bronkitis akut(news)

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Abdul Rohman

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Page 1: Bronkitis Akut(News)

Abdul Rohman

Page 2: Bronkitis Akut(News)

Tingkat KemampuanDIAGNOSIS RUJUK TERAPI

PENDAHULUANTERAPI

LANJUTAN

FISIK PENUNJANG SPESIALIS GAWAT DARURAT

LAB RO

1 + +

2 + + + + +

3A + + + + +

3B + + + + + +

4 + + + + +

Page 3: Bronkitis Akut(News)

Standar Kompetensi DokterRESPIRATORY

Uncomplicated Pulmonary TB

1 2 3A 3B 4

TBC with HIV 1 2 3A 3B 4TBC with Pneumothorax 1 2 3A 3B 4Acute Bronchitis 1 2 3A 3B 4Bronchiolitis 1 2 3A 3B 4Bronchial Asthma 1 2 3A 3B 4Status Asthmaticus 1 2 3A 3B 4Lung Emphysema 1 2 3A 3B 4Atelectasis 1 2 3A 3B 4Bronchietasis 1 2 3A 3B 4

Page 4: Bronkitis Akut(News)

RESPIRATORYCOPD 1 2 3A 3B 4

SARS 1 2 3A 3B 4

Pneumonia 1 2 3A 3B 4

Avian Influenza 1 2 3A 3B 4

Lung Abscess 1 2 3A 3B 4

Pulmonary Embolism 1 2 3A 3B 4

Lung Infarction 1 2 3A 3B 4

Pleurisy TBC 1 2 3A 3B 4

Pleurisy Cancer 1 2 3A 3B 4

Page 5: Bronkitis Akut(News)

RESPIRATORY

Pleurisy Lupus 1 2 3A 3B 4

Pneumothorax 1 2 3A 3B 4

Cystic Fibrosis 1 2 3A 3B 4

Aspiration Pneumonia 1 2 3A 3B 4

Page 6: Bronkitis Akut(News)

BRONKITIS AKUT

Dr. Abdul Rohman, SpP

K-4

Page 7: Bronkitis Akut(News)

BATASANProses radang akut pada saluran napas bawah

UPPER RESP TRACT INFECTION Acute Rhinitis Acute Sinusitis Acute Pharyngitis Laryngotracheitis and Epiglottitis Acute Ottitis Media

UPPER RESP TRACT INFECTION Acute Rhinitis Acute Sinusitis Acute Pharyngitis Laryngotracheitis and Epiglottitis Acute Ottitis Media

An inflamation of the tracheobronchial tree, usually in

assosiation with generalized respiratory infection

LOWER RESP TRACT INFECTION

Bronchitis Community-Acquired Pneumonia

Hospital-Acquired Pneumonia Pneumonia in the Compromised Host

Page 8: Bronkitis Akut(News)

ETIOLOGI

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- keringat malam sampai sesak napas

- sal napas atas lain : sore throat

Page 10: Bronkitis Akut(News)

PENUNJANG KLINIK

Lab rutin darah - Lekosit mungkin meningkat - Hitung jenis dominasi sel lekosit PMN

Sputum atas indikasi- berguna untuk deteksi dini

pneumonia Manula komorbid

(CHF, DM) Foto dada tidak spesifik, untuk exclude

pneumonia

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DIAGNOSIS BANDINGDIAGNOSIS BANDING

Page 12: Bronkitis Akut(News)

ACUTE BRONCHITIS Suspected HistoryPhysical examination

Recent upper respiratory tract infections or no known lung disease

Known history of chronic bronchitis

Acute exacerbation of chronic bronchitis

Patient afebrileNormal physical examination

Rales or fever ≥ 101°F

Infiltrate Negative

© assess likehood of influenzae A

pneumonias

High likelihood Low likelihood

Consider: Amantadine

Chest x-ray examination(B)

(A)

Page 13: Bronkitis Akut(News)

Low likelihood

Insignificant or nonpurulent sputum

Significant or purulent sputum

(D)

Patient otherwise healthy

Elderly patient or Patient with comorbidities

< 5 polymorphonuclear leukocytes > 5 polymorphonuclear leukocytes

Consider:Antibiotics

(E)Symptomatic treatment

Page 14: Bronkitis Akut(News)

PENATALAKSANAAN

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1 Nama penyakit / diagnosis :

Bronkitis Akut No. ICD-X : J. 20ialah proses radang akut pada saluran napas bawah. Tidak dijumpai kelainan radiologi. Penyebab tersering adalah virus. Bila berlangsung lebih dari 5 – 7 hari dan terjadi perubahan warna sputum perlu dipikirkan infeksi bakteri

