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Pemeriksaan Penunjang
1. Pemeriksaan darah
2. Tes alergi/prick test
3. Hitung eosinofil
4. Pemeriksaan lain dilakukan bergantung pada kondisi
klinis pasien
Physical examination
Diagnostic The patient looks shortness of breath, increased respiratory rate,
Criteria cyanosis due to laryngeal edema and bronchospasm. Hypotension is a
prominent symptom in anaphylactic shock. Presence of tachycardia,
periorbital edema, watery eyes, conjunctival hyperemia. Prodromal signs
on the skin include urticaria and erythema
Supporting examination
1. Blood test
2. Allergy test/prick test
3. Count eosinophils
4. Other examinations are performed depending on the clinical
condition of the patient
Prosedur Alat :
1. Nasal Canula/Breathing Mask
2. Infus Set
3. Syringe
4. Monitor TTV
5. Stetoskop
6. Emergency Set
Obat :
1. Adrenalin
2. NaCl Fisiologis
3. Aminofilin
4. Kortikosteroid : Dexametason/Hidrokortison
5. Antihistamin : Diphenhydramine
Prosedur :
1. Pasien dalam posisi trendeleburg atau berbaring dengan kedua
tungkai diangkat untuk membantu menaikkan venous return
sehingga tekanan darah ikut meningkat
2. Pemberian oksigen mulai 3-5 lpm, pertimbangkan tindakan
tracheostomi bila diperlukan
3. Pemasangan infus cairan plasma dextran merupakan pilihan
utama untuk mengisi volume intravasculer secepatnya. Jika cairan
tersebut tidak tersedia ringer laktat atau NaCl fisiologis dapat
diberikan. Pemberian infus cairan dipertahankan sampai tekanan
darah stabil
4. Adrenalin 0,3-0,5 ml dilarutkan 1:1000 diberikan secara
intramuscular yang dapat diulang 5-10 mnt. Jika respon
pemberian intramuskular kurang efektif, dapat diberikan secara
intravena dengan dosis 0,1-0,2 ml dilarutkan dalam spuit 10 ml
dengan NaCl fisiologis, diberikan perlahan
5. Aminofilin dapat diberikan dengan hati hati apabila
bronkospasme belum hilang dengan pemberian adrenalin.
Aminofilin diberikan 250 mg perlahan selama 10 menit secara
intravena. Dosis dapat dilanjutkan 250 mg secara drip bila
diperlukan
6. Antihistamin dan kortikosteroid merupakan pilihan kedua setelah
adrenalin. Kedua obat tersebut kurang manfaatnya pada tingkat
syok anafilaktik, dapat diberikan setelah gejala klinik mulai
membaik guna mencegah komplikasi. Antihistamin dapat
menggunakan difenhidramin HCL 5-20 mg IV dan untuk steroid
bisa menggunakan deksametason 5-10 mg IV atau hidrokortison
100-250 mg IV
7. Resusitasi jantung paru segera dilakukan bila pasien dalam
kondisi arrest. Angka kejadian henti jantung cukup tinggi pada
kasus syok, maka ditiap ruang dokter harus tersedia obat-obat
emergency, perangkat infus, cairan infus, dan perangkat
oksigenasi
8. Keluarga perlu diedukasi mengenai tindakan dan obat-obatan
yang diberikan kepada pasien
9. Pasien dirujuk ke layanan sekunder bila tidak terdapat perbaikan
dan setelah menangani kondisi emergency
Procedure
Tools :
1. Nasal Canula/Breathing Mask
2. Infusion Set
3. Syringe
4. Monitor TTV
5. Stethoscope
6. Emergency Set
Medicine :
1. Adrenalin
2. NaCl IV fluids
3. Aminophylline
4. Kortikosteroid : Dexamethason/Hydrocortisone
5. Antihistamin : Diphenhidramine
Procedure :
1. Patient in the Trendelenburg position or lying with both legs raised
to help increase venous return so the blood pressure also increases
2. Giving oxygen start from 3-5 lpm, consider tracheostomy if needed
3. Infusion of plasma fluid dextran is the main option to fill the
intravascular volume as soon as possible. If fluids are not
available Ringer lactate or physiological NaCl can be given. Fluid
infusion is maintained until blood pressure stabilizes
4. Adrenaline 0.3-0.5 ml diluted 1:1000 administered intramuscularly
which can be repeated 5-10 min. If the response to intramuscular
administration is less effective, it can be given intravenously at a
dose of 0.1-0.2 ml dissolved in a 10 ml syringe with physiological
NaCl, given slowly
5. Aminophylline can be given with caution if the bronchospasm has
not been relieved by administration of adrenaline. Aminophylline
is given 250 mg slowly over 10 minutes intravenously. Dosage can
be continued by 250 mg drip if needed
6. Antihistamines and corticosteroids are the second choice after
adrenaline. Both drugs are less useful at the level of anaphylactic
shock, can be given after clinical symptoms begin to improve to
prevent complications. Antihistamines can use diphenhydramine
HCL 5-20 mg IV and for steroids can use dexamethasone 5-10 mg
IV or hydrocortisone 100-250 mg IV
7. Cardiopulmonary resuscitation should be performed immediately if
the patient is in arrest. The incidence of cardiac arrest is quite
high in cases of shock, so in every doctor's room there must be
emergency medicines, infusion devices, infusion fluids, and
oxygenation devices.
8. Families need to be educated about the actions and drugs given to
patients
9. Patients are referred to secondary care if there is no improvement
and after handling emergency conditions
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