FIRST AID FOR SUDDEN UNCONSCIOUS PATIENT

Unexpected situation that calls for medical help can happen anywhere at any time. In this situation first responder who sees the casualty must take action by giving first aid. It is very important that first aid is given as soon as possible with appropriate first aid procedure. Responder has to do steps of screening emergency sign including consciousness, breathing and circulation of blood. Each sign reflects function of vital organ system. Consciousness is the higher function of central nervous system. Breathing reflects the function of respiratory system. Circulation of blood reflects the function of cardiovascular system.

Checking consciousness can be done by giving stimulus to casualty then checking respons. The stimulus can be sound, palpation or painful stimulus. If the casualty wakes up then we should ask about what he or she feels at that time and plan for immediate transportation to the nearest medical fascilitation. If he or she doesn’t wake up, we need to give painful stimulus. Pain can be created by pinching the tip of casualty’s finger nail or pressing eye brow area near the middle body line or pressing in the middle of the chest right to the sternum. If the casulty doesn’t respond to all the steps then we have to activate emergency medical system by calling 118-team and move to next steps of evaluating patient’s breath.

Breath can be evaluated by checking airway and chest movement. Airway is the channel for air flow to get inside and outside lungs. Checking airway means checking air flow. It can be done by listening to sound of breathing or feeling movement of air flow near the casualty’s nose or mouth. If there is no sound or stridor (snooring sound), airway may be obstructed. We should help the casualty by removing foreign object that is in the way of air way following triple airway maneuver as head tilt, chin lift or jaw thrust and open mouth. After securing airway, we must check chest movement to make sure whether the casualty breathes adequately. Breating frequency must be more than 11 times per minute and deep enough. If breathing is not adequate, give respiratory resucitation by mouth-to-mouth or mouth-to-nose rescucitation. Give at least enough two breathes then check the casualty’s circulation of blood.

Circulation of blood can be evaluated by checking carotid artery pulse. Carotid artery pulsation must be palpated by putting our three finger tips to casualty’s Adam’s apple and move 2 cm to left or right side. If there is no carotid artery pulsation felt then chest compression must be started. The first responder or helper must make the casualty lay down in prone position on flat and hard material. Then from the left or right side of casualty put hands palm to back on the middle body line in chest area, on the lower middle part of sternum. Then stright our upper and lower arm, do not hunch. Start chest compression by moving our body weight to stright arm. The depth of compression is between 3 centimetres to 5 centimetres. Make sure that helper hands always touch the chest during the compression up and down. The compression must be rhytmical. To do so, the helper must count ‘and one, and two and three and four and five’. One chest compression cycle consists of 6 times one to five count. After each cycle, two breathes rescutitation mut be given. Do it until six cycles. After that check for carotid pulse again. Redo chest compression until carotid pulsation is palpable or the casualty shows respons or until the medical emergency team comes. If it will take long time until medical emergency team comes, consider transporting the casualty to the nearest medical service fascilitation especially which provides defibrilation devices.

In general, we should keep in mind that the casualty is dying if proper first aid is not given as soon as possible. For unconscious breathing and circulatory arrest casualty, every one minute without help means possibility of survival is decreasing 10 precent. Properly check emergency sign including consciousness, breathing and circulation of blood! Activate emergency medical system by calling 118-team and do necessary first aid as soon as possible. Hopefully God will give her or him a chance to be revived through the first responder action.

By. James (Dwi Notosusanto)

Forensic The Silence Evidence

Forensic or legal medicine is one of specialistic branch of medicine field of study that helps law enforcement related to human body condition, life or death based on scientific and factual findings-the silence evidence. To be specialist in forensic medicine one should be able to combine his medical knowledge and skill with legal jurisdiction such as by making Visum Et Repertum. More focus on evidence left on human body after violation as well as natural diseases is undoubtedly necessary for scientific factor to interpret silence evidence and proof hypotesis on possible former happenings. Moreover, determination of disease or disability-related violation depends solely on attending competent doctor. So, in case of suspected criminal action on human, role of forensic medicine absolutely exists.

