Bimbingan Stroke Coass Minggu IV

8/18/2019 Bimbingan Stroke Coass Minggu IV

1/36

PENATALAKSANAANPENATALAKSANAANHIPERTENSI PADA STROKEHIPERTENSI PADA STROKE

AKUTAKUT

ALDY S RAMBEALDY S RAMBE


2/36

DEFINISI STROKEDEFINISI STROKE

Stroke adalah tanda-tandaStroke adalah tanda-tandaklini !an" #erke$#an"klini !an" #erke$#an"%e&at aki#at "an""'an%e&at aki#at "an""'an('n" i otak (okal )ata'('n" i otak (okal )ata'"lo#al*+ den"an "e,ala-"lo#al*+ den"an "e,ala-"e,ala !an" #erlan" 'n""e,ala !an" #erlan" 'n"./ ,a$ ata' $en!e#a#kan./ ,a$ ata' $en!e#a#kanke$atian+ tan&a adan!ake$atian+ tan&a adan!a&en!e#a# lain !an" ,ela&en!e#a# lain !an" ,ela

elain 0a k'ler1elain 0a k'ler1(WHO, 1986)(WHO, 1986)


3/36

REGULASI ALIRAN DARAH KE OTAKREGULASI ALIRAN DARAH KE OTAK

► Berat otakBerat otak ±± 1500 gr = 2- ! BB 1500 gr = 2- ! BB► "e#er$%a &ara' 1(-25! &ara' )g &$*o%*aka#"e#er$%a &ara' 1(-25! &ara' )g &$*o%*aka#

+a#t,#g .00 / 0 *er %e#$t = 50 /(0 *er +a#t,#g .00 / 0 *er %e#$t = 50 /(0 *er100 gr +ar$#ga# otak *er %e#$t3100 gr +ar$#ga# otak *er %e#$t3► S,**4) &ara' ke otak S,**4) &ara' ke otak

16 a7karot$& $#ter#a ka6 16 k$16 a7karot$& $#ter#a ka6 16 k$ 16 8$8te% 9erte:ro:a8$4er 16 8$8te% 9erte:ro:a8$4er


4/36

;AKTOR /;AKTOR


5/36

AUTOREGULASI SEREBRAL

? a&a4a' %eka#$8%e )g %e#gat,r agar a4$ra#&ara' *& arter$o4e teta* re4at$@ ko#8ta# *& *er,:a'a#

TD ke8e$%:a#ga# #,tr$8$ a$ra# +ar7 otak 7

? tek *er@,8$ %e#,r,# arter$ 8ere:ra4 &$4ata8$ tek7*er@,8$ %e#a$k arter$ 8ere:ra4 ko#8tr$k8$ B; teta* re4at$@ ko#8ta# &a4a% :ata8

TD )g ,k,* 4e:ar a,toreg,4ator) *4atea,


6/36

Arter$a4 Cre88,re %%Hg3


7/36

AUTOREGULASI CADA HICERTENSI

C&7 H$*erte#8$ kro#$8 a,toreg,4ator) *4atea, :erge8er keka#a#

Ce%:7&ara' -'$*ertro@$-re%o&e44$#g reak8$ t'&78t$%,4,8 ko#8tr$k8$ :er 3

reak8$ t'&78t$%,4,8 &$4ata8$ :er -3


8/36

DIA7NOSIS STROKEDIA7NOSIS STROKE

► KLINISKLINIS► S5ORIN78AL7ORITMA 3S5ORIN78AL7ORITMA 3

SIRIRA9 STROKE S5ORESIRIRA9 STROKE S5ORE

AL7ORITMA 7A9AH MADA dllAL7ORITMA 7A9AH MADA dll► RADIOLO7IS 3RADIOLO7IS 35T %an+ MRI+ an"io"ra:+ T5D5T %an+ MRI+ an"io"ra:+ T5D

► LPLP►

NEUROSONO7RAFINEUROSONO7RAFI► LABLAB

;; He 2ho $a ter hi ti$e+ $a ter hi li(e


9/36

NEURORADIOLO7INEURORADIOLO7I

► 7old tandard 3 5T %an7old tandard 3 5T %an► Ka&an dilak'kan =====Ka&an dilak'kan =====

► Tidak ada ketent'an !an" &a ti Tidak ada ketent'an !an" &a ti► In(ark e%ara radiolo"i 0i i#le > /?In(ark e%ara radiolo"i 0i i#le > /?

