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INTRODUCTION
Emergency Medicine has long been established especially in Australasia, Canada, Ireland, the United Kingdom
and the United States, in Asiaothe emergency medicine officially inauguration of Asian Society of Emergency
Medicine in Singapore on the 24th of October 1998 at the first Asian Conference on Emergency Medicine which
as Prof.DR.dr. Eddy Rahardjo,SpAnKIC and dr. Tri Wahyu Murni sat as member of Board Director.
It is thus sometimes seen to be synonymous with emergency medical careand within the province and expertise
of almost all medical practitioners. However, theEmergency Medicine incorporates the resuscitation and
management of allundifferentiated urgent and emergency cases until discharge or transfer to the care ofanother
physician. Emergency Medicine is an inter-disciplinary specialty, one which isinterdependent with all other
clinical disciplines. It thus complements and does not seekto compete with other medical specialties.
Basic science concepts to help in the understanding of the phatophysiology and treatment of disease.The
medical curriculum has become increasingly vertically integrated, with a much greater use of clinical examples
and cases to help in the understanding of the relevance of the underlying basic science, The Emergency
Medicine block has been written to take account of this trend, and to integrate core aspects of basic science,
pathophysiology and treatment into a single, easy to use revision aid.
In accordance the lectures that have been full integrated for studens in 6Th semester,
period of 2014, one of there is The Emergency Medicine Block.
There are many topics will be discuss as below:
Seizure and mental status changes, acute Psychiatric episode, Acute respiratory distress syndrome and failure,
Bleeding disorders (epistaxis, dental bleeding, vaginal bleeding) ,Shock, Cardiac critical care (Cardiac arrest and
CPR), Emergency toxicology and poisoning, Pregnancy induce Hypertension, Shoulder dystocia, Urologic
concern in critical care, Phlegmon, Acute Blistering and Expoliative skin, Trauma which potentially disabling and
Life threatening condition and Basic Clinical Skill
Beside those topics, also describes the learning outcome, learning objective, learning task,
self assessment and references. The learning process will be carried out for 4 weeks (20
days).
Due to this theme has been prepared for the second time, so many locking mill is available
on it. Perhaps it will better in the future
Thank you.
Planner
CURRICULUM CONTENTS
Mastery of basic knowledge with its clinical and practical implication.
Establish tentative diagnosis, provide initial management and refer patient
with :
SKILLS
To implement a general strategy in the approach to patients with critical ill through
history and physical examination and special technique investigations
To manage by assessing, provide initial management and refer patient with critical ill
PERSONAL DEVELOPMENT/ATTITUDE
Awareness to :
COMMUNITY ASPECT :
PLANNERS TEAM
NO.
NAME
DEPARTMENT
1.
Anesthesiology and
Intensive Therapy
Surgery
Neurology
ENT
Dentistry
Internal Medicine
Pulmonology
Pediatric
Obstetric-Gynecologic
Obstetric-Gynecologic
Surgery
Surgery
Radiology
Psychiatric
Dermatology
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
12.
13.
LECTURERS
NO.
1.
NAME
dr.Tjok Gde Agung Senapathi,
Sp.AnKAR (Chairman)
2.
dr.K
Suyasa,
SpB,SpOT(K)
(Secretary)
dr. IGN Budiarsa,SpS
dr.IGN
Mahaalit
Aribawa,
SpANKAR
3.
4.
5.
6.
7.
5.
6.
7.
8.
9.
10.
DEPARTMENT
Anesthesiology
and Intensive
Therapy
Surgery
Neurology
Anesthesiology
and Intensive
Therapy
Anesthesiology
and Intensive
Therapy
ENT
ENT
Dentistry
Internal Medicine
Pulmonology
Pediatric
ObstetricGynecologic
ObstetricGynecologic
PHONE
081337711220
03617879748
081558724088
0811399673
0811396811
08123868126
082236088687
081237874447
08113853707
08123989353
08123875875
085737046003
08123917002
08123636172
Surgery
08155753377
Surgery
Psychiatric
Dermatology
Surgery
Radiology
081339977799
08123618861
08970111090
081337096388
03617456639
FACILITATORS
(REGULAR CLASS)
NO
1
2
3
4
NAME
GROU
P
1
9
10
NO
1
2
3
4
5
6
7
8
9
10
NAME
dr. I Putu Adiartha Griadhi,
M.Fis
Drs. I Gede Made Adioka, Apt,
M.Kes
dr. I Nyoman Sutarsa , MPH
dr. I Nyoman Arcana, Sp.Biok
dr. I Made Susila Utama,
Sp.PD-KPTI
dr. I Made Suka Adnyana,
Sp.BP.
