dead case.pptx

8/18/2019 DEAD CASE.pptx

1/25

DEAD CASE

Ny. Katrin Polii


2/25

• Pasien pindah dari ICU ke ruangrawat IMC Neurologi pukul 1.!!


3/25

• 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


4/25

• A" 7 penurunan kesadaran e.% SD= +.:rontote&poral D onset hr.1!

• IC= +. >rontal $ilateral

• :r. ?asis %ranii

• Pneu&oense>al

•

=pt gr ,


5/25

• 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!

• #$s 4S(2CS(Pupil(a&


6/25

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&


7/25

• 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. otono& " inkontinensia uri et al;i <

Dilakukan pertukaran aga 1-:e$ruari ,!1 pukul !.!! wita


8/25




• Pneu&oense>al

•

=P' gr.II• Ane&ia 8=$"*/9


9/25


• ?ed rest


• Chest sioterapi

• #ral higine

• I4:D NaCl !/* )!!%%" KAEN -? B ,"1 ,1 gtt(&

• Ce>triaone ,, gr I.4 8h.119


• 4it C ,1 in a&p


• +anitidin ,1 in a&p

• in% ,1 ta$ p.o ;ia #2'



• 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



10/25

• 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


11/25

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!! %%


12/25

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


13/25

• 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. otono& " inkontinensia uri et al;i <

Dilakukan pertukaran aga 13:e$ruari ,!1 pukul !.!! wita


14/25




• Pneu&oense>al

•

=P' gr.II• Ane&ia 8=$"*/9

• =e&ate&esis


15/25


• ?ed rest


• Chest sioterapi

• #ral higine

• I4:D NaCl !/* )!!%%" KAEN -? B ,"1 ,1 gtt(&

• Ce>triaone ,, gr I.4 8h.119


• 4it C ,1 in a&p


• +anitidin ,1 in a&p

• in% ,1 ta$ p.o ;ia #2'



• KIE• Su%tion lendir $erkala

• Ne$uliHer ?isol;on " NaCl !/* " Co&$i;ent B1"1"1

• +a$er NS

• ?alans %airan



16/25

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


17/25

• 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!



• Pneu&oense>al

• =P' gr.II

• Ane&ia 8=$"*/9

• =e&ate&esis

• Susp. AKI

• Sepsis e.% susp. pneu&onia


18/25

P" 7 #, 7 l(& ;ia N+M


•

Cek Dl/ Ur/ Cr/ U5/ A2D %ito• Konsul ICU

• Para%eta&ol drips 1!!!&g

•

?alans %airan• KIE

• #$s 2CS( ''4( pupil( -! &enit


19/25

• 5a$ 13(,(,!1

• 5eukosit -,.00!

•

Eri" -/3,• =$" */)

• =t" ,/

•

'ro&$o" 1,*.!!!• Ur" 0

• Cr" 1/!


20/25

• 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


21/25

• 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


22/25

'eri&a Kasih


23/25


24/25


25/25

dead case.pptx

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