summary kegawatdaruratan perinatologi
DESCRIPTION
Gangguan Nafas pada Bayi Baru Lahir >> Resusitasi Neonatorum, Ikterus Neonatorum, HDN/PDVK, Hipotermia, BBLRTRANSCRIPT
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- Siska Febrina Fauziah, SST. -
RangkumanKegawatdaruratan
Perinatologi
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RESUSITASI NEONATUSBayi lahir >> cukup bulan?
Menangis/bernafas? Tonus otot baik? Cairan ketuban jernih?
Bayi kurang bulan >> kurang surfaktan >> inj. Dexamethason.
Cairan ketuban bercampur mekonium kental >> bayi bugar?? Ada usaha nafas, HR > 100x/m, tonus otot baik.
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Jika jawaban ya untuk keempat kriteria penilaian awal, maka lakukan perawatan rutin.
Jika salah satu jawaban tidak, maka lakukan tindakan sesuai temuan.
Jika bayi tidak menangis, maka lakukan JAIKAN.
Jika cairan ketuban bercampur mekonium kental, BUKAN bayi bugar, maka lakukan ETT pada JAIKAN.
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JAIKANNilai pernafasan, tonus otot, dan
warna kulit.Jika bernafas, warna kulit
KEMERAHAN, dan HR > 100x/m >>perawatan rutin.
Jika SIANOSIS sentral di sekitar bibir, beri tambahan O2.
Jika memerah >> observasi, jika menetap >> VTP.
Jika apnu atau HR < 100x/m >> VTP.
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VTPJika HR > 100x/m, bernafas, dan
warna kulit kemerahan >> observasi.
Jika HR > 100x/m, megap-megap >> VENTILASI.
Jika HR < 100x/m, belum bernafas>> VENTILASI.
Jika HR < 60x/m, belum bernafas >> VENTILASI & Kompresi Dada.
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VENTILASIJika HR > 100x/m, bernafas, dan
warna kulit kemerahan >> observasi.Jika HR > 100x/m, megap-megap >>
VENTILASI lagi.Jika HR < 100x/m, belum
bernafas>> VENTILASI lagi.Jika HR > 60x/m, belum bernafas >>
VENTILASI lagi.Jika HR < 60x/m, belum bernafas >>
VENTILASI & Kompresi Dada.
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VENTILASI & KOMPRESI DADA
Jika HR > 60 x/m, belum bernafas >> lakukan VENTILASI lagi.
Jika HR < 60 x/m, belum bernafas >> berikan efinefrin.
VENTILASI dilakukan sampai bayi bernafas.
KOMPRESI DADA dilakukan sampai HR > 60 x/m.
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Kebutuhan Asuhan BBL secara ascenden.
Nilai risiko untuk kebutuhan resusitasi, thermoregulasi, membersihkan jalan nafas,
mengeringkan dan menstimulasi untuk bernafas.
Beri tambahan O2 bila perlu,
memberikan VTP, intubasi
endotrakeal.
Kompresi dada, pemberian obat
Sem
aki
n d
iperl
uka
n
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GANGGUAN NAFASPADA NEONATUS
Dispneu/gangguan nafas : kesulitan bernafas.
Tacipnu : nafas cepat.Batasannya : kesulitan bernafas
kriterianya >> frekuensi nafas >60 x/m dengan 1 atau lebih tanda kesulitan bernafas, frekuensi nafas < 30 x/m, sianosis sentral, dan apnu > 20 detik.
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Tanda & GejalaTakipnuSianosisRetraksi dadaMerintihApnuPernafasan cuping hidung
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DiagnosisFrekue
nsi Nafas
Gejala Tambahan Gangguan Nafas Klasifikasi
> 60 x/’ dengan
Sianosis sentral DAN retraksi dada atau merintih
saat ekspirasi
Gangguan Nafas Berat
> 90 x/’ dengan
Sianosis sentral atau retraksi dada atau merintih
saat ekspirasi
< 30 x/’ dengan atau tanpa
Gejala lain dari gangguan nafas
60 – 90 x/’
dengan
tetapi tanpa
Retraksi dada atau merintih saat ekspirasi
Sianosis sentral Gangguan Nafas Sedang
> 90 x/’ tanpa Sianosis sentral atau retraksi dada atau merintih
saat ekspirasi
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DiagnosisFrekuensi Nafas
Gejala Tambahan Gangguan Nafas Klasifikasi
60 – 90 x/’ tanpa Sianosis sentral atau retraksi dada atau
merintih saat ekspirasiGangguan
Nafas Ringan
60 – 90 x/’ dengan tetapi tanpa
Sianosis sentral
Retraksi dada atau merintih saat ekspirasi
Kelainan Jantung
Kongenital
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Macam-macam Gangguan Nafas
Klasifikasi Gangguan
Nafas
Tanda & Gejala
Kondisi KhasR T A C M S
MAS x x x BCB, warna kehijauan pada tali pusat/kulit bayi, Takipnu khas > 120 x/’, mekonium dalam saluran nafas, ronkhi +
Pneumonia x x x Dispneu, terdapat GBS
HMD/RDS type 1 x x x x x BKB, hipotensi, hipotoni, pola RD pada hasil rontgen, terdapat atelektasis difus pada air bronchogram.