Making visum et repertum is one of legal ways the forensic doctor can communicate his medical interpretation on factual evidence found from victim. Visum et Repertum is written report on human body --whole or partial-- asked by police, made by doctor based on his/her knowledge and under doctor's pledge which mainly explains victim's identification, sign and related symptom of violence, and degree of disease or violation-related disability. In the reason that suspected criminal case has not been unsolved yet, any findings that give addditional clues must be recorded well to ensure that recalling of case could be held. Comprehensive health examination have to be done to prevent skip of important findings. After that, report is written down with 5 main compositions, as opening parts (head of letter and sentence "PRO JUSTITIA", introductory data (data on requesting police institution, brief description on personal victim profile, identity of examining doctor), report on factual findings (whole body character, related sign and symptoms, causal factor identified from victim), medicolegal conclusion (interpretation of report on factoal finding in correlation with jurisdiction) and closing pledge statement.

The Use of Medical Health Records

Medical Health Record is written collection of information about a patient’s health and treatment written by health care professionals. Doctor, nurses and other health care professionals write up medical/health records so that previous medical information is available when needed. A patient’s medical record should provide accurate information on: who the patient is and who provided health care; what, when, why and how services were provided; and the outcome of care and treatment. The medical record has four major sections: administrative, which includes demographic and socioeconomic data such as the name of the patient (identification), sex, date of birth, place of birth, patient’s permanent address, and medical record number; legal data including a signed consent for treatment by appointed doctors and authorization for the release of information; financial data relating to the payment of fees for medical services and hospital accommodation; and clinical data on the patient whether admitted to the hospital or treated as an outpatient or an emergency patient. Considering the composition of medical health record, there are four main uses of medical record. The main uses of the medical record are: to document the course of the patient's illness and treatment; to communicate between attending doctors and other health care professionals providing care to the patient; for the continuing care of the patient; for research of specific diseases and treatment; and the collection of health statistics.


Medical record has to be able to clearly document the course of patient’s illness and treatment reflecting that medical examination and procedure have been done. It is a must that as health care team we write what we do and we do what we write. Doing it will be good for medical health care team since evaluation of what have done to patients by looking at and redoing thinking of medical health record provides chance for improvement of health care team. Unwritten important things on medical treatment can be seen soon and prompt improvement can be done.


Medical record as means of communication between attending doctor and other medical health professionals providing care to the patient prevents misunderstanding and provides fast patient's status that will be useful for their consideration of making effective and efficient medical desicions. The doctor may need assistance from other medical health professionals such as health consultant, other health specialists, and nurses. Since they may be busy on their own tasks, spoken instruction or communication may not be enough. When cancellation is done, possibility on forgetting medical consuls or tasks may be forgotten. To overcome the forgetful situation, there should be reminder. In this case, written reminder--medical record-- will come in handy.


Medical record that is saved for several years is useful for continuing care of the patient. There may be some diseases or conditions that affect patient health condition further such as chronic diseases, potential relapse disease, allergy, and past medical treatment history. They must be considered while giving medical treatment to the patient because doing that will be considered as treating patient holistically. That is reasonable because we tend to be able to do proper, effective and efficient medical treatment to the patient if we get whole picture of patient health condition. Then, medical health team can concentrate more on continuing care of the patient without retreating uneffective past treatment.


Well documented medical records are also useful for research of disease, related treatment, and health statistics. Collecting them means collecting epidemiology data from population and this is valuable in the view of medical field of study. As ethical issues forbid medical health institutes to do intervensive procedure without evidence based medicine, data of patient continuing treatment and the result may provide basis on evidence based medicine without breaking the ethics. Then, possibility on researches of new medical intervensive procedure or method will be opened to improve the result of treatment.


In general, the use of medical health record brings good environment to development of medical health treatment. Adequate attention on proper making of medical health record ensures the optimal use of medical health record.
By. James (Dwi Notosusanto)

Injection Safety Procedure

Injection is one of common route drug administration that must be carefully practiced to lessen injection related side effect because of misuse or overuse of it. Health care workers should ensure themselves and patients that substance given by injection is useful for improving patients’ health condition and doesn’t cause life risky side effect. Practice related to injection before, during and after injection need to be handled based on safety procedure. While doing that, injection-related side effects must be prevented, be monitored and be treated well--if they occur--in order to prevent further complication that will worsen patient health status. Moreover, doing safe injection practice will also benefit health care workers since it prevents blood-borne pathogens transmission.

Injection is an infusion method of putting ­­liquid into the­­ body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body that must be used sensibly not only to promote the patient’ benefit but also to prevent injection giver injury. Since it is manual and invasive, the practice depends on health care team and needs special skill. Misuse and overuse of injection may occur. Misuse of injection occurs when injection doesn’t follow safety procedure such as sharing the same syringes with different persons or reusing syringes to inject different drugs. Injection is overused if unnecessary injection is done when oral formula may still be used.

