interesting case laporan

8/17/2019 interesting case laporan

http://slidepdf.com/reader/full/interesting-case-laporan 1/17

Normal Peningkatan WOB

LAPORAN KASUS MATI

IDENTITAS

Nama : D.R

No.CM : 1-59-94-xxJenis Kelamin : P

Tanggal Lahir : 24 Desemer 1999

!sia : 15 "ah#n$lama" : Ke%#h &K '''( )og*a+ar"a

Tanggal Mas#+ : 2, e%"emer 215 /Jam 0. '3Tanggal Meninggal : 29 e%"emer 215 /Jam 1. '3

Lama Peraa"an : 2 hari /6 7am3Pen#lis !"ama : 8r. aii8ha"#rrahmah

Co-$#"hor : 8r. Cessar; 8r.Jerr*; 8r.Dio; 8r.&alih /Chie angsal Mela"i 43; 8r. P#"# 8an

8r. $mel /"ase Kar8iologi3; 8r. ri /"ase Res%ira"ologi3; 8r.ag#s;8r.i<a+sono; 8r.Kris"* /"ase =n8o+rinologi3

PERIODE I : 28 September 2015, Jam 061! "I#

LOKASI : I$D %&r Lea'

PERIODE 1

PRIMARY SURVEY % Jam 061! "I# '

$$N P=ND'D'K$N



Pemer*)aa( 3*)* :

Kea8aan #m#m :Com%os men"is; =4@5MTan8a >i"al : N : 12 x(meni" TD: 15(5mmg RR /P95 12,(,4; P99 165(913

RR : 25x(meni" T : 65.,A C %B2 9 /NK 1L(mn"3 Leher: "eraa massa 8i "iroi8 sinis"ra;

a"as "i8a+ "egas; soli8; "i8a+ n*eri; J@P normal. Da8a :sime"ris; +e"inggalan gera+ /-3; re"ra+si/-3 Jan"#ng : 1 "#nggal; 2 s%li" "i8a+ +ons"an inis"ra Par# : onor (; >esi<#lar /(3 N;

s"ri8or ins%irasi /3 8i %ar# ela+ang. $8omen : s#%el; %eris"al"i+ normal; e%ar : "eraa 2 <m

a< Lien : "i8a+ "eraa =+s"remi"as : a+ral hanga";na8i +#a"; %er#si ai+. Ke%ala: +on7#ng"i>aanemis /-(-3; s+lera i+"eri+ /-(-3;%#%il iso+hor /(3; rele+ <aha*a /(3

D*a(4)*) Kera : S)p Tm4r T*r4*&, D3:eart 3a*+re, DE: Pe(/a*t Ja(t( Remat*,

DA: MI m4&erate, AI m4&erete, TI m*+&

T*(&aa( &*a(4)*) :

=K& 7am .6: in#s "a+i+ar8i <#riga hi%er"roi >en"ri+el +iriPeri+sa 8arah r#"in; ele+"roli"; LD; !N(<rea"inin; &BT(&PT; T; ?T4; &D

?o"o Ron"gen $P Thorax; '@ %l#g

T*(&aa(terap* : ?#rosemi8 mg(12 7am i> /1mg(+g(+ali3; Ca%"o%ril 6mg(12 7am %o /;5

mg(+g(127am3

SECONDARY SURVE Y &* I$D 7!0

Ke+-a( tama : esa+ na%as

R*.a/at Pe(/a*t Seara( : $na+ "er8iagnosis PJR se7a+ 6 "ah#n *ang lal# 8an r#"in +on"rol

+e %oli+lini+ +ar8iologi. Tera%i "era+hir men8a%a"+an %engoa"an r#"in 8enganPhenoxime"h*l%eni<illin 2x25mg; Ca%"o%ril /;6mg(+g3 2x12;5mg; 8an ?#rosemi8

/;0mg(+g3 2x 4mg.



a< Lien : "i8a+ "eraa =+s"remi"as : a+ral hanga";na8i +#a"; CRT E2 8e"i+. Ke%ala:

+on7#ng"i>a anemis /-(-3; s+lera i+"eri+ /-(-3; T6-T2;%#%il iso+hor /(3; rele+ <aha*a /(3

D*a(4)*) Kera : S)p Tm4r T*r4*&, D3:eart 3a*+re, DE: Pe(/a*t Ja(t( Remat*,

DA: MI m4&erate, AI m4&erete, TI m*+&

T*(&aa( &*a(4)*) :

=K& 7am .6: in#s "a+i+ar8i <#riga hi%er"roi >en"ri+el +iri

Peri+sa 8arah r#"in; ele+"roli"; LD; !N(<rea"inin; &BT(&PT; T; ?T4; &D?o"o Ron"gen $P Thorax; '@ %l#g

T*(&aa(terap* :

Lap4r Pr4 Sam*, SpAK ?#rosemi8 mg(12 7am i> /1mg(+g(+ali3; Ca%"o%ril 6mg(12 7am %o /;5 mg(+g(127am3; Kons#l en8o+rin $<< Raer

Lap4r Pr4 Ma&ar*(a, SpAK $<< 8iagnosis 8an Plan; Ron"gen "horax; Kons#l e8ah

Bn+ologi.

