Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

Latar Belakang dan Tujuan: Cedera Otak Traumatik (COT) merupakan cedera yang mempengaruhi tingkat kesadaran serta fungsi neurologis. Pemeriksaan GCS dilakukan untuk mengkategorikan keparahan yang terjadi pada COT. Kondisi pasca COT dapat menyebabkan terjadinya penurunan fungsi kognitif karena terjadi kerusakan pada sel-sel otak serta vaskularisasinya. Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara skor GCS dengan pemeriksaan fungsi kognitif menggunakan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) pada pasien COT di Instalasi Gawat Darurat (IGD) RSUD Ulin Banjarmasin.Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 48 sampel didapatkan secara consecutive sampling.Hasil: Pada COT ringan terdapat 2 pasien (10%) mengalami penurunan fungsi kognitif, COT sedang 15 pasien (83,3%), dan COT berat 9 pasien (90%). Analisis data menggunakan uji Chi-Square dengan tingkat kepercayaan 95% menunjukkan penurunan fungsi kognitif seiring dengan semakin beratnya COT (p=0,000).Simpulan: Terdapat hubungan antara skor GCS dengan fungsi kognitif menggunakan MMSE dan CDT pada pasien COT. Relationship between Glasgow Coma Scale (GCS) Score with Cognitive Function in Traumatic Brain Injury Patient at Emergency Department of Ulin General Hospital BanjarmasinAbstractBackground and Objective: Traumatic Brain Injury (TBI) is an injury that affects the level of consciousness and neurological function. GCS examination is done to categorize the severity that occurs in TBI. Conditions after traumatic brain injury cause cognitive function impairment due to damage of brain cells and its vascularization. Analyze the relationship between GCS scores and cognitive function test using MMSE and CDT in TBI patients.Subject and Method: This study was observational analytic in design with a cross sectional approach. A total of 48 samples were obtained by consecutive sampling.Result: In mild TBI there were 2 patients (10%) experienced decrease in cognitive function, moderate TBI was 15 patients (83.3%), and 9 patients (90%) in severe TBI. Data analysis used Chi-Square test with 95% confidence level which showed a decrease in cognitive function along with the increasing severity of TBI (p=0.000). Conclusion: There was a relationship between GCS scores and cognitive function using MMSE and CDT in TBI patients. 

Head injuries are a public health and a serious socio-economic problems in the world. Head injury classified quantitatively using the Glasgow Coma Scale (GCS) score. Consumptive coagulopathy that often arises in patients with head injury associated with a tenfold adjusted risk of death. Consumptive coagulopathy marked by a decrease in the number of platelets. The purpose of the study was to analyze the relationship between GCS score with total platelet count in head injury patients at Emergency Department Ulin General Hospital Banjarmasin. This study was an observational analytic cross sectional study. Seventy three samples were obtained according to the inclusions criteria with 28 mild head injury patients, 26 moderate head injury patients, and 19 severe head injury patients. Seven patients had thrombocytopenia, from moderate head injury and severe head injury groups. From statistical test using one way ANOVA with confidence level of 95% was obtained p=0.402. It can be concluded that there is no relationship between GCS score with total platelet count in head injury patients at Emergency Department Ulin General Hospital. Keywords: head injury, GCS, platelet count Abstrak: Cedera kepala merupakan masalah kesehatan masyarakat dan sosial ekonomi yang serius di dunia. Cedera kepala diklasifikasikan secara kuantitatif menggunakan skor Glasgow Coma Scale (GCS). Koagulopati konsumtif yang sering muncul pada pasien cedera kepala dapat meningkatkan risiko kematian menjadi sepuluh kali lipat. Koagulopati konsumtif ditandai dengan penurunan jumlah trombosit. Tujuan penelitian untuk mengetahui apakah terdapat hubungan antara skor GCS dengan jumlah trombosit pada pasien cedera kepala di IGD RSUD Ulin Banjarmasin. Penelitian ini bersifat observasional analitik cross sectional. Didapatkan 73 sampel yang sesuai dengan kriteria inklusi, dengan perincian 28 pasien cedera kepala ringan (CKR), 26 pasien cedera kepala sedang (CKS), dan 19 pasien cedera kepala berat (CKB). Tujuh pasien mengalami trombositopenia, dari kelompok pasien cedera kepala sedang dan cedera kepala berat. Dari uji statistik  menggunakanone-way ANOVA dengan tingkat kepercayaan 95% didapatkan nilai p=0,402. Dapat disimpulkan bahwa tidak terdapat hubungan antara skor GCS dengan jumlah trombosit pada pasien cedera kepala di IGD RSUD Ulin Banjarmasin. Kata-kata Kunci: cedera kepala, GCS, jumlah trombosit

