Pub Date : 2020-07-29DOI: 10.20473/ijar.v2i22020.22-29
N. S. Budi, P. Airlangga, B. Semedi
Introduction: Intracranial hemorrhage in inherited bleeding disorders is a medical emergency. The location of bleeding in most children is subdural and the most common cause is hemophilia. Although intracranial bleeding that occurs in people with hemophilia ranges from less than 5% of events, it is a life-threatening medical emergency so appropriate treatment is needed. Case Report: A boy patient 11 years old, 20kg weights have a seizure at home and followed by a decrease in consciousness. It was founded abnormalities in the form of anemia, prolonged FH (PPT 4x and APTT 4x), and hypocalcemia. The patient then was given main therapy; FVIII 100 IU/dL according to the FVIII target level calculated. The therapy continued with 500IU/12 hours according to the daily target of FVIII 50IU/dL. Discussion: The patient’s condition was getting better day by day. The patient’s consciousness started to improve after 14 days of postoperative. One month after that, the patient received koate treatment as the episodic handler. Diagnosing the exact cause in patients who have intracranial hemorrhage provides appropriate management so that the patients could be helped. Conclusion: Good collaboration between anesthesiologists, neurosurgeons, and pediatrics will increase the probability of successful management of critical bleeding without major sequelae.
{"title":"Intracranial Hemorrhage in Patients With Hemophilia A","authors":"N. S. Budi, P. Airlangga, B. Semedi","doi":"10.20473/ijar.v2i22020.22-29","DOIUrl":"https://doi.org/10.20473/ijar.v2i22020.22-29","url":null,"abstract":"Introduction: Intracranial hemorrhage in inherited bleeding disorders is a medical emergency. The location of bleeding in most children is subdural and the most common cause is hemophilia. Although intracranial bleeding that occurs in people with hemophilia ranges from less than 5% of events, it is a life-threatening medical emergency so appropriate treatment is needed. Case Report: A boy patient 11 years old, 20kg weights have a seizure at home and followed by a decrease in consciousness. It was founded abnormalities in the form of anemia, prolonged FH (PPT 4x and APTT 4x), and hypocalcemia. The patient then was given main therapy; FVIII 100 IU/dL according to the FVIII target level calculated. The therapy continued with 500IU/12 hours according to the daily target of FVIII 50IU/dL. Discussion: The patient’s condition was getting better day by day. The patient’s consciousness started to improve after 14 days of postoperative. One month after that, the patient received koate treatment as the episodic handler. Diagnosing the exact cause in patients who have intracranial hemorrhage provides appropriate management so that the patients could be helped. Conclusion: Good collaboration between anesthesiologists, neurosurgeons, and pediatrics will increase the probability of successful management of critical bleeding without major sequelae.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127763526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-29DOI: 10.20473/ijar.v2i22020.16-21
Lila Tri Harjana, Hardiono Hardiono
Introduction: Myasthenia gravis (MG) is an acquired autoimmune disorder clinically characterized by skeletal muscle weakness & fatigability on exertion with prevalence as high as 2–7 in 10,000 and women are affected more frequently than men (~3:2). Over 12-16% of generalized MG patients experience crisis once in their lifetime. A serious complication of myasthenia gravis is respiratory failure. This may be secondary to an exacerbation of myasthenia (myasthenia crisis) or to treatment with excess doses of a cholinesterase inhibitor (cholinergic crisis). Case Report: Thirty-two years old woman refereed from a private hospital to ED for further treatment with myasthenia in crisis, after nine days of treatment in the previous ICU. Patient already in intubation with mechanical ventilation and history of the treatment of a high dose of multiple anticholinesterase drugs and steroids without plasmapheresis or immunoglobulin intravenous. During admission, diarrhea was present, with no sign of GI infection. On the third day of admission, the patient performed a Spontaneous Breathing Trial and was a success then extubated. Then two day after extubation, the patient falls to respiratory failure and need mechanical ventilation. Anticholinesterase test was performed, and it shows no improvement in clinical signs, and diagnose as Cholinergic Crisis. After re-adjustment of anticholinesterase drug with a lower dose, clinically, the respiratory condition improved, and on the 10th day of admission, the patient was succeed extubated. At 12nd days of ICU admission, patient discharge from ICU. Discussion: Myasthenia and Cholinergic Crisis is a severe and life-threatening condition characterized by generalized muscle weakness with a respiratory compromise that requires ventilatory support. Respiratory failure may be present in the cholinergic crisis without cholinergic symptoms (miosis, diarrhea, urinary incontinence, bradycardia, emesis, lacrimation, or salivation). The most important management aspect of Myasthenia patients in crisis is the recognition and treatment of myasthenia vs cholinergic crisis.
