TIME TABLE
TIME Activity PIC
Oct.13th – Oct 26th,2017 Learning Activity Coordinator Oct 27th ,2016 Preparation for final test
Oct 30th ,2016 Evaluation Teams
MEMBERS TEAM
No Name Department Phone
1 dr. Made Agus Hendrayana, M.Ked (Coordinator) Microbiology 08123921590 2 Prof.DR.Dr. Tuti Parwati Merati, SpPD-KPTI Internal medicine 08123806626 3 dr. I Ketut Agus Somia, SpPD-KPTI Internal medicine 08123989353
5 dr. Anita Devi,M.Si Hyperbaric 081805505911
6 Dr.dr. Tjok Senapathi,Sp.An KAR Anestesiologi 081337711220 7 dr. I Made Ady wirawan,MPH,PhD Public Health 081239394465
LECTURERS
No Name Department Phone
1 Prof. DR. dr. Tuti Parwati Merati, SpPD-KPTI Internal Medicine 08123806626 2 dr. I Ketut Agus Somia, SpPD-KPTI Internal Medicine 08123989353 3 dr.i Gusti Ngurah Bagus Artana,Sp.PD Internal Medicine 08123994203 4 dr.Made Agus Hendrayana,M.Ked Microbiology 08123921590 5 dr. Luh Oliva Saraswati Suastika,Sp.JP Cardiology 081330530247
6 dr. Anita Devi,M.Si Hyperbaric 081805505911
7 dr. Made Susila Utama,Sp.PD-KPTI Internal Medicine 08123815025 8 Dr.dr. Tjok Senapathi,Sp.An KAR Anestesiologi 081337711220 9 DR.dr.Ketut Suega,Sp.PD-KHOM Internal Medicine 081338728421 10 dr.A.A.Yuli Gayatri,Sp.PD Internal Medicine 08123803985 11 dr. Ni Made Dewi Dian Sukmawati,Sp.PD Internal Medicine 08123320380 12 dr. I Made Ady wirawan,MPH,PhD Public Health 081239394465 13 dr.I Putu Adiartha Griadhi,M.Fis Fisiology 081999636899
~ FACILITATORS ~
No
Name
Group
Departement
Phone
(3
Venue
rdfloor)
2 Dr. dr. Tjok G.A Senapathi, Sp.An.
KAR A2 Anestesiology
081337711220 3rd floor: R.3.10
3 dr. Ni Made Dewi Dian Sukmawati, Sp.PD A3 MedicineInternal 08123320380 3rd floor:R.3.11
4 dr. Firman ParulianSitanggang, Sp.Rad(K)RI A4 Radiology 081337165566 3rd floor:R.3.12
5 dr. I GstNgr. Wien Aryana, SpOT (K) A5 Orthopaedi 0811385263 3rd floor: R.3.13
6 Dr.dr. IGAA Praharsini, SpKK,
FINSDV A6
Dermato
venerology 08123888794
3rd floor: R.3.14
7 Dr. Luh Made Indah Sri
HandariAdiputra, S.Psi., M.Erg A7 Fisiologi 081337095870
3rd floor: R.3.15
8 Dr.dr. AA. Mas Putrawati T., Sp.M(K) A8 Opthalmology 08123846995 3rd floor:R.3.16
9 dr. I Gede Budhi Setiawan, Sp.B(K)Onk A9 Surgery 08123923956 3rd floor:R.3.17
10 dr. I Kadek Susila Surya Darma, M.Biomed, Sp.JP, FIHA A10 Cardiology 08113853151 3rd floor:R.3.19
Regular Class (Class A)
English Class (Class B)
No
Name
Group
Departement
Phone
(3
Venue
rdfloor)
1 dr. Gde Somayana, Sp.PD B1 MedicineInternal 0816579888 3rd floor:R.3.09
2 Dr. dr. Ni Putu Sriwidyani, Sp.PA B2 Anatomy
Phatology 081337115012
3rd floor: R.3.10
3 Desak Kt. Ernawati, S.Si., Apt.,
M.Pharm., Ph.D B3 Farmakologi 081236753646
3rd floor: R.3.11
4 dr. Wayan Suryanto Dusak, Sp.OT
(K) B4 Orthopaedi 08123801878
3rd floor: R.3.12 5 dr. Agus Roy Rusly Hariantana
Hamid, Sp.BP-RE B5 Surgery 08123511673
3rd floor: R.3.13 6 dr. I.G.N. Budiarsa, Sp.S B6 Neurology 0811399673 3rd floor:
R.3.14
7 dr. Pontisomaya Parami, Sp.An.MARS B7 Anestesiology 08113800107 3rd floor:R.3.15
8 dr. Ida. Ayu Putri Wirawati, Sp.PK
(K) B8
Clinical
Phatology 082145723828
3rd floor: R.3.16
9 Dr.dr. A.A Wiradewi Lestari, Sp.PK B9 Clinical
Phatology 08155237937
3rd floor: R.3.17
10 Dr.dr. I Gede Ngurah Harry Wijaya
Surya, Sp.OG B10 Obsgyn 0811386935
3rd floor: R.3.19
CURRICULUM
AIM OF TRAVEL MEDICINE
3. To understand the science and it's practices of travelers medicine in the medical profession.
4. To describe etiology, patophysiology, clinical features, diagnosis, and management of travel related illness
5. To describe the 5 most common in travel related illness
LEARNING OUTCOMES
1. Know and can perform immunization and give chemoprophylaxis to prevent travel-related illness
2.
