Hypotension (Low Blood Pressure)

Hypotension would speak in our shadow is the first symptom is often dizzy and collapsed, it's often really asked by my patients in practice, when they come with complaints of dizziness they must ask is 'how about my blood pressure, doc?, whether down? According to my notes read, hypotension (low blood pressure) is a condition in which blood pressure is lower than 90/60 mmHg or blood pressure low enough to cause symptoms such as dizziness and fainting.

The  question asked by the patient was not wrong? Symptoms of dizziness and fainting are the most common symptoms experienced by patients hypotension. This phenomenon arises because of the interruption of oxygen delivery to the brain.

Body actually has mechanisms to stabilize blood pressure, blood pressure stability is important because pressure must be high enough to deliver oxygen and nutrients to all cells in the body and dispose of waste generated. If the pressure is too high, can tear the blood vessels and cause bleeding in the the brain (hemorrhagic stroke) or other complications. If pressure is too low, the blood can not provide oxygen and nutrients are sufficient for the cell and can not dispose of waste generated as it should.

Of the many causes of hypotension, the hypotension due to changes in body position or orthostatic hypotension was the most common. When patients are said to suffer from this type of hypotension? If found decreased systolic blood pressure that stayed below 80 mmHg or a decrease in systolic blood pressure over 30 mmHg followed by clinical symptoms when the body position changes from sleep to suddenly stand.

Clinical symptoms occur frequently varies enough complaints that patients presented more of a complaint autonomic neuropathy such as tiredness, dizziness, fainting, frequent yawning, said the vague, blurred vision, pale face, cold sweat, nausea, feelings of discomfort in the abdomen, a suck sensation. Complaints that arise are sometimes not closely related to the quality of disease. There symptom improvement trend in the morning when  wake up, the more calm when the day was late or the patient lay back down.

Then, what is the cause of this hypotension? Cause here can be grouped into three namely :

• Reduced cardiac output, cause abnormal heart rhythm, damage to or dysfunction of heart muscle, heart valve disease, pulmonary embolism.
• Decreased blood volume, cause heavy bleeding, diarrhea, excessive sweating, excessive urination.
• Increasing the capacity of the blood vessels, cause septic shock, exposure by the heat, diarrhea, vasodilator drugs (nitrates, calcium inhibitors, ACE inhibitors).

So what should be done in patients hypotension? Some things you can do to reduce the symptoms of hypotension include :

• Physical activity is done regularly such as walking are quite capable of reducing the incidence of symptoms.
• Sleeping with their heads held positions ± 30 cm and bedding can improve orthostatic hypotension the mechanism of reduced renal artery pressure which then stimulates the release of renin and increases blood volume.
• Using a drug that can raise blood pressure ...

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Fever Seizures (Febrile Convulsions)

While sat in the front lobby of a state hospital in Denpasar, I saw a father with his children in his arms hurriedly rushing into the emergency room. Curious, I ventured to ask the father what had happened to his son, his voice still panting heavily, father was told that his son was hit by step.

Step or seizures fever is very common in children. According to IDAI, events febrile seizures in children aged 6 months to 5 years of almost 2 - 5%. Seizure is a frightening thing, but usually not dangerous. Parents will panicked once get a child suffered a febrile seizure.

What is a fever seizures? Fever seizures are seizures that occur when an infant or child has a fever without any infection of the central nervous system. Febrile seizure occurred at the beginning of fever. Children will look strange for a while, then stiff  and rolled her eyes. Child is unresponsive for some time, breathing will be disturbed, and the skin will appear darker than usual. After the seizure, the child will soon return to normal. Seizures usually lasted less than 1 minute, but although rare can occur for more than 15 minutes.

In general, fever seizures can be divided into two types, namely:

• Simple febrile seizures (seizures fever Simplified): overall seizure that lasted <15 minutes and not recurring within 24 hours.
• Complex febrile seizures / complex partial seizures (seizures fever complex): focal seizures (involving only one part of the body), lasted> 15 minutes, and / or repeated in a short time (during the fever lasted).

So what distinguishes this febrile seizures with epilepsy? Although the same symptoms of seizures, and recurrent, but in children who suffer from epilepsy, episodes of seizures are not accompanied by fever.

There are several factors that influence the occurrence of recurrent febrile seizures include:

• Age <15 months during the first febrile seizure.
• History febrile seizures in the family
• Seizures fever occurs immediately after starting a fever or when the temperature was relatively normal
• History of fever is often
• The first seizure was complex febrile seizures

If the seizure occurs soon after a fever or if the body temperature is relatively low, it will likely happen again febrile seizures. Risk of recurrence of febrile seizures is 10% with no risk factors, 25% with 1 risk factor, 50% with 2 risk factors, and can reach 100% with = 3 risk factors.