{"title":"Myasthenia Crisis Vs Cholinergic Crisis: Challenges in Crisis Management Without Plasmapheresis or Intravenous Immunoglobulin (IVIG)","authors":"Lila Tri Harjana, Hardiono Hardiono","doi":"10.20473/ijar.v2i22020.16-21","DOIUrl":"https://doi.org/10.20473/ijar.v2i22020.16-21","url":null,"abstract":"Introduction: Myasthenia gravis (MG) is an acquired autoimmune disorder clinically characterized by skeletal muscle weakness & fatigability on exertion with prevalence as high as 2–7 in 10,000 and women are affected more frequently than men (~3:2). Over 12-16% of generalized MG patients experience crisis once in their lifetime. A serious complication of myasthenia gravis is respiratory failure. This may be secondary to an exacerbation of myasthenia (myasthenia crisis) or to treatment with excess doses of a cholinesterase inhibitor (cholinergic crisis). Case Report: Thirty-two years old woman refereed from a private hospital to ED for further treatment with myasthenia in crisis, after nine days of treatment in the previous ICU. Patient already in intubation with mechanical ventilation and history of the treatment of a high dose of multiple anticholinesterase drugs and steroids without plasmapheresis or immunoglobulin intravenous. During admission, diarrhea was present, with no sign of GI infection. On the third day of admission, the patient performed a Spontaneous Breathing Trial and was a success then extubated. Then two day after extubation, the patient falls to respiratory failure and need mechanical ventilation. Anticholinesterase test was performed, and it shows no improvement in clinical signs, and diagnose as Cholinergic Crisis. After re-adjustment of anticholinesterase drug with a lower dose, clinically, the respiratory condition improved, and on the 10th day of admission, the patient was succeed extubated. At 12nd days of ICU admission, patient discharge from ICU. Discussion: Myasthenia and Cholinergic Crisis is a severe and life-threatening condition characterized by generalized muscle weakness with a respiratory compromise that requires ventilatory support. Respiratory failure may be present in the cholinergic crisis without cholinergic symptoms (miosis, diarrhea, urinary incontinence, bradycardia, emesis, lacrimation, or salivation). The most important management aspect of Myasthenia patients in crisis is the recognition and treatment of myasthenia vs cholinergic crisis.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130384816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-29DOI: 10.20473/ijar.v2i22020.10-15
Ferrie Budianto, Philia Setiawan, H. Hamzah, E. Yulianti
Introduction: An alteration of cognitive function in geriatrics often occurred after a surgery procedure. To do a surgery, patients would go through the process with anesthesia, whether it is general or regional anesthesia. We aimed to identify the effect of general and regional anesthesia in increasing the risk of alteration in cognitive function from geriatrics who underwent elective surgery followed by other risks. Material and Method: This observational analytic study has a total sample of 60 patients who aged 60 years or more, and half of the total sample underwent an elective surgery with general anesthesia, whereas the other half with regional anesthesia at Gedung Bedah Pusat Terpadu Dr. Soetomo General Hospital in a range of October – November 2016. The cognitive function of patients was assessed with MMSE which is done in approximately 10 – 15 minutes. Result and Discussion: There was a statistically significant correlation between age and both preoperative MMSE score also the alteration of MMSE score after 3 days in patients with regional anesthesia (P-value = 0.032; 0.044). Also, the correlation between educational status and preoperative MMSE score (P-value = 0.001). There was also a statistically significant difference in alteration of the MMSE score after 3 days between patients with general and regional anesthesia which went through the hypotension phase (P-value = 0.022; 0.003). We identified that both general and regional anesthesia could lead to alteration of MMSE score (P-value = 0.001; 0.02) and there was a statistically significant difference between both of them (P-value = 0.001). Conclusion: Both general and regional anesthesia could lower the cognitive function of geriatrics, especially general anesthesia which happened to have a higher risk to occur. Other factors such as age, educational status, and hemodynamic condition during surgery, had their impacts toward lowering cognitive function in geriatrics.
