Criticall Ill Patient GT

7/23/2019 Criticall Ill Patient GT

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Identifikasi Dini Pasien Kritis

Dr. Gatoet Soeseno, MARS.


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Objectives Memahami pentingnya identifikasi dini

pada pasien-pasien yang beresiko menjadisakit kritis

Mengenali tanda-tanda awal sakit kritis

Mendiskusikan penilaian awal pasien sakit

kritis


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Kenapa pasien mati ?Kenapa pasien mati ?

(atau mengapa terjadi mati otak?)(atau mengapa terjadi mati otak?)

Kekurangan oksigenKekurangan oksigen Kehilangan energi (ATP)Kehilangan energi (ATP)

ToksinToksin

Kerusakan fisikKerusakan fisik


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Proses terjadinya sakit kritisProses terjadinya sakit kritis

Onset ofOnset ofillnessillness

Early Sign &Early Sign &

SymptomSymptom

ShockShock

InfectionInfection

TraumaTrauma

Compensation;Compensation;

Preserve brainPreserve brain

and heartand heart Fail/ decompFail/ decomp DeathDeath

Depends on;Depends on;gege

Se!erity of illnessSe!erity of illness"ree#isting disease"ree#isting disease

TachypneaTachypnea

TachycardiaTachycardia

HypertensionHypertension

pHpHLactateLactate

CRPCRP

LeucocyteLeucocyte

BradycardiaBradycardia

HypotensionHypotension

AlkalosisAlkalosis

SevereSevere

AcidosisAcidosisor!alor!al

"here #ere should #e$"here #ere should #e$

C o ! p e n s a t o r y p h a s e

Restlessness, anxiety, combativeness


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Dilihat dari penebab!penebabDilihat dari penebab!penebabterjadina henti jantung" berapaterjadina henti jantung" berapa

lama #aktu ang kita milikilama #aktu ang kita miliki

sebelum terjadi henti jantung?sebelum terjadi henti jantung?


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The Process of Ding$The Process of Ding$

Asphy%ia&Asphy%ia&'Air#ay Obstruction('Air#ay Obstruction(

'Apnea('Apnea(

)%san*uination)%san*uination

Pul!onary +ailurePul!onary +ailure

ShockShock

Brain +ailureBrain +ailure

Circulatory ArrestCirculatory Arrest,-./ !in,-./ !in

$$

$$

$$

$$

0Safar P1 Cerebral resuscitation after cardiac arrest& research initiatives and0Safar P1 Cerebral resuscitation after cardiac arrest& research initiatives and

future directions1 Ann )!er* 2ed //&3/45.663future directions1 Ann )!er* 2ed //&3/45.663

Pri!ary ventricularPri!ary ventricular

fibrillationfibrillation

Pri!ary AsystolePri!ary Asystole

Alveolar ano%ia /-3 !in/-3 !in

7 !in


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%erhentina sirkulasi& henti

jantung&cardiac arrest 10 detik

idak sadar

1!-"! detik #tak isoelektrik terjadi apnea

" to $ menit %enyimpanan &lucose dan glycogen di otak habis

' to ! minutes

(% habis %ompa listrik otak mati total


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%erapa lama #aktu angkita miliki untuk

mengembalikan sirkulasi

setelah henti jantung?


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The Process of DingThe Process of Ding

HentiHentisirkulasisirkulasi

- - - - - - -- - - - - - -

2ati klinis 8 henti sirkulasi total yan* potensial reversibel se!buh2ati klinis 8 henti sirkulasi total yan* potensial reversibel se!buh

se!purna ter!asuk fun*si otak jika dilakukan resusitasise!purna ter!asuk fun*si otak jika dilakukan resusitasi