,a$ ,a$

► Tidak &erl' #'r'-#'r' 5T- %an Tidak &erl' #'r'-#'r' 5T- %anke%'ali ra"' troke he$ora"ik1ke%'ali ra"' troke he$ora"ik1


10/36

PENATALAKSANAAN UMUMPENATALAKSANAAN UMUM

► Head '& @Head '& @ oo

► Bila $'ntahBila $'ntah *o8$8$ 4atera4 &ek,:$t,8 *o8$8$ 4atera4 &ek,:$t,8

► He%o&$#a%$k 8ta:$4 %o:$4$8a8$ :erta'a*He%o&$#a%$k 8ta:$4 %o:$4$8a8$ :erta'a*► Be:a8ka# +a4a# #a@a8 9e#t$4a8$ a&ek,atBe:a8ka# +a4a# #a@a8 9e#t$4a8$ a&ek,at► Kateter $#ter%$tte#Kateter $#ter%$tte#

► Ce#ata4ak8a#aa# TDCe#ata4ak8a#aa# TD► Korek8$ '$*o ata, '$*erg4$ke%$aKorek8$ '$*o ata, '$*erg4$ke%$a


11/36

PENATALAKSANAAN UMUMPENATALAKSANAAN UMUM

► Pertahankan 'h' t'#'h teta& nor$alPertahankan 'h' t'#'h teta& nor$al► Di (a"iaDi (a"ia NGT NGT►

a$ra# &a# e4ektro4$t 8e$%:a#ga$ra# &a# e4ektro4$t 8e$%:a#g► a$ra# I> kr$8ta4o$& ata, ko4o$&F HINDARIa$ra# I> kr$8ta4o$& ata, ko4o$&F HINDARI

)g %e#ga#&,#g g4,ko8a ata, '$*oo8%o4ar )g %e#ga#&,#g g4,ko8a ata, '$*oo8%o4ar

► "o:$4$8a8$ &a# re'a:$4$ta8$ &$#$ :$4a t$&ak a&a"o:$4$8a8$ &a# re'a:$4$ta8$ &$#$ :$4a t$&ak a&a

ko#tra$#&$ka8$7ko#tra$#&$ka8$7


12/36

PENATALAKSANAANPENATALAKSANAANKOMPLIKASIKOMPLIKASI

► Ke,an"Ke,an" &$a e*a% &$a e*a%► Stre88 ,4 er a#ta8$&aF a#tago#$8 H2F CCIStre88 ,4 er a#ta8$&aF a#tago#$8 H2F CCI► Ce#,%o#$a ega' &g# *o8$t$o#$#gCe#,%o#$a ega' &g# *o8$t$o#$#g &a#&a#

@$8$otera*$@$8$otera*$► TIK TIK 17 "a#$to4 20! 17 "a#$to4 20!

