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terapi cairan
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7/21/2019 Terapi cairan 2
http://slidepdf.com/reader/full/terapi-cairan-2-56d9cf58caafa 1/22
T e r a p i c a i r a n
Meiki permatasari
Pembimbing : dr. H. imam ghozali, Sp.
An
KOAS SMF AAST!S"#$MAH SAK"T P!#TAM"A %"TA& AM"
H$SA'A
7/21/2019 Terapi cairan 2
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7/21/2019 Terapi cairan 2
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7/21/2019 Terapi cairan 2
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KOMPA#T!M! (A"#A T$%$H
)*+ "T#AS!$A#
"T!#-ASK$A#+
"T!#T"S"A/+
7/21/2019 Terapi cairan 2
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7/21/2019 Terapi cairan 2
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Tekanan 0ang mempengar1hipergerakan cairan
Tekanan osmotik plasma : 23mOsm4
7/21/2019 Terapi cairan 2
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i5 is ic
i5
is ic
7/21/2019 Terapi cairan 2
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si6at si6at cairan
NaCl 3%,
Manitol 10%
a(l *,7+,#inger laktat
'e8trose +
7/21/2019 Terapi cairan 2
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increases ECFincreases ECF
ICF ISF PlasmaICF ISF Plasma
Replace acute/abnormalloss
Replace acute/abnormalloss
Isotonic infusionIsotonic infusion
7/21/2019 Terapi cairan 2
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increases ICF > ECFincreases ICF > ECF
ICF ISF PlasmaICF ISF Plasma
Replace Normalloss (IWL + urine)
Replace Normalloss (IWL + urine)
!potonic!potonic
7/21/2019 Terapi cairan 2
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increases I"Fincreases I"F
ICF ISF PlasmaICF ISF Plasma
Restrict#ui$
Restrict#ui$
!pertonic infusion!pertonic infusion
7/21/2019 Terapi cairan 2
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Si6at si6at cairan
&ela61ndin,e8pa61sin,plasma61sin,haemaccel,
haes steril 9+
'e8tran ,de8tran *, haessteril /*+,
7/21/2019 Terapi cairan 2
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7/21/2019 Terapi cairan 2
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Keb1t1han cairan
• )ml4kg%%4;am : /* kg pertama
• 2ml4kg%%4;am : /* kg ked1a
•/ml4kg%%4;am : sisa berat badanselan;1tn0a
(ontoh : <anita bb )* kg keb1t1han cairan per hari =)ml8/* kg "> )*
2ml8/*kg ""> 2*/ml82*kg sisa> 2*
total > 3* ml4;am ??? 3*ml 8 2) ;am > /72*4hari
7/21/2019 Terapi cairan 2
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'!H"'#AS"
O1tp1t@@inp1t, dan ter;adigangg1an keseimbangan
elektrolit.
7/21/2019 Terapi cairan 2
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'era;at dehidrasi%e&ala $e'sit Rinan *,
--
Se$an .* ,
--
-erat
>01,--
T1rgor k1lit
idah
Mata
$b1n 1b1n
#asa ha1sadi
Tensi1rin
normal
M1kosa lidahkering
ormal
ormal
Takikardi
T1r1npekat
M1n1r1n
1nak, kering
(ek1ng
(ek1ng
Takikardi, nadilemah
ebih t1r1nPekat danprod1ksimen1r1n
Sangatmen1r1n
Kecil kerip1t
Sangat cek1ng
Sangat cek1ng
???nadi s1litdiraba, sianosis,akral dingin
Tak ter1k1ran1ria
7/21/2019 Terapi cairan 2
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Re2i$rasi
B1mlah cairan 0angdiberikan: dera;atdehidrasi C+D 8 kg%% 8
/***ml
Bika dehidrasi berat Cs0okD :pertama tama di g101r2*cc4kg%% /?E* menit de<asa,E*?9* menit anak anak
(!K A'" ??? B"KA A'!K$AT, STOP.&AT" MA"T!A(! C 2?/ D
2/
B"KA T"'AK M!M%A"K, $A&" A&"
H"&&A A'" T!#A%A K$AT
*+ 3 BAM P!#TAMA*+ /9 BAM %!#"K$TA
7/21/2019 Terapi cairan 2
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(ontoh : de<asa 9* kg, nadi s1lit di raba, akral dingin, mata cek1ng,tidak ma1 min1m.
