gagal nafas & kedaduratan sis.resp

8/11/2019 Gagal Nafas & Kedaduratan Sis.resp

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DR. FACHRUL JAMAL, SpAn. KIC.

DEPT.ANASTESI & PERAWATAN INTENSIVE. FK-USK/RSUZA

BANDA ACEH

KEDADURATAN

SISTEM RESPIRASI

DAN GAGAL NAFAS

AKUT


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ANATOMY OF RESPIRATORY

SYSTEM

I. Upper Respiratory System

1. Nose and mouth2. Nasopharynx

3. Oropharynx

4. Laryngopharynx

5. Larynx

II.Lower Respiratory System

1. Trachea

2. Main bronchi

3. Lobar bronchi

4. Segmental bronchi

5. Small bronchi6. Bronchioles

7. Terminal bronchioles

8. Respiratory bronchioles

9. Alveolar ducts

10. Alveolar sacs

Condui ts or

connect ing tube

Respiratory

part


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The upper airway

The lower airwaysAlveolus


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Airway Obstruction

Coma

Aspiration

Maxillofacial

trauma Neck trauma


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KEDADURATAN DALAM

SISTEM RESPIRASI

DAPAT BERUPA GANGGUAN PD

JALAN NAFAS.(AIR WAY)

DAPAT JUGA PADA SISTEMPERNAFASAN.(VENTILASI)

AIR WAY & VENTILATORY FAILURE.


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GAGAL NAFAS

DAPAT BERUPA OBSTRUKSI JALAN

NAFAS & DEPRESI PERNAFASAN

HIPOVENTILASI SAMPAI APNOE PENYEBABNYA BISA BERMACAM2,

SPT : ANESTESIA,PENYAKIT, TRAUMA

BILA TIDAK DIATASI DENGAN CEPATBISA TIMBUL HIPOKSEMIA DAN

HIPERCARBIA.-KEMATIAN.


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TANDA-TANDA OBSTRUKSI

JALAN NAPAS

Cara : Look(Lihat), Listen(dengar),

feel(rasa).

Lihat =gelisah,kesadaran,pergerakandada/perut(see saw,rocking resp), retraksi iga dan

supra sternal,sianosis, dan pada trauma sering

adanya pergeseran trachea dan otot leher.

Dengar = adanya bunyi nafas tambahan ? Spt

snoring,gurgling dan crowing dan whizing.

Rasa = adanya udara dari hidung dan mulut,

adanya pergeseran trachea.


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Airway evaluation

LOOK Chest and abdomen

movement

Signs of respiratory distress

Color of skin, mucosa

Consciousness

LISTEN

air movement with your ear FEEL

air movement with your

cheek( Look- Listen - Feel )


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PATOFISIOLOGI

Penurunan kesadaran relaksasi ototlidah, pangkal lidah jatuh ke posterior

menutup orofaring sumbatan jalannapas.

Keadaan relaksasi spinter cardiac oesoakan terjadi regurgitasi,aspirasi isi

lambung dan pneumonia Aspirasi. Trauma wajah sering Kesulitan intubasi

segera krikotiroidotomi, trakheotomi ?


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Signs o f obs t ruct ion

snoring : base of tonguegargling : liquid

stridor : vocal cord spasm or edema

restlessness due to hypoxia

secondary breathing muscle(tracheal tug, intercostal retraction)

paradoxal chest & abdominal

movement

cyanosis (late sign)

MORE

SEVERE


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learing the airway

Obstruction due to the base of

tongue

jaw thrust

chin lift oro or naso-pharyngeal airway

tracheal intubation / LMA

Obstruction due to Liquid

suction

Obstruction at the plica vocalis

cricothyroidotomy


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Safest : Jaw thrustHead Tilt-Neck lift

Avoid head tilt


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Oro-pharyngeal tube

Not to be used in the presence of gag reflex

(Level A and V in AVPU or GCS > 10)


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Naso-pharyngeal tube

Doesnot stimulate vomiting

Be careful in patient suffering fractura basis cranii

Size 7 mm for adult or equiv to right little finger


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Advanced Airway Management

1. Tracheal intubation

with laryngoscopy

2. Cricothyroidotomy

needle / surgical

3.Laryngeal mask


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ACS 16

Definitive Airway


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Laryngeal Mask Airway


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Laryngeal Mask Airwaydipasang tanpa laringoskopi


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TRACHEAL INTUBATION

is indicated

Other airway methods failed

Difficult to ventilate with mask

Risk of pulmonary aspiration

Prevention of pCO2(head injury)

GCS < 8


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Risk of tracheal intubation

Hypoxia, vocal cord spasm

Increasing BP, bradycardia / asystole

Increasing ICP Neck movement may aggravate cervical

lesion

Patient with hypoxia and or convulsion usedto clench the jaw. Forcing laryngoscopy may

be deleterious to the head injured

Ideally, intubation require anesthesia and muscle

relaxant


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cricothyroidotomy

When tracheal intubation failedwhile clear airway is still needed

Patient can be ventilated


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Emergency oxygenation

Work up to 10 minutes

Can not eliminate CO2

Crico-thyroido-tomy


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TERSEDAK

(CHOKING)PADA KORBAN TERSEDAK SERING

DIJUM-

PAI HAL-HAL SEBAGAI BERIKUT: KORBAN MERASA TERCEKIK

ADA KAITANNYA DENGAN MAKANAN

TIDAK DAPAT BICARA < BERNAPAS

MUKA SEMBAB DAN BIRU

SEMULA SADAR TIDAK SADAR


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PERTOLONGAN PADA TERSEDAK DAPATDILAKUKAN SEBAGAI BERIKUT:

BACKBLOW / BACK SLAPS DILAKUKANPADA SEMUA USIA KORBAN

ABDOMINAL THRUST TIDAK DILAKUKANPADA : BAYI, DEWASA GEMUK/ HAMIL.

