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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.


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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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