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, espiration, !emodynamic, "eurology, and #sychiatry with 5 scenario. Each scenario is gi$en within % week. It is expected that each student is able to understand and master each learning ob&ecti$e. 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 f om the !e"en a ea of competency #octo by In#one!$an %e#$cal Co&nc$l' %. 'ommunication e fektif (. )asic clinical skills *. +pplication of biomedical sciences in medical practice ,. -anagement of health problems in indi$iduals, families and communities 5. .se of information technology 6. Introspecti$e and life long study 7. The application of ethics, morals and professionalism as well as patient safety.

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LE)RNIN* OB+ECTIVE, BLOCK a. *ENER)L -UR-O,E +t the end of this block, students are expected to/ %. +naly0ed of Emergency Sign and mark the Priority Sign. (. +ssessment and management of early (initial assessment) in the case of trauma 1 multiple trauma 1 psychiatric emergencies in the order of priority 2+3)3'4 *. +naly0ed the normal organ function and organ failure caused by trauma 1 multiple trauma ,. Explain and able to life sa$ing procedures and maintain organ function 5. +naly0ed and how to refer patients for definiti$e therapy

6. Explain the legal aspects of trauma and emergency situations b. ,-ECI)L -UR-O,E %. Explain the national policy in handling emergencies and disasters (. +naly0ing of Emergency Sign and mark the Priority Sign in cases of emergencies and traumatology. *. +naly0ing the failure of organ function due to trauma 1 multiple trauma ,. +ssessment and management of early 2initial assessment4 in the case of trauma 1 multiple trauma 1 drowning in the order of priority 2+3)3'4 5. +ble to perform life sa$ing procedures in cases of emergency caused by trauma 6. Explain and understand the use of drugs in treating patients with emergency 7. 'apable of analy0ing and management of $ascular in&uries 5. Initial examination and management of musculoskeletal trauma 6. +ble to explain the symptoms of eye emergencies %7. Explain the legal aspects of trauma and emergency situations a. Explain the informed consent in emergencies b. Explain how make a $isum et repertum %%. Explain the symptoms in the field of pediatric emergency %(. Explain the symptoms of respiratory emergency %*. Explain the mechanisms of airway obstruction in adults %,. .nderstand and master the handling of emergencies in thoracic trauma %5. Explains emergency in maxillofacial trauma %6. Explaining the symptoms of emergency E"T 2Ear "ose Throat4 %7. .nderstand the purpose and indications 8#9 action %5. Explain the results of radiological examination thorax and maxillofacial trauma %6. Explain the mechanisms of airway obstruction in adults and the management of airway obstruction 2respiratory resuscitation4 (7. Explains emergency obstetrics and gynecology (%. .nderstanding the signs and symptoms of shock 2hypoperfusion4 ((. +ble to calculate the fluid in the shock and bleeding (*. Explains emergency abdominal surgery and treatment (,. Explain the cardiac emergency (5. .nderstanding and assessing burns and principles of treatment of burns (6. Explain and capable of handling emergencies on the skin (7. ecogni0e emergencies at the in&ury head and the treatment (5. Explain the radiological examination to help establish the diagnosis of head in&ury (6. Explain a $ariety of emergencies in the field of neurology and handling *7. Explain the mechanism and management of disorders caused by impairment of consciousness intracerebral *%. Explain and perform how to stabili0e the trauma patient transport *(. :escribe the action or emergency patient referral management **. Explains emergency psychiatry and handling *,. Explain the type and management of poisoning

*5. Explain the gastroenterohepatologi emergency *6. Explain the emergency treatment of metabolic and endocrine *7. Explain the emergency treatment of hypertension and renal *5. Explain the forensic toxicology *6. +ble to recogni0e the signs of death ,7. +ble to therapy and techni;ues as well as 'ardiac #ulmonary )rain esuscitation 2 8#94 correctly in adults and children ,%. +ble to perform an endotracheal tube ,(. +ble to take the corpus alienum E"T 2Ear "ose Throat4 ,*. +ble to make <isum Et epertum .. REL)TED ,CIENCE,

1. 'ardiology 2. =ung
*. #ediatrics

4. >urgery. 5. "eurology. 6. Ear "ose Throat 2E"T4. 7. Eye. 8. >kin and ?enital
6. %7. +nesthesia adiology

%%. #sychiatry %(. @orensic /. REL)TION, WIT0 T0E OT0ER BLOCK, In studying this block, there are connection with some of the pre$ious block, ie/ %. )lock 6 2")>>4 (. *. ,. 5. 6. / "eurology, #ediatric, E"T, Eye, >urgery, #sychiatry, >kin and ?enital )lock 6 2 eproducti$e >ystem4 / 9bstetri )lock %7 2cardio$ascular system4 / Interna, @orensic )lock %% 2!ematoimunology4 / Interna, @orensic )lock %( 2 espiratory >ystem4 / Interna, #ediatric )lock %, 2?astroinstestinal >ystem4 / Interna

TO-IC TREE

&e'era (e)ala Jalan Nafas (Airway) Ne#r$l$gi% Sistem Pernafasan isa!ility" Ne#r$geni% Psi%iatri &e'era S)inal

Pernafasan (Breathing)

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1i)e tra#ma

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1ra#mat$l$gi

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LE)RNIN* )CTIVIT1

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T&to $al :iscussion tutorial on Emergency medicine there are 5 scenarios for 5 weeks. Each scenario consists of ( meetings, step %35 and step 7. >tep 6 independent learning to find answers the learning ob&ecti$es in the scenarios. >cenario is that many cases occur in general practice or in hospital.

B.

Lect& e :uring this block walk will be done se$eral times face to face with the speakers in the form of lectures. =ectures are gi$en will be tailored to each module each week. The function of college is to structuring the material, explanations are considered difficult sub&ects, discussion of material not co$ered in the tutorial, pro$iding a multidisciplinary $iew of science and integrate knowledge.

C.

Labo ato y >kill To train or e;uip psychomotor theory obtained should be gi$en medical skills training 2skills lab4. =earning aims to train students to be more skilled in dealing with cases found in general practice.This e$ent was held two sessions or two times with a ( x %77 minutes for each topic skills. #rior to execution skills will be held pre test lab or home work. @or students who pretest $alue of less than 77 then it will get the assignment from the '>=. The presence of skills lab must be %77A. >kills co$ered in this block3 related emergencies cases 2emergency medicine4.

D.

-lena y #lenary will be held at 6 weeks. Each topic in the tutorials will be displayed in the plenary by (3* groups designated. #lenary aim to e;uali0e studentsB perceptions about the =earning 9b&ecti$e in the scenario. +ttended by pengampu each course 1 expert. >tudents can directly ask the experts about what is doubtful or who do not understand.

E.

,elf *&$#e# Lea n$n2. >tudents learn to be independent based on the goals and ob&ecti$es of the scenario blocks, but can be de$eloped based on the recommended references or sources 3 sources obtained from the internet. Independent learning is the core of competency3based curriculum. >tudents are re;uired to report the results of their study to the group super$isor who has been appointed in writing. eporting the results of study done for e$ery module.

),,E,,%ENT 3R)%EWORK

Emergency total $alue of the end blocks %77A, between the one and the other does not compensate each other, while the details are as follows / %. Tutorial (. >kills =aboratory *. @inal Exam T&to $al! +ssessment tutorial consists of $erbal interactions of students during tutorials. +ssessed according to its acti$ity 2sharing, ideas, concentration, argumentation, domination, beha$ior 1 manners 1 attitude, discipline. >tudents are re;uired to follow tutorials %77A. 'omponents of the assessment tutorials also include an assessment of the written report guided independent learning. Cl$n$cal ,k$ll! Labo ato y The assessment is conducted e$ery end of the semester by assessing affecti$e, cogniti$e, and psychomotor skills. To assess studentsB ability in mastering medical skills will be held the 9b&ecti$e >tructured 'linical Examination 29>'E4. / (7A / (7A / 67A

3$nal E4am )lock final exam held in week 6 at the end of the block. The number of exam is %57 points with %3day exam. )lock test score of 57A of o$erall $alue. Terms of exam block is at least 57A college attendance.

BLUE -RINT E%ER*ENC1 %EDICINE

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Explaining the national policy in dealing with 'ogniti$e '*, ', (A emergencies and disasters

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>urgery

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and 'ogniti$e '*, ', (A

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of $ascular ',, '5 ',, '5 9rthopaedic >urgery Eye

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Initial examination and management of 'ogniti$e musculoskeletal trauma +ble to explain the symptoms of eye 'ogniti$e emergencies Explain the legal aspects of trauma and emergency situations a. Explain the informed 'ogniti$e consent in emergency b. +ble how to make $isum et repertum Datdaruratan explain his failure symptoms in the 'ogniti$e field of pediatrics Explaining the symptoms 'ogniti$e of respiratory emergency Explain the mechanisms of 'ogniti$e airway obstruction in adults .nderstand and master the handling of emergencies in 'ogniti$e thoracic trauma

(A

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>urgery

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Explains emergency in 'ogniti$e '*, ', (A maxillofacial trauma Explaining the symptoms ',, 'ogniti$e (A of emergency E"T '5 .nderstand the purpose and 'ogniti$e indications 8#9 action '5, '6 ,A

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>urgery E"T +nesthesia

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Explain the results of radiological examination 'ogniti$e '*, ', (A thorax and maxillofacial trauma

-'C

adiology

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Explain the mechanisms of airway obstruction in adults and management of airway 'ogniti$e obstruction 2respiratory resuscitation4 Explains emergency 'ogniti$e obstetrics and gynecology .nderstanding the signs and symptoms of shock 'ogniti$e 2hypoperfusion4 +ble to calculate the fluid 'ogniti$e in the shock and bleeding emergency surgery and 'ogniti$e

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9bstetrics and ?ynecology +nesthesia +nesthesia >urgery !eart

Explains ( * abdominal treatment

the cardiac 'ogniti$e '*, ', (A ( , Explain emergency .nderstanding and assessing burns and '5, (5 'ogniti$e (A principles of treatment of '6 burns (6 Explain and capable handling of the skin 'ogniti$e emergergency ecogni0e emergencies at the in&ury in head and the 'ogniti$e treatment '5, '6 '5, '6 (A

-'C

>urgery

-'C >kin and ?enital

(7

(A

-'C

"eurosurgical

(5

(6

*7

Explain the radiological examination to help 'ogniti$e '*, ', (A establish the diagnosis of head in&ury Explain a $ariety of '5, emergencies in the field of 'ogniti$e ,A '6 neurology Explain the mechanism and management of disorders '5, 'ogniti$e ,A caused by impairment of '6 consciousness intracerebral

-'C

adiology

-'C

"er$e

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"er$e

Explain and perform and * % how to stabili0e the patient 'ogniti$e transport of trauma :escribe the action or * ( emergency patient referral 'ogniti$e management emergency 'ogniti$e * * Explains psychiatry and handling Explain the type and *, 'ogniti$e management of poisoning *5 Explaining gastroenterohepatologi and 'ogniti$e handling emergency Explain the emergency treatment of metabolic and 'ogniti$e endocrine

'5, '6 ',, '5 ',, '5 '5, '6 ',, '5 ',, '5

(A

-'C

+nesthesia

(A (A (A (A

* * * *

-'C -'C -'C -'C

>urgery #sychiatry Internal -edicine Internal -edicine Internal -edicine Internal -edicine @orensic @orensic '>= +nesthesia '>= +nesthesia '>= E"T '>= @orensic '>= 9bgyn

*6

(A

-'C

Explain the emergency ',, (A * treatment of hypertension 'ogniti$e '5 and renal Explain the forensic *5 'ogniti$e '*, ', (A * toxicology '5, *6 +ble to recogni0e the signs 'ogniti$e (A * '6 of death +ble to therapy and the techni;ues of 8#9 'ogniti$e, #sychomotor and ,7 correctly in adults and +ttitude children 'ogniti$e, #sychomotor and , % +ble to perform an +ttitude endotracheal tube *7 ,* ,, ,( +ble to take the corpus alienum E"T +ble to make <isum Et epertum +ble to implant #roblem number -'C
Note '

-'C -'C -'C

9>'E

9>'E 9>'E 9>'E 9>'E

'ogniti$e, #sychomotor and +ttitude 'ogniti$e, #sychomotor and +ttitude 'ogniti$e, #sychomotor and +ttitude %67

+ccording to )loomBs taxonomy, competency to be achie$ed/

'% E only limited know, remember 1 memori0e '( E comprehension, translations and concludes '* E application, implementation, use the concepts, principles, procedures to sol$e problems ', E analysis, breaking the concept into its component parts, looking for a relationship between the problem '5 E synthesis, diagnosis, combine the parts into one '6 E e$aluation, comparing the $alues, ideas, methods with a standard >9#

RE3ERENCE,

,& 2e y' :r.dr. Iskandar 8apardi, >p)>. (77,.!ead In&ury. 8akarta /E?' >chwart0.(777. :igest #rinciples of >urgery. Edition 6th. 8akarta/E?' +. ?raham +pley, %66*.+pleyBs >ystem of 9rthopaedics and @ractures. >e$en Edition. .F. >abiston. (77,. Textbook of >urgery Teaching >cience %. 8akarta /E?'

Ob!tet $ an# *$nekolo2$ ' >astrawinata, >ulaiman. %65%.. Edition % )andung / Ellstar 9ffset.-edicine faculty of ..npad >astrawinata , >ulaiman #rof,et.al. (77,. 9bstetrics #atology. Edition (.8akarta /#ublisher E?'. >astrawinata, >ulaiman. %65%. ?ynecology. Edition % )andung / Ellstar 9ffset. -edicine faculty of .npad >arwono #rawirohard&o.%66%. 9bstetrics and ?ynecology.Third Edition. 8akarta/ Gayasan )ina #ustaka 'unningham, @.?ary Het.alI.(776. 9bstetri Dilliams. <olume %.Edition (%. 8akarta / E?'. >upono, 9bstetrics #hysiology.(77,.:epartment of 9bstetri and ?ynekology #alembang !ospital Teaching. -edical @aculty of >riwi&aya .ni$ersity.