在老年医学中，认知功能的改变通常发生在手术后。要做手术，病人要在麻醉的情况下进行，无论是全身麻醉还是局部麻醉。我们的目的是确定全身麻醉和区域麻醉对增加老年患者择期手术后认知功能改变风险的影响。材料和方法:本观察性分析研究共纳入60例60岁及以上的患者，其中一半患者于2016年10月至11月在Gedung Bedah Pusat Terpadu Dr. Soetomo总医院接受了全麻选择性手术，另一半患者接受了区域麻醉。用MMSE评估患者的认知功能，大约10 - 15分钟完成。结果与讨论:年龄与区域麻醉患者术前MMSE评分及3 d后MMSE评分变化均有统计学意义(p值= 0.032;0.044)。此外，教育程度与术前MMSE评分之间存在相关性(p值= 0.001)。经过低血压期的全麻和区域麻醉患者3 d后MMSE评分的改变也有统计学意义(p值= 0.022;0.003)。我们发现全身麻醉和区域麻醉都可能导致MMSE评分的改变(p值= 0.001;0.02)，两者差异有统计学意义(p值= 0.001)。结论:全麻和区域麻醉均可降低老年人的认知功能，特别是全麻发生的风险较高。其他因素，如年龄、教育程度和手术时血流动力学状况，对老年人认知功能的降低也有影响。
{"title":"Comparing Alteration of MMSE (Mini-Mental State Examination) Scores as Cognitive Function Test in Geriatrics After General and Regional Anesthesia","authors":"Ferrie Budianto, Philia Setiawan, H. Hamzah, E. Yulianti","doi":"10.20473/ijar.v2i22020.10-15","DOIUrl":"https://doi.org/10.20473/ijar.v2i22020.10-15","url":null,"abstract":"Introduction: An alteration of cognitive function in geriatrics often occurred after a surgery procedure. To do a surgery, patients would go through the process with anesthesia, whether it is general or regional anesthesia. We aimed to identify the effect of general and regional anesthesia in increasing the risk of alteration in cognitive function from geriatrics who underwent elective surgery followed by other risks. Material and Method: This observational analytic study has a total sample of 60 patients who aged 60 years or more, and half of the total sample underwent an elective surgery with general anesthesia, whereas the other half with regional anesthesia at Gedung Bedah Pusat Terpadu Dr. Soetomo General Hospital in a range of October – November 2016. The cognitive function of patients was assessed with MMSE which is done in approximately 10 – 15 minutes. Result and Discussion: There was a statistically significant correlation between age and both preoperative MMSE score also the alteration of MMSE score after 3 days in patients with regional anesthesia (P-value = 0.032; 0.044). Also, the correlation between educational status and preoperative MMSE score (P-value = 0.001). There was also a statistically significant difference in alteration of the MMSE score after 3 days between patients with general and regional anesthesia which went through the hypotension phase (P-value = 0.022; 0.003). We identified that both general and regional anesthesia could lead to alteration of MMSE score (P-value = 0.001; 0.02) and there was a statistically significant difference between both of them (P-value = 0.001). Conclusion: Both general and regional anesthesia could lower the cognitive function of geriatrics, especially general anesthesia which happened to have a higher risk to occur. Other factors such as age, educational status, and hemodynamic condition during surgery, had their impacts toward lowering cognitive function in geriatrics.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134121331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The use of ketamine and tramadol as postoperative analgesics for pediatric are still relatively rare, especially orally administrated. As an analgesic, ketamine blocks the NMDA receptor, the main excitatory transmitter in CNS; whereas tramadol blocks serotonin and norepinephrine uptake, thus preventing pain transmission on the spinal cord. Objective: The aim of this study is to compare the effectiveness of oral ketamine and oral tramadol as analgesics for postoperative acute pain in children. Method: A double-blind randomized clinical trial was conducted at Dr. Soetomo Hospital. The hospital ethical committee had approved this study. The subject includes thirty children aged 5-10 years old who fulfilled the inclusion criteria. They were divided into either ketamine groups or the tramadol group, in which each group consisting of fifteen patients. The regimen dosage that been given was 2mg/kg tramadol and ketamine as postoperative oral analgesics in the form of simple syrup. The FLACC table was used to evaluate pain score before and after administration of drugs (30-minutes, 1-hour, 2-hours, 3-hours, 4-hours, and at discharge from the recovery room). Result and Discussion: Based on the quantitative parameter of the FLACC (scale 0-10), there was a significant difference (p<0.05) between the first-hour postoperative administration and patient discharge from the recovery room. The patient of ketamine group had far lower FLACC value compared to the tramadol group. Rescue analgesics in the form of intravenous fentanyl were given to one patient (6.7%) in the ketamine group and four patients (26.7%) in the tramadol group. Conclusion: Ketamine proved to be a better and more effective postoperative oral analgesic compared to tramadol in this study.
