plenary dicussion

7/30/2019 Plenary Dicussion

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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


3/13

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


4/13

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?


5/13

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


7/13

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)

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