27 G4$8ero4 50! ora43 ata, 10! I>327 G4$8ero4 50! ora43 ata, 10! I>3 7 ;,ro8e%$&e7 ;,ro8e%$&e

7 I#t,:a8$ '$*er9e#t$4a8$ terko#tro47 I#t,:a8$ '$*er9e#t$4a8$ terko#tro4

57 Kra#$oto%$ &eko%*re8$@ 57 Kra#$oto%$ &eko%*re8$@ Kort$ko8tero$& %a8$' ko#tro9er8$a4 Kort$ko8tero$& %a8$' ko#tro9er8$a4


13/36

Stroke 5on ideration (orStroke 5on ideration (or

Mana"e$entMana"e$ent► Pri$ar! &re0entionPri$ar! &re0ention

A e $ent o( $odi:a#le (a%tor )BP+ diet *A e $ent o( $odi:a#le (a%tor )BP+ diet *

► 5on ider &e%i:% %a' e o( troke8TIA and5on ider &e%i:% %a' e o( troke8TIA andindi0id'al &atient (a%torindi0id'al &atient (a%tor

► Se%ondar! &re0entionSe%ondar! &re0ention►

S'r"i%al $ana"e$entS'r"i%al $ana"e$entECtra%ranial %arotid arter! di ea eECtra%ranial %arotid arter! di ea eS!$&to$ati% %arotid teno iS!$&to$ati% %arotid teno iA !$&to$ati% %arotid teno iA !$&to$ati% %arotid teno i


14/36

Stroke Pre0entionStroke Pre0ention

► Li0in" t!leLi0in" t!le► Mana"e$ent o( ri k (a%torMana"e$ent o( ri k (a%tor

► Medi%al inter0ention 3Medi%al inter0ention 3anti&lateletanti&lateletanti%oa"'lantanti%oa"'lant

► In0a i0e treat$entIn0a i0e treat$ent


15/36

STROKE ISKEMIK STROKE ISKEMIK

► I khe$ia ere#ral 3Adalah #erk'ran"n!a aliran darah keotak + ehin""a ter,adi "an""'an('n" i ere#ral 1

►Etiolo"i 3

1 tro$#o i.1 e$#oli@1 #erk'ran"n!a &er(' i i te$ik


16/36

5la i% Mani(e tation o(5la i% Mani(e tation o(Atherothro$#o iAtherothro$#o i

Unstableangina (UA)

Non-STelevated MI Stroke/TIA

Peripheral ArterialDisease (PAD)

Co on !nderl"ingatherothro bosis

Atherothro boti# event

(MI$ stroke$ vas#!lar death)

Pla%!e r!pt!rePlatelet a#tivationand aggregation Thro b!s &or ation


17/36

"e&$ a4 Tra$#$#g A8$a "$&&4e Ea8t

Atherothro$#o i 3 the Patholo"i%Atherothro$#o i 3 the Patholo"i%Pro%ePro%e

L

Occlusion

Acute Event

E bolis

Chronic Ischemia

Atheros#leroti#Pla%!e

Pla%!e'iss!re/Cra#king

/

!pt!re

Thro b!sIn#orporated

into Athero a

Thro b!s'or ation

StabilizedPlaque


18/36


19/36

r C '( l/*++g / enit) ,A IN AN .TA

ST AT0 I T0 API Ne!roproteksieper&!si

Nor alNor al

angg!an etab1 l!kosa( likolisis anaerobik)

angg!an etab1 l!kosa( likolisis anaerobik)

2aktoasidosis2aktoasidosis

angg!an ioki ia3i(sintesa protein)

angg!an ioki ia3i(sintesa protein)

angg!an etab1 0nersiangg!an etab1 0nersi

angg!an &!ngsional

(depolarisasi e bran)

angg!an &!ngsional

(depolarisasi e bran)

er!sakan 4istologis(Pannekrosis)

Ne!ron$ glia$ 0ndotel

er!sakan 4istologis(Pannekrosis)

