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Kronologis ny. kasiani

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1 KRONOLOGIS NY. Kasiani IDENTITAS Reg : 10073988 Nama : Ny. Kasiani Umur : 50 th Pekerjaan : Ibu Rumah Tangga Suami : Pekerjaan : Umur : Status : Menikah 1 x, cerai 16 th Alamat : Perumahan Karanglo Indah Blok I / IA Malang MRS : 8-11-2015 Tim Jaga : Supervisor : SUBYEKTIF Pasien rujukan dari RS Puri Bunda (SpOG) dengan Postop SVH-BSO, PA Clear cell adeno Ca Ovarii (Op tanggal 8 April 2015) Anamnesa : April 2015 Pasien datang ke poli onkogyn RSSA dengan membawa rujukan direncanakan adjuvant kemotx dengan Carboplastin Paxus dengan dx Ca ovarium post incomplete surgical surgery Telah dilakukan adj Kemotx Carboplastin Paxus sebanyak 6 sen (terakhir 14 Agustus 2015) Agustus 2015 Pasien direncanakan cek Ca 125 dengan hasil 132,40 diusulkan cek ulang Ca 125 1 bulan lagi dan USG Oktober 2015 Pasien kontrol dengan membawa hasil USG abdomen dengan curiga massa residif dan hasil Ca 125 = 132,4 (27 Agustus 2015) direncanakan secondary laparatomy KB : (-) HPPHT : menopause 2 tahun yang lalu
2 OBYEKTIF Keadaan umum : cukup CM Tekanan darah : 120/80 mmHg Nadi : 80 x/menit RR : 20 x/menit Tax : - Trec : - K/L : an +/+, ikt -/- Tho : Cor/ S1 S2 tunggal murmur (-) Pulmo/ Abd : flat, soefl, BU (+) N, met (-), Shifting dullness (-), nyeri (-) GE : Lochea (+) Laboratorium : DL : 11,9 / 45.550 / 41,4 / 1.080.000 FH : 15,2 / 24,8 SE : 139 / 4,30 / 110 OT/PT : 16 / 9 Alb : 3,09 GDS : 294 Ur/Cr : 33,7/1,72 UL : Protein +3 Asam laktat : 6,0 mmol/L BGA : PH : 7,18 PCO2 : 33,0 PO2 : 55,2 HCO3 : 12,4 BE : -16,1 SaO2 : 81,2 % Hb : 13,1 Suhu : 37,0 0C Konsul Kardiologi : Dx : P1001Ab000 pp SptB hari ke-9 1. Acute lung oedema 1.1 Non kardiogenik 1.2 Kardiogenik 2. HT emergency Rh - - Wh - - - - - - - - - -
3 3. Trombositosis 4. Asidosis metabolik 5. Azotemia 1. Renal 2. Prerenal 6. Hiperglikemia dt reactive in critical ill 7. Hipoalbuminemia dt renal loss 8. Septic condition 8.1 Infeksi puerpuralis PTx : O2 ~ ts anastesi Total cairan 1500cc/24 jam Balance cairan seimbang s/d 250 cc/24 jam IUFD NS 1000 cc + intake PO 500cc/24 jam Drip ISDN 0,5 mg/jam s/d TD < 140 Antibiotik ts IPD/Paru Konsul Anastesiologi : Dx : mengingat saat ini pasien datang dalam kondisi distensi batas paru, dilakukan intubasi endotrakeal dan perawatan ICU &ventilator. Konsul IPD: Dx : 1. DOC 1.1Septic MODS 1.2 PEB 1.3 CVA trombosis 2. Septic condition 2.1 Septic puerperalis 2.2 Uremicum 3. SOB respiratory failure tipe 1 dt no 2 3.1 ALO 3.1.1 non cardiogenic 3.1.2 cardiogenic
