lapja anastesi

8/15/2019 LAPJA ANASTESI

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Nama koass : Indira Suluh P Novasiska Indriyani H Elfta Syari Tania Yuza Putri

Tanggal : 2 Januari 201

!"P#$"N J"%" "NESTESI

I& I'ENTIT"S P"SIENA. Nama : Tn. OZB. Umur : 21C. Jenis Kelamin : LkD. No RM : 91191!. Alama" : Buki" Ra#a$ %ekan&aru.

'. Bera" Ba(an : )* k+

II& "N"(NESIS"& )*luhan +tama

N#eri ,eru" kanan &a-a se/ak 1 ari 0MR0

,& $i-ayat P*nyakit S*karang%asien men+elu n#eri ,eru" &a+ian kanan &a-a se/ak 1ari 0MR0$ n#eri (irasakan "erus menerus (an "i(ak&erkuran+ saa" is"iraa". N#eri a-aln#a (irasakan ,a(a(aera seki"ar ,usar kemu(ian &er,in(a ke &a+iankanan &a-a. %asien men+elu (emam 3 kem&un+$mual (an mun"a 3 $ BAB suli" BAK "i(ak a(a keluan.

.& $i-ayat P*nyakit 'ahulu%asien "i(ak ,erna men+alami keluan #an+ samase&elumn#a. Ri-a#a" i,er"ensi$ DM$ asma (an ,en#aki" /an"un+ (isan+kal.

'& $i-ayat P*nyakit )*luarga Ti(ak a(a keluar+a #an+ men+elukan keluan #an+sama (en+an ,asien. Ri-a#a" DM$ i,er"ensi$ asma$ (an,en#aki" /an"un+ (i keluar+a (isan+kal.

E& $i-ayat *konomi/ soial/ dan k*iasaan%asien a(ala seoran+ maasis-a$ ri-a#a" merokok (ankonsumsi al4ool (isan+kal.



& "(P!E" : Ri-a#a" aler+i makanan (an o&a" 5 o&a"an(isan+kal

( : Ti(ak a(a konsumsi o&a" ru"in$ ri-a#a" o,erasi 63P : Ri-a#a" i,er"ensi$ DM$ asma$ (an ,en#aki" /an"un+(isan+kal! : %asien "erakir makan (an minum ,ukulE : ,asien men+elukan n#eri ,eru" kanan &a-a

III& PE(E$I)S""N ISI) "& ST"T+S %ENE$"!IS

1. Kea(aan umum : "am,ak saki" se(an+2. Kesa(aran : kom,osmen"is7. Tan(a "an(a 8i"al :

•

Tekanan (ara : 12** mm;+• Na(i : <* =meni"• 'rekuensi na>as : 21 =meni"• 0uu : 7)$) o4

?. 0"a"us +i@i• BB : )* k+• TB : 1) 4m• MT : 22$2 k+m2

"I$3"Y

Clear$ ,asien (a,a" &er&i4ara (en+an lan4er$ "i(ak a(asum&a"an /alan na,as$ "i(ak a(a suara na,as "am&aan$em&usan na,as (a,a" (irasakan$ "i(ak a(a na,as4u,in+ i(un+.!ook : "i(ak "am,ak kelainanE8alua"e : /arak an"ara +i+i seri a"as (an &a-a 7 /ari$

/arak an"ara (a+u (an "ulan+ "iroi( 7 /ari$ /arak an"ara &en/olan "iroi( (an (asar mulu" 2 /ari

(allom,a"# : +ra(e 1#&s"ru4"ion : "i(ak a(a sum&a"an /alan na,as

Ne4k mo&ili"# : leer (a,a" &er+erak &e&as

,$E"THIN%'rekuensi na,as : 21 =meni"$ re+ular$ &en"uk (an+erakkan (in(in+ (a(a sime"ris$ "i(ak a(a re"raksi i+a(an ,en++unaan o"o" &an"u ,erna,asan0uara na,as : 8esikuler 3$ ronki 663$ -ee@in+ 663



,!##'Akral : akral an+a"$ mera$ kerin+'rekuensi na(i : 21 =meni"

CRT : 2 (e"ik Tekanan (ara : 12** mm;+Kon/un+"i8a : "i(ak anemis0klera : "i(ak ik"erik

