Protap Ilmu Penyakit Saraf

8/12/2019 Protap Ilmu Penyakit Saraf

1/44

STANDAR

PELAYANAN MEDIS

SMF SARAF

RUMAH SAKIT UMUM DAERAH ULIN

BANJARMASIN

2007

0


2/44

2007

RSUD ULIN

Jl. A. Yani 43

Telp.257472 /

252180 Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N

N(. D()*#en N(. Re+i$i N(. ,ala#an

1 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an

Di"e)*" R*#a Sa)i U#*#

Dae"a Ulin an!a"#a$in

D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *aNI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis NYERI KEPALA

2. ICD A. Tgang !"o" #Tnsion "$% &a'a(&)* ++.2

1. E%iso'i(,"nsion,"$% &a'a(& #* ++.20-* ++.21)

2. C&oni(,"nsion,"$% &a'a(& #* ++.22- * ++.2/)

B. Migain #* +/)

1. Tan%a aa #* +/.0)

2. Dngan aa #* +/.1)

C. Pas(a Taa #* ++.)

1. A(" %os""aa"i( &a'a(& #* ++.0)2. C&oni( %os""aa"i( &a'a(& #* ++./)

D. Na3gia Tigina3 #* ++.+7)

E. N$i K%a3a To !"a4 #* ++.22)

/. Ki"ia A. Tgang !"o"

1.

o S4ang,4angn$a "'a%a" 10 %iso' sangan

n$i 4%a3a 4ang 'ai 10 &ai5"a&n

o N$i 4%a3a 63angsng 'ai /0 ni" sa%ai 7 &ai

o S'i4i"n$a i3i4i 2 4aa4"is"i4 n$i 4%a3a

6i4"

, 3o4asi 6i3a"a3

, n4an a"a ngi4a" #"i'a4 6'n$")

, In"nsi"as ingan a"a s'ang

, Ti'a4 'i%6a" o3& a4"i8i"as "in s%"i

69a3an a"a nai4 "angga

o Ti'a4 'i9%ai

, Ma3 a"a n"a& #6isa ano4sia)

, L6i& 'ai sa" 43&an :o"o:o6ia a"a

:ono:o6ia

o Ti'a4 64ai"an 'ngan 43ainan 3ain

2.o Ra"a,a"a :4nsi sangan n$i 4%a3a 36i& 6sa

1


3/44

a"a saa 'ngan 1; &ai563an #10 &ai5"a&n)

B. Migain

1. Mign "an%a aa

o S4ang,4angn$a "9a'i ; sangan n$i

4%a3a 63ang 'ngan ani:s"asi sangan63angsng +,72 9a- $ang %n$ai s'i4i"n$a

2 4aa4"is"i4 6i4" ni3a"a3- 6'n$"-

in"nsi"as s'ang a"a 6a"- 6"a6a& 6a"

'ngan a4"i8i"as :isi4

o S3aa n$i 4%a3a 'is"ai sa3a& sa" 6i4"

nasa 'an a"a n"a&- :o"o:o6ia 'an :ono:o6ia.

o Sangan n$i 4%a3a "i'a4 64ai"an 'ngan

43ainan $ang 3ain

2. Mign 'ngan aa

o S4ang,4angn$a "9a'i 2 sangan n$i

4%a3a 63ang $ang 'i'a&3i g9a3a no3ogi

:o4a3 $ang 8si63 s(aa 6"a&a% ; < 20 ni"

'an 63angsng 4ang 'ai =0 ni".

o T'a%a" s'i4i"n$a sa" aa 6i4" ini $ang

8si63 s%"i ganggan 8isa3- ganggan

snsois- ganggan 6i(aa 'is:asia.

o Pa3ing s'i4i" 2 'ai 4aa4"is"i4 6i4"

, *9a3a 8isa3 &ooni 'an5a"a g9a3a snsois

ni3a"a3

, Pa3ing "i'a4 "i63 sa" a(a aa s(aa

ga'a3 > ; ni" 'an 5 a"a 9nis aa 3ainn$a> ; ni".

, Tia% g9a3a 63angsng > ; ni" 'an ? =0

ni".

o Ti'a4 64ai"an 'ngan 43ainan 3ain.

C. Pas(a Taa

1. A(" Pos""aa"i( &a'a(&

K3inis N$i 4%a3a- "i'a4 4&as

o T'a%a" "aa 4%a3a- 'iana n$i 4%a3a

"9a'i 'a3a 7 &ai s"3a& "aa 4%a3a a"a

ss'a& 4sa'aan %n'i"a %3i& 46a3i.

o T'a%a" sa" a"a 36i& 4a'aan 'i 6a@a& ini

, N$i 4%a3a &i3ang 'a3a / 63an s"3a&

"aa 4%a3a.

, N$i 4%a3a n"a%- ""a%i "i'a4 36i& /

63an s9a4 "aa 4%a3a.

2. C&oni( Pos""aa"i( &a'a(&

o N$i 4%a3a- "i'a4 4&as

o T'a%a" "aa 4%a3a- 'iana n$i 4%a3a

"9a'i 'a3a 7 &ai s"3a& "aa 4%a3a a"a

ss'a& 4sa'aan %n'i"a %3i& 46a3i.

o

N$i 4%a3a 63angsng 36i& 'ai / 63an s"3a&"aa 4%a3a.

2


4/44

D. Na3gia Tigina3

o Sangan n$i %ao4sisa3- s%on"an- "i6a,"i6a- n$i

"a9a- s%:isia3- s%"i 'i "s4- "s"- "6a4a

%a'a @a9a& a"a :on"a3 #n$a ni3a"a3)

66a%a '"i4 sa%ai 2 ni"- 63ang- "6a"as%a'a > 1 (a6ang N. Tigins #N. ). N$i

n$a isi 'a3a 9ang4a @a4" 68aiasi.

In"nsi"as n$i 6a" %si%i"asi 'a%a" 'ai "igg

aa #%3i4a naso3a6ia3is 'an 5 %i%i) a"a %a'a a4"i8i"as

&aian s%"i 6i(aa- 6as& 4a- n(4

9nggo"- goso4 gigi #trigger factors). Bn"4 sangan

asing,asing %asin saa. Dian"aa sangan

n$a asi"oa"is. Un$a "i'a4 a'a ':isi"

no3ogi4.

E. N$i 4%a3a "o o"a4

o N$i 'a%a" 6%a 6a" s%"i 'i"s4- 6'n$"

$ang :4nsi sangan 'an in"nsi"asn$a a4in

3aa a4in &6a" 'an 4a'ang,4a'ang 'ii4"i n"a&

%o$4"i3. Bgan"ng 3o4asin$a 'i o"a4- g9a3a

no3ogis 'a%a" "i63 a"a "i'a4. *9a3a

no3ogis 49ang :o4a3- ono%as- ganggan

snsi6i3i"as- ganggan %ng3i&a"an- ganggan n"a3-

%3%a - 'an 3ain,3ain.

+. Diagnosis

Ban'ing

o N$i 4%a3a %n$a4i" 3ain THT- gigi 3"- a"a-

&i%"nsi- %n$a4i" 'ngan 'a

o

*anggan %si4osoa"is;. Pi4saan

Pnn9ang

A.N$i 4%a3a "gang o"o"- 4a3a ag,ag 'a%a" 'i3a44an

%i4saan EM*)

B. N$i 4%a3a 8as43- 4a3a &6a" sangann$a EE*-

:o"o "ng4oa4- Mign 43asi4 'ngan sangan &6a" 'an

ign 4o%3i4a"a 'a%a" 'i%"i6ang4an a"ioga:i

a"a CT,S(an o"a4 'ngan 4on"as

C. N$i 4%a3a %as(a"aa 'a%a" 'i%"i6ang4an EE*

n"4 8a3asi 4a9an

D. Na3gia Tigina3 "i'a4 34an %i4saan

%nn9ang- 4(a3i a'a ':isi" no3ogis $ang ngaa&

%a'a 43ainan no3ogis :ngsi s4n' %3 'i3a44an%i4saan a'io3ogi #:o"o "ng4oa4- CT,S(an a"a

MRI)

E. N$i 4%a3a "o o"a4 &as 'i3a44an %i4saan

on"gn "ng4oa4- EE* 'an a"ioga:i a"a 3angsng

CT,S(an o"a4.

=. Kons3"asi o Bgan"ng 4ass Pn$a4i" Da3a- THT- Ma"a- gigi,

3"- 6'a& saa:- %si4osoa"is- 4a3a 'i%34an n"4

n(ai %n$6a6 4s"a4ania3 a"a %ngo6a"an 3an9".

7. Pa@a"an RS o Ra@a" 9a3an %a'a n$i 4%a3a "gang o"o"- n$i

4%a3a %as(a "aa a"a na3gia "igina3

o Ra@a" ina% %a'a n$i 4%a3a 8as43 'i%34an

/


5/44

%a@a"an &an$a %a'a s"a"s igns #o6a" "i'a4

no3ong) %a'a ign 4o%3i4asi

o N$i 4%a3a "o o"a4 &as 'ia@a" n"4

4s%3oasi 'an o%asi.

. Ta%i A. N$i 4%a3a "gang o"o"o Ana3g"i4 'an %3as o"o" #%nnang) 'ia%a-

%o6aa" Psi4o"a%i s%o"i: 4a3a 'i%34an.

o Fisio"a%i %anasan 'an asas o"o" 4'4

#4%a3a) 4a3a 'i%34an.

B. N$i 4%a3a 8as43

o Is"ia&a"- ana3g"i4 'an %nnang

o aso4ons"i4si 4a:go" / ,1 "a63" #"i'a4 6o3&

%a'a @ani"a &ai3 'an %n'i"a 4a'io8as43)

o Sa"i%"an 1 "a63"

o

F3naiin 1 ;,20 go Ka3a sangan sing si%o&%"a'in- %o%ano3o3

a"a %o"i:n- n"4 %n(ga&an

o Hin'ai :a4"o %n("s

C. N$i %as(a "aa

o Ana3g"i4

o Mino "ansi3i

o An"i "igo #%o43o%ain- 'i:n&i'ain-

6"a&is"in) 6i3a a'a 8"igo

o Psi4o"a%i #4a3a %3)

D. Na3gia "igina3

o Ana3g"i4 'an %nnang

o Di:n&i'an"oin / 100 g

o Ka6aa%in / ,1 "a63" G 200 g #o6a"

%i3i&an)

. S"an'a RS o Sa RS. K(a3i %a'a 4ass $ang 34an

"in'a4an in8asi: o%asi &as RS "i% A5B $ang

%n$ai Do4" S%sia3is B'a& Saa:

10. Pn$3i" o Han$a %a'a "o o"a4 $ang 6si:a" ganas a"a $ang

3"a4n$a 'a3a '4a" 6a"ang o"a4

11. In:o'

Consn"

o P3 ""3is- &an$a %a'a 4ass $ang 34an

"in'a4an in8asi: 'an o%asi12. Tnaga S"an'a o Do4"

o Bi3a 43&an "i'a4 &i3ang- a%a3agi 6"a6a& 6a"

a"a 'i'a%a"i 43ainan no3ogis #ign 4o%3i4a"a-

"o o"a4) &as 'i94 4 Do4" A&3i Saa:

1/. Laa

Pa@a"an

o Bo6a" 9a3an- 4(a3i %a'a s"a"s ign 4o%3i4a"a

'an "o o"a4 &as 'ia@a" $ang 3aan$a 6gan"ng

%a'a 6a" a"a s3i" 4ass "s6"

1+. Masa

P3i&an

o Bgan"ng 4a'aan asing,asing

1;. Hasi3 o Pa'a n$i 4%a3a "gang 'an %as(a "aa %a'an$a s6& "o"a3

+


6/44

RSUD ULIN

Jl. A. Yani 43

Telp.257472 /

252180 Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N


5 /41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an

Di"e)*" R*#a Sa)i U#*#Dae"a Ulin an!a"#a$in

D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

1. Diagnosis EPILEPSI

2. ICD *.+0

A. Mn" 6n"4 sangan

o E%i3%si #gan' a3 No. ICD *.+1.0 P"i"

a3 No. ICD *.+1.1 io43ons 'an 3ain,3ain).o E%i3%si 8o4a3 #o"ois- snsi6i3i"as- %asia3 4o%34s

'an 3ain,3ain). No. ICD *.+1.2

o S"a"s 4on83sis 5 s"a"s %i3%"i4is *.+1

B. Mn" %n$6a6

o I'io%a"is

o Si%"oa"is

/. Ki"ia K3inis

Sa" 4a'aan no3ogi4 $ang 'i"an'ai o3& 6ang4i"an

%i3%si $ang 63ang- $ang "i63 "an%a %o8o4asi.