dr. I Made Sudipta, Sp.THT-KL
dr. I Made Putra Swi Antara ,
S.Ked
dr. I Made Pande Dwipayana,
Sp.PD
dr. I Made Oka Negara, S.Ked
Biochemistry
081337141506
Radiology
08164745561
Histology
08123925104
Microbiology
08179747502
Histology
085339644145
Opthalmology
081338538499
Anasthesi
08123822009
Anasthesi
081805755222
Dermatology
081236234153
Neurology
081328049360
PHONE
DEPT
8
9
10
FACILITATORS
(ENGLISH CLASS)
GROUP
DEPT
1
2
3
4
5
6
7
8
9
10
PHONE
Fisiology
081999636899
Pharmacy
0361 - 8000382
Public Health
087860380028
Biochemistry
0811397960
Interna
08123815025
Surgery
081236288975
ENT
08123837063
Cardiology
08123804782
Interna
08123657130
Andrology
08123979397
VENUE
3nd floor:
R.3.09
3nd floor:
R.3.10
3nd floor:
R.3.11
3nd floor:
R.3.12
3nd floor:
R.3.13
3nd floor:
R.3.14
3nd floor:
R.3.15
3nd floor:
R.3.16
3nd floor:
R.3.17
3nd floor:
R.3.19
VENUE
3nd floor:
R.3.09
3nd floor:
R.3.10
3nd floor:
R.3.11
3nd floor:
R.3.12
3nd floor:
R.3.13
3nd floor:
R.3.14
3nd floor:
R.3.15
3nd floor:
R.3.16
3nd floor:
R.3.17
3nd floor:
R.3.19
TIME TABLE
Regular Class
DAY/DATE
TIME
1.
Tue,
9 Sept
2014
08.00-09.00
2.
Wed,
10 Sept
2014
3.
Thu,
11 Sept
2014
4.
Fri,
12 Sept
2014
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
LEARNING
ACTIVITY
VENUE
Highlight in
Class room
Emergency
Medicine(Chairman)
Individual Learning
SGD
Disc room
Break
Student Project
Plenary
Class room
Lecture 2.
Status Epilepticus
and Other Seizure
Disorders
Individual Learning
SGD
Break
Student Project
Plenary
Lecture 3.
Acute Psychiatric
Episodes
Individual Learning
SGD
Break
Student Project
Plenary
Class room
08.00-09.00
Lecture 4.
Acute Respiratory
Distress Syndrome
and Failure
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD
Break
Student Project
Plenary
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
CONVEYER
dr. Tjok Gde Agung
Senapathi, Sp.AnKAR
Facilitators
dr. Tjok Gde Agung
Senapathi, Sp.AnKAR
dr. IGN Budiarsa,SpS
Disc room
Facilitators
Class room
Class room
Disc room
Facilitators
Class room
dr. Ratep,SpKJ
Class room
dr Sucipta, SpTHT KL
( and ENT Team), Dr.
Dewa Made Artika, SpP,
dr. Dyah Kanyawati,SpA,
dr. Srie Laksminingsih,
SpR
Disc room
Facilitators
Class room
dr Sucipta, SpTHT KL
( and ENT Team)
Pulmo, Pediatric,
Radiology
DAY/DATE
TIME
5.
Mon,
15 Sept
2014
08.00-09.00
6.
Tue,
16 Sept
2014
7.
Wed,
17 Sept
2014
VENUE
Lecture 5.
Shock on Adult and
Pediatrik
Individual Learning
SGD
Break
Student Project
Plenary
Class room
08.00-09.00
Lecture 6.
