+

TUTOR : dr.Eny Wello

+
KELOMPOK 14
 Pridina Syadirah 11020140006

 Suci Walidalhuda 11020140023

 Qoidil Qoimil Chaesar 11020140048

 Muhammad Yatsrib Semme 11020140036

 Miftahul Jannah 11020140045

 Fauziah Abidah 11020140069

 Niswatun Hasanah Sukardi 11020140074

 Nirwana 11020140089

 Selly Silla Sakti 11020140104

 Ria Rizki Amaliyah 11020140113

+
SCENARIO 2

The 40-year-old man was taken to the

emergency room of the hospital with loss of
consciousness about 2 hours ago. Patients
snore, can not open the eyes and extremities
are only abnormal flexion with excitatory pain.
On physical examination was found vital signs
of blood pressure 100/50 mmHg, radial pulse
90x / minute, breathing 25x / minute,
Temperature 37 ° C. According to the family,
the patient has a history of hypertension but
irregular treatment.
+
KALIMAT KUNCI

 Man, 40 years old

 Loss of consciousness about 2 hours ago

 Snore, can not open the eyes and extremitas are only
abnormal flexion with excitatory pain.

 On physical examination was found:

Blood pressure: 100/0 mmHg

Radial pulse: 90x/minute

Breathing: 25x/ minute

Temperature: 37 0c
+
QUATIONS!

 Physiology of consciousness!

 Explain the cause and pathomechanism loss of consciosness

in intracranial and extracranial coma?

 Explain about airway, breathing and circulation!

 Explain how to use emergency drugs related with the cause

of loss conciseness?

 How come the patient got snore?

 The terms of transporting and referring to the patient with

consciousness decline?
+
1. Physiology of consciousness!
+ Explain the cause and pathomechanism loss of
consciosness in intracranial and extracranial coma?

Gorelick, Philip B. et all. 2014. Hankey’s Clinical Neurology. Second Edition. CRC Press. page 84-88.
+ Due to Herniation of The brain

Gorelick, Philip B. et all. 2014. Hankey’s Clinical Neurology. Second Edition. CRC Press. page 84-88.
+
Explain about airway, breathing
and circulation!
Airway
 In this case, the patients snore. So, we have to make sure the
airway clear from the snore. How?

 The snore made because a tounge that fall into the backward.
We can use some maneuver technique to make the airway
clear from the snore.

Reference : Advanced Trauma Life Support. Ninth Edition : American college of

surgeons
 +
Maneuvers, are :

- The Chin-lift Maneuver

- The Jaw-Thrust Maneuver

After that, if we have to do something else than the airway clear, we

can use this alternative to help stabilitated the airway while do
another work.

- Inserting oral airway (OPHA). But, this metod should not be used in
children and in conscious patients.

Reference : Advanced Trauma Life Support. Ninth Edition : American college of

surgeons
+
+
 + Breathing

Transient respiratory arrest and hypoxia are common with severe

brain injury and may cause secondary brain injury. Early
endotracheal intubation should be performed in comatose patients.

The patient should be ventilated with 100% oxygen until blood gas
measurements are obtained. Pulse oximetry is a useful adjunct, and
oxygen saturation of >98% are desirable.

Reference : Advanced Trauma Life Support. Ninth Edition : American college of

surgeons
 + Circulation

Euvolemia should be established as soon as possible if the patient is

hypotensive, using blood products, whole blood, or isotonic fluids, as
needed.

Reference : Advanced Trauma Life Support. Ninth Edition : American college of

surgeons
+ Explain how to use emergency drugs related
with the cause of loss conciseness?
+

Inotropic
Anti Arhytmia Anti Asthma I.V. Fluids
Agents
• Amiodarone • Adrenaline • Salbutamol • 0.9% saline
• Digoxin • Dopamine • 5% dextrose
• Dobutamine

Referensi : http://www.who.int/selection_medicines/country_lists/kir_emergency_2007.pdf
+ How come the patient got snore?

Reference :
http://www.webmd.com/sleep-disorders/tc/snoring-cause
F.Paulsen and J. Waschke. 2012. Sobotta Atas Anatomi Manusia jilid 3. Jakarta : EGC
 +

Reference :
http://www.webmd.com/sleep-disorders/tc/snoring-cause
F.Paulsen and J. Waschke. 2012. Sobotta Atas Anatomi Manusia jilid 3. Jakarta : EGC
6. The terms of
Transporting and
refering of patients
+Transportation guidelines

Planning

Passage Personnel

Procedures Properties

Te oh.1990.Sydney London Boston Singapore Toronto Wellington, Intersive

Care Manual. Third Edision
Transportation
+ Category

Intramural Ektramural
Transportation Transportation
• Prehospital (primer)
• Interhospital
(sekunder)
• International transport
+
Prehospita
l

Interhospital

International
Transport
+
Prehospital

Principle  Transport patient quickly and safely

toward the hospital

Lifting patients  Recognize the ability of self, the

patient’s body with a hover, keep
communication,“cradle/drag”,
“fore and aft carry”
+
The terms of Transporting and
refering of patients
 Stable condition of patient

 O2

 Put an IV Line, NGT and Catheter

 Communication with the destination hospital

 Letter of reference

 Accompanied by health care personnel

 Safe transportation (Do No Futher Harm)

Sethi, D., & Subramanian, S. (2014). When place and time matter: How to conduct safe inter-
hospital transfer of patients. Saudi journal of anaesthesia, 8(1), 104.
+

TERIMA KASIH