Understand the management of primary care practice specific for traveler 3. Diagnose, treat, and prevent traveler`s diarrhea4. Diagnose, treat, refer, and prevent DVT 5. Diagnose, treat, refer, and prevent ACS
6. Manage traveler with respiratory disease who undergo air travel
7. Diagnose, treat, refer, and prevent traveler with heat exhaustion and heat stroke 8. Diagnose, treat, refer, and prevent traveler with near drowning
9. Diagnose, treat, refer, and prevent traveler with decompression syndrome after dive
CURRICULLUM CONTENT
1. Know and can perform immunization and give chemoprophylaxis to prevent travel-related illness
a. Recognize the immunizations to prevent travel-related illness b. Recognize the prophylaxis for malaria
2. Primary care practice for travel medicine
a. Understand the primary care practice specific for traveler
b. Recognize the management of primary care practice specific for traveler 3. Diagnose, treat, and prevent traveler`s diarrhea
a. Understand the definition of traveler`s diarrhea b. Understand the etiology of traveler`s diarrhea c. Describe the pathogenesis of traveler`s diarrhea
d. Recognize the clinical manifestation of traveler`s diarrhea e. Recognize the management of traveler`s diarrhea
f. Understand the prevention of traveler`s diarrhea 4. Diagnose, treat, refer, and prevent DVT
a. Understand the predisposing factor of DVT b. Describe the pathophysiology of DVT c. Recognize the clinical presentation of DVT d. Recognize the management of DVT e. Understand the prevention of DVT 5. Diagnose, treat, refer, and prevent ACS
a. Understand the predisposing factor of ACS b. Describe the pathophysiology of ACS c. Recognize the clinical manifestation of ACS d. Recognize the management of ACS
e. Understand the prevention of ACS
6. Manage traveler with respiratory disease who undergo air travel a. Describe the flight environment
b. Recognize the physiological effects of exposure to altitude c. Recognize the clinical pre-flight assessment
d. recognize fitness to flight condition
e. recognize respiratory disorders with potential complication for air travel 7. Diagnose, treat, refer, and prevent traveler heat exhaustion and heat stroke
b. Describe the pathophysiology of heat exhaustion and heat stroke c. Recognize the clinical manifestation of heat exhaustion and heat stroke d. Recognize the complication of heat exhaustion and heat stroke
e. recognize the management of heat exhaustion and heat stroke 8. Diagnose, treat, refer, and prevent traveler with near drowning
a. Understand the definition of near drowning b. Describe the pathogenesis of near drowning
c. Recognize the clinical manifestation of near drowning d. Recognize the complication of near drowning
e. recognize the management of near drowning
9. Diagnose, treat, refer, and prevent traveler with decompression syndrome after dive a. Understand the definition decompression syndrome after dive
b. Describe the pathogenesis decompression syndrome after dive
c. Recognize the clinical manifestation decompression syndrome after dive d. Recognize the complication decompression syndrome after dive
e. recognize the management decompression syndrome after dive 10. Animal bite Objectives
a. To describe why rabies continues to be a feared zoonotic disease. b. To describe how is rabies spread
c. To describe disease that Rabies most commonly mimic d. To understand how Rabies is diagnosed
e. To describe the current recommendation for Rabies treatment f. To describe pre and post exposure prophylaxis
g. To describe clinical presentation of Rabies
h. To describe the clinical management of snake bite envenoming i. To describe the clinical management of scorpion sting envenoming
LEARNING TIME-TABLE
CLASS ROOM : 3TH FLOOR, ROOM A 3.01
No Days Topics Time Learning
Activity
Place PIC
B Class A Class
1 Friday Oct.13th
2017
Emerging Diseases Related Worldwide Travelling
08.00-08.30 09.00-09.30 Lecture Class room
Traveler`s diarrhea 08.30-09.00 09.30-10.00 Lecture Classroom Dr.Made SusilaUtama,Sp.PD 12.30 - 14.00 10.00-11.30 Student
Project 12.30 -14.00 10.00-11.30 Student
Project
thromboembolism 08.00-09.00 09.00-10.00 Lecture Classroom DR.Dr.Ketut Suega Sp.PD-KHOM 12.30 -14.00 10.00-11.30 Student
Project 10.30-12.00 13.30-15.00 Small Group
Discussion (SGD)
Disc. Room 12.00-12.30 11.30-12.00 Break
12.30 -14.00 10.00-11.30 Student Project
High altitude 08.00- 08.30 09.00-09.30 Lecture Class
Air travel: respiratory
disease related travel 08.30 - 09.00 09.30 - 10.00 Lecture Classroom Dr.I Gst.Ngr. Bagus Artana, Sp.PD 12.30 -14.00 10.00-11.30 Student
Project
heat stroke 08.00- 08.30 09.00-09.30 Lecture Classroom Dr.Made SusilaUtama,Sp.PD Air travel: Fit to Flight 08.30 - 09.00 09.30 - 10.00 Lecture Class
room 12.30 -14.00 10.00-11.30 Student
Project
Near drowning 08.00- 08.30 09.00-09.30 Lecture Class
room DR.Dr. Tjok Senapathi,Sp. An
Diving
Decompression Syndrome
08.30 - 09.00 09.30 - 10.00 Lecture Class room 12.30 -14.00 10.00-11.30 Student
Project
08.00 - 08.30 09.00-09.30 Lecture Class room
Dr. I K Agus Somia, SpPD-KPTI
Chemoprophylaxis for
travel related illness 08.30 – 09.00 09.30 – 10.00 Lecture Classroom Dr. I K Agus Somia, SpPD-KPTI
09.00-10.30 12.00-13.30 Individual learning (IL)
10.30-12.00 13.30-15.00 Small 12.30 -14.00 10.00-11.30 Student
Project
Medical evacuation 08.00-09.00 09.00-10.00 Lecture Class room 12.30 -14.00 10.00-11.30 Student
Project
Animal Bite 08.00- 08.30 09.00- 09.30 Lecture Class room
Dr.A.A Yuli Gayatri,Sp.PD Marine Envenomation 08.30 - 09.00 09.30 - 10.00 Lecture Class
room 12.30 -14.00 10.00-11.30 Student
Project
In the middle of block period a meeting is designed among the student representatives of every small group discussion, facilitators, and source person of the block. The meeting discuss about the ongoing teaching and learning process, quality of facilitators, and lecturers as the feedback to improve the next process.
MEETING OF THE FACILITATORS
All facilitators are invited to discuss all block activities with block contributors 1 week after meeting onf students representatives
ASSESMENT METHOD
Assessment will be held on end of the block period. The time provision is 100 minutes. The number of MCQ is 100 with passing point ≥ 70
STUDENT PROJECT GROUPS AND TOPICS
SGD GROUP
TOPIC Supervisor Student
Project A1 Bug Bites
A2 Jet Lag A3
Mental Health and Travel A4
Road Safety A5
Sex Tourism A6
Traveling with a Disability A7 Humanitarian Aid Workers A8
Last-Minute Travelers A9
Long-Term Travelers and Expatriates A10 Pregnant treveler
A11 Elderly traveler
A12 Travelling with children
SGD
GROUP TOPIC Supervisor StudentProject
B1
Travelers with Weakened Immune Systems B2 Travelers with Chronic Illnesses
B3
Adventure Travel B4
Cruise Ship Travel B5 Medical Tourism
B6 Travel to Cold Climates B7
Travel to Mass Gatherings B8 Fit to dive
B9 Travel Health Insurance B10 Travel to altitude after diving B11 Hajj travel
B12 Wilderness medicine
LEARNING PROGRAM
LECTURE 1
Emerging Diseases Related Worldwide Travelling
It is believed that increased global travel is the reason for the recent resurgence of many infectious diseases in the world. International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly.
as well as underdeveloped health care services. Many travelers are also unaware of potential hazards in different parts of the world and do not take the necessary precautions, such as getting necessary vaccines or taking preventive medicine.
Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas.
Many of the newly discovered infections have actually been in existence for a long time, but doctors have not seen them in areas where new outbreaks occur. With people's ability today to travel anywhere in the world within 36 hours or less, formerly little-known infections are picked up and rapidly spread to areas where they previously did not exist.
LECTURE 2
Traveler’s diarrhea
Traveler’s diarrhea (TD) is the most common travel-related health problem that affects up to half of travelers during their first 2 weeks abroad. A case of TD is described as the sudden onset of loose, watery stools associated with abdominal pain, fever or tenesmus. Fever occurs commonly and blood is noted in stools rarely. Nausea and vomiting are also common in the first few hours, adding to the discomfort and water loss. TD usually presents as an acute illness, resolving completely in less than a week. Bacteria are the most common cause of TD and ETEC (enterotoxigenic E. coli) is the most common bacterial cause. Salmonella, Shigella and campylobacter make up the majority of remaining bacterial pathogens. Host factors such as age, pre-existing immunity, underlying medical conditions and genetic factors play a role in susceptibility to TD. Effective pre-travel counseling may motivate some travelers to avoid risky food and drink, which may in turn reduce diarrheal incidence. Since most TD is bacterial in origin, traveling with appropriate antibiotics for treatment and prevention is also important.
LECTURE 3
Air travel and ACS
Cardiovascular events are the main cause of deaths among travelers and of in-flight emergencies on commercial aircraft. Persons with underlying heart disease should review their itineraries with a physician prior to departure; travel in harsh environments or to remote destinations is not wise.
LECTURE 4
Air travel and thromoembolism
DVT and thromboembolism have long been proposed as possible complication of air travel. Pulmonary embolism (PE) has been suggested as a culprit in deaths related to air travel, although evidence linking air travel to DVT has been somewhat elusive. Many studies found that 18% of sudden deaths among long distance travelers were attributable to PE.
General perspective of Travel Medicine
Travel Medicine is the branch of medicine that deals with the prevention and management of health problems of international travelers. It is concerned with both prevention and management of illness related to travel
Why TM ?
• Increased trend of travelers : many more people are travel abroad
• Scope has largely evolved in response to changing of travel trend, such as :
• The reason for travel and types of travel has become much more diverse.
• Organized package tour remain popular, but many traveler are becoming more adventurous and choose to backpack out with ‘tourist‘ areas, go on expedition into remote areas sometime in several countries and work as volunteers for prolonged period.
• Travel for business take a common place.
• In addition, potentially vulnerable groups of people such as the very young, the elderly, pregnant women and those with underlying medical problems or disabilities and immune compromized are traveling more than ever before.
As a result of these changes, more people need information, more advise and more prophylactic prior and during travel
Important component of TM includes not only vaccination and prophylaxis for malaria, but also advise on accident prevention, sexual health and guidance on contraception, safety food and water, hygiene and other precautions
History of TM ?
The disciplines of TM evolved initially from infectious disease, tropical and preventive medicine and historically from quarantine and international health regulations, the subject encompasses the whole range of clinical and preventive medicine; this includes care of the travelers with special needs such as, children, the elderly, pregnant women, and person with underlying medical problems: cardiovascular, respiratory, kidney, GIT, metabolic , neurological, malignant, HIV and behavioral dis.
TM concerned with both prevention and management of illness related to travel Illness may result from exposure to infection, accidents, psychological upset, environmental hazards and political unrest
The specialty of TM therefore is truly interdisciplinary and international specialty involving numerous disciplines including , tropical medicine, infectious diseases, microbiology, public health and nursing.
Continued surveillance of illness and disease both in the host countries and returning travelers is necessary to allow sound risk assessment to be made for intending travelers. This is a crucial area for development within the specialty
Dissemination of information regarding real or potential risks can both prevent illness and increase detection of illness in travelers who have returned to their country of origin. This may have important public health implications when considering secondary cases or outbreaks as a results of travelers returning with infections
Risks in Travel
Risk in travel can be non communicable and communicable disease
Non-Communicable disease :
• Aircraft travel, reduced O2, pressure and humidity • Motion sickness
• DVT’s and immobility • Altitude
• Heat/cold/humidity • Sunburn
• Water safety
• Accidents and Injuries • Animals and Insects
• Accidents, vehicles, marine
• Snakes, (vipers, cobras and kraits ) • Marine stings
There are many potential diseases spread via : • Food and water
• Insect vectors • Soil and water
• Sexual contact, Body-fluid exposures • Animals
LECTURE 6
High altitude illness
High altitude medicine is one of medical science that discuss human adaptation that occur in high altitude environment. It is importance for us to study this topic because some people travelling to high area, expedition to the mountain, and excellent physiology research in high altitude. Understanding human adaptation to high altitude provide us importance information needed for planning the trip and avoid many disease that may occur.
Aclimatization is the key point during high altitude travelling. Failure in this process will affect our body condition manifest as several high altitude problems. Acute Mountain Sickness (AMS) is the most common syndrome occur in high altitude, followed by high altitude cerebral edema, and hipoxic hipoksia. As a medical doctor it is importance to understand this topic, especially in region that choosen as traveller destination.
LECTURE 7
Air travel and respiratory disease related travel
For the vast majority commercial flights are safe, but a rising number are at risk of respiratory complications triggered by hypoxemia, immobility and dehydration. Patients with severe airways disease require assessment before flying. It is anticipated that these patients will have already seen a respiratory specialist for their condition.
LECTURE 8
Heat exhaustion and heat stroke
hour. ES should be the working hypothesis in any cases of collapse during exercise or immediately, apparently healthy individual whose body core temperature is high and who presents with neurological sign (from aggressiveness to coma). Prolonged exertion, warm climate, very high body core temperature and dry skin are typically linked with EHS. Treatment of HS is supportive. Cooling should be initiated vigorously immediately upon collapse. The most practical and efficient method of cooling is the use of large quantities of tap water, which is readily available. No drug is effective in reducing body temperature.
