Tatalaksana syok septik dengan infeksi intraabdomen et causa perforasi gaster di ICU

Dhanu Pitra Arianto, Suwarman Suwarman

Abstract


Latar belakang: Syok septik didefinisikan sebagai bagian dari sepsis didasari oleh gangguan sirkulasi dan sel atau kelainan metabolik yang akan meningkatkan angka mortalitas secara bermakna.Laporan kasus: Laki-laki, 69 tahun, diagnosa syok septik dengan infeksi intrabdomen e.c. perforasi gaster dirawat di ICU setelah dilakukan operasi laparatomi eksplorasi. Pasien mendapatkan tindakan perawatan  dengan manajemen sepsis bundle segera setelah diagnosa ditegakkan, menjalani perawatan di icu selama tujuh hari. European Society of Intensive Care Medicine (ESCIM) pada tahun 2018 memperbaharui sepsis bundle dimana dari semua langkah perawatan sepsis awal yang sebelumnya harus diselesaikan dalam 3 dan 6 jam sekarang harus diterapkan dalam 1 jam (1-h bundles), segera setelah diagnosa sepsis ditegakkan. Pada kasus ini pasien dengan keluhan nyeri perut selama satu minggu sebelum masuk rumah sakit, pemeriksaan penunjang darah laktat 4,2 mmol/L, pemeriksaan rontgen abdomen terdapat pneumoperitonium, dilakukan sepsis bundle dalam 1 jam dan laparatomi emergensi. Perawatan dilanjutkan di ICU dengan antibiotik meropenem, support norepineprin dan ventilasi mekanik. Pasien berangsur pulih selama di ICU, ditandai dengan klinis, hasil penunjang laboratorium, dan rontgen yang membaik.Kesimpulan: Pada manajemen pasien sepsis, waktu sangatlah penting. Kecepatan diagnosis, pemberian antibiotik, dan menjaga kestabilan hemodinamik adalah komponen penting untuk mendapatkan luaran yang baik.  


Keywords


Sepsis; syok septic; sepsis bundle; infeksi intraabdomen

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DOI: http://dx.doi.org/10.24912/tmj.v2i2.7861

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