Bleeding Disorder
Class room
09.00-10.30
Individual Learning
10.30-12.00
SGD
12.00-12.30
Break
12.30-14.00
Student Project
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
8
Thu,
18 Sept
2014
LEARNING
ACTIVITY
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Disc room
Class room
CONVEYER
dr. IGAG Uttara Hartawan
, SpAnMARS; dr. Dyah
Kanyawati, SpA
Facilitators
dr. IGAG Uttara Hartawan
, SpAnMARS; dr. Dyah
Kanyawati, SpA
dr SariWulan, SpTHT KL
( and ENT Team)
dr. Megadhana, SpOG(K)
OBGYN
-
Disc room
Facilitators
Plenary
Class room
Lecture 7.
Cardiac Arrest and +
Cardiopulmonary
Resuscitaton
Individual Learning
SGD
Break
Student Project
Plenary
Class room
dr SariWulan, SpTHT KL
( and ENT Team)
dr. Megadhana, SpOG(K)
OBGYN
dr. IGN Mahaalit Aribawa,
SpANKAR
Lecture 8
Emergency
Toxicology and
Poisoning
Individual Learning
SGD
Break
Student Project
Plenary
Class room
Disc room
Facilitators
Class room
Disc room
Facilitators
Class room
DAY/DATE
9
Fri,
19 Sept
2014
10
Mon,
22 Sept
2014
11.
Tue,
23 Sept
2014
12.
Wed,
24 Sept
2014
TIME
08.00-09.00
VENUE
Lecture 9
Pregnancy Induce
Hypertension
Individual Learning
SGD
Break
Student Project
Plenary
Class room
08.00-09.00
Lecture 10
Shoulder Dystocia
Class room
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD
Break
Student Project
Plenary
08.00-09.00
Lecture 11.
Trauma Which Potentially
Disabling and life
Threatening Conditions
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD
Break
Student Project
Plenary
08.00-09.00
Lecture 12
Acute Blistering and
Exfoliative Skin (TEN &
SJS)
Individual Learning
SGD
Break
Student Project
Plenary
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
DAY/DATE
LEARNING ACTIVITY
TIME
LEARNING
Disc room
Class room
Disc room
Class room
CONVEYER
dr. Megaputra,
SpOG(K)
Facilitators
dr. Megaputra,
SpOG(K)
dr. Wayan
Megadhana,
SpOG(K)
Facilitators
dr. Wayan
Megadhana,
SpOG(K)
dr. Ketut Suyasa,
SpB SpOT(K) Spine
dr. Wayan Subawa,
SpOT
Fasilitator
Class Room
Disc room
Class Room
VENUE
CONVEYER
ACTIVITY
13
Thu,
25 Sept
2014
14
Fri,
26 Sept
2014
15
Mon,
29 Sept
2014
08.00-09.00
Lecture 13.
Phlegmon & Carries
Class room
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD
Break
Student Project
Plenary
Disc room
08.00-09.00
Class room
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Lecture 14.
Urologic Concern in
Critical Care for
NonTrauma Case
Individual Learning
SGD
Break
Student Project
14.00-15.00
Plenary
Class room
08.00-09.00
Lecture 15
Urologic Concern in
Critical Care for
Trauma Case
Individual Learning
SGD
Break
Student Project
Plenary
Class room
08.00-selesai
08.00-selesai
Team
08.00-selesai
Team
08.00-selesai
Team
08.00-selesai
Team
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
16.
Tue,
30 Sept
2014
17.
Wed,
1 Oct
2014
18.
Thu,
2 Oct
2014
19.
Fri,
3 Oct
2014
20.
Mon,
6 Oct
2014
Class room
Disc room
Disc room
Class room
21-22
English Class
DAY/DATE
1.
Tue,
9 Sept
2014
2.
Wed,
10 Sept
2014
3.
Thu,
11 Sept
2014
4.
Fri,
12 Sept
2014
TIME
09.00-10.00
LEARNING
ACTIVITY
VENUE
Highlight in
Emergency
Medicine(Chairman)
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
Lecture 2.
Status Epilepticus
and Other Seizure
Disorders
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Lecture 3.
Acute Psychiatric
Episodes
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
09.00-10.00
Lecture 4.
Acute Respiratory
Distress Syndrome
and Failure
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
CONVEYER
dr. Tjok Gde Agung
Senapathi, Sp.AnKAR
-
Disc room
Class room
Facilitators
dr. Tjok Gde Agung
Senapathi, Sp.AnKAR
dr. IGN Budiarsa,SpS
Disc room
Class room
Class room
Facilitators
dr. IGN Budiarsa,SpS
dr. Ratep,SpKJ
Disc room
Class room
Facilitators
dr. Ratep,SpKJ
Class room
Disc room
Class room
Facilitators
dr Sucipta, SpTHT KL ( and
ENT Team)
Pulmo, Pediatric, Radiology
10
DAY/DATE
TIME
5.
