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Kuliah 2 Kegawatan Asthma, Pneumonia Copd
Kuliah 2 Kegawatan Asthma, Pneumonia Copd
KEGAWAT DARURATAN
SISTEM PERNAPASAN
(SERANGAN ASMA AKUT,
PNEUMONIA DAN
COPD)
ASTHMA
BRONCHIALE
Asma
Wall thickening
inflammation
-- mucus gland
hypertrophy
Bronchus
Secretions
Wall thickening
inflammation
repair
-- remodeling
Bronchiole
Loss of alveolar
attachments
Wall thinning inflammation elastolysis
Alveoli
Coalescence
Elasticity
2-Agonists
Virus?
Adenosine
Exercise
Fog
Antigen
BRONCHOCONSTRICTION
Mast cell
Macrophage
AIRWAY
HYPERRESPONSIVENESS
Virus?
-lymphocyte
Reduction in Asthma
Attack
Improvement in the
control
Corticosteroids
PJ
of AsthmaBarnes
symptoms
Management of Asthma
Exacerbations(Emergency)
Oxygen
Inhaled short-acting beta2-agonist
hourly or continuously + inhaled
anticholinergic
Systemic corticosteroid
Admit to Hospital
Intensive Care
Inhaled beta2-agonist hourly or
continuously + inhaled anticholinergic
IV corticosteroid
Oxygen
Possible intubation and mechanical
ventilation
15
Controller:
Controller:
Controller:
None
Controller:
Daily inhaled
corticosteroid
Daily inhaled
corticosteroid
Daily longacting inhaled
2-agonist
Daily inhaled
corticosteroid
Daily long
acting inhaled
2-agonist
plus (if needed)
-Theophylline-SR
-Leukotriene
-Long-acting inhaled
2- agonist
-Oral corticosteroid
When
asthma is
controlled,
reduce
therapy
Monitor
STEP Down
16
PNEUMONIA
DEFINITION
Inflammation and consolidation of
lung
tissue due to an infectious agent
17
COMMUNITY
ACQUIRED (CAP)
Outpatiet
Inpatient
ICU
Typical
Atypical
HOSPITAL
ACQUIRED
(HAP)
18
19
PNEUMONIA/CAP
Merupakan infeksi saluran nafas bagian
bawah (ISPB)
SEAMIC Health Statistic 2001
penyebab kematian nomer 6 di Indonesia
SKRT Depkes 2001 ISPB penyebab
kematian nomer 2 di Indonesia
Definition
Pneumonia is infection of the gas
bronchial tree)
(Tracheitis or pharyngitis are
infections of the trachea or pharynx
respectively)
21
Pneumonia pathogenesis
22
Pneumonia
in immunocompetent
patients
Community-acquired pneumonia
Hospital-acquired pneumonia (also
in
immunocompromised patients
23
Treatment of CAP
24
25
MANAGEMENT
of
28
29
Treatment of HAP:
Group 1
30
Treatment:
32
Treatment:
ceftazidime 2 g q8h IV or cefepime 2g q8h IV
OR
imipenem-cilastatin 1 g q8h IV(ELASTYN )
OR
meropenem 1 g q8h IV
OR
piperacillin-tazobactam 4.5 g q6h IV
PLUS
ciprofloxacin 400 mg q8h IV or levofloxacin 750 mg q24h IV
OR
gentamicin or tobramycin 5-7 mg/kg q24h IV or amikacin 1520 mg/kg q24h IV
+/vancomycin 1 g q12h IV or linezolid 600 mg q12h IV
34
Chronic Obstructive
Pulmonary Disease
(COPD)
COPD
Alveolar macrophage
CD8
lymphocyte
+
MCP-1
Neutrophil
PROTEASE
INHIBITORS
Neutrophil elastase
PROTEASES MatrixCathepsins
metalloproteinases
Mucus hypersecretion
(Chronic bronchitis) 39
COPD - SIGNS
HYPERINFLATION
DECREASED EXPANSION CHEST
PROLONGED EXPIRATION/WHEEZE
SIGNS PULMONARY HYPERTENSION
40
Noxious stimulation
Chronic
inflammation
Destruction,
repair and
remodeling
Abnormal function
and symptoms
MANAGING
EXACERBATIONS
ANTIBIOTICS
CONTROLLED OXYGEN
BRONCHODILATOR - BETA AGONIST
ANTICHOLINERGIC,
THEOPHYLLINE
STEROIDS
NIV BIPAP
INTUBATION/VENTILATION
TREAT HEART FAILURE IF PRESENT
(RESPIRATORY STIMULANTS?)
1
INHALED
ANTICHOLINERGI
CS
IPRATROPIUM BROMIDE
OXITROPIUM BROMIDE
TIOTROPIUM BROMIDE
BRONCHODILATORS
FOR COPD
3
2
COMBINATIO
N
INHALER
BETA 2
AGONIST
4
THEOPHYLLI
NE
IPRATOPRIUM BROMIDE
&
SHORT ACTING INHALED
BETA 2 AGONIST
Antibiotics
Acute exacerbations of COPD are
Antibiotics
A meta-analysis of controlled trials of
Oxygen
Long-term oxygen therapy:
reduced mortality
improvement in quality of life in
patients with severe COPD and
chronic hypoxemia (partial
pressure of arterial oxygen, <55
mm Hg).
46
Corticosteroids
Inhaled corticosteroids are now the
47
Approximately 10 percent of
Manage
Exacerbations
Key Points
Exacerbations of respiratory
symptoms requiring medical
intervention are important clinical
events in COPD.
The most common causes of an
exacerbation are infection of the
tracheobronchial tree and air
pollution, but the cause of about
one-third of severe exacerbations
cannot be identified (Evidence B).
Manage
Exacerbations
Key Points
Inhaled bronchodilators (beta2agonists and/or anticholinergics),
theophylline, and systemic,
preferably oral, glucocorticosteroids are effective for the
treatment of COPD exacerbations
(Evidence A).
Manage
Exacerbations
Key Points