TTN/RDS type 2 x BCB, Barrel chest, terdapat garis hilar pada hasil foto thorax.
Pneumotoraks x x x Tension pneumotoraks, pergeseran mediastinum.
BPD x Wheezing, sekret endotrakeal kental, retensi CO2
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Down ScorePembeda 0 1 2 Keterang
an
Frekuensi nafas
< 60 x/’ 60 – 80 x/’ > 80 x/’Skor < 4 =
tidak gawat nafas
Retraksi dada
Tidak ada Ringan Berat
Sianosis Tidak sianosis
Hilang dengan O2
Menetap walaupun diberi O2 Skor 4 – 7
= gawat nafas
Air entry Udara masuk bilateral baik
Penurunan ringan udara masuk
Tidak ada udara masuk
Merintih Tidak merintih
Terdengar dengan stetoskop
Terdengar tanpa alat bantu
Skor > 7 = ancaman
gagal nafas
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TRAUMA LAHIRTrauma Kepala
◦ Caput succedanum
◦ Cephal haematom◦ Subgaleal
haematomFraktur Tulang
Tengkorak◦ Fraktur linier _ _◦ Fraktur kompresi -
_-
Perdarahan Intrakanial◦ Perdarahan subdural◦ Perdarahan
subarachnoid◦ Perdarahan epidural◦ Perdarahan
intraserebralTrauma Jaringan
Lunak◦ Tortikalis◦ Brachial palsy
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TRAUMA JARINGAN LUNAK
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TORTIKOLIS
Ada 3 type :Tortikolis dengan
massa tumor (40%)
Tortikolis muskular
Tortikolis postural
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TORTIKOLISRobeknya serabut
otot/fasia disertai pembentukan hematom & fibrosis.
Malposisi intrauterin/ perinatal menyebabkan iskemia, edema, fibrosis pada otot sternokleidomastodeus.
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TRAUMA FLEKSUS BRAKHIALIS
Ada 3 jenis, yaitu :Erb’s palsyKlumke’s palsyTrauma seluruh
fleksus brakhialis
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Jenis-jenis Brachial Palsy
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TRAUMA FLEKSUS BRACHIALIS
Perbedaan
Jenis
Erb Palsy Klumke’s Palsy
Trauma seluruh fleksus
brachialis
Segmen terkena
C5 – C7 C8 – Th 1 C5 – Th 1
Angka kejadian 90% 1% 10%
Posisi Adduksi, internal rotasi bahu, ekstensi siku,
prenasi tangan, fleksi pergelangan tangan
dan jari, asimetri refleks moro.
Kelumpuhan otot intrinsik tangan dan
fleksor pergelangan tangan dan
jari.
Flaksid.
Refleks genggam
+ - -
Refleks biseps - + -
Komorbid Trauma nervus fernikus, paralisis
diafragma ipsilateral.
Syndrom Homer (ptosis,
meiosis, anhidrosis) ipsilateral.
Jarang.
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PENENTUAN USIA KEHAMILAN
New Ballard Score
Physical Maturity
Neuromuscular
Maturity
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NEW BALLARD SCOREPhysical Maturity
◦ Skin◦ Lanugo◦ Plantar surface◦ Breast◦ Eye/ear◦ Genital
(male/female)
Neuromuscular Maturity◦ Posture◦ Square window◦ Arm recoil◦ Popliteal angle◦ Scarf sign◦ Heel to ear
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Neuromuscular Maturity
Postur & Tonus Otot
Square Window
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Neuromuscular Maturity
Arm Recoil Popliteal Angle
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Neuromuskular Maturity
Scarf Sign Heel to Ear
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Maturity RatingUsia kehamilan =
score physical + score neuromuscular.
