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Dyspnea - DR Allen
Dyspnea - DR Allen
Allen Widysanto
DYSPNEA
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Pulmonary Cardiac
dyspnea dyspnea
OBSTRUCTION
RESTRICTION
VENTILATION
IMPAIRMENT
IMPAIRMENT OF
OXYGEN TRANSFER
DIFFUSION
SHUNTING
PERFUSION ANEMIA
INADEQUATE
CARDIAC OUTPUT
3 MAJOR CATEGORIES
DYSPNEA
CHRONIC RECURRENT
ACUTE DYSPNEA PROGRESSIVE PAROXYSMAL
DYSPNEA DYSPNEA
Acute dyspnea
LOWER UPPER
RESPIRATORY RESPIRATORY
TRACT TRACT
NEOPLASMA
PNEUMONIA
TRACHEA
SPONTANEOUS OBSTRUCTION/COMPRESSION
PNEUMOTHORAX
INFECTIOUS CROUP
ATELECTASIS
SIGNS AND SYMPTOMS
LARYNGEAL OR
TRACHEAL
OBSTRUCTION
Chronic progressive dyspnea
CONGESTIVE
INTERSTITIAL DISEASE
HEART (Occupational Lung Diseases)
FAILURE
CHRONIC OBSTRUCTIVE
PULMONARY
DISEASE
ASTHMA
HYPERSENSITIVITY
PNEUMONIAS SARCOIDOSIS
COLLAGEN DISEASES
(scleroderma, SLE,
GRANULOMATOUS Polyarteritis nodosa,
DISEASE Wagener’s
granulomatosis,
rhematoid lung )
RECURRENT PAROXYSMAL DYSPNEA
ASTHMA
Allergen LVH
Viral MS
Bacterial
Parasit
Fungi
ONSET of BREATHLESSNESS
SUDDEN
ONSET
Accumulation of PE GRADUAL
Partial/complete airway occlusion ONSET OVER
due to growth of lung cancer MONTHS OR YEARS
COPD
Lung fibrosis
Non-respiratory causes
(anemia, hyperthyroidism)
RISK FACTORS FOR RESPIRATORY DISEASE
• Oxygen
• Opiates
• Anxiolytics
Reduce the sense of effort and improve
respiratory muscle function
RESPIRATORY
FAILURE
• Corticosteroids
• Leucotriene antagonists and inhibitors
• Expectorant
• Sedative ( Lorazepam )and muscle relaxant ( Propofol)
particularly for the patients who are receiving
mechanical ventilator.
In patients not receiving MV, sedative drugs (
barbiturates, benzodiapines, opioids) are
contraindicated.
• Chest physiotherapy
MECHANICAL VENTILATION
• Indications for intubation and MV:
Physiologic Clinical
ASMA
OBSTRUCTION
REVERSIBILITY
VARIABILITY
• Obstruction
Ratio
FEV 1
75% atau FEV 1 80% pred
FVC
Reversibility
At least 12 percent improvement in FEV1 or 15 %
improvement either spontaneously, after inhalation of
a bronchodilator or in response to a trial of glucocorticoid
Variability
PFR night – PFR morning
X 100 %
½ ( PFR night + PFR morning)
Penatalaksanaan Eksaserbasi di Rumah Sakit (1)
Penilaian awal (sesuai derajat berat/ringannya serangan asma)
Riw. penyakit, pemeriksaan fisik, penggunaan otot bantu napas, frek. nadi, frek. napas,
APE atau VEP1, saturasi O2, AGD pada pasien berat & pemeriksaan lain jika ada indikasi.
Terapi awal
• Inhalasi agonis 2 aksi singkat, dg nebulisasi, TERUS MENERUS selama 1 jam
• Oksigen untuk mencapai saturasi O2 90% (95% pada anak-anak)
• Kortikosteroid sistemik jika tidak ada respons segera/jika akhir-akhir ini mendapat steroid
peroral atau jika serangan asmanya berat
• Sedasi merupakan kontraindikasi pada penanganan serangan akut/eksaserbasi
Penilaian ulang : tanda-tanda fisik, APE, saturasi O2, & pemeriksaan lain yang diperlukan
Respons baik 1-2 jam Respons tidak lengkap Respons buruk dalam 1-2
• Respons menetap 60 menit 1-2 jam jam
sesudah t/ terakhir • Riw. risiko tinggi • Riw. risiko tinggi
• Pem. fisik normal • Pem. fisik gejala asma • Pem. fisik gejala asma berat,
• APE > 70% ringan/sedang mengantuk, & bingung
• Tidak ada distres • APE < 60% • APE <30%
• Saturasi O2 >90% (anak 95%) • Saturasi O2 tidak membaik • PCO2 >45 mmHg
• PO2 <60 mmHg
Rawat jalan : Rawat inap (bangsal): Rawat ICU :
• Agonis 2 inhalasi • Oksigen • Oksigen
• Pertimbangkan kortikosteroid • Inhalasi agonis 2 inhalasi • Inhalasi agonis 2 inhalasi
oral (pada kebanyakan pasien) antikolinergik antikolinergik
• Pendidikan pasien • Kortikosteroid sistemik • Kortikosteroid IV
• Pertimbangkan agonis 2 IV
• Minum obat secara benar • IV magnesium • Pertimbangkan teofilin IV
• Tinjau rencana kerja • Pertimbangkan aminofilin IV • Mungkin perlu intubasi &
• Tindak lanjut pengobatan • Pantau APE, saturasi O2, nadi. ventilasi mekanis
secara tepat
ARDS
TERAPI