,$"INKesa(aran : Kesa(aran kom,osmen"is

,!"''E$ : %ro(uksi urin 3,#3E!ns,eksi : %eru" "am,ak (a"ar (an sim"eris$

s4ar 63Auskul"asi : Bisin+ usus 3 ? kali meni"%al,asi : 0u,el$ M4. Burne# si+n 3$ Ro8sin+ si+n

3$ %soas si+n 63%erkusi : Tim,ani

,#NE'rak"ur : "rauma 63$ >rak"ur 63Lain6lain : 6

I4& PE(E$I)S""N PEN+NJ"N%Dara ru"in Kimia (ara

;B : 17$? m+(l Ureum : 6;T : ?2$7 Krea"inin : 6BC : 1.?** mm7 A0T : 6 Trom&osi" : ?12.*** uL ALT : 6

Lain6lain :

4& 'I"%N#S" )E$J" 5 A,,en(i4i"is aku"4I& $ EN."N" T"T" !")S"N" 5 A,,en(ek"omi

4II& $EN."N" TIN'")"N "NESTESI 5Eeneral anes"esia(en+an "ekniK

in"u&asi !T EA6!T34III& ST"T+S "S" 5 A0A !



I6& PE$SI"P"N "NESTESI 5

%ersia,an ,asien• %asien (i/elaskan "en"an+ ,rose(ur ren4ana "in(akan anes"esi

EA : !T3• %asien (imin"a ,uasa ) /am se&elum o,erasi• %asien (imin"a mele,askan +i+i ,alsu$ ,eriasan (an &esi6&esi

lain #an+ a(a a"au meleka" ,a(a "u&u ,asien• %a(a ,asien (i,asan+kan akses in"ra8ena (en+an F 4a"e"er

no. 1 E (an se" "rans>usi (en+an loa(in+ 4airan kris"aloi($,as"ikan 4airan mene"es lan4er

• %akaian ,asien (ile,as (an (i+an"i (en+an &a/u o,erasi• %asien (i,osisikan "i(ur "erlen"an+• Dikamar o,erasi$ ,a(a ,asien (i,asan+kan "ensime"er (an

sensor sa"urasi O2. !8aluasi na(i$ "ekanan (ara (an sa"urasi*2 ,re6o,erasi

%ersia,an ala"• Mem,ersia,kan mesin anes"esi$ moni"or$ selan+ ,en+u&un+

4onne4"or3G >a4e mask$ "ensime"er$ sensor sa"urasi *2$

memas"ikan selan+ +as *2 (an N2* "eru&un+ ke sum&ersen"ral$ men+isi ,enu 8a,ori@er se8oHuran4e (an isoHuran4e• Mem,ersia,kan s"e"osko,$ +a+an+ &la(e larin+osko,

!TT /enis kin+kin+ nomor )$G <G (an <$ $ +ue(el$ ,las"eri,aI= 2 lem&ar ukuran 1$ = 1$ 4m 2 lem&ar ukuran = 74m$ in"ro(u4er$ 4onne4"or$ ko"ak (an selan+ su4"ion$ s,ui" 2*44

• Mem,ersia,kan s,ui" o&a" 7 44$ 44 (an 1* 44• Ala" in>use 4on"inue

%ersia,an o&a"• 'en"an#l 1 5 7 m4+k+&& = )* k+ 1** m4+• %ro,o>ol 1$ 5 2$ m+k+&& =)* k+ 1* m+• A"ra4urium &es#la"e *$ 5 *$) m+k+&& = )* k+ 7) m+• O2 2 lmeni"$ N2O 2lmeni"$ isoHurane 28ol• Ke"orola4 1 7* m+/am



• Trama(ol 1** m+ (ri, (alam RL ** ml• On(an4en"ron m+? mL

6& Taha7an "n*st*si 5

Pr*m*dikasiBolus >en"an#l 1** m!

#ksig*nasi"lirkan O2 2 Lmeni" melalui >a4e mask (an alirkan ke (e,an-a/a ,asien.

InduksiBolus ,ro,o>ol 1** m+$ ,eriksa reHek &ulu ma"a in++ane+a"i8eA"ra4urium &es#la"e 7) m+

4*ntilasi 8 In9*ksi musl* r*la:ant Kuasai ,a"ensi /alan na>as ,asien (en+an 4ara

men+eks"ensikan ke,ala ,asien$ ,asan+ +u(el un"ukmen4e+a li(a men#um&a" /alan na>as ,asien.

