o bat emergency
TRANSCRIPT
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OBAT EMERGENCY
TRI CAHYANI WIDIASTUTI, M.Sc., Apt
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Obat – Obat Emergenc
Obat!"batan emergency ata# ga$at %ar#rat
a%a&a' "bat!"bat ang %(g#na)an #nt#)
mengata*( *(t#a*( ga$at %ar#rat ata# #nt#)re*#*(ta*( + life support .
engeta'#an mengena( "bat!"batan (n( pent(ng
*e)a&( #nt#) mengata*( *(t#a*( ga$at %ar#rat
ang mengancam na$a %engan cepat %an
tepat.
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OBAT2AN EMERGENCY
On*et cepat
e-e) *egera a%a #m#mna %(ber()an me&a( (ne)*( /SC, IM, I01 a%a #m#mna memp#na( rentang terap( *emp(t
penga$a*an )etat D(*(ap)an %an %(*e%(a)an %(tempat g m#%a' %(ang)a# Obat 'ar#* *e&a *(ap pa)a( Har#* 2 tepat 3 D"*(*, Wa)t#, Cara, D4. C"nt"'3 a%rena&(n,%&&
PERAN PERAWAT: Mengeta'#( (n%()a*( %an )"ntra(n%()a*( pember(an "bat Mamp# me&a)#)an meng'(t#ngan %"*(* ang tepat Mamp# member()an "bat5 emergenc %engan r#te ang
tepat Mengeta'#( 'a&5 g 'ar#* %(e6aa*( *ete&a' pember(an
"bat
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Obat Emergency
Adrenalin Ephedrin S.Atropin Diazepam Lidocain 2%
Lanoxin Furosemide almethason Antihistamin
!y"lo"apron!A #lu"onas
$abic Dextrose &%
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RUTE PEMBERIAN OBAT1. TOPIKAL
*a&ep, be%a), cream, %&&
2. ORAL
*r#p)ap&et, )ap*#&,
3. SUBLINGUAL
e-e) *angat ber6ar(a*( antar (n%(6(%#c"nt"'3 n(-e%(p(n, N(tr"g&(cer(n4. SUPPOSITORIA
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5. INJEKSI• INTRADERMA7
• SUB8UTAN• INTRAMUS8U7ER
• INTRA0ENA
6. ENDOTRAKHEAL /Me&a( p(pa ET1
Maa! "#!$#%&a' ($a)2 I*3 . I0 b"* /%(ber()an &ang*#ng1 .
I0 9#*' /*ete&a' %(b"*, %(&an#t)an%engan :;!5; m& Sa&(ne1 . Dr(p+ In-#*("n /%(camp#r (n-#*+ infusion
pump, syringe pump1
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PENGENCERAN+ PELARUTAN
Se%(aan "bat (ne)*(3 S#%$,-
• D(tamba')an a
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C(')(/ 1:
Ce-"ta4(m : g /:;;; mg1+ 6(a& D(tamba' *ampa( :; m7 a
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C(')(/ 2: D(a@epam /:; mg+ 5 m&1 encer)an mena%( =
m& Berat ba%an 5; )g D"*(* ;, mg I0 pe&an 5; 4 ;, 60 !
D(a@epam : amp#& m& a
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",!"8:
D"pam(n /Amp#& 5;; mg+ = m&
5;;. ;;; #g+= m&1 Berat ba%an pa*(en 2; )g, D"*(* g %(b#t#')an = #g+)gBB+men(t D"pam(n g %(b#t#')an 2; 4 = 2
,+!#'&)
8ecepatan *r(nge p#mp p# %a&am m&+am
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D(&+9a! 12.,+9a!
()a 0"me *r(ngep#mp =; m& /= m&%"pam(ne 2= m&NS1
!a-a 1 ! 4.,
D("a!&'# &$,),/-a'
2,+!#'&)
K##"a)a'%&'# ",!"7 !+ 9a!8
12.,+9a!4.
,+!
3 !+ 9a
5;;.;;; #g+ =; m& 2.;;;
5;; 4 ; men(t :5.;;;
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m&+ am 4 2.;;; #g+am :5.;;;
#g+am
:5.;;; #g+am :5.;;;+; men(t 5;;#g+ men(t
()a %"pam(ne %(encer)an 5; m& ?? A%rena&(ne : #g+men(t ??
