pacu 2 - possum + high risk surgical patient
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7/25/2019 PACU 2 - POSSUM + HIGH RISK SURGICAL PATIENT
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POSSUM + PASIENBEDAH RISIKO
TINGGIStase PACUIRFAN M HARDI
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High
RiskSurgicalPatient
Pasien :- Risiko yang
lebih tinggiari !o!ulasi
yang"en#alani
!e"be ahan
yang sa"a
Prose urPe"be ahan
:- Risiko lebih
tinggi$Mortalitas
%&'(
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Clinical Criteria High-RiskSurgical Patient
Ri)ayat !enyakit car iores!irasi beratsebelu"nya* In+ark Miokar Akut* C,PD*
an Stroke
Penyakit !e"buluh arah berat yang"elibatkan aortaUsia % . tahun engan keterbatasan+isiologi satu atau lebih organ /ital
Pe"be ahan kanker yang berat $e0g0oeso!hagecto"y* gastrecto"y* cystecto"y(
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Clinical Criteria High-RiskSurgical Patient
Penyakit ab o"en akut yang isertaiinstabilitas he"o ina"ik $!eritonitis*!er+orate /iscus* !ancreatitis(
Per arahan akut yang banyak % 1 unitsSe!tike"ia2ultur arah !ositi+ atau a anya +okus se!tik3agal na+as Pa,4 5 10. kPa on FI,4 % .06atau /entilasi "ekanik % 61 #a"3agal gin#al akut ureu" % 4. ""ol7l ataucreatinine % 48. ""ol7l
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POSSUM
P hysiological an O!erati/e S e/erityS core +or the en U"eration o+ Mortality anMorbi ity
ike"bangkan oleh Co!elan et al 9 9Dua bagian:
Skor +isiologis : 94 /ariabel
Skor !e"be ahan : 8 /ariabelDihitung engan ru"us
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Surgery Stress-Response andAnesthesia
Cardiovascular changes Rise in car iac out!ut* heart rate* bloo !ressure* increase "yocar ial contractility*increase o;ygen e"an 0
Blood volume distribution Peri!heral an s!lanchnic /asoconstriction coronary an cerebral /aso ilatation0
Respiratory Changes Increase res!iratory rate0
Fluid and electrolyte changes So iu" an )ater retention0
Coagulation Hy!ercoagubility an +ibrinolysis0
Immunosuppression
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T RIM! "!SI#
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