Pp Case Kelompok

8/16/2019 Pp Case Kelompok

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CASE KELOMPOK ICU

CEDERA KEPALA BERAT

DWI JULIANIKA PUTRI

REZA PRIATNA

RIKA KHAIRUNNISA S

WANLY SYAHRIZAL


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PENDAHULUAN

LATAR BELAKANG


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• WHO KLL menyebabkan !"## kema$%an &a'a anak (# )

*" $+, $a+-n 'an . /0!### kema$%an &a'a 'e1a2a m-'a (*3

) 4" $+,!

• Da$a B%na P5675am RSUD A5%8%n A9+ma' (4##3, :

9e'e5a ke&a;a men'-'-k% &e5%n7ka$ &e5$ama 'a5% *# be2a5

ka2-2 $e5banyak &a'a %n2$a;a2% 5a1a$ %na& be'a+ 2-bba7%an

be'a+ 2a5a8 2ebanyak // ka2-2< */ ka2-2 CKR= *3"

ka2-2 CKS= 0/ ka2-2 CKB!


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TINJAUAN PUSTAKA

ANATOMI KEPALAK-;%$ ke&a;a

Te5'%5% 'a5% 3 ;a&%2an (SCALP, :

> skin a$a- k-;%$

- connective tissue a$a- ?a5%n7an &enyamb-n7

- aponeurosis a$a- galea aponeurotika

- loose conective tissue a$a- ?a5%n7an &en-n?an7 ;6n77a5

> pericranium

!


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b! T-;an7 $en7k65ak

Te5'%5% 'a5% k-ba+ (ka;@a5%a, 'an ba2%2 k5an%%!

D%ben$-k 6;e+ bebe5a&a $-;an7 ya%$- 856n$a;=

&a5%e$a;= $em&65a; 'an 6k2%&%$a;!

R6n77a $en7k65ak 'a2a5 '%ba7% a$a2 / 862a ya%$- :

862a an$e5%65 $em&a$ ;6b-2 856n$a;%2= 862a me'%a$em&a$ $em&65a;%2 'an 862a &62$e5%65 5-an7 ba7%

ba7%an ba1a+ ba$an7 6$ak 'an 2e5ebe;-m!


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9! Men%n7en

) D-5a ma$e5

) Se;a&-$ a5ak+n6%'

D%&%2a+kan 'a5% &%a ma$e5 6;e+ spatium

subarakhnoid yan7 $e5%2% 6;e+ liquor

serebrospinalis!

) P%a ma$e5 Me;eka$ e5a$ &a'a &e5m-kaan k65$ek2 2e5eb5%!


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'! O$ak

Te5'%5% 'a5% bebe5a&a ba7%an :

Proensefalon (6$ak 'e&an, $e5'%5% 'a5%2e5eb5-m 'an diensefalon

Mesensefalon (6$ak $en7a+,

Rhombensefalon (6$ak be;akan7, $e5'%5%'a5% &6n2= me'-;a 6b;6n7a$a 'an 2e5ebe;;-m!


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e! Ca%5an 2e5eb562&%na; (CSS,

> D%+a2%;kan 6;e+ &;e-2 k+656%'e-2

'en7an ke9e&a$an &56'-k2% 2ebanyak4# m;?am!

> 6;-me CSS 65an7 'e1a2a ±*3# m;

'an '%+a2%;kan 2ek%$a5 3## m; CSS+a5%!


11/51

PERJALANAN LCS

• CSS men7a;%5 'a5% @en$5%ke; ;a$e5a; me;a;-%

865amen m6n56 men-?- @en$5%ke; III=

ak-a'-k$-2 'a5% sylvius men-?- @en$5%ke; I!

CSS akan '%5eab265b2% ke 'a;am 2%5k-;a2%@ena me;a;-% 75an-;a2%6 a5ak+n6%' yan7

$e5'a&a$ &a'a 2%n-2 2a7%$a;%2 2-&e5%65!

A'anya 'a5a+ 'a;am CSS 'a&a$ meny-mba$75an-;a2%6 a5ak+n6%' 2e+%n77a men77an77-

&enye5a&an CSS 'an menyebabkan kena%kan

$ekanan %n$5ak5an%a;!


