Saturday, January 15, 2011

Exercise For Hypertension : Emergency Learning



DIFINISI SENAMAN

Senaman adalah merupakan satu seni yang dirancang dan mengikuti displin yang tinggi untuk melakukan pengerakan tubuh supaya tubuh kita berfungsi dengan lebih baik dan menggelakan berlakunya sebarang kecederaan.


EXERCISE AND HYPERTENSION

While the current research base is not strong enough to draw a firm conclusion, studies published to date suggest that moderate-intensity activity (40 to 75 percent of the maximum oxygen uptake) mat be most effective in lowering blood pressure. The current intensity recommendation for hypertensive individuals is to use low to moderate intensity exercise.
Regular physical activity has also been shown to be effective in reducing the relative risk of developing hypertension by 19 to 30 percent. Similarly, a low cardio-respiratory fitness in middle age is associated with a 50 percent greater risk of developing hypertensive. Results have been similar in both men and women.
Prior to starting a new program, individuals with known hypertension should obtain clearance from their primary care physician. It is important to remember that the key to a successful exercise program is consistencyovertime. Don’t try to conquer the world the first time out. Be patient, start slowly and gradually increase frequency and duration. During the planning phase carefully consider what barriers might stand in the way of consistency; then develop strategies and accountabilities to assist in eliminating these barriers.
Endurance activities such as walking, swimming, cycling and low impact aerobics should be the core of the exercise program. Exercises that include an intense isometric component that can cause extreme and adverse fluctuations in blood pressure should be avoided. As aerobic conditioning improves, add low resistant, high repetition weight tranning.Circuit training is preferred over free weights. During weight training, holding one’s breath should be avoided because it can result in large fluctuations in blood pressure and increase the potential of passing out or, in some individual, possibly result in life threatening events such abnormal heart rhythms.
Ideally hypertensive individuals should exercise five to six times per week depending on their initial fitness level. However, improvement can be achieved with as little as three sessions per week. The total exercise duration should be in the range of 30 to 60 minutes per session. People with lower levels of fitness should start with shorter duration (10 to 15 minutes) and gradually (5 minutes increments every 2 to 4 weeks) increase to the 30 – 60 minute goal.



SAFE EXERCISE TIPS.

A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Fortunately, it’s a risk factor that you can do something about. Regular exercise, especially aerobic exercise, has many benefits, including lowering high blood pressure. It can also:

•Strengthen your heart and cardiovascular system.
•Improve your circulation and help your body use oxygen better.
•Improve heart failure symptoms.
•Increase energy levels so you can do more activities without becoming tired or short of breath.
•Increase endurance.
•Improve muscle tone and strength.
•Improve balance and joint flexibility.
•Strengthen bone.
•Help reduce body fat and help you reach a healthy weight.
•Help reduce stress, tension, anxiety and depression.
•Boost self image and self esteem.
•Improve sleep.
•Make you feel more relaxed and rested.
•Make you look fit and feel healthy.

Exercise can be divided into basic types:

•Stretching or the slow lengthening of the muscles. Stretching the arms and legs before and after exercising helps prepare the muscles for activity and helps prevent injury and muscle strain. Regular stretching also increases your range of motion and flexibility.

•Cardiovascular or aerobic exercise is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body’s ability to use oxygen. Aerobic exercise has be most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and your breathing.

•Strengthening exercises are repeated muscle contractions (tightening) until the muscle becomes tired.

Every exercise session should include a warm-up, conditioning phase and a cool-down.


1. Warm-up. This helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate) and body temperature. It also helps improve flexibility and reduce muscle soreness. The best warm-up includes stretching, range of motion activities and the beginning of the activity at a low intensity level.

2.Conditioning. This follows the warm-up. During the conditioning phase, the benefits of exercise are gained and calories are burned. Be sure to monitor the intensity of the activity (check your heart rate). Don’t over do it.

3.Cool-down. This is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean to sit down! In fact, do not sit, stand still or lie down right after exercise. This may cause you to feel dizzy or lightheaded or have heart palpitations (fluttering in your chest). The best cool-down is to solely decrease the intensity of your activity. You may also do some stretching activity you did in the warm-up phase.

Warning

Stop exercising and rest if you have any of the following symptoms.
•Chest pain
•Weakness
•Dizziness or lightheadedness
•Unexplained weight gain or swelling

Algorithm Narrow-complex Tachy : Emergency Learning


Algorithm Narrow-complex Tachy

Algorithm A systole : Emergency Learning


A systole Mx

Friday, January 14, 2011

Arterial Blood Gas Sampling Demonstration : Emergency Learning


ABG : Normal Values

pH 7.35 - 7.45
PaCO2 35-45 mm Hg
PaO2 80-100 mm Hg
TCO2 22-32 mmol/l
aHCO3- 22-26 mmol/l
sHCO3- 22-26 mmol/l
aBE +2 mmol/l
sBE +2 mmol/l
SaO2 95-98%

Arterial Blood Gas Sampling Demonstration : Emergency Learning

Arterial Blood Gases [ABG] : Emergency Learning


Part 1 ABG Learning

Definitions

pH

Negative log of Hydrogen ion activity
pH = -log [H+]

PaO2

The partial pressure of Oxygen in the gas phase in equilibrium with the arterial blood

PaCO2

The partial pressure of Carbon Dioxide in the gas phase in equilibrium with the arterial blood

HCO3

Concentration of bicarbonate in the plasma calculated from the pH and PCO2 using the Henderson-Hasselbach equation

