LAPORAN PERIOPERATIF PASIEN LIVE DEMO OKA ENDOSCOPY

NO Identitas Diagnosa Tindakan ASA Rencana

1 Supriadi, Lk, 37 Varices Esofagus Ligasi Varices ASA IV
Thn - Sepsis, TD: 94/63 mmhg, RR: 26 x/mnt, T: 39,1
- Distensi Abdomen LP: 90 cm, RR: 26 x/mnt, SPO2:
84% RA, Venectasi +
- Cxr: Pluero Pneumoni, Ves+/+, Rh-/-, Wh-/-
- Anemia 9,2 gr/dl
- Trombositopeni 44.000/mm3
- Pemanjangan Faal Koagulasi PT: 1,72x, APTT: 2,02x
- Hipoalbumin 2,35
- Peningkatan Fungsi Ginjal, Ur: 63, Cr: 1,2 UO>
0,5cc/kgbb/jam
- Hiponatremi 123 mmol/L
- Hiperkalemi 5,0 mmol/L
- HbsAg +
2 Salbiah, Pr, 67 Colitis Infeksi Colonoscopy ASA II
Thn - Anemia 9,3 gr/dl
- Cxr: Pneumonia, RR: 19 x/mnt, Ves +/+, Rh -/-, Wh -
/-
- Hipokalemi 3,2 mmol/L
- Geriatri 67 thn
3 Abubakar, Lk, Popyp Recti Polypectomy ASA II
73 Thn - HT Stage I TD: 140/90 mmhg, Mets 6, EKG: SR 79
bpm, Cxr: -, Th: -
- DM Tipe 2, GDS: 170 mg/dl, Th:-
- Anemia 11, 5 gr/dl
- Geriatri 73 thn
4 Jamaliah, Pr, 56 Cholelithiasis + Endoscopy ASA III
Thn Cholecistitis Ultrasonografy - HHD TD: 118/70 mmhg, Mets 4-5, EKG: NSR 64
bpm, LVH, Echo: LVH Eksentris dengan EF 73 %, Th:
Herbesser 1 x 100 mg
 - Anemia 9,6 gr/dl
- Peningkatan Fungsi Hepar, Bil Direct: 0,6 mg/dl
5 Muslyadi, Lk, 48 Varises Esofagus Ligasi Varises ASA II
Thn - Sirosis Hepatis, SGOT: 40, SGPT: 30, HBSAG +
- PSMBA Perbaikan, Melena -, Hematemesis –
- Anemia 10,2 gr/dl
- Leukopeni 3.300/mm3
- Trombositopeni 86.000/mm3
6 M. Shaleh, Lk, Varises Fundus Ligasi Varices + Glue ASA III
52 Thn Injection - Pemanjangan Faal Koagulasi, PT: 1,4 x, APTT: 1,6 x
- Trombositopeni 25.000/mm3
- Leukopeni 1.500/mm3
- Anemia 8,6 gr/dl
- Peningkatan Fungsi Ginjal, Ur:17, Cr: 1,06
- Hiperglikemi, KGD: 317
- HbsAg +
7 Zulhilmi, Lk, 44 Varises Esofagus Ligasi Varices ASA III
thn - DM tipe 2, GDS: 272, Th: Homalog 12-12-12
- EKG: Sinus Bradikardi 58 bpm, AV Block Derajat 1,
murmur-, gallop-, Mets: 6, Cxr:-
- Pemanjangan Faal Koagulasi, PT: 1,4x APTT: 1,7x
- Trombositopeni 103.000/mm3
- Leukopeni 4.400/mm3
8 Amiruddin, Lk, Cholangio Ca dd: Ca Endoscopy ASA III
58 Thn Caput Pankreas Ultrasonografy + FNAB - Peningkatan Fungsi Hepar, Ikterik +, SGOT: 129
SGPT: 164 Bil Total: 21,92 Bil Indirect: 4,37
- HT Stage 1, TD; 140/90 mmhg, Murmur-, Gallop-,
Mets 6, EKG: SR 69 bpm, Iskemik Inferior ( T
Inverted II, III, AVF) Th: Amlodipin 1x10 mg
- DM Tipe 2, GDS: 190 mg/dl, Th: Levemir 0-0-0-10