| Friday, March 23, 2007 |
| "CARA EDAN: LEBIH PERCAYA DIRI BERBICARA KUNCI SUKSES MEMIMPIN, MENJUAL, DAN BERPRESENTASI" |
Tahukah Anda, bahwa bentuk dan macam komunikasi bisa memicu konflik? Tahukan Anda bahwa konflik sesungguhnya dipicu oleh kesalahan komunikasi? Bagaimanakah metode komunikasi bisa meminimalisir konflik?
DEFINISI KONFLIK
1. Konflik adalah pergesekan atau friksi yang terekspresikan di antara dua pihak atau lebih, di mana masing-masing mempersepsi adanya interferensi dari pihak lain, yang dianggap menghalangi jalan untuk mencapai sasaran.
2. Konflik hanya terjadi bila semua pihak yang terlibat, mencium adanya ketidaksepakatan.
Ada lima macam gaya komunikasi Anda yang bisa memicu konflik.
KOMUNIKASI NEGATIF
Anda pasti mengetahui bahwa ada orang atau pihak tertentu yang 'secara alamiah' berperilaku seperti Tom and Jerry. Perilaku seperti ini cenderung melekat secara konstan, karena sifatnya lebih menyerupai karakter diri dari pada penyakit yang harus disembuhkan.
Apa yang pasti dari perilaku seperti ini, adalah efeknya yang buruk terhadap pihak lain. Karakter ini dapat menyedot dan menghabisi antusiasme, energi dan rasa percaya diri orang-orang sekitar.
Apa yang dapat dilakukan dengan gejala ini, adalah mendorong orang yang bersangkutan untuk mengkonfrontir perilakunya sendiri. Dan ini, hanya dapat dilakukan jika orang-orang di sekitar bisa terlibat aktif dengan memberi masukan tentang perilaku dan karakter negatif itu.
Secara teknis, pendekatan terbaik yang dapat dilakukan adalah melatih apa yang disebut dengan "I message". Contoh pengungkapannya adalah sebagai berikut:
"Saat SAYA mengutarakan suatu pendapat atau usulan, SAYA merasakan bahwa sikap negatif Anda membuat SAYA frustrasi, dan SAYA menemukan bahwa bekerjasama dengan Anda menjadi lebih sulit dari semestinya."
Orang yang berkarakter negatif, memiliki kecenderungan untuk mempersepsi segala sesuatu yang sampai di telinganya, apa yang bisa terlihat oleh matanya, sebagai bentuk-bentuk serangan. Sikap negatifnya, adalah bagian dari sistem survivalnya. "I message" dalam hal ini, adalah untuk meredam persepsi itu.
Jika Anda merasa punya banyak "musuh", karakter Anda mungkin harus dibenahi.
KOMUNIKASI BLAMING
Masih ingat yang satu ini: "Litle-litle to me. Litle-litle to me. Salary no up-up." Maksudnya, "Dikit-dikit gua. Dikit-dikit gua. Gaji mah kagak naek-naek." Inilah yang terjadi, pada korban dari orang yang memiliki kecenderungan komunikasi blaming. Ia cenderung menyalahkan -- dan selalu menyalahkan orang-orang di sekitarnya.
"I message" yang ditimpali dengan menciptakan lingkungan pembelajaran yang lebih baik, adalah cara terbaik untuk mengakalinya. Carilah isu utama dari sikap menyalahkan itu, tangani satu per satu, jangan sekaligus.
Jika Anda sering melihat orang lain salah, mungkin Anda memang sering menyalahkan. Jika memang demikian, latihlah untuk selalu spesifik dan detil berkaitan dengan suatu kesalahan.
KOMUNIKASI SUPERIOR
Anda mungkin boss. Waspadalah. Cara berkomunikasi ini dipenuhi dengan perintah, nasehat, dan pesan-pesan yang penuh moralitas. Semua itu memang diperlukan, akan tetapi jika setiap kalimat dan uraian yang keluar dari mulut melulu hanya tentang itu, maka kepekaan dari orang-orang sekitar akan menyusut jauh. Bahkan, komunikasi seperti ini akan membuat orang-orang di sekitar menjadi bosan. Mereka akan mengalami frustrasi, penolakan dan bahkan dalam tingkat tertentu akan memunculkan inspirasi untuk mensabotase.
Sekali lagi, "I message" yang ditimpali dengan pendekatan asertif (emosi dan personal), bisa sangat membantu keadaan.
Anda mungkin boss. Waspadalah. Cobalah untuk lebih asertif dan personal. Sering-seringlah mengobrol dengan bawahan.
KOMUNIKASI TIDAK JUJUR
Seringkali, ketidakjujuran dalam berkomunikasi akan menciptakan "kegagalan mendengar". Lebih dari itu, cara komunikasi ini akan menciptakan "kegagalan berempati". Ciri-cirinya, apa yang dikomunikasikan hanyalah berbagai hal di sekitar masalah, dan bukan masalah itu sendiri.
Ada juga ciri-ciri lain, akan tetapi bukan merupakan patokan utama, yaitu komunikatornya cenderung menggunakan kata-kata "Kita". Padahal, maksud "kita" di sana tidak lebih dan tidak kurang adalah dirinya sendiri.
Ada kecenderungan, komunikator yang demikian secara sengaja tidak menindaklanjuti perilaku yang tidak profesional, atau perilaku yang dapat merusak tim kerja, padahal bisa ditindaklanjuti. Semuanya itu, jelas akan mengarah pada tidak berfungsinya tim kerja. Untuk membenahinya, diperlukan sebuah suasana yang terbuka, jujur, saling menghormati, berhenti saling menyalahkan, saling mengganggu, dan menyediakan akses bagi setiap orang.
Jika Anda sering bekerja dengan menyendiri, waspadai gaya komunikasi ini.
KOMUNIKASI SELEKTIF
Komunikatornya dalam hal ini, sering berasumsi tentang apa yang perlu diketahui oleh orang lain. Ia tidak berfokus pada apa yang secara obyektif memang perlu diketahui orang lain. Perilaku ini dilatarbelakangi oleh keinginan untuk tetap memegang kekuasaan, mempertahankan status quo.
Untuk membenahinya, diperlukan keterbukaan dan akses kepada setiap informasi yang penting.
CONTOH KOMUNIKASI YANG TIDAK EFEKTIF
Contoh-contoh cerminan komunikasi yang dapat mensabotase tim:
"Yang penting kerjaan gua beres."
Sikap ini akan memperlemah kekuatan dan kerjasama tim.
"Bukan gua yang salah kok."
Ini juga tidak sehat, sebab sama dengan mengatakan "Yang salah orang lain."
"Kalo Dia yang salah ya biarin aja, toh bukan Gua."
Sikap ini juga tidak membantu tim.
Sikap-sikap seperti di atas akan menghancurkan tim kerja secara keseluruhan.
LIMA CIRI KOMUNIKASI POSITIF
1. Kita Senasib Sepenanggungan
Unjuk kerja kelompok atau tim, dipersepsi lebih penting daripada unjuk kerja individual. Gaya menyalahkan, disadari atau tidak akan meroketkan unjuk kerja salah satu anggota tim, tapi tidak melejitkan unjuk kerja tim secara keseluruhan.
2. Tidak Ada Anggota yang Lebih Penting dari Anggota Lain
Materi oleh: Lee Hopkins dar Milis Bicara |
posted by Eko Priyanto @ 8:59 AM   |
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| Friday, March 9, 2007 |
| High Blood Pressure (Hypertension) |
What is high blood pressure?
High blood pressure or hypertension means high pressure (tension) in the arteries. The arteries are the vessels that carry blood from the pumping heart to all of the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase the blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called “pre-hypertension”, and a blood pressure of 140/90 or above is considered high blood pressure. The systolic blood pressure, which is the top number, represents the pressure in the arteries as the heart contracts and pumps blood into the arteries. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure, therefore, reflects the minimum pressure to which the arteries are exposed.
An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. Accordingly, the diagnosis of high blood pressure in an individual is important so that efforts can be made to normalize the blood pressure and, thereby, prevent the complications. Since hypertension affects approximately 1 in 4 adults in the United States, it is clearly a major public health problem.
Whereas it was previously thought that diastolic blood pressure elevations were a more important risk factor than systolic elevations, it is now known that for individuals older than 50 years of age systolic hypertension represents a greater risk.
How is the blood pressure measured?
