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blok kegawatdaruratan
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Definisi Masuknya zat racun ke dalam tubuh melalui saluran
pencernaan, inhalasi atau kontak langsung yang menimbulkan gejala
yang khas.Pada dasarnya semua zat kimia dapat menimbulkan keracunan
tergantung jumlah dan cara masuknya ke dalam tubuh.
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TANDA2 KGD
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Signs that may indicate poisoninginclude the following:Drug or
chemical containers that are open, spilled, or out of placeUnusual
odors (e.g., on breath or clothing, in the air)Spills and stains on
clothing, skin, flooring, etc.Acute (sudden) or chronic
(long-lasting) symptoms (e.g., behavior changes, drowsiness, heavy
drooling, stomach pain, sweating, vomiting)
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Mild symptomsBehavior changes RestlessnessDiarrheaDizzinessLoss
of appetiteMinor skin or eye irritationNausea or upset
stomachPassing cough (cough that comes and goes)Thirst
Moderate symptomsBlurred visionConfusion and
disorientationDifficulty breathingDroolingExcessive tearingFeverLow
blood pressure (hypotension)Loss of muscle control and muscle
twitchingPersistent coughRapid heart rateSeizuresSevere
diarrheaSevere nauseaSweatingThirstTremblingWeakness
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Severe symptomsCardiopulmonary arrestConvulsionsDisseminated
intravascular coagulation (condition that causes uncontrolled
bleeding or blood clotting)Esophageal stricture (narrowing of the
organ that carries food from the mouth to the stomach)Fever (often
high)Inability to breatheIncreased respiration (rapid
breathing)
Loss of consciousnessMuscle twitching (uncontrolled and
severe)Rapid heart rate with low blood pressureRespiratory distress
that requires intubation (involves passing a tube down the trachea
[windpipe] to the lungs to provide breathing assistance; mechanical
respiration [i.e., a ventilator] may be necessary)Seizures that do
not respond to treatment (called status epilepticus)Thirst (often
extreme)
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PRIMARY SURVEY
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Sign & symptoms food poisoningAbdominal pain: Most severe in
inflammatory processes; painful abdominal muscle cramps suggest
underlying electrolyte lossVomiting: Major presenting symptom ofS
aureus, B cereus,orNorovirus[3]Diarrhea: Usually lasts less than 2
weeksHeadacheFever: May be an invasive disease or an infection
outside the GI tractStool changes: Bloody or mucousy if invasion of
intestinal or colonic mucosa; profuse rice-watery if cholera or a
similar processReactive arthritis: Seen withSalmonella, Shigella,
Campylobacter,andYersiniainfectionsBloating: May be due to
giardiasis
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DiagnosisFocus on assessing the severity of dehydration. General
findings may include the following:Mild dehydration:A dry
mouthdecreased axillary sweatdecreased urineMore severe volume
depletion:OrthostasisTachycardiahypotension
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Salmonellatyphiinfection:Upper abdominal rose spot
maculeshepatosplenomegalyYersiniainfection:Erythema
nodosum,exudative pharyngitisVibrio vulnificusorV
alginolyticusinfection: cellulitis,otitis media
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ManagementMost food-borne illnesses are mild and improve without
any specific treatment.Some patients have severe disease and
require hospitalization, aggressive hydration, and antibiotic
treatmentThe main objective in managing patients with food
poisoning is adequate rehydration and electrolyte
supplementation.which can be achieved with either an oral
rehydration solution or intravenous.Patients should avoid milk,
dairy products, and other lactose-containing foods during episodes
of acute diarrhea.
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KERACUNAN SINGKONG(CASSAVA)
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Definisi Terjadi pada singkong yang mengandung glikosida
sianogenik linamarin pada lapisan luar.Singkong memiliki enzim
linase yg memecah kompleks ini lepasin HCN (asam sianida)HCN jumlah
kecil dpt dinetralkan tiosianat.
