t☒•:* *

.
.
Kegawatdamratan Neonates
MI S F IT S

Bugis

|
dr ↳ seizures

|
µ
.

trauma elestrakranial toxins ( home remedies )

paling seeing → Kapala
✓ kaput sesksadeaneum → Melena ti shuhera Crr) s Intestinal catastrophes
-
kaput setahematom-tidakmekwah.su turn → Formula dilution or over concentration

↳ seeing tidak hiking ,

Malati kalsifikasi .

Dibawahnya G) tubing
→
sepsis

www.gmsehinggapenyerapannyasulit
g. .
,mm .mn,

metabolic disturbances (hypoglycemia hyponatremia)

Yang berbahaya → diatas periosteum tapitetaptidakdibatasi
→
,

dptdiidentifikasiberdasarkanpemeriksaanfis.ir
Janis trauma
sum ra Ctldarah → perdarahan subgaleal
, lahiryg señngterjadi
posisi deformitas tidak Simoni
dgnadanga : anatom is age
-

Perdarahan intracranial tusahterlihat pd blinis → mjuk be Rs rakanunmkmencan.fi/-1ggn.saraf .

untrue CT scan .
Trauma
lahiryg paling señngtejadi adalah di daerah Kapala (ekstrakranial ,

waiter 's tip :

tanyanterbukakebe.laKang Kalo Kita Kasi
tangan Kranial intracranial )
,
.

(
,

Kita dia akan menggemggamlsepertipelayansaatdibeoikanh.pl

Khas ERB KAPUT SUKSEDANEUM
s
palsy
[ mengecil dm lebihñngan melewati samra Csehingga
tapi gd reflex genggam Palsy Biasanya akan 2-3 hari
Clawing : Sama E. → KHAS Klump ke , ,

tampakkepalanyapay-uklmemanjangkeatas.skarena berada diatasepikra -

fulit untukmengenalikejang pd neo hams Kare na trial aponeurosis sehinggabisakemanasajabepihdo.tn/terbentuk

tampilannyayg ,

↳ tefap hrs perhatikan blinis

.

tdkkhassperti pd anak → bola Mata Ke Kiri Kanan ( Doll 's eyes)

"
.
-

HEMATIN
,

mulutmengecap.tanganmenggemgg.am G) kejut gitu

"
.
SEFAL

Membedakanbayimenangisdgnmerinh.tn brdah-ftidakberbqhaya.fi/d*arah.hilangnyalama bisat tidak

/

dibatasisuH-bradadiatasperiosterbuka.fi
ekspresi Masi fam ↳ pender .
"

,
mulut & Mata melewatisutura-sehinggatidakmelewaligan-stengah.CH di daerah
pane .

pale men
angis ,
mulut term trip , G) grunting → bemsaha .
tall → .

hang a di Salah Satie Sisi kepala ,

) Suara tangisan Arter .

positifdiakhir ekspirasi team , pd lapisan diatastulang.tidakakanbisamenyebrangkesi.si lainnya
lebih Kareena dibatasiobh Alturas agitation
ring
v

keening pd wajah bias a an Karen a

lajunyaygsetalo Kau
-
.

dal → bis a untrue man perkirakan level bilirubin

nya sudahberapa
Karena
dibawahnya them pakah

tulang ,
akan Sulit untrue
terjadipenyerapan

[
""" "" """ "" " "" "" "" " " " " ""
""
" "" ""

tu lebih lama untrue hiking

Unhlktherujuk STABILISASI DULU jangan merujuk dlm headaan
.

→ →

Rejang ,
distress napas ,
Kita merujuk bukan untie memindahkan
tarnation .

fetus terdenyar G) udara hem busan : 0

I
Unhlkpenilaian air entry fuaranyaterdengaragakjauh - :
1

( gunakan stetoskoppd ( ti date herdengar 2 :

kedua sisi dada)

letargi-bayiterlihatcendemnglemas.nl it dibangunkan digerakkan , ,

bila di ban Sul it untrue

gunKan terbangun .

< 35,5°C → DANGER sign → Kalo gd inkubator ,

skin to skin

Hot to touch compare to the obs ever 's

, body / mother 's baby ;
737,5°C → lepas

para Ian suhulihgkungan < suhu tub uh .

(
,

}
Letargi ④ poor feeding Kombi nasi yg
Fast breathing ④ chest retraction ⑤ grunting seeing

Sangat panting bagi Kita untrue Mengen ali kegawatdamtratan neonates

gaga , gp, ,am, an g. man , ga, un,ng, n ,n ,

ga
, www.an ,,,, , many
,
man , y.ua, n,
ang map, gaga,, nagging , nayan ggn way,
laniut sehinyga teraba Karas →
lama kdamaan akan

tumbuhtYYYaYa1g"¥Ja¥r§Ña%?!yg nenyatu
,

sudan besar otaksudah

agar ,

berkembang .

Causes of shock / severe illness in the newborn : THE MISFITS

THE
endocrine congenital adrenal
hyperplasia thyrotoxicosisi. )
|
,

Heart disease congenital hypothermia

>
hypoxia resp complaints)
,
,
,

↳ trauma / non accidental trauma

Sind roma Nefrotik
d-
Pengganti prednisone apabilatdktersedia.makabisapertimbangkanmetil.pro
dr. Ramayana hisdone hrs diperhahkan polensilebih tinggi ( 415 doris prednisone
, .

o
proteinuria masif → >
5mg 1dL dipstick :
> +++ (Pada urine pagi hari)
,
gebelumpemberiankorh.tosteroid pd SN , bisa Kita lakukan Manton test → Karna
o
Hipo albumin ea → thus us 5N ,
hams < 294dL Kenya penggunaanjangka panjang → ttimun → Manuel gejala
"
TB akibattlinkksi TB
o
Edema - ring an → kelopak Mata , pretibia Ceksmiemitas)
\ berat → anasarka Cselunehtubuh) . Penyukurannuhisi pd anak dgn edema dilakukandgnpengukuranlingkarleng.am
atas .
→ misalnyarendah bisadicurigai edema Karna intake protein ygrendah.CM EP)
220mg 1dL Cbempakompensasi)
.

Hiperkoleslenlemia
.

°
→ >

sindoom netrofik dpt berdiñ sendin atau bersamaanlakibat

Linter si lain .

Kongenital
☒ idiopathic
Sekunder

kebanyakan SN pd anak , pada biopisimenunjukkan minimal

change disease scr mikooskopis ,

sehinggalebih diagnostic ditihat
(dgn lainnya
mikroskop elektron . & vnakroskopis ,
lab .

'
Kareena in Adak semua dilakukan biopsi
tang sung .
Bia
Sanya
change Sangat sensitifdgnpengobatan
minimal steroid
yg
.

kduarla albumin be urine

lesi pd glomerulus → Mr permeability →

→
proteinuria → hypoalbuminemia Conant pressure It) → edema
- -

Kenapabisa terjadi hiperlipidiemia hiperkolesterolemia Kareena , ,

albumin
tadiygbanyakhil-agmenyeb-abkanemak.hnudahkan
Molekul besar melewati
"
pembuluhdarah .

Kalo ketemu edema peñksa protein Kalo

pasion ,
urine
nya .

Fasi litas Kerrang ,

boleh dibakar→ akan terhihat denatures protein

bempapenggumpalan .

akibathipoalbuminemiaakibathip)olhiperfllkalemia.TL
Bisajuga ing at ada kemungkinan edema
?

kortikostenoid Yg Seling digunakan adalah prednisone .

↳ penggunaan obat hrs disesuaikan

dgn BBA Cyg dili hat

dari BB)
adalah BB IDEAL string
digunakan
BB yg ,
Karena

pd edema terjadi → BB .

Pemberian doris 60mg / m2

:
setiap hari dibagi ,
,

3 don's → .
3×1 hari fpagi siang sore) jgn Malam !
, ,
→

Initial → Selama 9 minggu → evaluasi → (1)remisi ?

Pennisi : proteinuria f) 3✗
pemeriksaanberhemt-tumt.se/ang "

tapperingoff-4omg1m@sehari.K
G) Pennisi → lanjutkandgn

Kali berhemt
"
min um
1×1 hari
Evabuasi → proteinuria f) 3 →

! Kalo 17 DAK
hentikanpengob.at an
Gbolehpertimbangkan alkylating agent
Ctapi hrs rujuk) .

Untuk edema seeing Karena G) retensinahium →

, sehingga perks diet
pendah garam (tapi hrs di -

Tr furosemide duaungdgn
p diet na -

searing ⑦
diuretiktalbygmin-triumt.tl
Pada pasion dgn edema berat ,

Hams pash Kan duty mslhginjalnya

✗ Cpembeñan steroid ) sudah teratasidulu .

Karna Kalo masibermasalah Rec Keadaan damrat → G) edema anagarka

.
.

albumin akan tons kduar

walaupuntdahdibetikan .
 A G- DA dr Badai
. Chronic Kidney Disease dr .
Oke Rina
Lika CO2 >> → keadaan milieu makin asam , → HC04 BiaSanya Kalo G) gagalginjalkronis-kemsakannyasudahjauhleb.in lama terjadi
Mihai timbal gejalapdtahap3-sindromuremikltandaawalyg.sering nampak :
Ednapas fetor are -

miaem ) .

Alport syndrome (gagalginjqlpdusia

Riwayat pnyginjaldlmkduarga untukmengetahui ± keen
ungkinan
Alergi Susu Sapi dr. Maharani Sangat dini ) Pada
.

pasion anak dgnmualmuntah ,

Coba ukurdulu an tropometri →
kemungkinanjika G)short

Masur allergen → di Sini bempa protein Susu → ditangkap ohh APC stature →
sorting akibat G)ggnginjal .

(den doit cell , DID di presentasikan Kesel T Lalu bantu Prinsiptatalaksana PGK teksidiri dgnhipoldisplasiaginjalakan G) progresivitaslebih banding

-µ
→ → mem anak lambat

Pencegahan ) 99 910 memlonetril.is .

hasilkan set B → men ghasilkan set plasma → men gebuarkan IgE pwgresiuifag → Lakukan diet
ygsesuai ,
cth :
ttgaram
(men gingat protein Ini Sbg allergen ) → SENS in Sasi ,
f) gejala Prevensikomplikasi

Kalo hiperlensi ④ proteinuria → ACE inhibitor ( captopril enapñl)

(
,

Untukbisamemimbulkan gejalala ,
hams G) crosslink antar 2 anti
-

hipertensi ⑦ overload → Diuretik ( furosemide t)

bodi berbÉdÉ%yg dibentuksebelumnyadanantibodib.am selelah 4) s
hrs cepatditangani & terms di monitor ,
Karen a pasien Sura berhenh send in untie di follow up tern
'
.

f)

Cksposurtembalialergen) → alergenmendudukiaantibodiberbeda.ba .

pembahangejalaygsignitikan dari proteinuria -11 ke -12 , pdhal Sem akin

tinggi proteinuria nya ,
Maka

mbisa pecan histamine ,

set mast .
& mediator Iain
mya semakincepatjatuhkegagalginj.at .

tanpa mediasi IgE yg kbih Kalo lejadiasidosis metabolite

Adajugaplelepasan set mast Mana se hrs segeradiatasi dgn pemberian Na HCO } Kareena tidakadaobatyg
-

,
, ,

ring terjadi dibanding Kan ygdimediasi IgE 11,51 ) .

. bekerjaapabila pH sudah < 7,0 atau 7,5 ( ? ?)
Semai Umar → abut
Untuk the mash Kan TBI
'

pen Ksa nanpropomem

.
.

Bayi dgn Asleksklusifjugabisaflkemungkinanalergisususapi ,

Karena
yg Gagalginjal
/ lerlambat → Kronis

Akut & tennis 10 sesak → akut

ibunyamasihmengkonsumsisususapi.sehinggamanajemennya bukan_ anemia , & keadaan ,

Unum
pasien ⇐ → Kuni ,
menghentikan ASI -

nya melainkan
,
henhkan konsumsisususqpi
ibunya .

6gal a mu nail biasa < Usia

1 bulan (min .
sdh 1 Ming gu minum Susu level kreatinin & Keadaan
creationin 3 sudahmuntah " → aka:t

sapi krn hrs G) poses sensitisasi )

" M" m Pd" "
( creation in 3 Masi bisa tenancy
"
→ Kron is
to ksiko
.
,

>

Seling Salah diagnosis eñtemaneonatovum fusion

bane tahir
,
saat bayi
5- than ) diberikan 2-3✗ susu sapi Karena ibu bellum bisa member
.

ASI Karen a Ihi adalah bentukawalmembaiknya iman sibayidi

Membuat Status Johannes
,

awal kehidupah ( hiking dlm 5- than) dr .

Hams pertaina sekali Identities pasion Tehama

(
Faktorrisiko → G) n' way at atopidlmkduarga (Ibu bapak , ,
& Sau -
( Umar
Tenis Alamin
dara Kan dung) .

8kt Ky
Pada ASS berat ,
WAJIB RUNK SPESIAHS ,
tapi bila G) Kegan at -

caramelahirkan
anafilaksis tanganilerlebihdahulu Riwayat kelahiran
damratan Cth :
⇐
→
di banns oleh siapa
.

Bila Sud ah G) per Bai Kan gejala ,

mam hiking → Coba la -
lo Kasi mmahsakitlpuskesmas / bidan → untrue mengetahui adakah kemung

kukan Provo Kasi dgn minum Susu sapi / ibuminum SMH nah blah dilakukan penyantikan wit k ,
& Cara banluanygtersedia .

sapi LAGI .

Riwayat kehamilan .

f) perbaikan → kemungkinan diagnosis lain later gi Maka -

Overload

(
>
an lain ataubersamaandgn Susu sapi) .

Bisapdanakdgneosinofilik colitis → 1^99 eosinofilpadq

oleh
Saharan PenceMaan sehinggaapapunygdimakan
,

akan akan gampangtersensitisasi .

 Pem@riksaanFisisNe0nahtSprof.6uslihanPadaneonatus.sa
at monitor tanda vital suhu lebih baik bagi neonates untie hipertermidibandingkan
menjadi hipolermi . → hipertermimasihbisadiberikanobatuntukt.tn suhu ,
naman hipotermia suhu

lingkungan & tub uh bayiitu sendin

yg
hrs Pt suhutubuhnya .

< 2500
gr → In pre Maher / Kecil Masa kehamilan

> 3800 gr -7 besar Masa kehamilan .

Pada bayi hasit pindahandañ RS Iain atau bidan ,

Kita perla untrue melakukanevaluasi

Wang dari neonates dari awal Cdiharapkan bidan/ dotter ygmembantu tumtikut) .

Komponen Transf usi Darah dr. Olga

PRC selalu 175

pediatric
Kato di PMI dim into
tapiuntukbayiituterlahubanyak.jadis.edu
•
, cc ,

bag ( ) Yang 50 cc .
175 cc
hrs hab is dim waktu 3- 4 jam .

bis a di kinda
• Pada Hb £7 grldl , apabila 4) pny dgn terapi spesihk lain → cth : ADB

↳±gkalibeñ2
(supplementasi besi ) .
AHA ( steroid ) diutamakan duty .
10 to 9 ,
"
i

" 30 CC per Kali beri 7- ✗ 10 ✗ 4

•
Hati mem pakan organ ygjugamemproduksi father pem be
-

Kuan daran → sehingga Pada pasiendgn hepatitis sang at wajqr

tnperdarahan atau It) abnormalities hematology screening test .

•
Reaksi trans fysi akutyg paling berat adalah an afilaksis

Delayed rxtranfusi biasa G) underlying disease / condition , paling Serino → iron overload ( ferritin > 1000, ataupemberi an
suplemtasi besi 3 Kali → management beñkan kdasibesi )
:

D
?⃝
 Hemato-onkologi.dr.se/vi Anshan Nvtrisi Pediatric
dr.winrake.luhanutamaseningdatang.de
¥I% ngan keluhanpucatatauperdarahan .
Menentukanmasalahnutrisi
< 2 th n

[ status
→
dehidrasi

) BB1trsatauBB1p@dgnintantometeryDet.Bes
Pacaf hemolitik giti :

[
~

[ Fanning
i
\ Cara
detisiensi pemberian responanakterhadappembeñan &

-4,2As
makan .

Hati aplastik flat

BIffFaei ( waterton)
.

✗ lool
Perdarahan
berarti
Kegan as an
Dongan kurva Kaloyan's pertumbuhansejajar dgnpersentil 50 ,

Trombosit pd def besi bias

anya
normal atau >> (jarangdibawah normal) pola pertumbuhan baits untukmelihatpolaltrenpertumbuhan .