The blood pressure usually is measured with a small, portable instrument called a blood pressure cuff (sphygmomanometer). (Sphygmo in Greek means pulse, and a manometer measures pressure.) The blood pressure cuff consists of an air pump, a pressure gauge, and a rubber cuff. The instrument measures the blood pressure in units called millimeters of mercury (mm Hg).
The cuff is placed around the upper arm and inflated with the air pump to a pressure that blocks the flow of blood in the main artery (brachial artery) that travels through the arm. With the arm extended at the side of the body at the level of the heart, the pressure of the cuff on the arm and artery is gradually released. As the pressure in the cuff decreases, the health practitioner listens with a stethoscope over the artery at the front of the elbow. The pressure at which the practitioner first hears a pulsation over the artery is the systolic pressure. As the cuff pressure decreases further, the pressure at which the pulsation finally stops is the diastolic pressure.
What causes high blood pressure?
Two forms of high blood pressure have been described--essential (or primary) hypertension and secondary hypertension. Essential hypertension is a far more common condition and accounts for 95% of hypertension. The cause of essential hypertension is multifactorial, that is, there are several factors whose combined effects produce hypertension. In secondary hypertension, which accounts for 5% of hypertension, the high blood pressure is secondary to (caused by) a specific abnormality in one of the organs or systems of the body. (Secondary hypertension is discussed further in a separate section below.)
Essential hypertension affects approximately 75 million Americans, yet its basic causes or underlying defects are not always known. Nevertheless, certain associations have been recognized in people with essential hypertension. For example, essential hypertension develops only in groups or societies that have a fairly high intake of salt, exceeding 5.8 grams daily. In fact, salt intake may be a particularly important factor in relation to essential hypertension in several situations. Thus, excess salt may be involved in the hypertension that is associated with advancing age, African American background, obesity, hereditary (genetic) susceptibility, and kidney failure (renal insufficiency).
Genetic factors are thought to play a prominent role in the development of essential hypertension. However, the genes for hypertension have not yet been identified. (Genes are tiny portions of chromosomes that produce the proteins that determine the characteristics of individuals.) The current research in this area is focused on the genetic factors that affect the renin-angiotensin-aldosterone system. This system helps to regulate blood pressure by controlling salt balance and the tone (state of elasticity) of the arteries.
Approximately 30 % of cases of essential hypertension are attributable to genetic factors. For example, in the United States, the incidence of high blood pressure is greater among African Americans than among Caucasians or Asians. Also, in individuals who have one or two parents with hypertension, high blood pressure is twice as common as in the general population. Rarely, certain unusual genetic disorders affecting the hormones of the adrenal glands may lead to hypertension. (These identified genetic disorders are actually considered secondary hypertension.)
The vast majority of patients with essential hypertension have in common a particular abnormality of the arteries. That is, they have an increased resistance (stiffness or lack of elasticity) in the tiny arteries that are most distant from the heart (peripheral arteries or arterioles). The arterioles supply oxygen-containing blood and nutrients to all of the tissues of the body. The arterioles are connected by capillaries in the tissues to the venous system (or the veins), which returns the blood to the heart and lungs. Just what makes the peripheral arteries become stiff is not known. Yet, this increased peripheral arteriolar stiffness is present in those individuals whose essential hypertension is associated with genetic factors, obesity, lack of exercise, overuse of salt, and aging. Inflammation also may play a role in hypertension since a predictor of the development of hypertension is the presence of an elevated C reactive protein level (a blood test marker of inflammation) in some individuals.
What do patients feel with high blood pressure?
Uncomplicated high blood pressure usually occurs without any symptoms. Therefore, hypertension has been labeled "the silent killer." In other words, the disease can progress without symptoms (silently) to finally develop any one or more of the several potentially fatal complications of hypertension such as heart attacks or strokes. As a matter of fact, uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens when there are no symptoms, and those affected fail to undergo periodic blood pressure screening.
Some people with uncomplicated hypertension, however, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision. The presence of symptoms can be a good thing in that they can prompt people to consult a doctor for treatment and make them more compliant in taking their medications. Not infrequently, however, a person's first contact with a physician may be after significant damage to the end-organs has occurred. In many cases, a person visits or is brought to the doctor or an emergency room with a heart attack, stroke, kidney failure, or impaired vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant complications have developed.
About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor. In these patients, the diastolic blood pressure (the minimum pressure) exceeds 140 mm Hg! Affected persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension is a medical emergency and requires urgent treatment to prevent a stroke (brain damage).
How is end-organ damage assessed in the patient with high blood pressure?
As already mentioned, chronic high blood pressure can lead to an enlarged heart, kidney failure, brain or neurological damage, and changes in the retina at the back of the eyes. Examination of the eyes in patients with severe hypertension may reveal damage--narrowing of the small arteries, small hemorrhages (leaking of blood) in the retina, and swelling of the eye nerve. From the amount of damage. The doctor can gauge the severity of the hypertension.
As noted previously, people with high blood pressure have an increased stiffness, or resistance, in the peripheral arteries throughout the tissues of the body. This increased resistance causes the heart muscle to work harder to pump the blood through these blood vessels. The increased workload can put a strain on the heart, which can lead to heart abnormalities that are usually first seen as enlarged heart muscle. Enlargement of the heart can be evaluated by chest x-ray, electrocardiogram, and most accurately by echocardiography (an ultrasound examination of the heart). Echocardiography is especially useful in determining the thickness (enlargement) of the left side (the main pumping side) of the heart. Heart enlargement may be a forerunner of heart failure, coronary (heart) artery disease, and abnormal heart rate or rhythms (cardiac arrhythmias). Proper treatment of the high blood pressure and its complications can reverse some of these heart abnormalities.
Blood and urine tests may be helpful in detecting kidney abnormalities in people with high blood pressure. (Remember that kidney damage can be the cause or the result of hypertension.) Measuring the serum creatinine in a blood test can assess how well the kidneys are functioning. An abnormal (elevated) level of serum creatinine indicates damage to the kidney. In addition, the presence of protein in the urine (proteinuria) may reflect chronic kidney damage from hypertension, even if the kidney function (as represented by the blood creatinine level) is normal. In fact, protein in the urine alone signals the risk of deterioration in kidney function if the blood pressure is not controlled. Even small amounts of protein (microalbuminuria) may be a signal of impending kidney failure and other vascular complications from uncontrolled hypertension. African American patients with poorly controlled hypertension are at a higher risk than Caucasians for most end-organ damage and particularly kidney damage.
Uncontrolled hypertension can cause strokes, which can lead to brain or neurological damage. The strokes are usually due to a hemorrhage (leaking blood) or a blood clot (thrombosis) of the blood vessels that supply blood to the brain. The patient's symptoms and signs (findings on physical examination) are evaluated to assess the neurological damage. A stroke can cause weakness, tingling, or paralysis of the arms or legs and difficulties with speech or vision. Multiple small strokes can lead to dementia (impaired intellectual capacity). The best prevention for this complication of hypertension or, for that matter, for any of the complications, is control of the blood pressure. Recent studies have also suggested the angiotensin receptor blocking drugs may offer an additional protective effect against strokes above and beyond control of blood pressure.
Which lifestyle modifications are beneficial in treating high blood pressure?
Lifestyle modifications refer to certain specific recommendations for changes in habits, diet and exercise. These modifications can lower the blood pressure as well as improve a patient's response to blood pressure medications.
Alcohol
People who drink alcohol excessively (over two drinks per day) have a one and a half to two times increase in the prevalence of hypertension. The association between alcohol and high blood pressure is particularly noticeable when the alcohol intake exceeds 5 drinks per day. Moreover, the connection is a dose-related phenomenon. In other words, the more alcohol that is consumed, the stronger is the link with hypertension.
Smoking
Although smoking increases the risk of vascular complications (for example, heart disease and stroke) in people who already have hypertension, it is not associated with an increase in the development of hypertension. Nevertheless, smoking a cigarette can repeatedly produce an immediate, temporary rise in the blood pressure of 5 to10 mm Hg. Steady smokers however, actually may have a lower blood pressure than nonsmokers. The reason for this is that the nicotine in the cigarettes causes a decrease in appetite, which leads to weight loss. This, in turn, lowers the blood pressure.
In one study, the caffeine consumed in 5 cups of coffee daily caused a mild increase in blood pressure in elderly people who already had hypertension, but not in those who had normal blood pressures. What's more, the combination of smoking and drinking coffee in persons with high blood pressure may increase the blood pressure more than coffee alone. Limiting caffeine intake and cigarette smoking in hypertensive individuals, therefore, may be of some benefit in controlling their high blood pressure.
