ALL CASES

EMERGENCY DUTY
Friday, February 5th 2016
Ika/Riyu/Restu

Dr. dr. Sri Mulatsih, Sp.AK

dr. Kristia Hermawan, M.Sc, Sp.A

RESTU

EMERGENCY ROOM DUTY

Emergency cases

Priority cases

: 3

Non Priority cases

: 2

Other case

Total 9

: 2

: 2

RESTU

EMERGENCY CASES
No

Name and Diagnosis

Ward

F.K.R/F/8 y.o/Parakan
(Referral case from RSK Ngesti Waluyo Parakan)

PICU
(dr. Desy Rusmawaningtyas,
Sp.AK)

- Ketoasidosis Diabeticum
- Sepsis
- Diabetes Mellitus type I
2

INTERESTING CASE

M.B.S/M/5 y.o/Nyutran
(Referral case from RSI Hidayatullah)
- Dengue Shock Syndrome (4th day of fever)

PICU
(dr. Desy Rusmawaningtyas,
Sp.AK)

RESTU

PRIORITY CASES
No

Name and Diagnosis

Ward

A.R.A/F/7 m.o/Ngemplak

Melati 2
( Prof. dr. M. Juffrie, Sp.AK)

- Cholestasis
- 2nd day of Febris c.b UTI susp
- Phymosis
2

V.P.A/F/6 y.o/Parakan
(Referral case from RSK Ngesti Waluyo
Parakan)
- ALL susp
- Hyperleucocytosis
- Febrile Neutropenia

Estella 2
(dr. Eddy Supriyadi, Ph.D,Sp.AK)

RESTU

PRIORITY CASES
No

Name and Diagnosis

Ward

A.Z.A/M/1,5 m.o/Lodoyong
(Referral case from RS Akademik UGM)

Melati 2
(dr. Roni Naning,Sp.AK)

Community acquired Pneumonia

RESTU

NON PRIORITY CASES

No

Name and Diagnosis

Ward

V.A.P/M/2 y.o/

Ambulatory
(Dr. dr. Sri Mulatsih,
Sp.AK)

- Thyphoid fever
2

R.A.A/M/2 y.o/
- Acute Rhynopharyngitis
- Scabies

Ambulatory
(Dr. dr. Sri Mulatsih,
Sp.AK)

RESTU

OTHER CASES
No Name and Diagnosis

Ward

Pediatric Surgeon

F.C/M/15 y.o/Kalisoko
- Acute appendicytis

L.J.W/M/8 y.o/Keparakan
- Acute appendicytis

Pediatric Surgeon

THANK YOU

PRIMARY SURVEY

FKR/8y.o

T
I
C
L
S

RESTU

WOB Normal
No retraction

Pale (-), Mottled (-), sianosis (-)

Assessment: CNS Dysfunction
Plan:
A :airway positoning
B: Rebreathing Mask 5 lpm
C: IVFD NaCl 0,9%

RESTU

SECONDARY SURVEY

15 days BA : child looked letargis, she could do routine activity, no fever,

no cough and coryza, no history of poliuria, polidipsia, and polifagia.

10 days BA : still looked weak, complained about headache, warm in

palpable (t : ?). Complaints still persist. 2 days after, child brought to
private clinic, doctor told that she had anemia, got therapy syrup? 3x1

8 days BA : her complaints still persist. Parents said that her mixie
activity was increased in night, 5-7x, she drink > 8 cup/day, fever?

2 days BA : she complained about earache, chest pain, and looked more
letargis, vomit 1x 200 cc RS Sukorejo (15.00). In emergency unit
got yellow pulv? And child still could walk by herself, went to bathroom
3x.
18.30 chest pain then fainted she brought to RSK Ngesti Waluyo

RESTU

SECONDARY SURVEY (cont)

Emergency unit RSK Parakan : hypovolemic shock rehydration with NaCl

0,9% 360 cc evaluation bolus NaCl 0,9% 360 cc and continue with
maintanance 70cc/hour

Fluid has been changed to D5 NS since 4/02/16.