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8! Ten$65%-m

Ten$65%-m 2e5ebe;% memba7% 56n77a $en7k65ak

men?a'% 5-an7 2-&5a$en$65%a; ($e5'%5% 'a5% 862a k5an%%

an$e5%65 'an 862a k5an%% me'%a, 'an 5-an7 %n85a$en$65%a;(be5%2% 862a k5an%% &62$e5%65,!

7! Pe5'a5a+an 6$ak


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Pa'a 2aa$ 9e'e5a :

Se7e5a $e5?a'% ma22a 2e&e5$% 7-m&a;an 'a5a+

'a&a$ $e5-2 be5$amba+ 2emen$a5a TIK ma2%+ 'a;am

kea'aan n65ma;! Saa$ &en7a;%5an CSS 'an 'a5a+%n$5a@a2k-;e5 men9a&a% $%$%k 'ek6m&en2a2% maka

TIK 2e9a5a 9e&a$ akan men%n7ka$!

K6n2e& -$amanya a'a;a+ ba+1a

@6;-me %n$5ak5an%a; +a5-2 2e;a;- k6n2$an

(Doktrin Monro-Kellie,


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• A;%5an 'a5a+ 6$ak (ADO, n65ma; ke 'a;am 6$ak&a'a 65an7 'e1a2a an$a5a 3#>33 m; &e5 *## 75am

?a5%n7an 6$ak &e5 men%$! Pa'a anak= ADO b%2a

;eb%+ be2a5 $e57an$-n7 &a'a -2%anya!

• Pen-5-nan ADO 'a&a$ men9a&a% 3#F 'a;am >*4

?am &e5$ama 2e?ak 9e'e5a &a'a kea'aan 9e'e5a

6$ak be5a$ 'an k6ma 2e5$a men%n7ka$ 'a;am 4>/

+a5% be5%k-$nya= $e$a&% &a'a &en'e5%$a yan7 $e$a&k6ma ADO $e$a& '% ba1a+ n65ma; 2am&a%

bebe5a&a +a5% a$a- m%n77- 2e$e;a+ 9e'e5a!


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K;a2%8%ka2%


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CEDERA KEPALA BERAT

• A'a;a+ 9e'e5a ke&a;a 'en7an Ska;a K6ma

G;a2761 />= &%n72an ;eb%+ 'a5% ?am 'an

a'anya 'e8%2%$ ne-56;67%2!

• Pen'e5%$a 'en7an 9e'e5a ke&a;a be5a$

$%'ak mam&- me;ak-kan &e5%n$a+>&e5%n$a+

2e'e5+ana 1a;a-&-n 2$a$-2

ka5'%6&-;m6ne5nya $e;a+ '%2$ab%;%2a2%!


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Nilai GCS = (E+V+M), nilai terbaik =

15 dan nilai terburuk = 3

Sk65 Respon ebuka ata (E) Respon !erbal (V) Respon otoril (M)

* Tak a'a 5eak2% 'en7an5an72an7an a&a&-n

Tak a'a 5eak2% 'en7an5an72an7an a&a&-n

Den7an 5an72an7an nye5%=$%'ak a'a 5eak2%

4 B-ka ma$a b%;a '%5an72an7nye5%

S-a5a $%'ak ?e;a2 Den7an 5an72an7an nye5%=$%mb-; 5eak2% ek2$en2%

abn65ma;

/ B-ka ma$a b%;a '%&an77%;a$a- a'a 5an72an7an 2-a5a

Ka$a>ka$a $%'ak $e5a$-5 Den7an 5an72an7an nye5%=$%mb-; 5eak2% 8;ek2% abn65ma;

" B-ka ma$a 2&6n$an B%n7-n7= '%265%en$a2% 1ak$-=$em&a$= 'an 65an7

Den7an 5an72an7an nye5%=mena5%k an776$a ba'an

3 > K6m-n%ka2% @e5ba; ba%k= ?a1aban $e&a$

Den7an 5an72an7an nye5%='a&a$ men7e$a+-% $em&a$5an72an7an

> > Men7%k-$% &e5%n$a+


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Peme5%ka2aan ne-56;67%2

*! Re2&6n &-&%; $%'ak be5'%;a$a2% &a'a kea'aan ak-$

4! Pe57e5akan ma$a

/! Pe57e5akan 1a?a+

"! Re2&6n 2en265%k 'a&a$ '%?a'%kan 'a2a5menen$-kan $%n7ka$ ke2a'a5an 'en7an membe5%kan

5an72an7an &a'a k-;%$ &en'e5%$a!

