3. isi emersion 2003 fk

INTRODUCTION

1. OVERVIEW BLOCK

Emergency medicine block will be implemented in semester 7, the fourth year. This block runs for 6 weeks to 5 weeks on and one week for the exams. This block has the burden of six credits. In this block students will learn about the emergency sign, priority sign, the treatment of emergency cases and emergency drugs. Emergency medicine block consists of 5 modules, Traumatology, Respiration, Hemodynamic, Neurology, and Psychiatry with 5 scenario. Each scenario is given within 1 week. It is expected that each student is able to understand and master each learning objective.The learning strategies that will be used in this block includes the seven jump tutorial discussion, , clinical skill laboratory, lectures , independent study and plenary.The competency of block taken from the seven area of competency doctor by Indonesian Medical Council:

1. Communication e fektif

2. Basic clinical skills

3. Application of biomedical sciences in medical practice

4. Management of health problems in individuals, families and communities

5. Use of information technology

6. Introspective and life long study7. The application of ethics, morals and professionalism as well as patient safety. 2. LEARNING OBJECTIVES BLOCK

a. GENERAL PURPOSE

At the end of this block, students are expected to:

1. Analyzed of Emergency Sign and mark the Priority Sign.

2. Assessment and management of early (initial assessment) in the case of trauma /

multiple trauma / psychiatric emergencies in the order of priority (A-B-C)

3. Analyzed the normal organ function and organ failure caused by trauma / multiple trauma

4. Explain and able to life saving procedures and maintain organ function

5. Analyzed and how to refer patients for definitive therapy

6. Explain the legal aspects of trauma and emergency situations b. SPECIAL PURPOSE

1. Explain the national policy in handling emergencies and disasters

2. Analyzing of Emergency Sign and mark the Priority Sign in cases of

emergencies and traumatology.

3. Analyzing the failure of organ function due to trauma / multiple trauma

4. Assessment and management of early (initial assessment) in the case of trauma /

multiple trauma / drowning in the order of priority (A-B-C)

5. Able to perform life saving procedures in cases of emergency caused by trauma

6. Explain and understand the use of drugs in treating patients with emergency

7. Capable of analyzing and management of vascular injuries

8. Initial examination and management of musculoskeletal trauma

9. Able to explain the symptoms of eye emergencies

10. Explain the legal aspects of trauma and emergency situations

a. Explain the informed consent in emergencies

b. Explain how make a visum et repertum

11. Explain the symptoms in the field of pediatric emergency

12. Explain the symptoms of respiratory emergency

13. Explain the mechanisms of airway obstruction in adults

14. Understand and master the handling of emergencies in thoracic trauma

15. Explains emergency in maxillofacial trauma

16. Explaining the symptoms of emergency ENT (Ear Nose Throat)

17. Understand the purpose and indications RJPO action

18. Explain the results of radiological examination thorax and maxillofacial trauma

19. Explain the mechanisms of airway obstruction in adults and the management of airway obstruction (respiratory resuscitation)

20. Explains emergency obstetrics and gynecology

21. Understanding the signs and symptoms of shock (hypoperfusion)

22. Able to calculate the fluid in the shock and bleeding

23. Explains emergency abdominal surgery and treatment

24. Explain the cardiac emergency

25. Understanding and assessing burns and principles of treatment of burns

26. Explain and capable of handling emergencies on the skin

27. Recognize emergencies at the injury head and the treatment

28. Explain the radiological examination to help establish the diagnosis of head

injury

29. Explain a variety of emergencies in the field of neurology and handling

30. Explain the mechanism and management of disorders caused by impairment of

consciousness intracerebral

31. Explain and perform how to stabilize the trauma patient transport

32. Describe the action or emergency patient referral management

33. Explains emergency psychiatry and handling

34. Explain the type and management of poisoning

35. Explain the gastroenterohepatologi emergency

36. Explain the emergency treatment of metabolic and endocrine

37. Explain the emergency treatment of hypertension and renal

38. Explain the forensic toxicology

39. Able to recognize the signs of death

40. Able to therapy and techniques as well as Cardiac Pulmonary Brain Resuscitation (RJPO) correctly in adults and children

41. Able to perform an endotracheal tube

42. Able to take the corpus alienum ENT (Ear Nose Throat)

43. Able to make Visum Et Repertum

3. RELATED SCIENCES

1. Cardiology2. Lung3. Pediatrics4. Surgery.5. Neurology.6. Ear Nose Throat (ENT).7. Eye.8. Skin and Genital9. Anesthesia10. Radiology11. Psychiatry12. Forensic4. RELATIONS WITH THE OTHER BLOCKS

In studying this block, there are connection with some of the previous block, ie:

1. Block 6 (NBSS) : Neurology, Pediatric, ENT, Eye, Surgery, Psychiatry, Skin and Genital2. Block 9 (Reproductive System) : Obstetri

3. Block 10 (cardiovascular system) : Interna, Forensic

4. Block 11 (Hematoimunology) : Interna, Forensic

5. Block 12 (Respiratory System) : Interna, Pediatric

6. Block 14 (Gastroinstestinal System) : InternaTOPIC TREE

LEARNING ACTIVITY

A. Tutorial

Discussion tutorial on Emergency medicine there are 5 scenarios for 5 weeks. Each scenario consists of 2 meetings, step 1-5 and step 7. Step 6 independent learning to find answers the learning objectives in the scenarios. Scenario is that many cases occur in general practice or in hospital.

B. Lecture

During this block walk will be done several times face to face with the speakers in the form of lectures. Lectures are given will be tailored to each module each week. The function of college is to structuring the material, explanations are considered difficult subjects, discussion of material not covered in the tutorial, providing a multidisciplinary view of science and integrate knowledge.

