tetanus anestesi.pptx
-
Upload
nola-soendang-dewi -
Category
Documents
-
view
236 -
download
0
Transcript of tetanus anestesi.pptx
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 1/35
PENANGANANKEGAWATDARURATAN PADA
TETANUS
1. THEODORA PURBA 110100267
2. NOLA SOENDANG DEWI 1101001543. SIRI GANESAN CHANDRAN 110100473
Super!"#r$dr. Soejat Harto, SpAn. KAP
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 2/35
LATAR BELAKANG
• Te%&'u" &(&)&* "u&%u %#+"e,!& &+u% -&'(!"e/&/+&' #)e* 'eur#%#+"!' -&'
(!*&"!)+&' #)e* C)#"%r!(!u, %e%&'! (!%&'(&!(e'&' "p&",e #%#% -&' per!#(!+ (&'/er&%.
• #r%&)!%&" %e%&'u" ,e)e/!*! 50 (e'&'
per+!r&&' u,)&* +e,&%!&' 00.0001.000.000 #r&' per %&*u' "e/&!&' /e"&rp&(& 'e#'&%u".23 e,&%!&' %e%&'u"'e#'&%u" (!per+!r&+&' "e/e"&r 24.000+e,&%!&' per %&*u'
LATAR BELAANG
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 3/35
DISTRIBUTION
I%" #8%e' 9&))e( %*e "!)e'% +!))er "!'9e!'8&'%" #8%e' (!e /e8#re %*e!r /!r%* !"
re9#r(e(.
EPIDEIOLOGI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 4/35
DEFINISI
•
Te%&'u" &(&)&* "u&%u %#+"e,!& &+u%-&' (!"e/&/+&' #)e* 'eur#%#+"!'-&' (!*&"!)+&' #)e* C)#"%r!(!u, %e%&'!(!%&'(&! (e'&' "p&",e #%#% -&'per!#(!+ (&' /er&%.
• Te%&'u" /!&"&'-& &+u% (&',e'!,/u)+&' p&r&)!%!+ "p&"%!+ -&'(!"e/&/+&' %e%&'#"p&",!' -&'
,erup&+&' 'eur#%#+"!' -&'(!pr#(u+"! #)e* C)#"%r!(!u, %e%&'!.
• C!r! u%&,& (&r! %e%&'u" &(&)&*
+e+&+u&' #%#% :"p&",e; %&'p& (!"er%&!
DE<INISI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 5/35
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 6/35
CAUSATI?E AGENT
• Clostridium tetani
Left. Staned p!" fro# a #$ed anaero%& nfe&ton. At 'ea"t t(reed)erent &'o"trda are apparent.
R*(t. E'e&tron #&ro*rap( of +e*etat+e Clostridium tetani &e''".
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 7/35
PATOGENESIS DANGEALA KLINIS
PATOGENESIS DAN GE@ALALINIS
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 8/35
DIAGNOSISDIAGNOSIS
A'&,'e"!"
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 9/35
S+#r A/)e%%Gr&(e I :r!'&';
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 10/35
S+#r D&+&r
S+#r 1 S+#r 0
&"& !'+u/&"! 7 *&r! 7 *&r!
A>!%&' pe'-&+!% 4 &, 4 &, Te,p&% ,&"u+ T&)! pu"&% u%eru"
8r&+%ur %er/u+&
p#"%#per&%!8 /e+&"
"u'%!+&' I
Se)&!' %e,p&%
%er"e/u%
Sp&",e :; :;P&'&" /&(&' :per
re+%&);
34 0C 34 0C
T&+!+&r(!& (e>&"& 120 F,e'!% 120 F,e'!%
Ne#'&%u" 150 F,e'!% 150 F,e'!%
T!'+&% @u,)&* S+#r Pr#'#"!"