Inte na '

>udoyo +D, >etiyohadi ), +lwi I, et.al. (776. Interna. Ed ,. 8akarta. -edical @aculty of Indonesia .ni$ersity.

)ne!the!$a ' +nestesiologi.(77,. 8akarta/ -edical @aculty of Indonesia .ni$ersity.

Eye ' #rof >idarta Ilyas.(77,. >cience of Eye. Third Edition. :aniel ? <aughan.(777. ?eneral 9phthalmology. Edition %,. 8akarta/ Didyamedika dr. "ana Di&aya. %66*.>cience of Eye. 8akarta J ?aya )aru. #rof >idarta Ilyas . (77,.+tlas >cience of Eye. 8akarta /

ENT '

#rof. :r. Efiaty +rsyad >oepardi, >pT!T 2F4 et.al. (77*. Ear "ose Throat !ead and "eck. Edition 5th. 8akarta/ -edical @aculty of Indonesia .ni$ersity. +dams )oies !igler. %667. )9EI>, E"T :isease Text )oks. Edition 6. 8akarta / E?'.

,k$n an# *en$tal ' #rof.:r. .>.>iregar,>p.FF,. (77,. Illustrated +tlas of >kin. Edition (. 8akartaJ E?'. #rof.:r. dr. +dhi :&uanda , et al. (77(.>kin :isease. @irst Edition. 8akarta/ )alai -edical @aculty of Indonesia .ni$ersity.

Ra#$olo2y '

>&ahriar asad.(77(. adiology :iagnostic. Edition Fedua. 8akarta/ -edical @aculty of Indonesia .ni$ersity

+T=+> adiology.(777. 8akarta/ -edical @aculty of Indonesia .ni$ersity.

3o en!$k ' Textbook of forensik dan medikolegal @F .nair, de -a&o -edical @aculty of Indonesia .ni$ersity .@orensic >cience.(77,. 8akarta / -edical @aculty of Indonesia .ni$ersity

-y!hc$at yc' :r. usdi -aslim.(77(. :iagnostic of mental disorder. ##:?83III. 8akarta.

Ne& olo2y' +dam <ictor.(777.#rincipal of "eurology. 8akarta /E?' #rof.:r. -ahar -ard&ono.(775. )asic of 'linical "eurology. 8akarta /E?' ichard >. >nell.(776. 'linical "euroanatomy. 8akarta /E?'

-e#$at $c'

=ecturer of -edical @aculty of Indonesia .ni$ersity. %665.#ediatric..8akarta J Info -edika 8akarta. #rof.:r.'oory >. -atondang dkk, #hysical :iagnosis in 'hildren

%ODUL 1 T a&matolo2y C0)-TER I. T0E 3IR,T WEEK LE)RNIN* OB+ECTIVE, >tudents are able to / %. Explaining the national policy in dealing with emergencies and disasters (. +naly0ed the Emergency Sign and mark the Priority Sign in case of emergencies and Traumatology. *. +ssessment and management of early 2initial assessment4 in the case of trauma 1 multiple trauma 1 drowning in the order of priority 2+3)3'4 ,. +naly0ing the failure of organ function due to trauma 1 multiple trauma 5. +ble to perform life sa$ing procedures in cases of emergency caused by the trauma 1multiple trauma 6. Explain and understand the use of drugs in treating patients with emergency 7. 'apable of analy0ing t auma handling and management of $ascular in&uries 5. Explain the hemodynamic emergency 6. Initial examination and management of musculoskeletal trauma %7.Explain the legal aspects of trauma and emergency situations a. Explain the informed consent in emergencies b. Explain how to make a $isum et repertum E4pe t lect& e' ). ,& 2e y Lect& e 1 by # . 1&5a 0a &n6 ,p. B a. Introduction of emergency block 2(7 minutes4 b. Explaining the national policy in dealing with emergencies and disasters 2,7 minutes4 c. +naly0e the failure of organ function due to trauma 1 multiple trauma 2,7 minutes4 Lect& e ( by # . -$ ma 0&ta& &k6 ,p. B a. 'apable of analy0ing handling and management of $ascular in&ury traumatology 257 minutes4 Lect& e . by # . )!7e#$ -&t a6 ,p. OT 8 # . E##y %a &#&t ,6 ,p.OT a. Initial examination and management of musculoskeletal trauma 2%77 minutes4

(.

)ne!the!$a Lect& e 1 by # . )chma# )!!e2af6 ,p. )n a. b. +naly0e the Emergency >ign and mark the #riority >ign in case of emergencies Traumatology. 257 minutes4 +ssessment and management of early 2initial assessment4 in the case of trauma 1 multiple trauma 1 drowning in the order of priority 2+3)3'4 257 minutes4 Explain and understand the use of drugs in dealing with emergency patients 2%77 minutes4

Lect& e ( by # . )chma# )!!e2af6 ,p. )n a. ..

3o en!$c Lect& e 1 by # . E"$ D$ana6 ,p. 3 a. b. Explain the legal aspects of trauma and emergency situations 2informed consent in emergencies4 257 minutes4 <isum et repertum 257 minutes4

/.

Eye Lect& e 1 by # . 0elm$ %&chta 6 ,p. % +ble to explain the symptoms of eye emergencies 2%77 minutes4

T&to $al >cenario % ,k$ll Lab' <isum Et epertum

C0)-TER II. ,CEN)RIO 1

E)RT09U)KE VICTI%,

+ boy of %6 years was brought to the Emergency .nit immediately after he had remo$ed from the rubble by an earth;uake 6.7 ichter scale. The patient is awake, looking pale. !e felt pain in right thigh. 9n physical examination found deformity in the right thigh, $isible bone protruding through the skin which causes the wound in the right thigh %7 cm with a fair amount of bleeding., ight leg look shorter, and the patient can not lift his right leg.

C0)-TER III. REVIEW RE3ERENCE, , CEN)RIO 1' E)RT09U)KE VICTI%, ). Nat$onal pol$cy $n #eal$n2 7$th eme 2enc$e! an# #$!a!te !' >et in integrated emergency response system, include/ 9rdinary people/ the common people ha$e to master the skills of basic life support Emergency communication system/ %%7 police, %%* fire, ambulance %%5 >upport systems 2fire brigade, police, ed 'ross4/ trained as a medical first responder #re3hospital emergency ambulance, there are three types/ 3 )asic types / +ble to perform the procedure +)': 3 #aramedic Type/ +)': K in$asi$e measures 2intubation, lung puncture, infusion, drugs4 3 Type of motorcycle is e;uipped with e;uipment and medicine, but without a stretcher e. (,3hour emergency unit f. :isaster plan and training (. Eme 2ency an# p $o $ty !$2n! >ymptoms and signs in medical emergencies / >ymptoms and signs in medical emergencies is $ery di$erse, distincti$e and not typical. +bnormal changes of the patientBs $ital signs are lead to medical emergencies. >ome things that can be obser$ed suspicion in patients who directs us to a problem medical is/ ,ymptom!' @e$er #ainful "ausea, $omiting Excessi$e urination, or not at all :i00iness, feeling faint, was coming to an end >hortness of breath or ha$e difficulty Excessi$e thirst or hunger, a strange taste in mouth a. b. c. d.

,$2n' 'hanges in mental status 2unconscious, confused4 'hanges in heart rhythmJ fast or $ery slow pulse, irregular, weak or $ery strong

'hanges in respiratory, rhythm and ;uality of the mucous membrane color 2pale, bluish, red too4 'hanges in skin condition/ temperature, humidity, excessi$e sweating, extremely dry, including discoloration of the mucous membranes 2pale, bluish, red too4 'hanges in blood pressure )ead eyes/ $ery large or $ery small Typical odor of the mouth or nose +bnormal muscle acti$ity such as sei0ures or paralysis ?astrointestinal disorders/ nausea, $omiting or diarrhea >ign 3 9ther 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

T $a2e' Triage is the process of sorting patients by se$erity of specific in&uries or illnesses 2based on the most likely to experience clinical deterioration soon4 to determine the priority of the medical emergency treatment and transportation priorities 2based on a$ailability of the means for action4. Ta22$n2 an# 2 o&p$n2 ba!e# t $a2e #riority Lero 2)lack4/ #atient death or fatal in&ury may be ob$ious and not resuscitated @irst #riority 2 ed4/ #atients se$ere in&uries that re;uire rapid assessment and medical actions and transport immediately to stay ali$e 2eg, respiratory failure, torako3abdominal in&ury, head in&ury or facial maksilo3weight, shock or se$ere bleeding, se$ere burns4 #riority Two 2Gellow4/ The patient needs help, but with a less se$ere in&ury and certainly will not experience life threat in the near future. #atients may experience an in&ury in a broad range of species 2eg, abdominal in&uries without shock, chest in&ury without respiratory disorders, ma&or fractures without shock, head in&ury or cer$ical spine is not weight, and minor burns4 Third #riority 2?reen4/ #atients degan minor in&uries that do not re;uire immediate stabili0ation, re;uiring simple first aid but re;uire periodic reassessment 2soft tissue in&uries, fractures and dislocations of the extremities, facial in&uries, maksilo without airway disorders, and psychological emergency4 #riority @our 2)lue4/ the first group of $ictims with in&uries or critical and potentially fatal penyaki which means do not re;uire action and transport, and

#riority @i$e 2Dhite4/ the first group is definitely dead.

..

In$t$al mana2ement of t a&ma ca!e! ' The initial assessment is done on the case, of course, related to the patientBs $ital signs including blood pressure, pulse, respiration and body temperature, and status consciousness. @urther assessment associated with trauma to the patientBs condition. In this case the patient suffered an open fracture of the assessment is / ). In!pect$on (look) The presence of deformity 2deformity4 such as swelling, shortening, rotation, angulation, bone fragments 2open fracture4. -alpat$on (feel) #resence of tenderness 2tenderness4, crepitus, neurological and $ascular status examination in the distal fracture. #alpation of the extremity the fracture, the in&ury in$ol$es the distal arterial pulsation, skin color, capillary refill test. %o"ement (moving) The existence of limited motion in the fracture area. -hy!$cal e4am$nat$on of the ca!e: 9btaining a thorough history of the mechanism of in&ury may help identify orthopedic in&uries. @or example, past medical history, medications, and pre$ious in&ury.

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L$fe !a"$n2 p oce#& e! $n ca!e! of eme 2ency Ba!$c l$fe !&ppo t I":I'+TI9"> +. >top breathing >top breathing characteri0ed by the absence of chest mo$ement and breathing the air flow from the $ictim 1 patient. >top breathing is a case that should be taken )asic =ife >upport. (. >top cardiac In the e$ent of cardiac arrest, it will happen immediately stop the circulation. >topping the circulation of these will ;uickly lead to brain and $ital organs of

oxygen deficiency. Troubled breathing 2whee0ing4 is an early sign of impending cardiac arrest.

'ardiac pulmonary resuscitation consists of two stages, namely/ >ur$ey of #rimary 2#rimary >ur$ey4, which can be done by e$eryone >econdary >ur$ey 2>econdary >ur$ey4, which can only be performed by trained medical and paramedical personnel and is a continuation of the primary sur$ey.

-RI%)R1 ,URVE1 In the primary sur$ey focused on breathing assistance and help with circulation and defibrillation. To be able to remember easily the primary sur$ey measures formulated by the alphabet +, ), ', and :, namely ) B C D ; E ; E airway 2airway4 breathing 2breathing assistance4 circulation 2circulatory assistance4 defibrilation 2electrical therapy4

) <)$ 7ay= )$ 7ay +fter completing the basic procedure, followed by action/ %. (. Examination of the airway. 9pen the airway.

B <B eath$n2= ,&ppo t of b eath 'onsists of two stages/ %. Ensure $ictim 1 patient is not breathing. )y looking upward mo$ement turunn$a chest, listening for breath sounds and feel the breath of the $ictim 1 patient (. #ro$ide breathing assistance. If the $ictim 1 patient is not breathing, breath support can dilakukkan through word of mouth, nose or mouth to mouth to a stoma 2hole made in the throat4

C <C$ c&lat$on= 0elp c$ c&lat$on 'onsists of two stages/ %. +scertain whether the heart rate of $ictims 1 patients. Dhether or not heartbeat $ictim 1 patient can be determined by palpating the carotid artery in the neck area $ictim 1 patient. (. #ro$ide help circulation. If it has been confirmed no heartbeat, then they could be assisted circulation or the so3called external cardiac compression, performed with the following techni;ues/

D <DE3IBRIL)TION= Defibrilation or in the Indonesian language translated by the term defibrillation is to pro$ide a therapeutic electrical energy. This is done if the causes of cardiac arrest (cardiac arrest) is an abnormal heart rhythm called $entricular fibrillation. In the present is already a$ailable tools to :efibrillation 2defibrillator4 which can be used by lay people, called +utomatic External :efibrilation, where the tool can find $ictims of cardiac arrest defibrillation should be performed or not, if necessary defibrillation de$ice can gi$e the signal to rescuers to perform defibrillation or continuing help breathing and circulation assistance only. >. D &2! $n pat$ent! 7$th eme 2ency ' Re!&!c$tat$on # &2! <asopressin / +drenaline, dobutamine, dopamine )nt$?a hythm$a # &2! 9ther / +tropine, calcium oute of administration / #eripheral $eins, central $eins, Intracardia, trachea, intraosseous @. Type! of f act& e! an# 7o&n#! 3 act& e! Def$n$t$on' @ractures 2broken bones4 is a breakdown of the continuity of the bone structure and is determined according to the type and extent. 2>melt0er >' M )are )?, (77%4 Type! of f act& e!' To be more systematic, the type of fracture can be di$ided by/

Locat$on )one fractures can occur in anywhere like on diafisis, metaphysical, epiphyseal, or intraartikuler. If the fracture is obtained in con&unction with dislocation of &oints, it is called a fracture dislocation. W$#e :i$ided into a complete fracture 2complete4 and incomplete 2incomplete4. Example is an incomplete fracture of the crack. Conf$2& at$on 8udging from the line frakturnya, can be di$ided into trans$erse 2hori0ontal4, obli;ue 2angled4, or spiral 2spiral 1 twist the stem around the bone4. If more than one fracture line, then called kominutif, if one part broken while the other side of the bend is called greenstick. @racture with fragments dri$en into the 2often occurs in the skull and facial bones4 is called depression, ha$e a compression fracture where the bone 2occurs in the spine4 is called compression. Relat$on!h$p bet7een the f act& e )etween the fracture can still relate 2undisplaced4 or far apart 2displaced4.

