MODULE GENERAL EMERGENCY LIFE SUPPORT 1

PROBLEM BASED LEARNING

#9 GROUP

Group Members

Alvin Fajri Yudistio (Leader) Dian Nirmala Aprilia (Secretary) Amal Arifi Hidayat (Notulen) Dini Lukita Hapsari Andhika Hilman Pramudita Mega Kahdina Tatit Syahadani A. Zefrizal Nanda Mardani Nur Aprilianita Pratama Ersalina Primadita Luthfi Hidayatullah Atisomya Kinanthi Olyvia Sita Aldisa Thadea Rafaela Andira Ledyastatin

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Scenario
A man 27 years old, fell while running a race mounting nut on August 17 celebrations. The patient was taken to the ER by ambulance. A few moments later the patient experienced loss in consciousness and seemed anxious. The examination found a quick breath (tachypnea), left upper limb look swell and there are small wounds with a little blood on the surface.

Main Problem

A man 27 years old, fell while running a race mounting nut on August 17 celebrations, a few moments later, he experienced a decrease in consciousness and seemed anxious. Found a tachypnea, left upper limb look swell and there are small wounds with a little blood on the surface.

Keywords
Falls from heights Decrease in consciousness Anxious Tachypneu Swelling in left upper limb Small wounds

Anamnesis
Name: Mr. S. Occupation: Unemployment Status: Not married. Fall at a height of 3 m and crushed by falling to the position of another participant above him.

Sign and Symptoms

Loss in consciousness Anxious Left upper limb look swell There are small wounds with a little blood on the surface Occurred kussmaul breathing, convulsions, cyanosis, pallor, not moving at all, and cardiac arrest.

Physical Examination
Blood pressure: 90/- mmHg RR: 36 x/minute fast, symmetrical HR: 128 x/minute weak charging Perifer perfussion: Cold, wet, pale Response to verbal Spine : Normal Breath sounds : Normal

Laboratory Examination

X-Ray : Oblique fracture femur sinistra (shorten and displacement)

Hypothesis

Mr. S experienced hypovolemic shock and bleeding in due to fall from a height.

Early Mind Mapping

ER
3m Vital Sign: RR= 36 X/minute Blood pressure: 90/- mmHg HR: 128 X/minute weak charging Perifer Perfussion: Cold, wet, pale General Conditions: Decrease in consciousness Anxious Tachypneu Swelling in left upper limb Laboratory Examination: X-Ray : Oblique fracture femur sinistra (shorten and displacement)

Signs of Shock

Hypovolemic Shock

Learning Issues I

Types of shock

Inflammation and the mechanism

Inflammation is a protective respond to local injury or damage caused by injured tissue in that area, it will destroy, reduce or confining the agent of injured tissue (Dorland, 2002). There are two types of imflammation:

Acute inflammation Chronic inflammation

Physical examination for femoral fracture

Inspection Palpation Range of motion Check the spine and other lower extremity joints Muscle strength Sensory examination Hop test

Cause of unconscious
Unconsciousness is the condition of being not conscious, a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Loss of consciousness may occur as the result of traumatic brain injury, brain hypoxia, severe poisoning with drugs that depress the activity of the central nervous system, severe fatigue, and other causes.

Analysis I

Analysis I
The cause of loss of consciousness and instability caused by the patient's condition left femur fracture. The results of X- ray that we get, looks oblique fracture experiencing shorten and displacement. This causes bleeding inside and triggered the edema and shock hipovolemic.

Analysis I
At first sight there is not serious problem considering there are only small wounds on the skin surface. But that internal bleeding that occurs due to a fracture in the making vital sign patient decrease can endanger the patients life if not treated immediately.

Learning Issues II

Basic Life Support

Basic Life Support refers to maintaining adequate ventilation and circulation until a means can be obtained to reverse the underlying cause of the arrest.
One of the key points taught in BLS are the "ABCs":

Airway Breathing Circulation

Advance Life Support

ALS (Advanced Life Support) is basically one step up from basic life support. The early stages are the same as BLS. Some actions that which are usually taken in ALS:

Tracheal intubation Cardiac monitoring and cardiac defibrillation Transcutaneous pacing Intravenous cannulation (IV) Intraosseous (IO) access and intraosseous infusion etc.

Fracture management
Diagnosis of the fracture is done mainly by plain films but may also include CT and/or MRI imaging. The basic principles of fracture management are the obtaining and maintaining of fracture reduction. Obtaining a reduction may involve manipulating a fracture while maintaining a reduction involves the splinting of a fracture.

Shock management

General management

Airway and breathing maintenance

Oxygen and saturation monitor Cardiac monitor Intravenous access and send blood to lab Control any external bleeding applying pressure Foley catheter monitor urine output Ongoing assessment of clinical parameters

Shock management

Specific management

ABCs

Consult surgery if active control of internal hemorrhage is needed Fluid resuscitation:

Ringers lactate or normal saline 1-2 liters administered rapidly (20ml/kg in children) 3 ml fluid for 1 ml blood loss Blood transfusion: If no response or transient response to 2 - 3L fluids Platelets and FFP

Ethical and legal aspects of emergency

In emergency life support doctor used to take an action directly so that the doctor use presumed Consent, which consent medically without the consent of the patient or accompanying family in order to save the life of patients. The doctor must give the information once the patient is awake or there is a family that has come.

Ethical and legal aspects of emergency

When

patient arrived in hospital, doctor should write down all the actions taken for the patient honestly and completely. If there are nobody accompanies the patient, the hospital should give best emergency life support freely.

Analysis II

Analysis II
The cause of loss of consciousness and instability caused by the patient's condition left femur fracture. The results of X- ray that we get, looks oblique fracture experiencing shorten and displacement. This causes bleeding inside and triggered the edema and shock hipovolemic.

Analysis II

Patient fall from a high 3m that caused swollen at his left tight (lower limb) with a little bleeding and some sign of shocked such as unconscious, tachypnea breathing, impalpable pulse and blood pressure 90/-. Result of left tight x-ray showed patient get fracture with oblique type. Because his left tight get swollen and oblique fracture but with a little bleeding indicate that patient suffer inside bleeding and closed fracture.

Analysis II

Bleeding at tight or femur area will cause 1.5-2 l blood loss (30-40 % from 5L total blood volume) that caused hypovolemic shock. The only way to make the patient condition better soon is replace the blood volume that loos soon by give him infusion as emergency help. When we give infusion, accompanied this action with airway and bleeding management that arranged from CPR, monitoring airway management, and set the patient to shock position to elevate intracranial pressure accordingly.

Analysis II

Do infusion by give NaCl 0.95 20-40 cc/kg at 10-20 minutes. Than check the hemodynamic. If the value of hemodynamic good continue with give deficit remaining & maintenance infusion. But if the hemodynamic value bad repeat give NaCl 0.95 20-40 cc/kg for 10-20 first minutes until hemodynamic test shows good and continue with give deficit remaining & maintenance infusion too. Continue with fracture management.

Final Hypothesis

Mr.

S had fracture that cause hipovolemic shock.

Final Mind Maping

Open word document

Conclussion

A man 27 years old fell while running a race as high as 3 meters mounting nut. Patient experienced loss of consciousness, seemed agited, upper left leg was swollen and there was a little blood minor injuries. From examination of the patient breathing 36 times per minute, pulse 128 times per minute, blood pressure of 90/- mmHg, occurs percussion tissue and results of X-Ray photo from patient. The results of patients suspected of having symptoms of hypovolemic shock (much liquid out) and closed fractures occur with this type of fracture is oblique.

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