Men*e"#7#i: Presen"an

/8r. Lea3 /8r. $>is3



Per*4&e II : Ta(a+ 159201! am 1800

SECONDARY SURVE Y &* #a()a+ Me+at* 9 am 8!0 %&rA*)'

Ke+-a( tama : esa+ na%as

R*.a/at Pe(/a*t Seara( : 2MSMRS ana+ mengel#h a8a en7olan +e<il /se#+#ran +elereng3

8an %egal 8i sel#r#h leher; "eng+#+ hingga 8a8a. Pasien n*eri "enggoro+an; ma+in lama en7olanma+in esar se%er"i men8esa+ leher; "i8a+ 8a%a" 8igera++an

; "i8a+ a8a 8emam; s#ara "i8a+ sera+. Pasien min#m s#%lemen eralie *ang erisi asam amino8an >i"amin selama sa"# mingg#. Pasien m#lai "i8a+ min#m Ca%"o%ril; ?#rosemi8 8an

Phenoxime"h*l%eni<illin +arena oa" hais 8an PJ "i8a+ 8a%a" 8ig#na+an. Pasien "i8a+ min#moa"-oa"an "erse#" se7a+ 2 MMR hingga 1 MMR 1MSMRS en7olan ma+in memesar;

m#lai sesa+ na%as; nam#n masih 8a%a" era+"i>i"as; a8a a"#+; "i8a+ a8a 8emam; 8i%eri+sa+an +e

%oli +ar8iologi 8an 8i+ons#l+an +e %oli e8ah lal# 8ila+#+an !&. asil !& 22(9(15 "er8a%a"gamaran massa "iroi8 sinis"ra 8engan "an8a-"an8a malignansi *ang men8e>iasi "ra+ea +e arah

8e+s"ra ser"a "a+ "am%a+ lima8eno%a"i <olli. !SMRS %asien mengel#h s#ara +a8ang

menghilang 8an sera+; sesa+ na%as hilang "im#l; memera" 7i+a eraring +e sisi +anan ma#%#n+iri; "i8a+ a"#+; "i8a+ a8a 8emam. MRS sesa+ na%as memera"; a"#+ ngi+il; sesa+ na%as

memera" 8engan a+"i>i"as ringan se%er"i +e +amar man8i; "i8#r 8engan %osisi se"engah 8#8#+;

"i8a+ eng+a+ 8i +a+i; "i8a+ a8a 8emam; "i8a+ er8ear-8ear.

I(4rma)* tamba-a(

R*.a/at Pe(/a*t Da-+: $man8el esar saa" +elas 6 D; 8emam "inggi 8engan +a+i

eng+a+ merah +elas 5 D; +a+i eng+a+ merah +am#h lagi +elas D-1 MP. DemamRema"i+ $+#" "er8iagnosis se7a+ 6 "ah#n *ang lal#

R*.a/at Pe(/a*t Ke+ara: Ria*a" %en*a+i" 7an"#ng 8isang+al; Ria*a" %en*a+i" gon8o+ 8i + l Ri +i + i + 8i + l Ri +i li / + il



orm#la; #lan F 12 #lan : ##r saring; s#s# orm#la; 12 #lan F 24 #lan : nasi leme+; 24

#lan F se+arang : nasi se%er"i ma+anan +el#arga; se7a+ 1 mingg# "era+hir; s#li" menelan; 8an

nas# ma+an er+#rang. S*mp+a( : a+*ta) &a( a(t*ta) maa(a( ba*

R*.a/at Peremba(a( : M4t4r* a)ar: er7alan 12 #lan; erlari 24 #lan. M4t4r* -a+):

men<ore" 12 #lan. #*<ara: meng#<a%+an 1 +a"a 12 #lan; i<ara mengga#ng+an 2 +a"a 2"ah#n. S4)*a+: ma+an sen8iri 24 #lan. Brang "#a "i8a+ inga" se<ara %ersis %er+emangan ana+

