05aprc terapi cairan
TRANSCRIPT
-
8/6/2019 05APRC TERAPI CAIRAN
1/22
11
FLUID THERAPY ANDFLUID THERAPY AND
MEDICATIONSMEDICATIONS
Fluid resuscitationFluid resuscitation
Specific drug therapySpecific drug therapy
DeliveryDelivery
InfusionsInfusions
Komisi Resusitasi Pediatrik
UKK PGD IDAI
-
8/6/2019 05APRC TERAPI CAIRAN
2/22
22
Resuscitation FluidsResuscitation Fluids
Used forUsed for
Volume replacementVolume replacement
Fluid of choiceFluid of choice
Normal salineNormal saline
Lactated Ringers solutionLactated Ringers solution
Acetated Ringers solutionAcetated Ringers solution
(Colloid solution)(Colloid solution)
-
8/6/2019 05APRC TERAPI CAIRAN
3/22
33
Rapid Infusion is determined by :
Dimension of vascular catheter
(diameter & length)
Pressure
Viscosity
-
8/6/2019 05APRC TERAPI CAIRAN
4/22
44
-
8/6/2019 05APRC TERAPI CAIRAN
5/22
55
-
8/6/2019 05APRC TERAPI CAIRAN
6/22
66
-
8/6/2019 05APRC TERAPI CAIRAN
7/22
-
8/6/2019 05APRC TERAPI CAIRAN
8/22
88
Drug DeliveryDrug Delivery
Drugs must ultimately reach the centralDrugs must ultimately reach the central
circulationcirculation
Intravascular boluses should be followedIntravascular boluses should be followed
by at least a 2by at least a 2 -- 5mL normal saline bolus5mL normal saline bolus
-
8/6/2019 05APRC TERAPI CAIRAN
9/22
99
Sites for Drug AdministrationSites for Drug Administration
Peripheral veinsPeripheral veins
IntraosseousIntraosseous
Central veinsCentral veins
EndotrachealEndotracheal
-
8/6/2019 05APRC TERAPI CAIRAN
10/22
1010
Drugs that can be givenDrugs that can be given
endotracheallyendotracheally
LidocaineLidocaine
EpinephrineEpinephrineAtropineAtropine
NaloxoneNaloxone
-
8/6/2019 05APRC TERAPI CAIRAN
11/22
1111
Endotracheal Drug DosesEndotracheal Drug Doses
Epinephrine dose is 10 x IV dose :Epinephrine dose is 10 x IV dose :
0.1 mg/kg (use 1 : 1.000)0.1 mg/kg (use 1 : 1.000)
Other drug doses are increased :Other drug doses are increased :
22 3 x IV dose3 x IV dose
-
8/6/2019 05APRC TERAPI CAIRAN
12/22
1212
Endotracheal Drug DeliveryEndotracheal Drug Delivery
Drug
Dilute with3 5 mL NS
Instill directly
Positive-pressure breaths
Instill via catheter
Flush 3 5 mL NS
-
8/6/2019 05APRC TERAPI CAIRAN
13/22
1313
Epinephrine DosesEpinephrine Doses
IndicationIndication IV/IO DoseIV/IO Dose ET DoseET Dose
BradycardiaBradycardia 0.01 mg/kg0.01 mg/kg 0.1 mg/kg0.1 mg/kg
0.1 mL/kg0.1 mL/kg
(1:10.000)(1:10.000)
0.1 mL/kg0.1 mL/kg
(1:1.000)(1:1.000)Asystole/VF/VTAsystole/VF/VT
Initial doseInitial dose 0.01 mg/kg0.01 mg/kg 0.1 mg/kg0.1 mg/kg
0.1 mL/kg0.1 mL/kg
(1:10.000)(1:10.000)
0.1 mL/kg0.1 mL/kg
(1:1.000)(1:1.000)
Subsequent dosesSubsequent doses 0.1 mg/kg0.1 mg/kg 0.1 mg/kg0.1 mg/kg
0.1 mL/kg0.1 mL/kg
(1:10.000)(1:10.000)
0.1 mL/kg0.1 mL/kg
(1:1.000)(1:1.000)
-
8/6/2019 05APRC TERAPI CAIRAN
14/22
1414
Other resuscitation DrugsOther resuscitation Drugs
DrugDrug Indication for useIndication for use
AtropineAtropine Symptomatic bradycardiaSymptomatic bradycardia
Sodium bicarbonateSodium bicarbonate Documented acidosisDocumented acidosis
NaloxoneNaloxone NarcoticNarcotic--inducedinduced
respiratory depressionrespiratory depression
Calcium chlorideCalcium chloride Hypocalcemia,Hypocalcemia,hyperkalemia,hyperkalemia,
