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    BAGIAN ANESTESIOLOGI,TERAPI INTENSIF LAPORAN KASUS

    DAN MANAJEMEN NYERI FEBRUARI 2016

    FAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN

    MANAJEMEN JALAN NAPAS

    OLEH :

    Latifah Husna Zulkafli

    C111 11 871

    PEMBIMBING :

    dr. Bamban HS. Suikr!m!

    KONSULEN :

    dr. Alams"ah A.A Husain# S$.An

    %&BA'A(AN %ALAM )AN*(A +,*AS (EPAN&+E)AAN (L&N&( BA*&AN

    ANES+ES&-L-*& +E)AP& &N+ENS& %AN MANAJEMEN N/E)&

    ,N&0E)S&+AS HASAN,%%&N

    MA(ASSA)

    1

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    %A +A) &S&

    Judul H l ! " 1

    D #$ % I&' 2

    H l ! " P(")(& * " +

    L -% " K &u&

    Id("$'$ & P &'(" .

    A" !"(&'& K(lu* " .

    P(!(%'/& " F'&'/ .

    P(!(%'/& " L -% $-%'u! P(!(%'/& " P("u" ") 6

    A&&(&&!("$ 6

    Pl ""'") 6

    F-ll-3 U 4

    T'" u " Pu&$ /

    I5 P("d *ulu " 10

    II5 A" $-!' d " F'&'-l-)' &'&$(! %(& '% &'555555555555555555555555555555555555555555555

    III5 Kl &'#'/ &' - &$%u/&' l " " & 1+

    IV5 P(")(l-l " l " " & 1

    V5 P(")(l-l " l " " & $ * l " u$ 22

    P(! * & " +6

    D #$ % Pu&$ / +

    2

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    HALAMAN PEN*ESAHAN

    Y ") (%$ "d $ ") " d' 3 * '"' !("7 $ / " *3 :

    Nama LA+& AH H,SNA Z,L(A L&

    N&M C 111 11 871Judul Mana23m3n Jalan Na$as

    T(l * !("7(l(& '/ " $u) & l -% " / &u& d l ! % ")/ /( "'$(% " /l'"'/ d

    B )' " A"(&$(&'-l-)', T(% ' I"$("&'# d " M " (!(" N7(%' F /ul$ & K(d-/$(% "

    U"'8(%&'$ & H & "udd'"5

    M / && %, F( %u %' 2016

    KONSULEN PEMBIMBING

    dr. Alams"ah Amb! Ala# S$.An. dr. Bamban HS. Suikr!m!

    3

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    LAP-)AN (AS,S

    Mana23m3n Jalan Na$as $ada Pasi3n d3n an (3sadaran M3nurun

    &d3ntitas Pasi3n

    N ! : Mu*&'"

    U!u% : +. $ *u"

    J("'& K(l !'" : L /'9L /'

    RM : 4+0216

    BB : . /)

    TB : 160 !IMT : 2150; !2

    4

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    $ ! / /(l '" ", )(% / l(*(% ( &, "7(%' $(l " =9?, ! && d' l(*(% =9?,

    $% /( d' $(") *5

    B2 : N d' ;6

    B : Su (l, (%'&$ l$'/ d /(& " "-%! l5

    B6 : M- 'l'$ & = ?,(d(! =9?, "7(%' $(/ " =9?, ! && $u!-% =9?, #% /$u% =9?

    P(!(%'/& " L -% $-%'u! =2 J "u %' 2016?

    +ES+ )ES,L+ N-)MAL 0AL,ECB@ 2 52 10+

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    P(!(%'/& " @T S " /( l $ " /-"$% & '%''& " /&' l =2 J "u %' 2016?:

    • P("d % * " ( 'du% l %()'- #%-"$ l'& /'%' d " #%-"$-$(! -% l'& / " "

    • P("d % * " &u % *"-'d

    • Mul$' l( "(u!- ( * l %()'- #%-"$-$(! -%- %'($ l 'l $(% l d " %()'- # l

    (%( %'

    • F% /$u% -& #%-"$ l'& 'l $(% l

    • B% '" &3(ll'")

    A&&(&&!("$: /(& d % " !("u%u" ( $% u! $' % '" '" u%7 G@S =E2M.V2?

