plenary dicussion
TRANSCRIPT
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PLENARY DICUSSION
week 6th
Friday, Nov 9th 2012
27 D
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Dinda Putri Amir
Dinda Wijaya
Muhammad Iqbal Fadhil Alfino Azmi
Rizka Yunidha Anwar
Novilla Rezka Sjahjadi Akbara Pradana
Marcella Dorainne
Nursyazwani bt Abu
Bakar
Ildiani R. Ramli
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SKENARIO 6 : JANTUNG TN. AFIL
Tn. Afil 50 years, came to the clinic with dizziness
and palpitation since 1 day ago. Complaints
pounding've felt since 4 months ago, but did not
interfere with his daily activitiesThe patients blood pressure was 150/100 mm
Hg., pulse 120x/minutes ireguler, dan respiration 22
breaths per minute. Lung exam in normal range, on
examination of the heart was found HR 160 bpm,ireguler, bising susah dinilai. Following is the ECG
obtained Atrial fibrillation with rapid ventricular
response. he was admitted to hospital
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Mr. Afil hospitalized in CVCU with monitoring,
infusion, oxygenation. moments later Mr. Afil
asleep and suddenly awakened by the cries of
the neighbour patient's family newly enrolled
patients died of cardiac arrest, and taken to
the forensics to undergo an autopsy at the
request of law enforcement. How do youexplain what happened to Mr.. Afil and the
neighbours?
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Terminology
Atrial fibilation : impaired of electrical activityof atrial wall
Heart rate : the number of heartbeats per unit
of time, typically expressed as beats perminute (bpm).
Rapid ventricular response
Cardiac arrest :the cessation ofnormal circulation of the bloof due to failureof the heart to contract effectively
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Autopsy : a medical procedure that consists of
a thorough examination performed on a body
after death, to evaluate disease or injury that
may be present and to determine the cause
and manner of a person's death
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Problem identification and analysis
1. why Mr. afil complained of dizziness andpalpitations whether there is a relation withage and gender?
Dizziness is caused by impaired of blood supplyparticularly to the brain
tend to be much at the age of 50 years and
above, and especially men2. why even been felt since 4 months ago but
did not interfere with the activity?
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The specialized conducting system includes
the sinoatrial (SA) node, the atrioventricular
(AV) nodal region, and the ventricular
conducting system composed of bundle of his,
the bundle branches, and the Purkinje fibers.
so when the function of the SA node is
compromised, the heart can still work withthe role of another pacemaker cells.
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3. What is the interpretation of physical exam?
blood pressure 150/100 mmHg HTN Stage
II (JNC VII)
Pulse 120 bpm, HR 160 bpm tachycardia
Respiration rate 22 breaths per minute
tachypnoe Lung exam the underlying disease is not
from the lung
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4. What indications do referrals?
Doctors think that this is an emergency and mustbe followed
5. What is the caused of cardiac arrest?Hipertension
Cigarrete
Drugs of heart userPrevious heart injuries
MI
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6. what information is obtained from the
autopsy?
Anatomy of the heart due to infark, thrombus,
atherosclerotic lesion, brain lesion, neoplasm,
kidney due to TNA, digitalis intoxication.
7. heart rate monitor
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Scheme
RISK FACTOR
Clinical Manifestation
(Dizziness, palpitation) EXAMINATION
PHYSICAL
EXAM
LUNG EXAM
HEARTMURMUR
ECGAFIB
REFERRAL
CVCU
MANAGEMENT
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LEARNING OBJECTIVES
ARRYTHMIAS (Epidemiology, etiology, risk
factors, pathophysiology, clinical
manifestation, examination (routine labs,
ECG), Treatment)
MEDICOLEGAL ASPECT OF SUDDEN CARDIAC
DEATH (SCD)