The Doctor Notes

NEW HOME

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 27 Jun 2009 10:46:00 PDT

hi to all colleagues & friends..

now THE DOCTOR NOTES move to our new home.. (click the banner below)

KEKERASAN DI NEGERIKU

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Thu, 04 Jun 2009 11:02:00 PDT

Baru saja menonton acara Indonesia 60 Detik di SCTV, di propinsi Sumatera Utara, seorang lelaki berusia sekitar 50 tahunan yang bekerja sebagai petani perkebunan berdiri tegak di halaman rumah menantang aparat kepolisian, para pamong praja dan petugas pengadilan serta pam swakarsa perkebinan, untuk mempertahankan rumahnya yang akan dirubuhkan yang berdiri di atas tanah yang disita sambil menggendong alat penyemprot hama, tetapi lalu dikerubuti oleh beberapa aparat dari kepolisian yang langsung melumpuhkan dan membawanya ke kendaraan kepolisia, sementara tampak istrinya serta dua anaknya yang masih sangat belia menangis histeris yang entah karena sedih ayah mereka dikerubuti oleh para polisi atau karena rasa takut yang amat sangat karena suasana yang ricuh.

Setelah sang ayah diamankan oleh aparat, kini giliran sang istri serta dua anak yang masih sangat belia itu dibawa paksa.

Berikut link beritanya : Indonesia 60 Detik

Sungguh tak terasa air mata ini bergulir di pipi, hati ini terasa sesak..

Apakah kasus meninggalnya seorang anak yang baru berusia 4 tahun karena tersiram kuah bakso yang gerobaknya dibalikkan aparat pamong praja saat razia belum cukup dijadilan bahan pelajaran dan bahan introspeksi?

Apakah kasus-kasus kekerasan yang melanggar HAM juga belum cukup dijadilan bahan pelajaran dan bahan introspeksi?

Apakah kekerasan sudah menjadi cara yang lazim digunakan para aparat yang seharusnya mengayomi, melindungi, melayani masyarakat yang nota bene yang menggaji para aparat itu?

Apakah mulut sudah tidak dapat lagi dimaksimalkan fungsinya sebagai alat diskusi untuk memberikan pengertian?

Apakah otak tidak dapat lagi berpikir, bagaimana kalau hal yang sama terjadi kepada kita?

Apakah hati ini sudah tidak ada rasa belas kasihan walau setitik?

Sang ayah beserta istri dan dua anaknya itu bukanlah penjahat, tapi kaum papa yang bernasib sungguh tragis di negeri yang sedang berusaha berdiri dari keterpurukan ini..

Terus terang saya tidak dapat membayangkan bagaimana psikologis dua anak itu...
Mungkin perlu juga disertakan dokter ahli jiwa dalam tim penggusuran pemerintah daerah, jangan hanya aparat pamong praja dan polisi saja..

Padahal dasar hukum dan aturan di negeri tercinta ini sudah sangat jelas,

Pancasila dan UUD 1945
UU No 2 Tahun 2002 tentang kepolisian
UU No 39 Tahun 1999 tentang Hak Asasi Manusia
UU No 26 Tahun 2002 tentang Peradilan HAK
Kitab Undang-Undang Hukum Pidana

Sungguh tepat rasanya saat ini jika kita bernyanyi,

"kulihat ibu pertiwi,
sedang bersusah hati..
air matanya berlinang.."

PENTING UNTUK DOKTER INDONESIA..!!!

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Mon, 01 Jun 2009 14:08:00 PDT

Saat ini anggota IDI seluruh Indonesia berjumlah kurang lebih 80.000 dokter, 60.000 diantaranya adalah dokter umum dan 20.000 lainnya adalah dokter spesialis. P2KB merupakan kebutuhan yang seharusnya dapat dijalani oleh semuanya.
Saat ini program P2KB online baru diakses oleh sekitar 3000 dokter umum, dan beberapa perhimpunan dokter spesialis sedang mengembangkan web P2KB masing-masing.
Namun program ini masih terkendala beberapa hal, antara lain :

Masih banyak teman-teman sejawat yang tidak memiliki akses internet, terutama yg bertugas di daerah pedalaman.
Masih banyak teman-teman sejawat yang sudah memiliki akses internet belum paham melakukan browsing dan lain-lainnya.
Masih banyak teman-teman sejawat yang sudah mengerti akan akses internet bahkan sudah terdaftar sebagai user P2KB tapi tidak secara rutin memasukkan datanya ke log book masing-masing secara online.

IDI dengan segala upaya telah melakukan sosialisasi baik langsung ke wilayah membekali pengurus BP2KB wilayah agar berbagi tugas dalam membina anggota, maupun sosialisasi melalui online (berupa file-file yang bisa didownload).
Saat ini pula sedang mencoba menggagas kerjasama dengan beberapa provider internet agar dapat dibangun jaringan internet yg terjangkau hingga ke pelosok, agar dapat dinikmati oleh teman-teman sejawat yang bertugas di daerah sangat terpencil.
Memang hal ini masih baru, namun kapan lagi dokter Indonesia melangkah maju ke depan agar tidak tertinggal dari dokter-dokter teman sejawat di luar negeri.
Berusaha agar semua anggota terlayani dengan program ini. Berharap dokter Indonesia memiliki kompetensi global dalam ilmu & teknologi namun tetap beretika.

Dalam Undang-undang Praktek Kedokteran Republik Indonesia Pasal 28 disebutkan "pengembangan pendidikan kedokteran berkelanjutan merupakan tugas dan dilakukan oleh organisasi profesi dan lembaga lain yg telah diakreditasi oleh organisasi profesi", satu2nya organisasi profesi kedokteran di Indonesia adalah IDI.
Dengan kata lain berdasarkan Undang-undang tersebut seluruh dokter Indonesia wajib untuk mengikuti P2KB. Apalagi semenjak ditandatanganinya kerjasama IDI - KKI mengenai alur pembuatan STR ulang dimana KKI untuk mendapatkan berkas berupa sertifikat kompetensi hanya berasal dari Portal P2KB IDI, yaitu data dari seluruh kegiatan P2KB yg diinput oleh seluruh dokter. Jika telah mencapai 250 SKP selama 5 tahun, kolegium akan menerbitkan sertifikat kompetensi sebagai syarat pembuatan STR ulang.
Bagi teman-teman sejawat yang tidak sempat atau mempunyai keterbatasan dalam mengakses internet, IDI cabang tempat mereka terdaftar wajib membantu memasukkan datanya, sehingga tahapannya mulai dari offline dulu di IDI cabang masing-masing, yang kemudian akan dipandu ke arah online.
Bagi teman-teman sejawat yg mempunyai akses internet dapat secara mandiri memasukkan datanya ke P2KB online.
P2KB online diakses melalui :

Masuk ke alamat IDI ONLINE.
Klik gambar di pojok atas yg terdapat tulisan P2KB online.
Masuk ke halaman CPD, klik dokter umum.
Masuk ke halaman program CPD, klik Program I.
Masuk ke halaman P2KB online, klik membership.
Baca persetujuan, jika akan melanjuti klik "saya setuju".
Isi form registrasi secara secara lengkap benar, jangan sampai salah.
Setelah sampai step 4 jangan lupa klik SAVE.
Tunggu 1-2 hari jawaban "user ID" & "password" ke email anda untuk melakukan login.
Sebaiknya menggunakan aplikasi browsing "Mozilla Firefox".

Adapun dokumen bukti-bukti kegiatan yang harus di input di P2KB online adalah :

Menangani pasien di klinik /Rumah Sakit /puskesmas : surat keterangan dari pimpinan yang berwenang, mengenai jumlah pasien dalam satu bulan.
Menangani pasien di praktek pribadi : laporan dalam bentuk tabel yg menyebutkan tanggal, nama dalam bentuk inisial (mengingat rahasia medik), umur, diagnosis, terapi, kemudian di scan / foto dan harus tampak jelas.
Melakukan tindakan diagnostik : laporan dalam bentuk tabel yg menyebutkan tanggal, nama dalam bentuk inisial (mengingat rahasia medik), umur, jenis pemeriksaan, kesimpulan hasil pemeriksaan, kemudian di scan / foto dan harus tampak jelas.
Penyuluhan pasien : surat tugas.
Kesertaan dalam penanganan bencana : surat tugas.
Kesertaan dalam seminar : sertifikat yang terakreditasi IDI.
Menangani pasien dengan intervensi : laporan dalam bentuk tabel yg menyebutkan tanggal, nama dalam bentuk inisial (mengingat rahasia medik), umur, diagnosis, tindakan medis yang dilakukan, kemudian di scan / foto dan harus tampak jelas.
Diskusi kasus : surat keterangan dari pimpinan.
Peserta dalam workshop : sertifikat yang terakreditasi IDI.
Menguji mahasiswa : surat tugas.
Membimbing skripsi : surat tugas.
Menjadi pengurus : Surat Keputusan.
Mengikuti ronde bangsal : surat keterangan.
Menulis / menterjemahkan buku : scan cover buku yang memuat nama

Untuk yang lainnya dapat disesuaikan dengan kegiatan di atas.

Selamat berusaha untuk kemajuan anda dan bangsa!!

(dicopy dari pesan IDI ONLINE, dengan beberapa perubahan redaksional)

LALAI ATAU MUSIBAH?