C. Laboratory SkillTo train or equip psychomotor theory obtained should be given medical skills training (skills lab). Learning aims to train students to be more skilled in dealing with cases found in general practice.This event was held two sessions or two times with a 2 x 100 minutes for each topic skills. Prior to execution skills will be held pre test lab or home work. For students who pretest value of less than 70 then it will get the assignment from the CSL. The presence of skills lab must be 100%. Skills covered in this block-related emergencies cases (emergency medicine).

D. Plenary

Plenary will be held at 6 weeks. Each topic in the tutorials will be displayed in the plenary by 2-3 groups designated. Plenary aim to equalize students' perceptions about the Learning Objective in the scenario. Attended by pengampu each course / expert. Students can directly ask the experts about what is doubtful or who do not understand.E. Self Guided Learning.

Students learn to be independent based on the goals and objectives of the scenario

blocks, but can be developed based on the recommended references or sources - sources obtained from the internet. Independent learning is the core of competency-based curriculum. Students are required to report the results of their study to the group supervisor who has been appointed in writing. Reporting the results of study done for every module.

ASSESSMENT FRAMEWORK

Emergency total value of the end blocks 100%, between the one and the other does not compensate each other, while the details are as follows :

1. Tutorial : 20%

2. Skills Laboratory : 20%

3. Final Exam : 60%

Tutorials

Assessment tutorial consists of verbal interactions of students during tutorials. Assessed according to its activity (sharing, ideas, concentration, argumentation, domination, behavior / manners / attitude, discipline. Students are required to follow tutorials 100%. Components of the assessment tutorials also include an assessment of the written report guided independent learning.Clinical Skills Laboratory

The assessment is conducted every end of the semester by assessing affective, cognitive, and psychomotor skills. To assess students' ability in mastering medical skills will be held the Objective Structured Clinical Examination (OSCE).Final ExamBlock final exam held in week 6 at the end of the block. The number of exam is 150 points with 1-day exam. Block test score of 50% of overall value. Terms of exam block is at least 80% college attendance.BLUE PRINT EMERGENCY MEDICINE

No. GoalDM LV BB Qty MTD Part of

1 Explaining the national policy in dealing with emergencies and disasters Cognitive C3, C4 2% 3 MCQ Surgery

2 Explains emergency signs and mark the Priority Sign in the case of Traumatology Cognitive C4,

C5 2% 3 MCQ Surgery

3 Assessment and management of early (initial assessment) in a case of trauma / multiple trauma / drowning in the order of priority

(ABC) Cognitive C4,

C5 2% 3 MCQ Anesthesia

4 Able to perform life saving procedures in cases of emergency caused by trauma Cognitive C4,


5 Able to analyze the function of organ failure due to trauma / multiple trauma Cognitive C4,

C5 4% 6 MCQ Surgery

6 Explain and understand the use of drugs in treating patients with emergency

Cognitive C4,


7 Able to explain and management of vascular injuries Cognitive C3, C4 2% 3 MCQ Surgery

8 Initial examination and management of musculoskeletal trauma Cognitive C4,

C5 2% 3 MCQ Orthopaedic Surgery

9 Able to explain the symptoms of eye emergencies Cognitive C4,

C5 2% 3 MCQ Eye

10 Explain the legal aspects of trauma and emergency situations

a. Explain the informed consent in emergency

b. Able how to make visum et repertum Cognitive C4,

C5 2% 3 MCQ Forensic

11 Watdaruratan explain his failure symptoms in the field of pediatrics Cognitive C5,

C6 4% 6 MCQ Pediatric

12 Explaining the symptoms of respiratory emergency Cognitive C5,

C6 4% 6 MCQ Lung

13 Explain the mechanisms of airway obstruction in adults Cognitive C5,


14 Understand and master the handling of emergencies in thoracic trauma Cognitive C4,

C5 2% 3 MCQ Surgery

15 Explains emergency in maxillofacial trauma Cognitive C3, C4 2% 3 MCQ Surgery

16 Explaining the symptoms of emergency ENT Cognitive C4,

C5 2% 3 MCQ ENT

17 Understand the purpose and indications RJPO action Cognitive C5,


18 Explain the results of radiological examination thorax and maxillofacial trauma Cognitive C3, C4 2% 3 MCQ Radiology

19 Explain the mechanisms of airway obstruction in adults and management of airway obstruction (respiratory resuscitation) Cognitive C4,


20 Explains emergency obstetrics and gynecology Cognitive C4,

C5 2% 3 MCQ Obstetrics and Gynecology

21 Understanding the signs and symptoms of shock (hypoperfusion) Cognitive C4,


22 Able to calculate the fluid in the shock and bleeding Cognitive C5,


2 3 Explains emergency abdominal surgery and treatment Cognitive C4,

C5 2% 3 MCQ Surgery

2 4 Explain the cardiac emergency Cognitive C3, C4 2% 3 MCQ Heart

2 5 Understanding and assessing burns and principles of treatment of burns Cognitive C5,

C6 2% 3 MCQ Surgery

26 Explain and capable handling of the skin emergergencyCognitive C5,

C6 2% 3 MCQ Skin and Genital

27 Recognize emergencies at the injury in head and the treatmentCognitive C5,

C6 2% 3 MCQ Neurosurgical

28 Explain the radiological examination to help establish the diagnosis of head injury Cognitive C3, C4 2% 3 MCQ Radiology

29 Explain a variety of emergencies in the field of neurology Cognitive C5,

C6 4% 6 MCQ Nerve

30 Explain the mechanism and management of disorders caused by impairment of consciousness intracerebral Cognitive C5,

C6 4% 6 MCQ Nerve

3 1 Explain and perform and how to stabilize the patient transport of trauma Cognitive C5,


