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TROPICAL MEDICINE (SEPSIS (Komplikasi ((Acute renal failure), ARDS,…

- - - - sepsis disertai hipotensi (TDS< 90 mmHg atau turun >40mmHg)
    - - disfungsi 2 atau lebih organ tubuh
    - - disertai disfungsi organ,hipoperfusi, atau hipotensi
    - - kumpulan gejala akibat respons sistemik terhadap inflamasi (Sistemic Inflammatory Respons Syndrome = SIRS) akibat infeksi.
    - - Sepsis disertai terapi vasopressor untuk meningkatkan MAP>65mmHg, dan Laktat >2 mmol/L dengan resusitasi adekuat
  - - - Akibat Hilang respon simpatis, mediator inflamasi, endotoksin & Nitric oxide
  - - - Fever or hyportermia (temperature > 38.3 C or < 36 C)
        
        Heart rate > 90 beats/min or > 2 SD above the normal value for age
        
        Tachpnea
        
        Altered mental state
        
        Significant edema or positive fluid balance (>20 ml/kg over 24 h)
        
        Hyperglycemia (plasma glucose > 120 mg/dl or > 7.7 mmol/l) In the absence or diabetes
    - - Leukocytosis (wbc count > 12,000/µl)
        
        Leukopenia (wbc count > 4,000/µl)
        
        Normal wbc count with > 10% immature forms
        
        Plasma C-reactive protein level > 2 SD above the normal value
        
        Plasma procalcitonin level > 2 SD above the normal value
    - - Arterial hypotension (SBP < 90 mmHg, MAP < 70, or an SBP decrease
        
        40 mmHg in adults or < 2 SD below normal for age)
        
        SVO2 > 70%
        
        Cardiac index > 3,5 l/min x M-23
    - - Arterial hypoxemia (PaO2/FiO2 < 300)
        
        Acute oliguria (urine output < 0.5 ml/kg/h or 45 mmol/1 for at least 2 h)
        
        Creatinine increase > 0,5 mg/dl
        
        Coagulation abnormalities (INR > 1.5 or aPTT> 60 s)
        
        Ileus (absent bowel sounds)
        
        Thrombocytopenia (platelet count < 100,000/µl)
        
        Hyperbilirubinemia (plasma total bilirubin > 4 mg/dl or > 70 mmol/l)
        
        Hyperlactatemia (> 1 mmol/l)
    - - Penurunan Capillary refill time
  - - - Acute renal failure
- - - - Meningitis
      - Endocarditis
      - Osteomyelitis
      - Sepsis
      - Cellulitis
      - Peritonitis