3! Peme5%k2aan ne5@-2 k5an%a;

! Kek-a$an 'an 2%me$5%2 'a5% ;e$ak an776$a 7e5ak

ek2$5%m%$a2 'a&a$ '%?a'%kan 'a2a5 -n$-k men9a5%

$an'a 7an77-an 6$ak 'an me'-;a 2&%na;%2!


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• P%;%+an -n$-k '%a7n62%2 9e'e5a ke&a;a a'a;a+ CT 29an!• CT 29an '%;ak-kan &a'a 2em-a 9e'e5a 6$ak 'en7an

ke+%;an7an ke2a'a5an . 3 men%$= amne2%a= 2ak%$ ke&a;a

+eba$= GCS*3 a$a- a'anya 'e8%2%$ ne-56;67%2 86ka;!

• D%a7n62%2 -n$-k 9e'e5a ke&a;a= CT 29an 'a&a$

mem&e5;%+a$kan $an'a $e5?a'%nya 85ak$-5= &e5'a5a+an

&a'a 6$ak (+em65a7%,= 7-m&a;an 'a5a+ (+ema$6m,= ;-ka

mema5 &a'a ?a5%n7an 6$ak (k6n$-2%6,= 'an -'em &a'a ?a5%n7an 6$ak! Se;a%n %$- ?-7a 'a&a$ '%7-nakan 86$6

rongent 2%na5 = MRI 'an an7%675a8%!


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Pena$a;ak2anaan

"enatalaksanaan a#al $edera kepala berat

Peme5%k2aan 'an &ena$a;ak2anaan

• ABCDE•Primary Survey 'an 5e2-2%$a2%•Secondary Survey 'an 5%1aya$ AMPLE•Ree@a;-a2% ne-56;67%2: GCS

•Oba$>6ba$an (Man%$6;= H%&e5@en$%;a2% 2e'an7 (PCO4/3

mmH7,= An$%k6n@-;2an,•Te2 D%a7n62$%k (2e2-a% -5-$an, : CT S9an= en$5%k-;675a8%-'a5a= An7%675am


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Primary survey dan Resusitasi

Airway dan Breathing

Pena$a;ak2anaan 2e7e5a ?%ka

$e5?a'% a&nea : %n$-ba2%

en'6$5akea;!

Pen'e5%$a men'a&a$ @en$%;a2%'en7an 6k2%7en *##F 2am&a%

'%&e56;e+ +a2%; &eme5%k2aan

ana;%2%2 7a2 'a5a+ 'an 'a&a$

'%;ak-kan &enye2-%an yan7$e&a$ $e5+a'a& %O4!

T%n'akan +%&e5@en$%;a2% +a5-2

+a5-2 '%&e5$a+ankan an$a5a 43>

/3 mmH7 (/=/>"=0 kPa,!

Sirkulasi

H%&6$en2% 'an +%&6k2%a

a'a;a+ &enyebab -$ama

$e5?a'%nya &e5b-5-kan

&a'a CKB! Se7e5a'%;ak-kan $%n'akan -n$-k

men65ma;kan $ekanan

'a5a+nya= Semen$a5a

&enyebab +%&6$en2%'%9a5%= 2e7e5a ;ak-kan

&embe5%an 9a%5an -n$-k

men77an$% @6;-me yan7

+%;an7!


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A&aka+ ;e2% $%'ak b%2a '%6&e5a2%= a$a- b%2a '%6&e5a2%=

mana7emen$nya $e5'%5% 'a5%:

• Ob2e5@a2% 'en7an +a$%>+a$% men77-nakan

G;a2761 C6ma S9a;e!• Me;ak-kan $%n'akan &en-5-nan -'em 6$ak

• K6n$56; $em&e5a$-5

• N-$5%2%• Pe5a1a$an 5-$%n &a2%en yan7 $%'ak 2a'a5 $e5ma2-k

-2-2= kan'-n7 kem%+ 'an &e5a1a$an $ekanan

%n$5ak5an%a;


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;n'%ka2% 6&e5a2% &a'a 9e'e5a ke&a;a +a5-2

mem&e5$%mban7kan +a; '%ba1a+ %n%:

• S$a$-2 ne-56;67%2

• S$a$-2 5a'%6;67%2

• Pen7-k-5an $ekanan %n$5ak5an%a;


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%n'%ka2% 6&e5a2% &a'a +ema$6ma %n$5ak5an%a;

:

• Ma22a +ema$6ma k%5a>k%5a "# 99• Ma2a 'en7an &e57e2e5an 7a5%2 $en7a+ ;eb%+ 'a5% 3 mm

• EDH 'an SDH ke$eba;an ;eb%+ 'a5% 3 mm 'an

&e57e2e5an 7a5%2 $en7a+ 'en7an GCS a$a- k-5an7!• K6n$-2%6 9e5eb5% 'en7an '%ame$e5 4 9m 'en7an e8ek

ma22a yan7 ?e;a2 a$a- &e57e2e5an 7a5%2 $en7a$ ;eb%+

'a5% 3 mm!

• Pa2%en ) &a2%en yan7 men-5-n ke2a'a5annya

'%kem-'%an 1ak$- '%2e5$a% be5kemban7nya $an'a>$an'a

;6ka; 'an &en%n7ka$an $ekanan %n$5akn%a; ;eb%+ 'a5% 43

mm H7!


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KASUS

%dentitas "asien &

• Nama : Tn! A

• Um-5 : *" Ta+-n

• Jen%2 Ke;am%n : Lak%>;ak%

• A;ama$ : A%5 T%5%2

• MR : /4

'nanesis

Pa2%en ma2-k ICU RSUD A5%8%n A9+ma' $an77a; 0 eb5-a5% 4#*#&-k-; #/!/# WIB 'en7an 9e'e5a ke&a;a be5a$!

eluan *taa & ('lloananesis denan oran tua)

• Pen-5-nan ke2a'a5an


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Ri#aat "enakit Sekaran &

• " Jam 2ebe;-m ma2-k 5-ma+ 2ak%$ (SMRS,= &a2%enmen7a;am% ke9e;akaan ;a;- ;%n$a2! Pa2%en

men7en'a5a% 2e&e'a m6$65 'en7an ke9e&a$an $%n77%=

'a5% a5a+ be5;a1anan m-n9-; m6b%; 'en7an ke9e&a$an

$%n77% 'a5% be;6kan! Pa2%en $e5?a$-+ 'en7an ke&a;a$e5ben$-5 a2&a; 'an +e;m yan7 '%7-nakan &e9a+!

Pa2%en m-n$a+ 'an kem-'%an $%'ak 2a'a5kan '%5%!

Pe5a'5a+an 'a5% m-;-$= +%'-n7 'an $e;%n7a $%'ak a'a!

Pa2%en ?-7a men7a;am% ;-ka>;-ka '% 1a?a+= 'a'a= 'an

kak%! Pa2%en '%ba1a ke RS B 'a;am kea'aan $%'ak

2a'a5= 'an 2e7e5a '%5-?-k ke RSUD AA!


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• D% RSUD AA= &a2%en ma2%+ 'a;am kea'aan $%'ak 2a'a5=

ka5ena kea'aan &a2%en ?e;ek &a2%en '%5a1a$ '% ICU!

Ri#aat "enakit eluara &

T%'ak a'a yan7 be5+-b-n7an

Ri#aat "enakit -aulu &

T%'ak a'a yan7 be5+-b-n7an

Ri#aat .perasi &

T%'ak a'a

" ik /i ik (t l 0 / b i


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"eeriksaan /isik (tanal 0 /ebruari

212)&

• Kea'aan -m-m : Tam&ak 2ak%$ be5a$• Ke2a'a5an : GCS "ET (E* M/ ETT,

• Tan'a>$an'a @%$a;

TD : *"404 mmH7

Na'% : */men%$= na'% k-a$ 'an 5abaan +a;-2

S-+- : /0= C

Na8a2 : 4# men%$ (@en$%;a$65 $5%77e5 *# men%$,= P6;a &e5na8a2an

SIM 'en7an 2a$-5a2% O4 F

• BB : 3# k7

• Ma$a: E'em &a;&eb5a (,= +ema$6m &a;&eb5a (>,= k6n?-n7$%@a anem%2 (,=2k;e5a $%'ak %k$e5%k= '%ame$e5 &-&%; 44= 5e8;ek2 &-&%; (,!