S'ang4an 6ang4i"an %i3%si sn'ii a'a3a& sa"

ani:s"asi 43ini4 $ang 'is6a64an o3& 3%asn$a a"an

3is"i4 $ang a6noa3- 636i& 'an sin4on- 'ai non

$ang #""aa) "3"a4 %a'a 4o"4s s6i. A4"i8i"as

%ao4sisa3 a6noa3 ini n$a "i63 in"i""n

'an self- limited.

Sin'oa %i3%si a'a3a& %n$a4i" %i3%si $ang 'i"an'ai

o3& s4%3an g9a3a $ang "i63 6saaan #"as4

"i% 6ang4i"an- "io3ogi- ana"oi- :a4"o %si%i"an sia

saa" a@i"an- 6a"n$a %n$a4i"- si43s &aian 'an

%ognosa).

A. Ki"ia Diagnosiso *9a3a s6i :o4a3 a"a #%nnan ganggan

;


7/44

4sa'aan- 49ang- %as"si 'an 3ain,3ain) $ang

"i63 63ang

B. E%i3%si Fo4a3

o Mani:s"asi 43inis :o4a3 a"a ani:s"asi 43inis 3ain

$ang 'i"n9ang 'ngan 43ainan EE* :o4a3 #(on"o& %i3%si %asia3 4o%34s 5 %i3%si 3o6s "%oa3is-

%i3%si :o4a3 s'&ana 'an 3ain,3ain).

C. E%i3%si Si"oa"is

o E%i3%si "s6" %a4an g9a3a 'ai sa"

%n$a4i" #"o- CD 'an 3ain,3ain). P3 'i(igai

%i3%si si"oa"is 6i3a 6n"4 sangann$a :o4a3-

%i3%si 3ai %a'a sia 36i& 'ai 20 "a&n- %i3%si

%ogsi:- %i3%si $ang s3i" 'i"angg3angi 'ngan

o6a".

D. S"a"s Kon83sis

o Sangan 49ang $ang 63angsng 3aa #36i&

'ai /0 ni") a"a sangan 49ang "an%a %3i&an

4sa'aan

+. Diagnosis o K9ang 'a

o Sin4o%

o Na4o3%si

o Mign

o Ba"& Ho3'ing S%33s

o His"ia

;. Pi4saan

Pnn9ang

o EE*- :o"o %o3os 4%a3a 'i3a44an 6i3a a3a" "s'ia

o CT,S(an 4%a3a- %ngsi 36a3 'i3a44an a"asin'i4asi #6i3a 'i%i4i4an %i3%si si%"oa"is)

o Un"4 'a%a" 3i&a" :4 sa%ng o6a" 'an %n$6a6

49ang 'a%a" 'i%i4sa

o Daa& %i: 3ng4a% #DPL)- :ngsi &a"i- :ngsi

gin9a3 #n"4 4on"a'is4si o6a")- 34"o3i" #Na- K- Ca- C3)-

g3a 'aa&- 4a'a o6a" #4a3a %3)

=. Pa@a"an RS o Ra@a" 9a3an

o Ra@a" ina% 6i3a %i3%si si%"oa"is 'an %3

4s%3oasi

o Ra@a" ina% 6i3a s"a"s 4on83si7. Ta%i %"in$ip

o Sga s"3a& 'iagnosis- gna4an sa" 9nis o6a"

4o6inasi o6a" 'igna4an 6i3a "i'a4 ""angg3angi

'ngan sa" 9nis o6a". Pa'a @ani"a $ang asi&

ng4in &ai3 gna4an Ka6aa%in- @ani"a &ai3

$ang "3a& nggna4an o6a" 3ain 3an9"4an %ngo6a"an.

o Dosis 'inai44an 6"a&a% sa%ai sangan 6&n"i-

3a3 %"a&an4an 2,+ "a&n 66as sangan- 4'ian

'i"n4an 6"a&a%.

-a an i*na)an

o Fno6a6i"a3 1,; g54gBB

o Fni"oin ;,10 g54gBB 'osis 6iasa 3ai 'ngan

=


8/44

/00 g5&ai

o K3ona%a 0-0;,0-2 g54gBB- 3ai 'ngan 'osis

4(i3 ""aa 'igna4an %a'a %i3%si Mio43oni4 'an

P"i" Ma3

%enaala)$anaanS"a"s Kon83si

o T9an ng&i3ang4an 49ang "'4 36i& 'ai =0 ni"

"'ii a"as

Taap I

o E8a3asi %n'i"a 0,1; ni"

o P6ai4i sis" 4a'ios%iasi

o !4sign 6i3a %3

o Ba" 'iagnosis

o Pasang in:s

o La44an %i4saan 3a6oa"oi DPL- 34"o3i"-- 4a"inin- 4a'a o6a" an"i%i3%si-Drug Sreen-

Metabolic Sreeen

o *34osa 2; g i8

Taap II

o Mng&n"i4an 49ang 'a3a 20,/0 ni"- 4'ian

Dia%a I 2 g5ni" 'ngan 'osis 10,+0 g

#&a"i,&a"i '%si %na:asan). Bsaaan 'ngan

Dia%a 6i4an in:s Fni"oin 20 g54gBB 'a3a

NaCL :isio3ogis 'ngan 4(%a"an "i'a4 36i& 'ai ;0

g5ni" #a@asi EK*) 'an "4anan 'aa&)

Taap IIIo S"3a& /0 ni" s3an9"n$a

, In"6asi- %asang EE*- %"i6angan ans"si

- sn"aa i" 'i3a44an

, In:s Fni"oin "a6a&an 10 g54gBB a"a

Fno6a6i"a3 'ngan 4(%a"an "i'a4 36i& 'ai 100

g5ni" #%&a"i4an &i%o"nsi)

o Bo3s Li'o4ain 2 g54gBB I 'i i4"i 'ngan in:s

/,10 g54gBB59a

Taap I:

o

La44an anas"si %a'a $ang :a4". S"an'a RS o Ps4sas5sa RS #n"4 s"a"s 4on83si 36i&

6ai4 6i3a a'a 'iang ICU)

. Pn$3i" o Ra4si a3gi #(on"o& Sin'o S"8n Jo&nson)

o E' s6i 4ana ganggan %na:asan a4i6a"

49ang,49ang "s,ns %a'a s"a"s 4on83si

o A3a" 4a'ios%"o $ang "i'a4 sia% %a4ai a"a

"3a6a" 6"in'a4

10. In:o'

Consn"

o P3 ""3is

11. Tnaga S"an'a o Do4" - 6i3a "i'a4 a'a Do4" A&3i saa:

12. 3aa Pa@a"an o Pa'a s"a"s 4on83si sa%a 49ang "a"asi-

4sa'aan %3i& 'an 4a'aan "3a& ng4in4an

7


9/44

n"4 6o6a" 9a3an

o Pn'i"a 6o6a" 9a3an s4ang,4angn$a 2,;

"a&n 66as sangan

1/. Masa

P3i&an

o Pa'a s"a"s 4on83si 36i& 4ang 1 ingg

1+. Pa"o3ogi o Jaang- 6i3a 4asan$a 'i o%asi #isa3 "o)

1;. A"o%si o Bi3a 'i%34an

RSUD ULIN

Jl. A. Yani 43

Telp.257472 /252180 Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N


8 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. DIA*N!SIS *AN**UAN PEREDARAN DARAH !TAK #STR!KE)

2. ICD *.+;- *.+=- I. =0- I.=1

/. Ki"ia o S"o4 a'a3a& ani:s"asi 43ni4 'ai ganggan :ngsi

s6a3- 6ai4 :o4a3 a%n n$3& #g3o6a3)- $ang

63angsng 'ngan (%a" 36i& 'ai 2+ 9a- a"a 6a4&i

'ngan a"- "an%a 'i"4ann$a %n$6a6 s3ain 'ai

%a'a ganggan 8as43a

Jeni$ S"()e

a. S"o4 Non Hoagis

, Tansin" Is4i( A""a(4 #TIA)- R8si63 Is4i(

No3ogi( ':isi" #RIND) #*.+;) , To6osis s6i

, E6o3i s6i

6. S"o4 Hoagis

, P'aa&an In"as6a3 #I.=1)

, P'aa&an S6aa4&noi' #I.=0)

+. Diagnosis

Ban'ing

o Taaa 4a%i"is

o Ens:a3i"is

o To !"a4

;. Pi4saan

Pnn9ang

o La6oa"oi H6- H"- L4osi"- LED- To6osi"-

Aggasi "o6osi",8is4osi"as %3asa #6i3a ng4in)-3i%i'- g3a- asa a"- - 4a"inin- &oosis"in-


10/44

@a4" %'aa&an- @a4" %64an- as"%- 34"o3i"-

in "in

o Pngsi 36a3 #a"as in'i4asi)

o EK*

o Ra'io3ogis :o"o "&oa4s- "ng4oa4- 3&- CT,s(an-MRI- Do%3 U3"ason'- a"ioga:i #6i3a a'a)

=. Kons3"asi o Pn$a4i" Da3a #*in9a3- Hi%"nsi- En'o4in-

Ka'io3ogi) n"4 4on:iasi 43ainan ogan "4ai"

o B'a& s$aa:- n"4 4ass &oagis $ang %3 'i

o%asi #anisa- AM- 8a4asi &a"o)

o B'a& 8as43- s34"i: n"4 4ass "o6osis- a"i

4s"a4ania3 #"o6on'a"4"oi)

7. Pa@a"an RS o Pn'i"a 6a #4ang 'ai s%3& &ai)

o Pn'i"a 'ngan g9a3a 43inis $ang %ogsi:

. Ta%i a. Se;a"a U#*#1. U

Di"94an "&a'a% :ngsi 8i"a3 %a,%a- 9an"ng-

gin9a3- 4si6angan 34"o3i" 'an (aian gii- &igin

2. K&ss

Pn(ga&an 'an %ngo6a"an 4o%3i4asi

R&a6i3i"asi

Pn(ga&an s"o4 "in'a4an %oo"i:- %i 'an

s4n'

. Se;a"a 6*$*$

1. S"o4 Is4i45In:a4

o An"i aggasi %3a"3" as%iin- "i43o%i'in-43o%i'og3- 'i%ii'ao3

o To6o3i"i4 ",PA #&as n&i 4i"ia in43si)

o An"i4oag3an &%ain- LMH- &%ainoi' #n"4

so4 6o3i) #*i'3in s S"o4 200+)

o No%o"4"an

2. P'aa&an S6aa4&noi'

o An"i s%aso8as

o No%o"4"an

/. P'aa&an In"as6a3

6(n$e"+ai


11/44

o &i'os:a3s a4i6a" %'aa&an in"a8n"i43 a"a

s633

o *CS 7

Te"api 6(#pli)a$i

, An"i'a 3a"an ani"o3 20, An"i6io"i4a- an"i'%san- an"i4on83san a"as in'i4asi

, An"i"o6osis 8na 'a3a 'an 6o3i %a

%enaala)$anaan Fa)(" Ri$i)(

An"i&i%"nsi :as a4" s"o4 'ngan %s$aa"an

""n" #*i'3ins S"o4 200+)

