Cara Membaca EKG: 7 Kriteria Interpretasi EKG

1. Frekwensi (Heart Rate)
  • N : 60- 100
  • Irama regular: [1500/∑ kotak kecil antara R-R] atau [300/∑ kotak sedang antara R-R] 
  • Irama irreguler (selama 6 detik)
  • ∑ kompleks QRS (R – R) X 10
  • Jika ireguler (aritmia), rekam lead II panjang

2. Irama (Rhythm)
  • Sinus rhythm : bila gelombang P selalu diikuti gelombang QRS-T
  • Sinus tachycardi : > 100
  • Sinus bradycardi : < 60 Aritmia

3. Gel.P (P wave) 
  • Adalah : awal sampai dengan akhir gelombang P 
  • N : lebar <0,11> ; tinggi <0,25>
  • Kepentingan:
    • 1. aktivitas atrium
    • 2. arah aktivitas atrium
    • 3. pembesaran atrium

4. Jarak P – QRS (PR Interval)
  • Adalah : awal gelombang P sampai dengan awal gelombang QRS
  • N : 0,12 - 0,20 detik
  • Kepentingan :
    • 1. >0,20 : AV Block
    • 2 <0,12 : 
    • 3. berubah-ubah : Wandering Pacemaker 

5. Kompleks QRS 
a. Lama / lebar (duration) 
  • Adalah : awal sampai dengan akhir gelombang QRS 
  • N : <0,10> detik
  • Kepentingan : adanya Bundle Branch Block
  • 0,10 - 0,12 = Incomplete BBB
  • >0,12 = Complete BBB
b. Sumbu (Axis)
  • Lead I & AVF
  • N : (-30) sampai dengan (+110)
  • (-30) sampai dengan (-90) : LAD (Left Axis Deviation)
  • (+110) sampai dengan (+180) : RAD
  • (+180) sampai dengan (+270) / (-90) sd (-180) : extreme axis
c. Bentuk (Configuration)
  • (+) : I, II, aVF, V5, V6 ;
  • (-) : aVR, V1, V2
  • Bifasik : III, aVL, V3, V4
  • Kepentingan : Q patologis, RAD/LAD, RVH/LVH

6. Segmen S – T (ST Segment)
  • Adalah: akhir gelombang QRS (J Point) sampai dengan awal gelombang QRS T
  • N : - 0,5 mm sd + 2,5 mm
  • Kepentingan : untuk mengetahui adanya kelainan otot jantung (ada tidaknya iskemia dan infark).

7. Gel T (T Wave)
  • Adalah: awal sd akhir gel. T
  • N : min 1 mm
  • Kepentingan: untuk mengetahui adanya kelainan otot jantung (iskemi/infark) ; dan kelainan elektrolit
  • Gelombang T (+) : I, II, aVF, V2-V6
  • Gelombang T (-) : aVR
  • Bifasik : lead III, aVL, V1

Farmakologi Lactulosa

Lactulosa tidak dapat dihidrolisis oleh enzim disaccharidase di usus kecil, sehingga hanya diabsorbsi dalam jumlah kecil. Lactulosa terdegradasi dalam usus besar oleh flora bakterial menjadi asam lemak rantai pendek, terutama menjadi asam laktat dan asam asetat, sehingga mengurangi pH kolon dan meningkatkan tekanan osmotik di lumen usus.

Farmakologi Domperidone

Domperidone merupakan antagonis dopamin yang mempunyai kerja anti emetik. Efek antiemetik dapat disebabkan oleh kombinasi efek periferal (gastroprokinetik) dengan antagonis terhadap reseptor dopamin di kemoreseptor “trigger zone” yang terletak diluar saluran darah otak di area postrema.
Pemberian oral domperidone menambah lamanya kontraksi antral dan duodenum, meningkatkan pengosongan lambung dalam bentuk cairan dan setengah padat pada orang sehat, serta bentuk padat pada penderita yang pengosongan lambungnya terhambat, dan menambah tekanan pada sfingter esofagus bagian bawah pada orang sehat.