4 4. trombositos 4.1 secondary dt no 2 4.2 ........ trombosis 5. renal azotemia 5.1 dt no 2 5.2 volume depletion 6. hyperglikemia critical ill 6.1 dt no 2 6.2 DM 7. Hypertension stage 1 7.1 secondary dt PEB 7.2 Primary HT PTx : O2 10 lpm IVFD NS 10 tpm Fluid dlm 6x200 cc/ jam Balance cairan seimbang Inj levofloxacin 1x500 mg iv Inj cefoperazone 2x1 gr iv Per NGT - Aspirin 50-100 mg/hari - Rencana Bromoparent..... jika KU baik Konsul paru P1001Ab000 PP spTb hr-9 1. ALO 1.1 non cardiogenic 1.2 cardiogenic 1.3 PEB 2. Hyperglikemia 2.1 reaktif 2.2 2.2 DM tipe 2 3. Azotemia 4. Hipoalbuminemia 5. Septic condition 5.1 sepsis puerperalis Advis : Saat ini tidak ada penatalaksanaan khusu dalam bidang kami, namun pasien dalam resiko tinggi untuk pneumonia. Pasien akan kami ikuti Saran : CXR AP, sputum gram kultur dan sensitivitas antibiotika, kultur darah, BGA serial per 6 jam
5 Ptx: O2 ~ TS anestesi Lain-lain ~ TS anestesi, kardio, obgyn, IPD Assessment : P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + septic condition + severe ARDS + MODS + Penurunan kesadara +Leukositosis + Azotemia + Trombositosis + Hiperglikemia Planning: PDx : BGA serial/6 jam, DL, OT/PT, LDH /24 jam, UL, kultur darah, kultur sputum ~ TS paru PTx: Pro perawatan ICU O2 , ventilator ~ TS Anestesi Drip SM maintenance, SM 40^% dlm RD5 500 cc 10 gr habis dalam 24 jam stop Tx inj Inj. Cefazolin 1 gr iv (skin test) Inj. Metochlorpramide 1 amp iv - Inj Ranitidin 2x1 amp iv - Inj furosemid 20-20-0 iv Tx lain ~ TS anestesi, kardio, IPD, Paru Pmo : Obs VS, keluhan, DJJ KIE c/ Spv_________________________________Acc DR. dr. Kusnarman K, Sp.OG-K
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FOLLOW UP PENDERITA TGL Subyektif Obyektif Assesment Planning 9/11/2015 OBGYN (-) Keadaan umum : tampak sakit berat, CM GCS dalam sedasi midazolam TD : 144/66mmHg N : 180 x/mnt RR : 32 x/mnt SAT O2 93% on Ventilator BIPAP K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh + + Wh - - + + - - + + - - P/ Abd : Flat , supel, BU (+) N, Met (-) FU ttb, GE : lochea (+) alba P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + penurunan kesadaran + Shock septic + MODS + severe ARDS + Leukositosis + Azotemia + Trombositosis + Hiperglikemia reaktif Pdx : c/ IPD c/Kardio,c/Paru, kultur darah, BGA serial/12 jam, Lab lengkap/12 jam Ptx : - pro perawatan ICU - Resusitasi bersama TS EM dan Anestesi - IVFD RL life line - O2 ventilator sesuai TS anestesi - Tx Inj: - Inj cefazolin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj ranitidine 2x1 amp iv - Inj metoclopamid 3x1 iv - Inj furosemide 20-20-0 iv - Drip SM 40% 20 gr habis dlm 24 jam ( on syringe pump) bila KI (-) PMo : Obs. VS, kel, prod urin 10/11/2015 06.45 IPD ( tropik infeksi) Penurunan kesadaran KU: tampak sakit berat GCS : 1x1 TD : 85/41 mmHg HR : 161 x/mnt Prod urine 900 cc/6 jam Lab: Hb: 9.9 11.1 Leukosit: 45550 60930 Trombosit : 1.080.000 1.000.000 1. DOC 1.1 Septic MODS 1.2 Respiratory failure 2. Septic MODS 2.1 Sepsis Puerperalis 2.2 Urosepsis 3. Respiratory failure tipe 1 4. Leukositosis berat 4.1 dt no 2 Pdx : Kultur darah & sensitivity tes, kultur urine & sensitivity tes, GDI/II, lipid profile, Ur/Cr/3 hari, DR/3 hari, Ptx : - Bed rest - NGT (+) diet cair 6x200 cc - Balance cairan seimbang
