1. Tingkat kesadaran


    Tingkat kesadaran adalah ukuran dari kesadaran dan respon seseorang terhadap rangsangan dari lingkungan, tingkat kesadaran dibedakan menjadi :

    1. Compos Mentis (conscious), yaitu kesadaran normal, sadar sepenuhnya, dapat menjawab semua pertanyaan tentang keadaan sekelilingnya.
    2. Apatis, yaitu keadaan kesadaran yang segan untuk berhubungan dengan sekitarnya, sikapnya acuh tak acuh.
    3. Delirium, yaitu gelisah, disorientasi (orang, tempat, waktu), memberontak, berteriak-teriak, berhalusinasi, kadang berhayal.
    4. Somnolen (Obtundasi, Letargi), yaitu kesadaran menurun, respon psikomotor yang lambat, mudah tertidur, namun kesadaran dapat pulih bila dirangsang (mudah dibangunkan) tetapi jatuh tertidur lagi, mampu memberi jawaban verbal.
    5. Stupor (soporo koma), yaitu keadaan seperti tertidur lelap, tetapi ada respon terhadap nyeri.
    6. Coma (comatose), yaitu tidak bisa dibangunkan, tidak ada respon terhadap rangsangan apapun (tidak ada respon kornea maupun reflek muntah, mungkin juga tidak ada respon pupil terhadap cahaya).

    Perubahan tingkat kesadaran dapat diakibatkan dari berbagai faktor, termasuk perubahan dalam lingkungan kimia otak seperti keracunan, kekurangan oksigen karena berkurangnya aliran darah ke otak, dan tekanan berlebihan di dalam rongga tulang kepala.

    Adanya defisit tingkat kesadaran memberi kesan adanya hemiparese serebral atau sistem aktivitas reticular mengalami injuri. Penurunan tingkat kesadaran berhubungan dengan peningkatan angka morbiditas (kecacatan) dan mortalitas (kematian).

    Jadi sangat penting dalam mengukur status neurologikal dan medis pasien. Tingkat kesadaran ini bisa dijadikan salah satu bagian dari vital sign.

    Penyebab Penurunan Kesadaran

    Penurunan tingkat kesadaran mengindikasikan difisit fungsi otak. Tingkat kesadaran dapat menurun ketika otak mengalami kekurangan oksigen (hipoksia); kekurangan aliran darah (seperti pada keadaan syok); penyakit metabolic seperti diabetes mellitus (koma ketoasidosis) ; pada keadaan hipo atau hipernatremia ; dehidrasi; asidosis, alkalosis;

    pengaruh obat-obatan, alkohol, keracunan: hipertermia, hipotermia; peningkatan tekanan intrakranial (karena perdarahan, stroke, tomor otak); infeksi (encephalitis); epilepsi.

    Mengukur Tingkat Kesadaran

    Salah satu cara untuk mengukur tingkat kesadaran dengan hasil seobjektif mungkin adalah menggunakan GCS (Glasgow Coma Scale). GCS dipakai untuk menentukan derajat cedera kepala. Refleks membuka mata, respon verbal, dan motorik diukur dan hasil pengukuran

    dijumlahkan jika kurang dari 13, makan dikatakan seseorang mengalami cedera kepala, yang menunjukan adanya penurunan kesadaran. Metoda lain adalah menggunakan sistem AVPU, dimana pasien diperiksa apakah sadar baik (alert), berespon dengan kata-kata (verbal), hanya berespon jika dirangsang nyeri (pain), atau pasien tidak sadar sehingga tidak berespon baik verbal maupun diberi rangsang nyeri (unresponsive).

    Ada metoda lain yang lebih sederhana dan lebih mudah dari GCS dengan hasil yang kurang lebih sama akuratnya, yaitu skala ACDU, pasien diperiksa kesadarannya apakah baik (alertness), bingung / kacau (confusion), mudah tertidur (drowsiness), dan tidak ada respon (unresponsiveness).