Indikasi
  • Untuk pengobatan gejala dispepsia fungsional
  • Untuk mual dan muntah akut.
  • Untuk mual dan muntah yang disebabkan oleh pemberian levodopa dan bromokriptin lebih dari 12 minggu.
Kontra Indikasi
  • Penderita hipersensitif terhadap domperidone.
  • Penderita dengan prolaktinoma tumor hipofise yang mengeluarkan prolaktin.
Dosis
Dispepsia fungsional :
  • Dewasa dan usia lanjut : 10-20 mg, 3 kali sehari dan jika perlu 10–20 mg, sekali sebelum tidur malam tergantung respon klinik. Pengobatan jangan melebihi 12 minggu.
Mual dan muntah (termasuk yang disebabkan oleh levodopa dan bromokriptin) :
  • Dewasa (termasuk usia lanjut) : 10–20 mg, dengan interval waktu 4–8 jam.
  • Anak-anak (sehubungan kemoterapi kanker dan radioterapi) : 0,2–0,4 mg/Kg BB sehari, dengan interval waktu 4–8 jam.
  • Obat diminum 15–30 menit sebelum makan dan sebelum tidur malam.
Efek Samping
  • Jarang dilaporkan : sedasi, reaksi ekstrapiramidal distonik, parkinson, tardive diskinesia (pada pasien dewasa dan usia lanjut) dan dapat diatasi dengan obat antiparkinson.
  • Peningkatan prolaktin serum sehingga menyebabkan galaktorrhoea dan ginekomastia.
  • Mulut kering, sakit kepala, diare, ruam kulit, rasa haus, cemas dan gatal.
Interaksi Obat
  • Domperidone mengurangi efek hipoprolaktinemia dari bromokriptin.
  • Pemberian obat anti kolinergik muskarinik dan analgetik opioid secara bersamaan dapat mengantagonisir efek domperidone.
  • Pemberian antasida secara bersamaan dapat menurunkan bioavailabilitas domperidone.
  • Efek bioavailabilitas dapat bertambah dari 13% menjadi 23% bila diminum 1½ jam setelah makan.
Peringatan dan Perhatian
  • Hati-hati penggunaan pada wanita hamil dan menyusui.
  • Tidak dianjurkan penggunaan jangka panjang.
  • Hati-hati penggunaan pada penderita gangguan fungsi hati dan ginjal.

Bad Breath / Bau Nafas tak Sedap

Bad breath, sometimes called halitosis, is an unpleasant odor of the breath.

Causes and symptoms

Bad breath can be caused by a number of problems. Oral diseases, fermentation of food particles in the mouth, sinus infections, and unclean dentures can all contribute to mouth odor. Many non-oral diseases, such as lung infections, kidney failure, or severe liver disease, can also cause bad breath, though rarely. Many people think that bad breath can originate in the stomach or intestines; this is extremely rare. The esophagus is usually collapsed and closed, and, although a belch may carry odor up from the stomach, the chance of bad breath being caused from air continually escaping from the stomach is remote. Cigarette smoke can cause bad breath, not only in the cigarette smoker, but also in one who is constantly exposed to second-hand smoke.

Diagnosis

The easiest way to determine if one has bad breath is to ask someone who is trustworthy and discrete. This is usually not too difficult. Another, more private, method of determining if one has bad breath is to lick one's wrist, wait until it dries, then smell the area. Scraping the rear area of the tongue with a plastic spoon, then smelling the spoon, is another method one can use to assess bad breath.

Treatment

The most effective treatment of bad breath is to treat the cause. Poor oral hygiene can be improved by regular brushing and flossing, as well as regular dental checkups. Gentle brushing of the tongue should be part of daily oral hygiene. In addition to good oral hygiene, the judicious use of mouthwashes is helpful. Mouth dryness, experienced at night or during fasting, or due to certain medications and medical conditions, can contribute to bad breath. Dryness can be avoided by drinking adequate amounts of water. Chewing gum may be beneficial.

