Lapsus Anes Manajemen Airway

8/18/2019 Lapsus Anes Manajemen Airway

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BAGIAN ANESTESIOLOGI,TERAPI INTENSIF LAPORAN KASUS

DAN MANAJEMEN NYERI FEBRUARI 2016

FAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN

MANAJEMEN JALAN NAPAS

OLEH :

Latifah Husna Zulkafli

C111 11 871

PEMBIMBING :

dr. Bamban HS. Suikr!m!

KONSULEN :

dr. Alams"ah A.A Husain# S$.An

%&BA'A(AN %ALAM )AN*(A +,*AS (EPAN&+E)AAN (L&N&( BA*&AN

ANES+ES&-L-*& +E)AP& &N+ENS& %AN MANAJEMEN N/E)&

,N&0E)S&+AS HASAN,%%&N

MA(ASSA)

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HALAMAN PEN*ESAHAN

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KONSULEN PEMBIMBING

dr. Alams"ah Amb! Ala# S$.An. dr. Bamban HS. Suikr!m!

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10/38

+&NJA,AN P,S+A(A

MANAJEMEN JALAN NA AS

I5 PENDAHULUAN

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l " " &, "$ % l '": (/'/ "< (% $ " d l(*(% d " $% u! l ")&u")

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U& * (%-l-") ""7 $(%) "$u") ("7( "7 , 'l / %("

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&( l '", $% /(-&$-!' d $ d')u" / " &( ) ' 'l'* "5#5 P % l'&'& '$ &u %

P % l'&'& '$ &u % l'") &(%'") d'&( / " -l(* / %(" l(&' d "(%8u&

l %'")(u& %(/u%(" /' $ ! "' ul &' d %-&(& - (% &' d' d (% * l(*(%,

!'& l"7 - (% &' $'%-'d(/$-!'5 U& * (%$-l-") ""7 &()(% d'l /u/ "

$% /(-&$-!'5

)5 S &!( l %'")

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8 ) l?5 A! ") 8 ) l / " !("u%u" d *' -/&' , &'d-&'&, ("d(%'$

/(& d % " !("u%u" d " l '"9l '"5 Su % " & &( (%$' -$-l d'$'u

=crowing ? d l * !(%u / " $ "d 7 ") /* &5 U& * (%$-l-") ""7

d l * d(") " !(! (%'/ " - $ (lu! u* -$-$5

+5 Su! $ " d' 3 * l %'") 1

5 T% /(

Su! $ " 7 ") $(% d' d $% /( d $ d'&( / " -l(* $u!-% 7 ")

!("d(& / $% /( , $% u! /' $ - (% &' 7 ") d $ !("'! ul/ "

$% /(-! l &( d " $% u! l ")&u") /' $ /( (l / " 7 ") l '"5 G( l

/l'"'& d $ (%u &u! $ " %&' l ! u u" &u! $ " $-$ l5

U& * (%$-l-") ""7 d l * &()(% d'l /u/ " (! & ") " '

("d-$% /( /(!ud' " d'l " u$/ " d(") " $% /(-&$-!'5

17


18/38

5 B%-"/u&

Su! $ " d %-"/u& d $ d'&( / " -l(* ("d &'"), & &!(

%-"/u&, d " $u!-%5 B'l &u! $ ""7 d'&( / " -l(* & '% &' ("d

&'") d $ d " d & $ /( d' " &'(" (%d'%', ! / ("d &'") '"'

/ " ("d(%u") ! &u/ /( %-"/u& / " "5 H l '"' d'&( / " / %("

" $-!' %-"/u& / " " l( '* 8(%$'/ l5 G( l 7 ") d $ d' u! ' d

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%u5

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-&$( "7 !("))u" / " %-"/-&/- ', &(l " u$"7 !(")*'& "7 $ u!(" ( '$ ("d &'") 7 ") ! &u/ d(") " l $ (" ( '$ /*u&u&5

B'l &u! $ ""7 -l(* / %(" & &!( %-"/u&, / " $(%d(") % &u %

" & 3*((>'") d " d "7 $ "d 9$ "d *' -/&' $ u *' (%/ % ' 5 U& *

(%$-l-") ""7 d l * &()(% !(! (%'/ " %-"/-d'l $-%5

IV5 PENGELOLAAN JALAN NAPAS

•

M(! u/ l " " & $ " l $2

T(/"'/ '"' d')u" / " d ("d(%'$ &u! $ " l " " & /' $ l'd * 7 ")

