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Principles of Medical Emergency Treatment

Written By nursingstikes on Friday, December 28, 2012 | 8:23 PM

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Principles of Medical Emergency Treatment
 

Medical emergencies can happen to a person or group of people at the time and anywhere. This can be either a sudden attack of disease, accident or natural disaster. This situation requires immediate help that can be either first aid until the next relief well at the hospital. Such actions are intended to save lives and limit disability and prevent alleviate the suffering of patients.
    This situation requires knowledge and skills in addition to the good of the helper and adequate facilities, also needed a perfect organization.


CRITICAL CARE MEDICINE 

Critical Care Medicine, is one form of medical activity from the scene of an emergency management system starting from the scene to the hospital.
    First aid is usually given by people around the victim; of them will contact the nearest health worker or doctor. Not uncommon that members of police and firefighters involved in this. This aid should be given precisely the wrong treatment because it will result in death or disability. It becomes a fairness when against members of the police or fire department were given education and training about it.
    After first aid is given, then the patient is transported to a local hospital, as far as possible with a special transport, such as ambulances are equipped with equipment and health workers.
    During our drive to the hospital, patients continued to receive help and close supervision.
    In the hospital patients get good relief by doctors and health workers. Hospitals with intensive Handling Unit ( Intensive Care Unit ) is the end of the chain of control patients in the Critical Care Medicine.

ATTITUDE HELPER 

Because the people who responded to severe pain in critical condition, the doctor must race against time to save the lives of patients. In this situation do not act in panic but stay calm and deft.
    The things that must be considered against the victim:
    1. Breathing and heart rate.
         If the patient stops breathing, immediately doing CPR effectively doing mouth to mouth breathing, and in conjunction with this study whether there is cessation of heartbeat. If the heart stops beating, perform external cardiac massage.
    2. Bleeding
        Make efforts to stop the bleeding, especially bleeding from large blood vessels.
    3. Shock
        Watch for signs of shock and prevention.
    4. Prevent aspiration of vomit patients with patient position tilted to one side of the body.
    5. Do not rush to move the victim from his place before certain transportation facilities are adequate.
  Against people with fractures, first made dressings.

MEDICINE AND EQUIPMENT

Some of the equipment and medicine needed as a minimal first aid in the management of emergency medic is:
    Equipment
   1. Ordinary sanitary.
   2. Sterile gauze.
   3. Triangular bandage.
   4. Plaster.
   5. Cotton.
   6. Tourniquet.
   7. Syringes.
   8. Simple surgical tools.
   9. Tools infusion and transfusion.


Medication
1.    Antiseptic medicines.
       Drug-drug injection.
          adrenaline, 1 mg / ml
          aminophylline, 250 mg / 10 ml
          ampicillin, 250 mg and 500 mg
          atropine sulphate, 0.6 mg / ml
          chorpheniramine maleate, 10 mg / ml
          chlorpromazine, 50%, 2 ml
          dextrose 50%, 20 ml
          diazepam, 10 mg / 2 ml
          digoxin, 0.5 mg / 2 ml
          ergometrine, 0.5 mg / ml
          ethyinoradrenaline, 2 mg / ml
          forosemide, 20 mg / 2 ml
          hydrocortisone sodium succinate, 100 mg
          hyoscine N-butylbromide 20 mg / ml
          morphine sulfate, 15 mg / ml
          penicillin G, 1mega U (600 mg)
          pentazocine 45 mg / 1.5 ml and 60 mg / 2 ml
          pethidine HCl, 100 mg / 2 ml
          phenobarbitone sodium, 200 mg / ml
          phytomenadione 10 mg / ml
          salbitamol, 0.5 mg / ml
          trifulpromazine, 20 mg / ml
          aquadestilata

2. Oral Medications.          
          ampicillin, 250 mg and 500 mg          
          chlorpheniramine maleate, 4 mg          
          metronidazole, 200 mg           
          pencillin-VK, 250 mg           
          pentazocine, 50 mg           
          pethidine, 50 mg          
          terbutaline 0.5 mg / ml           
          tiemonium bromide, 50 mg
         
3. Drug-drug per infusion.
          Ringer lactate 
          Glucosa 5% 
          NaCl

   Other equipment in the room must have a minimum of medical emergencies include: oxygen tank with regulator and flowmeter and a simple suction device that can run on battery. For emergency room medical equipment facility that is more perfect is to be provided kinds of drugs and additional facilities as follows:

Drugs

AgNO3 20-30%
Trikloro acetic acid
aminophylline
isuprel
sedilanid
klonidin
mannitol 20%
urea 30%
30% glycerin in water
asetasolamid
2% acetic acid
ATS 1500 U
tulle. Savlon
sulfadiazine
antivenom polivalen
heparin
ether
hidroklorotiasid
serpasil
adona AC 17
ergometrin
sintosinon
magnesikus sulfas
pentotal
ketalar
difenhidramin

The drugs for infusion: 

liquid plasma expander 
2 A fluid
tutofuchsin 
aminofuchsin 
glycerin 
dextrose 5%

Tools

Water seal drainage
DC shock
intubator endotracheal
sparkplug Nelaton
catheter Fowley
EMO tools
obstetric surgical instrument
vacuum mattress
infant resuscitator
Electro convulsive Therapy
drain
litter
splint




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Beginsels van Mediese Noodbehandeling,Parimet e trajtimit të urgjencës mjekësore,مبادئ العلاج الطبي الطارئ,Սկզբունքները Բժշկական Արտակարգ Բուժում,Təcili tibbi müalicə prinsipləri,Prinsip Pengobatan Medis Darurat,Larrialdietarako osasun-printzipioak,Beginselen van de medische Emergency Treatment,Принципи на Медицински спешно лечение,
Прынцыпы неадкладнай медыцынскай дапамогі,Zásady Zdravotnické záchranné léčby,
Principper for Medicinsk Akut behandling,Põhimõtted kiirabiauto ravi,اصول درمان پزشکی اورژانس,Principios de tratamento médico de emerxencia,პრინციპები სამედიცინო გადაუდებელი მკურნალობა,चिकित्सा आपातकालीन उपचार के सिद्धांतों,עקרונות לטיפול רפואי דחוף, Principles of Medical Emergency Treatment
Prionsabail na Cóireála Éigeandála Leighis, Meginreglur Medical Emergency Meðferð
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, Principiile de tratament medical de urgenţă, Принципы неотложной медицинской помощи
, Принципи медицинске хитне лечење, Načela nujnega zdravljenja, Принципи медицинске хитне лечење, Zásady Zdravotnícke záchranné liečby, Principios de Tratamiento Médico de Emergencia, Periaatteet Medical Emergency hoito, Kanuni za matibabu ya dharura, Principer för medicinsk Akutvård, ลักการรักษาพยาบาลฉุกเฉิน, Tıbbi Acil Tedavi Prensipleri, Принципи невідкладної медичної допомоги, میڈیکل ایمرجنسی علاج کے اصول, Nguyên tắc điều trị y tế khẩn cấp, Egwyddorion Triniaeth Meddygol Brys,פּרינציפּן פון מעדיקאַל עמערגענסי טרעאַטמענט, Αρχές Ιατρική Περίθαλψη έκτακτης ανάγκης

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Emergency Breathing System

Written By nursingstikes on Thursday, December 27, 2012 | 11:08 PM

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Emergency Breathing System
 

Epistaxis
Airway obstruction
Massive hemoptysis
Status asmatikus
Thoracic trauma



 
Epistaxis

Epistaxis or bleeding from the nasal cavity are common and most will stop spontaneously or by simple actions such as pressing the nose. Nevertheless there are hard cases that require immediate relief to not be fatal.

Various causes of epistaxis
A. Because local
1. Trauma: sneeze, nose picking, hit hard, irritating gas, foreign bodies.
2. Infection: rhinitis, sinusitis, specific granuloma.
3. Neoplasms: juvenilis nasopharynx angiofibroma.
4. Congenital: hereditary hemorrhagic teleangiectasia (Osler).
 

B. Because systemic
1. Cardiovascular: hypertension, Aartiriosklerosis.
2. Blood disorders; ITP, hemofili, leukemi.
3. Infection: typhoid, influenza, morbilli.
4. Changes in atmospheric pressure: Caisson disease.
5. Endocrine: menarche, pregnancy, menopause.

According to the source, epistaxis divided into:
1. Anterior epistaxis:
    Originating from plexus Kiesselbach or a. etmoidalis anterior. Especially in the encounter with the children, usually minor and easily overcome.
2. Posterior epistaxis:
    Coming from a. sfenopalatina and / or a. etmoidalis posterior. Often there is at an advanced age due to hypertension or arteriosclerosis. Usually severe and rarely stops spontaneously.

Management:
Having principles:
1. Stop the bleeding.
2. Prevent complications.
3. Prevent repeated by finding the cause.

1. Determine the origin of bleeding by putting a tampon in the wet with adrenaline 1 / 1000 and pontokain 2%, aided by a vacuum.
Wherever possible the patient in a sitting position.
 

