Download - DEAD CASE.pptx
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8/18/2019 DEAD CASE.pptx
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DEAD CASE
Ny. Katrin Polii
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• Pasien pindah dari ICU ke ruangrawat IMC Neurologi pukul 1.!!
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• S" penurunan kesadaran
• #" KU" $erat Kes" %o&a
• '" 1!()! N" * +", S" -/0 Sa#," **
• 2CS " E,M34, PE++5 6(6 ukuran -&&7-&&
• '+M" KK tde
• nn. %ranialis " kesan paresis 879
• St. &otorik "
•
'" n +:" 66(66(66 6(6(6 +P" 7 7• N 66(66 6(6 7 7
• St. Sensorik" tde
• St. otono& " inkontinensia uri et al;i
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• A" 7 penurunan kesadaran e.% SD= +.:rontote&poral D onset hr.1!
• IC= +. >rontal $ilateral
• :r. ?asis %ranii
• Pneu&oense>al
•
=pt gr ,
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• P" 7 !, 3 l(& ;ia nasal kanul
• ?ed rest
• Ele;asi kepala/ leher/ punggung -!@
• Chest sioterapi
• #ral higine
• I4:D NaCl !/* )!!%%" KAEN -? B ,"1 ,1 gtt(&• Ce>triaone ,, gr I.4 8h.119
• Citikolin ,)!!&g I.4
• 4it C ,1 in a&p
• Para%eta&ol -1!!!&g drips I.4
•
+anitidin ,1 in a&p• in% ,1 ta$ p.o ;ia #2'
• 'el&isartan !&g !7!7I
• A&lodipin 1!&g I7!7!
• #$s 4S(2CS(Pupil(a&
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JAM TekananDarah
Suhu
Saturasi
Sikap
1*.!! 1!(*! -/* *
,!.!! 1!(*! -/0 *
,1.!! 1!(*! -/0 **
,,.!! 1!(*! -/* **
,-.!!2CS"E,M341 'ho" +h7(7Fh7(7
,!!(! -/* * 7I4:D NaCl !/* 1!!%% 61 a&p ni%ardipine Mulai )! gtt(&8&ikrodrips9 titrasi tiap1) &enit ,) gtt sa&pai 'D 1!(!7#$ser;asi4S(2CS(Pupil(Ga&
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• S" Penurunan kesadaran 869
• #" KU" $erat Kes" ko&a
• '" 1!(*! +" 0 S" -/0 Sa#," *
• 2CS " E,M34 PE++5 6(6 ukuran -&&7-&&
• '+M" KK tde• nn. %ranialis " kesan paresis N.0 UMN Sin
• +e>. $atang otak 869
• St. &otorik "
•
'" n +:" 66(66(66 6(6(6 +P" 7 7• N 66(66 6(6 7 7
• St. Sensorik" tde
• St. otono& " inkontinensia uri et al;i <
Dilakukan pertukaran aga 1-:e$ruari ,!1 pukul !.!! wita
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8/18/2019 DEAD CASE.pptx
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• A" 7 penurunan kesadaran e.% SD= +.:rontote&poral D onset hr.1!
• IC= +. >rontal $ilateral
• :r. ?asis %ranii
• Pneu&oense>al
•
=P' gr.II• Ane&ia 8=$"*/9
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8/18/2019 DEAD CASE.pptx
9/25
• P" 7 !, 3 l(& ;ia nasal kanul
• ?ed rest
• Ele;asi kepala/ leher/ punggung -!@
• Chest sioterapi
• #ral higine
• I4:D NaCl !/* )!!%%" KAEN -? B ,"1 ,1 gtt(&
• Ce>triaone ,, gr I.4 8h.119
• Citikolin ,)!!&g I.4
• 4it C ,1 in a&p
• Para%eta&ol -1!!!&g drips I.4
• +anitidin ,1 in a&p
• in% ,1 ta$ p.o ;ia #2'
• 'el&isartan !&g !7!7I
• A&lodipin 1!&g I7!7!
