Flashcard Ppw - Ritz.docx

UFEME

FBC

Glu : DM Bilirubin : Hepar problem (Negative) Ketone: Carbohydrate problem (Nil) Specific Gravity : Kepekatan Urine (1.005-1.025) Blood : UTI (Nil) pH: Calculi (4.5-8, normal acidic) Protein: Renal, Glomerulus problem (<150mg/d) Urobilinogen : Hepar problem (0.5-1mg/dl) Nitrate :Increase-infection(Negative) WBC: infection, keruh (<2-5) Leu:infection (negative)

WBC: 4-11 NEU: Bacteria infection (2.0-7.5,54-62%) LY: increase=virus (1.0-3.5,25-33%) MO :poisoning (0.2-0.8,3-7%) EO: parasit (0.0-0.4) BA: Allergic reaction (0.0-0.2,0-0.75%) RBC: 4.5-6.5 HGB: M=13.5-18, F=11.5-16.5 HCT: M=48-54, F=35-41 MCV: 10-96 MCH: warna darah (26-39)

IV DRIP

ECG

Jumlah amount x drop factor (20 titis/min) Jumlah masa (minit)

1) Heart rate: 60-100,300/kotak besar,1500/kotak kecil, 3-4 kotak besar normal

IV INFUSION PUMP

2) Rhythm: ada PQRST, xde P=junctional rhytm 3) P wave : Atrial Flutter, Bifid

Jumlah amount (ml) Jumlah masa (jam)

/

60 x ?cc = ? hour

PLT:150-450

4) Q wave: tinggi P+Q=0.08=deep Q=old infact (2 kotak kecil)

MEDICATION DOSAGE Req dose(mg) X stock volume(ml) = Volume stock dose(mg) given

5) QRS :PVC=ectopic, RBBB=MiRRor, LBBB=WiLLiam

6) ST Segment: Angina (depress 2 kotak), MI ( elevate 2 kotak), Pericarditis: curve ST

PAEDRIATRIC V/S

7) RR interval : 1st degree =PR prolonged(xlebih 1 kotak besar) , 2nd degree , Mobitz 1= PR+1QRS, Mobitz 2= PR+2QRS, 3rd degree =complete heart block(P+QRSx related) 8) T wave: Tall T : hypercalemia (5 kotak kecil) , T inverted: Angina

LIFE THREATENING A = Airway Obstruct T = Tension Pneumothorax O = Open Chest Wound M = Massive Haemothorax F = Flail Chest C = Cardiac Tamponade

Respiratory Rate Blood Pressure(mmhg) <1 = 30-40/min < 1 years =80-90 1-2=25-35/min 1-2 years = 85-95 2-5=25-30/min 2-5 years = 85-100 5-12=20-25/min 5-12 years = 90-110 Heart (Pulse)/min >12 years = 100-120 Newborn = 125 6= 100 1-11=120 8= 90 2 = 110 10=90 4 = 100

CONDITION OF LIFE THEARTENING (6H5T) Hypovolumic Hypoglycemia Hypothermia Hypoxia

Hyper/Hypocalemia Hydrogen ion (acidosis)

Tamponade Trauma Toxins Thrombosis Tension Pneumothorax

~ Ikhlas Daripada Harith Baharudin’Ritz .. Selamat Maju Jaya kawan kawan 

GCS EYE Spontaneous =4 To call = 3 To pain = 2 No response =1 MOTOR Obey command =6 Localize pain =5 Withdrawl pain =4

COCKTAIL FOR HYPERKALEMIA VERBAL Orientated =5 Confused =3 Inappropriate word =3 Inappropriate sound No response =1 Flexion to pain = 3 Extension to pain = 2 No response = 1

1g of KCL + 100cc N/S

   

Type I – 1-15% 1 blood : 3 kristaloid Type II – 15-30% 1 blood : 1 koloid Type III – 30-40% Type IV - >40% STOP BLEEDING = compress, bandage, elaveta, ice pack, tornique, t&s,direct pressure,adrenaline pack,cambac bac,cautherazation,ligate,tranxemix acid,glu stich,splint TANDA2= pallor(CRT<2s), BP low, tanda2 shock,tachy,cold/clamines

GCS drop Pupil unequal Altered mental status ENT bleed Racoon eye

INTRAABDOMINAL INJURY (BP Low + Pulse High) 

FAST CORRECT FOR HYPOCALEMIA

TYPES OF BLOOD LOSS

HEAD INJURY ( BP High + Pulse Low)     

1) 10mg Calcium Gluconate run in 10min (1g in 1min) 2) 50cc Dextrose 50% 3) 10 unit Insulin

Hypovolumic Shock

CERVICAL SIGN

SECONDARY SURVEY ( SAMPLE)

1) NSAID  N- Neurological deficit (confused)  S- Spinal Tenderness  A- Above clavicle injury  I – Intoxicity (mabuk)  D – Distracting pain 2) Hematoma di kepala 5) CFS fluid dlm darah 3) Ada battle sign ( tengok bila letak gauze x 4) ENT Bleeding x campur dengan darah)

