PENUGASAN KGD II

Materi : Syok (Ns. Rosma Karinna Haq, S.Kep., M.Kep.)

CASE STUDY

A 77-year-old man is admitted to the intensive care unit (ICU) of a

university hospital from the operating room. Earlier the same day, he had
presented to the emergency department with abdominal pain. His medical history
included treated hypertension and hypercholesterolemia, previous heavy alcohol
intake, and mild cognitive impairment. In the emergency department, he was
drowsy and confused when roused and was peripherally cold with cyanosis. The
systemic arterial blood pressure was 75/50 mm Hg, and the heart rate was 125
beats per minute. The abdomen was tense and distended. After the administration
of 1 liter of intravenous crystalloid to restore the blood pressure, a computed
tomographic scan of the abdomen showed extraluminal gas and suspected
extraluminal feces consistent with a perforated sigmoid colon. He was treated
with intravenous antibiotics and taken to the operating room for laparotomy.
During this procedure, gross fecal peritonitis from a perforated sigmoid colon was
confirmed; resection of the sigmoid colon with closure of the rectal stump and
creation of an end colostomy was performed with extensive peritoneal toilet and
washout.

On arrival in the ICU, he is still anesthetized, the trachea is intubated, and

the lungs are mechanically ventilated with a fraction of inspired oxygen of 0.4; the
arterial blood pressure is supported with a norepinephrine infusion. When the
patient was in the operating room, he received a total of 4 liters of crystalloid. On
his arrival in the ICU, the vital signs are a blood pressure of 88/52 mm Hg, heart
rate of 120 beats per minute in sinus rhythm, central venous pressure of 6 mm Hg,
and temperature of 35.6°C. An analysis of arterial blood shows a pH of 7.32, a
partial pressure of carbon dioxide of 28 mm Hg, a partial pressure of oxygen of 85
mm Hg, and a lactate level of 3.0 mmol per liter.
Tugas :
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