cell's oxygenation
DESCRIPTION
kuliah dan pengetahuan mengenai cell oxygenationTRANSCRIPT
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CO2
O2 Distribusi sirkulasi darah
O2
difusi
Ventilasi Airway
breathingparu
arteri
MAKROSIRKULASI
cair ginal
antung
ekskresi
!ena MIKROSIRKUL
"O#
O#
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Elektr$lit % &las'a
arteriole
End-venule
sel
O2
CO2
Na%
K%
"l(
Na%
K%
"l(
'it$ch$ndria
MIKROSIRKULASI
Eritr$sit
darah
Na%
"l(K%K%
Na%
"l
( A)&
A)&
perfusi
perfusi
Saluran ly'
phe
Saluran ly'pheSaluran ly'phe
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&ENDA*+L+AN&ENDA*+L+AN
,AN+SIA *ID+&,AN+SIA *ID+& A)& A)&
KO,&ENSASIKO,&ENSASI
A)& A)& ,E)A-OLIS,E,E)A-OLIS,E ,I)O"*OND.IA,I)O"*OND.IA
KO,&ENSASI )+-+*KO,&ENSASI )+-+* ADA&)ASI SEL ADA&)ASI SEL
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&ENDA*+L+AN&ENDA*+L+AN
METABOLISME PROSESMETABOLISME PROSES GLUCOSAGLUCOSA
# A)&# A)& ANAE.O-E ANAE.O-E GLUCOSA 6 PGLUCOSA 6 P
ASAM PIRUATASAM PIRUAT PROSES A!AEROBPROSES A!AEROB
PROSES AEROBPROSES AEROB ASAM LAKTAT ASAM LAKTAT ACET"#L CoAACET"#L CoA
""%% La$tat-La$tat-
)"A cycle)"A cycle
ASIDOSIS /dl' darah0 ASIDOSIS /dl' darah0
12 A)& % *12 A)& % *22O % "OO % "O22A%B 2ATP%&6 ATP &' ATPA%B 2ATP%&6 ATP &' ATP
A
BB
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ASAM LAKTATASAM LAKTAT dibawa kedibawa ke
*epar 'elalui darah*epar 'elalui darah
**%% laktatlaktat 3 3
/dala' darah0/dala' darah0
terikat *b *b"Oterikat *b *b"O## ke &aru ke &aru
( COCO22
larut Air *larut Air *##O % "OO % "O
## * *
##"O"O
11((
/.enal -uffer0/.enal -uffer0
GinalGinal
*% *"O*% *"O11((
Reabsorb
si di
tubulus
contortus
DARAHDARAHNaNa + HCO+ HCO33
(NaHCO(NaHCO33
) bufer) bufer
Keluar
bersama
urine
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4ISIOLOGI SEL 5ANG4ISIOLOGI SEL 5ANG
-E.*+-+NGAN DNG O-E.*+-+NGAN DNG O##
,IK.OSI.K+LASI,IK.OSI.K+LASI
End arteri$leEnd arteri$le SelSel EndEnd
ly'phe !enulely'phe !enule
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,IK.OSI.K+LASI,IK.OSI.K+LASI
End arteriole sel otot (olos )an*a+ vasodilatasiEnd arteriole sel otot (olos )an*a+ vasodilatasi ,, rese(tor rese(tor
sel elastis +uran vaso+onstri+sisel elastis +uran vaso+onstri+si .. rese(tor rese(tor
AORTA Sel otot (olos +uran +er/a 0ilatasi nor1alAORTA Sel otot (olos +uran +er/a 0ilatasi nor1al
Sel elastis )an*a+Sel elastis )an*a+ .. ,, rese(torrese(tor 33
End arteriole lu)an saluran dilalui sel-sel dara4End arteriole lu)an saluran dilalui sel-sel dara4
dindin saluran (ori dindin dilalui $airandindin saluran (ori dindin dilalui $airandara4dara4
(ada +eadaan tertentu E+stravasasi(ada +eadaan tertentu E+stravasasi
1ele)ar $airan dara41ele)ar $airan dara4
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Pele)aran (ori dindin vas+uler Pele)aran (ori dindin vas+uler
5Bendunan 2Peristi7a &5Bendunan 2Peristi7a &
Pd Keadaan (at4oloisPd Keadaan (at4olois
rea+si radan - "*(o8ia * "e)at9la1area+si radan - "*(o8ia * "e)at9la1a
:In;la1asi< - to8in +u1an se(sis:In;la1asi< - to8in +u1an se(sis
Lo+al in;la1ator* In;la1asi *an luasLo+al in;la1ator* In;la1asi *an luas
Res(ond S*ndro1e S*ste1i$ In;la1ator*Res(ond S*ndro1e S*ste1i$ In;la1ator*
:LIRS< Res(ond S*ndro1e:LIRS< Res(ond S*ndro1e
:SIRS<:SIRS<
Ede1a lo+alEde1a lo+al
"*(ovolu1e intra vas+uler "*(ovolu1e intra vas+uler
