Speech Stroke

Good morning ladies and gentleman

The honorable lecturer nursing and friends that I love. First of all, the blessing of  God we may gather in this place. Before delivering my speech, I would like to introduce my self, My name is Made Udayati. In this opportunity, I would delivering my speech about “Stroke”

Ladies and gentleman, Stroke was the second most frequent cause of death worldwide in 2008. Approximately 9 million people had a stroke in 2008. It is ranked after heart disease and before cancer.

Stroke is the sudden death of brain cells due to a problem with the blood supply. When blood flow to the brain is impaired, oxygen and important nutrients cannot be delivered. The result is injury and then death to brain cells resulting in abnormal brain function. Blood flow to the brain can be disrupted by either a blockage or rupture of an artery to the brain.

There are two major types, embolic or ischemic stroke and hemorrhagic strokes. Stroke by common usage usually refers to the more common embolic or ischemic stroke. These strokes occur from a blood clot that occurs inside the vessel and prevents blood flow to brain. Besides the development of atherosclerotic plaque and high blood pressure.

Other factors increasing the risk of stroke include smoking, diabetes. High homocysteine levels in the blood can also increase the risk of stroke. A clot that cuts off blood flow to a part of the brain is the most common cause. Plaque material or pieces of blood clots that travel to the brain are other common sources.

Overall, the chief cause of strokes are related to hardening of the arteries, which allows fatty deposits to accumulate inside the arteries causing a cascade of injury to the vessel walls eventually leading to clots that form inside the blood vessels. The slow development of atherosclerosis, which decreases blood flow to the brain, results in shrinkage of the brain. A stroke can also result from bleeding or from a busted blood vessel in the brain as the result of high blood pressure.

Ladies and Gentleman, so that I can convey in this opportunity. Love your life before stroke love you. I apologize if my attitude is not pleasing in your hearts. As a finally, thank you for your attention.

Good morning…

Speech The Pancreas

Good morning ledies and gentlemen, Good morning my honoreble instructor, And good morning my friends. Thanks for the opportunity you given to me to standing in front of you to present my speech about “The Pancreas”, before I started, I wont to say thank you for God, because of his blessing we can meet here in this “english lesson”, in my speech I just wan tell you about pancreas in the general knowledge.

Ledies and Gentlemen, The pancreas is a gland organ that is located in the abdomen. It is part of the digestive system and produces important enzymes and hormones that help break down foods. The pancreas has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.
Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach. The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.

The honorable ladies and gentleman , The pancreas is a 6- to 10-inch (18 to 25 cm) long organ located behind the stomach in the back of the abdomen. It is spongy and shaped somewhat like a fish that is extended horizontally across the abdomen. The head of the pancreas is the largest part and lays on the right side of the abdomen where the stomach is attached to the first part of the small intestine (the duodenum). It is here where the stomach empties partially digested food into the small intestine and this chyme mixes with the secretions from the pancreas. 

The tail or body of the pancreas - its narrowest part - extends to the left side of the abdomen next to the spleen. There is a duct that runs the length of the pancreas, and it is joined by several small branches from the glandular tissue. The end of this duct is connected to a similar duct that comes from the liver, which delivers bile to the duodenum.
There are two main types of tissue found in the pancreas: exocrine tissue and endocrine tissue. Most of the pancreas - about 95% - is exocrine tissue that produces pancreatic enzymes to aid digestion. A healthy pancreas makes about 2.2 pints (1 liter) of these enzymes every day. 

The remainder of the pancreas is composed of hundreds of thousands of endocrine cells known as islets of Langerhans. These grape-like cell clusters produce important hormones that regulate pancreatic secretions and control blood sugar.

Ledies and Gentlemen , A healthy pancreas is able to produce the right chemicals at the right times in the right quantities in order to properly digest the food we eat. After food enters the duodenum, the exocrine tissues secrete a clear, watery, alkaline juice that contains several enzymes that break down food into small molecules that can be absorbed by the intestines. These enzymes include:

·         Trypsin and chymotrypsin to digest proteins.

·         Amylase to break down carbohydrates.

·         Lipase, to break down fats into fatty acids and cholesterol.

The endocrine portion of the pancreas, or islets of Langerhans, is composed of several cells that secrete hormones directly into the bloodstream. Insulin is a hormone secreted by pancreatic beta cells in response to a rise in blood sugar. The hormone also moves glucose from the blood into muscles and other tissues so they can use it for energy. In addition, insulin helps the liver absorb glucose, storing it as glycogen in case the body needs energy duringstress or exercise.