$u* /( (l / ")5 M " u8(%9! " u8(% 7 ") d'l /u/ " d $ (%u :

o %ead(tilt

@ % : l($ // " & $u $(l / $ ") " d' d *' &'(" d " $(/ " /( 3 *,

&(*'")) /( l !(" d' $(") d * &(*'")) ("7 ")) l'd * $(% ")/ $ /(

d( "5

o Chin(lift

@ % : )u" / " %' $(") * d " %' $(lu" u/ u"$u/ !(!() ") $ul ")

d )u &'(", /(!ud' " ")/ $ d " d-%-") $ul ")"7 /( d( "5

o )aw(thrust

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19/38

@ % : d-%-") &udu$ % * ") /'%' d " / " " /( % * d( " &(*'"))

%'& " )')' 3 * (% d d' d( " %'& " )')' $ &5 A$ u )u" / "

' u %' /( d l ! !ulu$ (%& ! d(") " %'9 %' l '" $ %'/ d )u /(

d( "5

• M(! u/ l " " & d(") " l $

o P' -%-# %'")

1? P / ' & %u") $ ") "

2? Bu/ !ulu$ &'(" d(") " % *'"9l'#$ $ u )u" / " ' u %' d "

$(lu" u/

+? S' / " ' -%-# %'") 7 ") $( $ u/u% ""7

.? B(%&'*/ " d " & *' ' -%-# %'") ) % l' '" d " !ud *

d'! &u// "5

? A% */ " l(")/u") " !(")* d /( l ")'$9l ")'$ =/( l $ l?

6? M &u// " &( %u*, u$ % l(")/u") " !(") % * /( 3 * l'd *

4? D-%-") (l "9 (l " & ! ' -&'&' $( $

? Y /'"/ " l'd * &ud * $(%$- ") d(") " ' -%-# %'") d(") " !(l'* $

-l " &, % & / " d " d(") %/ " &&u % " & & (! & ") "5o P' " &-# %'")

1? P / ' & %u") $ ") "

2? N'l ' (& %"7 lu ") *'du") d(") " (& %"7 ' " &-# %'") 7 ")

/ " d'! &u// "

+? N'l ' d / * /(l '" " 8u! " &'

.? P' " &-# %'") d'-l(&' d(") " (l', d(!'/' " u) lu ") *'du") 7 ")

/ " d'! &u// "5 B'l (%lu d $ d' (%'/ " 8 &-/-"&$%'/&' *'du")

? P() ") ' " &-# %'") &(d(!'/' " %u &(*'")) u u")"7

!(")* d /( $(l'") 5

6? D-%-") (l "9 (l " *'")) &(lu%u*"7 ! &u/, & ! 'l !("'l ' d / *

l'% " ud % d' d l ! ' 5

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20/38

4? F'/& &' d(") " l(&$(%5

G ! % +515 = ?oropharyngeal airway tube, *b+ nasopharyngeal airway tube

•

M(! (%&'*/ " l " " & /' $ &u! $ " ("d &'") '% o S u " %'

1? P & ") & %u") $ ") "

2? Bu/ !ulu$ &'(" d(") " 39$*%u&$ d " $(/ " d )u /( 3 *

+? Gu" / " 2 %' = %' $(lu" u/ d " %' $(") *? 7 ") (%&'* $ u

d' u")/u& d(") " & %u") $ ") "< / & u"$u/ !(! (%&'*/ " d "

!(")-%(/ &(!u ("d &'") d l ! !ulu$

o D(") " l $ &u $'-"

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G ! % .515 l $ &u $'-"

• P(")(l-l " l " " & /' $ &u! $ " ("d &'") d $4

o Bac blow-bac slap d'l /u/ " d /-% " d(3 & & d %

1? B'l /-% " ! &'* &(! -7-") ", % ")/ul d %' (l / ")

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P(%$ * "/ " /-% " ") " & ! ' $(%&u")/u%5

+? B(%'/ " u/ul "


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• B'l $'d / $(%l'* $, $'u / " " & !ulu$ /( !ulu$, & ! 'l

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$(%&u! $, &()(% l /u/ " d-!'" l $*%u&$ l )' d " &($(%u&"7

? B'l $'d / (%* &'l '/'%/ " /%'/-$'%-'d-$-!' /(!ud' " d'&u&ul

$% /(-&$-!'5

V5 PENGELOLAAN JALAN NAPAS TAHAP LANJUT

5 INTUBASI ENDOTRAKEAL 4

Tu u " d'l /u/ ""7 '"$u &' ("d-$% /( l d l * u"$u/ !(! (%$ * "/ "

l " " # & ) % $($ $(", !(" () * & '% &' &(%$ !(! (%!ud * (! (%' "

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("d-$% /( l d l * :

