Cardiac Arrest Picu Kematian Michael Jackson

BINTANG pop Michael Jackson meninggal di usia 50 tahun akibat cardiac arrest. Stasiun TV Los Angeles KTLA melaporkan bahwa Los Angeles fire officials sempat merespon panggilan 911 dari rumah Jackson. Tapi, Jakson sudah tidak bernafas lagi saat petugas tiba di sana. Para medis melakukan prosedur darurat medis (Cardiopulmonary resuscitation/CPR) dan melarikannya ke UCLA Medical Center. Meskipun rumah sakit tidak membeberkan detail kondisi Jackson, dia dinyatakan meninggal akibat cardiac arrest. Apa beda cardiac arrest dengan serangan jantung? Menurut Douglas Zipes, MD, MACC, seorang profesor dari Indiana University School of Medicine, dalam cardiac arrest, jantung berhenti bekerja dengan benar. Cardiac arrest, menurut Zipes, berbeda dengan serangan jantung, tapi bisa terjadi akibat serangan jantung. Cardiac arrest, merupakan gangguan ritme jantung saat bilik jantung bagian bawah, berdetak sangat cepat, 4-600 kali dalam semenit. Ritme jantung ini, lantut Zipes, mencegah kontraksi bilik jantung bagian bawah dan menghambat pemompaan darah ke otak dan ke seluruh bagian tubuh. Dan, jika tidak segera diatasi bisa mengakibatkan kematian dalam waktu 4-5 menit. Saat terjadi gangguan ritme jantung, terang Zipes, bilik jantung bagian bawah sama seperti sekantung cacing yang sudah tidak lagi efektif menekan. Akibatnya tidak ada darah yang dipompa ke seluruh bagian tubuh. Dan jika tidak ada oksigen dalam pembuluh darah yang bisa dipompa ke otak, maka otak akan segera mati. CPR, menurut Zipes, bisa membantu agar darah tetap mengalir. Tapi diperlukan kejutan listrik ke jantung, baik dari alat penyalur listrik dari luar maupun peralatan internal jantung, untuk mengejutkan jantung agar kembali ke ritme normal."Beberapa aliran darah harus distimulusi, baik dengan CPR atau dengan alat pengejut untuk mengembalikan jantung ke fungsi normal," ujar Zipes, seperti dikutip situs webmd. Menurut Zipes, 30-50% kasus cardiac arrest merupakan manifestasi dari penyakit jantung yang belum kelihatan. Jadi, Anda mungkin tidak akan merasakan rasa sakit di dada, sulit bernapas. Anda mungkin tidak merasakan gejala apapun.

Infants With Fetal Distress Are Most Affected by General Anesthesia for Cesarean Delivery

The infants most affected by general anesthesia for cesarean delivery are those who are already compromised in utero, according to the results of a study reported in the April 29 Online First issue of BMC Medicine. Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia," write Charles S. Algert, from Kolling Institute of Medical Research, University of Sydney in Sydney, Australia, and colleagues. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections. The study cohort consisted of 50,806 infants delivered by cesarean delivery from 1998 to 2004 for indications of planned subsequent cesarean delivery, failure to progress, or fetal distress. The investigators compared outcomes of neonatal intubation and 5-minute Apgar scores of less than 7 for deliveries performed with the mother under general anesthesia vs those performed with the mother under spinal or epidural anesthesia. For all 3 indications and across all levels of hospital, the risk for adverse outcomes was increased for cesarean deliveries performed with the patient under general anesthesia. Low-risk, planned subsequent cesarean deliveries had the largest relative risks for resuscitation with intubation (relative risk, 12.8; 95% confidence interval [CI], 7.6 - 21.7), and for Apgar scores of less than 7 (relative risk, 13.4; 95% CI, 9.2 - 19.4). Unplanned cesarean deliveries because of fetal distress had the largest absolute increase in risk (5 extra intubations per 100 deliveries and 6 extra Apgar scores <>

The Australian National Health and Medical Research Council supported this study. The study authors have disclosed no relevant financial relationships. BMC Med. Published online April 29, 2009.

Incidence of and risk factors for awareness during anaesthesia.

