Problem 5 Kegawatdaruratan-HOTRIS

7/23/2019 Problem 5 Kegawatdaruratan-HOTRIS

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Problem

5HOTRIS A.V.405100002


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LO (Learning Obje!i"e#

1. $$. %eni& 'APSA )ara *a+ai

,o&i& - /ra&i *a+ai

om*li+a&i

e+ !er3aa* men!al - be3a"ior

2. $$. P3&ial - men!al omorbii! (a+!orre&i+o#.

. $$. 6rain i&orer &am*ai !erjai ai!ion.

4. $$. Pemeri+&aan *en/njang7 iagno&i& a8i&(!er/!ama I#7 ,,.

5. $$. Ta!ala+&ana Pili3an !a!ala+&ana

e/n!/ngan - +er/gian

9. $$. Progno&i&.


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)ommon ,r/g& o Ab/&e


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O*ioi :i!3ra;al

3!!*


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Pa!o&iologi

3!!*


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S3or! - Long Term Ce!&Heroin

3!!*


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Heroin :i!3ra;alD&Sm!om&

3!!*


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Heroin O"ero&eD&Sm*!om&


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COCCAINE
http://heroin-drug.com/


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$e!3EAm*3e!amine

S3ab/

Sympathomimetics


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e+ $e!3am*3e!amine

3!!*


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)iriEiri +e!ergan!/ngan'APJA

einginan ang !a+ !er!a3an+an/n!/+ meng+on&/m&i 1 < K a! ang!ergolong 'APJA.

eener/ngan /n!/+ meM o&i&.

e!ergan!/ngan *&i+i& a+anmenimb/l+an +eema&an7 e*re&ian gejala *&i+i& lain a*abilai3en!i+an


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GEJALA KLINISPENYALAHGUNAAN NAPZA :

Per/ba3an Ni&i+ jalan &em*oongan7 biara *elo ( ael #7 a*a!i& (

a/3 !a+ a/3 #7 mengan!/+7 agre&i. 6ila !erjai +elebi3an o&i& ( O"ero&i& # naa&

&e&a+7 en/! jan!/ng an nai lamba!7 +/li!!eraba ingin7 ba3+an meninggal. Saa! &eang +e!agi3an ( Sa+a/ # ma!a mera37

3i/ng berair7 meng/a* !er/&7 iare7 ra&a &a+i!&el/r/3 !/b/37 mala& mani7 +ejang7 +e&aaranmen/r/n.

Pengar/3 jang+a *anjang *enam*ilan !ia+&e3a!7 !ia+ *er/li !er3aa* +e&e3a!an an+eber&i3an7 gigi +ero*o&7 be+a& &/n!i+an *aalengan.


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Per/ba3an &i+a* an *erila+/ Pre&!a&i i &e+ola3 men/r/n7 !ia+ mengerja+an

!/ga& &e+ola37 &ering membolo&7 *emala&7 +/rangber!angg/ng ja;ab.

Pola !i/r ber/ba37 begaang7 &/li! ibang/n+an*agi 3ari7 mengan!/+ i +ela& a!a/ !em*a! +erja. Sering ber*ergian &am*ai lar/! malam7 !er+aang

!ia+ */lang !an*a ijin. Sering meng/r/ng iri7 berlama lama i +amar

mani7 meng3iar ber!em/ engan anggo!a+el/arga ang lain. Sering mena*a! !el*on an ia!angi orang ang

!ia+ i+enal ole3 anggo!a +el/arga ang lain. Sering berbo3ong7 min!a bana+ /ang engan

berbagai ala&an !a*i !ia+ jela& *engg/naanna7mengambil an menj/al barang ber3arga mili+&eniri a!a/ +el/arga7 men/ri7 !erliba! +e+era&anan &ering ber/r/&an engan *oli&i.

Sering ber&i+a* emo&ional7 m/a3 !er&ingg/ng7*emara37 +a&ar7 berm/&/3an *en/rigaan7

!er!/!/* an *en/3 ra3a&ia.


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Opioid

Fm/mna ig/na+an /n!/+menga!a&i neri melal/i me+ani&meee+ e*re&i *aa o!a+.

$orn &ering ig/na+an (mei*aa neri aa7 eema *ar/7 an/n!/+ menga!a&i ra&a &a+i!

berlebi3an *aa +egana&an.


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Fama!o!i"eti Ketea"#a"


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Fama!o!i"eti!a

Ketea"#a"

Ab&or*&i ,i&era* engan bai+ ari aera3 &/b+/!an anin!ram/&+/ler7 *erm/+aan m/+o&a 3i/ng a!a/ m/l/!.