, An"i6io"i4a :as a4" s"o4 'ngan %s$aa"an ""n"

#*i'3ins S"o4 200+)

, An"i'is3i%i'ia a"as in'i4asi

Te"api N(n


12/44

o Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3-

9an"ng- &i%"nsi- DM) 4o%3i4asi 9a'i "%ang "in'i&

1=. Pa"o3ogi o Bi3a 'i3a44an "in'a4an 6'a& #"i'a4 6gi" %n"ing)

17. A"o%si o Bi3a %3- a"as %in"aan %o3isi- %nga'i3an 'ngan

siin 43aga

RSUD ULIN

Jl. A. Yani 43

Telp.257472 /

252180 Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N


11 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis TRAUMA SUSUNAN SARAF

2. ICD S.0=

A . Saa: Psa"

o Taa Ka%i"is no.S.0=

1. Koosio s6i #C'a !"a4 Ringan)

no.S.0= 0

2. Kon"sio s6i #C'a !"a4 S'angBa") no.ICD. ; I

/. P'aa&an %i'a3 no.s.0=.+

+. P'aa&an s6'a3 no.S.0=.;

;. Taa 4a%i"is $ang 'is"ai :a4" """%

'an :a4" "64a

o Taa M'33a s%ina3is

1. Koosio '3a s%ina3is

2. Kon"sio '3a s%ina3is

/. Dis"ai 34sasi a"a :a4" 8"6a

B. Saa: Pi:

o A83si a'i4s

o Lsi %34ss

11


13/44

o Lsi saa: %i: #3ngan 'an "ng4ai)

/. Ki"ia

Diagnosis

A. Saa: %sa"

1. Minia3 O Si%3 Ha' In9$ #SHI)

, Ni3ai S4a3a Coa *3asgo@ 1; #noa3)

, Ksa'aan 6ai4, Ti'a4 ansia

2. C'a !"a4 Ringan #C!R)

, Ni3ai S4a3a Coa *3asgo@ 1+ a"a

, Ni3ai S4a3a Coa *3asgo@ 1;- 'ngan

, Ansia %as(a ('a 2+ 9a- a"a

, Hi3angn$a 4sa'aan 10 ni"

, Da%a" 'is"ai g9a3a 43ini4 3ainn$a- isa3n$a a3-

n"a&- sa4i" 4%a3a a"a 8"igo

/. C'a !"a4 S'ang #C!S)

, Ni3ai S4a3a Coa *3asgo@ ,1/

, Hi3angn$a 4sa'aan 10 ni" ""a%i 4ang 'ai =9a

, Da%a" a"a "i'a4 'i"4an a'an$a ':isi" no3ogis

, Ansia %as(a ('a s3aa 4ang 36i& 7 &ai

#6isa %osi"i: a"a nga"i:)

+. C'a !"a4 Ba" #C!B)

, Ni3ai S4a3a Coa *3asgo@ ;,

, Hi3angn$a 4sa'aan = 9a

, Di"4an ':isi" no3ogis

, Ansia %as(a ('a 7 &ai

;. Kon'isi Ki"is, Ni3ai S4a3a Koa *3asgo@ /+

, Hi3angn$a 4sa'aan = 9a

, Di"4ann$a ':isi" no3ogis

Pendarahan epidural

o Da%a" "9a'i n$"ai 4oosio a"a%n 4on"osio

s6i

o Biasan$a "9a'i 'a3a 2 2+ 9a

o Da%a" 'i'a&3i in"8a3 3si'- 4'ian 4sa'aan

64

o Di'a%a"i 3a"a3isasi #1 %%i3 i'iasis) 'is"ai

43%&an a"a :34s %a"o3ogis anggo"a ga4 sisi$ang 3ain

o 70 4ass 'i'a%a"i 9ga :a4" "%oa3is

Pendarahan subdural

o Da%a" "9a'i n$"ai 4oosio a"a%n 4on"sio

s6i.46an$a4an s6a4" a"a 4onis.

o T9a'in$a 36i& 3aa- 66a%a &ai sa%ai 66a%a

63an ss'a& "aa.

o Pa'a $ang a4" "9a'i (%a" s%"i %n'aa&an

%i'a3

o Sa4i" 4%a3a $ang "i'a4 &i3ang- 4a'ang,4a'ang a3a&

ng&6a".

12


14/44

o Di'a%a"i 'a %a%i3- 3a"asasi- 4a3a 36i& 3aa 3agi

'a%a" "9a'i %nnan 4sa'aan.

Trauma kapitis dengan disertai fraktur

o Dngan 6an"an a3a" on"gn "a%a4 :a4" a"a

%a'a ins%4si "a%a4 3angsng 'aa" a"a9aingan

Trauma medula spinalis

o A'an$a "aa %a'a 'aa& s%an9ang "3ang

63a4ang

Komosio medula spinaIis

o A'an$a n$i s"%a" $ang 4a'ang,4a'ang 'a%a"

'is"aiganggan no3ogi- s"inggi "aa- sanga"

ingan 'an sn"aa.

Kontusio medulla spinalis

o A'an8a n$i s"%a" $ang 'is"ai ganggan

no3ogi s"inggi "aa- ganggan o"ois-

snsi6i3i"as 'an a"ono.

Disertai luksasi atau fraktur vertebra

o K3inis sana 'ngan 4on"sio '3a

o Dngan 6an"an on"gn "a%a4 34sasi aa :a4"

8"6a

B Saa: Pi:

o A'an$a "ai4an $ang 636i&an a"a "aa 3angsng

%a'a %o4sia3 anggo"a ga4.

vulsi radikso N$i s"%a" anggo"a ga4 6agian %o4sia3 %a'a

saa" 49a'ian 'ii4"i 43%&an "o"a3 %ann

!esi Pleksus

o K9a'ian saa "a%i 43%&an 'a%a" "o"a3 a"a

s6agian

!esi saraf perifer

o A'an$a "aa s"%a". 'i'a%a" 43%&an 'an

ganggan snsi6i3i"as 66a%a o"o" $ang 'i%saa:i

saa: $ang 6sang4"an.'i'a%a"i gangan %ga4an

"i'a4 "o"a3

+. Diagnosis

Ban'ing

A. Saa: %sa"

"l"rauma kapitis

o Pn'aa&an o"a4 #s"o4)

o !8'osis #in"o4si4asi) !6a" %nnang 'an a34o&o3

o Ra4si 4on8si


o Ta4 a'a 'iagnosis 6an'ing

B. Saa: %i:

Monono%a"i a4"

;. Pi4saan

Pnn9ang

Trauma kapitis

o Ron"gn %o3os "ng4oa4 AP53a"o Fngsi 36a3 4a3a 'iagnosis ag4an 'an "a4 a'a

1/


15/44

4on"ain'i4asi.

o EE* 'an a"ioga:i a"a 3angsng CT,S(an o"a4 %a'a

%n'aa&an %i'a3 'an s6'a3.


o Ron"gn 8"6a 6sang4ano Fngsi 36a3 4a3a "a4 a'a 4on"ain'i4asi

o Po"nsia3 E8o4 #SSEPSoa"osnso$ E8o4' Po"nsia3)

Saraf perifer

o Pi4saan EM* #3("o$oga%&$ )

=. Kons3"asi o Bgan"ng in'i4asi 6'a& saa: a"a 6'a& "3ang

7. Ta%i Tgan"ng 'a9a" 6a"n$a ('a

3 . Minia3

, Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a"

, Is"ia&a" 'i a&

, Di6i nas&a" aga 46a3i 4 Ra& Sa4i" 6i3a a'a"an'a,"an'a %'aa&an %i'a3- s%"i oangn$a 3ai

"3i&a" ngan"4 #4sa'aan 3ai "n,gia3a 3(i'

in"8a3)

2.C'a !"a4 Ringan #Koosio S6i)

, Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a"

, !6s8asi 'i Ra& Sa4i" 2 &ai

, K3&an &i3ang- o6i3isasi

, Si%"oa"is an"i 8"igo- an"i "i4- ana3g"i4a

, An"i6io"i4a #a"as in'i4asi)

/. C'a !"a4 S'ang 'an Ba" #Kon"sio S6i)

a. Ta%i UUn"4 4sa'aan nn

, La44an ssi"asi

, B6as4an 9a3an na:as #Ai@a$)- 9aga :ngsi %na:asan

#Ba"&ing)- Ci(3a"ion #"i'a4 6o3& "9a'i &i%o"nsi-

sis"o3i4 Saa 'ngan a"a 36i& 'ai 0 nHg)- na'i-

s& #"i'a4 6o3& sa%ai "9a'i %i4sia)

, Ksi6angan (aian 'an 34"o3i" 'an n"isi $ang

(4%- 'ngan 4a3oi ;0 36i& 'ai noa3

, Jaga 4si6angan gas 'aa&

, Jaga 46si&an 4an'ng 4i&- 4a3a %3 %asang

4a"", Jaga 46si&an 'an 43an(aan 9a3 in"a8na , R6a&

%osisi n"4 (ga& '46i"s , Posisi 4%a3a

'i"inggi4an /0 'a9a"

, Pasang s3ang nasogas"i4 %a'a &ai 4'a- 4(a3i

4on"a in'i4asi $ai" %a'a :a4" 6asis 4anii

, In:s (aian iso"onis

, Bi4an o4sign ssai in'i4asi

6. Ta%i K&ss

1. M'i4an"osa

, Mnga"asi "4anan "inggi in"a4ania3- 6i4an

Mani"o3 20

1+


16/44

, Si%"oa"is ana3g"i4- an"i"i4- an"i%i"i4

, An"i%i3%si 'i6i4an 6i3a "9a'i 6ang4i"an %i3%si

%as(a ('a

, An"i6io"i4a 'i6i4an a"as in'i4asi

, An"i s"ss 3( 'i6i4an 6i3a a'a %'aa&an3a6ng

2. !%asi 6i3a "'a%a" in'i4asi

(. R&a6i3i"asi

, Mo6i3isasi 6"a&a% 'i3a44an s(%a"n$a s"3a&

4a'aan 43ini4 s"a6i3

, Nos"oasi 'an No&a6i3i"asi 'i6i4an ssai

Trauma Kapitis dengan fraktur tertutup

o Ti'a4 'i3a44an "in'a4an 4&ss- 4(a3i %a'a :a4"

i%si: 'ngan 4'a3aan 36i& 'ai 0-; (. !%asi si"o

'i49a4an 4a3a "4anan in"a4ania3 ninggi sa4i"4%a3a &6a" 'an n"a&.

Trauma Kapitis dengan fraktur tertutup

o Di6i4an an"i6io"i4 'osis "inggi n"4 n(ga& in:4si

o"a4 'an 4ons3"asi 4 6agian 6'a& saa: n"4

%n6si&an 'an %n9a&i"an s3a%" o"a4.

Komosio medula spinalis

o Is"ia&a" 'an o6oansia5no"o%i4

o Fisio"a%i

Kontusio medula spinalis

o

Is"ia&a" 'an o6oansia5"io"oni4o D4sa"ason $ang 'i6i4an 'a3a ang4aian 'is"ai

%6ian an"asi' a"a si"i'in.

