laporan kasus pyopneumothorax1-2

8/17/2019 Laporan Kasus Pyopneumothorax1-2

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LAPORAN KASUS

SEPSIS EC PIOPNEUMOTHORAKS + PNEUMONIA KOMUNITAS +

HIPERTENSI STAGE I

PEMBIMBING:

dr. Dede Kurniawan

PENYUSUN :

!e" #$%%$%%%&$'

Ander(!n K!)an #$%%$%%$$*'

Car!( . Ta),u-!!n #$%%$%%$$'

Y!/ana C. A. Hu0a-ara0 #$%%$%%1$2'

!(e,/ine G!riana #$%%$%%1'

KEPANITERAAN KLINIK RSUP H. ADAM MALIK

DEPARTEMEN PULMONOLOGI DAN KEDOKTERAN RESPIRASI

3AKULTAS KEDOKTERAN UNI4ERSITAS SUMATERA UTARA

MEDAN

*%$&


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KATA PENGANTAR

Puji dan syukur penulis panjatkan kepada Tuhan Yang Maha Esa, yang

telah memberikan berkat dan rahmat-Nya, sehingga penulis dapat menyelesaikan

laporan kasusyang berjudul“Piopneumothoraks ec. Pneumonia Komunitas

!epsis "ipertensi stage #$.

!elama penulisan laporan kasus ini, penulis banyak mendapatkan

bimbingan dan arahan, dan untuk itu penulis mengucapkan terima kasih kepada

dr. %ede Kurnia&an atas bimbingan dan ilmu yang sangat berharga untuk

penulis.

Penulis menyadari laporan kasus ini masih jauh dari sempurna.'ntuk itu,

penulis mohon maa( dan juga mengharapkan masukan berupa kritik dan saran

yang membangun demi kesempurnaan laporan kasus ini.!emoga makalah ini

dapat berguna bagi kita semua.

Medan, )*!eptember )+

Penulis

1


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DA3TAR ISI

Ka0a Pen5an0ar....................................................................................................i

Da60ar I(i...............................................................................................................ii

BAB $ Penda/uuan............................................................................................$

BAB * Tin7auan Pu(0a8a....................................................................................1

. %e(inition o( Pneumonia.............................................................................

). /lassi(ication o( Pneumonia.......................................................................

. /ommunity 0c1uired Pneumonia 2/0P3...................................................

. "ospital-ac1uired pneumonia4nosocomial 2"0P3......................................*. 0spiration pneumonia.................................................................................*

5. Pneumonia in the#mmunocompromised.....................................................*

6. %iagnosis o( Pneumonia.............................................................................*

7. Management o( Pneumonia........................................................................5

8. /omplications Pneumonia..........................................................................6

+. Pre9ention o( Pneumonia............................................................................6

. Pyopneumothora:.......................................................................................7

). !epsis..........................................................................................................7

BAB 1 La,!ran Ka(u(.........................................................................................9

BAB & Ke(i),uan..............................................................................................*$

Da60ar Pu(0a8a.....................................................................................................**

2


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1

CHAPTER $

INTRODUCTION

Ba85r!und

Pneumonia is generally de(ined as in(lammation o( the lung

parenchyme, that includes distal terminal bronchioles, respiratory

bronchioles and al9eoli, causing consolidation and impaired gas

e:change.Pneumonia has many etiologies, such as bacteria, 9irus, (ungi,

parasite, and chemical substances. /linical mani(estations o( pneumonia

include cough, chest pain, (e9er, and dyspnea. Pneumonia occurs in all age

group and is one o( the cause o( death in the old &ith chronic disease.

Pneumonia has the highest morbidity and mortality rate in the &orld.