CHEST THUST DILAKUKAN PADA BAYI 8 TAHUN SEPERTI PADA DEWASA.


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Heimlichs Manuver


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Abdominal Thrust


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Pukulan antara duaskapula

Back Blows


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PERIKSA LAGI

TIUP LAGI

TIDAK MASUK

TENGKURAPKAN

BACK BLOW / BACK SLAPS

TERLENTANGKAN.

PERIKSA MULUT

TIUP LAGI

DST


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RESPIRATORY FAILURE

GAGAL NAFAS)

PENILAIAN NYA ADALAH ADANYA

GANGGUAN PADA PARAMETERVENTILASI DAN ATAU PARAMETER

OKSIGENISASI. {PaCO2 & PaO2}.


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BEBERAPA PARAMETER

PARAMETER VENTILASI :

PaCO2 : 35-45 mmHg.

ETCO2 : 25-35 mmHg.PARAMETER OKSIGENISASI :

PaO2 : 80-100 mmHg.

SaO2 : 95-100 mmHg.


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Breathing Evaluation

Look - chest movement, flaring nostrils,intercostal retraction

Listen - breath sound, abnormal sounds

Feel - air movement through mouth / nose

Palpation - chest movement, symmetrical?

Percussion - Damped?Hypersonor ?

Symmetrical?

Auscultation (stethoscope) -Breath soundpresents? Symmetrical?


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34

Signs of respiratory

distress

Rapid shallow breathing

Flaring nostrils

Intercostal and neckretraction

Rapid pulse

Hypotension

Distended neck veins

Cyanosis (late sign)


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KRITERIA GAGAL NAFAS

ADA 3 CARA :

PONTOPPIDAN :RR>35,PaO260

SHAPIRO :PaO2 50.

Petty : PaO2 50 mmHg(Acute Ventilatory

Failure).


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Open chest

wound? Sucking

wound?

Penetrating chest wound

Sucking chest wound Close the wound


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37

A piece of plastic sheet

fix with adhesive tape on

3 sidesone way valve

to prevent pressure build-up

inside pleural cavity whileclosing the wound

previous method:

cover with sterile gauze

impregnated with vaselin

(risk of pressure build-up)

How to Cover Penetrating Chest Wound


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38

Tension

Pneumothorax

Diagnosis by clinical signs onlyAffected side will show

Palpation less chest expansion

Palpation of trachea

shifts away to normalside

Percussion hypersonor (empty sound)

Auscultation reduced breath sound

Do needle thoracostomy,

do not wait for X-ray confirmation


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Palpate The Trachea at

Sternal Notch

Look more

carefully for

pneumothorax inthe presence of

Rib fractures

Subcutaneous

emphysema


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40

Needle Thoracostomy to Confirm

Pneumothorax

Needle and Filled Syringe System)

Bubble (+)= pneumothorax

Dont pull out the

needle until thoracic

drain is inserted

Bubble (-) and the

water was sucked

slowly inside

= no pnumothoraxPull needle out before

the syringe emptied

to avoid inducing

pneumothorax

lenght5 cm

water


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Rib fractures? Flail Chest ?4.

Inspiration Expiration


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1

2

Hemothorax?5.


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Subcutaneous EmphysemaFeels like grasping thin plastic sheet

Most caused by pneumothorax


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THERAPY: Artificial ventilation

12-20 x / minute, until chest rises

start ventilation to abnormal breathing, do not

delay until apnea occurs additional oxygen (if available)

if air enters the stomach, do not deflate by

pressing the epigastrium (risk of aspiration).Insert a nasogastric tube instead


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ACS 46

Oxygenate and Ventilate

Goal: Achieve Maximal cellular O2

O2at 10-12 liters / minute

Tight-fitting oxygen reservoir mask

Ventilate

Avoid prolonged attempts at

intubation without oxygenation


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47

Artificial ventilation was provided along with

in-line immobilisation hold the head and

neck)

to prevent the neck from moving excessively


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Artificial ventilation via tracheal tube:1. More effective oxygenation and removal of CO2

2. Prevent pulmonary aspiration

3. No interruption of cardiac compression during CPR


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VENTILATOR

Masa kini


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ACS 51

O

2

/ Hgb Dissociation

Cure


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52

Any Question.


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Penatalaksanaan

Bila pasien telah di diagnosa gagal nafas

maka Intubasi Endotracheal segera

harus di pasang dan dilanjutkan denganventilasi mekanik.(ventilator).

Bila pasien dlm kondisi Impending dapat

di coba dengan Pemberin oksigen kadartinggi denga Face Mask 10-12 L/mnt.

Segera cari penyebab utama dan obati.


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TERIMA KASIH

WASSALAMUALAIKUM

WARAHMATULLAHI WABARAKATUH.

gagal nafas & kedaduratan sis.resp

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