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PNEUMONIA INFLAMATION OF THE LUNG

PNEUMONIA INFLAMATION OF THE LUNG. dr . Ery Olivianto, SpA Dr. dr . Wisnu Barlianto, SpA (K) Prof . D r . d r. HMS. Chandra K usuma , SpA (K) Child Health Department Faculty of Medicine Brawijaya University Saiful Anwar General Hospital. Klasifikasi :. Klinis : Ringan Sedang

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PNEUMONIA INFLAMATION OF THE LUNG

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  1. PNEUMONIA INFLAMATION OF THE LUNG dr. Ery Olivianto, SpA Dr. dr. Wisnu Barlianto, SpA(K) Prof. Dr. dr. HMS. Chandra Kusuma, SpA(K) Child Health Department Faculty of Medicine Brawijaya University Saiful Anwar General Hospital

  2. Klasifikasi : • Klinis : • Ringan • Sedang • Berat • Anatomis/radiologis • Berdasarkan pada jaringan yang terkena ? Kurang/tidak Memuaskan

  3. 1. Alveolar pneumonia 1.1. Lobar pneumonia 1.2. Multiple lobar pneumoni 1.3. Lobular pneumonia / (scattered alveolar) • Keradangan di saccus alveolaris • Bronchus dan • Jaringan interstitial Tidak terkena

  4. 2. Interstitial bronkopnemni • Bronchus • Interstitial Terutama di zona peribronchial 3. Mixed pneumonia • Alveoli • Bronchus • Interstitiel Terkena secara luas

  5. Etiologis : • Bakteri • Virus • Mycoplasma • Jamur • Aspirasi • Loffler syndrome • Hipostatik

  6. Virus : RSV, adeno, entero, para infl

  7. Gambaran klinis : Demam Dyspnea Napas cepat Cyanosis Batuk Retraksi Grunting P.C.H. (Nasal faring) Nyeri dada Rales Nyeri perut Wheezing Muntah Suara nafas  Poor feeding Perkusi redup Irritability Meningismus Demam Tachypnea 90% dx ditegakkan

  8. GAMBARAN KLINIS, LAB. EPIDEMIOLOGI, ETIOLOGI : BP PADA BAYI & ANAK

  9. Indikasi MRS pneumonia • Dalam keadaan toksis (distres nafas) : • Tachypnea (RR > 50/menit) • Retraksi • Dispnea • Cyanosis • Umur < 6 bln • Tidak dapat makan/minum • Kesadaran  • Komplikasi  • Perawatan dirumah kurang • Perlu pengawasan tiap hari • Penyebab : stafilokokus

  10. Therapi / penatalaksanaan : • Anti biotik • Virus : • jika ringan tidak perlu, baru diberikan pada : • Sakit berat (toksis) • Klinis = bacterial pneumonia • Umur < 3 bln dengan panas + progressive • Usia sekolah yang klinis Pn. Bakterial • Bakteri • < 3 bln (gram  / θ) • Kombinasi : • Ampicillin 100 – 150 mg/KgBB/hr/N/ IM • Genta/Garamycin 5 – 7 Mg/Kb/hr/N/II

  11. 4 bln – 5 thn (H. Infl + Strept. Pn) • Kombinasi : • PPC/Chloramphenicol • Ampicillin/Chlorampenicol • Dugaan stafilokokus • Amoxicillin/Kloksasilin 50 Mg/Kg/hr/IM/N/PO • 5 – 18 thn (stept. Pn ) • PPC 50.000 – 100.000 Cl/Kb/hr/IM • Ampicillin • Mycoplasma : erythromycin 40 – 50 Mg/Kg/hr/PO

  12. D. • Kotrimoksasol pada Pneumonia Pneumokistik Karinii • Anti viral (Aziclovir , ganciclovir) pada pneumonia karena CMV • Anti jamur (amphotericin B, ketokenazol, flukonazol) pada pneumonia karena jamur • Imunoglobulin

  13. Dosis dan cara pemberian OBAT DOSIS/KgBB/24JAM CARA Kloramphenikol 50 – 100 mg iv/oral, 4x/hari Ampisilin 50 – 100 mg im/iv, 4x/hari Cloxacillin 50 mg im/iv, 4x/hari Eritromisin 50 mg po, 4x/hari Gentamycin 5-7 mg im/iv, 1-2x/hr Kotrimoksazol 6 mg (TMP) po, 2x/hari Obat lain...............................

  14. Pemilihan obat berdasarkan umur dan penyebab

  15. Simtomatik – suportip • Infus • O2 + uap, chest fisioterapi • NABIC (natrium bicarbonat) • Expectoran/bronchodilator : jika perlu • Therapi komplikasi : • Empyema  drainages • Pneumothorax  isap

  16. Komplikasi : • Abscess paru • Empyema/pleural eff • Perdarahan • Bronchiectasis • Pneumo/pyopneumothorax • Sepsis/septic shock • Gagal nafas

  17. Bronchiolitis • Dasar diagnosis penting : • Rhinitis – Batuk – Wheezing Expiratoir • Tachipneu • Foto paru : Hyperaeration • Umur < 2 tahun • P.A. : • Bronchiolar Inflammatory Exudate • Mucosal edema • Penyempitan jalan napas • Etiologi : • RSV  • Influenza/Parainfluenza • Adeno virus

  18. Klinis • 1 – 2 hari rhinitis ringan • Selanjutnya : • Batuk  (bertahap) • Wheezing Exp. • Respiratory distress : • PCH (Pernapasan Cuping Hidung) • Intermitten Cyanosis • Inspirasi : Retraksi • Rales diffus • Suara nafas  • Expirasi 

  19. Lab : Normal • Foto Rö : Hyperinflation • DD : • Bronchopneumonia • Rö : Infiltrat • Lekositosis • Pertussis • Lekositosis Limfositosis • Decomp. Cordis •  • Cardiomegali • Retardasi

  20. Asthma Bronchiale • DD terpenting : • Umur > 2 tahun • Family Allergy • Kumat-kumatan • Eosinofilia (Hidung/Darah) • Bronchodilator  • Komplikasi : • Infeksi sekunder • Pneumothorax • Mediastinal emphysema • Apnea  Resp. Failure

  21. Therapy : • MRS jika : • Umur < 2 tahun • Apnea/Cyanosis • Wheezing berat • RR > 60/menit • P.CO2 > 45 mmHg • P.CO2 < 60 mmHg • Jika berat  infus • O2 + uap • Antibiotika bila infeksi sekunder  • Kortikosteroid : Coba jika gawat

  22. Lain-lain : Sedativa : Hindari • Bronchodilator : Manfaat Θ • Digitalisasi : Tidak perlu • Acidosis : Perlu koreksi • Prognosis : • Gejala akut hilang : 2 – 7 hari • Hilang sama sekali : 7 – 10 hari • Mortalitas > 50% : • CHD • Tidak diobati • 50%  Asthma • < 1% : Gagal napas jika tidak diobati

  23. Di Ruang Riset Seattle Washington University bersama Inul USA

  24. Sekian Pakde’ne INUL DARATISTA

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