    Pl ""'") :T(% ' d %' )' " A"(&$(&':

    • P & ") IV $* 1 G d(") " R'")(% L /$ $ +0 $ !

    • D'l /u/ " '"$u &' ("d-$% /( l ETT 450 ID d(") " %-&(du% & :

    o P &'(" -&'&' &u '"(, IV l'"( RL +0$ !, !-"'$-% $(/ " " d % *,

    d("7u$ " d', EKG, d " & $u% &' -/&')("

    o P(! (%' " #("$ "7l 100 ! )'d'!( 1 )< !

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    B1: RR 20

    B.: u%'"( (%/ $($(% .09 0 < !

    B : &u (l, (%'&$ l$'/ = ? /(& "

    "-%! l

    B6: (d(! =9?, #% /$u% =9?

    A: /(& d % " !("u%u" ( TBI G@S

    6 =E2M.V ?

    P: %(" " '"$u &' ("d-$% /( l

    9 B(%'/ " O2 8' 8("$'l $-%

    !-d( TV .00 RR 16 V@

    F'O2 100 S O2 ;;

    9 P & ") IV $* 1 G

    d(") " R'")(% L /$ $ 21

    $ !

    9 H( d u +0 0

    9 M '"$(" " (: #("$ "7l

    +0! )< !-l ! 1, !)< !

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    9

    B.: u%'"( (%/ $($(% .09 0 < !

    B : &u (l, (%'&$ l$'/ = ? /(& "

    "-%! l

    B6: (d(! =9?, #% /$u% =9?

    A: /(& d % " !("u%u" ( TBI G@S

    =E2M+V ?

    9 TV .00, RR 20 S O2

    ;0 , F'O2 60

    9 F("$ "7l +0! )< !

    '&-/-% 2, !! ODS, R@ <

    B.: u%'"( (%/ $($(% .09 0 < !

    B : &u (l, (%'&$ l$'/ = ? /(& "

    "-%! l

    B6: (d(! =9?, #% /$u% =9?

    A: /(& d % " !("u%u" ( TBI G@S. =E1M+V ?

    9 O2 8' 8("$'l $-% F'O2

    100

    9 IVFD RL 20 $ !

    9 H( d u +0 0

    9 F("$ "7l +0! )< !

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    B1: RR +0

    B : &u (l, (%'&$ l$'/ = ? /(& "

    "-%! l

    B6: (d(! =9?, #% /$u% =9?

    A: TBI =E1M+V ?

    9 IVFD RL 20 $ !

    9 H( d u +0 0

    9 F("$ "7l +0! )< !

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    +&NJA,AN P,S+A(A

    MANAJEMEN JALAN NA AS

    I5 PENDAHULUAN

    D l ! * l /() 3 $d %u% $ " !(d'/ /'$ !(")(" l $%' & /(d-/$(% " ) 3 $ d %u% $,

    7 /"' %(&u&'$ &', /(d %u% $ " !(d'/ d "intensive care 5 U"$u/ !("u" ") /(*'du "

    &(l ! ! & /%'$'&, /($') %'"&' d' $ & '& d'/(% / " d' %u! * & /'$, d' $(! $

    /( d' ", &(l ! $% "& -%$ &' d " d'd l ! %u! * & /'$5 D l ! * l $'"d / " %(&u&'$ &'

    "$u") %u, /'$ !(! )' !(" d' + $ * : 1

    15 B "$u " *'du d & % =BHD?< Basic Life Support d(") " $u u " u"$u/

    -/&')(" &' 7 ") d(/u $, !(l' u$':

    A. Airway control

    B. Breathing support

    C. Circulation support

    25 B "$u " *'du l " u$< Advanced Life Support d(") " $u u " !(!ul'*/ " d "

    !(! (%$ * "/ " &'%/ul &' & -"$ ", !(l' u$':