RESTU

PHYSICAL EXAMINATION

CNS : PCS E3M4V1, no seizure

CVS : HR 120x/min, TD : 111/82, stabil hemodinamic, warm akral, CRT < 2 sec

Resp : RR 26x/min, SpO2 99%

GIT : NGT, peristaltic (+), hepatomegaly 2 cm bac/bpx

GUT : DC, product (-)

Integumen : motlet (-), anemis (-)

Regio auricula sinistra : bulging, reddish, pain (+)

Neurological status : physilogic reflex on low extremity was increased, Kernig

sign (+)

Fadla

LABORATORIUM

RESTU

Parameter

3/2/16

5/2/16
Sardjito

Normal range

Hb (g/dL)

13.6

11.8

10.8 15.6

Hct (%)

40.5

34.2

33 45

Platelet

522,000

170,000

184,000-488,000

WBC

34,560

14,650

3,980 10,040

RBC

5.19 x 106

4.36 x 106

3.8 5.8

MCV (fL)

78

78.3

69 93

MCH (pg)

26.2

27

22 34

MCHC (g/dL)

33.6

34.5

32 36

Natrium

133

115.22

132 145

Kalium

5.69

4.64

3.1 5.1

Klorida

105

94

96 111

Kalsium

10.16

2.35

8.8 10

Fadla

LABORATORIUM
Parameter

5/2/16
Sardjito

Normal range

Albumin

2.94

3.4 - 5

SGOT

73

15 37

SGPT

39

12 78

BUN

26.4

7 - 20

Creatinine

1.82

0.6 1.3

264

74 - 140

GDS

3/2/16

RESTU

HIGH

PPT

11.9

APTT

26.6

INR

0.84

Fadla

URINALISIS

RESTU

Parameter

3/2/16

4/2/16

5/2/16
Sardjito

Normal range

Glucose

+3

+3

+3

Negative

Protein

+-

+1

+1

Negative

Bilirubin

Negative

+3

Negative

Negative

Urobilirubin

Normal

Normal

Normal

Normal

pH

5.5

6.0

5.0

4,5 8,0

Urine Gravity

1.015

1.015

< 1.005

1.000 1.030

Blood

+1

+3

+1

Negative

Keton

+3

+-

+1

Negative

Nitrit

+-

Negative

Negative

Negative

Leukocyte
Esterase

Negative

+1

Negative

Negative

Fadla

URINALISIS

RESTU

Parameter

6/2/16

7/2/16

Normal range

Glucose

+3

+3

Negative

Protein

+-

+1

Negative

Bilirubin

Negative

+3

Negative

Urobilirubin

Normal

Normal

Normal

pH

5.0

6.0

4,5 8,0

Urine Gravity

1.010

1.015

1.000 1.030

Blood

+2

+3

Negative

Keton

+1

+-

Negative

Nitrit

Negative

Negative

Leukocyte
Esterase

Negative

+1

Negative

Fadla

Parameter

3/2/16

4/2/16

5/2/16

5/2/16
Sardjito

Satuan

Normal range

pH

6.94

6.96

7.29

7.28

pCO2

12

11

19

13.5

mmHg

35 45

pO2

160

111

208

249.5

mmHg

80 100

BE

- 28.1

- 28.1

- 15.3

- 17.7

mmol/L

-2 - 3

TCO2

2.8

2.8

9.7

6.6

mmol/L

22 29

HCO3

2.4

2.4

9,1

6.2

mmHg

18 23

stHCO3

4.5

4.7

12.4

10.2

mmHg

22 24

Natrium

133

133

124

115.2

mmol/L

132 145

Kalium

3.4

3.2

2.7

4.64

mmol/L

3.1 5.1

Klorida

105

105

101

94

mmol/L

96 111

Anion Gap

26.4

22.6

16.7

mmHg

10 - 20

Hb

13.6

12.6

13.9

11.8

g/dl

10.8 15.6

Hct

40.5

38

42

