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AKUT
• Obat
• Pestisida
! Cholinergic syndromes
! Anticholinergic syndromes
! Sympathomimetic syndromes
•Confusion
♦Organophosphate
•central nervous system depression
♦carbamate insecticides
•weakness
♦physostigmine, edrophonium
•salivation
♦some mushrooms
•lacrimation
•unary
•fecal incontinence
•gastrointestinal craping
•emesis
•diaphoresis
•muscle fasciculations
•pulmonary edema
•miosis
•bradycardia
•tachycardia
•seizures
The Most Common Toxic Syndromes
Anticholinergic syndromes
♦Delusions ♦Cocaine
♦Paranoia ♦amphetamine
♦Tachycardia (or brandycardia if the ♦methamphetamine (and its derivaties 3,
drug is a pure alpha-adrenergic agonist) 4-methylenedioxyamphetamine, 3, 4-
♦Hypertension methylene-dioxymethampetamine, 3,4-
methylenedioxyethamphetamine, and 2,
♦hyperpyrexia
5-dimethoxy-4-bronmoamphetamine)
♦Diaptoresis ♦over-the-counter decongestants
♦Piloerection (phenylpropanolamine, ephedrine and
♦Mydriasis pseudoephedrine)
♦Hyperreflexia In caffeine and theophyline overdoses,similar
(Seizures, hypotension findings, except for the organic psychiatric
signs, result from catecholamine release
dysrhythmias may occur in severe cases)
The Most Common Toxic Syndromes
Opiate, sedative or ethanol intoxication
Common signs Common causes
♦Coma •Narcotics
♦respiratory depression •barbiturates
♦miosis •benzodiazepines
♦hypotension •ethchlorvynol
♦brandycardia •glutethimide
♦hypothermia •methyprylon
♦pulmonary edema •methaqualone
♦decreased bowel sounds hyporeflexia •meprobamate
♦needle marks •ethanol
(Seizures may occur after overdoses of some •clonidine
narcotic, notably propoxyphene) •guanabenz
• Rute Oral : bau mulut/muntahan, luka bakar mukosa
mulut, waspadai kemungkinan kerusakan esofagus
dan lambung
• EKG
Aspek Terapi terpenting
• Antidot spesifik
• Meningkatkan ekskresi
Keadaan Klinis Yang Perlu Mendapat
Perhatian
Koma
! Kejang
! ! Henti jantung
! ! ! Henti napas
! ! ! ! Syok
Penatalaksanaan
Tindakan ABCDE
• Airway
• Breathing
• Circulation
• Decontamination
• Eliminasi
1. Stabilisasi : ABC
2. Dekontaminasi
3. Eliminasi
4. Antidotum
6. Rujukan
Stabilisasi
C. Penatalaksanaan sirkulasi
Dekontaminasi
B. Dekontaminasi mata
D. Dekontaminasi gastrointestinal :
1. Induksi muntah
2. Pengenceran
3. Bilas lambung
4. Arang aktif
5. Katartik
6. Irigasi usus
7. Endoskopi
8. Tidakan Bedah
1. Induksi muntah
• Cara :
• psn kejang
Komplikasi
Kontra indikasi :
• penurunan kesadaran
• menelan hidrokarbon
• Cara : posisi kepala miring ke kiri dan menunduk.
lindungi jalan nafas dg posisi trendellenberg dan left
lateral decubitus. pd pasien tak sadar pasang ETT.
• ileus/obstruksi GIT
Komplikasi
• konstipasi
• distensi lambung
• Alkalinisasi Urine
• Hemodialisis
• Hemoperfusi
• Dialisis Peritoneal
• arsenikum : Dimercaprol
• Amfetamin : lorazepam
• Opioid : nalokson
• Parasetamol : N-asetilsistein
• Warfarin : vit K1
• Ubur-ubur : antivenom
• jengkol : Na Bikarbonat
Penatalaksanaan Keadaan
Khusus
• Kejang : diazepam
• Koma/ stupor :
• - Dextrosa
• - Tiamin
• - Nalokson
Rujukan
• Rujukan Pasien
• Alkali
• Minyak tanah
• Karbonmonoksida
• warfarin
OVERDOSIS
Alur Tatalaksana Intoksikasi Opium
-Aloanamnesa
Intoksikasi golongan opiat -Riwayat pemakaian obat
-Bekas suntikan (Needle track sign)
-Pemeriksaan urin
Penanganan kegawatan