PRESENTASI BEDAH ORTHOPAEDI

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PRESENTASI BEDAH ORTHOPAEDI

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PRESENTASI BEDAH ORTHOPAEDI

PRESENTASI BEDAH ORTHOPAEDIOleh :Mahasiswa Magister Farmasi Klinik Fakultas Farmasi Universitas Airlangga2014Terapi Analgesik beberapa pasien bedah f (kasus orthopAEdi)2Nama Px/ umurNy.IAR/31 thAn. M.M./10 th DiagnosisUnstable pelvis stable HD+Amputasi traumatik below knee (D) OF Femur (D) 1/3 tengah gr IIIA + Simpisialiris gr III + CF numerus (D) 1/3 tengah dg lesi n. Radialis + OF antebrakhiali (D) segmental + OF metacarpal II + OF Head metacarpal IV + OF baris phalang promixal dig. II, III manus (D)EDH FTP (s) + CF tibia 1/3 tengah (d) post craniomotomy evaluasi EDH +post LAC H-0 + post osteoplastisTindakan16/5 Amputasi above knee (D) ec traumaticRepair laserasi perinei + labium mayor (S) + pasang drain + pasang tampon vaginaCraniomotomy evaluasi EDH +post LAC H-0 + post osteoplastisSkala nyeri64TerapiInj. Ketorolac 3x1 (15/5 17/5)Inj. Tramadol 3x100mg (15/5 19/5)Paracetamol 3x500 mg (17-25/5)Inj. Ketorolac 3 x30mg (22/5,23/5)Paracetamol tab 3x500 (tgl 24-26/5)3Nama Px/ umurNy.SU/48 thTn.S/21 thDiagnosisOF intercondyler femur (D)OF Antebrachial 1/3 Distal Grade II OGF + OF Cruris (S) 1/3 Tengah Grade Ii OCP + CF Femur D/STindakan2/5 - Debridemen screwing+TST

10/5 - Debridemen screwing +TST4/5- Debridement + LAC +TST DS +BKC

20/5-Platting antebrachial (D)Skala nyeri67TerapiKetorolak 3x30 mg (2/5-5/5)Tramadol 3x100 mg (3/5-4/5, 6/5-10/5)Parasetamol 3x500 (5/5-7/5, 11/5-26/5 prn)Ketorolak 3x30 mg (3/5-7/5, 20/5-23/5)Tramadol 3x100 mg (8/5-10/5)Paracetamol 3x500 (11/5-19/5, 24/5-28/5)4Jenis Nyeri(Dipiro, 2011)5

NYERI AKUTNYERI KRONISSIGNSHypertension, tachycardia, diaphoresis, mydriasis, and pallor, but these signs are not diagnostic. In some cases there are no obvious signs. Comorbid conditions usually not present. Outcome of treatment generally predictable.

Laboratory TestsPain is always subjective. There are no specific laboratory tests for pain. Pain is best diagnosed based on patient description and history.

SignsHypertension, tachycardia, diaphoresis, mydriasis, and pallor are seldom present. In most cases there are no obvious signs. Comorbid conditions often present (e.g., insomnia, depression, anxiety). Outcome of treatment often unpredictable.

Laboratory TestsPain is always subjective. Pain is best diagnosed based on patient description and history. There are no specific laboratory tests for pain; however, history and/or diagnostic proof of past trauma (e.g., computed tomography) or present disease state(Dipiro, 2011)6

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Analisis Nyeri yang Digunakan Wong Baker Face ScaleMerupakan metode yang simple dan banyak digunakan memiliki kekurangan yaitu kurang sensitif dan tidak dapat digunakan untuk anak-anak < 2 th

8Penatalaksanaan nyeri akut9

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(Dipiro, 2011)11Nama Px/ umurAn. MM/10 th Ny.IAR/31 thNy.SU/48 thTn.S/21 thSkala nyeri4667Tingkat NyeriModerate-SevereSkala Nyeri dan Terapi Pasien12

Multimodal Management of Acute Pain : The Role of NSAID

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Efek Samping Penggunaan Opioid(Dipiro, 2011)1415

16Farmakokinetika analgesik17ParacetamolKetorolacTramadolBioavailibility70-90%80-100%70-90%Tmax10-60 minutes 0,09 hour2-3 hourOnset 99%20%MetabolismLiverSulfate and glucuronide conjugationOxidized by CYP2E1 and CYP3A4Liver :conjugation with glucuronic acidLiver :CYP 2D6, CYP3A4, CYP2B6EkskresiMainly excreted in urine as conjugatesExcreted in urine (92%) as parent drug (60%) or metabolites (40%) and in feces (6%)UrinUnchanged drug 30%Metabolite 60%Half life2.7hours (adult)1,5-2 (infant and children)5,09 hours in adults3.8-6.1 hours in pediatric patients4.5-9.5 hours

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Ketorolac(AHFS ,2011, Lacy, 2009)2121Dosis Ketorolak

Dewasa :Anak :

(BNF for Children, 2012; Lacy, 2009)Guideline of Pain Management, 2012222-16 years : I.V.: Initial dose: 0.5 mg/kg followed by 0.25-1 mg/kg every 6 hours for up to 48 hours; maximum daily dose: 90 mgWeight