MANAGEMEN

GAWAT NAFAS PADA

BAYI DAN ANAK
•How do you initially
assess a patient in
respiratory distress?
 Initial Assesment
• Rapid assessment
–Quickly determine severity of
respiratory condition and stabilize child
–Respiratory distress can quickly lead to
cardiac compromise
 Initial Assesment
• Airway
– Support or open airway with jaw thrust
– Suction and position patient
• Breathing
– Provide high concentration oxygen
– Bag mask ventilation
– Prepare for intubation
– Administer medication
• Circulation
– Establish vascular access: IV/IO
Is The patient able
to speak or cry ?
Position the airway.
• Position the airway in a neutral sniffing
position.
• If spinal injury suspected, use jawthrust
maneuver to open the airway.
 Airway Opening Manoeuvres
Chin lift/head tilt

Infants Smaller children

Neutral head position Sniffing position
with chin lift with chin lift
Slide 9
Airway Opening Manoeuvres
Chin lift/head tilt

Older children/adults
Backward head tilt with pistol grip
Slide 10
11
Oropharyngeal Airways
Use: to keep the airway open in an unconscious patient

•Use with caution

and to facilitate bag and mask ventilation

•If airway is able to be

maintained with head
positioning and jaw
support
don’t use an
oropharyngeal
airway

Slide 15
Oropharyngeal Airways

•Potential problems:
Trauma
Obstruction
Illicit a gag reflex
causing aspiration
Laryngospasm

•Vagal response

Slide 16
23
Nasopharyngeal Airway
Simple mask
partial rebreathing mask
aspirationfsh.swf
 Breathing
If breathing is absent or inadequate:

n Give 2- 5 rescue breaths allowing

about 1 second per inspiration
n Sufficient breath to achieve gentle
rise and fall of chest

Slide 31
32
 Bag and Mask
Correct mask size: cover mouth and nose only

Holding the mask: C-grip

Slide 33
 Bag and Mask
• Mask size
 If too big you may get an air leak and also
potential damage especially with pressure
applied to the eyes
• Self inflating bag
 Connect to oxygen 10L/Min
 Once reservoir bag full, delivering 95-100%
oxygen
 Pressure release valve prevents too high
pressure
 Self-inflating can be
Slideused
35 to deliver room air
• a self-inflating BVM is preferred over an
anesthesia ventilation bag
• should have an oxygen reservoir
FiO2 90% to 95% is obtained when 10
to 15 L of oxygen is administered.
• The smallest bag that should be used is the
450-mL
 Neonatal bags that are smaller (250 mL)
do not provide effective tidal volume for
small infants.
 Self Inflating Bag Sizes

Preterm Adult
Infant (1600ml)
(240ml) >25kg
<2.5kg

Child (500ml) 2.5 – 25kg

Slide 37
 Checking Self Inflating Bags

• Check that the self inflating bag compresses and

reinflates quickly and air is felt from patient outlet
• Check the one way valve opens when self inflating bag
is compressed
• Occlude patient outlet with hand and compress bag,
listen for the pressure release value to release
• Take off oxygen reservoir bag and place over the patient
outlet. Inflate the reservoir bag checking for holes Slide 38
Bag mask ventilation
Bag to Mask Ventilation
Monitor the Effectiveness of
Ventilation
Monitor the Effectiveness of
Ventilation

• Visible chest rise with each breath.

• Oxygen saturation.
• Heart rate.
• Blood pressure.
• Distal air entry.
• Patient response.
• Contraindicated if
gag-reflex is intact

• Higher success rate

• Does NOT protect

from aspiration

• Difficult to maintain
during transport
 Foreign Body
Assess Severity

Severe airway Effective Cough

obstruction Mild airway
Ineffective Cough obstruction

Unconscious Conscious Encourage

coughing
Continue to check
victim until recovery
Call for Call for help
or deterioration
help Give up to 5 back
Call for help
Commence blows
CPR If not effective
Give up to 5 chest
Slide 51
thrusts
Back blows infant Back blows small child
Slide 52
 Hand
position is
lower half
of the
sternum

Chest thrusts infant Chest thrusts small child

Slide 53
TERAPI OKSIGEN
• Terapi oksigen merupakan terapi initial pada
kasus gangguan pernafasan

Penggunaan Rasional
• Mengerti konsep deliveri oksigen
• tepat memilh perangkatnya
Faktor yang mempengaruhi oksigenasi
• Kemampuan transfer molekul oksigen dari
udara atmosfir ke Alveolus
• Tekanan partial O2 Alveolus
 Faktor yang PAO2

• FiO2
• alveolar gas exchange;
• the mixed venous oxygen content;
• Distribusi ventilation / perfusion.
 FiO2

