MORNING REPORT

Thursday , February 7 2019

 Visi Misi FK UNSRI
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 VISI FK UNSRI
 Menjadi Fakultas Kedokteran Terkemuka di Asia Tenggara yang Berbasis
Pendidikan, Penelitian dan Pelayanan di Bidang Ilmu Kedokteran dan
Kesehatan pada Tahun 2025
 Visi Misi FK UNSRI
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 MISI FK UNSRI
 Menyelenggarakan dan mengembangkan pendidikan di bidang Ilmu
Kedokteran dan Kesehatan sesuai dengan standar internasional berbasis
kearifan lokal
 Menyelenggarakan dan mengembangkan penelitian di bidang Ilmu
Kedokteran dan Kesehatan yang berkualitas sehingga dapat dikenali dan
diaplikasikan dalam pengembangan ilmu di tingkat nasional dan
internasional
 Menyelenggarakan dan mengembangkan pengabdian dan pelayanan
kepada masyarakat sebagai pusat rujukan di bidang Ilmu Kedokteran dan
Kesehatan
 Menyelenggarakan dan mengembangkan mutu sistem manajemen dan tata
kelola yang efisien dan berkualitas
 PROGRAM PENDIDIKAN
ILMU KESEHATAN ANAK
VISI
MENJADI PUSAT PENDIDIKAN DOKTER SPESIALIS ANAK PILIHAN DI
TINGKAT NASIONAL YANG MENGHASILKAN DOKTER SPESIALIS ANAK
YANG KOMPETEN DAN BERKUALITAS INTERNASIONAL TAHUN 2020
MISI
1. MENYELENGGARAKAN PENDIDIKAN KEDOKTERAN BERBASIS
KOMPETENSI BERSTANDAR NASIONAL, MUTAKHIR, PROFESIONAL,
DAN BERLANDASKAN KEILMUAN BERBASIS BUKTI
2. MENYELENGGARAKAN PENELITIAN KEDOKTERAN DAN KESEHATAN
YANG INOVATIF, UNGGUL, KOMPETITIF DAN BERORIENTASI PADA
PENGEMBANGAN ILMU DAN BERMANFAAT BAGI MASYARAKAT
3. MENYELENGGARAKAN PELAYANAN KESEHATAN ANAK YANG
HOLISTIK DAN KOMPREHENSIF
4. BERPERAN AKTIF DALAM PENGEMBANGAN PENDIDIKAN,
PENELITIAN KEDOKTERAN, PELAYANAN KESEHATAN ANAK DAN
PENGABDIAN MASYARAKAT
 DOCTORS ON DUTY
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Junior On Duty Madya On Duty

dr. dr.
dr.

Madya II On Duty Emergency on duty:

dr. Lilik dr. Dera

Onsite Supervisor Supervisor On Duty

dr. Yusmala, Sp.A (K) dr. Yusmala, Sp.A (K)
 CO-ASSISTANT ON DUTY

Jaga IKA – B Jaga IKA – C

Rahma Kurnia L., S.Ked Alvinnata, S.Ked
Egi Nabilla, S.Ked Mohan Babu R., S.Ked

Jaga IGD Jaga Neonatus

Yudistira W., S.Ked Jennifer F. H., S.Ked
 NEW PATIENTS ON DUTY
No Identity Diagnosis/Differential Diagnosis Level of Division
7 Severity

1 Indah/ Girl/ Anemia gravis ec susp hemolytic anemia Hematology

13 y.o

2. Aliyah/ Girl/ Psychosomatic Out patient

13 y.o

3. Lesti/ Girl/ Upper airway obstruction PICU

3 y.o

4. Aldi/ Boy/ Increase of ICP ec hydrocephalus + susp ineffective Neurology

4 m.o shunt

5. Bela/ Girl/ Parotitis Infection

3 y.o

6. Ineza/ Girl/ Susp. Encephalopathy dengue Infection

8 y.o
Indah /girl/13 years
old NORMAL

Appearance Breathing
Normal Normal

Circulation
Abormal

Respiratory & Breathing :

