DISPNU

Dispnu atau sesak nafas adalah nafas yang pendek

disertai tanda objektif dari pernafasan yang sulit,
memerlukan banyak tenaga atau yang tidak
mengenakkan.
1. AKUT
A. Pulmoner : Pneumonia, asma, pneumothorax spontan,
bronkiolitis akut
B. Non Pulmoner : edema paru kardiogenik

2. KRONIK :
Pulmoner :
Non Pulmoner

Respiratory Emergencies
Bronkopneumonia or Pneumonia
Etiology: Bacterial pneumonia constitutes 10-30% of infections.

Pathology: Inflammation of the lung caused by a microorganism

Age: Findings vary with age

Respiratory Emergencies
Clinical Findings of Pneumonia

Tachypnea
Cough
Chills
Malaise
Fever
Rales

Respiratory Emergencies
Interventions for Pneumonia
Obtain a CXR
Place the child on cardiorespiratory monitor and pulse
oximeter.
Administer oxygen if needed.
Begin antimicrobial therapy
Administer antipyretics
Ensure hydration

Kesimpulan :
Dasar Diagnosa :
Demam, batuk, sesak, pernafasan cepat dan dangkal,
pernafasan cuping hidung, retraksi dinding dada, suara
nafas vesikuler menguat sampai bronkial.
Bising tambahan : ronki basah halus nyaring
Pengobatan :
Antibiotika : - Ampicillin
- Chloroamphenicol
Suportip : - Bersihkan jalan nafas
- Oksigen
- IVFD

Respiratory Emergencies
Bronchiolitis
Etiology: Viral, most commonly RSV
Pathology: Inflammatory reaction of the bronchioles, causing air
trapping and wheezing
Age:

< 2 years

Respiratory Emergencies
Clinical Findings of Bronchiolitis

Cough
Wheezing
Tachypnea
Apnea
Moist rales
Low-grade fever
Tachycardia

Respiratory Emergencies
Interventions for Bronchiolitis
Oxygen
Cardiorespiratory monitor and pulse oximeter
Aerolized bronchodilator
Albuterol
Racemic epinephrine
Assure hydration - IV

Respiratory Emergencies
Bronchiolitis: Possible Need for Hospitalization

Infants < 2 months of age who need oxygen or IV fluids

Inability to maintain oral hydration
Hypoxemia
RR > 60 breaths/minute
History of prematurity, apnea, or underlying cardiac,
pulmonary, or immune problems

Kesimpulan :
Dasar Diagnosa :
Umur kurang 2 tahun, demam sub fibris, sesak nafas akut
dengan tanda obstruksi, experium meanjang, wheezing
expirasi.

Pengobatan :
Antibiotika profilaksis non allergik
Suportif

Adanya udara bebas dalam cavum pleura yang terjadi

akibat trauma atau pecahnya blep akibat pneumonia
Klinis : sesak akut
hemi toraks cembung, perkusi tympani
suara nafas menghilang, stempremitus melemah
Penanggulangan : - Toraks foto
- tentukan tertutup/ pentil
- tentukan paru yang kolaps
< 20 % konservatip
> 20% pasang WSD

Adanya cairan bebas dalam cavum pleura

Klinis : . Sesak
. Hemitoraks asimetris
. Perkusi redup
. Suara nafas menurun

Tatalaksana : - Toraks foto

- punksi percobaan
- Rivalta test
- Cairan serous --- bila sedikit konservatip
- cairan pus -----WSD

Respiratory Emergencies
Asthma

Affects 10% of children

Causes 25% of school absenteeism
Hospitalization rate has tripled
Death rate has increased in last 15 years
Accounts for 5% of PICU admissions

STATUS ASTHMATICUS:
Asthma attack refractory to initial therapy

Respiratory Emergencies
Pathology for Asthma
Bronchial Muscle Spasm
Mucosal Edema
Thick Mucus Secretion

Respiratory Emergencies
Clinical Findings for Asthma

Wheezing
Tachypnea
Retractions
Nasal flaring
Use of accessory muscles

Cough
Anxiety
Dehydration
Tachycardia
Late bradypnea

Respiratory Emergencies
Interventions for Asthma

Oxygen
Beta2-agonist bronchodilator
Consider steroids
Medications
Consider mechanical ventilation

Respiratory Emergencies
Asthma: Relative Intubation Criteria
Deterioration in state of consciousness with inability to
protect the airway
Apnea or near apnea
Hypoxemia refractory to maximal FiO2

Respiratory Emergencies
Asthma: Intubation Issues
Intubation may worsen bronchospasm
BP may fall with intubation due to hypovolemia and
cardiopulmonary interactions
Severe hypoxia can occur despite optimal rapid sequence
induction technique
Bag-mask or bag-ET ventilation will be difficult due to the
airway pressure required
Pneumothorax risk increases after intubation

Respiratory Emergencies
Asthma: Referral to a CRPC
Post-arrest with or
without intubation
Failure to improve
after intensive ED Rx
Air leak syndrome
Clinical dehydration
or risk of dehydration

Altered

LOC
Exhaustion
Deteriorating patient
Drug toxicity
Silent chest

Respiratory Emergencies
Asthma: Common Failures of Management

Underestimating severity of symptoms

Lack of dynamic observation
Underuse of beta-agonists and steroids
Instituting mechanical ventilation after arrest, not before

Kesimpulan
Dasar diagnosa : Batuk, sesak nafas, mengi
Pengobatan serangan akut :
Berikan salbutamol (nebules)
Serangan ringan : 1 x nebulesperbaikan
Serangan sedang : 2 3 x . Perbaikan
Serangan berat : > 3x .. Gagal rawat (status asma)

Status Asmatikus :
Ivfd..
Aminofilin Iv1/3 bolus + 2/3 drip
Kortikosteroid Iv
Nebulasi tiap 4-6 jam.. Stabil Pulang dengan Pulv Asma

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Tenangkan penderita
Tempatkan penderita diruang yang cukup ventilasi
Longgarkan pakaian penderita
Anamnesa singkat : - kapan mulai sesak, penyebab sesak
Berikan oksigen
Lakukan pemeriksaan fisik dan tentukan diagnosa
sementara
Berikan terapi sesuai diagnosa
Berikan terapi suportif
evaluasi