PLENARY DISCUSSION

16 B Group
Annisa Anggraini
Indria Asrinda
Kartika Julia
Maghend
Muhammad Reza N
Nur Aini Rahmah

Regina Veriska
Ayedia
Rey Mas Fakhrury
Rifan Ahadi Rizki
Rizkha Amalya
Wirza Rahmania

SCENARIO 1: Pest exterminator caused
disastrous
Farhan, 42, was taken to a hospital emergency room because he was
found unconscious in his field vegetables. Farhan was found still wearing
boots and carrying pest control equipment. From the anamnesis it is
known that Farhan did not like to use personal protective equipment
when spraying crops.
On physical examination found signs of acute poisoning and
immediately given action to save Farhan. At the time of treatment in
emergency department the doctor also treat another patients, a lecturer
with complaints of shortness of breath and pain in the gut. From the
results of X-ray photo of the piston, found signs of left ventricular
hypertrophy and long infarction. Laboratory tests found
hypercholesterolemia. The lecturer had been suffering from hypertension
and rarely control. Doctors advised to make changes to his lifestyle and
control regularly.
How do you explain what happened to Farhan and lecturer?
Terminology
Unconsciousness : the decrease of ability to
see and respond the stimulation by the
environment
Acute poisoning
Poisoning : undesireable substance entry the
human body and caused a damage to organs
function
Acute : the direct influenced by the poison to the
human body in a short time but relatively
dangerous


Hypertrophy : excessive organ enlargement
because of cell size increase
Asphyxiate : the difficult to take a breath
(dyspnea) because of respiratory disturbance
Hypercholesterolemia : high cholesterol levels
in the blood due to the accumulation of
cholesterol and lipids in the blood vessels, and
high LDL in the blood.
Hypertension : diseases caused by disorders
of blood circulation so that the blood pressure
above normal
Infarct : local area of ischemic necrosis
produced by occlusion of blood vessels either
arterial or venous drainage
Identify the Problems
1. Why farhan unconscious and how the effect
of using personal protective equipment
when spraying crops?
2. What is the signs of intoxication
3. What is first aid for the person who poisoned
by pesticide?
4. Why are acute toxins occurred on Farhan?
5. Why there is shortness of breath and pain in
the gut ?
6. What causes left ventricular hypertrophy and infarction?
7. What are the causes and consequenses of
hypercholesterolemia?
8. What is the relationship of hypertension and rarely
control the disease suffered by the patient?
9. Why doctors recommend lifestyle changes and control
regularly?
Brainstorming
1. Why farhan unconscious and how the effect of using
personal protective equipment when spraying crops?

There are 3 components of insecticide, one of which is
the organophosphates, these substances can reduce
awareness. Organophosphates inhibit acetylcholinesterase
going to break acetylcholine, and then acetylcholine
accumulate in your body. The number of acetylcholine
receptors that will bind to muscarinic receptors and
nicotinic will be exposed for longer, thus arises excitation
(excessive arcing nerve impulses). Due to continuous
excitation, the ATP will run out, thus decreasing the ability
of the cell to homeostasis, and cell injury occurs in the
cerebral cortex area, so he was not aware.
2. What is the signs of intoxication
Intoxication can be classified into 3 groups mild acute
intoxication , severe acute and chronic.
1.) mild acute Intoxication :
Dizziness ,headache , skin mild irritation, the body
feels pain, and diarrhea.
2.) severe acute :
Nausea, chills, abdominal cramps, difficulty breathing,
salivation, shrinking the eye pupil, and increased pulse
rate/blood preasure.
Very severe poisoning can lead to unconsciousness,
convulsions, and even death.

3.) Chronic more difficult to detect because it is not
immediately felt and causes no specific symptoms and
signs.
However, chronic toxicity in the long term can cause
health problems. example irritation of eyes and skin,
cancer, birth defects, and neurological disorders, liver,
kidney and respiratory.

3. What is first aid for the person who poisoned by
pesticide?

1. Dont be panic, in order to be able to think to do the most
appropriate action and fast.
2. If the victim's skin is exposed to pesticides, washing clothes
and immediately open up to clean with water and soap.
3. If the eyes of victims exposed to the pesticide, wash with
plenty of water for 15 minutes, use water-washing shower
first so that pesticides are carried by the water faster
4. If pesticides are ingested and the victim is still conscious,
make victim vomit by giving a solution of warm water that
has been mixed with as much salt 1 tablespoon full. If
pesticides ingested, to note that never give artificial
respiration by word of mouth.