#n #ndonesia, according to the data (rom !ur9ei Kesehatan ;umah Tangga

2!K;T3 in )++, pneumonia and respiratory tract in(ection accounts (or

deaths per ++,+++ population 2in male3 and )7 deaths per ++,+++

population 2in (emale3."ardiyanto and colleagues reported that (rom )*

patients in "asan !adikin "ospital in


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to *,87 per ++,+++ patients. Mortality rate &as reported to be around -

*+=, &hich might be caused by limited data, &ith higher mortality rate

2*+=3 i( no a9ailable diagnostic e:amination and drainage.,*

!epsis is de(ined as !#;! &ith kno&n (ocal in(ection and positi9e

culture. 0lthough !#;!, sepsis, and shock are usually related to bacterial

in(ection, bacteremia doesn@t necessarily ha9e to be there.5

Procalcitonin is a calcitonin prohormone that is released during

sepsis and is kno&n as a sign o( in(ectious disease. The concentration o(

procalcitonin can reach ,+++ ng4mA during se9ere sepsis and septic

shock. !tudy by /ut and colleagues sho&s an increase in procalcitoninconcentration can be used to diagnose sepsis earlier. "o&e9er, this study

only included sepsis patients in #/' and does not compare &ith nonsepsis

patients and such &e cannot kno& the comparison bet&een procalcitonin

concentration and the se9erity o( sepsis.5

#ncidents o( sepsis &as around 6*+,+++ cases per year, &ith its

(re1uency increasing &ith higher resistance microorganisms,

immunocompromised, and post surgery patients.5


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3

CHAPTER *

TINAUAN PUSTAKA

$. De6ini0i!n !6 Pneu)!nia

Pneumonia is an acute in(lammation o( the lung parenchyme that is

caused by microorganisms 2bacteria, 9irus, (ungi, parasite3. Pneumonia

that is caused by mycobacteria tuberculosis is not included.6,7Pneumonitis

is a lung in(lammation that is not caused by microorganisms 2chemical

substances, radiation, aspiration, drugs, etc.8

*. Pneu)!nia Ca((i6ia0i!n$%

a.


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• #n alcoholics, some de(ense mechanisms o( the respiratory tract is

impaired. There is coloniation o( gram negati9e bacteria in theoropharyn:, impaired cough re(le:, s&allo&ing mucociliary

disorder and (unctional impairment o( the lymphocytes,

neutrophils, monocytes, and al9eolar macrophages.

• 0n impairment o( the mucociliary transport system, cellular and

humoral de(ense mechanism, and increased 9ulnerability to

Streptococcus pneumoniae and H. inflluenzae are (ound in

smokers.

• !peci(ic pathogens causing /0P areStreptococcus species, H.

Influenza, Mycoplasma Pneumoniae, Chlamydia species,

Legionella pneumophila, Gramnegati!e "acilli, #naero"ic

"acterial pneumoniae, Co$iella "urnetti, Staphylococcus species,

%ocardia species, #ctinomyces israelli, Pasteurella multocida,

&rancisella tularensis, 'ersinia pestis, (acillus antharacis ,

(rucell species, Mora$ella catarrhalis.

&. H!(,i0a=A;uired Pneu)!nia>N!(!8!)ia Pneu)!nia #HAP'$$


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(oreing substance aspiration can cause acute respiratory distress and in

a (e& cases predispose to incidents o( bacterial pneumonia.

. Pneu)!nia in 0/ei))un!!),r!)i(ed$$e9er

• Producti9e cough &ith mucoid or purulent or sometimes bloody

sputum

• indings depends on the sie o( lesion. 0symmetric e:pansion o(

the chest can be (ound during inspection, increased tactile (remitus,

dullness on percussion, and broncho9esicular to bronchial breath sounds

&ith (ine crackles that may become coarse crackles during resolution o(

disease.

c. Fther e:aminations

;adiological (inding B

• #n(iltrate to consolidation &ith $air bronchogram$

•


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• Aeukocyte countB +.+++4ul I +.+++4ul

• !hi(t to the le(t

• #ncreased E!;

• #ncreased procalcitonin

• #ncreased /;P

• Positi9e blood and sputum culture

• Positi9e urinary antigent test 2'0T3

•


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*. ;espiratory (ailure

5. !epsis

6.


