Allcase_Restu_5Feb2016

7/21/2019 Allcase_Restu_5Feb2016

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ALL CASES

EMERGENCY DUTYFriday, February 5th 2016

Dr. dr. Sri Mulatsih, Sp.AK

dr. Kristia Hermawan, M.Sc, Sp.A

Ika/Riyu/Retu


2/44

EMERGE!" R##M D$%"

Emer&ency cases ' (

)ri*rity cases ' +

*n )ri*rity cases ' (

#ther case s ' (

%*tal


3/44

EMERGE!" !ASES

N! Na"e a#d Dia$#!i %ard

- .K.R// y.*/)arakan0Re1erral case 1r*m RSK &esti 2aluy* )arakan3

)I!$0dr. Desy Rusmawanin&tyasSp.AK3

- Ket*asid*sis Dia4eticum- Sepsis- Dia4etes Mellitus type I

( M.5.S/M/6 y.*/yutran0Re1erral case 1r*m RSI Hidayatullah3

)I!$0dr. Desy Rusmawanin&tyasSp.AK3

7 Den&ue Sh*ck Syndr*me 08th day *1 1e9er3

&NTEREST&NG CASE


4/44

)RI#RI%" !ASES


- A.R.A//: m.*/&emplak Melati (0 )r*1. dr. M. ;u11rie, Sp.AK3

- !h*lestasis- (nd day *1 e4ris c.4 $%I susp- )hym*sis

( > susp- Hyperleuc*cyt*sis- e4rile eutr*penia


5/44

)RI#RI%" !ASES


+ A.?.A/M/-,6 m.*/>*d*y*n&0Re1erral case 1r*m RS Akademik $GM3

Melati (0dr. R*ni anin&,Sp.AK3

!*mmunity ac@uired )neum*nia


6/44

# )RI#RI%" !ASES


-


7/44

#%HER !ASES


- .!/M/-6 y.*/Kalis*k* )ediatric Sur&e*n

7 Acute appendicytis

( >.;.2/M/ y.*/Keparakan )ediatric Sur&e*n

7 Acute appendicytis


8/44

THANK YOU


9/44

%I

!

>S

2#5 *rmal

* retracti*n

)ale 073, M*ttled 073, sian*sis 073

Assessment' !S Dys1uncti*n

)lan'

A 'airway p*sit*nin&5' Re4reathin& Mask 6 lpm

!' I


10/44

SE!#DAR" S$R


11/44

SE!#DAR" S$R


12/44

)H"SI!A> EJAMIA%I#

!S ' )!S E+M8


13/44

LA+RATR&UM)arameter +/(/-= 6/(/-=

Sardit**rmal ran&e

H4 0&/d>3 -+.= --. -. -6.=

Hct 0B3 8.6 +8.( ++ 86

)latelet 6((, -:, -8,78,

25! +8,6= -8,=6 +, -,8

R5! 6.- -= 8.+= -= +. 6.

M!< 01>3 : :.+ = +

M!H 0p&3 (=.( (: (( +8

M!H! 0&/d>3 ++.= +8.6 +( +=

atrium -++ --6.(( -+( -86

Kalium 6.= 8.=8 +.- 6.-

Kl*rida -6 8 = ---

Kalsium -.-= (.+6 . -

Fad-a

LA+RATR&UMd-


14/44

LA+RATR&UM)arameter +/(/-= 6/(/-=

Sardit**rmal ran&e

Al4umin (.8 +.8 7 6

SG#% :+ -6 +:

SG)% + -( :

5$ (=.8 : 7 (

!reatinine -.( .= -.+

GDS HIGH (=8 :8 7 -8

))% --.