Salt
The American Heart Association recommends that the consumption of dietary salt be less than 6 grams of salt per day in the general population and a lower level (for example, less than 4 grams) for people with hypertension. To achieve a diet containing less than 4 grams of salt, a person should not add salt to their food or cooking. Also, the amount of natural salt in the diet can be reasonably estimated from the labeling information provided with most purchased foods.
Obesity is common among hypertensive patients, and its prevalence increases with age. In fact, obesity may be what determines the increased incidence of high blood pressure with age. Obesity can contribute to hypertension in several possible ways. For one thing, obesity leads to a greater output of blood because the heart has to pump out more blood to supply the excess tissue. The increased cardiac output then can raise the blood pressure. For another thing, obese hypertensive individuals have a greater stiffness (resistance) in their peripheral arteries throughout the body. In addition, insulin resistance and the metabolic syndrome described previously occur more frequently in the obese. Finally, obesity may be associated with a tendency for the kidneys to retain salt. Weight loss may help reverse problems related to obesity while also lowering the blood pressure. It has been estimated that the blood pressure can be decreased 0.32 mm Hg for every 1 kg (2.2 pounds) of weight lost down to ideal body weight for the individual.
Some obese people, especially if they are very obese, have a syndrome called sleep apnea. This syndrome is characterized by the periodic interruption of normal breathing during sleep. Sleep apnea may contribute to the development of hypertension in this subgroup of obese individuals. This happens because the repeated episodes of apnea cause a lack of oxygen (hypoxia). The hypoxia then causes the adrenal gland to release adrenalin and related substances. Finally, the adrenalin and related substances cause a rise in the blood pressure.
Exercise
A regular exercise program may help lower blood pressure over the long term. For example, activities such as jogging, bicycle riding, or swimming for 30 to 45 minutes daily may ultimately lower blood pressure by as much as 5 to15 mm Hg. Moreover, there appears to be a relationship between the amount of exercise and the degree to which the blood pressure is lowered. Thus, the more you exercise (up to a point), the more you lower the blood pressure. The beneficial response of the blood pressure to exercise occurs only with aerobic (vigorous and sustained) exercise programs. Therefore, any exercise program must be recommended or approved by an individual's physician
How is high blood pressure treated?
Goals of treatment
Keep in mind that high blood pressure is usually present for many years before its complications develop. The idea, therefore, is to treat hypertension early, before it damages critical organs in the body. Accordingly, increased public awareness and screening programs to detect early, uncomplicated hypertension are the keys to successful treatment. The point is that by treating high blood pressure successfully early enough, you can significantly decrease the risk of stroke, heart attack, and kidney failure.
The goal for patients with combined systolic and diastolic hypertension is to attain a blood pressure of 140/85 mm Hg. Bringing the blood pressure down even lower, as mentioned earlier, may be desirable in African American patients, and patients with diabetes or chronic kidney disease. Although life style changes in pre-hypertensive patients is appropriate, it is not well established that treatment with medication of patients with pre-hypertension is beneficial.
Starting treatment for high blood pressure
Blood pressure that is persistently higher than 140/ 90 mm Hg usually is treated with lifestyle modifications and medication. If the diastolic pressure remains at a borderline level (usually under 90 mm Hg, yet persistently above 85), however, more aggressive treatment also may be started in certain circumstances. These circumstances include borderline diastolic pressures in association with end-organ damage, systolic hypertension, or factors that increase the risk of cardiovascular disease, such as age over 65 years, African American decent, smoking, hyperlipemia (elevated blood fats), or diabetes.
Any one of the several classes of medications may be started, except the alpha-blocker medications. The alpha-blockers are used only in combination with another anti-hypertensive medication in specific medical situations. (See the next section for a more detailed discussion of each of the several classes of anti-hypertensive medications.)
In some particular situations, certain classes of anti-hypertensive drugs are preferable to others as the first line (choice) drugs. For example, angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blocking (ARB) drugs are the drugs of choice in patients with heart failure, chronic kidney failure (in diabetics or non-diabetics), or heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). Also, beta-blockers are sometimes the preferred treatment in hypertensive patients with a resting tachycardia (racing heart beat when resting) or an acute (rapid onset, current) heart attack.
Furthermore, patients with hypertension may sometimes have a co-existing, second medical condition. In such cases, a particular class of anti-hypertensive medication or combination of drugs may be chosen as the first line (initial) approach. The idea in these cases is to control the hypertension while also benefiting the second condition. For example, beta-blockers may treat chronic anxiety or migraine headache as well as the hypertension. Also, the combination of an ACE inhibitor and an ARB drug can be used to treat certain diseases of the heart muscle (called cardiomyopathies) and certain kidney diseases where reduction in proteinuria would be beneficial.
In some other situations, certain classes of anti-hypertensive medications should not be used (are contraindicated). Dihydropyridine calcium channel blockers used alone may cause problems for patients with chronic renal disease by tending to increase proteinuria. However, an ACE inhibitor will blunt this effect. Furthermore, the non-dihydropyridine type of calcium channel blockers should not be used in patients with heart failure or certain abnormal heart rates or rhythms (arrhythmias). On the other hand, these drugs may be beneficial in treating certain other arrhythmias. Also, some drugs, such as minoxidil, since it is so powerful, usually are relegated to second or third line choices for treatment. Clonidine is an excellent drug but has side effects such as fatigue, sleepiness, and dry month that make it a second or third line choice. That is, it is used only after all of the first and second line drugs have been tried without success. Finally, see the section below on pregnancy for the anti-hypertensive drugs that are appropriate or inappropriate for use in pregnant women.
Treatment with combinations of drugs for high blood pressure
The use of combination drug therapy for hypertension is not uncommon. At times, using smaller amounts of one or more agents in combination can minimize side effects while maximizing the anti-hypertensive effect. For example, diuretics, which also can be used alone, are more often used in a low dose in combination with another class of anti-hypertensive medications. In this way, the diuretic has fewer side effects while it improves the blood pressure-lowering effect of the other drug. Diuretics also are added to other anti-hypertensive medications when a patient with hypertension also has fluid retention and swelling (edema).
The ACE inhibitors or angiotensin receptor blockers may be useful in combination with most other anti-hypertensive medications. ACE inhibitors and angiotensin receptor blockers have additive effects in treating patients with cardiomyopathies and proteinuria. Another useful combination is that of a beta-blocker with an alpha-blocker in patients with high blood pressure and enlargement of the prostate gland in order to treat both conditions simultaneously. Caution is necessary, however, when combining two drugs that both lower the heart rate. For example, adding a beta-blocker to a non-dihydropyridine calcium channel blocker (e.g., diltiazem or verapamil) warrants caution. Patients receiving a combination of these two classes of drugs need to be monitored carefully to avoid an excessively slow heart rate (bradycardia). Combining alpha and beta-blockers may be beneficial for cardiomyopathies and hypertension. Carvedilol (Coreg) is useful for cardiomyopathies and labetalol for hypertension patients.
Emergency treatment of high blood pressure
In a hospital setting, injectable drugs may be used for the emergency treatment of hypertension. The most commonly used agents in this situation are sodium nitroprusside (Nipride) and labetalol (Normodyne). As already mentioned, emergency medical therapy may be needed for patients with severe (malignant) hypertension. In addition, emergency treatment of hypertension may be necessary in patients with short duration (acute) congestive heart failure, dissecting aneurysm (dilation or widening) of the aorta, stroke, and toxemia of pregnancy (see below).
Treatment during pregnancy
Women with hypertension may become pregnant. These patients have an increased risk of developing preeclampsia or eclampsia (toxemia) of pregnancy. These conditions usually develop during the last three months (trimester) of pregnancy. In preeclampsia, which can occur with or without pre-existing hypertension, affected women have hypertension, protein loss in the urine (proteinuria), and swelling (edema). In eclampsia (toxemia), convulsions also occur and the hypertension may require prompt treatment. The foremost goal of treating the high blood pressure in toxemia is to keep the diastolic pressure below 105 mm Hg in order to prevent a brain hemorrhage in the mother.
Hypertension that develops before the 20th week of pregnancy almost always is due to pre-existing hypertension and not toxemia. High blood pressure that occurs only during pregnancy, called gestational hypertension, may start late in the pregnancy. These women, however, do not have proteinuria, edema, or convulsions. Furthermore, gestational hypertension appears to have no ill effects on the mother or the fetus. This form of hypertension resolves shortly after delivery, although it may recur with subsequent pregnancies.
