Abdul RohmanJombang, 11 Mei 1950 Keluarga : 1 orang isteri, 3 orang anak Pekerjaan : TNI AL Pendidikan : Dokter Umum 1979 (UNAIR) Pendidikan : Spesialis Paru 1994 (UNAIR)

Tingkat KemampuanDIAGNOSIS FISIK PENUNJANG RUJUK SPESIALIS GAWAT DARURATTERAPI PENDAHULUAN TERAPI LANJUTAN

LAB

RO

1 2 3A

+ + + + + + +

+ + + + +

3B4

++

++

++

+

+

++ +

Standar Kompetensi DokterRESPIRATORYUncomplicated Pulmonary TB TBC with HIV TBC with Pneumothorax Acute Bronchitis Bronchiolitis Bronchial Asthma Status Asthmaticus Lung Emphysema Atelectasis Bronchietasis 11

22

3A3A

3B3B

44

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3A 3A 3A 3A 3A 3A 3A 3A

3B 3B 3B 3B 3B 3B 3B 3B

4 4 4 4 4 4 4 4

RESPIRATORYCOPD SARS Pneumonia Avian Influenza Lung Abscess Pulmonary Embolism Lung Infarction 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3A 3A 3A 3A 3A 3A 3A 3B 3B 3B 3B 3B 3B 3B 4 4 4 4 4 4 4

Pleurisy TBCPleurisy Cancer

11

22

3A3A

3B3B

44

RESPIRATORYPleurisy Lupus Pneumothorax Cystic Fibrosis Aspiration Pneumonia 1 1 1 1 2 2 2 2 3A 3A 3A 3A 3B 3B 3B 3B 4 4 4 4

K-4

BRONKITIS AKUT

Dr. Abdul Rohman, SpP

BATASANProses radang akut pada saluran napas bawah

An inflamation of the tracheobronchial tree, usually in assosiation with generalized respiratory infectionUPPER RESP TRACT INFECTION Acute Rhinitis LOWER RESP TRACT INFECTION Acute Sinusitis Bronchitis Acute Pharyngitis Community-Acquired Pneumonia Laryngotracheitis and Epiglottitis Hospital-Acquired Pneumonia Acute Ottitis Media Pneumonia in the Compromised Host

ETIOLOGIMost commonly respiratory viruses : rhinovirus, coronavirus, influenza viruses, and adenovirus

Also : Mycoplasma pn, Chlamydia pn.,

Bordetella pertussisMay also - secondary invasion with : Haemophillus influenza, streptococcus pn

MANIFESTASI KLINIS- Self-limiting disease - Perjalanan peny : 1-2 minggu, terkadang 1 bln - Pendekatan Dx. dengan menyingkirkan :pneumoniadan infeksi influenza A

- Batuk : kering mukoid purulen - Demam (low grade ))

Trakeobronkitis : burning substernal pain very painful substernal sensation w/ cough

PENUNJANG KLINIK Lab rutin darah - Lekosit mungkin meningkat - Hitung jenis dominasi sel lekosit PMN Sputum atas indikasi - berguna untuk deteksi dini pneumonia Manula komorbid (CHF, DM)

DIAGNOSIS BANDING

ACUTE BRONCHITIS Suspected(A) HistoryPhysical examination Known history of chronic bronchitis Recent upper respiratory tract infections or no known lung disease

Acute exacerbation of chronic bronchitis Patient afebrile Normal physical examination Rales or fever 101F Chest x-ray examination

(B)

Negative

Infiltrate pneumonias

assess likehood of influenzaeHigh likelihoodConsider: Amantadine

A

Low likelihood

Low likelihood

Insignificant or nonpurulent sputum

(D)

Significant or purulent sputum

Patient otherwise healthy

Elderly patient or Patient with comorbidities

< 5 polymorphonuclear leukocytes

> 5 polymorphonuclear leukocytes

Symptomatic treatment

(E) Consider:

Antibiotics

PENATALAKSANAAN2.Non-Medikamentosa Eliminasi pencetus batuk (dust & dunder)

Hidrasi (terapi cairan)Humiditi dengan uap air Istirahat Oksigen Me kualitas patient-physician visit : - resiko pe antibiotik yang tidak perlu - durasi batuk lama 10-14 hari, dll

PENYULIT SeptikemiaPneumonia

Empiema

Abses paru

1

Nama penyakit / diagnosis :

Bronkitis Akut 20

No. ICD-X : J.

