tag:blogger.com,1999:blog-87624158167773081232024-03-13T17:47:20.000-07:00LABIRINWelcome to my BloG.... Thankfull for visiting it...
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Let's enjoy it..together.. ^^Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-8762415816777308123.post-50483347960598896802013-10-25T01:18:00.002-07:002013-10-25T01:18:27.209-07:00 Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-30103041421385683402012-01-22T09:35:00.000-08:002012-01-22T09:51:55.297-08:00LUKA BAKAR<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVW5i8jWc9GgM7ukuOZqhPa6IRoNznt4n7X5SXX_-gj6leUtmbZolJ_r7PK002J8LbRSVyWirvNIp4XmmVEBIp_Q9d3b1K93WCr4-xdUDpVu6LcX3UizW91b-mNXKELVlfc6lyeWN0eaQ/s1600/fire.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVW5i8jWc9GgM7ukuOZqhPa6IRoNznt4n7X5SXX_-gj6leUtmbZolJ_r7PK002J8LbRSVyWirvNIp4XmmVEBIp_Q9d3b1K93WCr4-xdUDpVu6LcX3UizW91b-mNXKELVlfc6lyeWN0eaQ/s1600/fire.jpg" /></a><b><span lang="EN-US">Definisi </span></b></div>
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ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i><span lang="EN-US">Luka bakar</span></i><span lang="EN-US"> adalah hilang atau rusaknya sebagian jaringan tubuh yang disebabkan oleh trauma benda tajam atau tumpul, perubahan suhu, zat kimia, ledakan, sengatan listrik atau gigitan hewan. <b><i>(buku Ilmu Ajar bedah. Syamsuhidayat)</i></b></span></div>
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ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i><span lang="EN-US">Luka bakar</span></i><span lang="EN-US"> adalah kerusakan secara langsung maupun yang tidak langsung pada jaringan kulit yang tidak menutup kemungkinan sampai ke organ dalam, yang di sebabkan kontak langsung dengan sumber panas yaitu api, air/ uap panas, bahan kimia, radiasi, arus listrik, dan suhu sangat dingin. </span></div>
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<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
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<b><span lang="EN-US">Etiologi </span></b></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Termal (suhu > 60˚) → api, air panas</span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Arus listrik, </span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Bahan kimia,</span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Radiasi, </span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">suhu rendah (frost bite),</span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Tersambar petir, </span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Ledakan.</span></div>
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<span lang="EN-US">Penyulit yang timbul pada luka bakar antara lain : gagal ginjal akut, odema paru, SIRS (Systemic Inflamatory Response Sindrom), infeksi, dan sepsis serta parut hipertropik dan kontraktur.</span></div>
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<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
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<b><span lang="EN-US">Tiga zona luka bakar :</span></b><span lang="EN-US"></span></div>
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<b><span lang="EN-US"> 1. Zona koagulasi :</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Daerah yang langsung mengalami kerusakan (koagulasi Protein) akibat pengaruh panas.</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">2. Zona Stasis :</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Daerah yang berada di luar Zona koagulasi terjdi, pada daerah ini terjadi kerusakan enotel pembuluh darah , trombosit, lekosit, dan gangguan perfusi jaringan, perubahan permeabilitas kapiler.</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">3. Zona Hiperemi :</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Daerah di luar zona stasis dimana terjadi vasodilatasi tanpa banyak melibatkan reaksi.</span><span lang="EN-US"></span></div>
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<b>Klasifikasi luka bakar</b><b><span lang="EN-US"></span></b></div>
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<b>Berdasarkan kedalaman luka bakar</b><b><span lang="EN-US"></span></b></div>
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<b>a.</b> <b>Luka bakar derajat I</b><b><span lang="EN-US"> (</span></b><b><span lang="EN-US">Superficial thickness)</span></b><b><span lang="EN-US"></span></b></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kerusakan terjadi pada lapisan epidermis<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kulit kering, hiperemi berupa eritema<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak dijumpai bulae<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri karena ujung-ujung saraf sensorik teriritasi<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penyembuhan terjadi spontan dalam waktu 5-10 hari<span lang="EN-US"></span></div>
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<b>b.</b> <b>Luka bakar derajat II</b><b><span lang="EN-US"> (</span></b><b><span lang="EN-US">Partial thickness)</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kerusakan meliputi epidermis dan sebagian dermis, berupa reaksi inflamasi disertai proses eksudasi.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Dijumpai bulae.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri karena ujung-ujung saraf teriritasi.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Dasar luka berwarna merah atau pucat, sering terletak lebih tinggi diatas kulit normal.<span lang="EN-US"></span></div>
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Luka bakar derajat II ini dibedakan menjadi 2 (dua), yaitu :<span lang="EN-US"></span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Derajat II<i> </i>dangkal<i> (superficial) </i></b><span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kerusakan mengenai bagian superfisial dari dermis.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Organ-organ kulit seperti folikel rambut, kelenjar keringat, kelenjar sebasea masih utuh.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penyembuhan terjadi spontan dalam waktu 10-14 hari.<span lang="EN-US"></span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Derajat II dalam (<i>deep</i>)</b><span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kerusakan mengenai hampir seluruh bagian dermis.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Organ-organ kulit seperti folikel rambut, kelenjar keringat, kelenjar sebasea sebagian besar masih utuh.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penyembuhan terjadi lebih lama, tergantung epitel yang tersisa. Biasanya penyembuhan terjadi lebih dari sebulan.<span lang="EN-US"></span></div>
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<b>c.</b> <b>Luka bakar derajat III</b><b><span lang="EN-US"> (Full thickness)</span></b><b><span lang="EN-US"></span></b></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kerusakan meliputi seluruh lapisan dermis dan lapisan yang lebih dalam.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Organ-organ kulit seperti folikel rambut, kelenjar keringat, kelenjar sebasea mengalami kerusakan.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak dijumpai bulae.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kulit yang terbakar berwarna abu-abu dan pucat. Karena kering letaknya lebih rendah dibanding kulit sekitar.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Terjadi koagulasi protein pada epidermis dan dermis yang dikenal sebagai eskar.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak dijumpai rasa nyeri dan hilang sensasi, oleh karena ujung-ujung saraf sensorik mengalami kerusakan/kematian.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penyembuhan terjadi lama karena tidak terjadi proses epitelisasi spontan dari dasar luka.<span lang="EN-US"></span></div>
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<b>Berdasarkan tingkat keseriusan luka</b><span lang="EN-US"></span></div>
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American Burn Association menggolongkan luka bakar menjadi tiga kategori, yaitu: <span lang="EN-US"></span></div>
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<b><span lang="EN-US">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Luka bakar mayor</b><b><span lang="EN-US"> (Berat)</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Luka bakar dengan luas lebih dari 25% pada orang dewasa dan lebih dari 20% pada anak-anak.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Luka bakar <b><i>fullthickness</i></b> lebih dari 20%.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Terdapat luka bakar pada tangan, muka, mata, telinga, kaki, dan perineum.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Terdapat trauma inhalasi dan multiple injuri tanpa memperhitungkan derajat dan luasnya luka.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Terdapat luka bakar listrik bertegangan tinggi.<span lang="EN-US"></span></div>
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<b><span lang="EN-US">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Luka bakar moderat</b><span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span> Luka bakar dengan luas 15-25% pada orang dewasa dan 10-20% pada anak-anak.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span> Luka bakar <b><i>fullthickness</i></b> kurang dari 10%.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span> Tidak terdapat luka bakar pada tangan, muka, mata, telinga, kaki, dan perineum.<span lang="EN-US"></span></div>
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<b><span lang="EN-US">c.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Luka bakar minor</b><span lang="EN-US"></span></div>
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Luka bakar minor seperti yang didefinisikan oleh Trofino (1991) dan Griglak (1992) <span lang="EN-US"></span></div>
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adalah :<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Luka bakar dengan luas kurang dari 15% pada orang dewasa dan kurang dari 10 % pada anak-anak.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Luka bakar <i>fullthickness</i> kurang dari 2%.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terdapat luka bakar di daerah wajah, tangan, dan kaki.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Luka tidak sirkumfer.<span lang="EN-US"></span></div>
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<span lang="EN-US">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terdapat trauma inhalasi, elektrik, fraktur.</div>
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<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
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<b>Berdasarkan perjalanan penyakitnya luka bakar dibagi menjadi 3 fase, yaitu :</b><b><span lang="EN-US"></span></b></div>
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<b><span lang="EN-US">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Fase akut</b><span lang="EN-US"></span></div>
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Pada fase ini problem yang ada berkisar pada gangguan saluran napas karena adanya cedera inhalasi dan gangguan sirkulasi. Pada fase ini terjadi gangguan keseimbangan sirkulasi cairan dan elektrolit akibat cedera termis bersifat sistemik.<span lang="EN-US"></span></div>