    . rug and fluid treatment

    !. !lectrocardiography

    ". "ibrilation treatment

    +5 B "$u " *'du ")/ " ")< #rolonged Life Support d(") " $u u " u"$u/

    (")(l-l " '"$("&'# !("$ &' ! "u&' , !(l' u$':

    $. $auging

    %. %uman mentation

    &. &ntensive care

    B(%d & %/ " $ * " $(%&( u$, ! " (!(" l " " & !(%u / " & l * & $u

    d %' $') ("'& "$u " *'du d & % (%& ! d(") " 8("$'l &' d " ! " (!("

    &'%/ul &', 7 ") / " (%&'# $ d %u% $ 'l $'d / d'$ ") "' &()(% 5

    10

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    G "))u " l " " & d " 8("$'l &' !(%u / " (! u"u* $(% ( $ d

    &'("5 Ad "7 /($'d /! ! u " u"$u/ !(") "$ % d % * 7 ") $(%-/&')(" &' /( -$ /

    d " &$%u/$u% 8'$ l l '""7 / " !("7( / " *' -/&' %'") "5 2

    II5 ANATOMI DAN FISIOLOGI SISTEM RESPIRASI

    S'&$(! %(& '% &' !(" /u & lu% " " & 7 ") !("u u %u, %u '$u &("d'%', d "

    &$%u/$u%,&$%u/$u% $*-% /& =d d ? 7 ") (% (% " !("7( / " l'% " ud % ! &u/ d "

    /(lu % %u !(l lu' & lu% " " &5 S lu% " " & d l * $ u") $ u ' 7 ")

    !(") ")/u$ ud % "$ % $!-(% d " / "$u") ud % = l8(-lu&?, l8(-lu& !(%u / "

    & $u9& %u"7 $(! $ (%$u/ % " ) & "% % ud % d " d % *5 S lu% " " & (% 3d %' & lu% " " & l =*'du")?5 S lu% " *'du") !(! u/ /( d l ! # %'") =$("))-%-/ "?,

    7 ") (%#u")&' &( ) ' & lu% " (%& ! u"$u/ &'&$(! (%" & " d " (" (%" "5

    T(%d $ du & lu% " 7 ") (% & l d %' # %'") $% /( , 7 ") d'l lu' -l(* ud % u"$u/

    !("u u %u, d " (&-# )u&, 7 ") d'l lu' -l(* ! / " " u"$u/ !("u u l ! u")5 +

    Ud % d l ! /( d " "-%! l ! &u/ /( # %'") !(l lu' *'du"), $($ ' ud %

    u) d $ ! &u/ !(l lu' !ulu$ /($'/ & lu% " *'du") $(%&u! $ 7 '$u, "d d $

    (%" & !(l lu' !ulu$ /($'/ "d 'l(/5 K %(" # %'") (%#u")&' &( ) ' & lu% "

    (%& ! u"$u/ ud % d " ! / " " ! / &(3 /$u !("(l " $(% d' !(/ "'&!( %(#l(/&

    7 ") !("u$u $% /( ) % ! / " " ! &u/ /( (&-# )u& d " u/ " /( & lu% " " &5

    E&-# )u& &(l lu $(%$u$u /( u '' /($'/ !("(l " u"$u/ !(" () * ud % ! &u/ /(

    l ! u") &(3 /$u (%" &5 +

    L %'") $ uvoice bo' , $(%l(% / d' '"$u ! &u/ $% /( 5 T-" -l " "$(%'-% l %'")

    !(! ("$u/ /u" = Ad !:& l( ?5 P'$ &u % , du '$ %'") " (l &$'/ 7 ")

    !(l'"$ ") d' '"$u ! &u/ l %'"), d $ d'%() ")/ " d " d' -&'&'/ " d l ! (% ) '