Steps of doing safety injection procedures include preparation before the injection, execution during the injection and evaluation after the injection. First, equipments and drugs should be provided for related patient. They include syringe, needle, gloves, torniquet, alcohol swab and dry cloth. Make sure that the equipments are sterile. Tell patient about procedure that will be done and ask for patient’s approval. Second, injection techniques must suit patient’s condition and be done by right procedure. There are 4 techniques, subcutaneus injection, hypodermic injection, muscular injection and intraveinous injection and each technique mustn't subtitute other technique without competent doctor supervision. Third, all medical sewage must be disposed in appropriate place. There are containers for disposal of syringes and sharps. Then, monitoring patient’s condition is important. Look for any signs of injection related side effect and tell the patient to beware of symptoms that may occur following the injection. If necessary, laboratory check should be done to see asymptomatic effect. Consult medical health team when side effect occurs since rapid and well treatment must be held to guard against complication whether it can be devastating or fatal.

Doing these will ensure not only patients’ safety but also health workers’ safety. Since chronic diseases as hepatitis B virus, hepatitis C virus and HIV transmit by blood, safety procedure that prevent patients’ blood contact to health workers will limit the transmission. In general, injection safety procedure is a must to prevent unwanted events for patients and health worker team.
By. James (Dwi Notosusanto)

Principles of Genital Hygiene

Genital hygiene is one of modifiable factors for urinary tract infection and reproductive tract disease. It depends on how one behaves on taking care of self genital hygiene by doing self care and routinely doing medical examination. It is so personal that every one is responsible for his or her benefit. Genital hygiene includes cleanliness, genital skin acidity, odor, dryness and moist of genital and the surrounding area. These are to support the natural body defense mechanism which is the existence of beneficial bacteria (normal floras) that prevents the growth and accumulation of potential pathogens (infectious microorganisms). Since genital is part of urinary tract in human and part of reproductive tract in man and pathogens can spread, person with poor genital hygiene is prone to genital infection and disease that will lead to urinary tract infection and reproductive tract disease.

To achieve favorable state, one should make effort on keeping good genital hygiene by doing general personal hygiene care, genital hygiene care, and medical check ups on certain condition. General personal hygiene care means paying attention to general body hygiene especially part of body closely related to genital such as hands, anus and area surrounding genital. Genital hygiene care means paying attention to genital (penis and scrotum for man, external part of vagina, labia major and labia minor for woman and pubis for adults). Medical check ups on certain condition means having medical examination from competent doctor considering uncomfortable symptoms of urinary and reproductive tract.

There are also clothing factor that play role in genital hygiene care, especially clothes related to genital. They are underwear, pants, towel, toilet paper, and sanitary napkins. They are used to provide comfort for genital and they should be replaced when no longer clean nor dry. It is also advisable that sharing of personal clothes not be done.

Besides all of those factors, correct knowledge on how to clean genital is also important. Excessive procedures such as frequent use of antiseptic, deodorant, soap, hot water and perfumes can not ensure good genital hygiene. In fact, irritation may occur following the procedures. Direction of washing genital, healthy sexual behavior, hormonal state influencing genital condition, and special treatment for baby and uncircumcised man are things that should come into consideration.
By. James (Dwi Notosusanto)

Steps of Positioning Traffic Accident-Patient

Traffic accident-patients are at ease of getting disabilities or even death if not treated well as soon as possible. Critical injuries following the accident include bone fracture and internal injury. These can be fatal if they cause failure in cardiovascular system, respiratory system or central nervous system. Medical first responder should do steps of determining fatal cause and help positioning the patients to ensure life savings. Without knowing them, wrongly positioning the patients may further worsen the patient’s condition or even lead to sudden death.