G → bedakan
stunting anakberperawakanpendekakibat ggngizikwnis
→
- dgn stunted

}
Ferrous glukonat 35mg dais Iobesitas gunakan penguin ran
Y¥
→
Khusus untrue penguin ran ,

go , mg
Ferrous soul fat 65 doris kelentuanygmanaygdigunakan Adalah batasnya 2
→
mg
<2 thn :
WHO 2006
Nahin m fer ed at → 20% dani dos is ②batnga tahan y 2 2 thn
: CDC 2000
↳ mis 300mg obat
-

e)
↳ 60mg elemental besi
2¥ zoo
②
=
✗
Men entukan kebutuhan nutrisi .

( t ) elemental besi ( pure) (than ( sa)] Untukmengetahai height lusiaknnolegis) → darikurua PBIU atau
'

Drops → 15mg →
:
2×1 send ok obat
age
( laughing dikasi gausa
di Kali Kali lagi )
-
,
TB / U → tarik garis horizontal dañtitik tinggi pasien sampaimemotong ,

f. %, that
}
Paniytopienia bed dgnterapheuh, kurva 2- -

score median → itulahusia normal dgn tinggi signal

\
.

an

detisiensi
( I leukosit , trial sesuaidgn Unhukmengetahui BB ideal
menumtusianya plotkan BB & 1-Banak
Aplastic
,

trombosit
hiya pdleurva
) BBITB lalu tank gan's tums Vertical
,
.

t RBC / Hb
sampaimemotongkurva
median lihat
,
memo Tong pd BB berapapdangka di Kiri /Kanan .

"

Khas anemia defisiensi besi ③ Memento Kan rule

"

pencil cell → . .

pembeñannutrisi
Hbf >7 In :O -1% ④ Men
entukanjenis 2-at huhisiljenismakanan .

⑤ Evaluasilpengkajianrespons .

Hb Az 1^4-7
( significant
Tapi Hbf normal
✓ tangka pendek-iakseptabilitas.toleransi.efeks.amping
"
"
lfanglea panjang pesembuhanpny → ,
. .
.

Populasi Anak &

Pny nya -

Prof Chaim . {saranorgan.hi

t n tguaknana kagektnedemaitumorlkedganansefal
sampembo usm.hn}
kitatdabisamenghitung status nuhisidgnpurvabiasa gunakanlingkar ,

Permasalahanyg paling umum &

banyan → preterm birth .

tone irritability Consol ability

Appearance TICLS (

Feeding Practice dr
:
, , ,

Look , speech . Infant . winra

Breathing /work of breathing ;
cyanosis lebih
re circulation .
?⃝
 Juvenile Idiopathic Arthritis dr Rita

(
.

Heart Disease → arthn's pd

Yang mernbedakannya dgn Rheumatic RHD

migrans lberpindah sendi ygterkena)

"
bersi fat
poly arthritis & .

'

Yang pointing dibawah 16 th n onsetnya ,

naman dpt
menetap hingg a dewasa ,

danjarang on uncut Pada anak < 6 bulan

.

FRA di AS
Pada th n £2010 →
mining kin Masih Seri ng disebut 1- FCA dieropa
↳ Juvenile chronic arthritis

hang dgn pemfis → lab

hanyamengkonfirmasi.si
Diagnosis tetapdiutamakan a anamnesis &

_☒:÷:÷÷:÷:*
.

Morning stiffness Clebih seeing" dikduhkan orang dewasa ,

cut it
ahak
menggam barkan)

Fatigue , anorexia
,
etc .

Inspection → palpation → movement → 4) special test :

pGALS 1 Pediatric Gait ,

Arms legs spine)

pemeriksaan Musculoskeletal pd
, ,
anak

usia Sekolah It) pain / stiffness pd send i otot,

→
,
punggung
(E) kesulitan bepakaian sendin

% ft)
kesulitannaiktumntangga.LI
posture & kebiasaan
OBSERVE bukabajusemua ( ideal
nya)
☒
→

(
skin rash

deformitas (Panjang kaki tdk Sama , leg alignment ,

f- Scoliosis I bengkak send i

,
I telapak kaki
.
rata)
,

alan normal

y
child ± rasa sakit
walking Jalan jinjit apakahbisatertap
,

Jalan dgn turn it bejalan

. . .
Dan banyak lagi . . .

Dokumentasi P 6 Als screening → ambit kesimpulan.ltapiindikatornyaapaberartikitaoun.gg dia JIA)

pemeñksaan RF → meaningless → Seling RF f) dan kalopun FRED dia

tianya.mengg.am
Untuk
'

, ,

sehinggajarangdidqpatipd early
barkan adanya roses chronic erosive destructions 81A
p
.

Oligoarticular FIA ⑦ AN Alt) → G) Mr risk of having uveitis & iridooydih's →

bisadilakukan pemeñksaan Slit lamp →

early detection .

Systemic FIA → F- M -

,
M 1-6
g. o .
→ G)arthritis 3 1- joints with or preceded
by fever of at least 2 weeks duration documented to be
daily ( quotidian )
" "

at least 3 hari ⑦ Evanescent Inon fixed ) erythematous rash → salmon pink rash

☒
-

f) itchy machopapules
pembe saran KGB ,

Hepa to splenomegaly
serositis
nodules
Polyarthritis 81A → 35 joints Simehis small jonits ± subcutaneous

✓
.

, ,
,

RF (t) → (t) associated dgn RA pd Musa dewasa ,

→ risk of erosion / destructive bone joints , ,
etc .

- RFC-7
 According to the recent

Drug Allergy
European
position paper on childhood NSAIDs
.

reaction ( ADK) is defined

"

Adverse drug by WHO as a

response in children < logo . most responses

to druga which is noxious ,

& Unintended ,
Which occurs at doses are non -

immunologic ,
cross inhale .

normally used in man for prophylaxis diagnosis . ,

or therapy of disease .
rant ,
& easily attributed to cofactors

Type A → dose dependent PREDICTABLE consequences of such as exercise or infection

/
.

ADR, the known pharmacological action of the drug In children > logo on the other
\
.

Type B → dose dependent , UNPREDICTABLE & Unrelated ,

hand the reactions
,
are similar to

( I
to the

G) Drug
drug 's pharmacological
Hipersensitivity → resemble
action

allergic reactions For the management of NSAID hypersensitivity confirmed diagnosis

,
those of adult .

& classification
=
drug allergy are required and an alternative NSAID other than the culprit drug is needed →
[ Drug Provocation Test) of this are recommended
DAS are classified according to the bell & Coombs
system of hypersensitivity DPT
:
.

Type [ Drug specific

I -

IgE antibodies)
② Type II ( cytotoxic reactions mediated by drug specific IgG antibodies)
- ADR after vaccination must be differentiated between allergic & nonallergic reactions
③ Type II (immune complex reactions ) IMMEDIATE non -

allergic reactions include local injection site reactions (swelling redness , ,

or

④ Type Ñ ( delayed type hypersensitivity -

reactions mediated by cellular imma -

soreness)& constitutional symptoms such as fever .
→ NOT A CONTRAINDICATION for future

nity T-lymphocytes)
: vaccine doses .

immediate allergic rx → minutes to 4 hrs (urticaria angioedema

,

( delayed
.

The common culprit drugs causing DHS in children are antibiotics , NSAIDs ,
Vaccine hypersensitivity anaphylaxis)
antiepileptic drugs ( AEDS)
,
& vaccines .
-

type rx -1 hours to days after injection crashes t) .

↳
Clinical manifestations - Cutaneous
symptoms TT :
Macedopapular Usually do not require allergic evaluation self ,

④
limiting ,
do not contraindicate future doses .

ptions (MPE s) urticaria angioedema , ,

,

SCARS fixed drug eruptions fesp . sulfonamide) .

Vaccine allergies are rarely triggered by the microbial
antigen ; rather
they are
( severe cutaneous Adverse GI symptoms :
nausea vomiting diarrhea more commonly induced by other components such as egg protein stabilizers such
, , , ,

Reactions) potentially life

(
→
gelatin milk latex
-

riparian as or
protein antibiotics preservatives adjuvants
, ,
& .

threatening
,
reactions
Isolated respiratory reactions → mostly
involve cytotoxic
}
- T-cell
• DRESS
• TEN activation → a certain Period restricted to NSAIDs → I part of anaphylaxis .

• SFS must pass before SCARS be -

✓ come full -
blown

↳ The culprit drug were commonly used , including antibiotics &

antipyretics ,
or

but chronically AEDS

uncommon used drugs including
,
.

Penicillin
major groups ( cephalosporin
Beta-lactam antibodies
(THE MOST PREVALENT
( Carbapenem

☒
minor Groups
that induce
in children )
hypersensitivity monobactam
. oxacephem
davulanic acid .

NSAIDs → pain relief , fever control anti inflammation in children , .

?⃝
 Nardi Nogi Anak dr Tina
.

Caymanian -

Kalo adasesak na pas saataktivitas →

cuñgai adamaSalah beban pd
janning & pam .

Pada org sehat , lerdengar bunyi janning

:
2

Kamp mitral & trikuspidalis [ Kamp atrioventricular →

"
BF I →
penutu pan
face sickle venwikd tub dub ]
[ Tua
"
tanda mulainya
"
-

-
↳
r

fasepengo song an atrium Kiri &

pengisianvenhikel Kiri .

② BFI → penunepan Kamp putmoral 1 Kamp semilunar]

"
aorta & → tanda dimu -

tain fuse diastole venhikd

ya
.

Gangguanjantung pd anak 13th n →

auriga aqui
red →
paling seeing RHD
(Rheumatic Heart Disease)

± bifasik
/
Normal EKG : hrs ada
←
p→ what

axis normal : hrs berada

di kuadran I
"
hams
"
sinus name gelombang Pterbtakdihuadran I
mengarahkeh-tn-scposih.tl
: →

Depnesi → tumn kebawah dari gan's isoelektrik

Kalo
memanjang ?
Ebvasi → naik keatasdarigan-sisoelekm.ie ff diabiasanya G) ra -

"
Anak biasa 0,20ms ( 5 Kotak) → PR interval normal dang di jan tung
C- tis)
-

,
d- h :
pen Kar .

poly arteritis otitis etc

f) p erythema
.

marginahem

Ra Po CES KRITERI A

¥.am?YbMtamodi1e
MAYOR
zones
chorea
.

>

chorea → St. Vitus dance anaknyatdkdptbegalanlums.lerlihatseperh.menari

'
→ ,

tangan dan kaki bergerate cepattaklerkoordinasi → G) kerusan an ganglia nya .

RHD tidak puny ales diagnostic Klin is kñteña Jones

, jadi munni hang a
anamnesis →

khusus Acute Rheumatic Fever atau kriteria WHO 2003 RHD

Demain rematikbisab.cm lang apabilatelah bemlang Kamp

jantunynya sudah
→
,
msak .

(
Saat dia besar →
>
sebutannya Penyakit Fanning Reumahk ( PJR)

Karena raw an seningbemlang → tents teyadiinflmasibemlang ohh streptokokus memsak →

da ri kaPocEstadi
Kamp mitral > aortic > pulmohal
regurgitation Pada pnyini.

hang , ,
a

hinggahrsdiberikanprofilaksisbempapenisih.nl?)sampai
karditisygmeninggalkangejalasisa.se
asia 25-30 th n agar lerhindari dari kejadian PJR
yg
men etap .
?⃝
?⃝
 Tumbah them Bang ( Nelson chapter 20 volume 1)
Biologic influences on development include genetics ,
in utero
exposure to teratogens ,
the

long-term negative effects of low birth weight (neonatal morbidity plus increased rates
of subsequent adult onset obesity coronary heart disease stroke hypertension & type 2
-

, , , ,

diabetes) postnatal illnesses

, exposure to hazardous substances & maturation .

✓ attachment refers to
biologically
Physiologic influences on development
→ a determined

]
tendency of a
young child to seek
proximity to the
parents during times of stress & to reestablish a

contingent response → to nonverbal goes

-

sense of well-being after a stressful experience .

heroes create the groundwork for the shared

that critical for
reciprocity
'

attention & are

social development
later language & .

The developing fetus in gestational period .

is affected by sosial & environmental influences ,

nutritional status ; substance illicit) ; and

including maternal use [both legal &
psycho -

logic trauma .

SOMATIC DEVELOPMENT

}
Embryonic period
3rd week : (t) neural plate on the

ectodermal surface
5th week : forebrain midbrain , ,

hindbrain
8th week G) gross structure of
:

the nervous system

}
Fetal period
By the time of birth the structure of ,
brain is complete .

Many cells will undergo

apoptosis .

Synapses will be pruned back &

new connections
will be made ,
largely as a

result of experience
No behavioral evidence of neural function
.

is detectable until the 3rd month

.

Reflexive responses to tactile stimulation develop in cranio caudal

sequence By week 13-14 .

,
breathing &
motions appear The grasp reflex appears at 17 week and is well developed
swallowing .

by 27 week

Eye opening occurs around 26-28 Week .

During the 3rd trimester fetuses respond to external stimuli

, w/ HR elevation & body movements ,

which be observed ultrasound

can
using .

Fetal movement increases in response to sudden auditory tone but decreases after several

repetitions
a

. This demonstrate
habituation learning repeated stimulation ,
a basic form of in which results

in response decrement Tt the tone changes pitch the movement increases which is
evidence again
a . in ,
,

distinguishes
that the fetus
repeated between a familiar ,
tone , and a novel tone .
 penularanpenyakit ataugangguan kekebalantubuh
GiZi Burak
-

• Balita dari
keluargasosio -

ekonomirendah
-
• Balita berkebutuhankhusus .

Istilah panting sebelummulai Di

lihgkungansanitasi bunk
: •

•
Dropout ( Do) → bayigitiburuklkurangygtdkmelanjutkanpengoba -

Ctabsen berthMt turnt pada bayi

< 6 bulan jangka pendekygdptdilakukan adalah
tan > 2✗
Pencegahangizi bunk IMD mom
-

• 1=75 (Formula 757 → Makanan CAIR terbuat dari Susu , gula Minya
,
K,& berikan Asl eksklusif ,
serta pemantauan pertumbuhandan perKembangan sejakawalkehidu -

mineral mix yg G) 75kcal setiap 100mL → fase STABILISASI pan pemeriksaan neonatal esensial
, dgnpendekatan MTBS (Managementerpadu Balita Sakit)
,

f- 100 100 kkalsetiap 100mL → fase TRANS 151 REHAB1- Father risikogizibumkbayibay.io bulan ygseningdikmukan
Meagan dung
• → & :

LITASI .
• BBLR 1<2500 gr) •
Pola aguh Karang :
manajemenlaktasi Salah ,
Ibu G) mslh psi Kolo -

• G-izibumk (severe wasting) → gizi balita ygditandai dgn : •

Premaher gis .
pemberiansusu formula tdkbenar .

① pitting edema bilateral 1min keduapunggung kaki) .

•
Png & Retain an bawaan

② BB / PB atau BBHB < -3 SD gin

-

indicator
~
⑦ LILA < 11,5cm pd balita legia 6-5gbu① bum" unhtk Usia
6- sg balan Pñnsip Penagahan kekurangangizi pd balita Usia 6-59 bulan adalah , :

Kerrang (wasting)
c- ① PMBA
Gizi ditandaidgn Sentai rekomendasi kapasitas 1ambung : 25 -30mL /kg BB Minyan & Umar sumber
• → : →
sedan i :

granada
.

① → SDC BBIPB atau BBITB < LSD kurva WHO Ygbisa

energi elision ygdpt members tambahan MPASI tanpamemperbesarjumlahlvo
dipakai unhlkgiti bunuel ?) energi pd -

② 11,5cm f LILA < 12 , 5cm lame Maranan → ygdianjurkan :

30-451 dari total kebutuhan
.
energi per hari .

• Perkembangan →
pembahanfungsitubuhmenjaailebihsempurna
( psikomotot mental , ,
Soria 1)
• pertumbuhan →
bertambahnyaukuranfisikdariwaktukewakm.gg
ditandai dgnbertambahnya beratbardan , Panjang / tinggi badan ,

dan lingkarlepala .

•
RUTF (Ready to Use therapeutic Food ) → makanan PAD AT gizi ,

ygdiperkaya 2-at giti miter untukterapi balita giti bunk ② Poncegahanpenyakit → G) imunisasidasar 19 bulan) LENGRAP , jambankeluarga ,

Semai standar WHO sanitasibaik polusit

.

