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Bakul-Patofisiologi Trauma
Bakul-Patofisiologi Trauma
Department of Urology
Medical School Airlangga University - Dr. Soetomo Hospital
Surabaya
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PATOFISIOLOGI TRAUMA
Definisi :
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TRAUMA pada JARINGAN/ORGAN
KERUSAKAN
PERDARAHAN
NYERI
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JENIS TRAUMA
• Ledakan benda berkecepatan tinggi, benda
tajam (tusukan, irisan, sabetan), benda tumpul
• Suhu tinggi/rendah
uap panas
luka bakar
frostbite (suhu dingin)
• Arus listrik tegangan tinggi
• Bahan kimia
• Radiasi, ionisasi
• Gigitan, sengatan
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KERUSAKAN AKIBAT TRAUMA
Bentuk :
Diastase (kerobekan), memar, erosi, lecet, hancur
(crush injury), jaringan hilang
Lokalisasi :
• Jaringan lunak + kulit : - luka terbuka
- luka tertutup
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HEBAT TUNGGAL
TRAUMA
RINGAN GANDA
LOKAL
TANDA + GEJALA
REAKSI TUBUH
(Bagian dari proses SISTEMIK
Penyembuhan secara alami)
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INSULT HEBAT / BERAT
4 I-s
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Bacteremia
Other
Fungemia
Viremia BURNS
Other
Pancreatitis
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SIRS and MODS
Inflammatory and organ dysfunction responses to injury. Normal response to an injury or insult may
decrease after 3 to 5 days or be reactivated by a complication. A continuous inflammatory response is
seen with systemic inflammatory response syndrome (SIRS) and can eventually progress to organ
dysfunction (reprinted from 4). 15
Beal et al, JAMA, 1994;271;226-233
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SEPSIS :
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Severe Sepsis :
Sepsis associated with organ dysfunction,
hypoperfusion abnormalities, or hypotension.
Hypoperfusion abnormalities include but are not
limited to :
1. lactic acidosis,
2. oliguria
3. or an acute alteration in mental status
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Septic Shock :
Sepsis-induced hypotension despite
fluid resuscitation PLUS hypoperfusion
abnormalities
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MODS
Organ Dysfunction associated with Severe Sepsis and
Septic Shock :
Brain : confusion 22
OSLER’S DICTUM
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SIRS MODS MOF
BUKAN PENYAKIT
BUKAN SINDROMA
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SIRS Systemic Inflammatory Response Syndrome
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DEAR SIRS
WE ARE SORRY TO SAY
THAT
WE DON’T LIKE YOU
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Sir Isaac Newton :
To every action is always an equal reaction
or
The mutual action of two bodies upon each other
are always equal, and directed to contrary parts
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BIOLOGICAL SYSTEMS, such as the
human body, are more complicated
than the simple physical systems Sir
Isaac was describing
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MACROPHAGE ( morfologi ) :
Sel besar
Inti bulat/indented
Lisosom + fagolisosom
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MACROPHAGE ( fungsi ) :
• Nonspecific phagocytosis/pinocytosis
• Specific phagocytosis opsomized microorganisms
(Fc receptors + complement receptor)
• Killing ingested microorganims
• Digestion + presentation of antigens to T + B lymphocyte
• Secretion of :
enzymes : lysozyme, collagenases, elastase, acid hydrogenases
complements + coagulation factors
some prostaglandins and leukotrienes
several regulatory molecules (interferon, Interleukin-1)
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MACROPHAGE ( jenis ) :
Histiosit
Sel Kupffer
Osteoclasts
Microglial cells
Synovial type A cells
Interdigititating cells
Langerhans cell
Langerhans, epitheloid cells
Inflamed tissues
Multinucleated giant cells
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MACROPHAGE
monoblast
promocyte
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CYTOKINE (SITOKIN) : (cyto + kinesis)
movement
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SITOKIN
Mencegah SIRS ?
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Proses dilepasnya
NAMUN
Aktivasi yang berkelanjutan / berlebihan justru
MERUGIKAN
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NORMAL STRESS RESPONSE
• PERUBAHAN KARDIOVASKULER
takikardi, kontraktilitas, curah jantung (CO), konsumsi oksigen
• “CASCADE” : - koagulasi
- komplemen
- sistem fibrinolitik
Stage I
Lokal : Sitokin
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SITOKIN
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Stage II
- Sejumlah kecil sitokin masuk sirkulasi
growth factor
Luka sembuh
Infeksi teratasi
Homeostasis pulih 41
Stage III
Sitokin Destruktif
( semula protektif )
MOD
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Figure 1. First hit, second hit, and sustained hit that can occur with systemic
inflammatory response syndrome (SIRS). ARDS, adult respiratory distress
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syndrome; MODS, multiple organ dysfunction syndrome.
Figure 2. Three stages of the systemic inflammatory
response syndrome reaction 44
Crit Care Med 1996 Vol. 24,
TRAUMA
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TRAUMA BERAT dan KEMATIAN
POLA DISTRIBUSI “TRI MODAL”
1 2 3
TRAUMA BERAT 47
JALAN TOL menuju kematian
Trauma multipel
Sumber infeksi
Immunocompromised
Sistem
Penunjang berbagai organ
(ICU)
SIRS
MODS
ARDS, DIC, ARF, KARDIOMIOPATI
Meninggal
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Cerra
JAMA Vol. 271, 1994 49
1991 Concensus Conference
Dirintis konsistensi
Memperhatikan aspek-aspek :
Klinik (bedside)
Laboratorium
Literatur terkait
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SIRS MODS/MOF
MORTALITAS TINGGI
tidak bermanfaat
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