As laktat: 6 Ur/Cr: 33.7/1.72 4.2 Hematologi disorder 5. Trombositosis 5.1 secondary dt infeksi 5.2 essensial 6. azotemia renal dd pre renal 7. hiperglikemia 7.1 reaktif 7.2 DM tipe 2 - Inj cefoperazone 3x1 gr iv - Inj levofloxacin 1x500 mg iv - Inj Omeprazole 1x40 mg 10/11/2015 08.10 OBGYN Dalam sedasi Keadaan umum : tampak sakit berat GCS dalam sedasi (midazolam 2 mg, morfin, fentanyl 2 mg) TD : 102/65 mmHg N : 130 x/mnt RR : 12 x/mnt Tax : 38.1 C SAT O2 98 % K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh - - Wh - - - - - - + + - - P/ Abd : FU ~ simfisis, kontraksi uterus baik, BU (+) N, met (+) GE : lochea (+) Prod 75 cc/jam Lab: BGA : 7,21/53.2/134.7/18.6/-7.2/98.1% FiO2: 225 P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + Septic condition + Mild ARDS + MODS + Penurunan kesadaran + Leukositosis + Azotemia + Trombositosis + Hiperglikemia Pdx : BGA serial/12 jam, OT/PT, LDH/24 jam, UL/24 jam, DL Ulang, kultur darah, kultur sputum. Ptx : - perawatan ICU lanjut - O2, IVFD, ventilator sesuai TS anestesi - Drip SM maintenance ~ jadwal jika kontra indikasi (-) - Tx Inj: - Inj cefaperazone 2x1 g iv - Inj Levofloxacin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj Paracetamol 3x 1 gr iv - Inj furosemide 3x20 mg iv - Tx lain ~ TS anestesi, cardio, Paru, IPD
10/11/2015 Paru Hasil MR 1. P1001Ab000 PP SptB hr-10 2. PEB 3. ALO 3.1 non cardiogenic 3.2 cardiogenic 4. infeksi puerperalis sepsis puerperalis 5. Hipoalbuminemia 6. Hiperglikemia 7. azotemia Pdx : CXR AP sudah, sputum gram kultur& sensitivitas antibiotika, kultur sputum, BGA serial. Ptx : - O2 ~ TS anestesi - Antibiotika ~ TS obgyn - Lain-lain ~ TS obgyn, anestesi, IPD 10/11/2015 Kardiologi - GCS : 1x1 (on midazolam 2mg/jam dan Morfin 2mg/jam) T: 100/61 mmHg (MAP=75) Hr: 155 x/mnt RR: 26 x/mnt SAT O2 : 99% Pasien dengan ventilator Setterd PCV S: 38.1 JVP= R+2 CmH2O Rh - - Wh - - - - - - - - - - cor: S1S2 tunggal, regular murmur(-) Abd: supel Ekstremitas: akral dingin, kering Edema =(-) Perdarahan pervaginam (+) 1. P1001Ab000 PP SptB hr-10 2. Septic condition 3. PEB 4. Post ALO 4.1 non cardiogenic 4.2 cardiogenic 5. Ascidosis metabolic respiratoric 6. Azotemia 7. Hipoalbuminemia 8. Hiperglikemia In critically ill Pdx: ECG ulang, Echocardiografi Ptx: - Inj furosemide inj tunda - Drip ISDN tunda
11/11/2015 08.10 OBGYN Dalam sedasi Keadaan umum : tampak sakit berat GCS dalam sedasi (midazolam 2 mg/jam + morfin 1 mg/jam) TD : 116/81 mmHg N : 137 x/mnt RR : 20 x/mnt (dobutamin 5mcg/kg/mnt + NE 0,05 mcg/kg/mnt) SAT O2 K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh - - Wh - - - - - - - - - - P/ Abd : FU ~ simfisis, kontraksi uterus baik, BU (+) N, met (-) GE : lochea (+), Flx (-) Prod 110 cc/jam P1001 Ab000 PP SPtB Hr ke-11 + PEB + SOB ec ALO cardiogenic dd non cardiogenic + Septic condition + Severe ARDS + MODS + Penurunan kesadaran + Leukositosis + Azotemia + Trombositosis + Hiperglikemia + Post Veneneuraphy Pdx : BGA serial/6 jam, OT/PT, LDH/24 