CKB

Disampaikan pada pemantapan profesi KGD: Ns. Arcellia Farosyah P., S.Kep., MSc

Hukum Monroe Kelly

¡ Darah

¡ Cairan serebrospinal

¡ Parenkim Otak

PENINGKATAN TIK

PO2 & PCO2 ¡ PCO2 tinggi:

vasodilatasi

¡ Asidemia: aliran darah ke otak meningkat

¡ PCO2 rendah: vasokonstriksi

¡ Alkalemia: aliran darah ke otak berkurang

CPP = MAP - ICP

CPP : Cerebral Perfusion Pressure MAP : Mean Arterial Pressure ICP : Intra Cranial Pressure

CPP < 70 mmHg Iskemik Otak

Case 1

Mr. A is brought to A&E Department via EMS with full C-spine precaution. The patient was state in multiple fracture due to highway accident.

GCS: 8 with raccoon eyes sign; BP: 160/90 mmHg; HR: 100x/m; RR: 35x/m. Blood running from his nose.

Source: Huizenga et al., 2009

Pengkajian (IGD)

¡ A

¡ B

¡ C

¡ D

Dx. Penunjang?

Protokol Khusus: Resusitasi Otak

1.  IV: Normovolume

2. Hiperventilasi

3. Manitol 20%, 1 gr/kgBB

4.  Furosemide, 0.3-0.5 mg/kgBB

5. Antikonvulsan

Indikasi Masuk ICU 1.  Tipes 1: Hypoxemia <50%

2.  Tipes 2: Hypercapnia >50%

Ventilator Settings 1. RR 4-20x/m

2.  Tidal Volume 5-15cc/KgBB

3.  FiO2% 40-100%

4.  I:E Ratio 1:2 / 1:1.5

INDIKASI MASUK ICU

Mr. A has been on the ventilator for 24 hours after post craniotomy surgery. You volunteered to care for him today, since you know him from the intubation yesterday.

The settings: PCMV 14, VT 700, PEEP 5 mmHg, FIO2 60%, I:E 1:2. Since 07:00, RR 20x/m. On drugs. SaO2: 100%. High pressure alarm (The time is now 11:00). Patient look uncomfortable

Source: Plambex, 2009

Drugs 1.  Sedatives: propofol

2.  Analgesics

3.  Paralytics / NMBs (Neuromuscular Blocking agents: Norcuron

4.  Neuroleptics: Haldol

Pengkajian (ICU)

¡ A

¡ B

¡ C

¡ D

Dx. Penunjang?

ABG

¡ PaCO2 is 28, the pH is 7.48, and the PaO2 is 120

¡ (normals: PaCO2 35-45 mm Hg, pH 7.35-7.45 mm Hg, PaO2 80-100 mm Hg).

¡ Based on the ABG, the pulmonologist changes the vent settings to SIMV, rate 10, PS 10, FIO2 40%. The VT remains 700, RR 24. How will these new settings help Mr. Hill?

Weaning criteria 1.  TV: at least 5ml/Kg

2. MV: less than 10l/m

3. RR: less than 25x/m

4. ABG

5. Klinis

GOODLUCK!!