When the bleeding was coming from the anterior:
2. Replace the tampon soaked in adrenaline 1 / 1000 and pontokain 2% for 5-10 minutes, and pressed toward the septum.
3. After the tampon is removed, bleeding from the caustic with AgNO3 solution of 20-30% or 2-6% trichloroacetic acid or with electrocautery.
4. If still bleeding, put tampons anterior consisting of cotton or gauze that was given boorzalf or bismuth iodine paraffin paste (BIPP).
Tampons are maintained for 1-2 days (when using boorzalf) or 3-4 days (when using BIPP).

When the bleeding was coming from the posterior:
5. Try to cope with the caustic and anterior tampon.
6. If failed, the posterior pairs of tampons (Bellocq );
How:
- Tampon is comprised of roll gauze that has two threads on one end and a thread at the other end.
- Enter the characters from the rubber into the anterior nares to look at orofarings and pull it out through the mouth.
- At the end of the catheter is attached to one of two existing threads on one end and the catheter withdrawn through the nose. In the same way that other threads released through the other nostril.
- Then the two threads that have come out through the nostrils was withdrawn, while the index finger of other hand to help push towards the nasopharynx, until proper shut koana.
- Lau both are tied to the other tampon which is located near the nasal cavity. Yarn from the other end out through the mouth and attached loosely in cheek, this thread is useful to draw out the tampon when will be released.
- If you need to be installed also the anterior tampon.
- Patients should be treated and tampons removed after 1-2 days. The following antibiotics.

When the bleeding has been settled despite the above measures, consider artery ligation surgery:
7. Ligation for bleeding anterior done a. esmoidalis anterior by making an incision from the medial part of    eyebrows downward along the bridge of the nose up to slightly below kantus internus; after the network is separated will look a. etmoidalis anterior.
8. Ligation for bleeding posterior done a. internal maxillary by making an incision in the crease gingivobukal as in Caldwell Luc operation; after entering the maxillary sinus posterior sinus wall removed so that it looks a. internal maxillary and its branches in fosapterigomaksilaris.

COMPLICATIONS
Of bleeding:
- Anemia.
- Shock.
- From installation tampons:
- Sinusitis, otitis mrdis, septikemi.
- Hemotimpanum.
Molle-laceration palate.
Airway obstruction
Is an emergency that can be caused by various reasons, among others:
1. Airway edema: can be caused by infection (diphtheria), allergic reactions or due to instrumentation (endoktrakeal pipe installation, bronkopi) and blunt trauma.
2. Foreign objects.
3. Tumors: cysts larings, larings papilloma, laryngeal carcinoma; usual blockage occurs slowly.
4. Trauma larings area.
5. Muscle spasm larings: tetanus, emotional reaction.
6. Abductor muscle paralysis of the vocal cords (abductor paralysis): especially when bilateral.
7. Congenital Negligence: laryngeal web, causing fistula trakeoesofagus laringotrakeomalasia.

SYMPTOMS AND SIGNS
Can be divided into four stages (Jackson):
     I. Shortness of breath, stridor inspiration, retraction suprastrernal; general situation is still good.
     II. Symptoms of stage I + retraction epigastrium; patient became restless.
     III. Symptoms of stage II + retraction supra / infraklavikular, people are very nervous and sianotik.
     IV. Symptoms of stage III + intercostal retraction, people try very hard to breathe the air: long run going central respiratory paralysis, the sufferer becomes apatik and eventually died.


MANAGEMENT:
When caused by foreign objects (such as choking on food) try out immediately with the Heimlich maneuver:
A. patient in a sitting position / standing:
    1. .- helper sit / stand behind the patient.
         - wrap both hands around the patient.
         - make a fist with one hand, other hand gripping the fist with the thumb facing the abdomen and placed in the epigastrium.
        - do it firmly and quickly pushing towards the top.
        - this action can be repeated several times.   

   2. If not successful, try to hook a foreign object with a finger that was tied into the larings.
   3. When hard or foreign object is located in, patients in the bend and in a strong pat on the back of both the scapula.
 
B. patient in the supine position:
 
1 .- helper kneel on both knees in patients with left and right side of the patient's body
     - one palm placed on the epigastrium patients, the other palm on it
     - apply pressure with the heel of the hand with a strong and rapidly towards the top
     - this action can be repeated several times
2. If the patient vomited, twisting his body and clean his mouth.


If the above methods fail or when not caused by foreign objects, prepare immediately bronchoscopy or tracheotomies.
     Against persons with airway obstruction stage I and II be taken koservatif with oxygen, bronchodilators drugs (aminophylline, Bisolvon) and anti-edema (Papasee); and tight control over symptoms.
     Airway obstruction stage III and IV require intubation or tracheotomies immediate action.

Intubation
It is the act of laying pipes endokrakeal (usually has a cuff) or bronchoscope.

Difficult or not can be taken on larings edema, weight larings trauma, tumor n.rekurens closed glottis or bilateral paralysis. This method is relatively easy and quick to do, but:
- causes trauma that can arise larings scarring that makes it difficult extubation.
- not easy to set up more than 2 x 24 hours.
- often despite themselves so as to endanger patients.
- blocking peroral intake.

Tracheotomies
An act making the airway just by making a hole (stoma) in the trachea.
According to the urgency divided into:
- Emergency tracheostomy
Performed on an emergency, usually in areas glottis (high tracheostomy); should be replaced with low tracheotomies.
- Orderly tracheotomy
An action plan, carried out on ring III or below (tracheostomy below (low trakeostomy)

Technique:
- Premedication with atropine sulfate 1 mg i.m.
- Patient within hiperektensi position on the neck, if necessary neck propped up with pillows / bags of sand.
- After skin incision and antisepsis area of action, given local anesthesia (infiltration) with procaine 1% starting from the thyroid cartilage to the trachea previous supraster fossa region must be marked with endotracheal tube or bronchoscope.
- Incision is made from the bottom of the cartilage krikoid until suprasternal fossa, right in the horizontal, although cosmetic worse.
- Subcutaneous tissue is set aside, as far as possible do not cut the blood vessel, cut the muscle fascia in the midline.
- After the tracheal rings are visible, the thyroid isthmus is set aside (if necessary separated) to open fourth tracheal ring; bleeding treated.
- Can be injected a few drops of 5% cocaine through interkartilago I to prevent irritation of the installation cannula.
- Trachea should be opened in the midline below the third ring, then made a hole or flap in accordance with the cannula that will be installed.
- If any, foreign objects can be searched and removed through the stoma with the help of nasal speculum and forceps; if it is a foreign body was located distal to the stoma and can be retrieved, push to one of the bronchial airways to open for some and immediately send it to places that have facilities bronchoscopy.
- Post-actions do not need stitches, if necessary, can be made loose stitches at both ends insisisi.

Some things to note:
- insisis which complicates the search too short trachea and facilitate the occurrence of subcutaneous emphysema.
- cannula as far as possible in accordance with melted diameter of the trachea:
   - if too small will be easy to move, giving rise to stimulation.
   - if too big will reduce tracheal wall, resulting in easy necrosis.
   - if too pentek, easy off and into the subcutaneous.
   - if too long end will shift the tracheal wall that stimulates granulation and stenosis.

Treatment of post tracheotomies:
- secretions are often cleaned with a vacuum, every 15 minutes.
- cannula in cleaned at least once a day;'m cannula out to 2-3 days.
- cloth pads cannula should be replaced when wet to avoid dermatitis.
- dekanulasi done gradually, at first closed 1/4bagian, if no complaint cap ½ parts, etc. ¾ and finally closed completely, only then cannula is removed.


Complications tracheotomies
:
- bleeding, especially from a truncated thyroid skin incision.
- the infection-prone perikondritis thyroid, pneumonia.
- granulation tissue
- tracheal stenosis or larings.
- fistulas trakeoesofagus.
- subcutaneous and mediastinal emphysema.
- pneumothorax.


MASSIVE HEMOPTYSIS
Cough is accompanied by bleeding more than 600 ml within 24 hours (Cook).
Classification of bleeding (Pursel):
+             : cough with bleeding-shaped stripes of blood in the sputum.
+ +          : a cough with bleeding 10-30 ml
+ + +       : a cough with bleeding 30-150 ml
+ + + +    : a cough with bleeding> 150 ml
Important to distinguish between haemoptysis with the aspiration of gastrointestinal bleeding (hematemesis), who coughed:
Haemoptysis, haematemesis clinical differences
Hemoptysis
- Colour pink
- No food scraps, foaming
- Reacting base
- History of lung disease / heart

Hematemesis
- Color black red
- Often mixed with food scraps
- Reacting acid
- History of gastrointestinal disease

Usually caused by pulmonary tuberculosis (TB) / (TBC), bronchiectasis, lung abscess or neoplasm which roughly can be predicted from the nature of the bleeding:
- If there is bleeding lines in sputum, usually due to acute bronchitis or pneumonia.
- If there is constant light bleeding is usually caused by endobronchial neoplasms
- If bleeding occurs in large numbers is usually caused by pulmonary infarction, cavities or bronchiectasis.
Patients may die because:
- Asfiksi airway obstruction caused by blood clots.
- Shock due to massive bleeding.

