The document discusses basic emergency life support (B GELS) for handling emergency patients. It outlines the objectives and skills participants should have in managing emergency patients, including recognizing emergencies, diagnosing and treating airway/breathing/circulation issues, altered mental status, and providing oxygen therapy. It also discusses causes of airway obstruction, techniques for opening the airway both with and without devices, and indications for definitive airway procedures like endotracheal intubation or cricothyrotomy.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Basic life support is a course run by American Heart Association that teaches about handling cardiac arrest in Out of Hospital and In Hospital Situations. This Presentation covers important aspects of the same.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Basic life support is a course run by American Heart Association that teaches about handling cardiac arrest in Out of Hospital and In Hospital Situations. This Presentation covers important aspects of the same.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. T P U
Peserta mampu menangani penderita gawat darurat dengan baik dan benar
T P K
Peserta mampu :
1. Mengenal penderita gawat darurat
2. Mengetahui macam-macam penyebab kegawat daruratan
3. Memahami sistematika penanganan penderita gawat darurat
4. Mendiagnosa kegawatan jalan nafas / airway
5. Menangani kegawatan jalan nafas / airway
6. Mendiagnosa kegawatan nafas / breathing
7. Menangani kegawatan nafas / breathing
8. Memberikan terapi oksigen
9. Mendiagnosa gangguan sirkulasi
10. Menangani gangguan sirkulasi
11. Mendiagnosa gangguan kesadaran
12. Menangani gangguan kesadaran
3. Penderita Gawat Darurat
Penderita yang oleh karena suatu penyebab
(penyakit, tindakan, kecelakaan)
bila tidak segera ditolong akan cacat,
kehilangan anggota tubuh atau meninggal
11. SURVAI KESEHATAN RUMAH SAKIT (SKRT) 1986
DAN 1992
• Kematian jantung Urutan 2
• Kematian trauma Urutan 4
• Kematian jantung di Jakarta
1991 2535 orang
1992 2746 orang
1993 2961 orang
1994 3255 orang
1995 1283 orang (sampai maret)
• Kematian kecelakaan lalu lintas di Indonesia
1991 10.621 orang
1992 9.819 orang
1993 10.038 orang
1994 11.004 orang
1995 9.251orang
12.
13. USA : TRAUMA
• Trauma penyebab kematian ketiga setelah cancer
dan atheroselerosis
• Usia 1- 44 tahun (produktif) penyebab kematian pertama
• Jumlah kecelakaan : 60 juta / tahun
• 30 juta perlu perawatan medik
• 3,6 juta perlu MRS
• 9 juta cacat :
3000.000 permanen
8.700.000 temporer
• Kematian 145.000 / tahun
• Trauma – related costs > $ 100 milyar / year
14. HASIL SURVEY DI PROPINSI :
NTT, KALBAR, KALTENG, SUMUT, BENGKULU
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Macam Kasus
Trauma / kecelakaan lalu lintas
Diare
Malaria – panas – kejang
ISPA – batuk – sesak
Stroke – tidak sadar
TBC – batuk darah – sesak
Jantung – hipertensi, infark
Obsgyn – perdarahan, eklampsia
Intoksikasi – gigitan ular - peptisida
% Kasus
20 %
17 %
15,6 %
12,2 %
8,6 %
7,7 %
7,6 %
6,4 %
4,9 %
Trauma : 25 %
Non trauma : 75 %
15.
16. BILA TERJADI HENTI NAFAS DAN HENTI JANTUNG
Keterlambatan
1 menit
4 menit
10 menit
Kemungkinan berhasil
98 / 100
50 / 100
1 / 100
17.
