42033309-Gawat-Darurat.ppt

7/21/2019 42033309-Gawat-Darurat.ppt

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PENYAKIT GAWAT

DARURAT KULIT

1. Sindroma Stevens-Johnson (SSJ)

2. Nekrolisis Epidermal Toksika (NET)

3. Staphylococcal Scalded Skin Syndrome

4. em!i"#s $#l"aris


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Drug Reaction %echanism #nkno&n 'ncidence 31

23 ca#sed *ysulfonamides,penicillins+ and *loodprod#cts

Typical rashes,#rticaria+ an"ioedema+and mor*illi!orm rash

atency, &ithin 3

ho#rs to a !e&

&eeks Treatment,

discontin#e

responsi*le dr#"s


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Erythema Multiforme Tar"et lesions

E% minor vs. E% ma/or (Stevens-

Johnson syndrome)

0 delayed hypersensitivity reaction

%any etiolo"ic !actors, herpes,

mycoplasma, drugs.etc.


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Erythema Multiforme omplications

1 vis#al impairment

Evol#tion to TEN %#cosal dama"e

ne#monia, 1 o!

death Treatment, systemic

steroid5


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Typical iris lessi!ns


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Ery"#e$a M%l"i&!r$e '

(ap%lar, %r"icarial, )esic%ler "ar*e" lesi!ns inacral dis"ri+%"i!n


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INDR!MA TE"EN

#!$N!N %#&enyakit *erlep#h k#lit ak#t+ ditandai

6e/ala rodroma , sakit kepala+ demam+

atral"ia+ sakit ten""orokan T7'0S,

Kelainan kulit

Kel. sel. Lendir orifisium kel m#kok#tan

Kel. Mata

6/l konstit#si, 89 /elek


9/70Sindrom Stevens-Johnson MDL/PKD/Jan/2006


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%en"enai sem#a #sia ( :: ;-3th)+


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Manife'ta'i (lini')

6e/ala prodromal, demam+ malaise+atral"ia+ sakit ten""orok

8#lit, mak#la eritem+ pap#l+ vesikel+lesi tar"et+ p#rp#ra+ *#la dindin"kendorerosi+ ekskoriasi

Sel. lendir ori!isi#m, kr#sta hemora"ik- matakon/#n"tivitis+ !oto!o*i+ #lserasi

kornea


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Pemeri('aan *enun+ang )

>9 r#tin, E>+ lekositosis+ anemia+ eosino!ilia

8imia darah,


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Kon'ulta'i) Spesialis penyakit dalam spesialis

anak

Spesialis mata

Spesialis T?T


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Penatala('anaan)a. 9%9%, ra&at inap (kp '9)

a&asi 89 dan tanda vital atasi keseim*an"an cairan dan

elektrolit

*ila ?* tran!#si darah diet l#nak+ cair total parenteral

n#trition


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,- ITEMIK

8ortikosteroid (lihat 89), prednison -2 m"hr live savin" (parenteral+ oral)+

tapperin" o!!.

8as#s *erat@ deksametason '$ 4A;m"selama 3-1hr *ila 89 mem*aik "anti

prednison.

8as#s rin"ansedan", prednison -

m"hr (oral) dit#r#nkan secara

*ertahap.


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B*at hemostatik(kp) -- p#rp#ra l#as0nti*iotik , "entamisin+ eritromisin+

se!alosporin+ linkomisin

Simetidine

0ntihistamin

Cila demam , kompres+ antipiretik


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c- T!PIKALC#la aspirasi

esi *asah kompres

esi m#l#t, *etadine "ar"le *oraks "liserin

kenalo" in oral *ase

8on/#n"tivitis, salep mata 0CD8S


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Kom*li(a'i)1. Cronkopne#moni

2. 6a"al "in/al3. 6"" keseim*an"an elektrolit


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esic%lar and "ar*e" lesi!ns !&

EM


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S-S Ini"ial S"a*e '

(ar"ially c!n%en" ery"#e$a"!%s /i"# d%s0y cen"presen"in* as a" a"ypical "ar*e" lesi!ns


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S-S ' Ad)anced s"a*e

Generali1ed $ac%lar er%p"i!n /i"# de"ac#$en" !&

necr!"ic epider$is


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S-S ' E2"ensi)e necr!sis and er!si!ns !& "#e lipsand !ral $%c!sa


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NEKR!LII EPIDERMAL

T!KIK %NET&enyakit k#lit *erlep#h ak#t yan"

serin"kali *eraki*at !atal:: pada oran" de&asa

>id#"a ada h#* d" aler"i o*at

( s#l!a+ antikonv#lsan+ NS0'>)


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26/70

6am*ar NET

MDL/PKD/Jan/2006Nekrolisis epidermal toksik


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Manife'ta'i (lini')6/l prodromal D

tampak sakit *eratdemam

kesadaran .