• H%'-n7 : De@%a2% 2e&$-m= &e5'a5a+an 'an &eny-mba$an(>,

• P%&% : @-;n-2 ek2k65%a2% be5-k-5an 3/ 9m!

• M-;-$ : B%b%5 $%'ak 2%an62%2= ke5%n7!


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Peme5%k2aan

orak

'bdoen"aru 4antun

In2&ek2% Ge5akan 'a'a 2%me$5%2 k%5% 'ankanan= 5e$5ak2% %7a (>,=@-;n-2ek2k65%a2% be5-k-5an "4 9m

Ik$-2 k65'%2 $%'ak $e5;%+a$= '%2$en2% (>,=;-ka 6&e5a2% (>,

:

Pa;&a2% T%'ak 'a&a$ '%;ak-kan Ik$-2 k65'%2 $e5aba '% RIC * ?a5% me'%a; ;%neam%'9;a@%9%;a5%2 2%n%2$5a

nye5% $ekan (>,

Pe5k-2% Da;am ba$a2 n65ma; Da;am ba$a2 n65ma;

A-2k-;$a2% S-a5a na8a2 @e2%k-;e5 k%5% 'ankanan= 56nk+% ba2a+ (>>,=1+ee%n7 (>>,

B-ny% ?an$-n7 $e5a$-5=b-ny% ?an$-n7 $amba+an(>,

B%2%n7 -2-2 (,

• Ekstreitas : Re8%;;%n7 ka&%;e5 ba%k! Ak5a; +an7a$= 2%an62%2 (>,= e'ema $-n7ka% (>,


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33/51

iia -ara&

• TB%; : #=0 m7'; A;b : 4=3 m7';

• DB%; : 4= m7'; TP : "=# m7';

• BUN : * m7'; U5e-m : /"=4 m7';

• C5ea : *=3 m7'; G;6b : *=3 m7';• AST : 443 m7'; Hb2A7 : n6n 5eak$%8

• ALT : *3# m7';

C s$an & In$5a9e5ebe5% Haem655a7%e

-ianosis era & CKB GCS 3 ET 'en7an ICH


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35/51

S . ' pLema+

SS" & Kea'aan -m-m: $am&ak 2ak%$ be5a$=P-&%; : 44= Ke2a'a5an: GCS: E*M/ET=5e8;e : V: TD: *"/03 mmH7= MAP : N': */I = Sa$ : FRespirasi: C6n$56; (men77-nakan @en$%;a$65,

&6;a SIMT : "3# %O4 : 3#F

RR : *# PEEP : 3'G-&&H: 0=/ mmH7 BE: >0=*&CO4 : 4 mmH7 HCO4 : *3= mm6;L

&O4

: *" mmH7 SO4

: F

Elektrolit & Na : *"/ mm6;L= K : "=4 mm6;LCa : #= mm6;L-iuresis&ma2-kan : 4"# 99 = Ke;-a5an: *3## 99IWL : ## 99 = Ba;an9e : 3"# 99

CKB GCS "ET ICH

En$e5a;: &-a2a=

NGT '%a;%5kanbe51a5na me5a+ke+%$amanPa5en$e5a;: NaC;#=F< RL /:*

Man%$6; "*43 99+a5% A >

S >

T >

H Hea' U& /#6

U %n? 5an%$%'%ne 443

m7+a5%G >

OLLOW UP DI RUANG ICU (

eb5-a5% 4#**,


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6lain&

• In? 9e8$5%a6n 4* 75+a5%(+a5% ke 4,

• In?! T5aneam%9 a9%' /3## m7+a5%

• P%5a9e$am // 75+a5%

Ren$ana&

• Pe5%k2a AGD 'an e;ek$56;%$ 2e$%a& +a5%


37/51

S . ' pLema+

SS" & Kea'aan -m-m: $am&ak 2ak%$ be5a$=P-&%; : 44= Ke2a'a5an: GCS: E*M/ET=5e8;e : V: TD: *"04 mmH7= MAP : N': */I = Sa$ : FRespirasi: C6n$56; (men77-nakan @en$%;a$65,