34.2

33 - 45

SO2

99

97

100

99.7

7.35 7.45

RESTU

Fadla

Parameter

6/2/16

Satuan

Normal range

pH

7.26

pCO2

19.7

mmHg

35 45

pO2

202.5

mmHg

80 100

BE

- 15.8

mmol/L

-2 - 3

TCO2

9.4

mmol/L

22 29

HCO3

8.8

mmHg

18 23

stHCO3

12.1

mmHg

22 24

Natrium

125

mmol/L

132 145

Kalium

mmol/L

3.1 5.1

Klorida

107

mmol/L

96 111

Calsium

2.6

mmol/L

2.15 2.55

Hb

13.9

g/dl

10.8 15.6

Hct

40.5

33 - 45

SO2

99.4

7.35 7.45

RESTU

Fadla

LABORATORIUM

RESTU

Parameter

5/2/16
Sarjito

Satuan

CRP

57

mg/L

Procalsitnonin

30.41

ng/mL

Normal range

RESTU

GDS MONITOR
3/2

4/2
6.30

4/2
7.30

4/2
5/2
6/2
6/2
6/2
6/2
6/2
7/2
16.30 13.30 06.00 10.00 14.00 18.00 22.00 3.00

7/2
8/2
16.00 00.00

498

484

442

295

153

112

32

391

373

56

199

206

224

MBS

RESTU

PRIMARY SURVEY
T
I
C
L
S

WOB Normal
No retraction

Pale (+), Mottled (-), sianosis (-)

Assessment: CVS dysfunction
Plan:
A : airway positioning
B : room air
C : Dobutamin 5mcg/kg/menit

MBS

SECONDARY SURVEY

4 days BA : child got high fever (t :?) with vomitus, no headache, no

abdominal pain. Went to RSH, got paracetamol and anti emetic.

3 days BA : child still got fever, no vomiting, no headache, no abdominal

pain. He continued the therapy.

DOA : fever started to decrease, vomiting, abdominal pain (+), child looked
weeak went to RSH run blood test : Hb : 17,1, Hct : 53,4%, AL : 4.700,
Net : 70,9%, Lim : 23,3%, AT : 103.000

In Emergency unit RSH he was assessed as shock resuscitation with RL

40cc/kg and Gelafuchsin 10cc/kg pulse was weak referred to RSS.

Post resuscitation Hct : 40, AT : 102,000

Last mixie in 01.30, no melena, no gum bleeding, no epistaxis.

RESTU

RESTU

PHYSICAL EXAMINATION

CNS : PCS E4V5M6, no seizure

CVS : HR 150 - 170x/min, TD : 117/70, hemodinamic was stable, cold

acral, weak pulse, CRT 2 sec

Resp : RR 26x/min, SpO2 99%, no retraction

GIT : NGT, peristaltic (+), nyeri tekan (+)

GUT : Diuresis : 1,7 cc/jam

Integumen : petechiae (-)

LABORATORIUM

MBS

6/2/16
00.00

RESTU

Parameter

5/2/16
23.00

6/2/16
Sardjito

Hb (g/dL)

17.1

Hct (%)

53.4

40

41.2

32 47

Platelet

103,000

102,000

72,000

150.000-450.000

WBC

4,700

3,400

3,600 11,000

Neutrofil

70.9

57.7

50 70

Limfosit

23.3

32.6

20 40

Basofil

0.3

0.3

01

Eosinofil

1.5

14

Monosit

5.8

9.4

28

MCV (fL)

83

77.6

80 100

MCH (pg)

26.5

26

26 34

MCHC (g/dL)

32.1

33.5

32 - 34

13.8

Normal range
11.7 15.5

LABORATORIUM

MBS

RESTU

Parameter

6/2/16
Sardjito

Normal range

Parameter

6/2/16
Sardjito

Normal range

PPT

14.6
(13.8)