The use of medications for hypertension during pregnancy is controversial. The key question is, "At what level should the blood pressure be maintained?" For one thing, the risk of untreated mild to moderate hypertension to the fetus or mother during the relatively brief period of pregnancy probably is not very large. Furthermore, lowering the blood pressure too much can interfere with the flow of blood to the placenta and thereby impair fetal growth. So, some sort of a compromise must be met. Accordingly, not all mild or moderate hypertension during pregnancy needs to be treated with medication. If it is treated, however, the blood pressure should be reduced slowly and not to very low levels, perhaps not below 140/80.
The anti-hypertensive agents used during pregnancy need to be safe for normal fetal development. The beta-blockers, hydralazine (an old vasodilator), labetalol, alpha methyldopa (Aldomet), and more recently, the calcium channel blockers have been advocated as suitable medications for hypertension during pregnancy. Certain other anti-hypertensive medications, however, are not recommended (they are contraindicated) during pregnancy. These include the ACE inhibitors, the ARB drugs, and probably the diuretics. ACE inhibitors may aggravate a diminished blood supply to the uterus (uterine ischemia) and cause kidney dysfunction in the fetus. The ARB drugs may even lead to death of the fetus. Diuretics can cause depletion of the blood volume and so impair placental blood flow and fetal growth.
Which medications are used to treat high blood pressure?
Angiotensin converting enzyme inhibitors (ACE Inhibitors) and angiotensin receptor blockers
The angiotensin converting enzyme (ACE) inhibitors and the angiotensin receptor blocker (ARB) drugs both affect the renin-angiotensin hormonal system, which, as mentioned previously, helps regulate the blood pressure. The ACE inhibitors work by blocking (inhibiting) an enzyme that converts the inactive form of angiotensin in the blood to its active form. The active form of angiotensin constricts or narrows the arteries, but the inactive form cannot. With an ACE inhibitor as a single drug treatment (monotherapy), 50 to 60 percent of Caucasians usually achieve good blood pressure control. African American patients may also respond, but they require higher doses and frequently do best when an ACE inhibitor is combined with a diuretic. (Diuretics are discussed below.)
As an added benefit, ACE inhibitors may reduce an enlarged heart (left ventricular hypertrophy) in patients with hypertension. These drugs also appear to slow the deterioration of kidney function in patients with hypertension and protein in the urine (proteinuria). Moreover, they have been particularly useful in slowing the progression of kidney dysfunction in hypertensive patients with kidney disease resulting from Type 1 diabetes (insulin-dependent). Accordingly, ACE inhibitors usually are the first line drugs of choice to treat high blood pressure in cases that also involve congestive heart failure, chronic kidney failure in both diabetics and non-diabetics, and heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). ARB drugs are currently recommended for first line renal protection in diabetic nephropathy (kidney disease).
Patients who are treated with ACE inhibitors who also have kidney disease should be monitored for further deterioration in kidney function and high serum potassium. In fact, these drugs may be used to reduce the loss of potassium in people who are being treated with diuretics that tend to cause patients to lose potassium. ACE inhibitors have few side effects. One bothersome side effect, however, is a chronic cough. The ACE inhibitors include enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril and Prinivil), benazepril (Lotensin), quinapril (Accupril), perindopril (Aceon), ramipril (Altace), trandolapril (Mavik), fosinopril (Monopril), and moexipril (Univasc ).
For patients who develop a chronic cough on an ACE inhibitor, an ARB drug is a good substitute. ARB drugs work by blocking the angiotensin receptor (binder) on the arteries to which activated angiotensin must bind to have its effects. As a result, the angiotensin is not able to work on the artery. (Recall that angiotensin is a hormone that constricts the arteries.) The ARB drugs appear to have many of the same advantages as the ACE inhibitors but without the associated cough. Accordingly, they are also suitable as first line agents to treat hypertension. ARB drugs include losartan (Cozaar), irbesartan (Avapro), valsartan (Diovan), candesartan (Atacand), olmesartan (Benicar), telmisartan (Micardis), and eprosartan (Teveten).
In patients who have hypertension in addition to certain second diseases, a combination of an ACE inhibitor and an ARB drug may be effective in controlling the hypertension and also benefiting the second disease. For example, while treating hypertension, this combination of drugs can reduce the loss of protein in the urine (proteinuria) in certain kidney diseases and perhaps help strengthen the heart muscle in certain diseases of the heart muscle (cardiomyopathies). Note that both the ACE inhibitors and the ARB drugs are not to be used (are contraindicated) in pregnant women. (See the section above on pregnancy.)
Beta-blockers
The sympathetic nervous system is a part of the nervous system that helps to regulate certain involuntary (autonomic) functions in the body such as the function of the heart and blood vessels. The nerves of the sympathetic nervous system extend throughout the body and exert their effects by releasing chemicals that travel to nearby cells in the body, for example, muscle cells. The released chemicals bind to receptors (molecules) on the surface of the nearby cells and stimulate or inhibit the function of the cells. In the heart and blood vessels, the receptors for the sympathetic nervous system that are most important are the beta receptors. When stimulated, beta-receptors in the heart increase the heart rate and the strength of heart contractions (pumping action). Beta-blocking drugs acting on the heart, therefore, slow the heart rate and reduce the force of the heart’s contraction.
Stimulation of beta-receptors in the smooth muscle of the peripheral arteries and in the airways of the lung causes these muscles to relax. Accordingly, beta-blockers cause contraction of the smooth muscle of the peripheral arteries and thereby decrease the blood flow to the tissues throughout the body. As a result, the patient may experience, for example, coolness in the hands and feet. Likewise, in response to the beta-blockers, the airways are squeezed (constricted) by the contracting smooth muscle. This squeezing (impingement) on the airway causes wheezing, especially in individuals with a tendency for asthma. In short, beta-blockers reduce both the force of the heart's pumping action and the blood pressure that the heart generates in the arteries.
Beta-blockers remain useful medications in treating hypertension, especially in patients with a fast heartbeat while resting (tachycardia), cardiac chest pain (angina), or a recent heart attack (myocardial infarction). For example, beta-blockers appear to improve long-term survival when given to patients who have had a heart attack. Whether beta-blockers can prevent heart problems (are cardio-protective) in patients with hypertension any more than other anti-hypertensive medications, however, is uncertain. Beta-blockers may be considered for treatment of hypertension because they also may treat co-existing medical problems. For example, beta-blockers can help treat chronic anxiety or migraine headaches in people with hypertension. The common side effects of these drugs include depression, fatigue, nightmares, sexual impotence in males, and increased wheezing in people with asthma. The beta-blockers include atenolol (Tenormin), propranolol (Inderal), metoprolol (Toprol), nadolol (Corgard), betaxolol (Kerlone), acebutolol (Sectral), pindolol (Visken), and bisoprolol (Zebeta).
Diuretics
Diuretics are among the oldest known medications for treating hypertension. They work in the tiny tubes (tubules) of the kidneys to remove salt from the body. Water (fluid) also may be removed along with the salt. Diuretics may be used as single drug treatment (monotherapy) for hypertension. More frequently, however, low doses of diuretics are used in combination with other anti-hypertensive medications to enhance the effect of the other medications.
The diuretic hydrochlorothiazide (Hydrodiuril) works in the far end (distal) part of the kidney tubules to increase the amount of salt that is removed from the body in the urine. In a low dose of 12.5 to 25 mg per day, this diuretic may improve the blood pressure-lowering effects of other anti-hypertensive drugs. The idea is to treat the hypertension without causing the adverse effects that are sometimes seen with the higher doses of hydrochlorothiazide. These side effects include potassium depletion and elevated levels of triglyceride (fat), uric acid, and glucose (sugar) in the blood.
Occasionally, when salt retention causing accumulation of water and swelling (edema) is a major problem, the more potent, so-called, loop diuretics may be used in combination with other anti-hypertensive medications. (The loop diuretics are so called because they work in the loop segment of the kidney tubules to eliminate salt.) The most commonly used diuretics to treat hypertension include hydrochlorothiazide (Hydrodiuril), the loop diuretics furosemide (Lasix) and torsemide (Demadex), the combination of triamterene and hydrochlorothiazide (Dyazide), and metolazone (Zaroxolyn). For those individuals who are allergic to sulfa drugs, ethacrynic acid, a loop diuretic, is a good option. Note that diuretics probably should not be used in pregnant women.
Calcium channel blockers (CCBs)
Calcium channel blockers inhibit the movement of calcium into the muscle cells of the heart and arteries. The calcium is needed for these muscles to contract. These drugs, therefore, lower blood pressure by decreasing the force of the heart's pumping action (cardiac contraction) and relaxing the muscle cells in the walls of the arteries.
