HEMODIALYSIS THERAPY SUSTAINED LOW EFFICIENCY DAILY DIALISIS FOR CHRONIC KIDNEY DESEASE PATIENT IN INTENSIVE CARE UNIT

Kidney failure is a clinical condition characterized by an irreversible decline in kidney function, to a degree that requires the permanent renal replacement therapy, in the form of dialysis or kidney transplantation. Dialysis consists of two major categories such as dialysis / hemodialysis intermittent and continuous dialysis / continuous renal replacement therapy (CRRT). SLEDD is the latest technique of renal replacement therapy that uses conventional hemodialysis equipment, but the therapeutic results like continuous dialysis therapy / CRRT were appropriate used in patien with critical ill.</p

CERVICAL GUNSHOT INJURY

The incident of cervical spine injury and cervical spinal cord injury is between 2.0% to 5.0%. The advanced trauma life support (ATLS) stated that a patient with multiple traumas should be assumed tohave cervical spine injury especially if the patient loses consciousness when present in the ER. It is stressed that cervical spine injury requires continuous immobilization of the patient’s entire body using a semirigid collar as well as a backboard with tape and straps before and during transfer to a defnitive care facility. The understanding of the mechanism of injury is the most important as the forces transferred are signifcantly different causing different injuries. A serial case reported by Walter and Adkins found that there was no signifcant difference between the patients that have a bullet removed from the neck and patients that have a bullet left in the cervical cord. In both cases, there was no improvement to the neurologic outcome. Kupcha recommends doing selective wound management and observation of retained intracanal bullet fragments in a patient with complete lesion. Surgical decompression after the injury is not recommended. We report a case of 14 year old boy who was treated at Sanglah Hospital referred froman out-of-island Type C Hospital with a spinal cord injury - American Spinal Injury Association A (SCI ASIA A) caused by a gunshot wound in the cervical. Surgical decompression and bullet removal was performedas well as fusion stabilization. He is then treated in the intensive care unit for 48 hours with a slight improvement in motoric of upper and lower extremities