Ne!ron$ glia$ 0ndotel50nerg" 'ail!re650nerg" 'ail!re6

50le#tri#al

'ail!re6

50le#tri#al

'ail!re6

5Ion P! p 'ail!re6l!ta ate elease $

Ca in&l!7$'ree radi#als$ dst

5Ion P! p 'ail!re6l!ta ate elease $

Ca in&l!7$'ree radi#als$ dst

8+-9+

:8

;+

*8

*+

+-<

KASKADE ISKEMIK KASKADE ISKEMIK


20/36


21/36

pen! bracore

* ho!r ; ho!r :-< ho!r * ? * > ;-: ? * >


22/36

Ce#go:ata# S*e8$@$k Stroke I8ke%$kCe#go:ata# S*e8$@$k Stroke I8ke%$k

"e%,4$'ka# a4$ra# &ara' ke"e%,4$'ka# a4$ra# &ara' ke&aera' $8k'e%$k&aera' $8k'e%$k

"e4$#&,#g$ +ar$#ga# otak ter'a&a*"e4$#&,#g$ +ar$#ga# otak ter'a&a*ker,8aka# ak$:at $8k'e%$ker,8aka# ak$:at $8k'e%$

STRATE7I

REPERFUSION

NEUROPROTE5TION


23/36

STROKE HEMORA7IK STROKE HEMORA7IK

;; Man %annot di %o0er ne2 o%ean +Man %annot di %o0er ne2 o%ean +'nle he ha the %o'ra"e to loo e i"ht o('nle he ha the %o'ra"e to loo e i"ht o( the hore


24/36


25/36

► Ni$odi&ine 'nt'k %e"ah 0a o &a $eNi$odi&ine 'nt'k %e"ah 0a o &a $e► O&era i 3O&era i 3

1 PSA tadi'$ I dan II aki#at &e%ahn!a1 PSA tadi'$ I dan II aki#at &e%ahn!aBerr!8 a%%'lar ane'r! $ --- %li&&in" Berr!8 a%%'lar ane'r! $ --- %li&&in"

.1 Pada ko$&lika i hidro e(al'.1 Pada ko$&lika i hidro e(al'o# tr'kti( --- h'ntin"o# tr'kti( --- h'ntin"

PSA


26/36

HIPERTENSI PADA STROKEHIPERTENSI PADA STROKE

AKUTAKUT

5ARA UKUR TD 35ARA UKUR TD 3Min1 .C &en"'k'ran den"an elan"Min1 .C &en"'k'ran den"an elan"2akt' -. $enit+ kiri dan kanan2akt' -. $enit+ kiri dan kananPo i i d'd'kPo i i d'd'k

TD tertin""i TD tertin""iMAP 4MAP 4 SBP I . DBPSBP I . DBP

@@


27/36

PEDOMAN PADA SI AKUTPEDOMAN PADA SI AKUT

Th8 adek'at ---- $ortalita dan $or#idita Th8 adek'at ---- $ortalita dan $or#idita T$&ak &$tera*$ ke ,a4$ TDS J 220 %%Hg ata, TDD J 120T$&ak &$tera*$ ke ,a4$ TDS J 220 %%Hg ata, TDD J 120

%%Hg%%HgB$4a o8 8,&a' %e#gg,#aka# o:at a#t$ '$*erte#8$B$4a o8 8,&a' %e#gg,#aka# o:at a#t$ '$*erte#8$8e:e4,% 8troke ---- ter,8ka#F teta*$ o:at a#t$ '$*erte#8$8e:e4,% 8troke ---- ter,8ka#F teta*$ o:at a#t$ '$*erte#8$:ar, &$t,#&a *e%:er$a##)a 8a%*a$ .-10 'ar$ *a8 a:ar, &$t,#&a *e%:er$a##)a 8a%*a$ .-10 'ar$ *a8 a

o#8eto#8et


28/36

PEDOMAN PADA SI AKUT )lan,'tan*PEDOMAN PADA SI AKUT )lan,'tan*

TDD > / $$H" --- hi&erten i e$er"en i TDD > / $$H" --- hi&erten i e$er"en i Th8 3 Th8 3 dri& kontin'dri& kontin'

nikardi&in+ diltia6e$+ ni$odi&in dllnikardi&in+ diltia6e$+ ni$odi&in dll

TDS > .@ $$H" dan8ata' TDD . - / $$H" TDS > .@ $$H" dan8ata' TDD . - / $$H"