, !in, !in .7 !in.7 !in ., !in., !in /7 !in/7 !in



9e!balinya sirkulasi9e!balinya sirkulasi


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Ti!eTi!e

: survival: survival

+ast rate+ast rateSlo# rateSlo# rateoneone

ResuscitationResuscitation

'*+,TAT,O-'*+,TAT,O-

NEED FOR SPEEDNEED FOR SPEED


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LV failure Compensation Early Stage

contr Preload CO local control; dilatasi Humoral; Anuria, Na

Congestion Myocardial Sympatetic; HR!or"

CPAP Signs of low CO; Hypoperfusion cool and clammy e#trimitis, lo!

capillary re$ill, tacycardia,

narro! pulse pressure and lo! urine out put

Pulmonary Pa%& Matcing edema 'et!een Supply ( demand

Redistri'ution 'lood $lo!

to )ital organ *sa)ing Heart ( +rain -ate Stage

Consciousness

Pulmonary Di)ersi o$ 'lood $lo!, use respiratory Dysritmia

compliance muscle

Dyspnea Hyper)entilation Reduced

Air!ay PaC%& !or" o$ +reating

resistance


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The Process of DingThe Process of Ding


- - - - - - -- - - - - - -


)%isa bernafas spontan%isa bernafas spontan)%isa sadar atau stupor%isa sadar atau stupor)-eurologi ada deficit-eurologi ada deficit

)%isa bernafas spontan%isa bernafas spontan)%isa sadar penuh%isa sadar penuh)-eurologi bisa normal-eurologi bisa normal

$$



2ati klinis2ati klinis



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The Process of Ding cont.The Process of Ding cont.

- - - - - - -- - - - - - -


)%isa nafas pontan%isa nafas pontan)Tidak sadarTidak sadar)/egetative tate/egetative tate)0 Abnormal0 Abnormal

)ApneaApnea)komakoma)%rain Death%rain Death),soeletric 0,soeletric 0

$$




2ati klinis2ati klinis



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1engenal fase kompensasi

pasien sakit kritis *isilogis

anda aktivasi simpatis +R,RR,,sweating anda inflamasi.peradangan sistemik +/R/emp,

rush anda hipoperfusi sistemik

+cap2refill,confusing.agitation

3iokimia 3ase deficit.raised lactate 4eucocytosis.leucopenia hrombocytopenia Raised urea and creatinine Raised 5R%


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Assessing the patient

3asic investigations Tachpnoea+merupakan indikator sakit

kritis yang paling penting

achycardia

ypotension +gangguan kardiovaskular ygtersering pada pasien sakit kritis yg akut,penyebabnya hipovolemi. sepsis

(cidosis +adanya metabolic acidosissalahsatu dari indikator penting dari sakit kritis


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Dua faktor penting pada

peelidikan a#al

(rterial 3lood &ases 6 3lood 4actate 5apillary 3lood &lucose


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Tachpnoea(hyperventilation)

Minute ventilation M7 8 RR x 7

3lood &as (nalysis 92':.23.1"0.-10.;;(RE /@R7DE


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urve The cene

o determine if it is safe to proceed withthe rescue2

(void all dangerous situations2 f you are not properly trained and do not

have the necessary eFuipment do notapproach the victim2

?ever risk your own life


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%efore 6ou Approach The /ictim

5heck for unsafe conditions that will threatenyour safety and that of the bystanders

4ook for clues and try to find out what happened >angers include downed power lines, traffic, fire,

unstable structures, deep or swift moving water

f conditions change, you may then be able to

approach the victim or victims (sk bystanders for information or for help

/peak to victim in a calm reassuring manner


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Primar urve

his procedure takes a few seconds and is the

difference between life and death2 he %rimary survey is also referred to as the

(35As2

his principle is the basis of our class

Eou will be able to observe signs of lifethreatening conditions


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PAT,-T A1-T

5heck to see of the victim G

/ 5#?/5#@/ (/ (? #%D? (RH(E

/ 3RD(?&

(/ ( D(R3D(

/ 34DD>?& /D7DRD4E he primary survey takes only secondsto perform


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+heck The Air#a

( victim who can talk or cry is consciousandhas an open airway

f the victim is unconscious, open the victimAsairway ead ilt. 5hin 4ift his action moves tongue away from the