,i&!rib/&i Teri+a! *aa *ro!ein *la&ma engan ani!a& berbeaEbeaon&en!ra&i !inggi *aa jaringan ang *er/&ina be&ar o!a+7 *ar/7 3a!i7 ginjal7 an lim*a.on&en!ra&i oba! i o!o! &+ele! m/ng+in rena3 mer/*a+an aangan oba! /!ama +rn !imb/nanna be&ar.Penimb/nan *aa jaringan lema+ &e!ela3 &eringiberi+an o*ioi li*o*ili+ eng an o&i& !inggi angme!aboli&mena lamba! &e*er!i en!anl.Sa;ar ara3 o!a+ +on&en!ra&i i o!a+ rela!i lebi3rena3Agen amo!eri+ (mi& morn# lebi3 &/li! men/j/ o!a+

Heroin - oeine

lebi3 m/a3 menemb/& &a;ar ara3o!a+.

$e!aboli&me O*ioi i/ba3 &ebagian be&ar menjai me!aboli! *olar ie+&+re&i+an engan &egera ole3 ginjal.Heroin i3iroli&i& ole3 3a!i 9 monoae!l mor*3inemor*3ine !er+onj/ga&i engan a&.gl/+/rona!

mor*3ine monogl/oronie an mor*3ine 9


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RSPTOR OPIOI,

Re&e*!or o*ioi ang !era*a! ialam &/&/nan&ara */&a! &ama bai+na engan ang aai&e*anjang jaringan *erier

Re&e*!or re&e*!or ini normalna i&!im/la&i ole3*e*!ia enogen (enor*3in&7 en+e*3alin&7 annor*3in i*ro/+&i /n!/+ mere&*onrang&angan ang berba3aa


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$% &'( &a#o"is mophi"e( ) OP*) $O+(morphine opioid receptors)

,i!em/+an i ba!ang o!a+7 an !3alam/& meial

Analge&ia &/*ra&*inal7 e*re&i *erna*a&an7e/*3oria7 &ea&i7 meng/rangi mo!ili!a&ga&!roin!e&!inal7 +e!ergan!/ngan &i+.

$/1 analge&ia7 e/*3oria7 3i*o!ermia

$/2 brai+ari7 e*re&i na*a&7 mio&i&7 e/oria7*en/r/nan +on!ra+&i /&/& an +e!ergan!/ngan &i+

Kappa &,( &a#o"is !etocy!-a.oci"e() OP/) KO+(kappa opioid receptors)

,ij/m*ai iaera3 limbi+7 area ien&e*3alon7ba!ang o!a+7 an &*inal or

S*inal analge&i+7 e*re&i na*a& an mio&i&73i*o!ermia


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0e-ta &1( &a#o"is de-ta2a-a"i"e2de-ta2-e%ci"e2e"!epha-i"() op3 da" do (delta opioidreceptors)

Lo+a&ina l/a& i o!a+ e+na bel/m e+e!a3/i engan bai+

,e*re&i na*a&7 i&*oria7 3al/&ina&i7 "a&omo!or&!iml/a&i

Si#ma &4( &a#o"is "2a--y-"ometa.oci"e( In3ibi&i o!o!7 &*inal analge&i+

e+ *&+omime!i+7 &*3oria7 an &!re&E e*re&i


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ALU+ 5A5ALAKSANA IN5OKSIKASIOPIU$


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Ge6a-a K-i"is

Pen/r/nan +e&aaran i&er!ai &ala3

&a!/ ari

1. Nre+/en&i *erna*a&an 128


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5i"da!a"

Penanganan +ega;a!an

6eba&+an jalan na*a&

6eri+an o+&igen 10Q &e&/ai +eb/!/3an

Pa&ang in/& e+&!ro&e 5Q emergen&i a!a/ 'a)l 07@Q

airan +oloi bila i*erl/+an

Pemberian an!io!/m nalo+&on

Tan*a 3i*o"en!ila&i o&i& a;al iberi+an 074 mg i"

,engan 3i*o"en!ila&i o&i& a;al iberi+an 1E2 mg i"


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6ila !ia+ aa re&*on& alam 5 meni! nalo+&on 1E2 mg i"

3ingga !imb/l re&*on& *erbai+an +e&aaran an 3ilangna

e*re&i *erna*a&an7 ila!a&i */*il7 a!a/ !ela3 mena*ai o&i&ma+& 10 mg.

e+ nalo+&on ber+/rang 20 40 meni! *a&ien a*a! ja!/3 +e

alam +eaaan o"ero&i& +embali &e3ingga *erl/ *eman!a/an

+e!a! !anaE!ana *en/r/nan +e&aaran7 *erna*a&an7 *er/ba3an*/*il7 an !ana "i!al lainna &elama 24 jam.

