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PENATALAKSANAAN EPISTAKSIS

PENATALAKSANAAN EPISTAKSIS. Umar Said Dharmabakti Bagian THT FKUI RS Dr. Cipto Mangunkusumo Jakarta. ETIOLOGI. FAKTOR LOKAL TRAUMA NEOPLASMA Deviasi Septum Reaksi inflamasi lokal: alergi, infeksi, polip, iritasi Benda asing . FAKTOR SISTEMIK HIPERTENSI GGN. PEMBEKUAN DARAH

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PENATALAKSANAAN EPISTAKSIS

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  1. PENATALAKSANAANEPISTAKSIS Umar Said Dharmabakti Bagian THT FKUI RS Dr. CiptoMangunkusumo Jakarta

  2. ETIOLOGI FAKTOR LOKAL • TRAUMA • NEOPLASMA • Deviasi Septum • Reaksi inflamasi lokal: alergi, infeksi, polip, iritasi • Benda asing FAKTOR SISTEMIK • HIPERTENSI • GGN. PEMBEKUAN DARAH • Obat-obatan • Osler-Weber-Rendu • Lainnya: alkoholisme, demam tifoid, demam rematik, ggn. kardiovaskuler 10% Kasus IDIOPATIK

  3. AnatomiPembuluhDarahSeptum & Dinding Lateral Hidung

  4. Blood supply of the Nose

  5. BAGAN ALIR PENATALAKSANAAN EPISTAKSIS RESUSITASI (Jika Diperlukan)

  6. BAGAN ALIR PENATALAKSANAAN EPISTAKSIS

  7. Pemeriksaan Fisik THT

  8. Penatalaksanaan Perdarahan Septum Ringan • AsaldaripleksusKiesselbach • Banyakpadaanak • Berhentispontan • Cara sederhana • Duduk • Tenang • Pijithidung • 10 menit

  9. IDENTIFIKASI SUMBER PERDARAHAN • SumberperdarahanTIDAK TAMPAK • BekuandarahbersihkanHISAPdgnpompapenghisap • Tampon kapas adrenalin 1/10.000 + lidokain 2 % VASOKONSTRIKSI • Berhentisementara LOKALISIRsumberperdarahan • TIDAK BERHASIL  NASOENDOSKOPI (jktersedia)

  10. MENGHENTIKAN PERDARAHAN • PilihanUtama: KAUTERISASI • Perak Nitrat 30-50% • “Albothyl” • Kauterelektrik • Daerah yang dikauter • PleksusKiesselbach • Mukosasumberperdarahan • Mukosa area for. sfenopalatina • Arterisfenopalatina

  11. Teknik Kauterisasi Pleksus Kiesselbach

  12. Kauter / ligasi A. Sfenopalatina • Kauterisasi / Ligasi • Ujung terdistalsuplaipembuluhdrhronggahidung • Menurunkantekanan & alirandrh mel arteri & cabanganastomosis • Tekniklebihmudah

  13. Epistaksis tdk berhenti • NE tdk tersedia --> Bagan Alir

  14. Tampon gulung / kapasvaselin-betadin / BIPP • Murah • Abrasi/laserasimukosawaktumemasang & mengangkat • Tidaknyaman

  15. Tampon anterior • Tampon gulung / kapas • vaselin-betadin / BIPP • Murah • Abrasi/laserasimukosawaktumemasang & mengangkat • Tidaknyaman

  16. Merocel (kapasspons)

  17. Merocel (kapasspons)

  18. Tampon Posterior Buat tampon posterior Masukkan katerer dr hidung ke mulut

  19. Tampon Posterior Ikat tampon dan tarik Letakkan tampon di nasofaring

  20. Tampon Posterior

  21. Tampon Posterior • Kateterfoley • Balonisiudara/air • Fiksasidgn tampon anterior • Tekanantdkmerata menutupkoana

  22. Tampon gel hemostatik + balon (Rapid RhinoR) Menginduksi bekuan darah fisiologis ~ agregasi platelet aktif Balon u/ menekan perdarahan

  23. Embolization • Embolisation of the internal maxillary artery is effective and safe. • It was initially reserved for patients in whom surgery failed, although recent literature supports embolisation as first-line treatment in specified cases because of safer procedures and increased experience

  24. TERAPI KAUSA

  25. TERAPI KAUSA • Sesuai dengan ETIOLOGI • Mencegah REKURENSI • Krim AB • Kontrol hipertensi • Rujukan dini ke Hematologi • Terapi bedah spesifik: SMR / septoplasti, dermoplasti, ekstirpasi tumor

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