Th8 3 Th8 3 In(' la#etalolIn(' la#etalolPilihan lain nikardi&in+ diltia6e$ dllPilihan lain nikardi&in+ diltia6e$ dll


29/36

PEDOMAN PADA SI AKUT )lan,'tan*PEDOMAN PADA SI AKUT )lan,'tan*

TDS ? -.@ $$H" dan8ata' TDD - . $$H" --------- TDS ? -.@ $$H" dan8ata' TDD - . $$H" --------- Th8 e$er"en i dit'nda ke%'ali ada 3 Th8 e$er"en i dit'nda ke%'ali ada 3

PIS+ "a"al ,ant'n"+ M5I ak't+ 77A+ ede$aPIS+ "a"al ,ant'n"+ M5I ak't+ 77A+ ede$a

&ar'+ di ek i aorta+ en e(alo&ati hi&erten i( &ar'+ di ek i aorta+ en e(alo&ati hi&erten i( 9ika TD teta& #ertahan etelah .C di'k'r den"an elan" 9ika TD teta& #ertahan etelah .C di'k'r den"an elan"2akt' G $enit 32akt' G $enit 3

Th8 3 Th8 3 La#etalol .-@C . -@ $"8hariLa#etalol .-@C . -@ $"8hariata'ata'

Ni(edi&ine $"8G ,a$Ni(edi&ine $"8G ,a$ata'ata'5a&to&ril G+. J . $"8? ,a$5a&to&ril G+. J . $"8? ,a$

TD dit'r'nkan a$&ai $ak i$al . -. MAP TD dit'r'nkan a$&ai $ak i$al . -. MAP


30/36

PEDOMAN PADA PIS AKUTPEDOMAN PADA PIS AKUT

TDS > .. $$H" ata' TDD > . $$H" TDS > .. $$H" ata' TDD > . $$H" t'r'nkan TD edini dan e%e&at $'n"kin t'r'nkan TD edini dan e%e&at $'n"kin T','an 3 $e T','an 3 $e e&e%a 9a8oge#$k ak$:at terga#gg,#)a e&e%a 9a8oge#$k ak$:at terga#gg,#)a

BBB &$ &aera' $8ke%$ 8ek$tar *er&ara'a# BBB &$ &aera' $8ke%$ 8ek$tar *er&ara'a# Ce TD Ce TD

------ %e re8$ko re:4ee&$#g ata, *er&ara'a# )a#g%e re8$ko re:4ee&$#g ata, *er&ara'a# )a#gter,8 %e#er,8ter,8 %e#er,8

------ ta*$ +,ga %e $8ke%$ &aera' 8ek$tar 'e%ato%ta*$ +,ga %e $8ke%$ &aera' 8ek$tar 'e%ato%Ma&$ a#t$ '$*erte#8$ &$:er$ka# :$4a TDS J 1 0 %%HgMa&$ a#t$ '$*erte#8$ &$:er$ka# :$4a TDS J 1 0 %%Hgata, TDD J 100 %%Hg ata, "AC J 1 5 %%Hgata, TDD J 100 %%Hg ata, "AC J 1 5 %%Hg


31/36

PEDOMAN PADA PIS AKUTPEDOMAN PADA PIS AKUT)lan,'tan*)lan,'tan*

TDS > .@ $$H" ata' TDS > / $$H" TDS > .@ $$H" ata' TDS > / $$H" Th8 3 nikardi&in+ diltia6e$+ ni$odi&in Th8 3 nikardi&in+ diltia6e$+ ni$odi&in

