Systemic Lupus Erythematosus (SLE)

DEFINITION
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder. SLE may affect the skin, joints, kidneys, and other organs.

CAUSE
SLE is a problem with the body's normal immune system response.
Normal Function of the immune : the immune system helps protect the body from harmful substances.
In patient with an autoimmune problem, the immune system could not tell the differential between the harmfull substance & healthy one. An overactive immune attacks otherwise healthy cells & tissues. SLE may be mild or severe enough to cause death. It may occur at any age, but appears most often in people between the ages of 10 and 50. It is also can caused by certain drug (drug-induced systemic lupus erythematosus). It is about hypersensitivity reaction to a medication. The drug may react with cell materials, causing the body to form antibodies that attack the body's own healthy cells.

Several medications are known to cause drug-induced lupus :

• Chlorpromazine
• Hydralazine
• Isoniazid
• Methyldopa
• Penicillamine
• Procainamide
• Quinidine
• Sulfasalazine

Symptoms tend to occur after taking the drug for at least 3 to 6 months.
Persons with drug-induced lupus erythematosus may have symptoms that affect the joints (arthritis), heart, and lungs. Other symptoms associated with SLE, such as lupus nephritis and nervous system (neurological) disease, are rare. Drug-induced lupus affects men and women equally.

Symptom :
The condition may affect one organ or body system first. Others may become involved later.
Almost all people with SLE have joint pain and swelling. Some develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees.
Other common symptoms include:

• Chest pain when taking a deep breath
• Fatigue
• Fever with no other cause
• General discomfort, uneasiness, or ill feeling (malaise)
• Hair loss
• Mouth sores
• Sensitivity to sunlight
• Skin rash -- a "butterfly" rash over the cheeks and bridge of the nose affects about half of people with SLE. The rash gets worse in sunlight. The rash may also be widespread.
• Swollen lymph nodes

Other symptoms depend on what part of the body is affected:

• Brain and nervous system:
  • Headaches
  • Mild cognitive impairment
  • Numbness, tingling, or pain in the arms or legs
  • Personality change
  • Psychosis
  • Risk of stroke
  • Seizures
  • Vision problems
• Digestive tract: abdominal pain, nausea, and vomiting
• Heart: abnormal heart rhythms (arrhythmias)
• Kidney: blood in the urine
• Lung: coughing up blood and difficulty breathing
• Skin: patchy skin color, fingers that change color when cold (Raynaud's phenomenon)

Burn

burn is caused most commanly by fire (dry heat). It also can caused by friction, chemicals, electricity or radiation. 

*friction - occurs when skin is scraped off by contact with a surface such as roads, carpets, or other hard floor surfaces.

*Chemical - Most chemicals that cause burns are either strong acids or bases. Chemical burns can be deceiving, however. Some agents can cause deep tissue damage not readily apparent when you first look at it.

*Electrical - often cause serious injury inside the body. Look for an entry and exit point as this is often a 

                   characteristic of this type of injury.

Depth of burns.

• Superficial (first degree) - The skin is red, hot and painful but without blisters. Damage is superficial and temporary.
• Partial-thickness (second degree) - The outer layer of skin is damaged. The skin has blisters besides being red, hot and painful.
• Full-thickness (third degree)- All layers of the skin are damaged. The skin may be pale and leathery, or charred. It is relatively painless on the point of the burn because the nerves are damaged. The pain experienced will more then likely result from the surrounding burns which are of lesser degree.

ComplicationsInhalation burns -- there may be burned lips, mouth, and throat.

1. Face may be reddened or burned.
2. Patient may have difficulty breathing or coughing. (consider the use of Salbutamol)
3. Soot around mouth and nose
4. Nose hairs, eyelashes, eyebrows may have singeing 
5. Airway oedema

Electrical burns with high voltage (>1000 V) or high amperage commonly damage multiple organ systems, and may be associated with cardiac arrest.

In the case of severe burns the patient may be in shock (falling blood pressure, severe fluid and blood loss) and possibly will be hysterical. 

Burns are at increased risk of being infected.

Management

GO DR SHAVPU ACBC 

Safety:  

• Only put out a fire if safe to do so.
• Be sure not to contaminate yourself when dealing with chemical burns

Cool the burn with water. (Ensure that the cooling process does not become excessive as this can cause shivering and possibly hypothermia), Administer entonox for pain relief, Remove items of clothing or jewellery that are hot and wet and not stuck to the skin, Cover the burn with a sterile dressing (cling film is good as it provides an air free environment which stops the nerves becoming stimulated, thus reducing pain), Do not apply creams or lotions, Do not burst blisters, treat for shock if necessary, cover unburned areas with a blanket to prevent the patient becoming too cold. 

When dealing with chemical burns - Remove the patient from the affected area (If safe to do so, otherwise wait for the fire service), Remove any contaminated clothing while preserving the patients dignity, Brush off any powdered chemical, Wash the contaminated body part with water for 20 minutes (be aware not to get chemical onto an unaffected part of the body). Phosphorus burns should be kept continually wet.

Secondary survey
ASHICE (consider)

Transport to hospital Consider transporting to a burns unit if a local one is available.

Interview Preparation

Before the interview

Learn about the company

Prepare answer

Study and practice

Find out exactly - the fact and figure

Good night sleep

During the interview

Be punctual

First impression

Listen actively

Speak clearly

Be positive

Sit comfortably

Ask question

After interview

Say thank you

Follow up

Chin up

CPR a.k.a Cardiopulmonary Resuscitation

What is CPR?

