UPDATE LAPORAN PASIEN ICU/HCU

Laporan Pasien Dinas Sore,Tanggal 17/03/2021

Total pasien 5 Konfirmasi COVID 19 4

4 Pasien Kriteria HCU 5

Pria

Wanita 1 Pasien Kriteria ICU 0

Cluster - Kapasitas Bed HCU tersedia 6

Probable - Kapasitas Bed Emergency tersedia 2

Suspect - Total Kapasitas Bed HCU/ICU 24

Jumlah TNI 0 Jumlah Polri 0

Konfirmasi Negatif 1 Jumlah Bed Tersedia 39

Jumlah Dokter Pershift 5 orang Jumlah Perawat Per Shift 14 perawat pelaksana + 2 PJ
perawat
5 HFNC
1 Pasien Negatif

0 Rencana Rujuk

0 ATENSI

1 Baru
1. Tn Erwin /41 th/RM S Rencana : P: GDS 18/03/21
47804 Keluhan : sesak (+) - Weaning bertahap 06:00 :
berkurang, batuk (+) - Obs. KU, TTV, ● O2 via HFNC,FiO2 50%, flow 40 14.00 :
MRS : 04/03/2021 sesekali tanda-tanda lpm, T 37 C 22.00 :
perdarahan ● IVFD NaCl 0.9% + aminofilin
Riw penyakit : Hipertensi - Prone position 360mg/24 jam
18/03/21 sejak 5 thn yll namun min 12 jam/ hari GDS 17/03/21
LOS 14 tidak rutin minum obat - FU Expertise Ro Antikoagulan 06:00 : 215 mg/dL (2 IU)
IMCU 2 RPO : Irbesartan 15/3/21 ● Drip heparin 12.500 unit/12 jam. 14.00 : 282 mg/dL (4 IU)
HCU 7 1x150mg - Cek OT/PT 20/3/21 Cek APTT jam ke 10 (Regimen 22.00 :211 mg/dL (2 IU)
RKS : riw. merokok - FU DL, elektrolit aPTT kosong) STOP
Diagnosa : disangkal Ur Cr, AGD ● SC lovenox 1x0.4ml (07.00) AGD (17/3/21) FiO2 55%
● Confirmed Covid 19 (18/3/21) SC lovenox 1x0.6 ml (14.00) pH: 7.4
Simptomatik Berat O - FU Ro Thorax SC lovenox 1x0.4ml (22.00) SaO2: 97.9
(perbaikan) Ku : TSB (18/03/21) PaCO2: 26.9
Kes : CM Antibiotik
● ARDS Moderate PaO2: 91.4
TD : mmHg ● PO Levofloxacin 1x750mg (H1)
● Hipertensi HR : 75 x/i Lapor hasil lab 15/3/21 dr. ● Inj Meropenem 3x1gr (H7/7) HCO3: 19.7
● DM tipe II RR : 18 x/i Pras SpPD (17/3/21) : BE: 2.2
● Obesitas grade I T : 36,6C - Curcuma 3 x1, cek Antiinflamasi
SpO2 : 98-99%, FiO2 fungsi hati 3 hari ● Inj Dexamethasone 2x5mg (H10) GDS 16/03/21
Swab positif PCR 50%, flow 40 lpm, kemudian ● PO Colchicine 2x0.5 mg (H8) 06.00 :159 mg/dL
01/03/2021 14.00 : 265 mg/dL (4iu)
Visite dr. Rofiman, Sp.P Imunomodulator 22.00 : 176 mg/dL
Hasil swab 14/3/21 Diet: MLDMRG 2100kkal 17/3/21 ● Resfar → TAO
POSITIF - Terapi lanjut ● PO Erdostein 3x300mg (H10) LAB (15/3/21 -> keluar 17/3/21)
Balance Cairan/24 Jam Eritrosit 5.01
(17/3/21) Visite dr. Mega Sp.P Antihipertensi
BB : 99,6 kg I: (16/03/21) ● PO Amlodipin 1x10mg (malam)
Hb 15
TB : 169 cm O: - PO Levofloxacin ● PO Candesartan 1x16mg (malam) Ht 41.9
IMT : 34.6 BC : 1x750 mg selama ● PO Bisoprolol 1x 5mg (pagi) MCV 83.6
DU : 5 hr, mulai besok MCH 29.9
IMPROVE score : 5 - Inj. Meropenem MCHC 35.8
(tanpa INR) ROX index 17/3/21 3x1 gr, lanjut smp Antidiabetik Leukosit 8400
00.00 : 8.17 hari ke-7. ● Drip insulin 1 iu/jam,
Trombosit 463000
Ro Thorax 15/3/21 02.00 : 9.42 - Weaning FiO2 55% ● Sliding scale/8 jam kelipatan 50
04.00 : 9.71 mulai besok naik 2 iu. B/E/N/L/M 0/0/78/17/5
06.00 : 8.73 ● Target GD 100-180 OT/PT : 44/85
08.00 : 9.37 Visit dr. Yulia Sp.An Ur/Cr : 41/0.9
10.00 : 9.4 (16/3/21) Na : 134
 12.00 : 9.4 - FiO2 75% Vitamin K : 5.1
● PO Vit C 1x1000mg Cl : 100
14.00 : 9.70 Visite dr. Ulfa, SpP ● PO Vit D3 1x5000u
16.00 : 12.10 15/3/21 ● PO Zinc 1x20mg
18.00 : 8.6 - Terapi lanjut
AGD (15/3/21 -> keluar 17/3/21) sudah
20.00 : 9.80 Obat lain konfirmasi lab
22.00 : 9.80 Visite dr. Tissy, Sp.An ● Inj Omeprazole 2x40mg pH: 7.03
Balance Cairan/24 jam 15/3/21 : ● PO Spironolacton 2x100mg SaO2: 75
(16/3/21) - Weaning bertahap ● PO Codein 3x10mg PaCO2: 13.6
intake: 2062.6 cc FiO2 85% Flow 50 ● PO Cetirizine 1x10mg PaO2: 39
output: 4.160 cc lpm ● PO Atorvastatin 1x40mg HCO3: 8.3
Kesan : - ● PO Melatonin 2x3mg BE: -14.9
DU: 1,7 cc/KgBB/jam
Advice dr. Prasetyo,, ● PO Curcuma 3 x1tab