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ADRENALIN 7EPINEPHRIN8.
INDIKASI: Fbr(&a*( 6entr()e& /01, ta)()ar%( 6entr()e& tanpa %en#t na%( / pulseless 0T1,
a*(*t"&, EA /Pulseless Electrical Activity 1 Mengata*( gangg#an *(r)#&a*( /S") %(*tr(b#t(-1 meng'(&ang)an br"nc'"*pa*me
SEDIAAN: amp#& :3:;;; /: mg+: m&1+ amp#& :3:;;;; /;,: mg + : m&1 R,)#: I* ,/0 ET 72;3 < (& I*80 I'=,&(' 1 !+5 ! D5>+NS 72
,+!L8
DOSIS:
CPR 3 : mg I0 9#*' /%(()#t( :; m& NS1, %(#&ang != men(t 5! 5,= mg ET /%(&ar#t)an %&m :; m& NS1
A'a?a-)&- 3 ;,= mg SC+IM S/(- 3 (n-#*("n : #g+men(t, t(tra*( *ampa( ma4 :; #g+mnt
B%('-(&a)(%: ;, mg SC /*arat )"n%(*( ant#ng bag#*1
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ME8ANISME 8ERA 3
Men(ng)at)an )e)#atan )"ntra)*( ant#ng
Men(ng)at)an )"n%#)*(
HR men(ng)at Men(ng)at)an re*(*ten*( 6a*)#&er B na()
E-e) *amp(ng 3
en(ng)atan te)anan %ara' %an -re)#en*( na%( %apat
menebab)an (*)em(a m(")ar%, ang(na, %an
pen(ng)atan )eb#t#'an ")*(gen m(")ar%
D"*(* be*ar t(%a) men(ng)at)an perba()an )e*#%a'an
/"#tc"me1 *tat#* ne#r"&"g(*, ba')an b(*a menebab)an
%(*-#ng*( m(")ar% p"*t
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ATROPING"&"ngan ant()"&(nerg()
INDIKASI: A**t"&e+EA /5n% &(ne *ete&a' a%rena&(n1 Un*tab&e bra%()ar%(a 8erac#nan )"&(nerg() /"rgan"-"*-at1
SEDIAAN:Amp#& ;,5= mg+ : M&
DOSIS:
A&)(+PEA : : mg I0 9#*', %(#&ang – = men(t/ma)* mg1 5 – mg %(&ar#t)an %a&am :; m& NS
B%a&-a%&a : ;,= mg I0 9#*', %(#&ang t(ap –= men(t/ma)* mg1
K#%a,'a' (%a'(=(=a): :!5 mg, %(#&ang t(ap 5!=men(t *ampa( ter%apat tan%a atr"p(n(*a*(
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E@EK:
Men(ng)at)an )"n%#)*(
HR na()Men#r#n)an *e)re*( )& ant()"&(nerg()
PERHATIAN: Dapat memperb#r#) (*)em(a m(")ar%
/ta)()ar%(, pa&p(ta*(1 Menebab)an bra%()ar%(a para%")*a& /
;,= mg1 H(perten*(, )eang T(%a) berg#na #nt#) b&") A0 n"%e %eraat
5 t(pe II %an %eraat
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LIDOKAIN+ LIGNOCAININDIKASI: M#&t(-")a& 0C /Paroxismal Ventrikel Contraction1 0T /6entr()e& ta)()ar%(1+ 0 /6entr()e& Fbr(&a*(1
SEDIAAN:
amp#& 2; mg+5 m7
DOSIS: H#')& 9a'),' -a%#'a *@+*T : %"*(* (n(*(a& : –
:,= mg+)g I0 b"* *@ %#=%a-)#% : ;,= – ;,= mg+)g I0 b"*, %(#&angt(ap = – :; men(tJ ma)*(ma& )a&( pember(an /mg+)g1
E'()%a-#a : 5 – 2 mg+)g
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E@EK: Men(ng)at)an e-e) DC *'"c) Men#r#n)an HR
E@EK SAMPING: Depre*( perna-a*an 8eang
Bra%()ar%(a arre*t
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AMIODARONINDIKASI: 'ent( ant#ng re-ra)ter ter'a%ap R, *'"c), %an 6a*"pre*"r Ar(tm(a 6entr()e& ber#&ang /0 ata# 0T %engan
'em"%(nam() ta) *tab(&1
SEDIAAN:A!", 15 !+ 3 !
