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Knowledge of primary survey on lowering consciousness among Pasar Petisah citizens Suherman, Jessen; Lubis, Andriamuri Primaputra; Paramita, Deryne Anggia; Nasution, Afrida Aryani
Jurnal Prima Medika Sains Vol. 6 No. 1 (2024): June
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v6i1.5313

Abstract

Lowered consciousness is a life-threatening condition that necessitates prompt assessment and first aid. One crucial method for addressing such emergencies is the primary survey, which aims to identify and treat life-threatening conditions quickly. Pasar Petisah, one of the largest and busiest markets in Medan, is a high-risk location for such emergencies due to its crowded nature. Therefore, the community at Pasar Petisah needs to have a strong understanding of the primary survey procedure. This study is a descriptive cross-sectional analysis that uses primary data collected through questionnaires. The sample size consists of 97 subjects, selected using non-probability sampling techniques. The results indicate that among the 97 participants, only 3 (3.1%) demonstrated a good level of knowledge about the primary survey, 41 (42.3%) had a sufficient level of knowledge, and 53 (54.6%) had a lacking level of knowledge. Regarding readiness to perform the primary survey, 61 individuals (62.9%) reported feeling prepared, 23 individuals (23.7%) were doubtful, and 13 individuals (13.4%) felt unprepared. Overall, while the community at Pasar Petisah generally lacks adequate knowledge about conducting a primary survey in cases of lowered consciousness, a majority still express readiness to perform the primary survey in emergency situations.
A Case Report Total Intravenous Anesthesia Combined with Peribulbar Block in Vitrectomy Operation with Heart Disorder Lubis, Andriamuri Primaputra; Lubis, Adhika Syaputra
Majalah Anestesia & Critical Care Vol 40 No 2 (2022): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (350.568 KB) | DOI: 10.55497/majanestcricar.v40i2.251

Abstract

Introduction: Vitrectomy is eye surgery to evaluate the retina by removing the vitreous gel which is principally carried out in three stages, namely retinal detachment repair, membrane peeling, and crystalline lens. In this operation, the anesthetic technique that needs to be emphasized is not increasing intraocular pressure and avoiding the oculocardiac reflex. This operation can be performed with a peribulbar or retrobulbar block, however, total intravenous anesthesia may also be considered in patients with other comorbidities.Case Presentation: Male, 55 years old, 96 kgs, with the chief complaint of blurred vision in the last 3 weeks ago. There were no other complaints but the patient has a history of hypertension, diabetes mellitus type II, congestive heart failure with a history of mitral valve replacement (MVR), and permanent pacemaker (PPM) usage from 2015. The patient had a history of warfarin and novamox usage 7 days ago. From the exam, the patient was diagnosed with ablatio retina + post-MVR and scheduled to have a vitrectomy. The patient was positioned supine with 300 heads up. The patient was given 3 liters of oxygen via nasal cannula, premedicated with fentanyl 50 mcg, then induced with propofol 100 mg bolus intravenously until sleep nonapnea before continuing with continuous propofol via syringe pump. The patient was maintained by propofol 0.5 mg/kg BW/hour. Next, the patient was given a peribulbar block with 2mL Lidocaine 2% and 2mL Bupivacaine 0.5%. During operation, there was no significant hemodynamic fluctuation until finished. Conclusion: The patient thus will undergo vitrectomy can be performed with peripheral nerve blocks such as retrobulbar anesthesia or peribulbar anesthesia. However, after knowing about the patient’s medical history, in this case, with a history of cardiac events and also undergone open-heart surgery, total intravenous anesthesia combined with a peribulbar block was considered the most suitable technique.
Pengaruh Pemberian Tiamin Intravena terhadap Kadar Tumor Necrosis Factor Alpha (TNF- α) pada Pasien COVID-19 di Ruang Isolasi Lubis, Andriamuri Primaputra; Annisa Syifanurhati; Muhammad Ihsan
Majalah Anestesia & Critical Care Vol 40 No 2 (2022): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (328.064 KB) | DOI: 10.55497/majanestcricar.v40i2.259