BC : (-) 2097.4 SpPD via telpon : ● PO Paracetamol 3x500mg kp Hasil swab 14/3/21
- SC lovenox ● PO Hufagrip 3X1 -> TAO
Ro Thorax (10/3/21) Balance Cairan/ Jam POSITIF
1x0.4ml (22.00) ● Inh ultibro 1x1-> TAO
(15/3/21) - Alprazolam 2x0.5 CT helicase 32.3
BC : (-) 1130.8 mg 2 hari RdRp : 33.8
Terapi Selesai
ROX index 16/3/21 Visit (14/3/2) dr Priscilla GDS 15/3/21
08.00 : 5,77 SpAn : ● Heparin 2x7500iu sc H2 (11/3/21) 06.00 : 194 mg/dL
10.00 : 5.89 - Jika tidak ada ● PO Ambroxol 3x1→ STOP 14.00 : 124 mg/dL
perbaikan / ● PO Alprazolam 2x0.5 mg 2 hari 22.00 : 155 mg/dL
12.00 : 5.87
progress buruk (H2/2) selesai (16/3/21) siang
14.00 : 6.60 edukasi pasien utk ● Inj Levofloxacin 1x750 mg (H10) GDS (14/3/21)
Kesan : pemasangan (17/3/21)
ROX index 15/3/21 BiPAP
06.00 : 229 mg/dL
- Pneumonia ● Inj Remdesivir 1x100mg (H10/10)
06.00 : 6.41 (17/3/21)
14.00 : 305 mg/dL
bilateral 08.00 : 6.05 Visit (14/3/2) dr Tina SpP : 22.00 : 211 mg/dl
- Tidak tampak 10.00 : 6.41 - Codein 3x10 mg
kardiomegali 11.00 : 6.26 - Terapi lain lanjut GDS (13/3/21)
12.00 : 6.41 - R/ Ro Thorax ulang 06.00 : 152 mg/dL
16.00 : 6.59 14.00 : 216 mg/dL
Konsul (14/3/2) dr Siti 22.00 : 224mg/dL
18.00 : 6.6
Ro Thorax (04/3/21) KFR:
20.00 : 6.8 - Disarankan utk
22.00 : 6.25 LAB (11/3/21 -> keluar 13/3/21)
tidak posisi supine
00.00 : 5.40 Eritrosit 5.12
- lebih baik miring
02.00 : 5.63 kanan atau kiri Hb 15.1
Ht 43.2
 ROX index 14/3/21 advis dr. Pras, Sp.PD MCV 84.4
06:00 : 5.08 13/3/21 via WA : MCH 29.5
08:00 : 5.24 (prone) - Tambah dosis MCHC 35
10:00 : 4.95 lovenox 1x0.4 ml
Leukosit 5600
jam 07.00
12:00 : 5.01 Trombosit 352000
- Sc. Lovenox 2x0.6
14:00 : 4.95 ml 14.00 dan B/E/N/L/M 0/0/70/23/7
Kesan : 17:00 : 5.26 OT/PT : 27/38
22.00
- Bronkopnemonia 19.00 : 5.28 ur/cr : 69/0.9
bilateral 21.00 : 5.16 Visite dr. Mega, Sp.An Na : 133
- Tidak tampak dan dr. Erry, Sp.P 13/3/21 K : 4.9
kardiomegali - PO Cetirizine
Cl : 102
Balance Cairan/24 jam 1x10mg - TAO
(14/3/21) - PO Codein
2x10mg AGD 1 jam post pasang HFNC (11/3/21
I : 2517.5 cc
- PO Atorvastatin -> keluar 13/3/21)
O : 4240 cc
1x40mg pH: 7.4
BC : (-) 1722.5 cc - Inh symbicort 2x2 SaO2: 97
DU : 1,7cc/kgBB/jam puff - TAO - ganti PaCO2: 28.6
ultibro 1x1-> TAO PaO2: 78.2
- Inj. levofloxacin
HCO3: 22.6
ROX index 13/3/21 lanjut s/d 10 hari
atau sampai lab DL BE: 0.9
06.00 : 6.28
08.00 : 6.05 keluar
- IVFD NaCl 0.9% + GDS (12/3/21)
10.00 : 4.79
aminofilin 06.00 : 174 mg/dL
14.00 : 5.24
360mg/24 jam -> 14.00 : 265 mg/dl
16.00 : 7.87
observasi 22.00 : 154 mg/dl
18.00 : 5.14 takikardi
GDS (11/3/21)
22.00 : 4.6 Visite dr. Tissy, Sp.An 06.00 : 227 mg/dL
24.00 : 5.4 12/3/21 12.00 14.00 : 270 mg/dL
02.00 : 5.23 - HFNC FiO2 90% 22.00 : 196 mg/dL
04.00 : 5.38 flow 60lpm
Laboratorium
Visite dr. Jaka, Sp.P (9/3/21)
ROX index 12/3/21
12/3/21 09.00 PT:10.6
00.00 : 4.87
- IV Remdesivir aPTT: 37.4
02.00 : 7.37
1x100mg lanjut Na: 133
04.00 : 6.04
06.00 : 5.91 sampai hari K: 4.3
08.00 : 7.5 (prone) ke-10 Cl: 99
10.00 : 7.9 (prone)
12.00 : 7.5 Konsul dr. Samsul, AGD (9/3/21)
Sp.JP 11/3/21 pH: 7.49
- Jika TD >200/100 SaO2: 98.1
Balance Cairan/24 am berikan drip PaCO2: 28.2
(13/3/21) nicardipin PaO2: 94
I : 2463 cc 5-15mg/jam HCO3: 22.2
O : 3750cc dengan target BE: 0.6
BC : (-)1286 cc MAP turun 35%.
DU : 1cc/kgBB/jam Pertahankan 24 GDS (14/03/21)
jam kemudian 06.00 : 229mg/dl
tappdown.
ROX Index (11/3/21) GDS 17-03-2021
03.00 : 5.80 Advice lapjag 11/03/21: 12.00: 282 mg/dL
04.00 : 5.33 - HFNC T 37C
06.00 : 6.92 - PO Candesartan
10.00 : 8.54 1x16mg
17.00 : 7.62 - PO Bisoprolol
22.00 : 5.38 1x5mg
- Inj. Meropenem
3x1gr
- Ambroxol → STOP
- Heparin drip
12.500/12 jam
lanjut, kontrol klinis
- Drip insulin 1
iu/jam, sliding scale
lanjut, target GD
100-180.
- PO Melatonin
2x3mg
- PO Alprazolam
0,5mg EXTRA

