Endo 1 9 2
Endo 1 9 2
Kontrol metabolik
Infeksi Wound control
Vascular
Off loading
GDP 34
GD2PP 46
Chol Total 35
Chol LDL 11
Chol HDL 5
Trigliserida 44
GDS 28/8
08.30 77 extra D40 2fl
10.30 74 extra d40 2fl
12.30 105
13.30 100
15.30 68 extra d40 3 fl
17.00 87 extra d40 2fl
14.30 73 extra d40 2 fl
21.00 91
22.30 78 extra d40 2 fl
29/8
00.30 106
02.30 87 extra d40 1fl
04.30 93
09.00 54 extra d40 2fl
13.30 74 extra d402fl
21.00 58 extra d40 3 fl
30/8
01.00 60 extra d40 2fl
05.00 74 extra d40 2fl
10.00 206
31/8
05.00 96
21.00 216
01/09
02.00 195
05.00 139
Kendali Metabolik
- GDS: 139 mg/dl --> Inf. D10% 20tpm, Protokol Hipoglikemia bila GDS<70mg/dl
- Hemoglobin 6.9 --> Tranfusi PRC Target Hb>10gr/dl
- Leukosit 14.7 -- Inj. Meropenem 1gr/8jam
- Albumin 2.2 ---> Inf. Albumin 25% 100cc extra
- Calsium 0,99 --> Inj. ca glukonas 1amp/24jam
- Cr: 2,4, Ur 163 --> Inf. Renxamin 1fl/24jam, Hemodialisa
Plan Diagnosis:
- GDT
- SPE
- Elektrolit urin
Plan Terapi:
- GDS: 96mg/dl --> Inf. D10% 20tpm, Protokol Hipoglikemia bila GDS<70mg/dl
- Hemoglobin 6.9 --> Tranfusi PRC Target Hb>10gr/dl
- Leukosit 14.7 -- Inj. Meropenem 1gr/8jam
- Albumin 2.2 ---> Inf. Albumin 25% 100cc extra
- Calsium 0,99 --> Inj. ca glukonas 1amp/24jam
- Cr: 2,4, Ur 163 --> Inf. Renxamin 1fl/24jam
Plan Diagnosis
- GDT
- SPE
- Elektrolit urin
Target
- Infeksi teratasi
- Tanda peradangan berkurang
Kendali Luka:
- Tampak luka pada femur Dextra
Plan Terapi:
- Medikasi luka/hari
- Wound dressing dengan menggunakan Prontosan dan allevyn
Plan Monitoring:
Awasi luka setiap hari
Target:
Tanda peradangan dan pus berkurang
Off Loading
- Bebat luka jangan terlalu kencang
- Miring kanan kiri
Edukasi Keluarga:
- Cara merawat luka
- Cara menggunakan insulin
- Diet DM
- Jangan gunakan sepatu ketat
- Jika jalan gunakan alas kaki
Tx Endo:
- Diet DM 1500kkal
- Inf. D10% 16tpm mikro
- Inf. Asam Aminoketo 1 flash/24jam
- Inf. Clinoleic 1fl/24jam
- Inj. D40 2fl bila GDS< 50mg, 1 fl bila GDS antara 50-100mg
- Medikasi luka dengan prontosan dan allevyn
Tx Intensivist:
PAsang NGT
Diet tinggi protein 1500kkal, extra putih telur 6biji per hari
Inf D10% 10 tpm
Inf. Asam Aminoketo 1 flash/24jam
Inf Plasbumine 1fl/24 jam
Inf. Clinoleic 1fl/24jam
Inj. Furosemid 20mg/8jam
Inj. Meropenem 1gr/8jam D3
