CURRICULUM VITAE

N a m a : Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K)Alamat : Jln.Karsa No F 1 Kompleks Eks KOWILHAN I Sei.Agul Medan 20117Jabatan : Guru Besar Tetap FK- UISU / Luar Biasa FK- USU Penasehat Perhimpunan Dokter Paru Indonesia Pusat

Anggota Dewan Asma Nasional Anggota Kolegium Perhimpunan Dokter Paru Indonesia Pusat Anggota Pokja Asma Perhimpunan Dokter Paru Indonesia Pusat Anggota Pokja PPOK Perhimpunan Dokter Paru Indonesia Pusat

Anggota Tim Akreditasi Pendidikan Dokter Spesialis Paru Nasional Ketua Perhimpunan Dokter Paru Indonesia Cabang Sumu

Ketua Departemen Pulmonologi dan Kedokteran Respirasi FK-UISU Dewan Pembina Yayasan Asma Indonesia Wilayah Sumut

Riwayat Pendidikan: - Dokter Umum, FK-USU Medan,1979 - Dokter Spesialis I Paru, FK-UI Jakarta, 1990 - Dokter Spesialis II Paru, Konsultan Asma/PPOK, Dewan Penilai Keahlian PDPI

Pusat, 1995 Pendidikan tambahan: - Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989

- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990 - Pelatihan Respiratory Physiologi, ”JAPAN RESPIRATORY PHYSIOLOGIST

CLUB”, Kyoto- Japan 1990 - Spirometry Training Course, Department of Respiratory Medicine, National University Hospital Singapore, Singapore 1997

- Workshop of Bronchoscopy and Autofluorecent Bronchoscopy, RS Persahabatan Jakarta, Jakarta September 2005

- Training of the new interventional technique of bronchosfiberscopy”(Optical Coherence Tommograhy) , Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo - Japan 2007- Workshop of the new technique of bronchoscopy, Postgradute Medical Institute, Singapore General Hospital, Singapore 2008 - Respiratory Masterclass Asthma and COPD, Singapore 2011- Asia Area PATHOS Speaker’s Summit, Jakarta September 2013

- Workshop on Medical Thoracoscopy, The American College of Chest Physicians-The Indonesian Association of Pulmonologist, RS Persahabatan Jakarta, Jakarta November 1997

- Workshop on Reformation of Higer Education System,HEDS-JICA, Jakarta 1998

- Pulmonary Infections Course, Postgraduate Medical Institute, Singapore General Hospital, Singapore 2001

- Bronchoscopy &Thoracoscopy Workshop, Postgraduate Medical Institute, Singapore General Hospital, Singapore 2005

- Workshop on Transbronchial Lung Biopsy and Trasbronchial Needle Aspiration PDPI Cabang Jakarta, RS Persahabatan Jakarta ,Jakarta 1997 - Workshop on Respiratory Physiology and Its Clinical Application, RS Pusat Angkatan Darat Gatot Subroto Jakarta, Jakarta Juni 1997

ACUTE RESPIRATORY FAILUREACUTE RESPIRATORY FAILUREDIAGNOSTIC DIAGNOSTIC

AND AND MANAGEMENTMANAGEMENT

TAMSIL SYAFIUDDINTAMSIL SYAFIUDDIN

DEPARTMENT OF PULMONARY AND RESPIRATORY DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE MEDICINE

FAKULTAS KEDOKTERAN UISU/USUFAKULTAS KEDOKTERAN UISU/USU

MEDAN 2014MEDAN 2014

Respiratory AssessmentRespiratory Assessment

• Airway– Open and Clear

– Needs Intervention

• Breathing– Inspection

– Palpation

– Percussion

– Pulse Oximetry

– Auscultation

• Circulation & Vital Signs

• History

Initial Assessment

• Airway – open,no noises

• Breathing – 12-20 times per minute

• Circulation – warm, pink, dry, strong pulses

• Disability – mental status clear

• Vital Signs

Respiratory failure

•Impairment in OImpairment in O22 uptake uptake•Impairment in COImpairment in CO22 elimination elimination

•Both Both

Abnormal arterial blood Abnormal arterial blood gasesgases

ACUTE RESPIRATORY FAILUREACUTE RESPIRATORY FAILURE(SPECTRUM OF CAUSES OF ARTERIAL HYPOXEMIA)(SPECTRUM OF CAUSES OF ARTERIAL HYPOXEMIA)

LUNGLUNG

OTHERSOTHERS

Causes of Respiratory Emergencies

• Failure of:– Ventilation : air in/ air out– Diffusion : movement of gases– Perfusion : movement of blood

• Compounded by:• Inflammation/mucus production

Hypoxia – low oxygen to cells

Causes of hypoxia• Hypoxic hypoxia – not enough oxygen• Anemic hypoxia– not enough hemoglobin• Stagnant hypoxia – not enough perfusion