The elat$on!h$p bet7een f act& e 7$th !& o&n#$n2 t$!!&e @ractures can be di$ided into an open fracture 2if there is a relationship between bone and the outside world4 or a closed fracture 2if there is no relationship between the fracture and the outside world4.

9pen fractures are di$ided into se$eral grades, namely/ * a#e I * a#e II * a#e III / / / clean cuts, less than % cm in length. more extensi$e in&ury without extensi$e soft tissue damage. highly contaminated, and extensi$e soft tissue damage.

-hy!$cal E4am$nat$on ' 1. In!pect$on (look) The presence of deformity 2deformity4 such as swelling, shortening, rotation, angulation, bone fragments 2open fracture4. (. -alpat$on (feel) #resence of tenderness 2tenderness4, crepitus, neurological and $ascular status examination in the distal fracture. #alpation of the extremity the fracture, the in&ury in$ol$es the distal arterial pulsation, skin color, capillary refill test. .. %o"ement (moving)

The existence of limited motion in the fracture area. E4am$nat$on ,&ppo t' %. adiologic examination 2x3rays4, in areas suspected fracture, must follow the rules of the role of two, consisting of/ Includes two images are anteroposterior 2+#4 and lateral. 'ontains two fractures of the &oints between the proximal and distal parts. 'ontains two extremity 2especially in children4, both the in&ured and those not exposed to in&ury 2to compare with normal4 #erformed twice, namely before and after the action action. (. =aboratory examinations, including / outine blood, )lood clotting factors, )lood type 2especially if the surgery will be performed4, .rinalysis, 'reatinine 2muscle trauma may increase the burden of creatinine for renal clearance4. +rteriography examination performed if suspicion of $ascular damage caused by the fracture.

Compl$cat$on!' The cause of fracture complications in general can be di$ided into two, namely because of the trauma itself, could also be due to the handling of the fracture is called iatrogenic complications. Def$n$t$on of InA& y Dound is a state of loss 1 breakdown of the continuity of the network 2-ans&oer, (777/*664. +ccording In ET"+, in&ury is an in&ury to the tissue that interferes with normal cellular processes, the wound can be described by the damage to the kuntinuitas 1 unity of body tissue that is usually accompanied by loss of tissue substance. Cla!!$f$cat$on of Wo&n#! Dound distinguished by/

1=

Ba!e# on the ca&!e! a4 b4 c4 d4 e4 f4 Excoriation or abrasion <ulnus scisum or cuts <ulnus laseratum or wound <ulnus punctum or stab wounds <ulnus morsum or animal bites <ulnus combotio or burns

(=

Ba!e# on the p e!ence 8 ab!ence of t$!!&e lo!! a4 Excoriation b4 >kin a$ulsion c4 >kin loss

.=

Ba!e# on the #e2 ee of contam$nat$on a) Clean cuts a4 The cut electi$e b4 >terile, potentially infected c4 There is no k ontak the oropharynx, espiratorius tract, tract elimentarius, genitourinarius tract. b) Clean cuts tercema r a4 b4 c4 d4 c) The cut electi$e #otential infection/ minimal spillage, normal flora 'ontact with the oropharynx, respiratory, and genitourinarius elimentarius =onger healing process

Contaminated wounds a4 #otential infection/ spillage of elimentarius tract, gall bladder, genito urinary tract, urine b4 The new trauma in&uries/ lacerations, open fractures, penetrating wounds.

d)

Dirty wounds a4 +s a result of the surgery is highly contaminated b4 <isceral perforation, abscess, old trauma.

Type of 7o&n# heal$n2 There are three types of wound healing, where the di$ision is characteri0ed by the number of the lost tissue.

1= (=

Primary Intention Healing 2primary wound healing4 that is the healing that occurs immediately after the attempted bertautnya wound edges usually with stitches. Secondary Intention Healing 2>econdary wound healing4 is a wound that does not ha$e a primary healing. This type is characteri0ed by the presence of extensi$e in&ury and loss of tissue in large numbers. The healing process occurs more complex and longer. Dounds of this type are usually kept open. Tertiary Intention Healing 2Tertiary wound healing4 that is wound was left open for a few days after debridement action. 9nce belie$ed to be clean, the wound edges 2,3 7 days4. This wound is the last type of wound healing 2-ans&oer,(777/*67 J In ET"+, (77,/,4.

3)

Wo&n# 0eal$n2 -ha!e The wound healing process has three phases, namely the inflammatory phase, proliferation and maturation. @rom one phase to another phase with a continuity that can not be separated.

%4 #hase Inflammation
This phase appears soon after in&ury and can continue for 5 days. Inflammation ser$es to control bleeding, pre$ent the in$asion of bacteria, remo$ing debris from the wound tissue and prepare for continued healing process.

(4 #hase #roliferation
This stage lasts from day 6 up to * weeks. @ibroblasts 2connecti$e tissue cells4 ha$e a ma&or role in the proliferati$e phase.

*4 #hase of maturation
This stage lasts from the day (% 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 $ascularity 2-ans&oer, (777/*67J InET"+, (77,/%4. ,ome of the !tep! that m&!t be con!$#e e# $n clean$n2 the 7o&n# that $!' %4 Irrigation by as much as possible in order to remo$e dead tissue and foreign bodies. (4 emo$e all foreign ob&ects and excision of all dead tissue. *4 ?i$e an antiseptic ,4 If the re;uired actions can be performed by administering a local anesthetic 54 If you need to do the closure of the wound 2-ans&oer, (777/ *65J ,774 ,&t& $n2 7o&n#! 'lean wounds and are belie$ed not to ha$e an infection and was less than 5 hours may be

sewn primer, while the wound is hea$ily contaminated or not demarcated and should be allowed to reco$er per sekundam or per tertiam. Wo&n# clo!& e Dound closure is to stri$e for better en$ironmental conditions in the wound healing process takes place so that optimal. Con!$#e at$on # e!!$n2 'onsiderations in the closed dressing and bandage the wound is $ery dependent on the assessment of the condition of the wound. >er$es as a protecti$e dressing to the e$aporation, an infection, seek a good en$ironment for wound healing, as fixation and suppression effects that pre$ent the gathering of blood seepage causing hematoma. *$"$n2 )nt$b$ot$c! ?i$ing antibiotics to the wound clean principle need not be gi$en antibiotics and the wound is contaminated or dirty it needs to be gi$en antibiotics. Remo"al of the !t$tche! >titches remo$ed when the function is no longer needed. Time of suture remo$al depends on $arious factors such as, location, type of appointment of in&ury, age, health, attitudes of patients and the presence of infection

RE3ERENCE,

+tkinson >, !amblin 8 8, Dright 8 E '. >hock. In the book/ !and book of Intensi$e 'are. =ondon/ 'hapman and !all, %65%J %53(6. )artholomeus0 =, >hock, in the book/ >afe +naesthesia, %666J ,753,%* )uckley , #anaro ':+. ?eneral principles of fracture care. +$ailable at http/11www.emedicine.com1orthoped1byname1?eneral3#rinciples3of3@racture3'are.htm. =ast .pdate/ 8uly %6, (777 @emur @ractures. +$ailable at/ http/11medisdankomputer.co.cc1NpE*57. =ast .pdate/ -arch %5, (776 9pen fracture. +$ailable at http/11bedahugm.net1)edah39rthopedi1@raktur3Terbuka.html. =ast

update/ 8anuary 5, (776 @racture. +$ailable at http/11bedahugm.net1)edah39rthopedi1@racture.html. =ast .pdate/ +ugust *, (775. @racture. +$ailable at http/11www.klinikindonesia.com1bedah1fraktur.php. =ast update/ 8anuary 7, (776 -angunsudire&o >. @racture healing, treatment, and complications, book %. Issue %. =ondon/ %656 as&ad, '. Introductory book 9rthopaedic >urgery ed. III. Garsif Datampone. -akassar/ (777. pp. *5(3,56 >&amsuhida&at , Dim :e 8ong, Textbook of >urgery, re$ised ed, E?'. "ew Gork/ %665. pp. %%*5366 Thi&s = ?. The !eart in >hock 2Dith Emphasis on >eptic >hock4. In a collection of papers/ Indonesian >ymposium 9n >hock M 'ritical 'are. 8akarta, Indonesia, +ugust *7 3 >eptember %, %666J %3,. Dilson @, ed. >hock. In the book/ -anual of 'ritical 'are. %65%J c /%3,(. Limmerman 8=, Taylor D, :ellinger #, @armer 8', :iagnosis and -anagement of >hock, in the book/ @undamental 'ritical >upport. >ociety of 'ritical 'are -edicine, %667.

%ODULE ( Eme 2ency of Re!p$ at$on C0)-TER I. T0E ,ECOND WEEK LE)RNIN* OB+ECTIVE, >tudents are able to / %. (. *. Explain the symptoms in the field of pediatric emergency Explaining the symptoms of respiratory emergency Explain the mechanisms of airway obstruction in adults

,. 5. 6. 7. 5. 6.

.nderstand and master the handling of emergencies in thoracic trauma Explains emergency in maxillofacial trauma Explaining the symptoms of emergency E"T .nderstand the purpose and indications 8#9 action Explain the results of radiological in$estigations thorax and maxillofacial trauma Explain the mechanisms of airway obstruction in adults and the management of airway obstruction 2respiratory resuscitation4

E4pe t lect& e' ). -e#$at $c Lect& e 1 by # . 3e #$6 ,p. )n Emergencies in pediatrics 2%77 minutes4

(.

,& 2e y Lect& e / by # . 1&5a 0a &n6 ,p. B a.Emergencies in thoracic trauma 25 7 minutes4 Lect& e > by # . 1&5a 0a &n6 ,p. B a.Traumatology maxillofacial 257 minutes4

..

)ne!the!$a Lect& e . by # . In# a 3a$!al6 ,p. )n a. Explain the symptoms of respiratory emergency 2%77 minutes4 Lect& e / by # . Den#y %a&lana6 ,p. )n b. Explain the mechanisms of airway obstruction in adults and drowning 2drowning4 257 minutes4 c. Explain the management of airway obstruction 2respiratory resuscitation4 257 minutes4 Lect& e > by # . Un#an2 Koma &#$n6 ,p. )n .nderstand the ob&ecti$es and actions 'ardiac #ulmonary )rain 2%77 minutes4

esuscitation 2 8#94

/.

ENT <Ea 6 No!e6 Th oat= Lect& e 1 by # . 3atah ,atya W6 ,p. ENT a. Emergencies in E"T 2%77 minutes4

>.

Ra#$olo2y Lect& e 1 by # . Ka yanto6 ,p. Ra# a. Explain the results of radiological examination and maxillofacial trauma of the thorax 2%77 minutes4

T&to $al >cenario ( ,k$ll lab 'ardiac #ulmonary )rain esuscitation 2 8#94 in children and adults 1 Traumatology +d$anced =ife >upport 2+T=>4

C0)-TER II. ,CEN)RIO ( 3)CE, TR)U%) + boy aged 5 years was brought to the Emergency .nit after an accident. !e bounced from the host and his bike hit the pa$ement and the bottle containing the li;uid battery rupture and the li;uid is brought about him. 'onscious patient, suffering from facial and &aw in&uries are $ery se$ere, the patient also look crowded. 9n physical examination the doctor found the patientBs difficulty answering the ;uestion being asked by a doctor because of the deformity on the right cheek and out of the mouth and nose bleeding.

