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DECREASE IN CONCIOUSNESS

Group 6

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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