Trauma medula spinalis disertai Iuksasi atau fraktur

o D4sa"ason $ang 'i6i4an 'a3a ang4aian

o Kons3"asi 6'a& saa: n"4 4ng4inan o%asi

vulsi radiks# lesi pleksus dan lesi saraf perifer

o No"o%i4 'an :isio"a%i. Ka3a "'a%a" 3si "o"a35%"s

4ons3"asi 4 6'a& saa: n"4 4ng4inan

%n$a6ngan

. Pa@a"an RS o Taa saa: %sa" &as 'ia@a"

o Taa saa: %i: 6iasan$a "i'a4 'ia@a" 4(a3i

'is"ai :a4" "3ang a"a ganggan 4&i'%an s&ai,

&ai

. S"an'a RS o Pa'a 4oosio s6i sa RS

o Yang 3ainn$a. RS $ang %n$ai 'o4" S%sia3is Saa:-

$ang a& sa4i" "i% C-B-A

10. Pn$3i" o Kana "i'a4 'i4"a&i %"o3ongan %a'a saa" "aa

'a%a" %6a" 4a'aan %a'a 4ass 'ngan :a4"

s8i4a3.

o Kana "9a'in$a (%a". 4a"ian 'a%a" "i63 s63

'a%a" 'i3a44an o%asi %a'a %'aa&an %i'a3o Kana "6a"asn8a "naga a&3i B'a& saa:. %n'i"a

1;


17/44

'a%a" ningga3 s63 'i4ii 4 RS 8ang 36i& Bsa

o Kon"sio 6a" 'ngan ganggan 9i@a oganis

o Kana 'a$a gnasi s3 saa: sanga" s'i4i"-

4"3a6a"an 'a%a" n$6a64an 4a"ian "o"a3 s3 saa:

11. In:o'Consn"

o T"3is- n"4 $ang 6si4o a"a 34an "in'a4anin8asi:5o%asi

12. Tnaga S"an'a o Do4" S%sia3is Saa:

o Do4" 'i "%a" $ang "i'a4 a'a 'o4" s%sia3is-

"a%i 4a3a 'a%a" &as 'i4ii 4 RS $ang a'a 'o4"

s%sia3is

o Do4" s%sia3is 6'a& saa: 'an 6'a& "3ang 4ass $ang

34an.

1/. Laa

Pa@a"an

o Un"4 $ang ingan /, = &ai 'an $ang 6a" 36i& 'ai =

&ai

1+. Hasi3 o Koosio 'an Kon"sio ingan s6& "o"a3o Kon"sio $ang 36i& 6a" sing a'a 43&an #g9a3a) sisa

o Kon"sio '33a. 3si "o"a3 a'i4s- %34ss 'an saa:

%i: sing 'i'a%a"i 43%&an %ann

1;. Pa"o3ogi o Bi3a a'a "in'a4an o%asi

1=.A"o%si o Sing 'i%34an %a'a 4ass,4ass 44asan n"4-

4%n"ingan 'i4o3ga3 #%nga'i3an)

1=


18/44

RSUD ULIN

Jl. A. Yani 43

Telp.257472 / 252180

Fax.252229an!a"#a$in

%&NAN'ANAN %ASI&N

N(. D()*#en N(. Re+i$i N(.

,ala#an

17 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis NEUR!PATI #*anggan Saa: T%i O %i:a3 No%a"&$)

2. ICD *.=0

/. Ki"ia A'a3a& sa" %n$a4i" 'ngan g9a3a 43ini4 $ang "i63

4ana 43ainan saa: %i:- n$a 6%a 'gnasi

non,in:3aasi $ang 3as 'ngan g9a3a $ang 3i%"i

43a&an o"oi4- ganggan snsoi4- ganggan a"ono

'an 3a&n$a :34s "n'on. Saa: %i: $ang "4na

3i%"i sa a4a saa: s%ia3is- s3 gang3ion a'i4s

'osa3is- sa a4a saa: %i: 'ngan sa (a6ang

"ina3n$a- ssnan saa: a"ono- 'an saa: o"a4 4(a3i

saa: o%"i4s 'an o3:a4"ois.+. Diagnosis o Po3ioi3i"is

17


19/44

Ban'ing o A"o:i o"o" s%ina3 #spinal muscular atroph$)

o Mias"nia ga8is

o M3"i%3 s43osis

o ALS 'an 3ain,3ain

;. Pi4saanPnn9ang

o Pi4saan 3io #(aian s6os%ina3) n"4 s3-

%o"in- g34osa- NaC3- ino3ogi #6i3a %3)

o Daa& "%i "in- g34osa- 4o3s"o3- .

Ka"inin- 34"o3i"- 3oga 6a"- ino3ogi- 6asi3 "a&an

asa- %i4saan 4a'a 8i"ain B1- B=- B12 'an 3ain,

3ain.

o Bi3a a'a "an'a,"an'a ania %nisiosa- %i4sa

&a"o3ogi 3ng4a%

o Uin "in

o Pi4saan 34"oioga:i #EM*)

o Pi4saan %o"nsia3 ("san Soa"osnsoisSoa"osnsois

o EK*

o Bio%si saa: o"o" #a"as in'i4asi)

=. Kons3"asi o Pn$a4i" 'a3a #n'o4ino3ogi- ino3ogi-

&a"o3ogi- "o4si4o3ogi 'an 3ain,3ain 6gan"ng 4asa).

B'a& Saa: 5B'a& #6i3a %3)

o K3i" #6i3a 4asa 3%a- &%s 'an 3ain,3ain).

7. Pa@a"an RS o No%a"i a4" sga ina%. Bi3a "i63 gangan

%na%asan #%a'a sin'o Lan'$)- 'i%34an %a@a"an

in"nsi: 'i ICUo Pa'a B33s %a3s$- no%a"i 4ana "4anan #Sa"'a$

nig&" %a3s$) 'an no%a"i ingan- 'a%a" 6o6a" 9a3an.

o No%a"i 4onis- 6gan"ng 4a'aan - 6i3a 6a"

a@a" ina%- 6i3a ingan (4% 6o6a" 9a3an.

. Ta%i o Bi3a 4asan$a 'i4"a&i- 4assn$a 'i"angg3angi

, n'o4in #Dia6"s 33i"s- i- &i%"ioi'- 'an 3ain,

3ain)- o6a"i %n$a4i" 'asan$a

, H%s# A($(3o8i- si%"oa"is)

, L%a #Ri:a%isin- DDS 'an 3ain,3ain. !%asi %a'a

4ass ""n")

,Taa #ng4in %3 "in'a4an o%a"i:)o No"o%i4 #4o6iansi 8i"ain B1- B=- B125

siano4o6a3ain 'an 3ain,3ain)

o Pa'a ':isinsi gii 'an :ngsi %n$a%an

'i%6ai4i

o Si%"oa"is #n"4 n$i sa3isi3a"- 4a6aa%in-

'an 3ain,3ain)

o Pa'a sin'oa *i33an Ba,S"o&3- 3an'$ 'an

8aiann$a

, Ko"i4os"oi' ACTH- Ko"ison- P'nison #asi&

6an$a4 %6'aan %n'a%a" "n"ang o6a" ini). Pa'a$ang 63ang 5 3a%s 4o"i4os"oi' 6an$a4

1


20/44

an:aa"n$a. !6a",o6a" ino%san Aa"io%in

, P3asa%asis

, Inog3o63in #+00 g54g5&ai n"4 ; &ai)

, An"i8ia3 6o3& 'i(o6a

, An"iin:3aasi 6o3& 'i(o6a. S"an'a RS o Sa RS. Bi3a 'i(igai a4an "i63 ganggan

%na%asan- sga 94 4 RS $ang 36i& 3ng4a%

#i3i4i ICU)

10. Pn$3i" o Kana %n$a4i"

, T9a'i %ogsi:i"as- ganggan %na%asan

o Kana "in'a4an

o Pa@a"an 'an :isio"a%i $ang 4ang (a" 'a%a"

'a&4an "9a'in$a in:4si "a4"s inais-

'46i"s- 4on"a4".

11. In:o'Consn"

o

P3 ""3is- %3 ""aa 6agi $ang 'i(igai 6a"%ogsi:

12. Tnaga S"an'a o Do4" - 6i3a a'a Do4" S%sia3is Saa:

1/. Laa Pa@a"an o Ra"a,a"a 2 ingg sa%ai 1 63an

1+. Masa P3i&an o Bgan"ng 4a'aan- a'a $ang (%a" "a%i a'a %3a

$ang "i'a4 'a%a" 649a n"4 s3aan$a

1;. Hasi3 o Un$a s6& 'ngan "an%a g9a3a sisa

o Jnis s"o4 3ain n$a s6& 'ngan g9a3a sisa

'ai $ang ingan sa%ai $ang 6a"


9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i

"%ang "in'i&

1=. Pa"o3ogi o Pa'a 4ass ""n" n"4 as"i4an 'iagnosis

'i%34an 6io%si saa: 4a'ang,4a'ang o"o",o"o" #9aang)

17. A"o%si o Bi3a 'i%34an #9aang)

1


21/44

RSUD ULIN

Jl. A. Yani 43

Telp.257472 / 252180

Fax.252229

an!a"#a$in

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,ala#an

20 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis MIASTENIA *RAIS

2. ICD *.70.0

/. Ki"ia o A'a3a& sa" %n$a4i" a"oin $ang "9a'i 4ana

sangan %a'a as"i34o3in s%"o 'ai nos43a

9n("ion o"o" 6gais o3& sa" an"i6o'i- a'a + "i%

1. !(3a $as"nia2. Mi3' gna3i' $as"&nia

20


22/44

/. S8 gna3i' $as"&nia

+. M$as"&nia (isis

+. Diagnosis

Ban'ing

o No%a"i

o Sin'oa La6",Ea"n

o *anggan 'i 6i'ang THT #'is:oni- 'is:agi)o *anggan 'i 6i'ang a"a #%"osis- o:"a3o%3gi)

;. Pi4saan

Pnn9ang

o Pi4saan EM* #Ts Yo33$- "s Ha8$ Mas3an'-

Pi4saan EM* sa6" "ngga3- sing3 :i6 EM*).

o Pi4saan an"i6o'i an"i ACHR 'an an"i o"o" 3i4 'i

'aa& #6i3a a'a)

o Pi4saan ino3ogi

o Fo"o ong"n "oa4s PA53a"5o63i4 1; 'a9a" #n"4

3i&a" a'an$a %6saan "is)

o CT,S(an "oa4s #6i3a a'a)

o Ts Pos"igin 5 "s "nsi3on=. Kons3"asi o Ino3ogi #6i3a a'a in'i4asi)

o P3ono3ogi #6i3a a'a "ioa)

o B'a& "oa4s #6i3a a'a "ioa)

7. Pa@a"an RS o Ra@a" ina% sga %a'a 4ass 6a"

o Bi3a 'i(igai a4an "i63 4isis ias"nia- %3

'ia@a" s(aa in"nsi: 'i ang ICU

. Ta%i o An"i4o3ins"as #A(&E) nos"igin 6oi'

#Pos"igin) 7-;,+; g "ia%2,= 9a 'an a"a %ii'os"igin

#s"inon) /0,120 g "ia% +,= 9a #'issai4an

46"&an)o Ko"i4os"oi'

o Inos%san nons"oi'

o Aa"ioin a"a si43os:ai' # 6i3a 'ngan ACHE "i'a4

6&asi3)

o Ti4"oi

o P3asa:osis %a'a ias"nia ga8is $ang 6a" a"a

4isis ias"nia

. S"an'a RS o Sa RS. Bi3a 4a'aan ng4in4an 94 4 RS

$ang %n$ai %a@a"an 3ng4a% #ICU)