"e"a%i men#r#" i#; %er+emangan ana+n*a "i8a+ "erlama" 8ian8ing+an "eman sea*an*a. $na+

se+arang 8#8#+ 8i +elas 1 MK 8i )og*a+ar"a; "i8a+ %ernah "inggal +elas; 8a%a" mengi+#"iolahraga ringan 8an "i8a+ a8a hama"an 8alam eri<ara 8an ersosialisasi Ke)a( : "i8a+

"er8a%a" +em#n8#ran %er+emangan

R*.a/at Im(*)a)* : $na+ s#8ah men8a%a" e%a"i"is ;2;4; #lan; C& 1 #lan; DPT 2; 4;; #lan. Polio ; 2;4;; #lan. Cam%a+ 9 #lan 8an #langan 1x. Ke)a(: 'm#nisasi 8asar ses#ai

8engan PP' 8an "i8a+ 'D$'

R*.a/at )4)*a+ e4(4m* &a( +*((a( : $*ah 8an i# e+er7a seagai %en7#al nasi rames;

%enghasilan "i8a+ "en"# se+i"ar se7#"a %er#lan. $na+ mer#%a+an ana+ %er"ama 8ari 8#a

ersa#8ara 8an "inggal ersama a*ah; i# 8an a8i+. R#mah +os era8a 8i ling+#ngan %er+o"aan8i )og*a+ar"a 8engan 8#a +amar; a"a% gen"ing; lan"ai "egel; >en"ilasi <#+#%; s#mer air min#mP$M. Ke)a(: s"a"#s e+onomi menengah +e aah; sosio ling+#ngan ai+.

Pemer*)aa( 3*)*

Kea8aan #m#m :Tam%a+ sesa+ na%as; Com%os men"is

Tan8a >i"al : N : 1 x(meni" TD: 12(0 mmg RR /P95 12,(,4; P99 165(913 RR : 24x(meni"

T : 6;6A C %B2 99 /NK 1L(mn"3 Stat) A(tr4p4metr*: era" a8an 50 +g; "inggi a8an

11 <m; ling+ar +e%ala 55 <m; ling+ar lengan a"as 22 <m; ling+ar 8a8a ,,;5 <m; ling+ar %er#" 0<m. (! EGE1; P(! -1EGE; (P EGE1; LL$(! EGE1 Ke)a(: "a"#s giHi ai+. Le-er:

"eraa massa 8i "iroi8 sinis"ra; #+#ran 5<mx9<m; a"as "i8a+ "egas; soli8; "i8a+ n*eri; J@P

normal. Da8a :sime"ris; +e"inggalan gera+ /-3; re"ra+si /-3 Jan"#ng : 1 "#nggal; 2 s%li" "i8a+



/3

- Ti8a+ "am%a+ %emesaran limono8i <olli ila"eral

Ke)*mp+a(- Massa "h*roi8 sinis"ra 8engan "an8a-"an8a malignan<* *ang men8e>iasi "ra<hea +e arah

8ex"ra

- Ti8a+ a8a lima8eno%a"h* regio <olli

a)*+ EK$ 28=2015 &* I$D

- R : 9 x(meni" /,-113- 'rama : sin#s

- PR ;, /;1-;23- R ;, /;5-;13

- T ;4 /;6-;443- $xis 5o /-6o-15o3

- R@1 2 /-13

- @1 15 /5-23- R@2 6 /2-2;53

- @2 1, /,-513

- R@5 15 /5-613- @5 /-0;53

- R@ 10 /0-213

- @ /;2-53- P %#lmonal "i8a+ a8a

- P mi"ral a8a

- @1R@ : 62

- @1R@5 : 6- @2R@ : 65

Ke)*mp+a(

- Normal sin#s rh*"m



- $r+#s aor"a 8i +iri; "i8a+ "am%a+ Co$(PD$

- =#si %eri+ar8 minimal

A))e)me(t:- Massa Regio Colli s#s% Ca Tiroi8

- D? : ear" ?ail#re

D= : Pen*a+i" Jan"#ng Rema"i+D$ : M' Mo8era"e; $' Mo8era"e; T' mil8

- =#si %eri<ar8 /minimal3

- =#si Ple#ra inis"ra

- !%%er air a* %ar"ial os"r#<"ion e< s#s% malignan<*

Re(<a(a pe(e+4+aa(:

T*(&aa( &*a(4)*):

- Raa" ersama en8o+rinologi

- Kons#l res%irologi #n"#+ e#si %le#ra sinis"ra

- Kons#l e8ah on+ologi #n"#+ s#s%.Ca "h*roi8- Kons#l TT #n"#+ %en*em%i"an "ra+hea a+ia" massa

- Kons#l gigi m#l#" #n"#+ oral h*gine +arena %asien mengg#na+an +aa" gigi

- Kons#l Ra8iologi #n"#+ mo8ali"as %emeri+saan %a8a +e<#rigaan Ca Th*roi8

T*(&aa( terap*:

- Bx*gen Nasal Cann#le 2Ll(meni"

- Ke#"#han <airan 8engan oli8a* egar- 'n7e+si Ceo"axim 1 mg(+g(hari 125 mg(, 7am i> /13

- Kons#l 8i>isi en8o+rinologi 8an +ar8iologi.