Princip umumpencegahangiti bunk ,

antara Iain :

① Penyiapankesehatan & status gitiibuhamildilakukansejakmasarema.pemantauanperhsmbuhan balita →

gunakankarhl Menujusehat ( KMS) ygterdptdlm
ja danselanjutnya Saat Usia sub ur buku KIA .

Penyebab Utama hambatanperhembuhan ( growth faltering) ada 3. yaitu :

✓ pola hid up

onsumsi tablet tambahdarah

sehatbergiziseimbang a. AMPan Makan and

b. G) Penyakitinfeksiakut /tennis
fkualitas & kuantitas)

Retainan calc at /bawaan

kmselingpranikah C-
ygmemengaruhikemampuan makan

.÷÷÷÷÷÷÷÷÷.•."*.. .*
per ni Kahan dini keha Milan pd
Mencegah &
femaja ps : Growth faltering :
infants & children who fail to
grow & develop at a normal rate compared to
meningeal Kan kepesertaan
-

KB other 1

menerapkanpraktikhigiene & sanitasi personal serta Favor n'sikoterjadinyahambatanpertumbuhan :

kesulitanmenyusu (t ) Kel Kongenital

lingkeungan .
ANAK : BBLR , ,
G) infeksi ,
.

,
Makan tdkadekuat ,

terlambatlkecepatan MPASI .

② t.unamim.n.m.a.ananan.n.a.r.in#....... ± am.in
alitas standar pekerja .

③ Pen ing Katan status gizi & kesehatananakmdaluistrakgi Pembeñan UMUM : ekonomi on ,
Pendidikan ⇐
, aksesfasres suit , higiene personal a
( PMBA)
"

Makan
bayi & anak ygdilakukandgn prakhk ttandar Emas BBIU

⇐
PBIU atau TBH
"

Yang selanjutnya status balita

Maranan Bayi & Anak > Mana Indeks antropomehi untukpenentuan giti
④
BBIPB atau BBM
dini LA

✓ Inisiasimenyusui rtumbuhan & imunisasi

T Ast eksklusif
Co -6 bulan)
hrs
lingkarkepala /4 .

dilengkapi & dimonitor

Pembeoian MPASI 76 bulan
[ sepertitercantumpdbuku Balita G) indikasihambatanperhlmbuhanlh.si tidaklanjutygdptdilakukan
Asl
dikmskanhingga-2thnkmykesenatant.by & Anap Konya
:
,

07<6 bulan pemeriksaan indicator pertumbuhan n'

wayat
penilaianpnsesmenyusui
: >
>

④ Perhatiankhususdibeñkankepdbayi & balita dgntaktor risikoakan imunisasilpny > father Nikolain > Tindale lanjutsesuaikondisi :

men galami
kekurangangizi misalnya KM Seling men Yumi TotalAlesana gitibumk CKALOMEMANG
: • •
, 612-1

• Bayi yglahirdanibu KEK danlatau iburemaja premature BBLR ,

,
•
konselinggitiibumenyusui BURUK)

lumbar , G) kdainanbawaan .
•
konsdingstimulasitumbuhkembang
•
Perbaikifaktorrisiko / underlying disease
Balita G) inleksikronisatauakutbemlang & adanyasumberpenularan Rujukanlerkait mis imunisasi Pantauperbaikan tiap 2mi
nggu → Putih
• • : • .

,
 07 Balita G- 5g bulan :
pemeriksaan indicator perhembuhan > nil ai asupan & pola
pembevian Makan men unit umur >
riwayatimunisasilpny-faktorn.si -

lain
ko >
Trdaklanjut :

•
konselingpolamakansesuaiUMvR@Pemben.a n maKanan tambahan
ftimulasi tumbuhkembang gizi Kerrang (Ead !)
u
untrue balita
-
-
•
✓

Rujukan program Perbaiki FR/underlying disease

✓
•
,
mis : imunisasi • ✓

✓
• Tatalaksana giti bunk (KALO i.YA ) •
Pantausetiap 2 minggu → putih
✓
✓

Penemuandinikasusbeñsikokekurongangizi G) apendekatan :

padapemen-ksaanmtinatautybewbatsakit.PE
Pasif sengaja
→ tidal ,

BBHB
YEA
PB atau TB → 2- score
meliputi status
-

merits aan gin

⇐
,

Pitting edema bilateral dilakukan di fasi litas kesehatan

Rawat jalan tingleat pertamalpuskesmas .

② balita ygtidakidatangkeposyandu Dilakukan

puskesmasperawatanygmampumemben.pe/aLiLAd8n
Aktif → pangas sweeping .

Rawat inapdilakukan di

⇐ Pemenksaan dgnkomplikasi ( kecualipd bayi

denhfikasi balita dgnhambatanperhimbuhan Yaman balita giti bunk <6 bulan HA -

\ Pemeriksaan pitting edema bilateral RUS di rumah sakit) therapeutic , Feeding center
,
RS
prata ma ,
Serta RS
mengenalibalitayg kurus
C B dan A.
tipe , ,

Balita benesikogizi Karang ataugizi bunk ygperludinjuk adalah :

)
¥m¥I¥.:¥?:!!÷i¥¥¥:I:
a) (6- 59 bulan) LILA KUNING ( 11,5£
w1.EE?I--ampainaa.adarom-
Balita P < Riscm dan
dgn

|
MERAH ( < 11,5cm )

(
.

b) Balita G) hambatan pertumbuhan Pti Kasi med is , pitting oedema <<

,

a) Balita G) pitting edema bilateral natsu Makan baik

d) Balita tampak hi
kurus rawat jalan → lanjutpemulihan -

yaudalanjatseka.cn#aBBpBatauBB/tBs-2sD
,

e) Balita <6 Kalo ga terse dia

bulan G)
kesulitanmenyugu .
,

inapajasampaipemulihanpay.ga.nygp.nu
lian rawat
, amp , , , ,, , ,, , www..ua , , , , , , ,,µ,
µ, anyway ana.p.nu gyu, ,

antara Iain : ng edema .

① Balita gitib.am#Usia6-59bulandpt RAWAT JALAN bila ,

: >
Tidaksemua balita gizibumkakanmenjalaniafaselersebut.t-asestabiliso.si & tran -

f) komplikasi med is inap Sedanglean fase rehab ilitasidptdilakukan

• Sisi untie
ygperlulayanan rawat .

|
• Natsu Makan baik padalayanan rawat jalan .

•
keluargamampumerawat dgnbimbinganlenagakesehatan 4 Ease perawatan & pengobatangitibumk Pada balita :

② Balitagiziburuk Usia 6-59 bulan hams RAWAT I NAP

,
bila : ① Fasestabilisasi → awal ,
bias anya 1-2 hari → Pemantauan :
tanda vital ,
tanda baha .

BB < 4kg ✓* natsu Makan t.lu ya ,

derajat edema ,
asupan formula ,
trekuensidetekasi ,
kmsistensi feces volume ,
un:

* ""om" """ "dis *•"" """ mm " me . "" "" " " ""

③ SIMLA bayi Klan dgnindeks BB/ PB < -3s Ddanlatau G) pitting edema Tanda bahaya tidakbisamenyusu memuntahkanmakananlminu man keja
UMUM :
, ,
-

bilateral HARUS rawat inap !

ng , rewellgelisah letargisltidak Sadar stridor sianosis akralpucat & dingin
, ,
, ,
.

② Ease Tran Sisi → peralihandari Habilisasikerehabilitasi dgntujuan memberikesem -

ALUR PENA PISAN MASALA H GI ZI Patan tubuhuntkberadaptasiterhadappembeñan energi & protein ygsemakin

kekurangan gizi-bisaakutlkwnis.disebabkanasupanzatgia.gg
tdkmema .

Morning Kat .

dai ggnpenyerapandanlatau metabolism e 2-at gitiakibat pay ⑦ sanitasi

,
③ Faserehabilitasi → dptdibeñkan di laganan rawat inap & jalan → fasetumbuhkejar
& f) higienis ( ) pembeoian energi sebesar 150-220 kkal / KGBB /hari dlmbentuk 1=100 atau RUTF
Penang pangan Rtyg
anan t

(
.

bettahap ,
-1-2-4 minggu Kemajuandinilai
. davi Kenai Kan BB setelahfasetransisi

Kdebihangizi → disebabkanoleh ketidakseimbangan ampan

energi (energy in -

& meneñma 1=100 / Ruff .

take) agn energy ygaigunakan (energy expenditure) dim waknilama Pemantauan :

mencatatasupan formula & ABB

Berdasarkanklasifikasi WHO Kerrang giziakutdibagi ,

2,
yaitu :
④ Fate tihdaklanjut → lanjutan tumbuhkejardgh pembeoian Maranan keluarga
① Balita Siti Kura ng → indeks -2s, > BB/ ppsataup.rs/tpy-zspataudgn peng . & pembeñan maKanan tambahan pemulihan ( PMT -

p )
UKU ran 11,5£ LILA < 1215cm (6- 59 bulan)
⑧h
.

② Balita giti bunk → indeks BBIPB atau BBITB < -3 SD ATAU dgnpengukuran Inikan Peckman pencegahan & tatalaksanathn 2020 (khususrawatjalan) → disitu

LILA < ii. 5am ATAU G) pitting edema bilateral ,

min .

pdkedua punggung kaki .

diajugajelasinkeempatfase.ini lolangkahnya Tapi digg 2019 menun

& .

, .

jukkanyg rawat jalan hanyamengikutiygrehabilitasilpemben.am 1=100 /RUTF)

sedangkan rawat ihapbandahygmemakaikeempattase.im fstabilisasi , transisi ,

rehab) , jadigimana ?
?⃝
 by
* HIM C- MM HMM / HUH 110 Hog my DMB Hmp •
i. MOM yo# Old MM MYGUM •
yosoqmp.ymtmodpmp.yn.bg MM •
Buoy say to MMM GP me •
u •
0m01 MOM #90dm www.t of
d •
404 MMM !P MM !# I
0.0%8 HMMMM my# •
n.AM MMMM f) •
moms • :
b) 0dm ¥09 HMM IMM MM
ummm! ← HAHM HAH ← Off -98 4h94 MM µ
0,599 DO too
'
' UMMM 7! 08 db.ws
7. I 98C mm :
summat #
!bdMS Mff db.MS
OHH MM IMM
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f-(pomoomPmµnq!tmAMAOpÑ
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bd UH -9 UH 9AM HIM UDHAM (HIM MM
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mom ynqmymnpsdmnuomubpbfl.MG 9MM UNH BUH
y
-
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SOUDA EMMA mm
#
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i

opmtmybdmmom.AM#1d9o.ms2PdH8HM!&dH-stI-
MOP
MY # d M myth .fm/WdGoSnM ,
7- .
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db.ms GUM MMMM
-

y.to#yqyopUDS- 10PM
to some I ④ OMG At ! 1-
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MOM 4%5%01 OHBA / www.t#GMPMsy-b!M.HBedH-
UMMMM
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÷÷÷÷:÷÷:÷÷:/
 Cara melihat dan Menen Mean dilakukanbersamaandgnmenga
"
tanda dehidrasi :
Meng atasigangguankeseimbangelekmdit biasa dpt -

① Letargis → lemas , tidakwaspada ,

tidklertariklerhadapkejadiansekitar tasi dehidrasi .
Pada anak gitibumkterjadiggn.keseimbangancairanelekmoh.tl
② Gelisah newel temtamabiladisentuhlditanganiuntktindakan mineral Sehingga diberikan mineral mix ygditambahkankedlm
& → .
. untune
mengatasinya
③ Hair Mata → Saat balita 1=75 atau 1=100 dan Reso Mal
Manangis .

Saat timbal
④ Mata cekung →
tanya apakahmemangsepertibiasanyaataubambe.berapa Tubuhanakgizi bumkrelahf G) Kadar Natrium 3) & Kalia me di banding anak normal .

⑤ Mullet & lidah

Kering → raba
dgnjariyg KERING & BERSIH untie men entukanapakahlidah Langan obatianakedemdgndiuretikum.pemberian N atrium berlebihan dpt menyebab .

ataumulutnya leering .
Kan kematian .

ggh.ee/ektrolitnya-berikan Mineral mix ④ 1--75/1=100

⑥ Haus → what apakah balita ingin MERAIH CANGKIR Saat diberi Re so Mal -

Saat cangkirdisi
-

Fadi , untrue Cai ran → berikan Re so Mal untie rehidrasi .

ngkirkan apakah , balita Masih

inginminumlagi .

"

⑦ Turgor keel it → tank lapis an kill it danjaringambawahkulitpelan Cpd Anak di Kalita b- Pemantauan → waspada gejalakelebihancairan-gagaljanhingdankemah.am
⇐
.

domen) paan Polan Cubit-

Selam a 1 DENK dan lepaskan Lika kill it Masih TERUPAT
RR HR ,

trek miksi
: Akan
&
matai e
VolumeYa qanmulaif7diure→
*
Kaeo a) → pipis berarti
. .

Muntah
,

trek BAB &

mungkin G) perbaikan Karna awalnya
)
.

( 72 dtk) LAMB AT Att biasa lambat pd wasting

" "
-

→ : anak ,

biasa anak betum ada pipis

.

mombaiknyahidrasi
'€"¥!ngm"m¥a }
Tanda
Mulut basrah
seeing tidaktampakpd
anak Siti bunk
fontane, .

SEMUA balita giti bunk dgn DI ARE / PENURUNANFLH URINE

dianggap Mengal am i dehidrasi , ←
walaupu A) rehidrasi
turgor putit membaik
pen uh
vingan Pada dehidrasi ringan /sedang tetapupayakanmemberikan terapi rehidrasi oral Apabila BB yg hiking Saat dehidrasi
.
:
.

HARUS memantau
tidal manglein secara oral , Cai ran dibeñkan metal ui NGT sampai anakbisa minum Langan Dehidrasi 5% ⇐

}
4-
Ring
•
an :
KenaiKan BB
.

gunakan IMUS untie rehidrasi Recuali pdkasusdohidrasi berat •

Dehidrasisedang 5- 10% Fadi Kalou shh
dengan syok
:
.

rehidrasi , G) Kenai Kan BB sebesarini

Dehidrasi berat 10 15%
•
pasiendehidrasi data ng
:
-

davi BB awal saat .

Kali um rehidrasiberhasil
✓ GunaKan 1amtan oral it standarygtdahdimodifikasi dgn a Natrium & →
•
Syok :
15-201 .
.

yglebih dikenal dgn Rehydration solution for malnutrition ( Reso MAD Bila dilemukan tanda kelebihancairan (RR meningkats-xlmeni.ie/tRmeningkat 15×1

Oralit → Pada anak 612-1 BURUK hrs diencerkan 2 Kali agar Kadar Natrium menit
) ,
hentikan leg era pembeñan Cai ran / Resonate nilai Kang shh i. jam .

menjadilebih rend ah , untrue menghindari relensi air

,
edema , & gaga / janning .

② Gula → Untrue menambah energi &

Menagahhipoglikemia .

semuabalitagitibumkdianggapmenden.la inleksi pada Saat data ng ke takes &

③ Lamitan elektrolit /mineral mix →

mengatasiggnkeseimbanganelektrolit & segeradiben antibiotic → semua hrs diberikan antibiotic Spektrum Luas !
50-100 Ml
mineral Zinc CMR)jika balita
Kali um Magnesium lupmm & 12th n Ben Kan imunisasi 36 bulan belum pernah diimunisasi
'

, Sep :
, ,
,
.
→
ti apai are cam pale &

100-200 Ml
Tika anak G) diane berikan Re so Mal Hap Kali di are ath n → atau f) MR sebelumusia 9 bulan
,
nap diary .

f) komplikasi → AMOXICILLIN ClsmglkgBB Po / 8jam ,

5 hari )
Pilihan antibiotic f- ( ) t kompli Kasi → GENTAMICIN 17,5mg 1kg BB IM atau IV. 1×1hail
µ ,
7 HARI
2 hari 5 hari
• ,, ,
④ tambahkan terqpi spesifik AM PICKIN 150mg 1kg BB AMOXICILLIN 125
-40mg 1kg BB
Unhlk intersi yg diketahui Sep :
Matan v16jam) 18 jam PO )
, ,

TB Anak HIV meningitis malaria , , ,

.