Mon,
15 Sept
2014
09.00-10.00
6.
Tue,
16 Sept
2014
7.
Wed,
17 Sept
2014
VENUE
CONVEYER
Lecture 5.
Shock on Adult and
Pediatrik
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
Disc room
Class room
09.00-10.00
Lecture 6.
Bleeding Disorder
Class room
10.00-11.30
Student Project
Facilitators
dr. IGAG Uttara Hartawan
, SpAnMARS; dr. Dyah
Kanyawati, SpA
dr SariWulan, SpTHT KL
( and ENT Team)
dr. Megadhana, SpOG(K)
OBGYN
-
11.30-12.00
ISTIRAHAT
12.00-13.30
Individual Learning
13.30-15.00
SGD
Disc room
Facilitators
15.00-16.00
Plenary
Class room
09.00-10.00
Lecture 7.
Cardiac Arrest and +
Cardiopulmonary
Resuscitaton
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
dr SariWulan, SpTHT KL
( and ENT Team)
dr. Megadhana, SpOG(K)
OBGYN
dr. IGN Mahaalit Aribawa,
SpANKAR
Lecture 8
Emergency
Toxicology and
Poisoning
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
8
Thu,
18 Sept
2014
LEARNING ACTIVITY
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Disc room
Class room
Disc room
Class room
Facilitators
dr. IGN Mahaalit Aribawa,
SpANKAR
dr. Agus Somya, SpPD
KPTI
Facilitators
dr. Agus Somya, SpPD
KPTI
11
DAY/DATE
9
Fri,
19 Sept
2014
10
Mon,
22 Sept
2014
11.
Tue,
23 Sept
2014
12.
Wed,
24 Sept
2014
TIME
09.00-10.00
VENUE
Lecture 9
Pregnancy Induce
Hypertension
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
09.00-10.00
Lecture 10
Shoulder Dystocia
Class room
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
09.00-10.00
Lecture 11.
Trauma Which
Potentially Disabling
and life Threatening
Conditions
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
09.00-10.00
Lecture 12
Acute Blistering and
Exfoliative Skin (TEN &
SJS)
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Disc room
Class Room
LEARNING ACTIVITY
VENUE
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
DAY/DATE
LEARNING ACTIVITY
TIME
CONVEYER
dr. Megaputra,
SpOG(K)
-
Disc room
Class room
Disc room
Class room
Facilitators
dr. Megaputra,
SpOG(K)
dr. Wayan
Megadhana,
SpOG(K)
Facilitators
dr. Wayan
Megadhana,
SpOG(K)
dr. Ketut Suyasa,
SpB SpOT(K) Spine
dr. Wayan Subawa,
SpOT
-
Disc room
Class Room
Facilitators
dr. Ketut Suyasa,
SpB SpOT(K) Spine
dr. Wayan Subawa,
SpOT
dr. Ketut
Suryawati,SpKK
Facilitators
dr. Ketut
Suryawati,SpKK
CONVEYER
12
13
Thu,
25 Sept
2014
14
Fri,
26 Sept
2014
15
Mon,
29 Sept
2014
09.00-10.00
Lecture 13.
Phlegmon & Carries
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
09.00-10.00
Class room
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
Lecture 14.
Urologic Concern in
Critical Care for
NonTrauma Case
Student Project
ISTIRAHAT
Individual Learning
SGD
Disc room
Facilitators
15.00-16.00
Plenary
Class room
09.00-10.00
Lecture 15
Urologic Concern in
Critical Care for
Trauma Case
Student Project
ISTIRAHAT
Individual Learning
SGD
Plenary
Class room
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Class room
Disc room
Class room
Disc room
Class room
16.
Tue,
30 Sept
2014
17.
Wed,
1 Oct
2014
18.
Thu,
2 Oct
2014
19.
Fri,
3 Oct
2014
08.00-selesai
08.00-selesai
Team
08.00-selesai
Team
08.00-selesai
Team
20.