, Kisis ias"nia

, 4isis 4o3ingi4

o Kana "in'a4an

, 9aang

11. In:o'

Consn"

o P3 ""3is

12. Tnaga S"an'a o Do4" - 6i3a a'a Do4" S%sia3is Saa:

1/. Laa Pa@a"an o Bgan"ng 4a'aan

1+. Masa P3i&an o 1 Mingg. Pn'i"a &as ""a% 4on"o3 s"3a& 43inis

s6&

1;. Hasi3 o T4on"o3

o Kng4inan 3%as

21


23/44

1=. Pa"o3ogi o Bi3a 'i3a44an "i4"oi

17. A"o%si o Jaang

RSUD ULIN

Jl. A. Yani 43

Telp.257472 / 252180

Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N


22 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis *AN**UAN !T!T #MI!PATI)

2. ICD *. 71- *. 72 #Ms(3a D$s"o%&asis an' o"& M$o%a"i()

/. Ki"ia o Sa" 43ainan $ang 'i"an'ai o3& a6noa3n$a

:ngsi o"o" #%a4an %6a&an %a"o3ogi %i) "an%a

a'an$a 'n8asi %a'a %i4saan 43ini4- &is"o3ogi4 a"ano:isio3ogi

22


24/44

o *9a3a s%si:i4 Bi3a a4an 6angn56'ii "an%a

ganggan- %n'i"a 6sa&a ngang4a" 'an n'oong

6a'ann$a 4 a"as s'i4i" 'i s'i4i" so3a&,o3a&

an9a" 4 a"as "&a'a% 'iin$a sn'ii $ang 'is6"

*o@s signo *o3ongan 'is"o:i o"o"

, Pogsi: 'an &'i"

Jnis D(&nn #'is"o:i Ms(3o Pogsi:) $ang

ganas 'an 9nis 'is"o:i 'ngan 3o4a3isasi 'an

"i4a" %a'a 9nis 43ain %ia #se%-linked). Dis"o:i

Ms(3o Pogsi: "i63 6angs,angs %a'a

sia /,; "a&n 'an 6iasan$a ningga3 s63 sia

20 "a&n.

o *o3ongan io"oni

, Bi3a 4on"a4si a4"i: o"o"- ""a% 6"a&an 66a%a @a4"

'a3a 4a'aan 4on"a4si #3a4sasi "3a6a")

@a3a%n angsang inisia3 s'a& 6&n"i. Misa3n$a

6i3a "angan gang ssa" 'ngan a" %n'i"a

"i'a4 6isa 3%as4an %gangann$a 'ngan (%a"-

4ana o"o",o"o" "angan asi& ""a% 'a3a 4a'aan

4on"a4si

o *o3ongan %o3ioiosi"is

, Dis"o:i o"o" $ang 'is"ai asa n$i 3o4a3 'an "an'a

angsang 'ngan @ana 4a&,a&an %a'a 43i"

4a 'an 'a'a #skin rash)

o *o3ongan Mio%a"i 4ana ganggan n'o4in 'an"a6o3i4 isa3n$a Dia6"s 33i"s

o *o3ongan Mias"nia *a8is #s'a& 'i6a&as sn'ii)

+. Diagnosis

Ban'ing

o No%a"i

o Po3ioi3i"is

;. Pi4saan

Pnn9ang

o Pi4saan ni s 'aa& S*!T- S*PT- LDH

'an CPK

o Pi4saan g3a 'aa&- :ngsi "ioi' #a"as in'i4asi)

o Pi4saan E34"oioga:i #EM*)

o Pi4saan Ron"gn "3ang

o

EK*o Bio%si o"o" #6i3a ng4in)

=. Kons3"asi o Pn$a4i" Da3a #6i3a 4asan$a ganggan

En'o4in5"a6o3i4

7. Pa@a"an RS o Ra@a" ina%

o Bi3a a'a %n$3i" 54a'aan 3a& a"a n"4

nga44an 'iagnosis %as"i 'an n(ai 4asan$a

. Ta%i o Pa'a $ang &'i"

o Di"aa4an %n(ga&an #aiag (ons33ing)

isa3n$a oang "an$a i4" 43aga 6n(ana

o S%o"i:

o Fisio"a%i

2/


25/44

o Bi3a 4asa 'i4"a&i sga "angg3angi #isa3n$a

ganggan n'o4in)

o Ta%i S%o"i: P6ian %'nison

, Dis"o:i s43 1 g5KgBB5& s3aa = 63an

, Po3ioiosi"is 1 g5KgBB5& s3aa / 63an , Da%a" 'i6i4an continousl$ a"a alternating

, i"ain E 6o3& (o6a

. S"an'a RS o Un"4 nga44an 'iagnosis %as"i- %3 RS $ang

%n$ai EM*- Pa"o3ogi K3ini4 'an Pa"o3ogi Ana"oi


, Pa'a 9nis D(&nn #Dis"o:i Ms43o Pogsi:)

%n$a4i" a4an 64 s(aa 6"a&a% 'an 6iasan$a

ningga3 s63 sia 20 "a&n

o Kana "in'a4an

, Jaang11. In:o'

Consn"

o P3 ""3is

12. Tnaga S"an'a o Do4" U- 6i3a "i'a4 a'a Do4" S%sia3is Saa:

1/. Laa Pa@a"an o S"3a& 'iagnosis %as"i- %n$3i" a"a 4asa s'a&

'i"angg3angi %n'i"a 'a%a" 6o6a" 9a3an ""aa n"4

:isio"a%i.

1+. Masa P3i&an o Bgan"ng 4a'aan- %n$a4i"n$a (n'ng

64 %a'a "i% '(&nn

1;. Hasi3 o Dngan %a@a"an 'an :isio"a%i %n'i"a asa

6ai4 #s6& %asia3). Jnis 3ainn$a n$a

s6& 'ngan g9a3a sisa 'ai ingan sa%ai 6a".


9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i

"%ang "in'i&.

1=. Pa"o3ogi o Bio%si o"o" n"4 'iagnosis

17. A"o%si o Bi3a %3 #9aang)

2+


26/44

RSUD ULIN

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an!a"#a$in

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25 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis RA6IAL'IA DAN IS6IAL'IA

Kasa o Pn$6a6n$a 6an$a4- nan $ang %a3ing

2;


27/44

a'a3a& sa" 'is4s in"8"6a3is $ang nga3ai

%" a"a 'gnasi 'ngan "9a'in$a 4s"si

s6agian an3s 'ngan &niasi n43s %3%oss.

Po"si 'a%a" "9a'i 4 aa& %os"o3a"a3 a"a 4

"nga& #i'3in)o Pa'a n$a a'a "aa $ang 'iss3 o3&

"i63n$a n$i a'i43

o Hniasi a"a %o"si n43s %3%oss n$6a64an

%n4anan %a'a a'i4s 'an n$6a64an g9a3a. Ha3 ini

6iasan$a "9a'i 'i 'aa& 36a3- nan 6isa 9ga

"9a'i 'i 'aa& s8i4a3 - 9aang 'i 'aa& "oa4a3.

o Ba4ia3gia 'an is4ia3gia %a4an g9a3a- 64an sa"

%n$a4i". S&ingga &as 'i%a$a4an n(ai

%n$6a6n$a. Pn$6a6 n$i a'a3a& 4o%34s- 4ana

3i%"i 4"3i6a"an o"o" 'an s43" 'an s"4" $ang

6&6ngan 'ngann$a s%"i %n$a4i" %38is 'an

a6'on- 9ga 43ainan %os"a3 'an 9ga :a4"o,:a4"o

%si4ogni4.

o N$i %nggng 6a@a& #NPB) a'a3a& n$i $ang

'iasa4an 'aa& %nggng 6a@a&- 'a%a" %a4an

n$i 3o4a3 a%n n$i a'i43 a"a 4'an$a. N$i

ini "asa 'ian"aa s'" iga "6a@a& 'an 3i%a" 6o4ong

6a@a& $ai" 'i'aa& 36a3 a"a 36o sa4a3 'an

sing 'is"ai 'ngan %n9a3aan n$i 4 aa& "ng4ai

'an 4a4i. N$i $ang 6asa3 'ai 'aa& %nggng

6a@a& 'a%a" 'i94 4 'aa& 3ain a"a s6a3i4n$a n$i$ang 6asa3 'ai 'aa& 3ain 'iasa4an 'i 'aa&

%nggng 6a@a& #:' %ain).

2. ICD *. 71- *.72 #Ms43a D$s"o%&asis an' !"& M$o%a"i()

/. Ki"ia "a)ialia

o N$i a'i43 'ai 3& $ang n9a3a 4 3ngan-

$ang 6"a6a& 6i3a 6a"4- ng9an

o P3 'i%i4sa s3& "3ang %nggng ""aa

s8i4a3 'ngan %&a"i4an a'a "i'a4n$a 43ainan

%os"- ':oi"as- n$i "4an 'an 4"o4 s"a s%as

o"o".

o Da%a" "9a'i ganggan o"ois 6%a %asis 6i3a"'a%a" sa" 4o%si a'i4s.

o Bi3a 43ainan &an$a 6%a ii"asi a'i4s- "a4 'i9%ai

ganggan o"oi45%asis. *anggan snsi6i3i"as $ang

"9a'i ssai 'a"o $ang "4na

o R:34s :isio3ogis %a'a sgn $ang "4na nn

#(on"o&n$a :34s 6is% 'an 6a4ioa'ia3is %a'a

sin'oa C;5= a"a :34si "is% %a'a sin'oa C=57)

I$)ialia

o N$i a'i43 'ai 'aa& 36a3 $ang n9a3a 4

'aa& is4ia'i4s- "s n9a3a 4 "ng4ai 6a@a& 'an6gan"ng 3"a4 3si- 6isa 4 9ai,9ai 4a4i. #(on"o&

2=


28/44

n9a3a 4 9%o3 4a4i %a'a sin'o S1)

o P3 'i%i4sa s3& "3ang %nggng ""aa

36osa4a3 'ngan %&a"i4an a'a "i'a4n$a

43ainan %os"- ':oi"as- n$i "4an 'an 4"o4 s"a

s%as o"o". Dngan a'an$a n$i a'iasi 4 is4ia'i4sa"a%n 4 aa& 36o sa4a3- a4a 6iasan$a 3o'osis

36a3 a4an 64ang 4ana s%as in8o3n" 'ai

o"o",o"o" %nggng. Biasan$a 9ga 6isa 'i9%ai

s4o3iosis 36a3- 'ngan s4o3iosis "oa4a3 $ang

4o%nsa"oa.

o Pasin a4an 6asa&a n"4 3"a44an 6a"

6a'ann$a %a'a sisi $ang 4on"a3a"a3 'an %osisi 6a'an

aga4 6ng44 'an aga4 iing 4 %osisi $ang sa4i"-

n"4 ng&in'ai %gangan saa: $ang "4na.

o Pa'a n$i $ang &6a"- a4a %n'i"a a4an

ngangi 4s"nsi 3""- 'an &an$a 3"a44an 9ai,

9ai 'i 3an"ai n"4 ng&in'ai 'oso:34si $ang a4an

na6a& n$in$a.

o Tan'a %angsangan ninga3 'a%a" "i63- 6%a

3as %a'a sisi "4na a"a%n Coss Las %a'a

sisi 4on"a3a"a3.

o Mo'i:i4asi "an'a 3as a'a3a& "an'a Bagga' $a4ni

'ngan 3a44an 'oso:34si 4a4i- a"a%n "an'a

Si(a' 'ngan 3a44an 'oso:34si 9%o3 4a4i- a4a

n$i a'i43 a4an 6"a6a&.

o Tan'a Na::iig ni634an n$i a'i43 $ang6"a6a& 6i3a 6a"4- 6sin- a"a%n %a'a %n4anan

8na 9g3ais. Ka'ang,4a'ang n$i 9s" 6"a6a&-

%a'a %3%asan %n4anan. Pi4saan ini 9ga 'a%a"

'i3a44an 'ngan "s 8asa38a. Tan'a n$i s@a4"

'is& 6ng44- a4a %asin a4an 3a44an

:34si %a'a 3"" n"4 n(ga& "gangn$a N.

