evaluation of etiology and treatment methods for epistaxis
TRANSCRIPT
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8/19/2019 Evaluation of Etiology and Treatment Methods for Epistaxis
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EVALUATIONETIOLOGY TREATMENT METH
FOR EPISTAA REVIEW AT A TERTIARY CARE HOSPITAL IN CENT
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EVALUASI ETIOLDAN METPERAWA
EPISTASEBUAH ULASAN PADA RUMAH SAKIT PERAWATDI NEP
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BACKGROUND
• Epistaksis m!"paka# sa$a% sat" k&a!"!ata# pa$i#s!i#' &itm"i pa&a THT
• Biasa#(a %a#(a mm)"t"%ka# tata$aksa#a k*#s!+s&!%a#a ttapi t!ka&a#' mm)"t"%ka# !a-at i#
• I#si&# s"$it &i#i$ai. p!ki!aa# statistika/ skita! 012p*p"$asi aka# m#'a$ami pistaksis &is"at" saat &a%i&"p#(a. &a# skita! 02 mm)"t"%ka# p#a#'a#m&is
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PERMASALAHAN
• Ti&ak a&a p!*t*k*$ pasti &a$am p#a#'a#a#pistaksis. -a$a"p"# t!&apat )!)a'ai ma3am3a!a p#a#'a#a#
• Ti&ak a&a &ata m#'#ai ma3am p#''"#aa#
m*&a$itas t!api )!&asa!ka# ti*$*'i &a!i pist• Ti&ak a&a#(a &ata mpi!is m#'#ai ti*$*'i
pistaksis (a#' mm)"t"%ka# %*spita$isasi
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PERTANYAAN PENELITIAN
• La#'ka%4 $a#'ka% apaka% (a#' pat"t &i$ak"ka# p#a#'a#a# pistaksis5
• Apaka% p#&!ita $aki4$aki $)i% )a#(ak &i)a#&p!mp"a#5
• B!apaka% p!s#tas pistaksis a#t!i*! &a# p*st!i*!5
• B!apaka% p!s#tas pistaksis )!&asa!ka# ti*$*'i5
• B!apaka% p!s#tas tata$aksa#a )!&asa!ka# m*&a$itas(a#' &i'"#aka#5
• Apaka% p#()a) t!s!i#' pistaksis5
• Apaka% p#()a) k&"a t!s!i#' pistaksis5
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HIPOTESIS
• P#()a) t!s!i#' pistaksis m!"paka# p#()a) i&i*6ti&ak &apat &ii&#ti7kasi8
• P#()a) t!s!i#' k&"a pistaksis a&a$a% %ip!t#si
• Tata$aksa#a k*#s!+ati, 3"k"p "#t"k m#a#''"$a#'i s)
)sa! kas"s pistaksis• Epistaksis a#t!i*! $)i% )a#(ak t!9a&i &i)a#&i#'ka#
pistaksis p*st!i*!
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BAHAN DAN CARA
• St"&i !t!*spkti,
• S")9k/ pasi# (a#' mas"k &#'a# pistaksis pa&a )a'ia# C%i-a# M&i3a$ C*$$' Ta3%i#' H*spita$ a#ta!a )"$a# Ma(:1; Pasi# )!asa$ &a!i "#it !a-at 9a$a#. "#it '&a!"!at &a# !"9"ka# &a!i &pa!tm# $ai#> Pasi# m$ip"ti s
!#ta#' "sia>• K!it!ia i#k$"si/ Pasi# s'a$a "m"!. '#&! apap"#. (a#'
m#'a$ami pistaksis
• K!it!ia ksk$"si/ Pasi# (a#' ti&ak m$ak"ka# a&misi pa&atmpat p#$itia# s$ama 9a#'ka -akt" p#$itia#
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BAHAN DAN CARA• I#+sti'asi !"ti# m$ip"ti. %it"#' &a!a% $#'kap.
%m*'$*)i#. t!*m)*sit. '"$a &a!a% s-akt".$kt!*$it. "!"m?3!ati#i#. "!i# !"ti#. '*$*#'a#&a!a%>
• Fakt*! k*a'"$asi/ PT. APTT. )$&i#' tim. 3$*tti#tim.
• CT s3a# kpa&a pasi# t!t#t" "#t"k m#(i#'kkm"#'ki#a# #*p$asma pa&a %i&"#'. si#"spa!a#asa$ &a# #as*,a!i#'
• ECG. CXR "#t"k kas"s (a#' mm)"t"%ka# *p!a
&a$am ka&aa# a#st%sia "m"m
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BAHAN DAN CARA• I#+sti'asi a-a$ m#''"#aka# !i#*sk*pi a#t!i*! 444 sit
)$&i#'
• Pasi# &#'a# p!&a!a%a# )!"$a#' ata" p!&a!a%a# &i)a'ia# p*st!i*! ata" pa&a !i#*sk*pi a#t!i*! ti&akm#"#9"kka# a&a#(a p!&a!a%a# &i$ak"ka# #as*#&*sk*
• P#ata$aksa#aa# m$ip"ti k*#s!+ati, &a# pm)&a%a#
• K*#s!+ati,/ #asa$ &!*p *@(mta*$i# ata" @($*mta*$3a"t!iati*# &a!i tmpat p!&a!a%a# s3a!a $kt!ik makimia-i. a#t!i*! p*st!i*! #asa$ pa3ki#' 6tamp*#8
• Pm)&a%a#/ #&*s3*pi3 $3t!*3a"t!iati*#. E#&*s3*p$i'ati*#
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BAHAN DAN CARA
• Tata$aksa#a k*#s!+ati, &i$ak"ka# t!$)i% &a%"$"
• Pa&a )a'ia# a#t!i*! &#'a# ka"t!isasi kimia-i Si$+! Nit!at = 2 at
$kt!*ka"t!isasi &#'a# )ip*$a! ka"t!