LECTURE 9
Air travel and Fit to Fly
Each year, approximately 3.3 billion people are estimated to travel by aircraft. Furthermore, the passenger numbers are expected to reach 7.3 billion by 2034, as predicted by the International Air Transport Association (IATA). While many of these people have medical conditions that pose no risk to themselves or to other passengers, there are some medical conditions that should preclude flying or require pre-flight evaluation.
Most airlines have medical passenger policies to determine fitness to fly, in order to minimize the risk of disruption to other passengers and crew, the likelihood of the aircraft diversion, and risks to the passenger’s safety. A passenger medical information form is commonly used, which asks details from both patient and doctor, about diagnosis, prognosis, desired supplemental oxygen, food, etc.
Reduced oxygen tension, pressure changes and reduced space and mobility are the principal effects on the health of the air-traveler. Modern commercial airliners fly with a cabin altitude of between 4000 and 8000 feet (1200 and 2400 m) when at cruising altitude (30.000-39.000 feet), which means a reduction in ambient pressure of the order of 20% compared with sea level and a consequent reduction in blood oxygen saturation of about 10%. The cabin air is relatively dry, and the limited room available in the non-premium cabin may be a factor to be considered.
In determining the passenger’s fitness to fly, a basic knowledge of aviation physiology and physics can be applied to the pathology. Any trapped gas will expand in volume by up to 30% during flight, and consideration must be given to the effects of the relative hypoxia encountered at a cabin altitude of 8000 feet (2400 m) above mean sea level.
LECTURE 10 Near drowning
Traditionally, the terminology used to describe submersion injuries has been confusing and impractical. In the past, drowning referred to death within 24 hours of suffocation from submersion in a liquid, whereas near-drowning described victims who survived at least 24 hours past the initial event regardless of the outcome. In 2005, the World Health Organization (WHO) published a new policy defining drowning in an attempt to clarify documentation and better track submersion injuries worldwide.
Drowning was defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” Furthermore, the WHO policy states that “drowning outcomes should be classified as: death, morbidity, and no morbidity. … Use of the terms wet, dry, active, passive, silent, and secondary drowning should no longer be used.” As such, the term near-drowning should not be used, and the association of the term drowning with a fatal outcome should be abandoned.
Risk Factors
In one study of boating fatalities, most of which were due to drowning, an association between blood ethanol concentration and risk of death from drowning while using watercraft was established Odds ratios of fatality from drowning followed a trend from 2.8 (95% confidence interval [CI] 1.6, 4.8) for a blood ethanol concentration (BEC) of 1 to 49 mg/dL to 37.4 (95% CI 16.8, 83.0) for a BEC of 150 mg/dL or greater compared with sober case controls.
Pathophysiology
Unexpected submersion triggers breath-holding, panic, and a struggle to surface. Air hunger and hypoxia develop, and the victim begins to swallow water. As breath-holding is overcome, involuntary gasps result in aspiration The quantity of fluid aspirated, rather than the composition, determines subsequent pulmonary derangement.
Sign & Symptom
Many submersion injuries are witnessed. Toddler drownings are an important exception, however, often occurring because of a lapse in supervision. Occasionally, the history of coughing, choking, or vomiting in a patient found near a body of water suggests the diagnosis. Signs of pulmonary injury may be obvious in a submersion victim who is hypoxic, cyanotic, and in obvious respiratory distress or arrest.
More subtle clues, such as increased respiratory rate and audible rhonchi, rales, or wheezes, should alert the clinician to evolving respiratory compromise. Submersion victims swallow a significantly greater volume of water than is aspirated, and gastric distention from positive-pressure ventilation during rescue is common. As a result, 60% of patients vomit after a submersion event. Aspiration of gastric contents greatly compounds the degree of pulmonary injury and increases the likelihood that acute respiratory distress syndrome will ensue. In addition, aspiration of particulate contaminants such as mud, sewage, and bacteria may obstruct the smaller bronchi and bronchioles and greatly increase the risk of infection both bacterial and fungal in nature.
Prognostic
Many factors may help predict patients who will survive a submersion injury neurologically intact. Submersion victims who arrive in the emergency department alert with normal hemodynamics are unlikely to experience neurologic impairment. Circumstantial variables that portend a poor outcome include victim age younger than 3 years, submersion for longer than 5 minutes, and initiation of cardiopulmonary resuscitation (CPR) more than 10 minutes after rescue. With the exception of victim age, however, such measurements are generally either unknown or inaccurately estimated at the time of a patient's arrival in the emergency department. Objective findings on emergency department arrival that are associated with an unfavorable prognosis include hypothermia, severe acidosis, unreactive pupils, a Glasgow Coma Scale score of 3, and asystole or the need for ongoing CPR.
Neurologically intact survival is reported for individual patients even with several of these factors present, and none of several proposed scoring systems using combinations of these variables shows 100% predictive power
LECTURE 11
Diving decompression syndrome
Decompression syndrome is the most common consequence of diving activities. Knowledge about this condition very important because of its different approach and management.
Immunization to prevent travel-related illness
Pre-travel immunization divide into three categories : recommended as part of routine health maintenance irrespective of international travel; may be required into a country; and recommended because of risk during travel.
LECTURE 13
Chemoprophylaxis for travel related illness (Malaria)
Malaria is one of the most severe infectious diseases of travelers. Nearly all cases in travelers are preventable. Prevention and best management of malaria include awareness of risk, avoidance of mosquito bites, compliance with chemoprophylaxis, and prompt diagnosis in the event of a febrile illness either during or on return from travel.
LECTURE 14
Medical Evacuation
Transport pasien dalam keadaan kritis mempunyai resiko pada pasien sehingga merupakan tantangan yang sangat besar bagi para klinisi. Alasan untukmelakukan transport pada pasien adalah untuk mendapatkan pelayanankesehatan tambahan, diagnostik atau terapiutik yang lebih canggih tidaktersedia.
Pasien dalam keadaan kritis memiliki sedikit atau tidak samasekali cadangan fisiologis tubuhnya. Memindahkan pasien seperti tersebut menimbulkan suatu masalah tersendiri dan dapat menimbulkan suatu perubahan fisiologis yang merugikan dan dapat mengancam keselamatan pasien saat transportasi. Sehingga transport pasien kritis harus dilakukan dengan persiapan yang matang dan perhatian yang seksama dan detail pada hal-hal yang harus diperhatikan.
