Fistul Entero Kutan (FEK)

Pengertian Fistula Abnormal communication between two epithelialized

FEK Abnormal communication between the bowel lumen and skin
Surgical Site
Infection
(SSIs)

Surgical
wound

Class I
 Infeksi (-)
 Terapi kulit : primary suture
Class II
 Hollow Viscus : spt : respiratory, alimentary, genitourinary tract
 Terapi kulit : primary suture
Class III
 Spt juga open heart
 Terapi Bisa ditutup primer/ delay
Class IV
 Terapi : delay dg VAC

Klasifikasi 1. Anatomi
FEK - Gaster, duodenum(22%), jejenum(29%) Ileum
2. Etiologi
- Post Operasi (90%) - Cancer (29 %)
- Chorn disease - Radiasi
3. Physiologi
- Low : < 200 ml
- Moderate : 200- 500
- High : > 500
KHAS FEK FRIEND
F : Foregn Body
R : Radiasi
I : Inflamasi
E : Epitelisasi
N : Neoplasma
D : Distal Obstruction

Terapi 1. Debridement – drainase (bila abses)

2. Antibitik broad spectrum (initial) – dengan sesuai kultur
Paling banyak gr (+)  hati2 dengan (methicillin resistant Staphylococcus
aureus (MRSA) infection  ok terjadi bila pasien dengan FEK disertai
selulitis yang tidak sembuh dengan drainase bedah dan pemberian antibiotik
lini pertama tidak memadai
maka pemberian harus diberikan antimikroba
3. Pemberian antibiotik meliputi gr (+) + gr (-) + anaerob spt : vancomisin +
carbapenem
4. Hiperbarik oksigen  clostridium perfringens
SEPSIS
Definisi Menurut CCC (critical care congress)
A Life Threatening organ disfunction coused by dysregulated host respon to nfection

Definisi sepsis shock

 A subset of sepsis in which underlying circulatory and cellular/ metabolic
abnormalities are profound enough to substantially increase mortality
QuickSOFA 1. RR > 22x/mnt
(qSOFA) 2. Penurunan Kesadaran
3. TD utk Sistole krg dari sm dg 100

SOFA

SISTEM one hour Bundle

Terapi

Severe Sepsis
 Documentation of suspected or “possible” source of infection
 AND
 ≥2 SIRS criteria
AND
 Organ dysfunction evidenced by any one of the following:
SUMBER 1. Schwart (hal 150)
2. ESCAVO Sepsis 2018
3. Trauma Surg Acute Care Open 2017;0:1–6