Three major types of calcium channel blockers are used. One type is the dihydropyridines, which do not slow the heart rate or cause other abnormal heart rates or rhythms (cardiac arrhythmias). These drugs include amlodipine (Norvasc), sustained release nifedipine (Procardia XL, Adalat CC), felodipine (Plendil), and nisoldipine (Sular).
The other two types of calcium channel blockers are referred to as the non-dihydropyridine agents. One type is verapamil (Calan, Covera, Isoptin, Verelan) and the other is diltiazem (Cardizem, Tiazac, Dilacor, and Diltia). Both the dihydropyridines and the non-dihydropyridines are very useful when used alone or in combination with other anti-hypertensive agents. The non-dihydropyridines, however, are not recommended (contraindicated) in congestive heart failure or with certain arrhythmias. Sometimes, however, these same dihydropyridines are useful in preventing certain other arrhythmias.
Many of the calcium channel blockers come in a short-acting form and a long-acting (sustained release) form. The short-acting forms of the calcium channel blockers, however, may have adverse long-term consequences, such as strokes or heart attacks. These effects are presumably due to the wide fluctuations in the blood pressure and heart rate that occur during treatment. The fluctuations result from the rapid onset and short duration of the short-acting compounds. When the calcium channel blockers are used in sustained release preparations, however, less fluctuation occurs. Accordingly, the sustained release forms of calcium channel blockers are probably safer for long-term use. The main side effects of these drugs include constipation, swelling (edema), and a slow heart rate (only with the non-dihydropyridine types).
Alpha-blockers
Alpha-blockers lower blood pressure by blocking alpha-receptors in the smooth muscle of peripheral arteries throughout the tissues of the body. The alpha-receptors are part of the sympathetic nervous system, as are the beta-receptors. The alpha-receptors, however, serve to narrow (constrict) the peripheral arteries. Accordingly, the alpha-blockers cause the peripheral arteries to widen (dilate) and thereby lower the blood pressure.
Recent evidence, however, suggests that using alpha-blockers alone as a first line drug choice for hypertension may actually increase the risk of heart-related problems, such as heart attacks or strokes. Alpha-blockers, therefore, should not be used as an initial drug choice for the treatment of high blood pressure. Examples of alpha-blockers include terazosin (Hytrin) and doxazosin (Cardura).
Alpha-blockers are particularly useful in patients with enlargement of the prostate gland (which usually occurs in older men) because these drugs reduce the problems associated with urinating. Alpha-blockers alone, however, have a relatively small blood pressure-lowering effect. Accordingly, when hypertension coexists with prostatic enlargement, another anti-hypertensive medication should be used together with an alpha-blocker. For example, tamsulosin (Flomax) or alfuzosin (Uroxatral) are alpha-blockers that work well in combination with other anti-hypertensive medications.
Clonidine
Clonidine (Catapres) is an antihypertensive drug that works centrally. That is, it works in a control center for the sympathetic nervous system in the brain. The drug is referred to as a central alpha agonist because it stimulates alpha-receptors in the brain. The result of this central stimulation, however, is to decrease the sympathetic nervous system outflow and to decrease the stiffness (resistance) of the peripheral arteries. Clonidine lowers the blood pressure, therefore, by relaxing (dilating or widening) the peripheral arteries throughout the body. This drug is useful as a second or third line drug choice for lowering blood pressure when other anti-hypertensive medications have failed. It also may be useful on an as-needed basis to control or smooth out fluctuations in the blood pressure. This drug tends to cause dryness of the mouth and fatigue so that some patients do not tolerate it. Clonidine comes in an oral form or as a sustained release skin patch. For more information, please see the drug monograph on Clonidine.
Minoxidil
Minoxidil is the most potent of the drugs that lower blood pressure by dilating the peripheral arteries. This drug, however, does not work through the peripheral sympathetic nervous system, as do the alpha and beta-blocker drugs, or through the control center in the brain, as does clonidine. Rather, it is a muscle relaxant that works directly on the smooth muscle of the peripheral arteries throughout the body. Minoxidil is used for patients who have not responded to any other medications. It must be combined with a beta-blocker or clonidine to prevent an increase in the heart rate and with a diuretic to prevent retention of fluid (swelling). Minoxidil may also increase hair growth. For more information, please see the drug monograph on Minoxidil.
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Source: http://www.medicinenet.com/high_blood_pressure/article.htm#toc1bp |
| posted by Eko Priyanto @ 5:31 PM |
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| High Blood Pressure / Hypertension By Eko Priyanto |
Many people have high blood pressure for years without knowing it. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure or kidney failure. The only way to tell if you have high blood pressure is to have your blood pressure checked. According to recent estimates, one in four U.S. adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don't even know they have it. This is why high blood pressure is often called the "silent killer."
Blood pressure is the force blood exerts on the walls of the arteries as the heart pumps it through the arteries. An increase in the blood volume pumped from the heart would increase blood pressure & cause blood vessels to dilate. It is measured as the systole & diastole pressures where systole blood pressure (SBP) accounts for the pressure when the heart contracts (resulting in a heart beat) whereas the latter (DBP) accounts for the pressure when the heart relaxes. Represented as 130/80mm Hg where the SBP is 130 mm Hg & 80 mm Hg is the DBP.
A normal reading should be 130/80mm Hg & below. When blood pressure is up, the reading would be above 140/90mm Hg.
What causes high Blood pressure / Hypertension
What can trigger hypertension? Excess alcohol, obesity & stress. Other possible triggers : air pollution, perfume, tobacco smoke, food allergens (like coffee, chocolate, milk, sugar, salt, wheat & nuts). People with BMI (Body Mass Index) greater than 25 are more likely to develop high blood pressure.
In 90 to 95 percent of high blood pressure cases, the cause is unknown. In fact, you can have high blood pressure for years without knowing it. That's why it's the silent killer -- it creeps up on you. When the cause is unknown, you have what's called essential or primary hypertension. Factors that may lead to high blood pressure in the remaining 5-10 percent of cases, which are known as secondary hypertension, include:
• Kidney abnormality
• A structural abnormality of the aorta (large blood vessel leaving the heart) existing since birth
• Narrowing of certain arteries
According to a study at the Yale University School of Medicine, the use of medications containing phenylpropanolamine (PPA) may increase the risk of a stroke. PPA is a common decongestant found mainly in cold-cough medications as well as slimming products. People with hypertension should avoid taking PPA
Symptoms of High Blood Pressure
Symptoms of high blood pressure are almost non-existent. Although some patients complain of dizziness, headaches or blurred vision, most patients only discover they need hypertension treatment when their blood pressure is taken.
What does high Blood pressure / Hypertension do to your body?
High blood pressure adds to the workload of your heart and arteries. Your heart must pump harder, and the arteries carry blood that's moving under greater pressure. If high blood pressure continues for a long time, your heart and arteries may not function as well as they should. Other body organs may also be affected. There is increased risk of stroke, congestive heart failure, kidney failure and heart attack. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
What about low Blood pressure ?
Within certain limits, the lower your blood pressure reading is, the better. In most people, blood pressure isn't too low until it produces symptoms, such as lightheadedness or fainting. In certain disease states, it's possible for blood pressure to be too low. Examples include:
• Certain nerve disorders or endocrine disorders
• Prolonged bed rest
• Decreases in blood volume due to severe bleeding (hemorrhage) or dehydration
What can help prevent hypertension? A low-carbohydrate, low-fat, low-salt, high-fibre diet, quitting smoking, consuming fresh garlic or garlic tablets.
Blood pressure / Hypertension Treatment
The goal of treatment for most patients is to lower the systolic blood pressure below 140 mm Hg and the diastolic blood pressure below 90 mm Hg. In some patients, such as those with diabetes, it is recommended that blood pressure be lowered even further, to a systolic pressure below 130 mm Hg and a diastolic pressure below 85 mm Hg.
Treatment for high blood pressure involves life-style modification and drug therapy (or pharmacological therapy) .
Life style modification
In some patients, particularly those whose blood pressure is moderately elevated, life style modifications alone may achieve treatment goals. Patients who require pharmacological therapy may reduce the number and doses of medications through life style modification. The following modifications in diet and physical activity should be discussed with a doctor or health care provider.
• Weight loss. Overweight patients can reduce blood pressure by losing weight. Gradual weight loss through modified calorie intake and increased physical activity is a good approach. A goal of losing 10-15 pounds is reasonable for many patients.