Aliran dara4 +e sel 1enurunAliran dara4 +e sel 1enurun
O8*en $ell 1enurunO8*en $ell 1enurun
"*(o8ia =re+7ensi den*ut /antun 1enin+at !adi 1e"*(o8ia =re+7ensi den*ut /antun 1enin+at !adi 1e
67 "$'busti$
&er'eabilitas
dinding
kapiler
'eningkat
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Stress (ada tu)u4 di)entu+ (latelet tro1)osit dara4Stress (ada tu)u4 di)entu+ (latelet tro1)osit dara4
ter/adi vaso+onstri+si o8*en sel teranuter/adi vaso+onstri+si o8*en sel teranu
!itri$ O8*de :!O< 1en$ea4 (e1)entu+an (latelet!itri$ O8*de :!O< 1en$ea4 (e1)entu+an (latelet
:Rea+si In;la1asi< 1enu)a4 vaso+onstri+si vasodilatasi:Rea+si In;la1asi< 1enu)a4 vaso+onstri+si vasodilatasi
o8*en )isa lan$ar o8*en )isa lan$ar
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Sel dara4Sel dara4 Erit4ro$*teErit4ro$*te 1elalui lu)an end1elalui lu)an end sel dara4 * lain sel dara4 * lain
arteriolearteriole
Meru)a4 )entu+ (roses in;la1asiMeru)a4 )entu+ (roses in;la1asi
:dia(edesis<:dia(edesis<
Ber/alan satuBer/alan satu22 1asu+ /arinan 1asu+ /arinan
0i antara sel0i antara sel
Mele(as OMele(as O22
ParuParu22
Meni+at COMeni+at CO22
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SELSEL
METABOLISM!E :MITOC"O!0RIA<METABOLISM!E :MITOC"O!0RIA<
O8*en dari luar Ion e+stra selO8*en dari luar Ion e+stra sel
AA
B Per;usiB Per;usiC :Perlu ATP<C :Perlu ATP<
Su((l* dara4 O>#GE! %Su((l* dara4 O>#GE! % !UTRISI!UTRISI
olu1e dara4 :Glu+osa<olu1e dara4 :Glu+osa<
") Ion Intra sel") Ion Intra sel
ATPATP
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PER=USIPER=USI perluperlu ATPATP
Ion-ion Ion-ionIon-ion Ion-ion
E8tra sel IntraselE8tra sel Intrasel ATPATP
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ATPATP ΘΘ
Perfusi terganggu gangguan Glucosa tak masukPerfusi terganggu gangguan Glucosa tak masuk
Pertukaran ionPertukaran ion ΘΘ perfusi perfusi ⊕⊕ selsel
Kompensasi tubuhKompensasi tubuh metabolisme tak berlangsung metabolisme tak berlangsung
CathecolaminCathecolamin (glucosa(glucosa ΘΘ))
Vasokonstriksi periferVasokonstriksi perifer ATPATP ΘΘ
Akral dinginAkral dingin
ShockShock
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Ganuan (er;usiGanuan (er;usi S4o$+ S4o$+
:(ertu+aran ion:(ertu+aran ion ΘΘ))
--ion intra sel tak bergerak keluarion intra sel tak bergerak keluar
!on e"tra sel tak dapat masuk sel !on e"tra sel tak dapat masuk sel
Aliran cairan dari end arteriole ke end #enule tetapAliran cairan dari end arteriole ke end #enule tetap
!on e"tra sel berkurang!on e"tra sel berkurang
Cairan intra sel lebih pekatCairan intra sel lebih pekat
$enarik cairan di sekitar$enarik cairan di sekitar
Sel menggelembung (%&sfunction) $'%Sel menggelembung (%&sfunction) $'%
Sel l&sis (ailure) $'Sel l&sis (ailure) $'
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Sel 1enele1)un 0*s;un$tion reversi)leSel 1enele1)un 0*s;un$tion reversi)le
Sel l*sis :(e$a4< =ailure irreversi)leSel l*sis :(e$a4< =ailure irreversi)le
O8*enO8*en
ATPATP Ele+trolitEle+trolit
Glu$osa :sel lain< :dari in;us<Glu$osa :sel lain< :dari in;us<
Sel 1enele1)unSel 1enele1)un
:0*s;un$tion<:0*s;un$tion<
Sel nor1al +e1)aliSel nor1al +e1)ali
O
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O8*enO8*en
ATPATP Ele+trolitEle+trolit
Glu$osa :sel lain< :dari in;us<Glu$osa :sel lain< :dari in;us<
Sel l*sis :(e$a4<Sel l*sis :(e$a4<