Fn!/+ *enega3an ri* nalo+&on &a!/ am*/l alam 500

,5Q a!a/ 'a)l 07@Q iberi+an alam 4 9 jam.

Sim*an &am*el /rin /n!/+ *emeri+&aan /rin an la+/+an

o!o aa.

Per!imbang+an *ema&angan TT


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Pa&ien ira;a! an i+on&/l!a&i+an +e Tim

'ar+oba 6agian Ilm/ Pena+i! ,alam /n!/+

*enilaian +eaaan +lini& an renana re3abili!a&i.

6ila *erl/7 *a&ien &ebel/mna i*a&ang 'T/n!/+ menega3 a&*ira&i.


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Pe"#o7ata"

'alo+&one

em *ar/ *emberian nalo+&on i&am*ing

o+&igen an re&*ira!or bila i*erl/+an

Hi*o!en&i airan i" ang ae+/a!7 o*amin

Pa&ien jangan ioba /n!/+ m/n!a3 (*aa

in!o+&i+a&i oral#

/mba3 lamb/ng

6ila +ejang iae*am i" 5E10 mg


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SIN0+O$ PU5US O8A5)9I5H0+A9AL SYN0+O$&SAKAU(


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Sinrom PFTFS O6AT< ;i!3ra;al&nrom (&a+a/#

9 E jam &e!ela3 o&i& !era+3ir

Se!ela3 &/a!/ *erioe 1E2 mingg/*ema+aian +on!in/


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PATONISIOLOI

Toleran&i Pemberian /lang ee+!i"i!a&

,o&i& K re&*on& &e*er!i a;al *emberian

A+!i"a&i re&e*!or $/ rea*on &el/leri3/b/ng+an engan *er/ba3an &i&!em*emba;a *e&an +e/a (&eon me&&enger&&!em#7 !erma&/+ *eng3amba! aenll

la&e - o&orila&e *ro!ein

rili& A6A*aa ba!ang o!a+

i 3 l


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:i!3ra;al &nrome3eroin

Heroin */na +emam*/an menir/ 'T !er!en!/(enor*3in an en+e*3alin# ang i*ro/+&i &earaalamia3 ole3 !/b/3

nor*3in an en+e*3alin i&e+re&i &aa! +i!a mera&a

&enang an meng3amba! !imb/lna neri A;alna 3eroin mem*er+/a!7 +arena iberi !er/&E

mener/& lamaElama !/b/3 meng/rangi *ro/+&i an&e+re&i enor*3in an en+e*3alin &am*ai &/a!/ &aa!!ia+ i&e+re&i


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gejala

ram o!o! *ara3 an neri !/lang7 iare bera!7+ram *er/!7 rinorea7 la+rima&i7 *iloere+&i7meng/a*7 emam7 ila!a&i */*il7 3i*er!en&7i!a+i+aria7 i&reg/la&i !em*era!/r (*i*o!ermia

an 3i*er!ermia#7 ber+eringa! ejala re&i/al in&omnia7 brai+aria7

i&reg/la&i !em*era!/r7 an +ean/an

ejala *ener!a +egeli&a3an7 iri!abili!a&7 e*re&i7

!remor7 +elema3an7 m/al7 an m/n!a3


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An!io!e


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3!!*


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Per!olongan *er!ama

Ra/n ang !er!elan $in/m+an &/&/7 !el/r +oo+7 &/&*en&e !erig/7

a!a/ +en!ang !/mb/+ ang il/ma!+an alam air K 5 !3 1 li!er

5 !3 2 ang+ir

Fn!/+ meng3amba! *enera*an an mengener+anra/n

Rang&ang *a&ien agar m/n!a37( +oro&i#

6eri+an *ena3ar 'a!ri/m &/la!

Per!a3an+an &/3/ !/b/3 engan &elim/!


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Ra/n ang !erin3ala&i 6a;a *a&ien 3ir/* /ara &egar

Longgar+an *a+aian ang +e!a!

6eri *erna*a&an b/a!an engan in3ala&ilang&/ng

Per!a3an+an &/3/ !/b/3 engan &elim/!

on!amina&i +/li!