MANAGEMENT:

A. Conservative.
1. Rest lying with his head lower and tilted to the side of pain.
2. Clean the airway of blood clots; if necessary give oxygen intermittent.
3. Put the liquid infusion; if necessary to do blood transfusions.
4. Avoid loud cough by giving
    - Sedatives: - phenobarbital with a maximum dose of 250 mg / administration, im; or - diazepam 10-20 mg  iv / im.
    Antituif; - codeine 10-20 mg orally.
5. Coagulant drugs
   - Vitamin K 10 mg iv.
   - Adona AC - 17R 50-100 mg/3-4 hour iv.
6. Ice bag on your chest

Further action, if possible:
7. Determining the origin of bleeding with X-ray images and bronchoscopy
8. Determining the cause and treatment.

B. Surgery.

Surgery is considered an emergency when there is no indication as follows (Busroh)
1. Patient coughing up blood> 600 ml / 24 hours and in the observation does not stop
2. Patient coughing up blood between 250-600 ml / 24 hours with Hb <10 g % and coughing up blood mash continue.
3. Patient coughing up blood between 250-600 ml / 24 hours with Hb> 10 g %, but conservative treatment for 48 hours, do not stop coughing up blood.
Before the surgery done, as far as possible checked for lung function and make sure the origin of the bleeding, while the type of surgery ranged from segmentektomi, lobectomy and pneumonektomi with or without torakoplasti.

STATUS ASMATIKUS
INTRODUCTION
Status asmatikus is a severe asthma attack, took place within a few hours to several days, which is not member i improvement on the usual treatment.
Status asmatikus an emergency medic who can berakbat death, therefore:
- In the event of an attack, should be addressed Seara appropriate and preferred to overcome respiratory effort.
- The state should be prevented by taking into account factors that stimulate the emergence of an attack (dust, pollen, certain foods, respiratory infections, stress, emotion, etc.)

Symptoms and Signs

1. Patients in a state of severe shortness of breath accompanied by expiratory wheezing (wheezing); can be accompanied by a cough with thick sputum, difficult expelled.
On examination the patient was restless, breathe using the muscles of additional premises signs of central cyanosis, tachycardia, pulsus paradoksus and longitudinal phase accompanied ekspirium wheezing.
2. Examination of sputum and blood laboratirium eosinofili there, especially in allergic asthma.

MANAGEMENT

The principle of the laboratory are listed in Table 1.

Table 1. The principle of management of Status Asmatikus
1. Diagnisis asmatikus status
Important factors to consider:
a. Weighing attack
b. Drugs that have been given (drug and dosage)
       2. Bronchodilator drug administration
       3. Penilaan to repair attack
       4. Consideration of corticosteroids
       5. After the attack subsided;
a. Search of factors
b. Modifications further supporting treatment

1. Brokodilator
Not used bronchodilator drugs administered orally, but the medications used bronchodilators are inhaled or per enteral.
If you have previously been used sympathomimetic drug class, it should be given in per enteral aminophylline causes the different mechanism of action, and vice versa, if the drug group had previously used oral theophylline, the class of sympathomimetic drugs should be given by aerosol or parenterally. Drug-drug class of sympathomimetic bronchodilators selective form of adrenoceptor-B2 (orsiprenalin, salbutamol, terbutaline, isoetarin, fenoterol) has the properties is more effective and longer working lives and less side effects compared with non-selective form (adrenaline, ephedrine, isoprenalin .)
- The drugs in aerosol bronchodilators work faster and less systemic side effects. Good for use in children or in adults with severe shortness of breath. At first given two straws from a metered aerosol devise (Alupent R) (metered aerosols). If the improvement, can be repeated every 2 hours. If the assessment up to 10-15 minutes showed no improvement, give intravenous aminophylline.
- Sympathomimetic bronchodilator drugs side effects tachycardia. The use of parenterally in the elderly should be careful, be dangerous in hypertensive disease, cardiovascular and cerebrovascular. In adults tested with 0.3 ml of solution epineprin 1: 1000 in subcutan, whereas in children given a dose of 0.001 mg / kg subcutan (1 mg per ml) which can be repeated every 30 minutes for 2-3 times depending on needs.
- Provision of aminophylline intravenously with an initial dose of 5.6 mg / kg, in adults and children alike who injected slowly within 5-10 minutes. Furthermore, as a supporter dose is 0.9 mg / kg / hour infusion administered. Side effects that may arise is the blood pressure down, especially if the gift is not slowly.

TABLE 2. Bronchodilator medications

Adult Dose Name Dose How children
Adrenaline 0.1 to 0.5 mg 0.1 mg / kg SK
(1 mg / ml) 0.1 to 0.2 mg
(With dilution)
Isoprenalin
             (0.2 mg / ml) of 20-100 ug 0.1 ug / kg / min IV
(Slow)
Etilnoradrenalin 2 mg from 0.2 to 1 mg SK
            (2 mg / ml) 0.25 mg 5 ug / kg SK
             Terbutaline
            (0.5 mg / ml;
            0.1 mg / ml)
            Aminophylline 5.6 mg / kg IV as in adults
           (0.25 g / 10 ml) followed by
0.9 mg / kg / BW / hour

2. Corticosteroids

If giving bronchodilators drugs showed no improvement, followed by corticosteroids.
- 200 mg of hydrocortisone (Solu CortefR) or a dose of 3-4 mg / kg, given intravenously as a dose threshold and can be repeated every 2-4 hours parenteral to control acute attacks, premises followed by 30-60 mg of prednisone or with a dose of 1-2 mg / kg / day orally in divided doses, then the dose reduced gradually.
3. Giving oxygen can be through nasal kanule with O2 flow rate 2-4 liters / min and flowed through the water to member humidity
Expectorant drug such as gliserolguaiakolat can also be given.
To improve the state of dehydration, then the intake of fluids by mouth or infusion should be sufficient, in accordance with the principles of rehydration.
Antibiotics are given if there is infection.

Thoracic trauma

In general, any trauma to the thorax, either sharp or blunt, may:
In skin and soft tissue, injuries, bruising, subcutaneous emphysema
- on the bone: broken ribs, broken sternum, paradoxical breathing.
- the pleura: pneumothorax, hemotoraks, hemopneumotoraks, kilotoraks, serotoraks.
- in lung tissue: traumatic wet lung.
- in the mediastinum: pneumodemiastinum, roberakan esophagus, bronchus tear.
-at the heart : hemoperikardium bronchus .
-at the heart : hemoperikardium ,cardiac injury .
The principle of treatment of thoracic trauma are:
1. Overcoming the shock
2. Maintain airway
3. Restore / maintain airway negative pressure pleural space.
4. Pain relief.
- Stability of the chest wall
- Thoracotomy, if there are indications:
- - continuous bleeding 3-5 ml / kg / hour for 3-6 hours
- Pneumothorax is resolved in the normal way
- A torn esophagus
- Heart Injury

SUBCUTANEOUS EMPHYSEMA

It can be seen from the air krepitasi palpable under the skin, usually starting around the wound penetrating the chest wall or rib fractures. The air can come from outside, but generally from rips pleural.


Management


- Generally do not need to do anything because it will be absorbed by itself.
- Be wary of emphysema are:
• Not be accompanied by an open wound of the chest wall (eg in blunt trauma), because certainly there are also pneumothorax, emphysema when then quickly spread and the patient became short of breath with percussion hipersonor means there has been tension pneumothorax - soon stab in the area between the ribs II / III line midklavikular with a large needle to penetrate the chest cavity, while preparing waterseal drainage
• Starting from the neck area because it can indicate pneumomediastinum.


BROKEN BONE AND BREATHING PARADOXICAL RIBS

Broken ribs can be accompanied by pain and can pierce; pleura, causing pneumothorax. Paradoxical breathing occurs when there is motion in the opposite chest wall during breathing from a broken rib bones that surround a particular area. This situation is cause hypoxia because outside air can not reach the alveoli.


Management

- Pain is treated with local anesthetic intercostal nerve blogs concerned; needle inserted along the bottom edge of the ribs. Not recommended because of sedative suppress cough reflex and respiration.
- Simple rib fractures do not have to be taken, because of fixation to the detriment of the chest wall during respiratory movement
- But if there is paradoxical breathing, fixation should be done with the tape width, with an emphasis
- Attached patch from a healthy area of ​​the chest wall, encircling the wound down to healthy areas as well.

- Previous to put gauze over the wound in order to emphasis thick.
- Fixation performed during expiratory
- Pleaster installed-layered, as far as possible not aligned with a broken line.
Traction can also be performed for the same, namely the broken area with a wire tied to the objects do not move around the patient.