Abstract

Introduction : Many cytokines and inflammatory mediators play a role in the progression of COVID-19 disease, including the interleukins, interferons, and tumor necrosis factor-α (TNF-α.) groups. An intervention is needed to reduce the levels of this cytokine. Thiamine has the potential to reduce levels of proinflammatory cytokines, especially TNF-α. Objective: To determine the effect of intravenous thiamine administration on TNF-α levels in COVID-19 patients in the isolation room of RSUP H Adam Malik. Methods: This study used an analytical design of one group pre test - post test in the isolation room of Haji Adam Malik General Hospital Medan with a sample size of 16 people. Samples were given thiamine IV 200 mg/12 hours and then the levels of TNF-α were measured by ELISA method. Results: Characteristics of the sample obtained were equal in number of males and females (1:1), the mean age was 43 ±14.78 years, the mean BMI was 23.31 ± 6.55, the mean systolic was 122.50 ± 5.77 mmHg and diastolic 88.88 ± 6.55 mmHg. The majority of the sample (50%) had no comorbidities. Before administration of thiamine, the median TNF-α was 186.5 pg/mL with a minimum and maximum value (171-420 pg/mL) and after administration of thiamine, the median TNF-α was 180.50 pg/mL with a minimum and maximum value (122-200 pg/mL) obtained a p value of 0.001 < 0.05 (there is a significant effect). Conclusion: In this study, the mean TNF-α level was lower when given intravenous thiamine. This decrease in TNF-α levels was also found to be significant after intravenous thiamine administration.
Plasmapheresis in Myasthenia Gravis Crisis Rifani Masharto, Alegra; Lubis, Bastian; Lubis, Andriamuri Primaputra; Nadeak, Rommy
Majalah Anestesia & Critical Care Vol 41 No 3 (2023): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v41i3.290

Abstract

Introduction: Myasthenic crisis is the most lethal complication of myasthenia gravis. Referral to an intensive care unit is crucial in managing the myasthenic crisis. Hereby, we report a case of a myasthenic crisis in a 30-year-old female who underwent plasmapheresis. The patient underwent a 12-hour procedure for plasmapheresis and was discharged to a normal ward the next day. Although plasmapheresis is costly, its efficacy should be considered as the main treatment for myasthenic crisis. Case Illustration: Female, 30 years old, weighed 60 kgs, with myasthenia crisis. The patient came to an emergency department and was then intubated before being admitted to the intensive care unit. The physical diagnostic was normal and laboratory findings were leukocytosis. The patient was treated with normal saline, antibiotics, high-dose corticosteroids, and pyridostigmine. The patient was done plasmapheresis with synchronized intermittent mandatory ventilator mode. The patient was examined every 30 minutes. The physical examinations were relatively normal. The plasmapheresis procedure was ended in 12 hours. From the literature, plasmapheresis was found to have significant results for myasthenia gravis compared to conventional therapy because of its blood separation technique to remove autoantibodies. The next day patient was extubated with normal physical examinations and normal laboratory findings. The patient then moved from the intensive care unit to the normal ward and outpatient on the third day of hospital stay. The patient was given oral medicine that included antibiotics, corticosteroids, and pyridostigmine. Conclusion: From this case, we can see that plasmapheresis therapy has a really good outcome compared to other conventional therapy. However this therapy is expensive, so most healthcare providers don’t cover the payment. Hopefully, most hospitals and healthcare providers can cover up for this treatment to save many myasthenia gravis crisis. Keyword: Intensive Care Unit; myasthenic crisis; myasthenia gravis; plasmapheresis; treatment efficacy
Perbandingan Efektifitas Bisoprolol 2,5 mg dan Bisoprolol 5 mg dalam Mengontrol Denyut Jantung pada Pasien Sepsis di Ruang Rawat Intensif Pohan, Alfindy Maulana; Lubis, Bastian; Lubis, Andriamuri Primaputra
Majalah Anestesia & Critical Care Vol 42 No 2 (2024): Juni
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v42i2.339

Abstract

Latar Belakang: Sepsis merupakan keadaan disfungsi organ yang mengancam jiwa di mana terjadi disregulasi respon tubuh terhadap infeksi. Sepsis dikaitkan dengan pelepasan katekolamin endogen masif yang memberikan hasil klinis buruk. Takikardia merupakan prognostik yang buruk pada pasien sepsis. Pasien sepsis dengan takikardi yang mendapat terapi beta-blocker dihubungkan dengan penurunan angka kematian. Bisoprolol merupakan antagonis selektif-ß1 yang mempunyai efek kronotropik negatif. Penggunaan beta-blocker dapat berkontribusi pada perlindungan sistemik dari lonjakan katekolamin yang terjadi selama sepsis. Bisoprolol menurunkan denyut jantung sehingga dapat mengurangi kontraktilitas miokard, lalu mengurangi kebutuhan oksigen miokard yang meningkat pada pasien sepsis.Metode: Penelitian ini merupakan randomized clinical trial (RCT) dengan double blind. Pengumpulan data dengan metode prospektif dilaksanakan di RSUP. H. Adam Malik Medan periode Desember 2022 – Februari 2023. Pemilihan sampel dengan consecutive sampling yang memenuhi kriteria inkusi dan eksklusi. Semua sampel akan diambil data denyut jantung, tekanan darah, tekanan arteri rata-rata (MAP), dan laktat yang nantinya akan dilakukan perhitungan secara statistik. lanjut dengan secara statistik.Hasil: Dengan uji T Independent pada denyut jantung, tekanan darah sistol, tekanan darah diastol, dan MAP pada 2 jam dan 12 jam setelah perlakuan terdapat perbedaan yang signifikan, didapatkan nilai p < 0,05. Hasil serupa didapatkan pada pemeriksaan laktat pada 24 jam setelah perlakuan, terdapat perbedaan yang signifikan, nilai p < 0,05.Simpulan: Berdasarkan hasil studi kami, terdapat perbedaan yang bermakna antara pemberian bisoprolol 2,5 mg dan bisoprolol 5 mg. Pada penelitian ini menunjukkan bahwa pada pemberian bisoprolol 5 mg lebih efektif dibandingkan dengan bisoprolol 2,5 mg dalam menurunkan denyut jantung pada pasien sepsis
Comparison of Changes in Cortisol Levels in the Blood of Patients Undergoing Craniotomy Using Continuous Infusion Lidocaine and Fentanyl Syaputra, Adhika; Irina, Rr Sinta; Lubis, Andriamuri Primaputra; Harahap, Juliandi
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.565