- Ca%"o%ril ;6 mg(+g(12 7am 6 mg(12 7am %.o

- ?#rosemi8e 1 mg(+g(12 7am mg( 12 7am i.>- Ca%"o%ril 6 mg(12 7am %.o

- ?#rosemi8e mg( 12 7am i.>%rionola<"one 25 mg( 24 7am % o



2= September 2015 am 0700 Me+at* 9 %&rA*)'

Sbet* esa+ a8a; 8emam "i8a+ a8a; a"#+ %ile+ "i8a+ a8a; s#ara hilang

Obet* PC : =4@4M5Ke)a( mm $na+ "am%a+ lemah

Pemer*)aa( *)* Kea&aa( mm :Tam%a+ lemah Com%os men"is

Ta(&a *ta+ : N : 16 x(meni" TD: 14(5 mmg RR /P95

12,(,4; P99 165(913 RR : 66x(meni" T : 6;2A C %B2 99 /NK 1L(mn"3

Le-er: "eraa en7olan %a8a leher; "i8a+ 8a%a" 8igera+an; J@P

mening+a"

Da&a :sime"ris; "i8a+ a8a +e"inggalan gera+ ; "i8a+ a8a re"ra+siJan"#ng : 1 "#nggal; 2 s%li" "i8a+ +ons"an; ising /3 sis"oli+

gra8e 2; 'C '''-'@ LP inis"ra Par# : onor (; >esi<#lar /

+anan; men#r#n +iri3; s"ri8or ins%irasi /3 8i %ar# ela+ang.

Ab&4me( : s#%el; %eris"al"i+ normal; e%ar : "eraa 2 <m aah

ar<#s <os"a. Lien : "i8a+ "eraa

E)trem*ta) : a+ral hanga";na8i +#a"; CRT E2 8e"i+.

Kepa+a: +on7#ng"i>a anemis /-(-3; s+lera i+"eri+ /-(-3; T6-T2;%#%il

iso+hor /(3

a)*+ K4()+ Ra&*4+4*

- Dila+#+an "h*roi8 s<in"igrai 8an CT-s<an leher 8engan

mengg#na+an ahan +on"ras

TT

- #s%e+ massa me8ias"in#m *ang men8esa+ "ra+hea 8an +arina

+e arah 8e+s"ra- T#mor "iroi8

aran :

- $+ses #n"#+ "ra+heos"omi s#li" 8ila+#+an



Appearance

Tonus ↓

Interactivity ↓

Consolability ↓

Look ↓Speech ↓

WOB !eningkat

Circulationti"ak pucat

#n"#+ mo8ali"as %emeri+saan %a8a +e<#rigaan Ca "iroi8; +ons#l"asi

gigi m#l#"; +ons#l"asi TT /"#ngg# 7aaan e8ah on+ologi3.

T*(&aa( terap*:- Ce+ TD "ia% 7am

- Miring +e +anan

- Phenoxime"h*l%eni<illin 2x25mg

- Ca%"o%ril ;5 mg(+g(12 7am 2x 6 mg %o

- ?#rosemi8 1mg(+g(127am i> 2x mg i>

? Nie8i%in 5mg s#ling#al 7i+a i%er"ensi emergensi

;atata(

2= September 2015 am 19!5

PRIMAR@

SURE@

Assesment: Distress Respirasi

Management:

A: perta-a(a( p4)*)* a+a( (apa)

#: Ter%asang B2 NRM 5li"er(meni"

;: oli8a* segar

SE;ONDAR@

SURE@

Sbet*: a(a p4)t &ar* amar ma(&*, (apa) )e)a



Appearance

Tonus ↓

Interactivity ↓

Consolability ↓

WOB !eningkatSpO# $%&

Pemer*)aa(

Pe((a(

-

A))e)me(t Dis"ress res%irasi e< De<om%ensasi Kor8is DD Par"ial os"r#<"ion

o aira* e< massa "iroi8

Pen*a+i" Jan"#ng Rema"i+

P+a( B2 NRM 5-, L(meni"Morin ;1mg(+g(+ali 5mg(i>

?#rosemi8 ;5mg(+g(+ali /ex"ra3 6 mg

De*a)* Se-ar)(/a A+a)a(

1. Pasien "#r#n 8ari "em%a" "i8#r +e

+amar man8i

Pasien e8res" "o"al 8i "em%a" "i8#r

8an meng#rangi a+"i>i"as isi+.