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  2. BONES TERMINOLOGY



    Several terms are used to refer to features and components of bones throughout the body:

    Bone featureDefinition
    articular processA projection that contacts an adjacent bone.
    articulationThe region where adjacent bones contact each other — a joint.
    canalA long, tunnel-like foramen, usually a passage for notable nerves or blood vessels.
    condyleA large, rounded articular process.
    crestA prominent ridge.
    eminenceA relatively small projection or bump.
    epicondyleA projection near to a condyle but not part of the joint.
    facetA small, flattened articular surface.
    foramenAn opening through a bone.
    fossaA broad, shallow depressed area.
    foveaA small pit on the head of a bone.
    labyrinthA cavity within a bone.
    lineA long, thin projection, often with a rough surface. Also known as a ridge.
    malleolusOne of two specific protuberances of bones in the ankle.
    meatusA short canal.
    processA relatively large projection or prominent bump.(gen.)
    ramusAn arm-like branch off the body of a bone.
    sinusA cavity within a cranial bone.
    spineA relatively long, thin projection or bump.
    sutureArticulation between cranial bones.
    trochanterOne of two specific tuberosities located on the femur.
    tubercleA projection or bump with a roughened surface, generally smaller than a tuberosity.
    tuberosityA projection or bump with a roughened surface.

    Several terms are used to refer to specific features of long bones:

    Bone featureDefinition
    diaphysisThe long, relatively straight main body of a long bone; region of primary ossification. Also known as the shaft.
    epiphysisThe end regions of a long bone; regions of secondary ossification.
    epiphyseal plateAlso known as the growth plate or physis. In a long bone it is a thin disc of hyaline cartilage that is positioned transversely between the epiphysis and metaphysis. In the long bones of humans, the epiphyseal plate disappears by twenty years of age.
    headThe proximal articular end of the bone.
    metaphysisThe region of a long bone lying between the epiphysis and diaphysis.
    neckThe region of bone between the head and the shaft.


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  3. HEART ATTACK


    What is a heart attack?

    A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen,causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

    Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.




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  4. SURGICAL SAFETY CHECKLIST

    CLICK PICTURE FOR BETTER RESOLUTION

    Example from ER Season 15 Episode 19 of the need for following a checklist to ensure consistency of measurement.



    This is a demonstration of how the WHO Safe Surgery Saves Lives Checkist functions in an operation, in this case a hernia repair. For more information on the Checklist and the Safe Surgery Saves Lives Campaign, visit www.safesurg.org.
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  5. CARDIAC ARRHYTMIA



    Example of ventricular fibrillation, a deadly cardiac arrhythmia if not treated within minutes


    Simulation and electrocardiogram corresponding to the heart's normal sinus rhythm. The atrial contraction is initiated by the depolarization wave (shown in yellow), which originates from the sinoatial node and corresponds to the P wave on the ECG. After a delay passing through the atrioventricular node, the activation passes to the ventricles and produces a contraction. The QRS complex indicates ventricular depolarization (shown in yellow), while the T wave corresponds to ventricular repolarization.
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  6. NASAL CANNULA (NC)


    The nasal cannula (NC) is a device used to deliver supplemental oxygen or airflow to a patient or person in need of respiratory help. This device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils. Oxygen flows from these prongs.[1] The nasal cannula is connected to an oxygen tank, a portable oxygen generator, or a wall connection in a hospital via a flowmeter. The nasal cannula carries 1–6 litres of oxygen per minute. There are also infant or neonatal nasal cannulas which carry less than one litre per minute; these also have smaller prongs. The oxygen fraction provided to the patient ranges roughly from 24% to 35%, or the cannula may merely supply humidified air.

    The nasal cannula was invented by Wilfred Jones and patented in 1949 by his employer, BOC.


    Supplemental oxygen

    A nasal cannula is generally used wherever small amounts of supplemental oxygen are required, without rigid control of respiration, such as in oxygen therapy. Most cannulas can only provide oxygen at low flow rates—up to 6 litres per minute (L/min)—delivering an oxygen concentration of 28–44%. Rates above 6 L/min can result in discomfort to the patient, drying of the nasal passages, and possibly nose bleeds (epistaxis).

    The nasal cannula is often used in elderly patients or patients who can benefit from oxygen therapy but do not require it to self respirate. These patients do not need oxygen to the degree of wearing a non-rebreather mask. It is especially useful in those patients where vasoconstriction could negatively impact their condition, such as those suffering from strokes. It may also be used by pilots and passengers in small, unpressurized aircraft that do not exceed certain altitudes. The cannula provides extra oxygen to compensate for the lower oxygen content available for breathing at the low ambient air pressures of high altitude, preventing hypoxia. Special aviation cannula systems are manufactured for this purpose.