ATAUJika hanya
dilakukan pemeriksaan fisik saja, maka usia kehamilan = score physical X 2.
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Maturitas dan Pertumbuhan Intrauterin
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HDN / PDVKDefinisi : penyakit
perdarahan pada BBL akibat kekurangan faktor pembekuan (Vit. K dependent factors >> F. II, VII, IX, X).
Klasifikasi :◦ Early onset◦ Classic disease◦ Late onset
Penyebab :◦ Cadangan Vit. K di
hati rendah.◦ Transfer Vit. K dari
placenta rendah.◦ Kadar Vit. K ASI
rendah.◦ Sterilitas saluran
pencernaan bayi.Pencegahan :
pemberian Vit. K1 0,5 - 1 mg IM pada BBL.
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FaktorPeranan dalam
Pembekuan Darah Tes
I Fibrinogen Prekursor fibrin PT
II ProtrombinProenzim, diaktifkan oleh tromboplastin PT
III TromboplastinDiperlukan untuk mengubah protrombin menjadi trombin PT
IV Ion CalsiumDiperlukan pada semua tahap PT
V ProaccelerineDiperlukan untuk pembentukan tromboplastin PT
VII ProconvertineDiperlukan untuk mengubah protrombin menjadi trombin
VIII AHFDiperlukan untuk pembentukan tromboplastin PTT
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FaktorPeranan dalam
Pembekuan Darah Tes
IXKomponen tromboplastin plasma
Diperlukan untuk pembentukan tromboplastin PTT
X Trombokinase
Diperlukan untuk pembentukan tromboplastin dan perubahan protrombin menjadi trombin
PT
XI PTADiperlukan untuk pembentukan tromboplastin PTT
XII Faktor HagemanMengawali proses pembekuan darah in vitro PTT
XIII Faktor stabilisasi fibrin
Mengubah fibrin menjadi polimer fibrin PTT
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Klasifikasi HDNEarly Onset Classic
Disease Late Onset
Age 0 – 24 hours 2 – 7 days 1 – 6 months
Site of hemorrhage
Cephal hematom, subgaleal, intrakranial, GIT, umbilikus, intraabdominal
GIT, ear, nose, throat, mucosal, intrakranial, circumcision, cutaneous, injection sites
Intracranial, GIT, cutaneous, ear, nose, throat, mucosal, injection sites, thoracic
Etiology/risk Maternal drugs, inherited coagulopathy
Vit. K deficiency, breast feeding
Cholestatis, malabsorption Vit. K, Abetalipoprotein deficiency, idiopathic, warfarin ingestion
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Klasifikasi HDNEarly Onset Classic
Disease Late Onset
Prevention Vit. K IM at birth or to mother avoid high risk medication
Vit. K IM at birht
Vit. K IM and high dose oral Vit. K during periods of cholestatis and malabsorption
Incidence Very rare 2% if not given Vit. K
Dependent on primary disease
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Diagnosis BandingKomponen HDN
Penyakit Hati DIC
Morfologi eritrosit
Normal Sel target Sel target, sel burr, fragmentosit, sferosit
PTT Memanjang Memanjang Memanjang
PT Memanjang Memanjang Memanjang
Fibrin split product
Normal Normal/naik sedikit
Naik
Trombosit Normal Normal Menurun
Faktor yang menurun
II, VII, IX, X I, II, V, VII, IX, X
I, II, V, VIII, XIII
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IKTERUS Ikterus/Jaundice : Warna
kuning pada kulit dan mukosa akibat peningkatan kadar bilirubin dalam darah (>2 mg/dL).
Hiperbilirubin (>13 mg/dL): Komplikasi dari ikterus yang menyebabkan infeksi pada otak.
Terlihat ikterus jika kadar bilirubin darah 5 - 7 mg/dL.
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METABOLISME BILIRUBIN
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Derajat Ikterus menurut Kramer
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THERAPY
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Berbagai Masalah pada BBLRHipotermi & TermolabilKesulitan bernafasMasalah gastrointestinal dan nutrisiImaturitas fungsi hatiImaturitas susunan saraf pusatImaturitas fungsi ginjalImaturitas imunologisMasalah kardiovaskulerMasalah hematologiMasalah metabolisme
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Mekanisme Kehilangan Panas pada Bayi