Pasien s#8ah 8ieri+an

e8#+asi nam#n %asienmens"r#asi 1 sehingga

ersi+#+#h +e +amar

man8i "an%a mela%or

%a8a "enaga +eseha"an*ang a8a 8i angsal

2= September 2015 am 1510

PRIMAR@

SURE@



Da&a :sime"ris; "i8a+ a8a +e"inggalan gera+ ; "i8a+ a8a re"ra+si

Jan"#ng : 1 "#nggal; 2 s%li" "i8a+ +ons"an; ising /3 sis"oli+

gra8e '''(; 'C '@ LP inis"ra Par# : onor (; >esi<#lar /+anan; men#r#n +iri3; R +anan minimal

Ab&4me( : s#%el; %eris"al"i+ normal; e%ar : "eraa 2 <m aahar<#s <os"a. Lien : "i8a+ "eraa

E)trem*ta) : a+ral hanga";na8i +#a"; CRT E2 8e"i+.

Kepa+a: +on7#ng"i>a anemis /-(-3; s+lera i+"eri+ /-(-3; T6-T2;%#%iliso+hor /(3

Pemer*)aa(

Pe((a(

-

A))e)me(t Dis"ress res%irasi e< DD Par"ial os"r#<"ion o aira* e< massa

<olliDe<om%ensasi Kor8is e< Pen*a+i" Jan"#ng Rema"i+

P+a( 'n"#asi =T No. .5

La%or 8r.'n"an; %$$8>i<e: $<< in"#asi ila a8a >en"ila"or

ila >en"ila"or "i8a+ a8a; %er"imang+an #n"#+ 8ila+#+an RJP %a8a

%asien

;atata( Jam 1515

Mela%or+an %a8a 8r.'n8ah Kar"i+a; %$

: se"elah 7alan 8ari +amar man8i ana+ mengel#h sesa+; "erasa

se%er"i "er<e+i+ Kea8aan #m#m :Tam%a+ lemah; gelisah

Tan8a >i"al : N : 15 x(meni" TD: 10(0 mmg /P95 12,(,4;

P99 165(913 RR 42 ( i" T 6 A C B2 , /NRM



Jam 1525 Me+ap4ra( e &rI(&a- Kart*a,SpA

S: pa)*e( a)p*(

Kea8aan #m#m :Tam%a+ lemah; gelisahR 15x(meni"; RR 42x(meni"; T 6. C; TD 10(0mmg; %B2

0Par# : >esi<#lar men#r#n +iri; s"ri8or ins%irasi /3; R

minimal 8i %ar# +anan; re8#% 8i %ar# +iri

A))e)me(t:

$ir a* %ar"ial os"r#<"ion e< s#s% Ca "iroi8

De<om%ensa"io Cor8is

A&*): $<< in"#asi; 7i+a %erl# 8engan an"#an anes"esi

Jam 15!0 Per)*apa( b*+a a(a bra&*ar&* &a( ap(e

Kea8aan #m#m :Tam%a+ lemah; gelisah

Tan8a >i"al :R x(meni" RR : 1-15x(meni"

A))e)me(t:

$%ne#

ra8i+ar8iP+a(:

RJP

NRM 1 LPM

Jam 1590 S: P4)t a&ere(a+*( pertama &a( a(a ma)*- ap(e &a(

bra&*ar&*

B: RR 5x(meni"; RR on agging

A))e)me(t:$%ne#ra8i+ar8i

P+a(:



$%ne#

ra8i+ar8i

Plan: RJP; NRM 1 l"(meni"; $8renalin 1<<(+g(+aliJam 1600 S: A(a (a&* t*&a teraba

B: R "i8a+ a8a; RR "i8a+ a8a;%#%il mi8riasi mas+simal; =K&

la".

