupun silinder)

 Nasal kanul

 Face mask

 Venturi mask
 RUMUS
= (4 X KECEPATAN ALIRAN
OKSIGEN DALAM L/MENIT) + 21%

1 L/mnt = 25 %
2 L/mnt = 29 %
3 L/mnt = 33 %
4 L/mnt = 37 %
5 L/mnt = 41 %
6 L/mnt = 45 %
 Device Flow Rates Delivered O2

Nasal cannule 1 l/mnt 21 – 24 %

2 l/mnt 25 – 28 %
3 l/mnt 29 – 32 %
4 l/mnt 33 – 36 %
5 l/mnt 37 – 40 %
6 l/mnt 41 – 44 %

Simple oxygen face mask 6–10 l/mnt 35 – 60 %

Face mask with O2 6 l/mnt 60 %

reservoir 7 l/mnt 70 %
8 l/mnt 80 %
9 l/mnt 90 %
(nonrebreathing mask) 10–15 l/mnt 95 –100 %

Venturi mask 4–8 l/mnt 24 – 40 %

10–12 l/mnt 40 – 55 %
 Nitroglycerin – bekerja sebagai vasodilator
 Drugs of choice
 Angina pectoris

 Myocardial infarction

 SUBLINGUAL – 0.3-0.4 mg dapat diulang setelah 5 mnt (max: 3

doses)
 Translingual aerosol spray – 0.4 mg
 Should not be use along with Sildenafil (VIAGRA)
 MORPHINE SULFATE

 Narcotic analgesic

 diberikan pada nyeri dada ; MI

 Dose: 1-4 mg IV over 1 - 5 mnt dapat diulangi 5-30menit

hingga nyeri dada reda

 Adverse effects: respiratory depression and hypotension

 Naloxone (Narcan) Reverses the action of morphine

 ATROPINE SULFATE

 Menghambat aksi dari N. VAGUS

 bradycardia, asystole, AV block, Memperbaiki system
konduksi atrioventrikuler
 Bradikardi : 0,5 mg IV diulang setiap 3 – 5 menit (maksimal

0,003 – 0,004 mg/kgBB)

 Asistol : 1mg IV di flash dengan NaCl 0,9% sebamnyak 10 – 20

CC, tangan ditinggikan diulang setiap 3 – 5 menit

 Dosis melalui ETT 2 – 2,5 kali IV dengan cara pemberian sama

dengan adrenalin.
 Obat kelompok beta adrenergic – increase HR–for
HYPOTENSION
 monitor heart rate
 Improves perfusion of the heart and brain

 Bronchodilation

 Digunakan pada ; hypotensi, pulseless VT, VF, status

asthmaticus, asistole, PEA

 monitor cardiac and hemodynamics
 ADRENALIN/EPINEPHRINE

Bradikardi tidak stabil - tidak berespon dg atropine drip

 Dosis standar pada henti jantung 1 mg IV di flash dengan NaCl 0,9 %
sebanyak 10 – 20 CC lalu tangan ditinggikan diulang setiap 3 – 5
menit.

 Pemberian melalui ETT dosis 2 – 2,5 x dosis IV lalu dorong dg NaCl

0,9 % 10 CC lakukan hiperventilasi

 Dosis pada bradikardi tidak stabil 2 – 10 mcg/mnt

 Digunakan untuk Asidosis

 Dosis: 1meq/kg IV, may be repeated at 0.5meq/Kg every 10

mnt
 Anti
aritmia
1. MANNITOL
 Osmotic diuretic – for cerebral edema  may increase ICP
 initial dose – 0.5-1g/kg IV of 25% solution
 Note: highly irritating to the veins ; forms crystals

2. METHYLPREDNISOLONE
 Indication: spinal cord injury/cerebral edema
 Contraindications:
 HIV infection
 pregnancy
 Uncontrolled diabetes
 INGESTAN

 May be corrosive (alkaline and acid agents that cause tissue

destruction)
 Alkaline products:
products Lye, drain and toilet bowl cleaners,
bleach, non-phosphate detergents, button batteries
 Acid products: toilet bowl and metal cleaners, battery acid
 Poisoning Management
 Control the airway, ventilation and oxygenation.

 monitored for changes ; ECG, VS, and neurologic status

 Note for

Amount, time since ingestion, signs and symptoms, age and

weight, health history are determined.
 Insert Foley catheter - to monitor renal function

 blood examinations - test for poison concentration

 Treat SHOCK
 CATATAN
Ingestion of corrosive poison
 give water or milk - for dilution
 not attempted if patient has acute airway obstruction, or if
with evidence of gastric or esophageal burn or perforation.
 Ipecac syrup - induce vomiting in the alert patient
 Gastric lavage for the obtunded patient
 aspirate is tested
 Activated charcoal administration if poison can be
absorbed by it
 Cathartic - when appropriate
 Ingested Poison Warnings!!!