C0)-TER III. REVIEW RE3ERENCE, , CEN)RIO (' 3)CE, TR)U%) ). In$t$al a!!e!!ment on fac$al t a&ma )!!e!!ment on 3ace T a&ma !istory of trauma to t!e face +mple use of acronyms in the e$aluation of facial trauma patient (allergies, medications, past history, last meal, events surrounding the accident) can facilitate a history of trauma with lengkap.* +cronyms can also be used if the trauma of threatened &iwa., )!k !pec$f$c B&e!t$on! abo&t t a&ma' -echanism of trauma Dhether the patient had lost consciousness :oes the patient ha$e $ision problems such as double or blurred $ision Is dental patients can normally closed 2normal occlusion4 Dhether the patient can bite without pain :oes the patient possess an area that feels numbness or tingling in the face In women, ask if the trauma is deri$ed from a partner or a person being under threat In children, ask the same thing as the woman to menenetukan whether there is $iolence on children. Deformities of t!e face looks >welling, asymmetry, obli;ue, with skin abrasions to the soft tissue in&ury !ematoma or bleeding in the wound or the mouth of the hole gidung and as a way out bleeding from the maxillary sinus 1 fracture P!ysical e"amination Examination of systematic head and face can be the starting point and is done in a consistent treatment to pre$ent checks being let loose. In patients with acute facial trauma, physical examination can be disrupted by the swelling of the face. >econdary asymmetrical facial appearance of the fracture can usually be hidden. 'heck for tenderness, crepitus 2without a strong emphasis for flat bones4, Ostep inO or discontinuity edge orbital bone and bone madibula rhyme. 'heck as well as the right and the left side and compare.
* (

Examiner carefully assessed for neurological deficits, including facial trigeminal ner$e and facial. >ensory disturbances in the forehead, cheeks, and lower lip. =acerations, contusions, and abrasions of the skin can focus the examiner to indicate parts that ha$e a risk of ner$e in&ury.
*

'omplete eye examination includes e$aluation of a history of eye disease, $isual acuity, perception of light and red light, ocular motility, pupil assessment, and examination of the con&uncti$a and eyelids. =ong3term morbidity in facial fractures are the most associated with ocular and orbital damage.
*

!ipestesia the

second

nostril
(

'heeks bulge disappeared

Examination of the oral ca$ity particularly important in patients who mehilangan teeth, bone fragments, or foreign body when there is trauma. Identification and remo$al of prosthetic oral ca$ity needs to be done. 9cclusion and interkuspasi carefully done because both mandibular and maxillary fractures can result in malocclusion. In the oral ca$ity appears occlusion disorders 2malocclusion4 that bulge premolars are not met with the hollow tooth opponent 1 partner, can also appear gingi$al laceration fracture area, maxilla are sometimes found floating in the hematoma 2floating maxilla4
*

%a4$llofac$al T a&ma an# cla!!$f$cat$on -axillofacial trauma can be classified into two parts, the hard tissue facial trauma and facial soft tissue trauma. -axillofacial trauma to the tissue can include soft tissue and hard tissue. The meaning of facial soft tissue is soft tissue that co$ers the face of hard tissue. Dhile the definition of hard tissue facial bones of the head is composed of %. (. *. ,. 5. 6. 7. =e @ort I =e @ort II =e @ort I=I "asal bone )one arch 0igomatikus -andibular bone )one 1 maxillary Eye socket bone Tooth +l$eolar bone / =imited to the al$eolar trauma left, right, or bilateral. / Trauma pyramid os maxillary, nasal, 0igomaJ occur separation of the center of the face with cranial bone. /Trauma of the maxillary bone, nose, 0igoma, orbitaJ place separations around the bones of the face with a base kranii

=e @ort classification used to help diagnose and p treatment /

3ac$al !oft t$!!&e t a&ma Dound 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. Ba!e# on the type! of $nA& $e! an# the ca&!e a. b. c. d. Excoriation The cut, wound, wound &ab. )urn ?unshot wound

T a&ma $! a!!oc$ate# 7$th an ae!thet$c &n$t @a$orable or unfa$orable, is associated with =angerBs lines

@igure %. +. ). =aceration that crosses the line of =anger unfa$orable cosmetic result in poor healing. @acial incision is placed parallel to =angerBs lines 2#edersen ?D. #ractical textbook oral surgery 2oral surgery4. ather #urwanto language, )asoeseno. 8akarta/ E?', %657/((64.

(.

%a4$llofac$al t a&ma %ana2ement of fac$al t a&ma Primary survey# airway airway disorders result from direct trauma to the larynx, foreign bodies 2including an aspirated tooth and bone fragments4, or massi$e bleeding from the upper airways. Treatment of airway disorders is ;uite difficult with the trend that %7A of patients had facial trauma and cer$ical spine trauma.
*

b reathing It consists of two stages/ %. Ensure the patient 1 $ictim is not breathing )y seeing the mo$ement of the chest rise and fall, hear and feel the breath of breath, a techni;ue helper hold the ears and nose abo$e the mouth of the patient 1 $ictim while still maintaining the airway remains open. :o no more than %7 seconds (. #ro$ide breathing assistance !elp the breath can be done through word of mouth, mouth to nose, mouth to stoma 2a hole made in the throat4. espiratory assistance gi$en by ( times, each time blowing time from %.5 to ( seconds and the $olume of 777 ml 3 %777 ml 2%7 ml 1 kg or until $isible chest patients 1 $ictims gi$en oxygen mengembang.Fonsentrasi %63%7A. "ote the patientBs response c irculation The most important action is to help the circulation of @oreign heart massage. External 'ardiac -assage 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 ca$ity, and occlusion. !ead in&ury (brain injury) may delay the timing of the operation of open reduction internal fi!ation ("#$%) in bone ftraktur face. If there are wounds, co$ered with moist gau0e while awaiting definiti$e therapy -andibuka bilateral fracture should be stabili0ed 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 1 nose tamponade.
(

dvanced Handling !andling information that is in the first week post3trauma. -andibular fracture/ reduction and fixation of the maxillary arch with a wire or bar produced union and the occlusion is achie$ed within P 5 weeks. eduction and screw fixation with mini plates do not re;uire locking teeth as in the wire and arch bar. @racture of the maxilla/ the reduction of the sulcus approach ginggi$obucalis and infra cilliar palpebra inferiorJ can also be fixed with wire or mini screw plate. ima important orbital fracture repositioning and fixation surgery to restore form and restore the function of orbital motion of the affected eye. "asal fracture repair should not be too long since the trauma, gi$en the nasal bones are flat and often broken3shaped impression, de$iation or crushed. .. Eme 2ency $n tho a4 t a&ma 'ause of/ +irway obstruction, ma&or hemothoraks, cardiac tamponade, pneumothorax persisted. %ana2ement of eme 2ency ' :etermination of in&ury 2penetrating thoracic wall or not4 :etermination of $ital functions 2if necessary resuscitation4 'leanup and closure of wounds )$ 7ay ob!t &ct$on @rom outside the airway/ @oreign @rom within/ The tongue that closes the airway !ow 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.

/.

T a&matolo2y $n the eye! an# t eatment ). B. Def$n$t$on Eye trauma is whether or not intentional acts that cause eye in&ury. The type! of eye t a&ma 1. )CID TR)U%) Traumatic acid is one type of chemical eye trauma and emergencies including the eyes caused by chemical substances are acidic with a p! Q7. >ome acids are often the eye is sulfuric acid, acetic acid, hidroflorida, and hydrochloric acid. #roper management of the trauma chemical is irrigated with sterile isotonic saline and check the p! of the ocular surface by putting the indicator in the fornix of a sheaf of papers. epeat the irrigation if the p! is not located between 7.* to 7.7. 2<aughan, (7774. (. B),E TR)U%) The trauma of alkaline chemicals will gi$e a mild irritation to the eyes when $iewed from the outside. !owe$er, when seen on the inside of the eye, this trauma resulted in an emergency base. )ase will penetrate the cornea, camera oculi anterior, and to the retina ;uickly, so it ended in blindness. +t the base trauma will occur corneal collagen tissue destruction. 'oagulation chemicals are alkaline and cell happening persabunan process, accompanied by dehydration. +ccording to the classification Thoft, basa trauma can be di$ided into / :egree % /'on&uncti$al hyperemia T er&adi accompanied by keratitis pungtata :egree ( /'on&uncti$al hyperemia T er&adi with loss of corneal epithelium ?rade * /9ccuri con&uncti$al hyperemia accompanied by necrosis and loss of corneal epithelium ?rade , / perilimal con&uncti$al necrosis by 57A +ction if there is trauma to ;uickly perform basic irrigation with normal saline as long as possible. Dhen irrigation may be done at least 67 minutes after trauma. #atients were gi$en sikloplegia, antibiotics, E:T+ to bind bases. E:T+ is gi$en after % week of trauma base, necessary to

neutrali0e the collagenase which is formed on the se$enth day. 'omplications that can occur is simblefaron, corneal opacification, edema, and neo$asculari0ation of the cornea, cataracts, accompanied by ptisis eyeball. .. -enet at$n2 t a&ma Is a trauma in which some or all layers of the cornea and sclera ha$e damage. Et$olo2y 9ccurs due to the entry of foreign ob&ects into the bulbus oculi / R R 3 3 3 3 3 3 3 -etal / -agnet, the magnet is not "on3metallic :ecreased $isual acuity =ow intra3ocular pressure Iridocornealis shallow angle >hape and location of the pupil changes "o sightings of the cornea or sclera rupture Tissue prolapse 2off4, such as iris, lens, retina 'on&uncti$al chemosis

Cl$n$cal %an$fe!tat$on!

%ana2ement Topical antibiotics, eyes closed, and immediately sent to the eye doctor to do surgery. >ystemic antibiotics administered orally or intra$enously, anti3tetanus prophylactic, analgesics, and sedati$es if necessary. should not be gi$en local steroids and splint should not be pressing the eyeball. Expenditures of foreign ob&ects should be done in a hospital with ade;uate facilities. /. Bl&nt t a&ma %. )lunt trauma palpebra + blunt impact could push the eye back to the possibility of damaging the structure on the surface 2eyelids, con&uncti$a, sclera, cornea and lens4 and the structure of the back of the eye 2retina and neural4. )ecause palpebra a protecti$e ball when there is trauma to the eye it will do reefleks close. This will cause the occurrence of hematoma palpebra. !ematoma is due discharge of blood from damaged blood $essels in the trauma (. )lunt trauma to the lens

a. b. c.

=ens dislocation. =ens dislocation occurred in 0onula Linn which breakup will lead to impaired lens position. =ens subluxation. #artly due to rupture so that the lens Linn 0onula mo$e. =uxation +nterior lens. If all the 0onula Linn around the e;uator dropped out due to trauma to the lens into the anterior chamber. =uxation #osterior lens. In blunt trauma is hard on the eyes may occur due to rupture the posterior lens luksasi Linn 0onula around the e;uator of the lens ring so that the lens falls into the glass body and sinking on the plain below the #olus posterior ocular fundus. Traumatic cataract. In the blunt trauma of the anterior subcapsular cataracts will be seen or posterior. 'ontusion cataract lenses pose like a star, and can also be printed in the form of cataract is called a <ossius ring

d.

e.

*.

)lunt trauma to the cornea 'orneal abrasion is a state in which the corneal epithelium regardless of which can be caused by blunt trauma, sharp trauma and chemical trauma and foreign bodies subtarsal. +nd recurrent corneal abrasion can cause extreme pain, which is an emergency corneal abrasion to the eye that can lead to ulceration and edema of the cornea which would disturb the $isual acuity

,.

Trauma fundus oculi )lunt trauma to the eye can lead to abnormalities in the retina, choroid, and optic ner$e. 'hanges that occur may include retinal edema, retinal hemorrhage, retinal detachment, and optic ner$e atrophy. If found patients with blunt trauma and sharp $ision that can not be corrected with the glasses, while the clear eyes of the state media, it can be estimated by abnormalities in the fundus or in the back of the eyeball 29phthalmologist +ssociation of Indonesia, (77(

RE3ERENCE, +pley and >olomon, @racture and 8oint In&uries in &pley's System of "rthopaedics and %ractures, >e$enth Edition, )utterwordh3!einemann, =ondon, %66*, pp. ,6635%5. +rmis, #rinciples of @racture +ge Sistema in (usculos)eletal *rauma, @F.?-, =ondon, p/ %3*(. )erend -E, !arrelson 8-, @eagin 8+, @ractures and :islocation in >abiston 8r :', *e!boo) of Surgery *he +iological +asis of (odern Surgical Practice, @ifteenth Edition, D) >aunders 'ompany, #hiladelphia, %667, pp. %*65 to %,77. 'arter -+, +natomy and #hysiology of )one and 8oints in #rice >+, Dilson =-, ,linical Pathophysiology ,oncepts of Disease Processes, )ook II, issue ,, E?', 8akarta, %66,, p %%753 57. :orland, -edical :ictionary, (6th edition, E?' -edical )ook #ublishers, =ondon, %666, p 5(*,6*5,%%%6. as&ad ', in $ntroduction to Trauma Surgery (Ds, .&ung #andang =amumpatue >tars, %665, p/ *,*35(5 eksoprod&o, >, the set of -:s examination of Surgery %aculty of (edicine -ecture, #ublisher )inarupa script, 8akarta, %665, p/ ,5*3,7%. >&amsuhida&at , -usculoskeletal >ystem in >yamsuhida&at , de 8ong D, *e!tboo) of Surgery, E?', 8akarta, %667, p/ %%(,3%(5

%ODULE . Eme 2ency hemo#ynam$c C0)-TER I. T0E T0IRD WEEK LE)RNIN* OB+ECTIVE, %. (. *. ,. 5. 6. 7. 5. Explains emergency obstetrics and gynecology .nderstanding the signs and symptoms of shock 2hypoperfusion4 +ble to calculate the fluid in the shock and bleeding Explains emergency abdominal surgery and treatment Explain the cardiac emergency .nderstanding and assessing burns and principles of treatment of burns Fnow and be able to perform stabili0ation actions with strict monitoring on burns Explain and capable of handling emergencies on the skin

E4pe t lect& e' 1. Ob!tet $c! an# *ynecolo2y Lect& e 1 by # . Ta&f$B& ahman R6 ,p. O* a. Emergency 9bstetrics and ?ynecology 2%77 minutes4 (. 0ea t Lect& e 1 # . )! $5al T6 ,p. +a. Emergency heart 2%77 minutes4 .. ,& 2e y Lect& e > by # . 1&5a 0a &n6 ,p. B a. burns, treatment principles, and criteria for inpatient stabili0ation and reference 2%7 7 minutes4 Lect& e @ by # . -$ ma 0&ta& &k6 ,p. B a. aspect of emergency abdominal surgery and treatment 2%77 minutes4 /. )ne!the!$a lect& e @ by # . Un#an2 Koma &#$n6 ,p. )n a. .nderstanding the signs and symptoms of shock 2hypoperfusion4 257 minutes4 b. )eing able to calculate the infusion of fluids in shock and bleeding 257 minutes4

>.