A))e)me(t:

Conirm Dea"h

Pasien 8in*a"a+an meninggal 8i ha8a%an +el#arga 8an %e"#gas

me8is

Plan: Raa" 7enaHah

De*a)* Se-ar)(/a A+a)a(

1. Pasien "i8a+ 8ila+#+an in"#asi

a"a# "irei8o+"omi

Pasien 8ila+#+an

%en*elama"an 7alan

na%as

Massa "iroi8 "erliha" 8ari

gamaran ron"gen

men8e>iasi "ra+ea sehinggasaran 8ari agian TT "i8a+

m#ng+in #n"#+ 8ila+#+an

"irei8o+"omi

SE#A# KEMATIAN

1. Pen*a+i"- %en*a+i" *ang %er7alanann*a erh##ngan langs#ng 8engan sea +ema"ian.

a. Pen*ea +ema"ian langs#ng / %en*a+i" *ang se<ara langs#ng men*ea+an

+ema"ian3 $A$AL JANTUN$ %I50'



Pasien a8alah ana+ %erem%#an #sia 15 "ah#n *ang 8a"ang 8engan +el#han sesa+ na%as

8an ria*a" Pen*a+i" Jan"#ng Rema"i+ /PJR3 8alam %engoa"an selama 6 "ah#n. Pasien 8a"ang

8engan massa 8i "iroi8 sinis"ra; #+#ran 5<mx9<m ; a"as "i8a+ "egas; soli8; "i8a+ n*eri *ang8i#+"i+an 8engan gamaran !& semingg# seel#m mas#+ R er#%a Massa "h*roi8 sinis"ra

8engan "an8a-"an8a malignan<* *ang men8e>iasi "ra<hea +e arah 8ex"ra. er8asar+an anamnesis

8i8a%a"+an ana+ mengel#h en7olan %a8a leher se7a+ 2MMR 8an en7olan memesar 8anmem#a" %asien merasa sesa+ na%as 1MMR. 6MR s#ara %asien hilang 8an en7olan 8i

leher 8irasa+an ma+in memesar. Pasien masih 8alam %engoa"an PJR 8engan

Phenoxime"h*l%eni<illin 2x25mg; Ca%"o%ril 2x12;5mg; 8an ?#rosemi8 2x 4mg. Nam#n; %asien %#"#s oa" selama 1 mingg# seel#m mas#+ R. aa" 8a"ang 8i '&D; %asien mengalami

ge7ala 8e<om%ensasi 7an"#ng seagai a+ia" 8ari PJR.Dalam %eraa"an; %asien 8ila+#+an e<ho+ar8iograi 8an 8i8a%a"+an +elainan ana"omis

er#%a Mi"ral 'ns#isiensi /M'3 Mo8era"e; $or"a 'ns#isiensi /$' Mo8era"e3; Tri+#s%i8'ns#isiensi /T'3 mil8 8engan =#si %eri<ar8 /minimal3. Pasien 7#ga 8ila+#+an =K& 8engan hasil

irama sin#s normal; axis normal 8an hi%er"roi a"ri#m +iri. asil ro"gen "er+ai" massa

men#7#++an 7aringan l#na+ "#mor regio <olli *ang men8esa+ 8an men*em%i"+an #8ara "ra+ea +earah 8e+s"ra; ses#ai 8engan gamaran massa "iroi8 ser"a a8an*a e#si %le#ra sinis"ra.

elama %eraa"an 6 7am "erse#"; %asien 8i+ons#l+an +e eragai 8i>isi "er+ai"

se%er"i e8ah on+ologi; ra8iologi; +ar8iologi; res%ira"ologi; TT 8an gigi m#l#". Dari agian e8ah on+ologi s#s%e+ Ca "iroi8 8an meng#s#l+an %emeri+saan !& <olli 8engan ron"gen

<er>i+al so" "iss#e $P(La"eral. Dari agian ra8iologi men*aran+an %enega+an 8iagnosis Ca

"iroi8 8a%a" 8ila+#+an 8engan s<in"igra8i 8an CT <an leher erahan +on"ras. Dari TT s#s%e+ massa me8ias"in#m *ang men8esa+ "ra+hea 8an +arina +e arah 8e+s"ra DD "#mor "iroi8.

er8asar+an gamaran ron"gen *ang 8imili+i %asien; TT men*im%#l+an a+an s#li" #n"#+

8ila+#+an "ra+eos"omi 8an meng#s#l+an $J massa "iroi8 seagai %enega+an 8iagnosis <a "iroi8

7i+a masalah na%as %asien s#8ah "era"asi.!n"#+ menga"asi gagal 7an"#ng %asien; selama %eraa"an %asien 8ihar#s+an "irah

aring "o"al 8an "i8a+ oleh eran7a+ 8ari "em%a" "i8#r. Nam#n; %asien 8i+e"ah#i "#r#n 8ari

"em%a" "i8#r men#7# +amar man8i +arena *ang ersang+#"an mens"r#asi 8an "i8a+ n*aman 7i+a