( )
Kalo di ped o man G) komplikasibelum membaikdlmwaktu 48jam
2011 ,
Misa
Inga pdyg ,

dpt ditambahkan kloramfenikol 125mg 1kg BB /8 jam ,

Shari ,
IV atau IN atau 16 jam

Kaw µna µ, meningitis, pilingnanny,on, unpyyg ,, pomp ,µag, kopgmokgazogp,

,,

,
pan ,

( 25mg SMX ④ 5mg TMP /KGBB / 12J am ,

5 hari
) .

lakukan Pemban' an Rosana I lebih lambat dari rehidrasipadaanakdgngizibaik

99¥
:

Bein 5mL / 30 men it Pahtau

•
KGBB SERA P untuk
ajam pertama .

" "
•
sdaniutnyabaikantksomals-10MVKGBBA.am bereta- Selina door 1=75 dim dots

telahditentukan.SENAP 2AM Salama 10 jam 81h

pash tergantung seberapabanyak
.

→ :

anak Mau , volume tinjaygkduar apakah , anak muntah .

•
Selanjutnya berikan F- 75 secarateratursetiap ajam .
?⃝
 0 bat anti helminvite - (t) komplikasi → dptdiberikan SETELAH masukfase rehab ilitasi

↳ hang a untrue
yg G) komplikasiajaatauygtdkkomplikasijugadikasi ? ?
Di 2020 & 2019 G) tapi di 2011
Gada
pembceoiannya ,
.

< 5th n → WHO 2006 LLA

Untrue LLA f
75th n → Fracicncho

Tanda
 • Skin lesions /dermatitis ( perineum groin limbs ears armpits)
Mathurin
, , ,
,
.

-
• subcutaneous fat retention w/ loose inner
inguinal skin folds .

infiltrates )
Menumt adalah
detisiensi.to/ebihan.atauketidakseimbanganampan Hepatomegaly ( from fatty liver
.

WHO ,
→ nutria • .

dan atau energi Dibagi

.
2 kelompok Utama : MARASMUS → it occurs as a result of total calorie insufficiency this

④
.

ads to overt loss of adipose tissue & muscle wasted ( BBITB Gsp)
Kekurangan gizi → bisaakut/ Kronk disebabkan asupan Eat gin ygtdkmemadai
• → .

99h penyerapandanlatau metabolism @

2-at giziakibat pay ④ sanitasiqpenanganan
i
I Pemfis : • Failure to thrive → BB tidakbertambah
f) higienis ( stunting TB/Ut Wasting :B BABI underweight
pangan Rt yg (t) irritability apathy
: : •
.
, ,
&

BB / ut ,
& insutisiensildetisiensimikronutrien .
• G) sunken fontanelles as a result of dehydration .

•
Kdebihangizi → disebabkanolehketidakseimbangan ampan energi (energy intake) • General appearance → shrunken & wasted due to reduced

dgn energy ygdigunakan (energy expenditure) dlmwakhilama ( overweight, Obe levels of subcutaneous fat old
" "

appearance
-

→ man

gitag & diet terkait NCD Noncommunicable -

Diseases , Sep : Diabetes , pny .

Janning ,
•
(t) weight loss , initially noticeable in the groin or axilla →
,

Kanker) .
buttocks → face → thigh .

•
Hypotension hypothermia , ,
&
bradycardia .

KE KURA NGAN 612-1 : •

Tend to be associated w/ other micronutrient deficiencies
checklist MTBS untrue pemeriksaan giti bunk :

✓ Vit A

Iron
.

deficiency
deficiency &
:
dry eyes
anemia
& Bitot

koilonychia
spots

① Identities ygjelas Chama orgtua jeniskdamin tanggal lahiri

:

nanna anak , Umar ,

Hipokalsemia Chovsiek signs
,
trousseau
.
,
: or

Prolonged deficiency in Vit D: associated rickets other

② Anamnesis AWAL
calcium & or
.

bone deformities .

• Muntah / di are →
tampilanbahanmuntahldiare.lama ,
& frekuensi .

MARAS Mcc Kwashiorkor

-
→ mix marasmus kwashiorkor
•
Mata cekung ( Yg ban terjadi ) shrunken & wasted appearance

•
leering → terakhir Kapan
lancing berkurang /volume t trekuensit
, , ,
fakit
•
G) akrallerabadingin .

atrofi
kesadaran ( tampakmengantuk tidakaktif letargis) *
}i§:m
•
Menuhin , .
.

③ Anamnesis LANFUTAN bans

Tgi%mbang
•
Riwayat / MPASI AN
O→ protruded
a
•
Riwayatpemberian Makan ( sebelumnya &
beberapahañsebdumsakit) .

( hepatomegali belly
→¥178s
(e) pitting edema
ttlemak
0
• bilateral atautampak Makin kurus
g- subrutan

①
→ skin
• ft) kontak dgn pendenta campak / TB lesions

•
(E) Sakit camp ak dlm 3 bulan lerakhir .

•
Riwayatpenyakit ( diary ,
15pA , campak ,
TB , dll ) → edema
→
edema
• Berat tahir
↳ ↳ kwashiorkor ↳
sosial) marasmus maras mic kwashiorkor
•
Riwayattumbuhkembang ( visual ,
motoñk ,

•
ft) KMS & mdakukan penimbangan nitin di
Posyandy
•
Riwayat imunisasi & pemberian vitamin A .
prominence
d-
thinkers

Keadaansosialekonomii@Pendidikanorgtua.d
•

① 11

①
.

'
baggy

"¥€÷÷÷É÷÷÷
pants
(1) ggnsirkulasi akraldingin HRT kesadarant
: , ,

÷.am rectal /ear dahi 738°C armpit

suhu hipolermia ( < 36°C) ataudemam ( / :
:
,

Sangat

FHT
pucat
Itesi
:

→
:*
G)anemia berat
def Vit A
.
. ; Icekung → dehidrasi

.
KELE BI HAN 6 / ZI
Obesitaslkegcmukan adalah
: obesitas

→
& overweight

kdainanlpnyygditandaidgnpenimbunan
: tanda infeksi
Abdomen → kembung . bisingusus hepatosplenomegali , jannganlemaktubuh scr berlebihan .

Kulit → tanda inleksi purpura female SC , keening

68919 Klink wajahygmembulat
,

Pemtmembuncitdisertaidin
,

Edema atrofi otot

: • • .

the
1^9 carbo
hydrates
.

,
,

Untrue giti bunk , kondisiygdidapatkan ,

antara Iain :

f protein content .
• pipitembem ding pent berlipatlipat .

Usually protein malnutrition bilateral

KWASHIORKOR marked w/ severe &
extremity swelling •
Daga rangKap •
keduatungkaiumumnya mem

④Tha
-

: .

Pemfis : • G) peripheral pitting edema that begins independent regions & proceeds cranially .
•
leherrelahfpendek bentuk ✗

G) Marked muscle atrophy Pada

"

stunt
" • • Dada yg
membusungdgn •
anak or → G) buried

Abdominal distension (± dilated bowel loops pay Udara (t ) penis

• &
hepatomegaly) .

ygmembesar .

) Ajar lemak
"
Round face ( prominence of the cheeks facies
"

Terbatasnya
or moon •
gerakan panggul
• . .

• Thin , dry peeling ,

skin w/ confluent areas of scaling & hyper pigmentation .
•
Kulit : Mam panas inlertrigo
,
,
acan (slipped capital femoral Epiphy -

hair that falls those's nigricans jerawat sis / SCFE)

•
Dry full hypo pigmented out or is easily plucked
.

, . ,
,
 ÷"""
"÷!
re latif
"
①
p.m, bum,
& din
ding point
berlipat

←
iii. em

)(
Distribusijaringanlemak ( temtamapdremaja)
f-
shoulders ( back)
pinggang ( chest ( not necessarily the breast)
arms , &
,

APPLE shape body → 9 dada &

PEAR shape body / GYNECOID Tpinggul & paha ( I"+nFg% )

"
~ → .

ben tuk
kaki ✗

your hip circumference > chest

your waist isn't prominent
( chest circumference > hips
ur waist isn't prominent
,

weight of the 9 lean

tissue
overweight → in excess
average for height ,
body mass or adipose
or both .

Pñnsiptatalaksana overweight & obesitas adalah mengurangiasupan energi sorta mening -

Katkankduaran energi .

Tujuan utama fatal alesana → perbaikankesehatanfisikjangka panjang metaluikebiasaan

hidup yg sehat scr permanent . Ada 4 tahapdgn intensities >> . yaitu :

"
Pasion obese
"
* Tahap I pencegahan Plus
→
mom torus Kan diripdmakanyg
sertakeluarga
sehat & aktivitasfisiks.bg Upayapencagahan
(t) diet & jadwal Makan terencana
"

Tahap I Man ajemen BB tersmlktur

"
* → a waktu
,

Menonton TV ,
aktiuitas fi sik /bertha in aktif terencana (60min /day) ,
CATAT PEMA -

NTAUAN PER KAKU .

Intervensi multi disipliner menyetumh

"
* tahap Ii

meningkatkanintensitaspembahanperilaku.fr
"
→

Kuningan dokherspesialisygterlibat dotter &

✗?
@ Kuensi .

Maranan
G) Pemantauan lebihterstmktur
←
⇐ diet
jangkapendek
-17 Tim Multi discipliner target aktivitasfisik .

G) Evaluasi sistemik → pengukuran tubuh , diet , aktivitasfisik → di awal program & beber9Pa

interval .

Kunjungan ke dotter yg Regular

hrs dijadwalkan tiap .
MING GU 1min .
8- 12mi nggu) .

II " "

* Tahap Inlervensi Pelayanan Terrier → untie remajayqobesitasberat.lanjutan

Csibutramine)
"
tahap III. G) pemberian obat an ,
diet Sangat rendah Katori ,
I bedah .

Pr0M0sikancarahimtamamerekayg
dupsehatpds@muaanakaorangtua.te
PRIMER : Mem

Pence obesitas /
gahan .

\
G) FR

SEKUNDER aktivitas
& TERSIER 7)
Pengamran diet ; ,

fink mengubahpolahidup ( perilaka) & melibatkan

,
,

kduargadlm probes terapi .

Obesity risk factors

÷t!!;!÷÷
:
'
T calories > use Mr saturated
obesitas unhealthy eating behaviors → &

fylitnyamengatasi Kecenderungan unhealthy lifestyle

-
,

→
jalan pintas Sep untrue me Makai . •
trans tats .
+ added
sugar
"
penggunaan obat an → sampaikanbahwasampaisaatiniBEWMADAOB.AT AND high amounts of stress

OBES HAS yg diperbolehkan penggunaannya pd Anak & remaja free obatdiatas) •

Age → A) childhood obesity the risk as
you age .
.
. ,

•
Unhealthy environment → low socioeconomic status , easy access to
unhealthy fastfoods ,

exposure to chemicals ( obesogens)

•
Family history & genetics ,
race or ethnicity
• sex → women tend to store less unhealthy fat in the abdomen than met do .
ADDITIONAL IN FOS FROM NELSON :

Nelson 's malnutrition weighten more to Undernutrition

Under nutrition is an IMBALANCE between nutrient requirements and intake /delivery

that then results in deficits -

of energy protein
,
,
or micronutrients -
that may negatively
affect growth & development .

The most common mechanisms for illness related -

causes of insufficient growth include :

o• Failure to ingest sufficient calories ,

or starvation leg . cardiac failure fluid restriction)
,

•
Increased nutrient losses (e. g. protein losing enteropathy
-

,
chronic diarrhea)

•
Increased metabolic demands (e. g. extensive burn injuries)
• Altered nutrient absorption or utilization (e.g. cystic fibrosis ,
short bowel synd ) .

ACUTE malnutrition → duration <3 months .

Malnutrition indicators if we look at it from the growth charts Pov :

Proposed suggestions for preventing obesity :

normalize BMI before pregnancy

PREGNANCY
⇐ Don't smoke
Maintain moderate exercise as tolerated
Monitor
gestational weight
exclusive for 6 months continue w/ other foods for 12 months
breastfeeding :
i

POSTPARTUM &
Postpone introduction to baby foods to 4-6 months &
juices to 12 months
INFANCY
Eat meals as a family in a fixed place & time
Do not skip meals especially breakfast
FAMILIES
,

\¥em%! %?!?!?!?!!n%d
use small

Do not use
plates

food
&

as a
keep serving dishes

reward !
rooms ;
away from the table
restrict limes torn & videogames

Eliminate candy & cookie

sakes as fundraisers

"¥;÷÷;÷÷!;÷÷;÷:*
saw
Install water fountains hydration stations
&

Educate teachers .
especially physical education & science faculty ,
abt basic nutrition &
the benefits of physical activity
* soso.onam.nae.ie" """
Additional measurements that are useful for following the progress of the acutely Mal not minimum standard of
mandate physical reduction including so min of streams exercise
,
-

n' shed child mid upper circumference CMUAC) and hand

5 times weekly
arm
grip strength
.

are - -
.

exercise & safe play facilities for children of all ages

Increase family friendly
-

MUAC is a
particularly useful anthropometric measure when weight may be distorted COMMUNITIES ⇐ Discourage of elevators & moving walkways
the use
provide information on how to shop & prepare healthier versions of culture specific foods -

by use of corticosteroids or fluid status (e. g. ascites edema) → ④ also

.
malignancy? )
Explain the biologic or genetic contributions to obesity
of children
For children 36g o . .
,
hand -

grip strength maybe a more acute measurement response to nut

-

HEALTH CARE ⇐ Give

work
age-appropriate expectations for bodyweight in
toward classifying obesity as a disease to promote recognition
ppg , ,☐ypg
.

titional intervention than MUAC because muscle function reacts earlier to changes
nutritional
in
,

dynamometer of strength
status than does muscle mass → using but still ,
there's no exact range .
To establish a healthy eating habits in children ,
we can do :
,

• Do not punish a child during mealtimes w/ regard to eating → the emotional

atmosphere of a meal is very important →

pleasant & happy .

• Do not use foods as REWARDS

Parents siblings & peers should model healthy eating tasting new foods &

eating
• , .
,
,

a well balanced meal

-

Children should be exposed to wide

range of foods tasks & textures
•
a -

, ,

• New foods should be offered multiple times → to prevent favoritism &

acceptance after repealed exposure .

•
Forcing a child to eat certain food will decrease the child 's preference for that food →

children 's wariness of new foods is normal & should be expected

• Parents should control what foods are in the home → restricting access of foods in the

home will increase a child 's desire for that food .

children tend to be of satiety Allow children to

respond
• more aware more than adults .
so
" "

satiety
to eating & stop .
Do not force children to CLEAN THEIR PLATE .
 breathing & circulation ( w/ continuous monitoring of vital signs including
STATUS EPILEPTICUS
,
,

) of the underlying etiology (e. g. hypoglia)

ECG & determination &
management
The KAE has relined the definition of SE to reflect the time at which treatment should

studies
be initialed ( tt) and time at which continuous seizure
activity leads to longterm sequelae Laboratory including glucose sodium calcium , magnesium CBC basic

m e lt
, , , ,
,

type of
tabolic needed for ALL PATIENTS
2) injury depending
such as panelneuronal on the SE .

,
Ct scan ,
& continuous EEG .
are .

14
,

> pseudo SE →
psychological conversion reaction MIMICKING SE

.•+¥÷÷÷÷÷÷÷;:÷÷÷÷÷÷
-

For generalized tonic clonic seizures SE is defined "" "min min

mutation or decerebrate / decorticate posturing

:÷÷÷
.

✓ as continuous convulsive activity or "

-

focal )
→ identifying the type of se ( generalized vs
, .

activity WITHOUT regaining of

.

recurrent generalized convulsive seizure consciousness .

[ subtle sym : minimal myoclonic jerks OR absent :

electro -

( t1 =
5min ; ta 330 min) .

monitoring patients who

> the therapy particularly
,
in are

Paralyzed intubated.
( t 1=10 m ;
&
For focal -
seizures SE → G) impaired awareness 1-2=30 min)

For Absence SE → t 1=10-15 mini ta =

unknown) .
The initial
emergent the raphy should be → lasting
started for convulsive seizures 75 mins &

involves the use of benzodiazepine medication .

With all options

epilepticus ( Generali respiratory de
type of convulsive status
The most SE is
-

- ,

common press ion is a potential side effect

for which the patient should be
2-ed tonic, Ionic ,
or tonic clonic -

) .

monitored .

If seizures persist 5 mins after the

Other types : G) non convulsive status ( focal w/ impaired awareness , absence ) initial benzodiazepine dose , 9
2nd dose of the drug should be

, myoclonic status ,
epigram ,
& neonatal 8E .

a
④ might need
given .