Guideline atau pedoman sudah tersedia dan prinsip-prinsip utama dalam melakukan transport pasien kritis meliputi 5P:
1. Planning (perencanaan)
2. Personnel (jumlah yang cukup disertai dengan kemampuan yang sudah terstandarisir dalam evakuasi pasien kritis).
3. Properties (alat yang dipakai dalam transportasi)
4. Procedures (alat yang dipakai mengukur kestabilan keadaan pasien sebelum dan saat diberangkatkan)
5. Passage (pilihan rute dan tehnik transport).
LECTURE 15 Animal Bite
Rabies, Herpes B and envenoming are the diseases that result from bites by rabid mammals or bites and stings by venomous animals, especially snakes and scorpions. In all cases, appropriate early treatment, including therapeutic anti-sera, can prevent life-threatening systemic spread of the virus or venom toxins.
Introduction
In recent years, the growth of the adventure travel market in particular eco-tourism, extreme dive and wilderness safari has increased opportunities for travelers to encounter dangerous species. For travelers to remote destinations pre-travel safety education should be extended to include first aid for bite and sting injuries and potentially, provisioning of standby antibiotics for prophylaxis of high-risk wounds
Mammals Bite or Scratch Wounds
animals are children under 15 years of age.. In travelers, bite wounds are mostly causes by dogs (51%), monkeys (21%) and cats (8%). The wounds inflicted are often a combination of punctures, avulsions, abrasions and crush injuries, the last of which may not be apperent until compartment syndrome develops. Rabies virus, a rhabdovirus present in infected animal’s saliva is inoculated into the bite wound, enter peripheral nerves and spreads to the central nervous system where it causes a lethal encephalomyelitis. Fortunately the availability of efficacious and save vaccines and immunoglobulin has prevented many fatalities and almost 10 million people receive post exposure treatment annually after potential rabies exposure, mostly following dogs bites. In Addition, increase public and clinician awareness about the risk associated with an injury from a macaque, improved first aid after exposure, the availability of better diagnostic test, and improved antiviral therapeutics have decreased the case-fatality ratio to 20% in treated people.
Before departure, travelers should have a current tetanus vaccination or documentation of having received a booster vaccination within the previous 5-10 years. Travel health provider should assess a traveler’s need for pre-exposure rabies immunization. In order to prevent infection, all wounds should be promptly cleaned with soap and water, and the wound promptly debrided, if necrotic tissue, dirt or other foreigner materials is present. Travelers who might have been expose to rabies or Herpes B should contact a reliable health care provider for advice about rabies or Herpes B post-exposure prophylaxis. Snake bites
Snakebite accounts for the majority of severe envenoming in tropical developing countries. Physicians with experience treating snakebite generally agree that while elapids (cobra and kraits) account for the greatest number of deaths, vipers account for the greates number of bites. Viper venoms is rich in enzymes, which cause local pain, swelling, tissue damages, coagulopathy and for some species, damage to the kidneys, adrenals and pituitary gland. Venom from cobras may be myonecrotic, leading to devastating tissue injury; neurotoxic, leading to respiratory failure or possess mixed activity. Poisonuos snakes are hazards in many locations, although deaths from snakebites are rare. If snakebite result in intravenous injection of venom, syncope and death may occur quickly. Deaths occurring within hours usually result from paralysis of respiratory muscles following bites from kraits, mambas, coral snakes and Philippine cobra. Death after 12 hours is likely to be caused by defibrination-related hemorrhage and shock following viper bite. In developing regions, patients may suc-cumb days after the bite, due to complications such as renal failure, secondary wound infection or failure of mechanical ventilation due to power outages.
A large percentage of cobra and viper bites, between 25%-40% do not result in envenoming and may be treated conservatively, while continuing to observe for delayed onset of symptoms.
For extra precaution, when practical, travelers should wear heavy, ankle-high or higher boots and long pants when walking outdoors in areas possibly inhabited by venomous snakes. Travelers should be advised to seek immediate medical attention any time a bite wound breaks the skin or when snake venom is injected into their eyes or mucous membranes. Immobilization of the infected limb and application of a pressure bandage that does not restrict blood flow are recommended first aid measures while the victim is moved as quickly as possible to a medical facility. Specific anti-venoms are available for some snakes in some areas, so trying to ascertain the species of snakes that bite the victim may be critical.
Insect Bites and Scorpion Stings
Venom from insects can produce severe allergic reactions and lead to life-threatening anaphylactic shock. More commonly, insect bites and stings are painful and produce local reaction (redness and swelling) at the site.
morbidity and in some case death secondary to hypersensitivity reaction. Most Hymenopthera venom contains serotonin, histamine and in some tropical hornet species, acetylcholine. The sting injuries cause immediate pain, which tends to decrease over min 30 in the case of honeybees (Apidae) or hours in the case of large hornets (Vespidae). Honeybees have a barbed stinger. When the bee attempts to fly away, it is eviscerated, leaving the stinger and the contracting venom gland behind. When present, the stinger gland complex should be immediately removed with minimal regard to method, as even minor delays will increase the amount of venom that is delifvered. Additional care; washing with soap and water, verifying tetanus immunization and monitoring for infection. Oral non-steroidal antiinflammatory agent (NSAIDs) such as ibuprofen are effective in reducing pain, and swelling, but are little value after swelling is established. Oral antihistamines are effective at reducing local pruritus which appears minutes to hours after the sting injuriy. Cold pack relieve pain associated with Hymenopthera sting injuries. Treatment of hypersensitivity reactions should be initated as soon as systemic symptoms appear. The most effective therapy is prompt treatment with 1:1000 epinephrine hydrochloride (0.25-0.5 ml, subcutaneous). Patients with severe reactions are likely to need a second injection. Sting injuries that develop pain, erythema and lymphadenopathy should be treated with antibiotics with activity against Gram positive skin flora.
Some spider species, such as the hobo spider (Tageneria) and violin spider group (violin or recluse spider; Loxosceles) and several tipes of wolf spider (Lycosa) possess venom capable of causing necrotic skin lesions. In the case of Loxosceles spider, necrosis may be severe. Systemic effect of Loxosceles spiders include renal failure, hepatic insufficiency and hemolysis. No FDA approved polyspecific antivenin is available for the treatment of Loxosceles envenoming and treatment remains unsatisfying and supportive. Widow spiders (Latrodectus) have a worldwide distribution and are responsible for a significant number of neurotoxic envenoming. All widow spiders are a web-dwelling species and it is a female spiders that are responsible for human bites. Widow spiders prefer to build webs near attractant for insects such as trash dump, refuse pile and latrines. Bites by widow spiders may initially be mild, however rapid onset of cramping and muscular spasms cause considerable pain. Small children are at increased risk of envenoming and a bad outcome. Highly effective antivenins against widow spider bites are produced in Australia, South Africa and USA.
