ARDS ec BRONKOPNEUMONIA

dr. WINNY MUTIA

 “ Shorthness Of Breath “
Lina, a 11 months girl, was taken by his mother to the RSMP Emergency Room because of shortness of breath that has been worsened since 1
day ago. Two days earlier, Lina began to look short of breath and had difficulty in eating and drinking. Since four days ago, she also had a cough
and runny nose accompanied by a high fever. She has never experienced shortness of breath before and there is no history of allergies. Lina has
never been taken to a doctor before.
Lina lives with his parents and 3 older siblings in a 4 x 4 m semi-permanent house with no bedrooms, and only 2 windows. Her first sister in
this week having a cold and cough. His father is known to have a habit of smoking 1 packs a day. There is no history of a long cough in his
family and taking medicine for 6 months. Lina has never been breastfed since birth. Currently, he eats regular porridge 3 x half a small bowl per
day. Lina has a history of immunizations: BCG, scar (+); DPT 1,2; HiB 1,2; Hepatitis 0,1,2; Polio 0,1,2. Currently, the pandemic is still ongoing.

Physical Examination:
Current Body Weight = 8 Kg, Body Length = 69 cm
General Condition: looks very sick
Vital Sign: BP 80/50 mmHg, Pulse 120 x/minute, regular, RR : 58 x/minute, T: 39.6 0C, oxygen saturation 90%.

Spesific Examination:
Head: oral circum cyanosis (+), nostril breath (+), conjunctiva is not anemic, no head bobbing
Neck: within normal limits, no lymph node enlargement
Thorax:
Pulmo
Inspection: There are intercostal and subcostal retractions.
Palpation: Stem fremitus increases in both lung fields (child is crying)
Percussion: dim in all lung fields.
Auscultation: vesicular increase, soft, loud wet crackles in both lung fields, wheezing is not audible.
Cor
Inspection: Normal chest shape, no visible ictus cordis
Palpation: ictus cordis not palpable
Percussion: within normal limits
Auscultation: Normal I/II heart sound, gallop (-), murmur (-)
Abdomen: flat, supple, not palpable splenic liver, normal bowel sounds
Extremity: no clubbing finger found, no edema, no pale.

Laboratory Examination:
Blood Examination: Hb: 11,6 gr/dl, Leukocyte: 24.000 /mm3, Diff. Count: 1/1/8/70/18/2, LED: 18 mm/jam, CRP 36 mg/L
 Bronkopneumonia

Definisi

Bronkopneumonia adalah diagnosis

pneumonia untuk anak dengan usia < 2 tahun.
Bronkopneumonia merupakan infeksi yang
mengakibatkan peradangan pada paru-paru
yang disebabkan oleh virus, bakteri, atau
jamur.

Etiologi

Tersering adalah Streptococcus pneumoniae

Faktor Risiko
Usia  daya tahan tubuh anak berusia < 2 tahun cenderung belum berkembang
Immunodefisiensi
Infeksi nosokomial  HAP/VAP
kelengkapan imunisasi,
kepadatan hunian
defisiensi vitamin A
defisiensi Zinc (Zn),
faktor lingkungan (polusi udara)
Manifestasi Klinik

Gejala nonspesifik : demam, menggigil,

sefalgia, resah dan gelisah, gangguan
gastrointestinal seperti muntah, kembung,
diare, atau sakit perut.
Gejala pada paru: demam dan batuk pilek,
gejala napas cuping hidung, takipnu, dispnu,
dan timbul apnu, retraksi.
Diagnosis
Pemeriksaan fisik
Peningkatan laju pernapasan (RR)
Rektraksi dinding dada
Stem fremitus dapat meningkat atau
melemah
Pemeriksaan perkusi bisa didapati dullness
Pemeriksaan auskultasi ditemukan RONKI
BASAH HALUS NYARING, suara pernapasan
bronkial, dan friction rub.
Pemeriksaan X-Ray
Infiltrat
Konsolidasi dengan air bronchogram
Gambaran kavitas
Infiltrat bilateral atau gambaran
bronkopneumonia
Pemeriksaan Laboratorium
leukositosis (shift to the left): infeksi oleh S.
pneumoniae, H. influenzae, dan bakteri
batang gram negatif.
C-reactive protein (CRP) meningkat akibat
respon inflamasi terutama akibat infeksi
bakteri.
Pemeriksaan mikrobiologis: sampel didapat
dengan cara mengambil cairan bronkus
(bronchoalveolar lavage) pada saat
bronkoskopi dan aspirasi cairan pleura.
Pewarnaan sputum: Mengidentifikasi
spesies
Kultur sputum: untuk mengidentifikasi
patogen
Kultur darah,
Kultur cairan pleura
 ARDS
Acute Respiratory Distress Sydrome (ARDS) merupakan suatu kondisi kegawat daruratan di bidang pulmonology yang terjadi karena adanya
akumulasi cairan di alveoli yang menyebabkan terjadinya gangguan pertukaran gas sehingga distribusi oksigen ke jaringan menjadi berkurang
Tatalaksana
Bronkopneumonia

Tatalaksana
Rawat Jalan (Pneumonia Ringan)
Cotrimoxazol 4mg/kg/kali, dosis 2x sehari 3 hari oral
Amoxicillin 25 mg/kg/kali, dosis 3x sehari, 3 hari oral

Rawat Inap (Pneumonia Berat)

Terdapat min.1 : head bobbing, pernafasan cuping hdidung, tarikan diding dada
foto toraks: infiltrasi luas, konsolidasi luas
Tatalaksana:
O2 nasal kanul 2-4 L/menit
Infus: rehidrasi, pemberian obat IV
Pengobatan simptomatis
Antibiotik IV

Ampicillin / Amoxicillin 25-50 mg/kgBB/kali IV, 4x sehari, 5 hari. Lanjut di rumah:

Amoxicilin oral untuk 5 hari selanjutnya
Kombinasi Amoxicillin-Gentamicin, (Gentamicin  2-5 mg/kgBB/hari dibagi 4 dosis)
Ceftriaxone 80-1000 mg/kgBB/hari, 1x sehari, 5 hari
Komplikasi
Sepsis
Efusi pleura: Empiema (pus dalam rongga pleura)
ARDS

Prognosis
Quo ad vitam: dubia ad bonam
Quo ad functionam: dubia ad bonam
Quo ad sanationam: dubia ad bonam

SKDI
Hepatisasi merah : daerah perifer dimana terdapat
edema dan perdarahan
Hepatisasi abu abu: daerah konsolidasi luas
TERIMAKASIH