{"title":"Ketamine Versus Tramadol Effectiveness as Postoperative Oral Analgesics on Pediatric Patients Age 5-10 Years in Elective Surgery at Dr. Soetomo Hospital Surabaya","authors":"Herdiani Sulistyo Putri, Elizeus Hanindito, Herdy Sulistyono","doi":"10.20473/ijar.v2i22020.1-9","DOIUrl":"https://doi.org/10.20473/ijar.v2i22020.1-9","url":null,"abstract":"Introduction: The use of ketamine and tramadol as postoperative analgesics for pediatric are still relatively rare, especially orally administrated. As an analgesic, ketamine blocks the NMDA receptor, the main excitatory transmitter in CNS; whereas tramadol blocks serotonin and norepinephrine uptake, thus preventing pain transmission on the spinal cord. Objective: The aim of this study is to compare the effectiveness of oral ketamine and oral tramadol as analgesics for postoperative acute pain in children. Method: A double-blind randomized clinical trial was conducted at Dr. Soetomo Hospital. The hospital ethical committee had approved this study. The subject includes thirty children aged 5-10 years old who fulfilled the inclusion criteria. They were divided into either ketamine groups or the tramadol group, in which each group consisting of fifteen patients. The regimen dosage that been given was 2mg/kg tramadol and ketamine as postoperative oral analgesics in the form of simple syrup. The FLACC table was used to evaluate pain score before and after administration of drugs (30-minutes, 1-hour, 2-hours, 3-hours, 4-hours, and at discharge from the recovery room). Result and Discussion: Based on the quantitative parameter of the FLACC (scale 0-10), there was a significant difference (p<0.05) between the first-hour postoperative administration and patient discharge from the recovery room. The patient of ketamine group had far lower FLACC value compared to the tramadol group. Rescue analgesics in the form of intravenous fentanyl were given to one patient (6.7%) in the ketamine group and four patients (26.7%) in the tramadol group. Conclusion: Ketamine proved to be a better and more effective postoperative oral analgesic compared to tramadol in this study.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131153337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-30DOI: 10.20473/ijar.v2i12020.13-19
Fariza Nur Aini Widyani, April Poerwanto Basuki, Djohar Nuswantoro
Introduction: Triage is a system to sort patients based on their urgency for care during an emergency. In addition, to determine patient’s severity, triage reduces time wasted and overcrowding in the emergency room.1 Triage errors such as over-triage or under-triage must not exceed 35% and 5% of the total numbers of patients respectively. Dr. Soetomo General Hospital of Surabaya with its status as one of type “A” hospital in Indonesia that has good amenities, facilities, and infrastructures which is also the main referral hospital from Primary or Secondary Health Care, is prone to patients overcrowding. The high number of patients and the demands for high-quality service as the main referral hospital require higher qualification from health care professionals in term of cognitive, skills, and attitude. Objective: This study conducted to evaluate the level of knowledge of the ER (Emergency Room) nurses at Dr. Soetomo General Hospital in 2019 towards triage. Methods and Materials: This study is a quantitative descriptive study using a validated questionnaire with 32 nurses as the samples. Results and Discussion: Demographic profile showed that majority of nurses are: female (52%), age 26 – 35 years old (46 %), graduated from D3 (61%), have been working in this field for >15 years (46%), attended Basic Life Support Training (33%), and have moderate knowledge in triage (61%). Conclusion: Emergency room nurses of Dr Soetomo General Hospital had adequate knowledge in triage. The researcher considers there might be some factors influencing nurse’s knowledge in triage.