• Physical activity. Regular, moderate aerobic exercise can modestly decrease blood pressure and has many other beneficial effects. A program of gradually increased activity is most prudent, such as taking a brisk, 20-30 minute walk, 3-5 times a week. All persons with chest pain (angina) and known or suspected heart disease should talk to their doctor before beginning a exercise program.
• Salt (sodium chloride) restriction. Excessive salt intake can contribute to hypertension in some people. Even modest restriction of salt may decrease blood pressure. Generally, many doctors advise those with high blood pressure to avoid salty food and to limit daily sodium intake to no more than approximately 2.4 grams.
• Alcohol consumption. Moderate alcohol intake (one or two glasses of an alcoholic beverage a day) does not appear to cause hypertension; however, chronic heavy alcohol use elevates blood pressure. This is the most common reversible cause of high blood pressure. Therefore, hypertension patients who drink alcohol excessively should discuss this issue with their health care provider and reduce their consumption of alcohol.
Treatment with Drugs
Blood pressure = Resistance of artery x cardiac output.
Reducing cardiac output
The drugs responsible for a cardiac output reduction are called beta-adrenoreceptor blocking drugs; these drugs are very effective in reducing the blood pressure and have, moreover, a protective effect on the heart.
Their principle is to decrease the cardiac output by decreasing the frequency of the heart. Thus, these drugs must be supervised regularly because they slow down the heart rate in a very significant way.
They are excellent products for the patients who have had a myocardial infarction or who present an angina pectoris. Nevertheless, they are contra-indicated in the case of a very low heart rate, of cardiac insufficiency, asthma, chronic bronchiolitis obliterans and in the case of a dead hand.
Their undesirable side-effects are represented by a tiredness, a cooling of the limbs, digestive disorders, impotence, insomnia and nightmares. It is very important not to stop this treatment suddenly. Generally, only one tablet per day is prescribed, in the morning.
Principal beta-blockers are: the atenolol, the acebutalol, the propranolol, the celiprolol, the metoprolol, the pindolol, the nadolol, the carteolol, the esmolol, the timolol, the penbutolol, the bisoprolol, and the betaxolol.
Relaxation of the peripheral artery
These drugs, still called calcium blocker or calcium channel antagonist, are frequently employed because of their low number of counter-indications. Their undesirable side-effects consist of oedemas of the lower limbs (especially ankles), headaches and hot flushes.
The principal calcium antagonist therapies in France are: the nifedipine, the nitrendipine, the diltiazem, the lacipidine, the félodipine, the amlodipine, the nicardipine, the verapamil, and the bépridil.
Drugs that act on the cerebral receptor
Many drugs will reduce the blood pressure by acting directly on the cerebral receptor, which controls the blood pressure: these drugs are called central alpha agonist.
Their principal side-effects consist of: somnolence, sedation, dry mouth, impotence and galactorrhea.
Measuring Blood Pressure
The device of measurement includes an inflatable cuff, a dial of measurement and a stethoscope.
The principle of measurement consists in recording not the blood pressure directly in the artery but the arterial counter pressure by squeezing the artery on which the pressure is measured.
The doctor uses cuff (or an arm-band), which will be gradually filled with air to press the artery below. The doctor listens to, using his stethoscope, to the noise emitted by blood at the time of its passage in the artery.
When the band is sufficiently inflated to compress the artery that is below, blood cannot pass any more and the doctor thus does not perceive any noise. Then, the cuff is gradually deflated and the noise now perceived defines the maximal blood pressure (systolic blood pressure). As the band carries on its deflation, the noise of the artery disappears again and the physician measures the pressure corresponding now to the minimal (diastolic blood pressure).
False Blood pressure
Certain people get a false high blood pressure for several reasons: the size of the cuff, which could be too small compared to the circumference of the arm, or the conditions of measurement of the blood pressure are not good (period of stress, absence of rest before the measurement of arterial pressure).
Homeopathic remedies for Hypertension
Lachesis: Main remedy for Hypertension. Patient is worse on walking. Sleeps into an aggravation. Restlessness. Can't bear tight clothes. This remedy should be tried first. Give in 1M potency once in a month.
Aurum Met: Due to suppressed anger or resentment. Over sensitiveness. Roaring in head; violent headache; fear of death; palpitation; hopelessness and despondency.
Aconite: Palpitation; great anxiety; pulse full, strong, hard.
Allium Sativa: Suitable for fleshy people who eat a lot especially non-vegetarians. This remedy has vaso-dilatory properties. Fall in blood pressure begins usually 30 to 45 minutes after 20 to 40 drops doses of mother tincture.
Natrum Mur: For patients who have craving for salt and who worry a lot. Suppressed anger. 200 of higher potencies are usually better.
Gelsemium: When due to sudden shock provoked by bad news. 1M.
Ignatia: Due to disappointments or grief. 200.
Lycopodium: For low blood pressure and weakness.
Source: http://www.bringhealth.com/hypertension.html |
| posted by Eko Priyanto @ 5:26 PM |
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| CPR |
Definition of Cardio Pulmonary Resuscitation
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of mouth-to-mouth rescue breathing and chest compression that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.
When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing.
Cardiac Arrest Symptoms and Causes
Cardiac arrest is the sudden loss of cardiac function, when the heart abruptly stops beating. A person whose heart has stopped will lose consciousness and stop normal breathing, and their pulse and blood pressure will be absent. Unless resuscitative efforts are begun immediately, cardiac arrest leads to death within a few minutes. This is often referred to by doctors as “sudden death” or “sudden cardiac death (SCD).”
Ventricular fibrillation is the most common cause of cardiac arrest. Ventricular fibrillation occurs when the normal, regular, electrical activation of heart muscle contraction is replaced by chaotic electrical activity that causes the heart to stop beating and pumping blood to the brain and other parts of the body. Permanent brain damage and death can occur unless the flow of blood to the brain is restored within five minutes. Heart attack is the most common cause of ventricular fibrillation. Less common causes of cardiac arrest include respiratory arrest (loss of breathing function), choking, trauma, electrocution, and drowning.
Early cardiopulmonary resuscitation (CPR) and defibrillation (electrical impulses delivered to the chest to restore normal heart rhythm) are the only way to reverse a cardiac arrest. These lifesaving measures must be instituted within a few minutes after cardiac arrest in order to have any chance of success. For every minute that passes without defibrillation, a person’s chances of survival decrease by seven to ten per cent. In areas where emergency medical services are able to provide defibrillation within five to seven minutes, the survival rate for cardiac arrest has been reported to be as high as 49%. It is rare for a resuscitation to be successful if more than ten minutes have elapsed following a cardiac arrest.
Cardiac arrest is obviously a serious medical emergency. The mortality (death rate) from cardiac arrest can be decreased by providing immediate CPR and prompt defibrillation. Many public places are now equipped with automated external defibrillators (AEDs) that allow lay persons to provide emergency defibrillation in case of cardiac arrest.
CPR FOR ADULT
There are 5 steps that we used to call DR ABC
A. DANGER
Before starting to help other we must check whether there is danger arround ,for example fire, knife , leaking gas, if it is there we must anticipate so it won't harm not only the victim but also for us as rescuer. We want help other but wont hurt us.
B. RESPONSE
Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
If the lone healthcare provider witnesses the sudden collapse of a victim of any age, after verifying that the victim is unresponsive the provider should first phone 777 and get an AED if available, then begin CPR and use the AED as appropriate. Sudden collapse is more likely to be caused by an arrhythmia that may require shock delivery.
If the lone healthcare provider is rescuing an unresponsive victim with a likely asphyxial cause of arrest (eg, drowning), the rescuer should provide 5 cycles (about 2 minutes) of CPR (30 compressions and 2 ventilations) before leaving the victim to phone the emergency response number.
C. AIRWAY: Clear the airway
1. Put the person on his or her back on a firm surface.
2. Kneel next to the person's neck and shoulders.
3. Open the person's airway using the head tilt-chin lift. Put your palm on the person's forehead and gently push down. Then with the other hand, gently lift the chin forward to open the airway. Or jaw thrust maneuver (grasping the posterior (back) aspects of mandible (lower jaw) with the fingers of both hands (with the thumbs at the chin) and lifting up) if there is suspicion about cervical fracture.
4. Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Do not consider gasping to be normal breathing. If the person isn't breathing normally or you aren't sure, begin mouth-to-mouth breathing.
D. BREATHING: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or mouth-to-
nose breathing if the mouth is seriously injured or can't be opened.