Appearace: Nasal flare (-), retraction (-)
T: alert (+)
I: interaction (+)
C: consability (+)
Circulation:
L: look or gaze (+)
Pale extremity (+), CRT > 3”
S: speech or cry (+)
Identity: Indah Lestari/ girl / 13 years old

Time of Admission in ER : 17.00 PM

ANAMNESIS
Main Complain : Pale
Additional Complain : Icteric, lethargic
Present Illness History
Since 10 days before admission, patient looked pale. Additional complaints were icteric
in both eyes and felt lethargic. The patient denied any history of easy bruisability,
epistasis, gum bleeding, or overt evidence of bleeding from any site. Additionally, she
denied any change in appearance or color in her urine and stool; and had no history of
jaundice. There is no history of long fever. Past history of taking a specific drug (-) use of
mosquito coil (-) live around the plantation (-). Patient felt more lethargic and then
admitted to RS Sekayu. Patient initial lab test showed abnormal hemoglobin (3,2 g/dL),
RBC (0.30), Ht (4.4%), MCV (146,7 fL), MCH (106.7 pg), MCHC (72.7 g/L),
anisopoikilocytosis. Patient then referred to RSMH for further evaluation and further
treatment.
Past Illness History
• History of the disease with the same complain previously denied
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 Medication History
Paracetamol tab (500 mg) : 3 x 1 (3 months ago)

Family History
• History of the disease with the same complain in family was denied

History of immunization
Basic immunization completed (+)

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 Physical Examination
General Condition :
Sensorium : E4M5V6 RR : 28 x/m Anemic (+)
BP : 110/40 mmHg T : 36.60C Cyanotic (-)
HR : 104 x/m SpO2 : 99% Dyspnea (-)
Icteric (-)

Specific Condition
Head : nasal flare (-) icteric sclera (+), anemic conjunctiva (+), pharynx
hyperemic (-) tonsil T1-T1
Chest : symmetrical, retraction (-)
Heart : normal 1st and 2nd heart sound, murmur (-), gallop (-)
Lung : vesicular (+) normal, rales (-/-), wheezing (-/-)
Stomach : flat, supple, liver impalpable, spleen S1
Extremity : cold extremity, CRT > 3’’

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 Body Weight : 34 Kg
Body Height : 143 cm

BB/U = Between P3-P10

TB/U = Under P3

BB/TB
34/36 x 100%=94,4%

Nutritional status :
Good nutritional status with
short stature

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 PROBLEMS ASSESMENT
1. Anemia Anemia gravis ec susp anemia
2. Icteric hemolytic
3. Lethargic

DIAGNOSIS/DIFFERENTIAL WORKING DIAGNOSIS

DIAGNOSIS Anemia gravis ec susp thalassemia +
Thalassemia B12 / Folic acid deficiency
B12 / Folic acid deficiency
AIHA
Sideroblastic anemia
G6PD deficiency anemia
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PLAN EXAMINATION THERAPY
• Routine blood test, DPL, reticulocyte, - Education to the family and patient
peripheral blood smear, bilirubin,
Hb analysis, B12, Ferritin, TIBC -O2 nasal 2 lpm
• Cross match - IVFD DS ½ NS
• Blood transfusion
- PRC transfusion

DIET MONITORING
• Diet as usual (sesuai kebutuhan) • General condition
• Vital sign
• Hb

ADMISSION Haematology
 Laboratory Finding (11/09/2018) RSMH
Result Normal Value Unit
Haematology :
Haemoglobin 2.9 12.0 – 14.4 g/dL
RBC 0.17 4.75 – 4.85 106/mm3
WBC 4.78 4.5 – 13.5 103/mm3
Ht 8 36-42 %
PLT 199 217 – 497x 103 103/µL
Diff count 0/2/60/28/9 0-1/1-6/50-70/20-40/2-8 %

MCV 152.9 75-87 fl

MCH 171 25-31 pg
MCHC 112 33-35 %
Total bilirubin 5.20 0.1 – 1.0 mg/dL
Direct bilirubin 0.80 0 – 0.2 mg/dL
Indirect bilirubin 4.40 < 0.8 mg/dL
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