{"title":"Triage Knowledge of Emergency Rooms Nurses at Dr Soetomo Regional General Hospital","authors":"Fariza Nur Aini Widyani, April Poerwanto Basuki, Djohar Nuswantoro","doi":"10.20473/ijar.v2i12020.13-19","DOIUrl":"https://doi.org/10.20473/ijar.v2i12020.13-19","url":null,"abstract":"Introduction: Triage is a system to sort patients based on their urgency for care during an emergency. In addition, to determine patient’s severity, triage reduces time wasted and overcrowding in the emergency room.1 Triage errors such as over-triage or under-triage must not exceed 35% and 5% of the total numbers of patients respectively. Dr. Soetomo General Hospital of Surabaya with its status as one of type “A” hospital in Indonesia that has good amenities, facilities, and infrastructures which is also the main referral hospital from Primary or Secondary Health Care, is prone to patients overcrowding. The high number of patients and the demands for high-quality service as the main referral hospital require higher qualification from health care professionals in term of cognitive, skills, and attitude. Objective: This study conducted to evaluate the level of knowledge of the ER (Emergency Room) nurses at Dr. Soetomo General Hospital in 2019 towards triage. Methods and Materials: This study is a quantitative descriptive study using a validated questionnaire with 32 nurses as the samples. Results and Discussion: Demographic profile showed that majority of nurses are: female (52%), age 26 – 35 years old (46 %), graduated from D3 (61%), have been working in this field for >15 years (46%), attended Basic Life Support Training (33%), and have moderate knowledge in triage (61%). Conclusion: Emergency room nurses of Dr Soetomo General Hospital had adequate knowledge in triage. The researcher considers there might be some factors influencing nurse’s knowledge in triage.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130524476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.20473/ijar.v1i12019.1-7
Filipus M Yofrido, Lila Tri Harjana
Introduction: Disasters occur in all areas of the world and cause harm to populations, property, infrastructure, economies, and the environment.1Harm to populations includes death, injury, disease, malnutrition, and psychological stress.1Social-friction often isn’t recognized during disaster response and recovery. Objective: This report explored the existence of social-friction in disaster situation which able to make recovery more complex. Method: This was qualitative study with phenomenology report approach. The data collection was done by indepth interviewing five inhabitants when doing emergency disaster response two weeks after massive earthquake in North Lombok. Result and discussion: Two out of five inhabitants were Lombok native-people, the rest were immigrant. An inhabitant reported their feeling treated unfair by aid agencies because they received less aid than others. In another chance, when distributing clean-water, we were intercepted, they argue that they got more lack of water than another group who live far distally. Both claimed treated unfair making a dispute friction.Ethnic or social origin, language, religion, gender, age, physical or mental disability, and sexual orientation are just some of the deep-rooted causes of social-friction that can have such a devastating impact on their lives.Social-friction in everyday life rarely endangers lives, but in an emergency situation, it can be life-threatening. It affects not only people’s ability to survive the crisis, also their capacity to recover and regain their livelihoods. Conclusion: Risk reduction and preparedness are just as important a part of the process as any aspect of a disaster.Dialogue is fundamental in good programme design, monitoring and evaluation, and systematic efforts to listen to all groups affected by disaster can help pre-empt and remedy unfair-perception.Perhaps,most importantly, understanding and respecting the complex cultural context in which aid agencies are working and using the strategies and mechanismsto detectand minimize social-friction, will result great improvement in the effectiveness and equity of perceived support in humanitarian assistance.2
{"title":"Social-Fairness Perception in Natural Disaster, Learn from Lombok: A Phenomenological Report","authors":"Filipus M Yofrido, Lila Tri Harjana","doi":"10.20473/ijar.v1i12019.1-7","DOIUrl":"https://doi.org/10.20473/ijar.v1i12019.1-7","url":null,"abstract":"Introduction: Disasters occur in all areas of the world and cause harm to populations, property, infrastructure, economies, and the environment.1Harm to populations includes death, injury, disease, malnutrition, and psychological stress.1Social-friction often isn’t recognized during disaster response and recovery. Objective: This report explored the existence of social-friction in disaster situation which able to make recovery more complex. Method: This was qualitative study with phenomenology report approach. The data collection was done by indepth interviewing five inhabitants when doing emergency disaster response two weeks after massive earthquake in North Lombok. Result and discussion: Two out of five inhabitants were Lombok native-people, the rest were immigrant. An inhabitant reported their feeling treated unfair by aid agencies because they received less aid than others. In another chance, when distributing clean-water, we were intercepted, they argue that they got more lack of water than another group who live far distally. Both claimed treated unfair making a dispute friction.Ethnic or social origin, language, religion, gender, age, physical or mental disability, and sexual orientation are just some of the deep-rooted causes of social-friction that can have such a devastating impact on their lives.Social-friction in everyday life rarely endangers lives, but in an emergency situation, it can be life-threatening. It affects not only people’s ability to survive the crisis, also their capacity to recover and regain their livelihoods. Conclusion: Risk reduction and preparedness are just as important a part of the process as any aspect of a disaster.Dialogue is fundamental in good programme design, monitoring and evaluation, and systematic efforts to listen to all groups affected by disaster can help pre-empt and remedy unfair-perception.Perhaps,most importantly, understanding and respecting the complex cultural context in which aid agencies are working and using the strategies and mechanismsto detectand minimize social-friction, will result great improvement in the effectiveness and equity of perceived support in humanitarian assistance.2","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115656887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.20473/ijar.v1i12019.19-25
David Wicaksono, L. Herawati, Herdy Sulistyono
Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient’s pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients’ pain level were measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion: The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.