,#r%&)!%&" :;
R!'&' 01 20
Se(&' 23 10 20
Ber&% 4 20 40S&'&% /er&% 56 50
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 11/35
S+#r P*!))!p
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 12/35
PENATALAKSANAAN
1. Ter&p! "up#r%!8 &>&)
2. &'&e,e' )u+&
3. e'*e'%!+&' pe)ep&"&' %#+"!' (!(&)&, )u+&
4. e'e%r&)!"&"! %#+"!' -&' /e)u,
%er!+&%.5. #'%r#) ,&'!8e"%&"! +)!'!" pe'-&+!%
&+!/&% %#+"!' -&' "u(&* %er!+&%
PENATALASANAAN
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 13/35
KO-PLIKASI
S"te# or*an Ko#p'a"
@&)&' '&p&" A"p!r&"! "p&",e )&r!' #/"%ru+"! %er+&!%
pe'u'&&' "e(&%!8.
Re"p!r&"! Ap'eu *!p#+"!& &&) '&p&" %!pe I (&' II
ARDS +#,p)!+&"! &+!/&% e'%!)&"! ,e+&'!" &'+& p&'&' :,!"&)'-& p'eu,#'!&;
+#,p)!+&"! %r&+e#"%#,!.&r(!#&"+u)&r T&+!+&r(!& *!per%e'"! !"+e,!& *!p#%e'"!
/r&(!+&r(!& &r!%,!& &"!"%#) &&) &'%u'.Re'&) G&&) !'&) !'8e+"! (&' "%&"!" ur!'.
G&"%r#!'%e"%!'&) S%&"!" !)eu" per(&r&*&'.
u"+u)#"+e)e%&) R&/(#,!#)!"!" ,-#"!%!" #""!9&'" 9!r9u,"9r!p%&
8r&+%ur &+!/&% "p&",e.L&!')&!' Pe'uru'&' /er&% /&(&' %r#,/#e,/#)!",e
"ep"!" "!'(r#, (!"8u'"! ,u)%!#r&'.
OPLIASI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 14/35
PEN/EGAHAN
1. Per&>&%&' )u+& -&' &(e+u&%
2. I,u'!"&"! &+%!8 (&' p&"!8
I,u'!"&"! &+%!8 (!)&+u+&' (e'&',e,/er!+&' %e%&'u" %#+"#!( :TT; -&'/er%uu&' ,er&'"&' %u/u* u'%u+,e,/e'%u+ &'%!%#+"!'.
I,u'!"&"! &+%!8 (&p&% (!,u)&! "e&+&'&+ /eru"!& 2 /u)&' (e'&' pe,/er!&'!,u'!"&"! DPT &%&u DT. U'%u+ #r&'
(e>&"& (!u'&+&' %e%&'u" %#+"#!( :TT;.
PENCEGAHAN
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 15/35
@&(>&) I,u'!"&"! A+%!8 Ter*&(&p Te%&'u"
B&-! (&' &'&+ '#r,&). I,u'!"&"! DPT p&(& u"!& 246
(&' 151 /u)&'.
D#"!" +e5 (!/er!+&' p&(& u"!& 4
6 %&*u'.
Sepu)u* %&*u' "e%e)&*'-& :u"!&
1416 %&*u'; (!/er!+&' !'e+"! TT(&' (!u)&' "e%!&p 10 %&*u' "e+&)!.
B&-! (&' &'&+ '#r,&) "&,p&! u"!&
7 %&*u' -&' %!(&+ (!!,u'!"&"!
p&(& ,&"& /&-! &>&).
DPT (!/er!+&' p&(& +u'u'&'
per%&,& +e,u(!&' 2 (&' 4 /u)&'
"e%e)&* !'e+"! per%&,&.
D#"!" +e4 (!/er!+&' 612 /u)&'"e%e)&* !'e+"! per%&,&.
D#"!" +e5 (!/er!+&' p&(& u"!& 4
6 %&*u'.
Sepu)u* %&*u' "e%e)&*'-& :u"!&
1416 %&*u'; (!/er!+&' !'e+"! TT
(&' (!u)&' "e%!&p 10 %&*u' "e+&)!.
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 16/35
ad0a' I#!n"a" AtfTer(adap Tetan!"
Usia ≥ 7 tahun yang belum pernah
diimunisasi.