PNEUMOTHORAX AND HEMOTORAKS

Symptoms and signs

- Side of the affected do not participate in breathing, percussion hipersonor (in pneumothorax) or deaf (in hemotoraks) or there together (hemopneumotoraks); breath sounds disappeared.
- May be accompanied by subcutaneous emphysema and rib fractures.
- If the complaint shortness of breath behind the (pain) quickly become heavy suspicion of tension pneumotorax,
- Radiological lung shadows appear smaller, surrounded by a radiolucent area (pneumothorax), when there are local indicate radioopak hemotoraks.

Management

- When the radiologic pneumothorax only covers <15% of lung tissue and minimal complaints, just observations alone; if > 15% or widespread severe complaints must be puncture or drainage waterseal
- Determine whether intact or tear the visceral pleura
- When the chest wall intact (blunt trauma), pneumothorax must be caused by tearing of the visceral pleura careful of the possibility of tension pneumothorax
- When you open the chest wall (sharp trauma) patients were told to cough and when the visceral pleura will spray the air ripped out of the wound.
- Do not rush suturing the chest wall, because if it is turned inside the visceral pleura that action will change the open pneumotoraxs be closed / tension pneumothorax is more dangerous.
- If the visceral pleura intact enough to do the tap:

How to:

- Patients in a sitting position, tap on the contrary made in the posterior axillary line between the ribs as high as VII-VIII.
- Regional puncture is cleaned with antiseptic and then given a local anesthetic infiltration
- Use a needle puncture made with a large syringe ( No. 15-16 ), along the edge of the edge of the ribs, and the air / liquid sipped slowly so the lungs inflate could adjust in back.
- If the patient coughs, may be sucking too fast or lung puncture needle tip untouched; exploitation should be stopped for a moment and needles a little pulled.
- After completion puncture puncture area covered with sterile gauze.
- If the visceral pleura will measure the tear or bleeding, should be done waterseal drainage (WSD).

How to:

- Position the patient and the region together with pleural puncture.
- After anesthesia, do the skin and subcutaneous incision.
- After that puncture through the incision wound trokar which was installed in the cannula pointing slightly upward through the muscle
- After reaching the pleural cavity trokar released and immediately insert a catheter / tube of rubber which is still clamped into the cannula.
- Cannulas released and the catheter / rubber pipe connected to the bottle
- Check that the clamp is opened and the pleural cavity relationship with the bottle remains smooth with respect to:
- The exit of the air / liquid.
- Undulation in the pipe bottle after the air / liquid do not come out again.
- Catheter / rubber pipe in the sewing on the skin around it covered with sterile gauze.
It is worth noting here that:
1. Catheter / rubber pipe must be covered from the possibility of entry of outside air
- Bottles should not be located higher than the mounting catheter in the chest wall, except in a state clamped.
Simplest bottle is a bottle I which can be made from infusion bottles, should be filled liquid antiseptic (sublimat or KMnO4 ) and stopper penetrated by two long pipes associated with the pleural cavity and the tip should always be located 3-5 cm below the surface of the liquid, this important to note when the pleural cavity flowing fluid (blood) which will raise the surface of the liquid in the bottle; being left short pipe connected with the outside air. Close the bottle need not airtight.
When I was with a bottle pressure of the pleural cavity can not be negative, such as pleural tear is too large, continuous exploitation jarus done (continuous suction), for it must be used bottle bottle series II or III.
Series III better, especially if the pleural cavity still produce liquid so that bleeding can be more precise Jumah measured and do not have any time to measure the depth of the second pipe
When the suction is stopped, the pipe leading to the suction device must be clamped.
3. When the pressure of the pleural cavity had been negative but fixed lungs do not expand, it means there is airway obstruction give Mukolitik, for example OBH 3 x 15-30 ml / day and recommend that patients often cough.

WET TRAUMATIC LUNG

Symptoms and Signs:

- Mainly occurs after blunt trauma.
- The patient complained of cough-cough, sometimes accompanied by blood, chest pain, shortness of breath; no fever
- On auscultation rhonchi sound evenly wet.
- It is important to distinguish from bronkopnemoni because clinical and radiologic picture similar

Management:

- Rest lying
- Release of the airway by:
- Encourage patients often cough.
- Pain is removed with intercostal nerve block anesthesia, sedatives are not recommended because suppress cough reflex.
- Sip mucus, if necessary, until the trachea; exploitation still be conducted even if the patient coughs because just when the lender will be pushed into the proximal
- When you need to do a tracheostomy.
- Drugs: Mukolitik and bronchodilators, for example:
- OBH 3 x 20 ml / day or
- Bisolvon 3 x 1-2 tablets / day

PNEUMOMEDISTINUM

Suspect pneumomedistinum when emerging subcutaneous emphysema that began in the area of ​​the neck, especially when accompanied by severe shortness of breath and shock. Radiological appear radiolucent shadow in the mediastinum and around the heart, or retrosternal on the lateral projection

Management:

- Mediastinotomi
- In accordance with a tracheostomy, and then proceed to the mediastinum in blunt with tracheal ring finger down and then performed a tracheostomy
- When accompanied by tears or brounkus esophagus and progressive pneumomediastinum will arise, in this case must be made Thoracotomy

TAMPONADE AND INJURED HEART

Accompanied by a rapidly deteriorating general condition accompanied by increased jugular venous pressure, cardiac deaf widespread, distant heart sounds and pulsus paradoksus sounded.
When the pericardium participate ripped, there will also hemotoraks.

Management:

 Shock-Overcome
- Perikardiosentesis
- Patient half-sitting position ( angled 35-40 o to vertical )
- Puncture needle is inserted in the left paraxifoid area toward the left shoulder
- This action is only temporary, must be followed by Thoracotomy
- Thoracotomy for repair rips or pericardium and heart wall


google translator of the article title from all countries in the world
Nood asemhalingstelsel, Sistemin emergjent Frymarrja, نظام الطوارئ التنفس, Արտակարգ Շնչառական համակարգի, Təcili Solunum Sistem, Sistem Pernapasan Darurat, Larrialdi Breathing Sistema, Noodgevallen Breathing System, Спешни дишане система, Надзвычайная дыхальная сістэма, Nouzové Dýchací systém, Emergency Vejrtrækning System, Avarii ,Hingamissüsteemi, اورژانس سیستم تنفس,
Sistema de Emerxencia Respiración, საგანგებო Breathing სისტემა, Emergency Breathing System, आपात श्वास प्रणाली,
חירום מערכת הנשימה
Córas Análaithe Éigeandála, Neyðarnúmer Öndun System, Di respirazione di emergenza del sistema, 緊急呼吸システム
, Emergency Breathing System, D'emergència del sistema de respiració, 긴급 호흡 시스템
, Ijans Respirasyon Sistèm, Hitna disanje sustav, Emergency System Respiratio, Avārijas Elpošanas sistēmas, Neatidėliotinos Kvėpavimo sistema, Sürgősségi Légzököri
, За итни случаи на системи за дишење, Sistema Nifs 'emerġenza, 紧急呼吸系统
, 緊急呼吸系統
, Sistem Pernapasan Kecemasan, Emergency Breathing System, Emergency paghinga System
, Emergency układ oddechowy, Sistema de Emergência Respiração, Système respiratoire d'urgence, Respiratia de urgenţă Sistem, Чрезвычайная дыхательная система, Хитна дисање систем, Nujna dihanje System, Núdzové Dýchací systém, De emergencia del sistema de respiración, Emergency hengitysjärjestelmien, Kinga ya dharura System, Akut andningssystemet, ระบบทางเดินหายใจฉุกเฉิน, Acil Solunum Sistemi
, Надзвичайна дихальна система
, ایمرجنسی کے سانس لینے کا نظام
, Hệ thống cấp cứu thở
, System Anadlu Argyfwng
, גוואַלד ברידינג סיסטעם
, Συστήματος Έκτακτης Ανάγκης Αναπνοή

verpleegsters, verpleging, infermieret, pleqsh, الممرضات، والتمريض, բուժքույրեր, բուժքույրական, tibb bacıları, Danışmanlık, perawat, keperawatan, erizainak, erizaintzako, verpleegkundigen, verpleegkundig, медицински сестри, медицински сестри, медсёстры, догляд за хворымі, zdravotních sester, ošetřovatelství, sygeplejersker, sygepleje, õed, hooldus-
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Emergency Cardiovascular System

Written By nursingstikes on Wednesday, December 26, 2012 | 10:30 PM

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Emergency Cardiovascular System


Shock
Dengue shock syndrome
Acute heart trouble
Hypertensive crisis
Acute cardiac infarction


SHOCK
Shock an emergency caused by failure of blood perfusion to the tissue, resulting in cell metabolism disorders. In a severe state of the cell damage that can not be restored again (shock irreversible); therefore important to identify circumstances that can be accompanied by shock, early symptoms and to overcome it.