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<span lang="EN-US">Ø<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b><span lang="EN-US">Cedera Inhalasi </span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Mekanisme trauma dibagi 3 :</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">1. Inhalasi Carbon Monoksida (CO)</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">CO merupakan gas yang dapat merusak oksigenasi jaringan , dalam darah berikatan dengan Hb dan memisahkan Hb dengan O2 sehingga akan menghalangi penggunaan oksigen.</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">2. Trauma panas langsung mengenai saluran nafas</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Sering mengenai saluran nafas bagian atas jarang mengenai bagian bawah karena sebelum mencapai trachea secara reflek terjadi penutupan plica dan penghentian spasme laryng. Edema mukosa akan timbul pada saluran nafas bagian atas yang menyebabkan obstruksi lumen, 8 jam pasca cedera. Komplikasi trauma ini merupakan penyebab kematian terbanyak.</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">3. Efek samping sisa pembakaran</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Gas karosen, aldehid akan mengiritasi mukosa membran karena merupkan toksik yang iritan.</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Ø<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b><span lang="EN-US">Cedera Termis </span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">Menimbulkan gangguan sirkulasi keseimbangan cairan & elektrolit, sehingga berakibat terjadi perubahan permeabilitas kapiler dan menyebabkan odema selanjutnya terjadi syok hipovolemi. </span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Fase sub akut</b><span lang="EN-US"></span></div>
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Fase ini berlangsung setelah shock berakhir. Luka terbuka akibat kerusakan jaringan (kulit dan jaringan dibawahnya) menimbulkan masalah inflamasi, sepsis dan penguapan cairan tubuh disertai panas/energi.</div>
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<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
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<b><span lang="EN-US">c.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Fase lanjut</b><span lang="EN-US"></span></div>
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<span style="color: #a64d79;">Fase ini berlangsung setelah terjadi penutupan luka sampai terjadi maturasi. Masalah pada fase ini adalah timbulnya penyulit dari luka bakar berupa parut hipertrofik, kontraktur, dan deformitas lainnya.</span></div>
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<b>Ukuran luas luka bakar</b><span lang="EN-US"></span></div>
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Dalam menentukan ukuran luas luka bakar kita dapat menggunakan beberapa metode yaitu :<span lang="EN-US"></span></div>
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<b><i>1.</i></b> <b><i>Rule of nine</i></b><span lang="EN-US"></span></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">kepala dan leher = 9%</span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">ektrimitas atas = 2X9% (kiri dan kanan)</span><span lang="EN-US"> </span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">paha dan betis = 4 X 9 % (kiri dan kanan)</span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">dada, perut, punggung, bokong = 4 X 9% </span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">perinium dan genitalia = 1%</span></li>
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<span lang="EN-US">Rumus tersebut tidak digunakan pada anak bayi karena luas permukaan anak jauh lebih besar dan luas relatif permukaan kaki lebih kecil.</span></div>
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<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
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<b><i><span lang="EN-US">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i></b><b><i> Diagram</i></b><b><i><span lang="EN-US"></span></i></b></div>
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<span lang="EN-US">Rule of Nine</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNYq5bln_vON0enHxy6w3VOWdCIv2D2yzuup0AQPhoIQ7e7fLZNHnkwYUaFw4UdGYN_tPep7VYOQmeLB_9hVpMwVy6lBy3e2o6nMFNRINYG5g45xdfy8vkM5mv7PAbwUxGwnvgoldcRCU/s1600/Untitled.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNYq5bln_vON0enHxy6w3VOWdCIv2D2yzuup0AQPhoIQ7e7fLZNHnkwYUaFw4UdGYN_tPep7VYOQmeLB_9hVpMwVy6lBy3e2o6nMFNRINYG5g45xdfy8vkM5mv7PAbwUxGwnvgoldcRCU/s320/Untitled.jpg" width="186" /></a></div>
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Penentuan luas luka bakar secara lebih lengkap dijelaskan dengan diagram Lund dan Browder sebagai berikut:</div>
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<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" height="594" style="border-collapse: collapse; font-family: inherit; margin-left: 23.4pt; width: 282px;"><tbody>
<tr style="page-break-inside: avoid;"> <td rowspan="2" style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LOKASI<span lang="EN-US"></span></div>
</td> <td colspan="5" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 221.85pt;" valign="top" width="296"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">
USIA (Tahun)<span lang="EN-US"></span></div>
</td> </tr>
<tr style="page-break-inside: avoid;"> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
0-1<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1-4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5-9<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
10-15<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
DEWASA<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
KEPALA<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
19<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
17<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
10<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
7<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LEHER<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
DADA & PERUT<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
PUNGGUNG<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
13<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<span lang="EN-US">BOKONG</span> KIRI<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<span lang="EN-US">BOKONG</span> KANAN<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<span lang="EN-US">GENITALIA</span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
1<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LENGAN ATAS KA.<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LENGAN ATAS KI.<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
4<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LENGAN BAWAH KA<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
LENGAN BAWAH KI.<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
TANGAN KA<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
TANGAN KI<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
2,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
PAHA KA.<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
6,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
8,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
8,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
9,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
PAHA KI.<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
6,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
8,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
8,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
9,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
TUNGKAI BAWAH KA<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
6<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
7<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
TUNGKAI BAWAH KI<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
5,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
6<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
7<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
KAKI KANAN<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 109.6pt;" valign="top" width="146"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
KAKI KIRI<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 41.85pt;" valign="top" width="56"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 36pt;" valign="top" width="48"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45pt;" valign="top" width="60"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63pt;" valign="top" width="84"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
3,5<span lang="EN-US"></span></div>
</td> </tr>
</tbody></table>
<div style="font-family: inherit;">
<br /></div>
<div style="font-family: inherit;">
<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div>
<div class="MsoNormal" style="font-family: inherit; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<b><span lang="EN-US">Penegakan Diagnosis :</span></b></div>
<div class="MsoNormal" style="font-family: inherit; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="font-family: inherit; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">
<b><span lang="EN-US">Anamnesis :</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="font-family: inherit; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;">
ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Biodata → Terdiri atas nama, umur, jenis kelamin, pendidikan, pekerjaan, alamt, tnggal MRS, dan informan apabila dalam melakukan pengkajian klita perlu informasi selain dari klien. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: inherit; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;">
ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Keluhan utama → nyeri, sesak nafas. Nyeri harus diperhatikan paliatif, severe, time, quality. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: inherit; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;">
ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Riwayat penyakit sekarang</span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: inherit; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;">
ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Gambaran keadaan pasien mulai tarjadinya luka bakar, penyebab lamanya kontak, pertolongan pertama yang dilakukan. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="font-family: inherit; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;">
ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Riwayat penyakit masa lalu </span></div>
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ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Resiko kematian akan meningkat jika pasien mempunyai riwayat penyakit kardiovaskuler, paru, DM, neurologis, atau penyalagunaan obat dan alcohol</span></div>
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ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Riwayat penyakit keluarga </span></div>