Imunisasi dasar terdiri dari 3 injeksi
TT yang diberikan pada kunjungan
pertama, 4-8 minggu setelah injeksi
pertama, dan 6-! bulan setelah injeksi
kedua.
Injeksi TT diulang setiap " tahun
sekali.
Ibu hamil yang belum pernah diimunisasi. #anita hamil yang belum pernah
diimunisasi harus menerima ! d$sis
injeksi TT dengan jarak ! bulan %lebih baik pada ! trimester terakhir&.
'etelah bersalin, diberikan d$sis ke-3
yaitu 6 bulan setelah injeksi ke-! untuk
melengkapi imunisasi.
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 17/35
Pand!an pe#%eran pro1'a""tetan!" pada pa"en tra!#a
Riwayat imunisasi
tetanus sebelumnya
Luka rentan tetanus Luka tidak rentan tetanus
TT HTIG TT HTIG
Tidak diketahui atau ( 3 )a )a )a Tidak
≥ 3 d$sis Tidak
%ke*uali ≥ +tahun sejak
d$sis terakhir&
Tidak Tidak
%ke*uali ≥ " tahunsejak d$sis
terakhir&
Tidak
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 18/35
Pand!an pe#%eran pro1'a""tetan!" pada pa"en tra!#a
• U'%u+ &'&+ 7 %&*u' (&p&% (!u'&+&' DPT"e/&&! pe'&'%! TT.
• D#"!" pr#)&+"!" HTIG -&'
(!re+#,e'(&"!+&' &(&)&* 250 IU (!/er!+&'!'%r&,u"+u)&r.
• Ap&/!)& %!(&+ %er"e(!& HTIG (&p&%(!u'&+&' &'%! %e%&'u" "eru, :ATS; -&'/er&"&) (&r! "eru, +u(& (e'&' (#"!"30006000 IU.
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 19/35
LAPORAN ASUS
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 20/35
ANA-NESIS
T!an W, 22 ta(!n
KU 3 KEANGTELAAH 3 Ha' n da'a# pa"en "eja 4(ar "e%e'!# #a"! r!#a( "at. Kejan*
%er'an*"!n* ter!" #ener!" tanpa d"ertapen!r!nan e"adaran. Kejan* ran*"an*dj!#pa. Waja( #en5ern*a dj!#pa.
L#a (ar 5an* 'a'!, a anan pa"en
tert!"! d!r e'apa "a0t d %e'aan*
r!#a(n5a. G* (ta# dan %er'!%an*dj!#pa. Pa"en "!da( #endapatperto'on*an perta#a dar RS SUR6A Bnja,dan dr!j! e RSUP H. Ada# -a' -edan.BAB dan BAK da'a# %ata" nor#a'.
RPT $ T!(&+&(&RPO $•e%r#'!(&J#)•D!&Jep&,• ATS• R&'!%!(!'• O'(&'"e'%r#'
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 21/35
TI-E SE7UEN/ES
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 22/35
Pe#er"aan F" B4 $ &!r>&- 9)e&r (e'&' ETT N#. 7.5 9uK
%erp&"&' RR$ 20F,e'!% SP $ e"!+u)er ST $ SFGFC FF R!> &",&F"e"&+F/&%u+F&)er! $FFF M LP $ IB8 $ &+r&) $ HFPF TD $ 120F0 HR $ 0100F,e'!% TF?$ 9u+up CRT 2 (e%!+ T $37.2CB9 $ Se'" $ DPO M pup!) $ !"#+#r (!&,e%er +!r!
