PROGNOSIS DALAM 24 JAM DENGAN METODE ACUTE PHYSIOLOGI AND CHRONIC HEALTH EVALUATION (APACHE) II PADA PASIEN GAGAL JANTUNG KIRI DI IGD RUMAH SAKIT

Abstract

Heart failure causes high morbidity and mortality due to the heterogeneous clinical syndrome ofcardiac overload. Nurses activating Code Blue require the dexterity of conducting a rapid assessmentof patients who come to the ER using the APACHE II method. The purpose of this study was to findout how the prognosis in 24 hours with the APACHE II method in left heart failure patients in thehospital emergency room. This study used an observational analytic method with a prospective cohortdesign. The sample is 48 respondents. Selected based on consecutive sampling 18 to 25 March 2019at dr. Soedarsono Pasuruan. The results showed that the prognosis within 24 hours using theAPACHE II method in left heart failure patients at dr. Soedarsono Pasuruan with an AUC value of0.853, a sensitivity value of 0.757 and a specificity of 0.818 was included in the strong category inscoring the prognosis within 24 hours of left heart failure patients. While the results of laboratory testsinclude pH, HCO3-, sodium, potassium, creatinine, hematocrit, WBC Count. and APACHE II totalscore. The pH score is 7.21. HCO3_ 18.87mmol/L. Na+ is 123.27 mmol/L. The K+ value is 3.23mmol/L. Creatinine is 2.53 mol/L. Hematocrit 28.19%. The WBC Count value is 22.24 cells/µl.APACHE II total score 35.48. Laboratory results of blood pH are predicted to have an effect onprognosis and mortality. Increased risk of mortality occurs if blood pH <7.1 and pH <6.8. The increasein hydrogen ion concentration/blood acidity in metabolic acidosis is indicated by Kussmaul, aiming toreduce blood PCO2 to compensate for the decrease in blood bicarbonate. Respiratory muscle fatigueoccurs when Kussmaul breathing takes place continuously. Signs of hypocarbia cause cerebral bloodvessel vasoconstriction so that blood flow to the brain decreases. Severe metabolic acidosis results incentral nervous system depression leading to coma and seizures. In conclusion, APACHE II canpredict clinical deterioration in left heart failure patients within 24 hours.Keywords: APACHE II, Left Heart Failure.