3 2 Describe the action or emergency patient referral management Cognitive C4,

C5 2% 3 MCQ Surgery

3 3 Explains emergency psychiatry and handling Cognitive C4,

C5 2% 3 MCQ Psychiatry

34 Explain the type and management of poisoning Cognitive C5,

C6 2% 3 MCQ Internal Medicine

35 Explaining gastroenterohepatologi and handling emergency Cognitive C4,


36 Explain the emergency treatment of metabolic and endocrine Cognitive C4,


37 Explain the emergency treatment of hypertension and renal Cognitive C4,


38 Explain the forensic toxicology Cognitive C3, C4 2% 3 MCQ Forensic

39 Able to recognize the signs of death Cognitive C5,

C6 2% 3 MCQ Forensic

40 Able to therapy and the techniques of RJPO correctly in adults and children Cognitive, Psychomotor and Attitude OSCE CSL

Anesthesia

4 1 Able to perform an endotracheal tube Cognitive, Psychomotor and Attitude OSCE CSL

Anesthesia

43 Able to take the corpus alienum ENT Cognitive, Psychomotor and Attitude OSCE CSL

ENT

44 Able to make Visum Et Repertum Cognitive, Psychomotor and Attitude OSCE CSL

Forensic

42 Able to implantCognitive, Psychomotor and Attitude OSCE CSL

Obgyn

Problem number MCQ 160

Note :

According to Bloom's taxonomy, competency to be achieved:

C1 = only limited know, remember / memorize

C2 = comprehension, translations and concludes

C3 = application, implementation, use the concepts, principles, procedures to solve problems

C4 = analysis, breaking the concept into its component parts, looking for a relationship between the problem C5 = synthesis, diagnosis, combine the parts into one

C6 = evaluation, comparing the values, ideas, methods with a standard SOP REFERENCES

Surgery:

( Dr.dr. Iskandar Japardi, SpBS. 2004.Head Injury. Jakarta :EGC

( Schwartz.2000. Digest Principles of Surgery. Edition 6th. Jakarta:EGC

( A. Graham Apley, 1993.Apley's System of Orthopaedics and Fractures. Seven

Edition. UK.

( Sabiston. 2004. Textbook of Surgery Teaching Science 1. Jakarta :EGC

Obstetri and Ginekologi :

Sastrawinata, Sulaiman. 1981.. Edition 1 Bandung : Ellstar Offset.Medicine faculty of .Unpad

Sastrawinata , Sulaiman Prof,et.al. 2004. Obstetrics Patology. Edition 2.Jakarta :Publisher EGC.

Sastrawinata, Sulaiman. 1981. Gynecology. Edition 1 Bandung : Ellstar Offset. Medicine faculty of Unpad

Sarwono Prawirohardjo.1991. Obstetrics and Gynecology.Third Edition. Jakarta: Yayasan Bina Pustaka

Cunningham, F.Gary [et.al].2006. Obstetri Williams. Volume 1.Edition 21. Jakarta : EGC.

Supono, Obstetrics Physiology.2004.Department of Obstetri and Gynekology Palembang Hospital Teaching. Medical Faculty of Sriwijaya University.

Interna :

Sudoyo AW, Setiyohadi B, Alwi I, et.al. 2006. Interna. Ed 4. Jakarta. Medical Faculty of Indonesia University.

Anesthesia :

Anestesiologi.2004. Jakarta: Medical Faculty of Indonesia University.Eye :

Prof Sidarta Ilyas.2004. Science of Eye. Third Edition.

Daniel G Vaughan.2000. General Ophthalmology. Edition 14. Jakarta: Widyamedika

dr. Nana Wijaya. 1993.Science of Eye. Jakarta ; Gaya Baru.

Prof Sidarta Ilyas . 2004.Atlas Science of Eye. Jakarta :

ENT :

Prof. Dr. Efiaty Arsyad Soepardi, SpTHT (K) et.al. 2003. Ear Nose Throat Head and Neck. Edition 5th. Jakarta: Medical Faculty of Indonesia University. Adams Boies Higler. 1997. BOEIS, ENT Disease Text Boks. Edition 6. Jakarta : EGC.

Skin and Genital :

Prof.Dr. R.S.Siregar,Sp.KK,. 2004. Illustrated Atlas of Skin. Edition 2. Jakarta; EGC.

Prof.Dr. dr. Adhi Djuanda , et al. 2002.Skin Disease. First Edition. Jakarta: Balai Medical Faculty of Indonesia University.

Radiology :

Sjahriar Rasad.2002. Radiology Diagnostic. Edition Kedua. Jakarta: Medical Faculty of Indonesia University

ATLAS Radiology.2000. Jakarta: Medical Faculty of Indonesia University.

Forensik :

Textbook of forensik dan medikolegal FK Unair, de Majo

Medical Faculty of Indonesia University .Forensic Science.2004. Jakarta : Medical Faculty of Indonesia UniversityPyshciatryc:

Dr. Rusdi Maslim.2002. Diagnostic of mental disorder. PPDGJ-III. Jakarta.

Neurology:

Adam Victor.2000.Principal of Neurology. Jakarta :EGC

Prof.Dr. Mahar Mardjono.2005. Basic of Clinical Neurology. Jakarta :EGC

Richard S. Snell.2006. Clinical Neuroanatomy. Jakarta :EGC

Pediatric:

Lecturer of Medical Faculty of Indonesia University. 1998.Pediatric..Jakarta ; Info Medika Jakarta.