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Mon, 25 May 2009 23:39:00 PDT

Semalam saya menonton berita Reportase Malam yang disiarkan di Trans TV, dan ada satu berita yang menurut saya sangat menarik meskipun itu bukanlah berita utama, tetapi bagi diri saya yang memiliki profesi sebagai seorang dokter, inilah berita utama bagi saya.

Berita tersebut adalah tentang terpotongnya sebagian dari glan penis seorang anak akibat disunat pada salah suatu acara sunatan massal yang diadakan oleh salah satu perusahaan rokok yang bekerja sama dengan Fakultas Kedokteran Universitas Andalas, Padang, Sumatera Barat.

Dalam berita tersebut diutarakan bahwa hal tesebut baru diketahui oleh orang tua korban setelah beberapa waktu setelah anak tersebut disunat tetapi pendarahan belum berhenti, oleh dokter yang menyunat anak tersebut diberi tahu bahwa hal tersebut bukan hal yang mengkhawatirkan, pendarahan tersebut berasal dari luka bekas potongan dan jahitan, dan akan berhenti beberapa saat lagi. Namun sesampai di rumah, pendarahan tersebut tidak berhenti, lalu orang tua anak tersebut membawa anaknya ke rumah sakit umum daerah setempat untuk memeriksakan pendarahan tersebut.

Di rumah sakit tersebut barulah diketahui bahwa pendarahan tersebut berasal dari glan penis yang terpotong sebagian. Dan akhirnya orang tua si korban mengadukan hal tersebut kepada polisi yang lalu disikapi oleh polisi dengan memanggil beberapa pihak yang diduga terkait dengan hal tersebut yang mengakibatkan kecacatan seumur hidup dengan tuduhan kelalaian medik.

Kesimpulan saya terhadap kejadian diatas :

Hal tersebut bukanlah musibah tapi kelalaian dan kecerobohan dokter yang bertugas sebagai operator, apapun alasannya.

Pendapat saya :
Sirkumsisi memanglah hanya merupaka bedah minor, tetapi sering saya alami, beberapa dokter muda sangat menganggap hal tersebut sepele, sehingga banyak sekali kecerobohan terjadi. Dan yang sanagt saya sayangkan, jika benar hal-hal yg diberitakan tersebut benar-benar terjadi, maka selain terjadi kecerobohan dalam melakukan tindakan medik, dokter tersebut juga melakukan penipuan terhadap pasiennya. Sangat besar kemungkinan, dokter tersebut ingin menyelamatkan dirinya sendiri tanpa mengingat Sumpah dokter. Sungguh sangat memalukan dan sangat tidak pantas pribadi tersebut berprofesi sebagai seorang dokter.

Dan sirkumsisi yang bagi pemeluk agama Islam yang notabene agama mayoritas di Indonesia, adalah suatu kewajiban dan suatu hal yang membahagiakan, tetapi kini menajdi suatu hal yang menyedihkan. Saya tak dapat membayangkan bagaimana perasaan anak tersebut 10 - 15 tahun lagi, saat dia mulai mengerti akan fungsi-fungsi dari sebuah penis, meski saat ini hanya anak tersebut bisa merintih kesakitan saja, tanpa memikirkan masa depannya.

Saya pribadi, oleh teman-teman senior maupun adik-adik junior dikenal sangat galak, mereka tidak akan berani menjadi asisten saya bila menurut mereka dirinya belum menguasai teori dasar yang menyangkut sirkumsisi atau tindakan medis apapun, bahkan ada pula yang menilai saya sebagai pribadi yang kasar dan suka menghambat proses pengajaran bagi diri mereka yang ingin menjadi seorang operator meski telah bertahun-tahun menjadi asisten. Mereka akan mencari operator senior yang lebih mudah memberikan kesempatan menjadikan mereka operator.

Menurut saya, sistem ingin cepat segera menjadi operator & memberikan kesempatan atau menaikkan status teman-teman sejawat yang ingin menjadi operator bukanlah dari berapa lama waktu telah menjadi asisten atau masalah senioritas dan junioritas tetapi lebih kepada kemahiran serta yang paling penting adalah rasa tanggung jawab terhadap profesi dan pasien kita.

Hal-hal inilah yang sering dilupakan oleh teman-teman senior yang telah menjadi operator ataupun yang masih menjadi asisten dan ingin menjadi operator, sering kali hanya dengan berdasarkan faktor kedekatan, rasa rasa kasihan dan alasan-alasan lainnya yang tidak masuk akal.

Sering saya diminta untuk memberikan pelatihan sirkumsisi ataupun saat sedang membimbing adik-adik junior, dan pada satu kesempatan pasti akan saya sampaikan, "sirkumsisi itu seharusnya tidak termasuk bedah minor, tetapi bedah mayor, karena meski barang yang dikerjakan realtif kecil dan tekniknya mudah, tetapi barang tersebut merupakan modal hidup dan berlaku seumur hidup, jika terjadi kegagalan, banyak-banyaklah berdoa dan bertobat, semoga pasien kita tersebut tidak memberikan sumpah serapah kepada hidup kita, seumur hidup kita dan seumur hidupnya!".

Memang, hal yang tersulit adalah kemampuan menilai diri sendiri.

Saya pribadi dalam menjalankan profesi kedokteran berprinsip, "perlakukanlah seluruh pasien-pasien kita sebagaimana dirimu ingin diperlakukan jika kita menjadi seorang pasien, berikanlah yang terbaik dari yang kita miliki dan tidak boleh ada satu kesalahan pun dari setiap tindakan kita, baik disengaja ataupun tidak disengaja terhadap pasien kita terkecuali masalah nasib dan takdir".

Dan saya sangat berkeyakinan bahwa prinsip saya akan berjalan dengan baik bila kita:

Takwa kepada Tuhan Yang Maha Esa
Jujur, Ikhlas dan sepenuh hati
Disiplin

Semoga berguna bagi bagi teman-teman sejawat..

ALIH BAHASA UNTUK BERBANGGA BERBAHASA INDONESIA

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Fri, 24 Apr 2009 21:10:00 PDT

Akhirnya mulai hari ini saya memutuskan untuk memulai menulis di blog The Doctor Notes ini dalam bahasa kebanggaan saya, bahasa Indonesia.

Keputusan ini saya ambil karena beberapa pertimbangan, salah satunya adalah adanya aplikasi "Google Translator" yang juga telah menambahkan bahasa Indonesia ke dalamnya serta rendahnya angka statistik pengujung blog saya dari Indonesia dibandingkan dari negara lainnya.

Dan juga saya mencoba untuk mengangkat bahasa Indonesia meskipun masih banyak sekali direktori blog yang mensyaratkan bahasa blog yang anda miliki atau anda harus tulis dalam bahasa inggris, tetapi demi negeri kita tercinta ini, mari kita tunjukkan Jati Diri Bangsa Indonesia.

Untuk itu perlahan-lahan saya akan merubah seluruh tulisan saya ke dalam bahasa Indonesia, baik yang telah saya tulis ataupun yang akan saya tulis.

Semoga hal ini dapat memperteguh rasa kebangsaan kita.

Jangan Pernah Menilai Sesuatu Dari Kulitnya Saja, Terutama TEMAN SEJAWAT Anda

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Fri, 17 Apr 2009 23:41:00 PDT

Hai teman-teman sejawat..

Suatu hari saya membaca di sebuah blog yang ditulis oleh seorang Med-Blogger Indonesia, dokter yang berusia 27 tahun ini juga berprofesi sebagai seorang dosen di salah satu Fakultas Kedoteran di Universitas Islam swasta di Jakarta.

Berikut kutipan dari tulisannya :

"..... seorang berusia 30-an berbaju kemeja putih dengan 2 kancing paling atas terbuka (OMG !) plus name tag : DR. XXXXX, memeriksa kondisi fiksasi yang terpasang pada pasien baru, memegang perut tanteku yang mengeluh mual dan muntah, lalu ia memberikan instruksi yang sayang sekali tidak jelas terdengar oleh ku, dan segera dicatat oleh lelaki asisten yang membuntutinya dengan kertas buram bagai resep.

meski sesak dadaku melihat dokternya, melihat pola kerja seperti ini mau tidak mau aku mengakui ada tangan dokter yang bermain disini mengintrodusir pola kerja seperti di rumah sakit. Plang di depan juga mengisyaratkan bahwa klinik ini dibangun oleh seorang berpendidikan ....."

Menurut hemat saya, penulis tersebut sangat tidak memahami tentang Kode Etik Kedokteran dan belum pantas menjadi seorang dokter, apalagi sebagai pendidik para calon dokter.

Dia telah menghakimi sejawatnya, yang juga notabene adalah senior dalam keprofesian kedokteran, dengan penilaian sekilasnya tanpa memahami dan tanpa rasa keingintahuan tentang "apa", "kenapa" dan "bagaimana".

Selain itu juga, dia telah mempublikasikan kepada khalayak umum dalam bentuk tulisan di blog miliknya tanpa ada satu konfirmasi apapun kepada sejawatnya yang telah dipojokkan oleh pernyataan-pernyataannya.

Bahkan juga dia telah mencampur-adukkan hal-hal yang pribadi dan hal-hal yang berkaitan dengan profesi, sehingga keseimbangan akan faktor subjektif serta objektifitasnya dengan segala alasan bodohnya sangatlah diragukan.
Sungguh sangat naif terasa..

