PJB, PNEUMONIA INA 25desember15.ppt

8/18/2019 PJB, PNEUMONIA INA 25desember15.ppt

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Laporan Jaga

Jumat Pagi, 25 Desember 2015

dr Ony /dr. Argadr. Anggra /dr. Cempaka/dr. Prabu/ dr

Iqbal

dr. Febry/dr. David

dr. Indra


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Bangsal1. An. J, lelaki, 5 bulan/5 kg dengan

pneumonia dd bronkhiolitis, DE: PJBasianotik; DA: AD !!, "# moderate; D$:%&'A !!; do(n s)ndrome ; undensensus

testi*ulorum unilateral; gi+i baikunder(eight normoheight2. An D, perempuan, 15 taun/ 5! kg dengananemia apla"tika# gi$i baik normoweight

normoheight

'- pediatri 0

%!- 0


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Identitas

%ama & An. '

'eni" (elamin & )elaki

*mur & 5 bulan

Alamat & +anak 1 -/- !2/!2 0ebyk,(aranganyar

% - & !1312143

++/+ & 5kg / ! m


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Keluhan Utama

6e"ak %a7a"


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• ± % hari SMRS, pasien mengeluh sesak dan batuk semakinsering. !asien masih demam, turun bila diberikan obat

penurun panas,tetapi kembali demam setelah beberapa $amkemudian, pasien tidak ada keluhan pilek, muntah ataupun

diare. BAK dan BAB tidak ada keluhan. BAK #&'(hari

warna kuning $ernih. BAB )#%'(hari dengan ampas

ke*okelatan.• ) hari SMRS, pasien terlihat semakin sering batuk dan sesak .!asien pun masih mengeluh demam naik turun. !asien tidak

ada keluhan pilek, muntah dan diare. BAK dan BAB tidak ada

keluhan. +ikarenakan pasien semakin sesak, pasien berobat ke

RS+M.

• Saat di -+, pasien tampak gelisah, sesak, batuk, tidakdemam. BAK tidak ada keluhan. BAB terakhir )' MRS

dengan ampas kuning ke*okelatan.


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Riwaat Pena!it Dahulu

• -i8ayat "erupa & 9:;

• -i8ayat mndk & 9:; dengan

diagn"a P'+ a"iantik, A6D II -mderate, D8n "indrm klini"


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Riwaat Pena!it Keluarga

•-i8ayat keluarga dengankeluan "erupa9


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Riwaat Kehamilan dan Persalinan

• 6elama amil ibu pa"ien rutin kntrl kepu"ke"ma" dan rutin meminum vitamin yangdiberikan

• -i8ayat "akit "elama amil di"angkal

• Pa"ien lair "eara "pntan ditlng bidan padaumur keamilan > bulan dengan ++) 24!! gram P+? m

• 6aat lair pa"ien lang"ung menangi", tidak birudengan ketuban =erni

(e"an& ri8ayat keamilan dan kelairan dalam bata"nrmal


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Riwaat Imunisasi

• @ep + & ! bulan

• +C0 & 1 bulan

• DP/@i+ & 2, 3, ? bulan

• Pli & 1, 2, 3, ? bulan

(e"an & imuni"a"i "e"uai =ad8al Depke"


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Riwaat #utrisi

6aat ini pa"ien minum "u"u 7rmula"e=ak lair dengan

7rekuen"i 4 kali "ebanyak 2!


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Pohon Keluarga

I

II

III

Tn O, 45 thn

An. J 5 bulan, 5kg

Ny Y, 43 thn


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Pemeri!saan $isis(eadaan umum & tampak "akit "edang, "e"ak, mp" menti", gi$i baik

ital "ign &la=u nadi& 12! B/menit 6atura"i& > >19i"i dan tekanan ukup; >1 >2

la=u napa"& 54 B/menit

9reguler dan kedalaman ukup;

"uu& 3,? C perak"ilar

(epala & nrme7al, )( 3 m 9


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r & I & Iktu" krdi" tidak tampak

P & IC teraba di 6IC I )C6, tidak kuat angkat

P & bata" =antung "ulit dievalua"i A & +' I


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Btremita" & Akral Dingin &


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"tatus %i&i

• ++/* & 5/.3B 1!! G > 9P5E++/*EP25;under8eigt

• +/* & !/3 B 1!! G >5 9+/*G P25;

nrmeigt• ++/+ & 5/5.> B 1!! G 4? 9++/+G P25; gi$i

baik

• (e"impulan & gi$i baik, underweight, normoheight


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Da'tar (asalahSeorang anak lelaki (/ bulan (/ kg0