&6;a SIMT : "3# %O4 : 3#F

RR : *# PEEP : 3'G-&&H: 0=// mmH7 BE: >0=*&CO4 : /" mmH7 HCO4 : *0= mm6;L

&O4

: *3# mmH7 SO4

: F

Elektrolit & Na : *"/ mm6;L= K : "=" mm6;LCa : #=/ mm6;L-iuresis&ma2-kan : /*## 99 = Ke;-a5an: *"3# 99IWL : ## 99 = Ba;an9e : 3# 99

CKB GCS "ET ICH

En$e5a;: &-a2a=

NGT '%a;%5kanbe51a5na me5a+ke+%$amanPa5en$e5a;: NaC;#=F< RL /:*

Man%$6; "*43 99+a5%T6$%;a9 * 8;2+a5% A >

S >

T >

H Hea' U& /#6

U

6me&5a6;e 4"#m7G >

OLLOW UP DI RUANG ICU (

eb5-a5% 4#**,


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6lain&

• In? 9e8$5%a6n 4* 75+a5%(+a5% ke /,

• In?! T5aneam%9 a9%' /3## m7+a5%

• P%5a9e$am // 75+a5%

Ren$ana&



39/51

S . ' pLema+

SS" & Kea'aan -m-m: $am&ak 2ak%$ be5a$=P-&%; : 44= Ke2a'a5an: GCS: E*M/ET=5e8;e : V: TD: *#/3/ mmH7= MAP : 04N': *#I = Sa$ : FRespirasi: C6n$56; (men77-nakan @en$%;a$65,

&6;a SIMT : "3# %O4 : 3#F

RR : *4 PEEP : 3'G-&&H: 0="3 mmH7 BE: >/=*&CO4 : /# mmH7 HCO4 : 4#= mm6;L

&O4

: * mmH7 SO4

: *##F

Elektrolit & Na : *"" mm6;L= K : /=0 mm6;LCa : #=3* mm6;L-iuresis&ma2-kan : /43# 99 = Ke;-a5an: *3## 99IWL : ## 99 = Ba;an9e : 3# 99

CKB GCS "ET ICH

En$e5a;: &-a2a=

NGT '%a;%5kanbe51a5na me5a+ke+%$amanPa5en$e5a;: NaC;#=F< Man%$6; "*43

99+a5%T6$%;a9 * 8;2+a5% A >

S m%'a6;am *#m7

T >

H Hea' U& /#6

U

6me&5a6;e 4"#m7G >

OLLOW UP DI RUANG ICU (*#

eb5-a5% 4#**,


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6lain&

• In? 9e8$5%a6n 4* 75+a5%(+a5% ke " ,

• In?! T5aneam%9 a9%' /3## m7+a5%

• P%5a9e$am // 75+a5%

• D6b-$am%ne3## m7+a5%

Ren$ana&



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PEMBAHASAN

• Pa2%en Tn A= *" $a+-n ma2-k ICU

RSUD AA $an77a; 0 eb5-a5% 4#*#=

&-k-; /!/# WIB= 'en7an '%a7n62%2 CKB!

Pa2%en men'a&a$ $e5a&% &en76ba$an

'an $%'ak '%;ak-kan $%n'akan 6&e5a$%8!


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• Pa'a 2aa$ ma2-k ICU= k6n'%2% &a2%en$am&ak 2ak%$ be5a$ 'en7an GCS "ET!

Pa2%en 2-;%$ be5na8a2 'en7an 85ek-en2%

na8a2 ;amba$ 'an 'an7ka;! D%;ak-kan%n$-ba2% 'en7an $-?-an -n$-k b56n9+%a;

$6%;e$= men?a7a &a$en2% ?a;an na8a2=

mem&e5m-'a+ @en$%;a2% &62%$%8 'an6k2%7ena2% 'an -n$-k men9e7a+ a2&%5a2%

'an 5e7-57%$a2%!


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• Pe5na8a2an &a2%en '%ban$- 'en7an

@en$%;a$65 yan7 men77-nakan &6;a SIM

(S%n956n%e %n$e5m%$$en man'a$65y

@en$%;a$%6n,! Pa2%en $e5ma2-k 'a;am

&5%65%$a2 * 5a1a$ ICU ka5ena kea'aan

&a2%en $%'ak 2$ab%; yan7 memb-$-+kan

&e5a1a$an %n$en2%8 'an m6n%$65%n7 yan7

$%'ak 'a&a$ '%2e'%akan '% ;-a5 5-an7 ICU!