Pa8a negara er+emang; aringi"is 8an ine+si +#li" se%er"i im%e"igo mer#%a+an

%en*a+i" "ersering *ang 8isea+an +arena ine+si 8ari "re%"o+o+#s gr#% $ 8engan %#n<a+

insi8ensi %a8a ana+ 5-15 "ah#n. ?aringi"is s"re%"o+o+#s leih se8i+i" %a8a ana+ 8i "iga "ah#n %er"ama +ehi8#%an 8ian8ing %a8a orang 8easa. B menges"imasi+an seagian esar ana+-

ana+ se"i8a+n*a "er+ena se+ali %erio8e aringi"is %er"ah#n *ang 15-2 8isea+an oleh

&$ /&r#% $ e"a aemol*"i< "re%"o<o<<i3. Pa8a s#r>ei ana+ se+olah *ang seha" 8enganren"ang -1 "ah#n 8i8a%a"+an 15-05 ana+ mem%#n*ai an"i s"re%"olisin B 2 #ni" 8an 1-

5 ana+ se+olah *ang asim%"oma"i+ men7a8i %emaa s"re%"o+o+#s e"a hemoli"i+. &agal

7an"#ng %a8a %asien PJR erh##ngan 8engan %en*a+i" +a"#% mi"ral 8an aor"a ins#isiensi1.Ka"#% mi"ral %aling sering 8iserang /5-03 %a8a %asien PJR; men*#s#l +a"#% aor"a /253 8an

"ri+#s%i8 han*a 1. Ke%arahan 8ari +a"#% "er#"ama %a8a mi"ral ins#isiensi 8an s"enosis mi"ral;laman*a onse" hingga 8i"era%i; 7#ga 7enis +elamin 8imana ani"a leih sering mengalami

+e%arahan 8a%a" menen"#+an mor"ali"as 8an mori8i"as PJR 6. elain gagal 7an"#ng; +om%li+asi 7an"#ng lainn*a 8a%a" er#%a a"rial ari"mia; e8em %#lmo; emoli %#lmoner; hingga "rom#s

in"ra+ar8ia+. alah sa"# managemen 8ari gagal 7an"#ng *ang %en"ing a8alah mema"asi a+"i>i"as

isi+ %asien #n"#+ meng#rangi ge7ala-ge7ala4.aa" 8a"ang +e '&D; %asien mengel#h sesa+ na%as se"elah m#n<#ln*a en7olan 8i

leher *ang 8i<#rigai seagai <an<er "iroi8 8ari %emeri+saan !& regio <olli *ang 8ila+#+an

semingg# seel#m %asien mas#+ +e '&D. er8asar+an %eneli"ian re"ros%e+"i; %re>alensi no8#l"iroi8 %a8a ana+-ana+ han*a er+isar ;2-5 8ian8ing+an %a8a 8easa 8a%a" men<a%ai 6.

Nam#n insi8ensi *ang +e<il %a8a ana+-ana+ "erse#" mem#a" resi+o "er7a8in*a +eganasan leih

esar men<a%ai 2;4 8ian8ing+an 8easa; ah+an %ernah 8ila%or+an "er"inggi 64.'nsi8ensi +eganasan %a8a m#l"ino8#lar goi"er seesar 1-0 se8ang+an %a8a no8#l soli"er 1-

25. ean*a+ 6 +an+er "iroi8 %a8a rema7a erh##ngan 8engan 7#>enile a#"oim#ne

"iroi8i"is5.

Keganasan "iroi8 men*erang 2-6 +ali leih #m#m %a8a %erem%#an 7i+a leih 8ari 15"ah#n. emen"ara %a8a ana+-ana+ +#rang 8ari 15 "ah#n; %eran8ingan la+i-la+i 8an %erem%#an

1;5:1. eera%a %eneli"ian men#n7#+an hal ini 8i%engar#hi hormon %erem%#an +h#s#sn*a %a8a

saa" %#er"as memain+an %eranan %en"ing %a8a %ening+a"an insi8ensi +an+er "iroi85.



+eganasan. Te"a%i 1-2 ana+-ana+ 8a"ang 8engan me"as"asis +an+er "iroi8 *ang seagian

esar men7alar +e %ar#-%ar#5.

er8asar+an $meri<an Th*roi8 $sso<ia"ion /$T$3; "a"ala+sana ana+ 8engan no8#l"iroi8 ere8a 8engan +an+er "iroi8. !n"#+ ana+ 8engan s#%resi hormon T 8engan no8#l

"iroi8; s+in"igrai seai+n*a 8ila+#+an. Kom%rehensi #l"rasonogram leher seai+n*a 8ila+#+an

#n"#+ o%"imalisasi ren<ana o%erasi %a8a ana+ *ang ar# 8i<#rigai se>agai +an+er %a%iler "iroi8.seagian esar ana+ 8engan +an+er %a%iler "iroi8 ma+a a7i 8ila+#+an "o"al "iroi8e+"omi.

