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8/12/2019 Acute Respiratory Failure - Prof Tamsil
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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 20117
Jabatan : Guru Besar Tetap FK- UISU / Luar Biasa FK- USU
Penasehat Perhimpunan Dokter Paru Indonesia PusatKetua Perhimpunan Dokter Paru Indonesia Cabang Sumut
Dewan Pembina Yayasan Asma Indonesia Wilayah Sumut
Ketua Departemen Pulmonologi dan Kedokteran Respirasi FK-UISU
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 PusatAnggota Tim Akreditasi Pendidikan Spesialis Paru Nasional
Riwayat Pendidikan:
-Dokter Umum, FK-USU Medan,1979
-Dokter Spesialis I Paru, FK-UI Jakarta, 1990
-Dokter Spesialis II Paru, Konsultan Asma/PPOK, 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
8/12/2019 Acute Respiratory Failure - Prof Tamsil
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- 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
- Workshop on Medical Thoracoscopy, The American College of Chest Physicians-TheIndonesian 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
8/12/2019 Acute Respiratory Failure - Prof Tamsil
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ACUTE RESPIRATORY FAILURE
DIAGNOSTIC
AND
MANAGEMENT
TAMSIL SYAFIUDDIN
DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE
FAKULTAS KEDOKTERAN UISU
MEDAN 2013
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Initial Assessment
• Airway – open,no noises
• Breathing – 12-20 times per minute
•
Circulation –
warm, pink, dry, strongpulses
• Disability – mental status clear
•
Vital Signs
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Respiratory Assessment
• Airway
– Open and Clear
– Needs Intervention
• Breathing
– Inspection
– Palpation
– Percussion
–Pulse Oximetry
– Auscultation
• Circulation & Vital Signs
•
History
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Respiratory failure
•Impairment in O2 uptake•
Impairment in CO2 elimination•Both
Abnormal arterial blood gases
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ACUTE RESPIRATORY FAILURESPECTRUM OF CAUSES OF ARTERIAL HYPOXEMIA)
LUNG
OTHERS
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Causes of Respiratory Emergencies
• Failure of: – Ventilation : air in/ air out
– Diffusion : movement of gases
– Perfusion : movement of blood
• Compounded by:• Inflammation/mucus production
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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
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Cyanosis – blue discoloration
suggests hypoxia
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ACUTE RESPIRATORY FAILURE
HYPOXIA
•ALTITUDE
•HYPOVENTILATION
•DIFFUSION ABNORMALITTY
•RIGHT to LEFT SHUNT
•VENTILATION-PERFUSION ABNORMALITY
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ALTITUDE
INCREASE IN ALTITUDE
DECREASE IN BAROMETRIC PRESSURE
LOWERRING OF THE PO2 IN THE INSPIRED AIR
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HYPOVENTILATION
DRUG OVERDOSE AND NEUROMUCULAR WEAKNESS)
ACCUMULATION OF CARBON DIOXIDE
IN THE ALVEOLI
DISPLACING ALVEOLAR OXYGEN
PO2 AND PCO2
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DIFFUSION ABNORMALITY
PNEUMONIE
PO2 and PCO2
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RIGHT TO LEFT SHUNT
ALVEOLUS IS PERFUSED
BUT NOT VENTILATED
Extreme imbalance V/Q)
PO2 and PCO2
CARDIAC and NONCARDIAC
PULMONARY EDEMA
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Ventilation-Perfusion AbnormalityV/Q, 4/5 or 0.8 )
•
ASTHMA•COPD
•EMBOLI
PO2 and PCO2
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Acute Respiratory Failure
Airway obstruction •
COPD•Asthma
•Heart failure
Restrictive defects
•Pleural effusion
•Pneumothorax
•Infiltrative diseases
•Atelectasis
•Obesity
•Abdominal distention of all types
•Intertitial fibrosis of all types
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Acute Respiratory Failure continue )
Central nervous system depressions •Drugs
•Head injury
•Central nervous system infection
Chest wall abnormalities•Congenital and acquired deformities
•
Trauma flail chest)•Neuromuscular disease or blockade
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DIAGNOSTIC
•SUBJECTIVE
•OBJECTIVE
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ACUTE RESPIRATORY FAILURE
SUBJECTIVE
•Dyspnea
•Headache
•Confusion
•Unconsciousness
•Restlessness
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ACUTE RESPIRATORY FAILURE
Objective
•ABGAhypoxemia and respiratory acidosis )
•Underlying disease
CX examination )
•Tachycardia
•Hypotention
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BODY CELLS OF HEALTHY
AT REST REQUIRE
250 ml/minute Oxygen
NORMAL CELLULAR AEROBIC RESPIRATION
OXYGEN CONSUMTION)
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ManagementAcute respiratory failure
•General management
Improving the PaO2 )
•Specific management
Underlying disease )
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24
Management of The Airway
• Basic techniques:
1. Head tilt [ respiratory tract in one straight line ].
2. Chin left.
3. Jaw thrust [take tongue with its base & the only technique
done in suspected cervical spine injury patient ].
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THANK YOU
Syafiuddin San : You are the Inspiring woman
Imah San : You are the Wind beneath my wings
Arigato gozaimasu