KERACUNAN

1/26/2018
DEFINISI :
Adalah kejadian dimana organisme hidup kontak dengan zat
beracun dan mempengaruhi fungsi organisme mahluk hidup
tsb.
Toxicology:
Ilmu yang mempelajari efek yang kurang baik dari racun pada
mahluk hidup/organisme hidup

What is a Poison?
All substances are poisons;
there is none that is not a poison.
The right dose
differentiates a poison and a remedy.

Paracelsus (1493-1541)
1/26/2018 IRD RS. Saiful Anwar Malang
 The study of the adverse effects of a
toxicant on living organisms
• Adverse effects
– any change from an organism’s normal state
– dependent upon the concentration of active compound
at the target site for a sufficient time.
• Toxicant (Poison)
– any agent capable of producing a deleterious response
in a biological system
• Living organism
– a sac of water with target sites, storage depots and
enzymes

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 Dose
The amount of chemical entering the body
This is usually given as
mg of chemical/kg of body weight = mg/kg
The dose is dependent upon
* The environmental concentration
* The properties of the toxicant
* The frequency of exposure
* The length of exposure
* The exposure pathway

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 Exposure: Pathways
• Routes and Sites of Exposure
– Ingestion (Gastrointestinal Tract)
– Inhalation (Lungs)
– Dermal/Topical (Skin)
– Injection
• intravenous, intramuscular, intraperitoneal

• Typical Effectiveness of Route of Exposure

iv > inhale > ip > im > ingest > topical
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 Exposure: Duration
Acute < 24hr usually 1 exposure
Subacute 1 month repeated doses
Subchronic 1-3mo repeated doses
Chronic > 3mo repeated doses

Over time, the amount of chemical in the

body can build up, it can redistribute, or it
can overwhelm repair and removal
mechanisms IRD RS. Saiful Anwar Malang
1/26/2018
Pendekatan pada keracunan
• Pre-hospital :
- Din-Kes + BPOM – Elemenasi dan source
kontrol.
• Hospital
- Personal oleh Yan-med terkait.
- Massal Yan-med terkait dan Din-kes.

1/26/2018 IRD RS. Saiful Anwar Malang

Prehospital
• Setiap kasus keracunan yg bersifat KLB/
masal. Harus termonitor oleh Din-kes –
Kemenkes. ( kadang melibatkan BPOM ).
• Penangganan korban di lakukan di Faskes
mulai Pusk – RS.
• Kontrol Sumber Bahan pemapar oleh
Dinkes&BPOM dan kadang Kepolisian.

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Hospital
• Biasanya masuk lewat IGD, di antar
maupun datang sendiri.
• IGD harus punya sistim penangganan
pasien suspect Keracunan/Keracunan.
• RS- membuat laporan ke Dinkes ( kalo
belum, dan bahan pemapar di kirim ke
BPOM/Lab Keracunan.
• Di Intra RS biasanya melibatkan Multi
disiplin.
1/26/2018 IRD RS. Saiful Anwar Malang
 Dekontaminasi di RS
• Kata kunci :
“ Decontamination must be done immediately
and must be done right “

With chemical agents ...

... must remove victim
from the agent source • Do it fast
... must remove agent
from contaminated
personnel
• Do it right
 Decontmination
• Protect the patient from continued injury due to residual agent
• Protect the health care providers
• Protect the facility and allow it to continue to function
How ?
• Reduction of contamination
• Eliminating, or reducing, harmful effects

With Method Based On Principles :

• Destroy agent through chemical change
• Remove agent
• Physically shield agent
UNIVERSAL DECONTAMINATION PROTOCOL

1. Remove clothing quickly and seal in plastic impervious bags (save for
authorities). Strongly recommended even if exposure only to vapor or aerosol
agent.
2. Wash skin and shampoo with hypoallergenic liquid soap and copious tepid water
in sequential steps of rinse, soap, rinse, wait one minute, then final additional
rinse (20 minutes).
3. Latent response from cyanide or pulmonary agents do not require
decontamination.
4. Decontamination waste water may require special collection or treatment.
(Discuss with local water authorities; notify local water
authorities at the time of an event.)
5. Pure metals and strong corrosives require dry decontamination (i.e., gentle
brushing or vacuuming of larger particles) before water is
applied.
6. Clean and decontaminate the healthcare facility according to the specific agent
involved.
DEFINITIONS AND ASSUMPTIONS