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<b><span lang="EN-US">Pemeriksaan fisik</span></b></div>
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<span lang="EN-US">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">keadaan umum </span></div>
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<span lang="EN-US">Umumnya penderita datang dengan keadaan kotor mengeluh panas sakit dan gelisah sampai menimbulkan penurunan tingkat kesadaran bila luka bakar mencapai derajat cukup berat</span></div>
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<span lang="EN-US">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Vital sign </span></div>
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<span lang="EN-US">Tekanan darah menurun nadi cepat, suhu dingin, pernafasan lemah sehingga tanda tidak adekuatnya pengembalian darah pada 48 jam pertama</span></div>
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<span lang="EN-US">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan kepala dan leher</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Kepala dan rambut </span></div>
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<span lang="EN-US">bentuk kepala, penyebaran rambut, perubahan warna rambut setelah terkena luka bakar, adanya lesi akibat luka bakar, grade dan luas luka bakar</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Mata </span></div>
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<span lang="EN-US">kesimetrisan dan kelengkapan, edema, kelopak mata, lesi adanya benda asing yang menyebabkan gangguan penglihatan serta bulu mata yang rontok kena air panas, bahan kimia akibat luka bakar</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Hidung </span></div>
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<span lang="EN-US">perdarahan, mukosa kering, sekret, sumbatan dan bulu hidung yang rontok.</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Mulut</span></div>
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<span lang="EN-US">Sianosis karena kurangnya supplay darah ke otak, bibir kering karena intake cairan kurang</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Telinga</span></div>
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<span lang="EN-US">bentuk, gangguan pendengaran karena benda asing, perdarahan dan serumen</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Leher </span></div>
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<span lang="EN-US">posisi trakea, denyut nadi karotis mengalami peningkatan sebagai kompensasi untuk mengatasi kekurangan cairan</span></div>
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<span lang="EN-US">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan thorak / dada</span></div>
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<span lang="EN-US">Inspeksi bentuk thorak, irama parnafasan, ireguler, ekspansi dada tidak maksimal, vokal fremitus kurang bergetar karena cairan yang masuk ke paru, auskultasi suara ucapan egoponi, suara nafas tambahan ronchi</span></div>
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<span lang="EN-US">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Abdomen </span></div>
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<span lang="EN-US">Inspeksi bentuk perut membuncit karena kembung, palpasi adanya nyeri pada area epigastrium yang mengidentifikasi adanya gastritis.</span></div>
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<span lang="EN-US">6.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Urogenital </span></div>
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<span lang="EN-US">jika ada darah kotor / terdapat lesi merupakan tempat pertumbuhan kuman yang paling nyaman, sehingga potensi sebagai sumber infeksi dan indikasi untuk pemasangan kateter.</span></div>
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<span lang="EN-US">7.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Muskuloskletal </span></div>
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<span lang="EN-US">atropi, amati kesimetrisan otot, bila terdapat luka baru pada muskuloskleletal, kekuatan otot menurun karena nyeri</span></div>
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<span lang="EN-US">8.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan neurologi </span></div>
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<span lang="EN-US">Tingkat kesadaran secara kuantifikasi dinilai dengan GCS. Nilai bisa menurun bila supplay darah ke otak kurang (syok hipovolemik) dan nyeri yang hebat (syok neurogenik)</span></div>
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<span lang="EN-US">9.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan kulit </span></div>
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<span lang="EN-US">luas dan kedalaman luka. </span></div>
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<b><span lang="EN-US">Pemeriksaan diagnostik</span></b></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan serum : hal ini dilakukan karena ada pada pasien dengan luka bakar mengalami kehilangan volume</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Pemeriksaan elektrolit pada pasien dengan luka bakar mengalami kehilangan volume cairan dan gangguan Na-K pump</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Analisa gas darah biasanya pasien luka bakar terjadi asidosis metabolisme dan kehilanga protein </span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Faal hati dan ginjal</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">CBC mengidentifikasikan jumlah darah yang ke dalam cairan, penuruan HCT dan RBC, trombositopenia lokal, leukositosis, RBC yang rusak</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Elektolit terjadi penurunan calsium dan serum, peningkatan alkali phospate</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Serum albumin : total protein menurun, hiponatremia</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Radiologi : untuk mengetahui penumpukan cairan paru, inhalas asap dan menunjukkan faktor yang mendasari </span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">ECG : untuk mengetahui adanya</span></div>
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<span lang="EN-US"><b>Patofisiologi </b></span></div>
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<b><span lang="EN-US">Penatalaksanaan </span></b></div>
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<b><span lang="EN-US">Indikasi rawat inap :</span></b><span lang="EN-US"></span></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Dewasa derajat II > 15 %</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Anak & orang tua derajat II > 10 %</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Derajat III > 10 %</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Luka pada : wajah, tangan, genital/perineal</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Penyebabnya : kimia dan listrik</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Menderita penyakit lain : DM, hipertensi</span><span lang="EN-US"></span></li>
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<span lang="EN-US">Penderita dengan luka bakar > 40% diusahakan pemasangan CVP</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Bila Luas luka bakar :</span><span lang="EN-US"></span></div>
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<span lang="EN-US">- < 20% , tubuh masih bisa kompensasi</span><span lang="EN-US"></span></div>
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<span lang="EN-US">- > 20% , shock hipovolemik (perpindahan cairan intra ke ekstravasculer)</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Prinsip Penanganan :</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Jika api masih hidup penderita disuruh berhenti, menjatuhkan diri dan berguling di lantai / tanah (stop drop roll)</span><span lang="EN-US"></span></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Hilangkan heat-restore , bila < 15 menit siram air dingin</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">ABC</span><span lang="EN-US"></span></li>
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<b><i><span lang="EN-US"> Airway</span></i></b><span lang="EN-US"> , trauma inhalasi, pasang ET</span><span lang="EN-US"></span></div>
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<b><i><span lang="EN-US"> Breathing </span></i></b><span lang="EN-US"></span></div>
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<span lang="EN-US"> Bila terjadi Eschar (kulit kaku), lakukan Escharektomi, karena dapat menimbulkan sukar nafas. Bila perlu lakukan zebra incision pada tulang iga</span><span lang="EN-US"></span></div>
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<b><i><span lang="EN-US"> Circulation </span></i></b><span lang="EN-US"></span></div>
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<span lang="EN-US"> Digunakan formula Baxter dengan larutan Ringer Laktat, jangan memakai NaCl karena Cl memperberat asidosis.</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Formula Baxter : 4 cc/24jam x BB x %LB</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US"> Cara pemberian : - 8 jam pertama 50% (sejak kejadian LB)</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> - 16 jam kedua 50%</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Untuk anak-anak : 2 cc x BB x % LB = a cc</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US"> < 1 tahun : BB x 100 cc</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> 1 – 3 tahun : BB x 75 cc</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> 3 – 5 tahun : BB x 50 cc</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> b cc</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> Kebutuhan total = a x b , memakai lar RL : Dextran = 17:3</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Perawatan Luka Bakar :</span></b><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Derajat I</span></b><span lang="EN-US"> : </span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Cuci NaCl 500 cc </span><span lang="EN-US"></span></div>
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<span lang="EN-US"> - Zalf Bioplasenton untuk mencegah kuman masuk/infeksi</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Derajat II</span></b><span lang="EN-US"> : </span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Cuci lar savlon 5 cc dalam NaCl 500 cc </span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Sufratul</span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Tutup verband steril tebal , ganti tiap minggu</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Derajat III</span></b><span lang="EN-US"> : </span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Cuci lar savlon 5 cc dalam NaCl 500 cc tiap hari</span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Debridemen tiap hari</span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Escharektomi </span><span lang="EN-US"></span></div>
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<span lang="EN-US">- Dermazin/Burnazin (sulfadiazin) tiap hari</span><span lang="EN-US"></span></div>