The Clinic, shock divided into two major categories:
A. Hypovolemic shock-shock with reduced plasma volume.
1. Loss of plasma outside the body, bleeding, gastroenteritis, renal (diabetes mellitus, diabetes insipidus), skin (burns,
excessive sweat ).
2. Loss of body fluid in the space-hip or rib fractures, ascites, obstructive ileus, hemotoraks, hemoperitoneum.
B. Normovolemik-shock with normal plasma volume.
1. Kardigenik (coronary / non-coronary) - myocardial infarction, heart trouble aritmi.
2. Obstruction of blood flow, pulmonary embolism, tension pneumothorax, cardiac tamponade, aortic aneurima dissecans, intrakardiax (milksoma ball-vave thrombus).
3. Neurogenic-trauma / severe pain (hip joint dislocation, cervical dilatation is too fast, pull on funikulus spermatikus, gallbladder or gastric cardia), drugs (anesthetics, barbiturates, phenothiazines), orthostatic hypotension, bone marrow lesions.
4. Other-infection / sepsis (septic shock), anaphylactic reaction, endocrine failure ( miksedema, Addison), anoksi.

SYMPTOMS AND SIGNS
In general, the obtained picture of the failure of tissue perfusion that occurs through one of the following mechanisms:
1. Decreased circulating volume (hypovolemic shock)
2. The failure of the pump power of the heart (cardiogenic shock)
3. Changes in peripheral vascular resistance, decreased muscle tone vasomotor (anaphylactic shock, neurogenic and endocrine failure) or elevation of resistance (septic shock, obstruction of blood flow).


Symptoms that appear:

 
1. Cardiovascular System:
- Hypotension, systolic < 90 mm Hg or drop
30 mm Hg from the original.
- Tachycardia, pulse > 100 / minute, small, weak / not palpable.
- Decrease in coronary blood flow.
- Decrease in skin blood flow, sianotik, cold and wet; a slow capillary filling.
2. Respiratory system:
- Hyperventilation due anoreksi network, decreasing venous return and return elevated physiological dead and exaltation of physiological dead space in the lungs.
3. Central nervous system:
- Due to elevated hypoxia occurs capillary permeability, causing cerebral edema with symptoms 
decreased consciousness.4. Urinary tract system:
- Oliguric (dieresis <30 ml / h), can progress to anuri, uremi due to acute kidney trouble. 5. Biochemical changes, especially on a long and severe shock: - Metabolic Acidosis due to anoksi tissue and impaired renal function. - Hyponatremia and hiperkalemi. - Hyperglycemia - According to the severity of symptoms, can be distinguished four stages of shock, the division is especially true for hypovolemic shock and related with the amount of plasma lost:

Stadium :
1. Presyok
(compensated)

2. Light
(compensated)

3. Medium
(reversible)

4. Weight
(irreversible)

Plasma missing:
1. 10-15 %
+/- 750 ml

2. 20- 25 %
1000- 1200 ml

3. 30- 35 %
1500- 1750 ml

4. 35- 50 %
1750- 2250 ml




Symptoms:
1. Dizziness, mild tachycardia Systolic 90-100 mm Hg.

2. Fidget cold sweat, thirst, dieresis decreased, tachycardia> 100 / min systolic 80-90 mm Hg.

3. Restless, pale, cold, oliguric tachycardia> 100 / min systolic 70-80 mm Hg.

4. Pale, sianotik, cold, Tachypnoea, anuri, collapse of blood vessels, tachycardia / no longer palpable, the systolic 00-40 mm Hg


Note:
- The volume of plasma adults + / - 75 ml / kg, children 90 ml / kg, baby 80 ml ​​/ kg
-Children are more easily fall in shock (resulting in loss of > _ 10% plasma volume).
- It is important to suspect the cause, among others through blood tests ( Hb, Ht, Culture ), we are less likely to manipulate photos patient as it can aggravate the situation.
- blood sampling should be done before giving fluids, because the provision of fluids, especially plasma expander can complicate the interpretation of the results of the examination.


MANAGEMENT


Hypovolemic shock

 
1. When caused by bleeding, stop by tourniket swathe press or sewing.
2. Place the patient in shock position:
_  Head-high or slightly higher than the chest
_  Body of horizontal or slightly lower chest
_  Second leg straight, lifted
20 o
3. Note the general condition and vital signs; maintain airway. If you need to do resuscitation
4. Fluid:
_  The liquid is given as much as possible in a short time ( with the supervision of vital signs )
_  Before the blood is available or the shock is not caused by bleeding, can be given fluids:
_  Plasma: Plasmanate
_  Plasma eapander: Plasmafusin ( maximum 20 ml / kg ), dextran 70. ( Maximum 15 ml / kg body weight ), Periston, Subtosan, Hemacell plasma expander in large quantities may interfere with its mechanism of blood formation.
_  Other Fluids: Ringer-lactate, NaCl 0.9%. Should be combined with other fluids as quickly out into the extravascular space.
_  To obtain optimal results, place the infusion bottle as high as possible and use a large needle, if necessary, use a few veins at once, and do venaseksi.
_  Control is necessary:
_  Lung Auscultation to search for signs overhidrasi, a fine wet in the basal rhonchi caused pulmonary edema.
_  CVP ( if possible ) maintained at 16-19
cmH2O
_  Measurement dieresis over catheter placement, keep about 30 ml / hour
_  Except in irreversible shock, improvement is usually achieved colloidal state ( plasma / plasma expander ), when used non koloid fluid can be up to 8000 ml.
5. Provision of supportive medications:


a. Vasodilator
Can be given after there were improvements to the public, while continuing to be given fluids, with the aim of:
_  Diagnostic: if there
reduction blood pressure means the body is dehydrated.
_  Therapeutic: to improve vital organ perfusion by opening the pre and post ( capillary sphincter ).
_  Isoproterenol ( Isuprer ).
_  Dose of 2 mg in 500 ml glucose 5 - 10%. Precipitation is adjusted to maintain systolic pressure at about 60 mm Hg.
_  It can not be given when the heart frequency > 120 / minute or known to have heart problems because it has the effect of enlarging the heart oxygen demand and enhance myocardial irritability.
_  Stop the treatment when the frequency of heart > _ 150 / minute or aritmik.
_  Dopamine
_  Dose of 200 mg in 250 ml glucose 5 - 10%.
_  The number of droplets initially 2 mcg / kg / min, then adjusted for blood pressure.
_  Can be used as a substitute for isoproterenol.
_  Alpha adrenergic blockers.
_  Fenoksibenzamin ( Dibenzyline ) 1 mg / kg weight loss in 250-500 ml of glucose 5% or NaCl 0.9% per trip, or,
_  Chlorpromazine ( Largactil ) ¼ - 1 mg / kg iv Weight slow.


b. Vasokontriktor ( norepinerfrin, Aramine 'Ef-fortil ) is not recommended because it can aggravate circulation of vital organs.


c. Corticosteroids
When the degree of shock is not in accordance with bleeding, or if adequate fluid replacement is not seen improvements, consider the possibility of adrenal cortex insufficiency. For that given large doses of corticosteroids, eg, hydrocortisone 300 mg iv slowly ( in 30 seconds ), can be repeated until reaching a total dose of 2- 6 grams / 24 hours
Can also be used other preparations with a ratio of doses: 25 cortisone, hydrocortisone 20, metal prednisolone 4 and dexamethasone 0,75.
Often in hypovolemic shock and septic shock


d. Correction of acidosis
Na-bicarbonate given at a dose ( 0.3 x body weight x base excess ) is considered = 20 m Eq.
When possible, use of blood gas checks ( Astrup ) as a guide.


e. Diuretics
When blood tekaka and CVP have improved but remain dieresis < 30 ml / h, give 20 % mannitol 100 ml per drip in one hour: 

_  If after that dieresis > 40 ml / h, maintained with repeated doses of mannitol up to a maximum dose achieve 100 grams / 24 hours
_  If still < 40 ml / h, give etakrinat acid ( Edecrine ) 50-100 mg iv: 

   _   When dieresis improved ( > 40 ml / h ) maintained with a combination of mannitol and etakrinat acid.
   _   If still < 40 ml / h, considered to have occurred acute kidney pains 



Shock normovolemik

Its management is generally the same as the shock hipovelemik, namely in terms of position, patients and controls. Further tests need to be considered to find the cause (blood cultures, x-rays, EKG).

A. Cardiogenic shock.

Known from the history / presence of cardiac abnormalities that precede, supported by an EKG.
Distinguished by cardiogenic shock caused by coronary insufficiency coronary or cardiac infarction.
Cardiogenic shock caused by the lousy non-coronary heart disease, acute myocarditis or aritmi.
In addition to treatment of the cause, can be given as well:
- Norepinephrine (Levophed) 2 mg in 500 ml glucose 5% per drip by drip blood
pressure adjusted ( maximum 48 mcg / minute )
- Awarded in cardiogenic shock cardiogenic shock non-coronary and coronary heart beats
frequency 120 / minute
- Isoproterenol (Isuprel) given to non-cardiogenic shock with 
frequencyCoronary heart rate 120 / minute (see above)
- Other medications correction of acidosis, diuretics, corticosteroids (see above)

B. Neurogenic shock (Vaso-vagal syncope)

- The patient was placed immediately with the head lower; the examination may be obtained bradycardia.
- Eliminate the cause; if necessary can be given analgesics.
- In the case of bone marrow lesions, give corticosteroids to prevent bone
marrow edema.
Usually the patient will realize some time later after cerebral multiply by the actions above.
C. Syokseptik
Often preceded by severe systemic infections, mainly by gram-negative bacteria.
The situation changed from a high fever sufferers go into shock with
reduction consciousness, cold and clammy skin and hypotension, often accompanied by DIC. Blood cultures are not always positive, especially if the patient has received antibiotics previously.