'inilai dari ge;ala mer1pakan dera;at dehidrasi berat /*+.&101r 2* cc 8 9* kg > /2** cc4 /?E* menit,nilai nadi ;ika blmadek1at. $langi lagi sampai teraba adek1at. Bika s1dah adek1at STOP.%erikan cairan maintenanceHit1ng cairan 0ang har1s diberikan > /*+ 8 9* 8 /*** ml > 9*** cc
9***cc G /2** cc > )3** cc3 ;am " > 2)**cc, /9 ;am "" > 2)**cc
Selan;1tn0a berikan cairan maintenance ),2,/Kg " > )ml 8 /*kg > )*Kg "" > 2ml 8 /*kg > 2*
Kg sisa > /ml 8 )*kg > )*total > /** cc4 ;am. 2)**cc4hari
7/21/2019 Terapi cairan 2
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Terapi cairanPerioperati6 : 2ml4kg%%4;am p1asa
(ara pemberian : *+ dalam / ;ampertama2+ dalam / ;am ked1a2+ dalam / ;am ketiga
(ontoh : laki laki %% * kg, p1asa 3 ;am
2ml 8 * kg 8 3 ;am p1asa > //2* cc/ ;am pertama > 9*/ ;am ked1a > 23*/ ;am ketiga > 23*
1ka bakar : )cc 8 kg%% 8 l1as l1ka bakar(ara pemberian : *+ cairan total dalam
3 ;am pertama dan sisan0a /9 ;amberik1t n0a
(ontoh : peremp1an * kg, l1as l1kabakar 2*+)cc 8 * kg 8 2*+ > )***
3 ;am pertama > 2***/9 am berik1tn a > 2***
7/21/2019 Terapi cairan 2
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3urante operasi 4%eri tambahan cairan ses1ai dengan perdarahan 0ang
ter;adi'itambah dengan koreksi cairan ses1ai perhit1ngan cairan0ang hilang berdasarkan ;enis operasi
5enis operasi
Operasi kecil : 2?) ml4kg%%Operasi sedang : )?9 ml4kg%%Operasi besar : 9?3 ml4kg%%
6ore7si per$ara2an selama operasi•Perdarahan 2*+ dari perkiraan 5ol1me darah > berikankristaloid seban0ak 2 G E 8 ;1mlah perdarahan ata1 koloid
0ang ;1mlahn0a sama dengan perkiraan ;1mlahperdarahan ata1 camp1ran kristaloid koloid
•Perdarahan @ 2*+ dari perkiraan 5ol1me darah > tran61si
E-" (estimasi bloo$8olume )'e<asa : * ml4kg%%
Anak : 3* ml4kg%%eonat1s : 3?7*
7/21/2019 Terapi cairan 2
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(ontoh :Peremp1an de<asa * kg, men;alani operasi laparoskopi. amaoperasi E ;am. Kehilangan darah ** cc.
Ba<ab : 5enis operasi besar 4 3ml 8 * kg > )** cc4;am > )** 8 E ;am >/2** cc cairan hilang berdasarkan ;enis operasi
6ore7si per$ara2an !an ter&a$i selama operasi 4!%- > *ml 8 * kg > E** cc, 2*+ dari E** cc > ** ccKehilangan darah ** cc, berarti 2*+ !%-Maka :%erikan terapi cairan kristaloid E 8 perdarahan **cc > /** cc
Ata1 :
Terapi koloid 0ang ;1mlah n0a sama dengan perdarahan.
Ata1 : Terapi camp1ran koloid dan kristaloid
7/21/2019 Terapi cairan 2
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T ! # " M A K A S " H
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