Rapid squences intubation pada kasus status epileptikus
https://doi.org/10.22146/bns.v18i1.55064 Desin Pambudi Sejahtera(1), Imam Rusdi(2*), Damodoro Nuradyo(3)
(1) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author
Abstract
Status epileptikus merupakan kegawatdaruratan medik yang memerlukan terapi cepat dan agresif untuk mencegah kerusakan neuronal dan komplikasi sistemik. Masalah utama dan pertama yang harus dipikirkan adalah terjaganya patensi jalan nafas. Pengetahuan dan ketrampilan mengenai tatalaksana jalan nafas merupakan keahlian yang paling dibutuhkan dalam penanganan kegawatan SE di instalasi gawat darurat. Gangguan yang terjadi pada jalan nafas akan sangat cepat berpotensi mengakibatkan kematian. Target tatalaksana jalan nafas adalah menjamin patensi jalan nafas yang ditandai tercukupinya oksigenasi dan ventilasi. Tahapan penting dalam menjaga patensi jalan nafas, melakukan manuver sederhana untuk membebaskan jalan nafas, dan memberikan ventilasi secepatnya.
Tatalaksana jalan nafas berawal dari menilai patensi jalan nafas, menilai kesadaran, dan usaha nafas yang adekuat, dengan melihat peningkatan dada, dan dengan mendengar serta merasakan hembusan udara dari mulut dan hidung pasien. Pasien dengan obstruksi jalan nafas tidak dapat mencukupi pertukaran gas yang efektif. Obstruksi jalan nafas bisa sebagian atau total. Pasien dengan obstruksi jalan nafas total, tidak akan bisa bicara, dan mengalami hipoksia, dan akan sangat cepat mengalami penurunan kesadaran. Obstruksi nafas sebagian, lebih karena fungsional, karena palatum mole, lidah, dan jatuhnya epiglotis ke belakang dan bertemu dengan pharing bagian posterior. Manuver pembebasan jalan nafas meliputi head tilt, chin lift, dan manuver jaw thrust. Terkadang manuver-manuver tersebut tidak berhasil sehingga diperlukan alat bantu seperti Oropharingeal Airway ataupun Nasopharingeal Airway. Apabila dengan alat bantu tidak tercapai target oksigenasinya, maka perlu dipasang alat bantu nafas definitif berupa pemasangan Intubasi Endotrakea metode Rapid Squences Intubation (RSI). Pemasangan Intubasi Endotrakea RSI harus memperhatikan indikasi, tahap, komplikasi, dan mempertimbangkan risiko kegagalan.
Kegagalan intubasi dapat dikenali dengan berbagai pemeriksaan sederhana. Toleransi maksimal kegagalan tiap pasien berbeda, dengan estimasi tiga kali percobaan, atau sekitar sepuluh menit.
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DOI: https://doi.org/10.22146/bns.v18i1.55064
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