    [edit]Nasal high flow

    High flows of an air/oxygen blend can be administered via a nasal cannula to accurately deliver high concentrations of oxygen.[2] Respiratory gas humidification allows the high flows to be delivered comfortably via the cannula.[3] Nasal high flow can be used as an alternative to face mask oxygen and allows the patient to continue to talk, eat and drink while receiving the therapy.[4]


    References

    1. ^ Image of nasal cannula from Glasgow Rescue Squad
    2. ^ Sim, DA; Dean, P; Kinsella, J; Black, R; Carter, R; Hughes, M (September 2008). "Performance of oxygen delivery devices when the breathing pattern of respiratory failure is simulated.". Anaesthesia 62 (9): 938–40. PMID 18540928.
    3. ^ Turnbull, B (2008). "High-flow humidified oxygen therapy used to alleviate respiratory distress". British Journal of Nursing (Mark Allen) 17 (19): 1226–30. PMID 18974691.
    4. ^ Tiruvoipati, Ravindranath; Lewis, David; Haji, Kavi; Botha, John (September 2009). Journal of Critical Care (World Federation of Societies of Intensive and Critical Care Medicine). doi:10.1016/j.jcrc.2009.06.050. PMID 19781896

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  7. Glasgow Coma Scale



    Glasgow Coma Scale


    Eye OpeningE
    spontaneous4
    to speech3
    to pain2
    no response1
    Best Motor ResponseM
    To Verbal Command:
    obeys6
    To Painful Stimulus:
    localizes pain5
    flexion-withdrawal4
    flexion-abnormal3
    extension2
    no response1
    Best Verbal ResponseV
    oriented and converses5
    disoriented and converses4
    inappropriate words3
    incomprehensible sounds2
    no response1

    E + M + V = 3 to 15

    • 90% less than or equal to 8 are in coma
    • Greater than or equal to 9 not in coma
    • 8 is the critical score
    • Less than or equal to 8 at 6 hours - 50% die
    • 9-11 = moderate severity
    • Greater than or equal to 12 = minor injury

    Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.



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  8. Recycle

    Recycling symbols can be further divided into two separate categories.
    1. 'Recyclable' symbols marking products made from specific materials that are suitable for recycling depending on whether there is a collection mechanism in place within the local community for those particular materials.
    2. 'Recycled' symbols designating products containing recycled materials.

    'Recycled' symbol for paperboard

    'Recyclable' symbol for glass

    'Recyclable' symbol for corrugated

    'Recyclable' symbols for plastic
    bottles, containers and packaging

    Polyethylene Terephthalate (PETE or PET)

    MOLECULAR FORMULA:

    (-CO-C6H4-CO-O-CH2-CH2-O-)n
    Properties: toughness, strength, heat resistance, barrier to moisture and gas. Density: 1.35-1.38 g/cc

    Statistic: In 1999 PET accounted for 48% of plastic bottle resin sales, making it the most widely used resin in plastic bottles

    Description: PET, also referred to as polyester, is a popular packaging material for food and non-food products because it is inexpensive, lightweight, resealable, shatter-resistant and recyclable. PET is clear and has good moisture and gas barrier properties. Its color may be green. The flakes and pellets of cleaned postconsumer recycled PET are in heavy demand for use in spinning carpet yarns and for producing fiberfill and geotextiles.

    Packaging applications: Soft drink bottles, water bottles, beer bottles, mouthwash bottles, peanut butter containers, salad dressing containers, juice bottles, vegetable oil bottles

    Recycled products: Fiber, tote bags, new PETE containers for both food and non-food products, fabric for clothing, athletic shoes, luggage, upholstery, furniture, carpet, fiberfill for sleeping bags and winter coats, industrial strapping, sheet, and film, and automotive parts, such as luggage racks, headliners, fuse boxes, bumpers, grilles and door panels



    High Density Polyethylene (HDPE)

    MOLECULAR FORMULA:

    (-CH2-CH2-)n
    Properties: toughness, strength, stiffness, ease of forming, ease of processing, resistance to moisture and chemicals, permeability to gas. Density: 0.94-0.96 g/cc

    Statistic: In 1999 HDPE accounted for 47% of plastic bottle resin sales, making it the second most widely used resin in plastic bottles. HDPE and PETE together accounted for 95% of plastic bottle resin usage

    Description: Bottles made from HDPE come in both pigmented and unpigmented resins. The unpigmented resin is translucent. It also has good stiffness and barrier properties. Thus, it is ideal for packaging products having a short shelf-life such as milk. HDPE's good chemical resistance allows it to be used in containers holding household or inductrial chemicals. The pigmented resin has even better crack resistance and chemical resistance than the unpigmented resin.