TDS ? -.@ $$H" ata' TDD - / TDS ? -.@ $$H" ata' TDD - /$$H" ata' MAP @ $$H"$$H" ata' MAP @ $$H" Th8 3 la#etalol+ nikardi&in+ diltia6e$+ ni$odi&in Th8 3 la#etalol+ nikardi&in+ diltia6e$+ ni$odi&inPada (a e ak't TD tdk #oleh diPada (a e ak't TD tdk #oleh di 4e:$' &a$ 20- 4e:$' &a$ 20-

25! "AC25! "ACTDS 1 0 %%Hg &a# TDD 105 %%Hg ---- t,#&aTDS 1 0 %%Hg &a# TDD 105 %%Hg ---- t,#&a*e%:er$a# a#t$ '$*erte#8$*e%:er$a# a#t$ '$*erte#8$


32/36

PEDOMAN PADA PIS AKUTPEDOMAN PADA PIS AKUT)lan,'tan*)lan,'tan*

Bila ada $onitor I5P J &ertahankan 5PP >Bila ada $onitor I5P J &ertahankan 5PP > $$H" $$H"

Ri2a!at hi&erten i ) * J TD diRi2a!at hi&erten i ) * J TD di 8a%*a$ "AC 8a%*a$ "AC 1 0 %%Hg 1 0 %%HgCa8 a o*era8$ / *erta'a#ka# "AC 110 %%HgCa8 a o*era8$ / *erta'a#ka# "AC 110 %%HgB$4a TDS t,r,# 0 %%Hg --- :er$ 9a8o*re8or B$4a TDS t,r,# 0 %%Hg --- :er$ 9a8o*re8or


33/36

FAKTOR EKSTRAKRANIAL YAN7FAKTOR EKSTRAKRANIAL YAN7

MEMPEN7ARUHI TDMEMPEN7ARUHI TD

TD da&at $enin"kat aki#at 3 TD da&at $enin"kat aki#at 3tretre

kand'n" ke$ih &en'hkand'n" ke$ih &en'h n!erin!eri re &on : iolo"i terhada& hi&ok iare &on : iolo"i terhada& hi&ok ia TIK TIK


34/36

TIPS FOR 5LINI5IAN TIPS FOR 5LINI5IAN

Ni(edi&ine '#lin"'al 'lit dira$alkanNi(edi&ine '#lin"'al 'lit dira$alkane(ekn!ae(ekn!a

TD da&at TD da&at 8e ara &ra8t$88e ara &ra8t$8"e%:a'a)aka# *er@,8$ 8ere:ra4 *a&a 8troke"e%:a'a)aka# *er@,8$ 8ere:ra4 *a&a 8troke@a8e ak,t@a8e ak,t

►►HINDARI CENGGUNAANN


35/36

STROKE AKUTSTROKE AKUT

TDS >.@ TDS >.@ TDS > .@ TDS > .@ TDS ? -.@ TDS ? -.@ TDS ? TDS ? TDD > / TDD > / TDD . - / TDD . - / TDD - . TDD - . TDD TDD

UKUR UKUR KMDKMD

TDS > .@ TDS > .@ PIS ATAU 77NPIS ATAU 77NEND OR7ANEND OR7AN

) *) * )--* )--*

ANTIHIPERTENSIANTIHIPERTENSI OBSER ASI OBSER ASI PARENTERALPARENTERAL OBAT ANTIHIPERTENSIOBAT ANTIHIPERTENSI ORAL STLH HARI -ORAL STLH HARI -


36/36

THANK YOU THANK YOU

Bila en"ka' $e$#eri dariBila en"ka' $e$#eri dariharta$'+ tiada #an!aklahharta$'+ tiada #an!aklah&e$#erian it'1&e$#erian it'1

Bila en"ka' $e$#eri dariBila en"ka' $e$#eri darihati$'+ it'lah &e$#erianhati$'+ it'lah &e$#erian!an" &en'h arti1!an" &en'h arti1

Date post:	07-Jul-2018
Category:	Documents
Upload:	auladi-lubis-
View:	221 times
Download:	0 times

Bimbingan Stroke Coass Minggu IV

Documents