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C#la tipis+ kendor+ m#dah pecah

Tanda Nikolsky D esi m#kosa, *i*ir+ oral+ anorektal

esi k#lit, eritem+ vesikel+ *#la+ erosi+

ekskoriasi+ epidermolisis+ p#rp#ra terse*arsel#r#h t#*#h 24-4 /am pen"el#pasan

spontan.

?ilan"nya epidermis : ; emeriksaan pen#n/an" SSJ


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Diagno'i' ,an.ing)SSJ

em!i"#s v#l"aris


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Penatala('anaan)

a. 9%9%

- ra&at inap (kp '9)

- a&asi 89 dan tanda vital- atasi keseim*an"an cairan-elektrolit

- *l ?*(p#rp#ra l#as)trans!#si drh

- diet l#nakcairtotal parenteral n#trisi+

diet T8T-76


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,- ITEMIK

8ortikosteroid, deksametason 4-A; m"hr+'$ (1;-2; m"hr) selama 3-;hr tapp

o!!----- prednison oral

8l 3A; m"hr (*ila 8)0na*olik

B*at hemostatik (kp)+ *ila p#rp#ra l#as

0nti*iotik "entamisin 2 A m"

Simetidine

Cila panas , kompres antipiretik


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c- T!PIKAL esi m#l#t, kenalo" in oral *ase

esi k#lit, spt pera&atan l#ka *akar

dera/at ''

- kompres Nal !isiolo"is

- tid#r den"an alas da#n pisan"


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Kom*li(a'i) Sepsis

6a"al "in/al

6an""#an keseim*an"an elektrolit

erdarahan 6'

Cronkopne#moni


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STAPHYLOCOCCALBACTERIA

StreptococcusStaphylococcus


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StreptococcusStaphylococcus

Cli i l


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Clinical

Manifestations/Disease

S8'N !ollic#litis

*oils (!#r#ncles)

car*#ncles

impetigo (bullous & pustular)

scalded skin syndrome

Neonates and children under 4 years


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ClinicalManifestations/Disease Bther in!ections

rimary staphylococcal pne#monia


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Meta'tatic Infection'Bacteremia

Osteomyelitisdisease of growing bone

#lmonary and cardiovasc#lar

in!ection


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TAP$YL!/!//AL /ALDED

KIN YMDR!ME %0&

enyakit in!eksi :: anak (F; th)

Bk. eksotoksin Staphylococc#s a#re#s

"r#p '' !a"a G1 epidermolitik


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Manife'ta'i (lini')

demam(dia&ali 'S0+ in! mata telin"a)

8#lit, eritem tim*#l mendadak di lipatan

t#*#h, leher+ aksila+ in"#inal

menyel#r#h(24 /am) 24-4 /am, *#la *esar kendor.

>lm 2-3 hr pen"el#pasan k#lit

erosi.

Tanda nikolsky D

ada lesi tdk ditem#kan k#man


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>arah dan #rin r#tin

8#lt#r dari !ok#s in!eksi

8ons#ltasi, - spesialis anak

- spesialis mata

- spesialis T?T


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Diagno'i' ,an.ing)NET

SSJ'mpeti"o *#losa


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Penatala('anaan)a. 9%9%

- ra&at inap

- a&asi 89 dan tanda vital

- atasi keseim*an"an cairan H

elektrolit


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1- ITEMIK 8#man penye*a* resisten "ol. enisilin

dan tetrasiklin.

ilihan, - >ikloksasilin 4A2; m"hr

- 8loksasilin 3A2; m"hr

- Se!alosporin 4A2; m"hr


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c- T!PIKAL 7CI lesi eks#dati!

8rim 0C

8B%'80S',

1. ne#monia

2. Sepsis


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PEM2IGU "ULGARI enyakit k#lit *erlep#h aki*at a#toim#n

yan" menyeran" k#lit dan m#kosa.

%0N'


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(EM(HIG3S

3LGARIS


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8r#sta *ertahan lama+ hiperpi"mentasi Tanda Nikolsky D

redileksi, dada+ daerah intertri"inosa+

peri#m*ilikal serta m*rn m#kosa

8el m#kosa m#l#t

Ca# spesi!ik

Ciasanya #sia 3- th


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>9 r#tin+ kimia darah+ + kadar '"6 dalam

ser#m: 1 Ciopsi k#lit+ im#no!l#oresensi

lan"s#n" dan tidak lan"s#n" ( deposit'"6 dan pada ta#t dermoepidermal)

%ikr elektron,perl#nakan semenintersel#ler


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Kon'ulta'i)