3,,F +&'&' 3,,M RC$ FB: 3 BA :; #) $ 5099 F &, >&r'& $ +u'!'er'!*B; $ &/(#,e' $ "#epe) per!"%&)%!+ '#r,&) ,u&)
,u'%&* :;
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 23/35
port de entr5
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 24/35
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 25/35
L
ABOR
ATORIU-
PEMERIKSAANHASIL RUJUKAN
HEMATLGI
Hem!"l!bin #HG$% &'() "* &&(+,&-(-
Leuk!sit #.$/% 001234 mm' 5(-,&&(46&4'
Hemat!krit 50* '),-5*
Tr!mb!sit #PLT% 0+' 6 &4' &-4,5-46&4'
7AAL HEMSTASIS
PT &51- #&'1)% detik
APTT 0210 #'012% detik
TT &01) #&+% detik
INR &14-
GINJAL
Ureum5' m"8dL &29-- m"8dL
Kreatinin &10& m 8dL 4 +,& ' m 8dL
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 26/35
L
ABOR
ATORIU-
PEMERIKSAAN
HASIL RUJUKAN
ELEKTRLIT
Natrium #Na% &52 mE:8L &'-,&-- mE:8L
Kalium #K% 5(0 mE:8L '(3,-(- mE:8L
Kl!rida #/l% &4+ mE:8L )3,&43 mE:8L
META$LISME KAR$HI;RAT
Gluk!sa ;ara< #Sewaktu% &0+ m"8dL =044 m"8dL
HATI
A'%!#n 9,; *<dL 9,;=;,>
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 27/35
PE-ERIKSAANPENUNANG
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 28/35
PENANGANAN AWAL DIIGD 3
o
embebaskan jalan naas dengan melakukan intubasi TT n$ 7,+ *u.o /emasangan I0 line dengan b$re besar yakni 6 1, 8 1 untuk melakukan resusitasi
dan persiapan $perasi
o /emasangan kateter urine dan memantau urine $utput
o /emasangan 21T
o enilai derajat kelas perdarahan
o I0 5-'2
o
Inj 5anitidin +"mg! jamo Inj etria9$n gr! jam
o Inj ket$r$la* 3" mg 8 jam
o /emeriksaan lab$rat$rium, $t$ th$raks, head *t-s*an, *r$ss mat*h, dan persiapan
darah
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 29/35
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 30/35
S $ e&'
O $B1 $ &!r>&- 9)e&r (e'&' ETT N#. 7.5 9uK %erp&"&' RR$ 16F,e'!% SP $ e"!+u)er ST $ SFGFC FF R!>&",&F"e"&+F/&%u+F&)er! $ FFF M LP $ I
B2 $ &+r&) $ HFPF TD $ 110F60 HR $ 0100 F,e'!% TF? $ +u&%F9u+up CRT$ 2 (e%!+ T $ 364CB3 $ Se'" $ DPOM pup!) $ !"#+#r (!&,e%er +!r! 2 ,,F+&'&' 2 ,,M RC$ FB4 $ BA :; #) $ 5099F&, >&r'& $ +u'!' er'!*B5 $&/(#,e' $ "#epe) per!"%&)%!+ :; '#r,&)B6 $ #e(e,:; 8r&+%ur $ :;
4? Fe%r!ar 8>42
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 31/35
A$Pe'uru'&' e"&(&r&' e% 9&u"& Te%&'u"
P $I?<D RL 20 %%F!I?<D <e'%&'-) 200 ,9 (&)&, 50 99 N&C) 0 599F&,
I?<D D!&Jep&, 299F&,I?<D R#9ur#'!u, 399F&,I' e%r#'!(&J#) 500,F &,ATS :(e/r!(e,e'%; 1500 IUI' R&'!%!(!'e 50,F12 &,I' PCT 1 r :+Fp;?!% C 1 rF24 &,
DISKUSI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 32/35
DISKUSI
No. Ka"!" Teor
1. P&"!e' )&+!)&+! /eru"!& 66 %&*u'. Ep!(e,!#)#!
I'"!(e' (&' ,#r%&)!%&" )e/!*
%!'! p&(& +e)#,p#+ u"!&
'e#'&%u" (&' 50 %&*u'
(!/&'(!'+&' +e)#,p#+ u,ur
)&!'.
2. &+! +&'&' p&"!e' %er%u"u+ (ur! +e)&p& "&>!%
(! /e)&+&' ru,&*'-&.
E%!#)#!
Sp#r& C)#"%r!(!u, %e%&'!
/!&"&'-& ,&"u+ +e(&)&, %u/u*,e)&)u! )u+& p&(& +u)!% #)e*
+&re'& %erp#%#' %er%u"u+
&%&upu' )u+& /&+&r "er%& !'8e+"!