Konsul dr. Prasetyo,

SpPD (11/3/21)
 - Bolus heparin 5000
unit drip heparin
12.500 unit/12 jam.
Cek APTT jam ke
10

Lapor pasien baru dr

Tama SpAn (11/3/21)
- cek AGD
2. Ny. Eka Yuliyana Sari S: sesak(+) berkurang, R/ P/
/39 tahun / 48972 batuk (+) berdahak, dahak - Observasi TTV - HFNC FiO2 40% Flow 40 Lpm Lab 15/3/21
berwarna bening, makan - Prone position min - IVFD RL 500 cc/24 jam Eri : 4.4
MRS 10/03/21 dan minum dalam batas 12jam/hari HB : 11.9
normal, bak dan bab - Swab tgl 19 /03/21 Antivirus HCT : 33.8
biasa - cek DL, OT/PT, Ur/Cr, - Inj Remdesivir 1x200 m (h1) lanjut MCV : 76,8
18/3/21
Saat ini pasien Elektrolite 18/03/21 1x100 (h2-7 ) (H4/7) MCH : 27
LOS : 8 hari
menstruasi hari kedua - F/U ur/cr, Ot/PT MCHC : 35,2
IGD : 1 hari
15/3/21 Antibiotik Leu : 6.87
Tower 4 : 4
RPD : HT (-), DM, - FU : expertise Ro - Inj. levofloxacin 1x750 mg (H3/5) PLT : 231
IMCU 6 : 0 hari
Jantung, TBC disangkal Thorax 11/03/21 - Inj Cefotaxim 3x1 gr (H3/5)
HCU : 3 Hari
- Cek GDS tiap B:0
O: hari(pagi) Anti Inflamasi: E:0
A: KU: TSS - Cel lab lengkap dan - PO Metilprednisolon 3x8mg (2/5) N : 82
● Confirmed covid Kes: CM rontgen tiap senin - PO Colchisine 2x 0,5 mg (H4/5) L : 13
19 simptomatik TD: 112/89 mmHg dan kamis 18/3/21 M:5
berat HR: 63 x/m Immunodulator
● Obesitas grade II RR: 23 x/m (prone) Visite dr. Rofiman, Sp.P - Drip Resfar 1x5 gr (H2/5)->TAO Na : 135
● ARDS Mild 25x/m (supine) 17/03/21 pk.10.00 ganti PO erdostein 3x1 caps K : 3.3
SpO2: 99%ON HFNC - Dexametason TAO (H4/5) Cl :103
BB: 96,25 kg FiO2 40% Flow 40 ganti
TB: 152 cm Metilprednisolon Antikoagulan ph : 7.51
IMT: 41,5 Rox index 18/3/21 3x8mg PO 5 hari - Inj lovenox : 3x 0.4 ml SC jika ada SaO2 : 99.7%
01.00 - Cek GDS tiap hari sediaan 0,6 ganti ke 2 x 0,6 ml PaO2 : 162.7
Improve score 03.00 SC PCo2 : 22.2
0 tanpa INR dan UR/Cr 05.00 Advis visite dr. Mega HCO3 : 20
Sp.P 16/3/21: Vitamin : Base excess : -1
Rox index 17/3/21 - Inj Remdesivir ● PO zink 1x20 mg
CXR 11/3/21 14.00 12,7 dilanjutkan sd 7h ● PO Becefort 2x1
17.00 8,25 - PO OBH 3x1 ● PO Calgea 2x1
19.00 8.17 - terapi lain sementara
21.00 8.75 lanjut Lain-lain:
23.00 11,25 ● Inj. omeprazole 2x40 mg
konsul gizi 15/03/21 : ● PO cetirizine 2x1
Balance cairan/ 8 jam - diet lunak, rendah ● PO OBH 3x1 (TAO)
16/3/21 lemak
Input : 1316,8 CC Obat Selesai :
Output : 1640 ● Inj dexametason 2x5mg (H3/5)
Balance Cairan : (-) 323,2 selesai 16/3/21
Diuresis : 2,1 cc/8jam
Rox Index 16/3/51
01.50 6.6
03.00 6.87
04.00 6.94
06.00 8.6
08.00 10.0
10.00 6.36 (supine, SPO2
99, RR 28)
12.00 8.10
14.00 7.27
16.00 7.00
18.00