DOSIS: /#')& 9a'),' : ;; mg /%a&am 5; m& – ; m& D=K1 I0
b"* a%&)!&a #')%&-# : :=; mg I0 %a&am :; men(t /:=
mg+men(t1Ma&')#'a'# : : mg+men(t I0 %a&am am, )em#%(an ;,=mg+men(t I0 %a&am :L am /%"*(* ma)*(ma& 3 5,5 g+'ar(1
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PERHATIAN: $a)t# par#' *angat panang /*ampa(
2; 'ar(1 (ntera)*( "bat ang )"mp&e)* %an
m#&t(pe& '(p"ten*( /pa%a pember(an ber#&ang1 bra%()ar%(
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DOPAMINEINDIKASI: S'"c) /re-ra)ter ter'a%ap pember(an ca(ran1 "bat p(&('an )e%#a #nt#) bra%()ar%(a *(mt"mat(*
/*ete&a' atr"p(n1 H(p"ten*( /TDS ; mmHg1
SEDIAAN: Amp#& 5;; mg+ = m7DOSIS: 2 5 ,+-+!#'&) men(ng)at)an rena& b&""% 9" 5 1 ,+-+!') men(ng)at)an )"ntra)*( ant#ng
1 ,+-+ !') )"n*tr()*( *(*tem()
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PERHATIAN:
Sete&a' target tercapa(, t#r#n)anberta'ap /tapering1 Ja'a' mencamp#r+me&ar#t)an %engan
natr(#m b()arb"nat, &a)#)an
pengenceran %engan D=K, D= :+5 NS,D:; ;,:L NSJ R7
D(ber()an %engan syringe pump ata#
infusion pump, 'ar#* #a, %r(p, b#)anI0 b"* B(*a menebab)an ta)(ar(tm(a,
6a*")"n*tr()*( ang e)*e*(-
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DOBUTAMIN
INDIKASI: D(pert(mbang)an #nt#) )a*#* pump problems /gaga& ant#ng )"nge*t(-,*embab par#+congestive pulmonum1
%engan TDS ; – :;; mmHg a' t(%a)a%a tan%a!tan%a *")
SEDIAAN: Amp#& 5=; mg+ :; m7
DOSIS: 5 – 5; g+)g per men(t, t(tra*( *e'(nggaHR t(%a) *ampa( men(ng)at :; K %ar(baseline
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PERHATIAN:
C#a/ pember(an pa%a TDS :;;mmHg %an a%a tan%a!tan%a *") Menebab)an ta)(ar(tm(a T&a- $(#/ mencamp#r %engan
natr(#m b()arb"nat
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MOR@ININDIKASI: Chest pain %engan Acute Coronary Syndrome
/ACS1 ang ta) re*p"n %engan n(trat E%ema par# a)#t )ar%("gen() /b(&a TD a%e)#at1
SEDIAAN: Amp#& :; mg+ : m7DOSIS: D"*(* (n(*(a& 3 5 – 2 mg I0 %a&am : – = men(t,
*et(ap = *ampa( ; men(t D"*(* #&angan 3 5 – L mg pa%a (nter6a& = *ampa(
:= men(t Ma*#))an pe&an!pe&an %an t(tra*( *ampa( tercapa(
e-e)
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PERHATIAN T(%a) #nt#) (n-ar) (n-er("r B(*a menebab)an %epre*( napa* Menebab)an '(p"ten*( /pa%a pa*(en
%engan %ep&e*( 6"me ca(ran1 G#na)an %engan 'at(!'at(+per'at(an
pen#' pa%a )a*#* (n-ar) 6entr()e&
)anan Ant(%"t#m 3 na&")*"n /;,2 – 5 mg I01
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D(re)"men%a*()an #nt#) peng"batan T"r*a%e* %ep"(nte* pa%a 6entr()e& ta)()ar%(, )erac#nan%(g(ta&(*.B(*a #ga #nt#) mengata*( pree)&am*(aD"*(* #nt#) T"r*a%e* %e p"(nte* :!5 gr %(&ar#t)an%engan %e)tr"*e =K %(ber()an *e&ama =!; men(t.