A)%% (=.=

IR .8

Fad-a

UR&NAL&S&S


15/44

)arameter +/(/-= 8/(/-= 6/(/-=Sardit*

*rmal ran&e

Gluc*se L+ L+ L+ e&ati9e

)r*tein L7 L- L- e&ati9e

5iliru4in e&ati9e L+ e&ati9e e&ati9e

$r*4iliru4in *rmal *rmal *rmal *rmal

pH 6.6 =. 6. 8,6 ,

$rine Gra9ity -.-6 -.-6 -.6 -. -.+5l**d L- L+ L- e&ati9e

Ket*n L+ L7 L- e&ati9e

itrit L7 e&ati9e e&ati9e e&ati9e

>euk*cyteEsterase

e&ati9e L- e&ati9e e&ati9e

UR&NAL&S&SFad-a

UR&NAL&S&S


16/44

)arameter =/(/-= :/(/-= *rmal ran&e

Gluc*se L+ L+ e&ati9e

)r*tein L7 L- e&ati9e

5iliru4in e&ati9e L+ e&ati9e

$r*4iliru4in *rmal *rmal *rmal

pH 6. =. 8,6 ,

$rine Gra9ity -.- -.-6 -. -.+

5l**d L( L+ e&ati9e

Ket*n L- L7 e&ati9e

itrit 7 e&ati9e e&ati9e

>euk*cyteEsterase

e&ati9e L- e&ati9e

UR&NAL&S&SFad-a

)arameter +/(/-= 8/(/-= 6/(/-= 6/(/-= Satuan *rmal rFad-a


17/44

)arameter +/(/-= 8/(/-= 6/(/-= 6/(/-=Sardit*

Satuan *rmal r

pH =.8 =.= :.( :.( :.+6 :

p!#( -( -- - -+.6 mmH& +6 8

p#( -= --- ( (8.6 mmH& -

5E 7 (.- 7 (.- 7 -6.+ 7 -:.: mm*l/> 7( 7 +

%!#( (. (. .: =.= mm*l/> (( (

H!#+ (.8 (.8 ,- =.( mmH& - (

stH!#+ 8.6 8.: -(.8 -.( mmH& (( (

atrium -++ -++ -(8 --6.( mm*l/> -+( -

Kalium +.8 +.( (.: 8.=8 mm*l/> +.- 6Kl*rida -6 -6 -- 8 mm*l/> = --

Ani*n Gap (=.8 ((.= -=.: mmH& - 7 (

H4 -+.= -(.= -+. --. &/dl -. -

Hct 8.6 + 8( +8.( B ++ 7 8

S#( : - .: B

Fad-a

)arameter =/(/-= Satuan *rmal ran&eFad-a


18/44

)arameter =/(/-= Satuan *rmal ran&e

pH :.(= :.+6 :.86

p!#( -.: mmH& +6 86

p#( ((.6 mmH& -

5E 7 -6. mm*l/> 7( 7 +

%!#( .8 mm*l/> (( (

H!#+ . mmH& - (+

stH!#+ -(.- mmH& (( (8

atrium -(6 mm*l/> -+( -86

Kalium + mm*l/> +.- 6.-Kl*rida -: mm*l/> = ---

!alsium (.= mm*l/> (.-6 (.66

H4 -+. &/dl -. -6.=

Hct 8.6 B ++ 7 86

S#( .8 B

Fad-a

LA+RATR&UMFad-a


19/44

LA+RATR&UM

)arameter 6/(/-=

Sarit*

Satuan *rmal ran&e

!R) 6: m&/>

)r*calsitn*nin +.8- n&/m>

Fad-a


20/44

GDS M#I%#R

.(2 /(26*.0

/(2*.0

/(216*.0

5(21.*.0

6(206*00

6(210*00

6(21/*00

6(21)*00

6(222*00

(2.*00

1

8 88 88( (6 --( +( +- +:+ 6= - (= -

M+S


21/44

%I

!

>S

2#5 *rmal* retracti*n

)ale 0L3, M*ttled 073, sian*sis 073

Assessment' !


22/44

SE!#DAR" S$R


23/44

)H"SI!A> EJAMIA%I#

!S ' )!S E8


24/44

LA+RATR&UM

)arameter 6/(/-=(+.

=/(/-=.

=/(/-=Sardit*

*rmal ran&e

H4 0&/d>3 -:.- -+. --.: -6.6

Hct 0B3 6+.8 8 8-.( +( 8:)latelet -+, -(, :(, -6.786.