,k$n an# *en$tal Lect& e 1 by # . %. ,yafe$ 0am5ah6 ,p. K K emergency >kin 2%77 minutes4

T&to $al >cenario * ,k$ll lab ETT 2Endo tracheal tube4

C0)-TER II. ,CEN)RIO . ,TOVE EC-LODE, + woman of *5 years, 5 months pregnant during the antenatal care 2+"'4 has done regular to a gynecologist. :uring the +"' obtained blood pressure %571%77 mm!g, the second leg swelling. 9ne day he was taken to the Emergency .nit with burns along his chest and abdomen caused by the explosion of a sto$e when she was cooking. #atients are aware of pain in the chest and abdomen which caught fire. >lightly hoarse $oice, his eyebrows on fire. The patient complained of breathlessness and coughing, black sputum. )listers were found in the chest and abdomen, but the patient still feels pain. +t the time of the patientBs sudden sei0ure and tension obtained (771%%7 mm!g and a weak but rapid pulse. 9n examination :88 %67 x per minute .. =aboratory results obtained/ proteinuri K*.

C0)-TER III. REVIEW RE3ERENCE, , CEN)RIO .' ,TOVE EC-LODE, 1. The p $nc$ple of t eatment of b& n! an# the$ cla!!$f$cat$on )urn patients should be e$aluated systematically. The main priority is to maintain the airway remains patent, effecti$e $entilation and support the systemic circulation. Endotracheal intubation performed in patients suffering from se$ere burns or suspicion of inhalation in&ury or burns to the upper airway. Intubation can not be done if there has been a burn edema or fluid resuscitation is too much. In burn patients, intubation and nasotrakea orotrakea preferred o$er tracheostomy. T eatment of b& n! e!&!c$tat$on a. %ana2ement of a$ 7ay e!&!c$tat$on ' %. Intubation Intubation action done before the manifestation of mucosal edema causing obstruction. #urpose of intubation to maintain airway and the airway pemelliharaan facilities. (. 'ricothyroidotomy +iming with intubation only be considered too aggressi$e and lead to greater morbidity than intubation. 'ricothyroidotomy minimi0e dead space, tidal $olume increase, it is easier to do bronchoal$eolar rinses and the patient can talk, if compared with intubation. *. 9xygen administration %77A +ims to pro$ide the oxygen re;uirements when there is blocking the airway pathology of oxygen supply. )e careful in gi$ing large doses of oxygen as it can cause oxidati$e stress, so it will form free radicals that are $asodilator and modulator of sepsis. ,. 5. 6. +irway care >uction secretions 2periodic4 Inhalation therapy

+ims to seek a better air atmosphere in the airway lumen and li;uefy thick secretions so easily remo$ed. Inhalation therapy generally uses li;uid sodium chloride 7.6A base plus bronchodilator when necessary. +dditionally bias added substances with specific properties such as atropine sulfate 2lowering the production of secretions4, sodium bicarbonate 2to o$ercome cellular acidosis4 and steroids 2still contro$ersial4 7. 5. 6. b. inse bronchoal$eolar ehabilitati$e care for respiration Escharotomy on the wall of the piston which aims to impro$e lung compliance

%ana2ement of fl&$# e!&!c$tat$on @luid resuscitation is done by gi$ing replacement fluids. There are se$eral ways to calculate the fluid re;uirements of this / The 7ay E"an! %. (. *. Extensi$e burns 2A4 x weight 2kg4 into m= "a'l per (, hours Extensi$e burns 2A4 x weight 2kg4 to (, m= plasma per hour (,777 cc glucose 5A per (, hours

!alf of % K( K* is gi$en in the first 5 hours. The rest are gi$en in the next %6 hours. 9n the second day gi$en half the amount of fluid the first day. 9n the third day be half the amount of fluid the second day.

Ba4te 3o m&la Extensi$e burns 2A4 x weight 2kg4 x , m= !alf of the amount of fluid gi$en in the first 5 hours. The rest are gi$en in the next %6 hours. 9n the second day gi$en half the amount of fluid the first day. 9n the third day be half the amount of fluid the second day. c. N&t $t$onal e!&!c$tat$on In burn patients, the enteral feeding should be done early and the patient does not need to be fasted. If the patient is unconscious, then feeding through naso.gastric can tube 2"?T4. "utrition pro$ided should contain %73%5A protein, 57367A carbohydrates and (53*7A fat. Early nutrition can enhance immune function and pre$ent the atrophy of intestinal $illi. It is expected early nutrition can help pre$ent the occurrence of >I > and -9:>. T eatment of b& n! ?enerally to relie$e pain from burns used a small dose of morphine intra$enously 2initial adult dose/ 7.% to 7.( mg 1 kg and the 'maintenance' 53(7 mg177 kg e$ery , hours, whereas a dose of children 7.75 to 7.( mg 1 kg e$ery , hours4. )ut there is

also a pro$ision stating methadone 253%7 mg adult dose4 e$ery 5 hours is the treatment of chronic pain is good for all adult burn patients. If the patient still feels pain despite the administration of morphine or methadone, ben0odia0epines may also be gi$en in addition.

(.

Inhalat$on t a&ma Trauma can be defined as the inhalation of acute damage to the respiratory system caused by the inhalation of combustion products or $apor where the patient is in a closed room. egion are usually exposed to inhalation trauma is oropharings, tracheobronchial tree or lung parenchyma. >ome literature mentions inhalation trauma was found in *3%5A of patients who present with se$ere burns. The incidence of burns increases with age. Dith the highest incidence is found in o$er 56 years and the lowest incidence below the age group 53%, years. The pre$alence of men and women are e;ual, namely %/ %. TR)U%) %EC0)NI,% There are two mechanisms of occurrence of inhalation in&ury, namely carbon monoxide and smoke inhalation. >moke is di$ided into two, namely the direct trauma and smoke poisoning. :irect trauma to the respiratory system the most rare cases, some experts conclude that carbon monoxide poisoning is a ma&or cause of inhalation trauma. Carbon mono"ide 'arbon monoxide gas is a gas that is odorless, colorless and does not cause irritation resulting from incomplete combustion of carbon. Effect of this gas in the tissues causing hypoxia due to carbon monoxide binds to hemoglobin and oxygen and compete with binding to hemoglobin. +ffinity for carbon monoxide binds to hemoglobin (77 times more than the oxygen concentration karboksihemoglobin high enough so that e$en if the concentration of carbon monoxide in the air only 5A. Toxicity of carbon monoxide depends on the concentration in the air and how much exposure to carbon monoxide. Direct trauma Inhalation of hot, dry air 2*77 @ or more4 caused damage to the tissue in the upper respiratory tract and laryngs. In the edema can arise laryngs laryng, spasm laryngs, and shortness of breath. If there is hot steam $apor will cause damage to the distal part of the respiratory tract.
o

To"icity of smoke

In addition there are also noxious carbon monoxide gas that is the result of degradation of man3made material, while the nature of the material produced oxidation of sulfur and nitrogen, and aldehydes. 9ne of the aldehyde, acrolein showed irritation of the respiratory tract of the upper and pulmonary edema.

-athophy!$olo2y :irect effects of smoke inhalation on the loss of cilia function and se$ere mucosal edema. Dithin a few seconds then it will decrease surfakatan work which will be seen as micro and macro atelectasis. If inhalation trauma se$ere enough, it will cause damage to the al$eoli and the bronchial epithelium which will also spread to the capillary. Dhich in minutes will be detected as bronchial edema and peri$asculer, which will lead to the onset of whee0ing due to bronchial obstruction. Ekspetorasi black sputum usually occurs at this time. +fter se$eral hours, the mucosa of trakeobronkial will begin to form membrane peeling and mucopurulent. +t this time the patient will spend sputum and bronchial mucosa contain. 9nce established it will be followed by pseudomembranous necroti0ing bronchiolitis, hyaline membrane formation, intraal$eolar perdarhan, fibrin3thrombus formation, and the latter no pulmonary edema. DI)*NO,I, :iagnosis of inhalation in&ury on the basis that/ %4 +namnesis 9btained from the anamnesis causes burns and whether the patient is stuck in the house that tebakar or not. If the patient is stuck in the house then it will increase the likelihood of inhalation trauma. -eanwhile, when the cause of burns due to flames in the room that opens the possibility for the occurrence of inhalation in&ury is reduced. (4 Examination Examination re$eals a black3colored sputum, colored laryngs hita 2by examination laryngoskop4 is a significant sign of inhalation trauma. +s for some additional symptoms, among others, eyebrows and nose hair on fire, a hoarse $oice, cough and difficulty breathing. *4 In$estigations >e$eral in$estigations can be done to establish the diagnosis of inhalation in&ury / a4 'hest x3rays b4 )lood ?as +nalysis

c4 )ronchoscopy )ronchoscopy is the gold standard examination to confirm the presence of inhalation trauma. +t bronchoscopy examination found / )lack !yperemia, bronkorhea #etechial #ink3gray areas of necrosis S Dhite area is flat but sometimes conca$e

%)N)*E%ENT Treatment for patients with inhalation trauma, namelyJ %4 (4 *4 ,4 54 64 .. -ake sure the airway remains free to make endotracheal intubation. If there is a deep burn on the neck and the body then ;uickly made incisions to relie$e the neck and body. -ake sure the $entilation and ade;uate oxygenation to peripheral regions @luid resuscitation #ulmonary toilet and bronchodilators +nalgosedasi >pecific +ntidotum

%ana2ement of !hock <hemo#ynam$c= ,hock Re!pon!e eduction of shock begins with general measures aimed at impro$ing tissue perfusionJ impro$e oxygenation of the bodyJ and maintain body temperature. This action does not depend on the cause of shock. :iagnosis should be established so that it can be a causal treatment. Immediately pro$ide first aid in accordance with the principles of resuscitation +)'. +irway 2+ E water way) should be free if necessary with the installation of an endotracheal tube. espiration 2) E breathing) should be ensured, if necessary, to pro$ide artificial $entilation and administration of oxygen %77A . 'irculatory $olume deficit 2' E circulation) in true hypo$olemic shock or relati$e hypo$olemia 2septic shock, neurogenic shock, and anaphylactic shock4 should be treated with intra$enous fluids and if necessary the pro$ision of inotropic drugs to maintain cardiac function or $asoconstrictor drugs to cope peripheral $asodilatation.

%a$nta$n Re!p$ at$on %. (. *. ,. 'lear the airway. #erform exploitation, if any secretions or $omit. Tilted3head prop his chin, if necessary, attach a walker breath (/udel 0 oropharingeal airway). ?i$e oxygen 6 liters 1 minute If breathing 1 $entilation is inade;uate, gi$e oxygen to the pump lid (&mbu bag) or ETT.

%a$nta$n C$ c&lat$on Immediately attach an intra$enous infusion. 'an more than one infusion. -onitor pulse, blood pressure, skin color, the contents of the $ein, urine production, and 2'<#4. 3$n# an# O"e come Ca&!e )leeding is a common cause of shock in trauma patients, either because of bleeding or bleeding that looks in$isible. <isible bleeding, blee#$n2 f om 7o&n#!6 or hemateme!$! from gastric ulcer. )leeding is not $isible, such as bleeding from the gastrointestinal tract, such as duodenal ulcers, !plen$c $nA& y6 p e2nancy o&t!$#e the &te &!6 pel"$c f act& e!6 and la 2e or multiple f act& e!. /. Eme 2ency ob!tet $c ). )bo t$on +bortion is spending the products of conception are age less than (7 weeks of pregnancy. The diagnosis is based on the presence of amenorrhea, signs of pregnancy, $aginal bleeding, placental tissue and the possibility of spending fetal death. 9n septic abortion, $aginal bleeding a lot or moderate fe$er 2chills4, possible symptoms of peritoneal irritation, and possible shock. (. Ek!t a&te $ p e2nancy <ectop$c= The cause of this disorder is the o$um transport delays due to mechanical obstruction of the road that passes through the uterine tubes. Especially in the ampulla of tubal pregnancy, o$arian pregnancy is rare. The diagnosis is confirmed by the presence of amenorrhea *3%7 weeks, rarely longer, irregular $aginal bleeding 2not always4. .. -lacenta p e"$a #lacenta pre$ia is the implantation of the placenta into the lower uterine segment. The cause of this disorder is the phase shift occurs 1 o$er the placenta o$erlaps internum cer$ix which causes the release of the placenta.

/.

,ol&!$o <ab &pt$on= -lacenta #lacental abruption is a normal placenta detaching embedded in the wall of the uterus either partial mauppun complete, at the age of (7 weeks or more. The cause is retroplasenta hematoma due to bleeding from the uterus 2changes in blood $essel walls4, increased pressure in the room inter$illus enhanced by hypertension or toxemia. The diagnosis is confirmed through the findings of pain 2due to contraction peralinan often exist as a continuous pain, tetanik uterus4, bleeding per $agina 2rare and in se$ere cases, external bleeding $aries4, to weigh fluctuating heart sounds 2almost always exceeds the limits of the norm, it is generally not there are in se$ere cases4, shock 2weak pulse, rapid, low blood pressure, pallor, cold sweats, cold extremities, blue nails4. is dead or can not li$e.

>.