↳ rare condition

(
If the Emergent therapy w/ a
involving recurrent & smh Mes '
intractable focal onset → not recommended ! to be incubated
benzodiazepine is unsuccessful

seizures associated w/ retained awareness . ( persistent seizures 5 mins after

the 2nd benzodiazepine dos e) →

to phenytoin valproate , or
condition in which generalized myoclonic jerks are repeated continuously or occur
in
,

mignfneedio levetiracetam → and line

dusters lasting for a sufficiently long period usually ,

> 30min ④ppgitunqqy.ba
Udh masuk
be ininhaled

SE is most common in chicken < 5 Y -0 .

,
w/ an incidence in this
age group
of > 100

per 100.000 children . The phenobarbital dose used in neonates is usually 20mg 1kg as a loading dose →
Febrile SE → the most common type of SE in children but in infants & children the dose is ,
often lower to avoid
respiratory depression

Nonconvulsive SE manifests as a confusionat state dementia , , hyperactivity w/beha The neuro critical care society Guidelines on SE
suggest that definitive seizure
viral problems ; G) FLUCTUATING of consciousness w/ at times unsteady sitting or walking control should be achieved within 60 min -

of seizure onset → which may prompt

,

hallucinations , paranoia aggressiveness catatonia

, ,
and/or psychotic symptoms .

opting for the more aggressive therapy in a patient who has already had convulsive
Refractory SE → is SE that has FAILED to respond to therapy usually w/ > 2 ,
seizures for 730-60 mins .

medications (such as benzodiazepine & other me d) → Theres no minimum dur .

SE SE that has FAILED to resolve or recurs within 324hr All patients w/ who respond need to be admitted for com
Superrefractory → , SE , even the ones ,
to the ICU -

despite therapy that includes a continuous infusion ( such as : midazolam &

pen to -

pletion of therapy & monitoring .

barbital) For RSE treatment ,

an IV bolus followed by continuous infusion of midazolam / propofol/

New onset refractory SE ( NORSE) → subset of

-
RSE that can last for several weeks or Ion -
pentobarbital / thiopental is used .
→
subsequent bolus &
adjustment of the rate

and often but not

always have poor prognosis of the infusion usually made depending clinical EEG responses
Because
goer , ,
.

are ,
on & .

of patients paralyzed
most
becomes these need to intubate d & ,
the EEG the

the mechanisms leading to the establishment of sustained seizure activity seen in SE appear method of choice by which to follow them .

K
to involve failure of desensitization of AMPA glutamate receptors → G) persistence the is to stop electro graphic seizure activity before reducing the therapy
goal

[ of increased
excitability
reduction of GABA mediated inhibition -
→ as a result of intracellular
→ achieved

pattern for
by com plate

I 8- 20sec
flattening of
to ensure
the EEG

interruption of electrographic
or minimal : burst suppression

seizure .

internalization of GABAA receptors .

A this explains that SE is often less likely to stop in the next specific period of time Patient receiving these therapies require careful attention to blood pressure & to

the seizure has lasted to be decreasingly

the Why benzodiazepine
effective
longer & appear systemic ,
& Some develop multi
organ failure .

longer activity
the seizure lasts for patients have to be
It is not unusual to put into pentobarbital coma
.

during SE (t) >> cerebral metabolic rate give multiple vasopressors to maintain their BP during therapy
injury in SE happens coz & a corn pen
Neuronal
:
,
.

→ in cerebral blood flow that , after approximately 30min IS NOT ABLE

Suntory f- i

to keep up w/ of Leads to transition from ADEQUATE

INADEQUA TE
the increases CMR → →

oxgen factors injury forming

cerebral tensions → w/ other ,
contributes to neuronal .

THERAPY
↳ SE is medical emergency that requires initial
a & continuous attention to securing the airway ,
 the more you lose consciousness
B.

higher amplitude slow waves dominated

(slow sleep like)
by delta oscillations
→
-

wave -

(burst suppression) → G) alternative isoelectric lines & bursting

episodes
 Inadequate intake is the most common etiology seen in primary care se

Failure Thrive
-

to < 8 Weeks problems w/ feeding (e.g. poor sucking &

things .
In infants ,

F This is a common term used to describe lack of adequate weight gain in pediatric aged -

pa
-
swallowing) and breastfeeding difficulties are prominent .

tients → BBIU < 5th percentile on standardized growth charts

,
a decrease in weight percentile For older infants , difficulty transitioning to solid foods insufficient bra ,

of 7 2 major percentile lines on the growth chart ,

or < 80th percentile of median BB / TB ast milk or formula consumption ,
excessive juice consumption ,
& parental

atau BB / PB ratio .
avoidance of high calorie food often lead to FTT .

Most
pathological explanations for FTT can be broken into one of the
following groups : Family factors can contribute to inadequate caloric intake at
any age .

Failure of food intake underlies most these include mental health disorders ,
inadequate nutritional know -

of FTT and includes ledge financial difficulties POVERTY is the greatest single risk factor
cases
nearly all & .

episodes due to for FTT in developed &

developing countries
nonorganic causes
.

It often hinges on the parent child

Importantly .
Child neglect or abuse must be considered because chit ,

interaction :
maybe the parent not dren w/ FTT are 4 times more likely to be abused than children

offering enough food the children

,
-
W/out FTT .

sing to take enough food or a

combination
.

of both .
DIAGNOSTIC EVALUATION

Failure of utilisation is generally due An accurate detailed .

ace -

to gastrointestinal cause resulting in aunt of a child 's eating ha -

poor digestion . reduced absorption ,

bits , caloric intake ,
& parent

or excessive losses .
-
child interaction should be

the age of the child may hold dues obtained as a key step in de -

to the diagnosis ,
e.g. coeliac disease doesn't termining the etiology of

usually cause problems until after the in -

FTT .

trodaction of gluten containing solids

, ,
so fall off in growth is usually observed from 4- 8

Months of age .

Increased requirements occur in those infants who have a higher metabolic rate due to

chronic illness .

The first consideration in an infant

presenting w/ presumed FTT is identifying
normal
variants of growth :

those infants born of small

parents be small from birth
may
& will grow along their low
percentile
line for weight both
height
&

falling (sometimes below their

their weight percentiles for short periods of time) → at the lower end of normal .

Those infants w/ constitutional delay in growth ( delayed length or height rather than weight)
is delayed by months compared to their peers of the best identified
or
years same age → .

by bone age assessment (

most unreliable in the first 12 months of life) .

Premature neonates will often grow below but parallel to the normal growth curve ,
but when
corrected for gestation their growth parameters will usually fall within the normal range .

The final group of normal infants are those who are larger than expected at birth leg .

w/ gestational diabetes)
Macrosonic infants of mothers &
postnatally experience a period of

percentiles upward into the normal

"

catch dow growth ( growth restricted babies who

"
cross

range crosses percentiles downward) →

diagnosis best made in retrospect after other
causes
-

have been excluded the infant has shown to have steadied

& their growth been out in

to follow a lower growth percentile line .

 8in drom Horner → ptosis ⑦ miosis ④ anti hidrosis ⑦ Mata cekang ⑦
Pemepiksaan Fisik (OFFLINE) pucat .

KEPALA 1- lagoftalmus →
tidakmenutupsempurna ;
± hemangioma , ± horde -

mm

Bentuk & UKU ran → makrosefali ( > normal) → Kareena hid rosetalus Trckomunikans & non -
Roma - Clum

nikans ) ATAU megalensetali (Kepala besar, dani lebar ,

G)ggnneurologi ) .
Alis & but U Mata :
bayi prema her Tbelumfumbuh Pada find Cornelia de . .
lange

(< normal ) → & Sind Waardenburg alis Kin Menyatu di tengah

'

mikrosetali Karen a retard asi mental / motorik Tr ,

disgenesis otak ,
.

& Kanan .

infeksi virus Kongenital .

Glandular lakh Matis & du Klus nasolakoimalis : abnormal → 36 bulan ,
duktuslakñmalis

Kontrof Kepala → Taha pan pen anda -

o -

1 bulan → leherdiangkat kepalajatuh beta Kang belumlerbuka ( air Mata mengalir temp ; ± epifora fproduksi 1^99 )

(
µ
,

biladidudukkah Mata dehidrasi def Vit A, Sjogren

,
kepalajatuhkedepan .

Kering t → ,
. .

synd .

umurzmgg ,
zbu ,an µ, Akhirbu,an ke -
z → bike tengkurap.dptmengangp.at konjungn.ua : ± per.darahan.hiperemia1pe1ebaranp@mb.daran ,
edema ,
sekret ) .

tonic neck reflex (TNR) Oftalmianeonatomm G) gonorrhoeae palpebral

engket.tnsekretputulen.gwpuaa.ua
asymmetric Kepala sejenak :
,

,, vitamin , ✗a. µ, , mia , managing, : * , ,, , gang

, , paan ,, ,aµ ,,, ,m, , an →
ap.m.n.gagampaanyag.am#,.,..apa ,
,
→
gga , .

) tengan
Kiri ,
yg ipsilateral ( Kiri ) akan Saat walau behem stabit tire
,
Bitot 's spot ,
xerosis Kornea , teratoma/ asia ( penipisankornea → ulcer)

Kato JELAS bim osteogenesis

imperfect
EKSTENSI dan ygkontralateral Kanan) 5 balan → Kepalategak Saat duduk .
sklera : normal → putih ,
pdbayisedikitkebi man .
→

"
dlm Cta glukoma Marfan synd I nevus ikteñk
Kan FLEKSI .
→ pelan hiking , ,
. ; ,

4- 6 bulan ( NORMALNYA) Kornea : normal hams jernih ; I kekemhan ulkus , , pera dangan ( keratitis .
. glukoma ,

avitaminosis A , mukopolisakañdosis) .

Kraniotabes →
perlunakantabulaekslernatengkorak-tekanbag.be arang dan diatastelingadgn Pupil :
normal berbentuk but at & Simen's ( 3 -4mm) .
Peri Ksa ref leks
cahaya Clangsung

cukupkeras → normal :
£6 bulan seperti men@Kan bola ping pong .
& konsensual) , akomodas ( dekat → Kecil .
jauh → besar) .

kompresiotar → (→
/
,

reflekscahaya
abnormal :
(f) rakitis sifilis hipervitaminosis A hid.ro sefalus .
Midriasis (di Iasi pupil) → G) rangsang simpah's buta 17K ,
>>
.
Komal
metabog.pe →
, , , ,

¢,

Tanda Macewen / cracked -

pot sign → ketukkanjañpdtengkorak → ④ ada suara soup potretak .

.
Miosis (pupil Kecil ) → Sind Horner lesiotak .
,

normal :
Saat ubun " Masih lerbuka abnormal :
ubun
"
Pupil Putih → KataraK , retinopatipd premature displasia retina ; pupil Merah → albinism
,

Sudan menhtup → 17k / dilatasiventikelotak .

Lens a :
normal → jernih ; I hekeruhan (Katarab) ,
subluksasi / distorsi lensa / Marfan Synd) .

Rambut & keel it tepala → warna ,

kdebatan ,
dishibusipertumbuhan .
→ G) Mannu nisi :
Eksoftalmus enoftalmus ,

Merah jagung leering mudahdicabut

, , .

dll
Lihatkulitkepala ,
I infeksi , hemangioma ,
.

Ubun (Fontanel ) neonates suit teraba Kareena G) molding tengkorakferhuupsaat

"
→ normal :

Usia 6 bulan -
1 thn .

Terlambat → raki tis , hidrosetalus.si/i1is.osteogenis imperfecta rubella Kong mat

, .
.

nuwisi Sind Down

, .
.

Kecepatan → kraniosinostosis & osteoporosis .

BenMk :
N Cdataratausedikitcerung) → G) menonjol
:
TPTIK , maple syrup
urine disease hidrosetalus hematoma subdural dll HiceKung
, meningitis ,
, .
.

i
dehidrasi ,
malnuhisi .

Wajah → G) asimemiwajah →
paralisiswajahcwajahyg paresis tertinggal ,
tertarikkesisisehat)

G) pembengkakan → edema radanglokal.infeksikelenjarwajah.infeksigusi.dk ,

.

Dismorfik → Down syndrome →

trisomy 21 ,
craniofacial dysmorphic (upward slanting palpebral
fissures epi canthat folds low ,
,
-
set small folded
-

ears ,
flattened nasal bridges ,

short neck ,

Pierre robin -

syndrome → fetal oral & Maxillofacial malformation :

(e) u shaped deft
-

palate posterior displacement of tongue Cglossoptosis)

, , micrognathia (gd dagu) .

William syndrome deletion of chromo som 7. Elfin facies (long philtrum

microcephaly
→
,

flattened
abnormally ,
broad forehead , puffiness around the eyes & nose ,

) nasal bridge .

Hipertelorisme jaraKantar pupil

}
→ >>
Varia"
tekkantus normal
tanks medians bergoserke lateral
.

Mata → Visas :
dinilai scr kasar → neonates brxterhadapcahaya ,
1 bulan sudahmelihatbenda ,
2

bulan Mengikutigerakjari 26 bulan sudan bisgmefokuskan & mengenali sua tu Benda .

Palpebral :
Isimem's (Mata terbuka)
,
± ptosis Galah Sam tdkdptlsulitmembukaltertinggal ) .
 P ,
L tha z bulan 16 hari

BB 10kg
PB 80km 70cm

UNIUK memplotkan Usia →

completed MONTHS & YEARS
Curia jangan dibulatkan hrs

(
,
dan

garis vertikalnya goiboleh dilengah )

"

di
,

"

Kalo untuk ✗ di TB / PB kadang berko ma dan bolen dibulatkan

I Tapi , bisaditengah Kareena .

"

interpretasi

berisikogizile.br#imunisasibehvmlengkap
Kalo BB /TB > + ISD :

Ñe%%¥nak ath . imunisasi sndah sampai 9 bulan

-1 imunisañsdasar
lengkap .

Hep B OPV -0
Bayi uit K →
bam tahir → .
→ .
"

Rhum untie OPV

egg wajib dip arhatiknn warn@→ Merah gabisa oupake
lagi [ hammy a
agar jingo

1 bulan Kati BCG pedant Kalan expired gaboledipo.pe

'

→ → NaCl → ,
can NaCl lain Icc

2 bulan → pentavalen ( merle Penta bio ) :

um

[ expired

toes kocok ( homogenitas) → idea

Inga :

ditunggn 60 men it ,

chela Valeria OPV

" "
mganduny tapi prakñsnya is merit

3 tri OPV P1 ,
P2 , PB
Varsin MR →
pelamtaquades 0150

sekarang rolling OPV )

hang OPV (2 teles)
✓
a Meng
an
P1 ,
Pz ( bi -

Doris → qgcc pec . BCG ( 0,05 cc ) &

Pem hen an IPV → a) P2 →

unmkmeningkatkan pqmberian intramuscular , hee BCG Cinmakutan)
-

→ .

imun untie Varian polio z MR Csubkutan)

OPV (fetes)

Anak 1- SD →
DT
HD →
T⑨→ Yeo diterñ pd DT Karena reaksi KIM pdanakusia 37thn Iebihgampangterjadi

bulanKYYFL.fi?-orewn.,hanyaunhek/-kpsp lcuruaperhimbuhan
BB 2000g r Usia WHO
unmnbayi pumatur
→ 1

(④ pembulatan)

Seng anak g bulan ,

G) Hb ,
OPV -0 , pentavalent ,
OPV -2
,
BCG → selelah itu gd lagi
↳ utamakan yg Sentai jadwal dilanjutkan ,
Saat
-
imhamsnya dpt apa ,
lalu lanjutkan be ygterlewatdgn seeking 1 bulan .

vaktin hidup HRS defeat he freezer , bukan dlm free teruya FRL → Langan pemahletarranuansin
↳ ↳ nantibenubrrr di pinna kulkas .

gyaratguhu hulks hrs 2- 8°C

Langan letakkan minor man keaeali 1 air mineral di pin he vimsmah

kulras untie
'

menjagasuhu Saat Mah lampu .

↳
Kaya lagu nassar

i ca Cantin

milestone Chal -421 → Satu tidak ,

Pada
penggunuanbuku KIA , pd pemeñksaan Saja langsunglanjut ke KPSP
 Pasion TB anak dpt ditemukan metal ai
TUBE RKULOSIS AN AK
pen dekatan Utama
2

ftikontakeratdgn pasion TB menu lar

Hin is Sesma it Banak
- ( t) tanda gejala
droplet infection Karana infekgi scr inhalant Maka
Penal aran TB
biasanya →

droplet nukleiyg Kecil Saja 11-5 mikron )

hang ygdptmelalui & Menembus Sis Rekomendasi pendekatan diagnosis TB pd anak
-

a :

Anamnesis ( Kontakarat patientB gejala Klin is sesuai TB)

temmukosilier Satu ran napasuntukmencapaibronkidus & alveolus .
Basil TB ber -
&

kembangbiak & menyebar metal ni Sala ran limb & alirandarah .

