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    Manajemen Intoksikasi Dan Keracunan Gas

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    ahmad
    The document discusses management of intoxication and gas poisoning. It defines poisons as substances that cause harmful effects when administered to living organisms. It describes various gaseous and particulate air pollutants like carbon monoxide, nitrogen oxides, and smoke. Acute toxicity results from short-term high exposure while chronic toxicity is from prolonged low-level exposure. Factors like concentration, duration of exposure, and individual health influence toxicity. Inhalation of toxins can directly injure the lungs or cause systemic effects. Treatment focuses on oxygen therapy, ventilation, and managing the underlying condition. Carbon monoxide poisoning is also explained, noting its binding to hemoglobin prevents oxygen delivery.

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    Manajemen Intoksikasi Dan Keracunan Gas

    Uploaded by

    ahmad
    68 views27 pages
    The document discusses management of intoxication and gas poisoning. It defines poisons as substances that cause harmful effects when administered to living organisms. It describes various gaseous and particulate air pollutants like carbon monoxide, nitrogen oxides, and smoke. Acute toxicity results from short-term high exposure while chronic toxicity is from prolonged low-level exposure. Factors like concentration, duration of exposure, and individual health influence toxicity. Inhalation of toxins can directly injure the lungs or cause systemic effects. Treatment focuses on oxygen therapy, ventilation, and managing the underlying condition. Carbon monoxide poisoning is also explained, noting its binding to hemoglobin prevents oxygen delivery.

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    Manajemen Intoksikasi dan Keracunan Gas

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    The document discusses management of intoxication and gas poisoning. It defines poisons as substances that cause harmful effects when administered to living organisms. It describes various gaseous and particulate air pollutants like carbon monoxide, nitrogen oxides, and smoke. Acute toxicity results from short-term high exposure while chronic toxicity is from prolonged low-level exposure. Factors like concentration, duration of exposure, and individual health influence toxicity. Inhalation of toxins can directly injure the lungs or cause systemic effects. Treatment focuses on oxygen therapy, ventilation, and managing the underlying condition. Carbon monoxide poisoning is also explained, noting its binding to hemoglobin prevents oxygen delivery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    68 views27 pages

    Manajemen Intoksikasi Dan Keracunan Gas

    Uploaded by

    ahmad
    The document discusses management of intoxication and gas poisoning. It defines poisons as substances that cause harmful effects when administered to living organisms. It describes various gaseous and particulate air pollutants like carbon monoxide, nitrogen oxides, and smoke. Acute toxicity results from short-term high exposure while chronic toxicity is from prolonged low-level exposure. Factors like concentration, duration of exposure, and individual health influence toxicity. Inhalation of toxins can directly injure the lungs or cause systemic effects. Treatment focuses on oxygen therapy, ventilation, and managing the underlying condition. Carbon monoxide poisoning is also explained, noting its binding to hemoglobin prevents oxygen delivery.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    Management of Intoxication and

    Gas Poisoning

    Mohamad Arif
    Internal Medicine Departement
    Faculty of Medicine UNISSULA Semarang
    2019
    Definition

    • poison :any substance that causes a harmful


    effect when administered, either by accident or
    by design, to a living organism.
    • toxic properties of the chemical
    • the dose administered but also on
    • individual and interspecific variation
    Air pollutan
    • Gaseous Pollutants These substances are gases at
    normal temperature and pressure as well as vapors
    evaporated from substances that are liquid or solid.
    Example:
    carbon monoxide (CO) and carbon dioxide
    hydrocarbons
    hydrogen sulfide (H2S)
    nitrogen oxides (NxOy)
    ozone (O 3 )
    and other oxidants, sulfur oxides (SxOy).
    Particulate Pollutants :
    Fine solids or liquid droplets can be suspended
    in air.
    1. Dust. Relatively large particles about 100 μm that come
    directly from substances being used (e.g., coal dust, ash,
    sawdust, cement dust, grain dust).
    2. Fumes. Suspended solids less than 1 μm in diameter usually
    released from metallurgical or chemical processes (e.g., zinc
    and lead oxides).
    3. Mist. Liquid droplets suspended in air with a diameter less
    than 2.0 μ m (e.g., sulfuric acid mist).
    4. Smoke. Solid particles (0.05 – 1.0 μ m) resulting from
    incomplete combustion of fossil fuels.
    5. Aerosol. Liquid or solid particles ( < 1.0 μ m) suspended in
    air or in another gas.
    Acute vs chronic toxicity

    • acute toxicity can be defined as toxicity elicited


    immediately following short - term exposure to a
    chemical
    • High - level, short - term exposure pollutant
    • In contrast to acute toxicity, chronic toxicity is
    characterized by prolonged exposure and sub-lethal
    effects elicited through mechanisms that are
    distinct from those that cause acute toxicity.
    factors affecting inhalation
    toxicity:
    • Agent:
     concentration of inhaled toxin,
     duration of exposure, enclosed space,
     particle size and water solubility
    • Host :
     elderly or younger patients
     allergic or nonallergic bronchospastic response,
     exertional state or metabolic rate of the victim,
     history of smoking
     underlying lung debilitating illness, particularly underlying
    reactive airway
    Pathogenesis inhalation toxicity

    • may directly injure the pulmonary epithelium at


    various levels of the respiratory tract
    • wide range of disorders from tracheitis and
    bronchiolitis to pulmonary edema.
    • They may also resulting in systemic toxicity.
    • Thus, determining the mechanism of respiratory
    insufficiency, whether it is a result of direct injury
    of respiratory tract or systemic toxicity, is difficult.
    Inhalasi bahan toksik
    Akut : ALI /ARDS
    Efek lokal
    Aldehid Kronik :
    Nitrogen dioksida Fibrosis
    Asma
    Bronkiektasis,
    PPOK