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• Pa2%en men'a&a$ &enan7anan yan7 2e2-a%

-n$-k 9e'e5a ke&a;a ya%$- be5-&a $e5a&% &5%me5

'an $e5a&% 2ek-n'e5! Te5a&% &5%me5 '%an$a5anya

ke&a;a '%e;e@a2%kan /## -n$-k mem&e5;an9a5a;%5an @ena 'a5% ke&a;a 2e+%n77a memban$-

men-5-nkan $ekanan %n$5a95an%a;= men?a7a

+%&e5@en$%;a2% (PCO4 /#>/3 mmH7,= men?a7ake2e%mban7an +em6'%nam%k 'an 2-+- $-b-+

yan7 n65ma;= 'an &embe5%an 2e'a2% -n$-k

&a2%en 'a;am k6n'%2% 7a'-+ 7e;%2a+!


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• Men?a7a ke2e%mban7an +em6'%nam%k

'en7an $%n'akan 5e2-2%$a2% be5-&a

&embe5%an 'a5a+ a$a- 9a%5an

&en77an$%nya! Ha5-2 '%+%$-n7 ba;an9e

9a%5an -n$-k men7-&ayakan $e59a&a%nya

k6n'%2% e-@6;em%a 2e+%n7a &e58-2%

?a5%n7an 6$ak $%'ak men7a;am% 7an77-an

'an men9e7a+ $e5?a'%nya &en%n7ka$an

$ekanan %n$5a95an%a;!


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• Te5a&% 2ek-n'e5 yan7 '%be5%kan ya%$-

&embe5%an man%$6; 4#F yan7 me5-&akan

ba+an '%-5e$-%k 62m6$%9 yan7 '%7-nakan -n$-kmen-5-nkan $ekanan %n$5a95an%a; 'an

men9e7a+ $e5?a'%nya -'em 9e5eb5%!


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• Pembe5%an an$%b%6$%9 &568%;ak2%2 'a&a$

'%&e5$%mban7kan b%;a a'a 5%2%k6

$e5?a'%nya %n8ek2% 2ek-n'e5! An$%b%6$%9

yan7 '%7-nakan a'a;a+ yan7 mem%;%k%

&ene$5a2% ba%k ke 'a;am 9a%5an

9e5eb562&%na;%2= m%2a;nya 2e8$5%ak26n'en7an '62%2 *>4 75+a5%= 'en7an '62%2

mak2%ma; " 75+a5%!


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• Pen76ba$an ;a%n yan7 '%7-nakan ya%$-

an$%8%b5%n6;%$%k -n$-k men9e7a+ &en'a5a+an!

E8ek 2am&%n7 6ba$ %n% 'a&a$ mnyebabkan

7e?a;a 7a2$56%n$e2$%na; 2e&e5$% m-a; 'anm-n$a+! Se+%n77a &a'a &a2%en '%be5%kan 6ba$

76;6n7an an$%+%2$am%n &en7+amba$ 5e2e&$65

H4 (2e&e5$% 5an%$%'%ne, -n$-k men7+amba$5an72an7an 2ek5e2% 9a%5an ;amb-n7 'an

76;6n7an &56$6n &-m& %n+%b%$65 (2e&e5$%

6me&5a6;,!


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• Se;ama 'a;am &e5a1a$an ICU= &e5na8a2an&a2%en $e5k6n$56; 'en7an @en$%;a$65=

+em6'%nam%k ma2%+ be;-m 2$ab%; yan7 mana

'%?-m&a% &en%n7ka$an 2-+- $-b-+= na'%

men%n7ka$ 'an $e5ka'an7 $ekanan 'a5a+ &a2%en

men-5-n! Pa2%en ?-7a men7a;am% traumatic lung

injury yan7 mana &a2%en $e5;%+a$ 2e2ak na8a2

'an &a'a ETT &a2%en $e5'a&a$ 'a5a+! K6n'%2%&a2%en memb-5-k 'an 2e$e;a+ " +a5% '%5a1a$ '%

ICU &a2%en $%'ak $e5$6;6n7 ;a7% 'an men%n77a;!


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TERIMAKASIH

Pp Case Kelompok

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