Manajemen leptospirosis berat

Slides:

Advertisements

Similar presentations

D. P. Laporta MD presented to McGill Residents D. P. Laporta MD Departments of Adult Critical Care and Medicine, Sir MB Davis Jewish General Hospital McGill.

Advertisements

Jay Patel, MD CR FIRM C. Initial Evaluation What are the vitals? EKG Is this new or old? What has the rate of increase been? Is the patient mentating.

”FIRST AND FINEST” Lupus Enteritis: A Pain in the Gut LT James Prim, DO LCDR Shauna O’Sullivan, DO Naval Medical Center Portsmouth.

Ware, L. B. et al. N Engl J Med 2005;353: Physiology of Microvascular Fluid Exchange in the Lung.

The FREEDOM Study (Impact of Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances) Source Jaber BL, Schiller B, Burkart JM, et al.

III. Clinical Manifestations of Dengue and Dengue Hemorrhagic Fever CENTERS FOR DISEASE CONTROL AND PREVENTION.

Batu saluran kemih: Penyebab:

Ebola Facts October 14, Symptoms of Ebola Initial symptoms are nonspecific - may include fever, chills, myalgias, and malaise. Patients can progress.

Morning Report January 19 th, 2010 Jason Kidd.

Sumber: Human anatomy & physiology, Marieb, 6 th edition.

1 Heparin-associated 30 Day Mortality Zarychanski et al, CCM 2008;36:

Ebola Facts October 14, Symptoms of Ebola Initial symptoms are nonspecific - may include fever, chills, myalgias, and malaise. Patients can progress.

A Comprehensive Approach to Kidney Disease and Hypertension

Oct. 14 There is no evidence of bowel obstruction or dilatation. 1. Extensive axillary, mediastinal, abdominal, pelvic lymphadenopathy, as above, most.

11 Dr Foster Intelligence Variation in hospital services at weekends.

Julio A. Ramirez, MD, FACP Professor of Medicine Chief, Infectious Diseases University of Louisville Chief, Infectious Diseases Veterans Affairs Medical.

Sarah Struthers, MD March 19, 2015

Mortality Differences among Hospitalized Patients with Severe Community-acquired Pneumonia in Three World Regions: Results from the Community-Acquired.

Time – Immortal Bias in the analysis of “Influenza and COPD Mortality Protection as Pleiotropic, Dose-dependent effects of statins” by Floyd J, Frost et.

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME UPDATE IN DIAGNOSIS.

Excessive fluid is not needed: So why is Dr. Durward so wasteful? Timothy E Bunchman MD Professor & Director Pediatric Nephrology

Selected aspects of acid base physiology- acidosis in CKD

Haemofiltration for sepsis: burial or resurrection?

LSU Journal Club Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia A Systematic Review and Meta-analysis Scott Hebert,

Acute interstitial pneumonia Jason S. Vourlekis, MD Section of Pulmonary Medicine, National Naval Medical Center, Bethesda, MD, USA Clin Chest Med 25 (2004)

Simon Baudouin Senior Lecturer in Critical Care University of Newcastle.

PATHOGENESIS. The mechanisms of leptospiral pathogenesis are poorly understood; however Several candidate virulence factors have been identified that.

Ward Hagar USCF Benioff Children’s Hospital Oakland 9/10/2016.

Tantangan Penerapan EHR di Indonesia

Ebola Facts October 14, 2014.

Blood transfusion: When to transfuse and risks involved

Delayed Development of Pulmonary Hemorrhage in a Patient with Positive Circulating Anti-Neutrophil Cytoplasmic Antibody: A Clinical Dilemma Case Rep Nephrol.

The Current Diagnostic And Treatment of Vertigo

Acute Kidney Injury: An Introduction

Devices use for Neonatal AKI

Ebola Facts October 14, 2014.

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study Shen et.

HYPERTENSIVE CRISES Mini-Lecture.

Buffer transport in peritoneal dialysis

Ebola Facts October 14, 2014.

Bhandari et al. Am J Nephrol 2017;45: (DOI: / )

New options for the anemia of chronic kidney disease

HYPERTENSIVE CRISES.

Vicious Circle(s) of Hyperinsulinemia- Result in Weight Gain and Hypoglycemia Undue Or bolus Hypoglycemia Symptomatic or not!

PCP: Clinical Presentation

Study sample selection process.

Andrew Durward St Thomas NHS Foundation Trust Orlando 2017 CRRT IN AKI.

