1. Slide Appendisitis Perforasi Nikki

  • View
    213

  • Download
    0

Embed Size (px)

Text of 1. Slide Appendisitis Perforasi Nikki

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    1/49

    CASE PRESENTATION KEGAWATDARURATAN PADA APPENDISITIS PE

    Nikkita

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    2/49

    CASE REPORT 

    Identitas

     Nama : Tn. A Jenis Kelamin : L

    Usia : 28 tahun

    Agama : Islam

    Status Marital : Belum menikah

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    3/49

    Anamnesa  (15 April 2015 paa p!"!l 1#$15%

    Kel!&an !'ama  Nyeri perut seluruh area

    Os a'an) ian'ar "el!ar)a en)an "el!&an nyeri perut s SMRS$ N+eri irasa"an di seluruh area perut$ N+eri te hebat ketika bergerak $

    A,aln+a n+eri 'erasa i perut bagian kanan bawah- m!n an 'erasa 'er!smener!s se*a" 2 hari SMRS$ N+eri irasa iremasremas an ditusuk-tusuk $

    Kel!&an n+eri iser'ai en)an mual an nafsu makan ber

    men+an)"al aan+a "el!&an m!n'a&- lemas- emam- a'a!p!n  Tia" aa )an))!an ee"asi an 'ia" aa )an))!an /er"em

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    4/49

    Masuk Rumah Sakit-15 April 201 n+eri 'e

    rasa i per!' "anan /a,a& an 'erasa 'er!s

    mener!s se*a" 2 &ari SRS$ Diremasremas 3 i'!s!"

    '!s!" an men+e/ar "e sel!r!& aera& per!'

    N+eri i sel!r!& area per se*a" 1 &ari SRS

    4er)era" → tambah arah 4A4 (4!an) Air 4esar% / 4AK (4!an) Air Ke.il% /

    !al (% m!n'a& (% Nas! ma"an /er"!ran)

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    5/49

    Ri,a+a' Pen+a"i' Da&!

    Pasien men+a'a"an "erap meran+eri !l! &a'i +an) ian))ap se/a)ai sa"i' maa)$ Pasien men+ serin) men)"6ns!msi 6/a' maa

    ,ar!n)$ Kel!&an /er"!ran) s men)"6ns!msi 6/a' 'erse/!'$

    • 7T- D- Aler)i isan)"al

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    6/49

    PEERIKSAAN FISIK

    Keaaan !m!m  'ampa" sa"i' sean) • Kesaaran  K6mp6smen'is- GCS 15

    •  Tana'ana 8i'al

     Te"anan Dara& (TD% 1209:0 mm7)

    Nai (N%  #: ;9meni'

    S!&! (S%  C

    Respira'6r+ Ra'e (RR%  1: ;9meni'

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    7/49

    • Kepala  n6rm6.ep&al

    a'a  "6n*!n)'i?a 'ia" anemi"- s"lera 'ia" i

     Telin)a  se"re' (%

    7i!n)  se"re' (%

    !l!'  m!"6sa /asa& an lia& 'ia" "6'6r

    • @e&er  pem/esaran KG4 (%

    •  T&6ra;  sime'ris  – an'!n) 4!n+i an'!n) I B II re)!ler-)all6p (%-m!rm

     – Par!par! ?esi.!ler 9- r6n.&i 9- ,&eein) 9

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    8/49

    A/6men (S'a'!s @6"alis%

    Inspe"si  a'ar • Per"!si  'impani

    • A!s"!l'asi  4isin) Us!s (%

    • Palpasi  N+eri 'e"an (% i sel!r!& re)i6 a/6men- eans m!s"!lar (% isel!r!&

    • Ps6as si)n (%

    • O/'!ra'6r si)n (%

    • R6?sin) si)n (%

    • 4l!m/er) si)n (%

    • D!np&+ si)n (%

    PUNGGUNG "e'6" C8A 9

    EKSTREITAS a.ral &an)a'- CRT  2 e'i"- eema (%- sian6sis (%

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    9/49

    DIAGNOSIS KERA

    @a"ila"i 2: '&-en)an AcuteAbdmen e!c! Susp "eritnitis Susp Appendisitis "erfrasi

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    10/49

     [email protected] • P!asa pre 6perasi

    • I8FD Rin)er @a"'a' 20 'pm ma"r6 • Pemasan)an !rinar+ .a'&e'&er

    • ei"amen'6sa  – Ce'ria;6ne in* 2 ; 1 )r per I8

     – Ke'6r6la. in* 2 ;

