DEFINITIONS
Emergency Acute Respiratory Syndrome (Adult Respiratory Intensive Care Syndrome) is a type of lung failure with a variety of different abnormalities, which resulted in the collection of fluid in the lungs (pulmonary edema).
Severe acute respiratory syndrome is a medical emergency that can occur in people who previously had normal lungs. Although often called acute respiratory syndrome, acute adult, this condition can also occur in children.
CAUSE
Could cause any disease, directly or indirectly injure the lung:
Severe and widespread infection (sepsis)
Pneumonia
* Very low blood pressure (shock)
* Terhirupnya food into the lungs (inhaling vomit from the stomach)
* Multiple blood transfusions
* Damage to the lungs by inhaling a high concentration of oxygen
* Pulmonary embolism
* Injury to the chest
* Severe burns
* Drowning
* Operation cardiopulmonary bypass
* Inflammation of the pancreas (pancreatitis)
* Overdose of drug such as heroin, methadone, or aspirin propoksifen
* Severe trauma
* Blood transfusion (especially in very large quantity).
Symptoms usually appear within 24-48 hours after the occurrence of disease or injury.
SGPA often coincided with failure of other organs, like liver or kidneys. is one risk factor is cigarette smoking than SGPA. SGPA incidence is about 14 among 100 000 persons per year.
SYMPTOMS
Severe acute respiratory syndrome occurred within 24-48 hours of the basic abnormalities.
At first the patient will experience shortness of breath, usually in the form of rapid and shallow breathing.
Due to low oxygen levels in the blood, the skin looks pale or blue, and other organs like the heart and brain function disorders. The loss of oxygen because this syndrome can cause complications from other organ syndrome occurs immediately after or several days / weeks later when the patient does not improve the situation. Loss of oxygen that lasts a long time can cause serious complications such as kidney failure. Without proper treatment, 90% of cases ended with death. When given appropriate treatment, 50% of patients will survive. Because the patient is less able to fight infection, they usually suffer from bacterial pneumonia in the history of the disease. Other symptoms that may be found:
- Anxiety, feeling his end approaching
- Low blood pressure or shock (low blood pressure accompanied by other organ failure)
- Patients are often unable to complain because it looks very painful symptoms.
DIAGNOSIS
On physical examination using a stethoscope, abnormal respiratory sounds (like ronki or wheezing). Blood pressure is often low and the skin, lips and nails sufferer looks bluish (cyanosis, due to lack of oxygen).
Examinations are usually done to diagnose SGPA:
* X-ray chest (indicating the accumulation of fluid in a place that should be filled with air)
* Arterial blood gases
* Calculate the blood type and blood chemistry
* Bronchoscopy.
TREATMENT
Patients with severe acute respiratory syndrome treated in intensive care units.
Oxygen therapy is very important to correct the blood oxygen level, oxygen is often given in high concentrations (100% oxygen may be required). When oxygen delivery to the front lid not managed to overcome the problem, it is necessary to use tools respirator (ventilator). Ventilator delivering oxygen by using the pressure through a pipe inserted into the nose, mouth or trachea; pressure helps put oxygen into the blood. The applied pressure can be adjusted to help keep the opening small airways and alveoli, and to ensure the lungs do not receive excessive concentration due to excessive concentrations can damage the lungs and aggravate the syndrome. Other supportive treatment such as giving intravenous fluids or food (via infusion) is also important because dehydration or malnutrition may occur that could cause the cessation of organ function (a state known as multiple organ failure). Specific drugs given to treat infection, reduce inflammation and remove fluid from the lungs. For example, in infection are given antibiotics.
Showing posts with label Coronary Heart Disease. Show all posts
Showing posts with label Coronary Heart Disease. Show all posts
Thursday, May 27, 2010
Management of abdominal TRAUMA
INTRODUCTION
Abdominal cavity is a cavity with the support of the rear of the structure of the spine, lumbo-sacral torako entire cavity is filled with muscle and connective tissue which is relatively vulnerable to trauma, when compared with the framework of the chest.
On the top is below the diaphragm and pelvic diaphragm constituted by a skeleton propped up by the pelvis. The side of the face entirely in the form of the muscle, whose strength is relative depending on the degree of burden that are routinely given to the muscles.