• Pa&a )a'ia# p*st!i*! &#'a# $kt!*ka"t!isasi t!)a#t" #as*#&*sk*
• P!&a!a%a# &i"s/ tamp*# a#t!i*! &#'a# sp*#' '$ati# ata" kai#
• P!&a!a%a# )!"$a#' pa&a tamp*# a#t!i*! 444 &ipasa#' tamp*# p*st
• Tata$aksa#a )&a% 9ika 3a!a43a!a s)$"m#(a 'a'a$ m#'atp!&a!a%a#
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HASIL• < pasi# &#'a# pistaksis
• R#ta#' "sia = ta%"# %i#''a 0 ta%"#. =: $aki4$aki : p!mp"a#
• 01 6;>;2
• Eti*$*'i/ : 6>128 i&*patik. : pasi# %ip!t#si 6:>28. t!a"ma ; pa6;=>28 pasi#. ;< pasi# tamp*# p*st!i*! 6;0>0
• = pasi# 6028 m#9a$a#i t!api )&a%. : pasi# !sksi t"m*!. : pasi# ka"t!isa#&*sk*pik. ; pasi# spt*p$ast(
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DISKUSI• Epistaksis s!i#' &itm"i pa&a p!aktik s%a!i4%a!
•
T!9a&i pa&a sm"a !#ta#' "m"!• Di)a'i m#9a&i a#t!i*! &a# p*st!i*!
• A#t!i*! 9a!a#' mm)a%a(aka# ka!#a $tak#(am"&a% &ii&#ti7kasi. s"m)!#(a )!asa$ &a!i p$kiss$)a3%
• P*st!i*!. s"$it "#t"k m#'9%#tika# p!&a!a%a#ka!#a $tak#(a (a#' &a$am. s"m)! )!asa$ &a!p$@"s W**&!"
• Fakt*! "sia )!p#'a!"% t!%a&ap p!pa#9a#'a#
&"!asi p!&a!a%a#
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DISKUSI• Epista@is $)i% s!i#' pa&a a#ak4a#ak "sia k"!a#' &a!i ;
pasi#/ :;>=28 ss"ai &#'a# %asi$ p#$itia# Pa$$i# t>a• Laki4$aki J )a#(ak m#&!ita &is)a#&i#' p!mp"a# &#
p!)a#&i#'a# ;/;>0 ss"ai &#'a# p#$itia# $ai# 6H"a#'M')*!8. km"#'ki#a# ka!#a p!ia $)i% )a#(ak m$ak"kaakti+itas $"a! !"a#' &is)a#&i#' p!mp"a#>
•
P!+a$#si (a#' $)i% )a#(ak pa&a a#ak4a#ak km"#'ki#ka!#a k)iasaa# m#'"pi$
• P!+a$#si (a#' )a#(ak pa&a "sia t"a ka!#a a&a#(ak*m*!)i&itas sp!ti %ip!t#si &a# &ia)tsm$$it"s
• Eti*$*'i t!)a#(ak pa&a pistaksis a&a$a% i&i*patik. ss"
&#'a# st"&i &a!i C%!ist#s# t>a$•
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DISKUSI
• Tata$aksa#a t!)a'i &"a m#9a&i p#&kata# #*#s"!'i3a$ &a# s"!'i3a$
• N*# s"!'i3a$ t!mas"k. k*mp!si #asa$ &i'ita$.+as*k*#st!ikt*! t*pi3a$. ka"t!isasi $*3a$ 6kimia-
ma"p"# $kt!ika$. tamp*# a#t!i*! ata" p*st!i*• S"!'ika$ t!mas"k/ selective arterial embolization
arterial ligation
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KESIMPULAN• Epistaksis m!"paka# k*#&isi k&a!"!ata#
(a#' s!i#' &itm"i pa&a THT. (a#' )isa&i&!ita *$% sm"a k$*mp*k "m"!> P#(pa$i#' s!i#' pistaksis (a#' &apat&ii&#ti7kasi a&a$a% %ip!t#si. t!a"ma. &a
k*a'"$*pati> T!api k*#s!+ati, &i)"ktika#,kti, "#t"k m#ata$aksa#a pistaksis pa&s)a'ia# )sa! pasi#> T!api s"!'i3a$.&i$akka# 9ika t!api k*#s!+ati, 'a'a$ "#t"km#'#&a$ika# pistaksis