DUTY REPORT

September 20 2023
th

Duty Team September 19th ,

2023
 VISI DAN MISI PPDS IKA FK UNAND

Visi
• Menjadi penyelenggara pendidikan dokter spesialis anak terkemuka dan menghasilkan lulusan
yang bermartabat serta unggul dalam kesehatan bencana pada tahun 2028

Misi
1. Melaksanakan pendidikan dokter spesialis anak yang profesional dan bermutu serta unggul
di level nasional dan direkognisi di level internasional
2. Melaksanakan riset, menghasilkan publikasi dan Hak Kekayaan Intelektual (HAKI) di bidang
kesehatan anak melalui kerjasama multisenter di level nasional dan internasional
3. Melakukan kegiatan pengabdian masyarakat berbasis komunitas yang berkontribusi
terhadap peningkatan derajat kesehatan anak.
4. Berperan aktif dalam penanggulangan dan pelayanan kesehatan anak saat bencana.

Onsite consultant
COVID-19 Consultant
COVID-19 Neonatus consultan
Senior
Madya of ER
Madya of PICU/HCU
Madya of Perinatologi
Madya Of Ward
Junior of PICU/HCU
Junior of Perinatologi
Junior of Ward
Duty Team
: Dr.dr. Rinang Mariko , Sp. A (K)
: Dr. dr. Finny Fitry Yani, Sp.A (K)
: dr. Eny Yantri, Sp.A (K)
: dr. Idha Yulviwanti
: dr. Dya Mulya Lestari
: dr. Rudi Elfendi
dr. Vandra Davin
: dr. Zulfahmi
dr. Yenny Framela
: dr. Dwi Wahyu Kurniasari
dr. Muhammad Reza Syahli
: dr. Trisna Yunita
dr. Basri Hadi
: dr. Rezka gustya Sari
dr. Vanny Asrytuti
dr. Bismel Kasri Hanza
dr. Riche Anggresti
 PATIENT
RECAPITULATION
ROOM TOTAL
PICU 1 : 7 pasien
HCU 1 : 1 pasien
PICU 2 : 6 pasien
HCU 2 : 5 pasien
NICU 1 : 6 pasien
NICU 2 : 8 pasien
NICU 3 : 7 pasien
SCN : 6 pasien
AKUT : 17 pasien
KRONIK : 24 pasien
 Room TOTAL
New Patient : 1 pasien
Deacased Patient : 0 pasien
 NEW PATIENT
No Patient Identity Diagnose Covid Criteria Room

1 Assyfa Humaira/ Pr/ 14 bulan • Respiratory Distress Due to Recurrent Non Covid ER Intermediet
Bronchopneumonia
• Failure to Thrive
• Congenital Heart Disease due to Patent
Ductus Arteriosus
• Incomplete Immunization

2 Annasya Syafael / Pr / 2th 9 bl • Hiperpireksia ec sepsis Non Covid Akut

• Kejang demam komplek
• Diare akut tanpa dehidrasi

3 By. Dewi / Lk • Bblc 3100 gr Non Covid Rawat Gabung

 Deceased Patient
No Patient Identity Diagnose Room
1
NEW PATIENT
 Patient’s Identity
• Name : An. A
• Old : 14 old month
• Sex : Girl
• Born : 17-07-2022
• Mr : 01.16.04.95

Chief Complain
• Breathlessness since 1 day ago
 Pediatric Assessment Triangle

Appearance/ Brain Breathing

Tone : normotonus Breath sound : Stridor (-)

Interactiveness : interactive Position : no sniffing, no
Consolabillity : consolable tripoding
Look/Gaze: eye contact (+) Retraction : retraction (+)
Speech/cry: Speech (+) Nasal Flare : (+)

Circulation/ Body Colour

Pale : not pale

Cyanotic : not cyanotic
Mottling : not mottled

Conclusion : Respiratory Distress

 PRIMARY SURVEY
• Airway : Patent, no stridor
 Conclusion : airway paten
 action : none
• Breathing: RR : 40x/min, nasal flare (+), retraction epigastrium (+),
Oxygen saturation 92% with nasal canul O2 2L/i
 Conclusion : Respiratory distress
 Action : Oxygen supplementation, CPAP PEEP 6, FiO2 25%
• Circulation : CRT < 2 seconds, HR 130 x/minute regular, Temperature 36,9 C, pale (-), Mottled (-) Cyanotic (-)
 Conclusion : Normal
 Action : Observation for vital sign