As a result of protective construction abdominal cavity, the organs contained within the abdominal cavity becomes very susceptible to trauma either sharp or blunt trauma injury, trauma is a relatively "lightweight" is enough to cause organ damage, intra-torakal, but without handled quickly and appropriately, will be able to cause a fatal condition.
Three things that cause medical emergencies Intra-Abdomen, Namely:
th hemorrhage due to trauma that damage the liver, lymph, abdominal aortic or venous blood vessels of the mesentery, mesocolon and omentum, and retroperitoneal organ damage.
Peritonitis due to th difusa tercecernya intestinal contents into the peritoneal cavity due to intestinal leakage.
Dissemination th kidney damage and urinary bladder.
Pathophysiology
Abdominal Trauma divides the sharp trauma, trauma and blunt trauma bullets.
Trauma sharp or sharps puncture gave lesion on kutis and subcutis, when more deeply involve the abdominal muscles, and the puncture will penetrate deeper into the peritoneum and intraperitoneal organs capable of injuring or may directly injure when traumatic retroperitoneal organs come from behind. Very rarely encountered sharp penetrating trauma from the face to the rear wall of the abdomen or vice versa.
Sharp trauma of the abdominal wall will cause bleeding in situ, when the trauma through the peritoneum, there may be polas omentum.
Sharp trauma can easily injure the liver, mesentery and mesocolon, gastric, pancreatic or jar, but due to the nature of mobility, rarely injure the small intestine, colon, spleen and kidney.
Resulting from sharp trauma on the bleeding that usually is observed, or if the injury is affected by gastric, gastric acid will be found to spread within the peritoneal cavity, which will give a great enough stimulus, such as signs of peritonitis.
The situation somewhat different on the bullet penetrating trauma, in which organ damage rather "Complicated", because it made possible the emergence of multi-organ damage. Due to the rotation speed and bullet penetration which occurred, in the form of laceration injuries that occurred greater than the diameter of the bullet. In the event of perforation diameter of the abdomen, possible occurrence of intraperitoneal and retroperitoneal organ damage at once. In these circumstances, other than bleeding, frequent intestinal perforation was also found that multiple, and extensive retroperitoneal hemorrhage.
Blunt trauma from the direction of advance, the damage generally occurs due to trauma by pinching between the lumbar spine. The situation that often occurs is perforated gastric or hepatic rupture. Liver and spleen rupture was found in a state of hepatomegaly and / or splenomegali. Ruptured jar found, if at the appropriate trauma advance jars - jars in a state full of urine.
ENFORCEMENT DIAGNOSIS
Sharp trauma and penetrating trauma of the bullet is very easily diagnosed, which needs to be established with certainty is whether the trauma is through the abdominal wall. Blunt abdominal trauma requires a careful physical examination, to determine whether there is damage to intraperitoneal organs. Necessary to distinguish the existence of peritonitis or peritonitis due to reaction tertumpahnya intestinal contents or blood in the peritoneal cavity freely, or signs of bleeding peritonismus due to stimulation of the abdominal wall or retroperitoneal bleeding. When clinical diagnosis is not obtained by physical-certainty, abdominal x-rays need to be made in an upright position or semi-sitting and lateral decubitus position, with the hope of finding of free air or free intraperitoneal fluid.
Intraperitoneal hemorrhage allegations are supported by the location of trauma, general condition of patients, specifically the state of hemoglobin and hematocrit levels in blood, and when necessary with kanula puncture the abdominal wall.
Suspicion of renal trauma, which is supported by the diantarannya hematuria, can be assessed by making nefrografi with intra venous contrast (IVP) and rupture mug, can be detected with sistografi, which is found when blunt trauma is accompanied suprasimfisis signs of peritonitis, haematuria with a diuresis relatively small.
ACTION RESPONSE
Evaluation th state of the heart-lung
Overcome th state of shock as well as improving the condition of fluid and electrolyte balance
Place the catheter in dauer th
Exploration th injury / trauma laparotomy in all cases, sharp and penetrating trauma rounds, held in an operating room, in general narcotics, with a preparatory tool for laparotomy.