    ("$u/ -l(* -$-$ l %'")5 S(3 /$u ud % d'l(3 $/ " !(l lu' '$ &u % 7 ") /(" "),

    l' $ " $(%&( u$ (%)($ % u"$u/ !(")* &'l/ " (% ) ' &u % ' % 5 B' '%, l'd *, d "

    l $u! !-l( !(!-d'#'/ &' &u % !(" d' -l &u % 7 ") d $ d'/(" l'5 S(3 /$u

    !("(l ", '$ &u % !(l /& " / " #u")&' 7 ") $'d / (%/ '$ " d(") " ' %

    /(du "7 & l'") !("d(/ $ u"$u/ !("u$u '"$u ! &u/ /( $% /( 5 +

    11

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    G ! % 2515 '$ &u % d'l'* $ d %' '"$u $ & l %'")+

    D' (l / ") l %'"), $% /( $(% )' !(" d' du ") u$ ! , %-"/u& / " "

    d " /'%', 7 ") ! &'")9! &'") ! &u/ /( %u / " " d " /'%'5 D' d l ! ! &'")9

    ! &'") %u, %-"/u& $(%u& (% ")9 ") !(" d' & lu% " " & 7 ") &(! /'"

    &(! '$, ("d(/, d " "7 /, &( (%$' (% ") " &( u * -*-"5 @ ")9 ") 7 ")

    l( '* /( 'l d'/(" l &( ) ' %-"/'-lu&5 D' u u") %-"/'-lu& $(%!'" l (%/(l-! -/

    l8(-lu&, / "$u")9/ "$u") ud % * lu& $(! $ (%$u/ % " ) & "$ % ud % d " d % *5

    A) % l'% " ud % d $ ! &u/ d " /(lu % )' " %u $(! $ (%$u/ % "

    (%l ")&u"), /-"$'"u! & lu% " " & (")* "$ % d %' '"$u ! &u/ !(l lu' %-"/'-lu&

    $(%!'" l *'")) l8(-lu& * %u& $($ $(% u/ 5 T% /( d " %-"/u& (& % d l * $ u")7 ") u/u / /u $ / (%-$-$ 7 ") d'/(l'l'")' -l(* &(% ")/ ' " '" '" $ul ") % 3 "

    7 ") !(" () * & lu% " '"' !("7(! '$5 B%-"/'-lu& 7 ") l( '* /( 'l $'d / !(!'l'/'

    $ul ") % 3 " u"$u/ !(" ) "7 $(% $(% u/ 5 D'"d'") & lu% " '"' !(") "du") -$-%

    -l-& 7 ") d'& % #' -l(* &'&$(! & % # -$-"-! d " (/ $(%* d *-%!-" d " * "

    /'!' l-/ l $(%$("$u5 F /$-%9# /$-% '"' !(") $u% u!l * ud % 7 ") !(") l'% d %'

    $!-(% /( &($' /(l-! -/ l8(-lu&, d(") " !(")u * d(% $ /-"$% /&' -$-$ -l-&

    %-"/'-lu& &(*'")) !(")u * / l' (% & lu% " " & $(%!'" l5 +

    III5 KLASIFIKASI OBSTRUKSI JALAN NAFAS

    O &$%u/&' l " " & !(%u / " & l * & $u d %' ("7( ) ) l " & /u$5

    B(%d & %/ " d(% $ &u! $ ", - &$%u/&' l " " & d $ $(% d' &( % : 1

    12

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    • Su! $ " %&' l l " " &, d'$ "d ' d(") " u& * " & ! &'* d , &u %

    " & ! &'* $(%d(") % d " d(&'% " ud % (/& '% &' d %' !ulu$ $ u *'du")

    &'(" ! &'* $(% & , 7 ") d $ d'/($ *u' d %' d(&'% " ud % 7 ") !(l lu'