MO=MO=
Sel teta( l*sisSel teta( l*sis
?arinan ne+rose?arinan ne+rose
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Gl*$oenol*sisGl*$oenol*sis
((Glu$osa dara4 Kata)olis1eGlu$osa dara4 Kata)olis1e
- O8*en sel Glu$oneoenesis- O8*en sel Glu$oneoenesis
:le1a+@ (rotein tu)u4<:le1a+@ (rotein tu)u4<
Cir$ulation Breat4in Air7a* O8*en luar Cir$ulation Breat4in Air7a* O8*en luar
O8*en luar O8*en luar
Air7a*Air7a*
Ma+rosir+ulasi OMa+rosir+ulasi O22 Sel :1i+rosir+ulasi< Sel :1i+rosir+ulasi<
Breat4inBreat4in
Sir+ulasi Anato1is =isioloisSir+ulasi Anato1is =isiolois
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"*(o8ia di 1i+rosir+ulasi"*(o8ia di 1i+rosir+ulasi a+i)at anuan (ada - Oa+i)at anuan (ada - O22 su((l*su((l*
:=isiolois< - Air7a*:=isiolois< - Air7a*
- Breat4in- Breat4in
- Cir$ulation- Cir$ulation
Men*e)a)+an +e1atian Anato1isMen*e)a)+an +e1atian Anato1is
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4isi$l$gis4isi$l$gis (en*e)a) +e1atian (asien(en*e)a) +e1atian (asien Res(irator*Res(irator*
RateRate
!adi!adi TensiTensi :volu1e dara4 "*(o8ia s*ste1i$:volu1e dara4 "*(o8ia s*ste1i$
A+ralA+ral "*(o8ia siste1i+ di vas+uler< a+i)at anuan "*(o8ia siste1i+ di vas+uler< a+i)at anuan
KesadaranKesadaran "*(o+sia sentral"*(o+sia sentral Air7a*@ )reat4inAir7a*@ )reat4in
Pulse (ressure % Mean Arterial PressurePulse (ressure % Mean Arterial Pressure
Res(irator* rate entilasiRes(irator* rate entilasi
Menurun Menin+atMenurun Menin+at
+elainan s*ara; +elainan air7a* +elainan )reat4in+elainan s*ara; +elainan air7a* +elainan )reat4in
Sentral Peri;erSentral Peri;er :serat s*ara;<:serat s*ara;< Paru dd dada dia;ra1a Paru dd dada dia;ra1a
;ra+tur verte)rae $ervi$al a)do1en;ra+tur verte)rae $ervi$al a)do1en
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!adi!adi
S*ste1i+S*ste1i+
A+ralA+ral
*yp$8ia*yp$8ia:=isiolois<:=isiolois<
Sentral +esadaranSentral +esadaran
Aliran dara4 siste1i+ aliran dara4 sentralAliran dara4 siste1i+ aliran dara4 sentral
S-0 Pulse (ressure :-6<D stro+e volu1eS-0 Pulse (ressure :-6<D stro+e volu1e
TensiTensi
:Cir$ulation<:Cir$ulation< 0%59& :S-0< Mean Arterial PressureDaliran dara40%59& :S-0< Mean Arterial PressureDaliran dara4
:MAP< /antun :F- 5&<:MAP< /antun :F- 5&<
+e in/al :F-5&<+e in/al :F-5&<
:Ota+ :'- <:Ota+ :'- <
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Cir$ulation ?antun /uular vein (ressure :?P<Cir$ulation ?antun /uular vein (ressure :?P<
0indin (e1)ulu4 dara4 (e1)dr4 )esar (erdr4an0indin (e1)ulu4 dara4 (e1)dr4 )esar (erdr4an
end arteriole LIRSend arteriole LIRS
SIRSSIRS
Isi olu1e dara4 Tensi H - Pulse PressureIsi olu1e dara4 Tensi H - Pulse Pressure - Mean Arterial Pressure- Mean Arterial Pressure
Produ+si urine 7arnaProdu+si urine 7arna
/u1la4 /u1la4
K t 4 i 4 i
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Ken*ataan se4ari-4ariKen*ataan se4ari-4ari - MO0- MO0
ta+ da(at di+eta4ui diana( MO0ta+ da(at di+eta4ui diana( MO0
- MO=- MO= Tinda+anTinda+an - O8*en di(enu4i - O8*en di(enu4i
:resusitasi< - ?alan o8*en di(er)ai+i:resusitasi< - ?alan o8*en di(er)ai+i
EALUASIEALUASI
& i d& i d t
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&asien datang&asien datang di$ari +elainan ;isioloi -!adi@ a+ral@di$ari +elainan ;isioloi -!adi@ a+ral@
+esadaran+esadaran
- Tensi- Tensi
- Res(iator* Rate- Res(iator* Rate
