ppt lapsus icu

7/25/2019 Ppt Lapsus ICU

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Oleh :I Gede Sumertana Jaya H1A011030I Gusti Ayu Diah KW H1A011031

Pembimbing :dr Hi!rineli" S# An

Post Laparatomi H-2 et causa RupturDiafragma +Post WSD H-2 et causa Hemothorak

Dextra


2/29

ID$%&I&AS PASI$%%A'A : H(SIA : )*&AH(%

J$%IS K$+A'I%: +AKI,+AKI

A+A'A& : &$PAS S('-AWA -A.A&AGA'A :IS+A'S&A&(S : '$%IKAH%O .' : /**0)0'.S : 1 02 )01

&G+ P$'$.IKSAA% : )0 02 )01


3/29

P.I'A.4 S(.5$4AI.WA4

&er#asang 6entilat7r #ada tra8ea"sn7ring 9, " gargling 9, " strid7r 9,-.$A&HI%G

Pergera8an dinding dada tida8 simetris"dinding dada sisi 8anantertinggal" retra8si inter87sta9, " suara na;as 6esi8uler sebelah 8ananmenurun"


4/29

Se>7ndary Sur6eyKeluhan utama

Sesa8 na;as.i


5/29

.i


6/29

.i


7/29

.i


8/29

Pemeri8saan Esi8 9 )0 02 )01

Status generalisataKeadaan umum : lemahG?S :$3 5B '/

&e8anan darah : 0 0 mmHg%adi : * 8ali menit.. : )2 8ali menit

&em# : 3 " dera!at >el>iusStatus gi=i : -- / 8g" &- 1 />m" -'I )0" 9n7rm7


9/29

Status l78alisKe#ala : u8uran F bentu8 n7rmal" edema 9, "massa 9,'ata : simetris " anemis 9, " i>terus 9, " reCeB#u#il 9 " #u#il is787r" reCeB >ahaya langsung9 " re;8le8s >ahaya tida8 langsung 9

&elinga : bentu8 n7rmal" simetris" tida8 terda#atse8ret atau#un #eradanganHidung : u8uran simetris" se#tum de6iasi 9, "#erdarahan 9, " se8ret 9,

'ulut : sian7sis 9, " mu87sa tam#a8 8ering dan8emerah, merahan" #erdarahan 9, " gusi hi#eremi9,+eher : de6iasi tra>hea 9, " #erbesaran KG- 9,


10/29

th7ra8sIns#e8si : #engembangan dada tam#a8asimetris" sisi dada 8anan tertinggal"retra8si dinding dada 9, " i8tus >7rdis ta8tam#a8" !e!as 9 " 7t7t bantu na#as 9, "massa 9, " bentu8 n7rmal" #erna;asandibantu dengan 6entilat7r" #ada sisi 8ananter#asang WSD" dimana #ada tabung WSDdida#at8an adanya darah yang mengalirdari dada #asien" ;re8uensi na;as)2B menit


11/29

Pal#asi : #ergera8an dada asimetris" dada8anan tertinggal" 8re#itasi 9, " 678al;remitus sulit die6aluasi" i8tus >7rdisteraba di I?S 5 mid >la6i>ula line sinistra"nyeri te8an 9 disisi 8anan" massa 9,


12/29

Per8usi :

-atas Jantung: 8anan I?S II #arasternal linedeBtra" 8iri I?S 5 mid >la6i>ula line sinistra-atas #aru he#ar sulit di e6aluasi

s7n7r s7n7r

redu# s7n7r

redu# s7n7r


13/29

Aus8ultasi :

rh7n8i 9, , "


14/29

Abd7menIns#e8si :distensi 9, " terda#at !ahitan #7stla#ar7t7mi dan ter#asang selang drainaseAus8ultasi : bising usus 9 dengan;re8uensi 10 8ali menitPer8usi : sulit di e6aluasiPal#asi : nyeri te8an 9 " he#ar lien gin!alsde" de;ans mus>ular 9, "


15/29

$8stremitas$dema : , ,A8ral hangat :