Saran saya,
hargailah seluruh usaha seseorang, siapapun itu, terutama teman sejawat anda dan cobalah untuk mengerti serta telaahlah terlebih dahulu sebelum memberikan penilaian, sebab jika penilaian anada itu salah, sama artinya dengan membuka keburukan anda, ingatlah sumpah yang telah anda ucapkan, bedakanlah hal-hal yang berhubungan dengan profesi dan hal-hal pribadi.

Seburuk-buruknya senior anda, hormatilah sebagaimana layaknya anda menghormati yang lebih tua, ingat, anda tidak akan menjadi seorang dokter jika tidak ada mereka.

Akhirnya saya ingin berdoa, semoga teman-teman sejawat, terutama adik-adikku seluruhnya, hayatilah sumpah yang telah anda ucapkan, ingat, semuanya akan anda akan bawa hingga mati dan akan anda pertanggungjawabkan di akhirat nanti,
semoga Allah senantiasa membimbing kita di jalanNya,
Amin..

Note : please, always using your heart and brain in your life.. (before you talking)

55th Continuing Orthopaedic Education - Indonesian Medical Association - Indonesian Orthopaedic Association

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 28 Mar 2009 23:31:00 PDT

Theme : Orthopaedic Sport Injury

Dear colleague,

Continuing Orthopaedic Education is one of the most important event in Indonesian Orthopaedic Association agenda. This 55th occasion will be held in The Shangri-La Hotel, Surabaya, Indonesia.

I hope that the entire participant will share the experiences, and also increase their familiarity, knowledge, capability and tighten the family togetherness. I also warmly welcome you to participate in determining their future.

"Orthopaedic Sport Injury" will be the theme of this meeting. We know that sport injury and it's problematic effects will become an important issue in our country.

So, we believe this 55th COE 2009 in Surabaya will become a nice experience to be found out and enjoyed with our family.

Period : 18 - 20 June 2009

Place : Shangri-La Hotel, Surabaya

Contact :
Ph : 62213929655, 62213927371
Fax : 62213905894
Email : orthoui@dnet.net.id

TANAH AIRKU (my HomeLand)

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 28 Mar 2009 16:40:00 PDT

Tanah airku tidak kulupakan
kan terkenang selama hidupku
biarpun saya pergi jauh
tidak kan hilang dari kalbu

Tanahku yang kucintai
engkau ku hargai..

Walaupun banyak negeri kujalani,
dan mashyur permai di kata orang
tetapi kampung dan rumahku
disanalah ku rasa senang

Tanahku tak kulupakan
engkau ku banggakan

copy from : Lyrics of "Tanah AIrku" by Ibu Sud

1st Anniversary The Doctor Notes Blog

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sun, 01 Mar 2009 09:38:00 PST

Hi all..

Today already 1 year 7 days since I the first time made and wrote in The Doctor Notes blog.

I made and wrote in blog this together with increasingly the brightness about blog in Indonesia and I then had an opportunity to visit to several blog that his owner was a "blog master" in Indonesia.

Moreover also I want to very much shared the experience that had been experienced by me and that was undergone by me, definitely was not far and around my world and from my look spectacles as a medical doctor.
And definitely also with all the situations and the condition in Indonesia that occasionally made this heart sad, happy, but also proud.

Finally I said, my hope with the existence The Doctor Notes blog was to be able to share the experience with all the guest of the reader The Doctor Notes blog, I so as would the emergence of an enlightenment that will make this world to be increasingly beautiful as well as peaceful and prosperous as far as the grass root but also definitely I given the health as well as the strength in physical and critical think by Allah SWT.
Amien..

--- Happy Medical Blog ---

PONARI, the SHAMAN BOY PHENOMENON from East Java, Indonesia

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sun, 01 Mar 2009 05:19:00 PST

The phenomenon of the presence of the shaman-boy who was named PONARI in Jombang, East Java, that was accompanied enthusiastic the very tall community lately, ought to be made introspection by the government as well as the rank was involved in this the Department of the Health, the East Java province government and the Service of the Health of East Java.

This matter was good directly and directly did not show that the health service in Indonesia generally and especially in East Java still is bad, at least was depicted by dissatisfaction or the low level of the community's belief in the achievement and the quality of the health service that was provided by the government.

This was reality from the community that hoped big would the existence of the health service that was easy, fast and cheap. And ought to be faced as well as responded to seriously, if the government as well as they rank had the spirit served to this homeland sincerely and with all they heart.

There was one foolish matter that prop up, “if indeed the stone Ponari could cure the illness through the water media that was dipped in the stone, I hoped one day later, ponari dipped his stone or even exiled him to sea, so the person was sick all over the world could recover without must to the hospital, was just bathe in the beach”.

Cardio Pulmonary Resuscitation (CPR)

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 28 Feb 2009 12:00:00 PST

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped.

Ideally, CPR involves two elements: chest compressions combined with mouth-to-mouth rescue breathing. (A complete description of how to do both follows farther down in this article.)

However, what you as a bystander actually should do in an emergency situation really depends on your knowledge and comfort level.

The bottom line is that it's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone's life.

Here's the latest advice from the American Heart Association:

Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest presses of about two per second until paramedics arrive (described in more detail below). You don't need to try rescue breathing.
Trained, and ready to go. If you're well trained, and confident in your ability, then you can opt for one of two approaches: 1. Alternate between 30 chest compressions and two rescue breaths, or 2. Just do chest compressions. (Details described below.)
Trained, but rusty. If you've previously received CPR training, but you're not confident in your abilities, then it's fine to do just chest compressions.

The above advice applies only to adults needing CPR, not to children.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing.

To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED).

Before you begin
Assess the situation before starting CPR:

Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911.
If an AED is immediately available, deliver one shock if advised by the device, then begin CPR.

Remember the ABCs
Think ABC — Airway, Breathing and Circulation — to remember the steps explained below. Move quickly through Airway and Breathing to begin chest compressions to restore circulation.

AIRWAY: Clear the airway

Put the person on his or her back on a firm surface.
Kneel next to the person's neck and shoulders.
Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.
Check for normal breathing, taking no more than five or 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compressions to restore circulation.

BREATHING: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

With the airway open (using the head-tilt, chin-lift maneuver) pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation with chest compressions

Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Push hard and push fast — give two compressions per second, or about 120 compressions per minute.
After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.
If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. The American Heart Association recommends administering one shock, then resuming CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. Do not use an AED for infants younger than age 1. If an AED isn't available, go to No. 5 below.
Continue CPR until there are signs of movement or until emergency medical personnel take over.

To perform CPR on a child
The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED.
Use only one hand to perform heart compressions.
Breathe more gently.
Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths.
After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads.

Continue until the child moves or help arrives.

To perform CPR on a baby
Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR.

To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child.

If there's no response, follow the ABC procedures below and time the call for help as follows:

If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.
If another person is available, have that person call for help immediately while you attend to the baby.

AIRWAY: Clear the airway

Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.
Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

If the infant isn't breathing, begin mouth-to-mouth breathing immediately.

BREATHING: Breathe for the infant

Cover the baby's mouth and nose with your mouth.
Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.
Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation

Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.
Gently compress the chest to about one-third to one-half the depth of the chest.
Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 to 120 pumps a minute.
Give two breaths after every 30 chest compressions.
Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
Continue CPR until you see signs of life or until a professional relieves you.

CPR IN THREE SIMPLE STEPS

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 28 Feb 2009 11:19:00 PST

1. CHECK
Check the victim for unresponsiveness.

2. BLOW
Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second.

3. PUMP
If the victim is still not breathing normally, coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 30 times pump right between the nipples. Pump at the rate of 100/minute, faster than once per second.

1st Aid for Heart Attack

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Tue, 17 Feb 2009 10:48:00 PST

Overview, Causes, & Risk Factors

A heart attack happens when part of the heart muscle does not receive the supply of oxygen-rich blood that it needs to function. When the blood supply stops flowing to that part of the heart muscle, that muscle area dies. This can cause an abnormality in the rhythm or rate of the heartbeat, a condition called arrhythmias (a-rith-me-ahs). These arrhythmias can lead to cardiac arrest, in which breathing and heart function stop.

   The causes of a heart attack usually involve blood-clot formation or a spasm of one of the arteries that supplies blood directly to the heart muscle. These arteries are called coronary arteries. When the blood is blocked to a part of the heart muscle, the oxygen-rich blood that is needed by that part of the heart cannot reach it. As a result, the cells in that area are damaged or die. This usually occurs when the coronary artery has been narrowed due to a build-up of fatty deposits in the arteries, a condition known as atherosclerosis.

Symptoms & Signs

 The signs and symptoms of a heart attack vary. Chest pain or pressure usually occurs beneath the sternum, which is the bone in the center of the chest. The pain may spread to other parts of the chest, arms, usually the left arm, and left shoulder. There can also be pain in the neck, teeth and jaws. The pain tends to occur on the left side, but pain can occur in the right arm, right shoulder and right side of the neck. The pain can also spread to the back. On rare occasions, pain has also occurred in the legs. 
 In addition, a person having a heart attack may have one or more of the following symptoms:
abdominal pain.a "pressing" pain that lasts for some time.
pain not relieved by rest.indigestion-like pain with squeezing, or heavy pressure on the chest. Many people describe the pressure as "someone sitting on my chest" or a "tight band squeezing my chest.
"shortness of breath.light-headedness.
dizziness.
nausea.
sweating.
feeling of "impending doom" anxiety.