12.3 15.3

Natrium

130.9

136 145

46.9
(31.9)

27.9 - 37

Kalium

5.81

3.5 5

Klorida

97

98 107

D-dimer

427

< 230

Calsium

1.89

2.1 2.5

Fibrinogen

242

148 380

Protein total

5.5

6.4 8

Albumin

2.71

3.4 - 5

SGOT

82

15 37

SGPT

35

12 78

BUN

12.2

7 - 20

Creatinin

0.46

0.6 1.3

GDS

91

74 - 140

APTT

LABORATORIUM

MBS

6/2/16
00.00

RESTU

Parameter

6/2/16
21.30

6/2/16
Sardjito

Hb (g/dL)

15.3

Hct (%)

45.7

40

41.2

32 47

Platelet

16,000

102,000

72,000

150.000-450.000

WBC

5,760

3,400

3,600 11,000

Neutrofil

64

57.7

50 70

Limfosit

32

32.6

20 40

Basofil

0.3

01

Eosinofil

14

Monosit

32

9.4

28

MCV (fL)

78.7

77.6

80 100

MCH (pg)

26.3

26

26 34

MCHC (g/dL)

33.4

33.5

32 - 34

13.8

Normal range
11.7 15.5

LABORATORIUM

MBS

RESTU

Parameter

6/2/16
16.00

6/2/16
22.00

Normal range

Protein total

4.31

4.8

6.4 8.2

PPT

15.3

12.2 15.3

APTT

51.3

27.9 - 37

Fibrinogen

119

148 380

D-dimer

174

< 230

CK/CPK

187

39 - 308

CKMB

68

7 - 25

Natrium

128

136 145

Kalium

4.54

3.5 5

Calsium

1.77

2.1 2.5

Chlorida

96

98 - 107

IgM anti dengue

MBS

Pleural effusion

An MBS, 6
yo: BW: 20 kg
LABORATORIUM

Dengue Monitor
R

PP Hct

Tgl: 5-02-16 IV
1

3
2

72

5
4

7
6

Tgl: 6-02-16
9

11
10

13
12

15
14

17
16

19
18

23
1
3
5
7
9
11
13
15
17
19 23 21
24
2
4
6
8
10
12
14
16
18
20
22

51

24 100

47
43

1
24

3cc/kg/jam
Plasman
at 200cc

53.4

55

32 120

80

22

Plasman
at 200cc 3cc/kg/jam

64 200
56 180
48 160
40 140

21
20

115/7
2
100
40

49.2

45.7

41.2

60 6.5 39 70
40 5.5 35
4.5 31

5.5
4.8

3.5 27
2.5 23

Platelet (/mm3)
Abdominal circ.
(cm)

Tekanan
Hematokrit
Protein Plasma Darah
Nadi

4.31

10300102.0 72.000
0
00

110.00
0

Ringer Fundin

16.000

An MBS, 6
yo: BW: 20 kg
LABORATORIUM

Dengue Monitor
R

PP Hct

Tgl: 7-02-16 VI
1

3
2

72
64 200
56 180
48 160
40 140

7
6

9
8

11
10

13
12

15
14

17
16

19
18

21
20

22

23
1
3
5
7
9
24
2
4
6
8
10

VII
I13
11
12

15
14

3cc/kg/jam

55

32 120

51

24 100

47

80

5
4

Tgl: 8-02-16

43

100

43.8

60 6.5 39 70
40 5.5 35

37.5

4.5 31
3.5 27
2.5 23

Platelet (/mm3)
Abdominal circ.
(cm)

4.31

45,00
0

5.5

55,00
0

Tekanan
Hematokrit
Protein Plasma Darah
Nadi

Ringer Fundin

17
16

19
18

23 21
20
22

1
24

Ahmad

LABORATORIUM

RESTU

Parameter

5/2/16

Normal range

Hb (g/dL)

