FARMAKOLOGI PADA

KASUS TRAUMA
ANDRIAN SITOMPUL
PPDS 1 ILMU BEDAH
FK ULM
Pendahuluan
•Farmakoterapi : Suatu bagian ilmu dari farmakologi yang mempelajari
tentang penanganan penyakit melalui penggunaan obat-obatan.
•Setiap trauma memiliki penanganan yang berbeda sesuai dengan keluhan
pasien dan kondisi objektif pasien  Penggunaan Obat Yang Rasional

1. Tepat Diagnosis
2. Tepat Indikasi Penyakit
3. Tepat Pemilihan Obat
4. Tepat Dosis
5. Tepat Cara Pemberiaan
6. Tepat Interval Waktu Pemberiaan
7. Tepat Lama Pemberian
8. Waspada Terhadap Efek Samping
9. Tepat Penilaian Kondisi Pasien
 Mr. R. / 28 YO

Chief Complain : pain at the right leg

History of Current Disease:

Patient complained pain at the right leg after he fell from 3 meter high. He
fell because of hitted by electric when fixing a billboard. He fell to the right,
right side of the body first. There are no open wound in the leg. But the
right leg looks deform. There was a bruised in the chest, stomach and hand.
There are no short of breathing. He also complained pain in the whole
stomach. There were burns in neck, hand and foot. He didn’t remember
detail of the accident. There are no seizure, vomit and bloody leakage from
ear, nose and mouth.
Primary survey

• A: clear without c-spine control

• B: RR: 36 tpm, regular, retraction (-), rh (-), wh (-), SpO2:
98% with O2 10 lpm NRM
• C: HR 117 tpm, BP 80/60 mmHg
• D: GCS 14 (E3V5M6), pupil isochor (3 mm/3 mm), light
reflex (+/+), BH (-/-), BS (-/-), BR (-/-), BO (-/-),
lateralitation (-)
Secondary survey

• ALERGY : (-)
• MEDICATION : (-)
• PAST ILLNESS : (-)
• LAST MEAL : 8 hours before admision
• ENVIRONMENT : electrocute and fell from 3 meters high
in the road
 • Head : symmetric, normocephal

Head •
•
•
Eye : Anemic conj. (+/+), icteric sclera (-/-), isocor (3mm/3mm),
Mouth : Moist mucous membrane
Neck:Increased level of JVP (-)
Physical Diagnostic

• I : Symmetric respiratory movement, no retraction, VE (+)

Thorax •
•
•
P : Symmetric VF
P : Sonor at all lung fields
A : symmetric VBS, no rhonchi , no wheezing

Abdomen
• I : distension (-), VE(+)
• A : Bowel sound (+) decreased
• P : defans musculer (+), pain in all region
• P : tymphani (+)

Extremity • Cold extremities, CRT < 2 second

Local state
Localis status a/r femur D : Localis status a/r antebrachii D:
L : swelling (+), deformitas (+) false movement (+) I : combutio gr III 1 %
F: tenderness (+), krepitasi (+)
M : ROM limited dt pain
Localis status a/r gluteus D
I : combutio gr III 1%
F: tenderness (+)
Localis status a/r cervical posterior :
I : combutio gr III 1% Localis status a/r manus D :
F: tenderness (+) I : combutio gr III 0,5 %
F: tenderness (+)

Localis status a/r humerus D : Localis status a/r manus S :

I : combutio gr III 1% I : combutio (+) 0,5 %
F: tenderness (+) F: tenderness (+)
Hasil Laboratorium :
Hb : 13,6
Wbc : 7,1
Rbc : 4,09
Ht : 37,8
Plt : 266
PT : 9,4
APTT : 24,4
GDS : 149
SGOT : 887
SGPT : 614
Farmakoterapi Apa Yang Dapat Diberikan Pada Pasien Ini ?

Problem ?
1. Nyeri akibat fraktur dan luka bakar
2. Risiko infeksi lokal dan sistemik akibat luka bakar di
kulit
3. Adanya peningkatan heart rate
4. Peningkatan Fungsi Hati
Farmakoterapi apa yang mungkin diberikan pada kasus ini ?

1. Antibiotik profilaksis  Dibahas pada slide dr. Oscar

2. Antibiotik topikal
3. Analgetik
• Antibiotik apakah yang diberikan kepada pasien ?
 Antibiotik Topikal

 Topical antimicrobials for the prevention and treatment of burn wound infection
include mafenide acetate, silver sulfadiazine, silver nitrate solution, and silver-
impregnated dressings.
 In the event of a localized MRSA burn wound infection, fusidic acid and gentamycin
sulfate can be used as topical treatment.
 ANALGESIC

Pain in trauma has a role similar to the double-edged sword  knowing how
to manage pain in trauma patients is an important part of systemic approach
in trauma
• To provide adequate pain management in trauma patients require:
1. adequate assessment of age-specific pharmacologic pain management
2. identification of adequate analgesic to relieve moderate to severe pain
3. cognizance of serious adverse effects of pain medications, benefits >
adverse effects
4. regularly reassessing patients and reevaluating their pain management
regimen
 KESIMPULAN
Terapi Yang Bisa Diberikan Pada Pasien Ini ?

Antibiotik Profilaksis
Methicilin Sensitive : Sefalosporin, Penicilin Derivat + Sulbactam,
Methicilin Resistent : Vancomycin, Sulfametoksazol-Trimetropim

Antibiotik Topikal
Silver Sulfadiazine

Analgetik
Ketorolac iv, Ketoproven
Terima Kasih