). Sesak hari%. batuk 7 hari

. +emam hari

&. low nasal bridge

/. 1a2as *uping hidung "

3. low set ears

7. retraksi 4"5 sub*ostal

6. Suara na2s tambahan 0 RBK 4"("5, wheeing 4"("5, RB sulit die8aluasi

9. bising 4"5 sistolik grade %(3 !M di S: ;!SS

)


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DI)%#*"I" +)#DI#%

). !neumonia dd bronkhiolitis

%. Sindrom down 4klinis5

. ?sk SK

&. =ndesensus testis unilateral


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Laboratorium• @b & 11.2 g/dl

•@C & 32 • A) & .4 ribu/ul

• A & 2? ribu/ ul

• A & 3.> 'uta/ul

• C & 41.? /um

• C@ & 24.3 pg

• C@C & 3?.4 g/dl• -D &12.>

• P & .5 K

• PD & 1

• "/ +a"/ %et/ )im7 / n & !.?/ !.3/ 51.?/?3./?.2! 9;

• 0D6 & 1!4 mg/dl

(e"an & dalam bata" nrmal


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R* hora-

Kesan: menyokong pneumonia

Cor tak tampak membesar


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Diagnosis !er.a).!neumonia

%.+>0 !@B asianotik

+A0 AS+ , ?R moderate+0 ROSS

.?sk SK

&.Sindrom down 4klinis5

/.=ndesensus testis unilateral

3.-ii baik, underweight, normoheight


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erapi

• -a8at bang"al kardilgi• O2 na"al 2 lpm

• A6I/A6+ 4B 3! via %0

• In7 D1/? %6 12 /=am

• In=ek"i ampiillin 925 mg/kg/ =am;G 125 mg/ =am• In=ek"i gentamiin lading d"e 94mg/kg;G ?! mg,"elan=utnya 95mg/kg/2? =am;G 25 mg/2? =am

• Paraetaml 91!mg/kg/kali;G 5! mg via %0

• Drner 2B 1/1! tab per ral

• Fur"emide 2B 2 mg tab per ral

• 6pirnlatn 2B 3,125 mg tab per ral

• %ebuli$er %aCl !,> 5 /4 =am


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Plan*rinali"a / 7e"e" rutin

nitring• (*/6/"i2/?=am• +CD/4=am


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$ollow Up, "abtu 2/ Desember 2015(eadaan umum & tampak "akit "edang, "e"ak, mp" menti", gi$i baik

ital "ign &la=u nadi& 12! B/menit 6atura"i& > >19i"i dan tekanan ukup; >1 >2

la=u napa"& 54 B/menit

9reguler dan kedalaman ukup;

"uu& 3,? C perak"ilar

(epala & nrme7al,)( 3 m 9


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r & I & Iktu" krdi" tidak tampak

P & IC teraba di 6IC I )C6, tidak kuat angkat

P & bata" =antung "ulit dievalua"i A & +' I


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Btremita" & Akral Dingin &


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Diagnosis !er.a).!neumonia

%.+>0 !@B asianotik

+A0 AS+ , ?R moderate+0 Ross

.?sk SK

&.Sindrom down 4klinis5

/.=ndesensus testis unilateral

3.-ii baik, underweight, normoheight


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erapi

• O2 na"al 2 lpm 9k/p;• A6I/A6+ 4 B 3! via %0

• In7 D1/? %6 12 /=am

• In=ek"i ampiillin 925 mg/kg/ =am;G 125 mg/ =am 9II;

• In=ek"i gentamiin 95mg/kg/2? =am;G 25 mg/2? =am 9II;

• Paraetaml 91!mg/kg/kali;G 5! mgG 3 t L tk.p via %0

• Drner 2B 1/1! tab per ral

• Fur"emid 2B 2 mg tab per ral

• 6pirnlatn 2B 3,125 mg tab per ral

• %ebuli$er %aCl !,> 5 /4 =am


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+agaimana!ah prognosa pasien downsndrom dengan PJ+ P : anak dengan down syndo!