25! 8,: +,8 +,= --,

eutr*1il :. 6:.: 6 :

>im1*sit (+.+ +(.= ( 8

5as*1il .+ .+ -E*sin*1il -.6 - 8

M*n*sit 6. .8 (

M!< 01>3 + ::.= -

M!H 0p&3 (=.6 (= (= +8

M!H! 0&/d>3 +(.- ++.6 +( 7 +8

LA+RATR&UMM+S


25/44

LA+RATR&UM

)arameter =/(/-=Sardit*

*rmal ran&e

))% -8.=

0-+.3

-(.+ -6.+

A)%% 8=.0+-.3

(:. 7 +:

D7dimer 8(: (+

i4rin*&en (8( -8 +

)r*tein t*tal 6.6 =.8

Al4umin (.:- +.8 7 6

SG#% ( -6 +:

SG)% +6 -( :

5$ -(.( : 7 (

!reatinin .8= .= -.+

GDS - :8 7 -8

)arameter =/(/-=Sardit*

atrium -+.

Kalium 6.-

Kl*rida :

!alsium -.

LA+RATR&UMM+S


26/44

LA+RATR&UM

)arameter =/(/-=(-.+

=/(/-=.

=/(/-=Sardit*

*rmal ran&e

H4 0&/d>3 -6.+ -+. --.: -6.6

Hct 0B3 86.: 8 8-.( +( 8:)latelet -=, -(, :(, -6.786.

25! 6,:= +,8 +,= --,

eutr*1il =8 6:.: 6 :

>im1*sit +( +(.= ( 8

5as*1il .+ -E*sin*1il - 8

M*n*sit +( .8 (

M!< 01>3 :.: ::.= -

M!H 0p&3 (=.+ (= (= +8

M!H! 0&/d>3 ++.8 ++.6 +( 7 +8

LA+RATR&UMM+S


27/44

LA+RATR&UM

)arameter =/(/-=-=.

=/(/-=((.

*rmal ran&e

)r*tein t*tal 8.+- 8. =.8 .(

))% -6.+ -(.( -6.+

A)%% 6-.+ (:. 7 +:

i4rin*&en -- -8 +

D7dimer -:8 (+

!K/!)K -: + 7 +

!KM5 = : 7 (6

atrium -( -+= -86

Kalium 8.68 +.6 6

!alsium -.:: (.- (.6

!hl*rida = 7 -:

I&M anti den&ue L

M+S


28/44

)leural e11usi*n

LABORATD!g" M#!$t#%An MBS, 6 yo: BW


29/44

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

2

24

32

40

48

56

64

72

40

60

80

100

120

140

160180

200

2.5

3.5

4.55.5

6.5

23

27

3135

39

43

47

51

55

100

70

Tgl: 5-02-16 Tgl: 6-02-16R N PP Hct

LABORATD!g" M#!$t#%

Abdominal circ.

(cm)

R$!g% &"!'$!

102.0

00

72.000Platelet (/mm3)

IV V

H()t#*%$t

P%#t$! Pl)+()

T*)!)!

D)%),

53.4

115/7

2

N)'$

110.00

0

y

3cc*g)(

40

3cc*g)(

10300

0

41.2

49.2

5.5

4.31

Pl)+()!)t 200cc

Pl)+()!

)t 200cc

LABORATD!g" M#!$t#%An MBS, 6 yo: BW


30/44

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

2

24

32

40

48

56

64

72

40

60

80

100

120

140

160180

200

2.5

3.5

4.5

5.5

6.5

23

27

31

35

39

43

47

51

55

100

70

Tgl: 7-02-16 Tgl: 8-02-16R N PP Hct

D!g" M#!$t#%

Abdominal circ.

(cm)

R$!g% &"!'$!

5500

0Platelet (/mm3)

VI VII

I

H()t#*%$t

P%#t$! Pl)+()

T*)!)!

