Perawat berdiskusi

Initial Management and Evaluation of Severely Injured Patients

Posted by diskusiperawat on December 3, 2008

“Prioritas utama dalam penanganan korban kritis di lapangan termasuk mempertahankan jalan nafas/airway, adequate ventilation, dan monitor perdarahan luar/ external bleeding”

Sebelum korban di bawa ke rumah sakit, trauma team di emergency departement terdekat/ tempat patient di tranfer harus di beritahu terlebih dahulu terutama mengenai seberapa kritis kondisi korban. Sehingga ED dapat mempersiapkan segala sesuatunya sebagai contoh peralatan ventilator pada intubated patient atau blood pada korban perdarahan. Atau bahkan bantuan petugas kesehatan jika korban dalam jumlah banyak.

Pasien yang gelisah, tidak kooperative dan not responding terhadap pemberian oxygen dapat di assumsikan bahwa pasien mengalami hypoxic sampai ada bukti hasil lab. Sehingga pasien membutuhkan endotracheal intubation untuk memberikan ventilasi yang adequate and menangani hypoxia.

Hal-hal yang di perlu di perhatikan pada penanganan pasien kritis :

  • Pneumatic Antishock Garment (PASGs) ; Meskipun PASGs dapat membantu dalam immobilisasi fracture pada pelvic dan extremitas bawah dan juga dapat mengurangi kehilangan darah pada bleeding, peralatan ini tidak terlalu memberikan pengaruh pada pasien hypotensive. Perlu di ingat bahwa pemakaian peralatan ini juga dapat mungkin menyebabkan compartement syndromes terutama jika menggunakan tekanan yang tinggi dalam jangka waktu yg lama.
  • Prehospital Intravenous Lines ; Pemberian dini intravenous fluids at the scene is counterproductive jika transit time to the hospital kurang dari 15 menit. Sesungguhnya, kelebihan cairan dapat menyebabkan kemungkinan perdarahan kembali pada luka yang sudah berhenti sementara.
  • Establishing Intravenous Lines ; Jika pasien mengalami syock hypovolemik hebat yang menyebabkan vena collapse, atau ada riwayat penggunaan intravenous narcotic sebelumnya, mungkin akan sangat sulit mendapatkan vein access di peripheral. Sehingga pasien spt itu memerlukan subclavian veins untuk mendapatkan IV access yg tercepat. Percutaneous catheterization of internal jugular vein juga sangat bagus buat IV access terutama pada pasien yang indikasi memerlukan tindakan operative. Untuk perkiraan Pasien yang mengalami luka pada leher and dada atas membutuhkan minimal 1 venous access di lower extremitas, dan jika luka di perut di butuhkan 1 atau lebih IV lines terutama yang terdekat dengan vena cava superior.
  • Cardiopulmonary Resuscitation ; Open thoracotomy mungkin dapat di pertimbangkan di emergency resuscitation room pada pasien yang mengalami luka tusuk di dada dan mengalami cardiac arrest ketika baru datang di ED. Walaupun demikian open cardiac massage di ED jarang berhasil pada pasien dengan cardiac arrest yang disebabkan oleh luka tembak/ gunshot wound, penetrating intra abdominal injuries, atau pada trauma tumpul yang hebat pada kepala or trunk.
  • Control of External Bleeding ; Tourniquets jarang di gunakan tetapi jika diperlukan, pressure shoud be applied over the most proximal portion of the extrimity wound and cuff pressure should be well above the systolic pressure. karena jika pressure is slightly dibawah the systolic pressure, darah artery akan masih dapat mengalir ke extemitas sehingga menyebabkan increased venous bleeding.

Ref; Handbook of Trauma by Robert F. Wilson, 1999 Philadelphia

(artikel di link dari http://emergencyku.blogspot.com)

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bagus nih artikelnya 🙂

sharing pendapat yahh, sekarang ditempat kerja saya (afghanistan) sebagai alternatif pemasangan infus intravena kami lebih prefer ke Intraosseus dengan alat FAST. silahkan di googling aja pake keyword “FAST, intraosseus”. banyak koq artikel dan panduannya (salah satunya website dari australia juga). klo di kemasannya sih di refer ke http://www.pyng.com.

saya pernah ditraining sekali dan ternyata pemasangannya mudah dan simple. hanya perlu sedikit ‘nyali’ aja,hehehe.

ada bacaan tentang PASG juga,

SPECIAL NOTES:

1. May only be performed by Basic, Basic-IV, Intermediate 99 or Paramedic/RN personnel.

2. Head injury is not a contraindication.

3. The PASG should no longer be used for lower extremity long bone splinting. These injuries should be splinted using standard splinting devices or traction splints, when appropriate.