CPR a.k.a Cardiopulmonary Resuscitation.

Definition:

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

CPR involves combination of : 

-chest compressions  

-mouth-to-mouth rescue breathing

Indikasi:

-Cardiac Arrest victim

-Respiratory Arrest victim

(DRBC)

Danger      - Make sure the environment are safe.

Respon     - Check for the responsiveness

Airway      - Check for patient's airway 

Breathing   - Check for patient's breathing

Circulation - Check for patient's circulation

CPR Procedure

1. Check is the person conscious or unconscious. If patient appear unconscious, tap or shake the patient's shoulder & ask loudly, 'Are u ok?'. If no respon, call 999.

2. If an AED immediately available, deliver one shock if instructed by the device, then begin CPR.

3. Clear the airway.

-put the person on his @ her back on the firm surface.

-kneel next to the patient's neck & shaoulder.

-open airway using head tilt,chin lift.

-check for normal breathing(taking not more than 5 @ 10 sec.).Look for the chest movement, Listen for 

  normal breathing sound,Feel for the person breath on your cheek & ear.

-if patient isn't breathing normally, start mouth-to-mouth breathing.

-if patient is unconscious, directly perform chest compression.

4. Breath for the patient

-with the airway open(use head tilt,chin lift),pinch the nostril give mouth-to-mouth breathing.

-Give 2 rescue breath; give the 1st rescue breath & look if the chest rises.if does not a rise,give the 2nd 

  rescue breath.

5.Begin chest compression to restore circulation

-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 1st hand.

-makesure your elbows straight & position your shoulders directly above your hand.

-use your upper body weight as you push straight on the chest 2 inches.push hard as a rate of 30 compression

-after finish 30 compression, check for the carotid pulse.

-if there has a pulse but no breathing, just give rescue breathing.if there are no pulse & breathing, give 2 

 rescue breathing with 30 compression till there are sign of movement or emergency medical personnel take 

 over.

6.Recovery position

-put patient in recovery position when there are sign of breathing & pulse.

CAUTION!!!

If patient has pulse,do not perform chest compression.Just give 2 rescue breathing.

It is because chest compression would be disturb the normal heart beat.

http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

http://www.mayoclinic.com/health/first-aid-cpr/FA00061

Mechanical Ventilation

Indication

-Airway obstruction
-Inadequate oxygenation-O2 saturation (<90% on hi-flow oxygen via nonrebreather mask)
-Inadequate ventilation-hypoventilation (high pCO2, pH-acidosis)
-Increased work of breathing, ineffective breathing pattern
-Airway protection

Common Setting
*AC (Assist Control)
-Pt. triggers ventilator to deliver a breath. If apnea occurs, a minimum rate & volume will be delivered to the pt.

*CPAP (Continuous Positive Airway Pressure)
-Continuous, nonstop positive positive pressure is applied throughout entire respiratory cycle.

*BiPAP (Bilevel Positive Airway Pressure)
-Same as CPAP but with 2 preset setting ; one for inspiration & one for expiration

*CMV (Continuous Mandatory Ventilation)
-Ventilator delivers a set tidal volume at a set rate regardless of a pt.'s own attemps to breathe. Expect pt. to
  require sedation.

*IMV (Intermittent Mandatory Ventilation)
-Ventilator delivers a set tidal volume at a set rate, yet also allows the pt. to initiate breaths.

*PSV (Positive Support Ventilation)
-For pt. with spontaneous breathing. Ventilator delivers a preset positive pressure for the duration of
  inspiration when the pt. initiates a breath.

*SIMV (Syncrhonized Intermittent Mandatory Ventilation)
-Ventilator is triggered only by a patient-activated demand valve & therefore, synchronizes with the pt. own
  respiratory efforts.

*PEEP (Positive End-Expiratory Pressure)
-Maintains a preset positive airway pressure at the end of each expiration. PEEP is used to treat a PaO2 <60 mmHg on FiO2 >50%

Continuous Bladder Drainage (CBD)

Patient Care

1. Wash hands with soap & water before & after handling bag, catheter or tube.

2. Make sure urine bag are always below the level of patient's bladder all the time.

3. Check frequently to be sure not to kink or loops in tubing or that patient not lying on tubing.

4. Do not pull on catheter.

5. Wash around catheter entry site with soap & water twice a day or after bowel movement.

6. Do not use powder around catheter entry site.

7. Check around the catheter entry site for sign of irritation, redness, tenderness, swelling or drainage.

8. Offer fluids requently (if not contraindicated to patient's health status)

9. Empty urine bag each shift; note colour, clarity & odor.

10. Record urine output

11. Notify physician if any following:

- blood, cloudiness, foul odor

- urine output <30mL/hr

- irritation or leaking around catheter entry site.

- fever, abdominal or flank pain 

Just For Fun

This is a personality test. Pick your answers instinctively. There are no right or wrong answer.

Imagine you are in your house. You hear the faucet water running, the telephone ringing, the door bell ringing and the baby crying, all at the same time. Since you are alone, select the order that you would respond, from first to last.

1st action                                 2nd action

water                                         water
phone                                        phone
doorbell                                     doorbell
baby                                           baby


3rd action                                   4th action
water                                           water 
phone                                          phone
doorbell                                       doorbell
baby                                             baby

that was the qualities that u look for your partner, from the most important to least important.

-water: wealth     -phone: personality       -doorbell: looks      -baby: intelligence