D)%),N)'$

3cc*g)(

43.8

4500

0

5.54.31

37.5

LA+RATR&UMAh"ad


31/44

UM

)arameter 6/(/-= *rmal ran&e

H4 0&/d>3 -.: --.: -6.6

Hct 0B3 +-. +( 8:

)latelet 6+-, -6.786.

25! -+,8 +,= --,

eutr*1il -+.: 6 :

>im1*sit =+ ( 8

5as*1il .+ -

E*sin*1il -.6 - 8

M*n*sit -(.8 (

M!< 01>3 . -

M!H 0p&3 +.= (= +8

M!H! 0&/d>3 ++.= +( 7 +8

RNTGEN TRAAh"ad


32/44

)neum*nia 4ilateral

LA+RATR&UMA#ditya


33/44

)arameter (:/-/-= 6/(/-= *rmal ran&e

H4 0&/d>3 . :.6 -.- -(.

Hct 0B3 (8.8 (+.8 +6 8+

)latelet (:, -6.786.

25! (6,-+ -. (=.

eutr*1il 8: 6 :

>im1*sit +.6 (( 8

5as*1il 6.+ -

E*sin*1il .+ ( 8

M*n*sit :.+ (

M!< 01>3 8.- +.= :+ -

M!H 0p&3 (:.= (=.: (- ++

M!H! 0&/d>3 +(. +( (= 7 +8

LA+ 34!#t


34/44

LA+ 34!#t

)arameter (:/-/-= 6/(/-= *rmal ran&e

5iliru4in %*tal0m&/d>3

-=.=( -,(

5iliru4in Direct0m&/d>3

-8.: ,=

Al4umin 0&/d>3 (.8 (.=8 +, 8,

a -+6 -+= -86

K +.8 +,6 6,-

!l -+ -:

GDS - 7-8

5$ +.- = 7 (

!reatinin .(: .: -.(

5% 8 min 7

))% -:.6 sec -(.+ -6.+

A)%% 8-.6 sec (:. +:


35/44

LA+RATR&UMidi


36/44


H4 0&/d>3 -.8 -. -(.

Hct 0B3 +.8 +6 86)latelet -:8, (-:,78:,

25! 8,-+ =, -:,6

eutr*1il +8.B (6 =

>im1*sit 66B (6 7 6

5as*1il .(B -E*sin*1il .(B - 76

M*n*sit .:B - 7 =

M!< 01>3 :+ --

M!H 0p&3 (:.8 (+ 7 +-

M!H! 0&/d>3 +8.( (= 7 +8

UR&NAL&S&Sidi


37/44


Gluc*se e&ati9e e&ati9e

)r*tein e&ati9e e&ati9e

5iliru4in e&ati9e e&ati9e

$r*4iliru4in *rmal *rmal

pH =.6 8,6 ,

$rine Gra9ity -.6 -. -.+

5l**d e&ati9e e&ati9eKet*n e&ati9e e&ati9e

itrit e&ati9e e&ati9e

>euk*cyte Esterase e&ati9e e&ati9e


38/44

LA+RATR&UMi7a


39/44

)arameter 8/(/-= 6/(/-=Sardit*

*rmal ran&e

H4 0&/d>3 .+ .6 -. -6.=

Hct 0B3 (. (6 +=.8 8=.+

)latelet 8, -, -8,78,

25! ++:,-+ +-8,+ +, -,8

eutr*1il 8 + +8 :-

>im1*sit - - (6 8

5as*1il -E*sin*1il - +

M*n*sit -6 (

M!< 01>3 :=. : = +

M!H 0p&3 (8. (=. (( +8

M!H! 0&/d>3 +(.+ +8.- +( +=

LA+ 34!#ti7a


40/44

3

)arameter 8/(/-= 6/(/-=Sardit*

*rmal ran&e

SG#% -:.: 8

SG)% -. 8

5$ (.: -: 7 +:

!reatinin .= -

$ric acid -.

>DH -:8

atrium -+6.=

Kalium +.8

Kl*rida --

RNTGEN TRAi7a


41/44

Gam4aran 4r*n

i7a


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)ERI)HERA> 5>##D SMEAR


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Allcase_Restu_5Feb2016