• First responder
• Traditionally fire/EMS/Hazmat/law enforcement
• Typically act at the site of a release (incident)
• First receivers
• Typically include personnel in the following roles:
– Clinicians and other hospital staff that have a role in
receiving and treating contaminated patients
(decontamination, triage, medical treatment, and
security)
• Hospital is distant from the incident
– Thus the exposure of first receivers is limited to the
amount of contaminate on the victims, their clothing
and personal effects
Assumptions
• Transport of victims from the scene
• Decontaminated in the field to what extent?
• Serious patients will be transported after the masses
arrive at the hospitals
 Most Common Caused :
• Accidentally during the manufacture
• Industrial accidents
• Tanker truck accident
• Terrorist or military attack
• Train derailments
• Transportation
• Storage
• Deployment
 Bahan Berbahaya
Hazzardeus Material
Biological Agents Chemical Agents

• Epidemiology • Pulmonary Agents

• Clinical Presentations • Cyanide
– Pulmonary
– Neurologic • Vesicants
– Dermatologic • Nerve Agents
• Treatment Options • Incapacitating Agents
– Chemotherapy/Prophylaxis
– Vaccines • Riot Control Agents

Nuclear chemical biological

 Chemical Agents
• Warfare agents
– Sarin
– GF
– VX
• Toxic chemicals commonly used in industry
– Benezene
– Chlorine
– Pesticides
 Categories of Chemical Agents

• Blister Agents (Mustard Gas, Lewisite, Phosgene Oxime)

• Blood (Arsine, Hydrogen chloride, Hydrogen Cyanide)
• Choking/Lung/Pulmonary (Chlorine, Phosgene)
• Incapacitating (Agent 15, BZ, LSD)
• Nerve [Sarin (GB) Soman (GD) VX]
• Riot Control/Tear [CS, Bromobenzylcyanide (CA)]
• Vomiting (Adamsite, Diphenylchloroarisne)
 Penangganan Korban

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 Langkah Penatalaksanaan Keracunan :

1. Resusitasi dan stabilisasi .

2. Evaluasi klinis dan difinitiv diagnosa.
3. Dekontaminasi.
4. Absorbsi racun dengan eleminasi.
5. Perawatan suportif.
6. Disposisi.

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 RESUSITASI DAN STABILISASI.

Airway
Breathing
Circulation

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 EVALUASI KLINIS DAN DEFINITIF DIAGNOSA.

ANAMNESA :
- BAGAIMANA RACUN MASUK TUBUH :
- JUMLAH RACUN YANG MASUK.
- SUDAH BERAPA LAMA KONTAK.
- PERTOLONGAN PERTAMA YANG SUDAH DIBERIKAN.
- PROFIL PSIKOLOGI PENDERITA.
- GEJALA YANG TELAH DIALAMI PENDERITA.

1/26/2018 IRD RS. Saiful Anwar Malang

 Common Physical Signs in Toxicology
Likely Causative agent
Physical signs
Coma; drowsiness Alcohol, antidepressants, antihistamines, antipsychotics, barbiturates and
other sedatives, narcotics, salicylates
Breath odour Alcoholic breath: Ethanol
Smell of garlic: Arsenic, organophosphates, phosphorus
Odour of bitter almonds: Cyanides
Smell of acetone: Isopropanol, nail polish remover, salicylates
Pungent odour: Ethchlorvynol
Fragrance of violets: Turpentinne
Smell of oil of Wintergreen: Methylsalicylate liniment
Pearl-like odour: Chloral hydrate
Miscellaneous typical odours: Ammonia, kerosene, petrol, petroleum
distillates, phenol
Eyes Mushrooms (muscarinic properties), narcotics, organophosphates
Pupils: Amphetamines, antihistamines, atropine, barbiturates, cocaine,
Constricted glutethamide, Lysergic acid Diethylamide (LSD), methanol, opiate
(miosis) withdrawal, tricyclic antidepressants
Dilated Barbiturates, PCP, phenytoin, sedatives
(mydriasis) Botulism, digoxin, methanol, organophosphates
Nystagmus Alcohol, cocaine, LSD, mescaline, PCP
Visual disturbance
Visual hallucinations
1/26/2018 IRD RS. Saiful Anwar Malang
 Mouth: Amphetamines, antihistamines, atropine, narcotics
Dry Arsenic, corrosives, mercury, mushrooms, organophosphates, strychnine.
Salivation Lead, other heavy metals
Gum discoloration