La+u+an resusitasi H - O8*enasiLa+u+an resusitasi H - O8*enasi
- ?alan o8*en di(er)ai+i- ?alan o8*en di(er)ai+i
Evaluasi :;isioloi<Evaluasi :;isioloi<
"*(o8ia 4ilan "*(o8ia teta("*(o8ia 4ilan "*(o8ia teta(
Resusitasi lan/utResusitasi lan/ut
Sta)ilisasi +9( Suri$al resusitasiSta)ilisasi +9( Suri$al resusitasi
Pasien non trau1a di$ari +elainan ;isioloisPasien non trau1a di$ari +elainan ;isiolois
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Pasien non trau1a di$ari +elainan ;isioloisPasien non trau1a di$ari +elainan ;isiolois
Resusitasi EvaluasiResusitasi Evaluasi
Tinda+an de;initi; S*1(to1 % Sta)ilisasiTinda+an de;initi; S*1(to1 % Sta)ilisasi
SinSin
Pasien trau1a di$ari +elainan =isioloisPasien trau1a di$ari +elainan =isiolois
Resusitasi EvaluasiResusitasi Evaluasi
Tinda+an de;initi; di$ari +elainan Sta)ilisasiTinda+an de;initi; di$ari +elainan Sta)ilisasi
anato1is *ananato1is *an
tinaltinal
&engertian .esusitasi &e'enuhan $8ygen sel /'ikr$sirkulasi0&engertian .esusitasi &e'enuhan $8ygen sel /'ikr$sirkulasi0
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&engertian .esusitasi &e'enuhan $8ygen sel /'ikr$sirkulasi0&engertian .esusitasi &e'enuhan $8ygen sel /'ikr$sirkulasi0
"ara 9 ( &e'berian $8ygen ta'bahan"ara 9 ( &e'berian $8ygen ta'bahan
( &erbaikan Airway( &erbaikan Airway
( &erbaikan -reathing( &erbaikan -reathing
( &erbaikan "irculati$n( &erbaikan "irculati$n
&engertian Stabilisasi usaha agar kelainan fisi$l$gis tak teradi lagi&engertian Stabilisasi usaha agar kelainan fisi$l$gis tak teradi lagi
"ara 9 'enaga ( supplay $8ygen"ara 9 'enaga ( supplay $8ygen
( k$ndisi Airway tetap paten( k$ndisi Airway tetap paten
( k$ndisi -reathing tetap baik( k$ndisi -reathing tetap baik
( k$ndisi "irculati$n tetap baik( k$ndisi "irculati$n tetap baik
( !$lu'e darah( !$lu'e darah
( penghentian perdarahan( penghentian perdarahan
( 'enaga antung( 'enaga antung
E!aluasi penilaian ke'bali kelainan 4isi$l$gis setelah .esusitasiE!aluasi penilaian ke'bali kelainan 4isi$l$gis setelah .esusitasi
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E!aluasi penilaian ke'bali kelainan 4isi$l$gis setelah .esusitasiE!aluasi penilaian ke'bali kelainan 4isi$l$gis setelah .esusitasi
"ara 9 'enilai pasien berdasar "ara 9 'enilai pasien berdasar
( Nadi: akral hyp$8ya syste'ik( Nadi: akral hyp$8ya syste'ik
( kesadaran hyp$8ya sentral( kesadaran hyp$8ya sentral
( )ensi ( &ulse &ressure( )ensi ( &ulse &ressure
V$lu'e darahV$lu'e darah
( ,ean Arterial &ressure( ,ean Arterial &ressure
( +rine 9 ( ;arna( +rine 9 ( ;arna V$lu'e darahV$lu'e darah
( <u'lah( <u'lah
( .espirat$ry .ate Ventilasi( .espirat$ry .ate Ventilasi
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A)LS / A)LS / Ad!ance )rau'a Life Supp$rt Ad!ance )rau'a Life Supp$rt00
Pasien trau1a - (e1)erian O8*en ta1)a4anPasien trau1a - (e1)erian O8*en ta1)a4an
- (er)ai+an A@B@C Evaluasi H- (er)ai+an A@B@C Evaluasi H
disa)ilit* 0 disa)ilit* :!adi@ a+ral@disa)ilit* 0 disa)ilit* :!adi@ a+ral@
E e8(osure +esadaran@E e8(osure +esadaran@
Tensi@ urineTensi@ urine
Res( Rate<Res( Rate<
0e;initi; Suri$al0e;initi; Suri$alTera(i Re$us$itation Res$u$itation lan/utanTera(i Re$us$itation Res$u$itation lan/utan
:+alau (erlu<:+alau (erlu<
0i ATLS se1ua (asien trau1a diana(0i ATLS se1ua (asien trau1a diana(
+elainan ;isiolois+elainan ;isiolois