MANAGEMENT:

- Maintenance and general supervision
- Fluid therapy, if possible with CVP monitoring (see above)
- Antibiotics:
--Before blood culture results, provide a powerful combination of antibiotics, such as between classes of penicillin / penicillinase resistant penicillin with gentamicin.
- Group of penicillin:
Procaine penicillin, 50,000 U / kg (kilogram of body weight) / day im
( intra muscular ) , at the two doses
-Ampicillin 4-6 x 1 g / day iv (intravenous) for 7-10 days.
Penicillinase-resistant penicillin class:
-Cloxacillin (cloxacillin Orbenin) 4 x 1 g / day iv (intravenous) for 7-10 days is often combined with ampicillin, in which case each drug reduced the dose to half, or use a combination of existing preparations ampiclox 4 x 1 g iv (intravenous) for 7-14 days.
Gentamicin (Garamysin) 5 mg / kg (kilogram of body weight) / day for three doses of im ( intra muscular ) for 7 days; caution against
its nephrotoxic effect.
-If the blood culture results and there has been resistance, customized treatment. Some gram-negative bacteria that often cause sepsis and antibiotics are the recommended:



Table: Culture and antibiotic
-  Escherecia coli                       ampisillin / sefalotin
-  Klebsiella, Enterobacter         gentamisin
-  Proteus mirabilis                    ampisillin / sefalotin
-  Pr. Rettgeri,
Pr. Morgagni
Pr. Vulgaris                               gentamisin
-  Mima-Herellea                      gentamisin
-  Pseudomonas                        gentamisin
-  Bacteroides                           kloramfenikol / klindamisin
___________________________________________________________________

Cephalothin dose 1-2 grams every 4-6 hours, usually dissolved in 50-100 ml of fluid and given a drip in 20-30 minutes to eliminate phlebitis
- Chloramphenicol: 6 x 0.5 grams / day iv (intravenous)
- Clindamycin: 4 x 0.5 g / day iv (intravenous)
- Other drugs:
- - Vasodilator (see above)
- Diuretic
- Corticosteroids-hydrocortisone (Solu Coref ®) 500 mg iv (intravenous); can be repeated until a total dose of 2-6 grams / 24 hours
- Heparin is given when there is DIC, amounting to 100 U (1 mg) / kg iv (intravenous) every 4 hours; should be monitored by examination of clotting time.


D. Anaphylactic shock.
Usually occurs immediately after the injection of serum or drug-sensitive patients
against; besides signs of shock are also causing asfiksi bronchioles spasm and cyanosis.
Also often preceded by pain of the head, visual disturbances, urticaria and facial edema, and nausea.
Treatment:
Stop contact with the allergen
Attention to vital signs and airway; bilaperlu performed resuscitation and oxygen administration
-Epinephrine 1 / 1000 (0.5 to 1 ml of selected drugs sk (subcutaneous) / im ( intra muscular ), can be repeated 5-10 minutes later.
-Can also be given:
Antihistamine diphenhydramine ( Benadryl ® ) 10-20 mg iv (intravenous)
Corticosteroid hydrocortisone ( Solu-Cortef ® ) 100-250 mg iv (intravenous) is slow, when the real bronchioles spasm.

ENGUE SHOCK SYNDROME
Dengue shock syndrome (DSS) is a manifestation of dengue hemorrahegic heaviest fever (DHF).
DHF is an acute febrile illness in children 1-14 years old (particularly 2-6 years) characterized by fever, bleeding manifestations and tend to cause shock which can cause death.
Causes of Dengue virus is transmitted by the mosquito Aedes aegypti and Aedes albopictus may also


SYMPTOMS AND SIGNS


1. Sudden onset of fever for 2-7 days without obvious cause, then decreased lysis.
2. Bleeding manifestations; appear on the second-third day of fever in the form of tourniquet test (+), purpurae petechiae, ecchymosis until epistaxis, bleeding gums, hematemesis and melena.
Tourniquet test (+) in the first days, there are at most of the sufferers; and petechiae appeared on the third day until the sixth. Epistaxis and gum bleeding are less common are eating tract bleeding usually accompanies shock.
3. Enlargement of the liver, can generally be palpated on the surface of the fever. These symptoms are less typical and rank does not match the severity of the disease.
4. Signs of shock, usually appear on the third day until the seventh, when the fever begins to decline
5. Laboratory:
Thrombocytopenia (≤ 100,000 / mm 3) usually found on the third day until the seventh.
Increased hemotokrit ≥ 20% normally a sign of the beginning of the shock, therefore, needs to be checked regularly, if it is found, precautions must be done immediately.


MANAGEMENT:


1. Fluid:
- Given the shock or hematocrit > 40%
- Use Ringer-lactate or 2a (0.9% NaCl 5% glucose).
- Giving the first hour of 20 ml / kg (kilogram weight) / hour, then 10 ml / kg (kilogram weight) / hour. When shock has resolved, the droplets adjusted based on the control value of Ht.
- When used liquid 2a, need to be supplemented with Na-bicarbonate 1-2 m Eq / kg (kilogram of body weight) iv (intravenous), can be repeated.
- If the patient has been unconscious, can be coupled with drinking a lot (up to 2 L / 24 hours) in the form of sweet tea, syrup, milk, or O R S.
- If a shock more severe / not resolved, it is recommended also given plasma / plasma expander with 10-20 ml / kg (kilograms Weight)
- Transfusion of fresh blood of 10-20 ml / kg ( kilogram weight ) is recommended when there is massive bleeding or a very low hemoglobin; otherwise not be given when the hematocrit value was very high.
2. Hiperpireksi ( > 400 C ) overcome by giving antipyretics or cold compresses. Instead give preparations acetaminophen / paracetamol (Panadol, Biogesic) and do not salicylates because of the danger of bleeding ulcers.
3. Seizures are treated with anti-convulsants, such as diazepam 10 mg iv (intravenous)
4. Antibiotics are given when the old shock or no infectious complications
bacterium 
5. Corticosteroids do not need to be given.


ACUTE BAD HEART

 
Is a state of emergency due to the sudden nature of attacks and life-threatening.
Here lies the hemodynamic disturbances caused by the inability of the heart, especially the left ventricle to maintain cardiac output (cardiac output) to meet the needs of the circulatory network. This disorder causes the end diastonic output) to meet the needs of the circulatory network. This disorder causes the end diastonic left ventricular pressure rise; this will elevate the left atrial pressure as well as the load increases. Elevation of these pressures will continue to spread the pulmonary veins and pulmonary capillaries, resulting in dam and pulmonary edema and impaired gas exchange in the alveoli which can lead to severe and
hipoksi eventually death.

SYMPTOMS AND SIGNS

 
Primarily a manifestation of acute pulmonary edema:
1. Shortness of breath, orthopnea, cyanosis, restlessness
2. coughing, often with ripple bubbly and redness.
3. Wet crackles throughout the lungs, sometimes accompanied by wheezing (asthma cardiale) found:
4. Tachycardia; sometimes with gallops
5. Left ventricular enlargement
When performed radiological examination will appear:
6.
Fog throughout the lung, especially in the hilar
7. Left ventricular enlargement


MANAGEMENT

 
1. Morphine 5-15 mg sk (sub cutaneous) / im (intra muscular) / iv (intravenous) depending on the circumstances and the weight of the patient to reduce anxiety.
2. Position the patient is placed in a sitting or half sitting, and given pure oxygen with positive pressure.
3.
Posted rotating alternated venous tourniquets on all four extremities.
4. Aminophylline 240 mg iv (intravenous)
5. Quickly; after achieved, maintained by a maintenance dose.

                                          Preparations                      digitalis fast                       maintenance dose
Deslanosid cedilanid ®
0.2 to 0.4 mg iv ( INTA vein ), can be repeated every 4-6 hours.

