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Introduction to The Anaesthesiology and Reanimation

DR.,Dr. Hari Bagianto SpAnK.IC

Medical Faculty Brawijaya University

Adam was put into sleep before Eve was created from his rib.

The first Anesthesia


(1846)

Definition
An - esthesia = no pain Re - Animate = Rescusitation

Anaesthesiology and Reanimation


is To alleviate Pain and Distress To preserve life

The Dying Process


Through all the body system :

Hypotension Hypo perfusion Hypoxia Anoxia Cell Dead Organ Dead.

Philosophy
To alleviate Pain and Distress
Artificial / IatrogenicTrauma Critical Condition Life Support To preserve life

Anaesthesia Episode
Artificial Trauma
Inform Consent (patient Right) Pre-medication (alleviate Distress) Induction (Artificial Coma) Intubation (Artificial Apnoe) Relaxation (Artificial Paralyze) Maintenance/Bleeding (Haemodynamic Stability) The End of Anesthesia

Recovery of all the System


(Back to normal)

To Preserve Life = Life Support


Normal Accident / illness Diagnostic / Initial Treatment Field ED O.R.

Definitive Therapy / Operation


Recovery Intensive Care Ward R.R. ICU

Anaesthesiology Fields

Emergency and Critical Care Medicine Anaesthesiology Pain Management

Biphasic insult on the human body :


1.

During surgery, there is trauma to tissue which produces a barrage of nociceptive input After surgery, there is an inflammatory response which also generating of noxious input

2.

Redrawn with permission from Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg 1993;77:1049.

POST OPERATIVE PAIN MANAGEMENT

Postoperative pain can affects all organ systems and includes:

Respiratory - reduced cough, atelectasis, sputum retention and hypoxaemia Cardiovascular - increased myocardial oxygen consumption and ischaemia Gastrointestinal - decreased gastric emptying, reduced gut motility and constipation

White PF., (2002) Anesth Analg ; 94:577-585

Genitourinary - urinary retention Neuroendocrine - hyperglycaemia, protein catabolism and sodium retention Musculoskeletal - reduced mobility Psychological - anxiety and fatigue

White PF., (2002) Anesth Analg ; 94:577-585

Never give anaesthetic to the Patient without capability to Preserve Life

THANK YOU

Disaster plan

Disaster plan

Disaster plan

Disaster plan

(Paramedic) (BLS) Layman Police Fire Brigade Security Guard Civil Defense Scouts Red Cross 118 Emergency Ambulance Service

HOPE Emergency Nurse (BTLS, BCLS, BNLS, BPLS) Emergency Physician (ATLS, ACLS, ANLS, APLS) Trauma Surgeon (ATLS, BSS, DSTC, Peri OP CC)

DISASTER MANAGEMENT

E.D.

I.C.U

Ward

Rehabilitation DISASTER Access Emergency Telephone Number 110,113,118 Public Health Center

Pre-Hospital Phase

Hospital Phase

History in Indonesia
October 1997
Emergency Medicine Specialist Team from Singapore International Foundation starting to help development

Malang Trauma Service Center (MTSC)


at FKUB and Saiful Anwar Hospital Malang.

August 1998

Build Emergency Dept System at Saiful Anwar Hospital Malang Trauma Registry

February 2000
15th July 2003

Starting Medical Emergency Residency

Preparing Medical Emergency Residency

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Perform Residency Emergency Specialist


Professional Study Program 8 semester, focus on skill and knowledge in prevention, diagnosis and management in emergency situation.

Basic Specialist Training:


Gen.Pract. 4 semesters Graduate as a Magister

Advanced Specialist Training:


4 semesters Graduate as a Emergency Specialist

Emergency Specialist

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Fast responder for disaster for East part of Indonesia