Glucagon is a hormone secreted by pancreatic alpha cells when there is a decrease in blood sugar. Its primary job is to cause glycogen to be broken down into glucose in the liver. This glucose then enters the bloodstream in order to restore the level to normal.

Ladies and Gentlemen all, the pancreas is a very important organ in our body, therefore we must maintain in order to stay healthy and function properly with, balanced diet and avoiding smoking and excessive drinking will help keep the pancreas healthy and functioning.

Ok ladies and gentlemen that's all about pancreas. Thank's for your attention to listening my speech, and I'm sorry if that some bad words thank you.

Speech The Gastrointestinal System

Good morning ledies and gentlemen, Good morning my honoreble instructor, And good morning my friends. Thanks for the opportunity you given to me to standing in front of you to present my speech about “The Gastrointestinal System”, before I started, I wont to say thank you for God, because of his blessing we can meet here in this “english lesson”, in my speech I just wan tell you about gastrointestinal system in the general knowledge.

Ledies and Gentlemen , We need food to fuel our bodies for energy, growth and repair. The digestive system converts the foods we eat into their simplest forms, like glucose (sugars), amino acids (that make up protein) or fatty acids (that make up fats). The broken-down food is then absorbed into the bloodstream from the small intestine and the nutrients are carried to each cell in the body. 

The digestive tract begins at the mouth and ends at the anus. It is like a long muscular tube, up to 10 metres long, with digestive organs attached along the way.

A large reservoir of microbes, such as bacteria, live within the large intestine and, to a lesser degree, in vthe rest of the digestive system. These bacteria play an important role in healthy digestion. The exact types of bacteria are particular to each person. Other factors that influence the type of bacteria in your digestive system include where you live in the world, what health conditions you have and what medications you have received. 

Ledies and Gentlemen , Digestion begins in the mouth. The food is ground up by the teeth and moistened with saliva to make it easy to swallow. Saliva also has a special chemical, called an enzyme, which starts breaking down carbohydrates into sugars. Once swallowed, muscular contractions of the oesophagus massage the ball of food down into the stomach. 

The food passes through a sphincter, or small muscle ring, into the stomach. Here it is mixed with gastric juices. The stomach is a muscular bag and it churns the food to help break it down mechanically as well as chemically. The food is then squeezed through a second sphincter into the first part of the small intestine, called the duodenum.

Once in the duodenum, the food is mixed with more digestive enzymes from the pancreas and bile from the liver. Food is then squeezed into the lower parts of the small intestine, called the jejunum and the ileum. Nutrients are absorbed from the ileum, which is lined with millions of finger-like projections called villi. Each villus is connected to a mesh of capillaries. This is how nutrients pass into the bloodstream.

Ledies and Gentlemen all, The pancreas is one of the largest glands in the human body. As well as digestive juices, it secretes a hormone called insulin. Insulin helps to regulate the amount of sugar in the blood. Diabetes is a condition caused by problems with insulin production.

The liver has a number of different roles in the body, including:

·         Breaking down fats, using bile stored in the gall bladder

·         Processing proteins and carbohydrates

·         Filtering and processing impurities, drugs and toxins

·         Generation of glucose for short-term energy needs from other compounds like lactate and amino acids.

Once all the nutrients have been absorbed, the waste is moved into the large intestine, or bowel. Water is removed and the waste (faeces) is stored in the rectum. It can then be passed out of the body through the anus.

Ok ladies and gentlemen that's all about The Gastrointestinal System. Thank's for your attention to listening my speech, and I'm sorry if that some bad words thank you.

DO A SECONDARY SURVEY OF THE VICTIM

EMERGENCY ACTION PRINCIPLES (BCLS)

DO A SECONDARY SURVEY OF THE VICTIM

A.    EMERGENCY ACTION PRINCIPLES; SECONDARY SURVEY OF VICTIM

The secondary survey (detailed or focused assessment) is a systematic head-to-toe examination of every part of the patient’s body, including assessing the vital signs and obtaining a patient history. The call for EMS assistance is often the patient's entry point into the medical care system. It is important that EMS personnel conduct a systematic secondary survey to ensure medical or traumatic conditions are identified and the patient’s baseline is established. This will permit identification of changes in the patient’s condition.