Day I: 1.2 to 1.6 mg / day

Day II: 0.8 to 1.2 mg / day


1-2 x 0.25 mg / day, oral
Digoksin
Digoxin ®
Lanoxin®
0.25 to 0.5 mg iv (intravenous), can be repeated every 4-6 hours, maximum dose of 1 to 1.5 mg / day
2-3 x 0.125 mg / day orally
Folia digitalis


2-3 x 50 g / day, oral


During the administration of digitalis, note:
- Frequency and cardiac rhythm; dosage should be reduced or stopped when the frequency continues to slow down or there is an ectopic rhythm.
-intoxication symptoms: malaise, anorexia, nausea and vomiting
- Should be more careful in patients who had received digitalis before, parents, babies, electrolyte disturbances such as hypokalemia (often on the use of diuretics without potassium supplementation), impaired renal physiology and acute cardiac infarction.
6. Diuretics, for example furosemit (Lasix ®) 40-80 mg iv (intravenous) 40-80 mg iv (intravenous) then 20-40 mg iv (intravenous) / day.
Potassium supplementation should be accompanied by KCl 3 × 500-1000 mg (milligrams) orally / day.
7. Soft diet, low salt, low calories in small portions and frequent.
Avoid straining / constipation, if necessary, given laksans ( Dulcolax ® ) or klisma.
8. Finding and addressing the originator of anemia, thyrotoxicosis, pulmonary embolism, pulmonary infection, aritmi, endokarditis bakteriil subacute and others.
9. Finding and addressing the causes of congenital abnormalities, valve abnormalities, hypertension, tirotolsikosis.


ACUTE HEART INFARCTION
Cardiac infarction is necrosis as a result of reduced cardiac bibs blood supply to the muscles is due to coronary artery occlusion or thrombosis: can also be caused by shock or acute anemia. Varying degree of myocardial necrosis in histological until massif.
20% to 25% of patients died in the first attack. Commonest cause of death was cardiogenic shock.


CLINICAL SYMPTOMS:

 
Prodromal symptoms:
Prodromal symptoms can be felt 24 hours to several weeks before when a blockage; form of angina pectoris, palpitations, fatigue and headache. Infarction is more common in angina pectoris are:
- longer and more frequent frequency
- also arise when a break
- has been a long time.
Angina pectoris is accompanied elevation in temperature, increasing the number of leucocytes, as well as the elevation
negligence of the LED is a typical ECG Manifestation of cardiac infarction.

Symptoms in asthma attacks:
- Pain substernal, may also precordial or epigastrial; is heavy objects like pressure, tingling, sliced ​​or burning sensation that is difficult deciphered. Can spread to the left arm and neck. The pain begins suddenly breaks or work.
- Be accompanied by vomiting
- The inspection found:
- Patients in pain, cold sweat
- Decreased blood pressure
- Pulse at first slow, then fast
- Often there is an arrhythmia
- Heart sounds distant and weak, often there is protodiastolic gallops gallops or presystolic.

variation of clinical manifestations of acute cardiac infarction:
a. clinic with the play idea of the pain more than half denunciated hour to several days.
2. clinic with the play picture of the state of shock; often followed by shortness of breath and the higher the venous pressure
3. clinic axis right heart trouble arising gradually or become heavy
4. clinic with a lousy picture of acute left heart and pulmonary oedema
5. clinic axis denunciateds illustration of myocardial complications, such axis systemic embolic, or sudden death aritmi
6. clinic with atypical symptoms, resembling peptic ulcer, cholecystitis, urolithiasis, acute pancreatitis

examination assistant:
blood
lekositosis light.
the higher the led.
hipergli slope.

blood enzymes:
creatine phosphokinase (cpk): the higher the approximately 6 hours after the attack and normal back in the day. serum glutamic oxaloacetic transaminase third (sgot): up to 12-48 hours after the day to 4-7.
lactic dehydrogenase (ldh) increased after 48 hours and returned to normal on days 7-12.

ecg:
pasologik typical wave accompanied by denunciated increase of convex st segment and negative t wave followed and symmetric. most important is the appearance of pathologic q waves with amplitude exceeds the amplitude ¼ r and q to run at the beginning of the r peak of more than 0.02 seconds.

procedure:
objectives:
a. ease the work of the heart to replace the scar tissue of myocardial
2. reduce / eliminate pain
3. overcome the complications of arrhythmias, heart trouble shock
include:

overcome the pain with morphine 5-10 mg sub-cutaneous, may be repeated every ½ hour to a maximum of 60 mg. or meperidine (pethidin) 50-100 mg, may be repeated. do musical note be granted if the frequency is less than 12 breaths / min.
- connect the infusion of glucose 5% 500 ml/12 hours; and oxygen 4-6 litre / minute.
- physical and way of thinking rest for 2-3 weeks, if necessary, give the sedative mengazepam 5-10 mg iv.
- diet enough vegetables and regular bowel movement, if necessary, give laksans.
- overcome complications:
bradycardia:
½ mg of atropine sulfate im / iv, may be repeated every 15 minutes to a maximum of 2 mg.
if necessary additional dexamethasone 10 mg im / iv.
tachycardia (heart trouble-free:
lidocaine (xylocard ®) 50 mg im / iv.
extrasystole:
lidocaine 50 mg iv, followed by drip of 2 mg / min or repeated every 1/4, ½ hour.
vebrikasi ventricle:
dc shock, followed by resuscitation (see chapter resuscitation).
cardiac arrest:
general firmly in the chest 1/3 the bottom of the sternum and then proceed with resuscitation. (see chapter resuscitation).
presyok:
10-50 mg iv dexamethasone.
if blood pressure remains up, give effortil ® 10 mg iv.
shock:
dexamethasone (oradexon ®) 100-250 mg iv with
dopamine 2-5 mcg / kg / min per infusion.
if musical note managed to give too effortil ® 10 mg iv.
mild left heart trouble (wet basalt crackles):
furosemide (lasix ®) 20-40 mg / day im with.
kcl 500 mg / day or potassium durules 1 tablet / day.
left heart trouble was (wet crackles <50% lung): furosemide 40-80 mg / day iv with cedilanid ® 3 x 500 mcg (1 ml) / day im, subsequent doses adjusted kcl 3 x 500 mg / day or potassium durules 3 x 1 tablet / day. pains left heart weight (wet crackles> 50% lung):
furosemide 40-120 mg iv with
cedilanid ® 200 mcg every 2-4 hours, up to 1200 mcg / day, subsequent doses adjusted
kcl 3 x 500 mg / day or potassium durules 3 x 1 tablet / day.
5-10 mg of subcutaneous morphine.
replace tourniquet (see also chapter acute heart trouble).

crisis of hypertension
is a state in which the increase in blood pressure and settle at a higher value, such axis 120-150 mm Hg or more and / or accompanied by several complications, such axis:
a. encephalopathy
2. acute left heart trouble
3. brain hemorrhage
4. malignant hypertension (hypertension with edemapapila n. optici)
denunciated emergency that must be addressed, because it can lead to death caused by:
a. heart failure
2. cerebral ischemia
3. renal failure
4. brain hemorrhage
and also cause blindness

etiology:
a. primary (unknown)
2. parenchymal renal menyease (glomerulonephritis, pyelonephritis, polycystic kidneys, and others)
3. renovascular hypertension (stenosis a. renal, renal infarction, aneurismaa. renalis, arterial-venous fistula of kidney)
4.
adrenal hurts (primary aldosteronism, sinnital, phaeochromocytoma)
5. neurological menyeases (poliomyelitis bulber, rapidly increasing intracranial pressure, intermittent porphyria, and others)
6. toxemia gravidarum
7. aortic coarctation
should be remembered that is 90-95% of hypertensive patients who do musical note know why do we find (= primary hypertension essential hypertension) is therefore preferred in the treatment of blood pressure reduction and treatment of complications, a new cause is sought.

symptoms signs:
a. anamnesis:
severe headache and a sudden, located mostly neck area, especially early morning.
blurred vision.
anorexia, vomiting.
complaints associated with heart trouble, neurological abnormalities.
2. physical examination:
high blood pressure, especially mengastolic, ie 120-150 mm hg or more.
neurological symptoms, such axis hemiplegia afasiahemianopsia.
symptoms of heart trouble, the heart may be enlarged.
on fundoscopy obtained edemapapil, cotton wool patches, multiple hard exudates, star figure, macula prominent view.

