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    Amprahan HCU Kamis Pagi, 15 Februari 2024

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    alfaz zamzami
    The document summarizes the condition of 3 patients in the pediatric intensive care unit. Patient 1 is a 12 year old female being treated for bronchopneumonia, acute leukemia, stomatitis, suspected invasive candidiasis and left hand cellulitis. Patient 2 is a 5 year old female being treated for severe anemia due to beta thalassemia major, HbE and malnutrition. Patient 3 is a 6 month old male infant being treated for severe wasting and malnutrition. The document provides details on their diagnoses, treatments, monitoring plans and test results.

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    Amprahan HCU Kamis Pagi, 15 Februari 2024

    Uploaded by

    alfaz zamzami
    3 views6 pages
    The document summarizes the condition of 3 patients in the pediatric intensive care unit. Patient 1 is a 12 year old female being treated for bronchopneumonia, acute leukemia, stomatitis, suspected invasive candidiasis and left hand cellulitis. Patient 2 is a 5 year old female being treated for severe anemia due to beta thalassemia major, HbE and malnutrition. Patient 3 is a 6 month old male infant being treated for severe wasting and malnutrition. The document provides details on their diagnoses, treatments, monitoring plans and test results.

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    The document summarizes the condition of 3 patients in the pediatric intensive care unit. Patient 1 is a 12 year old female being treated for bronchopneumonia, acute leukemia, stomatitis, suspected invasive candidiasis and left hand cellulitis. Patient 2 is a 5 year old female being treated for severe anemia due to beta thalassemia major, HbE and malnutrition. Patient 3 is a 6 month old male infant being treated for severe wasting and malnutrition. The document provides details on their diagnoses, treatments, monitoring plans and test results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views6 pages

    Amprahan HCU Kamis Pagi, 15 Februari 2024

    Uploaded by

    alfaz zamzami
    The document summarizes the condition of 3 patients in the pediatric intensive care unit. Patient 1 is a 12 year old female being treated for bronchopneumonia, acute leukemia, stomatitis, suspected invasive candidiasis and left hand cellulitis. Patient 2 is a 5 year old female being treated for severe anemia due to beta thalassemia major, HbE and malnutrition. Patient 3 is a 6 month old male infant being treated for severe wasting and malnutrition. The document provides details on their diagnoses, treatments, monitoring plans and test results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    Amprahan HCU

    Kamis Pagi, 15 Februari 2024


    TIM WH : JGG/CLD/MUR/KAG
    DPJP: dr. Yunnie Trisnawati, M.Ked(Ped), Sp.A(K)

    Total : 3 Pasien
    HCU RB4: 3 Pasien

    1. (Bed 1) Hanaya Putri, perempuan, 12 tahun 4 bulan, RM 00916039, masuk HCU 07/02(H9)
    BB : 27 kg TB : 132,5 cm
    BB/U : 65,8% TB/U : <p3 BB/TB : 94,7%

    Balance 6 jam terakhir : +215 cc


    UOP 6 jam terakhir : 500 cc (3 cc/kgbb/jam)
    Balance 24 jam terakhir : +15 cc
    UOP 24 jam terakhir : 1695 cc (2.6 cc/kgbb/jam)
    Sensorium : GCS 15 E 4 V 5 M6
    HR : 111 x/menit (60-120 x /menit)
    RR : 28 x/menit (16-20 x/menit)
    Tekanan darah : 100/60 mmHg (P50-90 : 94-105 / 59-62 mmHg)
    GDS Pagi : 85 mg/dl
    FLACC :
    PELOD-2 Score :2
    Candida score :-
    DIC score :
    PRISM IV :%
    PDR :%
    Schofield : kkal
    Kebutuhan RDA x BBI : 1800 -2475 kkal
    Holiday Segar : 1600 cc

    Diagnosis:
    Bronkopneumonia + Akut leukemia dd/ALL, AML + Stomatitis + susp ISK + selulitis manus sinistra

    Terapi :
    - Terpasang nasal canule 3 lpm, SpO2 98-99 %
    - IVFD D5% NaCl 0,45% sesuai balance
    - Inj Levofloxacin IV 250mg/12 jam (12/2) H4
    - Inj. Ceftazidime 1gr/8jam (14/2) H2
    - Inj Parasetamol 400 mg/6 jam
    - Salbutamol 3x2 mg
    - N Acetylcysteine 2x200 mg
    - Kenalog 4x sue
    - Gentamisin 3xsue
    - Diet M2 1000 kkal + susu boost optimum 3x 100 cc
    - Kompres Nacl 5-10 menit di tangan kiri
    - Nebul NaCl 0.9%/8jam

    Rencana:

    1
    - foto thorax ulang
    - susul konsul bedah plastik
    - kultur pus
    - Balance cairan /6 jam