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/(l " % " (%" & "5

5 M(" () * /(!u")/'" " $(% d'"7 & '% &' l ! u") = d /( d " $'d / & d %, l ! u") ("u* d " $'d / d %(#l( $u/ ?5

d5 M(! (%!ud * (")'& " &(/%($ $% /(- %-"/' l5

(5 P(! / ' " 8("$'l &' !(/ "'& 7 ") l ! 5

#5 M(") $ &' - &$%u/&' l %'") /u$

I"d'/ &' )' (l /& " " '"$u &' ("d-$% /( l !("u%u$ $isele $ *u" 2002 1

"$ % l '" :

5 K( d " -/&')(" &' 7 ") $'d / d(/u $ 7 ") $'d / d $ d'/-%(/&'

d(") " (! (%' " &u l ' -/&')(" !(l lu' ! &/(% " & l5

5 K( d " 8("$'l &' 7 ") $'d / d(/u $ / %(" !("'")/ $"7 $(/ " "

/ % -"d'-/&'d d' %$(%'5

22


23/38

5 K( u$u* " u"$u/ !(")-"$%-l d " !(")(lu %/ " &(/%($ ul!-" l $ u

&( ) 'bronchial toilet 5

d5 M("7(l(")) % / " %-$(/&' $(%* d &'(" d(") " /( d " 7 ")

) 3 $ $ u &'(" d(") " %(#l(/& /' $ &u! $ " 7 ") $(% d'5

(5 P d &'(" 7 ") !ud * $'! ul l %'")-& &!(5

f. P d &'(" d(") " #'/& &' vocal cord.

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Id( l"7 , '"$u &' d' "$u - $ "(&$(&' d " - $ (lu! u* -$-$ =* %u&

$(" ) *l'?

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d l ! /( d " (/&$("&'5 I"' d'&( u$ &( ) ' Sniffing in the air position 5 K(& l * "

7 ") u!u! d l * !(")(/&$("&'/ " /( l d " l(*(%5 4

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G ! % 525 P' ("d-$% /( l4

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U&' D' !($(% d l ! =!!? P " ") = !?B 7' +, 12A" / . u&'

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• J'/ !("))u" / " &u '"7l *-l'"( d $ d' (%'/ " %(9/u% %'& &' d(") "

$% u%'u! 0,0 !)


26/38

d'l /u/ " u&/ul$ &' d d d(") " &$($(&/- , d'* % / " &u % " # & / " " d " /'%'

& ! 5 B'l d d d'$(/ " $(% & d l'% " ud % d' ' ("d-$% /( l5 B'l $(% d'

'"$u &' ("d-$% /( l 7 ") $(%l lu d l ! / " $(%d $ $ "d‐$ "d (%u &u % " # &

/ " " (% (d d(") " &u % " # & /'%', / d ")‐/ d ") $'! ul &u % whee ing , &(/%($

l( '* "7 / d " $ * " " l " " # & $(% & l( '* (% $5 J'/ d

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S(d ")/ " 'l $(% d' '"$u &' /( d (% * (&-# )u& ! / d (% *epigastrium $ u

) &$(% / " !(")(! "), $(%d(") % &u % & $ 8("$'l &' =d(") " &$($-&/- ?, / d ")‐

/ d ") /(lu % '% " l ! u"), d " ! /'" l ! &'(" / " " ! / &(! /'"

!(! '%u5 U"$u/ * l $(%&( u$ ' d' u$ d " '"$u &' d'l /u/ " /(! l' &($(l *

d' (%'/ " -/&')(" &' 7 ") u/u 5

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()&+E)&A E(S+,BAS&

NIF 9 20 ! H2O R(&$'") !'" V("$ 10 l

P @02 0 !!H) Vd < V$ 056

7ar 8 ! e iel /%andBoo of Anesthesiology /23395 63:

(!m$likasi &ntubasi End!trak3al 1

a. Selama laringos opi dan intubasi

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P(%#-% &' u##

b. #ada saat tube diposisi an

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Ed(! d " &$("-&'& =)l-$$'/, &u )l-$$'/, $% /*( ?

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5 KRIKOTIROIDOTOMI9TRAKEOSTOMI 2

K%'/-$'%-'d-$-!' d l * !(l /u/ " ("u&u/ " d !(! % " /%'/-$'%-'d

d(") " %u! (%u/u% " (& % &( ) ' l " '"$ & u"$u/ !(l /u/ " -/&')(" &' d "

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d $ !(")(lu %/ " ) & @O 25

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29/38

• P(%d % * "

• P %(&( "(%8u& l %7")(u& $ u "(%8u& %( u%("&

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• J ")/ " ") d $ !(!"7( / " "(u!-$*-%

T(/"'/ K%'/-$'%-'d-$-!'