Rox index 15/3/21

16.30: 544
17.00: 5,10
17.30: 4,95
18.00: 5,05
18,30: 5,63
3. Tn. Adi Wibowo/ 49 th / S: batuk (+) berdahak R/ P: EKG 17/3/21 Sinus Takikardi
47052 dirasakan berkurang, ● Obs KU, TTV ● O2 via HFNC Flow 55lpm Fio2
lemas (+), nafsu makan ● Prone position 65% → Flow 55 lpm FiO2 55% Lab 15/3/21 (Keluar tanggal 17/3/21)
17/3/21 berkurang minimal 12 jam/hari (pk 18.00) Hb16.1
Los    : 19 ● Ro Thorax 16/3/21, ● NaCl 500 cc /24 jam Ht 44
IMCU : 15 RPD:  FU expertise Leukosit 20.000
HCU : 2 Antijamur: Trombosit 396.000
HT (-), DM (-), Asma (-),
Konsul dr. Haris Sp.PD ● Ketokonazole 1x200 mg (H4/5) → Diff count B/E/N/L/M 0/0/87/9/4
Penyakit Jantung (-). (17/3/21) stop SGOT 17
- Insulin drip jalan ● Inj Mycamine 1x100 (H2/5) SGPT 27
A: Riw. Merokok 20 tahun yg 1,5 unit/jam (mulai Ur 57
● Post Conf. Covid 19 lalu (+) pk 12.00 17/3/21) Antibiotik: Cr 0.9
SB
● ARDS Moderate ● cefepime 3x1 gr IV  (H8/10) →
RPO: - Visite dr. Rofiman Sp.P stop Sliding Scale 17/3/21
● DM Tipe 2
(17/3/21) ● Inj meropenem 3x1 (H2/10) 06.00 76
O: - Anti inflamasi : ● Inj amikasin 1x1 gram (H2/3) 08.00 153
BB: 69 kg Colchisin lanjut → 12.00 290 -> masuk 1,5 unit drip insulin +
TB: 170 cm Ku: TSS
Kes: CM TAO → ganti Immunodulator bolus 8 unit
IMT: 23,8 (Normoweight) Metilprednisolon 18.00 150
TD : 118/72 mmHg ● Erdostein caps 3x1 (H10/10) ->
HR: 105x/m 3x8 mg (PO). Lanjut 00.00
Improve Score: 2,5 ( Tanpa RR: 25 x/m Evaluasi GDS per
CrCl dan INR) Spo2: 98% on HFNC hari Antikoagulan KGDH tgl 16/03/21
Flow 55 Fio2 55% - Erdostein lanjut ● lovenox 2x0,6 cc (H4) 06.00 = 80
- Teofilin p.r.n, bila 08.00 = 110
Ro Thorax 16/03/2021 SWAB: sesak baru Anti-inflamasi: 12.00 = 74
14/3/2021 NEGATIF  diberikan ● Inj Dexamethason 1x5 mg (H4/5) 13.00 = 225
→ STOP 18.00 = 101
09/3/2021 POSITIF CT Visite dr. Yulia, Sp.An 24.00 = 205
Value (Helicase 36,6 dan (16/3/21)
RdRp 38,9) ● Metilprednisolon 3 x 8mg (PO)
Turukan flow menjadi 55 Lab AGD (16/03/2021 di ICU):
lpm Inhalasi : pH: 7,5
ROX Index 17/3/21 SaO2: 99.9
06.00 6.5 ● Ultibro 1x1 puff
Advice dr. Siti Chandra, ● Berotec 4x4 puff TAO PaCO2: 23,1
08.00 5.2 Sp.KFR PaO2: 283,1
10.00 5.4 Prone position minimal 12 Bikarbonat: 19,7
12.00 7 Antidiabetik :
jam/hari ● Drip insulin 3 unit/jam→ 1,5 Base Excess: -0,4
14.00 6
16.00 6.62 unit/jam (mulai tgl 17/3/21)
Advice Ibu Rahma ● KGDH per 6 jam dan sliding scale Lab AGD (16/03/2021 02 pagi di IMCU):
18.00 7.20 Psikolog : pH: 7,5
20.00 6.85 skala 4 unit mulai 16/03/21 →
Insulin drip 1,5 unit/jam SaO2: 99.1
Ro Thorax 15/03/2021 ROX index 16-17/3/21 Sebaiknya nakes/dokter yg ● metformin 2x500 mg-> stop PaCO2: 19,7
23.00 5.38 sdg bertugas dapat ● Novorapid fixed dosed 16-16-14 PaO2: 116
00.00 7.07 mengajak pasien bercerita Unit -> stop Bikarbonat: 16,4
04.00 6.73 sesekali agar pikirannya Base Excess: -3.7
06.00 tdk dibiarkan kosong dan Lain-Lain:
dapat menghilangkan ● Inj. Omeprazole 2x40mg GDS 16/03/21
Balance cairan/ 8 jam kebosanan/kekhawatiranny ● Inj. Metoclopramide 3x5mg iv (kp) 06.00: 80 mg/dl
16/3/21 a. ● Atorvastatin 1x40mg
Intake: 1491 CC ● Calgae 2x1 ==================================
Output: 790 CC Visite dr. Mega Senja, ● Lactulasol syp 1 x 1 (kp)
BC: (+) 701 Sp.P ● Becefort 2x1 KGDH tgl 15/03/21
D 1,4 cc/kg/jam Turunkan flow menjadi 60 ● Zinc 1x20mg 06.00 : 118 mg/dl
Cek Lab lengkap 5 hari lagi ● Retaphyl/ Teofilin 2x300 mg (k/p 12.00 : 164 mg/dl
ROX Index 16/03/21 tambahkan OBH syrup 3x1 bila sesak) 18.00 : 100 mg/dl
03.00 4,42 ● Curcuma 3x1 24.00 : 80 mg/dl
Ro Thorax 10/03/2021 Visite dr. Yulia, Sp.An ; ● Loratadin 2x1
04.00 6,81
08.00 6,13 advice (14/03/21) =============================
18.00 4.03 insulin stop
Obat Selesai: Sliding Scale kelipatan 4 unit per 8 jam
Riwayat di IMCU: Advis dr. Efriadi, Sp.P 6/3/21 :
aminofilin 1 hari ini saja 14/3/21
15/03/2021 ● Colchicine 2x0,5 mg (H5) 06.00 : 357- 16 unit
Pukul 19.00 ● Spironolacton 2x100 mg (H5/5) 14.00 : 337,4-12 unit
TD : 124/70 mmHg Advis dr. Yulia, Sp.An via
RR: 24-25 x/i WA
5/3/21: Sliding Scale kelipatan 4 unit per 8 jam
HR: 88x/i curcuma 3x1
● Inj Ceftriakson 1x2gr (H5/5) 13/3/21
Spo2: 87-89% → ganti flow turun 50 lpm
Ro Thorax 05/03/2021 weaning jika pasien stabil 06.00 : 298 - 8 unit
menjadi NRM 10  lpm 11/3/21: 14.00 : 345 - 12 unit
Advis dr.Tissy, SpAn via ●  Remdesivir 1x200mg H1, 22.00 : 375 -16 unit
15/03/2021 1x100mg (h2-5) (H10/10)
WA 16/03/2021 di HCU 2
Pukul 18.00 ● Inj. Levofloxacin 1x750mg (10/10)
Pukul 05.32: Lab 12/3/21
TD : 121/73 mmHg ● Resfar 1x5 gram (H9/10) TAO
Ro Thorax ulang Eri : 5,63
RR: 24-25 x/i ● Inj Dexamethason 2x5 mg (H5/5) HB : 14,9
HR: 97x/i
Advis dr.Tissy, SpAn via HCT : 41,7
Spo2: 90-91% → ganti 12/3/21
WA 16/03/2021 di HCU 2 MCV : 74,1
menjadi SM 8  lpm ● Drip Heparin 10.000/24 jam
Pukul 04:52: MCH : 26,5
Edukasi untuk prone -->STOP MCHC : 35,7
Balance Cairan 24 jam :  ●  Ketoconazole 2x200 mg Leu : 12,1
setelah makan pagi
tgl 16/3/21 (H1)12/3, PLT : 343
I : 2697,8 ba/eo/neu/lymph/mono
Ro Thorax 28/02/2021 O : 2350
D : 1,4 cc/kgbb/24 jam Advis dr.Tissy, SpAn per 0/0/85/10/5
BC : +347,8 WA 16/03/2021 di IMCU:
Aff cateter HFNC100% flow 60lpm Sliding Scale kelipatan 4 unit per 8 jam
12/3/21
tgl 14/3/21 06.00-06.00 Lapjag 15/03/21: 06.00 : 219 - 4 unit
I : 3306 ● mycamine 1x100 14.00: 180- 0 unit
O : 2600 mg (5 hari) 22.00 : 399 - 16 U                 
D : 5,48 ● laporkan hari ke 4
BC : +706 dan cek DPL,ur,cr, 11/03/21
ot, pt, dan Ro SGOT 19
ROX Index 13/03/21 thorax (20/03/21) SGPT 47
02.00 : 7,35 ● meropenem 3x1 Ureum 54
05.00 : 7,67 selama 10 hari  Kreatinin 0,9
11 : Fio2 50% Flow 35 ● amikasin 1x1 gram
lpm selama 3 hari
● metformin dan 11/03/21
12.00 : 7,19 aPTT 41.4
15.00 : 8,17 novofrapid fixed
16.00 : FiO2 40% Flow 30 dosed stop
● kgdh per 6 jam dan Sliding Scale kelipatan 4 per 8 jam 11/3/21