Mon,
6 Oct
2014
08.00-selesai
Team
13
Individual Learning
Prepare For The
Examination
Team
Examination
ASSESSMENT METHOD
Assessment will be carried out onMonday 5 th of October2014. There will be 100 questions
consisting mostly of Multiple Choice Questions (MCQ) and some other types of questions.
The minimal passing score for the assessment is 70.Other than the examinations score,
your performance and attitude during group discussions will be consider in the calculation of
your average final score.Final score will be sum up of student performance in small group
discussion (5% of total score) and score in final assessment (95% of total score). Clinical
skill will be assessed in form of Objective structured clinical examination (OSCE) at the end
of semester as part of Basic Clinical Skill Blocks examination.
STUDENT PROJECT
Students have to write a paperwork with topic given by the lecturer. The topic will be
chosen randomly on the first day. Each small group discussion must work on one paperwork
with different tittle. The paperwork will be written based on the direction of respective
lecturer. The paperwork is assigned as student project and will be presented in class. The
paper and the presentation will be evaluated by respective facilitator and lecturer.
Format of the paper :
1. Cover
2.
3.
4.
5.
Introduction
Journal critism/literature review
Conclusion
References
Example :
Journal
Porrini M, Risso PL. 2005. Lymphocyte Lycopene Concentration and DNA Protection from
Oxidative Damage is Increased in Woman. Am J Clin Nutr 11(1):79-84.
Textbook
Abbas AK, Lichtman AH, Pober JS. 2004. Cellular and Molecular Immunology. 4th ed.
Pennysylvania: WB Saunders Co. Pp 1636-1642.
Note.
Minimum 10 pages; line spacing 1.5; Times new roman 12
14
LEARNING PROGRAMS
Abstracts of Lectures
LECTURE 1 : HIGHLIGHT
EMERGENCY MEDICINE
Tjok Gde Agung Senapathi
Objective
To describe
1.
2.
3.
4.
HighlightEmergency Medicine
Basic principal of Emergency Medicine
Triad Emergency Medicine
Ethics in critical care
Medical ethics is the art of resolving conflicts that arise around treatment and
treatment decisions. The conflict may involve the patient, family, caregivers, or society. An
approach to these conflicts is as necessary as, say, an approach to hypotension or oliguria.
Without an approach we would be ignoring the mechanism that led the conflict or problem in
the first place. A little preparation will allow one to be more comfortable when confronting
these situations, making responses more likely to be useful (and less likely to make things
worse).
There are four basic principles or medical ethics that give us the tools to begin to
resolve some of these conflicts : autonomy, beneficence, and justice. The weight we give
each of these four different principles is often determined by our individual and societal
morals.
15
16
17
RADIOLOGY
Srie Laksminingsih
Learning Objective
At the end of meeting, the student will be able to :
1. Describe the radiology imaging of thorax photo for IRDS (Idiopathic Respiratory
Distress Syndrome) case, Bronchopneumonia, CHD, Pericardial Effusion, Lung
Edema, Pneumothorax, Pleural Effusion, Vena Cava Superior Syndrome.
2. Describe the imaging of abdominal plain photo in : Illeus Obstruction, Paralytic Illeus,
Stone in the Urinary Bladder, Peritonitis, NEC, Cholelithiasis & Acute Cholecystitis.
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EPISTAXIS
Sari Wulan
Abstract
Epiptaxis is an alteration of normal hemostasis whitin nose. Hemostasis is compromised by
mucosal abnormalities, vessel pathology or disorders of coagulation. Etiology of epistaxis
may be local or systemic. The local epistaxis commonly causes by trauma, mild. The
systemic causes emperaly causes by hypertension and sever
Management of epistaxis is stop the bleeding, avoid complication treatment of initial
disorders.
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LECTURE 9 :
PREGNANCY INDUCED HYPERTENSION
Megaputra
Objective :
1. Define pregnancy induced hypertension
2. Review appropriate fetal/maternal assessment
3. Discuss appropriate anti hypertension and anti seizure therapy
4. Recognize when and how to transport patient with pregnancy induced hypertension
Hypertensive disorders in pregnancies are the leading causes of maternal death in
emerging countries. All caregivers must be able to promptly recognized the signs,
symptoms and laboratory findings of gestational hypertension with or without proteinuria
and with other adverse manifestation. Caregivers must appreciate fully the seriousness of
gestational hypertension, its potential for multi organ involment and the risk for perinatal
and maternal morbidity and mortality. The appropriate management of gestational
hypertension may vary based on the availability of resources. In this lecture student will
discuss such as : the classification and definition of hypertensive disorders in pregnancy;
management and treatment of gestational hypertension.