Respiration: Amphetamines, barbiturates (early effect), methanol, petroleum

Rate increased distillates, salicylates
(>20/min) Alcohol, barbiturates (late effect), narcotics
Rate decreased Botulism, organophosphates
(<10/min) Narcotics, organophosphates, petroleum distillates
Respiratory
paralysis
Wheezing/pulmonar
y oedema
Heart Rate: Digitalis, narcotics, sedatives
Bradycardia Alcohol, amphetamines, atropine, cocaine, salicylates
Tachycardia
Gastro-intestinal: Arsenic, heavy metals, lead, mushrooms, narcotic withdrawal,
Abdominal Colic organophosphates
Constipation Lead, narcotics
Diarrhoea Arsenic, boric acid, iron, mushrooms, organophosphates
Vomiting (sometimes Boric acid, caffeine, corrosives, heavy metals, phenol, salicylates,
bloody) theophylline

1/26/2018 IRD RS. Saiful Anwar Malang

 Skin: Barbiturates, carbon monoxide
Bullae Carbon monoxide, nitrites, strychnine
Cyanosis Arsenic, carbon tetrachloride, castor bean, mushroom (delayed effect),
Jaundice paracetamol (delayed effect)
Needle marks Amphetamines, narcotics, PCP
Purpura Salicylates, snake bites, spider bites
Redness and Alcohol, antihistamines, atropine, boric acid, carbon monoxide,
flushing of skin cyanide
Sweatiness Amphetaminess, barbiturates, cocaine, LSD, mushrooms,
organophosphates

Neuromuscular: Alcohol, amphetamines, antihistamines, barbiturate withdrawal,

Fasciculations/ chlorinated hydrocarbons, cyanide, isoniazid, lead, methaquolone,
convulsions organophosphates, phenothiazines, plants (a number of), salicylates,
Paralysis strychnine, tricyclic antidepressants
Ataxia Botulism, heavy metals
Alcohol, barbiturates, bromides, hallucinogens, heavy metals, organic
solvents, phenytoin

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 DEKONTAMINASI :

A. DEKONTAMINASI MATA DAN KULIT.

B. DEKONTIMASI PERNAFASAN.
C. DEKONTAMINASI GIT

1/26/2018 IRD RS. Saiful Anwar Malang

Waspadalah terhadap bahan material yang bisa mengacaukan
lingkungan kerja !!!!

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 Dekontaminasi.

1/26/2018 IRD RS. Saiful Anwar Malang

 DEKONTAMINASI MATA DAN KULIT.

• PERLINDUNGAN PENOLONG.
LATEX GLOVE , PASTIC GOGLE, MASKER, SCORT.

. PROSEDURE :
- PINDAHKAN KORBAN DARI TKP.
- SEMPROT/CUCI MATA DAN SELURUH TUBUH DENGAN AIR
BERSIH SELAMA 2 – 5 MENIT.
- UNTUK MATA DITERUSKAN SAMPAI 10 – 15 MENIT.
- SEMUA PAKAIAN HARUS DILEPAS DAN SELURUH PERMUKAAN
KULIT HARUS DICUCI DENGAN SABUN SELAMA 10 – 15 MENIT.
- JIKA SUDAH ADAD LEPUHAN KULIT/BLISTER, DITABURI DENGAN
FULLER’S EARTH / ATTAPULGITTE, BILAS DENGAN AIR 10 MENIT.
- JIKA TANGAN PX IKUT TERKONTAMINASI , KUKU AGAR DISIKAT
SECARA HALUS.
- JIKA PROSEDUR DIATAS SELESAI , BERI PAKAIAN KERING.
.