Exploration th wound to ensure, whether the wound through the peritoneum or not, if the wound through the peritoneum, exploratory laparotomy forwarded action.
th laparotomy exploration has been conducted to blunt abdominal trauma, when the lesion for signs of bleeding and / or intra-peritoneal free air.
Preparation th blood transfusion Hb level sufficient to at least 10 benchmarks.
Special Policy:
th arterial haemorrhage: controlled by ligation
th intestinal perforation / Gastric: closed perforations. When there are multiple intestinal perforation, or extensive laceration of the intestines / colon, should be simple to hemikolektomi resection, in order to minimize trauma and operation time shortened.
th liver rupture: a simple sewing done until lobektomia liver taste.
th Ruptured spleen: splenectomy performed, suturing the spleen to be unsatisfactory, because kerapukan network and the high level of bleeding.
Damage th pancreas: attempted reconstruction, when the trauma of the head of the pancreas which, if damaged section toward the caudal pancreatic body, pancreatic resection should be performed.
Ruptured th jar: usually just a simple suturing
th Ruptured kidney: tends to conservative therapy, antibiotics and hemostatikum. In a state of "Shattered Kidney" or the hilum progressive renal bleeding, considered nefrektomi action.
th prolapsed omentum: can not ever put omentum is not in the operating room in conjunction with exploratory laparotomy
CLOSING
yr, good observation, followed by quick action and adequate treatment, patients do not have to die as a result of abdominal trauma, except in the state of the abdominal aorta rupture.
Although th state of the process toward medical emergencies in abdominal trauma going pretty slow, does not mean we can put the triage victims of abdominal trauma at a low level.
th Need to exercise, education, adequate or extensive experience, so that someone who engaged in the field of medical emergencies can quickly, accurately and precisely, to determine the definitive diagnostics of abdominal trauma, especially in blunt trauma, so that therapy is fast, accurate and adequate can be applied.
th physical examination, clinical diagnostics is very important with or without medical support.
Abdominal cavity is a cavity with the support of the rear of the structure of the spine, lumbo-sacral torako entire cavity is filled with muscle and connective tissue which is relatively vulnerable to trauma, when compared with the framework of the chest.
On the top is below the diaphragm and pelvic diaphragm constituted by a skeleton propped up by the pelvis. The side of the face entirely in the form of the muscle, whose strength is relative depending on the degree of burden that are routinely given to the muscles.
As a result of protective construction abdominal cavity, the organs contained within the abdominal cavity becomes very susceptible to trauma either sharp or blunt trauma injury, trauma is a relatively "lightweight" is enough to cause organ damage, intra-torakal, but without handled quickly and appropriately, will be able to cause a fatal condition.
Three things that cause medical emergencies Intra-Abdomen, Namely:
th hemorrhage due to trauma that damage the liver, lymph, abdominal aortic or venous blood vessels of the mesentery, mesocolon and omentum, and retroperitoneal organ damage.
Peritonitis due to th difusa tercecernya intestinal contents into the peritoneal cavity due to intestinal leakage.
Dissemination th kidney damage and urinary bladder.
Pathophysiology
Abdominal Trauma divides the sharp trauma, trauma and blunt trauma bullets.
Trauma sharp or sharps puncture gave lesion on kutis and subcutis, when more deeply involve the abdominal muscles, and the puncture will penetrate deeper into the peritoneum and intraperitoneal organs capable of injuring or may directly injure when traumatic retroperitoneal organs come from behind. Very rarely encountered sharp penetrating trauma from the face to the rear wall of the abdomen or vice versa.
Sharp trauma of the abdominal wall will cause bleeding in situ, when the trauma through the peritoneum, there may be polas omentum.
Sharp trauma can easily injure the liver, mesentery and mesocolon, gastric, pancreatic or jar, but due to the nature of mobility, rarely injure the small intestine, colon, spleen and kidney.
Resulting from sharp trauma on the bleeding that usually is observed, or if the injury is affected by gastric, gastric acid will be found to spread within the peritoneal cavity, which will give a great enough stimulus, such as signs of peritonitis.