The secondary survey aims to detect and treat ‘everything else’. Therefore the secondary survey should not be started until the primary survey is complete, repeated, and the patient as stable as possible. There are three main elements to the secondary survey:

a)      Vital signs monitoring

b)      Top-to-toe survey

c)      Medical history (AMPLE)

1.         Assessment of Vital Signs

Initial set of vital signs should be taken on every patient. If it is not taken, a reason should be documented in the patient care report. Repeat at regular intervals (5-15 min.) or when there is a change in the patient’s status. If the patient’s condition is unstable more frequent assessments are required. Vital sign assessment must include:

a)      Respirations

·         present or absent

·         rate (document as breaths per minute)

·         rhythm

·         regular or irregular (note any patterns)

·         quality

·         evidence of dyspnea should be noted

·         shallow, labored, noisy (if possible, describe the sound)

·         evidence of accessory muscle use or diaphragmatic breathing

·         if EMS personnel are trained to perform chest auscultation this should be done in the primary survey and repeated in the secondary survey

·         bilateral, comparative auscultation of the lungs should be done anteriorly and posteriorly

·         note presence or absence of breath sounds

b)     Pulse

·      present or absent

·      rate (document as beats per minute)

·      rhythm

·      regular or irregular (note any patterns)

·      quality

·      strong, weak, absent

c)      Blood pressure

·      measure systolic and diastolic pressures, if possible

·      when assessing a BP

·      ensure the BP cuff size is correct

·      palpate a pulse distal to the BP cuff

·      rapidly inflate the BP cuff to approximately 30 mm Hg beyond the pressure at which the pulse initially disappears

·      place the stethoscope diaphragm over the site being utilized for assessment

·      deflate the BP cuff at a rate of approximately 2 mm Hg per second

·      note the systolic and diastolic pressures

·      fully deflate the BP cuff

·      document the pressures as systolic / diastolic in mm Hg

·      If the assessment was done by palpation, record the pressure as systolic/diastolic

·      document any difficulties in obtaining a blood pressure

·      patient’s position when measured

d)     Glasgow Coma Scale

·      score each component and record it on the patient care report

·      repeat the assessment at regular intervals (5-15 mins.) or when there is a change in the patient’s status

·      the “AVPU” scale can be used as an alternate method to assess level of consciousness during the primary survey, but a more formal assessment using the Glasgow Coma Scale is required for the Secondary Survey

2.      Head-To-Toe Survey

Detailed head-to-toe survey includes assessment of all parts of the body using observation, comparison for bilateral symmetry, inspection, auscultation (if within scope of practice), and palpation.

a)      Skin

·         check for evidence of cyanosis, diaphoresis, discoloration, or trauma

·         assess skin color, temperature and moisture

b)     Scalp and Skull

·         check for trauma or external bleeding

·         look for evidence of basilar skull fracture

·         inspect and gently palpate for depressions and impaled objects

·         assess for tenderness or pain

c)      Face

·         check for trauma or bleeding

·         check for cyanosis and diaphoresis

·         assess for tenderness or pain

·         assess for symmetry and facial droop

·         assess mouth for

·         foreign bodies

·         broken dentures and teeth

·         blood or vomitus

·         abnormal smells

·         impaled objects

·         assess lips for cyanosis or trauma

d)     Eyes

·         check for trauma or bleeding

·         look for glass eye or contact lenses

·         assess for tenderness or pain

e)      Pupils

·         check for abnormal shape(s)

·         look for cataracts or evidence of eye surgery

·         assess pupil size

·         note size in millimeters for each eye

·         assess the pupillary reaction to light

·         normal or slow

·         assess eye movement

f)       Ears and Nose

·         check for trauma or deformity

·         check for discharge or blood

·         assess for tenderness or pain

g)      Neck

·         check for trauma, jugular vein distension, or presence of a stoma

·         check for deformities of the bony spine or soft tissues

·         check for tracheal deviation

·         look for Medic-Alert identification

·         palpate for tenderness, swelling, or abnormalities

·         assess carotid pulse

h)     Chest

·         reassess the chest during the secondary survey

·         look for evidence of obvious trauma

·         examine for; signs of respiratory distress, use of accessory muscles, diaphragmatic breathing, paradoxical respirations, and penetrating injuries

·         palpate the chest for; symmetry on inspiration and expiration, tenderness and instability, subcutaneous emphysema

·         assess shape and symmetry

·         assess chest as far to the posterior as possible

·         auscultate for equality of breath sounds through bilateral comparison (if within scope of practice)

·         note any changes from assessments in the primary survey

·         treat for any flail segments, penetrating injuries, or impaled objects

i)        Abdomen

·         expose the abdomen

·         inspect the abdomen prior to a physical assessment for

·         obvious trauma, impaled objects, or evisceration

·         distension

·         use of accessory muscles during respirations and for diaphragmatic breathing