{"title":"Pain Level of Postoperative Orthopedic Patients at Dr. Soetomo General Hospital","authors":"David Wicaksono, L. Herawati, Herdy Sulistyono","doi":"10.20473/ijar.v1i12019.19-25","DOIUrl":"https://doi.org/10.20473/ijar.v1i12019.19-25","url":null,"abstract":"Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient’s pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients’ pain level were measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion: The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114616433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.20473/ijar.v1i12019.26-31
R. Alfaray, Muhammad Mahfud, Rafiqy Sa’adiy Faizun
Introduction: Ventilator-Associated pneumonia (VAP) is pneumonia that occurs in patients who have been mechanically ventilated for a duration of more than 48 hours. The duration of ventilator use was identified as a risk factor which is a trigger of VAP. Objective: This study aimed to determine the association between the duration of ventilator use and the incidence of VAP in patients in the Intensive Care Unit of Dr. Mohammad Hoesin General Hospital, Palembang. Method and Material: This study was an observational analytic study using a cross-sectional design. The samples were all patients who use a ventilator for more than 48 hours at the ICU room period of July 1, 2014, to June 30, 2015. Data were obtained from the patient’s medical records of a total of 146 patients, but the number of patients who comply with the criteria was 106 patients. Result and Discussion: Out of the 106 samples, 41 patients (38.7%) developed VAP and 65 patients (61.3%) did not develop VAP. The analysis using Chi-Square test showed that patients who used ventilator for >5 days had an OR = 3.273 compared to patients using ventilator 2-5 days (p-value = 0.016; 95% CI = 1.223 to 8.754). Conclusion: There is a significant association between the duration of ventilator use and the incidence of VAP in patients at the ICU of Dr. Mohammad Hoesin General Hospital, Palembang. Patients using ventilators for more than 5 days 3,386 times more at risk of developing VAP compared to patients using ventilators 2-5 days. The riskiest time for the patient using ventilator was more than 5 days of usage. And, the mortality rate of VAP patients was 63.4% from 41 patients while the mortality rate of whole ICU patients was 50.9%.
简介:呼吸机相关性肺炎(VAP)是在机械通气超过48小时的患者中发生的肺炎。使用呼吸机的持续时间被确定为触发VAP的危险因素。目的:本研究旨在确定巨港Dr. Mohammad Hoesin总医院重症监护室患者呼吸机使用时间与VAP发生率之间的关系。方法和材料:本研究为观察性分析研究，采用横断面设计。样本为2014年7月1日至2015年6月30日在ICU病房使用呼吸机超过48小时的患者。从患者病历中获得的数据共146例，但符合标准的患者数量为106例。结果与讨论:106例患者中，41例(38.7%)发生VAP, 65例(61.3%)未发生VAP。卡方检验分析显示，与使用呼吸机2-5天的患者相比，使用呼吸机>5天的患者OR = 3.273 (p值= 0.016;95% CI = 1.223 ~ 8.754)。结论:巨港Dr. Mohammad Hoesin综合医院ICU患者呼吸机使用时间与VAP发生率之间存在显著相关性。使用呼吸机5天以上的患者发生VAP的风险是使用呼吸机2-5天的患者的3386倍。患者使用呼吸机的最危险时间为使用5天以上。41例VAP患者的死亡率为63.4%，而全ICU患者的死亡率为50.9%。
{"title":"Duration Of Ventilation Support Usage And Development Of Ventilator-Associated Pneumonia: When Is The Most Time At Risk?","authors":"R. Alfaray, Muhammad Mahfud, Rafiqy Sa’adiy Faizun","doi":"10.20473/ijar.v1i12019.26-31","DOIUrl":"https://doi.org/10.20473/ijar.v1i12019.26-31","url":null,"abstract":"Introduction: Ventilator-Associated pneumonia (VAP) is pneumonia that occurs in patients who have been mechanically ventilated for a duration of more than 48 hours. The duration of ventilator use was identified as a risk factor which is a trigger of VAP. Objective: This study aimed to determine the association between the duration of ventilator use and the incidence of VAP in patients in the Intensive Care Unit of Dr. Mohammad Hoesin General Hospital, Palembang. Method and Material: This study was an observational analytic study using a cross-sectional design. The samples were all patients who use a ventilator for more than 48 hours at the ICU room period of July 1, 2014, to June 30, 2015. Data were obtained from the patient’s medical records of a total of 146 patients, but the number of patients who comply with the criteria was 106 patients. Result and Discussion: Out of the 106 samples, 41 patients (38.7%) developed VAP and 65 patients (61.3%) did not develop VAP. The analysis using Chi-Square test showed that patients who used ventilator for >5 days had an OR = 3.273 compared to patients using ventilator 2-5 days (p-value = 0.016; 95% CI = 1.223 to 8.754). Conclusion: There is a significant association between the duration of ventilator use and the incidence of VAP in patients at the ICU of Dr. Mohammad Hoesin General Hospital, Palembang. Patients using ventilators for more than 5 days 3,386 times more at risk of developing VAP compared to patients using ventilators 2-5 days. The riskiest time for the patient using ventilator was more than 5 days of usage. And, the mortality rate of VAP patients was 63.4% from 41 patients while the mortality rate of whole ICU patients was 50.9%.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124092514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.20473/ijar.v1i12019.13-18
