ASTHMA

INTRODUCTION

asthma is derived from the chronic inflammatory airway hyper-

Greek ασυμα, signifying disorder characterized by responsiveness,
panting, and was used increased responsiveness bronchospasm, and
initially as a synonym for of the airways to multiple reversible airway
“breathlessness” stimuli obstruction
EPIDEMIOLOGI
ANAMNESA
DAN
PEMERIKSAAN
FISIK
 FAKTOR
RESIKO
KEMATIAN
PPOK
 Chronic obstructive pulmonary disease (COPD) is
characterized by persistent airflow limitation
that is generally progressive and associated with
an abnormal inflammatory response to noxious
particles or gases

COPD has two main forms: chronic bronchitis,

INTRODUCTION defined in clinical terms, and emphysema,

defined in terms of anatomic pathology

The World Health Organization’s Global Initiative

for Chronic Obstructive Lung Disease → chronic
bronchitis, emphysema, bronchiectasis, and
asthma, and acknowledges that most patients
have a combination of the different diseases
FAKTOR RESIKO

tobacco smoke is the major risk factor for developing

COPD, only 15% of smokers will develop COPD.

Occupational dust, chemical exposure, and air pollution

are other risk factors for COPD

α1-Antitrypsin deficiency accounts for <1% of COPD

patients.
 The hallmark symptoms are
ANAMNESIS & chronic and progressive dyspnea,
PEMERIKSAAN cough, and sputum production;
FISIK

Physical findings may include

Lower airway
accessory
pursed-lip obstruction
tachypnea respiratory
exhalation causes expiratory
muscle use
wheezing
DIAGNOSIS BANDING
The diagnosis of
chronic, compensated
COPD is confirmed by
spirometry
TATALAKSANA
IGD
INDIKASI PENGGUNAAN NIV
INDIKASI RAWAT INAP
PNEUMONIA
INTRODUCTION

• an infection of the alveoli (the

gas-exchanging portion of the
lung) emanating from different
pathogens, notably bacteria and
viruses, but also fungi
• cough (79% to 91%), fatigue
(90%), fever (71% to 75%),
dyspnea (67% to 75%), sputum
production (60% to 65%), and
pleuritic chest pain (39% to 49%)
FAKTOR
RESIKO
PNEUMONIA
pneumothorax
• Tommy kristanto
• EMERGENCY MEDICINE
 pneumothorax

• Masuknya udara ke rongga pleura

• Tidak perlu terapi – MENGANCAM
NYAWA

• Faktor resiko
• postur (tinggi & kurus)
• Merokok
• Riwayat penyakit paru (PPOK,
TB, tumor)
• Genetik

Imran, J. B., & Eastman, A. L. (2017). Pneumothorax. Jama, 318(10), 974-974. 28

NON TENSION
PNEUMOTHORAX
 Apakah ukuran penting?
• Gold standar → CT Thorax
• X-ray thorax → Light index (BTS vs ACCP)
• Lung USG → “barcode sign”
Inocencio, M., Childs, J., Chilstrom, M. L., & Berona, K. (2017). Ultrasound findings in tension
pneumothorax: a case report. The Journal of Emergency Medicine, 52(6), e217-e220.
• Konservatif
• RR < 24
• nadi 60-120
• TD > 90/60
• Sao2 >90% room air
Intervensi

• Needle aspiration
• ICD / Intercostal Drain / CTD /
Chest Tube Drainage

Gurney, D. (2019). Tension pneumothorax: What is an effective

31
treatment?. Journal of Emergency Nursing, 45(5), 584-587.
Needle
aspiration
• ACCP tidak menyarankan
Needle Aspiration bila butuh
intervensi
• BTS menyarankan needle
aspiration hingga 2.5 L sebagai
Langkah pertama tatalaksana
pneumothorax
• 20 - 50% pasien → butuh ICD
setelah aspirasi

Zehtabchi, S., & Rios, C. L. (2008). Management of emergency department patients

with primary spontaneous pneumothorax: needle aspiration or tube
32
thoracostomy?. Annals of emergency medicine, 51(1), 91-100.
 CTD/ICD
• Ukuran minimal 24F
• Lokal anestesi/ premedikasi
sedasi

Zehtabchi, S., & Rios, C. L. (2008). Management of emergency department patients with primary spontaneous pneumothorax: needle
aspiration or tube thoracostomy?. Annals of emergency medicine, 51(1), 91-100. 33
Algoritma
pneumothorax
Afr J Thoracic Crit Care Med 2020;26(1):18-22.

34
Wong, A., Galiabovitch, E., & Bhagwat, K. (2019). Management of primary spontaneous pneumothorax: a review. ANZ Journal of Surgery, 89(4), 303-308.

35
 • Persistent air leaks (pal)
• Adanya kebocoran udara dari paru ke rongga pleura setelah
insersi CTD
• Rujuk ke BTKV → operatif
• 61% membaik dalam waktu satu minggu

• Lung injury
Komplikasi • Bronkopleura fistula
• Infeksi
• Recurrent pneumothorax

• Extra pulmonary injury

• Cardiac, gaster injury

The Power of PowerPoint | thepopp.com 36

GAGAL NAFAS
• weakness, fatigue, chest pain, or shortness of breath
• Inadequate oxygenation and ventilation can lead to altered mentation, including anxiety,
confusion, obtundation, or coma
• Type 1 respiratory failure → characterized by an arterial Pao2 of <60 mm Hg or an arterial Sao2
<90% in room air
• may be the result of conditions that affect oxygenation but not necessarily ventilation (e.g.,
pneumonia, pulmonary embolism)
• Type 2 respiratory failure is
• characterized by hypoxia with hypercapnia.
• often the result of conditions that affect ventilation (e.g., chronic obstructive pulmonary
disease). Treatment of type 2 failure requires not only optimizing oxygenation but also
supporting ventilation.