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 Perlindungan Penolong

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 Set-up decon teritorial

Pre-Hospital Phase Hospital Phase

First
Warm Zone

Cold Zone
Aid Hospital
Post
P1

Decontamination
Decontamination

Emergency Dept
Hospital Triage
Hot Zone

Triage

P2 Evac

P3

Wind

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Decontamination Zones in Field
( Pre-hospital Phase )

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 Ideal Approach to Training
for Prehospital team
Hospital Personnel 16 hrs
Total
40 hrs
Technician 16 hrs
Total
40 hrs
Gatekeeper
/Intervener

8 hrs Incident Commander /Safety/

Total
24 hrs Technical Reference

12 hrs
Total First Responder-Operations employees expected to
16 hrs take defensive actions and conduct decontamination

4
hours First Responder Awareness- those employees that may encounter a
hazardous materials emergency and/or conduct “directed self-decon.”

Hazard Communication- all employees

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UNIVERSAL PERSONAL PROTECTIVE
EQUIPMENT (PPE)*
Level A: Maximum protection against vapor and liquids.
Environment known to be immediately dangerous to lifeand
health (harm occurs within 30 minutes).
Fully encapsulating, chemical-resistant suit, chemically
resistant gloves and boots, and a pressure-demand supplied
air respirator (air hose) and escape self-contained breathing
apparatus (SCBA)

1/26/2018 IRD RS. Saiful Anwar Malang

• Level B: Minimum protection exposure to unknown hazards.
Full respiratory protection is required but danger to skin/risk
of dermal absorption from vapor is less.
Agent not identified, or concentration not known to be safe
(i.e.,field decontamination or ambulatory setting).
Nonencapsulating, splash-protective chemical resistant suit
(splash suit), chemical resistant gloves and boots/shoes,
and a pressure-demand supplied air respirator (air hostand
escape SCBA

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Level C: Until patient/victim decontamination completed.
Organic vapor/P11 cartridge respirator or hood,
non encapsulating chemically-resistant suit
and gloves

1/26/2018 IRD RS. Saiful Anwar Malang

 Kenapa harus siap?
• Bahwa industri semakin komplek,
• Peningkatan konflik.
• Terorisme.
Most Common Caused :
• Accidentally during the manufacture
• Industrial accidents
• Tanker truck accident
• Terrorist or military attack
• Train derailments
• Transportation
• Storage
• 1/26/2018
Deployment IRD RS. Saiful Anwar Malang
Fakta sejarah
March 1995 Sarin
12 Dead, 5500
Affected
May 1995 April
Plague 1997
1984 U235
1972 Salmonella June 1994
February 1997
Typhoid 200 Injured Sarin
Chlorine
7 Dead, 14 Injured,
200 Injured 500 2001 Anthrax
Evacuated 5 dead
??? Injured
1992 June
1984 Cyanide 1996
Botulinum Uranium
March 1995 December 1995
Ricin Ricin
1985
Cyanide April
1995 November 1995
Sarin Radioactive
Cesium
April-June 1995
Cyanide,
1/26/2018 IRD RS. Saiful AnwarPhosgene,
Malang
Ird rssa mlg Pepper Spray
Mustard History
• First Synthesized 1800’s
• WW1
• Italy 1930’s against Abyssinia
• Egypt 1960’s Yemen
• Iraq 1980’s Iran
• High Morbidity Low
Mortality

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Chemical Weapon

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Mustard Signs and Symptoms
• Binds Irreversibly within minutes.
• Onset of symptoms 4-8 hours
• Tissue Damage Within Minutes
Without Symptoms for Hours
• Topical – Eyes, Airway, Skin
• Systemic – Bone Marrow, GI, CNS

Mustard Skin
• Erythema 2-24 hours
• Small Vesicles may Coalesce to
form Bulla
• High Dose Exposure – Central
Zone of Coagulation necrosis

1/26/2018 IRD RS. Saiful Anwar Malang

Anthrax: Clinical
Cutaneous anthrax: eschar
(note central necrosis)

1/26/2018 IRD RS. Saiful Anwar Malang

Characteristic mediastinal widening (arrows)
From JAMA 1999:281:1735-1745
 DEKONTAMINASI PERNAPASAN

• PERLINDUNGAN PENOLONG.
LATEX GLOVE , PASTIC GOGLE, MASKER, SCORT.
. PROSEDURE :
- PINDAHKAN KORBAN DARI TKP (source of agent).
- BERI OKSIGEN 100% , HIGH FLOW.
- JIKA PERLU DILAKUKAN BRONCO-ALVEOLAR
LAVAGE.