Page 18: Bronkitis Akut(News)

2 Kriteria diagnosis Demam, batuk-batuk (dari batuk kering sampai berdahak), kadang-kadang disertai sesak napas dan disertai nyeri dada

3 Diagnosa differential

• Infeksi akut saluran napas bagian atas

•Bronkopneumonia•TB paru

Page 19: Bronkitis Akut(News)

4 Pemeriksaan penunjang4.1. Umum

4.2. Khusus

a.Foto toraks PA dan lateral

b.Laboratorium rutin darah

• Hitung leukosit mungkin meninggi

• Pada hitung jenis, terdapat dominasi sel leukosit PMN

c.Sputum mikroorganisme atas indikasi

Sesuai komplikasi

Page 20: Bronkitis Akut(News)

5 Konsultasi

-Dokter Spesialis Paru

6 Perawatan rumah sakit

- Rawat jalan

Page 21: Bronkitis Akut(News)

7 Terapi Umum7.1. Nonmedikamentosa:

7.2. Medikamentosa :

7.3. Terapi khusus : :

•Istirahat•O2

•Hidrasi (terapi cairan)

•Mukolitik•Ekspektoran•Antitusif bila perlu•Antibiotika bila perlu

•Terapi inhalasi bila perlu•Sesuai komplikasi

Page 22: Bronkitis Akut(News)

8 Standard rumah sakit :

- Tipe D

9 Penyulit9.1. Karena penyakit :

9.2. Karena tindakan

• Pneumonia• Abses Paru• Empiema• Septikemia

10

Informed consent :

- Tidak perlu

11

Standard tenaga :

- Dokter umum

12

Lama perawatan :

- Tak perlu rawat

Page 23: Bronkitis Akut(News)

9 Penyulit9.1. Karena penyakit :

9.2. Karena tindakan

• Pneumonia• Abses Paru• Empiema• Septikemia

-

10 Informed consent : - Tidak perlu

11 Standard tenaga : - Dokter umum

12 Lama perawatan : - Tak perlu rawat

Page 24: Bronkitis Akut(News)

13 Masa pemulihan : - 1 minggu

14 Output : • Sembuh total• Komplikasi

15 PA : -

16 Autopsi/ risalah rapat : -

17 Bidang terkait : • Radiologi• Mikrobiologi

18 Fasilitas khusus : -

Page 25: Bronkitis Akut(News)

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTION ATTENTION

ABOUT ABOUT “BRONKITIS “BRONKITIS AKUT”AKUT”

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Treatment Plan PRIMARY CARE VISIT

Patient presents w/ cough & symptoms of acute bronchitis

COMPLICATIONSIs bronchitis

uncomplicated

ComplicatedUncomplicated

TREATMENTTherapy based upon patient’s

comorbid conditions

DIAGNOSISAcute bronchitis?

Rule out other causes:- Pneumonia ?- Previous undiagnosed asthma?- GERD ?

Yes(Acute Bronchitis)

No(Other Causes)

CONSIDERATIONS:

See Treatment Plans Pneumonia or Asthma

Or treat GERD appropiately

Common Pathogens•Influenza A & B•Parainfluenza•Resp syncytial virus•Adenovirus

•Rhinovirus•Bordetella pertussis•Mycoplasma pneumoniae•Chlamydia pneumoniae

See next page for treatment

Page 30: Bronkitis Akut(News)

Treatment Plan (Continued)

TREATMENT – PHARMACOTHERAPY

Routline antibiotics are not recommended regardless of duration of cough unless pertussis is suspected

Symptomatic Pharmacotherapy•Inhaled or oral bronchodilators- Individualize therapy to patients w/ hyper-responsive airways (wheezing or bothersome cough)•Antitussives - May have moderate effect on duration & severity of cough

Suspected Pertussis•Perform diagnostic testing•Adminsiter antibiotic therapy-Macrolide-Co-trimoxazole

Page 31: Bronkitis Akut(News)

TREATMENT – NON-PHARMACOLOGICAL & PATIENT COUNSELING

Methods of Non-Pharmacological Treatment•Elimination of cough triggers (eg dust and dander)•Increase fluid intake•Increase humidity w/ vaporized air treatments in low humidity environments

Patient satisfication should not depend on receiving antibiotic therapy but on quality of physician visitQuality of patient-physician visit may be increased by :•Explaining that the duration of cough may last 10 -14 days after primary care visit•Reviewing risk of unnecessary antibiotic use:-Infection w/ antibiotic-resistant bacteria-GI symptoms -Chance of allergic reactions eg anaphylaxis, rash