jam, UL/24 jam, DL Ulang, kultur darah, kultur sputum, servix Ptx : - perawatan ICU lanjut - O2, IVFD, ventilator sesuai TS anestesi - Balance cairan seimbang Drip SM maintenance ~ jadwal jika kontra indikasi (-) - Tx Inj: - Inj cefaperazone 2x1 g iv - Inj Levofloxacin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj Paracetamol 3x 1 gr iv - Inj furosemide 3x20 mg iv - Tx lain ~ TS anestesi, cardio, Paru, IPD PMO : Observasi vs, luka heacting, prod urin KIE c/ senior 11/11/2015 06.50 IPD Penurunan kesadaran KU: tampak sakit berat GCS : 3x6 TD : 123/90 mmHg HR : 131 x/mnt Rh Anemia + Edema + 1. DOC 1.1 Septic MODS 1.2 Respiratory failure 2. Septic MODS 2.1 Sepsis Puerperalis 2.2 Urosepsis 3. Respiratory failure tipe 1 4. Leukositosis+trombosito sis dt no 2 Pdx : Kultur darah & sensitivity tes, kultur urine & sensitivity tes, DL/ 3 hari, Ur/Cr/3 hari Ptx : - Bed rest - NGT (+) diet cair 6x200 cc - Inj cefoperazone 2x1 gr iv - Inj levofloxacin 1x500 mg
5. Azotemia renal dt no. 2 6. Hiperglikemia dt reaktif iv - Inj Omeprazole 1x40 mg - Balance cairan 11/11/2015 Paru Hasil MR 1. ALO (perbaikan) 1.1 non cardiogenic 1.2 cardiogenic 2. infeksi puerperalis sepsis puerperalis 3. Hipoalbuminemia 4. Hiperglikemia 5. Azotemia OBG 6. P1001Ab000 PP SPtB hari ke 11 7. PEB Pdx : Sputum gram kultur sensitivitas antibiotika, BGA serial. Ptx : - O2 ~ TS anestesi - Antibiotika ~ TS obgyn - Lain-lain ~ TS obgyn, anestesi, IPD

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Kronologis ny. kasiani

  • 1. 1 KRONOLOGIS NY. Kasiani IDENTITAS Reg : 10073988 Nama : Ny. Kasiani Umur : 50 th Pekerjaan : Ibu Rumah Tangga Suami : Pekerjaan : Umur : Status : Menikah 1 x, cerai 16 th Alamat : Perumahan Karanglo Indah Blok I / IA Malang MRS : 8-11-2015 Tim Jaga : Supervisor : SUBYEKTIF Pasien rujukan dari RS Puri Bunda (SpOG) dengan Postop SVH-BSO, PA Clear cell adeno Ca Ovarii (Op tanggal 8 April 2015) Anamnesa : April 2015 Pasien datang ke poli onkogyn RSSA dengan membawa rujukan direncanakan adjuvant kemotx dengan Carboplastin Paxus dengan dx Ca ovarium post incomplete surgical surgery Telah dilakukan adj Kemotx Carboplastin Paxus sebanyak 6 sen (terakhir 14 Agustus 2015) Agustus 2015 Pasien direncanakan cek Ca 125 dengan hasil 132,40 diusulkan cek ulang Ca 125 1 bulan lagi dan USG Oktober 2015 Pasien kontrol dengan membawa hasil USG abdomen dengan curiga massa residif dan hasil Ca 125 = 132,4 (27 Agustus 2015) direncanakan secondary laparatomy KB : (-) HPPHT : menopause 2 tahun yang lalu
  • 2. 2 OBYEKTIF Keadaan umum : cukup CM Tekanan darah : 120/80 mmHg Nadi : 80 x/menit RR : 20 x/menit Tax : - Trec : - K/L : an +/+, ikt -/- Tho : Cor/ S1 S2 tunggal murmur (-) Pulmo/ Abd : flat, soefl, BU (+) N, met (-), Shifting dullness (-), nyeri (-) GE : Lochea (+) Laboratorium : DL : 11,9 / 45.550 / 41,4 / 1.080.000 FH : 15,2 / 24,8 SE : 139 / 4,30 / 110 OT/PT : 16 / 9 Alb : 3,09 GDS : 294 Ur/Cr : 33,7/1,72 UL : Protein +3 Asam laktat : 6,0 mmol/L BGA : PH : 7,18 PCO2 : 33,0 PO2 : 55,2 HCO3 : 12,4 BE : -16,1 SaO2 : 81,2 % Hb : 13,1 Suhu : 37,0 0C Konsul Kardiologi : Dx : P1001Ab000 pp SptB hari ke-9 1. Acute lung oedema 1.1 Non kardiogenik 1.2 Kardiogenik 2. HT emergency Rh - - Wh - - - - - - - - - -