    Riwayat Terapi:
    - TC 3 unit (Premed Inj.Furosemide 20 mg) (15/02 12.00)
    - Inj As. Traneksamat 300mg/8 jam
    - Inj Ampicillin 1gram/6jam/IV
    - Inj Gentamicin 150 mg/24 jam/IV
    - koreksi hipokalsemia Ca gluconas 15cc + NaCl 0,9% 15cc habis dalam 20 menit
    - TC 3 unit (premed inj furosemide) (11/2) selesai 00.00
    - PRC I 100 cc (premed inj furosemide) (10/2 jam 15.30)
    Transfusi PRC dengan target Hb 10 :
    - PRC I 100 cc 4/2, 14.00
    - PRC II 125 cc 5/2 09.00
    - PRC III 125 cc 6/2 13.00
    - Transfusi TC 3 unit 6/2 15.00
    - Transfusi TC 3 unit 7/2 17.00

    Jawaban Konsul:
    IPT (12/02) : Levofloxacin IV 250mg/12 jam (12/2) H1. ampisilin dan gentamicin aff

    Pemeriksaan penunjang :
    Echo 12/02 : Mild pericardial effusion
    Kultur darah 6/02 : Staphylococcus hominis
    Sensitif : Gentamicin ,Ciprofloxacin ,Levofloxacin, Moxifloxacin, Quinupristin/Dalfopristin, Linezolid ,Vancomycin,
    Tigecycline Nitrofurantoin, Rifampicin, Trimethoprim/Sulfamethoxazole
    3/2 6/2 7/2 11/2

    DL Hb 6.8/ Leu 6280/ Ht Hb 9.4/ Leu 5690/ Hb 9.1 /Ht 28.3 / Leu Hb 9,9/ Ht 29,2/ Leu
    20.8/ Plt 5000 Ht 28.5/ Plt 5000 6.120 / PLT 3.000 9540/ PLt 11.000
    MCV 81/ MCH 26.4/ MCV 78/ MCH MCV 80 / MCH 25.8 / MCV 78/ MCH 26,3/
    MCHC 32.7 25.8/ MCHC 33.0 MCHC 32.2 MCHC 33,9
    E 0/ B 0.2/ N 66.4/ L E 1.40/ B 0.2/ N N 61.2 / L 31.2 / M 6.7 / E E 0,1/ B 0,2/ N 79,2/ M
    29.3/ M 4.1 65.7/ L 27.6/ M 5.1 0.7 / B 0.2 3,5/ L 17

    Elektro Ca 6.81/ Na 137/ K 3.9/ Cl Na 135/ K 4,8/ Cl 102/ Ca


    lit 106 7,73

    AGDA pH 7,545/ pCO2 23,8/


    pO2 185,9/ HCO3 20,7/
    tCO2 21,5/ BE -0,1/ SpO2
    98,6%

    HST

    2
    RFT PT 11.9(11.8)/ INR 1.08/ BUN 13,1/ Ur 28/ Cr 0,35
    APTT 43.8(25)/ TT
    19.3(18.3)

    LFT

    Lain GDs 201 PCT 5.32 PCT 0,74

    Gambaran Darah Tepi Urinalisis


    Warna kuning keruh
    E: Normokrom / Glukosa -/
    normositer Bilirubin -/ Keton -/
    L: Jumlah normal, BJ 1.025/ pH 6.5/
    Bentuk normal Protein +1/ Nitrit -/
    T: Jumlah menurun, Leukosit +/ Darah
    bentuk sulit dinilai +/ Eri 30-35/ Leu
    10-15/ Epi 0-1/
    Casts -/ Kristal -

    2. (Bed 2) Gisella Florita Purba, perempuan, 5 th 11 bl , RM00916827, masuk HCU 15/02(H1)


    BB : 19 kg TB : 120 cm BBI : 20kg
    BB/U : 95% TB/U :p50-75 BB/TB : 86.3%

    Balance 6 jam terakhir : - cc


    UOP 6 jam terakhir : cc ( cc/kgbb/jam)
    Balance 24 jam terakhir : -cc
    UOP 24 jam terakhir : cc (cc/kgbb/jam)
    Sensorium : GCS 15 E 4 V 5 M6
    HR : 125 x/menit (60-120 x /menit)
    RR : 26 x/menit (16-20 x/menit)
    Tekanan darah : 100/60 mmHg (P50-90 : 94-105 / 59-62 mmHg)
    GDS Pagi : mg/dl
    FLACC :
    PELOD-2 Score :
    Candida score :-
    DIC score :
    PRISM IV :%
    PDR :%
    Schofield : kkal
    Kebutuhan RDA x BBI : 1800 kkal
    Holiday Segar : 1450 cc

    Diagnosis:
    Severe anemia ec Thalassemia beta mayor + HbE + gizi kurang + perawakan pendek

    Terapi :
    - IVFD RL 95cc/jam (5cc/kg) selama 2 jam

    3
    - Inj. Paracetamol 200 mg (kp)

    Rencana:
    Pantau overload cairan, Hemodinamik, UOP, balance cairan
    Cek Dl, LFT,RFT post rehidrasi
    Cek urinalisa
    Cek DL/hari

    Riwayat Terapi:

    Jawaban Konsul:
    HOM (13/02) :tidak perlu periksa lab ulang, lanjut transfusi

    Pemeriksaan penunjang :