hypermagnesemia,hypermagnesemia,
calcium channel blockercalcium channel blocker
overdoseoverdose
-
8/6/2019 05APRC TERAPI CAIRAN
15/22
1515
Comparison of Inotropic DrugsComparison of Inotropic Drugs
DrugDrug UsesUses
EpinephrineEpinephrine Symptomatic bradycardiaSymptomatic bradycardia
Shock (incl.anaphylactic)Shock (incl.anaphylactic)
HypotensionHypotension
Cardiopulmonary arrestCardiopulmonary arrest
DobutamineDobutamine Normotensive cardiogenic shockNormotensive cardiogenic shock
DopamineDopamine
Low doseLow dose Improve renal, splanchnic bloodImprove renal, splanchnic blood
flowflow
High doseHigh dose HypotensionHypotension
-
8/6/2019 05APRC TERAPI CAIRAN
16/22
1616
Preparation of Drug InfusionsPreparation of Drug Infusions
The Rule of6The Rule of6
Drug:Drug:
EpinephrineEpinephrine
Calculation rule:Calculation rule:
0.6 x BW(kg) = # mg0.6 x BW(kg) = # mg
to add to diluent toto add to diluent to
make 100 mLmake 100 mL
volumevolume
1 mL/h delivers 0.1 Qg/kg per minute
-
8/6/2019 05APRC TERAPI CAIRAN
17/22
1717
Preparation of Drug InfusionsPreparation of Drug Infusions
The Rule of6The Rule of6
Drug:Drug:
DopamineDopamine
DobutamineDobutamine
Calculation rule:Calculation rule:
6 x BW(kg) = # mg6 x BW(kg) = # mg
to add to diluent toto add to diluent to
make 100 mLmake 100 mL
volumevolume
1 mL/h delivers 1 Qg/kg per minute
-
8/6/2019 05APRC TERAPI CAIRAN
18/22
1818
Caveats of Drug InfusionCaveats of Drug Infusion
TherapyTherapy
Drug delivery is delayed at slow infusionDrug delivery is delayed at slow infusionratesrates
Titrate the infusionTitrate the infusion
Monitor heart rate and blood pressureMonitor heart rate and blood pressurecontinuouslycontinuously
-
8/6/2019 05APRC TERAPI CAIRAN
19/22
1919
Epinephrine Drip for a20Epinephrine Drip for a20--kgkgPatientPatient
Drug Dose Infusion Rate
12 mg
Dose = 0.6 x 20 = 12 mg in solution totaling 100 mL fluid
To deliver 0,1 Qg/kg per minute
1 mL/h
1.2 mg 10 mL/h
Dilute by factor of 10 Increase by factor of 10
-
8/6/2019 05APRC TERAPI CAIRAN
20/22
2020
Aids to Drug CalculationsAids to Drug Calculations
Percent solutionPercent solution
Percentage = number of grams perPercentage = number of grams per
100 mL (regardless of the substance)100 mL (regardless of the substance)
10 % solution = 10 g / 100 mL10 % solution = 10 g / 100 mL
= 0.1 g / mL= 0.1 g / mL= 100 mg/ mL= 100 mg/ mL
DD55W = mg glucose per mLW = mg glucose per mL50
-
8/6/2019 05APRC TERAPI CAIRAN
21/22
2121
Aids to Drug CalculationAids to Drug Calculation
Serial dilutionSerial dilution
1 : 100 ; 1 : 1.000 ; 1 : 10.000 =1 : 100 ; 1 : 1.000 ; 1 : 10.000 =
1 g of any substance per 100; 1.000; 10.000 mL1 g of any substance per 100; 1.000; 10.000 mL1 : 10.000 epinephrine = 1 g/10.000 mL1 : 10.000 epinephrine = 1 g/10.000 mL
= 1 mg/10 mL= 1 mg/10 mL
= 0,1 mg/mL= 0,1 mg/mL
-
8/6/2019 05APRC TERAPI CAIRAN
22/22
2222
Aids to Drug CalculationAids to Drug Calculation
Microgram (Microgram (QQg)g)
11 QQg = 1/1000 of a milligram, org = 1/1000 of a milligram, or
1 mg = 10001 mg = 1000 QQgg
How manyHow many QQg/mL are in a 1 : 10.000g/mL are in a 1 : 10.000
solution of epinephrine ?solution of epinephrine ?
1 : 10.000 = 1 g/10.000 mL
= 1000 mg/10.000 mL= 1 mg/10 mL
= 1000 Qg/10 mL
= 100 Qg/mL