Introduction: Since its operation in 2016, the Universitas Sumatera Utara Hospital (USU Hospital) has implemented Medical Services for patients with cardiac arrest conditions by forming a Code Blue team. Based on data in 2018, the number of patients who received the Code Blue emergency was 240 patients. There are still many cardiac arrest events at USU Hospital, it is necessary to evaluate the implementation of the Code Blue services and create an early warning system (EWS) for patients who are potentially in cardiac arrest to prevent high cardiac arrest cases that will economically harm USU Hospital.Method: We analyze the secondary data from the Medical Record, an interview with the code blue team, and an analysis of the resuscitation form that has been completed.Result: The results of the study (n=30) which experienced the most stop breathing and cardiac arrest before the implementation of EWS were chronic diseases with 63.3% (n=19) and after the implementation of EWS there were still chronic diseases with 56.7% (n=17). A paired t-test was conducted with the result that code blue services on the numeric response time parameter was different in response time of 0.266 minutes after the implementation of EWS services (p=0.354). Meanwhile related to the length of time for cardiopulmonary resuscitation(CPR) there is a time difference of 10,767 minutes after the implementation of EWS services, (p=0.000).Conclusion: Interpretation of EWS implementation can affect the time of the CPR performed because the worsening condition of the patient has been monitored before respiratory and cardiac arrest occurred. The conclusion of making an early warning system (EWS) at USU Hospital can be immediately implemented as stated in the guidelines as a form of service in medical and nursing services.

Mediastinal angiolipoma is a rare benign neoplasm composed of mature adipose tissue with an abnormal vessel. Owing to its unspecific symptoms and slow progressions, the diagnosis of this disease is often delayed by clinicians. Here we present a 68-years-old-woman presented with mild chest pain radiates to the back with chronic dry cough. Chest imaging showed right medial posterior intrathoracic mass attached to 3rd-5th vertebrae body without bone destructions. Exploratory thoracotomy with segmentectomy was successfully performed. Histopathology examinations showed adipose tissue surrounded by a blood vessel nest, typical for angiolipoma. The patient showed rapid recovery and was discharged a week after the surgery. After two years of follow-up, the patient showed no sign of tumor recurrence and was clinically stable. This case is the first occurrence of non-infiltrating mediastinal angiolipoma reported in Southeast Asia.

Introduction:The use of vascular access (AV-fistula) for long-term hemodialysis is still served as the primary choice. The fact that there is still a high rate of failure of arteriovenous fistulas procedure is one of the obstacles in the treatment of chronic kidney disease problems. This study aims to assess the risk factors for AV-fistula or AV-shunt failure and develop a risk scoring system for the failure of the AV-fistula procedure in patients with chronic kidney disease. Methods: This study is a prospective study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. The analysis focuses on the risk factors for AV-fistula failure and performs a scoring order using multiple logistic regression methods.Results: Based on this study, three variables were found to have significant values in determining the risk of AV-fistula failure scoring, namely local arterial condition (p<0.1), local venous condition (p<0.1), and arterial diameter (p<0.1). The scoring system for normal arteries, normal veins, and artery diameter >1.8 mm was scored 1. Scoring for veins and arteries with a history of puncture was 1. Arteries with stiff sensation with weak pulses and veins with a history of intravenous catheters scored 2. Conclusion:The use of scoring based on parameters of arterial diameter, local venous condition, and local arterial condition becomes a scoring system for predictors of the risk of failure of the AV-shunt procedure, with three scoring categories, namely low risk (score 0-1), medium risk (score 2 -3), and high risk (score 4-5). This study is only a preliminary study for arteriovenous fistula scoring (PAVAS Score) due to the limited sample size so that a large-scale follow-up study is needed to assess the validity of the proposed PAVAS score.