16/29

Pemer saan #enun angparameter 18/4/2 1! "i#ai

ru$uka%

H& '(8 1)-18

.b> )" 2"/,/"/

H>t ) "1 20,/0

W&c 1!(21 4( -11

Plt 1 ) 1/0,200

'>6 2 )"0 , )"0'>h 3 )*"0 , 31

'>h> 32" 3)"0,3*"0

Sg7t /3 @20

Sg#t /) @21

Gds 1/ @1 0

(reum ) 10,1/

Kreatinin 0" 0" ,1"3

-& ) 00 1 ,

?& 2 1/ ),


17/29

Pemeri8saan Analisa Gas DarahPH : *"3P?O) : 33

PO) : )H?O3 : 1 "/


18/29

7t7 &h7ra8 91 ,02,)01$mEsema sub8utisdeBtra(!ung selang WSD

#r7ye8si I?S 2,/P7steri7r?uriga 87ntusi7 #arudeBtra dd

br7n87#neum7niaDia;ragma deBtraireguler


19/29

Diagn7sisPost Laparatomi H-2 et causa RupturDiapragmaPost WSD H-2 et causa HemothorakDextra


20/29

&atala8sana5entilat7r teta# ter#asangIn;us .+ : %a>l )0 t#m%76algin 1gr 1) !am?e;triaB7n 1gr 1) !am

&ransamin /00mg 1) !am.antidin ) mg 1) !amPara>etam7l in;us !am

'7nit7ringKeluhan

&anda 6ital


21/29

Kebutuhan ?airan3/>> 8gbb !am 3/ >> B / 8g 1 0 >>

Out#ut(rin 2/0 >> 2 !am 1 00 >> )*00 )2 !am

IW+ : *00>> m) hari" rata rata luas #ermu8aantubuh 7rang ind7nesia : 1"3 m)" sehingga *00>> B1"3 10 >>

eses 100 >> hariAir hasil metab7lisme : 3/0>> m) luas #eru8aantubuh 3/0>> B 1"3 2// >>

&7tal 7ut#ut )*00>> 10>> 100>> 2//>> 21 / >>


22/29

In#utAir hasil metab7lsime 2// >>.+ 91 0,2// : )2 : 3 )0 t#m

Selisih 7ut#ut dan in#ut 21 / L 1 0 ))0/ >>


23/29

7ll7< u#*a%gga# 18 - 4- 2 1!

Subye8ti; : Sesa8 9 "lemas9 "nyeri lu8a 7#erasi9Obye8ti; :8eadaan umum lemah" G?S $35B'/"&D

100 *0mmhg" nadi0B m" .. ))B m" suhu 3 "3 ?

K + : an , , " i>t , , &h7ra8s : ? S1S) tunggal .eguler '9, G9, "

P 5es " .hn78i , , " Whee=ing , ,Abd7men : %yeri te8an 9 -using usus 9 n7rmal$8strimitas : a8ral hangat


24/29

Planing5entilat7r teta# ter#asangIn;us .+ : %a>l )0t#m%76algin 1gr 1) !am?e;triaB7n 1gr 1) !am

&ransamin /00mg 1) !am.antidin ) mg 1) !am

Para>etam7l in;us !am'ida=7lam )mg !amAtra>urium )0mg !amDur7gesi8 1) mg" selama 3 hari


25/29

7ll7< u#*a%gga# 1' - 4- 2 1!

Subye8ti; : Sesa8 9 "lemas9 "nyeri lu8a 7#erasi9Obye8ti; :8eadaan umum lemah" G?S $35B'/"&D 100 *0mmhg"

nadiB m" .. )1B m suhu 3 "/ ?

K + : an, , "i>t , , &h7ra8s : ? S1S) tunggal .eguler '9, G9, "

Pulm7 5es ".hn78i 9, Whee=ing 9,Abd7men : %yeri te8an 9 -using usus9 n7rmal$8strimitas : a8ral hangat


26/29

Planing5entilat7r teta# ter#asangIn;us amin7leban /00 >> hari

In;us .+ /00 >> hari &ut7;usin /00 >> hariS#7el %G&" s7nde susu B 100 ml'ida=7lam )mg !amAtra>urium st7#

&era#i lain lan!ut


27/29

7ll7< u#*a%gga# 2 - 4- 2 1!

Subye8ti; : Sesa8 9, "lemas9 "nyeri lu8a 7#erasi9Obye8ti; :8eadaan umum lemah" G?S $35B'/"&D 0 0mmhg"

nadi*B m" .. )2B m""" suhu 3 " ?

K + : an, , " i>t , , &h7ra8s : ? S1S) tunggal .eguler '9, G9, "

Pulm7 5es ".hn78i 9, Whee=ing 9,Abd7men : %yeri te8an 9 -using usus9 n7rmal$8strimitas : a8ral hangat


28/29

Planing5entilat7r teta# ter#asangIn;us amin7leban /00 >> hari

&ut7;usin /00 >> hariIn;us .+ /00>> haris7nde susu ) B 00 ml

&era#i lain lan!ut


29/29

* R, . .S,H

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