Reta$ne# placenta <-lacenta Incomplet&!= The cause of this disorder is retained 2born less powerful pain or pathology e;uipment4 and incarceration 2spasm in the isthmus region of the cer$ix, often caused by an o$erdose of painkillers4. :iagnosis is made by the placenta is not born spontaneously and was not sure if the placenta is complete.

@.

R&pt& e# &te $ The cause of uterine rupture include obstetric measures 2$ersion4, fetopel$ik imbalance, where the latitude is negligible for a drug o$erdose or labor induction of labor pain, scarring of the uterus 2the state after cesarean section, meomenukleasi, >trassman operation, wedge excision suetu tuba4, accidents 2 traffic accidents4, are $ery rare. ,ept$c !hock <Bacte $a6 En#oto4$n= The cause of this disorder is the inclusion of gram negati$e bacterial endotoxin 2coli, proteus, pseudomonas, aerobakter, enterococcus4. ?ram3positi$e bacterial toxin 2streptococci, ,lostridium welchii) is less common. We$2ht p eeclamp!$a The term eclampsia comes from the ?reek word for OthunderO. The word is used because it seems eclampsia symptoms occur suddenly without any prior signs of another. Eclampsia in women who suffer from sei0ures occur, followed by a comma. :ependent on the onset, di$ided into eclampsia eclampsia gra$idarum, eclampsia parturientum, and puerperal eclampsia. If either one of the following signs or symptoms are found in pregnant women, mothers predictably suffered se$ere preeclampsia. %. (. *. ,. )lood pressure was %671%%7 mm!g. 9liguria, the urine is less than ,77 cc 1 (, hours. #roteinuria, more than *g 1 liter. >ub&ecti$e complaints 2epigastric pain, $isual disturbances, headache, pulmonary edema, cyanosis, impaired consciousness4.

D.

E.

5. 9n examination, found increased le$els of li$er en0ymes with &aundice, bleeding in the retina, and platelets less than %77,777 1 mm. :iagnosis of eclampsia should be distinguished from epilepsy, sei0ures due to drug anesthesia, or coma due to other causes such as diabetes. The hardest complication is maternal and fetal mortality.

(.

T eatment of hype ten!$on of p e2nancy a. Cont ol of 0ype ten!$on b. o o o o o c. -ethyldopa 'lonidine HT3adrenergic agonistI 'alcium channel blockers !ydrala0ine )eta blockers Fnowledge about the pharmacokinetics of anti3!T drugs in breast milk is minimal. ?i$ing a thia0ide diuretic should be sad indarkan therefore can cause a decrease in milk production. -ethyldopa estimated safe for nursing mothers. Except for propranolol, another beta blocker type found in breast milk with high le$els. 'aptopril 'lonidine and le$els in breast milk is minimal.

- o"$!$on of the ant$hype ten!$"e effect of b ea!t fee#$n2

Ob!tet $c %ana2ement of -&bl$c 9n my first $isit to ask/ o o o o o o o 9ld hypertensi$e and type of drug used +nd a history of kidney disease or heart 9utcome of last deli$ery @undus examination occuli enal artery auscultation :orsalis pedis artery pulse examination 2coarctatio aorta4 Examination of T: in a sitting position

#hysical examination/

=aboratory tests at the first antenatal $isit/ o o o o o o o o 'omplete blood and urine examination enal physiology !epatic physiology >erum electrolyte E'? (,3hour urine creatinine clearance to see Thorax U3ray .ltrasound examination/ to determine the gestational age / etriksi regular food without salt The fre;uency of antenatal antenatal care more often than RE3ERENCE,

:iet ad$ice

+hmadsyah I, #rasetyono anyway. =uka. In/ >&amsuhida&at , de 8ong D, editor. Textbook of surgery. Issue (. "ew Gork/ -edical )ooks E?'J (775. h. 7*35. -oenad&at G. ) root in&uries. Issue (. "ew Gork/ #ublishing 'enter >chool of -edicineJ (77*. !eimbach :-, !olmes 8!. )urns. In/ )runicardi @', +ndersen :F, billiar T , :unn :=, !unter 8?, #ollock E, editors. >chwart0Bs principal surgery. 5 ed. .>+/ The -c?raw3!ill 'ompaniesJ (777. "arad0ay 8@U, +lson . Thermal burns. In/ >lapper :, Tala$era @, !irshon 8-, !alamka 8, +dler 8, editors. :ownloaded from/ http/11www.emedicine health. com . +gusuts (5, (776. >plit Thickness >kin ?rafting and @ull. :ownloaded from http/11www.burnsur$i$orsttw.org1burns1grafts.html. *7 +ugust (776 . 'uningham @?, -ac :onald #', ?ant "@, et al. !ypertensi$e :isorders in #regnancy. In/ Dilliams 9bstetrics. ((th ed. 'onnecticut/ +ppleton and =ange, (777/ ,,*3,5(. :ekker ?+, >ibai )-. Ethiology and pathogenesis of #reeclampsia/ 'urrent 'oncept. +-8 9bstet ?ynecol %665J %76/ %*56375. =ockwood '8 and -8 #aidas. #reeclampsia and hypertensi$e disorders In Dayne . 'ohen 'omplications of #regnancy. 5th ed. #hiladelphia/ Dilliams and Dilkins =ippicott, (777/ (77 3(6. >ibai )-. !ypertension in pregnancy. In/ 9bstetrics normal and problem pregnancies. , edition, 'hurchill =i$ingstone, .>+, (77(/ 57*366. eport of the "ational !igh )lood #ressure Education #rogram Dorking ?roup on !igh )lood #ressure in #regnancy. +-8. 9bstet ?ynecol, (777J %5*/ >% 3 >((. +ngsar -: et al. ?uidelines for -anagement of !ypertension In #regnancy In Indonesia. @etomaternal -edicine +ssociation #9?I
th

th

% ODUL / Eme 2ency ne& o2en$c C0)-TER I. 3OURT0 WEEK LE)RNIN* OB+ECTIVE, %. (. *. ,. 5. 6. ecogni0e emergencies at the in&ury head and penatalaksaannya Explain the radiological examination to help establish the diagnosis of head in&ury Explain a $ariety of emergencies in the field of neurology and handling Explain the mechanism and management of disorders caused by impairment of consciousness intracerebral Explain and perform and how to stabili0e the trauma patient transport :escribe the action or emergency patient referral management

E4pe t lect& e' 1. ,& 2e y lect& e D by # . ,&llyaman6 ,p. B, ecogni0e emergencies at the in&ury head and penatalaksaannya 2%77 minutes4 lect& e E by # . 1&5a 0a &n6 ,p. B a. Explain and perform and how to stabili0e the trauma patient transport 25 7 minutes4 b. :escribe the action or the management of emergency patient referrals 257 minutes4 (. Ne "e Lect& e 1 by # . Roe57$ )5ha y6 ,p. , Explain a $ariety of emergencies in the field of neurology and handling 2%77 minutes4

Lect& e ( by # . Roe57$ )5ha y6 ,p. , Explain the mechanism and management of disorders caused by impairment of consciousness intracerebral 2%77 minutes4 .. Ra#$olo2y Lect& e ( by # . Ka yanto6 ,p. Ra# Explain the radiological examination to help establish the diagnosis of head in&ury 2%77 minutes4

T&to $al >cenario , ,k$ll lab +ssessment of ?lasgow 'oma >cale 2?'>4

C0)-TER II. ,CEN)RIO /

Rac$n2

+ young man of %5 years in the conscious state was brought to the emergency unit after a motorcycle accident. The patient can not walk alone, confused speech. 9btained $ital sign obtained T: %57167 mm!g, pulse 67x 1 min, ( 5 x 1 min. esults found history anamnesis loss of consciousness for %7 minutes, and on physical examination found he matom in the region of the right orbit and right temporal region. +fter *7 minutes, the patient experienced a rapid decline in consciousness and response to pain is the lower, right pupil fixed and dilated, while the left pupil small and reacti$e.

C0)-TER III. REVIEW RE3ERENCE,

,CEN)RIO /' ac$n2 ). Way! to !tab$l$5e an# t an!po t t a&ma pat$ent! The focus of treatment of $ictims with head in&uries at area hospitals are pre sa$e li$es and pre$ent disability. In the pre3hospital phase of the emphasis gi$en to maintain the smooth airway, control bleeding and syock, patient stabili0ation and transport to the nearest hospital. irway (airway) 9xygenation of brain disorders and other $ital tissues are the fastest killer in the case of trauma. To a$oid the interference problem handling airway is a priority o$er all other issues. In patients with impairment of consciousness ha$e a high risk for the occurrence of airway disorders., In addition to checking the existence of a foreign body, airway obstruction may occur because the base of the tongue falling backwards so that it co$ers the flow of air into the lungs. In addition aspiration of gastric contents is also a danger that threatens the airway. $reat!ing (!el%s breat!ing) >econd act of belie$ing that there are no barriers to airway breathing is helpful. -ake sure the patientBs breathing is still there. Circulations (control bleeding) Efforts to mempertahnakan cirkulasi that can be done pre hospital is to pre$ent loss of blood in cases of trauma with bleeding. If you find any bleeding, apply first attempt to control bleeding by bandaging press on the in&ured area. Stabili&ation (maintain %osition) 9ften changes in patient position that is not true it will add to the in&ury suffered. "ot uncommon in cases of spinal cord in&uries are not properly handling the stabili0ation of secondary in&ury that would cause interference resulting in a more se$ere and reco$ery is not perfect. Installation of the traumati0ed limb splint, long spine board in case of in&ury to the spine and neck in neck in&uries can colar and stabili0ation of simple tools that others can reduce the risk of secondary damage due to an unstable position.

Trans%ortation (trans%ortation to Hos%ital) Dhere$er possible the patient was brought immediately to the nearest hospital for treatment can be done completely with the proper e;uipment. (. T a&ma cap$t$! an# cla!!$f$cat$on Trauma capitis is a mechanical trauma that directly or indirectly on the head and cause neurological dysfunction. &. Simple 1ead $njury Simple diagnosis can be confirmed by head injury There is a history of trauma capitis "ot pass >ymptoms of headache and di00iness

?enerally do not re;uire special treatment, &ust gi$en symptomatic medication and get enough rest. 2. ,ommotio ,erebri ,ommotio cerebri 2apoplexy4 is a stupor that lasted no more than %7 minutes due to head trauma, which is not accompanied by damage to brain tissue. #atients may complain of headache, $ertigo, and $omiting may appear pale. <ertigo and $omiting may be due to a concussion in a ma0e or terangsangnya centers in the brain stem. 'ommotio cerebri on may also ha$e retrograde amnesia, the memory loss during a limited period before the accident. +mnesia is due to elimination of recorded e$ents in the temporal lobes. +dditional checks are always made is a photo of the skull, EE?, memory checks. >ymptomatic therapy, treatment for *35 days for obser$ation of possible complications and gradual mobili0ation. 3. ,ontusio ,erebri +t contusio cerebri 2brain contusion4 hemorrhage3bleeding within the brain tissue without tearing &aringanyang in$isible, e$en though the neurons were damaged or lost. Dhat is important for the occurrence of lesions is the acceleration of the head contusion that instantly cause a shift in the brain and the de$elopment of destructi$e compression forces. >trong acceleration also means the head hyperextended. Therefore, the brain is too strong stretching of the brain stem, causing a re$ersible blockade of the tra&ectory of the ascending reticular diffuse. :ue to blockade it, the brain does not recei$e afferent input and, therefore, lost consciousness during re$ersible blockade lasts.

Incidence of lesions in the region contusio 4coup4, 4contrecoup4, and OintermediateO cause symptoms of neurologic deficit that may be a reflex babinsky positi$e and .-" paralysis. +fter pulleys consciousness returned, the patient usually indicates Oorganic brain syndromeO. :ue to the force de$eloped by the mechanisms that operate in the aforementioned trauma capitis, impaired autoregulation of cerebral blood $essels, resulting in $asoparalitis. =ow blood pressure and pulse become slow, or become rapid and weak. +s well as $egetati$e centers are in$ol$ed, it nausea, $omiting and respiratory problems can arise. In$estigations such as 'T3scan is useful to see the location of the lesion and the possibility of short3term complications. Therapy with antiserebral edema, anti3 bleeding, symptomatic, and treatment of neurotrophic 73%7 days. 5. -aceratio ,erebri -aceratio cerebri is said if the damage is accompanied by a tear piamater. =aceratio usually associated with a subarachnoid hemorrhage traumatika, acute subdural and intercerebral. =aceratio =aceratio can be di$ided into direct and indirect. =aceratio directly caused by penetrating head in&ury caused by a penetrating foreign body or fracture fragment, especially in an open depressed fracture. =aceratio while not directly caused by a se$ere deformity due to tissue mechanical strength. 6. %racture Database ,ranii %ractur be the basis cranii anterior fossa, fossa posterior fossa and the media. The symptoms depend on the location or where the affected fossa. @racture of the anterior fossa symptoms / >ubkon&ungti$al glasses hematoma without bleeding Epistaxis hinorrhoe

The distribution of other head in&uries / %$l# 0ea# InA& y V includes =aseratio and 'ommotio 'erebri o o o o ?'> score of %*3%5 There is no loss of consciousness, or if there is no more than %7 minutes The patient complained of di00iness, headache There is $omiting, there is retrograde amnesia and no abnormalities found on neurologic examination.

%o#e ate hea# $nA& y o o o o o o o o .. ?'> score of 63%( There are faint more than %7 minutes There are headaches, $omiting, sei0ures and retrograde amnesia "eurological examination found lelumpuhan ner$es and limbs. ?'> score Q5 ?e&alnya similar to 'F>, &ust in a more se$ere The occurrence of a progressi$e impairment of consciousness The presence of skull fractures and brain tissue apart.