Tumor Cerebellopontine angle (CPA) merupakan tumor fossa posterior terbanyak dan merupakan 5-10% dari tumor intrakranial. Penatalaksanaan anestesi pada kasus tumor CPA sangat menantang, dan memerlukan perhatian khusus terhadap disfungsi batang otak, posisi pasien, pemantauan neurofisiologi intraoperatif, dan adanya risiko venous air embolism (VAE). Pasien wanita, 16 tahun, 45 kg, suspek CPA tipe schwannoma akustik dengan keluhan sakit kepala selama 2 bulan. Tidak ada riwayat tinitus dan gangguan keseimbangan. CT-scan kepala memperlihatkan massa padat dengan bagian kistik di cerebellopontine angle kanan. Prosedur pembedahan dilakukan dalam posisi prone dan memanjang hingga 13 jam. Rumatan anestesi ditujukan untuk stabilisasi hemodinamik dan pencegahan hipotermia dengan penghangat blower dan infus hangat. Perdarahan selama pembedahan sekitar 1800 ml. Pasien diekstubasi setelah 3 hari di ICU. Prosedur bedah untuk tumor CPA memiliki risiko tinggi dan membutuhkan waktu lama, sehingga meningkatkan mortalitas dan morbiditas akibat risiko hipotermia dan ketidakstabilan hemodinamik yang lebih tinggi. Pada kasus ini dengan keterbatasan alat monitoring, dilakukan observasi ketat untuk kejadian VAE dan pencegahan komplikasi pascabedah dengan menjaga hemodinamik tetap stabil dengan pemberian cairan adekuat dan pencegahan hipotermia dengan penggunaan blower warmer dan infus hangat. Pada kasus ini, lama pembedahan selama 13 jam diantisipasi dengan monitoring yang ketat, pemberian volume adekuat dan pencegahan hipotermi. Prolonged Operation in Patient with Cerebellopontine Angle (CPA) TumorAbstractCerebellopontine angle (CPA) tumor is the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Anesthetic management is very challenging and needs special attention due to brain dysfunction, patient position, neurophysiological monitoring intraoperative, and the risk of venous air embolism (VAE). Female patient, 16 years old, 45 kg, with a suspected CPA acoustic schwannoma presented headache for 2 months. No history of tinnitus and balance disorders. Head CT-scan showed solid mass with cystic sections at right cerebellopontine angle. During procedure patient was in prone position and the operation took 13 hours long. Maintenance anesthesia aims to stabilize hemodynamic with adequate fluid replacement and prevention hypothermia with blower warmer and fluid warmer. Blood loss during the operation about 1800 ml. The patient was extubated after 3 days in the ICU. Surgical procedure in cerebellopontine angle surgery has a high risk and requires a long time. Prolonged duration of surgery will increases mortality and morbidity, because of the higher risk of hypothermia and hemodynamic instability. With limited monitoring equipment, we stabilize hemodynamic and to prevent the risk of VAE by adequate volume replacement. Hypothermia prevention by blower and fluid warmer. In this case, 13 hours long the operation makes us should maintenance hemodynamic by given adequate volume replacement and prevention of hypothermia.

Background and Objective: Severe head injury has an incidence of about 10% of total head injuries, severe head injury has the highest mortality rate. In head injury patients, Mean arterial pressure (MAP) value can affect the patient's mortality rate related to brain perfusion. This research aims to know mortality of severe head injury patients based on the mean arterial pressure at Ulin Hospital Banjarmasin in January 2018 – October 2021 period. Subject and Method: This research was retrospective descriptive study, with collected data from medical records using purposive sampling technique. Result: The results showed from 51 people diagnosed with severe head injury, death 72.5% and alive 27.5%. Mortality rate 100% with MAP < 50 mmHg, 77% with MAP > 150 mmHg. And in MAP 50-150 mmHg mortality rate about 62%. Measurement of MAP in patient with severe head injury affect the mortality rate related to brain perfusion which depends on intracranial pressure (ICP) and MAP. Mean arterial pressure affect cerebral blood flow. Adequate brain perfusion are factors to decrease mortality and increase survival outcome. Conclusion: mean arterial pressure affect mortality rate in patient with severe head injury