Prof.Dr.Coory S. Matondang dkk, Physical Diagnosis in Children

MODUL 1

Traumatology

CHAPTER I. THE FIRST WEEK LEARNING OBJECTIVESStudents are able to :

1. Explaining the national policy in dealing with emergencies and disasters

2. Analyzed the Emergency Sign and mark the Priority Sign in case of emergencies and

Traumatology.

3. Assessment and management of early (initial assessment) in the case of trauma / multiple

trauma / drowning in the order of priority (A-B-C)

4. Analyzing the failure of organ function due to trauma / multiple trauma

5. Able to perform life saving procedures in cases of emergency caused by the trauma /multiple trauma

6. Explain and understand the use of drugs in treating patients with emergency

7. Capable of analyzing t Rauma handling and management of vascular injuries

8. Explain the hemodynamic emergency9. Initial examination and management of musculoskeletal trauma

10.Explain the legal aspects of trauma and emergency situations

a. Explain the informed consent in emergencies

b. Explain how to make a visum et repertum

Expert lecture:

A. Surgery

Lecture 1 by dr. Yuzar Harun, Sp. B

a. Introduction of emergency block (20 minutes)

b. Explaining the national policy in dealing with emergencies and disasters (40 minutes) c. Analyze the failure of organ function due to trauma / multiple trauma (40 minutes)

Lecture 2 by dr. Pirma Hutauruk, Sp. B

a. Capable of analyzing handling and management of vascular injury traumatology (50 minutes)

Lecture 3 by dr. Aswedi Putra, Sp. OT / dr. Eddy Marudut S, Sp.OT

a. Initial examination and management of musculoskeletal trauma (100 minutes)

2. Anesthesia

Lecture 1 by dr. Achmad Assegaf, Sp. An

a. Analyze the Emergency Sign and mark the Priority Sign in case of emergencies Traumatology. (50 minutes)

b. Assessment and management of early (initial assessment) in the case of trauma / multiple trauma / drowning in the order of priority (A-B-C) (50 minutes)

Lecture 2 by dr. Achmad Assegaf, Sp. An

a. Explain and understand the use of drugs in dealing with emergency patients (100 minutes) 3. Forensic

Lecture 1 by dr. Evi Diana, Sp. F

a. Explain the legal aspects of trauma and emergency situations (informed consent in emergencies) (50 minutes)

b. Visum et repertum (50 minutes)

4. Eye

Lecture 1 by dr. Helmi Muchtar, Sp. M

Able to explain the symptoms of eye emergencies (100 minutes)

Tutorial

Scenario 1

Skill Lab:

Visum Et Repertum

CHAPTER II. SCENARIO 1

EARTHQUAKE VICTIMS

A boy of 16 years was brought to the Emergency Unit immediately after he had removed from the rubble by an earthquake 6.7 Richter scale. The patient is awake, looking pale. He felt pain in right thigh. On physical examination found deformity in the right thigh, visible bone protruding through the skin which causes the wound in the right thigh 10 cm with a fair amount of bleeding., Right leg look shorter, and the patient can not lift his right leg.

CHAPTER III. REVIEW REFERENCES

S CENARIO 1: EARTHQUAKE VICTIMS

A. National policy in dealing with emergencies and disasters:

Set in integrated emergency response system, include:

a. Ordinary people: the common people have to master the skills of basic life support

b. Emergency communication system: 110 police, 113 fire, ambulance 118

c. Support systems (fire brigade, police, Red Cross): trained as a medical first responder

d. Pre-hospital emergency ambulance, there are three types:

- Basic types : Able to perform the procedure ABCD

- Paramedic Type: ABCD + invasive measures (intubation, lung puncture, infusion, drugs)

- Type of motorcycle is equipped with equipment and medicine, but without a stretcher

e. 24-hour emergency unitf. Disaster plan and training

2. Emergency and priority signs

Symptoms and signs in medical emergencies :

Symptoms and signs in medical emergencies is very diverse, distinctive and not typical. Abnormal changes of the patient's vital signs are lead to medical emergencies. Some things that can be observed suspicion in patients who directs us to a problem medical is:

Symptoms:

( Fever

( Painful

( Nausea, vomiting

( Excessive urination, or not at all

( Dizziness, feeling faint, was coming to an end

( Shortness of breath or have difficulty

( Excessive thirst or hunger, a strange taste in mouth Sign:

( Changes in mental status (unconscious, confused)

( Changes in heart rhythm; fast or very slow pulse, irregular, weak or very strong

( Changes in respiratory, rhythm and quality of the mucous membrane color (pale,

bluish, red too)

( Changes in skin condition: temperature, humidity, excessive sweating, extremely

dry, including discoloration of the mucous membranes (pale, bluish, red too)

( Changes in blood pressure

( Bead eyes: very large or very small

( Typical odor of the mouth or nose

( Abnormal muscle activity such as seizures or paralysis

( Gastrointestinal disorders: nausea, vomiting or diarrhea

( Sign - Other signs that should not exist

( Think of all patient complaints are true. If the patient feel bad or uncomfortable it is

treated as a medical case

Triage:

Triage is the process of sorting patients by severity of specific injuries or illnesses (based on the most likely to experience clinical deterioration soon) to determine the priority of the medical emergency treatment and transportation priorities (based on availability of the means for action).

Tagging and grouping based triage

Priority Zero (Black): Patient death or fatal injury may be obvious and not resuscitated

First Priority (Red): Patients severe injuries that require rapid assessment and medical actions and transport immediately to stay alive (eg, respiratory failure, torako-abdominal injury, head injury or facial maksilo-weight, shock or severe bleeding, severe burns)

Priority Two (Yellow): The patient needs help, but with a less severe injury and certainly will not experience life threat in the near future. Patients may experience an injury in a broad range of species (eg, abdominal injuries without shock, chest injury without respiratory disorders, major fractures without shock, head injury or cervical spine is not weight, and minor burns)

Third Priority (Green): Patients degan minor injuries that do not require immediate stabilization, requiring simple first aid but require periodic reassessment (soft tissue injuries, fractures and dislocations of the extremities, facial injuries, maksilo without airway disorders, and psychological emergency) Priority Four (Blue): the first group of victims with injuries or critical and potentially fatal penyaki which means do not require action and transport, and

Priority Five (White): the first group is definitely dead.