I : "

# : "

O : 5 yeas su$%$al ate anak down syndo!dengan PJ&


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Survival analysis of Down syndrome with

congenital heart disease: a 5-years registry atQSNICH.Layangool T, Sangtawesin C, Kirawittaya T, Prompan W, Prachasilchai P,

Pechdamrongsakul A!C"#$%&ND: !own syndrome "!S# is the most common chromosomal abnormality

in children Atrio$%entricular septal de&ect "A'S!# is the most common congenital heart

disease "C(!# reported in !S The mortality rate o& !S with congenital heart disease"C(!# is )$* times higher than normal population The sur%i%al rate in !S has impro%ed

with time and has reported up to +- and .)- at one and ten years o& age,

respecti%ely

%'(C)I*(: To study the pre%alence o& C(!, clinical course, treatment, the o%erall

sur%i%al in patients with !S compare with those who are associated with C(!

+!)($I!, !ND +()H%D: All !S patients at /S01C( with parental signed consent

were enrolled in the registry The study was conducted &or ) years starting &rom 2ay

344* to April 343 All patients were &ollowed$up according to schedule modi&ied &rom

American Academic o& Pediatrics "AAP# health super%ision guideline Standard

treatment was gi%en to all those children with diagnosis o& C(! and5or other associated

diseases


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$(S&,)S: 6our hundred and two cases o& !S were enrolled Two cases were e7cluded due

to the parental incon%enience The mode and mean age o& the patients at registration were

and * months "$83# Two hundred and se%enty$one cases had an initial

echocardiographic diagnosis o& C(!, which included + o& Patent ductus arteriosus "P!A#,9+ o& 'entricular septal de&ect "'S!#, 9 o& A'S!, 9 o& secondum Atrial septal de&ect

"AS!#, 8 o& Tetralogy o& 6allot "T;6#, 3 o& Coractation o& Aorta "CoA#, o& other C(! and

99 o& combined lesions !uring the &ollow$up period, spontaneous closure o& P!A, 'S! and

AS! occurred in 98, 3 and ) cases, respecti%ely A&ter the e7clusion o& those who had

spontaneous closure, the pre%alence rate o& C(! in !S was 9+.- 'S! was the most

common lesion, slightly more than P!A 0inety$eight cases underwent cardiac surgery<

including + o& associated 'S!, 39 o& A'S!, 38 o& P!A, o& T;6, 9 o& CoA5AA repaired,one each o& Cor triatriatum and primum AS! Twel%e cases had catheter inter%entions,

including P!A occlusion "4 cases#, and case o& balloon dilatation o& re$CoA and coils

emboli=ation o& isolated ma>or aorto$pulmonary collateral artery Se%en cases were lost at

&ollow$up ?y using the hospital in&ormation and 0ational (ealth Security ;&&ice "0(S;#

database, 9* in&ants died during the &ollow$up period The causes o& death were immediate

post cardiac surgery in 4 cases "A'S! in +, 'S! in # and not associated with surgery in

* cases including C(6 in ., pneumonia in *, leukemia in 9, airway disease in , others *and unknown . cases The o%erall sur%i%al at and ) years o& age were +8- and .8-,

respecti%ely !S with C(! had a signi&icantly lower sur%i%al rate than those without C(! "p

@ 444#

C%NC,&SI%N: According to this study, the revalence rate of CHD in DS was high. *SD

was the most common lesion and has better prognosis than A'S! )he main cause of

death was a cardiac rolem. 6ollow$up patients by using modi&ied AAP guideline and

standard treatment can impro%e their o%erall sur%i%al


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• '%ld to !odeately edu(ed T (ell (ounts

• '%ld to !odeately edu(ed & (ell (ounts

• Absen(e o) no!al ly!*ho(yte e+*ans%on %n %n)an(y

• Thy!us s%e %s s!alle than age"!at(hed (ontols

• '%ld to !odeately edu(ed na%$e T (ell *e(entages, w%th (oes*ond%ng edu(t%on o) T (ell e+(%s%on (%(les-Te(s

• /ubo*t%!al ant%body es*onses to %!!un%at%ons

• 0e(eased total and s*e(%)%( %!!unoglobul%n A %n sal%$a• 0e(eased neuto*h%l (he!ota+%s

1mmune de&ects in !own syndrome


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erima Kasih

PJB, PNEUMONIA INA 25desember15.ppt

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