Scorpion are responsible for a significant number of fatalities in Central America, India, and North Africa. Most fatalities involve small children and debilitated patients. Scorpion venoms which are especially lethal in young children, release autonomic nervous system mediators causing myocardial damage, cardiac arrhythmias, pulmonary edema, shock, paralysis, muscle spasm and pancreatitis. Early administration of anti-venom is highly effective, together with intensive care support in severe cases. In addition, infectious diseases can be spread by insect bites, especially in tropical countries. Travelers are likely to be envenomed when they take a shower and step on scorpions that have fallen in to the tub. Many scorpions seek shelter in footwear or between folded clothing, leading to unfortunate encounters. Antivenin is produced against several of the more toxic species such as the Middle Eastern Leiurius and American Centruroides. In addition to antivenin , neorotoxic bites and stings may be treated with a compression bandage as for neurotoxic snake venoming.
Wearing protective clothing, applying insect repellents containing DEET are important preventive measures.
The general treatment include;
- Ice or cold pack and sting relief swabs (applied topically) will help alleviate local pain and swelling.
- Any bite or sting can become infected and should therefore be examined at regular intervals for progressive redness, swelling pain or pus drainage
- If anaphylactic shock occurs it must be treated immediately with epinephrine and antihistamines.
- A specifics antidote is available for those suffering severe symptoms Reference
1. World Health Organisation. Rabies. Geneva: WHO, 2011. URL: http//www.who.int/ith 2. Susan E., Charles E., Daniel Fishbein, Cathleen A. Hanlon, Boonlert Lumlertdacha,
Marta Guerra, et al. Human Rabies Prevention --- United States, 2008. MMWR Recommendations of the Advisory Committee on Immunization Practices. May 7, 2008 / 57(Early Release);1-26,28
3. World Health Organization. Rabies. Current strategies for human rabies pre and post-exposure prophylaxis, September 2010
4. Meslin FX, Hemachuda T, Wilde H, Gongal G. WHO Standards for Rabies Control. At The Occasion of the OIE Global Conference on Rabies Control: towards sustainable prevention at the source, Incheon Republic of Korea 7-9 September 2011
5. WHO Guide for Rabies Pre and Post –exposure prophylaxis in Humans. Department of Neglected Tropical Disease-Neglected Zoonotic Disease Team. Revised 15 Juni 2010 6. Weiss EA. A Comprehensive Guide to Wilderness and Travel Medicine. 3 rd ed. Adventure
Medical Kits, 2005: 121-133
LECTURE 16
Marine injuries and envenomations
Poisoning, envenomation, and direct trauma are all possible in the marine environment. Ciguatera poisoning can result from ingestion of predatory fish that have accumulated biotoxins. Symptoms can be gastrointestinal or neurologic, or mixed. Management is mostly symptomatic. Scombroid poisoning results from ingestion of fish in which histamine-like substances have developed because of improper refrigeration. Gastrointestinal and systemic symptoms occur. Treatment is based on antihistamines. Envenomations from jellyfish are painful but rarely deadly. Household vinegar deactivates the nematocysts, and manual removal of tentacles is important. Treatment is symptomatic. Heat immersion may help with the pain. Stingrays cause localized damage and a typically severe envenomation. The venom is deactivated by heat. The stingray spine, including the venom gland, typically is difficult to remove from the victim, and radiographs may be necessary to localize the spine or fragment. Surgical débridement occasionally is needed. Direct trauma can result from contact with marine creatures. Hemorrhage and tissue damage occasionally are severe. Infections with organisms unique to the marine environment are possible; antibiotic choices are based on location and type of injury. Shark attacks, although rare, require immediate attention.
LEARNING TASK
Case :
A family from Indonesia has plan a vacation to Hong Kong and China mainland next week. They came to you to get some advices.
Learning Task:
1. Explain any diseases in Hong Kong and China mainland that needs to be alerted by
LEARNING TASK 1
Emerging & Re-emerging Diseases Related Worldwide Travelling
LEARNING TASK 1
2. Describe the each way transmission of that diseases!
3. Explain to that family the preventive measures so they can prevent the diseases! 4. How the SARS and AVIAN FLU Disease can spread worldwide?
5. Describe the transmission mode of Legionnaire’s disease!
6. Describe the relationship between the Tourism and Legionnaire’s disease!
7. Explain the mechanism of MERS-Cov spread from animals to infect humans through! 8. Explain how to prevent MERS-Cov infection!
9. Describe the clinical signs and symptoms of Ebola virus infection! 10. Explain the Ebola virus transmission!
Self-assessment:
1.
What is the agent of Legionnaire’s disease? 2. What is their habitat?3. Describe the clinical signs and symptoms of Legionnaire's disease!
4.
Describe the clinical signs and symptoms of MERS-Cov infection! 5. What is the characteristic of Ebola virus?
Learning Task :
Traveler group from Netherland come to emergency dept of private hospital with diarrhea for 2 days, diarrhea more than 10 times for half day, stools without blood and slym, water only. Nausea, vomiting and abdominal pain was found. They have history fast food dinner in restaurant.
1. What is the possibility a cause of diarrhea in this ase?
2. How the management and treatment must you done in this case? 3. What is your suggest to travelers for prevention traveler diarrhea ?
Self Assessment
1. Describe etiology of Traveler’s Diarrhea 2. Describe pathogenesis of Traveler’s Diarrhea 3. Describe clinical pattern of Traveler’s Diarrhea 4. Plan for management of of Traveler’s Diarrhea 5. Describe complication
6. t may happen
7. Describe prevention of Traveler’s Diarrhea
Case :
A 55 years old man, British, fat, smoker, complain pain on his left chest, become worst and feel difficult to breath. He just arrived in Denpasar after has 4 hours flight from Thailand.
Learning Task :
1. What other anamnesis should be added to this case?
2. What kind of physical examination should be focused for this patient ? 3. What kind of other supported examinations suggested for the patient ? 4. What is the possible diagnose for this case ?
LEARNING TASK 2 Traveler’s diarrhea
LEARNING TASK 2 Traveler’s diarrhea
LEARNING TASK 3
Air travel and Acute Coronary Syndrome (ACS)
LEARNING TASK 3
5. What kind of early emergency treatment you should do for the patient ?
Self assessment
1.
Describe the predisposition factors for ACS related to the air travel !2.
Describe the trigers for ACS related to the air travel !3.