%asan+ >a4emask (an &eri aliran O2 2L meni"$ N2O 2Lmeni" (an se8oHuiran4e 2 8ol

Fen"ilasi se4ara manual$ e8aluasi ,er+erakan (in(in+(a(a (an sa"urasi O2

0e"ela /alan na>as (a,a" (ikuasai (en+an &aik$ &olusa"ra4ulum &es#la"e 7*m+ $ kemu(ian lan/u"kan8en"ilasi manual selama 76 meni".

!aringosko7i Le,askan >a4emask (an +ue(el %asan+ &la(e ,a(a +a+an+ larin+osko, (an ,e+an+

larin+osko, (en+an "an+an kiri Masukan larin+osko, ke (alam mulu" ,asien (ari sisi

kanan$ sin+kirkan li(a ke kiri$ ,osisikan ke,ala ,asieneks"ensi$ "elusuri li(a ,asien in++a "erlia" e,i+lo""is

(an ,li4a 8o4alis

Intuasi Masukan !TT no < (en+an "an+an kanan ke ara ,li4a

8o4alis 0am&un+kan u/un+ !TT (en+an selan+ mesin anes"esi



%as"ikan !TT "ela masuk ke "rakea (en+an 4ara lia",er+erakan (in(in+ (a(a sime"ris (an auskul"asi ,aru(en+an suara na>as #an+ sama kua" ,a(a la,an+an,aru kanan (an kiri saa" memom,a &alon.

'iksasi in"erna !TT (en+an men+em&an+kan &alon !TTmen++unakan u(ara (an s,ui" 2* Ml (an Iksasieks"erna (en+an men++unakan ,les"er.

Tu"u, ma"a ,asien (en+an ,les"er %asan+ +u(el ,a(a ,asien U&a se""in+ mesin anes"esi (ari manual s,on"an ke

%%F s,on"an (en+an ** Ml (an RR 12= meni"

(aint*nan* O2 2 L meni" N2O 2Lmeni" 0e8oHurane 2 8ol

T*ra7i airan

Ke&u"uan 4airan main"enan4e ,er /am M3 ? ml k+ BB /am = 1* K+ ?* ml /am 2 ml k+ BB /am = 1* k+ 2*ml /am 1 ml k+ BB /am = ?* k+ ?* ml /am

M 1** ml/am

Ke&u"uan 4airan ,en++an"i ,en+ua,an ,er /am O3O,erasi ,a(a ,asien ini "ermasuk o,erasi se(an+.0e(an+ :) mlk+ BB /am 6 7)* ml/am

Ke&u"uan 4airan ,en++an"i ,uasa %3% M = lama ,uasa% 1** ml/am = ) /am )** ml

%em&erian 4airan (uran"e o,erasi Jam : M O % 1** ml 7)* ml 7**

ml <)* ml

Jam : M O % 1** ml 7)* ml 1* ml )1* ml Jam : M O % 1** ml 7)* ml 1* ml

)1* ml

Ekstuasi Menu"u, aliran N2O (an se8oHuran4e



Alirkan oksi+en ) Lmeni" %as"ikan ,asien &erna>as s,on"an (an "era"ur Melakukan su4"ion slem ,a(a air-a# ,asien Men+em,eskan &alon !TT$ le,askan ,les"er Iksasi !TT$

4a&u" !TT$ (an se+era ,Pasan+ >a4e mask (en+anoksi+en ) Lmeni" !ks"ensikan ke,ala ,asien

$*ov*ry Dri, ke"orola4 )* m+ (an "rama(ol 1** m+ (alam **

mL

6I& Post #7*rasi %asien sa(ar 6 ,in(akan ke Re4o8er# Room RR3 ,an"au TTF "ia, 1 meni" mulai %ONF (an skala FA0 Oksi+enasi 2L meni" 8ia nasal 4anul n/eksi On(an4en"ron m+? mL Dri, anal+e"ik ,os" o,erasi 2* ",m:

Ke"orola4 1 7* m+/am Beri 4airan ruma"an RL 7* ",m %uasa in++a &isin+ usus ,osi"i> %in(akan ke ruan+an &ila ALD!R!T! skor



!"P#$"N J"%" "NESTESI

6II& I'ENTIT"S P"SIENE. Nama : N#. S.;. Umur : 2*. Jenis Kelamin : %r J. No RM : 911)?)K. Alama" : Minas &ara"$ 0iak.L. Bera" Ba(an : ? k+

6III& "N"(NESIS

%& )*luhan +tama%er(araan /alan lair.