Dr(p ;,=!: gr+am (6 *e&ama 52 am
Ma'#&,! S,=a)
In%()a*( 3 D(g#na)an #nt#) perba()an par# ang%(*ebab)an gangg#an (n'a&a*( %an #nt#) meng#rang(e%ema cerebr(C"nt"' 3 De4ameta*"n
K(%)&-()#%(&
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In%()a*( 3' D(ber()an #nt#) %#gaan '(per)a&em(a /)e&a* I1,
*ete&a' *(r)#&a*( *p"ntan ang t(mb#& pa%a 'ent( ant#ng &ama /)e&a* II B1,
' a*(%"*(* metab"&() )arena '(p")*(a /)e&a* III1 %an"6er%"*(* ant(%epre*( tr(*()&().
D"*(* : me
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In%()a*( 3 D(g#na)an #nt#) perba()an )"ntra)*( "t"t
ant#ng, *tab(&(*a*( membran *e& "t"t ant#ng ter'a%ap%ep"&ar(*a*(. #ga %(g#na)an #nt#) mencega' tran*-#*(ma*(- ata# e-e) tran*-#*( a)(bat %ara' %"n"r ang%(*(mpan &ama
D(ber()an *ecara pe&a'an!&a'an I0 *e&ama :;!5; men(tata# %engan mengg#na)an %r(pD"*(* 2!L mg+8g BB #nt#) )a&*(#m g)"nat %an 5!2mg+8g BB #nt#) 8a&*(#m )&"r(%a. Da&am tran-#*(, *et(ap
2 )ant"ng %ara' ang ma*#) %(ber()an : amp#&8a&*(#m gc"nat
Ka&,! ,('a) + -a&,! -(%&a
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D(a@epamrem(%()a*( %"*(* 3 = – :; mg "ra& +
IMIn%#)*( %"*(* 3 ;,: – ;,5 mg I0S#p&emen reg("na& 3 = – :; mg I0
S#p&emen I0 ane*t 3 )etam(nengg#naan &a(n 3 E)&*(a 8eang
Tetan#*
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#r"*em(%
In%()a*( 3 D(g#na)an #nt#)meng#rang( e%ema par# %an e%ema"ta)
E-e) *amp(ng ang %apat tera%()arena %(#re*(* ang ber&eb(' a%a&a''(p"ten*(, %e'(%ra*( %an '(p")a&em(a
D"*(* 5; – 2; mg (ntra 6ena
T#%a"& A')&$&()&-a
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T#%a"& A')&$&()&-a Tabe& :!53 Ant(b("t()a )a*#* (n-e)*( penerta )a*#* ga$at%ar#rat
Ant(b("t()a D"*(* 8eterangan
Amp(*(&(n
Ben@(&pen(*(&(n
8&"ram-en()"&
Gentam(*(n
D")*(*()&(n Tetra*()&(n
Metr"n(%a@"&
: g I0 t(ap 2 am ata# =;;mg /"ra&1 t(ap am:; #ta IU I0 per 2 am
: g I0 t(ap am
:,= )g+)g BB+%"*(* I0+IM per
L am:;; mg t(ap :5 am=;; mg t(ap am /angan%(ber()an ber*amaan%engan *#*# ata# anta*(%a1
: g I0 ata# per re)ta& t(ap :5
am ata# =;; mg "ra& t(ap am
Spe)tr#m a*, m#ra'
A%a e-e) *amp(ng *er(#*e-e)t(- #nt#) )")#* Gram /1 %anGOBa() #nt#) *ep*(*, pene)anan *#m!*#m t#&ang, panta# gambaran
%ara'E-e)t(- #nt#) Gram /!1 %an 9"ra#*#*A)t(- #nt#) )#man Gram /1, Gram/!1 terma*#) 8&am(%(a. Sebaga(gant( ata# )"mb(na*( %enganAmp(*(&(n. Ba() %()"mb(na*()an
%engan Metr"n"%a@"&
Ba() #nt#) Gram /!1 %an Aner"b.Dapat %()"mb(na*()an %enganAmp(*(&(n %an D")*(*()&(n. A&ternat(-%ar( )&(n%am(*(n. Re&at(- m#ra' %anm#%a' %(%apat. Serapan "ra&
mencapa( )a%ar *er#m ang *ama%engan Intra6ena
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Terima kasih
S B = )