Describe the mechanism of ACS related to the air travel !4.
Describe how to prevent ACS during flight trip !Case :
A 55 years old man, American, fat, smoker, complain his left lower limb is swelling, painful, cramp and pain on pressure. He just arrived in Denpasar after has 10 hours flight from United States.
Learning Task:
1. What other anamnesis should be added to this case?
2. What kind of physical examination should be focused for this patient ? 3. What kind of other supported examinations suggested for the patient ? 4. What is the possible diagnose for this case ?
Self assessment :
1. Describe the predisposition factors for venous thromboembolism related to the air travel
2. Describe the mechanism of venous thromboembolism related to the air travel 3. Describe how to prevent venous thromboembolism during long flight trip
Case:
A 28 year old woman from Swiss, come to you and ask your advise due to her plan to go to Lovina to join a Yoga training program for 4 weeks
Learning Task :
1. What kind of advise do she need ?
2. What other information do you need to know before giving her advice?
3. Does she need vaccination against rabies? And what other immunization does she need?
4. What does she need to do if 2 weeks post travels she suffering from fever?
Self Assessment :
1. Describe what is the unique of travel medicine, and what kind of specialist do involved in Travel Medicine!
2. Describe why traveler has more risks than non-traveler! 3. Describe type of traveler and their common risks! 4. Describe what Pretravel consultation is!
LEARNING TASK 4
Air travel and thromboembolism
LEARNING TASK 4
Air travel and thromboembolism
LEARNING TASK 5
General perspective of Travel Medicine
LEARNING TASK 5
5. Describe what is the important of post travel consultation!
Learning Task
1. Explain the basic physiology process that occur in our body system while travelling to high altitude environtment!
2. What is acclimatization? Explain the physiological process that occur in acclimatization?
3. If you want to climb 18000 feet mountain, how can you plan your trip?
4. Mention the altitude illness that may occur in high altitude and explain the prevention and treatment for these illness!
Case :
A 65 years old man, Spanish, painter, smoker, has already stayed at Ubud for long time. He plans to go to Spain. During stay in Ubud, he regularly control to practitioner and got some medicines like : aminofilin, salbutamol and bromhexin. In the last month he feels in stable and good condition.
Learning Task :
1. Is he fit to flight ? 2. Explain your reason !
Self assessment
1. Describe the air condition during flight (cabin pressure and air cabin quality) ! 2. Describe the physiology effect cause by high exposure!
3. Describe the respiratory abnormality complications that potentially occur during flight ! 4. Describe the pulmonary contraindication for air travel !
Learning task
Man, 24 years old, was referred to hospital with collapse and seizure. He have history of expose to high temperature when exercise. His body temperature was 41 degree Celcius and dry skin.
1. What kind of heat related illness in this case? 2. How the management must you done in this case? 3. How we can prevention heat related illness in traveler?
LEARNING TASK 6 High altitude illness
LEARNING TASK 6 High altitude illness
LEARNING TASK 7
Air travel and respiratory disease related travel
LEARNING TASK 7
Air travel and respiratory disease related travel
LEARNING TASK 8
Heat exhaustion and heat stroke
LEARNING TASK 8
Learning Task :
1. A 26-year-old woman at 29 weeks estimated gestational age of her first pregnancy presents for a consultation. She has a history of pain and spotting or light bleeding during the first trimester that resolved. She plans to fly from Denpasar to Amsterdam which takes about 18 hours including 1 transit.
A. Explain how air travel affects pregnancy in general!
B. Explain general considerations for pregnant women travelling by aircraft?
C. On the above case, what are your considerations and advice? Is she fit to fly?
2. A 60-year-old man with type 2 diabetes mellitus plans to travel by aircraft westward. He is taking medication to control the diabetes regularly, under physician supervision.The flight will take approximately 18 hours including transit.
A. Explain how long-haul westward air travel will affect this patient!
B. What are your considerations and advice? Is he fit to fly?
3. A 40-year-old man with a history of epilepsy presents for a travel consultation. He just recently experienced a short episode of seizure, about 1 week ago, at a hotel where he stays. However, he currently is under control with medication from a local neurologist. He plans to go back to his country and will take an approximately 9-hour flight.
A. Explain how air travel affects this patient!
B. What are your considerations and advice in this case? When will he be fit to fly?
Case :
A Group of teenagers was sweeming at the lake, when one of the boys failed to surface after diving off a platform. He was quickly found and rescued by another swimmer from the lake bottom. The patient was noted to be apneic and cardiopulmonary resuscitation (CPR) was initiated by one of bystanders. After the paramedics arrived, the patient was noted to have spontaneous shallow breathing, a weak palpable pulse and glasgow coma scale (GCS) score of 7 (eyes 1, verbal 2, motor 4). The paramedics intubated the patient and transported him to emergency department (ED). In the ED, the patient has an initial pulse of 70 beats perminute, blood pressure of 110/70 mmhg, spontaneous respiratory rate of 12 breaths perminute, temperature of 35,6°C, GCS score of 6 (eyes 1, verbal 1, motor 4) and oxygen saturation of 92% on 100% FiO2.
Learning Task
1. What are the complications associated with this condition? 2. What is the best treatment for this patient?
Self Assesment
1. Describe the pathophysiology of drowning injury 2. Describe the risk factor of drowning injury 3. Describe symptom and sign of drowning injury
LEARNING TASK 9 Air travel and Fit to Fly
LEARNING TASK 9 Air travel and Fit to Fly
LEARNING TASK 10 Near drowning
5. Describe management patient or victim of drowning injury 6. Describe differential studies of drowning injury
7. Describe preventive efforts of drowning injury
Case :
52 Years old Man, Germany, He did 3 dives yesterday afternoon, maximum depth 23 meters. After rapid ascent he felt chesttightness affecting difusely, mostly on left lung. It gradually worsened since the night. it’s came with concommitant numbness / tingling on shoulders and elbow. His legs felt weak so he cant walk unaided. He also felt dizzy, nausea, vomiting, left ear problem (ringing ears, ear block, ear pain) difficulty to urinate and very tired.
Learning Task :
1. What is the possible diagnosis for this Patient?
2. What is the first aid should recommended for this patient?
3. What is the treatment should recommended for this patient?
Self assessment
1. Describe the pathogenesis of decompression syndromes ! 2. Describe the clinical sign of decompression syndromes ! 3. Describe the treatment of decompression syndromes ! 4. Describe the preventions of decompression syndromes !