Diagnosis & Tests

 Diagnosis is most often made in the emergency room. The doctor will usually do a test called an EKG to study heart waves. Blood tests may also be done to help determine if the person is having or has had a heart attack. 
It is important for anyone suffering from chest pain to seek immediate medical help. The average person in the United States waits longer than 3 hours before seeking help for a heart attack. Women usually wait much longer than men. There are many ways to treat heart attacks, but many of these treatments must be administered within the first 6 hours after the chest pain has begun. The sooner a person gets to the emergency room, the better the chances are of surviving and reducing damage to the heart. 
It is also important to note that many people do not want to believe that they are having a heart attack. They often deny that the pain they are suffering is a symptom of a heart attack. There is a need to recognize that many men describe their pain as more intense and seek medical care much sooner than women. This means that many women will put off seeking medical care when they are suffering chest pain. They often believe that the heart attack symptoms are something mild or minimal, when in fact they are having a heart attack. 

Prevention & Expectations

 Controlling risk factors is the most important way to prevent a heart attack. 
 Blood pressure and cholesterol levels should be controlled. For people with high blood pressure or cholesterol, there are medications that are now used to help control these problems if lifestyle changes are not effective. 
Other important ways to prevent heart attacks include dietary changes, weight loss for people who are overweight, and management of diabetes. A daily exercise program is beneficial to help lose pounds or maintain weight and keep the heart healthy. 
Smoking and excessive alcohol use must be avoided. Smoking more than doubles the chance of developing heart disease. It is also important to limit alcohol intake, although small amounts of alcohol each day have been shown to reduce the rate of heart attacks in some people. 

Treatment & Monitoring

   
 Treatments for a heart attack involve some first aid measures. 
Have the person keep calm, sit down, and rest.
 
Do not move the person or get them to exert themselves in any way. Exertion will only increase the heart rate, which will increase the amount of oxygen that the heart needs to work.
 
Determine if the person is taking any heart medications. If the person has medication, such as nitroglycerin tablets, assist them in taking the medication. If the chest pain does not lessen within 3 minutes of taking the nitroglycerin, someone should call for emergency medical assistance.
 
Call for emergency medical help and then begin cardiopulmonary resuscitation (CPR) if the person is unconscious or unresponsive.
   
What are the side effects of the treatments? 
 The medications can sometimes cause headaches and a lowering of blood pressure. If CPR is performed, there can be multiple injuries to the lungs, chest wall, and the structures of the chest cavity during chest compressions. However, the chest compressions may be the only way to save the person's life. For this reason, the lifesaving benefits from CPR outweigh the risk of injury. 
 
What happens after treatment for the injury? 
After first aid has been given and medical help has arrived, the medical team will take over. The person suffering a heart attack will be transferred to the nearest medical facility for further treatment. The person may undergo a procedure called angioplasty, in which a catheter is placed into a large artery and then inserted into the heart to open up the artery. Surgery and grafts designed to bypass the clogged artery area may also be required.

1st Aid for Near Drowning

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Tue, 17 Feb 2009 10:41:00 PST

Overview, Causes, & Risk Factors

Near drowning occurs when a person becomes submerged in a liquid, usually water, making breathing difficult and causing near death or, in some cases, initial survival with the victim dying of related causes more than 24 hours later.

Near drowning is caused by lack of oxygen, whether or not water has entered the lungs. A deep pool of water is not the only drowning hazard. Someone can drown in a very small amount of water if the mouth and nose are covered, preventing the person from breathing.

Individuals at greatest risk for near drowning are those who are very young, very old, unable to swim, or those who tire easily. Many drowning or near-drowning cases are the result of recreational activities, such as boating or swimming. Other risk factors include swimming after drinking alcohol.

Symptoms & Signs

The signs and symptoms for near drowning are:

absence of breathing
lethargy or lack of energy
coughing
confusion
cyanosis, or bluish skin
abdominal swelling
vomiting
unconsciousness
spitting up water or fluid that is usually pink or frothy

Diagnosis & Tests

 A drowning victim will usually be spotted panicking at the surface of a body of water. Sometimes the person is found lying in the water or liquid, or on the shore near a large body of water.

Prevention & Expectations Prevent near drowning by following these guidelines:
Don't drink alcohol while boating or swimming.
Take a boating safety course.
Learn how to swim.
Know the sports safety guidelines for summer.
Don't swim right after eating.
Don't allow children to bathe, swim, or play in water without adult supervision.
Have the proper flotation devices on boats.
Use the proper flotation devices while swimming.
Don't swim if you start to feel overly tired.
Fence all areas where there is water, such as a spa or pool, to keep small children and others from falling in.
Buckets, tubs, and other objects that can hold water should be empty and out of the reach of small children.
Swim parallel to the shore until you are out of the current if you are caught in a riptide. Then swim toward the shore.

Treatment & Monitoring

  
What are the treatments for the injury? 
 First aid for near drowning includes the following steps:
Get the drowning person out of the water without placing yourself in danger. Tie a rope to a buoy, life preserver, or other flotation device and throw it to the person. Use the rope to pull them out of the water.
In deep water, try to use a boat or other object to reach the victim. Many people who are drowning will panic and pull the rescuer under water.
Check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation.Immediately contact the emergency medical system.Start cardiopulmonary resuscitation, or CPR, if the person stops breathing. Use 15 chest compressions for every 2 mouth-to-mouth rescue breaths.
Stay with the victim and continue CPR until emergency help arrives, or until the person begins to breath independently.
If CPR is not needed, change any wet clothing, warm the person, and give first aid for any injuries.
         
What are the side effects of the treatments? 
 If CPR is performed, there can be injury to the chest wall, muscle, and bone during chest compressions. The person may also choke on his or her vomit during CPR and rescue breathing. If the victim does start to vomit, turn the person on his or her side so that the vomit will not block the throat or airway. 
 
What happens after treatment for the injury? 
 After the person has recovered fully from a near-drowning experience, there are usually no long-term problems. In rare situations, permanent brain damage may result if there is a lack of oxygen for a significant period of time.

1st Aid for Poisoning

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 07 Feb 2009 08:07:00 PST

Overview, Causes, & Risk Factors

Poisoning occurs when a person comes in contact with a toxic substance. Contact can mean swallowing, inhaling, touching, or injecting a toxic substance.

Poisons are found in many household items. Because they cannot read container labels, small children are more likely to be poisoned. Poisonous items include:

prescription or over-the-counter medications
detergents
plants
pesticides
animals
paint
cosmetics
illegal drugs
occupational gases
foods
gasoline, kerosene, and fuel oil
antifreeze
windshield washer fluid
household cleansers
charcoal lighter fluid
carbon monoxide
food that hasn't been properly cooked, canned, or stored

Symptoms & Signs

The signs and symptoms of the poisoning can include:

abdominal distress
chest pain
chills
cough
diarrhea
dizziness
double vision
drowsiness
fever
headache
palpitations, or an unusual awareness of the heart beatloss of appetite
irritability
urinary incontinence, or loss of bladder control
nausea and vomiting
numbness
seizures
shortness of breath
skin rash
unresponsiveness
unconsciousness
unusual breath odor
weakness
cherry-red color to the skin

Diagnosis & Tests

If a person is unaware that he or she has been exposed to poison or is too ill to say what has happened, poisoning can be difficult to diagnose and treat. Healthcare providers can do blood and urine tests to determine the type of poison. If the poison is identified, seek emergency medical assistance and take the poison container. Healthcare providers can provide appropriate treatment immediately if they know what the poison is.

Prevention & Expectations

To prevent poisoning, follow these guidelines:

Keep all poisons out of children's reach.
Keep all prescriptions in a secure place out of children's reach.
Remove plants that can be poisonous to children or pets.
Teach children the meaning of the poison symbol on containers.
Be aware of poisonous substances around the house.
Report any industrial poisons that are harmful to family members to the local health department or the state or federal Environmental Protection Agency (EPA).
Do not store toxic or noxious substances in food containers.
Label all storage containers.

      
Be aware that many substances meant to be eaten can be toxic if taken in large amounts.

Treatment & Monitoring

Call the local poison control center to seek medical assistance. The phone number is in the front of most phone books. These centers are operated 24 hours a day, 7 days a week. Keep the number and address in an easy-to-reach place.

If someone has swallowed poison:

Check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation.
Contact the emergency medical system immediately.
Start cardiopulmonary resuscitation, or CPR, if the person stops breathing. Use 15 chest compressions for every 2 mouth-to-mouth rescue breaths.
If the person does not need CPR, try to find out what poisoned him or her. Pay attention to burns or smells that may help to identify the poison.
Call the local poison control center and follow the instructions given.
Do not induce vomiting unless told to do so. To induce vomiting take 1 tablespoon of syrup of ipecac followed by 2 glasses of water. Another way to induce vomiting is to give a glass of warm milk containing 3 teaspoons of salt or 1 teaspoonful of dried mustard.
If the person vomits, protect the airway by turning his or her head to the side. The rescuer should wear gloves or wrap his or her hand in a cloth before cleaning out the person's mouth. The poison is probably still inside the person's stomach.
Reassure and observe the person until medical help arrives. If there is poison on the clothing, remove the clothing. Clean the skin with water.