S- Sign and Symptoms P –Past Medical A – Allergic L- Last oral intake M- Medication E - Event lead to injury

FEVER INFECTION Neutrophil High + Lymphosite Low = Viral Neutrophil Low + Lymphosite High = Bacteria

SASARAN GLUKOSA (mmol/L)

ATRIAL BLOOD GASES (ABG)    

Respiratory Acidosis Respiratory Alkolosis Metabolic Acidosis Metabolic Alkolosis

pH Low High Low High

CO2 High Low Normal Normal

   

Rapid Assestment = head – toe Focus Assestment = Fast scan (nak tengok internal organ) V/S monitoring Pulse Rate= Rate+Rhythm

Sebelum makan (puasa) = 4-6 1 ½ -2 jam selepas makan = 4-8 Sebelum tidur (snack) = 7-8 3-4 pagi = 3.5-7

SYRUP PCM FOR PAED Body weight (Kg) x 15mg = ? ml 24

~ Ikhlas Daripada Harith Baharudin’Ritz .. Selamat Maju Jaya kawan kawan 

7Ps INTUBATION 1) Prepaartion: ( look for difficult intubation) look externally,malampati,obstruction,neck mobility

5) Pressure: BURP (Backward,Upward,Rightward,Pressure) 6)Placement :Auscultation

2) Pre Oxygenation – 100% O2 by NBM 3)Pre Treatment = LOAD (Lignocaine,Opiate,Atropine,Depolarizing(Suxa))

7) Rest intubate care : cardiac monitoring , V/S monitoring, CBD , Ryle Tube , Suction , Sedation, Fluid, Temperature

4) Paralysis

INTUBATION (LEMON + SOAP + ME) L = look (obesity,short neck,facial trauma) E = Evaluate( Difficult intubate 2:3:2) M = Mallampati O = Obstruction (Foreign Body) N = Neck Mobility M= Monitoring (V/S) S = Suction E = Equipment O = O2 A = Airway equipment P = Pre Medication

PUPIL    

Look for = Size / Equality for both / Reaction to light Normal size = 3mm Confirm death =Fixed dilated (8mm) Change when 1. Coma 2. Drug Overdose(pin point) 3. Less O2 supply (1 kecil,1 besar) 4. Medication =midracyl

SHOCK

AIRWAY DEVICES

Jenis = Hypovolumic, Cardiogenic, Septic, Neurogenic, Anafilaktik Tanda2 = 1) Cold and Clamines (<35°c) 7) Pallor/ CRT <2s 2)Berpeluh sejuk 8) Cyanosis 3) BP Low 4)PR High 5) Pt Confuse 6) Dehydration(Skin turgor,cutted bud,Shanken Eye,bibir kering)

1) Nasal Pronge: 1-6L 2) Face Mask :5-10L 3) Venti Mask: adjustable 4) High Flow mask 1. Rebreather: 80-90% O2(include O2 luar), contraindication : apnea pt 2. Non Rebreather : 90-100% 02 supply 5)BVM : Max 1.5L , Adult=700m, Clamp

ADJUNT AIRWAY (Backup Airway)

3) Laringeal Mask Airway (LMA) - Ukur – Sukat ikot berat badan - Dewasa – Size 4 to Size 5 , >70Kg =Size 4 - Indikasi = difficult intubation , no gag reflex - Cuff Ballon = 20 to 30cc udara

1) Oropharangeal Airway (OPA) // Airway Girdle - Ukur = middle of mouth to angle of jaw - Indikasi = buka airway, pt unconscious - Contra = pt ada gag reflex, facial injury 2) Nose Pharngeal Airway (NPA) -Ukur = tip of nose to tragus -Indikasi = pt unconscious, pt ada gag reflex, OPA xleh guna

~ Ikhlas Daripada Harith Baharudin’Ritz .. Selamat Maju Jaya kawan kawan 

VF VT Pulseless

FAST MANAGEMENT (Synchronize 50,100,150) 1) Fast AF 1. Synchronized 2. Pharmocology =  Digoxin (0.2 @ 0.5mg in 50cc NS) run ½ @ 1 hour  Amidarone 150mg (10min) 2) SVT  Adenosine 6mg,12,12 then defib(synchronize)  Adenosine 6mg, flush 20ml

TAGGING (Triage at Site)

ECG ANATOMIC GROUP

SIMPLE MANAGEMENT AMI M = Morphine O = O2 N = Nitrate (GTN) A = Aspirin C = Clopidogrel (Plavix)

DEFIBRILATION (200J)

R (Respiration)  < 30 =Yellow  > 30 = Red P (Perfussion)  < 2 Sec = Yellow  > 2 sec = Red M ( Mental Status)  Orientated = Yellow  X Orientated = Red

APO L = Lasix M = Morphine N = Nitrate (isoket) O = O2 P = Posture

I

aVR

V1

V1

Lateral

None

Septal

Anterior

II

aVL

V2

V5

Inferior

Lateral

Septal

Lateral

III

aVF

V3

V6

Inferior

Inferior

Anterior

Lateral

~ Ikhlas Daripada Harith Baharudin’Ritz .. Selamat Maju Jaya kawan kawan 