Is&ia'i4s. *anggan o"ois %asis 'a%a" "9a'i 6i3a

"'a%a" 4o%si a'i4s #(on"o&n$a %asis

'oso:34si 'an %3an"a:34si 4a4i %a'a sin'o L;,S1)

o *anggan snsi6i3i"as 'a%a" "9a'i %a'a 'a"o

$ang "4na. R:34s :isio3ogis nn %a'a sin'oL2,+ #:34s 3"") 'an %a'a sin'o S1 #:34s "i")

o Has 'i6'a4an an"aa ii"asi a'i4s 'an 4o%si

a'i4s.

o Diagnosis 4o%si a'i4s 'i"ga44an 6i3a a'a

, Pasis o"ois

, *anggan i4si ':4asi

o Tan'a,"an'a :i6i3asi %a'a sgn "4na %a'a

%i4saan EM*

+. Diagnosis

Ban'ing

o Ba4ia3gia

, To a'i4s , A83asi a'i4s "aa"is

27


29/44

, P34ss ni"is

, Sin'oa Ca%a3,Tnn3

, Sin'oa S4a3ns

, No3ogis a"o3ogis

o Is4ia3gia , To

, Fa4"

, Pasis %34ss

, Pasis N. Pons

, No%a"i4 'ia6"i4

, *anggan 8as43 %a'a a. I3ia4a 'an (a6ang,

(a6angn$a

, S%on'i3i"is 36a3is

, N. Is4ia'i4s ni"is %i- %ini"is- ninoa-

"aa %a'a saa:n$a a"a sn"i4an

;. Pi4saanPnn9ang

o Ba4ia3gia

, Fo"o on"gn s8i4a3 'ngan %osisi AP 53a"5o63i4

o Is4ia3gia

, Fo"o on"gn 36osa4a3 AP53a"

, LP 6gan"ng 4ass 'a%a" 'i%"i6ang4an- 6i3a

'i'ga a'a 4o%si a'i4s $ang 'is"ai 6n'ngan

a"a%n 'i'ga a'a "o '3a s%ina3is

, Pi4saan EM* n"4 %nn"an 3o4a3isasi-

6'a4an ii"asi a'i4s 'ngan 4o%si a'i4s-

8a3asi %ngo6a"an. Bi3a 'i'ga 4o%si a'i4s-

a4a- s"3a& %i4saan EM* 'i3a44ani3oga:i5CT,i3oga:i a"a%n MRI

=. Kons3"asi o Do4" S%sia3is Pn$a4i" Da3a. Bi3a a'a %n$a4i"

sis"a"is s6agai %n$6a6 a"a%n %n$"a %n$a4i"

o Do4" S%sia3is Psi4osoa"i4 6i3a "i'a4 'i"4an

43ainan 3ain

o Fisio"a%i n"4 "a4si s8i4a3 a%n 36a3-

asas 'an UK* a"a 3"ason'

7. Pa@a"an RS o Ra@a" ina% %a'a ii"asi a'i4s- 6i3a a'a 43ainan

no3ogis.

o N$i a'i43 "a4 ""a&an4an #o6a" "i'a4

no3ong)- "a4 'a%a" is"ia&a" 'i a&- 'i'ga a'a

%n$6a6 3ain $ang &as 'i 4s%3oasi

o Pa'a 4o%si a'i4s "3a4 %3 'ia@a" 4ana

"in'a4an o%a"i: "3a4 'i%34an

. Ta%i o Pa'a ii"asi a'i4s ""a%i n$a 4ons8a"i:

"36i& 'a&3- $ai"

, Tia& 6aing 'ngan %osisi $ang a"a 'ngan a3as

4as

, P6ian 6an"a3 %anas

, Sn"i4an an"si s(aa 3o4a3

, !6a" 3a4san o"o" - ana3gsi4 'an o6a" AINS, S3ain i" 'a%a" 'i3a44an "a4si s8i4a3 a%n

2


30/44

36a3 'an 9ga :isio"a%i 3ain

o !%a"i:

, In'i4asi o%asi

, In'i4asi o%asi si"o ia3a& "i63n$a %o3a%s 'ngan

%aa%asis #4o%si a'i4s). Pa'a 4o%sio a'i4s"in'a4an o%a"i: &as 'i3a44an s(%a"n$a s"3a&

'iagnosis 'i"ga44an n"4 n(ga& %asis 'an

a"o:i 36i& 3an9".

, *anggan i4si

, Pa'a %asis o"ois $ang "i63n$a a4" 'an

38an.

, Bi3a s'a& =, ingg "a%i 4ons8a"i: asi&

"'a%a" 43&an 'an g9a3a $ang 38an.

, Pa'a si'i: $ang 64a3i,4a3i 'ngan g9a3a $ang

4&as.

, Bi3a 'ngan %i4saan EM* 'ai o"o",o"o" sgn$ang 6sang4"an a"a o"o",o"o" %aas%ina3 a"a %aa

8"6a3 'i"4an a'an$a 'n8asi5:i6i3asi $ang

nn944an 4o%si a'i4s.

. S"an'a RS o Sa RS- 4(a3i %a'a 4ass $ang 34an

"in'a4an in8asi:5o%a"i: &as RS "i% A5B $ang

%n$ai a&3i 6'a& saa: 5 o"o%'i

10. Pn$3i" o Han$a a'a %a'a 4ass $ang "3a& 'io%asi- 4a'ang,

4a'ang n$i asi& a'a.

11. In:o'

Consn"

o S(aa 3isan %a'a %i4saan EM*

o P3 ""3is %a'a %i4saan LP- M$3oga:i-MRI 'an %a'a "in'a4an o%asi

12. Tnaga S"an'a o Do4" U

o Do4" S%sia3is Saa: 6i3a 43&an "i'a4 &i3ang-

a%a3agi 4a3a 6"a6a& 6a" a"a%n 'i'a%a"i 43ainan

no3ogis.

o Do4" S%sia3is B'a& Saa:5o"o%'i n"4 4ass

4o%si a'i4s $ang %3 o%asi

1/. Masa P3i&an o Bgan"ng %a'a asing,asing 4ass- nan

n$a %a'a ii"asi a'i4s 'i%34an @a4" +,=

ingg

1+. Hasi3 o Pa'a ii"asi a'i4s

o Biasan$a %ognosis 6ai4- 6i3a 'i3a44an "a%i 'an

:isio"a%i $ang 6ai4 'ngan is"ia&a" $ang (4%.

o Pa'a &nia 'is4s $ang 'io%asi

o Pa'a 25/ 4ass %ognosis 6ai4 'an %a'a 10 &asi3

"a4 as4an

o Taa %a'a %49aan

o Yang 93as %ognosisn$a s%"i %a'a n$a

"aa %a'a %49aan 'an 6i3a %o%a"i: g9a3a s'a&

a'a 36i& 'ai 1 "a&n 'ngan %6a&an a"o"is $ang

93as- isa3n$a anoa3i 36osa4a31;. Pa"o3ogi o Han$a 'i%34an %a'a 4ass $ang 'io%asi

2


31/44

1=. A"o%si o Sanga" 'ian94an - 6i3a "9a'i 4a"ian $ang &a%i

"a4 %na& "9a'i

RSUD ULIN

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Telp.257472 / 252180

Fax.252229

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%&NAN'ANAN %ASI&N


30 / 41

Tanal Te"i

1 J*li 2003

Dieap)an



/0


32/44

%R-S&DUR

T&TA% D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis TETANUS

2. ICD Q.2.0

/. Ki"ia Diagnosis o Pn$a4i" sis" saa: $ang %3angsngann$a a4" 'ngan

4aa4"is"i4 s%as "oni4 %sis"n 'an 4sas6asi

sing4a"

o Tiss,a&ang "4n(i

o Riss Sa'oni4s,"a4si s'" 3" 'ii4"i 'nan

n$i 'an 4a4 o"o"

o Paas%ina3 'an o"o" %" "9a'i s%as %a'a o"o",o"o"

agonis 'an an"agonis $ang sanga" &6a" sa%ai "9a'i

n$i 'an 44a4an $ang sanga" 6a" $ang 6isa

ni634an :a4"

o "6a 'osa3is "9a'i s%as %a'a o"o" %na%asan

$ang %a4an %n$6a6 4a"ian 6i3a "i'a4 (%a"

'i"o3ong

o *9a3a a"ono 6%a 6an$a4 4inga" 'an 3'a&. Jga

s4si :aing. "a4i4a'i 'an &i%o"nsi

o T9a'i 9ga a6'oio3isis $ang nga4i6a"4an

iog3o6ini 'an gaga3 gin9a3

+. Diagnosis

Ban'ing

o K9ang 4ana &i%o4a3sia

o Sin'oa &i%8n"i3asi5a4si &is"io E%i3%si

o Pa'angan 'aa& 3"

;. Pi4saan

Pnn9ang

o Pi4saan i4ooganis 6a4 n"4 n4an

&.tetani

o Pi4saan To4si4o3ogi n"4 n4an

""anos%asin

=. Kons3"asi o Do4" S%sia3is Ana4 Pina"o3ogi

o Do4" *igi

o Do4" S%sia3is B'a&

7. Pa@a"an RS o Ra@a" ina% sga- 6i3a %3 'i ang ICU. Ta%i o E4sisi 34a $ang (4% 36a

o Pn6ian "ono'ao3 7.; g4gBB"ia% = 9a oa3

a"a I !6a" ini 36i& 6ai4 %a'a %ni(i3in

o To4sis $ang asi& 'a3a si43asi 'in"a34an 'ngan

inisasi %asi: # 'uman Imunoglobulin ()))-*)))) +I

intramuskular,

o K9ang 'i6i 'ia%a ; g54gBB5&ai- 'a%a" 9ga

'ngan 'an'"o3n so'i = g54gBB53i" 3@a" N*T

o Pa'a 4ass $ang 6a" 'i6i4an o6a" 63o4a'

nos43a 'an 8n"i3asi 'ngan "4anan $ang %osi"i:s"a %&a"i4an 6a3ans (aian

/1


33/44

. S"an'a RS o RS 'ngan :asi3i"as ICU

10. Pn$3i" o *anggan n3an 'an %na%asan $ang 34an

"in'a4an 4&ss

11. In:o'

Consn" o

P3 ""3is- ""aa $ang 'i(igai 6a"

12. Tnaga S"an'a

o Do4" U

o Bi3a 'i(igai a4an "9a'i 4s3i"an %na%asan 94 4

RS $ang 3ng4a%

1/. Laa Pa@a"an o 2 ingg < 1 63an.