·         palpate the abdomen

·         assess each quadrant, by palpating gently using a flat hand and fingers

·         assess for evidence of peritoneal irritation

·         pain, guarding, or rigidity

j)       Pelvis

·         check for obvious trauma, impaled objects, or pain

·         check for symmetry or deformity

·         note pain or crepitus when the pelvis and symphysis pubis are palpated

·         assess for priapism and incontinence of urine or feces

·         check for evidence of hemorrhage

k)     Extremities

·         expose the extremities

·         check for obvious trauma, impaled objects, or hemorrhage

·         check for symmetry or deformity

·         check for pain or crepitus

·         check for color, warmth, circulation and movement in each extremity

·         pay particular attention to the hands and feet

·         check for paralysis, or changes or loss of sensation

·         look for any shortening or rotation

·         look for any joint injury

·         assess hand and foot strength

·         compare bilaterally

·         assess for edema

·         assess for pulses and adequacy of sensation and movement distal to any injury

·         look for the presence of Medic-Alert identification

l)        Back

·         if not contraindicated, the patient should be carefully log rolled to assess the back

·         cervical spine control should be maintained during assessment of the back

·         if appropriate, a back board (or equivalent device) should be positioned so that when the patient is log

·         rolled back it is directly onto the back board

·         check for obvious trauma or hemorrhage

·         check for localized pain or deformity of the spine

·         check for generalized pain and crepitus

·         check for movement and sensation distal to any suspected spinal injury

·         look for penetrating injuries or impaled objects

·         palpate for subcutaneous emphysema

3.      Medical History

A detailed history of a medical complaint is beyond the scope of this session and handout. However, for most casualties it’s worth asking the following questions and certainly for anyone likely to go to A&E:

·         Allergies (especially to any medication)

·         Medication (over the counter, prescribed, ‘recreational’)

·         Past Medical History (health problems, previous surgery)

·         Last food and drink

·         Events leading up to the situation (“How have you been recently?”)

Much of this will not affect the first aid management, but can have a huge impact on later care. Remember that seriously ill and injured people can fall unconscious, and so others may not have chance to ask these questions.    

B.     PRACTISE SESSION: SECONDARY SURVEY OF THE VICTIM

1.      Interview casualty

Ask:

·         His or her name.

·         What happened (mechanism of injury).

·         If he or she feels pain anywhere.

·         AMPLE (allergies, medications, past medical history, last meal, events preceding).

·         About pain-PQRST (provokes, quality, region/radiates, severity, time).

2.      Check vital signs

Level of consciousness

Note whether…

·         Person is alert (A).

·         Responds to verbal stimuli (V).

·         Responds to painful stimuli (P).

·         Is unconscious (U).

3.      Pulse

·         Locate pulse site.

·         Determine pulse rate.

Note…

·         Pulse rate.

·         If pulse is regular or irregular.

·         If pulse is hard to find.

4.      Breathing

Determine breathing rate.

·         Note breathing rate or whether the person is

·         Gasping for air.

·         Making unusual noises as he or she breathes.

·         Breathing excessively fast or slow.

·         Experiencing pain when breathing.

5.      Skin characteristics

·         Feel person's forehead with back of your hand.

·         Look at person's face and lips.

Note if skin is

·         Cold or hot.

·         Unusually wet or dry.

·         Pale, bluish, or flushed.

·         Check capillary refill.

·         Blood pressure  (Note: Blood pressure skill sheets follow.)

6.      Do head-to-toe examination

·         Look carefully for bleeding, cuts, bruises, and obvious deformities.

·         Ask if person has pain or discomfort.

·         Note any abnormalities.         

□ Check head

    Feel the skull for blood, lumps, or depressions.

    Look for fluid or blood in the ears, nose, or mouth.

    See if pupils respond to light.

    Note any changes in level of consciousness.

□ Check neck

    Feel sides and back of the neck.

    Feel shoulders and collarbone.

    Ask person to shrug shoulders.

□ Check chest

    Feel ribs and sternum.

    Ask person to take deep breath and blow air out.

□ Check abdomen

    Apply slight pressure to each side of abdomen, high and low.

□ Check hips/pelvis

    Push down and in on both sides of hips with your hands.

□ Check legs

    Feel both sides of each leg and foot, one at a time.

    Ask person to try to; Move toes, foot, ankle; Bend leg.

□ Check back

    Gently reach under person and feel the back.

□ Check arms

    Feel both sides of each arm and hand, one at a time.

    Ask person to try to move fingers, hands, and arms.