Khoir Amaliin, A. Nurrahmah, Nancy Margarita Rehatta, Choesnan Effendi
Introduction: Uncontrolled pain has many negative effects to the body. The Guideline of Pain Management has been specifically arranged, but assessment and pain treatment in the Emergency Room (ER) have not adequate yet. Integrated pain assessment before and after treatment is very important in monitoring pain management effectiveness. Objective: The aim of this study was to determine pain score of emergency patients before and after treatment. This study was also conducted to record the treatment timing that was given by the paramedics in the emergency room. Method and Material: This study was a description research with 40 trauma patients as samples in the ER at Dr. Soetomo Hospital. Patient’s pain level was measured twice, before the treatment and an hour after that. The pain level was measured using Visual Analog Scale (VAS). Patients were given ketorolac 30mg intravenous as the treatment. Result and Discussion: There were2.5% of the patients VAS 1 and the other 12.5% VAS 10. An hour after treatment 20% of the ER patients were free of pain and the rest 7.5% VAS 6. The average of VAS before the treatment were 6.38 ± 2.1and an hour after later they decreased to 2.23 ± 1.7. There were only 67.5% of the ER patients that were treated in the 1st hour, 17.5% of them were treated in the 2nd hour, the other 10% were treated in the 3rd hour, and the last 5% of them were treated in the 4th hour. Conclusion:The average value of pain was decreased when one hour after administration of pain therapy by paramedics, but therapy at different times showed no difference in the level of pain reduction that can be inferred.
不受控制的疼痛对身体有许多负面影响。虽然有专门的疼痛管理指南，但急诊室的疼痛评估和治疗还不够充分。治疗前后的综合疼痛评估对监测疼痛管理效果非常重要。目的:研究急诊患者治疗前后的疼痛评分。本研究还记录了急诊室护理人员给出的治疗时间。方法与材料:本研究是一项描述性研究，以Dr. Soetomo医院急诊室的40例创伤患者为样本。在治疗前和治疗后一小时分别测量患者的疼痛程度。采用视觉模拟评分法(VAS)测量疼痛程度。患者给予酮咯酸30mg静脉注射治疗。结果与讨论:评分为1分的占2.5%，评分为10分的占12.5%。治疗1小时后，20%的ER患者无疼痛感，其余患者VAS评分为7.5%。治疗前VAS评分平均值为6.38±2.1，治疗后1 h VAS评分平均值降至2.23±1.7。第1小时就诊的患者仅占67.5%，第2小时就诊的患者占17.5%，第3小时就诊的患者占10%，第4小时就诊的患者占5%。结论:护理人员给予疼痛治疗1小时后，疼痛的平均值有所降低，但不同时间的治疗对疼痛的减轻程度没有差异，可以推断。
{"title":"Pain Treatment On Trauma Patient In Dr.Soetomo General Hospital Emergency Room","authors":"Khoir Amaliin, A. Nurrahmah, Nancy Margarita Rehatta, Choesnan Effendi","doi":"10.20473/ijar.v1i12019.13-18","DOIUrl":"https://doi.org/10.20473/ijar.v1i12019.13-18","url":null,"abstract":"Introduction: Uncontrolled pain has many negative effects to the body. The Guideline of Pain Management has been specifically arranged, but assessment and pain treatment in the Emergency Room (ER) have not adequate yet. Integrated pain assessment before and after treatment is very important in monitoring pain management effectiveness. Objective: The aim of this study was to determine pain score of emergency patients before and after treatment. This study was also conducted to record the treatment timing that was given by the paramedics in the emergency room. Method and Material: This study was a description research with 40 trauma patients as samples in the ER at Dr. Soetomo Hospital. Patient’s pain level was measured twice, before the treatment and an hour after that. The pain level was measured using Visual Analog Scale (VAS). Patients were given ketorolac 30mg intravenous as the treatment. Result and Discussion: There were2.5% of the patients VAS 1 and the other 12.5% VAS 10. An hour after treatment 20% of the ER patients were free of pain and the rest 7.5% VAS 6. The average of VAS before the treatment were 6.38 ± 2.1and an hour after later they decreased to 2.23 ± 1.7. There were only 67.5% of the ER patients that were treated in the 1st hour, 17.5% of them were treated in the 2nd hour, the other 10% were treated in the 3rd hour, and the last 5% of them were treated in the 4th hour. Conclusion:The average value of pain was decreased when one hour after administration of pain therapy by paramedics, but therapy at different times showed no difference in the level of pain reduction that can be inferred.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125216281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.20473/ijar.v1i12019.8-12