 Vomiting is NEVER induced after ingestion of caustic

substances or petroleum distillates.

 Contact poison control center - PGH

 if an unknown toxic agent has been taken

 if it is necessary to identify an antidote for a known toxic

agent.
 OBAT-OBAT KERACUNAN

1. NALOXONE – anti-dote for opiates overdose

2. FLUMAZENIL – reverses respiratory depression

secondary to benzodiazepines

3. ATROPINE - reverses organophosphate poisoning

OBAT
SHOCK
 Epinephrine:

 α-adrenergic effects can increase coronary and cerebral

perfusion pressure by vasoconstriction

 β-adrenergic can increase myocardial contractility

 Given 1 mg per IV/IO every 3-5 minutes

 Sympathomimetic
 For hypotension (shock)
 It can increase HR when atropine has not been effective
 Dose: 1-20 mcg/kg/min (in 250ml D5W)
 Wean patient gradually – can result to severe hypotension if
abruptly stopped
 sympathomimetic with beta 1 effects (inc. heart rate)

 no vasoconstriction, only increase cardiac output

 dose: 250-1000mg in 250ml D5W or NSS

 An extremely potent vasoconstrictor

 Given when dopamine and dobutamine have failed

 Dose: 4-8mg to 250ml d5w or nss and infused at 0.5-30mcg/min

 ANAPHYLACTIC SHOCK
 ALBUTEROL ; Reverses bronchoconstriction

 administered via nebulizer

 side effects: tremors, tachycardia, dysrhythmia, hypertension

 DIPHENHYDRAMINE

 Anti-histamine

 Reduce histamine induced tissue swelling and pruritus

 25-50mg IV or deep IM
 DEFINISI
 Krisis hipertensi : Peningkatan hebat TD melebihi 120 mmHg

dengan disertai Gejala Kerusakan Organ Target berhubungan

dengan peningkatan TD

 Hipertensi Emergensi adalah Hipertensi berat (TD Sistolik > 160

mmHg atau / dengan TD Diastolik > 100 mmHg) yang

bermanifestasi dengan gejala gangguan organ target.

 Hipertensi Urgensi adalah Hipertensi berat tanpa gejala gangguan

organ target  perlu diturunkan dalam waktu tidak terlalu lama.

Klasifikasi Tekanan Darah >= 18 th tanpa Pengobatan
Anti-hipertensi atau tidak dalam Keadaan Akut
 Normal : TD sistolik < 120 mmHg
TD diastolik < 80 mmHg

 Pre Hipertensi : TD sistolik 120mmHg – 139 mmHg,

TD diastolik 80 – 89 mmHg

 Hipertensi : TD sistolik 140 – 159 mmHg, atau

Stadium I TD diastolik 90 – 99 mmHg

 Hipertensi
Stadium II : TD sistolik ≥ 160, atau
TD diastolik ≥ 100 mmHg
 Penatalaksanaan krisis hipertensi
KRISIS HIPERTENSI

HIPERTENSI EMERGENSI HIPERTENSI URGENSI

OAH iv (Klonidin dlm D 5%) Diuretik Loop

Furosemid iv Beta blocker
ACE Inhibitor
Ca Antagonist

Turun MAP ≤ 25 % TD 160/100 mmHg

Ganti dgn OAH oral
 DRUGS FOR
HYPERTENSIVE CRISIS
 LABETALOL
 Beta blocker

 Lowers heart rate, BP, myocardial contractility, and

myocardial O2 consumption
 Dose: 10mg IV push for 1-2 min

 (max dose: 150mg)

 Contraindicated in patients with Asthma
 DRUGS FOR
HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDE
 Mengurang (Reduces) tekanan darah arteri

 Effect: immediate vasodilation and BP goes down but

immediately goes up once the drug is stopped

 DRUGS FOR
HYPERTENSIVE CRISIS
 SODIUM NITROPRUSSIDE
 inactivated by light – wrap in aluminum foil

 Blue or brown discoloration – means drug is degraded

 prolonged use – can lead to cyanide poisoning

 FUROSEMIDE
 loop diuretic

 For acute pulmonary edema due to left ventricular

dysfunction or hypertensive crisis

 diuresis may start within 20 mins

 Adverse effects: hypotension, dehydration and electrolyte

imbalances
 dapat menyebabkan reaksi alergi