ialah proses radang akut pada saluran napas bawah. Tidak dijumpai kelainan radiologi. Penyebab tersering adalah virus. Bila berlangsung lebih dari 5 7 hari dan terjadi perubahan warna sputum perlu dipikirkan infeksi bakteri

2 Kriteria diagnosis

Demam, batuk-batuk (dari batuk kering sampai berdahak), kadang-kadang disertai sesak napas dan disertai nyeri dada Infeksi akut saluran bagian atas Bronkopneumonia TB paru napas

3 Diagnosa differential

4 Pemeriksaan penunjang 4.1. Umum

a.Foto toraks PA dan lateral b.Laboratorium rutin darah Hitung leukosit mungkin meninggi Pada hitung jenis, terdapat dominasi sel leukosit PMN c.Sputum mikroorganisme atas indikasi Sesuai komplikasi

4.2. Khusus

5 Konsultasi -Dokter Spesialis Paru 6 Perawatan - Rawat jalan rumah sakit

7 Terapi Umum 7.1. Nonmedikamentosa:

Istirahat O2 Hidrasi (terapi cairan)

7.2. Medikamentosa : Mukolitik Ekspektoran Antitusif bila perlu Antibiotika bila perlu 7.3. Terapi khusus : : Terapi inhalasi bila perlu Sesuai komplikasi

8

Standard rumah sakit :

- Tipe D

9

Penyulit 9.1. Karena penyakit

:

Pneumonia Abses Paru Empiema Septikemia

9.2. Karena tindakan 10 Informed consent 11 Standard tenaga 12 Lama perawatan - Tidak perlu : - Dokter umum : - Tak perlu rawat :

9

Penyulit 9.1. Karena penyakit :

-

Pneumonia Abses Paru Empiema Septikemia

9.2. Karena tindakan

10

Informed consent

: - Tidak perlu

11

Standard tenaga

:

- Dokter umum

12

Lama perawatan

:

- Tak perlu rawat

13 Masa pemulihan

:

- 1 minggu

14 Output

:

Sembuh total Komplikasi -

15 PA

:

16 Autopsi/ risalah rapat

:

-

17 Bidang terkait

:

Radiologi Mikrobiologi -

18 Fasilitas khusus

:

THANK YOU FOR YOUR ATTENTION ABOUT BRONKITIS AKUT

Acute bronchitis presents with acute onset of cough, frequently productive of clear or purulent sputum.

There are no specific radiographic findings in patients with acute bronchitis. The primary purpose of the chest x-ray examination is to exclude pneumonia in patients with fever and pulmonary findings on physical examination.

Influenza A virus epidemic is generally confined to winter months. During the epidemic season for influenza A, amantadine therapy should be considered for patients with acute bronchitis, especially elderly patients who are at increased risk for morbidity.

Treatment PlanPRIMARY CARE VISIT Patient presents w/ cough & symptoms of acute bronchitis

COMPLICATIONS Is bronchitis uncomplicated

Uncomplicated

Complicated

DIAGNOSISAcute bronchitis? Rule out other causes: - Pneumonia ? - Previous undiagnosed asthma? - GERD ?

TREATMENT Therapy based upon patients comorbid conditionsNo (Other Causes)

Yes (Acute Bronchitis)

See Treatment Plans Pneumonia or Asthma

CONSIDERATIONS: Common Pathogens Influenza A & B Parainfluenza Resp syncytial virus Adenovirus Rhinovirus Bordetella pertussis Mycoplasma pneumoniae Chlamydia pneumoniae

Or treat GERD appropiately

See next page for treatment

Treatment Plan (Continued)TREATMENT PHARMACOTHERAPY

Routline antibiotics are not recommended regardless of duration of cough unless pertussis is suspectedSymptomatic Pharmacotherapy Inhaled or oral bronchodilators Individualize therapy to patients w/ hyper-responsive airways (wheezing or bothersome cough) Antitussives May have moderate effect on duration & severity of cough Suspected Pertussis Perform diagnostic testing Adminsiter antibiotic therapy -Macrolide -Co-trimoxazole

TREATMENT NON-PHARMACOLOGICAL & PATIENT COUNSELING Methods of Non-Pharmacological Treatment Elimination of cough triggers (eg dust and dander) Increase fluid intake Increase humidity w/ vaporized air treatments in low humidity environments Patient satisfication should not depend on receiving antibiotic therapy but on quality of physician visit Quality of patient-physician visit may be increased by : Explaining that the duration of cough may last 10 -14 days after primary care visit Reviewing risk of unnecessary antibiotic use: -Infection w/ antibiotic-resistant bacteria -GI symptoms -Chance of allergic reactions eg anaphylaxis, rash