7/24/2019 Pneumonia (4)

1/27

PNEUMONIA

DEFINISI

Peradangan dan pemadatan jaringan

paru yang disebabkan oleh bahaninfeksius

7/24/2019 Pneumonia (4)

2/27

KLASIFIKASI

Community Acquired Pneumonia (CAP)- Pneumonia yang diproleh dari luar

rumah sakit Hospital Acquired pneumonia - Pneumonia yg timbul 7 jam atau lebih

setelah dira!at di rumah sakit "nstitution acquired pneumonia - Pneumonia karena tindakan pera!atan

di #$% di rumah dll&

PNEMONIA

7/24/2019 Pneumonia (4)

3/27

'ersering emam

*enggigil

Pleuritic chest pain (pleuropneumonia)

+atuk

$esak nafas $putum non produktif% produktif% rusty%

berdarah% berbau pada abses paru

MANIFESTASI KLINIK

7/24/2019 Pneumonia (4)

4/27

',P"CA .ejala klinik seperti diatas

isebabkan oleh Pneumococcus%

staphylococcus% H "n/uen0ae A',P"CA .eja penyakittidak khas

+atuk 1on produktif2 mukoid

isebabkan oleh egionella% mycoplasma%Chlamydia

Campuran antara typical and atypical

MANIFESTASI KLINIK

7/24/2019 Pneumonia (4)

5/27

*A1"34$'A$" 151 #4$P"#A'5# 1yeri kepala

*ual *untah 1yeri Abdomen iare

1yeri otot 2 *yalgia 1yeri sendi 2 arthralgia

Pasen tua lebih banyak keluhan dpyang muda

MANIFESTASI KLINIK

7/24/2019 Pneumonia (4)

6/27

$uhu

- emam- Hypothermia- Afebris pd 6 kasus

'hora8

"1$P49$" - hemithora8 yg sakit tertinggal PAPA$"

- :ocal fremitus meningkat P4#9;$"

- sonor memendek 2 dull A;$9;'A$"

- sub bronkial 2 bronkial

- ronki basah sedang nyaring

- pleural friction rub

PEMERIKSAAN FISIK

7/24/2019 Pneumonia (4)

7/27

P4*AA'A1P 35'5 '5#A9$2 "nfeksi

Perdarahan Cairan edema

9eganasan

"n/amasi penyebab lain

(

7/24/2019 Pneumonia (4)

8/27

P

NEUMO

NIA

7/24/2019 Pneumonia (4)

9/27

;4 '5 'he Cause can not be determined from the

clinical presentation Complete microbiological studies can

isolate

only = >6 of causati:e pathogen andtake

long enough time (? @ hours)

Pathogen isolated from sputum cannot besure

as the causati:e agent $5

4tiologic diagnosis of pneumoniacate ori0ed as

ETIOLOGIC DIAGNOSIS

7/24/2019 Pneumonia (4)

10/27

A*"$$"512#434# 4C"$"51

"mportant step after diagnosis has been made"ndication

#isk factors for a complicated course or *ortality inPatients !ith CAP

Age ? > yearsCo-morbid illnesses that are likely to be made !orse

by the pneumonia% especially chronic renal failure%

ischemic heart disease% congesti:e heart failure% andse:ere C5P

Concurrent malignancyPostsplenectomy stateAltered mental status

Alcoholism"mmunosuppresi:e therapy#espiratory rate ? D6 breaths per minuteiastolic blood pressure = 6 mm Hg systolic blood

pressure = E6 mmHg

7/24/2019 Pneumonia (4)

11/27

Hypothermia

Creatinine ? F>6 mm2l or +;1 ? 7 mm2l

eukopenia = D%6662ul or leucocytosis ? D6%6662ul5 = 6 mmHg or Pco ? @ mmHg !hile breathing room air

Albumin = D6 gm2l

Hemoglobin = E gm2l

Pseudomonas aeruginosa or $taphylococcus aureus as the cause of thePneumonia

+acteremic pneumonia

*ultilobe in:ol:ement on chest radiograph

#apid radiographic progression of the pneumonia deBned as increase inthe si0e of the pulmonary opacity of ? >6 !ithin D h

7/24/2019 Pneumonia (4)

12/27

5;' PA'"41'$ Chest G ray Complete leucoyte count 4lectrolyte

Creatinin 58ygen saturation $putum culture and gram stain

"1 PA'"41'$As abo:e$putum culture and gram stain+lood culture (t!ice)

DIAGNOSTIC WORK UP

7/24/2019 Pneumonia (4)

13/27

$P;';* C;';#4 A1 .#A* $'A"1

#4P#4$41'A'"

7/24/2019 Pneumonia (4)

14/27

$4#55., 35# PA'H5.41 *& Pneumoniae C& Pneumoniae Co8iella +ornetti egionella Pneumophilla Adeno:irus

"n/uen0a2Parain/uen0a #$