,e $o&! 0ea# InA& $e!

*la!2o7 Coma ,cale <*C,= e4am$nat$on The degree of in&ury can be assessed according to the le$el of consciousness through the ?'> system, the method of E-< 2Eyes, <erbal, -o$ement4 %. The ability of the eyelid 2E4 (. *. >pontaneously 9n orders #ain stimuli "ot react 'ommunication capability 2<4 ?ood orientation +nswer chaotic The words do not mean ?roan "o sound -otor skills 2-4 +bility according to the command =ocal reaction +$oidance +bnormal flexion Extension "ot react 6 5 , * ( % 5 , * ( % , * ( %

/.

%ana2ement of t a&ma cap$t$! - $o $ta! p e"ent$on of hea# t a&ma a. b. c. d. e. f. g. h. i. &. k. l. Impro$e cardio$ascular 2shock tackle4 @ix the balance of respiration, $entilation or good airway E$aluate the le$el of awareness 9bser$e the lesion in the head, whether there are impressions of fracture, signs 3 sign fracture of the cranial base, likuorhoe, be careful of the fracture cer$ical 2neck stabili0ation4 =esion obser$ed in other body parts 'omplete neurologic examination and U fot the head, neck, 'T3>can # erhatikan pupil 9$ercome cerebral edema @ix the balance of fluids, electrolytes and calories Intra3cranial pressure monitor >ymptomatic treatment or conser$ati$e If there is deterioration of consciousness accompanied by intra3cranial bleeding more than 75 cc, open kranioserebral penetrating in&ury, fracture impressions of more than % cm immediately made operati$e

>.

%ana2ement of pat$ent! 7$th $mpa$ ment of con!c$o&!ne!! %ana2ement of -at$ent! 7$th #ec ea!e# 8 kah$lan2an a7a ene!! 1. (. !andling emergency decompression of the lesion persisted space (space occupying lesions 1 >9=4 can sa$e patientsB li$es. If there is an increase in I'T, the following is the first treatment/ a. Ele$ation of the head b. Intubation and hyper$entilation c. >edation in the e$ent of se$ere agitation 2mida0olam %3( mg i$4 #. 9smotic diuresis with mannitol (7A % g 1 kg i$ e. .. /. :exametason %7 mg i$ e$ery 6 hours in case of cerebral edema by a tumor or abscess after this therapy I'# monitor should be installed.

'ases of suspected encephalitis by herpes $irus infection can be administered acyclo$ir %7 mg 1 kg i$ e$ery 5 hours 'ases of meningitis do therapy empirically. #rotect patients by ceftriaxon (x% ,x% g ampicillin i$ and pending culture results +irway protection/ ade;uate oxygenation and $entilation

*ene al The apy %.

(. .. /. >. @. D. E. F.

Intra$enous hydration/ using normal saline in patients with cerebral edema or increased I'# "utrition/ do administration $ia enteral nutrition by tube nasoduodenal, a$oid the use of naso gastric tube because of the threat of aspiration and reflux >kin/ a$oid pressure sores by tilting right and left e$ery % to ( hours, and use a mattress that can be de$eloped with wind and heel protector Eyes/ a$oid abrasion of the cornea with the use of lubricants or close your eyes with plaster )owel care/ a$oid constipation with stool softeners 2docusate sodium %77 mg *x%4 and the pro$ision of ranitidine 57 mg i$ e$ery 5 hours to a$oid stress ulcer caused by steroids and intubation )ladder treatments/ indwelling and intermittent catheters cateter urine e$ery 6 hours 8oint mobility/ passi$e 9- exercises to pre$ent contractures #rophylaxis of deep vein thrombosis 2:<T4/ 5777 iu sc administration e$ery %( hours, the use of pneumatic compression stockings, or both.

@.

Refe ence to ca!e mana2ement In accordance with the circumstances of each region $ary widely, depending on the selection of transportation facilities, security, geographical situation, and ;uickly achie$e the specified referral hospital. The principle is OTo get 7a definiti$e care in the shortest time B. Thus, whene$er possible should any patients with head trauma admitted to hospital with a 'T scan of existing facilities and neurological surgery. )ut, look at the situation and conditions in our country, where only in pro$incial hospitals ha$e facilities 2especially outside of 8a$a4, then the referral system as it is difficult to implement. Therefore, there are three things to do / %. (. *. Dhen it is within easy reach and without aggra$ate the condition of the patient, should be directly referred to the existing hospital neurosurgical facilities 2pro$incial hospital4. If not possible, should be referred to the nearest hospital surgical facilities. If the status of the +)' has not stabili0ed, could be referred to the nearest hospital to get better handling. :uring the trip, there could be a $ariety of circumstances such as shock, sei0ures, apnea, airway obstruction, and anxiety. Thus, while on the mo$e, the state of +)' patients must remain strictly monitored and super$ised. Dith the risk during transport, it is necessary in the preparation and transport re;uirements, which is accompanied by medical personnel, nurses are able to handle a minimum of +)', as well as emergency e;uipment and medicine 2among ambubag, oropharyngeal and nasopharyngeal tube, suction, oxygen, intra$enous fluids or = "a'l 7.6A, infusion sets, syringes 5 cc, (5 cc a;uabidest, dia0epam ampoules and $ials khlorproma0ine4. In addition, a complete referral letter and &ela s. )ut, often considered the social, geographical, and cost make it difficult to refer patients, so it is necessary to handle for us to determine the best decisions for the patient. There

are se$eral criteria for head in&ury patients are still being treated at home but with close obser$ation, namely/

%. (. *. ,. 5. 6.

9rientation of time and place is still good "o neurological focal symptoms. "o headache or $omiting 3 $omiting. There was no skull fracture. 'an anyone watching at home. esidence not far from health centers 1 sub3clinics. In addition, an explanation should be gi$en to the family to acti$ely super$ise 2and ask the patient to wake4 e$ery two hours. Dhere the headache gets worse, more fre;uent $omiting, sei0ures, decreased consciousness, and the paralysis then immediately report to the clinic or medical officer nearest.

RE3ERENCE, 'husid, ,orrelative neuroanatomy and %unctional 7eurology, part two. ?a&ah -ada .ni$ersity #ress, %66% !arsono, ,apita Sele)ta 7eurology, second edition. ?a&ah -ada .ni$ersity #ress, (77* +lexander 8, 1ead $njuries, #T :hiana #opular. >cholastic ?roup, 8akarta, %65% >idharta #, -ard&ono -, +asis of ,linical 7eurology, :ian akyat, 8akarta, %65% !asan >&ahrir, "eurology >pecialty "eurology, :ian akyat, 8akarta, (77, -ahar -ard&ono, #riguna >idharta, )asis of 'linical "eurology, dian people, 8akarta, (77, +rif et al -ans&oer Editor, >tructure of "er$e Trauma in >elekta 'apita -edicine Third edition $ol (, -edia +esculapius, 8akarta, (777 obert =. -artu0a, Telmo -. +;uino, Trauma in the -anual of "eurologic Therapeutics Dith Essentials of :iagnosis, *th ed, litle )rown M 'o, (777 'husid, ,orrelative neuroanatomy and %unctional 7eurology, part two. ?a&ah -ada .ni$ersity #ress, %66% !arsono, ,apita Sele)ta 7eurology, second edition. ?a&ah -ada .ni$ersity #ress, (77* +lexander 8, 1ead $njuries, #T :hiana #opular. >cholastic ?roup, 8akarta, %65% >idharta #, -ard&ono -, +asis of ,linical 7eurology, :ian akyat, 8akarta, %65% !asan >&ahrir, "eurology >pecialty "eurology, :ian akyat, 8akarta, (77, -ahar -ard&ono, #riguna >idharta, )asis of 'linical "eurology, dian people, 8akarta, (77, +rif et al -ans&oer Editor, >tructure of "er$e Trauma in >elekta 'apita -edicine Third edition $ol (, -edia +esculapius, 8akarta, (777 obert =. -artu0a, Telmo -. +;uino, Trauma in the -anual of "eurologic Therapeutics Dith Essentials of :iagnosis, *th ed, litle )rown M 'o, (777

%ODULE > Eme 2ency -!ych$at y C0)-TER I. T0E 3I3T0 WEEK LE)RNIN* OB+ECTIVE, %. (. *. ,. 5. 6. 7. Explains emergency psychiatry and handling Explain the type and management of poisoning Explaining gastroenterohepatologi and handling emergency Explain the emergency treatment of metabolic and endocrine Explain the emergency treatment of hypertension and renal Explain the forensic toxicology +ble to recogni0e the signs of death

E4pe t lect& e' 1. -!ych$at y Lect& e 1 by # . Wo o - ame!t$6 ,p. K+ Explains emergency psychiatry and handling 2%77 minutes4 (. Inte nal %e#$c$ne Lect& e 1 by # . )l$ Im on6 ,p. -D6 K*E0 Explain the type and management of poisoning 2%7 7menit4 Lect& e ( by # . )l$ Im on6 ,p. -D6 K*E0 Explain gastroenterohepatologi and handling emergencies 2%7 7 minutes4 Lect& e . by # . Teha Ka o ? K a o6 ,p. -D Explain metabolic and endocrine emergency treatment 2%7 7 minutes4 Lect& e / by # . )hma# Ta &na6 ,p. -D Explain emergency treatment of hypertension and kidney 2%7 7 minutes4 .. 3o en!$c Lect& e ( by # . E"$ D$an a?3$t 6 ,p. 3 Explain the forensic toxicology 2%7 7 minutes4 Lect& e . by # . E"$ D$an a?3$t 6 ,p. 3 +ble to recogni0e the signs of death 257 minutes4

T&to $al >cenario 5 ,k$ll lab Intake of @oreign 9b&ects 2'orpus +lienum4

C0)-TER II. ,CEN)RIO > 3EEL -UR,UED + (73year3old woman, left her boyfriend about a month ago. !e felt frustrated, often locked himself in his room, and feel there is talk about him, and something to tease him that he felt his girlfriend decided to use him because there guna.+khir3ultimately3his beha$ior is getting worse and finally he found his room with his mouth foaming , as well as his body was found a bottle of )aygon. The family immediately took him to the hospital.

C0)-TER III. REVIEW RE3ERENCE,

,CEN)RIO >' 3eel p& !&e# 1. Eme 2ency p!ych$at y a. estless noisy conditions >igns and symptoms/ estlessness, pacing, Gelling, >kip, skip, +ngry, angry, >uspicious K K K, aggressi$e, $iolent, agitation, !appy K K K, K K K >inging, >peaking chaotic, :isturbing other people, did not sleep for days, ItBs hard to communicate. -anagement/ b. Flormetia0ol %3( g per os, repeated e$ery ( hours If it is difficult, gi$e haloperidol 5 mg $alium (7 mg I- K in a separate syringe +lcoholic delirium, gi$e chlorproma0ine (77 mg %77 mg I- repeated e$ery ( hours, plus high3dose multi$itamin

+cts of $iolence (violence) 8iolence is a person of physical aggression against others. The $iolence may arise due to psychiatric disorders, but can also occur in ordinary people who can not handle the pressure of e$eryday life with a better way. 'linical features and diagnosis #sychiatric disorders are often related to/ #sychotic disorders such as schi0ophrenia and manic, especially when people are paranoid and ha$e hallucinations telling (commanding hallucinations) +lcohol intoxication or other substance Dithdrawal symptoms from alcohol or sedati$e3hypnotic drugs 'atatonic furor :epression agitatif #ersonality disorder is characteri0ed by anger and impulse control disorders 9rganic mental disorders, particularly those of frontal and temporal lobes of the brain #rotect yourself +lert to the signs of the emergence of $iolence -ake sure there is ade;uate staffing for patient safety tie

E$aluation and management of

)inding of patients only performed by trained staff. .sually after the binding of ben0odia0epines or antipsychotics gi$en #erform appropriate diagnostic e$aluation, the $ital signs, physical examination and psychiatric inter$iew. E$aluation of suicide risk Exploration of the possibility of psychosocial inter$entions to reduce the risk of $iolence "eed to be treated to pre$ent $iolence. 'ontinuous obser$ation

Therapy psikofarmaka +ntipsychotic drugs are usually gi$en c. >uicide (suicide) >uicide is the death of the intended and carried out by a person against himself. 'linical features and diagnosis !igh risk of suicide/ The man, the older the age, social isolation 1 li$ing alone, history of suicide 1 attempted suicide in the family, history of illness 1 chronic pain, 8ust finished the operation, does not ha$e a &ob. E$aluation and management of :o not lea$e the patient alone in the room emo$e ob&ects that could harm Therapy psikofarmaka Trans;uili0er gi$en lightly, especially if sleep disturbed. The drug of choice is lora0epam *x% mg daily, for ( weeks. :o not gi$e the drug in large ;uantities at once to the patient and the patient should control within a few days. d. :elirium 'linical features and diagnosis #rodromal Typically patients complain of fatigue, anxiety, iritabel, sleep disorders :isturbance of consciousness :ecrease in the clarity of the le$el of awareness on the en$ironment <igilance 'onsists of hyperacti$ity 2associated with withdrawal syndrome4 and hipoakti$itas 2all decreased acti$ity4 'oncentration problems -arked difficulties in maintaining presence, focus, and di$ert attention 9rientation In the mild delirium orientation disruption time, an interruption in se$ere delirium places and people orientation

=anguage and cogniti$e =anguage abnormalities occur and incoherence. -emory and cogniti$e functions commonly disturbed #erception <isual and auditory hallucinations occurred -ood >ymptoms are often/ anger, rage, fear is groundless >leep3wake disorders 9ften exhibit agitation at night and trouble sleeping E sundowning "eurological symptoms Include/ dysphasia, tremor, asterixis, incoordination, and urinary incontinence. )e supporti$e and not threatening eassure the patient 9ffer drug

Inter$iew guide and psychotherapy

E$aluation and management of The main thing is to treat the cause. Dhen the cause anticholinergic toxicity, use pisostigmin salicylate %3( mg I< 1 I-, can be repeated %53*7 minutes if necessary. e. :epression >ymptoms and signs/ >udden changes in life Early morning insomnia +gitation =oss of appetite and a willingness @eeling $ery desperate >ocial relations rewind >inful delusion "ot able to express thoughts and feelings Treatment/ E'T (electro.convulsive therapy) Tricyclic antidepressants %573(77 mg 1 day K ,x%7 mg $alium or %73(7 mg I-

(.