– shock

• Histotoxic hypoxia – unable to download– Cyanide poisoning

Cyanosis – blue discoloration suggests hypoxia

ACUTE RESPIRATORY FAILUREACUTE RESPIRATORY FAILURE

HYPOXIAHYPOXIA

•ALTITUDEALTITUDE

•HYPOVENTILATIONHYPOVENTILATION

•DIFFUSION ABNORMALITTYDIFFUSION ABNORMALITTY

•RIGHT to LEFT SHUNTRIGHT to LEFT SHUNT

•VENTILATION-PERFUSION ABNORMALITYVENTILATION-PERFUSION ABNORMALITY

ALTITUDEALTITUDE

INCREASE IN INCREASE IN ALTITUDEALTITUDE

DECREASE IN BAROMETRIC DECREASE IN BAROMETRIC PRESSUREPRESSURE

LOWERRING OF THE POLOWERRING OF THE PO22 IN THE INSPIRED IN THE INSPIRED AIRAIR

HYPOVENTILATION(DRUG OVERDOSE AND NEUROMUCULAR WEAKNESS)

ACCUMULATION OF CARBON DIOXIDE ACCUMULATION OF CARBON DIOXIDE

IN THE ALVEOLIIN THE ALVEOLI

DISPLACING ALVEOLAR DISPLACING ALVEOLAR OXYGENOXYGEN

POPO22 AND PCO AND PCO22

DIFFUSION DIFFUSION ABNORMALITYABNORMALITY

PNEUMONIEPNEUMONIE

PO2 PO2 and PCO2 and PCO2

RIGHT TO LEFT SHUNTRIGHT TO LEFT SHUNT

ALVEOLUS IS PERFUSED ALVEOLUS IS PERFUSED BUT NOT VENTILATEDBUT NOT VENTILATED(Extreme imbalance V/Q)(Extreme imbalance V/Q)

POPO22 and PCO and PCO22

CARDIAC and NONCARDIAC CARDIAC and NONCARDIAC PULMONARY EDEMAPULMONARY EDEMA

Ventilation-Perfusion Ventilation-Perfusion AbnormalityAbnormality

( V/Q, 4/5 or 0.8 )( V/Q, 4/5 or 0.8 )

•ASTHMA ASTHMA •COPDCOPD

•EMBOLIEMBOLI

POPO22 and PCO and PCO22

Acute Respiratory FailureAcute Respiratory Failure

Airway obstructionAirway obstruction•COPDCOPD

•AsthmaAsthma•Heart failureHeart failure

Restrictive defectsRestrictive defects•Pleural effusionPleural effusion

•PneumothoraxPneumothorax

•Infiltrative diseasesInfiltrative diseases

•AtelectasisAtelectasis

•ObesityObesity

•Abdominal distention of all typesAbdominal distention of all types

•Intertitial fibrosis of all typesIntertitial fibrosis of all types

Acute Respiratory FailureAcute Respiratory Failure ( continue )( continue )

Central nervous system Central nervous system depressionsdepressions

•DrugsDrugs•Head injuryHead injury

•Central nervous system infectionCentral nervous system infection

Chest wall abnormalitiesChest wall abnormalities•Congenital and acquired deformitiesCongenital and acquired deformities

•Trauma (flail chest)Trauma (flail chest)•Neuromuscular disease or blockadeNeuromuscular disease or blockade

DIAGNOSTICDIAGNOSTIC

•SUBJECTIVESUBJECTIVE

•OBJECTIVEOBJECTIVE

ACUTE RESPIRATORY FAILUREACUTE RESPIRATORY FAILURE

SUBJECTIVESUBJECTIVE

•DyspneaDyspnea•HeadacheHeadache•ConfusionConfusion

•UnconsciousnesUnconsciousnesss

•RestlessnessRestlessness

ACUTE RESPIRATORY FAILUREACUTE RESPIRATORY FAILURE

ObjectiveObjective

•ABGAABGA( hypoxemia and respiratory acidosis( hypoxemia and respiratory acidosis ) )

•Underlying diseaseUnderlying disease( CX examination )( CX examination )

•TachycardiaTachycardia

•HypotenHypotenttionion

BODY CELLS OF HEALTHYBODY CELLS OF HEALTHY AT REST REQUIRE AT REST REQUIRE

250 ml/minute 250 ml/minute OxygenOxygen

NORMAL CELLULAR AEROBIC RESPIRATION NORMAL CELLULAR AEROBIC RESPIRATION

(OXYGEN CONSUMTION)(OXYGEN CONSUMTION)

Management Management Acute respiratory failureAcute respiratory failure

•General managementGeneral management ( Improving the P( Improving the PaaOO2 2 ))

•Specific managementSpecific management( Underlying disease )( Underlying disease )

THANK YOUTHANK YOU

Syafiuddin San : You are the Inspiring woman

Imah San : You are the Wind beneath my wings

Arigato gozaimasu

Arigato gozaimasu