3. Initial management of trauma cases :

The initial assessment is done on the case, of course, related to the patient's vital signs including blood pressure, pulse, respiration and body temperature, and status consciousness. Further assessment associated with trauma to the patient's condition. In this case the patient suffered an open fracture of the assessment is :

A. Inspection (look)

The presence of deformity (deformity) such as swelling, shortening, rotation, angulation, bone fragments (open fracture).

2. Palpation (feel)

Presence of tenderness (tenderness), crepitus, neurological and vascular status examination in the distal fracture. Palpation of the extremity the fracture, the injury involves the distal arterial pulsation, skin color, capillary refill test.

3. Movement (moving)

The existence of limited motion in the fracture area.

Physical examination of the case?

Obtaining a thorough history of the mechanism of injury may help identify orthopedic injuries. For example, past medical history, medications, and previous injury.

4. Life saving procedures in cases of emergency

Basic life support

INDICATIONS

A. Stop breathing

Stop breathing characterized by the absence of chest movement and breathing the air flow from the victim / patient.

Stop breathing is a case that should be taken Basic Life Support.

2. Stop cardiac

In the event of cardiac arrest, it will happen immediately stop the circulation. Stopping the circulation of these will quickly lead to brain and vital organs of oxygen deficiency. Troubled breathing (wheezing) is an early sign of impending cardiac arrest.

Cardiac pulmonary resuscitation consists of two stages, namely:

( Survey of Primary (Primary Survey), which can be done by everyone

( Secondary Survey (Secondary Survey), which can only be performed by trained medical and paramedical personnel and is a continuation of the primary survey.

PRIMARY SURVEY

In the primary survey focused on breathing assistance and help with circulation and defibrillation. To be able to remember easily the primary survey measures formulated by the alphabet A, B, C, and D, namely

A = airway (airway)

B = breathing (breathing assistance)

C = circulation (circulatory assistance)

D = defibrilation (electrical therapy)

A (Airway) Airway

After completing the basic procedure, followed by action:

1. Examination of the airway.

2. Open the airway.

B (Breathing) Support of breath

Consists of two stages:

1. Ensure victim / patient is not breathing.

By looking upward movement turunnva chest, listening for breath sounds and feel the breath of the victim / patient

2. Provide breathing assistance.

If the victim / patient is not breathing, breath support can dilakukkan through word of mouth, nose or mouth to mouth to a stoma (hole made in the throat)

C (Circulation) Help circulation

Consists of two stages:

1. Ascertain whether the heart rate of victims / patients.

Whether or not heartbeat victim / patient can be determined by palpating the carotid artery in the neck area victim / patient.

2. Provide help circulation.

If it has been confirmed no heartbeat, then they could be assisted circulation or the so-called external cardiac compression, performed with the following techniques:

D (DEFIBRILATION)

Defibrilation or in the Indonesian language translated by the term defibrillation is to provide a therapeutic electrical energy. This is done if the causes of cardiac arrest (cardiac arrest) is an abnormal heart rhythm called ventricular fibrillation. In the present is already available tools to Defibrillation (defibrillator) which can be used by lay people, called Automatic External Defibrilation, where the tool can find victims of cardiac arrest defibrillation should be performed or not, if necessary defibrillation device can give the signal to rescuers to perform defibrillation or continuing help breathing and circulation assistance only.

5. Drugs in patients with emergency :

Resuscitation drugs

Vasopressin : Adrenaline, dobutamine, dopamine

Anti-arrhythmia drugs

Other : Atropine, calcium

Route of administration :

Peripheral veins, central veins, Intracardia, trachea, intraosseous

6. Types of fractures and wounds

Fractures Definition:

Fractures (broken bones) is a breakdown of the continuity of the bone structure and is determined according to the type and extent. (Smeltzer SC & Bare BG, 2001)

Types of fractures:

To be more systematic, the type of fracture can be divided by:

( Location Bone fractures can occur in anywhere like on diafisis, metaphysical, epiphyseal, or intraartikuler. If the fracture is obtained in conjunction with dislocation of joints, it is called a fracture dislocation.

( Wide Divided into a complete fracture (complete) and incomplete (incomplete). Example is an incomplete fracture of the crack.

( Configuration Judging from the line frakturnya, can be divided into transverse (horizontal), oblique (angled), or spiral (spiral / twist the stem around the bone). If more than one fracture line, then called kominutif, if one part broken while the other side of the bend is called greenstick. Fracture with fragments driven into the (often occurs in the skull and facial bones) is called depression, have a compression fracture where the bone (occurs in the spine) is called compression.

( Relationship between the fracture

Between the fracture can still relate (undisplaced) or far apart (displaced).

( The relationship between fracture with surrounding tissue

Fractures can be divided into an open fracture (if there is a relationship between bone and the outside world) or a closed fracture (if there is no relationship between the fracture and the outside world).

Open fractures are divided into several grades, namely:

Grade I : clean cuts, less than 1 cm in length.

Grade II : more extensive injury without extensive soft tissue damage.

Grade III : highly contaminated, and extensive soft tissue damage.

Physical Examination :

1. Inspection (look)

The presence of deformity (deformity) such as swelling, shortening, rotation, angulation, bone fragments (open fracture). 2. Palpation (feel)

Presence of tenderness (tenderness), crepitus, neurological and vascular status examination in the distal fracture. Palpation of the extremity the fracture, the injury involves the distal arterial pulsation, skin color, capillary refill test.