18. CHAIN OF SURVIVAL
Early Activation of EMS
Early Basic of CPR
Early Defibrillation
Early Advanced Life Support
22. CONCEPT
• ABCDE – approach to evaluation / treatment
• Treat greatest threat to life first
• Definitive diagnosis not immediately important
• Time is of the essence
• Do no further harm
23. INITIAL ASSESSMENT / MANAGEMENT
Injury
Primary survey and adjuncts
Resuscitation
Reevaluation
Secondary survey and adjuncts
Reevaluation
Optimize patient status
Transfer
24. Primary survey and resuscitation
of vital functions are done
simultaneously – a team approach
26. PENANGANAN PASIEN GAWAT DARURAT
• Pem. Fisik awal (A-B-C-D)
(Primary survey) + Lab. Awal
• Terapi suportif / resusitasi (life support)
Stabilisasi
• Pem. Fisik sekunder (Secondary survey)
Anamnesa
Dari kepala s/d kaki (B1 s/d B6)
• Pemeriksaan penunjang
• Diagnosa
• Terapi defenitif
27. CPCR / RJPO (Peter Safar)
1. Basic life support emergency oxygenation
A : Airway
B : Breathe
C : Circulate
2. Advanced life support Restoration of spontaneous
circulation
D : Drugs and Fluids
E : EKG
F : Fibrillations treatment
3. Prolonged life support post resuscitation brain –
oriented therapy
G : Gauging
H : Human mentation
I : Intensive care
28. KONSEP ATLS
• Primary Survey
A : Airway with C-spine control
B : Breathing with ventilation
C : Circulation with hemorrhage control
D : Disability : neurologic status
E : Exposure/environment with temperature control
• Resuscitation
• Secondary Survey
Head – to – toe evaluation and history
• Reevaluation
• Definitive care
29. KEY POINTS ACLS
In the Primary Survey, focus on basic CPR and
defibrillation
First A-B-C-D
• Airway :
Open the airway
• Breathing :
Provide positive – pressure ventilations
• Circulation :
Give chest compressions
• Defibrillation:
Shock ventricular fibrillation or pulseless
ventricular tachycardia (VF/VT)
30. KEY POINTS ACLS
In the Secondary Survey, focus on intubation,
intravenous (IV) access, and drugs and
why the cardiorespiratory arrest occurred
Second A-B-C-D
• Airway :
Perform endotracheal intubation
• Breathing :
Assess bilateral chest rise and ventilation
• Circulation :
Gain IV access, determine rhythm, give
appropriate agents
• Defibrillation Diagnosis (Think):
Search for, find, and treat reversible causes
31. PPGD (Penanggulangan penderita gawat darurat) Dokter umum
BLS
ALS
PLS
NLS
ACLS HIGH RISK
HIGH FREQUENCY
HIGH SUCCESS
PROCEDURE
- PRIMARY PREVENTION
- SECONDARY PREVENTION
LOCAL SPECIFIC
- MALARIA
- DHF
- GE
BLS : Basic life support (A, B, C, BRAIN)
ALS : Advance life support
ATLS : Advance trauma life support (Trauma oriented L.S)
ACLS : Advance cardiac life support (Cardiac oriented L.S.)
NLS : Neonatal life support
PLS : Pediatric life support
OLS : Obstetric life support
PTC
OLS
PTC : Primary trauma care
A : Airway
B : Breathing
C : Circulation
Dsan: Dokter spesialis
Anestesi
PENANGGULANGAN PENDERITA GAWAT DARURAT
Basic General Emergency Life Support (GELS)
ATLS
32. LIFE SUPPORT
A : Airway Support
B : Breathing Support
C : Circulation Support
D : Disability / Brain Support
35. PROTECTION FROM COMMUNICABLE
DISEASE
• Water impermeable apron
• Gown
• Gloves
• Face mask
• Cap
• Eye protection / goggles
• Foot covers
To prevent contact with body fluids patients
36.
37. T P U
Peserta mampu melakukan pengelolaan jalan nafas.
T P K
Peserta mampu :
-Mendiagnosa sumbatan jalan nafas/airway
-Mengetahui penyebab sumbatan jalan nafas/airway
-Mengelola sumbatan jalan nafas
- tanpa alat
- dengan alat
A (AIRWAY)
50. PENGELOLAAN PERLU :
CEPAT, TEPAT, CERMAT
Sumbatan Total :
• FRC (Functional Residual Capacity) : 2500 ml
• Kadar O2 15% x 2500 ml : 375 ml
• Kebutuhan O2 permenit : 250 ml
• Bila ada sumbatan total O2 dalam paru habis dalam
: 375 / 250 : 1,5 menit
68. Membrana cricothyroid
Pada keadaan gawat darurat
- Tempat injeksi transtracheal
obat emergency
- Tempat untuk
needle dan surgical
cricothyroidotomi
Bagaimana caranya ??
Obat apa saja boleh masuk ??
70. TUJUAN INTUBASI ENDOTRAKHEAL
1. Sebagai jalan nafas
2. Untuk oksigenasi
3. Untuk pemberian ventilasi
4. Mencegah aspirasi
5. Jalan pemberian obat (intra trakheal)
6. Bronchial toilet
MACAM INTUBASI ENDOTRAKHEAL
• Orotrakehal Lewat mulut
• Nasotrakheal Lewat hidung
72. PERALATAN INTUBASI ENDOTRAKHEHAL
• Laryngoscope dengan blade yang sesuai
• Tube dengan ukuran yang sesuai
• Jelly
• Anestetik lokal / spray
• Forceps – magill
• Bite block / oropharyngeal airway
• Adhesive tape / tali
• Suction – metal yang kauer
• Connectors
• Synringe (20 cc)
• Stylet
• Stetoscope
• End tidal CO2 monitor
79. INTUBASI ENDOTRAKHEAL
• Oksigenasi + ventilasi (5 menit)
• Alat dan obat siap
• Harus berhasil kurang 30 detik
• Bila > 30 detik belum berhasil oksigenasi + ventilasi ulang
• Penolong tak kuat tahan nafas
• Saturasi O2 menurun
• Monitoring :
Saturasi O2 (Pulse oxymeter)
End-tidal CO2 (Capnografi)
89. T P U
Peserta mampu menangani kegawatan
nafas/breathing
T P K
Peserta mampu :
-Mendiagnosa kegawatan nafas
-Mengetahui penyebab kegawatan nafas
-Mengelola kegawatan nafas
- tanpa alat
- dengan alat
B (BREATHING)
90. GANGGUAN VENTILASI
Penyebab
• Tindakan anestesi
• Penyakit
• Kecelakaan trauma
Lokasi
• Sentral
Pusat nafas
• Perifer
Jalan nafas Dinding dada
Paru Otot nafas
Rongga pleura Syaraf & jantung
91.