As mentioned, some medications, such as some high blood pressure medications, can cause dry mouth. If this problem is significant, a medication change, under the supervision of one's health care provider, may improve the dry-mouth condition. Oral or sinus infections, once diagnosed, can be treated medically, usually with antibiotics. Lung infections and kidney or liver problems will, of course, need medical treatment.

Prognosis

Most bad breath can be treated successfully with good oral hygiene and/or medical care. Occasionally, for patients who feel that these therapies are unsuccessful, some delusional or obsessive behavior pattern might pertain, and mental health counseling may be appropriate.

Acne / Jerawat

Jerawat adalah satu satu penyakit kulit yang terjadi apabila pori-pori kulit tersumbat oleh sebum, sel-sel kulit mati, dan bakteri. Pada umumnya, jerawat sering terjadi di wajah, dada, bahu, dan punggung, karena di sana banyak terdapat kelenjar sebacea.

Penyebab dan Gejala Jerawat
Penyebab pasti jerawat tidak diketahui. Adapun faktor-faktor risikonya diantaranya adalah:
  • Umur. Berhubungan dengan adanya perubahan hormonal dalam tubuh. Jerawat terutama terdapat pada remaja.
  • Jenis kelamin. Jerawat pada anak laki-laki biasanya lebih parah dan lebih banyak daripada anak perempuan.
  • Penyakit. Adanya gangguan hormonal akan mempersulit terapi jerawat pada anak perempuan.
  • Keturunan.
  • Perubahan hormonal. Jerawat sering tumbuh sebelum haid, selama kehamilan, dan menopause.
  • Makanan (diet). Makanan bukanlah penyebab jerawat, melainkan hanya sebagai faktor pemicu saja.
  • Obat-obatan. Tranquilizers, antidepresan, antibiotik, kontrasepsi oral dan steroid anabolik berefek samping tumbuhnya jerawat.
  • Higiene personal.
  • Kosmetik. Make-up yang berbahan dasar minyak dan hair spray dapat memperparah jerawat.
  • Lingkungan. Terpapar polusi udara dan keringat yang berlebihan dapat menstimulasi jerawat.
  • Stress / tekanan emosional.
Diagnosis Jerawat
Pada umumnya tidak sulit untuk mendiagnosis jerawat. Anamnesis mencakup pertanyaan tentang perawatan kulit, makanan (diet), faktor-faktor pemicu, pengobatan yang sedang digunakan, dan terapi yang telah dilakukan. Pemeriksaan fisik meliputi wajah, leher bagian atas, dada, bahu, punggung, dan daerah lainnya yang terkena. Kemudian ditentukan jenis dan deskripsi jerawat yang bersangkutan.
Test Laboratorium tidak diperlukan kecuali jika pasien mengalami gangguan hormonal atau masalah kesehatan yang lain. Dalam hal ini, analisa darah atau test lainnya mungkin diperlukan.

Penanganan Jerawat
Penanganan jerawat dilakukan dengan mengurangi produksi sebum, pengangkatan sel-sel kulit mati, dan membunuh bakteri dengan obat-obatan topical dan oral. Penanganan jerawat ini tergantung dari tingkat keparahan jerawat.

Prognosis Jerawat
Jerawat tidak dapat diobati, namun dapat dikontrol dengan penanganan yang tepat.

Pencegahan Jerawat
Tidak ada cara pasti untuk mencegah jerawat, namun dapat diminimalisir dengan:
  • mencuci muka 1 - 2 kali /hari.
  • menghindari pemakaian pembersih wajah yang abrasif.
  • gunakan make up yang bersifat non komedogenik dan mengandung pelembab.
  • sering keramas.
  • diet seimbang, menghindari makanan pencetus jerawat.
  • menghindari paparan sinar matahari.
  • jangan memencet jerawat.
  • menghindari stress.
Sumber : The Gale Encyclopedia of Medicine 3rd Edition

Flu Burung / Avian Influensa

Avian influenza, known more casually as bird flu, is an infectious disease caused by a family of viruses that normally infect birds. Beginning in 1997 an avian influenza called H5N1 has infected and caused the deaths of humans.