5. If ingested, pesticides and fungicides from the copper
compound, not stimulated stimulation vomiting, bowel or
to rinse stomach.
6. If that person stop breathing, immediately make artificial
respiration. Make sure the mouth is clear of saliva, mucus,
or foods that clog persons breathing.
7. Do not give milk or greasy food poisoning victims in
organoklorin, since the granting of the milk or food will
add oily organoklorin absorption by the digestive organs
8. If the victim is not aware of, so the breathing is not
interrupted. Clear the mouth of saliva, mucus, or food. If
the victim wears dentures, remove dentures. Then put
the victims at the position of tengkurap, with his head
facing to the side and resting on his arms are bent.


9. If the patient had a seizure, then try nothing makes
victims of injuries. Put a pillow under the head of the
victim, and then loosen clothing around the neck. Chock
the mouth so that the victim does not bite his tongue and
lips.
10. After that bring immediate sufferers to the nearest
hospital or clinic. Show packaging of pesticides to poison
him to have medical treatment can be determined quickly
that is most appropriate.

4. Why are acute toxins occurred on Farhan?
In these case we know that Farhan was spaying the plant
with insecticide. When farhan did it, he didn't wear mask in
his mouth and noses, so many gases entry to farhan's nose
when he was breathing. Insecticide gases has 3 materials,
such as organophosphates, organoklorat, and carbonate.
Organophosphates is a more dangerous than other.
Organophosphat can make loss of consciousness, in our body
it inhibit acetyl choline esterase, causes make a long time to
break down acetylcholine in the body tissues. If acetylcholine
is not broken down, it will make a tissues actively secret
nerve impulses.
Than makes atp in the body decreases, decrease of atp make
the body lacks the energy to transfer oxygen to the brain. So
that is the reason why farhan becomes poisoned and make
loss of consciousness


5.Why there is shortness of breath and pain in the gut?
a. Shortness of Breathe
Normal : 14-20 times / minutes
As a respon of changes in oxygen and carbondioxide
levels in tissue.

b. Heartburn
Pain arising from tissue damage.
nyeri akan menjalar ke berbagai tempat. salah satunya
adalah regio epigastrium yaitu tempat nyeri ulu hati
terjadi.

6. What causes left ventricular hypertrophy and
infarction?

Left ventricular hypertrophy is an adaptation of cells, left
ventricular hypertrophy of the left ventricle occurs because
cells experience stress pathological
Hypertrophy is an increase in cell size results in an increase in
the size of the organ. In the scenario of left ventricular
hypertrophy is an adaptation of hypercholesterolemia.
Infarction occurs due to lack of blood flow to the network so
that no nutrients and oxygen to keep running the functional
cells in the process of metabolism, infarction occurs here
because due to hypercholesterolemia, cholesterol can lead to
muscle specially in the heart muscle can not be adequate
nutrition so that will happen ischemic cell will be an end to
hypoxia and infarction. Hypoxic cells is a major cause cells into
the injury, cell injury will adapt if the stimulus can be removed
in the presence of adequate blood flow, but if not then it will
be irreversible cell injury and the death of muscle infarction.

7. What are the causes and consequenses of
hypercholesterolemia?

Causes of hypercholesterolemia
1. Amount of lipid intakes
2. Hypertension > liver works more actively to metabolize
lipid > liver produce more cholesterol and triglyseride >
hypercholesterolemia
3. LDL>HDL
4. Metabolic disease, ex: diabetes
5. Certain disease, ex: obesity
6. Habituation, ex: smoking, drinking
7. Genetic
8. Genre
Consequenses of hypercholesterolemia
1. Atherosklerosis > hypertension
2. Coroner heart disease 3. Miocard infark


8. What is the relationship of hypertension and rarely
control the disease suffered by the patient?

Hypertension resulted in further improve cardiac
performance resulting in left ventricular hypertrophy.
hypercholesterolemia patients also have resulted in the
emergence of plaque (atherosclerosis) which will disturb
the arterial blood flow or reduced venous drainage.
arteriosclerosis with increased oxygen demand due to
hypertrophy resulting in ischemic myocardial infarction
occurs. history of the disease has been suffered by the
patient, if not controlled properly will certainly exacerbate
the patient's medical condition.

9. Why doctors recommend regular control and
lifestyle changes ?

Although people with hypertension have to take medicine
for the rest of his life, but the quality of life is still guarded
by setting diet and a healthy lifestyle while to prevent us
from the risk of hypertension, and since early is to live
healthy, among others, reduce consumption of salt, dont
smoke, sports physical at least 30 minutes a day, and eat
more vegetables and fruits.