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7/27/2019 Decrease in Conciousness
http://slidepdf.com/reader/full/decrease-in-conciousness 1/19
DECREASE IN CONCIOUSNESS
Group 6
7/27/2019 Decrease in Conciousness
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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 thePUSKESMAS, the patient was not in any trauma
preceding the condition.
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Clarification
• Snoring: rough, noisy breathing during sleep
due to vibration of the uvula and soft palate
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The etiology of unconciousness
Etiology
Nontrauma
Extracranial
Circulatorycollapse-cardiac
cause(arrythmia,MI)
-septicemic shock-hypovolemic
Metabolic
cause
Alcohol/drug
intoxication
Intracranial
Cerebrovascular
disease
Infection of
CNS
trauma
Head traumaAbdominal
injuryThoracic injury
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Why the patient snoring?
unconciousParalyzed of
GlossopharyngealNerves
Motoricmovement of
tongue disturbed
Tongue partiallyblocking the
airway
Little amount ofair friction inairway lumencause snoring
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Classification of shock
• Hypovolemic: – decreased intravascular volume-dehydration or
hemorrhage
• Cardiogenic :
– inability of the heart to pump blood-MI,valvedisorders,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
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Sign of airway obstructions
• Cyanosis
• Wheezing
•
Choking• Altered conciousness
• Breathing difficulty
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“INITIAL ASSESSMENT” Preparation
Triage
Primary Survey ( ABCDE )
Resuscitation
Secondary Survey ( Head to toe evaluation )
Definitive Care
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Management
• PRIMARY SURVEY
Airway
-Look : pernafasan ada 32x/menit (tachypneu)
-Listen : terdengar suara snoring (sumbatan yang terjadikarena jatuhnya pangkal lidah ke belakang)
-Feel : ada hawa ekshalasi
Penanganan Airway
Head tilt atau chin lift, setelah jalan nafas bersih dan tidak adalagi obstruksi, dilakukan pemasangan pipa oropharing untukmempertahankan potensi jalan nafas. Tapi, apabila masihsesak kita lakukan penanganan bagian breathing
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Breathing
-Look : menggunakan otot bantu pernafasan atau tidak
-Listen : suara nafas kedua paru
-Feel : merasakan udara yang keluar dari mulut danhidung
Penanganan Breathing
Jika pasien masih takipneu setelah kita bebaskanAirway, mungkin terdapat masalah pada pernafasannya.Apabila terlihat retraksi otot pernafasan tapi keduagerak dada simetris, penanganan awalnya adalahpemberian terapi oksigen. Tetapi apabila gerak dadapasien tidak simetris kita curigai ada pneumothorax,
dan penanganannya adalah thoracotomi.
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Circulation
Penilaian sirkulasi bisa dilihat dari tanda klinissyok :
- Kulit telapak tangan dingin, pucat, basah
- Capillary refill time (CRT) >2detik
- Nadi cepat >100
- Tekanan darah sistole <90-100
- Kesadaran : gelisah s/d koma
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Disability
Pemeriksaan neurologis singkat :
Alert/AwakeVerbal stimulation
Pain stimulation
Unresponsive
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SECONDARY SURVEY
>Anamnesis :
- Alergi
- Medikasi
- Past Illness- Last Meal
- Event/Environtment
>Pemeriksaan fisik (head to toe)
>Pemeriksaan penunjang-Radiologi, pemeriksaan lab (darah danurine),analisa gas darah
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• Monitoring
Setelah melakukan semua penanganan pada
pasien, pasien perlu di monitoring terus
mengenai ABCD dan tanda vital lainnya
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Emergency drugs
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• Adrenalin
• efineprin
vasopresin
• Lidocain
• Amiodaron
Anti-arrithmic
• Dobutamin HCL
• Furosemide
• Digoxin
jantungkongestif
• Aminofilin
Bronchospasm
• Morfin
Pethidin
Analgetik
• Diazepam
Eklamsi
• MgSO4
Preeklamsi
• Diphenhy-dramineHCl/Delladryl
Anti-histamin
• Dopamin
• atropin
• Norefine-prin
• Noradrenalin
Bradikardi
• Cedocard(anginaperctoris)
• nitrogliserin
Anti-hiprtensi
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THANK YOU…
ANY QUESTION?
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Question
• What type of shock related to the case
• GCS for the patient
•
When do you initiate administriation of thedrugs ,is it necessary
• Oxygen treatment use