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    11/49

    PEERIKSAAN PENUNA

    @a/ R!'in 7/ 15$2 )r9l (n6rmal%

    @e!"6si' 12$200 )r9l (le!"6si'6

    7T 5$: (n6rmal%  T&r6m/6si' 1#0$000 (n6rmal%

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    12/49

    R6en')en T&6ra; AP

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    13/49

    1= April 2015 Dia)n6sa pre 6perasi 

    Acute Abdmen e!c! Susp "eritnitis e!c! Sus Appendisitis "erfrasi

     enis pem/ea&an

    #apartmi $ksplratif 

    Dia)n6sa p6s' 6perasi

    Appendisitis "erfrasi

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    14/49

    %llw &p "st'p-1( April 2015

    S&)*$+,.$

    • Pasien 'ia" men)el!&"an sa"i' paa l!" p6s'6p

    • Pasien s!a& a'!s sesaa' se'ela& 6pera

    selesai$ Pasien *!)a men)"6nHrmasi 'ela • Pasien men+an)"al m!al- m!n'a& ma!p

    sesa"$ Nam!n pasien merasa emam m se/el!m pemeri"saan$

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    15/49

    ')*$+,.$

    • Kesaaran 'ampa" sa"i' rin)an- .6mp6sme

    •  Tana'ana 8i'al

     Te"anan Dara& (TD% 1209:0 mm7)Nai (N% : "ali per meni'

    S!&! (S% C

    Respira'6r+ Ra'e (RR% 1: "ali per meni'

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    16/49

    • Kepala n6rm6.ep&al

    • a'a "6n*!n)'i?a 'ia" anemi"- s"lera 'i i.'eri.

    •  Telin)a se"re' (%

    7i!n) se"re' (%- 'erpasan) NGT paa n6"anan +an) s!a& 'ia" /erpr6!"si

    • !l!' m!"6sa /asa& an lia& 'ia" "6'6

    • @e&er pem/esaran KG4 (%

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    17/49

     T&6ra; sime'ris  an'!n) 4!n+i an'!n) I an II re)!ler-

    )all6p (%- m!rm!r (% Par!par! ?esi.!ler 9- r6n.&

    ,&eein) 9

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    18/49

    A/6men s'a'!s l6"alis

    • Inspe"si

     Tampa" ?er/an men!'!p l!"a p6s'6p lapar6'6m+- rem/esan (%

     Tampa" ?er/an men!'!p selan) rainase$ Pr6!"si a"'i ari rainase /er!pa .airan /er,arna mera&- rem/esan (%

    • Per"!si 'impani

    • A!s"!l'asi 4isin) Us!s = "ali per meni'

    • Palpasi s!pel- N+eri Te"an (% i area l!"a p6s'6p$

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    19/49

    • P!n))!n) "e'6" C8A 9

    • Geni'al 'erpasan) !rin "a'e'er en)an pr /er,arna "!nin) pe"a'

    • E"s'remi'as a.ral &an)a' an CRT  2 e

    ASS$SSM$N,

    @a"ila"i 2: '& POD I @apar6'6m+ e$. per e$. appenisi'is per6rasi

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    20/49

    "#ANNN/

    • NGT i.a/!'

    • ei"amen'6sa

    Ce'ria;6ne 2 ; 1 )r I8

    Ke'6r6la. 2 ;

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    21/49

    A""$NS

    "$R%'R

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    22/49

    A)'M$N

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    23/49

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    24/49

    /AA, A)'M$N

    Ga,a' a/6men mer!pa"an "linis +an) a"i/a' "e)a,a'a r6n))a per!' +an) /iasan+a menaa" en)an n+eri se

    "el!&an !'ama$ )a,a' a/ memerl!"an 'ina"an se)era /iasan+a mer!pa"an 'ina" /e

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    25/49

    NERI PERUT

     ENIS

    1$ N+eri ?iseral 2$ N+eri parie'al

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    26/49

    • N+eri ?iseral 'er*ai apa/ila 'erapa' ran)san)an paa 6r)a s'r!"'!r i alam r6n))a per!'- misaln+a "arena .eera a'a

    • Ran)san)an /er!pa 'ari"an- re)an)an- a'a! "6n'ra"si +an) a"an mens'im!l!s sis'em s+ara 6'6n6m paa peri'6ne!m ? men+elim!'i 6r)an6r)an per!' se&in))a menim/!l"an n+e s+ara 'erse/!' 'ia" pe"a 'er&aap ran)san)an ra/aan a pem6'6n)an se&in))a sa+a'an a'a! pen*a&i'an 'ia" a"an menim/!l"an n+eri$

    • Pasien +an) merasa"an n+eri ?iseral /iasan+a 'ia" apa' m se.ara 'epa' le'a" n+erin+a- se&in))a /iasan+a pasien men sel!r!& 'elapa" 'an)ann+a !n'!" men!n*!"an area n+eri$

    • N+eri ?iseral men!n*!"an p6la +an) "&as ses!ai en)an pe em/ri6nal 6r)an +an) /ersan)"!'an$

  • 8/18/2019 1. Slide Appendisitis Perforasi Nikki

    27/49

    • N+eri parie'alis (s6ma'is% 'er*ai "arena

    ran)san)an paa /a)ian +an) ipersaraH 6 sara 'epi- misaln+a re)an)an paa peri'6ne parie'alis an l!"a paa inin) a/6men$ N+erin+a le/i& a"!'- 'a*am (seper'i i'!s!"

    an apa' i'en'!"an l6"asin+a "arena sera s6ma'i. aJeren' lan)s!n) /eraa i sa'! si sis'em sara$ Ran)san)an apa' /er!pa ra/ ran)san) "imia,i- 'e"anan-