4. The PASG should no longer be used as an air splint for an unstable pelvis. A longboard and padding should be used instead.

punya pengalaman dengan PASG ini? silahkan di share disini 🙂

salam,

http://www.diskusiperawat.co.cc

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Posted in Info, Pre-Hospital, Tips | Tagged: , , | 1 Comment »

Nurse Annoyed at Being Told “You’re Smart Enough to Be a Doctor”

Posted by diskusiperawat on November 24, 2008

by Brian Carty, MD, MSPH
10-22-2008

In a new book of essays by nurses, “Reflections on Doctors” (2008), nineteen essays show physicians as the corrupt, dishonest, homicidal misfits that they really are. Not really; that’s a spoof. The essays are intelligent and well written, but do address some important issues.

Doctor-Nurse Relationship is Like a Marriage

The doctor-nurse relationship is in many ways a marriage writ large, with love, hate, mutual dependence, ambivalence, and uncertainties about power and responsibility. As in many marriages, though, the two parties would sometimes like to take separate vacations and have separate checking accounts.

“Smart Enough Not to Be a Doctor”

One essay is titled “Smart Enough Not to Be a Doctor.” The author, Pamela Gonzalez, RN, says that she has been told repeatedly throughout her career that she is “smart enough to be a doctor.” She considers this an insult.

Are Doctors Smarter Than Nurses?

Ms. Gonzalez complains that “This backward compliment suggests that choosing a professional path in the nursing field is for those with less intellectual abilities (sic) than those who choose to go to medical school.” Ms. Gonzalez says that she wants to reply “Yes. I was smart enough – and I chose not to be a doctor.”

Ms. Gonzalez graduated from an Ivy League college and had good grades and test scores. She writes well and sounds like a very competent professional. All of which suggest that she probably would have done well in medicine.

Some Aspects of Nursing Are More Appealing

So why didn’t she go to medical school? Ms. Gonzalez gives some supposed advantages of being a nurse rather than a doctor, such as being more directly involved with patients. She believes that patients will confide sensitive information to a nurse which they won’t disclose to a physician. Still, it’s hard to imagine a relationship which requires more trust and disclosure than the doctor-patient relationship, so these arguments aren’t very convincing. There may have been other reasons why she preferred nursing to medicine.

In Some Ways Medicine Is Not So Appealing

According to Ms. Gonzalez, becoming a doctor requires spending years training before seeing patients, and HMOs often control the time physicians spend with patients. Also, she wisely does not place much value on a high income. These reasons seem a little closer to the mark. I suspect, but cannot prove, that the reason Ms. Gonzalez didn’t go into medicine was the often extreme demands placed on physicians.

Besides, what’s wrong with being a nurse? Ms. Gonzalez must know that many physicians are unhappy with their pay and working conditions. Whether medicine is still a wise career choice is a complicated issue which cannot be discussed here. Ms. Gonzalez says she was “smart enough not to be a doctor.” Perhaps many doctors now practicing wish they had been that smart.

There Is Something to Be Said for a Job Which Doesn’t Consume Your Life

My father was an engineer. No weekend call, no 3 AM phone calls, no 80 hour work weeks. He didn’t have the status, income, or maybe even the job satisfaction of a physician, but he went home every day at 5 o’clock, and then his time was his own. I think there’s a lot to be said for that.

(Source : http://hotmedicalnews.com)

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One essay is titled “Smart Enough Not to Be a Doctor.” The author, Pamela Gonzalez, RN, says that she has been told repeatedly throughout her career that she is “smart enough to be a doctor.” She considers this an insult.

Hmm, beritanya masih hot tuhhh alias masih baru, hangat. bukunya aja keluaran tahun 2008.

Punya refleksi pribadi pengalaman anda dengan dokter?

Monggo diceritakan 🙂

Posted in Education, Hospital, Info | Tagged: , , , , | 10 Comments »

Kuwait Deportasi 700 Perawat Indonesia

Posted by diskusiperawat on December 3, 2008

02/12/2008 05:29
Kuwait Deportasi 700 Perawat Indonesia

Staff Ministry of Health Kuwait ( MOH ) bagian formalitas dokumentasi penerimaan karyawan baru untuk para imigran, menyatakan segera mendeportasi seluruh perawat asal Indonesia.

Mereka berencana mendeportasi seluruh perawat Indonesia, yang bekerja di Kuwait sehubungan tidak ada tanggapan yang serius dari pemerintahan Indonesia berkaitan dengan masalah verifikasi ijazah perawat Indonesia di Kuwait.