1/26/2018 IRD RS. Saiful Anwar Malang

DEKONTAMINASI GIT

• FAKTOR YANG MEMPENGARUHI PRODUKSI LAMBUNG :

- MAKANAN DALAM LAMBUNG
1. BANYAK LEMAK --- PENGOSONGAN LAMA
2. PENGOSONGAN LAMBUNG BIASANYA 1 – 2 JAM
3. BILA ISI PENGOSONGAN BISA SEKITAR 6 JAM.
- JUMLAH RACUN YANG MASUK.
- JENIS RACUN : SALICYLATE, BARBITURAT, TRICYCLIC
ANTI DEPRESSANTS MEMPERPANJANG WAKTU
PENGOSONGAN

METODA DEKONTAMINASI :
• DILUSI/ PENGENCERAN.
1. AIR ADALAH PENGENCER YANG TERBAIK
2. DOSIS YANG DIANJURKAN 100 – 200 ML PADA ANAK DAN
200 – 400 ML PADA DWS.
3. SUSU UNTUK BAHAN KAUSTIK ATAU IRRITANT .

1/26/2018 IRD RS. Saiful Anwar Malang

 EMESIS : ( MERANGSANG MUNTAH )
JANGAN LAKUKAN PADA ( Kontra indikasi ) :
1. PX TIDAK SADAR .
2. TIDAK ADA GAG REFLEK.
3. PENYAKIT JANTUNG YANG BERAT, EMPHYSEMA,
PENDARAHAN.
4. UMUR < 6 BLN.
PADA JENIS RACUN :
1. CEPAT MENURUNKAN KESADARAN , CARDIAC/
NEUROMUSCULAR COLLAP, NEUROMUSCULAR PARALYSIS
MIS: CYCLIC ANTI DEPRRESANT,ISONIAZID, PROPOXYPHENE,
BETA BLOKER.
2. HYDROKORBON – ASPIRASI --- INJURY PADA PARU.
3. ASAM/ ALKALI YANG KOROSIF

1/26/2018 IRD RS. Saiful Anwar Malang

 EMESIS :
1. SYRUP IPECAC : --- CNS --- MUNTAH.
DOSIS : 6 BLN – 12 BLN = 10 ML
1 TH - 12 TH = 15 ML
> 12 TH = 30 ML
2. APOMORPHINE
3. LARUTAN SABUN :
2 – 3 ML LARUTAN DITERJEN/SABUN DIENCERKAN 250 ML
AIR
4. RANGSANGAN MEKANIS .
5. OBSOLETE
( POTASSIUM , ANTIMONY TARTATE )

1/26/2018 IRD RS. Saiful Anwar Malang

 GASTRIC LAVAGE :
KONTRA INDIKASI
1. BAHAN KOROSIF BAIK ASAM /BASA.
2. MINYAK TANAH, BENSIN DAN SEJENISNYA.
3. KEJANG.
PROSEDURE :
1. GUNAKAN NGT UKURAN 32 – 36 Fr.
2. BILA PX SADAR BERI SEGELAS MINUM .
3. LINDUNGI JALAN NAPAS. BILA PX TIDAK SADAR PASANG ETT.
4. MIRINGKAN PX PADA SISI KIRI , DENGAN KEPALA LEBIH
RENDAH DARI BAHU.
5. GUNAKAN AIR BERSIH ATAU NS/PZ YANG DIHANGATKAN.
6. CHEK APAKAH TUBE PADA LAMBUNG.
7. I00 -200 ML AIR DIMASUKAN , KOCOK LAMBUNG & SEDOT
KEMBALI SAMPAI JERNIH.
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 8. MASUKAN 50 – 100 MG CHARCOAL AKTIF, SEBELUM
MENGELUARKAN NGT.
CHARCOAL AKTIF.
BAHAN PENYERAP AKTIP UNTUK BEBERAPA RACUN
SEPERTI :
Acetaminophen
Aliphatic alcohols
(3) Amitryptylline (and other tricyclic antidepressants)
Antipyrines
Arsenic
Aspirin
Atropine
Chlorpheniramine (and related antihistamines)
Chlorpromazine (and other phenothiazines)
Dextro-amphetamine
Digoxin
Glutethimide
Imipramide