3. Movement (moving)

The existence of limited motion in the fracture area.

Examination Support:

1. Radiologic examination (x-rays), in areas suspected fracture, must follow the rules of the role of two, consisting of:

( Includes two images are anteroposterior (AP) and lateral.

( Contains two fractures of the joints between the proximal and distal parts.

( Contains two extremity (especially in children), both the injured and those not exposed to injury (to compare with normal)

( Performed twice, namely before and after the action action.

2. Laboratory examinations, including :

( Routine blood,

( Blood clotting factors,

( Blood type (especially if the surgery will be performed),

( Urinalysis,

( Creatinine (muscle trauma may increase the burden of creatinine for renal clearance). Arteriography examination performed if suspicion of vascular damage caused by the fracture. Complications:

The cause of fracture complications in general can be divided into two, namely because of the trauma itself, could also be due to the handling of the fracture is called iatrogenic complications.

Definition of Injury

Wound is a state of loss / breakdown of the continuity of the network (Mansjoer, 2000:396). According In ETNA, injury is an injury to the tissue that interferes with normal cellular processes, the wound can be described by the damage to the kuntinuitas / unity of body tissue that is usually accompanied by loss of tissue substance. Classification of Wounds

Wound distinguished by:

1) Based on the causes

a) Excoriation or abrasion

b) Vulnus scisum or cuts

c) Vulnus laseratum or wound

d) Vulnus punctum or stab wounds

e) Vulnus morsum or animal bites

f) Vulnus combotio or burns

2) Based on the presence / absence of tissue loss

a) Excoriation

b) Skin avulsion

c) Skin loss

3) Based on the degree of contamination

a) Clean cuts

a) The cut elective

b) Sterile, potentially infected

c) There is no k ontak the oropharynx, espiratorius tract, tract elimentarius, genitourinarius tract.

b) Clean cuts tercema r

a) The cut elective

b) Potential infection: minimal spillage, normal flora

c) Contact with the oropharynx, respiratory, and genitourinarius elimentarius

d) Longer healing process

c) Contaminated wounds

a) Potential infection: spillage of elimentarius tract, gall bladder, genito urinary tract, urine

b) The new trauma injuries: lacerations, open fractures, penetrating wounds.

d) Dirty wounds

a) As a result of the surgery is highly contaminated

b) Visceral perforation, abscess, old trauma. Type of wound healing

There are three types of wound healing, where the division is characterized by the number of the lost tissue.

1) Primary Intention Healing (primary wound healing) that is the healing that occurs immediately after the attempted bertautnya wound edges usually with stitches.

2) Secondary Intention Healing (Secondary wound healing) is a wound that does not have a primary healing. This type is characterized by the presence of extensive injury and loss of tissue in large numbers. The healing process occurs more complex and longer. Wounds of this type are usually kept open.

3) Tertiary Intention Healing (Tertiary wound healing) that is wound was left open for a few days after debridement action. Once believed to be clean, the wound edges (4-7 days). This wound is the last type of wound healing (Mansjoer,2000:397 ; In ETNA, 2004:4).

Wound Healing Phase

The wound healing process has three phases, namely the inflammatory phase, proliferation and maturation. From one phase to another phase with a continuity that can not be separated.1) Phase InflammationThis phase appears soon after injury and can continue for 5 days. Inflammation serves to control bleeding, prevent the invasion of bacteria, removing debris from the wound tissue and prepare for continued healing process.2) Phase ProliferationThis stage lasts from day 6 up to 3 weeks. Fibroblasts (connective tissue cells) have a major role in the proliferative phase.3) Phase of maturationThis stage lasts from the day 21 and can last for months and ended when the signs of inflammation had disappeared. In this phase there is a wound remodeling is the result of an increase in tissue collagen, collagen breakdown and regression of excess wound vascularity (Mansjoer, 2000:397; InETNA, 2004:1).Some of the steps that must be considered in cleaning the wound that is:1) Irrigation by as much as possible in order to remove dead tissue and foreign bodies.2) Remove all foreign objects and excision of all dead tissue.3) Give an antiseptic4) If the required actions can be performed by administering a local anesthetic5) If you need to do the closure of the wound (Mansjoer, 2000: 398; 400)

Suturing woundsClean wounds and are believed not to have an infection and was less than 8 hours may be sewn primer, while the wound is heavily contaminated or not demarcated and should be allowed to recover per sekundam or per tertiam.

Wound closureWound closure is to strive for better environmental conditions in the wound healing process takes place so that optimal.

Consideration dressingConsiderations in the closed dressing and bandage the wound is very dependent on the assessment of the condition of the wound. Serves as a protective dressing to the evaporation, an infection, seek a good environment for wound healing, as fixation and suppression effects that prevent the gathering of blood seepage causing hematoma.

Giving AntibioticsGiving antibiotics to the wound clean principle need not be given antibiotics and the wound is contaminated or dirty it needs to be given antibiotics.