Severe gestational hypertension is an obstetrical emergency, which requires prompt
recognition, stabilization of mother and fetus and multi disciplinary approach to
management and treatment
LECTURE 10 :
SHOULDER DYSTOCIA
Wayan Megadhana
Objective
Use a systematic approach to the reduction of shoulder dystocia based upon the
physical mechanism of impact and disimpaction.
Shoulder dystocia is one of emergency problems during delivery. Following the
delivery of the head, there is impaction of the anterior shoulder on the symphysis pubis in
the AP diameter, in such a way that the remainder of the body cannot be delivered in the
usual manner. More than 50% of cases shoulder dystocia occur in the absence of any
identified risk factor. The student will discuss the assessment of shoulder dystocia, the
complication for fetus and mother, identification of risk factor, diagnosis and management
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LEARNING TASK
Day 1
HIGHLIGHT EMERGENCY MEDICINE
SELF ASSESMENT:
1.
Explain briefly about the scope of Emergency Medicine
2.
Explain the basic principals of Emergency Medicine
3.
Elaborate briefly about the details in Triad Emergency Medicine
LEARNING TASK
1.
As a general practitioner who works in public health centre, you were visited by a 40
years old man, who brought his brother 35 years old with seizure all over his body and
bubbles in his mouth.
(a) As a doctor what would you do?
(b) After the first aid the seizure has stopped but the patient is still unconscious.
What do you do next?
After a while the patient has seizure again, even before gaining consciousness.
(c) What caused the patient to seizure again?
(d) If u were working in the emergency room at the hospital, what would your
action be?
2.
When would you suggest a surgical intervention to an epileptic patient?
SELF ASSESSMENT
1.
Able to explain the causes of status epileptikus
2.
Able to give first aid for status epileptikus
3.
Able to identify patient with refractory epilepsy
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SELF ASSESSMENT
1. Mampu menegakkan diagnosis Gangguan Mental Organik, membedakannya
dengan Gangguan Psikosis fungsional lainnya.
2. Mampu melakukan wawancara singkat untuk menggali data dan merencanakan
pemeriksaan penunjang yang diperlukan untuk kasus-kasus Accute Psychiatry.
3. Mampu membuat perencanaan awal untuk menangani kasus-kasus Accute
Psychiatry.
4. Mengerti etio-patogenesis, pato-fisiologis dan psikodinamika terjadinya kasus-kasus
Accute Psychiatry.
5. Mampu membuat prediksi/prognosis suatu kasus AccutePsychiatry serta tahu kapan
harus merujuk pasien tersebut.
LEARNING RESOURCES
1. Kaplan & Saddocks Synopsis of Psychiatry, 10th ed
2. Kaplan & Saddocks Study Guide and Self Examination Review in Psychiatry, 7th ed.
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NEONATAL RESUSCITATION
LEARNING TASK :
Case 3 :
A baby born at 33 weeks gestation following a caesarean section present with respiratory
distress soon after birth with bradypnoea (RR : 18 times/minutes). Heart rate 80
times/minutes regulary. The baby is requiring oxygen, an intravenous line inserted to
provide maintenance fluids. The mother had a temperature of 380 C.
TASK :
1. What is the diagnosis?
2. What investigation should be carried out?
3. What treatment would you institute of this condition?
4. Despite your effort above the baby has a cardio respiratory arrest with the ECG
monitor, what is the immediate management?
5. what is the prognosis?
SELF ASSESSMENT :
1. To describe definition of perinatal asphyxia
2. To describe pathophysiology and etiology of asphyxia
3. To describe :
Perinatal management
Delivery room management
Postnatal management
4. To describe prognosis of perinatal asphyxia
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RADIOLOGY
LEARNING TASK
1. Describe the radiology imaging of thorax which is specific for :
a. IRDS
b. Bronchopneumonia
c. Congenital Heart Disease
d. Lung Edema
e. Pneumothorax
f. Pleural Effusion
g. Vena Cava Superior Syndrome.
