bronkitis akut(news)
TRANSCRIPT
Abdul Rohman
Tingkat KemampuanDIAGNOSIS RUJUK TERAPI
PENDAHULUANTERAPI
LANJUTAN
FISIK PENUNJANG SPESIALIS GAWAT DARURAT
LAB RO
1 + +
2 + + + + +
3A + + + + +
3B + + + + + +
4 + + + + +
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
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
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
BRONKITIS AKUT
Dr. Abdul Rohman, SpP
K-4
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
ETIOLOGI
- keringat malam sampai sesak napas
- sal napas atas lain : sore throat
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
DIAGNOSIS BANDINGDIAGNOSIS BANDING
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)
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
PENATALAKSANAAN
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
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
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
5 Konsultasi
-Dokter Spesialis Paru
6 Perawatan rumah sakit
- Rawat jalan
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
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
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
13 Masa pemulihan : - 1 minggu
14 Output : • Sembuh total• Komplikasi
15 PA : -
16 Autopsi/ risalah rapat : -
17 Bidang terkait : • Radiologi• Mikrobiologi
18 Fasilitas khusus : -
THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTION ATTENTION
ABOUT ABOUT “BRONKITIS “BRONKITIS AKUT”AKUT”
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
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
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