Sindroma Croup
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Transcript of Sindroma Croup
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Peradangan akut subglotis laring, trakea, & bronkus.
Gejala : › Batuk menggonggong› Suara parau› Stridor inspirasi
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Virus Human Parainfluenza Virus terutama tipe 1
(HPIV–1), HPIV-2, HPIV-3, dan HPIV-4.Influenza Tipe A dan B
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Adenovirus. Enterovirus.Respiratory syncytial virus (RSV). Measles.Coxsackievirus.Rhinovirus.Echovirus.Reovirus.Metapneumovirus.
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Bakteri
1. Streptococcus pyogenes.2. Streptococcus pneumoniae.3. Staphylococcus aureus.4. Haemophilus influenzae.5. Moraxella catarrhalis.6. Mycoplasma pneumoniae.7. Haemophylus influenza tipe B
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JamurCandida albicans
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Penyebab tersering obstruksi saluran nafas atas anak
Puncak : 6 bulan-6 tahun. Jarang > 6 tahun. Insidensi puncak usia 1-2 tahun Insidensi + 4,6 / 100 anak Rasio pria : wanita sebesar 1,5 : 1. Hampir 15% pasien sindrom croup
mempunyai keluarga dengan riwayat penyakit yang sama
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Virus dari nasofarings - ke larings & trakea
Tjd inflamasi, eritema & edema subglottic larynx dan trachea, khususnya di dekat kartilago cricoid : klinis terpenting (most clinically significant) → obstruksi
Subglotis : merupakan bagian tersempit pada pediatric airway
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Obstruksi → ↑ kecepatan & turbulensi aliran udara
Saat udara lewati plica vocalis & lipatan arytenoepiglottic, getarkan struktur tsb → stridor inspirasi
Awal stridor bernada rendah (low pitched), keras & terdengar saat inspirasi
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Bila obstruksi memberat → stridor melemah, nada tinggi (high pitched) & terdengar juga saat ekspirasi.
Plica vocalis edema : parau. Berlanjut → brokus & alveoli
: laringotrakeobronkitis & laringotrakeo-bronkopneumonitis
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1. Diawali ISPA ringan :
Demam 38-39°C, dapat > 40°C)
Pilek Suara serak Batuk ringan Dlm 12-48 jam terjadi
fase 2 :
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2. Obstruksi akibat inflamasi subglotis :
Suara serak Batuk menggonggong (croupy/
barky cough) Stridor inspirasi : KHAS
Gejala berhenti 3-7 hari
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Thoraks : › retraksi supraklavikular, suprasternal,
interkostal, epigastrial/ subkostal Bila hipoksia
› Gelisah› hipoksia bertambah berat : anak diam,
lemas, kesadaran menurun Pada kondisi berat : gagal napas. Pd kasus berat penyembuhan : 7-14 hari
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Ringan Sedang Berat Gagal nafas mengancam
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Ringan Sedang Berat Gagal nafas mengancam
•batuk menggonggong keras yang kadang-kadang muncul.
• Stridor yang tidak dapat terdengar saat pasien istirahat/tidak beraktivitas atau tidak ada kegiatan
• teradapat retraksi dada ringan.
•batuk menggonggong yang sering timbul,
• Stridor lebih bisa mendengar ketika pasien beristirahat atau tidak aktivitas.
• retraksi dinding dada yang sedikit terlihat, tetapi tanpaada gangguan pernapasan yaitu gawat napas (repiratory distress).
•Batuk menggonggong yang sering timbul,
•Inspirasi stridor lebih bisa mendengar saat aktivitas pasien atau kurang istirahat, akan tetapi, lebih terdengar jelas ketika pasien beristirahat, dan
•kadang-kadang disertai dengan stridor ekspirasi, retraksi dinding dada,
•gangguan pernapasan.
•Batuk kadang-kadang tidak jelas.
•stridor positif (kadang sangat jelas ketika pasien beristirahat),
•terdapat sedikit gangguan kesadaran (letargi), dan kelesuan.
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STRIDOR INSPIRASISTRIDOR INSPIRASI-NoneNone-At rest, with StethoscopeAt rest, with Stethoscope-At rest, no stethoscopeAt rest, no stethoscope
NILAI NILAI 0 1 2
KESADARANKESADARAN-NormalNormal-Penurunan KesadaranPenurunan Kesadaran
00 55
ALIRAN UDARAALIRAN UDARA-NormalNormal-TurunTurun- Amat terbatasAmat terbatas
00 11 22
SIANOSISSIANOSIS-NoneNone-Ada saat gelisahAda saat gelisah- Ada saat istirahatAda saat istirahat
00 44 55
RETRAKSIRETRAKSI-NoneNone-Ringan Ringan -SedangSedang-BeratBerat
00 11 22 33
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< 3 : croup ringan ~ mild
3-6 : croup sedang ~ moderate
> 6 : croup berat ~ severe
Rona E Molodow, 2007.
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X-Foto polos Leher AP :
Steeple sign (50%) : penyempitan area subglotis
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Tergantung stadium Tujuan :
› ↓ edema› Lunakkan sekret› Lancarkan airway.
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Menangis terus-menerus → › kebutuhan O2 ↑› otot pernafasan lelah› perburuk obstruksi.
Awasi HR, RR , respiratory mechanics, dan pulse oximetry untuk antisipasi hipoksia dini
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Prinsip dasar : anak senyaman mungkin didekap
Orang tua Standar Tx :
› Humidifikasi› Epinefrin › Steroid
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Alur Diagnosis & Terapi
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Prognosis Sindrom croup biasanya bersifat self-
limited dengan prognosis yang baik.
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Buku Ajar Ilmu Kesehatan Telinga Hidung Tenggorok Kepala dan Leher. Ed.VII. Efiaty Arsyad Soepardi,dkk. Badan Penerbit FK UI. Jakarta: 2012.
Kapita Selekta Kedokteran. Jilid II. Ed IV. Chris Tanto, dkk. Media Aesculapius. Jakarta: 2014
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