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1? P(%'/& &(!u /(l(")/ " l $5 Hu u")/ " &(l ") -/&')(" d(") "

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!(l lu' &(l ")"72? P & ") / $($(% IV u/u% " 1. d & -'$ 12

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+? D(") " $ ") " / " " $u&u/ /ul'$ d ) %'& $(") * =!'dl'"(? d' $ &

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u/u% " 115

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? L( & &(! %'$ d(") " / $($(% IV, /(!ud' " $ %'/ ! d%'" & ! 'l

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(% ("$u/ Y5

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30/38

4? V("$'l &' (%/ l d $ d'l /u/ " d(") " !("u$u & l * & $u lu ")

&(l ") -/&')(" (% ("$u/ Y $(% u/ d(") " ' u %' &(l ! 1 d($'/ d "

!(! u/ "7 &(l ! . d($'/5 T'"d / " &( (%$' '"' d $ (%$ * "

&(l ! +09. !("'$5

5 LARYNGEAL MASK AIRCAY =LMA?

L %7")( l M &/ A'%3 7 d l * &( u * l $ u"$u/ !(! (%$ * "/ " l "

" & $(" $ " '"$u &' $% /( , 7 ") $(%d'%' d %' $ u") $(%*u u") /( u## -8 l

7 ") (%#u")&' u"$u/ !(")u" ' l %'")5 1

LMA !(")'&' (/u") " "$ % F ( M &/ =FM? d " T% /( l Tu ( =TT? '/

d %' &()' -&'&' " $-!'& d " $'")/ $ '"8 &'5 D' u $ d %' /(l & &'l'/-" / %($ !(d'& d "

d $ d')u" / " /(! l'5 .

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15 T u") l " " & = '%3 7 $u (?

25 M &/(% / %($ d "

+5 G %'& '"#l &'5

I"d'/ &' :

6+ S( ) ' l$(%" $'# d %' 8("$'l &' # ( ! &/ $ u '"$u &' ET u"$u/airway

management 5 LMA u/ "l * &u $u (")) "$' " ET, /($'/ (! / ' " ET !(" d'

&u $u '"d'/ &'5

2+ P d (" $ l /& " "dificult airway 7 ") d'/($ *u' $ u 7 ") $'d /

d' (%/'% / "5

30

http://blogspot_co_id.comparinggenie.com/code/r.php?r=yahoo%7CLaryngeal+Mask&t=1&did=1&uid=61853144&type=bl&subid=583_22191&rkw=Laryngeal+Mask&rurl=http%253A%252F%2Fkotakmedis.blogspot.co.id%2F2012%2F12%2Flaryngeal-mask-airway.html&lnktype=10http://blogspot_co_id.comparinggenie.com/code/r.php?r=yahoo%7CLaryngeal+Mask&t=1&did=1&uid=61853144&type=bl&subid=583_22191&rkw=Laryngeal+Mask&rurl=http%253A%252F%2Fkotakmedis.blogspot.co.id%2F2012%2F12%2Flaryngeal-mask-airway.html&lnktype=10


31/38

9+ P d airway management &(l ! %(&u&'$ &' d &'(" 7 ") $'d / & d %/ "

d'%'5

.? P &'("9 &'(" d(") " %(#l( l " " # & $ & 7 ")intac / %(" '"&(%&' d $

!(!' u $(% d'"7 l %7")-& &!(5

K-"$% '"d'/ &' : 4,

1? P &'("9 &'(" d(") " %(&'/- & '% &' '&' l ! u") = ("))u" " d (!(%)(" 7

d l * (")( u l' " ?5

2? P &'("9 &'(" d(") " ("u%u" " -! l' " ( &'&$(! (%" # & ",

/ %(" seal 7 ") (%$(/ " " %("d * d u## LMA / " !(") l !' /( - -% "

d $(/ " " '"& '% &' $'"))' d " / " $(% d' (")(! ") " l ! u")5

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+? P &'("9 &'(" 7 ") !(! u$u*/ " du/u") " 8("$'l &' !(/ "'/ ")/ 3 /$u

l !

(3untun an LMA

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&'(" d(") " /(&ul'$ " '"$u &' d " 8("$'l &', $'d / !(!(%lu/ " %(l ",

!(")u% ")' ("))u" " - $ " l)($'/

Macam-Macam Laryngeal Mask Berdasarkan Perbedaan Volume Cuff Untuk

Beragam Pasien 4

Mask Size Patient Size Weight (kg) Cuff Volume (mL)

1 Infant


32/38

Mask Size Patient Size Weight (kg) Cuff Volume (mL)

" C%ild 6 !#"& U' to 1&

"1(" C%ild ")& U' to 1!

) *mall adult +)& U' to "&

$ ,ormal adult 6&- & U' to )&

! Larger adult + &-.& U' to )&

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u$ ! d l * & '% &'5

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K(d l ! " "(&$(&' !(%u / " &u $u * l 7 ") ("$'") u"$u/ /( (%* &'l " &(l !

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