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Reactions/Anaphylaxis
Emergency Response Team Sumbawa 2016
Anamnesis
Tn. M/24 tahun
Ps datang post disengat tawon 5 jam yang
lalu, bentol kemerahan disertai gatal (+)
Muntah (+) nyeri perut (+) , sesak napas (-)
kepala pusing (+)
Pem fisik
1. Primary survey
A : Clear, patent
B : Spontan, simetris, nafas cepat, RR: 23x/menit
C : Nadi kuat angkat, 112x/menit, akral hangat
D : GCS 15 (E4M6V5)
2. Secondary Survey
GCS = E4M6V5, TD : 120/60 mmHg, Nadi : 112 x/menit, RR : 23
x/menit, S : 36.9oC
Leher : JVP tidak meningkat
Jantung : Ictus cordis (-), batas jantung normal, S1-2 normal, murmur (-),
gallop (-)
Paru : pergerakan dada simetris, vesikuler +/+, rhonki -/- , wh -/-
Abdomen: soepel, nyeri tekan (+)
Ekstremitas : akral hangat, CRT<3 tungkai edem (-), urtikaria (+)
Tatalaksana Awal
Pasien ditempatkan di critical care
(P1)
NK 02 2 lpm
Pasang monitor
IVFD RL guyur
Planing
Cek GDS : 110 mg/dl
Lab lengkap: DL
Working Diagnosis
Anaphylaxis Reactions
Tatalaksana
IVFD RL 1 liter
Inj. Ranitidin 1 amp iv
Inj. Ondansetrone 1x8 mg iv
Inj Difenhidramin 2 amp iv
Inj Dexametason 2 amp iv
Inj Adrenalin 0,3 cc IM
Observasi 2-3 x 24 jam pada kasus anafilaktik,
Kasus ringan obsv 6 jam (Berikan steroid dan
antihistamin oral 3 x 24jam)
Anaphylaxis: a severe, potentially fatal, systemic allergic
reaction. The following scenarios constitute anaphylaxis:
1. The acute onset of reaction (min-hours) with
involvement of the skin, mukosal tissue or both and at least
one of the following;
a. Respiratory compromise (dyspnoes, stridor, wheeze),
b. Reduce blood pressure.
2. 2 of the following occur rapidly after exposure:
Involvement of skin/mucosal tissue
Respiratory compromise
Reduce BP
Persistent GE symptoms (eg crampy abd pain, vomiting)
3. Reduce BP after exposure