1. With the airway open (using the head tilt-chin lift) jaw trust if there is neck injury, pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head tilt-chin lift and then give the second breath.
3. Begin chest compressions — go to "CIRCULATION" below.
E. CIRCULATION: Restore blood circulation
1. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
2. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 1 1/2 to 2 inches. Push hard and push fast — give two compressions per second, or about 100 compressions per minute.
3. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn’t rise, repeat the head tilt-chin lift and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.
4. If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, open the kit and follow the prompts. If an AED isn't available, go to Number 5 below.
5. Continue CPR until there are signs of movement or until emergency medical personnel take over.
Check the presence of carotid pulse by putting two finger on the carotid vein site, if none then start CPR by compressing the heart.
The rescuer should compress in the center of the chest at the nipple line.
The rescuer should compress the chest approximately 1 to 2 inches, using the heel of both hands.
Lay rescuers should use a 30:2 compression-ventilation ratio for all (infant, child, and adult) victims. Healthcare providers should use a 30:2 compression-ventilation ratio for all 1-rescuer and all adult CPR and should use a 15:2 compression-ventilation ratio for infant and child 2-rescuer CPR.
( this is the latest one, as we know before 1 rescuer is 2 breath 15 compression, 2 rescuer 2 breath 5 compression).
CPR for Children (Ages 1-8)
To perform CPR on a child:
The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:
Healthcare providers (and all rescuers who complete the healthcare provider course, such as lifeguards) performing 2-rescuer CPR should use a 15:2 compression-ventilation ratio, and a 30:2 compression-ventilation ratio for one rescuer.
Rescuers should compress over the lower half of the sternum, at the nipple line (as for adults).
Lay rescuers should use 1 or 2 hands, as needed, to compress the child’s chest to one third to one half the depth of the chest.
Breathe more gently.
Continue until the victim moves, help arrives, exhaustion occurs, rigor mortise sets in.
CPR for Infant
Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR.
To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child.
If there's no response, follow the ABC procedures below and time the call for help as follows:
• If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 777 or your local emergency number.
• If another person is available, have that person call for help immediately while you attend to the baby.
AIRWAY: Clear the airway
1. Place the baby on his or her back on firm, flat surface, such as a table. The floor or ground also will do.
2. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
3. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.
If the infant isn't breathing, begin mouth-to-mouth breathing immediately.
BREATHING: Breathe for the infant
1. Cover the baby's mouth and nose with your mouth.
2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head tilt-chin lift and then give the second breath.
3. If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.
4. Begin chest compressions — go to "CIRCULATION" below.
CIRCULATION: Restore blood circulation
1. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.
2. Gently compress the chest to about one-third to one-half the depth of the chest.
3. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 times a minute.
4. Give two breaths after every 30 chest compressions.
5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until a professional relieves you.
WHEN WE CAN STOP CPR
1. Breathing or pulse restarts.
2. Medical assistance arrives.
3. Exhausion occurs.
4. Rigor mortise sets in.
ditulis oleh Arya Wirawan, Staff Nurse Clinic KHALDIYA, Kuwait |
| posted by Eko Priyanto @ 5:15 PM |
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| Thursday, March 8, 2007 |
| Komunikasi Efektif dalam Tim |
Salah satu komponen penting dalam membangun sebuah teamwork yang baik adalah adanya komunikasi yang efektif dalam tim tersebut. Komunikasi dapat memperkuat ataupun memperlemah bahkan menghancurkan sebuah tim. Good communication can build up a team, bad one can break it. Komunikasi yang baik dapat membangun kekuatan sebuah tim, sedangkan komunikasi yang buruk dapat menghancurkannya.
Berikut adalah artikel mengenai komunikasi efektif dalam sebuah tim, yang ditulis oleh Jimmy Sentoso, mahasiswa peserta mata kuliah People Skill II program Magister Management Universitas Bina Nusantara.
Bersatu kita teguh, bercerai kita runtuh. Tentu kita sudah sering mendengar semboyan tersebut di telinga kita. Semboyan ini merupakan salah satu semboyan dalam perjuangan bangsa kita dalam perang untuk merebut kemerdekaan. Hal ini dapat kita lihat secara nyata dalam contoh sebuah sapu lidi. Batang yang digunakan untuk membuat sapu lidi teramat tipis dan rapuh. Seorang anak berusia lima tahun pun dapat mematahkannya dengan mudah. Tetapi apa yang terjadi apabila kita menyatukan batang lidi yang teramat tipis dan rapuh tersebut menjadi sebuah sapu lidi? Jangankan seorang anak kecil yang berusia lima tahun, orang dewasa yang telah berusia dua puluh tahun pun tidak dapat mematahkannya walau ia menggunakan seluruh tenaganya. Begitu pula yang akan terjadi apabila kita bekerjasama dalam sebuah tim.
Sebenarnya, setiap orang di planet ini terlibat atau melibatkan diri dalam pembangunan tim. Oleh karena itu, kita dirancang untuk berfungsi dalam jalinan dan hubungan saling ketergantungan dengan orang lain. Hal ini tidak terlepas dari sifat manusia yang merupakan makhluk sosial, yang harus berinteraksi dengan sesamanya untuk dapat hidup dengan baik. Sebuah perusahaan merupakan kerjasama dari tim. Sebuah klub sepak bola merupakan hasil kerjasama sebuah tim. Bahkan untuk hal-hal yang bersifat individual pun tetap memerlukan sebuah tim untuk dapat berfungsi secara baik. Sebagai contoh dapat kita lihat pada olahraga perseorangan seperti olah raga tinju, lari, golf maupun catur. Kita tidak dapat berhasil mencapai suatu kesuksesan dalam olah raga tersebut tanpa adanya kerjasama. Seorang atlet tinju, lari, golf, dan olah raga individu lainnya tetap membutuhkan pelatih, manajer, maupun para pendukungnya untuk saling bekerjasama dalam mencapai sukses.
Kapan dan di mana pun orang bersama-sama atau berada dalam kebersamaan untuk menyelesaikan suatu pekerjaan, itulah sebuah tim. Prioritas utama sebuah tim apapun adalah untuk belajar berfungsi seefektif dan semulus-mulusnya sehingga secara individu dan bersama-sama, anggota tim itu dapat meraih sasaran yang tepat. Tidak ada seorang pun di dunia ini yang dapat meraih kesuksesan tanpa bekerjasama dengan orang lain.
Kekuatan Kerja Tim
TEAM (Tim) bukanlah sekedar kata, melainkan juga merupakan akronim untuk suatu kebenaran yang dahsyat, yaitu Together Everyone Achieve More. Konsep dari tim ini terbentuk dari kata yang sering kita dengar berulang kali, yaitu sinergi. Kata sinergi ini berasal dari bahasa Yunani sunergos, ”sun” berarti bersama dan ”ergon” berarti bekerja. Sinergi berarti interaksi dari dua individu atau lebih atau kekuatan yang memungkinkan kombinasi tenaga mereka melebihi jumlah tenaga individu mereka.
Kerja tim adalah kemampuan untuk bekerja sama menuju satu visi yang sama, kemampuan mengarahkan pencapaian individu ke arah sasaran organisasi. Itulah rangsangan yang memungkinkan orang biasa mencapai hasil yang luar biasa. Dalam mata kuliah Organizational Behavior yang pernah saya pelajari, terdapat demonstrasi bagaimana kerjasama dapat menghasilkan suatu hal yang luar biasa. Kami disuruh untuk membentuk beberapa tim yang beranggotakan lima orang, di mana kami semua belum memiliki kemampuan untuk menganalisis bidang ini dengan baik. Setiap orang dalam kelompok kami diminta untuk memberikan peringkat terhadap suatu hal berdasarkan urutan dari hal yang kami anggap paling penting. Setelah itu setiap pendapat dari kami digabungkan untuk mendapatkan rata-rata peringkat untuk setiap kelompok. Apa yang terjadi? Kesimpulan rata-rata kelompok kami mendekati jawaban yang telah diberikan. Bahkan apabila hasil dari setiap kelompok disatukan dan diambil rata-ratanya, maka penilaian kami hampir sama dengan penilaian para ahli di bidang tersebut.