  • 3. 3 3. Trombositosis 4. Asidosis metabolik 5. Azotemia 1. Renal 2. Prerenal 6. Hiperglikemia dt reactive in critical ill 7. Hipoalbuminemia dt renal loss 8. Septic condition 8.1 Infeksi puerpuralis PTx : O2 ~ ts anastesi Total cairan 1500cc/24 jam Balance cairan seimbang s/d 250 cc/24 jam IUFD NS 1000 cc + intake PO 500cc/24 jam Drip ISDN 0,5 mg/jam s/d TD < 140 Antibiotik ts IPD/Paru Konsul Anastesiologi : Dx : mengingat saat ini pasien datang dalam kondisi distensi batas paru, dilakukan intubasi endotrakeal dan perawatan ICU &ventilator. Konsul IPD: Dx : 1. DOC 1.1Septic MODS 1.2 PEB 1.3 CVA trombosis 2. Septic condition 2.1 Septic puerperalis 2.2 Uremicum 3. SOB respiratory failure tipe 1 dt no 2 3.1 ALO 3.1.1 non cardiogenic 3.1.2 cardiogenic
  • 4. 4 4. trombositos 4.1 secondary dt no 2 4.2 ........ trombosis 5. renal azotemia 5.1 dt no 2 5.2 volume depletion 6. hyperglikemia critical ill 6.1 dt no 2 6.2 DM 7. Hypertension stage 1 7.1 secondary dt PEB 7.2 Primary HT PTx : O2 10 lpm IVFD NS 10 tpm Fluid dlm 6x200 cc/ jam Balance cairan seimbang Inj levofloxacin 1x500 mg iv Inj cefoperazone 2x1 gr iv Per NGT - Aspirin 50-100 mg/hari - Rencana Bromoparent..... jika KU baik Konsul paru P1001Ab000 PP spTb hr-9 1. ALO 1.1 non cardiogenic 1.2 cardiogenic 1.3 PEB 2. Hyperglikemia 2.1 reaktif 2.2 2.2 DM tipe 2 3. Azotemia 4. Hipoalbuminemia 5. Septic condition 5.1 sepsis puerperalis Advis : Saat ini tidak ada penatalaksanaan khusu dalam bidang kami, namun pasien dalam resiko tinggi untuk pneumonia. Pasien akan kami ikuti Saran : CXR AP, sputum gram kultur dan sensitivitas antibiotika, kultur darah, BGA serial per 6 jam
  • 5. 5 Ptx: O2 ~ TS anestesi Lain-lain ~ TS anestesi, kardio, obgyn, IPD Assessment : P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + septic condition + severe ARDS + MODS + Penurunan kesadara +Leukositosis + Azotemia + Trombositosis + Hiperglikemia Planning: PDx : BGA serial/6 jam, DL, OT/PT, LDH /24 jam, UL, kultur darah, kultur sputum ~ TS paru PTx: Pro perawatan ICU O2 , ventilator ~ TS Anestesi Drip SM maintenance, SM 40^% dlm RD5 500 cc 10 gr habis dalam 24 jam stop Tx inj Inj. Cefazolin 1 gr iv (skin test) Inj. Metochlorpramide 1 amp iv - Inj Ranitidin 2x1 amp iv - Inj furosemid 20-20-0 iv Tx lain ~ TS anestesi, kardio, IPD, Paru Pmo : Obs VS, keluhan, DJJ KIE c/ Spv_________________________________Acc DR. dr. Kusnarman K, Sp.OG-K