• Disability : Pain (-), Pupil isochor (2mm/2mm), light reflex +/+, normotonic, seizure (-), body movement
symmetrical, Spastic (-)
 Conclusion : normal
 Action: none
• Exposure : Rash (-), Fracture (-), Hematoma (-), Burn injury (-)
 Conclusion : Normal
 Action : none
 PEWS

CONCLUSION : Score 4
Repeat PEWS in 20 min, vitals sign every hours, Plan of transfer to PICU
 Present Illness History
4 days ago 2 days ago 1 days ago

• Fever , continuosly, • Breathlessnes since 2 • Increase

with the peak was 38 days ago. Breathlessness since
C, no shivering, no • Breathlessnes is not 1 days ago, Especially
sweating, no seizures affected by weather, if the child cries
• Productive cough, food, or activity
hard to expulsion, not
affected by weather,
food or activity.
 SECONDARY SURVEY
Present Illness • There was no history of seizure
History • There was no contact with patient COVID-19
• There was no contact with patient positive tuberculosis
• There was no histry of choking
• There was no history Loss of body weight
• There was normal defecation and micturition.

Past Illness • The patient was hospitalized since 9 day ago and already controlled 1x, got cefixime 2x30 mg,
History furosemide 1 x 6 mg, captopril 3 x 4mg, asam folat 1 x 1 mg, N asetylsistein 2 x 3 mg, zink 1x10 mg,
amlodipine 1 x 1mg, allupurinol 1 x 50 mg, Dulcolax pediatric suppos1/3 tab extra

S • The patient is already known with PDA and recurrent Pneumonia, routine control to Kardiology
Outpatient Clinic with medication : Captopril 3x 4mg, Amlodipin 1x1 mg, Allupurinol 1x 50 mg, Ducloax
pediatric suppose, Furosemide 1x 6mg, Folic acid 1x1 mg,amlodipine 1x 10mg.
• The last echo on January 2023 with impression are situs solitus, balanced ventrikel, ALL pa TO La, PDA 3-
5 mm, ASD (-), VSD (-), EF 70%, tapse 2.1, MPAP 10 mmHg.
 SECONDARY SURVEY
Birth History • The patient was born section caesarean with birth weight 2800 gr, immediately cry after birth. There is
no history of cyanotic, breathlesness, jaundice after born.

Family Illness • Patient the second children from 2.

History
• There was no family members who had the same symptoms like patient.
• There was no family members who had chronic cough or dignosed with lung tuberculosis
• There was no family members who had congenital disease
S Food History Patient got formula milk since born, then continued to milk porridge at 6 months and soft meal at 9
months, now patient got some porridge with vegetable and protein.
Immunization Patient only got Hep B 0
Development Patient able to walk with holding the wall, say 1-2 words like mama-, papa-.
history
 SECONDARY SURVEY
Socio- Economic • Father’s patient has self-employed with salary less than Rp 1.000.000 in a month.
History • Mother ‘s patient has self-employed too with salary less than Rp 1.000.000 in a month.
• Parents has divorced, patient was taken care by her grandmother.

S
 General appearance : Severly ill,
BP 80/40 mmHg (P5-50), HR 130 times/minute, RR 40 times/minute, T : 36,9 C, oxygen saturation 99% CPAP PEEP 6 , FiO2 25%

BW 6.9 kg P5 67/22 Weight/age -3 < SD > -2

BH 68 cm P50 84/40 Height/age <-3 SD
Arm P90 97/54 Weight/height -2 < SD < -1
circumference 12 cm ( Normal) P95 101/58
P99 108/65
Nutritional status Underweight, very
stunted
Skin warm, no cyanotic, no pale, scar BCG (-),

Head Head Circumstances 41 cm (Microcephaly)

Eye Pale Conjungtiva +/+, sklera icterus -/-, pupil isokhor 3mm/3mm, light reflect +/+ palpebra edema -/-
O Nose Nasal flare (+), secret (-)

Ear Secret (-)

Mouth Cyanotic (-), pharynx : not hiperemic, T1-T1, crustae (-), ulcus palatum (-).