Removal of the stitchesStitches removed when the function is no longer needed. Time of suture removal depends on various factors such as, location, type of appointment of injury, age, health, attitudes of patients and the presence of infection

REFERENCES

Atkinson R S, Hamblin J J, Wright J E C. Shock. In the book: Hand book of Intensive Care. London: Chapman and Hall, 1981; 18-29.Bartholomeusz L, Shock, in the book: Safe Anaesthesia, 1996; 408-413Buckley R, Panaro CDA. General principles of fracture care. Available at http://www.emedicine.com/orthoped/byname/General-Principles-of-Fracture-Care.htm. Last Update: July 19, 2007Femur Fractures. Available at: http://medisdankomputer.co.cc/?p=380. Last Update: March 15, 2009Open fracture. Available at http://bedahugm.net/Bedah-Orthopedi/Fraktur-Terbuka.html. Last update: January 8, 2009Fracture. Available at http://bedahugm.net/Bedah-Orthopedi/Fracture.html. Last Update: August 3, 2008.Fracture. Available at http://www.klinikindonesia.com/bedah/fraktur.php. Last update: January 7, 2009Mangunsudirejo RS. Fracture healing, treatment, and complications, book 1. Issue 1. London: 1989Rasjad, C. Introductory book Orthopaedic Surgery ed. III. Yarsif Watampone. Makassar: 2007. pp. 352-489Sjamsuhidajat R, Wim De Jong, Textbook of Surgery, revised ed, EGC. New York: 1998. pp. 1138-96Thijs L G. The Heart in Shock (With Emphasis on Septic Shock). In a collection of papers: Indonesian Symposium On Shock & Critical Care. Jakarta, Indonesia, August 30 - September 1, 1996; 1-4.Wilson R F, ed. Shock. In the book: Manual of Critical Care. 1981; c :1-42.Zimmerman JL, Taylor RW, Dellinger RP, Farmer JC, Diagnosis and Management of Shock, in the book: Fundamental Critical Support. Society of Critical Care Medicine, 1997.MODULE 2

Emergency of Respiration

CHAPTER I. THE SECOND WEEK LEARNING OBJECTIVES

Students are able to :

1. Explain the symptoms in the field of pediatric emergency

2. Explaining the symptoms of respiratory emergency

3. Explain the mechanisms of airway obstruction in adults

4. Understand and master the handling of emergencies in thoracic trauma

5. Explains emergency in maxillofacial trauma

6. Explaining the symptoms of emergency ENT

7. Understand the purpose and indications RJPO action

8. Explain the results of radiological investigations thorax and maxillofacial trauma

9. Explain the mechanisms of airway obstruction in adults and the management of airway

obstruction (respiratory resuscitation)

Expert lecture:

A. Pediatric

Lecture 1 by dr. Ferdi, Sp. An

Emergencies in pediatrics (100 minutes) 2. Surgery


a.Emergencies in thoracic trauma (5 0 minutes)


a.Traumatology maxillofacial (50 minutes)

3. Anesthesia

Lecture 3 by dr. Indra Faisal, Sp. An

a. Explain the symptoms of respiratory emergency (100 minutes)

Lecture 4 by dr. Dendy Maulana, Sp. An

b. Explain the mechanisms of airway obstruction in adults and drowning (drowning) (50 minutes)

c. Explain the management of airway obstruction (respiratory resuscitation) (50 minutes)

Lecture 5 by dr. Undang Komarudin, Sp. An

Understand the objectives and actions Cardiac Pulmonary Brain Resuscitation (RJPO) (100 minutes)

4. ENT (Ear, Nose, Throat)Lecture 1 by dr. Fatah Satya W, Sp. ENT

a. Emergencies in ENT (100 minutes)

5. Radiology

Lecture 1 by dr. Karyanto, Sp. Rad

a. Explain the results of radiological examination and maxillofacial trauma of the thorax (100 minutes)

Tutorial

Scenario 2

Skill lab

Cardiac Pulmonary Brain Resuscitation (RJPO) in children and adults /

Traumatology Advanced Life Support (ATLS)

CHAPTER II. SCENARIO 2FACES TRAUMA

A boy aged 8 years was brought to the Emergency Unit after an accident. He bounced from the host and his bike hit the pavement and the bottle containing the liquid battery rupture and the liquid is brought about him. Conscious patient, suffering from facial and jaw injuries are very severe, the patient also look crowded. On physical examination the doctor found the patient's difficulty answering the question being asked by a doctor because of the deformity on the right cheek and out of the mouth and nose bleeding.

CHAPTER III. REVIEW REFERENCES

S CENARIO 2: FACES TRAUMA

A. Initial assessment on facial trauma

Assessment on Face Trauma

A history of trauma to the face

Ample use of acronyms in the evaluation of facial trauma patient (allergies, medications, past history, last meal, events surrounding the accident) can facilitate a history of trauma with lengkap.3 Acronyms can also be used if the trauma of threatened jiwa.4

Ask specific questions about trauma:

Mechanism of trauma

Whether the patient had lost consciousness

Does the patient have vision problems such as double or blurred vision

Is dental patients can normally closed (normal occlusion)

Whether the patient can bite without pain

Does the patient possess an area that feels numbness or tingling in the face

In women, ask if the trauma is derived from a partner or a person being under threat

In children, ask the same thing as the woman to menenetukan whether there is violence on children.

Deformities of the face looks

Swelling, asymmetry, oblique, with skin abrasions to the soft tissue injury

Hematoma or bleeding in the wound or the mouth of the hole gidung and as a way out bleeding from the maxillary sinus / fracture

Physical examination

Examination of systematic head and face can be the starting point and is done in a consistent treatment to prevent checks being let loose. In patients with acute facial trauma, physical examination can be disrupted by the swelling of the face. Secondary asymmetrical facial appearance of the fracture can usually be hidden. 3

Check for tenderness, crepitus (without a strong emphasis for flat bones), "step in" or discontinuity edge orbital bone and bone madibula rhyme. Check as well as the right and the left side and compare. 2

Examiner carefully assessed for neurological deficits, including facial trigeminal nerve and facial. Sensory disturbances in the forehead, cheeks, and lower lip. Lacerations, contusions, and abrasions of the skin can focus the examiner to indicate parts that have a risk of nerve injury. 3

