Dispnea pada pasien multipel fraktur ekstremitas post open reduction internal fixation

Ni Putu Novita Pradnyani; I Wayan Aryabiantara; Pontisomaya Parami

doi:10.15562/medicina.v49i2.55

Dispnea pada pasien multipel fraktur ekstremitas post open reduction internal fixation

Ni Putu Novita Pradnyani ,

I Wayan Aryabiantara ,

Pontisomaya Parami ,

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DOI: https://doi.org/10.15562/medicina.v49i2.55 |
Published: 2018-05-17

Abstract

Dispnea adalah keluhan yang sering memerlukan penanganan darurat tetapi intensitas dan tingkatannya berbeda-beda. Anamnesis yang lengkap sangat penting untuk memperoleh kepastian apakah pasien benar-benar menderita dispnea. Apabila dispnea telah ditegakkan, maka sangat penting untuk memperoleh data-data mengenai penyebab dispnea dan menilai gejala dan tanda lain yang berhubungan dengan dispnea. Dengan mendapatkan data yang lengkap kita dapat melakukan penanganan dispnea secara cepat dan tepat. Pada laporan ini disampaikan kasus laki-laki usia 19 tahun, dikonsulkan ke intensif dengan sesak nafas dan penurunan kesadaran post open reduction internal fixation (ORIF) et causa open fracture right tibia middle third grade II; openÂ fracture right fibula segmental; closed fracture left distal radius frykman VIII; closed frckture right distal radius frykman VIII hari ketiga. Pemeriksaan klinis dan pemeriksaan penunjang yang ada mendukung diagnosa acute respiratory distress syndrome (ARDS). Selama perawatan di ruang intensif, pasien mendapatkan farmakoterapi dan lung protective ventilation. Pasien mulai bisa disapih dari ventilator di hari ke 4, ekstubasi di hari ke 13 dan pada hari ke 17 pasien dipindahkan ke ruang perawatan. Target utama tatalaksana acute respiratory distress syndrome Â adalah mengembangkan alveoli secara optimal untuk mempertahankan gas arteri dan oksigenasi jaringan yang adekuat, keseimbangan cairan dan asam basa serta sirkulasi yang memadai sampai integritas membran kapiler kembali normal.Â Selain itu juga ditujukan untuk mengatasi faktor-faktor pencetus dan hal-hal lain serta memberikan terapi penunjang.

References

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS: Acute respiratory distress syndrome: the Berlin definition. JAMA 2012, 307:2526â€“2533.
Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM: The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012, 38:1573â€“1582.
Allen, K. and Bigatello, M.L., The Acute Respiratory Distres Syndrome (ARDS), in Bigatello, M.L. (ed). Critical Care Handbook of the Massachusetts General Hospital. Lippincott Williams & Wilkins. Philadelphia: 2010; (20)288-98
Repesse X, Charron C, Vieillard-Baron A: Right ventricular failure in acute lung injury and acute respiratory distress syndrome. Minerva Anestesiol 2012, 78:941â€“948.
Marino PL, Sutin KM. Principles of mechanical ventilation. In: Marino PL, Sutin KM, eds. The ICU book, 3rd ed., Philadelphia: Lippincott Wil- liams & Wilkins. 2007;457-70.
Duke G. and Bersten A.D., Non-Invasive Ventilation, in Bersten A.D., Neil S. (Eds). Ohâ€™s Intensive Care Manual. 6th edition. Butterworth Heinemann Elsevier. United Kingdom: 2009; Cp33,pp:429-35
Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation Study Investigators: Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008, 299:637â€“645.
Huh JW, Jung H, Choi HS, Hong SB, Lim CM, Koh Y: Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome. Critical Care 2009, 13:R22.
Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006, 354:1671â€“1684.
Fuller BM, Mohr NM, Drewry AM, Carpenter CR: Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Critical Care 2013, 17:R11.
Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med. 2006 May-Jun. 21(3):119-43.
The NHLBI ARDS Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15. 354(24):2564-75.

[1] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS: Acute respiratory distress syndrome: the Berlin definition. JAMA 2012, 307:2526â€“2533.

[2] Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM: The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012, 38:1573â€“1582.

[3] Allen, K. and Bigatello, M.L., The Acute Respiratory Distres Syndrome (ARDS), in Bigatello, M.L. (ed). Critical Care Handbook of the Massachusetts General Hospital. Lippincott Williams & Wilkins. Philadelphia: 2010; (20)288-98

[4] Repesse X, Charron C, Vieillard-Baron A: Right ventricular failure in acute lung injury and acute respiratory distress syndrome. Minerva Anestesiol 2012, 78:941â€“948.

[5] Marino PL, Sutin KM. Principles of mechanical ventilation. In: Marino PL, Sutin KM, eds. The ICU book, 3rd ed., Philadelphia: Lippincott Wil- liams & Wilkins. 2007;457-70.

[6] Duke G. and Bersten A.D., Non-Invasive Ventilation, in Bersten A.D., Neil S. (Eds). Ohâ€™s Intensive Care Manual. 6th edition. Butterworth Heinemann Elsevier. United Kingdom: 2009; Cp33,pp:429-35

[7] Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation Study Investigators: Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008, 299:637â€“645.

[8] Huh JW, Jung H, Choi HS, Hong SB, Lim CM, Koh Y: Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome. Critical Care 2009, 13:R22.

[9] Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006, 354:1671â€“1684.

[10] Fuller BM, Mohr NM, Drewry AM, Carpenter CR: Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Critical Care 2013, 17:R11.

[11] Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med. 2006 May-Jun. 21(3):119-43.

[12] The NHLBI ARDS Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15. 354(24):2564-75.

Dispnea pada pasien multipel fraktur ekstremitas post open reduction internal fixation

Abstract

References

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