Seperti diketahui jumlah perawat Indonesia yang bekerja di Kuwait sampai saat ini kurang lebih sekitar 700 orang, mereka mulai berdatangan ke Kuwait sejak perang teluk tahun 1991, kemudian disusul pada tahun 2000, 2001 dan terakhir tahun 2004.

Bekerja di bawah departemen kesehatan Kuwait memang menyenangkan Dengan gaji berkisar antara Rp15 ? Rp 18 juta setiap bulannya (kurs rupiah 12 ribu), disertai berbagai fasilitas lainya antara lain free apartment, free transportation, free food bagi perempuan, annual leave setiap satu tahun sekali, singkatnya dengan posisi sebagai perawat dan fasilitas serta gaji yang sangat besar sangat susah untuk didapatkan di negara sendiri, kira- kira menjadi pegawai negeri di negara orang jauh lebih sejahtera daripada menjadi pegawai di negeri sendiri.

Ada beberapa ketentuan yang di berlakukan oleh departmen kesehatan Kuwait terhadap semua pekerja imigran yang datang, antara lain adalah verifikasi semua keahlian yang diaplikasikan dengan verifikasi ijazah dari semua imigran.

Dalam hal ini Ministry of Health Kuwait ( MOH ) bekerjasama dengan Department Higher Education untuk melakukan verifikasi ijazah ini bagi semua imigran yang datang dari semua negara bukan hanya dari Indonesia.

Untuk Indonesia, mereka akan mengirimkan surat ke pemerintahan Indonesia dalam hal ini Departemen Kesehatan dan lembaga terkait yang mengeluarkan ijazah akademi keperawatan/sarjana keperawatan, untuk mengisi form tersebut dan memberikan pernyataan, bahwa ijazahnya benar-benar asli dan benar dikeluarkan oleh institusi Depkes tersebut.

Coba bayangkan pengiriman surat ini dari Departemen Kesehatan Kuwait disampaikan tahun 2000, tapi sampai sekarang belum ada balasan, kemudian tahun 2004 terkirim lagi tapi belum ada balasan juga. Makanya mereka sangat emosi dan menilai tidak ada respek sama sekali dari pemerintahan Indonesia, sepertinya aneh dan mustahil tapi itulah adanya dan memang benar-benar seperti itu.

Apa masalahnya jika surat verifikasi ijazah tidak ada balasan dari pemerintahan Indonesia, ini secara kasarnya mereka menganggap semua ijazah yang dimiliki oleh teman-teman perawat disini tidak bisa di pertanggung jawabkan alias palsu, sehingga mereka MOH (ministry of Health ) menganggap semua perawat Indonesia disini bekerja secara ilegal, tidak berdasarkan skill dan tidak punya keahlian karena ijazahnya tidak mampu untuk di verified.

Makanya atas dasar hal tersebut terlontar pernyataan bahwasanya mereka tidak akan segan-segan untuk mendeportasi seluruh perawat Indonesia yang bekerja disini. Memang sangat ironis disaat pemerintah tidak bisa menyediakan lapangan kerja bagi rakyatnya, bagi teman-teman yang sudah nyaman bekerja di sinipun terusik dengan ancaman deportasi karena kelalaian pemerintah merespon negara konsumen yang notabene Negara Kuwait sebagai pemakai tenaga kerja Indonesia.

Ternyata, bukan itu saja implikasinya, bagi teman-teman yang berkeinginan memutus kontrak hubungan kerja dengan MOH, mereka tidak mengizinkan sebelum masalah verifikasi ini benar-benar selesai. Sehingga banyak teman- teman perawat di sini yang mau pulang ke Indonesia, tidak bisa keluar dari Negara Kuwait.

Sungguh kasihan teman saya, sudah berbulan-bulan menunggu masalah verifikasi ini selesai tapi sampai saat ini belum ada kejelasannya, padahal dia berencana pulang sejak empat bulan yang lalu, keluarga dan suaminya sudah menunggu di rumah, kenapa anaknya sampai sekarang belum pulang-pulang.

