Download PANEL KEGAWAT DARURATAN SISTEM PERNAPASAN

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PANEL
KEGAWAT DARURATAN
SISTEM PERNAPASAN
(SERANGAN ASMA AKUT,
PNEUMONIA DAN COPD)
dan EDEMA PARU
ASTHMA
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2 Agonist Bronchodilator Response
Anticholinergic
Asthma Response
Panel A
COPD Response
Panel B
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Terapi Asma Masa Depan
Tujuan
penatalaksanaan
asma :
TOTAL KONTROL
Asma
Intermiten
Persisten
Tidak
terkontrol
Terkontrol
LABACS
Maintain
Tidak
terkontrol
Terkontrol
Tingkatkan
dosis
Boushey H. Is Asthma Control Achieveable ?, European Respiratory Journal , Dec 2004
Management of Asthma
Exacerbations(Emergency)

Inhaled beta2-agonist to provide prompt
relief of airflow obstruction

Systemic corticosteroids to suppress and
reverse airway inflammation
 For
moderate-to-severe exacerbations, or
 For
patients who fail to respond promptly and
completely to an inhaled beta2-agonist
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Risk Factors for
Death From Asthma




Past history of sudden severe
exacerbations
Prior intubation or admission to ICU
for asthma
Two or more hospitalizations for
asthma
in the past year
Three or more ED visits for asthma
in the past year
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Risk Factors for
Death From Asthma (continued)

Hospitalization or an ED visit for asthma
in the past month

Use of >2 canisters per month of inhaled shortacting beta2-agonist

Current use of systemic corticosteroids
or recent withdrawal from systemic
corticosteroids
PNEUMONIA
DEFINITION
Inflammation and consolidation of lung
tissue due to an infectious agent
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COMMUNITY
ACQUIRED (CAP)
Typical
Atypical
HOSPITAL ACQUIRED
(HAP)
Outpatiet
Inpatient
ICU
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Diagnosis of Pneumonia
• Clinical data points
–
–
–
–
–
–
–
Cough
Pleuritic chest pain
Purulent sputum,
Fever
Leukocytosis
Abnormal CXR
Abnormal ABG
• Sputum cultures identify the pathogen
Signs of CAP
• Patients typically appear short of breath
at rest
• Vital signs – fever, increased heart rate
and increased respiratory rate
• Chest exam – crackles over the affected
area
• Signs of consolidation: vocal and tactile
fremitus, dullness to percussion,
bronchial breath sounds, whispering
egophony
Investigations – to establish that a
patient has CAP
• CXR
– Characteristically abnormal in CAP (some
early disease may be an exception)
• White blood cell count
- WBC with left shift (if bacterial)
• Sputum
– Gram stain
Treatment of CAP
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Diagnosa HAP/Hospital Acquired
Pneumonia)(Emergency)
ATS (American thoracic Society, 1996). Bila gejala
pneumonia, terjadi 48-72 jam penderita masuk rumah
sakit, disebut HAP (dan diperkuat)dengan:
 Infiltrat baru atau perubahan infiltrat selagi terjadi onset
baru
 Hipo/hipertermi
 Produksi sputum
 Lekositosis/lekopenia (Staufler, 1996)

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MANAGEMENT

Antibiotic therapy is the cornerstone of treatment for
both CAP and HAP.

Initial therapy should be instituted rapidly.

Patients should initially be treated empirically, based
on the severity of disease and the likely pathogens.
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COPD
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COPD - SIGNS
 HYPERINFLATION
 DECREASED EXPANSION CHEST
 PROLONGED EXPIRATION/±WHEEZE
 SIGNS PULMONARY HYPERTENSION
AND/OR RVH (± CARDIAC FAILURE)
 CYANOSIS
 HYPERCAPNIA - ASTERIXUS, (PRE)COMA
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MANAGING
EXACERBATIONS(Emergency)
 ANTIBIOTICS
 CONTROLLED OXYGEN
 BRONCHODILATOR - BETA AGONIST
ANTICHOLINERGIC, ±THEOPHYLLINE
 STEROIDS
 INTUBATION/VENTILATION
 TREAT HEART FAILURE IF PRESENT
 (RESPIRATORY STIMULANTS?)
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INHALED
ANTICHOLINERGICS,
ANTIBIOTICS
IPRATROPIUM BROMIDE
OXITROPIUM BROMIDE
TIOTROPIUM BROMIDE
BRONCHODILATORS
FOR COPD
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2
COMBINATION
INHALER
BETA 2
AGONIST
SHORT ACTING INHALED
BETA 2 AGONIST
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THEOPHYLLINE
IPRATOPRIUM BROMIDE
&
SHORT ACTING INHALED
BETA 2 AGONIST
Manage Exacerbations
Key Points
• Inhaled bronchodilators (beta2-agonists
and/or anticholinergics), theophylline,
and systemic, preferably oral,
glucocortico-steroids are effective for the
treatment of COPD exacerbations
(Evidence A).
Manage Exacerbations
Key Points
• Patients experiencing COPD
exacerbations with clinical signs of
airway infection (e.g., increased volume
and change of color of sputum, and/or
fever) may benefit from antibiotic
treatment (Evidence B).
pulmonary edema
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Cause of acute pulmonary edema ?

Cardiogenic pulmonary edema


Hydrostatic or Hemodynamic edema
Non-cardiogenic pulmonary edema

Increased-permeability pulmonary edema, acute lung injury or
acute respiratory distress syndrome
Difficult to distinguish because of similar clinical manifestations
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Pulmonary Edema
Management
THE END
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Thanks for your attention!!
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