Rahmat Sayyid Zharfan, Ahmad Hakim, A. Purba, Soni Sunarso Sulistiawan, B. Semedi
Introduction: Sepsis is presented as a complex and multifactorial syndrome where the morbidity and mortality rates still high around the world. Strong evidencewith regard to early predictive factors for mortality and morbidity is rare to be provided. Objective: The aim of this study was to analyse the prominent predictors from the values of laboratory findings among patients with sepsis. Method and Material: The study was an analytic observational study with a case-control approach. The data were extracted from patients' medical records between 2014 and 2015. This study involved 50 septic patients admitted to Dr. Soetomo General Hospital, Surabaya, Indonesia. Blood urea nitrogen (BUN), creatinine serum, albumin, leukocytes count, haemoglobin, hematocrite, platelets, sodium, potassium, chloride, prothrombin time (PT), and activated partial thromboplastin time (APTT) were collected from blood samples. Logistic regression was used to estimate sepsis related mortalities frequencies and the relationship between laboratory findings and under 28-days mortality. Result and Discussion: From 50 patients, 22 patients were died (44%).The regression model was intially conducted using all three biomarkers as covariates, then using backward elimination, the covariate with the highest p-value was eliminated. The process was repeated until covariates with statistically significant remained. Multivariate analysis showed that albumin, leukocytes count, and prothrombin time (PT) were the findings associated with high mortality. The independent predictors of mortality identified by further multivariate regression analysis were taken into account as a lower than 3.5 g/dL of albumin, above12.000/µL of leukocytes count, and prolonged more than 14 seconds of prothrombin time; with p value <0,05 respectively (0.029; 0.049; 0.027). Conclusion: Notably, low albumin level, elevated levels of leukocytes, and prolonged prothrombin time were clinically considered as independent predictors of mortality among adult patients with sepsis.
{"title":"Albumin, Leukosit, And Protrombin As Predictors Of Sepsis Mortality Among Adult Patients In Soetomo General Hospital, Surabaya, Indonesia","authors":"Rahmat Sayyid Zharfan, Ahmad Hakim, A. Purba, Soni Sunarso Sulistiawan, B. Semedi","doi":"10.20473/ijar.v1i12019.8-12","DOIUrl":"https://doi.org/10.20473/ijar.v1i12019.8-12","url":null,"abstract":"Introduction: Sepsis is presented as a complex and multifactorial syndrome where the morbidity and mortality rates still high around the world. Strong evidencewith regard to early predictive factors for mortality and morbidity is rare to be provided. Objective: The aim of this study was to analyse the prominent predictors from the values of laboratory findings among patients with sepsis. Method and Material: The study was an analytic observational study with a case-control approach. The data were extracted from patients' medical records between 2014 and 2015. This study involved 50 septic patients admitted to Dr. Soetomo General Hospital, Surabaya, Indonesia. Blood urea nitrogen (BUN), creatinine serum, albumin, leukocytes count, haemoglobin, hematocrite, platelets, sodium, potassium, chloride, prothrombin time (PT), and activated partial thromboplastin time (APTT) were collected from blood samples. Logistic regression was used to estimate sepsis related mortalities frequencies and the relationship between laboratory findings and under 28-days mortality. Result and Discussion: From 50 patients, 22 patients were died (44%).The regression model was intially conducted using all three biomarkers as covariates, then using backward elimination, the covariate with the highest p-value was eliminated. The process was repeated until covariates with statistically significant remained. Multivariate analysis showed that albumin, leukocytes count, and prothrombin time (PT) were the findings associated with high mortality. The independent predictors of mortality identified by further multivariate regression analysis were taken into account as a lower than 3.5 g/dL of albumin, above12.000/µL of leukocytes count, and prolonged more than 14 seconds of prothrombin time; with p value <0,05 respectively (0.029; 0.049; 0.027). Conclusion: Notably, low albumin level, elevated levels of leukocytes, and prolonged prothrombin time were clinically considered as independent predictors of mortality among adult patients with sepsis.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130611534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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