Pemeri+saan laora"ori#m meli%#"i "riio8o"h*ronine /T63; "h*roxine /T43; an8 "h*roi8-

s"im#la"ing hormone /T3. +rining "ra8isional an"ara +an+er "iroi8 me8#lar /MTC3 8anhi%er%lasia C-sel "iroi8 8a%a" 8ila+#+an 8engan memeri+sa +a8ar +alsi"onin seel#m 8an se"elah

s"im#lasi %en"agas"rin. Ji+a 8i<#rigai +e arah MTC; ma+a ser#m <ar<inoemr*oni< an"igen/C=$3 har#s 8i#+#r. !rrin "am%#ng 24 7am 7#ga 8i%erl#+an #n"#+ meliha" me"aolisme

+a"e+olamin 7i+a %heo<hromo<*"oma a"a# %araganglioma 8ihilang+an seel#m 8ila+#+an"ireo8e+"omi #n"#+ men<egah +risis hi%er"ensi selama %eme8ahan.

Pemerian ra8ioa+"i 'o8ine-161 har#s 8ila+#+an 7i+a T 8ia"as 6mml!(L #n"#+

men<egah me"as"asis "#mor. Karena %asien ana+ han*a se8i+i" 8an seagian esar %rognosisn*a ai+ ma+a ra8io"era%i ini 8ire+omen8asi+an #"n#+ %asien 8engan no8#l ser>i+al; in>asi +e

s"r#+"#r >i"al a"a# *ang erme"as"asis 7a#h. emen"ara %emerian %enggan"i hormon T 8engan

le>o"h*roxine 8a%a" 8im#lai eera%a hari se"elah "ireo8o+"omi. <an "iroi8 seagai +on"rola7i 8ila+#+an 2-6 mingg# se"elah o%erasi a"a# #"era%i ra8ioio8ine.

Pa8a %asien; %ena"ala+sanaan el#m sam%ai +e "aha% %enega+an 8iagnosis +arena PJR

seagai %en*a+i" *ang s#8ah 6 "ah#n 8i8eri"a memera" men7a8i 8e+om%ensasi <or8is. al"erse#" mem#a" %asien 7#ga mengalami gagal na%as 8an "i8a+ 8a%a" 8ila+#+an "ireo8e+"omi

+arena %osisi massa "iroi8 men#"#%i 7alan mas#+ #n"#+ 8ila+#+an "irei8e+"omi.

DA3TAR P!T$K$

1. B =x%er" Cons#l"a"ion on Rhe#ma"i< ?e>er an8 Rhe#ma"i< ear" Disease /21 :

&ene>a; i"Herlan83 Rhe#ma"i< e>er an8 rhe#ma"i< hear" 8isease : re%or" o a B =x%er"



'N'LISIS ('S)S

Perempuan* +, th

P-. / tahun

Putus terapi + minggu ke herbal

Sesak napasP0N1'(IT -'NT)N2 .0!'TI(

!I mo"erate* 'I mo"erate* TI mil"

3ipertro4 ventrikel kiri

05usi perikar"ium minimal

Susp C' TI.OI6#!S!.S

Ben7olan massa "i leher

Pheno8imethilpenicilin #8#,%mg9urosemi" #8:%mg

Captpril #8+#*,mg

60CO!P CO.6IS

T3T '-3 7ika stabil

0(2

3ipertensi St II

0C3O

3IP0.T0NSI +$%;$%

SpO# $%& N.! ,LP!

'PN0)

B.'6I 2'2'L N'P'S

Intubasi;Trakeostomi ti"ak "apat "ilakukan

)S2 colli !assa tiroi" sinistra "engan tan"a malignancy

.ontgen Thora8 So5t tiss tuor colli* e5usipleura sinistra

.a"iolog CT scan 7ika stabiul

TS3 +*/+ <N %*/:=,*>,?

9: #@%% <N %*>+=+*+#?

0.,.

9.

1.11.

12.16.

14.15.

1.

10.

1,.

19.

2.

21.22.

26.

24.

25.

2.

20.

2,.

29.

6.

61.

62.

66.

64.65.

17Presentasi Kasus Kematian, September 2015, Hafiidhaturrahmah

AL 17.090

Hb 13,6

HCT 40,9

Segmen 79,9%

GDS 98

+,%;>,

!en"esak

interesting case laporan

Documents

Transcript of interesting case laporan