SELF ASSESMENT :
1. A mother who have a new born baby complaint that her babys lips is blue and
always breathing so fast.
a. What kind of congenital anomalies do you think about this case ?
b. What kind of simple radiology examination that you suggest to do ?
c. What kind of radiology imaging you can find in this case ?
2. An old man, complaint cough with sputum every morning, suddenly feel shortness
of breath and suffered from ches pain in his right chest, Patient also complaint that
he didnt got a fever.
a. What do you think about this case ?
b. What kind of radiology examination that you suggest to do ?
c. What kind of radiology imaging you can find in this case ?
BLEEDING DISORDERS
CASE 1 :
, 66 years old come to hospital with profuse bleeding in both of his nose and can not stop
spontaneusy. He never had nasal blocked symptom and he commonly complained head
ache and fluctuated blood pressure
QUESTION
1. What is the initial disease/disorder of the patient ?
2. How to manage the patient ?
3. What is the complication of the epistaxis and after managed the patient ?
SELF ASSESSMENT
1. Describe and discuss of causes of epistaxis
2. Describe kind of epistaxis
3. Manage and provide initial management and how to refer the patient
REFERENCE
1. Byron Bailey J., M.D, Epistaxis. In : Head and Neck Surgery Otolaryngology
Third Edition, Volume One. Philadelphia, London : LIPPINCOTT WILLIAMS &
WILKINS, Company ; 2001, p. 415-428
2. Eisele D W, MC Quone S.J.,Epistaxis. In : Emergencies of the Head and Neck.
Philadelphia, London : MOSBY. INC copyright 2000, p 239-262.
CASE 2 :
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Based on immediate observation, what is the patient going through and what
examination actions should be done to obtain the working diagnosis.
Describe briefly the immediate act of first aid that should be done to overcome the
emergency and what is the next step/therapy?
Based on your analysis what would have caused this emergency and explain its
pathogenesis and pathophysiology.
Explain the patients prognosis.
Case Scenario II
A male patient, 46 years old was brought to the PUSKESMAS by so many people after
being attacked by a fighter cock on his right leg. Blood splashing out of the back of his
knees was noted and it had been bandaged using normal cloth. At an early exam, the
patient was alert but anxious, complained of pain, looked pale, breathing increased and
his pulse were weak and fast.
Task:
1. Based on immediate observation, what is the patient going through and what
examination actions should be done to obtain the working diagnosis.
2. Describe briefly the immediate act of first aid that should be done to overcome the
emergency and what is the next step/therapy? Should this patient be referred? If
yes, where?
3. Based on your analysis what would have caused this emergency and explain its
pathogenesis and pathophysiology.
4. Explain the patients prognosis.
Case Scenario III
A girl aged 21 years was sent to the PUSKESMAS by family after having fever, vomiting
and refuses to drink-eat since 3 days ago. At an initial examination, patient was
conscious but quite anxious, complained of pain, looked pale, body felt hot, breath fast
and deep, pulse weak and fast, and stomach looked stretched. Extra informations were
that the patient was not married, delayed menses and have gotten treatment from
dukun beranak
Task:
1. Based on immediate observation, what is the patient going through and what
examination actions should be done to obtain the working diagnosis.
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LEARNING TASK
Case Scenario I
One Sunday morning, you are enjoying the fine morning at the Sanur Beach. At a
distance, you could see people looking panicked, is screaming for help. There was
young couple being dragged by a wave while they were bathing. The lady managed to
safe herself, where else the man at the beginning who are trying to safe his friend, was
dragged into the water. Then the life guard managed to safe the man and immediately
gave him first aid. You as a medical personnel, coincidently being there, should also give
first aid.
Task:
1. Based on immediate observation, what is the patient going through and what
examination actions should be done to obtain the working diagnosis.
2. Describe briefly the immediate act of first aid that should be done to overcome the
emergency and what is the next step/therapy?
3. Based on your analysis what would have caused this emergency and explain its
pathogenesis and pathophysiology.
4. Explain the complication and prognosis of this patient.
Case Scenario II
Once you were riding your personal car on the road. At one of the junctions you find a
stopping suddenly in the middle of the road, the driver was a male, age around 60 years
old, looked quiet, not moving and his right hand on his left chest. You as a medical
personnel, coincidently being there, should also give first aid.
