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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#