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<span lang="EN-US"> </span><span lang="EN-US"></span></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Hari ke-7 dimandikan air biasa, setelah mandi daerah luka didesinfektan sol savlon 1 : 30</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Luka dibuka 3 – 4 hari jika tidak ada infeksi / jaringan nekrose</span><span lang="EN-US"></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Posisi Penderita :</span><span lang="EN-US"></span></li>
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<span lang="EN-US">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Ekstremitas sendi yang luka posisi fleksi / ekstensi maksimal</span><span lang="EN-US"></span></div>
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<span lang="EN-US">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Leher & muka defleksi, semi fowler (bantal di punggung)</span><span lang="EN-US"></span></div>
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<span lang="EN-US">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Eskarektomi dilakukan bila luka melingkar atau berpotensi penekanan</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US"> Skin Graft dilakukan bila :</span></b></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Luka grade II dalam 3 minggu tak sembuh</span><span lang="EN-US"></span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Luka grade III setelah eksisi</span><span lang="EN-US"></span></div>
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<span lang="EN-US">ü<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Terdapat granulasi luas ( diameter > 3 cm)</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Medikasi : </span></b><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Antibiotika ( bila < 6 jam) diberikan Sefalosporin generasi III</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Analgetika</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Antasid (H2 blocker ) , untuk mencegah stress ulcer</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">ATS / Toxod</span><span lang="EN-US"></span></div>
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<b><span lang="EN-US">Nutrisi dan Roborantia</span></b><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">TKTP diberikan oral secepat mungkin</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Kebutuhan kalori menurut <b>Formula Curreri</b> :</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Dewasa = 25 cal/KgBB + 40 cal% LB</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Anak = 60 cal/KgBB + 35 cal% LB</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Roboransia </span><span lang="EN-US">à</span><span lang="EN-US"> vit C (setelah 2 minggu), vit b, vit A 10.000 U</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Ø<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Bila terjadi Ileus, stop makan/minum, pasang NGT</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Ø<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">LB > 40%, pasang CVP selama 4 hari, bila sampai 1 minggu ganti kateter</span><span lang="EN-US"></span></div>
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<span lang="EN-US">Ø<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Oliguri , berikan cairan cukup (CVP normal) dilakukan tes terapi manitol</span><span lang="EN-US"></span></div>
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<span lang="EN-US">o<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Dewasa = 10 cc/10-20 menit diulang tiap 6 jam</span><span lang="EN-US"></span></div>
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<span lang="EN-US" style="color: black;">o<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="color: black;">Anak = 0,2 mg/KgBB / 14-20 menit</span><span lang="EN-US" style="color: black;"></span></div>
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<b><span lang="EN-US">Prognosis dan Komplikasi</span></b></div>
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<b><span lang="EN-US">Prognosis</span></b></div>
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<span lang="EN-US">Prognosis dan penanganan luka bakar terutama tergantung pada dalam dan luasnya permukaan luka bakar dan penanganan syok hingga penyembuhan. Selain itu faktor letak daerah terbakar, usia, dan keadaan kesehatan penderita juga turut menentukan kecepataan kesembuhan. Luka bakar pada daerah perinium, ketiak, leher, dan tangan sulit dalam perawatannya, karena mudah mengalami kontraktur.</span></div>
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·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Luka bakar superfisial tidak menyebabkan kerusakan pada lapisan kulit yang lebih dalam (<i>dermis</i>).</span></div>
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·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Luka bakar dalam menyebabkan cedera pada dermis, pemulihan berlangsung sangat lambat dan bisa terbentuk jaringan parut</span></div>
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·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Luka bakar ringan pada kerongkongan, lambung dan paru-paru biasanya akan pulih tanpa menimbulkanmasalah. </span></div>
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·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Luka yang lebih berat bisa menyebabkan pembentukan jaringan parut dan penyempitan</span></div>
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<b><span lang="EN-US">Komplikasi</span></b></div>
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<span lang="EN-US">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Hipertropi jaringan parut.</span></div>
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<span lang="EN-US">Terbentuknya hipertropi jaringan parut pada luka bakar dipengaruhi oleh :</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Kedalaman luka bakar</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Sifat kulit</span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Usia pasien <span id="goog_728027839"></span><span id="goog_728027840"></span></span></div>
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<span lang="EN-US" style="font-size: 10pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Lamanya waktu penutupan kulit </span></div>
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<span lang="EN-US">Jaringan kulit menglami pembetukan secara efekif pada sebulan post luka, dengan warna berubah menjadi merah , merah tua sampai coklat dan teraba keras, setelah 12-18 bulan jaringan parut akan matur dan warna coklat muda akan teraba lembut / lemas.</span></div>
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<span lang="EN-US">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Kontraktur </span></div>
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<span lang="EN-US">Kontaktur dapat menyebabkan gangguan fungsi pergerakan. Beberapa tindakan yang dapat mencegah kontraktur adalah :</span></div>
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<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Pemberian posisi yang baik dan benar sejak dini</span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Ambulasi yang dilakukan pada 2-3 kali/hari segera mungkin pada pasien yang terpasang alat invasive, mobilisasi dibantu.</span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US">Pressure garment adalah pakaian yang dapat memberikan tekanan yang bertujuan menekan timbulnya hipertropi scar (menghambat mobilisasi dan mendukung terjadinya kontrakatur )</span></li>
</ul>
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<span lang="EN-US">By: </span><b><span lang="EN-US">choreecho@yahoo.co.id</span></b><br />
<b><span lang="EN-US">From : some of sources...^^ </span></b></div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-34309603445251023572011-12-12T08:29:00.000-08:002011-12-14T15:56:08.390-08:00ALHAMDULILLAH.....<div style="text-align: center;">
"<b>ALHAMDULILLAH................. .........YA ALLOH.........</b>"</div>
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Yap kira-kira itulah kata pertama yang terucap saat aq melihat hasil UKDI -ku . Refleks sumringah langsung tersungging dari bibirku. Rasanya ingin teriak sekuat-kuatnya....tapi kutahan. ..dan dalam hati aq menjerit.... <br />
"Aq luluuuusssss UKDI.......!!!!!" ( Trimakasih...ya AllOh :) )</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5txtLFqUkvIAbfU3RwVIUzXF_HMWMQOr4EulG6Pn74Mc90mJA60DOwumWnz6NPIqVnn9la4ZscPPM0ISDajsOoxAK_1tuXZJ8dwNnxLgQUieSz5XKOqPOmBsbQ1tXz2VBF5Yaq5t4fjg/s1600/syukur.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5txtLFqUkvIAbfU3RwVIUzXF_HMWMQOr4EulG6Pn74Mc90mJA60DOwumWnz6NPIqVnn9la4ZscPPM0ISDajsOoxAK_1tuXZJ8dwNnxLgQUieSz5XKOqPOmBsbQ1tXz2VBF5Yaq5t4fjg/s1600/syukur.jpg" /></a></div>
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Ya AllOh.....Aq tahu Engkau sangat sayang padaku. Tak henti-hentinya di setiap detik nafasku, aq selalu merasakan anugrah dan karunia-Mu yang begitu luar biasa. </div>
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Saat aq merasa lemah, goyah, dan putus asa... Engkau selalu berikan kekuatan padaku sehingga aq bisa melalui semuanya...<br />
<a name='more'></a>Ya AllOh.......Aq tau Engkau sangat dekat..... sangat dekat..... Begitu banyak pertolongan yang Engkau berikan. Tak mungkin aq bisa melewati semua ini tanpa petunjuk dari-Mu... </div>
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Ya AllOh......Engkau Maha Mengetahui segalanya yang terbaik untukku. Dan segalanya terjadi atas kehendak dan izin-Mu..... </div>
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Ya AllOh.......hanya Engkaulah satu-satunya yang dapat menjadikan sesuatu yang sepertinya tak mungkin menjadi sangat mungkin untukku..... </div>
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Ya....Rabb...., dengan kelulusan UKDI yang telah kuraih ini, kini tibalah aq di gerbang awal perjalan panjangku yang baru saja dimulai, aq mohon selalu petunjuk dan ridho-Mu Ya Rabb... di setiap langkah-langkahku..... A...Minnn...</div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-77784367407595038442011-12-11T18:03:00.001-08:002011-12-14T09:14:00.289-08:00ABORTION<div style="font-family: inherit;">
Dapet dari hasil iseng-iseng buka repost-an temen...eh aq nemu nih story yg menyentuh banget. Suer nih bukannya lebay, aq sampe nangis <span style="color: #6fa8dc;">/no</span> ngebacanya....Jadi aq repost lagi aja ke sini yakkk hehehe.....</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipurKG3iLyl9jsMbetEu_7JFpbD7eYiMNqv340V4l9phTgyyj_psPfPuwZXAdZS16O2yvShs0AYh-Gx4HfkGsBEP5Pa6DqcWt2wCRVQfhPUSEyY5YRCR7eaKUSEiYDPGzpQHDC1rSlh7Q/s1600/baby3.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipurKG3iLyl9jsMbetEu_7JFpbD7eYiMNqv340V4l9phTgyyj_psPfPuwZXAdZS16O2yvShs0AYh-Gx4HfkGsBEP5Pa6DqcWt2wCRVQfhPUSEyY5YRCR7eaKUSEiYDPGzpQHDC1rSlh7Q/s200/baby3.jpg" width="200" /></a></div>
This is a Story...Please read this! </div>
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Hi, Mommy.</div>
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...I'm your baby. You don't know me yet, I'm only a few</div>
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weeks old. You're going to find out about me soon, though, I promise.</div>