1/26/2018 IRD RS. Saiful Anwar Malang

 Iodine
Isoniazid
Meprobamate
Mercuric chloride
Methylsalicylate
Morphine
Nortryptilline
Paraquat
Phenobarbitone (and other barbiturates)
Penicillin
Phenylpropanolaamine
Phenytoin
Propoxyphene
Quinidine
Quinine
Saalicylates

1/26/2018 IRD RS. Saiful Anwar Malang

 BAHAN TIDAK BISA DISERAP :
Aromatic alcohols
Boric Acid
DDT (dichloro-diphenyl, trichloroethane)
Ethylene glycol
Iron
Lithium
Hydrocarbons
Heavy metals
Malathion
Methylcarbamate
Cyanides
Methanol
Acids and caustic alkalis

DOSIS :
DWS : DOS 1 = 30-50Gr DALAM 100 – 200 ML AIR PERORAL.
ULANGAN = 15 – 25 Gr / 50ML AIR SETIAP2- 4 JAM
SAMPAI 24 JAM

ANAK : DOS1: 1Gr/KGBB/50ML ORAL

ULANGAN 0,5 Gr/KGBB/50 AIR SETIAP 2-4 JAM.
1/26/2018 IRD RS. Saiful Anwar Malang
 -PERLU DIINGAT CHARCHOAL TIDAK DI SERAB OLEH
MUCOSA LAMBUNG ATAU USUS .

-PENGUNAAN CHARCOAL YANG BERULANG BISA

MENGGALAKKAN ELEMINASINYA OBAT YANG TERSERAP,
SEHINGGA MEMPENGARUHI SIRKULASI ENTERO-HEPATIK
DAN DIALISIS PADA GASTROINTESTINAL.

-PENYERAP BAHAN RACUN YANG LAIN MIS . FULLER’S

EARTH, PADA KERACUNAN PARAQUAT,ORGANOPHOSPHAT.

1/26/2018 IRD RS. Saiful Anwar Malang

 KATARTIK.
WALAUPUN KATARTIK BANYAK DIGUNAKAN UNTUK TX
KERACUNAN NAMUN KEUNTUNGANNYA MASIH DIRAGUKAN ,
KARENA KATARTIK MEMPERCEPAT PROSES PENYERAPAN
LAMBUNG.
BISA DIGUNAKAN SEBAGAI PENCEGAH EFEK KONSTIPASI PADA
CHARCOAL, SEHINGGA BISA DIPAKAI LEBIH BANYAK CHARCOAL.
KATARTIK TIDAK MEMPENGARUHI KERJA DARI CHARCOAL.

KONTRA INDIKASI
1. DIARE AKTIF.
2. OBSTRUKSI USUS/ILEUS.
3. HYPOVOLUMIA.
4. INFANT.
5. REANL FAILURE DAN ABDOMINAL TRAUMA.
1/26/2018 IRD RS. Saiful Anwar Malang
 HAL YANG PERLU DIPERHATIKAN SEBELUM PEMAKAIAN
KATARTIK :
1. TIDAK BOLEH DIGUNAKAN PADA USIA ANAK YANG COBA-
COBA
2. PADA ANAK YANG MEMGGUNAKAN PREPARAT PHOSPO-
SODA/SODA KUE TIDAK BOLEH MENGUNAKAN KATARTIK.
3. KATATIK DENGAN BAHAN DASAR MINYAK SUPAYA DIHINDARI --
- ASPIRASI DAN MENGGALAKAN PEYERAPAN RACUN.
4. PADA ANAK AGAR DIPANTAU STATUS CAIRAN DAN
ELEKTROLIT TERUTAMA PAD PENGUNA SORBITOL.
5. BAHAN KATARTIK DENGAN KANDUNGAN MAGNESIUM
SEBAIKNYA DI HINDARI UNTUK MENGULANG.