Spesialis T?T+ aler"i im#nolo"ik

Spesialis penyakit dalam

>'06NBS'S C0N>'N6,

- pem!i"oid *#losa

- SSJ

- NET


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Penatala('anaan)

a. 9%9%

- ra&at inap

- a&asi 89 dan tanda vital

- atasi keseim*an"an cairan H

elektrolit


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,- ITEMIK

8ortikosteroid, prednison -1;

m"hr (ter"ant#n" *erat rin"annya

penyakit)Tapperin" o!! dises#aikan kondisi

klinis dan kadar '"6 darah sampai

dosis pemeliharaan


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kom*inasi d" sitostatika #nt#k sparin"e!ectK (0=atioprin 1-3m"k"CC)

8l 3A ;m"hr

0na*olik (ana*olene 1A1 ta*hr)


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c- T!PIKAL

esi eks#dati! kompres esi erosi, - krim s#l!adia=in

- krim 0C *ila ada in!eksi8B%'80S',

1. sepsis+ kaheksia+ ""n keseim*an"an

elektrolit2. >r#" ind#ced dia*etes ok steroid

dosis tin""i


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G S


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PERBEDAAAN GAMBARAN KLINIS EMMINOR, SINDROM STEENS!"OHNSON,

NET

EM MINOR STEVEN

JOHNSON

NET

ET'BB6' $?S 089T BC0T BC0T

E7J00N0NENL08'T

089T+SI0S'7N0+7E897EN

089T+SI0S'7N0+E'

089T+SI0S'7N0+E'

7B>B%0 T'>08 0>0 7'N60N

0>0 0>0+ NLE7'89'T

PERBEDAAAN KLINIS EM MINOR, SS",


64/70

"NET

EM MINOR STEVEN

JOHNSON

NET

E79S' S'%ET7'S+>'SE%'N0T0

S'%ET7'S+8BNE7%'S

%98BS0 CEC0S SE>'8'T

JE0S+ 2EC'? JE0S+ 2EC'?

PERBEDAAAN GAMBARAN KLINIS EM MINOR SINDROM


65/70

PERBEDAAAN GAMBARAN KLINIS EM MINOR, SINDROMSTEENS!"OHNSON, NET

EMMINOR

STEVENJOHNSON

NET

?'STB0 8E70T'NBS'TNE87BT'8SETE%0T+ 9>E%+'NE7%'S

8E70T'NBS'TNE87BT'8SETE%0T+ 9>E%+'NE7%'S T08CE6'T9 JE0S

8E70T'NBS'TNE87BT'8SETE%0T+9>E%+ 'NE7%'S

T'>08 0>0SE>'8'T

6EJ008BNST'T9S'

T'>08 0>0 7'N60N

0>0 CE70T 0>0 CE70T

B760N>00%

T'>08 TE78EN0 80>0N6 80>0N6 SE7'N6

(ER4EDAAAN GAM4ARAN KLINIS EM MINOR,


66/70

(ER4EDAAAN GAM4ARAN KLINIS EM MINOR,SS-, NET

EM MINOR STEVEN JOHNSON NET

LAMA 1-3 %66 2-4 %66 3- %66

KOMPLIKASI T'>08 0>0 J070N6 (SET'8E%'+NE9%BN'+

E7>070?0N60ST7B'NTEST'N0+6060 6'NJ0+J0NT9N6

SE7'N6

MORTALITAS ;-1; ;-;

PENEM!"HAN T0N0079T

%9N68'N >00TTE7J0>'

PERBEDAAN NET DENGAN S#


67/70

PERBEDAAN NET DENGAN S#

NET SSSS

ETIOLO#I O!AT EKSOTOKSIN

RI$AAT

KEL"AR#A

TI%AK

MEN"NJAN#

AN##OTA LAIN&

IMPETI#O

"SIA ' () TAH"N * + TAH"N

EKSANTEM #ENERALISATA KHAS, $AJAH-

LEHER- KETIAK-

SELA PAHA


68/70

(ER4EDAAN NET DENGAN S5

NET SSSS

NERI PA%A

K"LIT

RIN#AN

SE%AN#

JELAS

TAN%ANIKOLSK

PA%A LESI J"#A PA%AK"LIT SEHAT

M"KOSA TERKENA

%EN#AN !ERAT

TI%AK

TERKENA

PERJALANAN

PENAKIT

/01 MIN##" /0( HARI



69/70


NET SSSS

TERAPI

SISTEMIK

KORTIKOSTEROI%

%OSIS TIN##I

PENISILINASE

RESISTEN

HISTOPA NEKROLISIS EPI%ERMIS

STR. !ASALIS

AKANTOLISIS-

2ELAH

S"!#RAN"LAR

MORTALITAS /+0+) 3 /01 3


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Than( You3

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42033309-Gawat-Darurat.ppt