Hammoud et al. Am J Nephrol 2016;44: (DOI: / )

Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface J. Croda,

Health ABC: Mortality risk by quintile of cystatin C

Thrombolysis therapy for Pulmonary Embolism

Atelectasis, acute respiratory distress syndrome & pulmonary edema

MANAGEMENT OF PCP Dr. Akaninyene A. Otu, MBBCh, DTM&H, MPH, MRCP (UK), FWACP University of Calabar Teaching Hospital Calabar, Nigeria.

PCP: Clinical Presentation

Section 3: Prevention and Treatment of AKI

Syncope: Evaluation and Differential Diagnosis Oleh: Ira Ristinawati Pembimbing: dr. Alfa Alfin Nursidiq, Sp.JP, FIHA LLOYD A. RUNSER, MD, MPH; ROBERT.

Dr Immaculate Kariuki Consultant Paediatrician Nairobi, Kenya

Nat. Rev. Nephrol. doi: /nrneph

Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface J. Croda,

Observed 60 day mortality from ARDS Network clinical Trials from 1997 to Observed 60 day mortality from ARDS Network clinical Trials from 1997 to.

Radiological evolution of acute respiratory distress syndrome over the first week in a 57-year-old male with non-Hodgkin’s lymphoma and H1N1 infection.

Ebola Facts October 14, 2014.

Ebola Facts October 14, 2014.

Bv+Bs regimen schedule.

Serial chest x-rays of our patient.

Distribution and change of the underlying disease in patients discharged with home mechanical ventilation (n = 854). ♦: chronic obstructive pulmonary disease;

Thirty-day crude mortality (%) and adjusted weekend admission ORs (±95% CI): effect of non-availability of NEWS, increasing NEWS band and ICU transfer.

Overall and recurrence-free survival.

ICU length of stay comparing LTV and HTV mechanical ventilation in adult patients with ARDS. ARDS, acute respiratory distress syndrome; HTV, higher tidal.

Presentation transcript:

Manajemen leptospirosis berat Gangguan ginjal akut Perdarahan paru M. Hussein Gasem

Manajemen pasien Leptospirosis (3) Pasien dengan disfungsi multi-organ Terapi suportif Keseimbangan cairan dan elektrolit Diuretika pada keadaan oliguri Transfusi darah (trombosit atau PRC) Ventilator utk pasien ARDS, perdarahan paru Dialisis (hemodialisis atau peritoneal dialisis)

Tatalaksana AKI pada Leptospirosis OVERHIDRASI DEHIDRASI ATN STADIUM OLIGOURI rehidrasi diuretika forced diuresis STADIUM DIURESIS (POLIURI) STADIUM OLIGOURI DIALISIS Dwi Lestari 2007

Mortality according to treatment group Door-to-dialysis time (from ICU admission to the initiation to dialysis) Mortality according to treatment group Delayed, alternate day dialysis Prompt and daily dialysis Andrade et al. Clin J Am Soc Nephrol2:739-44, 2007

Disfungsi organ/komplikasi pada Leptospirosis berat (n: 87) # Ginjal (AKI , oligurik or non-oligurik) 87 (100) Hepar (hiperbilirubinemia / icterus) Hematologi (trombositopenia, dg/ tanpa ganguan koagulasi , DIC¥) 85 (98) Kardiovaskuler (kelainan EKG, gagal jantung, syok dll) 74 (87) Gastrointestinal (“pankreatitis” , hematemesis, melena) 16 (19) Pulmo (perdarahan paru, ARDS dll) 5 (6) Mata (perdarahan retina, uveitis) 4 (5) Serebral (gangguang kesadaran, perdarahan otak) Note: Semua dikonfirmasi dg MAT; 18 pasian dg Lepto DriDot saja. MH Gasem dkk (2008)

Pulmonary involvement Pulmonary hemorrhage has been increasingly reported Lepto patients with PH highest mortality rates (50-70%) Clinical signs vary : sudden increase of RR to impending RF ARDS, chest pain, low Hb/Ht, hemoptysis not always found Clinical manifestation as CAP  caused by Leptospira sp Pulmonary involvement Histopathology (autopsy): diffuse intra-alveolar hemorrhage with or without alveolar damage Pathogenesis is not well understood Leptospirosis pulmonary hemorrhage syndrome (LPHS) Severe pulmonary haemorrhage syndrome (SPHS)

Corticosteroid in pulmonary leptospirosis including pulmonary hemorrhage methylprednisolone 1000 mg/hari selama 3 hari, iv bolus dilanjutkan dengan 1 mg/kgBB/hari oral Shenoy et al. Postgrad Med J 2006;82:602–606