%&)! pu"&% :%e%&'u" 'e#'&%#ru,;.
DISUSI
NO KASUS TEORI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 33/35
3 Pe,er!+"&&' -&' (!u,p&! p&(&
p&"!e'$
- R!>&-&% )u+& :;$ %er%u"u+ (ur!
p&(& +&+! +&'&' !! *!%&, (&'
/er)u/&'
- Ge&)& +)!'!"$ %r!",u" r!"u"
"&r(#'!9u"
Pe'e&+&' (!&'#"&
D!&'#"!" (&p&% (!%e&++&' (&r!
&,/&r&' +)!'!" (&' &(&'-& r!>&-&%
)u+& -&' ,e'(&*u)u!. T!(&+ &(& %e"
)&/#r&%#r!u, -&' (&p&%
,e'e&++&' (!&'#"& p&"%! %e%&'u".
WHO ,e'(e'!"!+&' pe'-&+!%
%e%&'u" p&(& (e>&"& -&!%u "e+ur&'
+ur&''-& %er(&p&% "&%u (&r! %&'(&
%&'(& /er!+u% $ %r!",u" &%&u r!"u"
"&r(#'!9u" &%&u +#'%r&+"! #%#% -&'
"&'&% '-er!.
W&)&upu' (e'!"! !'! ,e,!'%&
%er(&p&%'-& r!>&-&% )u+& &%&u +&+u
%e%&'u" u& /!"& %er&(! p&(& p&"!e'
-&' %!(&+ ,e,!)!+! r!>&-&% )u+&
-&' "pe"!+.
N KASUS TEORI
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 34/35
O
4. Pe'&%&)&+"&'&&' A>&)
• A!r>&-$ A!r>&- 9)e&r %er!'%u/&"! ETT N#.75 9uK
9"p!'e "%&/!)
• Bre&%*!'$ RR 16F! O+"!e' !& ETT LF! S&O2
• C!r9u)&%!#'$ C&p!))&r- Re)) T!,e 2 (e%!+ A+r&)$
HFPF TF? +u&%F9u+upTD$ 120F0 ,,H HR$0
100 F,e'!% reu)&r (!)&+u+&' pe,&"&'&' I?
)!'e (e'&' &//#9&%* 20G (&' (!/er!+&' I?<D RL
• D!"&/!)!%-$ e"&(&r&'$ GCS DPO A?PU$
u're"p#'"!e pup!) $ 3 ,, $ 3 ,, !"#+#r
RC $ F
• Ep#"ure$ 8r&+%ur :; #e(e,&:;
Pe'&%&)&+"&'&&' A>&)
• A!r>&- $ Sp&",e )&r!' (&p&% %er&(!
"eer& ,e'&+!/&%+&' #/"%ru+"!
"&)ur&' '&8&" &%&" &+u% (&'
re"p!r&%#r- &rre"%.
• Bre&%*!' $ Per'&p&"&' (&p&%
%erpe'&ru* &+!/&% "p&",e -&'
,e)!/&%+&' #%#%#%#% (&(&. Se)&,&
"p&",e -&' ,e,&'&' (&p&%
%er&(! *!p#e'%!)&"! /er&% (&' &p'e&
-&' ,e'&'9&, '-&>&. T&'p&
8&"!)!%&" e'%!)&"! ,e+&'!+ &&)
'&8&" &+!/&% "p&",e #%#% &(&)&*
pe'-e/&/ +e,&%!&' p&)!' "er!'
• C!r9u)&%!#'$ Pe,/er!&' 9&!r&'
!'%r&e'&
• D!"&/!)!%-$ <u'"! 'eur#)#!"
(!e&)u&"! u'%u+ (e"!% "er!u" -&'
,e)!/&%+&' #%&+ (&' "u,"u, %u)&'
/e)&+&'.
7/25/2019 tetanus anestesi.pptx
http://slidepdf.com/reader/full/tetanus-anestesipptx 35/35
SEIAN DAN TERIAASIH