1+. Masa P3i&an o Sa%ai "a4 "9a'i 4s3i"an %na%asan

o Pa'a :a4" 8"6a is"ia&a" 6aing 4ang 36i& 2 63an

1;. Hasi3

o Pa'a ana4,ana4 ;0 ningga3

o Ang4a 4a"ian "inggi 6i3a

a. "9a'i s%as $ang "i'a4 (%a" 'i"o3ong

6. Bi3a 9aa4 an"aa "9a'in$a 34a 'an a@i"an "9a'i ""ans %n'4

1=. Pa"o3ogi o Ti'a4 %3

17.A"o%si o Bi3a 'i%34an

RSUD ULIN

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Telp.257472 / 252180

Fax.252229

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/2


34/44

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i De$e#e" 200

1. Diagnosis MENIN*ITIS

, Mningi"is Ba4"ia3is A4"

, Mningi"is T643osis #A.17.0)

, Mningi"is ia3

2. ICD *.00

/. Ki"ia Diagnosis o A'a3a& sa" in:4si ssnan saa: %sa" $ang 6a" 'an

'a%a" ni634an g9a3a sisa $ang %ann. Pn$6a6

in:4si a'a3a& 6a4"i-8is a"a oganis $ang 3ain.

o M%a4an sa3a& sa" 4o%3i4asi 'ai %n$a4i"

"6(3osis- %n$ai o6i'i"as 'an o"a3i"as $ang

"inggi 'ngan %ognosis 64

o Da- a3ais- sa4i" 4%a3a- n"a&- sing "a%a4

ngan"4 'an (on:s' #4sa'aan nn)

o Bi3a "a4 'io6a"i- ngan"4 ng6ang4an n9a'i

so%o 'an 4oa

o *9a3a 43inis $ang 4&as 'i"4an "an'a angsangan

ninga3 6%a 4a4 4'4- "an'a 4nig

o P"4ia 'i9%ai %a'a ningo4o4 @a3a%n 'a%a" 9ga%a'a in:4si %no4o4- s"a:i3o3o4o4- 'an 66a%a

in:4si 8is. Ka'ang,4a'ang 'i9%ai 49ang a4i6a"

ning4a"n$a a"a in:4si 8na 3o4a3

o E' %a%i3 'i9%ai %a'a s6i"is 'i:s 'an ' o"a4

$ang . Ma3ais- sa4i" 4%a3a- ii"a63- %6a&an

"ing4a& 3a4 $ang 63angsng s3aa 2,= ingg.

Di9%ai 'a ingan 'an "an'a %angsangan s3a%"

o"a4

o Pa%i3 'a sing "9a'i. Ji4a "a4 'io6a"i 4a'aan so%o

6"a6a& 'an 'ii4"i 4a"ian. Ma3ais- sa4i" 4%a3a-

'a ingan- ngan"4 'an n"a&.

o Pi4saan %&a"i4an %n'i"a "a%a4 sa4i"

s'ang- 66a%a "'a%a" 4a4 4'4- ""a%i "i'a4 s93as

%a'a ningi"is 6a4"ia3is a4".

+. Diagnosis

Ban'ing

o In:4si 9a5%aasi" #&r$ptococcus neoformans a"a

To%oplasma gondii, sarkoid meningitis.

o T4anan %a'a s3a%" o"a4 $ang 'i:s o3& s3 ganas-

"as4 4asinoa- 3i:oa- 34ia- g3ioa-

3anoa 'an '3o63as"oa.

o Pa'a %aaninga3 a6ss ni634an a4si 3i:osi"i4

%a'a (aian o"a4.;. Pi4saan

I

o Pngsi 36a3 #6i3a "a4 a'a "an'a,"an'a %ninggian

//


35/44

Pnn9ang "4anan in"a4ania3)

o CT s(an a"a MRI 'i6a" s63 'i3a44an :ngsi

36a3 6i3a 'i9%ai %ninggian "4anan in"a4ania3.

o K3" 'aa& 'an (aian o"a4.

o P@anaan ga (aian o"a4- 9ga %@anaan i&3,Ni3sn

o Ka'a g34osa 'aa&- %i4saan 4an"i"a"i: (aian o"a4

n"4 93a& s3- &i"ng 9nis s3.

o Ka'a g34osa- %o"in- NaCL- 4a'a asa aino- 'an

n"4 n'a%a"4an an"ign 6a4"i 'i%i4sa

counterimmunoelectrophoresis radioimmunoassa$ a"a

"4ni4ELISA.

o C,a("i8 %o"in ning4a" 36i& 'ai 20 g53 in'i4asi

4ng4inan "ia'in$a ningi"is 6a4"ia3is.

=. Kons3"asi o

Do4" S%sia3is Pn$a4i" Da3ao Do4" S%sia3is Pa

o Do4" S%sia3is !n4o3ogi

o Do4" S%sia3is THT

o Do4" *igi

o Do4" S%sia3is Ra'io3ogi

o Do4" S%sia3is B'a& saa:

o Do4" A&3i La6oa"oi K3ini4

o Do4" A&3i Mi4o6io3ogi

o Do4" A&3i Paasi"o3ogi

7. Ta%i o

Ra@a" ina% n"4 sa %n'i"a $ang 'i(igain'i"a ningi"is

. Pa@a"an RS Pa'a oang '@asa

o L6i& 6ai4 'i'"4si 'a&3 'ngan %@ana ga a"a

"4ni4 n'a%a"4an an"ign $ang (%a".

o Kan %n$6a6 46an$a4an eisseria meningitidis

#Meningococcus, 'an Streptococcuspneumoni s&ingga

$ang 'i%a4ai a'a3a& 6n$3 %nisi3in s4a 'i9%ai 'i

In'onsia)

o Pi3i&an 3ain- %nisi3in 'ngan 'osis /00 g54gBB

in"a8na 'i6agi / 'osis 'i4o6inasi4an 'ngan

43oa:ni4o3 7; , 100 g54gBB %&ai,in"a8nao S:o"a4si ;0 g 4g BB "ia% = 9a I a'a3a& o6a"

"%i3i&

Pa'a ana4,ana4

o P6ian 'ini '4sa"ason 6i3a %n$6a6'.influenae

ngangi insi'n s3 "3i 'an 43ainan no3ogi

3ain.

o Pngo6a"an 'an &asi3n$a 6gan"ng (%a"n$a

%n(o6a"an.

o Pngo6a"an sga 6i3a 'i9%ai %3iosi"osis 3i:osi"i4

'an 4a'a g34osa (aian o"a4 $ang n'a&.o INH 20 g4g BB5&ai s3aa 1 63an #a4s =00 g &ai)

/+


36/44

3a3 'osis 'i"n4an 30 g54gBB5&ai

o Ri:a%isin 30 g54g BB5&ai- s3aa 2 63an

o Piainai' /0 g54gBB5&ai- s3aa 2 63an

K"iga o6a" ini 'i6i4an s&an s4a3i

o INH 'an i:a%isin 'i6i4an 30 63ano Pa'a 4a'aan $ang 6a" 'i"a6a& s"%"oisin 20 g5 4g

5BB5&ai- s3aa 2 ingg

o Ko"i4os"oi' 'a%a" 'i6i4an @a3a%n asi&

4on"o8sia3

o Pngo6a"an %a'a in:4si 8is "a4 a'a %ngo6a"an $ang

s%si:i4 4(a3i %ngo6a"an s%o"i: 'an "ia& 6aing

. S"an'a RS o Sa RS- 6i3a a'a %n$3i" a"a in'i4asi 94 4 RS

$ang 36i& 3ng4a% :asi3i"asn$a.

10. Pn$3i" Meningococcal septicaenia

o T3i snsoi,na3o K3%&an saa: 4ania3

o Hi'os:a3s

o E%i3%si

o Higoa s6'a3

o R"a'asi nn"a3

o A"o:i n.o%"i4s

11. In:o'

Consn"

o P3 'iin"a %a'a saa" a4an 'i %ngsi 36a3

12. Tnaga S"an'a o Do4" S%sia3is Saa:

o

Do4" S%sia3is Pn$a4i" Da3ao Do4" S%sia3is Pa

o Do4" S%sia3is !n4o3ogi

o Do4" S%sia3is THT

o Do4" *igi


o Do4" S%sia3is B'a& saa:

o Do4" A&3i La6oa"oi K3ini4

o Do4" A&3i Mi4o6io3ogi

o Do4" A&3i Paasi"o3ogi

o

Do4" 6i3a "a4 a'a 'o4" s%sia3is "s6"1/. Laa Pa@a"an o 1,2 63an n"4 ningi"is 6a4"ia3is 4"

o 2,= 63an n"4 ningi"is "643osis

o 1 63an n"4 ningi"is 8ia3

1+. Masa P3i&an o 1,2 63an n"4 ningi"is 6a4"ia3is a4"

o Ss'a& = 63an- 'ngan s3 no3ogis n$a

n"4 ningi"is "643osis

1;. Hasi3 o ningi"is 6a4"ia3 'a%a" (%a" s6& "o"a3 6i3a (%a"

'io6a"i 'an 4sa'aann$a 63 "gangg

o ningi"is "643osis s6& 3a6a" 'an n$a

ningga34an s3 no3ogiso ningi"is 8ia3 a'a $ang s6& "o"a3- a'a $ang n9a'i

/;


37/44

(a(a"5%i3%si

1=.Pa"o3ogi o Bi3a 'i9%ai %n$3i"

%&NAN'ANAN %ASI&N

/=


38/44

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3 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis ENSEFALITIS IRAL

2. ICD A./. A.;- A./. Ki"ia Diagnosis o Sa" %n$a4i" 'a a4" 'ngan 4sa4an 9aingan

%an4i sis" saa: %sa" $ang ni634an 49ang-

4sa'aan nn- a"a "an'a,"an'a no3ogis :o4a3.

o Skin rash# :aingi"is- 3i:a'ni"is- %3i"is- 4a'i"is-

i4"s- oganoga3i- 'ia 'an o4i"is

o Po'oa3 63angsng 1,+ &ai 6%a 'a- nggigi3-

sa4i" 4%a3a- a3ais- sa4i" "nggoo4an- 4on9ng"i8i"is-

n$i %a'a 4s"i"as 'an a6'on.

o Bi3a 646ang 9a'i ningi"is- 'i9%ai 4a4 4'4-

:o"o:o6ia. n8i %a'a %ga4an 6o3a a"a. Ksa'aan

nn.

o A'an$a nsn:a3i"is 'i"an'ai o3& a"a4sia. "o.

ganggan n"a3- ganggan 6i(aa- 43%&an

4s"ii"as- 49ang %ninggian "4anan in"a4ania3.