H& $i-ayat P*nyakit S*karang,asien (a"an+ (en+an keluan ,er(araan /alan lairse/ak Q 7* meni" 0MR0. %asien men+a"akan ,er(araanKeluar &an#ak kira6kira Q 12 +elas aua &er4am,ur(ara #an+ men++um,al.

I& $i-ayat P*nyakit 'ahulu%asien "i(ak ,erna men+alami keluan #an+ sama

se&elumn#a. Ri-a#a" i,er"ensi$ DM$ asma (an ,en#aki" /an"un+ (isan+kal.

J& $i-ayat P*nyakit )*luarga Ti(ak a(a keluar+a #an+ men+elukan keluan #an+sama (en+an ,asien. Ri-a#a" DM$ i,er"ensi$ asma$ (an,en#aki" /an"un+ (i keluar+a (isan+kal.



)& $i-ayat *konomi/ soial/ dan k*iasaan%asien a(ala seoran+ i&u ruma "an++a$ ri-a#a"merokok (an konsumsi al4ool (isan+kal.

!& "(P!E" : Ri-a#a" aler+i makanan (an o&a" 5 o&a"an(isan+kal( : Ti(ak a(a konsumsi o&a" ru"in$ ri-a#a" o,erasi 63P : Ri-a#a" i,er"ensi$ DM$ asma$ (an ,en#aki" /an"un+(isan+kal! : %asien "erakir makan (an minum ,ukul 1).** BE : ,asien men+elukan n#eri ,eruT &a+ian &a-a

6I4& PE(E$I)S""N ISI)

B. 0TATU0 E!N!RAL0. Kea(aan umum : Tam,ak saki" se(an+). Kesa(aran : Com,os men"is<. Tan(a "an(a 8i"al :

• Tekanan (ara : 11** mm;+• Na(i : =meni"• 'rekuensi na>as : 1 =meni"• 0uu : 7)$ 4

. 0"a"us +i@i• BB : ? k+• TB : 1* 4m• MT : 2* m2

"I$3"Y Clear$ ,asien (a,a" &er&i4ara (en+an lan4ar$ "i(ak a(asum&a"an /alan na,as$ "i(ak a(a suara na,as "am&aan$em&usan na,as (a,a" (irasakan$ "i(ak a(a na,as4u,in+ i(un+.!ook : Ti(ak "am,ak kelainanE8alua"e : Jarak an"ara +i+i seri a"as (an &a-a 7 /ari$

/arak an"ara (a+u (an "ulan+ "iroi( 7 /ari$

/arak an"ara &en/olan "iroi( (an (asar mulu" 2 /ari(allam,a"# : Era(e 1#&s"ru4"ion : Ti(ak a(a sum&a"an /alan na,asNe4k mo&ili"# : Leer (a,a" &er+erak &e&as

,$E"THIN%



'rekuensi na,as : 1 =meni"$ re+ular$ &en"uk (an+erakan (in(in+ (a(a sime"ris$ "i(ak a(a re"raksi i+a (an,en++unaan o"o" &an"u ,erna,asan0uara na,as : 8esikuler 3$ ronki 663$ -ee@in+ 663

,!##'Akral : akral an+a"$ mera$ kerin+'rekuensi na(i : =meni"CRT : 2 (e"ik Tekanan (ara : 11** mm;+Kon/un+"i8a : "i(ak anemis0klera : "i(ak ik"erik,$"INKesa(aran : kesa(aran kom,osmen"is

,!"''E$ Ti(ak "er,asan+ ka"e"er urin. Urin 3

,#3E!ns,eksi : ,eru" "am,ak (a"ar (an sim"eris$s4ar 63Auskul"asi : &isin+ usus 3 ) kali meni"%al,asi : su,el$ n#eri 63%erkusi : "im,ani

,#NE

'rak"ur : "rauma 63$ >rak"ur 63Lain6lain : 6

64& PE(E$I)S""N PEN+NJ"N%Dara ru"in

;B : 11.1m+(l;T : 72$) BC : 1).)** mm7

Trom&osi" : 2)<.*** uL

Lain6lain :CT : ?SBT : 2S

XVI. 'I"%N#S" )E$J" 5 E2%1A*;1 amil 69 min++u(en+an



a&or"us insi,iens e4 &li+"e(o8um.