BAHAN KATARTIK ANTARA LAIN :

Magnesium Sulpate, Magnesium Citrate. Dosis : 250mg/kg max.
25Gr
Sodium Sulphate atau Sorbitol.
1/26/2018 IRD RS. Saiful Anwar Malang
 ABSORBSI RACUN DENGAN ENHANCED/
PENINGKATAN ELEMINASI.
1. Forced alkaline diuresis
dapat dicapai dengan pemberian
500 ml NS
500 ml D5% + 20 ml 7.45 % potassium
chlorida
500 ml NS
Furosemide 20 mg IV

1/26/2018 IRD RS. Saiful Anwar Malang

 2. Forced Acid Diuresis
Jarang digunakan !
bisa digunakan untuk intoksikasi :
Quinine , amphetamine,
fenfluramine
prosedure : sama dengan forced
alkaline diuresis dengan
penambahan 1.5 gr amonium
chlorida pada NS

1/26/2018 IRD RS. Saiful Anwar Malang

 3. Multiple Dose active Charchoal
4. Haemodialysis, Haemoperfusion,
haemofiltration and peritoneal dialysis

1/26/2018 IRD RS. Saiful Anwar Malang

ANTIDOTUM

Antidote poisoning Treatment regime

N-Acetylcystein Paracetamol 1. Iv NAC 150 mg/kg
dlm 200 ml D5%
diatas 30min.
Diikuti
2. 1v NAC 50 mg/kg
dlm 500 ml D 5%
diatas 4 jam
diikuti
3. Iv NAC 100 mg/kg
dlm 1L
D5%diatas 16 jam

1/26/2018 IRD RS. Saiful Anwar Malang

 ATROPINE 1. Organophosphat 1-2 mg per 5 menit
2. Nerve agents sampai sekresi
3. Carbamat bronchial berkurang
4. Muscarinic agent NB: ukuran pupil
bukan tujuan akhir
terapi
ETHANOL 1. Methanol 1. Iv 7.5 ml/kg dari
2. Ethylene glycol 10% Ethanol,
dilanjutkan
2. 1v 1-2 ml/kg dari
10 % ethanol
untuk
mempertahankan
serum ethanol
pada 100mg/dl

1/26/2018 IRD RS. Saiful Anwar Malang

 Naloxone 1. Opioad 1. Iv 0.4 -2 mg
2. Clonidine diatas 5 menit
diikuti dengan
2. Iv 0.4 -0.8
mg/jam

Sodium Bicarbonat 1. Severe 1. Iv 1-2 mEq/jam

metabolic bolus diikuti
acidosis akibat 2. Infusion untuk
salicylat, mempertahanka
methanol, n pH darah
ethylene glycol 7.45- 7.5 dan
2. Tricyclic pH urine 7.5-8
antidepresssant
1/26/2018 IRD RS. Saiful Anwar Malang
PERAWATAN SUPORTIF

-Biasanya di ICU atau Ruang khusus

-Suportif pada Airway, Breathing, Circulation
-Toxin eleminasi.

1/26/2018 IRD RS. Saiful Anwar Malang

 DISPOSISI

• PX YANG MENGALAMI KERACUNAN MESKIPUN

KELIHATAN RINGAN
TETAPI BAHAN TIDAK DIKETAHUI / BELUM JELAS
AGAR DI MRS KAN.

- BILA DI PULANGKAN AGAR DI K I E , BILA ADA

KELUHAN SEGERA KEMBALI / MENCARI
PERTOLONGAN .

1/26/2018 IRD RS. Saiful Anwar Malang

Think – thank :
• Sistim penangganan, monitor dan evaluasi
sudah ada ( ? )
• Siapa Bermain Apa (?)
• Health Provider Protection ( ?)
• Health Provider Knowledge & Behavior (?)
• Public & Envioritment safety ( ? )
• Pomotion & Prevention ( ? )

1/26/2018 IRD RS. Saiful Anwar Malang

1/26/2018 IRD RS. Saiful Anwar Malang