② Pemfis (term asukanalisistumbuhkembang)
③ Uji tuberculin

Sampai pd alveolus Akan terjadi rxinflamagi . non spesifik Makrofag .

akan memfa ④ Konfirmasi bakleriologis (TCM ,
BTA smear, PCR Kultur , B)
gosit Basil TB tetqpi tidaksemtlanya man ⑤ Penunjanglainyg RELEUAN ( chest ✗
ray lambat pungsi
, ,
bio psi →

-
menyebar LIMFOGEN →
kelenjar regional Semai
organ ygkrkena)
✗
.

menyebar HEMATOGEN →
organ tub uh lain )
⑥ Henning HIV (Kalo Hain HN
'

ga
menyebarkett-tn-N66ANYA-lobusp.am disebelahnya .

Batur lama / persilen Ming gu (

> non remitting tidakpernah reda /

w w.npganamn.g umum/
72 :
-

Pada (
organ terlenfu Pam lemtamalapangan atas , ginjal ,
otak) ,
basil berkombang intensities D) iselelah penyebab Iain DIAN 6 KIRKAN

biak scr luas .

Sewakhi imUnitas spesifik Malai terbentuk ,
tubuh akan
mengham . •
Demain lama 72 minggu (umumnya sub febrile ,Ikeñngatmalam①

tetany
bat
perkembangan basil TB → G) Sakit TB krn imun spesifikcc (1^9 balita , Usia •
f) Natsu Makan /K aan G) failure to thrive Cmeskipun c-Dupaya

pubertas daya tahan tubuh Menuhin)

. . perbaikangiti 1-2 bulan ini )
tanpagejala
atautidaknaikdlmabulansebelumnyaumumio.in
"
•
BBK
→
,,
guy, µ ,, ana , g.
ang m ,, www.an , KM / Malaise
•

gum, ,, ,, , , , , ,
umum : de Mam tama (? ) sebab It BB anorexia iesu ••
gpegifik g- away ,
.

( lerganheng organ terlibat)

, ,

spesifik :
gibbus .
pliktenpdkmjungh.ua
Pemeriksaan bakteriologis → mengidenhfi Kasi Basil tahan asam CBTA)

Demain pd TB anak biasanya tidakterlalu tinggi . naiktumn ,

&
berlangsungaekup lama → secaralangsuhg dan Mycobacterium tuberculosis daribiakanataumetode
direct smear Untk BTA
hrs singkirtan penyebabdemam lama ( 72 minggu) lainnya .
Untrue penumnan BB , perla di .

pemeriksaanlainnyq-spe.si men ✗
bi akan /Kultur untukmenumbuhkar
avigai TB apabila telahdiberikantatalaksanagititetapbelumaao.perbaikan .
MTB

Pada anak Masih lebihdiutamakan

kUltur>T → Karen a TCM f) tidak

Gejalabatukkrohik ( 32 minggu) mempakan gejala Utama pd TB dewasa ,

TIDAK mempa -
Selalu menunjukah pasion bukan TB .

5th n
Ctlgejala TB

④I
EKSPEKTORASI / BANK → > pane
ygmenonjol Jambi /
¥
3 Cara MEN
,

pd TB anak
an
gejala .

f) dahak dikumpulkan
"

sampelbakteri dogs Asp , RAgypxagh.AM BUNG → ,

3 hañberhlmt Pd

prosesnya di parenkim → f)reseptor bank Kalan G) ba pagihañ

Disebabkan Karen a pd anak ,
.

INDUKSI SPUTUM → semua lemur lebihefekhf hasil .

>
aspirasilambung ,
→jlh
,

Sampaio bait lime positive

tuk biasanya disebabkan pembesarankelenjar yg menekanbwnkus → menekanreseptor bank di
.

brohkus Rohtak etat doth pasien TB menu lar ( BTA-10) G)number pen
AWAYat → -
.

TT Peri distal dimulaidaribagianmetafisistulangdgnpenyebo.mn away

dibukhkanapakahanaktelahtertularatautidak-U-tlgg.ae
.
ularan → Perla
Gibb" →
dari anterior longitudinal radiologi scatoping vertebra
ligamentmm
:

/
,

,a khum, Penunjan C-Dtonjolan Kecil temtama di limbus → kumpulan TUBERKULIN ( Utama untukmembantumenegakkan diagnosis
konjungtiuitis pliklenulan's
.

- →

neurotic dikdilingi set limosit makrofag & I set daria berink

MYNA
banyak.mempaKanmanifestasialergi@ndogen.h ④
B Pd Math Purified Standard ( PPD s)
,
Protein Derivatives
,
-
-

hang
µtpµ
dak disebabkan protein bakfeñ
'

a of tuberculin

tapi
berkulosisantigen
,
deh bakteñ lain Sep . stafilokokus .

benjolanyg multiple tidaknyeritekan

skrohelo derma dgn kulit DilatesKan Mantwux (intraKatan)
dilakukanpengukurandisamadgnsekitarnya.HU/Kus
→ A) , ,
warn a Cara

bridging ) berwarna livid e ( bluish red

transversal indurasinya dlm 48-72jam selelahpenyuntikan ameter
,
,

bed akan limtadenih's banal

.

IMMUNOCOMPETENT terma sukyg G) vaksin BCG

Dinyatakan positif bila →
a) in Ieksi TB
1- (1) sateit TB g- d 710mm

|
Deteksi dini TB Pada anak -1 TT tuberculin test IMMUNOCOMPOMISED → HIV ,
gitibumk.keganasan.dk
Kel hi last d 75mm
Pembesaran
Pemeriksaanpenunjang lain searing adalah foto f Paratrateal
.

yg rontgent atelectasis
Ctidakkhas) →
major clinical stages of tuberculosis
,

there
,

etusi pleura gbranmilier ,

are 3 :

( / | |
Diagnosis pash
.

: Kultur dahak → soul it dilakukan & R false

-

negative alternant PCR / TOM →

:
"" " " " """ " " """ "" "

Mycobacterium tuberculosis , tidak bisa membedakan TB akhf / A) infeksi TB dgn pasca • TST or IGRA f) (t) ( t)

TB (letapmendeleksi DNA Kaman TB ygtelah Mati ) . → Kultur juga bisa dari bit as 1amBung CSF •
chest x-ray e) ) granuloma or

f)
, ,
G) >
calcifications in
Cai ran
pleura ,
ataubiopsijahhgan .

the lung parenohym

lain → ujiserologi Physical G) plus sign &
WHO tidakmerekomendasikan untrue f)
Upaya diagnosis
exam f)
tujuan diagnosis
•
→
symptoms

tidak
TB pam atauekstrap.am Kareena hasn't poemeriksaanygtidakkonsislen &
tidaktepat &

lebihunggul di banding tuberculin test Uji tuberculin A) menandakan G) reaksi hypersensitivities trhadap
antigen
.

) ygdiberikan TB (tuberkuloprotein → PERNAH ADA Kelman ygmasuk

Perjalanan penyakit
tahan setelah anak
1-Banak

leñnfeksi
dariterinfeksimenjaaisakit
→
menjadi indicator G) transmit
TB
mayoritaslerjadi
TB dikomunitas
Selamat

.
ke
NF-fpegitpflalen-dayatahanx.tampaksehatakhff.ge
dlmtubuh anak → sudah TERI

&
it TB
radio logis
→ G) Klin is
?⃝
?⃝
 cepat , pasientdkperlu dating 2 Kali
Ii hat
KeungGalan bisamembedakan - ⑦ dañ BCG
\ } tuberculin tidakbisa , tapi sama
"
Semuabayidgn RX Pat <
aminggustlhvaksin BCG →
storing !
⑦ inleksi alarm
.

IGRA gabisabedaininkksiatausakit TB .

kesimpulan si stem storing :

Stor 36 → di diagnosis TB anak Klinis & Seg era beri OAT

② Star = 6 -
. TST ④ / ( ) cc
t ④
gejalalainnya → di diagnosis

ps Yang dikasi
.
OAT td hrs
\ TB anak Klin is

TST ⑦
& Seg era beri

Ict) cc -0 gejalalainnya
OAT

→ di diagnosis
dipantau Kalo G) perbaikan Klin is
prog ,gµg,
,

, anjuman nay,, yay, y, , y ,, yg , ,µµ,

,
,
µ, µ , ,
mga , ,
TST -0 / f) cc ④ gejala observasi 2-4
→
minggu ,

Kalan menetap ,
eualuasikembali kemungkinan

diagnosis TB & mjuk Ice tastes lebih tinggi .

TB Yg didiagnosis dgnsislem storing terma tuk dim klasifikasi TB

yg
ler -

diagnosis Saara Klin is .

Penutian diagnosis TB anak :

•
Definisi teams : TB konfirmasi bakteridogis /TB terdiagnosis Klin is

Lokasianatomi Pam /ekstrapamlsesuai organ )

• :

pemeriksaanhistopatologilemtama-di.laKu Kan pd TB Ekstra pan dgn Metodebiopsieksisi •

Riwayatpengobatan oat
sebelumnya : bane /
pengobatanulang (relapse)
Catan FNAB bilatidak mungkin dgn hash yg diharapkan .
:
lgagalpengobatan
G) granuloma dgn nekron's perkejuan di tengah DAN /ATAU Pemeriksaanbakteridogis & BTA Ctf) 1+1-7
nya Uji kepekaan TCM MTB
• :
,
, , ,

G) gamba ran set datia langerhans ,

DAN / ATAU MR / PR/ MDR / ✗DR / Rifampicin resistant

Kleman TB • Status HIV : (t) / t) / tidakdiketahui

Foto thorax → TI DAR KHAS ,

kecuali TB Mili er , sehingga t dijadikandasar utama
TB (disease )
tempi Cpengobatan ) → G) sakit
diagnosis Banak .
Tata/ alesana TB anak ( Ponce aksis.proh.la/esis primer
gahan ( profit ( exposure]
\
profitalesis sekunder
Untuk Sislem storing sebagai bantuan penegakan diagnosis setdah anamnesis ⑦ pemh's ( inaction)

HANYA dilakukan di tastes PRIMER Yg TERBATAS (tenaga med is atau Pada anak pesiko TB milieritu pd 5th n & metabolism eobat
perangKat anak < →
,

diagnosis) .
jugalebihcepat → memerlukandosisyglebih tinggi .

storing HANTA dipakaiuntuk deteksidini (screening)

inlermitlenfsxseming.su/.namunHARUSdilengkapidgn
Untuk tastes yg LENGKAP , , Pemboñan OAT LEI LEBIH BAIK di
banding
pem.diagnostiklainnya.gg/ebihlengkap .

110mg)

( 15mg)

(dibuku 30 -40 mg
dgn med :
35mg)

( 20mg)

( bike BB Karang ,
berikanupaya
perbaikan giti duty & evaluasi
Selamat bulan)

@
} Yang tidakmembaik
setelahpengobatanbaku
di puskesmas

→ C-Dpembesarankelenjarhiluslparatrake.at
ft) intiltrat , atelectasis konsolidasi segmental 110bar milier
, , ,

Kalsifikasi ⑦ infiltrate tuberaeloma

?⃝
 pseudo mem
Diphtheria
>

(
-

brane

4 Is an acute toxic infection caused by Corynebacterium species typically Corynebacterium ,

diphtheriae.
Coynebacteria are aerobic , non -

encapsulated , non-spore-forming mostly non ,

-
Monte pie ,
-

bull neck L-
/
om Orphic , gram ⑦ bacilli .
Selective medium leg cystine .
-
tellurite blood agar or tinsdate appearance

agar ) that inhibits growth of competing organisms is required for isolation and ,
when the characteristic of adherent membrane ,
extension beyond the Palatine

reduced
by C. diphtheriae. renders colonies gray -
black .
lfaucial) area , dysphagia ,
& relative lack of fever help differentiate diphtheria

from exudative caused by Streptococcus

pharyngitis pyogenes or EBU .

Unlike other diphtheroids Coorynetorm bacteria) , which are ubiquitous in nature ,

C. diph -

Patients w/ laryngeal diphtheria are at significant risk for suffocation because

then ae is an EXCLUSIVE inhabitant of human mucous membranes & skin .

Spread is prima - of local tissue edema & airway obstruction by the membrane .

w/ of
lily by airborne
respiratory droplets ,
direct contact
respiratory secretions symptomatic
individuals .
or exudate from infected skin lesions . ② Cutaneous
important in transmission Skin infections ↳ indolent progressive infection characterized by superficial ecthyma like
respiratory tract carriage
ASYMPTOMATIC is & skin car non a
-
-
-
.
, ,

n'age are SILENT reservoirs of c. diphtheria e. &

organisms can remain viable in dust or tomites non -

healing ulcer w/ a gray -

brown membrane .

for up to 6 months .
often coexist w/ staphylococcal & streptococcal skin infection (dermatosis laceration , ,

burn bite , .
or impetigo →
primary process )
when diphtheria was endemic , it primarily affected < 15
yo children Since the introduction
-
of Extremities > trunk or head →
pain tenderness erythema
, , ,
& exudate 1^9 , hyper/
natural natural exposure th
toxoid immunization ,
the disease has shifted to ADULTS who lack hyperesthesia .

to toXi genic c. diphtheria e in the vaccine era & have low rates of booster immunization .

←☒!I%!m• 'm.gg?a!onI: riw1?n;ni*dad

③ Infection
" ""
Factors contributing to the epidemic include at other sites
decreased childhood immunization rates
↳ Inthe
failure to respond aggressively during early phases
ear ( otitis externa ) , eye (purulent & Ulcerative
conjunctivitis) ,
& the geni .

of the epidemic
tal tract [ purulent
.

membrane form
& Ulcerative Valvo
vaginitis) → E) ulceration -

PATHO6ENESl5_ ation ,
& submucosal bleeding help differentiate from other causes .

infection The
Both toxigenic &
hontoxigenic C- diphtheria e cause skin & mucosal .

organism
usually remains in the superficial layers of skin lesions or
respiratory tract mucosa
,
indu -

DIAGNOSIS

Cincy local inflammatory reaction .

Specimens for culture should be obtained from the nose , throat, and
any
other

the major virulence of the organism lies in its ability to produce potent polypeptide exotoxin Maco cutaneous lesion .
A portion of membrane should be removed & submi -

which inhibits protein synthesis & causes local tissue necrosis & resultant local inflam tied for culture w/ underlying exudate
-

along .

Evaluation of a direct using Gram stain specific fluorescent antibody is

Malory response smear
.
or

UNRELIABLE .

culture isolates of
Within the first few
days of respiratory tract infection (usually in the pharynx) a ,
dense necrotic conyneform organisms should be identified to the species level
coagulum of organisms , epithelial cells fibrin leukocytes,
, , & erythrocytes forms INITIALLY , ,
&
toxigenicity & antimicrobial sensitivity tests should be performed for c. diph -

white & advancing to become a

gray -
brown .
leather like adherent PSEUDO MEMBRANE ( dip -
thence isolates .

in Greek)
" "

htheña → leather . Removal is difficult & reveals a bleeding edematous submucosa .

Paralysis of the palate &

hypo pharynx is an early local effect of diphtheria toxin .
COMPLICATIONS →
respiratory tract obstruction by pseudo membrane (may require
bronchoscopy or intubation and mechanical ventilation ) & 2 other remote tissues aflec -

CLINICAL MANIFESTATIONS ( based on the anatomic site of infection) ted by diphtheritic toxin → heart & nervous
system .

① Respiratory tract

↳ Tonsil or
pharynx > nose > larynx TREATMENT
Infection of the anterior nares is more common
among infants → a) Serco sanguineous purulent , (t) specific antitoxin as the mainstay of therapy ,
but only available in US from

erosive rhinitis w/ membrane formation ,

shallow ulceration of the external nares & upper lip CDC → neutralizes only free toxin & the efficacy diminishes w/ elapsed time

In tonsilar &
pharyngeal diphtheria e → (t) sore throat [ universal
→
early symptom) mild after the onset of mucocutaneous symptom
→ EQUINE DIPHTHERIA AND TOXIN

⑤Ykg g y
,

pharyngeal injection UNI /Bilateral tonsillar membrane formation (which can extend
,

to the front or back area ) .