17.00 : 11,02
sliding scale skala 06.00 : 324 - 12 unit
18.00 : 10.10
4 unit mulai besok 14.00 : 312 - 12 unit
Weaning NK 5 lpm
16/03/21 22.00 : 338 - 12 unit
RR : 22/ SpO2 : 97%
● drip insulin 3 06.00 : 219 - 4 unit
unit/jam lanjutkan
ROX Index 12/03/21
● mohon advice ke Lab 9/3/21
23.00 : 6,35
psikolog  Eri : 5.96
HB : 15.6
ROX index 11/03/21 Visit dr. Hario, Sp.P HCT : 43.7
14.00 : 7,65 15/03/21 : MCV : 73.3
16.00 : 6,35 ● Terapi Lanjut MCH : 26.2
18.00 : 7,50 ● Weaning O2 (min MCHC : 35.7
20.00 : 6,81 95%) Leu : 11.93
22.00 : 7,86 ● Lapor hasil leukosit PLT : 432
23.00 : 7,86 tgl 15/3-> terapi
05.00 : 7,4 lanjut tidak perlu 9/03/21
06.00 : 7,1 tambah antibiotik aPTT 49.5
ROX index 10/3/21 Advice Lapjag 14/3/21 ba/eo/neu/lymph/mono
05.00 : 6.85 ● Insulin fixed dosed 0/0/95/3/2
07.00 : 7,11 16-16-14
09.00 : 6,23 ● Metformin 10/03/2021
11.00 : 6,01 lanjutkan  aPTT 52.1
13.00 : 5,58 ● Retaphil 2x1 
15.00 6,28 ● Dexamethason kgdh 10/3/21
18.00 : 6.03 STOP 06:00 : 333
20.00 : 5,80 ● Berotec 4x4 12:00 : 356
22.00 : 6,03 ● Prone position  18.00 : 167
  ● Konsul KFR
ROX index 9/3/21
08.00 : Advice dr. Prasetyo
12.00 :  Sp.PD (14/3/21): kgdh 9/3/21
16.00 : 6,03 ● Naikkan dosis 06:00 : 270
20.00 : 6,28 Insulin Drip 12:00 : 385
24.00 : menjadi 3U/ jam , 18.00 : 286
Sliding scale
ROX index 8/3/21: dilanjutkan
01.00:  5.33 8/3/21
05.00 : 6,67 Visit dr. Rohmat, Sp. P : aPTT : 48,2
08.00 :  5,77 ● Loratadin 2x1
14.00 : 5,17 KGDH 8/3/21:
18.00 :5,77 Advice dr. Prasetyo SpPD 06.00 : 255
21.00 :  8,33 12/03/21: 12.00 : 291
24.00 : 6,02 ● heparin diganti 18.00 : 180
04.00 : 6,30 menjadi lovenox
2x0,6cc  AGD 7/3/21 on NRM 15 lpm
pH : 7,49
Visite dr.Mega Sp.P SaO2 : 82.9
12/03/21: PaO2 : 24.6
Erdostein lanjutkan sampai PCO2 : 80.9
hari ke-10 HCO3 19.4
BE : - 1.6
Advice dr. Prasetyo
Lab 6/3/21
Sp.PD 12/03/21:
Eri : 5.83
Drip insulin naik 2 unit/jam,
HB : 15.1
sliding scale lanjut per 8
HCT : 41.9
jam skala 4 unit
MCV : 71.9
visite dr. Erry, sp.P
MCH : 25.9
11/3/21
MCHC : 36
● weaning O2 HFNC
Leu : 9.63
● teofilin 2x300 mg
 ● symbicort 2x2 puff PLT : 365
-> TAO ba/eo/neu/lymph/mono
● vit d3 ganti -> 0/0/90/6/4
calgae 2x1
● goldtrion 2x1 -> Ro Thorax 5/3/21
TAO Kesan ;
● ketokonazole - Bronkopnemonia bilateral
2x200 mg (h1), - Tidak tampak kardiomegali
selanjutnya 1x200
mg (h2-5) Ro Thorax 28/2/21
● Codein stop Kesan :
- Tidak tampak pnemonia/spesifik proses
Konsul dr. Tomu Sp.P - Tidak tampak kardiomegali
11/3/21 via WA
● Remdesivir dan GDS 16-03-2021
Levofloxacin STOP 06.00: 80 mg/dL
● Cefepime Lanjut  08.00: 110 mg/dL
H10 12.00: 74 mg/dL
● Cek DPL 3 hari lagi 14.00: 255 mg/dL
-> tgl 12/3/2021
GDS 17-03-2021
Laporan jaga 10/03/21 12.00: 290 mg/dL
● drip insulin 1,5
unit/jam
● sliding scale per 8
jam skala 4 unit
mulai 11/03/21
< 200 = -
200-250 = 4 unit
250-300 = 8 unit
300-350 = 12 unit
>350 = 16 unit

