Gagal Nafas & Kedaduratan Sis.resp
Transcript of Gagal Nafas & Kedaduratan Sis.resp
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DR. FACHRUL JAMAL, SpAn. KIC.
DEPT.ANASTESI & PERAWATAN INTENSIVE. FK-USK/RSUZA
BANDA ACEH
KEDADURATAN
SISTEM RESPIRASI
DAN GAGAL NAFAS
AKUT
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ANATOMY OF RESPIRATORY
SYSTEM
I. Upper Respiratory System
1. Nose and mouth2. Nasopharynx
3. Oropharynx
4. Laryngopharynx
5. Larynx
II.Lower Respiratory System
1. Trachea
2. Main bronchi
3. Lobar bronchi
4. Segmental bronchi
5. Small bronchi6. Bronchioles
7. Terminal bronchioles
8. Respiratory bronchioles
9. Alveolar ducts
10. Alveolar sacs
Condui ts or
connect ing tube
Respiratory
part
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The upper airway
The lower airwaysAlveolus
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Airway Obstruction
Coma
Aspiration
Maxillofacial
trauma Neck trauma
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KEDADURATAN DALAM
SISTEM RESPIRASI
DAPAT BERUPA GANGGUAN PD
JALAN NAFAS.(AIR WAY)
DAPAT JUGA PADA SISTEMPERNAFASAN.(VENTILASI)
AIR WAY & VENTILATORY FAILURE.
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GAGAL NAFAS
DAPAT BERUPA OBSTRUKSI JALAN
NAFAS & DEPRESI PERNAFASAN
HIPOVENTILASI SAMPAI APNOE PENYEBABNYA BISA BERMACAM2,
SPT : ANESTESIA,PENYAKIT, TRAUMA
BILA TIDAK DIATASI DENGAN CEPATBISA TIMBUL HIPOKSEMIA DAN
HIPERCARBIA.-KEMATIAN.
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TANDA-TANDA OBSTRUKSI
JALAN NAPAS
Cara : Look(Lihat), Listen(dengar),
feel(rasa).
Lihat =gelisah,kesadaran,pergerakandada/perut(see saw,rocking resp), retraksi iga dan
supra sternal,sianosis, dan pada trauma sering
adanya pergeseran trachea dan otot leher.
Dengar = adanya bunyi nafas tambahan ? Spt
snoring,gurgling dan crowing dan whizing.
Rasa = adanya udara dari hidung dan mulut,
adanya pergeseran trachea.
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Airway evaluation
LOOK Chest and abdomen
movement
Signs of respiratory distress
Color of skin, mucosa
Consciousness
LISTEN
air movement with your ear FEEL
air movement with your
cheek( Look- Listen - Feel )
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PATOFISIOLOGI
Penurunan kesadaran relaksasi ototlidah, pangkal lidah jatuh ke posterior
menutup orofaring sumbatan jalannapas.
Keadaan relaksasi spinter cardiac oesoakan terjadi regurgitasi,aspirasi isi
lambung dan pneumonia Aspirasi. Trauma wajah sering Kesulitan intubasi
segera krikotiroidotomi, trakheotomi ?
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Signs o f obs t ruct ion
snoring : base of tonguegargling : liquid
stridor : vocal cord spasm or edema
restlessness due to hypoxia
secondary breathing muscle(tracheal tug, intercostal retraction)
paradoxal chest & abdominal
movement
cyanosis (late sign)
MORE
SEVERE
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learing the airway
Obstruction due to the base of
tongue
jaw thrust
chin lift oro or naso-pharyngeal airway
tracheal intubation / LMA
Obstruction due to Liquid
suction
Obstruction at the plica vocalis
cricothyroidotomy
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Safest : Jaw thrustHead Tilt-Neck lift
Avoid head tilt
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Oro-pharyngeal tube
Not to be used in the presence of gag reflex
(Level A and V in AVPU or GCS > 10)
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Naso-pharyngeal tube
Doesnot stimulate vomiting
Be careful in patient suffering fractura basis cranii
Size 7 mm for adult or equiv to right little finger
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Advanced Airway Management
1. Tracheal intubation
with laryngoscopy
2. Cricothyroidotomy
needle / surgical
3.Laryngeal mask
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ACS 16
Definitive Airway
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Laryngeal Mask Airway
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Laryngeal Mask Airwaydipasang tanpa laringoskopi
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TRACHEAL INTUBATION
is indicated
Other airway methods failed
Difficult to ventilate with mask
Risk of pulmonary aspiration
Prevention of pCO2(head injury)
GCS < 8
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Risk of tracheal intubation
Hypoxia, vocal cord spasm
Increasing BP, bradycardia / asystole
Increasing ICP Neck movement may aggravate cervical
lesion
Patient with hypoxia and or convulsion usedto clench the jaw. Forcing laryngoscopy may
be deleterious to the head injured
Ideally, intubation require anesthesia and muscle
relaxant
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cricothyroidotomy
When tracheal intubation failedwhile clear airway is still needed
Patient can be ventilated
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Emergency oxygenation
Work up to 10 minutes
Can not eliminate CO2
Crico-thyroido-tomy
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TERSEDAK
(CHOKING)PADA KORBAN TERSEDAK SERING
DIJUM-
PAI HAL-HAL SEBAGAI BERIKUT: KORBAN MERASA TERCEKIK
ADA KAITANNYA DENGAN MAKANAN
TIDAK DAPAT BICARA < BERNAPAS
MUKA SEMBAB DAN BIRU
SEMULA SADAR TIDAK SADAR
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PERTOLONGAN PADA TERSEDAK DAPATDILAKUKAN SEBAGAI BERIKUT:
BACKBLOW / BACK SLAPS DILAKUKANPADA SEMUA USIA KORBAN
ABDOMINAL THRUST TIDAK DILAKUKANPADA : BAYI, DEWASA GEMUK/ HAMIL.