    Packaging applications: Milk containers, juice bottles, water bottles, bleach, detergent, and shampoo bottles, trash bags, grocery and retail carrying bags, motor oil bottles, butter and margarine tubs, household cleaner bottles, yogurt containers, and cereal box liners

    Recycled products: Drainage pipe, liquid laundry detergent bottles, oil bottles, pens, benches, doghouses, recycling containers, floor tile, picnic tables, fencing, lumber, and mailbox posts

    Polyvinyl Chloride (PVC, sometimes V)

    MOLECULAR FORMULA:

    (-CH2-CHCl-)n
    Properties: toughness, strength, ease of blending, ease of processing, resistance to grease, oil, and chemicals, clarity. Density: 1.32-1.42 g/cc

    Statistic: In 1999 PVC accounted for 2% of plastic bottle resin sales.

    Description: Vinyl, or polyvinylchloride, has stable electrical and physical properties. It has excellent chemical resistance and good weatherability. Its flow characteristics make it well-suited for injection molding.

    Packaging applications: Window cleaner bottles, cooking oil bottles, detergent bottles, shampoo bottles, clear food packaging, wire and cable jacketing, medical tubing, with additional significant usage in household products and building materials, particularly siding, piping, and windows

    Recycled products: Binders, decking, paneling, mudflaps, roadway gutters, flooring, cables, speed bumps, and mats



    Low Density Polyethylene (LDPE)

    MOLECULAR FORMULA:

    ( - CH2 - CH2 - )n
    Properties: toughness, strength, flexibility, ease of sealing, ease of processing, barrier to moisture. Density: 0.91-0.93 g/cc

    Statistic: In 1999 LDPE accounted for just 1% of plastic bottle resin sales.

    Description: Because of its toughness , flexibility, and transparency, LDPE is commonly used in applications where heat sealing is necessary. It is also widely used in wire and cable insulation and jacketing.

    Packaging applications: Squeezable bottles, breadbags, frozen food bags, tote bags, clothing, furniture, dry cleaning bags, and carpet

    Recycled products: Film and sheet, loor tile, garbage can liners, shipping envelopes, furniture, compost bins, paneling, trash cans, lumber, landscaping ties


    Polypropylene (PP)

    MOLECULAR FORMULA:

    (-CHCH3-CH2-)n

    Properties: toughness, strength, resistance to heat, grease, oil, and chemicals, barrier to moisture. Density: 0.90-0.92 g/cc

    Statistic: In 1999 PP accounted for 2% of plastic bottle resin sales.

    Description: Polypropylene has the lowest density of the resins used in packaging. It is strong and is resistant to chemicals. Since it has a high melting-point it can be utilized in applications requiring that a container be filled with a hot liquid.

    Packaging applications: Yogurt containers, syrup bottles, ketchup bottles, caps, straws, medicine bottles

    Recycled products: Signal lights, battery cables, brooms, brushes, auto battery cases, ice scrapers, landscape borders, bicycle racks, rakes, bins, pallets, and trays

    Polystyrene (PS)

    MOLECULAR FORMULA:

    (-CHC6H5-CH2-)n
    Properties: ease of forming, clarity, low heat transfer, good thermal insulation. Density: 1.03-1.06 g/cc

    Statistic: In 1999 PS usage as a plastic bottle resin was essentially nil.

    Description: Polystyrene can be made into rigid or foamed products. It has a relatively low melting point.

    Packaging applications: Plates, cups, cutlery, meat trays, egg cartons, carry-out containers, aspirin bottles, compact disc jackets

    Recycled products: Thermal insulation, light switch plates, egg cartons, vents, rulers, foam packing, carry-out containers


    Other

    Properties: varies according to constituent resins

    Statistic: In 1999 there was minimal usage of resins in the 'other' category in plastic bottles.

    Description: The category of "Other" includes any resin not specifically numbered 1, 2, 3, 4, 5, or 6, or combinations of one or more of these resins.

    Packaging applications: Three and five gallon water bottles, certain food product bottles

    Recycled products: Plastic lumber, custom-made products


    Acrylonitrile Butadiene Styrene (ABS)

    Properties: resilient, low density, rigid, impervious

    Description: Acrylonitrile butadiene styrene was not part of the original resin identification system.

    Applications: Pipes, car bumpers, toy building blocks, golf club heads, enclosures


    source:link

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