If someone inhaled poison:

Call for help. Be careful and cautious. Do not try to rescue the person until it is certain that the gas has been cleared from the area.
Remove the person from the area. Before doing this, the rescuer should hold a wet cloth over his or her nose and mouth, and open all windows and doors to get rid of the fumes.
After removing the person from the danger, check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation.
Contact the emergency medical system immediately.
Start cardiopulmonary resuscitation, or CPR, if the person stops breathing. Use 15 chest compressions for every 2 mouth-to-mouth rescue breaths.Protect the airway by turning the head to the side if the person vomits. Try to clear the person's mouth of any vomit.Stay with the person until medical help arrives.
To avoid becoming ill, the rescuer should avoid the area or make sure the poison has been cleared from the area.

Vomiting is the most common side effect of treatment. This may be a natural reaction to the poison. If the poison control center advises doing so, give the person syrup of ipecac to induce vomiting. Be aware that the vomit can be inhaled into the lungs causing aspiration pneumonia. People providing care should be careful, too. They could get sick from inhaling or being sprayed by the poison.

Most people recover fully from being poisoned. In some instances, there are serious injuries to the lungs or to the mouth and esophagus, which is the tube leading from the mouth to the stomach. These people will require long-term follow-up care from a healthcare professional. Prevention is the key to avoiding future occurrences.

1st Aid for Shock

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Thu, 05 Feb 2009 09:24:00 PST

Overview, Causes, & Risk Factors

Shock occurs when blood flow throughout the body is decreased and the body tissues don't get enough oxygen. This lack of oxygen causes injury to many body systems. There may be brain, kidney, or heart damage; loss of a limb; and intestinal problems.

What are the causes and risks of the injury?

There are many causes for shock, including:

heart attacks
severe trauma, such as a serious motor vehicle accident
infections
diabetes
loss of blood
head injury
anaphylaxis, which is a severe allergic reaction
severe vomiting
hypothermia, or a drop in body temperature due to cold exposure
severe diarrhea

Shock is a life-threatening condition and requires emergency medical treatment immediately.

Symptoms & Signs

What are the signs and symptoms of the injury?

A person suffering from shock may have one or more of the following symptoms:

cool, clammy skin
dizziness
fainting
nausea and vomiting
unconsciousness
weakness
confusion
excessive thirst
shallow breathing
excessive sweating
rapid heartbeat
anxiety
bluish lips and fingernails
paleness
chest pain
inability to urinate

Diagnosis & Tests

  
How is the injury recognized? 
 Shock is usually diagnosed by seeing a pattern of change in a person's vital signs. The vital signs include pulse, blood pressure, and breathing. The vital sign pattern used to diagnose shock includes:
low blood pressure
weak but rapid heartbeat
rapid, shallow breathing
fever
decreased level of consciousness, such as  confusion or coma 
    
 Some blood tests can also help show some of the signs of shock. It is the complete picture that gives a diagnosis of shock rather than a single vital sign or lab test.

Prevention & Expectations 
  
What can be done to prevent the injury? 
 Some cases of shock can be prevented by keeping heart disease and  diabetes under control. A person with severe  diarrhea or vomiting, infection, or a head injury should be seen by a healthcare provider.

Treatment & Monitoring 
  
What are the treatments for the injury? 
 First aid treatment of a person in shock includes the following steps: 
 
 
 
 
Check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation.
Contact the emergency medical system immediately.
Start cardiopulmonary resuscitation, or CPR, if the person stops breathing. Use 15 chest compressions for every 2 mouth-to-mouth rescue breaths.
Stay with the person until medical assistance arrives.
Do not let the person eat or drink anything.
   
What are the side effects of the treatments? 
 The chest compressions of CPR can cause vomiting, injuries to internal organs, or broken ribs. Vomiting can be a problem if the vomit is caught in the airway and inhaled into the lungs. 
 
What happens after treatment for the injury? 
 Treatment for the effects of shock or for the underlying condition that caused the shock may last a few months or years, or it may need to be continued for the person's entire life.

Vertebral Compression Fracture - Compression Fractures of the Back

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Thu, 05 Feb 2009 08:59:00 PST

Overview, Causes, & Risk Factors

Brought on by force, a compression fracture is a break in a vertebra that causes it to collapse. The vertebrae are the box-shaped bones that make up the spine. Typically, a compression fracture is wedge-shaped, with more collapse in the front, due to force on the spine from forward bending.

What is going on in the body?

The spinal column of vertebrae, stacked one on top of another, supports the body in an upright position. When the force on the bone is greater than the strength of the bone, a compression fracture occurs. Fractures can also occur when the bones have been weakened. For example, in osteoporosis, fractures can occur spontaneously with no known injury. Compression fractures occur most often in the lower back or lumbar area. They also occur in the chest or thoracic area of the spine.

What are the causes and risks of the condition?

Most often, an injury is the cause. In young, healthy bone, a violent force such as a car accident or fall from a height is necessary to break the bone. In weak, thin bone, minor force such as sitting down hard or vigorous sneezing can cause the compression. Bone can be weak for various reasons, the most common being osteoporosis. Cancer can also weaken a vertebra.

Symptoms & Signs

What are the signs and symptoms of the condition?

Mild, moderate, or severe back pain, particularly in the upright position, is the main complaint. Lying down may relieve some of the discomfort. In most cases, the discomfort lessens a great deal within 6 to 8 weeks.

If several vertebrae are compressed, a rounded or hunched back may be noticed. Rarely, the compression fracture may be severe enough to cause pressure on the spinal cord or nerves. If this occurs, it could result in numbness, weakness, or paralysis of the legs, bladder, or bowels.

Other signs include tenderness over the compressed vertebra and spasm of the muscles around it. Standing with an erect posture may be hard.

Diagnosis & Tests

How is the condition diagnosed?

 Compression fractures of the back are suspected based on the medical history, symptoms, and signs. The diagnosis is confirmed by spine X-rays, particularly from the side view. Rarely, special X-ray tests such as a bone scan, MRI, or CT scan are used to make the diagnosis. The MRI and CT scan can show greater detail in more severe injuries that press on the spinal cord

Prevention & Expectations

  
What can be done to prevent the condition? 
Fractures can be avoided by keeping bones healthy through a healthy diet, which includes calcium and vitamin D intake. Weight-bearing exercise also helps stimulate bone growth and strength.
   
What are the long-term effects of the condition? 
The majority of compression fractures will heal without long-term problems. The greater the collapse, however, the greater the chance of future back pain. It's possible for the collapse to worsen and cause nerve problems or require surgery.
 
What are the risks to others? 
There are no risks to others.

Treatment & Monitoring   
What are the treatments for the condition? 
Often rest, reduced activity, and pain medicine are enough to relieve the discomfort. Temporary use of a back support, such as a brace, corset, or girdle, may also help. For more serious compression fractures, a larger brace or body cast may be needed. This will help protect the spine during the healing phase and prevent future collapse. For the most severe injuries, especially those resulting in nerve problems, surgery to correct the collapse and fuse the spine may be considered. As the fracture heals, it is important to exercise the muscles that help strengthen and straighten the back. Physical therapy may be used to teach the person the right ways to use the body for lifting and other activities.
 
What are the side effects of the treatments? 
Surgery might result in nerve injury, failure to correct the deformity, infection, or failure of the bone fusion to heal.
 
What happens after treatment for the condition? 
Pain is often relieved following rest, reduced activity, pain medicine, and physical therapy.

Clavicle Fracture - Collarbone Fracture

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Thu, 05 Feb 2009 08:45:00 PST

Overview, Causes, & Risk Factors

A collarbone fracture is a break that occurs in the collarbone, also called the clavicle. The collarbone is the bone that connects the breastbone, also called the sternum, to the shoulder blade.

What is going on in the body?

The collarbone is a long, narrow, S-shaped, solid bone. Because of its location and shape, it can be injured when the arm, elbow, or shoulder suffers any trauma. The collarbone is located in front of a number of key nerves and blood vessels. Rarely, these nerves and blood vessels may be injured when the collarbone is broken.

What are the causes and risks of the condition?

A collarbone fracture is often caused by a fall. Trauma may also occur during contact sports, such as ice hockey, football, or wrestling. Other causes may include:

a tumor in the collarbone
conditions that cause weak bones, such as osteoporosis
physical abuse, including child abuse or elder abuse

A newborn's collarbone may be broken during birth as the child travels through through the birth canal.

Symptoms & Signs

What are the signs and symptoms of the condition?

Symptoms of a fractured collarbone may include:

a visible deformity or bump that may be seen through the skin
a rubbing or grinding sensation when the arm is raised
a shoulder that flops down and forward
inability to move the arm
numbness or tingling sensation in the shoulder, arm, or hand
pain, ranging from moderate to severe
pain that increases with movement
a preference for holding the shoulder and arm close to the body with the arm supported
swelling around the shoulder and collarbone
weakness in the arm

Diagnosis & Tests

How is the condition diagnosed?

After doing a complete medical history and physical exam, the doctor may order:

a biopsy of any fluid or growths to check for infection or tumors
a nerve conduction test, also called an NCV, to measure nerve damage from the injury
blood tests to rule out infection, including a complete blood count
imaging tests, such as MRI, if a tumor is suspected
X-rays to locate the break and its severity

Prevention & Expectations

What can be done to prevent the condition?

A person can prevent some injuries by following sports safety guidelines for children, adolescents, and adults. A healthy diet with adequate calcium can help prevent some fractures caused by bone weakness.