%ana2ement of po$!on$n2 "$ct$m! %. >tabili0ation @orm of cardiopulmonary resuscitation promptly and precisely as follows/ (. =iberation of the airway Impro$ement of respiratory function Impro$ement of blood circulation system

:econtamination :econtamination is a therapeutic inter$ention aimed to reduce exposure to toxins, reduce absorption, and pre$ent damage. :econtamination of pulmonary :econtamination of the eyes >kin decontamination ?astrointestinal decontamination

In general the )aygon intoxication if swallowed dose subtoksik, decontamination is not necessary, except when swallowingW %77 mg 1 kg, then do/ a. b. c. Induction of $omiting ?astric aspiration and kumbah Effecti$e when carried out for (3, hours first, and with good techni;ue. +cti$ated charcoal 3 + single dose/ % g 1 kg or *73%77 g of adult and children %53*7 grams <!pec$f$c # &2! an# ant$#ot&m=

*.

Elimination +ction is the action to accelerate the elimination of toxins expenditures are circulating in the blood, or in the gastrointestinal tract after more than , hours. Dhen still in the ?I tract gi$en repeated doses of acti$ated charcoal *7357 g e$ery , hours #9 1 enteral. +nother act of elimination/ @orced diuresis, alkalini0ation of urine, urine acidification, hemodialysis 1 peritoneal dialysis.

,.

+ntidotum pro$ision 2if a$ailable4 In most cases of poisoning are $ery few types of toxins antidotumnya drugs and drug preparations that are commercially a$ailable antidotes are $ery few in number.

..

Type! of po$!on$n2 a. 'hemicals %. (. *. ,. 5. 6. 7. 5. 6. b. :rug %. (. *. ,. 5. 6. 7. c. %. (. *. d. +mphetamines :igoxin Isonia0id 9pioid #aracetamol Darfarin #ropranolol :atura 1 amethyst &manita phaloides 9leander 'yanide -ethanol 1 ethylene glycol eciprocal -ercury +rsenic "a hypochlorite Thallium 9rganophosphate @e

"atural toxins

+nimal toxins %. >corpion (. >nake *. >piders ,. 8ellyfish 3 8ellyfish @ood %. (. 8engkol 'assa$a

e.

f.

-icrobial toxin/ )otulinum

)ased on where toxins are/ In the wild o Toxins in natural gas

In households o o o o :etergent :isinfectant Insecticide 'leaner

In agriculture o o o Insecticide !erbicide #esticide

In industrial and laboratory o >trong acid o >trong base In food o '" in cassa$a o )otulinus toxin o #reser$ati$e o +dditi$es In medicine o o !ypnotic >edati$es

)ased on the organ of the body/ +re hepatotoxic "ephrotoxic

)ased on the effects of/ =ocal o o 'orrosi$e poison !alogen groups

>ystemic o o )arbiturates, alcohol, morphine 3W to the >># :igitalis and oxalate 3W towards heart

'9 to the blood !b

'ombination o 'arbolic acid, causing erosion of the stomach and depression >>

>e$eral types of toxins that ha$e the specific odor.

Table 1. 'haracteristic smell of the poison O#o +cetone +lmond ?arlic otten eggs Ca&!e Isopropyl alcohol, acetone 'yanide +rsenic, selenium, thallium !ydrogen sulfide, mercaptan

No +.

The cl$n$cal #in3point pupils, decreased :ilated pupils, decreased :ilated tachycardia 'yanosis !ypersali$ation "ystagmus, cerebellar signs Extrapyramidal symptoms

-o!!$ble ca&!e! 9pioids, 'lonidine, phenothia0ines, inhibitor cholinesterase/ organophosphates, carbamat )en0odia0epines

(. *.

pupils,Tricyclic antidepressants, amphetamines, ecstasy, cocaine, antihistamines, anticholinergics/ ben0eksol, ben0tropin '"> depressant drugs organophosphate 1 carbamate, insecticide ataxia,+lcohol, anticon$ulsants/ phenytoin, carbama0epine

,. 5. 6.

7.

#henothia0ines, haloperidol, metoclopramide

5.

>ei0ures

Tricyclic antidepressants, anticon$ulsants, theophylline, antihistamines, ">+I:s, phenothia0ines, isonia0id =ithium, tricyclic antidepressants, antihistamines ) 3 blockers, digoxin, opioids, 'lonidine, organophosphates, calcium antagonists 'ramp,Dithdrawal alkohol, opiat, ben0odia0epin takikardi,

6. %7.

!yperthermia )radycardia

%%.

+bdominal diarrhea, halusinasi

'linical simptom may indicate the cause of poisoning /. ,$2n ? !$2n! of #eath <tanatolo2$= Two stages of death/ %. 2. Somatic death 0 systemic death 0 clinical death ,ellular death 0 molecular death

>omatic signs of death %. (. *. =oss of mo$ement and sensibility 'essation of breathing 'essation of heart beat and blood circulation

>ign 3 signs of cellular death %. (. *. ,. 5. 6. :ecrease in body temperature 2argor mortis4 )ruised corpse 2li$or mortis4 igid bodies 2rigor mortis4 'hanges in skin 'hanges in eye :ecay and sometimes the process of mummification and adipocere

+ccording to the language, tanatologi deri$ed from Thanatos 2death3related4 and logos 2science4. -eanwhile, according to the terms, tanatologi is the study of death and the changes that occur after death and the factors influencing those changes. Dhile tanatologi itself is part

of the forensic medical science that studies about the things that has to do with death and the changes that occur after a person dies and the factors that influence it. ,ta#$&m Death In essence there are two stages of death stages, namely stage somatic death 1 mortality clinical 1 systemic death, and death of cellular 1 molecular death, but the stage of death is also di$ided into fi$e stages as follows/ %. >omatic death 1 clinical death 1 death is the cessation of the systemic function of the ner$ous system, cardio$ascular system, respiratory system and thus lead to irre$ersible tissue anoxia is complete and thorough. The death of cellular 1 molecular death is the cessation of acti$ity of the network system, cell and molecular body, resulting in the death of an organ or tissue that occur some time after somatic death. "ear3death 2suspended animation, apparent death4 is the third interruption of life support systems are determined by simple medical de$ices. Dith ad$anced medical e;uipment can still be pro$ed that the three systems are still functioning. ":E is often found in cases of poisoning a sleeping pill, electric shock and drowning. 'erebral death was damage to both hemispheres of the brain that is irre$ersible, except the brain stem and cerebellum, while the other two systems, namely the respiratory and cardio$ascular systems are still functioning with the aid of tools. )rain death 2brain stem4 is when the entire contents of the neuronal damage is irre$ersible intracranial, including the brain stem and cerebellum. Dith known brain death 2brain stem death4, it can be said as a whole person can not otherwise li$e longer, + @ sehin a tool can be stopped.

(.

*.

,.

5.

0o7 to Detect %o tal$ty 'hanges may occur early in the time of death or a few minutes later, for example, the heart and blood circulation stops, breathing stops, and corneal light reflex missing eye, pale skin, muscle relaxation occurs. )ut after some time off after the changes occur is clear, thus allowing a more definiti$e diagnosis of death. The signs of a bruised corpse 2li$or mortis 1 hipostatis 1 li$iditas post3death4, a rigid body 2rigor mortis4, decreased body temperature, decomposition 2#utrefection 1 decomposition4, mummifikasi, and adiposera, and or biochemical changes.

RE3ERENCE,

El$ira, >: and !. ?itayanti 9f (7%7. *e!tboo) of Psychiatry. =ondon/ @aculty of medicine. @aculty of -edicine, .I. 9f %667. Science %orensic (edicine. =ondon/ >chool of -edicine. F edokteran .I faculty., (776. (edicine $8 Edition. "ew Gork/ #ublishing 'enter for -edicine in the @aculty of -edicine, .ni$ersity of Indonesia. @aculty of -edicine, .I. ,apita Sele)ta (edicine. Issue *. "ew Gork/ -edia +esculapius. !ariadi, +. 9f (7%7. *e!tboo) of %orensic (edicine and Science (edi)olegal. "ew Gork/ @F .nair. #urwadianto, +. and )udi >. 9f (777. Emergency (edical ,are. "ew Gork/ )inarupa script.

,U%%)R1 O3 BLOCK )CTIVIT1 I. %o#&le I Top$c! =ecture % >urgery a. Introduction of block emergencies and #olicy national in dealing with emergencies and disasters 257 minutes4 b. The failure organ function due to trauma 1 multiple trauma 257 minutes4 =ecture ( >urgery -anagement of $ascular in&ury 2%7 7 minutes4 =ecture * >urgery Initial inspection and management of musculoskeletal trauma 2%77 ( x 57 B +nesthesia dr. >pan +chmad +ssegaf, minutes4 =ecture % +nesthesia a. Emergency >ign4 and mark the priority minutes4 b. +ssessment and management of early 2initial assessment4 in the sign in case of emergencies Traumatology. 257 ( x 57 B >urgery dr. +swedi #utra, >p.9T ( x 57 B >urgery dr. #irma !utauruk, >p.) Lect& e! N&mbe of 0o& ! ( x 57 B ,c$ence >urgery Info mant dr. Gu0ar !arun, >p.)

case

of

trauma

multiple

trauma 1 drowning in the order of priority 2+)'4 257 minutes4 =ecture ( +nesthesia The use of drugs in treating patients with emergency =ecture % @orensic a. + legal specification of trauma and emergency situations in 2informed emergencies4 b. <isum et repertum 257 minutes4 =ecture % Eye Emergency Eye 2%77 minutes4 II =ecture % 'hild Emergencies in pediatrics =ecture , >urgery a. Emergencies in thoracic trauma 257 minutes4 b.Trauma maxillofacial 257 minutes4 +nesthesia =ecture * espiratory emergencies +nesthesia =ecture , a. -echanism occurrence of airway obstruction drowning minutes4 b.-anagement airway obstruction in adults and 257 2drowning4 ( x 57 B +nesthesia dr. :endy -aulana, >p.+n ( x 57 B +nesthesia dr. Indra @aisal, >p.+n ( x 57 B >urgery dr. Gu0ar !arun, >p.) ( x 57 B #ediatric dr. @erdi, >p.+ ( x 57 B Eye dr. !elmi -uchtar, >p.consent ( x 57 B @orensic ( x 57 B +nesthesia dr. >pan dr. E$i :iana, >p.@ +chmad +ssegaf,

2respiratory resuscitation4 257 minutes4 +nesthesia =ecture 5 .nderstand the ob&ecti$es and ( x 57 B E"T ( x 57 B +nesthesia dr. .ndang Fomaruddin, >p.+n

actions of 8#9 E"T =ecture % Emergency in E"T adiology =ecture % The examination support thorax trauma III and maxillofacial radiologists 9bstetrics and ?ynecology lecture Emergency 9bstetrics ?ynecology 2%77 minutes4 !eart =ecture 'ardiac emergency >urgery =ecture 5 )urns, treatment principles, and criteria for inpatient stabili0ation and referral 2%77 minutes4 >urgery =ecture 6 +spects of emergency abdominal surgery and treatment +nesthesia =ecture 6 a. b. >igns and symptoms of shock 2hypoperfusion4 257 minutes4 @luid administration in shock and bleeding 257 minutes4 and

dr. @atah >atya D, >p.T!T dr. !aryadi, >p. ad

( x 57 B

adiology

( x 57 B

9)?G"

dr. Taufi;urrahman, >p.9?

( x 57 B ( x 57 B

!eart >urgery

dr. +sri0al T, >p.8# dr. Gu0ar +aron, >p.)

( x 57 B >urgery

dr. #irma !utauruk, >p.)

( x 57 B

+nesthesia

dr. .ndang Fomaruddin, >p.+n

=ecture :ermatology Emergency on the >kin IV >urgery =ecture 7 Emergency on in&ury head and the treatment >urgery =ecture 5 a. >tabilitation and transport of trauma patients 257 minutes4 b.-anagement emergency patient referral 257 minutes4 "er$es =ecture % Emergency in the field of neurology and treatment "er$es =ecture ( -echanisms and management of disorders caused by impairment of consciousness intracerebral adiology =ecture ( adiologist examination to help establish the diagnosis of head V in&ury 2%77 minutes4 #sychiatry lecture Emergency psychiatry and

( x 57 B

>kin and ?enital "eurosurgery

dr. -.>yafei !am0ah, >p.FF dr. >ullyaman, >p.)>

( x 57 B

( x 57 B

>urgery

dr. Gu0ar +aron, >p.)

( x 57 B

"er$e

dr. oe0wir +0hary, >p.>

( x 57 B

"er$e

dr. oe0wir +0hary, >p.>

( x 57 B

adiology

dr. !aryadi, >p. ad

( x 57 B #sychiatry

dr. Doro #ramesti, >p.F&

treatment2%77 minutes4 =ecture % interna The type poisoning and management of

( x 57 B

I#:

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dr. +li Imron, >p.#:.,

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dr. +.Taruna, >p.#:

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