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Detail Article

Journal Of Emergency

ISSN 2301-7864

Vol. 2 / No. 1 / Published : 2013-07

TOC : 3, and page :19 - 24

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Original Article :

Lactate levels, deficit bases, and metabolic acidosis measures as predictors factor laparotomy in patients with blunt abdominal trauma fast positive at emergency department of soetomo general hospital surabaya

Kadar laktat, deisit basa, dan asidosis metabolik sebagai faktor prediktor tindakan laparotomi pada pasien trauma tumpul abdomen dengan fast positif di ird rsu. dr. soetomo surabaya

Author :

  1. Vicky S Budipramana --> Dosen Fakultas Kedokteran / vicky@gmail.com
  2. Husnul Ghaib --> Mahasiswa Fakultas Kedokteran / husnul@yahoo.com

Abstract :

Background : Decision-making for surgery in blunt abdominal trauma patients with positive FAST examination (intra-abdominal bleeding) should be quick and precise. The action was based on physical examination and vital signs as haemodynamic parameter, which describes the condition of shock and tissue hypoperfusion.1 However, the signs of shock and tissue hypoperfusion of the physical examination and vital signs are often late, thus increasing mortality, whereby every 3 minutes late death will increase by 1%. Doubts and errors will delay the surgery, so the patient falls on the conditions that are often prolonged ireversible shock.2 Metabolic markers (lactate levels, base deficit, and metabolic acidosis) may appear earlier and more objective in measuring tissue hypoperfusion.1   Objective :  to prove whether metabolic markers can be used as a predictor factor for doing laparotomy in patients with intra-abdominal bleeding   Method: This research was a diagnostic test research with observational analytic design. The study population was patients with internal bleeding in IRD RSU Dr. Soetomo Surabaya. Consecutive sampling 40 samples were determined according to criteria of inclusion-exclusion. Processing data was  using SPSS 18.0 to test multivariate logistic regression analysis of multiple predictive models. ROC curve coordinates to determine the value of cut of point levels of lactate and base deficit.   Result : Statistically metabolic markers can predict the actions of a laparotomy with acidosis significance (p: 0.007), blood lactate (p: 0.008), and base deficit (p: 0.037). Based on the cut of point lactate levels (2.7 mmol / L) had a sensitivity of 92%, specificity 93%, positive predictive value 96%, negative predictive value 88%, accuracy 93%, and (-3.5 mEq / l ) has sensitivity 92%, specificity 73%, positive predictive value 85%, negative predictive value 85%, accuracy of 85%, whereas blood pH or acidosis had a sensitivity of 68%, specificity 93%, positive predictive value 94%, negative predictive value 64 %, and accuracy 78%. The combination of the levels of lactate and base deficit had a sensitivity of 100%, specificity 100%, positive predictive value 100%, negative predictive value of 100%, and 100% accuracy.   Conclusion : Levels of lactate, base deficit, and metabolic acidosis can be used as a predictor factor for laparotomy surgery in patients with intra-abdominal bleeding, the accuracy, respectively 93%, 85%, and 78%. Lactate levels together with a base deficit increased sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to 100%.

Keyword :

metabolic marker, laparotomy, intra-abdominal bleeding,


Daftar Pustaka :

  1. Hoff WS, (2002). ractice Management Guidelines for the Evaluation of Blunt Abdominal Trauma: The EAST Practice Management Guidelines Work Group. 53:602-15 : J Trauma


   


Archive Article

Cover Media Content

Volume : 2 / No. : 1 / Pub. : 2013-12
  1. The effect of hyperthermia as a remote hyperthermic preconditioning (rhp) on viability of random pattern skin flap in rat
  2. The effect of fat tissue mesenchymal stem cells to the total amount of receptor of basic fibroblast growth factor (bfgf) in wound healing process on males rabbit (oryctolagus cuniculus)
  3. Effect of adipose mesenchymal stem cells on angiogenesis process on rabbit skin wound
  4. Lactate levels, deficit bases, and metabolic acidosis measures as predictors factor laparotomy in patients with blunt abdominal trauma fast positive at emergency department of soetomo general hospital surabaya
  5. Relationship between intraoculi pressure, intracranial pressure and mean arterial pressure on severe brain injury patients
  6. Diagnostic test of serum glial fibrilary acidic protein for differentiating intracerebral hemorrhage stroke and non hemorrhage / ischemic stroke in acute stroke patients
  7. Effect of enteral glutamine supplementation for the low birth weight on gaining weigh pattern and level of faecal secretory iga
  8. Correlation between body mass indeks and incidence of hypotension on pregnant mothers undergoing caesarean section under spinal block anesthesia
  9. Analysis of the level of rationality of blood tranfusion in emergency surgery serviced in the emergency department soetomo general hospital surabaya