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. >e9er 2oral temperature D7/3 or hypothermia 2H5/3

). Tachypnea 2D) breaths4min3

. Tachycardia 2heart rate D8+ beats4min3. Aeukocytosis 2D),+++4mm3, leucopenia 2H,+++4mm3, orD+= bands

!e9ere sepsis is de(ined as sepsis &ith one or more signs o( organ

dys(unction.


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CHAPTER 1

CASE REPORT

Pu)!n!!5" and Re(,ira0!r" De,ar0)en0

Media S0ud" Unier(i0" !6 N!r0/ Su)a0ra

Medical ;ecord

NoB ++.5.6.) %ate B )) !eptember )+ %ay B !elasa

NameB Ngatiman 0ge B58 tahun !eksB Pria

Lob B Petani 0dd B %usun # 0man %amai No.)8)

;eligion B#slam

TlpB - "pB -

Main !),ain :!hortness o( breath

Addi0i!na C!),ain :/ough, /hest pain

Hi(0!r" :

•

!hortness o( breath has happen since month ago. ?heeing 2-3, historyo( &heeing 2-3. !hortness o( breath &as related to &eather.

• /ough has happen since ) &eeks ago. Producti9e cough 23, &hite sputum,

odor 2-3, hemoptoe 2-3, history o( hemoptoe 2-3

• /hest pain 23 since one &eek ago. Prickly like pain. ;adiating pain 23 to

the back. /hest pain is &orsen by coughing.

• #ntermitten (e9er 23 since &eek ago.

• "istory o( smoking 23 since + years ago, + cigarette4day. 2#< )++,

hea9y smoker3

• "istory o( 0TT 23 since )) !eptember )+ (rom a pulmonologist based

on clinical (indings and radiologist. Patient &as pre9iously treated in a

hospital due to dipsnoe and &as diagnosed &ith loculated pleural e((usion

de:tra ec pneumonia

• "ypertension 23 years ago

• %iabetes 2-3

RPT:"ypertension


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RPO:/e(ota:ime gr, P/T, Metronidaole, ;i(ampicin, #N", Pirainamide,

Etambutol,


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ECG:!inus tachycardia A0%

C/e(0 =Ra" :


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C/e(0 =Ra" in0er,re0a0i!n #AP> PA ' :

/hest -ray )) !eptember )+, 0P, KC enough

Trachea Ble(t side de9iation

/la9icle B symmetric

!capula Bsuper position

%iaphragm Banterior B 5th costae, posterior B +th costae, right

diaphragm hard to determine

/ostophrenicus sinus Bright B undeterminedO le(t B sharp

Aung Bhomogenous consolidation on middle to lo&er right lung,a9ascular on upper to middle right lung

"eart Bundetermine

/ostae B(racture 2-3

/onclusion B

"ydropneumothora: de:tra

La-!ra0!riu) 6indin5( :** Se,0e)-er *%$& #ER'

Hae)a0!!5"

/


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"aemoglobin 2"b3 B ,8 g= 2,)-6,3

Erythrocyte 2;


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MN cell B )5,)=

PMN cell B 6,7=

Di66eren0ia Dia5n!(e :

$.!epsis ec. Aoculated piopneumothora: de:tra ec.community ac1uired

pneumonia hypertension stage #

*.!epsis ec. Aoculated piopneumothora: de:tra ec.tb paru hypertension stage #

1.!epsis ec. Aoculated piopneumothora: de:tra ec.tumor paru hypertension

stage #

Dia5n!(e :

!epsis ec. Aoculated piopneumothora: de:tra ec.community ac1uired pneumonia

hipertensi stage #

Trea0)en0 in ER :

• % Na/l +,8= )+ gtt4i

• #nj. /e(tria:one )gr

•

#nj. Metronidaole *++ mg #C• #nj. ;anitidine *+ mg #C

• Nebule Centoline ),* mg

• Nebule >li:otide +,* mg

• 0lpraolam +,)* mg

• /odein )+ mg

• #nj. !0 amp

• #nj. Ketorolac + mg

Trea0)en0 in ward :

• % Na/l +,8= )+ gtt4i

• #nj. /e(tria:one ) gr4 ) jam

• #nj. Metronidaole *++ mg4 ) jam #C

• #nj. ;anitidine *+ mg4 7 jam #C

• Nebule Centoline ),* mg47 jam

• Nebule >li:otide +,* mg47 jam

• 0lpraolam +,)* mg

• /odein )+ mg

• #nj. !0 amp


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• #nj. Ketorolac + mg

•

Pannin5 :

• %!


