INFORMASI SIPENMARU PRODI D-IV KEPERAWATAN TA. 2012/2013

INFORMASI SIPENMARU PRODI D-IV KEPERAWATAN TA. 2012/2013

Berikut ini adalah informasi pendaftaran mhs baru/Sipenmaru Prodi D-IV Keperawatan Medikal Bedah dan Prodi D-IV Keperawatan Anestesi Reanimasi Poltekkes Kemenkes Ykt TA. 2012/2013. Pendaftaran Sipenmaru Prodi D-IV Keperawatan ini dilaksanakan secara off line.

Informasi selengkapnya & Formulir pendaftaran silahkan klik dan download  :
(utk D-IV Keperawatan Anestesi Reanimasi).
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Selamat mendaftar. Semoga Sukses !!! ... Amien...

Terapi Oksigen

Pengertian dan definisi terapi oksigen

Terapi oksigen adalah pengelolaan oksigen tambahan pada pasien untuk mencegah atau menangani hipoksia. Hipoksia adalah satu kondisi dimana tidak terpenuhi oksigen untuk memenuhi kebutuhan metabolisme jaringan dan sel (Herry and Potter, 2006). 

Difficult Intubation

Predictors Of Difficult Intubation: Study In Kashmiri Population

Arun Kr. Gupta , Mohamad Ommid , Showkat Nengroo , Imtiyaz Naqash and Anjali Mehta

Cite this article as: BJMP 2010;3(1):307 Download PDF

ABSTRACT Airway assessment is the most important aspect of anaesthetic practice as a difficult intubation may be unanticipated. A prospective study was done to compare the efficacy of airway parameters to predict difficult intubation. Parameters studied were degree of head extension, thyromental distance, inter incisor gap, grading of prognathism, obesity and modified mallampati classification. 600 Patients with ASA I& ASA II grade were enrolled in the study. All patients were preoperatively assessed for airway parameters. Intra-operatively all patients were classified according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value & negative predictive value. Results obtained showed an incidence of difficult intubation of 3.3 % of patients. Head and neck movements had the highest sensitivity (86.36%); high arched palate had the highest specificity (99.38%). Head and neck movements strongly correlated for patients with difficult intubation. KEYWORDS Intubation, Anaesthesia, Laryngoscopy

Introduction

The fundamental responsibility of an anesthesiologist is to maintain adequate gas exchange through a patent airway. Failure to maintain a patent airway for more than a few minutes results in brain damage or death¹. Anaesthesia in a patient with a difficult airway can lead to both direct airway trauma and morbidity from hypoxia and hypercarbia. Direct airway trauma occurs because the management of the difficult airway often involves the application of more physical force to the patient’s airway than is normally used. Much of the morbidity specifically attributable to managing a difficult airway comes from an interruption of gas exchange (hypoxia and hypercapnia), which may then cause brain damage and cardiovascular activation or depression².

Though endotracheal intubation is a routine procedure for all anesthesiologists, occasions may arise when even an experienced anesthesiologist might have great difficulty in the technique of intubation for successful control of the airway. As difficult intubation occurs infrequently and is not easy to define, research has been directed at predicting difficult laryngoscopy, i.e. when is not possible to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy. It is argued that if difficult laryngoscopy has been predicted and intubation is essential, skilled assistance and specialist equipment should be provided. Although the incidence of difficult or failed tracheal intubation is comparatively low, unexpected difficulties and poorly managed situations may result in a life threatening condition or even death³.

Difficulty in intubation is usually associated with difficulty in exposing the glottis by direct laryngoscopy. This involves a series of manoeuvres, including extending the head, opening the mouth, displacing and compressing the tongue into the submandibular space and lifting the mandible forward. The ease or difficulty in performing each of these manoeuvres can be assessed by one or more parameters⁴.

Extension of the head at the atlanto-occipital joint can be assessed by simply looking at the movements of the head, measuring the sternomental distance, or by using devices to measure the angle⁵. Mouth opening can be assessed by measuring the distance between upper and lower incisors with the mouth fully open. The ease of lifting the mandible can be assessed by comparing the relative position of the lower incisors in comparison with the upper incisors after forward protrusion of the mandible⁶. The measurement of the mento-hyoid distance and thyromental distance provide a rough estimate of the submandibular space⁷. The ability of the patient to move the lower incisor in front of the upper incisor tells us about jaw movement. The classification provided by Mallampati et al⁸ and later modified by Samsoon and Young⁹ helps to assess the size of tongue relative to the oropharynx. Abnormalities in one or more of these parameters may help predict difficulty in direct laryngoscopy¹.

Initial studies attempted to compare individual parameters to predict difficult intubation with mixed results^8,9. Later studies have attempted to create a scoring system^3,10 or a complex mathematical model^11,12. This study is an attempt to verify which of these factors are significantly associated with difficult exposure of glottis and to rank them according to the strength of association.

OBAT SISTEM SARAF PUSAT

1.1  DEFINISI SISTEM SARAF PUSAT

Susunan saraf pusat berkaitan dengan sistem saraf manusia yang merupakan suatu jaringan saraf yang kompleks, sangat khusus dan saling berhubungan satu dengan yang lain. Fungsi sistem saraf antara lain : mengkoordinasi, menafsirkan dan mengontrol interaksi antara individu dengan lingkungan sekitarnya.

Stimulan sistem saraf pusat (SSP) adalah obat yang dapat merangsang serebrum medula dan sumsum tulang belakang. Stimulasi daerah korteks otak-depan oleh se-nyawa stimulan SSP akan meningkatkan kewaspadaan, pengurangan kelelahan pikiran dan semangat bertambah. Contoh senyawa stimulan SSP yaitu kafein dan amfetamin

Sistem saraf dapat dibagi menjadi sistem saraf pusat atau sentral dan sistem saraf tepi (SST). Pada sistem syaraf pusat, rangsang seperti sakit, panas, rasa, cahaya, dan suara mula-mula diterima oleh reseptor, kemudian dilanjutkan ke otak dan sumsum tulang belakang. Rasa sakit disebabkan oleh perangsangan rasa sakit diotak besar. Sedangkan analgetik narkotik menekan reaksi emosional yang ditimbulkan rasa sakit tersebut. Sistem syaraf pusat dapat ditekan seluruhnya oleh penekan saraf pusat yang tidak spesifik, misalnya sedatif hipnotik. Obat yang dapat merangsang SSP disebut analeptika.

Obat – obat yang bekerja terhadap susunan saraf pusat berdasarkan efek farmakodinamiknya dibagi atas dua golongan besar yaitu :

• merangsang atau menstimulasi yang secara langsung maupun tidak langsung merangsang aktivitas otak, sumsum tulang belakang beserta syarafnya.

•menghambat atau mendepresi, yang secara langsung maupun tidak lansung memblokir proses proses tertentu pada aktivitas otak, sumsum tulang belakang dan saraf- sarafnya.

Obat yang bekerja pada susunan saraf pusat memperlihatkan efek yang sangat luas (merangsang atau menghambat secara spesifik atau secara umum). Kelompok obat memperlihatkan selektifitas yang jelas misalnya analgesik antipiretik khusus mempengaruhi pusat pengatur suhu pusat nyeri tanpa pengaruh jelas.