Learning Outcome Skenario 1

1. Memahami substernal pressure

a. Described as a substernal pressure sensation that also may be
characterized as a squeezing. Pramod Kerkar, MD, FFARCSI, Pain Assist Inc.
2016
b. Individual pain experiences just below the sternal bone Pramod Kerkar,
MD, FFARCSI, Pain Assist Inc. 2016
2. Menjelaskan aritmia, Iskemia, Infark miokard, gangguan Arteri coronaria,
sebagai precursor kejadian Congestive Heart Failure
a. Aritmia : Abnormal impuls / konduksi listrik Mempengaruhi otomatisasi
pacu jantung dan Mekanisme otomatisasi normal pada Sinus
Otomatisasi pacu jantung menjadi abnormal Penurunan potensial listrik
pada serabut jantung Konduksi listrik ke otot jantung yang lemah
Penurunan potensial kecepatan depolarisasi jantung Anisotropik
struktur otot jantung Pembengkakan jantung CHF
Myocardial Infarction, by A Maziar Zafari, MD ; 2016
3. Patofisiologi Congestive Heart Failure dan Aritmia secara konsep
a. Cedera pada otot jantung Penurunan curah jantung Stimulus pada
carotid baroreceptor dan renal receptor Stimulus pada carotid dan renal
mengakibatkan aktivasi SNS dan RAAS untuk meningkatkan denyut
jantung dan inotropi Aktivasi SNS menghambat pelepasan Beta Blocker
Fungsi ventrikel kiri semakin buruk tanda dan gejala gagal jantung
b. Cedera pada otot jantung Penurunan curah jantung Stimulus pada
carotid baroreceptor dan renal receptor Aktivasi BNP dan ANP
Vasokonstriksi pembuluh darah Penyimpangan hemodinamik tubuh
Fungsi ventrikel semakin buruk Gejala gagal jantung
Parmley W. W, American Journal of Cardiology. Pubmed. PMID 4014-051
4. Saturasi oksigen
PO2 : Tekanan O2 dalam darah 80-100
PCO2 : Tekanan CO2 dalam darah 35-45
HCO3 : Marker ketoasidosis
Saturasi oksigen : 95-98%
Orlando Region for Hospital Care Interpretation. Analysis of Blood Gas. 2004.
Orlando, USA
5. Kaitan suku, etnik, dan kejadian CHF
a. Differences in the incidence of CHF by ethnic

By Hossein Bahrami, Richard Kron, Juao La Lima : MESA Journal

Ethnic has no direct effect in the incidence, but between Afro America and
White Skin the comparison is 1 : 1,8 with 95% CI
b. Epidemiology of congestive heart failure in three ethnic group
Demirovic, Prineas R, Rudolph M 2001.
Africa American : 4,8%
White non Hispanic 4,9%
Hispanic Cuban 6,8%

Learning Outcome Skenario 2 :

1. Closed and Tension Pneumothorax
a. Tension pneumothorax : a life threatening condition that develops
when air is trapped in the pleural cavity under positive pressure,
displacing mediastinal cardiopulmonary function. Medscape.
Pneumothorax. July 20. 2016 by Brian J Daley, Mary C.
b. Closed pneumothorax : air or gas rets in to the pleural space
without ant outside wound, such as cancer or cystic fibrosis
Pneumothorax. Sick. Detroit. UXL. 2007. Student resources in
context.
2. Alkalosis Respiratorius
a. Left shift pathway :
Decrease release of O2 from Haemoglobin
Alkalosis
Decrease temperature
2,3 Biphosphoglycerate
Decrease methaemoglobin (Haemo which is carry O2)
Journal of Clinical Investigations. Regulation Mechanism of
Haemoglobinoxygen affinity in acidosis and alkalosis. Bellingham AJ,
Detter DJ, Lenfant C. 1971. Mar 50(3) 700-6
3. Emergency management
a. SAFE: Shout for help, Assess the victims, Make sure free from
danger, Evaluate the victims status
b. Beware of distract injuries

c. Evacuate victims if possible

d. Assess the airway function with cervical spine stabilization
e. Breathing
f.

Circulation

g. Investigate the mechanism of Injury whether caused by Vehiche,

Falls, or Deformity
The Prehospital Management of Chest Injuries : A Longitudinal
Statement : Royal College of Surgeon of Edinburgh, Caroline Lee
4. Patophysiology
Pneumothorax Mediastinal shift Compression on uninjured pulmo
kinking of the superior and inferior vena cava Decrease venous
return
Clinical manifestation of tension pneumothorax : DJ Roberts. 2014.
NCBI. BMC 3880980
Learning Outcome Skenario 3
1. Penyakit penyerta
a. Congestion in nasal sinuses or lungs
b. Runny nose
c. Cough
d. Sore throat
e. Body aches
f.

Fatigue

g. Breathing difficulties
h. Dizziness
i.

Low blood oxygen level

j.

Loss of consciousness

National Health Services. Respiratory Tract Infections. April 14 2015.

NHS UK
2. Komplikasi
a. Respiratory arrest
b. Respiratory failure
c. Congestive heart failure

National Health Services. Respiratory Tract Infections. April 14

2015. NHS UK
3. Faringitis
3.1 Clinical manifestation :
a. Difficulty in swallowing
b. Fever moderate
c. Chills
d. Malaise
e. Headache
f.

GI symptomps

3.2Diagnosis and Laboratory

a. Mclssac scoring system
b. Bacteriologic studies
c. Throat swabs
3.3Complications
a. Peritonsiliar abscess
b. Retropharyngeal abscess
c. Rheumatic fever
d. Arthritis, carditis, chorea, erythema marginatum.
3.4Management
a. Symptomatic : Fluid intake management, Analgesic,
Antipyretic, NSAIDs, Lozenges
b. Antibiotic : Penicillin and erythromycin
c. Surgical
Clinical practice guidelines. Management of sore throat. Ministry of
Health Malaysia ; Academy of Medicine Malaysia. April 2003