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Let me tell you some things about me. My name is John, and I've got</div>
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beautiful brown eyes and black hair. Well, I don't have it yet, but I</div>
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will when I'm born. I'm going to be your only child, and you'll call me</div>
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your one and only. I'm going to grow up without a daddy mostly, but we</div>
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have each other. We'll help each other, and love each other. I want to</div>
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be a doctor when I grow up.</div>
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<a name='more'></a>You found out about me today, Mommy! You were so excited, you couldn't</div>
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wait to tell everyone. All you could do all day was smile, and life was</div>
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perfect. You have a beautiful smile, Mommy. It will be the first face I</div>
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will see in my life, and it will be the best thing I see in my life. I</div>
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know it already.</div>
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Today was the day you told Daddy. You were so excited to tell him about</div>
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me! ...He wasn't happy, Mommy. He kind of got angry. I don't think that</div>
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you noticed, but he did. He started to talk about something called</div>
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wedlock, and money, and bills, and stuff I don't think I understand</div>
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yet. You were still happy, though, so it was okay. Then he did</div>
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something scary, Mommy. He hit you. I could feel you fall backward, and</div>
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your hands flying up to protect me. I was okay... but I was very sad</div>
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for you. You were crying then, Mommy. That's a sound I don't like. It</div>
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doesn't make me feel good. It made me cry, too. He said sorry after,</div>
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and he hugged you again. You forgave him, Mommy, but I'm not sure if I</div>
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do. It wasn't right. You say he loves you... why would he hurt you? I</div>
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don't like it, Mommy.</div>
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Finally, you can see me! Your stomach is a little bit bigger, and</div>
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you're so proud of me! You went out with your mommy to buy new clothes,</div>
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and you were so so so happy. You sing to me, too. You have the most</div>
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beautiful voice in the whole wide world. When you sing is when I'm</div>
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happiest. And you talk to me, and I feel safe. So safe. You just wait</div>
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and see, Mommy. When I am born I will be perfect just for you. I will</div>
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make you proud, and I will love you with all of my heart.</div>
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<br /></div>
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I can move my hands and feet now, Mommy. I do it because you put your</div>
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hands on your belly to feel me, and I giggle. You giggle, too. I love</div>
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you, Mommy.</div>
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Daddy came to see you today, Mommy. I got really scared. He was acting</div>
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funny and he wasn't talking right. He said he didn't want you. I don't</div>
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know why, but that's what he said. And he hit you again. I got angry,</div>
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Mommy. When I grow up I promise I won't let you get hurt! I promise to</div>
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protect you. Daddy is bad. I don't care if you think that he is a good</div>
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person, I think he's bad. But he hit you, and he said he didn't want</div>
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us. He doesn't like me. Why doesn't he like me, Mommy?</div>
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You didn't talk to me tonight, Mommy. Is everything okay?</div>
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It's been three days since you saw Daddy. You haven't talked to me or</div>
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touched me or anything since that. Don't you still love me, Mommy? I</div>
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still love you. I think you feel sad. The only time I feel you is when</div>
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you sleep. You sleep funny, kind of curled up on your side. And you hug</div>
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me with your arms, and I feel safe and warm again. Why don't you do</div>
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that when you're awake, any more?</div>
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<br /></div>
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I'm 21 weeks old today, Mommy. Aren't you proud of me? We're going</div>
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somewhere today, and it's somewhere new. I'm excited. It looks like a</div>
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hospital, too. I want to be a doctor when I grow up, Mommy. Did I tell</div>
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you that? I hope you're as excited as I am. I can't wait.</div>
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<div style="font-family: inherit;">
...Mommy, I'm getting scared. Your heart is still beating, but I don't</div>
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know what you are thinking. The doctor is talking to you. I think</div>
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something's going to happen soon. I'm really, really, really scared,</div>
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Mommy. Please tell me you love me. Then I will feel safe again. I love</div>
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you!</div>
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<br /></div>
<div style="font-family: inherit;">
Mommy, what are they doing to me!? It hurts! Please make them stop! It</div>
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feels bad! Please, Mommy, please please help me! Make them stop!</div>
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<br /></div>
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Don't worry Mommy, I'm safe. I'm in heaven with the angels now. They</div>
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told me what you did, and they said it's called an abortion.</div>
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<br /></div>
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Why, Mommy? Why did you do it? Don't you love me any more? Why did you</div>
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get rid of me? I'm really, really, really sorry if I did something</div>
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wrong, Mommy. I love you, Mommy! I love you with all of my heart. Why</div>
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don't you love me? What did I do to deserve what they did to me? I want</div>
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to live, Mommy! Please! It really, really hurts to see you not care</div>
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about me, and not talk to me. Didn't I love you enough? Please say</div>
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you'll keep me, Mommy! I want to live smile and watch the clouds and</div>
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see your face and grow up and be a doctor. I don't want to be here, I</div>
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want you to love me again! I'm really really really sorry if I did</div>
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something wrong. I love you!</div>
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<br /></div>
<div style="font-family: inherit;">
I love you, Mommy.</div>
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<br /></div>
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<br /></div>
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<br />
Every abortion is just…</div>
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One more heart that was stopped.</div>
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Two more eyes that will never see.</div>
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Two more hands that will never touch.</div>
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Two more legs that will never run.</div>
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One more mouth that will never speak.</div>
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If you’re against abortion, reblog.</div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-74937544850642712782011-12-05T00:41:00.001-08:002011-12-14T09:39:54.495-08:00PERSALINAN PRETERM<div class="Section1" style="font-family: inherit; text-align: justify;">
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<div class="separator" style="clear: both;">
<span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2d-2TktAjSWPuvhycYuvFJTCvNwROnNkZko6tx582PiMaaRhxguEtmC_wLfnkXQ9Jtn_s4F8mhP6MY4bfLhJ1S2fCjFR_KL4Dv7RWFDwW0lQViL9ClESpvkZZuZ_sHgaeXnkvHJ4dhBQ/s1600/baby2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2d-2TktAjSWPuvhycYuvFJTCvNwROnNkZko6tx582PiMaaRhxguEtmC_wLfnkXQ9Jtn_s4F8mhP6MY4bfLhJ1S2fCjFR_KL4Dv7RWFDwW0lQViL9ClESpvkZZuZ_sHgaeXnkvHJ4dhBQ/s200/baby2.jpg" width="200" /></a></span></div>
<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Definisi</span></b></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Persalinan yang berlangsung pada umur kehamilan 20-37 minggu dihitung dari HPHT. (ACOG’95)</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Bayi premature : bayi yang lahir pada usia kehamilan 37 mgg atau kurang→menurut (WHO)</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;"> </span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Epidemiologi</span></b></span></div>