6ila& +/li! engan air Siram +/li! engan air

)/i +/li! &am*ai ber&i3 engan air


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on!amina&i ma!a b/+a +elo*a+ ma!a /i engan air

mengalir &elam 5 mn!

igi!an /lar Imobili&a&i *a&ien 6eri+an an!i&er/m &*e&i+

%i+a 3ar/& i*ina3+an7 !an/ &elemb/!

m/ng+in Ra!!le &na+e /na+an !o/rni+e!7 in&i&i7 an3i&a* +iraE+ira 20 Q "enome !erb/ang alam0 mn! *er!ama


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Ra/n ang !erinje+&i (o"ero&i 6aring+an *a&ien

/na+an !o/rni+e! ari +are!

longgar+an &elama 1 mn! !ia* 15 mn!

Tar/3 +an!/ng e& *aa !*! &/n!i+an


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A'TI,OTF$


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A'TI,OTF$Zat toksik Antidotum

paraceramol N-asetil sistein

Arsen,Hg,Pb,Au BAL

Beta-blocker GLukagon

benzodiazepin Flumazemil

! !ksigen

"oumarin #it "

sianida Nitrit dan nitrat

digoksin $igoksin-%ab %ragment

met&anol etanol

&eparin protamin

'at besi de%eroksamin(NH piridoksin

narkotika nalokson

nitrit )etilen blue

!rgano%os%at dan karbamat Atropin,pralidoksim&a&


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In!o+&i+a&i *aa Ana+

In!o+&i+a&i &ering !erjai * ana+ +arena ana+2ener/ng mema&/++an &egala &e&/a!/ +em/l/!na

@2Q !erjai ir/ma37 @Q !eriri ari &/b&!an&i

!/nggal 90Q mer/*a+an &/b&!an&i nonEoba!2an7 40Q

&i&ana in!o+&i+a&i oba!

In!o+&i+a&i men/r/! /m/r 9 !a3/n +arena +eela+aan < *enganiaaan

9E12 !a3/n jarang !erjai

1E1@ !a3/n &engaja< *e+erjaan


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Renana *engelolaan in!o+&i+a&i*aa ana+

on!a+ a;al

Pera;a!an mei& a;al

Penega3an ab&orb&i $ening+a!+an e+&+re&i

"al/a&i labora!ori/m


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on!a+ A;al Tele*on

'omor !ele*on *ela*or Alama! "al/a&i bera!na +era/nan

6era! baan an /m/r Saa! menelan Ri;aa! mei& %eni& *emajanan %/mla3 *emajanan R/!e *emajanan H/b/ngan *enel*on engan *a&ien


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Pera;a!an $ei& A;al

S/r"ei Primer U#A6)

*engamanan jalan naa&7 ber&i3+an m/n!a3an7

*emberian o+&igena&i bila i*erl/+an7&!abili&a&i *ernaa&an

Sir+/la&i *enanganan &o+7 ari!mia an+on"/l&i

U#Pemberian an!io!

*! i!/na &am*ai +oni&i &!abil < i+e!a3/i*enebab in!o+&i+a&i


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Pemberian An!io!e

)O2 o+&igen 100Q < o+&igen 3i*erbari+ Sianiao+&igenAn!io!e in3aler amil ni!ri!7 lar/!an na!ri/m

ni!ri! Q7 lar/!an na!ri/m !io&/la! 25Q O*ia! nalo+&on $e!3emoglobin bir/ me!ilen Agen +olinergi+ a!ro*in

Lainna !ia+ &egera i*erl/+an7 iberi+an*a&a iagno&i& i!ega++an !anol /< in!o+&i+a&i gli+ol e!ilen


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$enega3 Ab&orb&i

T/j/an !era*i meng/rangi j/mla3 ra/n ang iab&orb&i

!/b/3

Ta!ala+&ana

me&i&

Pena3ar Arang

a!ar!i+


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1# me&i&

engan &ir/* i*e+a+ m/n!a32 3eba!*aa ana+ &/a3 m/lai !ia+ ila+/+an

,o&i& 5!3 15E0ml 7 9E12 bln 10 ml 7!ia+ /n!/+ ana+ 9bln

%alan naa& ilin/ngi g mele!a++an ana+*aa &i&i +iri engan +e*ala iba;a3

me&i& !ia+ bole3 i*i/ *aa ana+ lm+eaaan +oma7 +ejang27 menelan

a&am


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2# Pena3ar

,ig/na+an /n!/+ oba!2 angmen/r/n+an mo!ili!a& lamb/ng

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Problem 5 Kegawatdaruratan-HOTRIS

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