DECREASE IN CONCIOUSNESS

Group 6

Scenario
A 48 year old man was taken to PUSKESMAS in a lost of consciousness condition. After laid on the bed and undergone some examinations, the patient was not giving any response and remained snorring with breathing frequency of 32 times per minute, weak pulse 100 bpm. According to the family who took him to the PUSKESMAS, the patient was not in any trauma preceding the condition.

Clarification
Snoring: rough, noisy breathing during sleep due to vibration of the uvula and soft palate

Questions
The etiology of unconciousness? Why the patient snoring? Classification of shock? Sign of airway obstruction? How we manage this patient? Additional anamnesis Emergencies drugs

The etiology of unconciousness

Etiology

Nontrauma

trauma

Extracranial

Intracranial

Head trauma

Abdominal injury

Thoracic injury

Metabolic cause Circulatory collapse -cardiac cause(arrythmia, MI) -septicemic shock -hypovolemic

Alcohol/drug intoxication

Cerebrovascular disease

Infection of CNS

Why the patient snoring?

unconcious

Paralyzed of Glossopharyngeal Nerves

Motoric movement of tongue disturbed

Tongue partially blocking the airway

Little amount of air friction in airway lumen cause snoring

Classification of shock
Hypovolemic:
decreased intravascular volume-dehydration or hemorrhage

Cardiogenic :
inability of the heart to pump blood-MI,valve disorders,dysrhythmias,arrest

Distributive or vasogenic:
abnormality in the vascular system that produces a maldistribution of blood volume neurogenic anaphylactic, septic, capillary leak

Obstructive
tension pneumo, pulmonary embolism, pulmonary HTN

Sign of airway obstructions

Cyanosis Wheezing Choking Altered conciousness Breathing difficulty

INITIAL ASSESSMENT
Preparation Triage

Primary Survey ( ABCDE )

Resuscitation

Secondary Survey ( Head to toe evaluation )

Definitive Care

Management
PRIMARY SURVEY Airway -Look : pernafasan ada 32x/menit (tachypneu) -Listen : terdengar suara snoring (sumbatan yang terjadi karena jatuhnya pangkal lidah ke belakang) -Feel : ada hawa ekshalasi Penanganan Airway Head tilt atau chin lift, setelah jalan nafas bersih dan tidak ada lagi obstruksi, dilakukan pemasangan pipa oropharing untuk mempertahankan potensi jalan nafas. Tapi, apabila masih sesak kita lakukan penanganan bagian breathing

Breathing -Look : menggunakan otot bantu pernafasan atau tidak -Listen : suara nafas kedua paru -Feel : merasakan udara yang keluar dari mulut dan hidung Penanganan Breathing Jika pasien masih takipneu setelah kita bebaskan Airway, mungkin terdapat masalah pada pernafasannya. Apabila terlihat retraksi otot pernafasan tapi kedua gerak dada simetris, penanganan awalnya adalah pemberian terapi oksigen. Tetapi apabila gerak dada pasien tidak simetris kita curigai ada pneumothorax, dan penanganannya adalah thoracotomi.

Circulation Penilaian sirkulasi bisa dilihat dari tanda klinis syok : - Kulit telapak tangan dingin, pucat, basah - Capillary refill time (CRT) >2detik - Nadi cepat >100 - Tekanan darah sistole <90-100 - Kesadaran : gelisah s/d koma

Disability Pemeriksaan neurologis singkat : Alert/Awake Verbal stimulation Pain stimulation Unresponsive

SECONDARY SURVEY >Anamnesis : - Alergi - Medikasi - Past Illness - Last Meal - Event/Environtment >Pemeriksaan fisik (head to toe) >Pemeriksaan penunjang -Radiologi, pemeriksaan lab (darah dan urine),analisa gas darah

 Monitoring Setelah melakukan semua penanganan pada pasien, pasien perlu di monitoring terus mengenai ABCD dan tanda vital lainnya

Emergency drugs

 Adrenalin efineprin

Lidocain Amiodaron

Dobutamin HCL Furosemide Digoxin

Aminofilin

vasopresin

Anti-arrithmic

jantung kongestif

Bronchospas m

Morfin Pethidin

Diazepam

MgSO4

DiphenhydramineHCl /Delladryl

Analgetik

Eklamsi

Preeklamsi

Anti-histamin

Dopamin atropin Norefine-prin Noradrenalin

Cedocard(angina perctoris) nitrogliserin

Bradikardi

Anti-hiprtensi

THANK YOU ANY QUESTION?

Question
What type of shock related to the case GCS for the patient When do you initiate administriation of the drugs ,is it necessary Oxygen treatment use