Causes and symptoms

An influenza virus that birds carry in their intestines causes Avian flu. The virus spreads as infected birds excrete saliva, nasal secretions, and feces. Birds vulnerable to the flu become infected when they come into contact with the excretions or surfaces contaminated by the viruses.

Birds that survive the H5N1 infection can excrete the virus for at least 10 days. This has helped the H5N1 strain to spread through bird-to-bird contact from wild birds to domestic birds on farms in live bird markets. The virus can also spread in surfaces including manure, bird feed, equipment, vehicles, egg flats, and crates, and the clothing and shoes of people who come into contact with the virus.

In general, people who contract bird flu have symptoms similar to traditional human influenza including fever, cough, sore throat, and aching muscles. Other symptoms included eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications. Influenza weakens the respiratory system and leaves the lungs open to infection. Many people with flu die from a pneumonia caused by secondary bacterial infection. Bacteria are able to grow in the lungs because the body's defenses have been weakened by the flu virus.

Diagnosis

The symptoms of avian flu and human flu are very similar, so laboratory testing is needed to diagnose avian influenza. In addition to diagnosing the individual, testing in 2005 was performed to determine whether the infection was spreading from birds to people or from humans to humans.

Diagnostic tests for human flu are rapid and reliable, according to WHO. International laboratories within WHO's global network have high-security facilities and experienced staff to test samples of suspected avian flu sent from around the world. Test methods include a viral culture that analyses a blood sample and swabbings of the nose or throat. Other testing examines respiratory secretions.

In the United States, the Centers for Disease Control is among the organizations preparing for a possible outbreak of bird flu in humans. In addition to specifics related to diagnosing bird flu, CDC refers healthcare workers to precautions to prevent the spread of flu and other respiratory infections in medical settings.

Precautionary measures include restricting bird from coming into the United States from infected countries, testing poultry for avian flu viruses and euthanizing infected birds. People with symptoms of respiratory infection are advised to cover their mouths or use facial tissues when coughing or sneezing. After coughing or sneezing, individuals should wash their hands well with soap and water, alcohol-based hand rub, or antiseptic handwash.

In July 2007, The United States Food and Drug Administration approved the first vaccine for use against H5N1 bird flu. The vaccine will be administered in two injections about 30 days apart. It will not be available to individuals, but has been purchased by the United States government to be distributed through the public health system in the event that the H5N1 virus develops the ability to pass from person to person.

Treatment with existing drugs

Existing anti-viral drugs may be partially effective against avian flu viruses if they are administered promptly. In the United States, four drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment and prevention of influenza A viruses. Amantadine (Symmetrel), rimantadine (Flumadine), seltamivir (Tamiflu), and zanamivir (Relenza) have proven clinically effective in the treatment of human influenza A viruses in otherwise healthy adults.

However, avian flu research indicated that the H5N1 virus was resistant to amantadine and rimantadine, according to CDC. The other two drugs would "probably work," according to CDC. However effectiveness has not bee proven.

Prognosis

Bird flu has been fatal to fewer than 200 people as of mid-2007. Health organizations and government agencies focused on preventing or reducing the risks of a pandemic caused by bird flu.

Prevention

As of 2007, bird flu was primarily a risk for people in the United States who worked with poultry. Potentially vulnerable people included those working with poultry on farms, processing plants, and avian veterinarians. People working with birds in locations such as commercial poultry facilities, veterinary offices, and live bird markets should wear protective clothing. That equipment includes boots, coveralls, face masks, gloves, and headgear, according to the United States Department of Agriculture (USDA).

Furthermore, poultry producers should implement security measures to prevent the outbreak of a highly pathogenic virus. Those actions include keeping flocks away from wild or migratory birds and providing clothing and disinfectant facilities for employees. Plastic crates are recommended for use at live bird markets because they are easier to clean than wood crates. Cleaning and disinfecting areas are also important for preventing an outbreak. Infected birds will be quarantined or destroyed.

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