airway

5heck for 3reathing (irway may be obstructed by food, liFuid, or

other objects


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+7+K %'AT7,-0

4ook, listen and feel for signs of breathing

f victim is breathing chest #ill rise and fall

%osition yourself so you can hear and feel air as itescapes from victimAs nose and mouth

f victim is not breathing you must breathe forthe victim

his is called RD/5@D 3RD(?&


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+7+K +,'+*5AT,O-

5heck for blood circulation or pulse

5heck for severe bleeding

f the heart has stopped blood will not circulate

throughout the body

f the victim is breathing then their heart is beatingandcirculating blood

#n an infant check the pulse on the brachial arter

#n a child or an adult check the carotid arter 5heck the pulse for I! - 10 seconds

f no breathing or pulse administer rescue breathing andchest compressions


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(57(D DM/

/ummon additionalhelp from advanced

medical personnel ifany of the followingconditions existsG *nconsciousness

%reathing problems

Persistent chest orabdominal pain

-o pulse

evere %leeding

/omiting or passing

blood uspected poisoning

ei8ures" severeheadache" slurredspeech

uspected or obvioushead or neck injuries

uspected fractures

evere burns


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+O-DA'6 *'/6 #nce you are certain that the victim has no life!no life!

threateningthreateningconditions, you can begin the secondarsurve

Eou will gather information about the victim and any

conditions that ma become life!threateningma become life!threatening nterview the victim and bystanders

5heck vital signs

>o a head-to-toe examination to check for signs andsigns and

smptomssmptoms n some cases you may never have the opportunity or

need to conduct the secondar surve


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,-T'/,9 :*T,O-

Hhat happenedJHhat happenedJ

>o you feel any pain anywhereJ>o you feel any pain anywhereJ

>o you have any medical conditionsJ>o you have any medical conditionsJ (re you taking medicationsJ(re you taking medicationsJ

>o you have any allergiesJ>o you have any allergiesJ

hese Fuestions may be asked to the parent orresponsible adult if you are working with aninfant or a child


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5D5=?& 7(4 /&?/

P*5P*5 Hith every heartbeat a wave of blood moves through theblood vessels

his creates a beat called the pulse

( pulse can be checked in arteries that circulate close to thesurfaceG 5(R#>G

3R(5(4G

R(>(4

( normal pulse for an adult is I:0-K03%M (n abnormal pulse may be sign of a potential problemG

rregular pulse

Heak and hard to find pulse

Dxcessively fast or slow pulse


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5D5=?& D 7(4 /&?/

%reathing%reathing

( healthy person breathes regularly, Fuietly, andeffortlessly

(bnormal breathing may indicate a potentialproblem such asG &asping for breath

?oisy breathing whistling sounds, high pitched

wheeLing, gurgling, or snoring Dxcessively fast or slow breathing

%ainful breathing


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7AD TO TO ;A1,-AT,O-

/tart at the head ending at the toes, checking for anyabnormal conditions

@se your senses toG /mell unusual odors

4ook for pale or bluish skin, bruises, deformed body parts

%alpate all tender areas

5ontinue to monitor vital signs

#bserve any changes that indicate a life threateningsituation and provide necessary first responder care

RESUE !"RESUE !" (orban(orban


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RESUE !"BAS#$ %#"EBAS#$ %#"E

SU&&!R'SU&&!R'/e esadaran/e esadaran

adaradar

ida sadarida sadar

/e/e

NadiNadiosisi $antaposisi $antap

2da2daida adaida ada

6o$presi6o$presi

88 ali88 ali

per$enitper$enit

Nilai ira$a dan ce pulsNilai ira$a dan ce pulsRO/RO/2/92/9

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Criticall Ill Patient GT