Abstract

Background and Objectives: Craniotomy is a surgical procedure that involves part of the skull, temporarily removing it to expose the brain and carrying out intracranial procedures. The surgery can be considered as the standard model for assessing cortisol as a stress response. Cortisol in the blood can cause hemodynamic and physiological changes in the body such as increased heart rate, increased blood pressure, and also increased blood sugar levels. Some literature showed that continuous infusion of fentanyl and lidocaine - has an effect in maintaining the responses to stress, namely the level of cortisol in the blood. The aim aimed to determine the comparison of changes in cortisol levels in the bloodpatients undergoing craniotomy using continuous infusion lidocaine and continuous infusion fentanyl.Subject and Method: This research used a double-blind randomized controlled trial (RCT) with a pre-test and post-test with a control group design. This study divided the samples into 2 groups. Continuous infusion of lidocaine and continuous infusion of fentanyl were then checked for cortisol levels in the patient's blood before and after undergoing craniotomy.Results: The result of 28 samples that underwent craniotomy, 6 samples were excluded, so the total number of samples analyzed was 22 samples. Differences in mean cortisol levels before and after surgery in the lidocaine and fentanyl groups were 193.90 nmol/L and 153.90 nmol/L respectively with a P value of 0.021.Conclusion: In the study, it was found that cortisol levels increased in both fentanyl and lidocaine groups after a craniotomy. There is a significant difference between the two groups of fentanyl and lidocaine, where statistically the fentanyl group was better at maintaining blood cortisol levels after craniotomy than the lidocaine group.
Enteral Nutrition Tolerability Assessment in Septic Shock Patients in The ICU of RSUP H. Adam Malik Medan Ansari, Aulia Kamal; Lubis, Andriamuri Primaputra; Nadeak, Rommy Fransiscus
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.58873

Abstract

Background: Enteral nutrition is recommended within 24 to 48 hours after intensive care unit (ICU) admission when resuscitation and hemodynamic stability have been achieved. This study aims to determine the tolerability of enteral nutrition in septic shock patients in the ICU. Objective: To determine the tolerability of enteral nutrition in septic shock patients in the ICU of RSUP H. Adam Malik Medan.Methods: This study is a retrospective observational study, which was conducted in the ICU of the RSUP H. Adam Malik Medan by taking patient data from January to December 2022. The samples were septic shock patients who were admitted to the ICU using mechanical ventilation and vasopressors with a length of treatment of more than 48 hours. Data was collected on the time required for enteral nutrition administration, as well as assessing patient tolerability (presence of vomiting, residuals, and incidence of ileus). Other assessments included length of stay and mortality rate.Result: This study consisted of 47 samples, with 23 male (48.9%) and 24 female (51.1%) samples. Based on the underlying disease, 40.4% of the samples were diagnosed with pneumonia. In the tolerability of enteral nutrition, 83% of the samples were tolerant of early enteral nutrition, but with a high mortality rate of 89.4%. The initiation time of enteral nutrition in patients was 4.94 ± 1.79 hours (p=0.001). The average hospital stay for sepsis patients was 7.30 ± 6.55 days (p=0.001).Conclusion: Most sepsis and septic shock patients in the ICU are tolerant of early enteral nutrition <24 hours, but it does not reduce mortality.
Bronchial Toilets in Sepsis Patients Treated in The Intensive Care Unit (ICU): A review On Indications and Complications Lubis, Andriamuri Primaputra; Irina, Rr Sinta; Karim, T. Abdul
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.56989