Neck lymph node not palpable. jVP 5-2 cmH20

Thorax Inspection Normochest, retraction (+) on epigastrium and intercostalis

Pulmo Palpation Fremitus difficult to assess

Percution sonor

Auscultation Brochovesiculer , fine rales on both of lung, wheezing -/-

 Cardio Inspection Ictus cordis was not visible

Palpation Ictus cordis was palpable at 1 finger lateral LMCS intercostal VI

Auscultation Reguler, gallop (-), continuous murmur (+) RIC II Left Parasternal

Abdomen Inspection Distention (-), defans muscular (-),

O Palpation Supel, hepar was palpable 1/4-1/4 with sharp edge, spleen not palpable
Percution Tympani
Auscultation BU (+) Normal

Extremity Warm acral, CRT <2 second, pitting edema -/-

Genitalia and A1M1P1, Baggy Pants (-)

anorectal
 Laboratorium Blood gas
Hb 8.7 gr/dl analysis
Leucocyte 10.240/mm3
Thrombocyte 259.000 /mm3 pH 7,29
Ht 27% pCO2 32
MCV 57 fL pO2 202
MCH 19 pg HCO3- 15.4
MCHC 33 % BE -10.2
SpO2 100%
Diff count 0/0/6/58/33/3
IT Ratio 0,09 Conclusion Metabolic Acidosis with
hyperoxemia

O
Natrium 145 mmol/L
Kalium 5.2 mmol/L
Chloride 117 mmol/L
Calcium 9.3 mg /dL
Ureum 34 mg/dL
Creatinin 0.3 mg/dL

Conclusion Mycrositic Hypochrome

Anaemia
Chest X Ray September
19th 2023
Trachea in the midlle
Infiltrate in perihilar both of lung
CTR > 60%
Bone intact
Both Costophrenicus angle was sharp

• Impression : BronchopneumonIa and

Cardiomegaly
Problem Diagnose Therapy
• Dyspnea • CPAP PEEP 6, FiO2 25%
• Respiratory Distress Due to
• Cough • Temporary Fasting
• Fever
Recurrent Bronchopneumonia
• IVFD KAEN 1B 621 cc/24 hours (10 %
• Incomplete • Failure to Thrive
Retriction) 25cc/ hour
Immunization
• Congenital Heart Disease due to • Ampicilin 4 x 300 mg IV
• Continous murmur
• Gentamicin 2 x 20 mg IV
• Cardiomegaly
Patent Ductus Arteriosus
• Paracetamol 3 x 70 mg po
• Anemia • Incomplete Immunization • N asetilsistein 3x 35 mg
• Malnourished
• Mycrositic Hypochrome • Captopril 3x 4mg po
• Amlodipin 1x1 mg
Anaemia
Plan
• Blood culture, sputum culture
• Urinalysis
• Benzidin test
• Consult to respirology division, nutrion and metabolic disease division and
cardiology division
 Acyanotic Congenital Cyanotic
Heart Infection Incomplete immunization
Risk Disease

Factor PDA Recurrent

Bronchopneumonia
Local Inflammation response

Trigger inflammation Sistemic inflammation

Accumulation of exudate, response response
Problem microorganism

Infiltrate and consolidation on lung Decreased of Increased work

oxygenation of breathing

FEVER
Cough
Dispnea
Diagnostic
Anamnesis, physical examination, laboratory findings, rontgen thorax

Therapy Oxygen therapy, antibiotics, fluids

Ad vitam: Dubia ad bonam

Ad functionam: dubia ad bonam
Prognostic Ad sanationam: Dubia ad bonam
 September 20th, 2023 , 06.00 wib

S/ Patient on CPAP (PEEP 6, Fio2 25%), there no increasing of breathlessness, no desaturation, no

fever, no vomitus

O/ General apperance : Severely ill, TD 86/45 mmhg, HR 100 x/ menit, RR 25x/ minute, SpO2 : 98-99%
Mata : no anemic conjungtiva
Nose : no nasal flare
Thoraks : minimal retraction on epigastrium, intercostalis and suprasternalis. Fine rales on both of lung.
Abdomen : no distention, hepar palpable ¼ ¼ and lien not palpable
Extremity : warm, CRT < 2 second

A/Respiratory Distress Due to Recurrent Bronchopneumonia

• Failure to Thrive

• Congenital Heart Disease due to Patent Ductus Arteriosus

• Incomplete Immunization

• Mycrositic Hypochrome Anaemia

P/

• CPAP PEEP 6, FiO2 25%

• Temporary Fasting

• IVFD KAEN 1B 621 cc/24 hours (10 % Retriction) 25cc/ hour

• Ampicilin 4 x 300 mg IV

• Gentamicin 2 x 20 mg IV

• Paracetamol 3 x 70 mg po

• N asetilsistein 3x 35 mg

• Captopril 3x 4mg po

• Amlodipin 1x1 mg

• Aluupurinol 1x 50 mg po

• Zink 1x 10 mg po

• Folic Acid 1x1 mg po

THANK YOU