What are the long-term effects of the condition?

Long-term effects will depend on the extent of the fracture and the success of treatment. If a person was involved in sports or heavy lifting before the injury, his or her normal range of motion in the shoulder may be decreased. Chronic pain or soreness in the shoulder and collarbone may also occur. Damage to the nerves and blood vessels is also possible. This damage can lead to decreased sensation and other tissue damage.

What are the risks to others?

A collarbone fracture poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

Minor to moderate injury may require "RICE" therapy:

R : rest or reduced activity
I : ice or cold packs applied to the shoulder, for 15 minutes every 2 hours
C : compression of the affected area, such as with a special splint called a figure-of-8 splint or a sling
E : elevation of the shoulder or affected arm

Nonsteroidal anti-inflammatory drugs, also called NSAIDs, may be recommended to reduce inflammation and discomfort. Examples of NSAIDs are ibuprofen and naproxen.

After a few days to weeks, the initial pain and swelling will begin to subside, and the bone will start to heal. At this time, physical therapy or strength training exercises may help to increase the strength of the tendons and muscles. Ultrasound may also be used to warm the muscles and improve blood flow.

If conservative treatment is not successful, surgery may be needed. Sometimes, a bone graft may be needed to promote healing.

What are the side effects of the treatments?

There may be stomach upset, ulcers, or an allergic reaction to NSAIDs. Splints or slings can cause muscle tightening as well as skin irritation. Treatments that require surgery pose a risk of bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the condition?

In some situations, no further treatment is needed. Physical therapy and daily exercises may be advised to strengthen the muscles and help the bone continue to heal. Complete recovery from the fracture may take several months.

Nasal Bone Fracture - Nose Fracture

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Thu, 05 Feb 2009 08:36:00 PST

Overview, Causes, & Risk Factors

 A nose fracture is a break in the nasal bone. Most of the nose is made of cartilage, a soft spongy material. The upper portion of the nose has a bone underneath it called the nasal bone.

What are the causes and risks of the injury?
 Following are some of the possible causes of a nose fracture:
being flung into a hard object, such as in a motor vehicle accident
being hit on the side of the nose, such as in a fistfight
running into a hard object, such as another player's helmet during football

Symptoms & Signs

What are the signs and symptoms of the injury?A fracture of the nose usually involves the following:
black eyes on both sides
deformed appearance of the nose
difficulty breathing through the clogged nostril
a feeling of pain along the bridge of the nose and the area between the eyes
nasal pain and swellingnosebleed

Diagnosis & Tests

How is the injury recognized? Diagnosis of a nose fracture begins with a medical history and physical exam. If the fracture is not obvious, X-rays may be taken to check for a nose fracture.

Prevention & ExpectationsWhat can be done to prevent the injury? Sports safety guidelines should be followed by adults, adolescents, and children. Protective facewear should be worn while playing sports. Seat belts should be worn whenever a person is riding in a car. Avoiding trauma to the face helps to prevent nose fractures.

Treatment & MonitoringWhat are the treatments for the injury?First aid for a suspected nose fracture includes the following steps:
 Keep the person calm.
Have the person breathe slowly through the mouth and lean forward in a sitting position. This helps to prevent blood from going down the back of the throat, causing blockage. It also helps slow the blood flow.
Apply cold compresses to the nose to help reduce swelling and also slow down bleeding.Consider pain medication, including acetaminophen or ibuprofen.
Do not try to straighten a broken nose. Seek medical attention right away. 
 Anyone with a suspected nose fracture should see a healthcare provider. The provider can pack the nose with gauze or cotton. He or she can also attempt to reset the bones. If the provider is not seen immediately, the nose will swell. The person must then wait about five days before the bones can be reset. Antibiotics may be given during or after this time to prevent infection. 
In most cases, local anesthesia is applied to the inside of the nose to numb it. Special probes are inserted into the nose to lift the broken bones back into place. After the bones are set, the gauze or cotton may need to be repacked. 
More complicated injuries may require a surgeon to cut into the skin at the front of the nose. Through this skin incision, the surgeon can piece the bones back together with special tools. Sometimes a person needs to wear a special device on the outside of the nose to help the nose heal properly. Plastic surgery may be required at a later time to fix any cosmetic problems. 
What are the side effects of the treatments?All surgery involves the risks of bleeding and infection. Antibiotics have side effects, such as stomach upset and allergic reactions. 
What happens after treatment for the injury?Unless the injury is severe, a person is able to go back to his or her normal routine almost immediately.

ARTHROPLASTY (Knee Replacement)

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 31 Jan 2009 19:55:00 PST

The word 'arthroplasty' means 'reshaping of the joint'. 'Knee arthroplasty' is usually taken to mean 'knee replacement'. ‘Total knee replacement' is somewhat of a misnomer as the knee is not totally replaced but is really only re-surfaced.

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you're sitting or lying down.
If medications, changing your activity level and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By resurfacing your knee's damaged and worn surfaces, knee replacement surgery can relieve your pain, correct your leg deformity and help you resume your normal activities.
One of the most important orthopaedic surgical advances of the twentieth century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased its effectiveness.

How the Normal Knee Works

The knee is the largest joint in the body. Nearly normal knee function is needed to perform routine everyday activities. The knee is made up of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength.
The joint surfaces where these three bones touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily.
All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee.Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness and less function.

Common Causes of Knee Pain and Loss of Knee Function

The most common cause of chronic knee pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis are the most common forms.

Osteoarthritis usually occurs after the age of 50 and often in an individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
Rheumatoid Arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid that over-fills the joint space. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain and stiffness.
Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Is Knee Replacement for You?

The decision whether to have knee replacement surgery should be a cooperative one between you, your family and your orthopaedic surgeon. 
Reasons that you may benefit from knee replacement commonly include:

Severe knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
Moderate or severe knee pain while resting, either day or night
Chronic knee inflammation and swelling that doesn't improve with rest or medications
Knee deformity--a bowing in or out of your knee
Knee stiffness--inability to bend and straighten your knee
Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis.
Inability to tolerate or complications from pain medications
Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries

Most patients who undergo knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient's pain and disability, not age. Knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Realistic Expectations About Knee Replacement Surgery

An important factor in deciding whether to have knee replacement surgery is understanding what the procedure can and can't do.

More than 90 percent of individuals who undergo knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement won't make you a super-athlete or allow you to do more than you could before you developed arthritis.

Following surgery, you will be advised to avoid some types of activity, including jogging and high impact sports, for the rest of your life.

With normal use and activity, every knee replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. With appropriate activity modification, knee replacements can last for many years.

The Procedure

You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia, in which you are asleep throughout the procedure, and spinal or epidural anesthesia, in which you are awake but your legs are anesthetized. The anesthesia team will determine which type of anesthesia will be best for you with your input.

The procedure itself takes about one to two hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee.

Many different types of designs and materials are currently used in knee replacement surgery. Nearly all of them consist of three components: the femoral component (made of a highly polished strong metal), the tibial component (made of a durable plastic often held in a metal tray), and the patellar component (also plastic).

After surgery, you will be moved to the recovery room, where you will remain for one to two hours while your recovery from anesthesia is monitored. After you awaken, you will be taken to your hospital room.

Stay in the Hospital

You will most likely stay in the hospital for several days. After surgery, you will feel some pain, but medication will be given to you to make you feel as comfortable as possible. Pain management is an important part of your recovery, so talk with your surgeon if postoperative pain becomes a problem. Walking and knee movement are important to your recovery and will begin immediately after your surgery.

A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery.

Possible Complications After Surgery

The complication rate following knee replacement is low. Serious complications, such as a knee joint infection, occur in less than 2 percent of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit your full recovery.

Blood clots in the leg veins are the most common complication of knee replacement surgery. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood.

Although implant designs and materials as well as surgical techniques have been optimized, wear of the bearing surfaces or loosening of the components may occur. Additionally, although an average of 115 degrees of motion is generally anticipated after surgery, scarring of the knee can occasionally occur and motion may be more limited. This is particularly true in patients with limited motion before surgery. Finally, while rare, injury to the nerves or blood vessels around the knee can occur during surgery.

Recovery at Home

The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery.

Wound Care

You will have stitches running along your wound or a suture beneath your skin on the front of your knee. The stitches will be removed several weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until the wound has thoroughly sealed and dried. The wound may be bandaged to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some pain with activity and at night is common for several weeks after surgery. Your activity program should include:

A graduated walking program to slowly increase your mobility, initially in your home and later outside
Resuming other normal household activities, such as sitting and standing and walking up and down stairs
Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.

Avoiding Problems After Surgery

Blood Clot Prevention

Follow your orthopaedic surgeon's instructions carefully to minimize the potential of blood clots that can occur during the first several weeks of your recovery.

Warning signs of possible blood clots in your leg include:

Increasing pain in your calf
Tenderness or redness above or below your knee
Increasing swelling in your calf, ankle and foot

Preventing Infection

The most common causes of infection following knee replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.

For the first two years after your knee replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. After two years, talk to your orthopaedist and your dentist or urologist to see if you still need preventive antibiotics before any scheduled procedures.

Warning signs of a possible knee replacement infection are:

Persistent fever
Shaking chills
Increasing redness, tenderness or swelling of the knee wound
Drainage from the knee wound
Increasing knee pain with both activity and rest

Avoiding Falls

A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails or someone to help you until you have improved your balance, flexibility and strength.