3. laboratory;
proteinuria, hematuria mikroskopik.
urea, creatinine, calcium, phosphorus, can be normal or elevated alkali fosfatase

management:
a. hospitalization, bed rest
2. low-salt diet
treatment of complications such axis heart trouble, brain hemorrhage (see the chapter)
antihypertensive drug delivery:
i am in malignant hypertension complicated by bleeding or brain oedema, blindness, heart trouble acute, acute pulmonary oedema: a reduction in blood pressure can be done in two ways:
a. on the first day were given three memfferent drugs:
a. serpasil 0.5-1mg im may be repeated every 2-4 hours until the ideal mengastolic pressure is reached. later replaced with oral doses equal to the amount of groceries at 24 hours in advance.
2. furosemide (lasix ®) 20-40 mg im / iv, may be repeated every 2-4 hours until the salt and water retention is lost. on uremia moderate / heavy doses greater is required.
3. can choose one of the following drugs:
betablocker groups like oksprenolol (trasicor ®) 3-4 x 40 mg / day propranolol (interar ®) 3-4 x 1 tablet / day (contra indication of heart trouble or asmabronkhial) or another option: metal alpha dopa (aldomet) 3 - 4 x 125mg / day. the second dose of drug may be increased on the
fourth day, then every three days until the desired effect is achieved or eunuch effects. if a large dose has musical note been achieved ideal blood pressure, can be added vasosilator drug classes such axis prazosin (minipres) at a dose of 3 x 1 mg / day may be increased 2 mg every 3 days until a total dose of 120 mg / day
b. on the first day were given two kinds of drugs:
a. clonidine (catapres) 75-150 micrograms orally which can be repeated every 2-4 hours until desired effect is achieved or until a dose of 9 tablets / day. daily dose given in 3 times a day.
2. menguretics (eg, hct 25 mg) orally 1-2 tablets / day, may be raised one tablet every day until the desired effect is achieved. parenterally administered only when there is nausea, vomiting or severe oedema. when the dose is large enough while musical note yet achieved the desired effect, can be augmented vasodilator.
ii if the degree of severe complications or tekanana more than 150 mm hg mengastolic, administered the drugs in two ways:
a. clonidine (catapres) im / iv 75-150 micrograms can be repeated every 2 hours. it is also given menguretics with or without a vasodilator such axis in-lb
b. can choose one of the following drugs:
mengazoksid 300 mg. iv waktu15 injected in seconds.
hidralazin 20-40 mg menysolved in nacl 0.9% to 20 cc was injected iv
nitroprusid sodium 50 mg menysolved in 1 litre dekrose 5% per infusion given at 10 drops / min.
pentolinium 10 mg, menysolved in 20 cc 0.9% nacl administered iv
regitin 5-20 mg rapidly injected intravenously.
trimetafan (arfonad) 1000 mg menysolved in 1 litre deksrose 5% per infusion given at 10 drops / min.
5. keep denunciated eye on:
blood pressure, pulse and respiration closely.
signs of dehydration.
make a list of the balance of fluids in and out.


google translator of the article title from all countries in the world
kedaruratan sistem jantung dan pembuluh darah, nood van die hart en bloedvate, kedaruratan sistem jantung danpembuluh darah, Sistemi emergjent të enëve të zemrës dhe të gjakut, نظام الطوارئ في القلب والأوعية الدموية, Վթարային համակարգ սրտի եւ արյան անոթների, ürək və qan damarlarının fövqəladə sistemi, bihotzean eta odol-larrialdi sistema, аварыйнай сістэмы сэрца і крывяносных пасудзін, হৃদয় এবং রক্তনালীসমূহ জরুরী সিস্টেম, спешна система на сърцето и кръвоносните съдове, sistema d'emergència dels vasos sanguinis i del cor, 心脏和血管的应急系统, 心臟和血管的應急系統, hitne sustav srca i krvnih žila, záchranný systém ze srdce a cév, nødsystem af hjerte og blodkar,noodsysteem van het hart en de bloedvaten, emergency system of the heart and blood vessels, Emergency Cardiovascular System, urĝa sistemo de la koro kaj angioj, Avariisüsteemi südame ja veresoonte, emergency sistema ng mga puso at dugo vessels, hälytysajoneuvojen sydämen ja verisuonten, système de secours du coeur et des vaisseaux sanguins, sistema de emerxencia do corazón e os vasos de sangue, საგანგებო სისტემა გულის და სისხლძარღვების, Notfall-System des Herzens und der Blutgefäße, σύστημα έκτακτης ανάγκης στα αγγεία της καρδιάς και του αίματος, હૃદય અને રુધિરવાહિનીઓ કટોકટીની સિસ્ટમ, sistèm ijans nan bato yo kè ak san, חירום מערכת הלב וכלי הדם, दिल और रक्त वाहिकाओं की आपात प्रणाली, segélyhívó rendszer, a szív és az erek, neyðartilvikum kerfi á hjarta og æðum, córas éigeandála de na soithí croí agus fola, sistema di emergenza del cuore e dei vasi del sangue, ಹೃದಯ ಮತ್ತು ರಕ್ತನಾಳಗಳ ತುರ್ತು ವ್ಯವಸ್ಥೆಯು, 심장과 혈액 혈관의 비상 시스템, subitis systema cor et sanguinem vasa, avārijas sistēma sirds un asinsvadu, avarinis širdies ir kraujagyslių sistema, за итни случаи систем на срцето и крвните садови, kedaruratan sistem jantung dan pembuluh darah, sistema ta 'emerġenza tal-bastimenti tal-qalb u d-demm, nødsystem i hjerte og blodkar, اورژانس سیستم قلب و عروق خونی, 心臓と血管の緊急システム, System alarmowy z serca i naczyń krwionośnych, sistema de emergência do coração e os vasos de sangue, Sistemul de urgenţă din inima şi vasele de sânge, аварийной системы сердца и кровеносных сосудов, ,Хитна система срца и крвних судова, záchranný systém zo srdca a ciev, zasilni sistem za srce in ožilje, sistema de emergencia de los vasos sanguíneos y del corazón, dharura mfumo wa moyo na mishipa ya damu, nödsystem för hjärta och blodkärl, இதயம் மற்றும் இரத்த குழாய்கள் அவசர அமைப்பு, గుండె మరియు రక్త నాళాల అత్యవసర వ్యవస్థ, ระบบฉุกเฉินของหัวใจและหลอดเลือด, kalp ve kan damarlarının acil sistemi, аварійної системи серця і кровоносних судин, دل اور خون کی وریدوں کی ہنگامی صورت حال کا نظام, trường hợp khẩn cấp hệ thống của tim và mạch máu, system frys y pibellau galon a'r gwaed, גוואַלד סיסטעם פון די האַרץ און בלוט כלים

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EMERGENCY SYSTEM NERVE CENTER

Written By nursingstikes on Monday, October 22, 2012 | 7:03 PM

EMERGENCY SYSTEM NERVE CENTER
 Comma
 Spastic
 Trouble Circulation [of] center blood
 System center nerve trauma
 COMMA
 Comma [is] situation go down heaviest awareness, where patient [do] not react again to pain in bone stimulus. Comma happened if/when there are trouble/ damage [at] awareness center [in] midbrain and/ or talamus.
 TABLES OF VARIOUS CAUSE COMMA
 A. Disease intracranial a. Formation center nerve trauma b. trouble Circulation [of] brain blood c. Formation center nerve infection d. Formation center nerve tumor e. Attack- attack, epilepsy and spastic f. Degenerative center nerve formation disease g. High [of] intracranial pressure by various cause
 B. Disease ekstrakranial a. Vascular – syok, difficult [of] acute heart, hipertensi,hipotensi b. Metabolik – hepatic uremi diabetic,hipoglikemi, hiperglikemi, coma asidosis, hipoksi, electrolyte imbalance c. Poisoned – alcohol, barbiturate,narkotik, CO, anaesthetize otherly. d. Systematical infection [of] weight – pneumonia, malaria, typhoid e. Others – hipertermi, hipotermi, electrics syok, anafilatik syok
 DIAGNOSIS
 Aloanamnesis have to be taken accurately because important to determine cause referring to effort medication [of] kausal.
 Physical examination cover
1. Awareness storey; level
2. Fungsivital a. Temperature Body - Go up - systematical infection, termoregulator trouble, hyperpyrexia heat ( accompanied [by] dry husk - Go down- poisoned [of] barbiturate, failure [of] perifer sirkulasi, miksedema b. respiration - Tardy - poisoned [of] morphine, poisoned [of] barbiturat, hipotiroid - In & quickly - pneumonia, mellitus diabetis, uremi, intracranial disease - Cheyne-Stokes - high [of] intracranial pressure, damage [of] brain bar c. pulse - Tardy- hypertension block heart, high [of] intracranial pressure - Quickly- ektopik heart rhythm, trouble circulation [of] brain blood d. Blood pressure - High - circulation [of] brain, hypertension ensefalopati. - Low- poisoned [of] alcohol, poisoned [of] barbiturate, heart infark, septikemi, Addison disease
3. Husk - Sianosis - Bright red - poisoned [of] CO - Bruise- trauma - Bloated - face hiperemi and eye, teleangiektasi - poisoned [of] alcohol - Pale- blood - Many sweat- hipoglikemi, syok - Dry – diabetic asidosis, uremi - Downhill Turgor - dehydration
4. Respiration aroma - Alcohol - Acetone/ rotten fruits - diabetikum comma - Ammonia/ urin- uremi - Rotten - hepatikum comma
5. Nerve formation - Tes stimulate pain in bone [in] supraorbital area, sterna, inner [of] thigh or arm - If/When natural neck fleksi motion [of] prisoner - brain membrane iritasi - If/When entire/all natural neck motion [of] prisoner - [common/ public] rigititas, disparity [of] servikalis spina - And Hemiparese disparity [of] disparity [of] other content
6. Other inspection to look for cause, figured in disease and complikasi
7. figured in inspection  - blood - routine, ureum, blood sugar, liver function, culture - urin - protein, glucose, acetone, cell, culture.
 - lumbal punksi - pressure, cell, glucose, protein
 - radiologik - skull bone; angiografi
7:03 PM | 0 komentar

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