The steps are uncovering the A B C D of patients. A is securing patient’s airway. If sign of potential obstruction is found, positioning is needed. For example: if patient is lying flat on his back and vomits, he should be positioned to sleep on his unaffected or healthy (left or right) side so that the vomit will be more easily go out of respiratory tract. B is examining patient’s breathing. Inspect chest movement, determine whether it is deep enought and withing regular normal frequency. Untight clothing without moving patient. C is examining patient’s circulation status. It can be done by looking at the color of patient’s finger nail, checking the temperature and examining skin. The color is pale, the temperature is cold and the skin is sweating, patient may be having hypovolemic shock because of external or internal bleeding. Therefore the source of bleeding should be searched and his leg should be elevated higher than head to help directing blood to vital internal organs while he is lying flat. D is examining patient’s deformities. Fracture in cervical spinal vertebrae, ribs or head may be fatal if it is not treated well. Patient’s head should be made fixated by neck collar before moving the patient because moving it unwisely will possibly paralyze all patient’s extremities and even cause paralyze of breathing muscle. Patient having rib fracture may not be left lying on stomach because it will give further burden to breathing muscle. Patient’ can die of respiratory failure. After medical first responder is sure that A B C D patient’s is safe they can consider transporting patient’s to the nearest hospital.

By
James (Dwi Notosusanto)

The Importance of Bedmaking

Bed making is one of unavoidable and important procedures in taking care of patients who are in bed rest. No body wants to take a rest in a dirty and uncomfortable condition and so do the patients. As beds are where they spend most of their time in hospital, the condition of bed will affect the physical and psychological comfort for patients who are ill. Good bedmaking promotes good sleep and good sleep promotes optimum health and healing process. Therefore, it is essential the nurse keep the bed as clean and comfortable as possible.



Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be, dry, wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems(such as pressure ulcers). It must be clean and the open end of the pillow case must be facing away from the door to prevent an infection control issue. It is also important to make sure that it is odorless for the patients’ comfort. There are specific bedmaking techniques for use when a bed is occupied by a patient which is different from the unoccupied one. Moreover, there is also special matress to prevent and treat decubitus ulcers.




However, bedmaking can not substitute for nursing care. Periodically turning patient, doing skin care and positioning are procedures that need nurse’s help. Doing all these things will help the patients feel comfortable and lessen the illness.

By. Dwi Notosusanto (James)

Pentingnya Kejujuran Pasien dan Keluarganya

Bagi siapa saja yang pernah sakit atau ikut mengantarkan orang yang sakit hingga bertemu langsung dengan dokter seharusnya mengetahui bahwa hal pertama yang dilakukan dokter adalah bertanya tentang riwayat kesehatan dan penyakit pasien kepada pasien dan keluarganya. Dalam ilmu kedokteran ini disebut anamnesis.

Anamnesis merupakan 80 % modal dokter dalam melakukan diagnosis (penetapan daftar masalah) penyakit.Dalam anamnesis dibutuhkan kerjasama dari pasien dan keluarga untuk secara jujur memberikan informasi terkait data diri pasien, keluhan utama pasien, riwayat penyakit sekarang dan riwayat pengobatannya, riwayat penyakit dahulu dan pengobatannya, riwayat penyakit kelurga dan riwayat sosial ekonomi. Dalam anamnesis, dokter akan menggali gejala penyakit yang menunjukkan perjalanan penyakit sehingga didapat kemungkinan terbesar jenis penyakit pada pasien. Dalam melakukan anamnesis dokter menggunakan pengetahuan teori kondisi tubuh manusia dalam keadaan sehat dan sakit. Dokter berusaha dengan sungguh-sungguh untuk mendapatkan gambaran keadaaan kesehatan dan penyakit pasien secara penuh. Untuk itulah dokter harus mendapat informasi yang benar dari pasien dan keluarga.

Kejujuran pasien dan keluarganya merupakan awal dari kemungkinan penatalaksaan pasien dengan baik dan benar. Hal ini sangat menentukan pemeriksaan klinis maupun laboratorium lanjutan yang akan dilakukan oleh dokter. Misalnya, jika pasien dan keluarga tidak mengeluhkan keadaan sakit pada alat kelamin pasien maka dokter kemungkinan besar tidak akan memeriksa kelamin pasien. Jika pasien dan keluarga tidak mengeluhan keadaan sakit pada payudara pasien maka dokter kemingkinan besar tidak akan melakukan pemeriksaan mendetail pada dada pasien. Bila info dari pasien salah maka anamnesis akan tidak valid. Akibatnya 80% modal dokter dalam melakukan diagnosis (penetapan daftar masalah) penyakit akan terganggu. Yang terjadi kemudian ialah ketidakefektifan pengobatan karena penyakit yang mau diobati tidak terdeteksi.

Menimbang hal itu semua maka perlu disadari pentingnya Kejujuran Pasien dan Keluarganya kepada dokter. Bukankah dokter juga manusia dan dokter bukan paranormal. Jadi, bekerjasamalah dengan baik dengan cara berkata jujur.