presentasi KEGAWATDARURATAN ENDOKRIN.pdf

KEGAWATDARURATAN ENDOKRIN

1. ANALISA GAS DARAH

2. Sampeldaraharteridigunakanterutamauntuk
pemeriksaananalisagasdarah(AGD)arteri
Sampeldapatdiperolehmelaluiduacara,
●kateterdalamarteri,atau
●denganmenggunakanspuituntuk
tusukanarteripadapasienyanghanya
butuhsatukalipemeriksaan
Pengambilansampeldaraharterilebihsulitdibandingkan
sampeldarahvenakarenapembuluhdarahnyalebih
dalamdantidakterlihat/terabadengankomplikasiyang
lebihberat

3. Arteriradialismerupakanpilihanpertamakarenapalingdangkal,
memilikikolateral(arteriulnaris),danmudahperabaannya
Pilihanarteriberikutnyaadalaharteribrachialisdanarteridorsalispedis,
sedangkanarterifemoralismerupakanpilihanterakhir.Sebenarnya
pengambilansampeldariarterifemoralislebihmudahkarenaukuran
arterilebihbesar,tapiberesikomenyebabkanperdarahanyangsering
tidakdiketahuikarenalokasinyatertutupselimut

7. ANALISA GAS DARAH
SAMPLING DARAH
MONITORING TERAPI
ABSOLUT
-SIRKULASI INADEKUAT
-LUKA BAKAR
RELATIF
-BEKAS LUKA OPERASI
-MENGGUNAKAN ANTIKOAGULAN
-INFEKSI KULIT PADA TEMPAT PENUSUKAN

8. Peralatansampling arterial

9. •pre-heparinizedsyringe;
•needles(20,23and25gauge,ofdifferentlengths)–
chooseasizethatisappropriateforthesite

13. ProsedurKerja
1.Siapkanspuit3ccatauspuitkhususuntukAGDyangsudahpreheparinized.
Jumlahantikoagulan0,2mLheparin.
2.Bersihkandaeraharteriyangakanditusukdengankapas-alkohol70%danbiarkan
kering
3.Posisitanganhiperekstensipadapergelangan,diganjalhandukgulungataubantal
kecil
4.Tusukpadayangdenyutnyapalingmenonjoldengansudut45–60
o
(90
o
untuka.
femoralis)
5.Hisapdarahsecukupnyalalucabutjarumbesertasempritnyadansegeratutup
ujungjarumdengankaret,dansempritdibolak-balikbeberapakaliagardarah
bercampurheparin
6.Setelahjarumdicabut,tekandaerahitudengankapasataukassakering3-5menit
7.Segeradikirimkelaboratoriumdalamwaktukurangdari15menitataudiletakkanke
dalamwadahberisies(atauwadahpendinginlaindengansuhu1–5°C)untuk
meminimalkankonsumsioksigenolehleukosit.

18. Blood Gas Analysis
Sampleerror
Inappropriatecollectionandhandlingofarterialbloodspecimens
canproduceincorrectresults.
Reasonsforaninaccuratebloodresultinclude:
•presenceofairinthesample;
•collectionofvenousratherthanarterialblood;
•animproperquantityofheparininthesyringe,orimproper
mixingafterbloodisdrawn;
•adelayinspecimentransportation.

23. 23

24. 24

25. 25

26. The Power of PowerPoint -thepopp.com
HYPERKALEMIA
•KADAR KALIUM > 5,0 MEQ
•PALING BERBAHAYA
ELECTROLYTE IMBALANCE

27. The Power of PowerPoint -thepopp.com
SLIDE 27

28. The Power of PowerPoint -thepopp.com
SLIDE 28

29. The Power of PowerPoint -thepopp.com
HYPOKALEMIA
•KADAR KALIUM < 3,5 MEQ
•INFUS KALIUM 10 to 20 mEq/JAM
ELECTROLYTE IMBALANCE

30. The Power of PowerPoint -thepopp.com
HYPERNATREMIA
•KADAR NATRIUM > 145 MEQ
•Nacl0,9% volume
replacement
Hinggahemodinamikstabil
kemudiangantikeNaCl 0,45%
100 mL/hr
Target : terkoreksi10-12
meq/hari
ELECTROLYTE IMBALANCE

31. The Power of PowerPoint -thepopp.com
HYPONATREMIA
•KADAR NATRIUM < 135 MEQ
ELECTROLYTE IMBALANCE

32. HYPERGLYCEMIC
CRYSIS
TOMMY KRISTANTO
EMERGENCY MEDICINE

33. The Power of PowerPoint -thepopp.com
•DIABETES TYPE II PALING SERING
•MORTALITAS 5-20%
PENDAHULUAN
LIFE THREATENING!!