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  • 8. FOLLOW UP PENDERITA TGL Subyektif Obyektif Assesment Planning 9/11/2015 OBGYN (-) Keadaan umum : tampak sakit berat, CM GCS dalam sedasi midazolam TD : 144/66mmHg N : 180 x/mnt RR : 32 x/mnt SAT O2 93% on Ventilator BIPAP K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh + + Wh - - + + - - + + - - P/ Abd : Flat , supel, BU (+) N, Met (-) FU ttb, GE : lochea (+) alba P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + penurunan kesadaran + Shock septic + MODS + severe ARDS + Leukositosis + Azotemia + Trombositosis + Hiperglikemia reaktif Pdx : c/ IPD c/Kardio,c/Paru, kultur darah, BGA serial/12 jam, Lab lengkap/12 jam Ptx : - pro perawatan ICU - Resusitasi bersama TS EM dan Anestesi - IVFD RL life line - O2 ventilator sesuai TS anestesi - Tx Inj: - Inj cefazolin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj ranitidine 2x1 amp iv - Inj metoclopamid 3x1 iv - Inj furosemide 20-20-0 iv - Drip SM 40% 20 gr habis dlm 24 jam ( on syringe pump) bila KI (-) PMo : Obs. VS, kel, prod urin 10/11/2015 06.45 IPD ( tropik infeksi) Penurunan kesadaran KU: tampak sakit berat GCS : 1x1 TD : 85/41 mmHg HR : 161 x/mnt Prod urine 900 cc/6 jam Lab: Hb: 9.9 11.1 Leukosit: 45550 60930 Trombosit : 1.080.000 1.000.000 1. DOC 1.1 Septic MODS 1.2 Respiratory failure 2. Septic MODS 2.1 Sepsis Puerperalis 2.2 Urosepsis 3. Respiratory failure tipe 1 4. Leukositosis berat 4.1 dt no 2 Pdx : Kultur darah & sensitivity tes, kultur urine & sensitivity tes, GDI/II, lipid profile, Ur/Cr/3 hari, DR/3 hari, Ptx : - Bed rest - NGT (+) diet cair 6x200 cc - Balance cairan seimbang
  • 9. As laktat: 6 Ur/Cr: 33.7/1.72 4.2 Hematologi disorder 5. Trombositosis 5.1 secondary dt infeksi 5.2 essensial 6. azotemia renal dd pre renal 7. hiperglikemia 7.1 reaktif 7.2 DM tipe 2 - Inj cefoperazone 3x1 gr iv - Inj levofloxacin 1x500 mg iv - Inj Omeprazole 1x40 mg 10/11/2015 08.10 OBGYN Dalam sedasi Keadaan umum : tampak sakit berat GCS dalam sedasi (midazolam 2 mg, morfin, fentanyl 2 mg) TD : 102/65 mmHg N : 130 x/mnt RR : 12 x/mnt Tax : 38.1 C SAT O2 98 % K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh - - Wh - - - - - - + + - - P/ Abd : FU ~ simfisis, kontraksi uterus baik, BU (+) N, met (+) GE : lochea (+) Prod 75 cc/jam Lab: BGA : 7,21/53.2/134.7/18.6/-7.2/98.1% FiO2: 225 P1001 Ab000 PP SPtB Hr ke -9 + Pre eklamsia berat + SOB ec acute lung oedema ec cardiogenic dd non cardiogenic + Septic condition + Mild ARDS + MODS + Penurunan kesadaran + Leukositosis + Azotemia + Trombositosis + Hiperglikemia Pdx : BGA serial/12 jam, OT/PT, LDH/24 jam, UL/24 jam, DL Ulang, kultur darah, kultur sputum. Ptx : - perawatan ICU lanjut - O2, IVFD, ventilator sesuai TS anestesi - Drip SM maintenance ~ jadwal jika kontra indikasi (-) - Tx Inj: - Inj cefaperazone 2x1 g iv - Inj Levofloxacin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj Paracetamol 3x 1 gr iv - Inj furosemide 3x20 mg iv - Tx lain ~ TS anestesi, cardio, Paru, IPD