The role of antimicrobial therapy is to halt toxin production ,
treat localized info -

( prevent transmission of
1=7-10 days
Underlying soft
tissue edema & enlarged lymph nodes → cause bull -

neck appearance .
ti on ,
& the
organism to contacts .

/
& airway compromise if theres an extension further into the pharynx .
ERYTHROMYCIN → 40
-50mg 1kg BB/day divided dose per 6 hrs Poor IV i Max
.
-
284day
Penicillin 100.000-150 ooo 1411eg BB /day divided per 6 hrs
PENICILLIN
9-49 eons crystalline G → .
, IV or IM

procaine penicillin / KGBB / day per 12hr5 IM BBE 101-9

}
IU

-1300.000 IUIKGBB
→
.
for 14

Elimination of the organism should be documented by negative results of at least 2 successive cultures of Goo -
ooo / day per -12 hrs .
IM → BB > 10×9 days !

specimens from the nose & throat for skin) obtained 24hr apart after the completion of the therapy .
Treatment w/ erythromycin is repealed if either culture yields c. diphtheriae.
 SUPPORTIVE CARE substances to trigger
Immunogenicity → the ability of different an ad .

} 0%7:L!:p; tahr:Y?g"an!
" the
Droplet precautions → for patients w/ pharyngeal diphtheria cultures of specimen after cessation
aptive cellular & humoral cell immune response that is LONG TERM -
&

precautions for patients w/ diphtheria

.

contact → cutaneous leads to immunological memory .

Reactogenicity → refers to a subset of reactions that occur soon after va .

Cutaneous wounds are cleaned

thoroughly w/ soap & water .
Bed rest are essential during the acute Cci nation ,
& are a
physical manifestation of the inflammatory response

phase of disease usually for ,

72 weeks .
to vaccination .

PREVENTION For persons 3 7-

yo
. not
previously immunized for diphtheria three ,

protection serious disease caused by imported or

indigenously acquired C- diphtheria e depends on 015 me dose of lower-level diphtheria containing (with D= ) vaccine
against -

immunization .
are given in a
primary series of 2 doses at least 4 WEEK APART &

Asymptomatic case contact a 3rd dose 6 months after the 2nd dose → Tdap → Td → Td

(
.

All household contacts & people who have had intimate respiratory or habitual physical contact w/ a Those whose immunization is begun w/ DTap or DT before 1-
year of age

patient are
closely monitored for illness for 7- days . should 've a total of five 0,5 me dose of diphtheria containing
-

(E)
Cultures of the nose , throat and cutaneous lesions are performed Antimicrobial prophylaxis is vaccine by 6 year of age
any
.
.
,

monthsmo~nthsmont~hmonth~%ce.
,→% ¥o¥ FM
administered regardless of immunization status using
SINGLE injection of beneath in e penicillin (
6 600.000

for f Gyo , 1.200.000 units IM for > 69.07

①
funErythromycin
%h?¥muumuu
→¥p
, its 1M

140 -50mg 1kg BB / day divide 4×1day .

Po

Iorio
days .
max .
and an .

, d)
Diphtheria toxoid vaccine ,
in age appropriate form ,
is given to immunized individuals who have not

receive a booster dose within 5yr .

children who haven't received their 4th dose ( 18th month of life)
should be vaccinated Those who have received .
<3 doses of diphtheria toxoid or who have uncertain

immunization status should be immunized w/ an

age-appropriate preparation on a primary schedule .

Asymptomatic carnies
[ When antimicrobial given for
they identified prophylaxis is 10-14 days & an
age-appropriate
preparation
are ,

of immediately dipthena toxoid is administered if a booster has not been given within 1- year .

Droplet cutaneous precautions observed until at least 2 subsequent cultures obtained 24hr
or are
apart
after cessation of have results
therapy negative .

Repeat cultures are performed about 2 weeks after completion of therapy for cases & carriers ; if results

are positive ,
an additional 10 -

day course of oral erythromycin should be given & follow up -

cultures performed .

P.s. Only those who have an UNUSUAL contact w/ respiratory or oral secretions should be managed
as CONTACTS Investigation of the casual contacts of patients carriers or persons in the

community
.
or

without known exposure has

yielded extremely carriage low rates & not routinely recommended .

Vaccine
£ immunization does not preclude subsequent respiratory carriage of
toxigenicc.diphttheriae.it
Althing or cutaneous

complications
decreases local tissue spread , prevent toxic ,
diminishes transmission of the

organism ,
&
provides herd immunity when at least 70-801 . of a population is immunized .

2 preparations of diphtheria toxoids formulated according to the limit of flocculation (4)

content
are

✓
of quantity of
,
a measure the toxoid .

Pediatric preparations Gmo Gyr) -

→ i. e. DTAP ( Diphtheria ,
tetanus toxoid ,
a cellular Pertussis vaccine

,
DT ( Diphtheria & tetanus toxoid vaccine) : G) 6,7 -25 Lf units of diphtheria toxoid / 0,5mL dose .

\ Adult
preparations ( 77 yo) → Td : (t) 10% of pediatric diphtheria toxoid dose ; Tdap ( diphtheria &

tetanus toxoid ,
& acellular pertussis vaccine) :
G) I 2- 2,5 Lf units of toxoid per 0,5mL dose .

The higher potency ( with D=) formulation of toxoid is used for primary series & booster doses for children

through 6 yr of age because of superior immunogenicity & minimal reactogeni city For individual .
> 7- yo .

Id is recommended because the lower concentration of diphtheria toxoid is adequately immunogenic

& increasing the content of diphtheria toxoid heightens reactogeni city w/ increasing age .
 whoop follows inspired

Pertussis
purple until coughing , ceases & a loud as air traverses

the still partially closed airway .

"

Acute pertussis intense cough POSTTUSSNE EMESIS is common & exhaustion is universal The number&
"

respiratory tract infection ,

→
, preferable than whooping .

cough .
cot most infected individuals donot"wh" severity of paroxysms escalate over days to a week & remain at that
plateau
for days to weeks →
peak : >1 episode hourly .

Bordetella pertussis is the cause of epidemic pertussis & the usual cause of sporadic pertussis They .

③ convalescent stage [72 weeks) → number ,

severity & duration of episodes dimi -

are exclusive pathogens of humans & some

primates Cases typically
.
occur in immunocompromised nish .

persons children w/ intense exposure to animals

or
young .

Infants ( 3 months old the classic stages The catarrhal

Neither natural disease nor vaccination provides complete or lifelong immunity against Do NOT display .
stage

lasts only a few then after the most

pertussis reinfection or disease .
days or is unnoticed ,
&
insignificant startle
from a draft , light ,
sound . sucking ,
or stretching , a well -

appearing young infant

PATHOGENESIS begins to choke gasp gag

, ,
,
& flail the extremities w/ face reddened ,
.

Bordetella organisms are small , fastidious , gram f) Coccobacilli that colonize only cilia -

Apnea cyanosis can follow

& a coughing paroxysm ,
or apnea can occur as the only
ted epithelium .
symptom ( WITHOUT cough) .
Both are more common w/ pertussis than w/ neonatal

Only B. pertussis expresses Pertussis toxin ( PT) the , major virulence factor . PT has numerous pro - viral infection .

Paradoxically , in infants , cough & Whooping may become louder

Ven biologic activity (e.g. histamine sensitivity insulin .

secretion , leukocyte dysfunction) .
B. pertussis & more classic in convalescence .

produces an array of other biologically active substances After aerosol acquisition filamentous
hemagglutinin
. :

agg les 3).

pert (
some latino
gens p. Fimbriae [ Fim) types 2 and
,
and the 69 kDa -
actin Prn) protein are Adolescents & previously immunized children have foreshortening of all stages of

important of attachment to ciliated respiratory epithelial cells .

pertussis .
Adults have no distinct stages .
Classically ,
adolescents & adults describe

a sudden feeling of strangulation followed by uninterrupted coughs feeling of guff , .

inhibit clearance of bursting headache gasping breath

TÉadE & ,
PT →
organisms . ocation ,
,
diminished awareness & then a , usu -

↳ predominantly responsible for the local epithelial damage that

produces resp .

symptoms & facilitates absorption of PT .

Ally without a whoop .

Both antibody & cellular immune responses follow infection & immunization .
Antibody to PT neutralizes toxin ,

and
antibody to Prn enhances opsono phagocytosis .
Disease as well as DPT appear to drive a mixed cellular Posttussive emesis & intermittency of paroxysms separated by hours of well-being

& antibody (th 1) immunologic response while DTAP

,
& Tdap drive a narrow antibody -
dominant (Thz) response .
are specific clues to the diagnosis Distinguished .
from other nonspecific cough

illness by duration : 721 days .

Physical examination :
conjunctival hemorrhages & petechiae on the upper body are

common found .

DIAGNOSIS

should be suspected in any individual who has a pure or predominant complaint

of cough especially if the following features fever, malaise

myalgia
, are ABSENT :
,
or

tachypnea
,
exanthem or en anthem ,
sore throat , hoarseness . .
Wheezes , & rates .

Filamentous ( FHA) mediating adhere Pertussis should be suspected older children whose cough illness is
hemagglutinin is considered to be the major surface structure in
escalating at
-

nce to host cells , primarily to cilia on the airway ciliated epithelium . 7-10 days & Whose coughing is not continuous ,
but rather comes in burst It .

Adenylate cyclase toxin (Act) modifies a heparin inhibitable carbohydrate binding

-
domain of FHA to should be suspected in infants <3 Months old w/ gagging gasping apnea , ,

enhance its ability to mediate adherence to cultured lung epithelial cells , , cyanosis ,
or an apparent life -

threatening event → sudden infant death 1^9

CLINICAL MANIFESTATIONS Unless an infant w/ pertussis has

secondary pneumonia ( and then appears it D.
Classically Pertussis
,
is a prolonged disease ,
divided into catarrhal , paroxysmal ,
& convalescent stages . the findings on examination between paroxysms ,
including RR , are entirely

Catarrhal stages ( 1-2 weeks) begins insidiously after incubation period ranging from 3-12
days Foreign body aspiration should be considered in the differential di agnosia
'

→ an normal .

w/ non -

distinctive symptoms of congestion & rhino rrhea (⑦ low grade fever ,

sneezing ,
lacrimation ,

&
conjunctival suffusion)
Leukocytosis 115-000-100-000 cells / Mt ) caused by absolute
.

lymphocytosis
② Paroxysmal stage 12-6 weeks) → marked w/ cough which begins as dry intermittent irritative hack
, . is characteristic in the catarrhal stage Lymphocytes
.
are normal small cells .

& evolves into the inexorable paroxysms that are the hallmark of pertussis A well appearing w/ viral infections
rather than the large atypical lymphocytes seen
-

,
.

playful toddler w/ insignificant provocation suddenly expresses an anxious aura & may clutch Absolute increase in neutrophils suggests a differential diagnosis or secondary
parent
a

comforting beginning
or
cough single adult before a machine gun burst of uninterrupted
-
on a bacterial infection .

chin & chest held forward

exhalation , , tongue protruding maximally eyes bulging , & watering face ,
?⃝
chest radiographic findings are only mildly abnormal in the majority of hospitalized infants ,
Sho -

An antimicrobial agent always is given when pertussis is suspected or confirmed to

wing perihilar infiltrate edema (sometimes w/ a butterfly appearance ) & variable atelectasis decrease possible clinical benefit
or .

contagiousness & to afford .

• Triste of infantile hypertrophic pyloric stenosis → macrolide (erythromycin azithro

(
-

Polymerase chain reaction ( PCR) testing on nasopharyngeal wash specimens is the labora-
mycin ,
darithromyc.in ,
etc ) use in young infants lesp < 14 days old) < BENEFITS
.

of choice of pertussis identification If it only single primers ( IS 481) cannot SMH for infants
§E Trimethoprim
tory test B. . uses Alternative : -
sulfa methoxazole (TMP -
> 2 Months old

differentiate between Bordetella spp .

Multiplex assays using multiple targets can distinguish ☐ & children unable to receive atithro (④ CUS risk , allergic to macrolides infected , w/ rare
§
species .

§ macrolide
-
resistant strain ) .

For culture ,
a specimen is obtained by deep nasopharyngeal aspiration or w/ the use of
Age :
Azithromycin EÑ danthromycin TMP SM ✗-

a flexible swab held ,

in the posterior nasopharynx for 15 -30sec Cor until cough occurs) .

isolation media Lowe charcoal agar w/ 10% horse blood & 5- 40

The preferred are Regan -

µg 1mL ceph alexin and Stainer Scholle media w/ cyclodextrin

-
resins .

Direct fluorescent antibody testing of potential isolates using specific antibody for B. pertussis

& B. parapertussis .

Results of culture and PCR are expected to be positive in un immunized , untreated children

during the catarrhal & Early paroxysmal stages of disease Serologic tests for detection of → no Max dose
aorsmx ?
.

acute & convalescent

change in antibodies to B. pertussis antigens between samples are calm:#%)

the most SENSITIVE test in immunized individuals .

A single serum sample showing IgG antibody to PT > 90 T.lt/mLG2SD above the mean of ISOLATION
the immunized population) indicates recent symptomatic infection & usually is positive in Patient w/ suspected pertussis are placed in isolation w/ droplet precaution to reduce

the mid -

paroxysmal phase . dose respiratory or mucous membrane contact w/ respiratory secretions .

Screening for cough should be performed on entrance of patients to emergency depart

.

Tests for IgA and IgM pertussis antibody antibody to antigens other than PT merits office & clinics to isolation IMMEDIATELY ( Paroxysmal convalescence
,
or , , ,
begin &

are not reliable methods for serologic diagnosis of pertussis .

→ most contagious phase) until 5 days after initiation of AZT .

should be given promptly to

Atythromycin ALL

TREATMENT household other close contact

contacts & ,
regardless
Infants <3 months old w/ suspected pertussis usually are hospitalized 3- 6 Mo of age immunization history
as are
many or
symptoms
-

,
,
, .

old unless witnessed paroxysms are not well as patients of any age it signi In yo who have received
, severe as -

close contacts < 7- .

<4
,

fi cant complications occur . doses of DTAP ,

DTAP should be
given to complete

the caveats in assessment & care of infants w/ pertussis : the recommended series .

3rd DTAP dose > 6

Children < 7-
yo Who received
.
a

Mo before exposure ,
or a 4th dose 73 yr before

exposure ,
should be given a booster dose .

Individuals 39 go Should be .

given Tdap .

of life threatening events

☒ amssaq.fm?Y9nruYnY?onot
disease & likelihood
The
goals of hospitalization are to at the peak of the disease

\ prevent or treat complication

educate parents the natural history of the disease & what they can

do at home .

not life threatening have the

Typical paroxysms that are following features :

* Duration < 45sec

* Red but not blue color change

< 60 ✗ 1min in infants)

tachycardia bradycardia (not oxygen desaturation that
spontaneously
* or
,

resolves at the end of the COMPLICATIONS

paroxysm .

* whooping or strength for brisk self -

rescue at the end of paroxysm The principal complications of pertussis are apnea , secondary infections (e.g. otitis
self expectorated mucus plug media pneumonia ) &
physical sequelae of forceful
*
coughing
-

, .
,

* posttussive exhaustion but not unresponsiveness .

# UES :(+1 fever ,
tachypnea or respiratory distress between paroxysms
& absolute neutrophilia
Hospital discharge is appropriate if ,
over 48hr disease severity is unchanged or diminished
,

intervention is not Acute neurologic events during are the result of hypoxemia
required during paroxysm nutrition , is
adequate ,
f) complication , & parents pertussis almost always
are adequately prepared for care at home .
or hemorrhage associated w/ coughing or apnea in young infants .

AZITHROMYCIN is a drug of choice in all age groups for treatments

-

or post exposure prophylaxis

-
 The inhaled virus from the exposed droplets initially infects the respiratory
Measles tract 's lymphocytes ,
dendritic cells ,
& alveolar macrophages . It then spread to
disseminates throngout the bloodstream result
Measles virus is a single -
stranded .
lipid enveloped RNA virus . Humans are the only host of measles the
adjacent lymphoid tissue &

virus unlike the other species in this

, family Of.
the 6
Major structural proteins of measles virus the 2 , ting viremia &spread to distant organs .

of induction of immunity are the hemagglutinin ( H ) protein & the The dendritic cells
most important in terms virus residing in & lymphocytes transfers itself to the epi -

fusion (F) Protein thelial cells of the expelled

µpµm respiratory
.

respiratory tract which are shed & as

I H protein ><
neutralizing antibodies droplets during coughing &
sneezing infecting others ,
&
perpetuating the cycle .