    (!(%'/& " d(") " u"))u") $ ") " $ u $(l'") d(/ $ !ulu$ $ u *'du")5

    G( l d " $ "d l '" 7 ") d $ d'l'* $ d &u! $ " l " " & %&' l

    d l *:

    o A/$'8'$ & -$-$9-$-$ "$u (%" & "

    o R($% /&' &u % &$(%" l d " '"$(%/-&$ l

    o T(%d(") % stridor, snoring, atau gargling

    o T(%d $ $ "d 9$ "d *' -/&' d " *' (%/ % '+

    • Su! $ " $-$ l l " " &, d'$ "d ' d(") " $'d / $(%d(") %"7 &u % " &

    & ! &(/ l', $'d / $(% & d(&'% " ud % d %' !ulu$ $ u *'du")

    • &'(", u& * " & &'(" l( '* !("'")/ $ d(") " $'! ul"7 )(% / " d d

    % d-/& l d " l( '* !("'")/ $"7 /$'8'$ & -$-$ "$u " &5 T "d *' -/&'

    d " *' (%/ % ' (%$ ! * (% $5 B'l /( d " '"' $'d / &()(% d'$ "))ul ")'

    / " &()(% d''/u$' d(") " (%*("$'"7 #u")&' "$u") / %(" *' -/&' (% $5

    T (l +515 P(% "d'") " d(% $ &u! $ " l " " &1

    B(%d & %/ " l-/ &' &u! $ ", - &$%u/&' l " " & d $ d' )' !(" d' + l-/ &': 1

    15 Su! $ " d' $ & l %'")

    5 L'd * 7 ") $u* /( *' -# %'")5

    13

    Normal meningkat sangat meningkat tanpa gerak

    Terasa berkurang sangat berkurang tak terasa

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    H l '"' '& $(% d' d &'(" $'d / & d %, $(%u$ ! d &'("

    )(!u/, l(*(% ("d(/ d " l'd * (& %, !'& l"7 d 7'5 P d &'("

    $'d / & d %, $-"u& -$-$ ("7 ")) l'd * !("u%u" &(*'")) l'd * $u* /(

    % * -&$(%'-% =$(%u$ ! d &'(" d(") " -&'&' $(%l("$ ")? d "

    !("(! (l d d'"d'") -&$(%'-% # %'"), &(*'")) $(% d' &u! $ " %&' l

    7 ") d'$ "d ' d(") " &u % " & ")-%-/ =&"-%'")?5

    U& * (%$-l-") " 7 ") d'l /u/ " d l * triple airways manauver d %'

    S # %, 7 '$u: 1? (/&$("&' /( l , 2? d-%-") ! "d' ul /( d( ", d " +?

    ")/ $ d )u5 P d &'(" 7 ") !("d(%'$ $ * $ul ") l(*(%, ! "u8(% '"'

    * %u& d'l /u/ " d(") " * $'9* $', $(%) "$u") /( (%lu "5 K %(" $ *$ul ") &(%8'/ l $(%$u$u * "7 d $ d'd($(/&' !(l lu' (% ")/ $

    % d'-l-)'&, ! / u"$u/ (" ") " " /u$ /'$ !(") ")) d #% /$u%

    &(8'/ l d &($' &'(" !ul$' $% u! , $(%l( '* 'l d ) "))u "

    /(& d % " d " $ u (%lu/ " d' $ & /l 8'/ul 52

    E/&$("&' /( l d $ d'l /u/ " d(") " d(") " !ud *, 7 '$u !(" %u*

    "$ l $ u ("d l '" d' *u &'("5 B'l d(") " % '"' &ud * d $

    !(! ( &/ " l " " &, -&'&' '"' d' (%$ * "/ " d " /( l &'("

    d'!'%'")/ " u"$u/ !(" () * &u! $ " / %(" ("d '%, $ u &'("

    d'!'%'")/ " d(") " -&'&' !'%'") &$ 'l5 A 'l d(") " % '"' $'d /

    (%* &'l d $ d' & ") ' -%-# %'")5

    5 B("d &'")

    S ") $ "7 / ("d &'") 7 ") d $ !("7( / " &u! $ " l "