34. The Power of PowerPoint -thepopp.com
PATOFISIOLOGI
Fayfman, M., Pasquel, F. J., & Umpierrez, G. E. (2017). Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Medical Clinics,101(3), 587-606.

35. The Power of PowerPoint -thepopp.com
ETIOLOGI
CEO
DIRECTOR
DESIGNER
INFEKSI
40-60% ETIOLOGI
•Pneumonia
•Infeksisalurankemih INSULIN
Tidakpatuhmenggunakaninsulin
INFARK
Meningkatkanhormone stress 
glukoneogenesismeningkat
IDIOPATHY
Fayfman, M., Pasquel, F. J., & Umpierrez, G. E. (2017). Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state.Medical Clinics,101(3), 587-606.

36. Long, B., Willis, G. C., Lentz, S., Koyfman, A., & Gottlieb, M. (2021). Diagnosis and Management of the Critically Ill Adult Patient with Hyperglycemic
Hyperosmolar State.The Journal of emergency medicine,61(4), 365-375.

37. The Power of PowerPoint -thepopp.com
SLIDE 37
•TANDA-TANDA DEHIDRASI
•TANDA-TANDA INFEKSI
•GANGGUAN/PENURUNAN
KESADARAN
HHS
PEMERIKSAAN
FISIK
Richard Dawson

38. GDS : 1100, Na
145
HITUNG
OSMOLARITAS

39. The Power of PowerPoint -thepopp.com
ABC’s no 1
TERAPI HHS
STE
P 1
REHIDRASI
CEPAT
STE
P 2
KOREKSI
ELEKTROLIT
STE
P 3
TERAPI
INSULIN
STE
P 4
KOREKSI
ETIOLOGI
Long, B., Willis, G. C., Lentz, S., Koyfman, A., & Gottlieb, M. (2021). Diagnosis and Management of the Critically Ill Adult Patient with Hyperglycemic
Hyperosmolar State.The Journal of emergency medicine,61(4), 365-375.

40. REHIDRASI
Stoner, G. D. (2017). Hyperosmolar hyperglycemic state.American family physician,96(11), 729-736.

41. ELEKTROLIT
(KALIUM)
Stoner, G. D. (2017). Hyperosmolar hyperglycemic state.American family physician,96(11), 729-736.

42. INSULIN
Stoner, G. D. (2017). Hyperosmolar hyperglycemic state.American family physician,96(11), 729-736.

43. KOREKSI
ETIOLOGI

44. EDEMA CEREBRI
HIPOKALEMIA
HIPERKLOREMIA ASIDOSIS
HIPOGLIKEMIA
ACUTE LUNG OEDEMA

45. The Power of PowerPoint -thepopp.com
TAKE HOME MESSAGES
1
IDENTIFIKASI HHS HIPERGLIKEMIA,
HIPEROSMOLAR
2
ABC’s STILL NO 1
3
KOREKSI DEHIDRASI, GULA DARAH,
ELEKTROLIT & ETIOLOGI
4
EVALUASI TTV, URIN OUTPUT, GDS
5
RAWAT INTENSIF, MONITORING KOMPLIKASI

46. The Power of PowerPoint -thepopp.com
SLIDE 46
HYPOGLYCEMIA
Neonatal hypoglycemia GDS <
40 mg/dL
2 mL/kg D10% lanjutD10% 80-100
mL/kg/hari
DEWASA GEJALA MUNCUL
JIKA GDS 40-50 MG/DL
TERAPI DEWASA 1-3 FLASK
D40%
CEK GDS 10-20 MENIT PASCA
KOREKSI

47. Any Questions?
Thank You! 