What if your child's fever caused by immunization? Although immunization can cause fever, but rarely followed immunization febrile seizures. A study conducted showed the risk of febrile seizures in several types of immunization as follows:

• DTP: 6-9 per 100,000 immunizations. This risk is high on the day of immunization, and declined thereafter.
• MMR: 25-34 per 100,000 immunizations. The risk increases at 8-14 days after immunization.

Febrile seizures after immunization did not have a recurring tendency greater than febrile seizures in general. And febrile seizures after immunization is unlikely to be repeated in subsequent immunization. So febrile seizures is not a contra indication immunization.

Actually, what happens in the body when children have a febrile seizure? In the state of fever, 1 oC increase in temperature will result in an increase in basal metabolism of 10% - 15% and 20% oxygen requirement. As a result there is a change of balance of brain cell membranes and occur within a short time diffusion of potassium ions and sodium ions through the membrane before, resulting in loss of electrical charge.

Loss of electrical charge large enough to extend to the whole cell / cell membrane with the help of nearby neurotransmitters, resulting in seizures. Seizures were mostly coincided with the increase of high temperature and rapid infection outside the central nervous system, such as tonsillitis (inflammation of the tonsils), ear infections, and other respiratory tract infections.

Seizures usually stop myself. Once the seizure stops, the child does not give any reaction for a moment, but a few seconds / minutes later the child will wake up and realize again without neurological disorders. Febrile seizures are generally brief and do not cause dangerous symptoms remaining. But prolonged seizures (> 15 minutes) is very dangerous and can cause permanent brain damage.

Viewing events in the body's exposure to the above, I pull the red thread symptoms you can see when the child has seizures Fever, among others: the child has a fever (especially fever or body temperature increase occurs suddenly), tonic seizures, or grand mal klonik , fainting which lasted for 30 seconds-5 minutes (almost always occurs in children who have a febrile seizure).

Tonic posture (contraction and overall muscle stiffness that usually lasts for 10-20 seconds), klonik movement (contraction and relaxation of muscles strong and rhythmic, usually lasts for 1-2 minutes), bitten tongue or cheek, teeth or jaw clenched, incontinence (urine out or feces outside consciousness), respiratory disorders, apneu (stopping breathing), and bluish skin.

When children have seizures Fever, it is important that we should do include:

• If your child has a febrile seizure, quickly acted to prevent injuries.
• Put your child on the floor or bed and away from hard objects or sharp
• Turn head to one side so that saliva (spit) or vomit to flow out of the mouth
• Do not put anything in the mouth of the patient. Your child will not swallow his own tongue.
• Contact your child's doctor

Finally, the question arises how to prevent your children do not experience seizures fever, as I wrote above seizures can occur if the body temperature rises or falls rapidly. In most cases, seizures occur unexpectedly or can not be prevented. Formerly used anti-seizure drugs as a preventive measure in children who often have a febrile seizure, but this is rarely done.

In children who tend to have a febrile seizure, when they had a fever can be given diazepam (either by mouth or by rectal).  With proper handling and fast, travel well and are not disease causing death.

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Measles

Measles is a name familiar to the mothers who have a 9-month-old baby. Yes, because at the age of 9 months or rather 8 to 9 months, infants will receive measles immunization is one of the mandatory immunization of infants to prevent infant measles disease.

Measles is a highly contagious disease that mainly attacks children, although in some cases can also attack adults. In children with malnutrition situation in incidence of measles with complications potentially fatal or cause death. Before the measles vaccination is widely used, measles epidemics occurred every 2-3 years, particularly in children aged pre-school and elementary school children. if someone had suffered measles, then the rest of his life he would be immune to this disease.

The cause of this disease is a viral infection Rubella, measles therefore also often called fever Rubella. The virus is highly contagious, especially in children with immune bad. The virus enters the body through the medium of air from coughing, sneezing or dirt measles patient's hand. The patient can transmit the infection within 2-4 days before the skin rash.

Discriminating against measles with another fever is not too difficult. In people with measles will get high fever (the highest achieved after 4 days), white spots on the inside of the cheek in front of the molars, red and watery eyes, sore throat, runny nose, dry cough and distinctive hardware. In some children are vomiting and diarrhea, this unique spots appear behind the ears, face and then spreads to the entire body.

Complications arising in this disease is a major cause of death in measles. Complications include: middle-ear infections, bronchitis (infection of the lower respiratory tract), pneumonia (lung infection), encephalitis (inflammation of the brain).

Horrible is not it? Like other diseases diseases, measles was in there a few things we can do prior to the doctor. It acts, among others: stay at home until the disease is not contagious anymore, rest and drink plenty of fluids, taking anti-fever medicine, cough medicine. If the earache, discharge from the ear, fever constantly, seizures or sleepy immediately to the doctor.

We arrived at the doctor, measles patients will be given some medical measures to prevent complications but already there are complications when it will be efforts to treat the complications that exist. If doctors feel that patients require further treatment then the doctor may refer patients to the nearest hospital.

Finally, hopefully useful ...;)

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