Explicit recall of events during general anaesthesia is detected by direct questioning, as patients may not report awareness spontaneously or if they are questioned non-specifically. More than one interview is needed and credibility of reports should always be verified. The overall incidence of awareness has decreased over the last 40 years and is now 0.1-0.2%. Prospective study of patients who undergo general anaesthesia is the only valid method for determining the incidence of awareness. Studies of patients recruited through referrals by colleagues or advertisements, studies of compensation claims and those carried out through quality improvement systems are inadequate. Several factors increase the risk of awareness, including light anaesthesia, some types of surgery, a history of awareness, chronic use of central nervous system depressants, younger age, obesity, inadequate or misused anaesthesia delivery systems, insufficient knowledge about awareness, and ignoring the use of electroencephalographic monitors when the risk is otherwise increased.

Ghoneim MM. Department of Anesthesia, University of Iowa, Iowa City, IA 52244, USA. mohamed-ghoneim@uiowa.edu

Kapan transfusi sel darah merah dilakukan?

• Transfusi sel darah merah hampir selalu diindikasikan pada kadar Hemoglobin (Hb) <7 g/dl, terutama pada anemia akut. Transfusi dapat ditunda jika pasien asimptomatik dan/atau penyakitnya memiliki terapi spesifik lain, maka batas kadar Hb yang lebih rendah dapat diterima. (Rekomendasi A) • Transfusi sel darah merah dapat dilakukan pada kadar Hb 7-10 g/dl apabila ditemukan hipoksia atau hipoksemia yang bermakna secara klinis dan laboratorium. (Rekomendasi C) • Transfusi tidak dilakukan bila kadar Hb ≥10 g/dl, kecuali bila ada indikasi tertentu, misalnya penyakit yang membutuhkan kapasitas transport oksigen lebih tinggi (contoh: penyakit paru obstruktif kronik berat dan penyakit jantung iskemik berat). (Rekomendasi A) • Transfusi pada neonatus dengan gejala hipoksia dilakukan pada kadar Hb ≤11 g/dL; bila tidak ada gejala batas ini dapat diturunkan hingga 7 g/dL (seperti pada anemia bayi prematur). Jika terdapat penyakit jantung atau paru atau yang sedang membutuhkan suplementasi oksigen batas untuk memberi transfusi adalah Hb ≤13 g/dL. (Rekomendasi C)

Pain Control After Surgery

What is Pain? Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells, most sense pain and the fewest sense cold. When there is an injury to your body -- in this case surgery -- these tiny cells send messages along nerves into your spinal cord and then up to your brain. Pain medicine blocks these messages or reduces their effect on your brain. Sometimes pain may be just a nuisance, like a mild headache. At other times, such as after an operation, pain that doesn't go away -- even after you take pain medicine -- may be a signal that there is a problem. After your operation, your nurses and doctors will ask you about your pain because they want you to be comfortable, but also because they want to know if something is wrong. Be sure to tell your doctors and nurses when you have pain. Purpose of this Booklet This booklet talks about pain relief after surgery. It explains the goals of pain control and the types of treatment you may receive. It also shows you how to work with your doctors and nurses to get the best pain control. Reading the booklet should help you: Learn why pain control is important for your recovery as well as your comfort. Play an active role in choosing among options for treating your pain. Treatment Goals People used to think that severe pain after surgery was something they "just had to put up with." But with current treatments, that's no longer true. Today, you can work with your nurses and doctors before and after surgery to prevent or relieve pain. Pain control can help you: Enjoy greater comfort while you heal. Get well faster. With less pain, you can start walking, do your breathing exercises, and get your strength back more quickly. You may even leave the hospital sooner. Improve your results. People whose pain is well-controlled seem to do better after surgery. They may avoid some problems (such as pneumonia and blood clots) that affect others. Pain Control: What Are the Options? Both drug and non-drug treatments can be successful in helping to prevent and control pain. The most common methods of pain control are described below. You and your doctors and nurses will decide which ones are right for you. Many people combine two or more methods to get greater relief. Don't worry about getting "hooked" on pain medicines. Studies show that this is very rare -- unless you already have a problem with drug abuse.

Anesthesia machine in Asri Medical Centre Yogyakarta

The model of intensive care unit room

The five elements of the First Global Patient Safety Challenge

1. Blood safety
2. Injection and immunization safety
3. Safe clinical procedures
4. Safe water and sanitation in health care
5. Hand Hygiene