    13/02

    DL Hb 2,1/ Ht 6,0/leu 6420/ PLT 330.000/ MCV 44/ MCH 15,3/ MCHC 35
    E 0.5/B 0/N 67.7/L 26.2/M 5.6

    Elektr
    olit

    AGD
    A

    HST

    RFT

    LFT Bil total 1.04/Bil direk 0.34/SGOT 24/SGPT 6

    Lain Sadt
    eri : Hipokrom Anisopoikilositosis (Polikromasi(+), tear drop cell (+)
    Leukosit : Jumlah normal, bentuk normal
    thrombsit: Jumlah normal, Big trombosit (+)
    Urinalisa
    Warna kuning jernih/ glu -/ bil -/ ket -/ BJ 1.010/ pH 5.5/ prot -/ nit -/ leu
    -/darah -/ eri 0-1/leu 0-1/ epi 0-1/cast -/ kristal -/lain -
    Hasil Hb elektroforesis (30/11/2016) : HbA 3,2/ HbF 31,5/ HbE 59,6/
    HbA2 5,7

    3. (Bed 3) Gaffi Elgio Dirgantara, Laki-laki, usia 6 bulan, RM 00916749, masuk HCU 14/02(H2)
    BB : 5 kg PB : 83 cm BBI 11kg LLA 10cm (Z<-3)

    4
    BB/U : Z<-3 PB/U : Z>3 BB/TB : Z<-3

    Balance 6 jam terakhir : -147.5 cc


    UOP 6 jam terakhir : 300 cc (10 cc/kgbb/jam)
    Balance 24 jam terakhir : -300 cc
    UOP 24 jam terakhir : 1050 cc (8.75 cc/kgbb/jam)
    Sensorium : GCS 15 E 4 V 5 M6
    HR : 110 x/menit (110-170 x /menit)
    RR : 26x/menit (24-46 x/menit)
    Tekanan darah : 90/60mmHg (P50-90 : 93-95 / 53-55 mmHg)
    GDS Pagi : 90 mg/dl
    FLACC :
    PELOD-2 Score :5
    Candida score :-
    DIC score :
    PRISM IV :%
    PDR :%
    Schofield : kkal
    Kebutuhan RDA x BBI : 1210 kkal
    Holiday Segar : 500 cc

    Diagnosis:
    Sangk. Sepsis + sangk bronkopneumonia + sangkaan CHD + hipokalemia + hipokalsemia + Gizi buruk

    Terapi :
    -Terpasang o2 nasal 2 lpm -> SpO2 98%
    - IVFD D5 0.225% NaCl 20 cc/jam
    - Inj. Cefotaxime 125mg/8 jam / IV 14/02 H2
    - Vit B komp 1x1
    - vit C 1x50 mg
    - Diet SGM gain 100 60cc/3jam (480 kkal)

    Rencana:
    - konsul Divisi Kardio skrining echo 15/2
    - Rencana transfusi PRC, target Hb 10 (premed furosemid)
    PRC I 30 cc
    PRC II 35 cc
    PRC III 35 cc
    PRC IV 35 cc
    - Cek elektrolit jika ada pemeriksaan darah
    - susul kultur darah (14/2)
    - Pantau status hidrasi
    - Pantau WOB
    - Balance cairan / 6 jam

    Riwayat Terapi:
    - Koreksi hipokalsemia, dengan Ca Gluconas 0.5cc/kg = 2.5 cc Ca Glukonas + 2.5cc D5% habis dalam 20 menit (14/2)
    - Koreksi hipokalemia, dengan KCl 0.75mEq/kg = 3.8 mEq KCl + 11.4 cc D5% habis dalam 3 jam (14/2)

    5
    Jawaban Konsul:
    Hom : sangkaan sepsis, tranfusi target Hb 10
    NPM : kebutuhan kalori
    Faste stabilisisasi 100kcal x BB aktual = 100 x 5 = 500Kkal = 60cc 3jam
    susu SGM gain 100 60cc/3jam (Edukasi orangtua untuk beli dan cara pemberiannya 3sdt + 55cc air)
    Vitamin A, Vit B komp 1x1, vit C 1x50 mg

    Pemeriksaan penunjang :
    14/2 Ro. Thorax : Kardiomegali. Pneumonia.

    13/02

    DL Hb 3.2 / Ht 9.8/ leu 20,500/PLT 84,000/ MCV 92/


    MCH 29.9/ MCHC 32.7
    N 31.5/ L 47.2 / M 20

    Elektrolit Na 145/ K 2/ Cl 107/ Ca 6.3

    AGDA AGDA (sampel diambel O2 nasal kanul 1 lpm)


    pH 7.416/ pCO2 14.9/ pO2 184.6 / HCO3 9.6/ TCO2
    10.1/ BE -11.1/ SaO2 99.7%
    kesan: respiratory alkalosis terkompensasi penuh

    HST

    RFT BUN 13.2/ Ur 28/ Crea 0.39

    LFT SGOT 112 / SGPT 27/

    Lain GDS 156 mg/dL

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