    " &, !'& l"7 l("d'%, (/u " d % *, )')' l&u 7 ") l( &, !u"$ * "

    $ u ! / " " l '""7 5 B' & "7 $(% d' &u! $ " %&' l 7 ") d'$ "d '

    d(") " &u % " & ) %)l'") =&( (%$' -% ") (%/u!u%?, 'l &u! $ ""7

    d'&( / " -l(* ("d '%5

    U 7 (%$-l-") ""7 d l * d(") " !(! u/ l " " & !(l lu'

    $%' l( '%3 7 ! " u8(%, /(!ud' " !(!'%'")/ " /( l /-% " & ! 'l

    14

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    !(")-%(/ d(") " $ ") " =& u "? $ u !(")'& d(") " l $ '& 5 B'l

    (lu! (%* &'l !(l ")/ " l " " &, d $ d'l /u/ " l %'")-&/- '

    d " /(!ud' " !(") ! 'l d("d 7 ") d d' %-")) !ulu$

    5 P("7 /'$ '"#(/&' $ u $u!-% l " " & )' " $ &

    P("7 /'$ '"#(/&' $ u $u!-% l " " & )' " $ & 7 ") d $

    !("'! ul/ " &u! $ " l " " & )' " $ & d l * (! (& % " $-"&'l,

    -l' d %-")) *'du") d " ( (% $u!-% l '" d' %-")) !ulu$ d "

    d & % l'd *5

    U& * (%$-l-") ""7 d l * d(") " % - (% $'#, 7 '$u !(") ")/ $

    $u!-%, $ u 'l $u!-%"7 $'d / !u")/'" d' ")/ $ d " &u! $ ""7 (%&'# $ d %u% $ d " !(") " ! d $ d'l /u/ " $'"d / "

    /%'/-$'%-'d-$-!' d'l " u$/ " d(") " $%( /(-&$-!'5

    d5 T% u! d (% * 3 *

    T% u! /( l 7 ") !(")(" ' d (% * ! /&'l-# &' l d $ !(%u& /

    &$%u/$u% " $-!' %()'- '"', &(*'")) / " !(")) "))u & &( ud %

    !(l lu' l " " & $ &5

    U& * !(! ( &/ " l " " & d /-% " &( (%$' '"' d l *

    (%u& * &( ( $ !u")/'" !(l /u/ " %(/-"&$%u/&' l " " & )' "

    $ &5 S(!("$ % * l '"' (lu! '& d'/(% / ", u& * !(l ")/ " l "

    " & d'l /u/ " d(") " !(! & ") ' ("d-$% /( l $ u !(l /u/ "

    $% /(-&$-!' 'l ) ) l !(l /u/ " (! & ") " ' ("d-$%(/( l5

    25 Su! $ " d l %'")1

    5 B("d &'")

    B("d &'") d $ !("7u! $ %'! )l-$'& &(*'")) $(% d'

    &u! $ " $-$ l l " " & $ &5 G( l 7 ") $'! ul d l * /-% " / "

    &()(% !(!() ") l(*(%, $'d / '& ' % , $'d / '& (%" &, d " $'d /

    '& $u/5 B( (% & $ /(!ud' " d''/u$' d(") " &' "-&'& d " ("u%u" "

    /(& d % "5

    15

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    U& * (%$-l-") " 7 ") d'l /u/ " d l * 'l &'(" ! &'* & d %,

    ("-l-") (%d'%' !(! (l / ")' /-% ", /(du $ ") " d'&'l ")/ " d'

    ulu* $' /(!ud' " l /u/ " *("$ / " . / l' d(") " /u $ $ u '& u)

    d(") " !(!u/ul u"))u") d' "$ % &/ ul 5 B'l &'(" $'d / & d %,

    d'$'du%/ " $(l("$ ") d " d'l /u/ " *("$ / " d ulu* $' $ u &'("

    d'!'%'")/ " d " d'l /u/ " u/ul " d u"))u") &( (%$' $(%&( u$ d'

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