10.7

11.7 15.5

Hct (%)

31.8

32 47

Platelet

531,000

150.000-450.000

WBC

13,400

3,600 11,000

Neutrofil

13.7

50 70

Limfosit

63

20 40

Basofil

0.3

01

Eosinofil

1.5

14

Monosit

12.4

28

MCV (fL)

90.9

80 100

MCH (pg)

30.6

26 34

MCHC (g/dL)

33.6

32 - 34

Ahmad

RONTGEN THORAX

Pneumonia bilateral

RESTU

Anditya

LABORATORIUM

RESTU

Parameter

27/01/16

5/2/16

Normal range

Hb (g/dL)

8.0

7.5

10.1 12.9

Hct (%)

24.4

23.4

35 43

Platelet

207,000

150.000-450.000

WBC

25,130

10.000 26.000

Neutrofil

47

50 70

Limfosit

38.5

22 40

Basofil

5.3

01

Eosinofil

0.3

24

Monosit

7.3

28

MCV (fL)

84.1

83.6

73 109

MCH (pg)

27.6

26.7

21 33

MCHC (g/dL)

32.8

32

26 - 34

LAB (cont)

RESTU

Parameter

27/1/16

5/02/16

Bilirubin Total
(mg/dL)

16.62

< 1,2

Bilirubin Direct
(mg/dL)

14.07

< 0,6

Albumin (g/dL)

2.04

Na

135

136 145

3.84

3,5 5,1

Cl

103

98 107

GDS

109

80 -140

BUN

3.1

6 - 20

Creatinin

0.27

0.7 1.2

BT

4 min

PPT

17.5 sec

12.3 15.3

APTT

41.5 sec

27.9 37

2.64

Normal range

3,9 4,9

Vidi

LABORATORIUM

RESTU

Parameter

5/02/16

Normal range

Hb (g/dL)

10.4

10.8 12.8

Hct (%)

30.4

35 45

Platelet

174,000

217,000-497,000

WBC

4,130

6,000 17,500

Neutrofil

34.9%

25 60

Limfosit

55%

25 - 50

Basofil

0.2%

<1

Eosinofil

0.2%

1 -5

Monosit

9.7%

1-6

MCV (fL)

80

73 101

MCH (pg)

27.4

23 - 31

MCHC (g/dL)

34.2

26 - 34

Vidi

URINALISIS

RESTU

Parameter

5/02/16

Normal range

Glucose

Negative

Negative

Protein

Negative

Negative

Bilirubin

Negative

Negative

Urobilirubin

Normal

Normal

pH

6.5

4,5 8,0

Urine Gravity

<1.005

1.000 1.030

Blood

Negative

Negative

Keton

Negative

Negative

Nitrit

Negative

Negative

Leukocyte Esterase

Negative

Negative

Viska

LABORATORIUM

RESTU

Parameter

4/02/16

5/02/16
Sardjito

Normal range

Hb (g/dL)

9.3

8.5

10.8 15.6

Hct (%)

28.8

25

36.4 46.3

Platelet

48,000

81,000

184,000-488,000

WBC

337,130

314,300

3,980 10,040

Neutrofil

34 71

Limfosit

81

10

25 40

Basofil

01

Eosinofil

13

Monosit

15

28

MCV (fL)

76.8

79

69 93

MCH (pg)

24.8

26.9

22 34

MCHC (g/dL)

32.3

34.1

32 36

Viska

LAB (cont)

RESTU

Parameter

4/02/16

5/02/16
Sardjito

SGOT

170.7

< 40

SGPT

18.9

< 40

BUN

28.7

17 - 37

Creatinin

0.68

<1

Uric acid

10.9

LDH

1874

Natrium

135.6

Kalium

3.48

Klorida

101

Normal range

Viska

RONTGEN THORAX

RESTU

Gambaran bronkitis

Viska

PERIPHERAL BLOOD SMEAR

RESTU