How Your New Knee Is Different

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

After surgery, make sure you also do the following:

Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
See your orthopaedic surgeon periodically for a routine follow-up examination and X-rays, usually once a year.

Ligament Injury: ACL Reconstruction

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 31 Jan 2009 19:47:00 PST

Anterior cruciate ligament (ACL) reconstruction is the most common type of surgery for a completely torn acutely or chronic insufficient ACL with associated instability. ACL-deficient knees are at marked risk for developing meniscal injury. The loss of meniscal tissue is associated with degeneration. On the other hand, an isolated ACL tear without meniscal or chondral injury may not predispose to arthritis. It is rare to be able to repair the torn ACL by simply reconnecting the torn ends.

However, in very specific injuries when the ACL is detached from the femoral attachment site (such as in certain types of skiing accidents), it may be possible to perform a primary repair. Nevertheless, the mainstay of ACL tear management is reconstruction. Most surgeons now favor reconstruction of the ACL using a piece of tendon to replace the torn ACL.

Successful ACL reconstruction is dependent on a number of factors, including surgical technique, post-operative rehabilitation and associated secondary ligament instability. Today, ACL reconstruction is usually performed with arthroscopic assistance. The surgeon uses a graft, to replace the torn ACL. The graft may be taken from elsewhere in the patient's extremity (autograft), harvested from a cadaver (allograft) or may be synthetic.

Autograft
Autograft is the most widely performed orthopedic ACL reconstruction. The technique involves moving (harvesting) the patient’s own tissue. Commonly used autografts are the mid-third of the patellar tendon with bone attached at both ends, one or two medial hamstrings, or the quadriceps tendon with bone at one end. Results are somewhat similar and secondary effects are unique to the harvest site. Surgeon preference is the primary factor in selection.

Allograft 
An allograft is tissue that is harvested from a cadaver. (Donor tissue is kept at a tissue bank where it is screened for infection and then stored-most commonly frozen.) The advantage of using an allograft is that the patient's own tissue is not disturbed and thus there is no harvest site morbidity.

Synthetic
The advantages of synthetic grafts are the lack of harvest site morbidity, off the shelf availability, and no disease transmission. However, the failure rates of synthetic grafts tested in the USA were unacceptable. Synthetic grafts currently have inherent mechanical properties that do not closely resemble the normal ligament and as they are not living, they cannot repair themselves, as can natural ligaments.

Procedure
ACL reconstruction is usually not performed until a few weeks after the injury as studies have shown improved results when the knee has recovered from the acute injury response. That is, the knee has had resolution of swelling, pain and the patient has regained near full motion and strength.

During the procedure: The patient is anesthetized using general or spinal/epidural. Arthroscopy allows determination of associated injuries, which are usually treated at the same setting (e.g., meniscal tears or chondral trauma). The space in the knee where the PCL and ACL reside, the notch, is often narrow and in those cases it is widened (notchplasty) to accommodate the graft.

Then through a small separate accessory incision, a tunnel is drilled through the tibia (lower leg bone) and through the femur (the upper bone) in the same position as the original ligament attachment sites. The graft is fashioned to fit into these tunnels. The graft is fixed to the femur and tibia (upper and lower leg bones) by a variety of means. Once secure, the graft is checked for proper tension.

Recovery
While resting during the first 3 or 4 days, efforts are directed at minimizing the swelling and reestablishing quadriceps function. During this time elevation of the
knee, leg and ankle are emphasized. Moving frequently increases blood flow return from the extremity (e.g. ankle pumps).

Crutches are used to walk bearing weight as per doctor's orders. The emphasis is on a normal gait without limping.
Wear comfortable shoes.
Stay within your safe range of motion as directed by your doctor.
Bathe and shower after surgery as your surgeon directs.

Most surgeries are being done on an outpatient basis, although some patients stay overnight. After surgery, you will begin a rehabilitation program. The patient alone may do rehabilitation, with a certified athletic trainer or with a physical therapist. Formal therapy usually last 2-12 weeks and then is followed by a “home program” which will last until full strength and agility are achieved which usually takes four to six months. Following the rehabilitation, you may be placed on a return to sport program using a functional progression approach.

Complications/Risks

Graft failure due to re-injury, graft specific factors, tunnel placement, tensioning, or fixation methods
Blood clots (very rare)
Surgical wound infection
Risk of developing arthritis
Weakening of muscles
Lack of full range of motion

SIMPLE TRIAGE AND RAPID TREATMENT

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Sat, 31 Jan 2009 08:23:00 PST

Triage was the assessment, the sorting and the grouping of the sufferer who will get the medical handling of the evacuation in the condition for the mass incident or the disaster.

In the disaster incident usually many casualties, whereas the official and help equipment were very limited so as to have to carry out the sorting to determine the priority.

One of the methods triage in the disaster was START the abbreviation from Simple Triage And Rapid Treatment.
The START method really was easy to be carried out although by the layman even. This indeed because triage necessarily was done by anyone that the first time to the incident location. Results of the process triage was the grouping pederita appropriate heavy light him the problem in this sufferer.

So that his grouping is easy to be known by the other official then in triage very important to do labeling with the colour that has been acknowledged in an international manner that is Red, Yellow, Green, and Black.

RED -- > High Priority -- > needed the handling A.S.A.P.
YELLOW -- > Intermediate Priority -- > if immediately was not given by help would worsened.
GREEN -- > Low Priority -- > the Handling of the sufferer could action later.
BLACK -- > Lowest Priority -- > the sufferer who could not be maintained again or has died.

The START procedure:

The step 0 : Call casualties who still could be walking to approach to the side of the official that was safe location (collecting the area). Casualties who could walk approached was given the GREEN label.
The Step 1 (Airway + Breathing) : breathing check, If not breathing opened the respiratory tract, if continuing to not breathe gave the label of BLACK; breathing > 30 times/the minute or < > * breathing 10-30 times per minutet the refinery following.
The step 2 (Circulation) : Capilary test check (pressed the sufferer's Fingernail) afterwards free, if again was red more than 2 seconds (> 2 seconds) gave the label of RED. * If < > * If underexposure to capilary test, did the pulse cheque radialis, if being not felt or weak gave the label of RED. * If the pulse radialis was felt the refinery along with.
The step 3 (bounced the Status) * gave the simple order to the sufferer, If followed gave the label of YELLOW. * If could not follow the order gave the RED label.

After carrying out steps triage and gave the label/the sign to the sufferer, immediately to head te patient other that was not yet carried out triage.

Triage must be always evaluated to avoid the possibility of happening the time mistake triage. Or could also the change happened when the condition for the sufferer improved or worsened.

1st Aid for Loss of Consciousness

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Fri, 30 Jan 2009 17:51:00 PST

Overview, Causes & Risk Factors

Unconsciousness is defined as a state of unawareness or an inability to respond as a result of reduced brain stem activity.

There are many causes of unconsciousness, or loss of consciousness. It can be caused by illness or by injury. It can also be the result of excessive alcohol or drug use. Other causes include low blood sugar levels and fainting.

Symptoms & Signs

The signs and symptoms of unconsciousness include:

inability to respond. For example, a person may not be able to clear the throat, yawn, cough, or awaken.
Coma
Drowsiness
disorientation, a condition in which the person can't identify familiar people or places.

Diagnosis & Tests

Diagnosis of unconsciousness is made when a person will not awaken with gentle rousing. An individual who is unconscious will not be able to cough and may have difficulty breathing. The person will not be able to open his or her eyes and doesn't respond to stimuli such as touch or pain.

Prevention & Expectations

Prevention of unconsciousness focuses on treatment of the underlying problems. Control of blood sugar is required if someone has diabetes. An individual with diabetes should wear an identification bracelet to alert others in case he or she loses consciousness. Excessive alcohol and illegal drugs should be avoided.

Treatment & Monitoring

1st aid is the treatment that is usually provided when someone is unconscious:

Check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation.
If necessary, begin rescue breathing and cardiopulmonary resuscitation or CPR.
Contact the emergency medical system immediately.
If a spinal cord injury is suspected, avoid moving the person except to assist breathing. If the victim is unable to breathe, gently logroll him or her into a position so that rescue breathing can be started.
Gently restrain the victim if he or she becomes agitated.
Protect the victim from injury if seizures occur.
Keep the victim warm.
Stay with the victim until medical help arrives.
Try to get the victim to eat or drink something sweet upon regaining consciousness if he or she appears to have low blood sugar.

What are the side effects of the treatments?

Rolling a person with a spinal cord injury can worsen the damage. Therefore, it is important to move the victim only as needed to assist with breathing.

What happens after treatment for the condition?

The emergency medical system should be contacted immediately, and the person will be transported to the emergency department for care.

1st AID KIT

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Fri, 30 Jan 2009 17:35:00 PST

A first aid kit is a collection of supplies and materials that can be used as a first line of treatment for an injury or illness.

First aid kits can either be purchased or made by an individual. Several items are listed below that can be used in a first aid kit. Certain activities are related to risk of certain injuries. People involved in special activities may want to include more of some items in their kits than people who are not involved in those activities. First aid kits can be bought at sporting goods stores, pharmacies and some department stores. The following materials can be useful in a first aid kit.