Task:
1. Based on immediate observation, what is the patient going through and what
examination actions should be done to obtain the working diagnosis.
2. Describe briefly the immediate act of first aid that should be done to overcome the
emergency and what is the next step/therapy?
3. Based on your analysis what would have caused this emergency and explain its
pathogenesis and pathophysiology.
4. Explain the prognosis of this patient.
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CAUSTIC INTOXICATION
LEARNING TASK
1. Able to differentiate clinical manifestation of alkali or acid injury
2. Able to manage alkali and acid injury, by basic intoxication procedure
3. Able to monitor and early detection of serious complication and urgent consultation.
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SHOULDER DYSTOCIA
CASE :
In the labor ward, you as a intern help a pregnant woman in second stage of labor.
Following and easy application, after two time maternal pushing, there is moderately good
descent during the first pull but this slows down as the head is half out. What are potential
causes for this and what is your plan of action at this point?. If shoulder dystocia is
confirmed, what is your management?
UROLOGYC EMERGENCY
Case 1 An Old man that unable to void
A 73 years old man with multiple medical problems presented with complaints that he
could not void and had pain in the lower abdomen. He had a mild dementia, so much of the
history was from his wife, who accompanied him to the clinic. She stated that he had neither
incontinence, fever, nauses, nor vomiting, and he had any recent acute illnesses. The
patient had not had any recent change in medication, doses or frequency of dosing of his
pain medication. He had similar problems in the past, but the symptoms had resolved after
he underwent a transurethral resection of the prostate (TURP) 2 years ago. His wife also
stated that he had been able to void normally up until earlier this morning. Since that time
he had complained frequently about the urge to void and being to do so.
The patients medical history was extensive. Of particular note, he had metastatic
squasmous cell lung cancer and was placed in hospice care 2 weeks before presentation.
He had type 2 diabetes, hypertension, glaucoma, and benign prostatic hypertrophy (BPH)
His medication included an extended release morphine tablet for pain, rosiglitazone for his
diabetes, and recently discontinued ramipril and hydrochlorothiazide, which he had taken in
the past for his hypertension.
On examination, he was midly tender over the bladder, which was palpably distended. He
attempted to void for a urinalysis specimen and was unable to do so. A Foley catheter was
placed, and 240 ml of urine was collected. The urinalysis showed a trace of protein, and
results were otherwise negative; the pH was 7,3.
Question :
1. What are some cuases of acute urinary retention?
2. What are some typical symptoms of acute urinary tract obstruction?
3. What tests would be helpful in determining the cause of this patients urinary
retention?
4. What treatments would be useful in relieving the symptoms?
5. What are some complications of untreated acute urinary retention?
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Dermato emergencies
Case
A male twentytwo-year-old, who was started on Phenobarbital after his third febrile seizure.
Seven days later, he developed erythematous lesions over his extremities, face and trunk.
Over the next three days he developed fever to 105 degrees, and the erythematous lesions
became vesicular and bullous, and he was admitted to Sanglah General Hospital.
On arrival, the patient had diffuse involvement of his oral mucosa and conjunctiva. He was
intubated electively to protect his airway. Fiberoptic laryngoscopy revealed erosive mucosal
lesions in the mouth and oropharynx to the level of the larynx, which was not involved.
The patient's condition deteriorated. He required vasopressor support, developed gross
hematuria and significant hemorrhage from his lips and gums, requiring placement of
multiple oral packs and treatment with topical thrombin spray. Approximately 40% of his
body surface area was involved. Currently, he is slowly improving in the joint care in
Intensive Care Unit.
LEARNING TASK
1. According this case, what is the most likely diagnosis?
2. What does you needs the history of the patients to support the diagnosis?
3. What does the complete assessment of this patient?
4. What does your planning for management in this case?
SELF ASSESSMENT
1. Describe the principle clinical features of SJS, TEN and SSSS.
2. Describe the pathogenesis of emergencies skin disease.
3. Explain more detail the basic principle of management of the emergencies skin
disease.
4. Describe the prognosis and complication of the emergencies skin disease.
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~ CURRICULUM MAP ~
Medical Education Unit Faculty of Medicine Udayana University
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Smstr
10
Senior Clerkship
Senior Clerkship
Senior clerkship
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study
II
(1 weeks)
5
BCS (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
39