F protein x limit proliferation of the virus during infection The initial inflammation leads to symptoms of 3C 's ( coryza conjunctivitis , ,

&
cough) The appearance of fever .
coincides w/ the development of viremia .

The portal of entry of measles virus is through the respiratory tract or

conjunctiva e following con
-

The skin rash occurs after dissemination & is due to perivascular &
lymphocytic
tact w/ large droplet or small -

droplet aerosols in which the virus is suspended . Patients are in -

infiltrates .

tedious from 3 days before up to 4-6 days after the onset of rash During the prodromal phase the meade virus depresses host immunity by
suppressing
.

production through interferon its non structural proteins I and E. The

-

FACE -

TO -

FACE contact is not necessary because viable virus may be suspended in air ,
for increasing viral replication then triggers both humoral & cellular immunology :

long 1hr after the patient w/ the leaves Cal responses The initial humoral response consists of IgM antibody
production
as as source case a room .

days after for

,
which is delectable 3-4 the rash appears & can persist 6-8

PATHOLOGY weeks .

Subsequently IgG antibodies ,

are produced .
primarily against the viral
Measles infection causes necrosis of the respiratory tract epithelium & an
accompanying nucleoprotein Cellular .
immune response are essential for recovery as demons -

lymphocytic infiltrate Measles produces

.
a small -
vessel vasculitis on the skin & on the oral mu -

trained by elevated Tht dependent plasma interferon gamma levels during the
-
-

cats membranes → .

Histology of the rash & exanthem reveals intracellular edema &

dogs keratosis
acute phase . and subsequent Thz dependent It-4 -

,
Il 10, -

& It 13 levels .

associated w/ formation of epidermal syncytial giant cells → G) viral particles .

Warth in Finkel
> The measles virus is known to induce immunosuppression that last for
-

( dey giant can woe .

cells
CKS to years It is
hypothesized that measles infection induces proliferation of
.

measles
.

specific lymphocytes that replace the previously established memory cells

-

"

causing IMMUNE AMNESIA ! → enhance susceptibility of the host to seam -

infections
Maceiopapular day .

rash in measles
koplik
→ spot
The neutralizing IgG antibodies against hemagglutinin are responsible for

lifelong immunity block host cell receptors from

as
they binding the vines .

STAGE I. Entry MV particles deposited on :

In lymph0reticular tissue (thymus lymph nodes spleen

, , ,
tonsils bone marrow
,
, Peyer 's patches) → the conjunctiva will enter the space between
cornea and eyelids CA green arrows ) where

lymphoid hyperplasia is
, ,

prominent .

they can infect myeloid or lymphoid cells (B) .

MV particles inhaled into the respiratory tract

-1
( C & E green arrows) can either infect DC SIGN
-

dendritic cells in the upper respiratory tract with

Fusion of infected cells results in multinucleated giant cells
,
"
→ WARTHIN FINKELDEY GIANT
-

dendrites protruding respiratory mucosa (D)

into the

or dendritic cells ormacrophages in the alveolar

path ognomonic for measles w/ intranuclear
"
CELLS → up to 100 nuclei & intra
cytoplasmic & lumina of the lower respiratory tract (F) The infected .

immune cells subsequently migrate to nearby tertiary

inclusions . This cell is a large poly Karyocyles w/ , numerous nuclei distributed in
grape
-

lymphoid tissues & draining lymph nodes ( black) .

like clusters Mulberry cells) and are

( so -
called ,
associated w/ the prodromal phase of
STAGE II. Systemic Dissemination The MV infected :

measles infection It's involving a germinal center from a lymph node w/ reactive IYM
-

myeloid cells migrate the draining lymph nodes to

. "

l ympho i. i. ( black) where they transmit the virus

i d
CD to 150-1

hyperplasia
,

[ predominantly CDN
.

phocyles memory B- cells & CD4-1 &

T-cells ) ; (B) during viremia ,

infected cells enler the
circulation migrate systemically to various organs &
&

tissues ( green) Where the infection is further amplified

.

PATHOGENESIS
.

"
Infection of skin resident immune - cells results in vines
!
"

"
transmission to Pectin -9 epithelial cells (green patches;
"
'
+

of illness
"

exanthema period prodromal

Measles infection consists 9 phases incubation i.
-
--
- - -
-

(c) of
-

A few later depletion lymphoid

:
- -

days immune cells in

,
, ,

& tissues results in transient immune suppress

organs
-
-

phase
.

tous
-

&
recovery
-
-

ion (grey) MV T-cells infiltrate the skin where

-

specific
-
-
-
.
.

they clear the infected cells which results in the ty

Tasso
-

Tags 1+-1-7 days)

10-12
PRODROMAL
,

INCUBATION days in the background → viral load over time

pica measles skin rash ( red patches) the
green bell shaped curve .
-
.

,m§m
dated w/ epithelial necrosis
measles migrates
virus a giant cell formation in body tissues
to
regional lymph nodes I
t cells killed by cell-to-cell plasma
are 2-4
days after prodrome

primary viremia brane fusion associated w/ viral replication

EXANTHEMAtous 14
days after exposure (I 7-21 days)
dur
t
:
5- 6 days
te t
disseminates the virus to
(e) viral shedding begins with the onset of the rash anti -

¢7
,

µ , menu, , ,naan,, , y, body production begins ,

viral replication
to &
symptoms begin to subside
µ ,,,may www..gg , ,
virus to body surfaces
RECOVERY
 The clinical diagnosis of measles is more
challenging to clinicians unfamiliar w/ the
of via the air
STAGE III.Transmission new MV particles undernourished children
before the onset of rash in immunocompromised
: .

disease &
Natin at epithelial cells in the upper & lower
respiratory tract , ,
-
,

epithelium produce new virus particles and release them into

the mucus lining the lumen of the respiratory

tract ( A. C green: or in individuals w/ pre -

existing antibodies ( maternal immunity immune globulin , ,

arrows) Epithelial damage in infected lymphoid tissues such

vaccination)
,

previous
.

or
as the tonsils (A) ,
releases virus particles produced by lymphocytes .

(B) Epithelial
into the upper
respiratory tract damage in the The most laboratory for confirming measles virus infection is
.

common method detec

lower
respiratory tract induces cough Cc D) enhancing the
&
,

discharge of aerosols containing MV particles

lion of measles virus specific IgM 75 to
plasma About
.

antibodies in serum or .

people w/ measles will have detectable measles virus -

specific IgM antibodies

MU infection results in transient and profound suppression which leads to inarea after 4
a immune ,
.

days .

Sed susceptibility to opportunistic infections & increased childhood mortality The virus etticie Measles virus specific IgM antibodies within 1-3 weeks after the onset of
peak
-

. -

ntly replicates in lymphoid tissue .

Tertiary lymphoid tissues : BALT & GALT → G)Tt interact:

rash & decline to undetectable levels within 4-8 weeks Acute infection also .

on between CDI 50-1 lymphocytes and DC SIGN -

-1
Dcs → perfect site for Mv infection & ampli -

can be confirmed serologically by measuring a four fold-

or greater increase in

frication to enhance protective immunity against mucosal pa

. Since BALT & GALT are known -

measles virus -
specific IgG antibody levels between acute & convalescent Sera

thogens ,
obliteration of these lymphoid tissues in major entry portals for opportunistic in KC
-

and always require a serum specimens .

(the airways gut) facilitate infiltration of the by previously Enzyme linked immunoassay ( EIA)
1-ions & can mucosa on counte- is the most commonly used
serologic les
- -

red viruses or bacteria .

Ting Generally
.

,
a
previously susceptible person exposed to either vaccine or

wild-type measles virus will first Mount an IgM response and then an Ig 6
CLINICAL MANIFESTATIONS response The IgM response will be transient
.
11-2 months and the ) IgG
Koplikspotsrepresenttheenanthem response should persist for many years .

&
arepathognomonicsign d- measles Uninfected persons should be IgM negative and will be either IgG
negative
,

appearing 1-4
days prior to the onset IgG positive depending
or previous .
upon their infection & vaccination

d- the rash
theyistqppearasdis history and
EIA for IgM antibody requires only a
single serum specimen
-

. .

ordered lesions w/ bluish white spots is

diagnostic if positive .

inthecenlerofinneraspectsofthe For
IgG antibody 2 serum specimens ,
are required → The 1st specimen should
cheeks .at/-heleveld- the premolars be drawn as after rash onset possible The 2nd specimen should

dragon
soon as .

be

to involve the lips hard 10-30 days later → The test for both will be conducted AT THE SAME TIME
→
may spread .
.

palate ,& gingiva / rsmayalsooccurin

conjunctival fotdshvaginal
mucosa .

I too long ,
that's
complicated
why
&
clinician
invasive
pneler IgM testing
to take serum 2
first
times
&

.
It's too

Measles is acute febrile illness associated Measles virus infection also can be confirmed by detection of viral RNA through RT-PCR
an w/ the characteristic erythematous Macedopapular ,

Using throat samples BEFORE measles virus specific

rash The illness
begins w/ fever and typically at least ONE of the 3C's cough coryza & nasal
nasopharyngeal & urine -

. :
. , , , ,

conjunctivitis . IgM antibodies are detectable .

Koplik's spots appear the buccal mucosa as a small white papules provide
opportunity
on & an

clinically diagnose
to day measles a or two before the rash The rash appears 3-4 days . TREATMENT
after the onset of fever first on the face (forehead around the hairline/ → behind the ears → When presented with a potential case of measles airborne transmission precau
,
-

, ,

upper neck →
during the next 3 days → trunk → extremities Cconciding w/ the development lions should be initiated for 4 days after the rash presentation in otherwise he ..

of the adaptive immune response) .

The macular papular lesions are generally discrete ,
but atthy individuals and the duration of illness for immunocompromised patients .

may become confluent ,

particularly in the
upper body Initially .
,
lesions blanch w/ fingertip

By 3-4 most do not blanch w/ pressure Fine desquamate on specific antiviral therapy for measles -1he
pressure days occurs over more There's no
management of patients
.

.
,
,

severely involved areas .

w/ measles consist of supportive therapy to correct or prevent dehydration & nu -

the fever & catarrhal symptoms typically peak w/ the rash 13-4 days) .
As the rash re pre -
Mii on al deficiencies prompt , recognition & treatment of secondary bacterial in -

gents a perivascular lymphocytic infiltration children w/,

impaired cellular immunity might , fechins & provision of vitamin A .

not develop the characteristic rash or the rash might be delayed .

The rash fades in the same order that it happens :

HEAD TO EXTREMITIES .
In normal circumstances ,
vitamin A maintains epithelial tissue eriscnkialfor

vii. A stores depleted

immunological function .

During a measles infection ,

are

DIAGNOSIS resulting in an inability to resist the current & secondary infections associa .

readily recognised by clinicians familiar w/ the disease in people presenting w/

④
Measles is W/ measles
Dose
fever & generalized rash particularly during outbreaks or in patients w/ a history of travel
,
Age WHO recommendation ,

2 consecutive days plus there should be

}
> 1-
to endemic areas yo .

200.00016
.

⑦ more days to give

6- Hmo 100.0001--4 3rd dose 2-4 weeks later Vit Ator malnourished
The measles case definition : .

Generalized Macedopapular rash sensitivity 75-901 but t positive predictive for those G) Vit Adef children
Gmo
-

< so .oooIu
. .

Fever ( 738,3°C) value ,

so there's still need for serological clinical evidence

Either of 3C's cough coryza & conjunctivitis

:
, ,
confirmation .
 Antipyretics for comfort & fever control are useful .
For patients w/ respiratory tract invof Ig may be given up to 6 days
after exposure to prevent or
modify infection .

Vement , airway humidification &

supplemental oxygen maybe of benefit .

Immunocompetent children should receive 0,5mL 1kg BB (maximum dose in both

is effective in most cases but severe dehydration may require is 15m4kgBB.IM )

oral rehydration ,
cases .

antimicrobial therapy to prevent bacterial infect For children

intravenous therapy Prophylactic severely immunocompromised &
pregnant woman without evidence
-

ion is not indicated / recommended . of measles immunity Ig intravenously

,
is the recommended IG at 400mg / KGBB

Ig is indicated for susceptible HOUSEHOLD contacts of measles patients espe

Measles infection lethal Ribavirin is active in
in immunocompromised patients is highly .
-
→
,
-

vitro
against measles virus but still not
, enough evidence of this recommendation .
dally infants < Gmo of age pregnant women & immunocompromised persons
,
,
.

PREVENTION COMPLICATIONS
Pre exposure : vaccination
-

( MRIMMR) based
on each country regulations
Post exposure susceptible individuals
exposed
:

protected from
infection
to measles be
may
by either vaccine administration or with

Ig
The vaccine is effective prevention or

modification
in

of measles if given within 72hr of

exposure .
 Kalo alergitelur
"
Karna dibiakkanlinokulasidlm egg yolk
'

Hematoonkologi → hah raisin MR →

µ{
Coleman
( pucat
(e) perdarahan / bruising
hennery:/ Rejang
DD
-
penumnankesadaran

, µ, panpaoyagang.ua, unnu, meningitis anan , µ ,,

pumbesaran organ fhepatolsplenomgali) meningitis dewasa

ygkeeumroh
→ →

nyeñsendi / Many meningococcal

-

pneumococcus lebihdiutamakan pd
"
Valeria pasion
kenapa hiperkolesterolemia pd nephrotic syndwm ? Karna
hipo dgmkondisi pry janning bawaan
-
:
.

ygbawakolesterol-jadistaydisirhuiasi.gg
albumin → albumin
oral OPU untukmelindungi sat Cemal ? )
.

sister

gold kutur
¥¥a+
Isk → urine Sadar seletah tetanus
:
Rejang -1
(
epilepsihep-nispasca-t.gagalginj.at
urinal isis : leukogituria , Kalo ada darah & protein →
cnn.gr glomerular
kejangdemam nephrotic synd
}D④
meningitis
tydaksado.ir/-ensefalitis
.

↳ a complement it

✗ meningoensefalih
'

's
paling penning :

± rabies lebihakut deman

imunisasi , ,

.gg/ypumlenta1banhen-alis/KbihtihSsi-pnyinleksi
-

%"
-

"" " " " " "" peening,

-

ilmuainaksecaraumum
/ serosa try on

asma Klipokalemia → tetanic kata) tapitidakjpejang

☒
.

Sesakhafas brohkopneumohia
Hipoglikemi
(
KG balan
ahaksesak
(( toff par Covid-19
acidosis
.

respiration.ie/melaboEk
In
-

pernatremia
Hiponamemia } Rejang Kiakeukuduk pd meningitis
hebat Hypokalemia
akibat (e) intern pd men ingens
amounting gagaljanhrng men ahah
& rasasakit
( Rsu)
Bronchiolitis (paling panting)
yetidoyi
.

.
: trvims

④wheezing + normal atau hiperinflasi (hitam) sedikit

foto thorax
>

[
tsronkiolitis → tntditemakan pd anak
sangat Kecil ( 6- 9 bulan
)
(tiba ) yg ball ten
ydemamlebih
tinggi sesaklebih
"
aunt
bellum bang

}
, →

dem am
etiobsi ( maju
Bronko pneummi → trias
⇐ virus
-

pd anak →
sesaknapas

(
" ④ """""
kenaparetraksi ?
÷kÑdada
intiltrat →
toto thorax -1 got
-

↳ ahakhemakaiatoat bantu
Trias meningitis data" RR taki Pheu
pernapasan
intercostal lulu hah)
" " Mn
epigastric
"
trias encephalitis kesa duran (e) retraksi di

(
,

perp
as an
outing hiding
deman supradauiadaterairgkat
kejany
1
RMganganmevingeal.Ingo.tl#Lanar-ampi&chloram
Pilihanaikasiapa
↳ bayi
terganhengpola
} "

nangtasienkokimt-DIX.pl?EfnYi arabses.#
→ gentamicin kumannyapamasiag
Uh :)
-

TB
-
imurisah BCG -
\
unmkmencegah
1- Bama,
kepanjangan
µ
.

(
tes tuberculin dgn Cara haantoux
dd tifoid
demamsubfebñl > 2
minggu
→ :

BB tumn may
pywayatd.ge contact µ, ,

mehgapa polio henugahrerislensi

s bat -3

#1T¥ !
Sigal Janning
kardiologi .
VSD . aorta overriding pulmonary stenosis right ventricular hypertrophy ④ Eisenmenger syndrome
, ,
.

penicillin inj Cdurasi don's ) → Kalo ada abrgi alternant yg

oral !
RHD → tentative .

,
?
,