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Patof HCN keracunan protoplasmik dgn jalan melumpuhkan
pernapasan selMengganggu enzim pada proses oksidasi pusat napas
pada medula tdk berfungsi gagal napasKetidakmampuan jaringan
mengambil O2 darah vena pasien berwarna cerah seperti darah
arteri
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Tanda & gejalaTergantung pada jumlah kandungan HCN dlm
singkong.HCN jumlah besar :Kematian waktu singkat akibat gagal
napasMula2 panas pada perut, mual, pusing, sesak, lemah.Pernapasan
cepat, pendek,Bau nafas & muntahan yang khas (bitter
almond)Pingsan, kejang,Pupil midriasis, tanpa reaksiWarna kulit
merah bataSianosis tdk terlihat
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TatalaksanaEliminasi racun (muntah atau bilas lambung)Halangi
penyerapan racun lebih lanjut dgn pemberian antidotumNatrium nitrit
& Na-tiosulfat utk proses detoksifikasi.Na-tiosulfat
konsentrasi 10% i.v berikan pelan2 dgn dosis 0,5 ml/kgBB/kali
(sekitar 10-50 ml)Natrium Nitrit 3% ml, i.v. Pelan2Bila Na nitrit
tdk tersedia, Na-tiosulfat biasanya sdh cukup.
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Resusitasi dan suportifCairan IntravenaPemberian Oksigen sangat
pentingBila diberikan oksigen tekanan tinggi maka fungsi oksigen
tdk saja suportif namun juga sebagai antidotum.
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KERACUNAN JENGKOL(PITHECOLOBIUM)
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DefinisiJengkol berisi asam jengkolat, suatu asam amino yang
mengandung belerang.Gejala timbul akibat bertumpuknya asam
jengkolat dalam bentuk kristal pada tubuli ginjal, uretra, dan
ureter.
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Tanda & gejalaSakit pinggangNyeri perutMuntahSakit saat
BAKAir kemih keluar sedikit2 dgn butir2 putihUrin berbau
jengkolHematuria, oliguria, sampai anuriaInfiltrat pada penis,
skrotum, daerah suprapubikDapat terjadi gagal ginjal akut
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Tatalaksana Eliminasi racun (muntah dan bilas lambung)Antidotum
yang khas tdk adaKeracunan ringan : rawat jalan dgn anjuran byk
minum air soda (natrium bikarbonat) 1-2 gr/hari oral dibagi dlm 4
dosis pH urin alkalis (sekitar pH 8)Cairan IV bila ps tdk dpt minum
banyakGagal ginjal akut dialisis, baik hemodialisis maupun
peritoneal
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KERACUNAN BOTULISME(TEMPE BONGKREK)
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Definisi Pada proses pembuatan tempe bongkrek sering tjd
kontaminasi Clostridium botulinum dan/atau Bacteria cocovenans yg
mengubah gliserin racun toksoflavin.Toksin botulinum : neurotoksin
(eksotoksin)Kuman anaerob ini tumbuh dlm media minyak, daging, ikan
yg tdk sempurna diproses/diawetkan dan dijual dlm kaleng.
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Tanda & gejalaHambatan implus saraf pd motor endplate
kelumpuhanPendarahan pd saraf pusat dan proses degeneratif pd hati
& ginjalKelumpuhan pd mata, otot mata, n.cranialis scra
simetris,Disfagia/disartriaKelumpuhan otot pernapasanMuntah pd awal
penyakit (biasanya hebat)
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Tatalaksana Eliminasi racun dgn bilas lambung, obat
pencaharDepresi napas memberat : pernapasan mekanik buatan smpai
tanda vital membaikAntidotum : antitoksin botulisme IV 10-50 ml
stelah tes kulitKuanidin hidroklorida utk melawan blokade
neuromuskular dosis 15-35 mg/kgBB/hari dibagi dlm 3 dosis.