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3OLLO UP

** 0/ Se,0e)-er *%$&! B %ypsnoe 23

F B /onciousness B apatis

T%B +48+ mm"g

";B 7:4i

;;B ):4i

T B 6,o/

Eye B anemis 2-4-3, ikterik 2-4-3

/orB !!) 2N3

PulmoB !PB %ecrease breath sound on upper to lo&er right lung.

!TB /rackles 2-3, &heeing 2-3

0bdomenB soepel,


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0lpraolam tab : +,)* mg

/odein tab : )+ mg

#nj. Ketorolac + mg 4 7 jam/aptopril tab : 5,)* mg

*1 0/ Se,0e)-er *%$&

! B%yspnoe 23

F B /onciousness B apatis

T%B *+48+ mm"g

";B 7:4i

;;B ):4i

T B 6,o

/EyeB anemis 2-4-3, ichteric 2-4-3

/orB !!) 2N3

AungB !PB %ecrease breath sound on the upper to lo&er lobe o( right lung

!TB /rackles 2-3, &heeing 2-3

0bdomenB soepel,


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T B 6,o/

EyeB anemis 2-4-3, ichteric 2-4-3

/orB !!) 2N3

AungB !PB decrease o( breath sound on the upper to lo&er lobe right lung

!TB crackles 2-3

0bdomenB soepel,


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CHAPTER&

CONCLUSION

0 man, 58 years old, &ith dyspnoe, cough and chest pain &as diagnosed as sepsis

due to locculated pyopneumothora: pneumonia hypertension stage #.


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DA3TAR PUSTAKA

. /enters (or %isease /ontrol and Pre9ention ?ebsite. Pneumonia. 09ailable at

httpB44&&&.cdc.go94nchs4>0!T0T!4pneumonia.htm. 0ssessed 5 >ebruari

)++.

). Migerd LP. Aung in(ection I a public health priority. PloS Med )++5OBe65.

. Migerd LP. 0cute lo&er respiratory tract in(ection. % *ngl + Med

)++7O*7B65-6)6.

. >ry 0M, !hay %K, "olman ;/, /urns 0T, 0nderson AL. Trends in

hospitaliations (or pneumonia among persons aged 5* years or older in the

'nited !tates, 877-)++). +#M# )++*O)8B)6)-)68

*. ?underink ;G, Mutlu GM. PneumoniaB o9er9ie& and epidemiology. #nB

Aaurent GL, !hapiro !%, eds. *ncyclopedia of espiratory Medicine. F:(ord,

'KB Else9ier 0cademic PressO )++5B+)-+.

5. 0nna >, ?ibisono ML. Manajemen !epsis pada Pneumonia. Ma-alah

)edoteran espirasi. )++O2)3B*)

6. The 0merican "eritage.%ictionary o( the English Aanguage, th Ed. )+++.

"oughton Mi((lin /ompany.

7. Mayo /linic. %e(inition o( Pneumonia diunduh dari

httpB44&&&.mayoclinic.org4diseasesconditions4pneumonia4basics4de(inition4/

FN-)++)++) pada tanggal )* !eptember )+.

8. Mosby@s Medical %ictionary, 7th Edition. Else9ier, )++8.

+. Mandell A0, ?underink ;G, 0nueto 0, ile TM,


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. ?iemken TA, Peyrani P, ;amire L0. Global changes in the epidemiology o(

community-ac1uired pneumonia. espir Crit Care Med. )+)OO)-8.

. Torres 0, Menende ;, ?underink ;. Pyogenic , Fli9eira C0, !an9icente /, Pacheco E>, et al.

;e9ie& biomarkers in community-ac1uired pneumoniaO a state o( the art

re9ie&. Clinics )+)O5623B)-*.

7. /rain /M, !tol %, lu

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