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<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Angka kejadian persalinan preterm pada umumnya adalah <u>+</u> 6-10%. </span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">1,5 % terjadi pada umur kehamilan < 32 mgg.</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">0,5 % pada kehamilan < 28 mgg</span></li>
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</span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Etiologi </span></b></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Banyak kasus sebagai akibat proses patogenik yg merupakan mediator biokimia yg mempunyai dampak terjadinya kontraksi rahim dan perubahan serviks, yaitu :</span></div>
<ul>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Aktivasi aksis kelenjar hipotalamus-hipofisis-adrenal baik pada ibu maupun janin, akibat stress pada ibu atau janin</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Inflamasi desidua-korioamnion atau sistemik akibat infeksi asenden dari trktus genitourineria atau infeksi sistemik</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Perdarahan desidua</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Peregangan uterus patologik</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Kelainan pada uterus atau serviks.</span></li>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Kondisi selama kehamilan yg beresiko terjadinya persalinan preterm adalah :</span><span lang="EN-US" style="font-size: small; line-height: 115%;"> </span></div>
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<span style="font-size: small;"><u><span lang="EN-US" style="line-height: 115%;">Janin dan plasenta :</span></u></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;"> </span> </div>
<div class="Section2" style="font-family: inherit; text-align: justify;">
<ul>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Perdarahan trimester awal</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Perdarahan antepartum (plasenta previa, solusio plasenta, vasa previa)</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Ketuban pecah dini (KPD)</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Pertumbuhan janin terhambat</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Cacat bawaan janin</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Kehamilan ganda/gemeli</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Polihidramnion </span></li>
</ul>
<span lang="EN-US" style="font-size: small; line-height: 115%;"> <u>Ibu :</u></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;"> </span> </div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;"> </span> </div>
<div class="Section4" style="font-family: inherit; text-align: justify;">
<ul>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Penyakit berat pada ibu</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">DM</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Preeclampsia/hipertensi</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Infeksi saluran kemih/genital/intrauterine</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Penyakit infeksi dengan demam</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Stress psikologik</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Kelainan bentuk uterus/serviks</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Riwayat persalinan preterm/abortus berulang</span></li>
<li><span lang="EN-US" style="font-size: small; line-height: 115%;">Inkompetensi serviks (panjang serviks <u><</u> 1 cm)</span></li>
</ul>
</div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;"><a name='more'></a> </span></b><b><span lang="EN-US" style="line-height: 115%;">Patogenesis :</span></b></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Banyak teori yang menjelaskan patogenesis persalinan preterm (partus prematurus). Beberapa teori tersebut antara lain :</span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Diagnosis :</span></b></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Beberapa kriteria yg dipakai sebagai diagnosis ancaman persalinan preterm, yaitu :</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Kontraksi yg berulang sedikitnya tiap 7-8 menit sekali, atau 2-3 kali dalam 10 menit</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Nyeri punggung bawah (low back pain)</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Perdarahan bercak</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Perasaan menekan daerah serviks</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Pemeriksaan serviks menunjukkan telah terjadi pembukaan sedikitnya 2 cm, dan penipisan 50-80%.</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Presentasi janin rendah, sampai mencapai spina isiadika</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Selaput ketuban pecah dapat merupakan tanda awal terjadinya persalinan preterm.</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Terjadi pada usia kehamilan 22-37 mg. </span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Indikator klinik :</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Timbulnya kontraksi dan pemendekan serviks (secara manual/USG).</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Terjadi ketuban pecah dini.</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Indikator Lab :</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Leukosit dalam air ketuban (20/ml atau lebih)</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">CRP > 0,7 mg/ml</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 115%;">Leukosit dalam serum ibu > 13000/ml.</span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;">Indikator biokimia :</span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Fibronektin janin : </span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">o<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Kadar↑ pada vagina, serviks, air ketuban memberikan indikasi adanya gangguan pada hubungan antara korion dan desidua.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">o<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Pada kehamilan <u>></u> 24 mgg, kadar fibronektin janin <u>></u> 50 ng/ml mengindikasikan resiko persalinan preterm.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Corticotropin Releasing hormone (CRH) : </span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Pe↑ dini / pada TM 2 merupakan indicator kuat terjadinya persalinan preterm.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Sitokin Inflamasi:</span></i></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 35.45pt;">
<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Seperti IL-1β, IL-6, IL-8, dan TNF-α telah diteliti sbg indikator yg mgkin berperan dalam sintesis PGE.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Isoferitin plasenta :</span></i></span></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 0.0001pt 35.45pt;">
<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Pada keadaan normal (tidak hamil) kadarnya 10 U/ml. Kadar me↑ secara bermakna selama kehamilan dan mencapai puncak pada TM akhir : 54,8<u>+</u>53 U/ml. Pe↓ kadar dalam serum akan beresiko terjadinya persalinan preterm.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"></span><b><span lang="EN-US" style="line-height: 115%;">Penatalaksanaan</span></b></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;"> </span></b><span lang="EN-US" style="line-height: 115%;"> Beberapa langkah yang dapat dilakukan pada persalinan preterm, terutama mencegah morbiditas dan mortalitas neonatus preterm adalah :</span></span></div>
<ul>
<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span lang="EN-US" style="line-height: 115%;"> Menghambat proses persalinan preterm dengan pemberian tokolisis. </span></span></li>
<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span lang="EN-US" style="line-height: 115%;"> Pematangan surfaktan paru janin dengan kortikosteroid </span></span></li>
<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span lang="EN-US" style="line-height: 115%;"> Pencegahan terhadap infeksi, bila perlu. </span></span></li>
</ul>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 115%;">Tokolisis :</span></b></span></div>
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<span style="font-size: small;"><i><span lang="EN-US" style="line-height: 115%;"> Alasan pemberian :</span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Mencegah mortalitas dan morbiditas pada bayi premature</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Memberi kesempatan bagi terapi kortikosteroid untuk menstimulir surfaktan paru janin</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Memberi kesempatan transfer intrauterine pada fasilitas yg lebih lengkap </span></span></div>
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<span style="font-size: small;"><i><span lang="EN-US" style="line-height: 115%;"> Obat-obat tokolisis :</span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Kalsium antagonis </span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Nifedipin 10 mg/oral diulang 2-3 x/jam, dianjurkan tiap 8 jam sampai kontraksi hilang. Obat dapat diberikan lagi jika timbul kontraksi berulang.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Obat β-mimetik : </span></i></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Seperti terbutalin, ritrodin, isoksuprin, dan salbutamol, dapat digunakan, tetapi nifedipin punya ESO lebih kcil.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Sulfas magnesikus & antiprostaglandin (indometasin)</span></i><span lang="EN-US" style="line-height: 115%;"> : jarang dipakai karena efek samping pada ibu ataupun janin.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Untuk menghambat proses persalinan preterm selain tokolisis, perlu membatasi aktivitas (tirah baring)</span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 115%;">Kortikosteroid</span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Pemberian dimaksudkan untuk pematangan surfaktan paru janin, menurunkan insiden RDS, cegah perdarahan intraventrikular, menurunkan kematian neonates.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Diberikan jika usia kehamilan < 35 mgg.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Obat-obat yg diberikan : Betametason atau Deksametason</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Betametason</span></i><span lang="EN-US" style="line-height: 115%;"> : 2x12 mg i.m. dengan jarak pemberian 24 jam</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Deksametason </span></i><span lang="EN-US" style="line-height: 115%;">: 4x6 mg i.m dengan jarak pemberian 12 jam</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Pemberian tidak perlu diulang karena risiko terjadinya pertumbuhan janin terhambat.</span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">3.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 115%;">Antibiotika</span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Hanya diberikan bilamana kehamilan mengandung resiko terjadinya infeksi seperti pada kasus KPD. Obat diberikan per oral, yg dianjurkan :</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Eritromisin </span></i><span lang="EN-US" style="line-height: 115%;">: 3 x 500 mg selama 3 hari.