Bandages should include:

adhesive bandage strips or surgical tape in different sizes

butterfly bandages (1/4 inch and 1 inch)

elastic wraps for wrists, ankles, knees and elbows

adhesive tape

sterile cotton balls, eye patches and gauze pads (4 x 4 inches and 2 x 2 inches)

absorbent cotton

adhesive gauze, wrapping and rolls

triangular bandage

Equipment should include:

scissors

tweezers

bulb syringe

cotton-tipped swabs

paper cups

blanket

thermometer

disposable instant ice bag

Medications should include:

Syrup of Ipecac, which should be used only as directed by a poison control center

acetaminophen

ibuprofen

antiseptic solution

antibiotic ointment

hydrocortisone cream

bee sting kit, if one has a known sensitivity to bee stings

Miscellaneous items should include:

first aid manual

change for telephone calls

flashlight

tissues

soap

safety pins

disposable gloves

PS: for the expert skill, we just need a scapel or simple knife only and creativity.. :)

The Bone Health Benefits of Vitamin K

alloenendonesia@yahoo.co.id (Alloen Endonesia™) — Mon, 26 Jan 2009 21:35:00 PST

Summary

Vitamin K is a fat-solube vitamin that is a coenzyme in the ã-Carboxylation of several special proteins, including osteocalcin (OC).
OC is the most avundant non-collegenous protein in bone. Carboxylated OC Binds strongly to the hydroxyapatite mineral crystal lattice of the bone.
Inadequate vitamin K prevents the complete corboxylation of OC; meaning higher levels of undercarboxylated OC are present. This ‘inactive’from has a lower affinity for calcium and binds poorly to the hydroxyapatite mineral crystal lattice.
The US Adequate Intake (AI) for adult men and women over the ae of 19 years is 120ìg and 90ìg respectively per day.
Researh indicates that this AI maybe too low for optimal bone health.

Background
Vitamin K is a fat-soluble vitamin found predominantly in green leafy vegetables, dairy products and meat. There are two natural forms of vitamin K. K1 (phylloquinone), which is made in plants, and K2 (menaquinone), which is produced by intestinal bacteria and also found in animal foods such as meat and dairy. Vitamin K1 is the major source of vitamin K found in the diet.

Function
Vitamin K is a coenzyme in the ã-carboxylation of several proteins needed for bone metabolism and blood coagulation. In bone mineralisation, vitamin K is needed for the synthesis of two proteins, OC and matrix Gla-protein (MGP). OC is the most abundant non-collagenous protein in bone. It is produced by bone forming cells called osteoblasts and binds strongly to the mineral matrix of bone. If adequate vitamin K is present, OC can be “carboxylated” (through the synthesis of ã-carboxyglutamic acid). This allows the carboxylated OC to bind calcium causing a conformational change. This “activated” OC binds strongly to the hydroxyapatite mineral crystal lattice of the bone. In contrast, inadequate vitamin K prevents complete carboxylation, meaning that more undercarboxylated OC, which binds poorly to the hydroxypatite crystal lattice, will be formed. In addition to its presence in bone, a small amount of newly formed OC is released into the blood, which enables it to be measured easily. Serum OC is commonly used as a marker of bone turnover. A high level of undercarboxylated OC in the blood, as a percentage of total OC is indicative of low vitamin K status.

Adequate Intakes of Vitamin K
The latest US dietary recommendation for vitamin K is set as an Adequate Intake (AI) and is based on the average vitamin K intakes of healthy individuals. The AI for adult men and women over the age of 19 years is 120 ìg and 90 ìg per day respectively. However, several metabolic studies indecate that this recommendation is too low for optimal bone health. Intakes of vitamin K close to the recommended dietary intake levels are associated with high levels of circulating under-carboxylation of OC is not maximized.

Observational Studies on Vitamin K & Bone Health
This link between vitamin K and bone health is supported by studies that reported low dietary intakes of vitamin K were associated with a greater risk of hip fracture and low BMD. The Nurses Health Study was a large 10 year prospective cohort study of women aged 38-63 years. Over 72,000 women were recruited and their average baseline vitamin K1 intake was estimated at 192 ìg/day. During the follow up, Feskanich et al. (1999) it was found that hip fracure risk increased when vitamin K1 intakes dropped below 109 ìg/day. It is important to note that this intake cut off is higher than the current US recommendation of 90 ìg/day for adult women. The Framingham study looked at vitamin K1 intakes in older women. In this study the average baseline vtiamin K1 intake was estimated at 155 ìg/day. Booth et al. (2000) showed that low vtiamin K1 intakes in elderly men and women were associated with a higher risk of hip fracture. The authors concluded that vtiamin K1 has a more pronounced effect on fracture than on BMD. The risk of fracture was signifucantly lower (RR:0.35; 95% Cl: 0.13, 0.94) at vitamin K1 intakes of 254 ìg/day. Booth et al. (2003) also looked at other cohorts of younger men and women from the Framingham Study. These studies found that women in the lowest quartile of vitamin K1 intakes (70.2ìg/day) had significantly lower BMD at the hip and spine compared to those in the highest quartile (309 ìg/day); and there was a positive correlation between BMD and blood parameters of vitamin K status (serum K1 adn undercarboxylated OC) in young men. These associations suggest that poor vitamin K status has a negative impact on bone metabolism and that additional vitamin K would be advantageous.

Intervention Studies on Vitamin K & Bone Health
Several research groups haver published over 20 studies that have evaluated the effect of increasing vitamin K intake on different aspects of bone health. The trials published so far can be divuded into two groups:

(1) studies looking at the effects of vitamin K on the bone marker undercarbocylated OC; and 

(2) studies looking at the effects of vitamin K on BMD and fracture risk. 

Intervention Studies on Vitamin K & Bone Health cont. 
Of note in the first group of studies are two separate trials on healthy adults by Binkley et al. (2000;2002). They showed that various doses of vitamin K1 supplementation (250-2000 ìg/day) for 2 weeks significantly increased serum phylloquinone levels in a dose responsive manner and increased the percentage of ã-carboxylated OC. In these two intervention trials vitamin K has been supplemented at levels 12-15 times higher than the current recommended intake for men and women respectively. This suggest usual deitary intakes in these groups do not provide adequate vitamin K for maximal carboxylation of OC. Another study by Schaafsma et al. (2000) randomised postmenopausal women with normal or low bone mineral densities (BMD) to receive either vitamin D3 and vitamin K1 or placebo for 1 year. Women with low BMD had a lower percentage of carboxylated OC before supplementation started compared to those with normal BMD. This difference disappeared after vitamin K1 supplementation. This study also showed that as little as 80 ìg of vitamin K1 daily, on topof usual detary intake, can bringundercarboxylated OC levels in postmenopausal women back down to levels seen before menopause. 

In the second group of studies the intervention trials measured the direct effects of vitamin K supplementation on age-related bone loss, incidence of new and recurring osteoporotic fractures; BMD; and BMC. The best examples of which are the Maastricht Osteostudy and the DundeeBones and Vitamins Intervention Study (D-BAVIS). The Maastricht Osteostudy was a 3-year randomised, double-blinded placebo controlled suppplementation trial. Subjects were given either a placebo, or a supplement containing 8 ìg vitamin D3, 500 mg Calcium, 150 mg Magnesium and 10 mg Zinc, with or without vitamin K1 (1 mg). The group receiving the supplement containing vitamin K1 lost significantly less bone at the femoral neck (hip) than the groups not taking vitamin K1. In fact, the rate of bone loss decreased by 35-40% as compared to placebo. It has been concluded that if the observed effects of vitamin K continue over decades, life long supplementation could delay fractures by up to 10 years. The D-BAVIS was a 2-year placebo controlled trial where the impact of three different therapies on BMD and BMC at the hip and wrist were compared. Subjects were randomised to receive either a placebo; or 200 ìg vitamin K1; or 10 ìg vitamin D3 and 1 g calcium; or a combination of the two interventions. The main fingdings of the study included: baseline vitamin K status was sub optimal; supplementation with vitamin K significantly increased serum vitamin K; and there was a significantly increase in BMC and BMD at the ultra-distal radius (wrist) in the combination intervention grioup. The authors concluded that the results from the combined supplementation suggested a synergy between vitamin K and vitamin D. 

In another study by Kruger et al. (2005) vitamin K1 fortified milk powder was used as the intervention in a 16 week randomised controlled bonemarker trial. Women beween 20 and 35 years with a body mass index (BMI) between 20 and 30 were recruited and were randomised into three goups (n = 26 per group). The first group received no supplementation; the second received two sachets (50g) of high calcium skim milk (HCM) powder; and the third group received two sachets (50 g) of HCM powder, plus vitamin K1 per day. The milk powder supplements were identical (1000 mg Calcium, 5 ìg Vitamin D3, 3 mg Zinc, 495 ìg Vitamin A and 105 mg Magnesium per day), except for the vitamin K1 content (80 ìg per day). Replicate blood samples (within three days from each other) were collected between 8 and 10 a.m (overnight fast) for the baseline measurements, as well as, at weeks 2, 12 and 16 of the intervention. A full range of biochemical, hormone and bonemarker assays were completed. There were no significant differences between the groups at baseline. However, over the week intervention erum vitamin K increased and serum undercarboxylated OC decreased significantly in the HCM plus vitamin K1 supplement group. It is reasonable to conclude that these biochemical changes would be indicative of significant changes in BMD in the long-term.