parade bedah plastik
DESCRIPTION
parade bedah plastik di RSHS Bandungdilakukan setiap minggu untuk assesment pasien pasien dalam ruangan.TRANSCRIPT
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KM 2 dan Kenanga
Dr. Almahitta, Sp.BP(RE)K
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Baby M. Shiddiq / 2 month / MR. 15035621 /
kenanga 1Admission : October 10th, 2015
Consultant : Almahitta, dr., SpBP-RE
Working Diagnosis :• Hidrocephalus communicans• Pressure ulcer a/r occipitalis
Present State State RR : 45x/minHR : 140 x/min Temp : 36,9oC
Local state a/r occipitalis : multiple wound biggest size 10x4cm, smallest size 5x5cm, irregular edge, pus (-), slough (-), bledding (-)
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Clinical picture 26/11/2015
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Clinical picture 29/11/2015
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Clinical picture 4/12/15
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Clinical picture 7/12/15
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Clinical picture 21/12/2015
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Laboratory FindingLab 18/11/15 20/11/15 23/11/15 27/11/15 2/12/15 16/12/15
PT/ APTT/ INR
Hb 12,7 11,7 11,2 12 9.1
Ht 38 34 33 35 27
Leucosit 10.800 14.800 14.100 14.400 13.200
Trombosit 453.000 490.000 513.000 320.000
SGOT/ SGPTUr/ Cre
Blood Glucose
79
Na/K 137/3,9 132/4,1 135/5.4
Alb/Protot 2,7/5,2 2.8/5.0
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Pus culture (30/11/2015)Antibiotic Org.1
Amikacin S
Ampicilin Sulbactam R
Aztreonam R
Cefepime R
Ceftazidime R
Ceftriaxone R
Cephazolin R
Cotrimoxazole S
Gentamycin R
Meropenem R
Piperacillin Tazobactam R
Tigecyclin R
Founded 1. Acinetobacter baumanii
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Management
• Wound hygiene• Head Mobilization
– Wound care with duoderm gel every 2 -3 days • Antibiotic and another therapy according to Pediatric department
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Mr. Odang / 42 y.o / MR. 15028619 / Kemuning 2
OrthoAdmission : December 7th, 2015
Consultant : Almahitta, dr., SpBP-RE
Working Diagnosis :Post escharectomy at left hand + amputation of the right 5th toe POD 8 due to Electrical Burn Injury grade 2-3 with raw surface 7,25% at bilateral superior and inferior extremity that had been performed amputation of the right arm below elbow
Suspect fracture left thigh
Operating History1st Necrotomy Debridement & amputation of the little toe on December 14th, 2015December 22th Amputation of the right arm below elbow
Present State State 4BP : 138/78 mmHg RR : 22x/minHR : 87 x/min Temp : 37,3oC
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Clinical picture 20/12/2015
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Clinical picture 20/12/2015
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Post Op 21/12/2015
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Laboratory FindingLab 7/12/15 10/12/15 12/12/15 13/12/15 14/12/15
PT/ APTT/ INR
10,9/23,8/0,98
Hb 11,4 10,0 9,6
Ht 32 29 28
Leucosit 15.900 18.700 19.300
Trombosit 274.000 366.000 429.000
SGOT/ SGPT
45/74 62/61
Ur/ Cre 25/0,59 20/0,63
Blood Glucose
116
Na/K 125/4,3 122/3,8 125/3,3 123/3,4 126/3,6
Alb/Protot
3,0 2,6
AGD 7/12/15
10/12/15
12/12/15
pH 7,516 7,426 7,513
pCO2 28,3 33,3 28,0
pO2 78,8 73,9 84,8
HCO3 22,4 21,6 22,0
TCO2 42,3 50,4 41,6
BE 1,5 -1,6 1,1
SaO2 95,8 95 96,6
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Laboratory finding
Lab 21/12/15
PT/APTT/INR 13/40.3/1.07
Hb 9.2
Hct 28
Leukosit 9.800
Trombosit 597.000
Ur / Cr 24/0.57
Na / K 133/3.7
SGOT/SGPT 42/63
RBG 143
Alb/Tot. Prot. 2.7/6.4
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Management
• Vital sign observation• IVFD NaCl 0,9% 1500cc/24 hr • Ceftriaxone inj 1x2 g iv• Ranitidine inj 2x50 mg iv• Tramadol inj 3x30 mg iv• Wound dressing with duoderm gel + tulle POD 3• High protein diet• Consult to Rehabilitation Departement
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THANK YOU
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Working Diagnosis :Post necrotomy debridement and skin graft due to neglected burn injury grade 2AB 11% ec scald with raw surface 2.5%Anemia due to blood lossHypoalbuminemia due to low nutrition intake
Past surgical history:13 November 2015: necrotomy debridement19 November 2015: skin graft26 November 2015: ND + STSG07 December 2015: ND + STSG11 December 2015 : ND18 December 2015 : ND
Present State :Fully alertRR : 22 x/min, HR : 95 x/minTemp : 36,7 oC
Alfian/ ♂ / 5 y.o / MR. 15027968Admission : November 10th , 2015
Consultant : dr. Almahitta, SpBP-RE
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07.12.15
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11.12.15
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18.12.15
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21.12.15
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Pus culture for bacterial resistance
Pseudomonas aeruginosa
Antibiotic Nov 13rd 2015 Nov 20rd 2015 Nov 25rd 2015Amikacin R S SAmpicillin Sulbactam R R RAztreonam R S SCefepime R S SCeftazidime R S SCeftriaxone R R RCephazolin R R RCiprofloxacin R R SCotrimoxazole R S RGentamycin R S SMeropenem R S SPiperacillin Tazobactam R RTigecyclin R R R
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Management
• Vital sign observation• IVF RL:D5= 2:1 = 1000 cc/24 hrs• High protein and calorie diet
• Therapy:– Ceftazidime 3 x 150 mg IV– Paracetamol syrup 3-4 x 2 cth PO prn