![Page 1: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/1.jpg)
STABILISASI PRA RUJUKAN
KARDANA I MADE DIVISI NEONATOLOGI FK UNUD/RS SANGLAH DENPASAR
![Page 2: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/2.jpg)
PRINSIP RUJUKAN• Bila dimungkinkan à kirim ibu sebelum melahirkan
ke pusat kesehatan yang menyediakan perawatan khusus bagi maternitas dan bayi (RUJUKAN INTRA UTERIN)
• Pastikan bayi mendapatkan pelayanan yang lebih baik
• Regionalisasi rujukan• Stabilisasi pra rujukan
![Page 3: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/3.jpg)
Kriteria bayi yang harus dirujuk• Gangguan nafas• Asfiksia• Gangguan pemberian minum• Hipoglikemia, hipotermi berat• BBLR < 1750 g ??• Hipotermi sedang dan berat• Ikterus patologis• Kejang • Spasme• Infeksi sistemik/sepsis• Ganggn/obstruksi saluran cerna • Kelainan bawaan mayor• PJB
![Page 4: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/4.jpg)
BAYI DENGAN GAWAT NAPAS
![Page 5: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/5.jpg)
BAYI PASCA ASFIKSIA BERAT
![Page 6: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/6.jpg)
MASALAH PEMBERIAN MINUM
![Page 7: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/7.jpg)
BBLR
![Page 8: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/8.jpg)
IKTERUS PATOLOGIS
![Page 9: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/9.jpg)
KEJANG NEONATAL
![Page 10: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/10.jpg)
INFEKSI SISTEMIK NEONATAL
![Page 11: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/11.jpg)
OBSTRUKSI SALURAN CERNA
![Page 12: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/12.jpg)
KELAINAN BAWAAN
![Page 13: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/13.jpg)
JENIS RUJUKAN
• Di dalam rumah sakità Kamar operasi/kamar bersalin ke
ruang perawatan bayià Dari ruang intensif (NICU) ke ruang
intermediate atau sebaliknya• Di luar rumah sakità Bidan praktek swasta/rumah sakit
ke rumah sakit rujukan
![Page 14: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/14.jpg)
HAL LAIN YANG PERLU DIPERHATIKAN:
Persiapan keluarga- jelaskan alasan dirujuk, prognosis- inform consent- disertai ibu/keluarga
Kontak sebelumnya dengan tempat tujuan rujukan
Lakukan stabilisasi bayi sesuaidengan kemampuan yang ada !!!
Persiapan petugas, obat/alat, kendaraan
Formulir rujukan
![Page 15: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/15.jpg)
Data yang harus disediakan• Identitas bayi• Identitas orang tua• Riwayat kehamilan, persalinan, resusitasi• Obat yang dikonsumsi ibu• Nilai APGAR• Masa gestasi dan BB• Tanda vital• Prosedur yang talah dilakukan• pX penunjang yang dikerjakan
![Page 16: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/16.jpg)
Pre-Transpor/Post-ResusitasiPerawatan Stabilisasi Neonatus Yang Sakit
![Page 17: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/17.jpg)
MENGAPA MENGGUNAKAN SINGKATAN ?
S ugar + Safe care (perawatan gula + aman)
MENGAPA MENGGUNAKAN SINGKATAN ?
(Jalan napas)
(gula darah + aman)
(Temperatur)
(Tekanan darah)
(Pemeriksaan laboratorium)
(Dukungan emosional)
![Page 18: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/18.jpg)
![Page 19: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/19.jpg)
RISIKO HIPOGLIKEMIA …???• KMK (simpanan glikogen ↓• PREMATUR (simpanan glikogen ↓ ) • IDM (hiperinsulinism)• BMK (hiperinsulinism)• STRESS/SAKIT (utilisasi glukose ↑)
![Page 20: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/20.jpg)
Skrining kadar glukose darah• Skrining setiap 30-60 menit s/d kadarnya >50
mg/dl (2,8 mmol/L) min. 2x berturutan (glukotest)
• Jika rendah → glukose serum• Jika >150 mg/dl (8.3 mmol/L) 2x berturutan → pikirkan stress/sakit/prematur
PERTAHANKAN KADAR GULA DARAH 50-110 mg/dl
![Page 21: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/21.jpg)
TINDAKAN
• Minum segera bila kontra indikasi (-)• IVFD Dextrose 10% 60-80 ml/kg bb/hari• MONITOR KADAR GULA DARAH
![Page 22: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/22.jpg)
![Page 23: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/23.jpg)
HIPOTERMIA
![Page 24: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/24.jpg)
RISIKO HIPOTERMIA….???
• Prematur• KMK• Resusitasi berkepanjangan• Bayi sakit• Defek kulit (abdomen, tl belakang)
![Page 25: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/25.jpg)
Pencegahan hipotermia
![Page 26: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/26.jpg)
….Pencegahan hipotermia
![Page 27: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/27.jpg)
![Page 28: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/28.jpg)
![Page 29: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/29.jpg)
RESPIRATORY DISTRESS EVALUATION Down Score
0 1 2Respiratory Rate
< 60x/minute 60-80 x/minute >80x/minute
Retraction No retraction Mild retraction Severe Retraction
Cyanosis No cyanosis Cyanosis disappeared with O2
Cyanosis (+) with O2
Air Entry (+) Air entry decrease NO air entry
Gasping No gasping heard by stethoscope Heard without any tools
29
![Page 30: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/30.jpg)
Score < 4 Mild Respiratory Distress
Score 4 – 5 Moderate Respiratory Distress
Score > 6 Severe Respiratory Distress (blood gas analysis should be performed)
30
RESPIRATORY DISTRESS EVALUATION …Down Score
![Page 31: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/31.jpg)
Tindakan
• Airway (jalan nafas terbuka)• Oksigen (bila perlu)
- nasal canule (2-3 L/mnt à 21%)- sungkup (4-5 L/mnt à 40%)- head box (6-8 L/mnt à >50%)- CPAP- Ventilator mekanik
• Monitoring à sianosis hilang
![Page 32: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/32.jpg)
![Page 33: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/33.jpg)
SHOCK ?Tidak adekuatnya perfusi dan distibusi
oksigen pada organ dan jaringan
Penyebab- Hopovolumia- Kardiogenik- Septik
![Page 34: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/34.jpg)
GEJALA DAN TANDA• Respirasi : takipnea, usaha nafas ↑, gasping,
apnea• Perfusi perifir << (CRT >3 dt)• Nadi lembut, tak teraba• Tensi rendah/tidak terukur• Kulit dingin, pucat, sianosis,
mottled
![Page 35: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/35.jpg)
TINDAKAN• Hipovolumia
- perdarahan akut (-) à normal salin- perdarahan akut (+) à PRC, WBC
• Kardiogenek, septik à R/ kausal
![Page 36: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/36.jpg)
LAB WORK
• GULA DARAH• DL• KULTUR DARAH• DLL
![Page 37: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/37.jpg)
EMOSIONAL SUPPORT
![Page 38: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/38.jpg)
BAYI SIAP DIRUJUK
PINKWARM SWEET
![Page 39: STABILISASI PRA RUJUKAN - bhaktirahayu.com · • Monitoring à sianosis hilang ... - perdarahan akut ( -)](https://reader031.vdocuments.mx/reader031/viewer/2022021723/5c87f83509d3f291748c1ba6/html5/thumbnails/39.jpg)
SUKSMA………..