The situation somewhat different on the bullet penetrating trauma, in which organ damage rather "Complicated", because it made possible the emergence of multi-organ damage. Due to the rotation speed and bullet penetration which occurred, in the form of laceration injuries that occurred greater than the diameter of the bullet. In the event of perforation diameter of the abdomen, possible occurrence of intraperitoneal and retroperitoneal organ damage at once. In these circumstances, other than bleeding, frequent intestinal perforation was also found that multiple, and extensive retroperitoneal hemorrhage.
Blunt trauma from the direction of advance, the damage generally occurs due to trauma by pinching between the lumbar spine. The situation that often occurs is perforated gastric or hepatic rupture. Liver and spleen rupture was found in a state of hepatomegaly and / or splenomegali. Ruptured jar found, if at the appropriate trauma advance jars - jars in a state full of urine.
ENFORCEMENT DIAGNOSIS
Sharp trauma and penetrating trauma of the bullet is very easily diagnosed, which needs to be established with certainty is whether the trauma is through the abdominal wall. Blunt abdominal trauma requires a careful physical examination, to determine whether there is damage to intraperitoneal organs. Necessary to distinguish the existence of peritonitis or peritonitis due to reaction tertumpahnya intestinal contents or blood in the peritoneal cavity freely, or signs of bleeding peritonismus due to stimulation of the abdominal wall or retroperitoneal bleeding. When clinical diagnosis is not obtained by physical-certainty, abdominal x-rays need to be made in an upright position or semi-sitting and lateral decubitus position, with the hope of finding of free air or free intraperitoneal fluid.
Intraperitoneal hemorrhage allegations are supported by the location of trauma, general condition of patients, specifically the state of hemoglobin and hematocrit levels in blood, and when necessary with kanula puncture the abdominal wall.
Suspicion of renal trauma, which is supported by the diantarannya hematuria, can be assessed by making nefrografi with intra venous contrast (IVP) and rupture mug, can be detected with sistografi, which is found when blunt trauma is accompanied suprasimfisis signs of peritonitis, haematuria with a diuresis relatively small.
ACTION RESPONSE
Evaluation th state of the heart-lung
Overcome th state of shock as well as improving the condition of fluid and electrolyte balance
Place the catheter in dauer th
Exploration th injury / trauma laparotomy in all cases, sharp and penetrating trauma rounds, held in an operating room, in general narcotics, with a preparatory tool for laparotomy.
Exploration th wound to ensure, whether the wound through the peritoneum or not, if the wound through the peritoneum, exploratory laparotomy forwarded action.
th laparotomy exploration has been conducted to blunt abdominal trauma, when the lesion for signs of bleeding and / or intra-peritoneal free air.
Preparation th blood transfusion Hb level sufficient to at least 10 benchmarks.
Special Policy:
th arterial haemorrhage: controlled by ligation
th intestinal perforation / Gastric: closed perforations. When there are multiple intestinal perforation, or extensive laceration of the intestines / colon, should be simple to hemikolektomi resection, in order to minimize trauma and operation time shortened.
th liver rupture: a simple sewing done until lobektomia liver taste.
th Ruptured spleen: splenectomy performed, suturing the spleen to be unsatisfactory, because kerapukan network and the high level of bleeding.
Damage th pancreas: attempted reconstruction, when the trauma of the head of the pancreas which, if damaged section toward the caudal pancreatic body, pancreatic resection should be performed.
Ruptured th jar: usually just a simple suturing
th Ruptured kidney: tends to conservative therapy, antibiotics and hemostatikum. In a state of "Shattered Kidney" or the hilum progressive renal bleeding, considered nefrektomi action.
th prolapsed omentum: can not ever put omentum is not in the operating room in conjunction with exploratory laparotomy
CLOSING
yr, good observation, followed by quick action and adequate treatment, patients do not have to die as a result of abdominal trauma, except in the state of the abdominal aorta rupture.
Although th state of the process toward medical emergencies in abdominal trauma going pretty slow, does not mean we can put the triage victims of abdominal trauma at a low level.
th Need to exercise, education, adequate or extensive experience, so that someone who engaged in the field of medical emergencies can quickly, accurately and precisely, to determine the definitive diagnostics of abdominal trauma, especially in blunt trauma, so that therapy is fast, accurate and adequate can be applied.
th physical examination, clinical diagnostics is very important with or without medical support.
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