S/p N-epi jalan 7,5cc/jam
SP OMZ 80mg dlm 50cc NS kec 5cc/jam
Inj. Omz 40mg/12jam
Inj. Vit K 1amp/8jam
Inj. Ca glukonas 1amp/24 jam (3 hr)
NAC 3x200mg
Caco3 3x1
Sucralfatt 3x10cc
Candistatin drop 4x6tts
Tranfusi PRC 4 Kolf, 1 kolf/12 jam tetesan lambat (Target Hb > 8)
Mx:
- Cek Post Tranfusi, Elektrolit, Ur, Cr/3hari
- Cek GDS/2jam ---> Lapor Sub ENDO dr. Fadhli 081329423138
GDS
31/8 143/222
01/09 139
Hb 16.8
AL 5.1
AT 213
GDS 133
Ur 60
Cr 0.7
Na 125
K 4.7
Ca 1.14
HbA1c 7.7
GDP 163
GD2PP 166
Asam Urat 2.8
Chol Total 149
Chol LDL 88
Chol HDL 22
Trigliserida 157
AGD
pH 7.540
BE 1.2
PCO2 26.0
PO2 166
HCO3 22.2
SaO2 100
Laktat 2.50
Kesan Alkalosis Respiratorik Tidak Terkompensasi
Plan
Dx:
-
Tx Endo:
- Diet DM 1500kkal
- Koreksional Novorapid 2N bila GDS>200mg/dl
Tx Leader:
Head up 30
Inf NS 20 tpm
Inj Ranitidin 50 mg/12 jam
Inj. Mecobalamin/ 12 jam
Inj Diazepam 10 mg (k/p)
Inj Dexamethason 5 mg/8 jam H1 (tapp off)
Inf PCT 1 gr/12 jam
As Folat 1x1
Rencana MRI Brain Kontras hari ini
Lacak IgM/IgG Toxoplasma
Tx Infeksi:
Kotrimoksazole 1x 960mg
Tx Paru:
Inj Levofloxacin 750 mg/24 jam
Inj Hidonac 6cc/24 jam
Mx:
GDS 22 05
GDS
23/8 164/165
24/8 129/167
25/8 65/112
26/8
21.00 152
24.00 165
05.00 140
27/8 106/132
29/8 169/196
30/8 138/181
31/8 -/194
01/09 220
GDP 206
GD2PP 184
AU 5.7
Kol Total 159
LDL 95
HDL 53
TG 150
AGD
pH 7.486
BE -2.3
PCO2 28.0
PO2 73.9
Hct 33
HCO3 21.3
Total CO2 22.2
O2 Saturasi 95.2
Alkalosis Respiratorik terkompensasi Tidak Sempurna
Plan
Dx:
-
Tx Endo:
- Diet Sonde DM 6x200cc
- Inj Novorapid 4-4-4 IU SC
- Renxamin 1fl/24jam
- Clinoleic 1fl/24jam
Tx Nefro:
- IVFD NaCl 0,9% 10 tpm mikro
- Inf Asam Amino Keto 1fl/24 jam
- Inj Furosemid 20 mg/12 jam
- inj Meropenem 1gr/8 jam (E7) ---> usul stop
- Amlodipin 1 x 10 mg
- Candesartan 1 x 16mg ==> 1x32mg
- Carvedilol 1x6.25 mg
- Asam Folat 1 x 800 mcg
- CaCO3 3x1
- HD Extra 30/8/2022
Tx Infeksi:
- Inj Meropenem 1gr/8 jam (E7) ---> usul stop
Tx Gastro:
- Diet sonde 1600 kkal dibagi 6 kali pemberian
- Inj Omeprazole 80 mg bolus dilanjutkan Sp Omeprazole 80mg dalam 50cc NS Kec
5cc/jam H-2 --> stop Inj Omeprazole 40mg/12 jam
- In Metamizole 1mp/8 jam k/p
- UDCA 3x1
- Vip albumin 3x1
Tx Neuro:
- Inj mecobalamin 500 mcg/12 jam
- Cilostazole 1x100 mg
- Donepezil 1x2.5mg
Mx:
GDS 22 05