Visite dr. Tina, Sp. P

10/3/21
● weaning O2 HFNC
● dexamethasone
tapp off 1x5mg
(5hri)
Advis dr. Haris KGDH 9/3
:
● Terapi lanjut

Visit dr. Tomu Sp.P

● Terapi Lanjut
● Weaning 02

Advis dr. Haris, Sp. PD

8/3:
-novorapid naik 10-10-8
metformin 2x 500 mg

Visit dr. Riyadi, Sp. P (8/3)

:
-Terapi Lanjut

Advice wa dr. Haris, Sp

PD:
(7/3/21)
- Fixed dose aja 8-8-6,
tetap pantau pakai khdh/8
jam aja

Advice visit dr. Adhe, Sp

P
(7/3/21)
- Terapi remdesivir,
levofloxacin, resfar
dijadikan sampai 10 hari.
- cek AGD terbaru
 
Advis dr. Riana, Sp.P via
WA 7/3/21 (Hp IMCU 1)
● Codein 3x10 mg
● Cek AGD
● tambah cefepime
3x1 gr IV (5hr)
Visite dr. Adhe Sp.P
6/3/21
● Remdesivir lanjut
jadi 7 hari
● Resfar lanjut 7 hari 
● Lovofloxacin lanjut
7 hari
● weaning dengan
SM 8 lpm
4. Tn. Syahrullah/ 52th / S: batuk (+) sesekali, R/ P: AGD 17/3/21 on HFNC FiO2 85%
49876 sesak (-), ma/mi (+/+), ● Obs KU, TTV, ROX ● O2 via HFNC Flow 60lpm Fio2 pH 7,4
BAB (+), BAK (+) jernih index 90% Sao2 97,1
17/3/21 ● Prone position ● IVFD NaCl 500 cc /24 jam PCO2 21,4
Los    : 7 RPD:  minimal 12 jam/hari PaO2 84,4
IGD : 1 HT (-), DM (-), Asma (-), ● Fu. DL, Kimia, Antibiotik: HCO3 14,4
IMCU : 5 Penyakit Jantung (-). OT,PT, elektrolit ● Levofloxacin 1x750 m,g iv (H6/7) BE -7,4
HCU : 1 ur/cr (18/03/21) ● Azitromycin 1x500 mg ( H6/7)
Riwayat merokok selama ● CXR (18/3/2021) Sliding scale 17/03/21 (dr. haris sp.pd)
A: 5 tahun terakhir. Sudah ● Sliding scale/8jam Imunomodulator 14.00 414 (20U)
● Conf. Covid 19 berhenti sejak 2 bulan. ● Swab 22/03/21 ● Erdostein caps 3x1 (H4) 20.00 375 (12U)
Simptomatis Berat 06.00
● ARDS Severe RPO: - Advice dr. Samsul Sp.Jp Antikoagulan
● Alkalosis respiratorik 17/3/21 20.30 Wib ● lovenox 2x0,4 cc (H3) GDS 17/03/206.00 350
terkompensasi - amlodipin 1x5mg
O:
● Obese gr II Anti-inflamasi: Lab 14/3/21
Ku: TSB
● Elevated liver Advice dr. Jaka Sp.P ● Inj Dexamethason 2x5 mg (H5/5) Hb15,6
Kes: CM
enzyme 17/3/21 → Jika TAO ganti Ht 43,5
TD : 143/89 mmHg
● Hiperglikemia reaktif - lasix 1 amp/hr Metilprednisolon 3x8mg Leukosit 5,600
HR: 91 x/m
selama 3 hari jika ● Spironolakton 2x100 mg (H6/8) Trombosit 121.000
RR: 23x/m Spo2: 98-99%
BB: 90 kg sistol > 100mmHg ● Colchisine loading dose 1,5 mg 1 Diff count B/E/N/L/M 0/0/67/13/10
on HFNC Flow 60lpm
TB: 170 cm - pantau balance jam kemudian 0,5 mg H1 lalu SGOT 105
Fio2 90%
IMT: 31,1 (Obese gr II) cairan, target - 500 2X0,5 MG (H3) SGPT 107
Ur 49
ROX 18/03/21
Advice dr. Rofiman Sp.P Antivirus: Cr 1,4
IMPROVE SCORE 02.00
17/3/21 ● Remdesivir 2x100 mg (H1) lanjut
5 tanpa INR 04.00
- Lasix 1 amp/ hari H2-5 1x100mg (H2/5) AGD 17/3/21 on NRM 15lpm
06.00
evaluasi ulang pH 7,43
SWAB: setelah 3 hari Sao2 99,2
ROX index 17/03/21 Anti hipertensi :
11/3/2021 POSITIF PCO2 28,2
06.30 3,42 ● Amlodipin 1x5mg
E Gene Ct 17,18 Advice dr. Haris, Sp.PD PaO2 120,8
RdTp Gene Ct 16,34 07.30 5,44
17/03/21 Multivitamin: HCO3 19
09.30 3,33
- Sliding scale/8 jam ● Becefort 2x1 BE -3,4
Ro Thorax 13/03/2021 10.30 5,50
(200-250 dgn ● Curcuma 3x1
Kesan : 12.00 6,88
novorapid 4 unit,
brokopneumonia kanan 14.00 7,86
naik 50 naik 4 unit) Lain-lain:
tidak tampak 16.00 5,50
18.00 4.78 - Lasix 1amp/hari (17/03/21)
kardiomegali Visite dr. Rofiman, Sp.P evaluasi ulang setelah 3 hari
20.00 5.50
17/03/21 ((19/3/21)
22.00 5.67
- Extra lasix 1 amp
00.00
 - Spironolactone
evaluasi 3 hari lagi
- Lapor hasil AGD
via WA
- Jika dexamethason
kosong di farmasi,
ganti
Metilprednisolon
3x8mg + Cek GDS
tiap hari
Advice dr. Yulia, Sp.An
17/03/21
- Setting HFNC FiO2
90%, Flow 40lpm