  • 10. 10/11/2015 Paru Hasil MR 1. P1001Ab000 PP SptB hr-10 2. PEB 3. ALO 3.1 non cardiogenic 3.2 cardiogenic 4. infeksi puerperalis sepsis puerperalis 5. Hipoalbuminemia 6. Hiperglikemia 7. azotemia Pdx : CXR AP sudah, sputum gram kultur& sensitivitas antibiotika, kultur sputum, BGA serial. Ptx : - O2 ~ TS anestesi - Antibiotika ~ TS obgyn - Lain-lain ~ TS obgyn, anestesi, IPD 10/11/2015 Kardiologi - GCS : 1x1 (on midazolam 2mg/jam dan Morfin 2mg/jam) T: 100/61 mmHg (MAP=75) Hr: 155 x/mnt RR: 26 x/mnt SAT O2 : 99% Pasien dengan ventilator Setterd PCV S: 38.1 JVP= R+2 CmH2O Rh - - Wh - - - - - - - - - - cor: S1S2 tunggal, regular murmur(-) Abd: supel Ekstremitas: akral dingin, kering Edema =(-) Perdarahan pervaginam (+) 1. P1001Ab000 PP SptB hr-10 2. Septic condition 3. PEB 4. Post ALO 4.1 non cardiogenic 4.2 cardiogenic 5. Ascidosis metabolic respiratoric 6. Azotemia 7. Hipoalbuminemia 8. Hiperglikemia In critically ill Pdx: ECG ulang, Echocardiografi Ptx: - Inj furosemide inj tunda - Drip ISDN tunda
  • 11. 11/11/2015 08.10 OBGYN Dalam sedasi Keadaan umum : tampak sakit berat GCS dalam sedasi (midazolam 2 mg/jam + morfin 1 mg/jam) TD : 116/81 mmHg N : 137 x/mnt RR : 20 x/mnt (dobutamin 5mcg/kg/mnt + NE 0,05 mcg/kg/mnt) SAT O2 K/L: An -/- , ikt -/- Tho: C/ S1S2 Tunggal, reguler Rh - - Wh - - - - - - - - - - P/ Abd : FU ~ simfisis, kontraksi uterus baik, BU (+) N, met (-) GE : lochea (+), Flx (-) Prod 110 cc/jam P1001 Ab000 PP SPtB Hr ke-11 + PEB + SOB ec ALO cardiogenic dd non cardiogenic + Septic condition + Severe ARDS + MODS + Penurunan kesadaran + Leukositosis + Azotemia + Trombositosis + Hiperglikemia + Post Veneneuraphy Pdx : BGA serial/6 jam, OT/PT, LDH/24 jam, UL/24 jam, DL Ulang, kultur darah, kultur sputum, servix Ptx : - perawatan ICU lanjut - O2, IVFD, ventilator sesuai TS anestesi - Balance cairan seimbang Drip SM maintenance ~ jadwal jika kontra indikasi (-) - Tx Inj: - Inj cefaperazone 2x1 g iv - Inj Levofloxacin 3x500 mg iv - Inj metronidazole 3x500 mg iv - Inj Paracetamol 3x 1 gr iv - Inj furosemide 3x20 mg iv - Tx lain ~ TS anestesi, cardio, Paru, IPD PMO : Observasi vs, luka heacting, prod urin KIE c/ senior 11/11/2015 06.50 IPD Penurunan kesadaran KU: tampak sakit berat GCS : 3x6 TD : 123/90 mmHg HR : 131 x/mnt Rh Anemia + Edema + 1. DOC 1.1 Septic MODS 1.2 Respiratory failure 2. Septic MODS 2.1 Sepsis Puerperalis 2.2 Urosepsis 3. Respiratory failure tipe 1 4. Leukositosis+trombosito sis dt no 2 Pdx : Kultur darah & sensitivity tes, kultur urine & sensitivity tes, DL/ 3 hari, Ur/Cr/3 hari Ptx : - Bed rest - NGT (+) diet cair 6x200 cc - Inj cefoperazone 2x1 gr iv - Inj levofloxacin 1x500 mg
  • 12. 5. Azotemia renal dt no. 2 6. Hiperglikemia dt reaktif iv - Inj Omeprazole 1x40 mg - Balance cairan 11/11/2015 Paru Hasil MR 1. ALO (perbaikan) 1.1 non cardiogenic 1.2 cardiogenic 2. infeksi puerperalis sepsis puerperalis 3. Hipoalbuminemia 4. Hiperglikemia 5. Azotemia OBG 6. P1001Ab000 PP SPtB hari ke 11 7. PEB Pdx : Sputum gram kultur sensitivitas antibiotika, BGA serial. Ptx : - O2 ~ TS anestesi - Antibiotika ~ TS obgyn - Lain-lain ~ TS obgyn, anestesi, IPD