Case 1 :
A 30 years old woman, Australian, Laboratory’s employee, came to Sanglah Hospital. She plans to travel to Papua to collect blood sample for Malaria study. She wants to have immunization to prevent infections transmitted by blood or body fluid.
Learning Tasks
1. What kind of immunizations needed by this patient ?
2. What examination are required for this patients related with immunization? 3. How about immunization schedule?
4. How to evaluate response related with immunization ? Case 2
Male - 65 years old , from Bali plans to go to worship Tirta Yatra to the Ganges river in India . The man has a history of diabetes mellitus and chronic obstructive lung disease .
Learning Tasks
1. What the vaccinations are prioritized on the case 2. What kind of immunizations needed by this patient ?
3. What examination are required for this patients related with immunization? 4. How about immunization schedule?
5. How to evaluate response related with immunization ?
Case 3.
male, bali, 78 yrs, will going to Mecca for pilgrimage. Learning tasks
LEARNING TASK 11
Diving Decompression Syndrome
LEARNING TASK 11
Diving Decompression Syndrome
LEARNING TASK 12
Immunization to prevent travel-related illness
LEARNING TASK 12
1. What the Vaccinations required for pilgrims who will perform the pilgrimage 2. What examination are required for this patients related with immunization? 3. How about immunization schedule?
4. How to evaluate response related with immunization ?
Self Assessment
1. Describe type, method, and schedule of routine immunization for travelers 2. Describe type, method, and schedule of required immunization for travelers 3. Describe type, method, and schedule of recomended immunization for travelers
Case:
A 30 years old man, American, plan to go on vacation to Komodo island, West Manggarai, NTT from Denpasar for 2 weeks. He came to Sanglah Hospital to get advice and prophylaxis for malaria while in NTT.
Learning Tasks:
1. What kind of chemophrophylaxis given for this case ? 2. How about the schedule of the chemoprophylaxis ?
3. What kind of clinical condition should be evaluate related to this chemophrophylaxis ?
Self Assessment:
1. Describe Malaria prophlaxis for areas of chloroquin sensitives 2. Describe Malaria prophlaxis for areas of chloroquin resistant 3. Describe Malaria prophlaxis for areas of Mefloquine Resistant
Learning Task :
1. What is the key principle in transporting crititical ill patient ? 2. Transportation of critical ill patient are catagorized as ? 3. What is the outside hospital environment transportation ? 4. Describe the International transportation distance criteria
5. After completing the evacuation duty, each member of medical team should have
LEARNING TASK 14 Medical Evacuation
LEARNING TASK 14 Medical Evacuation
LEARNING TASK 13
Chemoprophylaxis for travel related illness (Malaria)
LEARNING TASK 13
Case 1.
Mr WS, 24 yo, a traveler, come to the emergency ward of Sanglah hospital with multiple stings on his face, neck and all of the extremities since 2 hours prior to admission when he had traveling to Alas Purwo. He complained painfulhot and icthi on the sting injuries.
Local status:
Face, neck and extremities:
Multiple sting injuries with stingers+ redness+ swelling+ Laboratory result:
Wbc: 16.67 K/ul, Neut: 8.71, Lymph: 4.43., Mono: 2.2, Eos: 1.38, Baso : 0.01, Hb: 11.9 g/dl, PLT: 165 k/ul, BS: 189
BUN,SC, GOT,GPT within normal limits
Case 2
IWP, Male 67 yo, balinese
Pain on left hand since 1 day PTA after got bitten by small green snake when he cut the grass
Swelling more worst and the skin become tens and pain. This makes he cant move his hand Bleeding from bite site was continuously event has tamponed
Local status:
Antebrachii S: black and redness, ulkus skizum ± 2 cm, edema (+), bula multipel diameter ± 2 cm with fluid inside and active bleeding +.
Laboratory result:
Wbc: 19.3 K/ul, Hb: 11.9 g/dl, PLT: 16.8 k/ul, PTT: 21.6, APTT: 36.9, INR: 1.9 BUN,SC, GOT,GPT, BS: within normal limmits
Learning task:
1. Find key words related to this case 2. Describe condition related to key words
3. Define organ system that involved in this condition and find probably cause of the key words
4. Define differential diagnosis and other examinations to support the diagnosis 5. Describe laboratory examination to diagnose snake bite
6. Define management of this case 7. Define complication and prognosis
8. Define prevention based on individual, family, and community
Self assessment:
1. Describe pathogenesis of rabies 2. Describe diagnosis of rabies
3. Define management of animal bite or scratch wounds and how can rabies be prevented
4.
To describe Three families of the dangerously venomous snakes in Indonesia 5. To describe clinical presentation spectrum of snake bite6. Describe the clinical management of snake bite envenoming 7. Describe the clinical management of insect bite envenoming 8. Describe the clinical management of scorpion sting envenoming
LEARNING TASK 15 Animal Bite
Learning Task :
1.
A 45 year old female come to your clinics with complain of nausea, vomiting, and diarrhea, since 6 hours prior to the admission and 30 minutes later complain of muscle aches and hallucinations. 12 hours before she had grilled snapper for supper. What do you think happening to her? How can that happen? How do you manage the case?2. A 31 year-old male from Canada presented to the emergency room with a hot, swollen foot. He was diving at Tulamben Beach , and got stung by a blue spotted stingray the day before. He felt a sharp pain to the top of his foot. He continued to dive most of the day. In the evening, his foot swelling and pain got progressively worse.What is the initial important thing to do for cases with acute stingray stung? At presentation in the ER, how do you manage this case?
3.
A 28 year old female come to the emergency room with history of immediate onset of severe pain following a sting by jellyfish. She has been surfing the Tuban outer reef at that time. A friend suggested her using urine to encounter the venom, but the skin around the stung area showed "cross hatched ladder" pattern and the pain get worse. What is the assessment of this patient? How do you manage the case? What kind of complication that can be expected in severe envenomations?Self Assessment
1. Recognize the signs and symptoms of dangerous envenomations
2. Discuss the importance of proper wound care principles when treating victims of envenomations
3. Understand the indications of antivenom therapy and the complications associated with its use
4. Review the potential pitfalls in the misdiagnosis
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
9
Senior Clerkship
8
Senior clerkship
7
Medical Emergency (3 weeks)
BCS (1 weeks)
Special Topic: -Travel medicine (2 weeks)
Elective Study III (6 weeks)
Clinic Orientation (Clerkship)
(6 weeks)
6 The Respiratory The The Urinary The Reproductive
LEARNING TASK 16 Marine Envenomation
System and