64II& $EN."N" T"T" !")S"N" 5 Kure"ase64III& $EN."N" TIN'")"N "NESTESI 5 TFA

6I6& ST"T+S "S" 5 A0A !66& PE$SI"P"N "NESTESI 5

%ersia,an ,asien• %asien (i/elaskan "en"an+ ,rose(ur ren4ana "in(akan anes"esi

TFA3• %asien (imin"a ,uasa ) /am se&elum o,erasi• %asien (imin"a mele,askan +i+i ,alsu$ ,eriasan (an &esi6&esi

lain #an+ a(a a"au meleka" ,a(a "u&u ,asien• %a(a ,asien (i,asan+kan akses in"ra8ena (en+an F 4a"e"er

no. 1 E (an se" "rans>usi (en+an loa(in+ 4airan kris"aloi($

,as"ikan 4airan mene"es lan4er.• %akaian ,asien (ile,as (an (i+an"i (en+an &a/u o,erasi• %asien (i,osisikan li"o"om#• Dikamar o,erasi$ ,a(a ,asien (i,asan+kan "ensime"er (an

sensor sa"urasi O2. !8aluasi na(i$ "ekanan (ara (an sa"urasi*2 ,re6o,erasi

%ersia,an ala"• Mem,ersia,kan mesin anes"esi$ moni"or$ selan+ ,en+u&un+

4onne4"or3G >a4e mask$ "ensime"er$ sensor sa"urasi *2$

memas"ikan selan+ +as *2 (an N2* "eru&un+ ke sum&ersen"ral$ men+isi ,enu 8a,ori@er se8oHuran4e (an isoHuran4e• Mem,ersia,kan s"e"osko,$ +a+an+ &la(e larin+osko,

!TT /enis kin+kin+ nomor )$G <G (an <$ +ue(el$ ,las"eri,aI= 2 lem&ar ukuran 1$ = 1$ 4m 2 lem&ar ukuran = 74m$ in"ro(u4er$ 4onne4"or$ ko"ak (an selan+ su4"ion$ s,ui" 2*44

• Mem,ersia,kan s,ui" o&a" 7 44$ 44 (an 1* 44• Ala" in>use 4on"inue

%ersia,an o&a"• 'en"an#l 1 5 7 m4+k+&& = ? k+ * m4+• Me"o4lo,rami(e ;Cl *$ m+k+&& = ? k+ 22$ m+• %ro,o>ol 1$ 5 2$ m+k+&& = ? k+ 1** m+• Oksi"osin 1* U• Me"#ler+ome"rin 1* U



• Ke"orola4 *$ 5 1 m+k+&& = ? k+ 7* m+

66I& Taha7an "n*st*si 5

Pr*m*dikasi

Bolus >en"an#l * m4Bolus me"o4lo,rami(e ;Cl 22$ m+

#ksig*nasiAlirkan O2 7 Lmeni" melalui kanul

InduksiBolus ,ro,o>ol 1** m+$ ,eriksa reHek &ulu ma"a in++a

ne+a"i8e

(aint*nan*

Oksi"osin 1* U Me"#ler+ome"rine 1* U

T*ra7i airanKe&u"uan 4airan main"enan4e ,er /am M3 ? ml k+ BB /am = 1* K+ ?* ml /am 2 ml k+ BB /am = 1* k+ 2*ml /am 1 ml k+ BB /am = 2 k+ 2 ml /am

M ml/am

Ke&u"uan 4airan ,en++an"i ,en+ua,an ,er /am O3 Ten"ukan a,aka o,erasi (era/a" rin+an se(an+ &era"Rin+an : ? Mlk+ BB /am 0e(an+ :) mlk+ BB /am ) = ? k+ 2<* ml/am

Bera" : ml k+BB /am

Ke&u"uan 4airan ,en++an"i ,uasa %3% M = lama ,uasa% ml/am = ) /am 1* ml

%em&erian 4airan (uran"e o,erasi

Jam : M O % ml 2<* ml 2ml )1* ml

$*ov*ry Bolus ke"orola4 7* m+

66II& Post #7*rasi



%asien sa(ar 6 ,in(akan ke Re4o8er# Room RR3 ,an"au TTF "ia, 1 meni" mulai %ONF (an skala FA0 Oksi+enasi 2L meni" 8ia nasal 4anul Dri, anal+e"ik ,os" o,erasi 2* ",m

Beri 4airan ruma"an RL 7* ",m %uasa in++a ,asien sa(ar %in(akan ke ruan+an &ila ALD!R!T! skor

lapja anastesi

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