    Efek sistemik : Karbon monoksida, Klorin


    Inhalasi agen toksik

    Kronik Akut

    Penyakit paru obstruksif Iritasi mukosa


    Asma/Rhinitis Erosi mukosa
    Bronkiektasis Keruskan mukosa
    Fibrosis Pneumonitis

    ALI/ARDS
     Acute Respiratory Distress Syndrome
    (ARDS)

    Adalah suatu sindroma gagal nafas


    akut akibat kerusakan sawar membran
    kapiler alveoli , sehingga menyebabkan
    edema paru akibat peningkatan
    permeabilitas.
    Bentuk ARDS yang lebih ringan adalah
    ALI (acute lung injury).
    Inhalasi bahan toksisk
    Analisa gas darah
    12-24 jam Hipoksemia menetap
    PO2 < 60 mmhg
    PO2/FiO2 < 200
    AADO2 > 300
    Distres pernafasan
    Perburukan sesak nafas
    Takipneu X R Thorak
    Infiltrat difus bilateral

    ARDS
    Tekanan baji kapiler paru/PCWP < 18
    mmhg
    ALI jika PO2/FIO2 200-300 mmhg
    Gejala klinis

    • Takipneu
    • Retraksi intercostal
    • Ronki baasah kasar
    • Hipotensi
    • Febris
    • Gagal multi organ
    Traum Kerusakan alveolar/endotel vaskuler
    a
    Aktivasi kaskade inflamasi

    Inisiasi : pelepasan mediator inflamasi ke paru


    dan sistemik
    Amplifikasi: Netrofil teraktivasi tertarik ke
    dan tertahan di paru
    Injuri: Netrofil melepaskan mediator inflamasi
    merusak paru dan merangsang inflamasi

    Kerusakan membran alveolar-kapiler


    Kerusakan membran alveolar-kapiler

    Peningkatan permeabilitas
    membran
    Aliran cairan ke alveoli

    Kerusakan surfaktan dan alveoli lanjut:


    1. Fase eksudatif
    2. Fase proliferatif
    3. Fase fibrosis
    Eksudatif :
     Edema interstisial dan alveolar
     Nekrosis sel pneumosit
     Terlepasnya membran hialin
     Pembengkakan sel endotel
     Pembentukan membran hialin
     Hipertensi pulmoner

    Proliferatif: proliferasi sel epitel pneumosit

    Fibrosis : peningkatan kolagen terbentuknya


    fibrosis
    Kriteria Diagnosis ARDS:

    1.Riwayat pencetus.
    2.Hipoksemia refrakter dengan terapi oksigen
    PaO2/FiO2 <200 .
    3.X Foto thorak : infiltrat bilateral difus.
    4.Tidak ada gejala edema paru kardiogenik
    dan tekanan baji ≤ 18 mmHg.
    Penatalaksanaan ARDS
    1. Terapi oksigen
    2. Intubasi dan ventilasi mekanis
    3. Terapi untuk memperbaiki oksigenasi
    - Vasodilator a. pulmoner ( nitrit okside, prostasiklin )
    4. Terapi pengganti surfactan
    5. Terapi anti inflamasi : Glukokortikoid
    6. Tatalaksana umum :
    - Optimalisasi hemodinamik : terapi cairan, koreksi
    anemia
    - Nutrisi : enteral feeding
    7. Terapi penyakit dasar
    Keracunan karbonmonoksida (CO)

    • Gas yang tidak berwarna, tidak berasa, tidak


    berbau,tidak mengiritasi
    • Pembakaran di ruangan tertutup atau dari asap knalpot
    mobil/motor
    • Batas paparan yang diperbolehkan 35 ppm 8 jam/ hari
    kerja
    • Paparan 1000ppm dalam beberapa menit dapat
    menyebabkan pembentukan COHb 50%
    CO

    Berikatan dengan Hemoglobin 250x lebih kuat dari


    O2

    O2 terlepas dari Hemoglobin COHB

    Pasokan O2 turun Interaksi protein heme

    Kurva penguraian HbO2 bergeser


    kekiri
    Pengurangan pelepasan O2 dari
    Hipoksia darah kejaringan
    Keracunan karbonmonoksida (CO)

    enzim sitokrom oksidase


    CO

    Oksidasi mitokondria ATP


    Gejala klinis
    Akut
    1. Ringan ( COHb : 10-30 %): Sakit kepala daerah
    temporal, sesak, pusing
    2. Sedang ( COHb : 30-50 % ) :Nyeri kepala hebat,
    kelelahan, pusing,mual, muntah, sinkop, takikardia,
    takhipnea
    3. Berat ( COHb : 50-80 % ) : Sinkop, kejang, koma,
    gangguan kardiovaskuler, kematian

    Kronik
    Parestesi jari-jari, memori menurun, Romberg sign +,
    perubahan mental

    Pulse Oksimetri akan tampak normal karena COHb memiliki


    spektrum serapan yang mirip dengan oksihaemoglobin.
    Management CO toxicity

    • avoid CO gas exposure


    • CO is only removed from the body through
    displacement by O2; therefore use high
    concentrations of oxygen
    • Raise the PaO2 as high as possible, intubate and
    100% O2 if necessary

    Oxford Handbook of Respiratory Medicine, 1st Edition


    Terima kasih

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