• Cek D5/Ur/ Cr/ 2DS/ Na/ K/ Cl/ :=/ Al$(2lo$ulin/ Protein total
• KIE
• Su%tion lender $erkala
• Ne$uliHer ?isol;on " NaCl !/* " Co&$i;ent B1"1"1
• Konsul +M
• Konsul giHi
• +a$er NS
• #$s 4S(2CS(Pupil(a&
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• 1-(,(,!1 !*.1)
• S" =e&ate&esis
•
P" 7 N2' ter$uka• Puasa USF
• #&epraHole in ,1 a&p
•
As. 'raneksa&at -)!!&g in a&p• Sul%ra>at sirup 3CII ;ia #2'
• #$at oral stop
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Dilakukan pertukaran aga 1-:e$ruari ,!1 pukul 1,.-! wita
• Ku " ?erat Kes " %o&a
• 'D " 1)!(*! N " ++ " , S " -/*
•
2CS " E,M341 Pupil -&&(-&& +C56(6 +C'5 6(6
• Sp!, " *
•
Urine " 1!! %%
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JAM TekananDarah
Suhu Saturasi Sikap
1-.!! ,!!(1!! -*/) * PC' drips
1!!! &g8I49 protapni%ardipine
13.!! 1*!(1!! -*/! *
1).!! 1)!(*! - *0 Ni%ardipine
tunda1*.!! 1!(1!! -*/) *
,1.!! 1)!(! -*/) * PC' drips1!!! &g8I49 urine
,!! %% 7777+ehidrasi%airan -)!%% 6Ko&pres
!1.!! 1)!(! -.! *
!-.!! 13!(0! -/ *0
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• S" Penurunan kesadaran 6/ de&a& 879/ keluar %airan%oklat 869
• #" KU" $erat Kes"ko&a +h 6(6 Fh 7(7
• '"1-!(*! N"* +", S$"-/) Sa#,"**
• 2CS " E,M34 PE++5 6(6 ukuran -&&7-&&• '+M" KK tde
• nn. %ranialis " kesan paresis N.0 UMN Sin
• St. &otorik "
•
'" n +:" 66(66(66 6(6(6 +P" 7 7• N 66(66 6(6 7 7
• St. Sensorik" tde
• St. otono& " inkontinensia uri et al;i <
Dilakukan pertukaran aga 13:e$ruari ,!1 pukul !.!! wita
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• A" 7 penurunan kesadaran e.% SD= +.:rontote&poral D onset hr.1!
• IC= +. >rontal $ilateral
• :r. ?asis %ranii
• Pneu&oense>al
•
=P' gr.II• Ane&ia 8=$"*/9
• =e&ate&esis
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8/18/2019 DEAD CASE.pptx
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• P" 7 !, 3 l(& ;ia nasal kanul
• ?ed rest
• Ele;asi kepala/ leher/ punggung -!@
• Chest sioterapi
• #ral higine
• I4:D NaCl !/* )!!%%" KAEN -? B ,"1 ,1 gtt(&
• Ce>triaone ,, gr I.4 8h.119
• Citikolin ,)!!&g I.4
• 4it C ,1 in a&p
• Para%eta&ol -1!!!&g drips I.4
• +anitidin ,1 in a&p
• in% ,1 ta$ p.o ;ia #2'
• 'el&isartan !&g !7!7I
• A&lodipin 1!&g I7!7!
• KIE• Su%tion lendir $erkala
• Ne$uliHer ?isol;on " NaCl !/* " Co&$i;ent B1"1"1
• +a$er NS
• ?alans %airan
• #$s 4S(2CS(Pupil(a&
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JAM TD Suhu
Nadi
Res
SaO2 Sikap
!*.!
!
1-!(*! -0/, , *
1!.!!
1-!(*! -/, ,3 * 7 Cairan dinaikkan sa&pai, gtt(&7 Su%tion
11.!
!
1!!(! -* 1,! 1 *) 7 ?alans %airan
7 5oading %airan )!!%%7 Su%tion
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• 11.3)
• S" keluar %airan %oklat 6/ de&a& 6/ urin dala& 3 a& 1!!%%
• #" KU" $erat Kes" ko&a
• '" 1!!(3! N"1,0 +"1, S$" 31@ Sa#,"
• 2CS" E1M14 Pupil isokor uk.3&&73&& re>. %ahaya &enurun/ re>. %ahaya
tidak langsung &enurun• A" 7 penurunan kesadaran e.% SD= +. :rontote&poral D onset hr.1!
• IC= +. >rontal $ilateral
• :r. ?asis %ranii
• Pneu&oense>al
• =P' gr.II
• Ane&ia 8=$"*/9
• =e&ate&esis
• Susp. AKI
• Sepsis e.% susp. pneu&onia
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8/18/2019 DEAD CASE.pptx
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P" 7 #, 7 l(& ;ia N+M
• Ele;asi kepala/ leher/ punggung -!@
•
Cek Dl/ Ur/ Cr/ U5/ A2D %ito• Konsul ICU
• Para%eta&ol drips 1!!!&g
•
?alans %airan• KIE
• #$s 2CS( ''4( pupil( -! &enit
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• 5a$ 13(,(,!1
• 5eukosit -,.00!
•
Eri" -/3,• =$" */)
• =t" ,/
•
'ro&$o" 1,*.!!!• Ur" 0
• Cr" 1/!
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• U5"
• Makroskopis " warna" kuning/ kekeruhan"agak keruh
• Ki&ia Protein 66• ?G" 1!1) 2lukosa nor&
• P=") Keton 6
• 5euko 6 Uro$ilinogen nor&• Nitrit neg ?iliru$in 6
• Eritrosit(darah 66666
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• 11.))
• '"!(3! N"1,(& +"1!(& S$-*/ Sa#," 0,
• 2CS" E1M14 Pupil isokor uk.)&&7)&& re>. %ahaya&enurun/ re>. %ahaya tidak langsung &enurun
• P"7 5oading %airan )!!%%
• +esusitasi paru
• 1,.!)
•
Nadi tidak tera$a/ tekanan darah tidak terukur/pupil &idriasis &aksi&al dilakukan EK2 danhasilnya asistole.
• Penye$a$ ke&atian" Syok septik
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8/18/2019 DEAD CASE.pptx
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'eri&a Kasih
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