4sa'aan $ang a4in nn sa%ai 4oa 'an 'a%a"

6a4& 'ngan 4a"ian- 9aang 'i9%ai %"osis 'an

%asis 6o3a a"a.

o Bi3a g9a3a %angsangan s3a%" o"a4 'is"ai 'is:ngsi

o"a4 'is6" ningons:a3i"is

+. Diagnosis

Ban'ing

o In:4si 6a4"i

o In:4si i4o6a4"io In:4si 9a

o 3n:4si %o"ooa

;. Pi4saan

Pnn9ang

o Pngsi 36ai 6i3a "a4 a'a "an'a %ninggian "4anan

in"a4ania3

Di8a3asi

, S3 n8a 4ang 'ai 100053-

3i:oonosi"i4

, Di9%ai i"osi" %a'a &%s si%34s

ns:a3i"is

, Po"in noa3 a"a s'i4i" ninggi #0,200g5'3)

/7


39/44

, *34osa 6iasan$a noa3

, P@anaan ga 'an 43" n"4 6a4"i

a. Ja

6. BTA

o Bi3a ng4in4an iso3asi 8is- "i" an"i6o'i n"4n(ai 'iagnosis "io3ogi

o Pi4saan 'aa&

, L4osi" noa3 a"a 34o%ni a"a

3i4osi"osis ingan

, Ai3as s sing ning4a" %a'a %ao"i"is

, Fngsi &a"i $ang a6noa3 'i9n%ai %a'a

&%a"i"is 8is 'an onon43osis in:4siosa.

o Pi4saan EE*

, Un$a 'i9%ai %3an6a"an

, A'an$a 4o%34s slo/ /ave$ang %io'i4 4

'aa& 3o6s "%oa3is ssisi a"a 'a sisi

n(iga4an sa" in:4si &%s si%3s 8is

#HS). Pa'a AIDS ns:a3i"is 9ga &an$a 'i9%ai

%3a6a"an

o Pi4saan CT s(an 'an MRI

, Pi4saan ini s6nan$a %n"ing ""a%i

a&a3. Bgna n"4 '"4si 'ini HS ns:a3i"is

o Bio%si 9aingan o"a4

, S%sin n"4 isoiasi 8is- %i4saan

&is"o%a"o3ogis- %i4saan 'ngan i4os4o%

34"on 'an ino:3osns. Bio%si o"a4 6gnan"4 nga44an 'iagnosis HS ns:a3i"is

o Pi4saan an"i6o'i an"ign s%si:i4 n"4 HS 'an HI

=. Kons3"asi o Do4" S%sia3is Saa:

o Do4" A&3i io3ogi

o Do4" A&3i Pa"o3ogi K3ini4

o Do4" A&3i Pa"o3ogi Ana"oi


o Do4" S%sia3is B'a& Saa:

o Do4" S%sia3is Ans"si

o

Fisio"a%is7. Pa@a"an RS o Ra@a" ina% sga n"4 sa %n'i"a $ang 'i(igai

'i"a ns:a3i"is

. Ta%i o Bsi:a" s%o"i:

o Bi3a 'i(igai %n$6a6n$a HS 'i6i4an A($(3o8i /0

g54gBB5&ai in"a8na- 'i6agi / 'osis s3aa 10 &ai.

. S"an'a RS o Un"4 %a@a"an s%o"i: sa RS

o Bi3a a'a %n$3i" a"a in'i4asi 94 4 RS $ang 36i&

3ng4a%

10. Pn$3i" o In:4si sa3an na%as 'an sa3an 4i&

o

K9ang $ang "s ns %a'a :asi3i"as ICU n"4na4os

/


40/44

11. In:o'

Consn"

o P3 ""3is 6i3a 'i%34an n"4 %n4si 36a3- 6io%si

o"a4

12. Tnaga S"an'a o Do4" n"4 "a%i s%o"i:

o Do4" S%sia3is Saa:- 'o4" S%sia3is Ans"si- 6i3a

49ang,49ang n9 4a a& s"a"s 4on83si1/. Laa Pa@a"an o Sa" 63an 6i3a "i'a4 "9a'i s3 no3ogis5%n$3i"

3ain. S3 no3ogis %3 'i3a"i& a&3i Fisio"a%i

o Pngo6a"an s &i'% 6i3a "9a'i %i3%si

1+. Masa P3i&an o 1,/ 63an- s6agian ningga34an (a(a" ""a%

1;. Hasi3 o Ens:a3i"is 8is "i'a4 a'a o6a"n$a- A($(3o8i 'a%a" 'i(o6a

'i6i4an %a'a HS ns:a3i"is 'ngan o"a3i"as 1,2

1=.Pa"o3ogi o Bi3a 'i3a44an 6io%si o"a4

17. A"o%si o Dngan %s"9an 43aga- n"4 visum et repertum

/


41/44

RSUD ULIN

Jl. A. Yani 43

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Fax.252229

an!a"#a$in

%&NAN'ANAN %ASI&N


39 / 41

%R-S&DUR

T&TA%

Tanal Te"i

1 J*li 2003

Dieap)an



D". ,. Ai#an* Sp%D6'&,

%e#ina Ua#a *a

NI%. 140 159 19

Tanal Re+i$i

De$e#e" 200

1. Diagnosis PENYAKIT PARKINS!N

2. ICD *. 20

/. Ki"ia Diagnosis o Pn$a4i" Pa4inson a'a3a& 6agian 'ai %a4insonis $ang

%a"o3ogis 'i"an'ai 'ngan 'gnasi gang3ia 6asa3is

""aa %as (o%a("a s6s"an"ia niga 'is"ai 'ngan

in43si si"o%3asi4 osino:i3i4 #!e/$s bodies,

o Pa4insonis a'a3a& sin'oa $ang 'i"an'ai 'ngan

"o @a4" is"ia&a"- igi'i"as- 6a'i4insia 'an

&i3angn$a :34s %os"a3 a4i6a" %nnan 'o%ain

4ana 66a%a s6a6

o To %a4an g9a3a $ang "i63 a4i6a" 3"%an

i"is "&a'a% "a4"s %iai'a3is. Dis6" 9ga resting

tremor 'ngan :4nsi +,; H a"a pill rolling tremor.

Da3a 4a'aan s"ss "o a4an 6"a6a&

+. Pi4saan Fisi4 o Da3a %i4saan 'a%a" 'i"4an "ias Pa4inson $ai"

:nona o'a 6gigi. 6a'i4insia 'an igi'i"as.Ba'i4insia

o Mnnn$a 4a%an n"4 3a44an ga4an @a9a&

'is"ai 6"a6a&n$a @a4" $ang 'i%34an n"4

3ai a"a ng6a& ga4an a4i6a"n$a 4s3&an

ga4an %n'i"a 6i 4san 3a6a".

o Da3a %i4saan 'a%a" 'i"4an %n'i"a 69a3an

'ngan 3ang4a& 4(i3,4(i3 s%"i 'is" #Marche petit

Pas, "an%a 3nggang- sa3i8a "i'a4 'i"3an. 4a "o%ng

$ang is4in ii4- :4nsi a"a 64'i% nn 'an

"3isan 66a& n9a'i 4(i3,4(i3.

Rigi'i"as

o Tons o"o" ninggi 4ana ning4a"n$a a4"i8i"as o"o

+0


42/44

nogaa ""aa %a'a o"o" :34so. Ka'aan ini

nnga4i6a"4an si4a% %n'i"a s%"i 6ong4o4

'ngan 4a4i ""44 #S"oo%ing).

o Disa%ing g9a3a 'i a"as 'a%a" 'i"4an &i%&i'osis-

&i%o"nsi %os"a3- ganggan i4si- 'nsia- '%si-%na%asan $ang 'ang4a3 'an "i'a4 6a"an s"a (aa

6i(aa $an ono"on.

o P9a3anan 43inis %n$a4i" Pa4inson 'i3i&a" 6'asa

"a&a%an n" Ho&n 'an Ya&

o S"a'i I

, *9a3a 'an "an'a %a'a sa" sisi

, *9a3a ingan

, *9a3a $ang "i63 nggangg "a%i "i'a4 ni634an

(a(a"

, To %a'a sa" anggo"a ga4

, *9a3a a@a3 'a%a" 'i4na3i oang "'4a"

o S"a'i II

, *9a3a 6i3a"a3

, T9a'i 4(a(a"an inia3

, Si4a%5(aa 69a3an "gangg

o S"a'i III

, *a44an "6& n$a"a 3a6a" 'ii

, *anggan 4si6angan saa" 69a3an56'ii

, Dis:ngsi s'ang

o S"a'i I

, *9a3a 36i& 6a", K"6a"asan 9aa4 69a3an

, Rigi'i"as 'an 6a'i4insia

, Ti'a4 a% an'ii

, To 64ang

o S"a'i

, S"a'i 4a4sia

, K(a(a"an 4o%34s

, Ti'a4 a% 6'ii 'an 69a3an

, M34an %a@a"an ""a%

;. Diagnosis

Ban'ing

o Sin'o Pa4inson S4n'

o Pas(ans:a3i"is 3"agi4a 8an (onoo. Da %3& "a&n

s"3a& 49a'ian in:4si 8is o"a4 "i63 g9a3a %a4inson.

o Ka'aan ia"ognis a4i6a" %6ian o6a" ""aa

:no"iain- &a3o%i'o3 'an 3i"i.

o A4i6a" 4a(nan C! a"a Mn

o Pn$a4i" saa: 3ain %n$a4i" s6o8as43a5

%a4insonis a"ios43osis

o A4i6a" 4a'aan 3ain s%"i "aa a"a "o o"a4.

=. Pi4saan

Pnn9ang

o Pa'a CT S(an a"a MRI- ng4in 'a%a" 'i"4an "an'a

'gnasi %a'a s6s"ansia niga.

o Da%a" 'i3a44an ana3isis (aa 69a3an ""aafoot print.7. Kons3"asi o Do4" S%sia3is Pn$a4i" Da3a

+1


43/44

o Do4" S%sia3is Ji@a

o Do4" A&3i Faa4o3ogi K3inis 6i3a 'i%34an

. Pa@a"an RS o Ra@a" ina% &an$a 'ian94an %a'a 4ass $ang 6a"

'ngan "9an n"4 ng"a&i 'i4an"osa $ang

(o(o4 'an 'osis $ang a'4a". Ta%i o M'i4an"osa

, Aan"a'in

, An"i4&o3ingi4 Bno"o%in si3a"- 6i%i'in-

"i&$%&ni'i3

, Do%aingi4 Ca6i'o%a 'an L8o'o%a Bnsai'

'an L8o'o%a

, Do%ain Aginis Boo4i%"in si3a"- %go3i'

si3a"- %ai%o3- %inio3- 3$si'

, C!MT In&i6i"o En"a(a%on- "o3(a%on

, MA!,Bin&i6i"o S3gi3in- Laa6i', , An"i !4si'an *3"aa" an"agonis- a3:a "o(o:o3- asa

As(o6a"- 6"a(ao"n

, Bo"3in "oin

, Po%ano3o3

o Non 'i4an"osa

, !%asi Ta3a"oi- %a3i'o"oi- "ans%3an"asi s6s"ansia

niga

, A63asi 'an s"i3asi o"a4

, R&a6i3i"asi 'i4

, Psi4o"a%i

10. S"an'a RS o Sa RS $ang %n$ai 'o4" S%sia3is Saa:11. Pn$3i" E:4 sa%ing 'a%a" 6%a

o F34"asi 4&asia" o6a" #on,o:: %&nonon)

o Hi%o"nsi %os"a3

o Nasa

o Dis4insia

o D%si n"a3

12. In:o'

Consn"

o Han$a %a'a 4ass o%a"i: $ang 63 %na& 'i49a4an

'i In'onsia

1/. Tnaga S"an'a o Do4" U- %a'a %n'i"a 'ngan 43&an $ang s'a&

"a"asi 'ngan %ngo6a"an $ang a'4a".o Do4" S%sia3is Saa:- 6i3a 4'ian "i63 :4 sa%ing

%6ian o6a" 9ang4a %an9ang

1+. Laa Pa@a"an o Bo6a" 9a3an- 4(a3i n"4 %n$saian o6a"- %n'i"a

'ngan :4 sa%ing %ngo6a"an $ang 6a" a"a '%si

n"a3 6a".

o Laa %a@a"an 6gan"ng %a'a 6a" a"a s3i"n$a 4ass

"s6"

1;. Masa P3i&an o Pn'i"a s3aan$a 6gan"ng %a'a 'i4an"osa

o Ha3 ini s3a$a4n$a n9a'i 6a&an %"i6angan 'a3a

i3i& 9nis o6a" 4ana %n'i"a a4an sanga" "66ani

o3& &aga o6a"

+2


44/44

1=.Hasi3 o Dngan "a%i $ang a'4a" %n'i"a 'a%a" 66as g9a3a

n"4 @a4" $ang 3aa a4an ""a%i 'osis a'4a" n"4

4n @a4" ""n" ng4in "i'a4 a'4a" 3agi n"4

@a4" s3an9"n$a s&ingga 'osis &as 'inai44an

17. Pa"o3ogi o Ti'a4 s3a3 %31. A"o%si o ,

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