Dwi Susilo, kurnia77@gmail.com
My Best Regard

Eko Priyanto
Mobile: +965 6942364

(message was copied from miling list inna_ppni@yahoogroups.com)

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jadi perawat emang susah.
perawat yang kerja di negara sendiri udah gak di urus, apalagi yang kerjanya jauh…

pemerintah Indonesia harus segera bertindak karena jika tidak maka sayang sekali (baca: memalukan) bila akhirnya perawat2 yang udah kerja disana akhirnya harus dipulangkan ke Indonesia hanya karena kelalaian pemerintah, dalam hal ini Dinas terkait, untuk MERESPON SEBUAH SURAT.

salam,

http://www.diskusiperawat.co.cc

(mereka yang terkait seharusnya bisa dikenakan pasal apa yahh? negligence – due to failure to act that may endanger 700 nurse’s life)

any comment? 🙂

Posted in Education, Info | Tagged: , | 5 Comments »

Crocodile tears

Posted by diskusiperawat on November 24, 2008

November 7, 2008, 1:36 pm

crocodile tears

it sounds overly dramatic that some mean remarks from a patient could move me to tears, but i was tired and that was my excuse.

the only thing was, i was too proud to cry in front of my fellow nurses, so i waited till it was my break, at 4 AM, an hour and a half after i was called “Nasty May”. i covered my face with the bath blanket, wiped the first drops of tear, when all of a sudden, the door opened and i had to stop being a baby. i left the doctor’s conference room to give way to a doctor who wanted to do something there. i swallowed hard, aware that crying was not an option, and in this particular case, pointless.

sometimes, i feel like everything is just so pointless.

i never wore a mask to clean smelly patients because i always had that picture of my mom when she had a necrotic wound on her toe and she was deeply hurt by a student nurse’s reaction of gagging at the smell of her wound. when she was crying in humiliation and self pity in that hospital room many years ago, i vowed i will never wear a mask except for isolated cases that require a mask for protection.

so, there he was, the whole 642 pounds of him, clean but with this distinct unbearable smell caused by trapped sweat between his skin folds. if i had any emotional reaction to the whole thing, it was defintely the feeling of sadness. i mean, it was a simple placement of condom catheter, but it took me a while to do it. he had to catch his breath while lifting his lower belly which was covering his penis. someone else had to push around his penis, while i gently pull it out for the procedure.

when it came off for the second time, he called me and said “i want my catheter replaced, and i want somebody who knows how to do it, not you.” i clarified his request just to make sure i heard him correctly, he said “yes, i want somebody else to do it, because obviously you don’t know how to do it correctly, and i don’t want to end up soaked in my own urine just because this catheter is out.” i said okay, told the charge nurse, and asked somebody else to fix the catheter.

“and that Nasty May, i don’t want to see her face again, and i don’t want her in my room again!” why he said this to the charge nurse, i have no idea. but when after all the commotion ended with the nursing supervisor in his room, he said that when i was placing the catheter, the patient care assistant and i were laughing, with shameless disregard to his dignity, and we had the audacity to continue laughing even when he told us “stop laughing, this is not funny!”

this was all a complete lie. the truth was, just like him, i found the whole situation heartbreaking. second of all, even if there was a remote possiblity i wanted to laugh, it was physically impossible for me to do so because i have been struggling with my breathing the whole 45 minutes i was in his room. my “no mask vow” worked against me, but i was determined not to break it, even if i had to hold my breath most of the times.

sometimes, i feel like it is not worth it. why bother being sensitive to patients’ needs when all they care about is trying to prove that they are being abused and are being treated unfairly?

it was strongly recommended by the nursing supervisor that i write an event form. when i asked him what event i should write about, i wasn’t being sarcastic. he said i have to give my side of the story and let the investigators know that i wasn’t laughing. i asked him, “you mean i’m supposed to write about an incident that never was?” he said yes.

“i wasn’t laughing when i placed the catheter” the thought of writing that was extremely absurd, so i didn’t. i stated the facts, and just hoped that whoever they are that will look into this case will see that i have not done anything wrong to this patient.

what killed me was his refusal to have me as his nurse anymore. after all the hours i spent in trying to make him feel comfortable, with no gratitude and appreciation, i never thought of refusing him on my next shift, because i felt it wasn’t fair. to him, to the other staff. he later retracted his request and said, “i want May back”, but frankly, the damage has been done.

but who says things should be fair? the more i think about it, the more i realize this whole experience was stupid, and it will be a waste of my time to cry.

believe me, sometimes, crying is overrated

(The story was copy pasted from http://www.aboutanurse.com)

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Crocodile tears?? air mata buaya? maksud loee?

C’mon, kita sedang berbicara mengenai air mata yang mengalir justru karena orang salah memahami tindakan kita. salah persepsi. salah mengerti.

Punya pengalaman dengan ‘air mata buaya’ anda sendiri? 🙂

Posted in Hospital | Tagged: , | 1 Comment »