Complete eye examination includes evaluation of a history of eye disease, visual acuity, perception of light and red light, ocular motility, pupil assessment, and examination of the conjunctiva and eyelids. Long-term morbidity in facial fractures are the most associated with ocular and orbital damage. 3

Hipestesia the second nostril

Cheeks bulge disappeared 2

Examination of the oral cavity particularly important in patients who mehilangan teeth, bone fragments, or foreign body when there is trauma. Identification and removal of prosthetic oral cavity needs to be done. Occlusion and interkuspasi carefully done because both mandibular and maxillary fractures can result in malocclusion. 3 In the oral cavity appears occlusion disorders (malocclusion) that bulge premolars are not met with the hollow tooth opponent / partner, can also appear gingival laceration fracture area, maxilla are sometimes found floating in the hematoma (floating maxilla)

Maxillofacial Trauma and classification

Maxillofacial trauma can be classified into two parts, the hard tissue facial trauma and facial soft tissue trauma.

Maxillofacial trauma to the tissue can include soft tissue and hard tissue. The meaning of facial soft tissue is soft tissue that covers the face of hard tissue.

While the definition of hard tissue facial bones of the head is composed of

1. Nasal bone

2. Bone arch zigomatikus

3. Mandibular bone

4. Bone / maxillary

5. Eye socket bone

6. Tooth

7. Alveolar bone

Le Fort classification used to help diagnose and p treatment :

Le Fort I : Limited to the alveolar trauma left, right, or bilateral.

Le Fort II :Trauma pyramid os maxillary, nasal, zigoma; occur separation of the

center of the face with cranial bone.

Le Fort ILI :Trauma of the maxillary bone, nose, zigoma, orbita; place separations around the bones of the face with a base kranii

Facial soft tissue trauma

Wound is the anatomical damage, discontinuities of a tissue by trauma from the outside arena. Trauma to the facial soft tissues can be classified by :

1. Based on the types of injuries and the cause

a. Excoriation

b. The cut, wound, wound jab.

c. Burn

d. Gunshot wound

Trauma is associated with an aesthetic unit

Favorable or unfavorable, is associated with Langer's lines

Figure 1.

A. Laceration that crosses the line of Langer unfavorable cosmetic result in poor healing.

B. Facial incision is placed parallel to Langer's lines (Pedersen GW. Practical textbook oral surgery (oral surgery). Rather Purwanto language, Basoeseno. Jakarta: EGC, 1987:226).

2. Maxillofacial trauma

Management of facial trauma

Primary survey:

airway: airway disorders result from direct trauma to the larynx, foreign bodies (including an aspirated tooth and bone fragments), or massive bleeding from the upper airways. Treatment of airway disorders is quite difficult with the trend that 10% of patients had facial trauma and cervical spine trauma. 3

b reathing : It consists of two stages:

1. Ensure the patient / victim is not breathing

By seeing the movement of the chest rise and fall, hear and feel the breath of breath, a technique helper hold the ears and nose above the mouth of the patient / victim while still maintaining the airway remains open. Do no more than 10 seconds 2. Provide breathing assistance

Help the breath can be done through word of mouth, mouth to nose, mouth to stoma (a hole made in the throat). Respiratory assistance given by 2 times, each time blowing time from 1.5 to 2 seconds and the volume of 700 ml - 1000 ml (10 ml / kg or until visible chest patients / victims given oxygen mengembang.Konsentrasi 16-17%. Note the patient's response

c irculation : The most important action is to help the circulation of Foreign heart massage. External Cardiac Massage can be done because most of the heart is located between the breastbone and the backbone so that the pressure from the outside can cause effects on the heart pump which was considered sufficient to regulate the blood circulation at least on the state of clinical death .

Secondary survey

neck examination, neurological, scalp, orbit, ear, nose, face, middle, mandibular oral cavity, and occlusion. Head injury (brain injury) may delay the timing of the operation of open reduction internal fixation (ORIF) in bone ftraktur face.

If there are wounds, covered with moist gauze while awaiting definitive therapy

Mandibuka bilateral fracture should be stabilized so as not to interfere with the airway

If there is a septal hematoma or hematoma auricula rice, drainage should be performed and followed by a swathe of press / nose tamponade. 2

Advanced Handling

Handling information that is in the first week post-trauma.

Mandibular fracture: reduction and fixation of the maxillary arch with a wire or bar produced union and the occlusion is achieved within 5 weeks. Reduction and screw fixation with mini plates do not require locking teeth as in the wire and arch bar.

Fracture of the maxilla: the reduction of the sulcus approach ginggivobucalis and infra cilliar palpebra inferior; can also be fixed with wire or mini screw plate.

Rima important orbital fracture repositioning and fixation surgery to restore form and restore the function of orbital motion of the affected eye.

Nasal fracture repair should not be too long since the trauma, given the nasal bones are flat and often broken-shaped impression, deviation or crushed.

3. Emergency in thorax trauma

Cause of:

Airway obstruction, major hemothoraks, cardiac tamponade, pneumothorax persisted.

Management of emergency :

Determination of injury (penetrating thoracic wall or not)

Determination of vital functions (if necessary resuscitation)

Cleanup and closure of wounds

Airway obstruction

From outside the airway: Foreign

From within: The tongue that closes the airway

How to deal with obstruction:

If the blockage seen taken with a finger or tool to pinch and pull

If looks do not blow back or back slaps

If the base of the tongue falls backwards doing headt tilt or chin lift.

4. Traumatology in the eyes and treatmentA. Definition

Eye trauma is whether or not intentional acts that cause eye injury.

B. The types of eye trauma

1. ACID TRAUMA

Traumatic acid is one type of chemical eye trauma and emergencies including the eyes caused by chemical substances are acidic with a pH