CHEST THUST DILAKUKAN PADA BAYI 8 TAHUN SEPERTI PADA DEWASA.
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Heimlichs Manuver
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Abdominal Thrust
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Pukulan antara duaskapula
Back Blows
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PERIKSA LAGI
TIUP LAGI
TIDAK MASUK
TENGKURAPKAN
BACK BLOW / BACK SLAPS
TERLENTANGKAN.
PERIKSA MULUT
TIUP LAGI
DST
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RESPIRATORY FAILURE
GAGAL NAFAS)
PENILAIAN NYA ADALAH ADANYA
GANGGUAN PADA PARAMETERVENTILASI DAN ATAU PARAMETER
OKSIGENISASI. {PaCO2 & PaO2}.
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BEBERAPA PARAMETER
PARAMETER VENTILASI :
PaCO2 : 35-45 mmHg.
ETCO2 : 25-35 mmHg.PARAMETER OKSIGENISASI :
PaO2 : 80-100 mmHg.
SaO2 : 95-100 mmHg.
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Breathing Evaluation
Look - chest movement, flaring nostrils,intercostal retraction
Listen - breath sound, abnormal sounds
Feel - air movement through mouth / nose
Palpation - chest movement, symmetrical?
Percussion - Damped?Hypersonor ?
Symmetrical?
Auscultation (stethoscope) -Breath soundpresents? Symmetrical?
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Signs of respiratory
distress
Rapid shallow breathing
Flaring nostrils
Intercostal and neckretraction
Rapid pulse
Hypotension
Distended neck veins
Cyanosis (late sign)
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KRITERIA GAGAL NAFAS
ADA 3 CARA :
PONTOPPIDAN :RR>35,PaO260
SHAPIRO :PaO2 50.
Petty : PaO2 50 mmHg(Acute Ventilatory
Failure).
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Open chest
wound? Sucking
wound?
Penetrating chest wound
Sucking chest wound Close the wound
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A piece of plastic sheet
fix with adhesive tape on
3 sidesone way valve
to prevent pressure build-up
inside pleural cavity whileclosing the wound
previous method:
cover with sterile gauze
impregnated with vaselin
(risk of pressure build-up)
How to Cover Penetrating Chest Wound
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Tension
Pneumothorax
Diagnosis by clinical signs onlyAffected side will show
Palpation less chest expansion
Palpation of trachea
shifts away to normalside
Percussion hypersonor (empty sound)
Auscultation reduced breath sound
Do needle thoracostomy,
do not wait for X-ray confirmation
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Palpate The Trachea at
Sternal Notch
Look more
carefully for
pneumothorax inthe presence of
Rib fractures
Subcutaneous
emphysema
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Needle Thoracostomy to Confirm
Pneumothorax
Needle and Filled Syringe System)
Bubble (+)= pneumothorax
Dont pull out the
needle until thoracic
drain is inserted
Bubble (-) and the
water was sucked
slowly inside
= no pnumothoraxPull needle out before
the syringe emptied
to avoid inducing
pneumothorax
lenght5 cm
water
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Rib fractures? Flail Chest ?4.
Inspiration Expiration
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1
2
Hemothorax?5.
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Subcutaneous EmphysemaFeels like grasping thin plastic sheet
Most caused by pneumothorax
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THERAPY: Artificial ventilation
12-20 x / minute, until chest rises
start ventilation to abnormal breathing, do not
delay until apnea occurs additional oxygen (if available)
if air enters the stomach, do not deflate by
pressing the epigastrium (risk of aspiration).Insert a nasogastric tube instead
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ACS 46
Oxygenate and Ventilate
Goal: Achieve Maximal cellular O2
O2at 10-12 liters / minute
Tight-fitting oxygen reservoir mask
Ventilate
Avoid prolonged attempts at
intubation without oxygenation
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Artificial ventilation was provided along with
in-line immobilisation hold the head and
neck)
to prevent the neck from moving excessively
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Artificial ventilation via tracheal tube:1. More effective oxygenation and removal of CO2
2. Prevent pulmonary aspiration
3. No interruption of cardiac compression during CPR
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VENTILATOR
Masa kini
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ACS 51
O
2
/ Hgb Dissociation
Cure
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Any Question.
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Penatalaksanaan
Bila pasien telah di diagnosa gagal nafas
maka Intubasi Endotracheal segera
harus di pasang dan dilanjutkan denganventilasi mekanik.(ventilator).
Bila pasien dlm kondisi Impending dapat
di coba dengan Pemberin oksigen kadartinggi denga Face Mask 10-12 L/mnt.
Segera cari penyebab utama dan obati.
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TERIMA KASIH
WASSALAMUALAIKUM
WARAHMATULLAHI WABARAKATUH.