Demonstrasi nyata lain mengenai prinsip sinergi dapat kita lihat pula dalam kontes kuda penghela dalam kontes kuda penghela di suatu pekan raya kota. Kuda juara dalam kontes tersebut mampu menghela gerobak seberat 2.250 kilogram. Juara kedua sanggup menarik beban sebesar 2.000 kilogram. Dalam teori, berarti kedua kuda tersebut secara bersama-sama harus mampu menggerakkan maksimum 4.250 kilogram. Untuk uji coba teori tersebut, pemilik kedua kuda memadukan kedua kuda dan membebaninya dengan gerobak. Semua orang yang melihat terperangah. Kedua kuda tersebut mampu menarik beban seberat 6.000 kilogram, atau 1.750 kilogram lebih berat dibanding jumlah upaya yang mampu mereka lakukan sendiri-sendiri. Sinergi dapat dipakai untuk menyatukan tenaga individu, menutup keterbatasan individu, untuk menggandakan upaya individu, supaya sasaran yang lebih banyak dan lebih besar dapat dicapai.
Komunikasi
Ada lima komponen atau unsur penting dalam komunikasi yang harus kita perhatikan. Kelima unsur tersebut adalah: pengirim pesan (sender), pesan yang dikirimkan (message), bagaimana pesan tersebut dikirimkan (communication channel), penerima pesan (receiver), dan umpan balik (feedback). Pesan tersebut disampaikan melalui suatu media komunikasi, sehingga dapat diterima dengan baik oleh si penerima, dan menghasilkan umpan balik yang berguna bagi si pengirim pesan. Yang dimaksud media komunikasi di sini bukan hanya berupa percakapan secara langsung dengan menggunakan suatu bahasa yang dapat dimengerti, melainkan segala hal yang dapat membuat individu saling berinteraksi dan saling mengerti mengenai pesan apa yang akan disampaikan, sehingga tidak terjadi salah penafsiran mengenai isi dari pesan tersebut. Media komunikasi tersebut bisa juga berupa isyarat melalui gerakan tubuh, morse, maupun melalui alat bantu seperti surat, gambar, serta alat bantu visual lainnya.
Komunikasi dalam Tim
Untuk dapat membangun kerjasama dalam sebuah tim, diperlukan komunikasi antaranggotanya agar tujuan bersama dapat tercapai. Pernahakan kita membayangkan apa yang terjadi dalam suatu tim apabilla setiap anggota tim tidak dapat berkomunikasi dengan baik dengan anggota tim lainnya? Seberapa pun hebatnya kemampuan individu dalam suatu tim, mereka tidak akan ada gunanya apabila tidak dapat berkomunikasi antara yang satu dengan lainnya. Mereka hanya akan menjadi sebuah kelompok yang tidak tahu ke mana arah yang akan dituju. Keahlian mereka akan menjadi sia-sia apabila mereka tidak dapat mengkomunikasikannya dengan orang lain. Seperti yang telah dikatakan oleh William Shakespeare ”No man is lord of anything, though in and of him there be much consisting, till he communicate his part to other.”
Contoh nyata yang sering kita lihat adalah pada pertandingan sepak bola. Sering kali pada pertandingan sepak bola, di mana terdapat suatu tim yang bertabur bintang dengan skil individu yang tinggi kalah oleh sebuah tim yang berisikan pemain dengan kemampuan skill individu yang tidak begitu menonjol. Apa yang menyebabkan tim tersebut dapat menang? Komunikasi yang baik dan saling pengertian antarpemain dalam tim tersebutlah yang menyebabkan tim yang diisi oleh pemain yang memiliki skill rata-rata dapat berubah menjadi tim yang hebat dan menakutkan. Hal ini telah diakui oleh pelatih sepak bola manapun di dunia ini. Mereka mengakui bahwa skill individu merupakan hal yang penting, tetapi ada hal yang lebih penting dalam suatu tim sepakbola; yaitu kerjasama tim, kesadaran akan tugasnya masing-masing dan saling pengertian antarpemain tim tersebut.
Hukum Komunikasi Efektif
Prinsip dasar yang harus kita perhatikan dalam berkomunikasi dapat kita rangkum dalam satu kata, yaitu REACH (Respect, Empathy, Audible, Clarity, Humble), yang berarti merengkuh atau meraih.
Hukum pertama dalam berkomunikasi adalah Respect. Respect merupakan sikap hormat dan sikap menghargai terhadap lawan bicara kita. Kita harus memiliki sikap (attitude) menghormati dan menghargai lawan bicara kita karena pada prinsipnya manusia ingin dihargai dan dianggap penting. Jika kita bahkan harus mengkritik seseorang, lakukan dengan penuh respek terhadap harga diri dan kebanggaan orang tersebut. Samuel Johnson mengatakan bahwa ”There will be no RESPECT without TRUST, and there is no trust without INTEGRITY.”
Hukum kedua adalah Empati, yaitu kemampuan kita untuk menempatkan diri kita pada situasi atau kondisi yang dihadapi oleh orang lain. Rasa empati akan memampukan kita untuk dapat menyampaikan pesan (message) dengan cara dan sikap yang akan memudahkan penerima pesan (receiver) menerimanya. Jadi sebelum kita membangun komunikasi atau mengirimkan pesan, kita perlu mengerti dan memahami dengan empati calon penerima pesan kita. Sehingga nantinya pesan kita akan dapat tersampaikan tanpa ada halangan psikologis atau penolakan dari penerima. Prinsip dasar dari hukum kedua ini adalah ”Perlakukan orang lain seperti Anda ingin diperlakukan.” ”Seek first to understand then be understood to build the skills of emphatetic listening that inspires openness and trust.” (Stephen Covey)
Empati bisa juga berarti kemampuan untuk mendengar dan bersikap perseptif atau siap menerima masukan atau pun umpan balik apa pun dengan sikap yang positif. Banyak sekali dari kita yang tidak mau mendengarkan saran, masukan apalagi kritik dari orang lain. Padahal esensi dari komunikasi adalah aliran dua arah. Komunikasi satu arah tidak akan efektif manakala tidak ada umpan balik (feedback) yang merupakan arus balik dari penerima pesan.
Hukum ketiga adalah Audible. Makna dari audible antara lain: dapat didengarkan atau dimengerti dengan baik. Kunci utama untuk dapat menerapkan hukum ini dalam mengirimkan pesan adalah:
a. Buat pesan Anda mudah untuk dimengerti
b. Fokus pada informasi yang penting
c. Gunakan ilustrasi untuk membantu memperjelas isi dari pesan tersebut
e. Taruhlah perhatian pada fasilitas yang ada dan lingkungan di sekitar Anda
f. Antisipasi kemungkinan masalah yang akan muncul
g. Selalu menyiapkan rencana atau pesan cadangan (backup)
Hukum keempat adalah kejelasan dari pesan yang kita sampaikan (Clarity).
Pesan yang ingin disampaikan harus jelas sehingga tidak menimbulkan multi interpretasi atau berbagai penafsiran yang berlainan. Clarity juga sangat tergantung pada kualitas suara kita dan bahasa yang kita gunakan. Penggunaan bahasa yang tidak dimengerti, akan membuat isi dari pesan kita tidak dapat mencapai tujuannya. Seringkali orang menganggap remeh pentingnya Clarity, sehingga tidak menaruh perhatian pada suara (voice) dan kata-kata yang dipilih untuk digunakan. Beberapa cara untuk menyiapkan pesan agar jelas yaitu:
a. Tentukan goal yang jelas.
b. Luangkan waktu untuk mengorganisasikan ide kita
c. Penuhi tuntutan kebutuhan format bahasa yang kita pakai
d. Buat pesan Anda jelas, tepat dan meyakinkan
e. Pesan yang disampaikan harus fleksibel
Hukum kelima dalam komunikasi tim yang efektif adalah sikap rendah hati (Humble)
Sikap ini merupakan unsur yang terkait dengan hukum pertama untuk membangun rasa menghargai orang lain, biasanya didasari oleh sikap rendah hati yang kita miliki. Kerendahan hati juga bisa berarti tidak sombong dan menganggap diri penting ketika kita berbicara. Justru dengan kerendahan hatilah kita dapat menangkap perhatian dan respons yang positif dari si penerima pesan.
Kita telah mengetahui betapa hebatnya fungsi dari suatu tim, di mana sekumpulan orang yang biasa saja dapat menghasilkan suatu output yang luar biasa. Namun tim tersebut akan menjadi tidak efektif apabila kita tidak dapat saling berkomunikasi. Oleh karena itu diharapkan kita dapat menggunakan kelima hukum komunikasi tersebut untuk membantu kita dalam menciptakan suatu tim yang solid. *****
Sumber: Shoot, Seri Management Terapan, 2002. B.S. Wibowo, dkk |
| posted by Eko Priyanto @ 9:15 AM |
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