• Tekanan oxygen akan turun dari 159mmHg

diluar mulut menjadi 101 mmHg di alveolus

Faktor yang mepengaruhi besarnya penurunan

(1) H2O
(2) CO2yang dikeluarkan dari kapiler paru
(3) the incomplete gas exchange with every
breath.
 FiO2 PAO2
• PAO 2 = (Pb-PH2O) FiO2 – PaCO2 (1.25)
The variables that determine the FiO delivered
by a nasal cannula include:
• the capacity of the available oxygen reservoir,
• the oxygen flow; and
• the patient’s breathing pattern
PERHITUNGAN FiO2
• the anatomic dead space is 2cc/kg,
• The anatomic reservoir is 1/3 of the anatomic
dead space.
• then the capacity of the reservoir is 2/3 cc/kg.
• Oxygen flow is expressed in cc per second
when calculating the FiO .
 Oxygen flow is expressed in cc per
second when calculating the FiO .

• X L/min = X 1000cc/ 60 sec

= X 16.7cc/sec
 Pengisian Oksigen
• Waktu inspirasi ( dihitung dalam detik)
• Waktu pengisian ruang reservoir anatomik
terjadi pada ¼ akhir fase ekspirasi ( pada fase
ini tidak ada flow udara yang keluar )
 contoh
• Berapa besar FiO2 yang didapat dari 2 liter
O2 via nasal cannula 2
• Bayi BB 5kg dengan Laju nafas 40 kali per
minute.
Variabel FiO2 dengan Kanul Nasal

• 1) Kapasitas reservoir oksigen

• 2) Flow oksigen
• 3) Pola nafas pasien
BB 5kg , RR 40 kali per minute
BB 5kg , RR 40 kali per minute
BB 5kg , RR 40 kali per minute
BB 5kg , RR 40 kali per minute

Oxygenation and Oxygen Therapy Michael Billow, D.O

Oxygen Delivery
Systems
 low flow
• oxygen mixes with entrained room air during
inspiration because the oxygen flow is less
than the patient’s inspiratory.
• It deliver variable concentration of oxygen23%
to 80%.
nasal cannula.

simple oxygen mask.

 high flow:
• flow rate and reservoir capacity provide
adequate gas flow to meet the total inspired
flow requirements of the patient.
• High-flow systems can reliably deliver either
low or high inspired oxygen concentrations.
nonrebreathing masks.
Venturi masks.
oxygen hoods
oxygen tents.
 Diagnostic studies for evaluation of acute
respiratory distress

Bedside testing: Pulse oximetry

INDICATION:
• All patients with respiratory distress

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 Diagnostic studies for evaluation of acute
respiratory distress

Bedside testing: Pulse oximetry

Normal values despite hypoxia seen in patients with severe anemia,

carboxyhemoglobin, or sickle cell disease

Falsely low values obtained in patients with pulse oximeter not correlating
with pulse, poor peripheral perfusion, venous congestion,
methemoglobinemia, certain nail polish colors, and in patients receiving vital
dyes (eg, methylene blue) during surgical procedures

75
 Pulse oximetry

90

PaO2 (kPa)
 Sources of error
• Poor peripheral perfusion
• Dark skin
• False nails or nail varnish
• Lipaemia
• Bright ambient light
• Poorly adherent probe
• Excessive motion
• Carboxyhaemoglobin or methaemoglobin
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
Diagnostic studies for evaluation of
acute respiratory distress
 Steeple sign

The AP view demonstrates tapering of the upper trachea, known as the "steeple sign" of croup. Note that the finding can be
simulated by differing phases of respiration even in normal children.
Courtesy of the Department of Diagnostic Imaging, Texas Children's Hospital.

85
 Croup lateral neck radiograph

Lateral neck radiograph showing subglottic narrowing and distended hypopharynx

86
consistent with acute laryngotracheitis.
 Bacterial tracheitis

Lateral neck radiograph showing intraluminal membranes and tracheal wall irregularity consistent wit
bacterial tracheitis.
Courtesy of R. Paul Guillerman, MD, Department of Radiology, Baylor College of Medicine.
87
Retropharyngeal
abscess

Lateral neck radiograph demonstrating widening of the retropharyngeal space and reversal of the normal cervical spine
curvature. The retropharyngeal space is considered widened if it is greater than 7 mm at C2 or 14 mm at C6. The epiglottis and
subglottic area in this radiograph are normal.
Courtesy of Joe Black, Department of Diagnostic Imaging, Texas Children's Hospital. 88
 “ EACH MINUTE
IS CRITICAL TO ACHIEVING
BOTH SURVIVAL AND
A FAVORABLE
NEUROLOGIC OUTCOME. ”

89
…SELESAI...