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span lang="EN-US" style="line-height: 115%;">Ampisilin</span></i><span lang="EN-US" style="line-height: 115%;"> : 3 x 500 mg selama 3 hari.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Tidak dianjurkan pemberian ko-amoksilasif karena risiko NEC.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Beberapa hal yg diperhatikan pada Px pasien dengan KPD/ PROM (Preterm Premature Rupture of the Membrane) :</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Semua alat yg digunakan untuk periksa vagina harus steril</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Periksa dalam vagina tidak dianjurkan, tetapi dilakukan dengan pemeriksaan speculum</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Pada px USG jika ada pe↓ indeks cairan amnion (ICA) tanpa adanya kecurigaan kelainan ginjal dan tdak adanya IUGR (Intrauterine Growth Restriction) mengarah pada kemungkinan KPD.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Penderita dengan KPD/PROM dilakukan terminasi kehamilan pada usia kehamilan 36 minggu. Bila ditemukan adanya bukti infeksi (klinik /lab), maka terminasi dipercepat/induksi, tanpa melihat usia kehamilan.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Persiapan persalinan preterm perlu pertimbangan berdasar :</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Usia gestasi</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><u><span lang="EN-US" style="line-height: 115%;">></span></u><span lang="EN-US" style="line-height: 115%;">34 mgg : dapat melahirkan di tingkat dasar / primer, mengingat prognosis relative baik.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><u><span lang="EN-US" style="line-height: 115%;"><</span></u><span lang="EN-US" style="line-height: 115%;"> 34 mgg : dirujuk ke RS dng fasilitas perawatan neonates yg memadai.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Keadaan selaput ketuban</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Bila didapat KPD/PPROM dengan usia kehamilan <28 mgg, maka ibu & keluarga dipersilahkan untuk memilih cara pengelolaan setelah diberi konseling dngan baik</span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Cara Persalinan :</span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Jika janin presentasi kepala → partus pervaginam.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Seksio sesarea hanya dilakukan atas indikasi obstetric.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Jika letak sungsang 30-34 mgg → seksio sesarea dapat dipertimbangkan .</span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Perawatan Neonatus :</span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Perlu diperhatikan keadaan umum bayi, biometri, kemampuan bernapas, kelainan fisik, dan kemampuan minum.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Keadaan kritis bayi premature yg harus dihindari : kedinginan, pernapasan tidak adekuat, trauma.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Suasana hangat sangat diperlukan utk cegah hipotermia.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">ASI diberikan lebih sering, jika tidak mungkin dapat diberikan dengan sonde atau dipasang infuse. </span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Pencegahan terjadinya persalinan preterm :</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Hindari kehamilan pada ibu terlalu muda (< 17 tahun)</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Hindari jarak kehamilan terlalu dekat</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Menggunakan kesempatan periksa hamil dan memperoleh pelayanan antenatal yg baik</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Anjuran tdk merokok atau menggunakan obat terlarang</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Hindari kerja berat dan perlu cukup istirahat</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Kenali dan obati infeksi genital/sal kencing</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Deteksi & pengamanan factor resiko terhadap persalinan preterm.</span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Komplikasi </span></b></span></div>
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<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Mengalami kelainan jangka pendek :</span></span></li>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">RDS (Respiratory Distress Syndrome)</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Perdarahan intra/periventrikular</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">NEC (Necrotizing Entero Cilitis),</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Displasi bronko-pulmonar</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Sepsis</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Paten Duktus Arteriosus.</span></span></div>
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<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Mengalami kelainan jangka panjang :</span></span></li>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Serebral palsi</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Retinopati</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Retardasi mental</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">ü<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Disfungsi neurobehavioral dan prestasi sekolah yg kurang baik.</span></span></div>
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<li><span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="line-height: 115%;">Kematian perinatal.</span></span></li>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Prognosis </span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Pada kehamilan umur 32 mgg dengan berat bayi >1500 gr keberhasilan hidup sekitar 85%. sedang dengan berat < 1500 gr keberhasilan sebesar 80%.</span></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;"> Pada kehamilan umur <32 mgg dengn berat bayi < 1500 gr angka keberhasilan hanya 59%. </span></span></div>
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<span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">Sumber :</span></b></span></div>
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<span style="font-size: small;"><span lang="EN-US" style="line-height: 115%;">Ilmu Kebidanan Srawono Prawirohardjo. Edisi 4</span></span></div>
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<span style="font-size: x-small;"><span lang="EN-US" style="line-height: 115%;"><a href="http://www.kalbe.co.id/files/cdk/files/158_09Fetalfibronectinsbgprediktopartusprematurus.pdf">www.kalbe.co.id/files/cdk/files/158_09Fetalfibronectinsbgprediktopartusprematurus.pdf</a> </span></span></div>
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<span lang="EN-US" style="font-size: small; line-height: 115%;"><span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-41796437413939144362011-12-05T00:06:00.000-08:002011-12-14T15:59:04.974-08:00CRAZY HEART<div class="MsoNormal" style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpQeaWZgKWf7YZCyatnRciQsQlehozrA6ktd2NQFJNJGEZ3vDHqr-TMYWZprsbQHiL1ecWVwKI2Cg6pDq2xDIfWdpxEk_aFdAaNyHQ06eA6k1q-hZyoOwSbEw_8uaL8ZIMJhqcKXWEV_M/s1600/heart.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="148" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpQeaWZgKWf7YZCyatnRciQsQlehozrA6ktd2NQFJNJGEZ3vDHqr-TMYWZprsbQHiL1ecWVwKI2Cg6pDq2xDIfWdpxEk_aFdAaNyHQ06eA6k1q-hZyoOwSbEw_8uaL8ZIMJhqcKXWEV_M/s200/heart.jpg" width="200" /></a>If you can feel my heart, my thought, through every note that I made for you...</div>
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For every mistake that I‘ve taken , I just wanna say that I apologize with you</div>
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I can’t forget every moment that I’ve shared with you when we were still together</div>
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My heart still beats hard when I see your name</div>
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But it’s hurt, more and more hurt coz I can only see you without talking with you.....</div>
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You have been strange....... ,too strange... more and more be strange .. You ignore me... I’m so sad...</div>
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Just tears fall.....with a shock feeling....I ‘m down and very weak...</div>
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<a name='more'></a>There are no chance any more for us to get along well..</div>
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Every beautiful memory with you just make me become more and more hurt...</div>
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I hate to realize the fact that I still miss you now, every day, every time...</div>
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Too difficult for me to forget you... So many things that make me easy to keep you in mind</div>
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I hate this...I hate this.... I hate this.....coz I can’t forget you even just for one day..</div>
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Now...I’m like a dumb girl....who still look at your name without saying anything...</div>
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Just speechless..... ...</div>
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Yeah ..I’m so dumb................ and crazy! It's crazy heart...!</div>
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Dedicate for someone in another part of the earth...</div>
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I’m so sorry.....for all that clashes...</div>
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I still respect you as the awesome one..... </div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com0tag:blogger.com,1999:blog-8762415816777308123.post-26405486290263564172011-11-19T09:07:00.000-08:002011-12-14T15:40:51.881-08:00TRICHOTILLOMANIA<div style="background-color: #f4cccc; text-align: justify;">
Hweiii......my first post akhirnyaaa /blush . Setelah sekian lama ni blog dibuat n' dianggurin..hihi...</div>
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Oke deh karena aq bingung mau nulis apaan, so buat permulaan aq coba sharing referat aq aja dulu yeee.. Referat ini tentang <b>Trichotillomania</b>. Intinya, ini suatu perilaku kejiwaan yang suka cabut2in rambutnya sendiri...(kurang kerjaan banget ya.. /nobigdeal ). Cekidot ! </div>
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<span class="longtext"><b><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUA</span></b></span><span class="longtext"><b><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">N</span></b><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span></span><br />
<span class="longtext"><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Rambut merupakan suatu struktur solid yang terdiri atas sel yang memiliki keratinisasi padat, berasal dari folikel epidermal yang tumbuh ke dalam dermis. Salah satu dari bentuk kelainan rambut adalah alopesia, yakni</span></span><span class="longtext"><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> hilangnya </span></span><span class="longtext"><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">rambut dari</span></span><span class="longtext"><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> kulit.<sup>1,2</sup></span></span><i><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span></i><br />