Standard bicarbonate

Plasma [HCO3-] present in a blood sample, fully oxygenated at 38oC and equilibrated in vitro with PCO2 40 mmHg.
It is the plasma [HCO3-] after elimination of respiratory component and is an index of degree of metabolic alkalosis or acidosis

Buffer Base
Total amount of all the conjugate bases in 1L of arterial blood which can accept H+ in the blood.
Hb-/HbO2- = 9 mmol/L
HCO3- = 24 mmol/L
Protein = 15 mmol/L
TOTAL = 48 mmol/L

A mixed disorder
Two or more primary acid-base abnormalities coexist

Compensation
Refers to normal body processes tending to return arterial pH back to normal (Respiratory or Renal)


Video Take ABG

Thursday, January 13, 2011

Paraquat Poisoning : Berita : Kematian Paraquat : Emergency Learning

Wanita tertekan teguk racun


Paraquat Poisaning

LEDANG: Penyesalan seorang ibu tunggal beranak tiga yang nekad membunuh diri dengan meminum racun rumpai, tetapi berubah fikiran dan menghubungi rakan supaya diselamatkan gagal menyelamatkan dirinya apabila dia meninggal dunia ketika dirawat di Hospital Pakar Sultanah Fatimah (HPSF) Muar.

Mangsa berusia 41 tahun menetap di Taman Mulia dekat Bukit Gambir di sini, meninggal dunia di HPSF kira-kira jam 1.30 tengah hari Isnin lalu iaitu tiga jam selepas dimasukkan ke hospital itu.


Dalam kejadian kira-kira jam 10.30 pagi Isnin lalu, mangsa yang tertekan selepas berpisah dengan suaminya kira-kira enam tahun lalu dan terpaksa menyara tiga anak bersekolah mengambil jalan singkat dengan meneguk racun rumpai jenis Paraquat.

Bagaimanapun, dia dikatakan menyesal selepas meneguk racun itu sebelum menelefon seorang rakan dan merayu supaya segera dihantar ke pusat rawatan berhampiran.


Difahamkan, mangsa sempat berbual dengan rakannya selepas minum racun menceritakan tekanan hidup yang dihadapi sejak bercerai dengan suaminya beberapa tahun lalu. Ibu tunggal terbabit menyuarakan kesukarannya hidupnya mencari pekerjaan lebih baik kerana usianya yang lanjut dan tidak mempunyai pengalaman bekerja.

Mangsa yang tinggal berjauhan dengan keluarganya itu hidup bersama tiga anak remaja berusia belasan tahun sejak ditinggalkan suami.


Difahamkan, dalam perjalanan ke hospital mangsa mengaku menyesal minum racun.

Bagaimanapun, sebaik tiba di Hospital mangsa tidak sedarkan diri selain mulutnya berbuih.

Mangsa gagal diselamat kira-kira tiga jam selepas rawatan.

Ketua Polis Daerah Ledang, Superintendan Harun Idris ketika dihubung menerima laporan kematian wanita terbabit kira-kira jam 1.30 tengah hari Isnin lalu.

Wednesday, January 12, 2011

Shock : Emergency Learning : Note

Definition of Shock:

Shock is a clinical syndrome which occurs
when there is an abnormality of the circulatory
system that results in inadequate organ perfusion
and tissue oxygenation.


Types of shock

1. Hypovolaemic

2. Cardiogenic – AMI,Cardiomyopathy

3. Distributive
Neurogenic
Septic
Anaphylactic

4. Obstructive – T.P/thorax,C.Tamponade


HYPOVOLAEMIC SHOCK

Most common cause of shock in the trauma
patient

Haemorrhage is defined as an acute loss of
circulating blood volume

Normal blood volume in adult : 7% of body weight
Normal blood volume in child. : 80mls/kg

AEMTC TRAUMATOLOGY : Subspecialty : Emergency Learning : AEMTC

Topics for dicussion

1. GOLDEN PRINCIPLES OF TRAUMA CARE
- The Golden Principles of Trauma Care
- Summary

2. INJURY PREVENTION
- Scope of the Problem
- Concept of injury
- Prevention as the solution
- Concept of Injury Prevention
- Evolving Role of Paramedic
- Summary

3. KINEMATICS OF TRAUMA
- Energy
- Blunt and Penetrating Trauma
- Using Kinematics in Assessment
- Summary

4. ASSESSMENT AND MANAGEMENT
- Establishing Priorities
- Scene Assessment (Scene Size-up)
- Primary Survey (Initial Assessment)
- Resuscitation
- Secondary Survey (Focused History and Physical Examination)
- Definitive Care in the Field
- Monitoring and Reassessment (Ongoing Assessment)
- Communication
- Pain Management
- Summary
5. AIRWAY MANAGEMENT AND VENTILATION IN TRAUMA
- Anatomy
- Physiology
- Pathophysiology
- Summary

6. THORACIC TRAUMA
- Anatomy
- Physiology
- Pathophysiology
- Assessment
- Management of Specific Injuries
- Summary




7. ABDOMINAL TRAUMA
- Anatomy
- Pathophysiology
- Assessment
- Management
- Summary


8. SPINAL TRAUMA
- Anatomy and Physiology
- Pathophysiology
- Assessment
- Management
- Summary


9. SPECIAL CONSIDERATIONS IN TRAUMA OF THE
ELDERLY

- Anatomy and Physiology of Aging
- Assessment
- Management
- Abuse and Neglect of the Elderly
- Summary


10. HEAD TRAUMA
- Anatomy
- Physiology
- Pathophysiology
- Assessment
- Specific Head Trauma Conditions
- Management
- Transportation of critically head injured patient
- Summary