Advice dr. Jaka, Sp.P

17/03/21
- AGD ulang 1 jam
post HFNC, lapor
hasil
- Avigan ganti
Remdesivir 2x100mg
(H1), 1x100mg
(H2-5)
5. Tn. M. Sakti Akbari/24 th/ S : Pindahan dari IMCU R/ P: GDS 16/3/21 = 100
RM 48926 tower 7 17/3/21 ● Obs KU, TTV O2 HFNC FiO2 65% Flow 55lpm
● Prone position (Weaning terakhir 17/3/21 17.00) AGD 17/3/2021 15:00 (HCU)
LOS 7 Sesak dan batuk minimal 12 jam/hari IVFD NaCL 0,9 500cc/24 jam pH 7.5
IMCU 0 hari berdahak frekuensi ● Cel ulang DL, SaO2 99
HCU 0 hari sering, Belum BAB 3 Ur/Cr, Antivirus: PaCO2 20
hari, riw. merokok (-) SGOT/SGPT, Remdesivir 1x200 mg (H1), 1x100 mg PaO2 271
BB 63 KG RPD : HT, DM ,Penyakit Elektrolit 18/3/21 (H2-5) -> (H2/5) HCO3 17.1
TB 168 paru disangkal ● Ro Thorax, Swab BE -3.2
IMT 22,3 18/3/21 Antibiotik:
- Inj Levofloxacin 1x750 mg (H2/5) LAB 15/3/2021 (IMCU 7)
IMPROVE Score 3.5 RPO: - Advice dr. Rofiman, Sp.P - Inj. Ceftriaxone 1x2 gr (H1/5) AGD 15/3/21
(tanpa INR) (17/3/21): pH 7.4
O: - Bromhexine 3x1 Antiinflamasi : SaO2 92,7
Ku: TSB tab - Inj Dexamethasone 2x5 mg (H2/5) PaCO2 27,9
A: Kes: CM - Colchisine 2x0,5 (H1) PaO2 54,5
- Confirmed TD : 123/86 mmHg Lapjag 17/3/21: HCO3 22,9
Covid-19 HR: 60 x/m - Laxadin 3x1 Antikoagulan: BE 1,6
simptomatik berat SpO2: 99% - Cetirizine 1x1 Lovenox 2x0,6 ml TAO -> Lovenox 3x0,4
- ARDS Sedang RR: 26-28 x/m on HFNC - Symbicort 3x2 ml, jika sudah ada sediaan 0,6 ml kembali Eri 5,49
FiO2 65% Flow 55lpm ke 2x0,6 ml Hb 15
Advice dr. Jaka, Sp.P: Ht 41,7
Foto thorax 16/3/21 ROX Index 17/3/2021 - Erdostein stop → Imunomodulator: MCV 76
14.00 : 7.3 ganti Drip Resfar PO Erdostein 3x300 mg STOP 13/3/21 → MCH 27.3
17.00 : 7,62 1x5gr Drip Resfar 1x5gr dalam NS 100 cc habis MCHC 36
19.00 : 5,25 dalam 4 jam (H1/5) Leu 5,72
21.00 : 6,62 Konsul dr. Efriadi, Sp. P Trom 156
00.00 : Advice (16/3/21) : Multivitamin: Baso/Eos/ Neut/Lymph/Mono
02.00 : - Avigan ganti - PO Fituno 2X1 0/ 0/ 67/ 23/ 10
05.00 : Remdesivir 1x200 - PO Becefort 2x1 GDS 114
: mg (H1), 1x100 SGOT 26
(H2-5) Lain-lain: SGPT 13
- Inj Dexamethasone - Inj Omeprazole 2x40 mg Ureum 22
2x5 mg - Inj Ondansentron 3x8 mg Kreatinin 0,9
- PO codein 2x10 mg
Konsul dr. Prasetyo, - PO PCT 3X500mg K/P LAB 10/3/21 (T6)
Sp.PD Advice (16/3/21) : - PO Laxadin 3x1 Eri 5,1
- Ondansetron - PO Cetirizine 1x1 Hb 14
3x8mg - Symbicort 3x2 puff Ht 41,6
- PO Bromhexine 3x1 tab MCV 80
 - Lovenox 3x0,4 ml MCH 27
jika lovenox 0,6 MCHC 34
Foto thorax 10/3/21 sudah ada diganti Leu 6.5
lovenox 2x0,6 ml Trom 156
Baso/Eos/ Neut/Lymph/Mono
0/ 0/ 72/ 20/ 8
GDS 75
SGOT 19
SGPT 12
Ureum 22
Kreatinin 1.1
Dokter Jaga Siang Tim 4 yang budiman : Perawat Pagi Tim 5 yang baik hati:

1. dr. Yelsen Penanggung Jawab Perawat Tim 5 :

2. dr. Irkha
3. dr. Wira 1. Nida Fadhillah (PJ 1)
4. dr. Onny
5. dr. Uci 2. Victor Sentralia Jaya(PJ 2)

Perawat Pelaksana :

1. Yulianingrum

2. Martina Ulfa

3. Mita Anggraini

4. Chairul Basari

5. Jergamus J Faot

6. Heddy May

7. Andreas Septianus

8. Tidi Ransenjani

9. Siti Rahma Derlauw

10. Hendra

11. Wan Nazmi

12. Rahmat Laila

13. Maulida nurliza

14. Sri Wahyuni

15. Eferoni Zibua

16. Hijrah