Gastrointestinal Emergency 7ed 2009

Nonvariceal upper gastrointestinal bleeding Peptic ulcer is the most common cause of nonvaricea upper gastrointestinal bleeding. These ulcers are mainly caused by Helicobacter pylori or by nonsteroidal antiinfl  ammatory drugs. H. pylori can be found in the stomach in 95% of patients with a duodenal ulceand in most patients with a gastric ulcer not associ ated with NSAID use. Daily NSAID usage causes an estimated 40-fold increase in gastric ulcer creation and an 8-fold increase in duodenal ulcer creation [2] As the peptic ulcer defect invades deeper into the gas troduodenal mucosa, the arterial wall weakens and necrosis develops. This leads to the development of a pseudoaneurysm which can rupture and then bleed ing may result. Duodenal ulcers are more common

Read More
https://www.box.com/s/f391d5e0ef09fb4d08ca

Diagnosis and Management Emergency MEdicine 7Ed

Many changes have been made to this new edition, which incorporates the latest ideas and evidence base underpinning the best emergency medicine care. The whole text has been revised and updated from the latest 2010 international guidelines on cardiopulmonary resuscitation, right through to favourite handy hints
and practical tips. Also included are brand new sections on Critical Care Emergencies and Practical Procedures, plus expanded sections on Paediatric Emergencies, Infectious Disease and Foreign Travel Emergencies, and Environmental Emergencies, and the addition of normal laboratory values and precise
drug doses.
A standardized approach to every condition has been retained throughout, with the text consistently formatted to maximize ease of use and the practical delivery of patient care. This book is as much designed for the bedside as it is for studying.The text is now supported by a wealth of additional online material at http://
lifeinthefastlane.com/. This includes high-resolution clinical images, procedural videos, case-based clinical questions, additional reading material and links to online references, all available for free.
The emergency department is rightly regarded as the ‘front door’ to the hospital. No matter how busy it may be, or how much inpatient beds are at a premium, each new patient deserves high-quality care from the moment he or she arrives. We hope this book will help you deliver on this challenge.

Read more...
https://www.box.com/s/bb4f3e8c31f502c94e57

Emergency Medicine

SUGGESTED OUTLINE OF ATTACK
The following outline provides one method of consistently approaching and treating an exam patient. This system includes a “Primary Survey,” which may be interrupted for acute interventions and ordering of tests, a “Secondary Survey,” and provision of treatment and disposition. A brief outline is provided below; details of each phase are described in the following sections. It is usually important to cover all of these issues during each case. The editors strongly encourage you to develop your own individualized approach to the patient based on the current history, the physical, and on the treatment approach of your own practice.


Read more
https://www.box.com/s/3c5a47e72e6f96dae1a6

DM Guedlines 2011

Current criteria for the diagnosis of
diabetes

• A1C 6.5%. The test should be performed in a laboratory using a method that isNational Glycohemoglobin Standardization Program (NGSP)-certified and standardized to the Diabetes Control and Complications Trial (DCCT) assay
• fasting plasma glucose (FPG) 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h, or
• 2-h plasma glucose 200 mg/dl (11.1mmol/l) during an oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
• in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dl (11.1 mmol/l)
• in the absence of unequivocal hyperglycemia, result should be confirmed by repeat testing.

Read more .... 
https://www.box.com/s/a29de8979659632d5fd2

NANDA NURSING DIAGNOSIS 2009-2011

Activity/Rest

ability to engage in necessary/desired activities of life (work and leisure) and to obtain adequate sleep/rest

• Activity intolerance 
• Activity intolerance, risk for
• Disuse syndrome, risk for
• Divisional activity, deficit
• Fatigue
• Insomnia
• Mobility: bed, impaired
• Mobility: physical, impaired
• Mobility: wheelchair, impaired
• Sedentary lifestyle
• Sleep deprivation
• *Sleep pattern disturbed
• Sleep, readiness for enhanced
• Transfer ability, impaired
• Walking, impaired 

Selengkapnya dapat di download disini

NANDA DIAGNOSIS 2009-2011  

NIC Interventions

Demam dan Mengigil

Definisi Operasional

•  Demam Adalah kenaikan suhu tubuh melebihi normal disertai peningkatan pusat pengatur suhu dihipotalamus
• Suhu tubuh normal : 36,5-37,5^oC, Variasi Suhu Tubuh Normal: 0,4 ^oC
• Pada usia 18-40 Th, suhu tubuh normal 36,8 ^oC±0,4^oC
• Suhu paling rendah pada pukul 06.00 (37,2 ^oC) dan paling tinggi pada pukul 16.00-18.00 (37,7 ^oC)
• Demam jika Suhu pada pukul 06.00 (>37,2 ^oC) dan pada pukul 16.00-18.00 (>37,7 ^oC), suhu rektal lebih tinggi 0,4 ^oC dari suhu oral
• Hiperpireksia jika suhu mencapai 41,5 ^oC

Anamnese pada kasus Demam

• Demamnya sudah berapa lama, demamnya akut atau demam berkepanjangan
• Pola demam (intermiten,remiten, continues,septik, atau pola tertentu)
• Gejala yang muncul sebelum dan setelah demam
• Riwayat bepergian ke daerah tertentu (Malaria investigations)
• Riwayat penggunaan obat-obatan
•  

Penyebab dan Patofisiologi

• Proses Infeksi ;Malaria, Influensa, Dengue Fever, Diarea Akut (Virus,Bakteri,Parasit,Jamur) --> Pengeluaran Toksin (Lipopolisakarida- Gram^-, Enterotoksin-Gram⁺) --> Demam
• Proses Inflamasi/Peradangan Atau kerja Imun, Trauma, Proses Pembedahan, Proses Keganasan --> Peningkatan Sitokin Pirogenik/Pirogen Endogen (IL-1, IL-6, TNF, CTNF,IFN) --> Demam
• DEMAM --> Kompensasi Tubuh Terhadap Demam --> Thermoregulator/Hipothalamus --> Aktivasi Neuron Vasomotor --> Vasokontriksi --> Penurunan aliran darah perifer --> pelepasan panas tubuh menurun -->Timbul perasaan dingin --> Kontraksi otot untuk menghasilkan panas  -->MENGIGIL (Jika panas tubuh melalui aliran darah cukup, periode menggigil tidak terjadi)

Perawatan dan Pengobatan

• Setelah anamnesis ditegakkan, jika terjadi demam tinggi hingga hiperpireksia segera lakukan kompress hangat atau kompres dingin,  sesuaikan dengan mekanisme apa yang ingin digunakan untuk menurunkan demam
• Pemantauan secara ketat terhadap adanya perubahan sistem kardivaskuler, kinerja jantung dan paru-paru. Hal ini dikaitkan dengan terjadinya peningkatan kebutuhan oksigenasi pada saat demam terjadi.
•  Kolaborasi pemberian antipiretik, anti inflamasi non steroit, dan kortikosteroid
•  Hati-hati terhadap penggunaan antipiretik secara rutin karena dapat membuat masking pada pola demam dan proses infeksi
• Jika penurunan panas cepat dibutuhkan, dapat dilakukan pemberian selimut dingin kombinasi antipiretik
• Fever Management, Fluid and Elektrolit Inbalance Management, Infection Management