Neurogenik Fever

There was an increased risk of development of NF among patients with severe TBI who had experienced either diffuse axonal injury (DAI) or frontal lobe injury of any form.
Other risk factors predicting early hyperthermia include Glasgow Coma Scale score in the emergency department ≤ 8, paediatric trauma score ≤ 8, cerebral oedema or DAI on initial head computed tomography, admission blood glucose > 150mg/dL ,    white cell count   > 14,300cells/mm3, and systolic hypotension

Critical care management of severeTBI in adults

TBI is divided into two discrete periods:

The primary brain injury is the physical damage to parenchyma (tissue, vessels) that occurs during traumatic event, resulting in shearing and compression of the surrounding brain tissue.

The secondary brain injury is the result of a complex process, following and complicating the primary brain injury in the ensuing hours and days.
Secondary, intracranial brain insults include cerebral edema, hematomas, hydrocephalus, intracranial hypertension, vasospasm, metabolic derangement, excitotoxicity, calcium ions toxicity, infection, and seizures

Secondary, systemic brain insults are mainly ischemic in nature , such as:

• TTV : Hypotension, Hypertension (SBP > 160 mm Hg, or mean arterial pressure [MAP] > 110 mm Hg), Fever (temperature > 36.5°C), Hypothermia (temperature < 35.5°C)
• BGA : Hypoxemia, Hypocapnia, Hypercapnia, Hypo-osmolality (plasma osmolality [P Osm] < 290 mOsm/Kg H₂O, Acid-base disorders (acidemia: pH < 7.35; alkalemia: pH > 7.45)
• DL : Anemia, 
• SE : Hyponatremia (serum sodium < 142 mEq/L)
• GDA : Hyperglycemia, Hypoglycemia

General monitoring

• electrocardiography (ECG monitoring)
• arterial oxygen saturation (pulse oxymetry, SpO₂), capnography (end-tidal CO₂, PetCO₂)
• arterial blood pressure (arterial catheter)
• central venous pressure (CVP)
• systemic temperature
• urine output
• serum electrolytes and osmolality

Humidified High Flow Oxygen For Preterm Neonates

• Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. 
• International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available. 
• High Flow Therapy reduces the work of breathing – the effort required to breathe in and out - by delivering breathing gas at flow rates that exceed a baby's inspiratory demand. It is delivered through a simple loose fitting nasal cannula that is comfortable for the baby. The breathing gas is heated and humidified to make the high flow rates easy to tolerate.
• Infants are able to more effectively ventilate (exchange carbon dioxide for oxygen) on High Flow Therapy. The high flow rates of breathing gas flush out the CO₂ and fill the upper airway with fresh oxygenated gas after each breath.

Severe Tetanus dg Autonomic Storm

Severe tetanus is associated with profound autonomic instability.
This usually starts a few days after the spasms and lasts 1–2 weeks.
Increased sympathetic tone causes vasoconstriction, tachycardia and hypertension. 

‘Autonomic storms’ are associated with raised catecholamine levels. These alternate with episodes of :

• sudden hypotension
• sudden bradycardia 
• sudden asystole. 

SLE dengan Mesenteric Vasculitis

Panggilannya : LMV (Lupus Mesenteric Vasculitis)

Gejala bisa saja :

1. Abdominal angina, pain in the colon, distension and pseudo-blockage
2. Nausea, anorexia, vomiting and abdominal distension
3. Mesenteric vasculitis is an extremely serious complication and is highly lethal (50%)

Abdominal CT (with contrast):

• Showed discrete ascites and diffuse jejunoileal thickening, with the “target sign,” suggestive of an ischemic process that takes place in the microvasculature
• Comb Sign (seperti sisir)
  

Lab Test For SLE

LABORATORY TESTS 

1. General Tests (DL, RFT, UL, GDA, kolesterol, CRP)

1. Urinalysis 
2. Leukocyte Count 
3. Hematocrit 
4. Platelet Count 
5. Creatinine/Blood Chemistry 
6. Plasma Proteins 
7. Erythrocyte Sedimentation Rate 
8. C-Reactive Protein 
9. Blood Glucose 
10. Cholesterol