<i><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Trichotillomania (trichotillosis) </span></i><span class="longtext"><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">adalah suatu bentuk alopesia neurosis yang ditandai oleh dorongan abnormal untuk mencabut rambut. Bagian yang terlibat umumnya regio frontal kulit kepala, alis, bulu mata, dan jenggot.<b> </b>Area rambut yang hilang bisa berbentuk linier ataupun berupa bentuk yang aneh. Prevalensinya berkisar antara 0,5-3,5 % dengan onset usia rata-rata 10 sampai 13 tahun. </span></span><span style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Penyakit ini tujuh kali lebih sering terjadi pada anak-anak </span><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">dibandingkan </span><span style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">orang dewasa</span><span lang="EN-US" style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> dan a</span><span style="-moz-background-clip: border; -moz-background-origin: padding; -moz-background-size: auto auto; background-attachment: scroll; background-image: none; background-position: 0% 0%; background-repeat: repeat; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">nak perempuan 2,5 kali lebih sering daripada anak laki-laki</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span lang="EN-US">Penyakit ini biasanya dilatarbelakangi oleh stres psikososial baik dalam keluarga maupun lingkungannya.<sup>3,4</sup></span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span></i><br />
<i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"><a name='more'></a></span></i><br />
<i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Trichotillomania</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">merupakan</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">salah satu</span> <span class="hps">gangguan</span> </span><span class="hps"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">psikiatris primer </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">yang disebabkan oleh</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">diri</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> sendiri</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span lang="EN-US">Pembahasan </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">tentang</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">trichotillomania </span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">lebih banyak </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">ditemukan</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">dalam jurnal</span> <span class="hps">psikiatri</span></span><span class="hps"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">s </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">daripada</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">jurnal</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">dermatologis</span>. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Namun</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> kenyataan di lapangan menunjukkan bahwa <span class="hps">j</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">umlah pasien</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">trichotillomania</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">yang </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">terlihat</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">di</span> <span class="hps">klinik</span> <span class="hps">dermatologi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">jauh lebih</span></span><span class="hps"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> banyak</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">dari</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> <span class="hps">jumlah</span> <span class="hps">yang terlihat</span> <span class="hps">pada</span> <span class="hps">klinik</span> <span class="hps">psikiatris</span>.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Bahkan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> dalam sejarahnya,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> orang yang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">pertama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> mendeskripsikan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">penyakit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> ini </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">adalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> seorang ahli dermatologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">P</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">e</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">rancis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> bernama</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Francois Hallopeau</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">.<sup>2,5 </sup></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"><sup><br />
<i></i></sup></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Trichotillomania</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">harus</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> dibedakan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">dengan bentuk </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> lain</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> dari </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">alopesia</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">misalnya alopesia areata, alope</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">sia traksi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">, alope</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">s</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">ia androgen</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">ik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> dan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> alope</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">s</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">ia mu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">s</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">in</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">osa.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Selanjutnya, karena pengobatan dini menghasilkan prognosis yang lebih baik dan mencegah komplikasi, </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">maka ahli </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">dermatologi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> memiliki peran penting dalam </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">mendiagnosis penyakit ini.</span><br />
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Pada referat ini akan dibahas mengenai gejala klinis, pemeriksaan, diagnosis dan penatalaksanaan </span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">trichotillomania</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">dari aspek dermatologi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;"> Dengan demikian diharapkan referat ini dapat membantu para dokter dan mahasiswa kedokteran mendapatkan informasi mengenai </span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">trichotillomania</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">.</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">Well........, tu cm pendahuluannya kalo sobat readers mau versi lengkapnya boleh send email kok ke aq ntar bisa langsung aq kirimin, maklum bukannya pelit gak mau ngasih lengkap disini, tapi cm sekedar melindungi hak cipta /please hehehe... :P . Nah ini..aq cantumin aja referensinya... okey...</span></div>
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<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 180%;">DAFTAR PUSTAKA</span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Millard LG, Cotterli JA. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Psychocutaneous Disorders. In Burns T, Breathnach S, Cox, N, Griffiths C, editors. Rook's Textbook of Dermatology. 7th ed. Australia: Blackwell Publishing; 2004; p.611-621</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">2. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Wan C. Trichotillomania. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Chonbuk National University. Korea.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> 20</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">09</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">. Available from <a href="http://emedicine.medscape.com/article/117365"><span style="text-decoration: none;"><span style="color: orange;">http://emedicine.medscape.com/article/117365</span></span></a> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> .Access : Aug 31, 2009</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sandoz A, Koenig T, Kusnir D, Tausk F. Psychocutaneous Diseases. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology In General Medicine. 7<sup>th</sup> ed. USA: McGraw-Hill; 2008; p.914-915.</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">James WD, Berger TG, Elston DM. Neurocutaneous Dermatoses. In: Andrew’s Diseases of The Skin Clinical Dermatology. 10th ed. Canada: Saunders Elsevier, 2006; p.62-63.</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: neurobiology and treatment. Neurosci Biobehav Rev. Jun 2009; 33(6):831-42.</span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">6.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF. Hair Diseases. In: In: Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. 5th Ed. New York: McGraw-Hill; 2009; p.846-847.</span></div>
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<span class="citation"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span class="citation"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Zuchner S, Cuccaro ML, Tran-Viet KN, <i>et al.</i> SLITRK1 mutations in trichotillomania. Mol.Psychiatry 2006 ; 11(10): 887–889. </span></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span style="color: #a64d79;">8</span>.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span style="color: #a64d79;">Chamberlain SR, Menzies L, Sahakian BJ, Fineberg NA. Lifting the veil on trichotillomania. </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span style="color: #a64d79;">Am</span> <span style="color: #a64d79;">J Psychiatry 2007 ; 164:568-574</span></span></div>
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<span class="citation" style="color: #a64d79;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span style="color: #a64d79;">Sperling L. Allopecias. In Bolognia J, Jorizzo J, Rapini R, editors. Dermatology. 2</span><sup style="color: #a64d79;">nd</sup><span style="color: #a64d79;">. USA: Mosby Elsevier; 2008.</span></span></div>
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</div>Cho^^http://www.blogger.com/profile/14191735329904575661noreply@blogger.com8