92. GANGGUAN VENTILASI
(penderita masih bernafas)
Look / Lihat
Sianosis Takhipnea
Status mental Distensi vena leher
Asimetri dada Paralisis otot nafas
Listen / dengar
Keluhan: “Tak bisa nafas!”
Stridor, wheeze
atau hilang suara nafas
93. Feel / raba
Hawa ekspirasi
Emfisema subkutan
Krepitasi / tenderness / nyeri
Deviasi trakhea
Adjuncts
Pulse oximeter
CO2 detector
Gas darah
X-ray dada
…………gangguan ventilasi
(penderita masih bernafas)
94. BEBERAPA ISTILAH
• Ventilation
Aliran (volume) udara keluar – masuk paru
• Tidal volume
Volume udara yang dihisap/dikeluarkan pada
satu kali nafas biasa
6 – 8 ml / kg bb 70kg: 400 – 55 ml
• Minute volume
Tidal volume x freq.
6 – 8 l / menit
96. From: Pontoppidan,H.,Laver,M.B.,and Geffin,B,Acute respiratory failure in the surgical patient,
in Welch.,C.E.(ed): Advances in surgery, volume 4,Chicago, Year.
Book Medical Publishers,1970,p.163
After 15 minutes of 100% O2
Except in chronic hypercapnia
Ventilation :
•VD/VT
•PaCO2 mm hg
Oxygenation :
• A – a DO2 mm hg
• PaO2 mm Hg
Mechanics :
•Respiratory rate/Min
•Vital capacity mml/kg
•Inspiratory force cm h2o
0,3 – 0,4
35 – 45
50 – 200
100 – 75
(air)
12 -25
70 – 30
100 - 50
0,4 – 0,6
45 – 60
200 – 350
200 – 70
(mask O2)
25 – 35
30 – 15
50 – 25
> 0,6
> 60
> 350
< 70
(mask O2)
>35, <10
< 15
< 25
Intubation
Ventilation
tracheostomy
Close
monitoring,oxygen,p
hysical Tx
Normal
Criteria
97. DASAR PEMBERIAN VENTILASI
• Intermittent positive pressure ventilation (IPPV)
• Penderita tak bernafas
Nafas buatan (controlled ventilation)
• Penderita masih bernafas / tak adekuat
Nafas bantuan (assisted ventilation)
Diberikan pada akhir ekspirasi
• Tekanan oropharing > 25 cm H2O udara masuk
esophagus distensi lambung
98. ………….dasar pemberian ventilasi
• Sellick’s maneuver
Menekan cricoid kebelakang sehingga esophagus
terjepit diantara cricoid dan corpus vertebra leher
Agar :
Udara tak masuk lambung
Isi lambung tak mengalir ke oropharing
Tak boleh pada cedera tulang leher
• Nafas buatan :
Tidak volume 10-15ml/kg
Frequensi 12-15 / m
99. CARA PEMBERIAN VENTILASI
Tanpa Alat
Mouth to mouth
Mouth to nose
Mouth to mouth and nose
Dengan Alat
Safar airway
Esophageal obturator airway
Face mask / pocket mask
Laryngeal mask
Bag-valve-mask
Bag-valve-tube
Ventilator
106. T P U
Peserta mampu mengelola kegawatan sirkulasi.
T P K
Peserta mampu :
-Mendiagnosa gangguan sirkulasi
-Melakukan penanganan gangguan sirkulasi
C (Circulation)
107. C (Circulation)
Assessment of organ perfusion
- Level of conciousness
- Skin color and temperature
- Pulse rate and character
- Urinary output
108. SHOCK
An abnormality of the circulatory system
that result in inadequate organ perfusion
and tissue oxygenation
115. CO = SV X F
preload C after load
EDV SVR
VR
BP = CO X SVR
116. T P U
Peserta mampu menilai gangguan kesadaran.
T P K
Peserta mampu :
-Menilai dengan menggunakan metode AVPU
-Menilai dengan menggunakan metode GCS
-Menilai reaksi pupil
-Memahami bahaya penurunan kesadaran
-Mengetahui penyebab penurunan kesadaran.
D (DISABILITY)