Abstract

The respiratory system is very important for human life. Its performance determines the quality of life. Physical exercise helps patients suffering from various diseases to build physical fitness, improve respiratory mechanisms, and reduce secretions. It is important to choose the right technique for such patients, using fitness and strength training, breathing exercises, bronchial cleansing. Bronchial clearing aims to remove respiratory tract secretions that contribute to recurrent inflammation and respiratory distress. This is based on the position which facilitates the removal of dense secretions due to the influence of gravity. Pharmacological measures to reduce the secretions in the respiratory tract and facilitate coughing, should be administered prior to drainage. Tracheo-bronchial toilet is a method used to clear mucus and secretions from the airways. The benefits of a tracheo-bronchial toilet include preventing infections such as pneumonia and improving drainage of secretions. Methods used in tracheo-bronchial toilets include temporary naso-tracheal intubation with small tubes, percussion, positioning, and coughing. A tracheotomy can also be performed for lung clearance. Toilet bronchoscopy is a potentially therapeutic intervention to aspirate retained secretions in the endotracheal tube and airway and restore atelectasis. 
Perbandingan Pemberian Fentanil dengan dan tanpa Lidokain Intravena terhadap Hemodinamik Pasca-Intubasi Endotrakeal dan Nilai Nyeri Tenggorokan Pascaoperasi di RSUP H. Adam Malik Medan Wijaya, Yudhi; Lubis, Andriamuri Primaputra; Wijaya, Dadik Wahyu
Majalah Anestesia & Critical Care Vol 42 No 3 (2024): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v42i3.341

Abstract

Latar Belakang: Intubasi endotrakeal dilakukan dalam berbagai situasi seperti kegagalan ventilasi noninvasif pada pasien perawatan intensif. Nyeri tenggorokan (postoperative sore throat) dan suara serak (hoarseness) merupakan komplikasi intubasi endotrakeal yang paling sering terjadi karena menyebabkan trauma mukosa jalan napas. Insiden nyeri tenggorokan dan suara serak akibat intubasi endotrakeal berkisar antara 5,7 – 90%, di mana 14,4 – 50% keluhan nyeri tenggorokan dan suara serak tersebut muncul segera setelah operasi. Metode: Desain penelitian ini menggunakan uji klinis acak terkontrol tersamar ganda (randomized double blind controlled clinical trial), untuk mengetahui pemberian fentanil dengan kombinasi lidokain dan fentanil terhadap hemodinamik pasca-intubasi endotracheal tube. Hasil: Usia rerata pada kelompok A yaitu 46-55 tahun, sedangkan pada kelompok B yaitu 26-35 tahun. Penurunan hemodinamik terutama mean arterial pressure (MAP) pasca-intubasi pada kelompok A (89,79 ± 8,74 mmHg) lebih kecil dibandingkan dengan kelompok B (91,81 ± 8,39 mmHg). Peningkatan visual analogue score (VAS) pada sore throat pasca-intubasi pada kelompok B (2,05 ± 0,74) lebih besar daripada kelompok A (1,81 ± 0,68). Pada uji normalitas didapatkan MAP pre-intubasi dan pasca-intubasi, serta sore throat pasca-intubasi terdistribusi normal (p > 0,05). Rerata sore throat kelompok A adalah 1,81 ± 0,68 dan kelompok B 2,05 ± 0,74 dengan nilai p sebesar 0,284 (p > 0,05). Simpulan: Tidak terdapat perbedaan bermakna sore throat pasca-intubasi pada kedua kelompok. Tidak terdapat perbedaan bermakna pada hemodinamik dan penilaian nyeri tenggorokan pascaoperasi pada pemberian fentanil dengan kombinasi lidokain intravena dan fentanil intravena pasca-intubasi endotracheal tube.
Hubungan Rasio SpO2/FiO2 dengan Rasio PaO2/FiO2 Pada Pasien Acute Respiratory Distress Syndrome (ARDS) di ICU RSUP H. Adam Malik Pramono, Agus; Lubis, Andriamuri Primaputra; Ihsan, Muhammad
Majalah Kedokteran Indonesia Vol 74 No 5 (2024): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.74.5-2024-1462

Abstract

Introduction: The PaO2/FiO2 (P/F) ratio is the main choice for invasively assessing ARDS. The SpO2/FiO2 (S/F) ratio can be used as a noninvasive oxygenation parameter in ARDS patients. This study was conducted to determine the relationship between the SpO2/FiO2 ratio and the PaO2/FiO2 ratio. Methods: This study was observational with a cross-sectional research method to see the relationship between the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in ARDS patients. The total sample was 29 intubated ICU patients diagnosed with ARDS. This study excluded patients with congestive heart disease, anemia, and systolic blood pressure less than 90 mmHg. Result: A linear regression analysis was obtained between the PaO2/FiO2 and the SpO2/FiO2 ratio with a relationship coefficient of 0,955 and p-value of 0,001. A relationship was found between the S/F ratio and the P/F ratio in assessing the severity of ARDS (p-value less than 0.05). Conclusion: Assessment analysis of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio has a relationship so that it can be used as a predictor of ARDS.