ppt case 1 internsip
TRANSCRIPT
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PENYAKIT JANTUNGBAWAAN
“ASIANOTIK”
Created by :
Fajar Nugraa !u"ya #$ePe%b&%b&'g : dr( Abdu" G$)ur*
S+(JP
,SU -jat&r$t$ #u%aja'g./01
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PEN-A2U#UAN
340/// 5e"a&ra'&du+
6S- 7/89/* P-A0/* AS- ;(
PS ;
C$ar
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SIRKULASI JANIN
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KEADAAN SIRKULASI PASCALAHIR
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Perubahan Sirkulasi Normal Pasca Lahir
Tahanan vaskular ulmonal menurun!
Tahanan vaskular sis"emik menin#ka"!
Duk"us ar"eriosus menu"u!
$oramen ovale menu"u!
Duk"us venosus menu"u!
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PENYAKIT JANTUNGBAWAAN
Ke"a&'a' +ada =tru5tur ja'tu'g atau)u'g=& =&r5u"a=& ja'tu'g ya'g d&ba>adar& "a&r a5&bat ga'ggua' atau5egaga"a' +er5e%ba'ga' =tru5tur ja'tu'g +ada )a=e a>a" +er5e%ba'ga' ja'&'
. Ke"$%+$5:0( Pe'ya5&t Ja'tu'g Ba>aa' N$' S&a'$t&5
.( Pe'ya5&t Ja'tu'g Ba>aa' S&a'$t&5
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% $ak"or Pen&ebab
'! $ak"or Ekso#en
. Teru"ama selama (ua bulan er"amakehamilan virus Rubella) "ali(omi()
oba" lain) ra(iasi
%! $ak"or En(o#en
.$ak"or #ene"ik) kelainan kromosom)
ri*a&a" PJ+ anak sebelumn&a!
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A"ur -&ag'$=t&5
A'a%'e=a
r&>aya
t+e'ya5
&t
Pe%er&
5=aa'?=&5 EKG
F$t$
T$ra5
E5$5ar
d&$gra?
Kateter&=a=&
ja'tu'g
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Anamnesa
+a"uk anas berulan#
,na##uan men&usui
,an##uan "umbuh kemban#
Ti(ak a(a ri*a&a" sel siano"ik
Jara'g batu5 +a'a=
Ga'ggua' %e'yu=u&
Ga'ggua' tu%bu 5e%ba'g
,&>ayat =+e" =&a'$t&5
Ser&'g j$'g5$5
A"&ra' 5e +aru %e'&'g5at:
A"&ra' 5e +aru ber5ura'g :
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PENYAKIT JANTUNG BAWAAN SIANOTIK
. KE#O!POK BESA,
a"&ra' dara 5e +aru ber5ura'g O#IGE!IC #UNGS
$b=tru5=& a"&ra' dara 5e +aru : PS*PA
da' , # =u't %e"a"u& de)e5 d& ja'tu'g : PFO* AS-* 6S-
a"&ra' dara 5e +aru ber"eb&a' P#ET2O,IC #UNGS
TGA C$%%$' !&&'
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PJB“ASIANOTIK”
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PENYAKIT JANTUNG BAWAAN ASIANOTIK
. KE#O!POK BESA,
lesi / lubang d& ja'tu'g a"&ra' +&rau
5&r& 5e 8 5a'a'P-A* 6S-* AS-* A6S-
lesi obstruktif d& ja'tu'g 5&r& atau5a'a' ta'+a a"&ra' +&rau
AS* C$A* PS
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aliran pirau dari kiri ke kananmelalui defek di jantung
aliran pirau dari kiri ke kananmelalui defek di jantung
aliran darah ke paruberlebihan
aliran darah ke paruberlebihan
PJB AIAN!TIK"ENGAN PI#AU "A#I KI#I KE KANAN
Be$ar %&'ka$i defek
Be$ar %&'ka$i defek
tahanan(a$kuler paru
tahanan(a$kuler paru
PENYAKIT JANTUNG BAWAAN
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•
sesak nafas• kesulitan mengisap susu• infeksi paru berulang• gagal tumbuh kembang• gagal jantung
• tanpa gejala
• dengan gejala
aliran dapat berubah $e$uai
dengan penurunan tahanan(a$kuler paru
PENYAKIT JANTUNG BAWAAN AIAN!TIK
"ENGAN PI#AU "A#I KI#I KE KANAN
aliran darah ke paru
berlebihan
aliran darah ke paruberlebihan
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6e'tr&
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Pat$?=&$"$g&6S-
8P&rau dar& #6 5e ,6 be=ar
8-&"ata=& #A* #6 da' PA
82&+erte'=& +u"%$'a"
2 taa'a' a=5u"er +aru t&'gg&
2 +e'ya5&t a=5u"er +aru
2 +&rau dar& 5a'a' 5e 5&r& 888=&'dr$%a E&=e'%e'ger
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Ga%bara' K"&'&=
0(6S- 5e
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C"ubb&'gF&'ger
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Pe%er&5=aa' Pe'u'ja'g
0(F$t$ T$ra5=
a(#6 %e%be=ar
b(Pe%bu"u dara &"u= %e%be=ar
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Pe'ata"a5=a'aa'
0(tau' +erta%a de)e5 b&=a%e'ge
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Atr&a" Se+ta" -e)e
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8P&rau dar& #A 5e ,A
8-&"ata=& ,A* ,6 da'PA
82&+erte'=& Pu"%$'a"
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Pe%er&5=aa' Pe'u'ja'g
0(F$t$ T$ra5=
a(,A da' ,6 %e%be=ar
b(6a=5u"ar&=a=& +aru %e'&'g5at
.(EKG
a(Su%bu ,S '$r%a" atau berde&a=& 5e 5a'a'
b(,BBB &'
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Pe'ata"a5=a'aa'Beda +e'utu+a' AS-d&"a5u5a' b&"a ra=&$ a"&ra'+u"%$'a" terada+ a"&ra'=&=te%&5 +:=D .:0 +adaa'a5 u=&a 89 tau' d&tu'da : &+erte'=& +u"%$'a"
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Per=&=te't -u
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Pat$?=&$"$g& P-A
8P&rau dar& 5&r& 5e 5a'a' be=ar
8-&"ata=& #A* #6* AO da' PA
82&+erte'=& +u"%$'a"
2taa'a' a=5u"er +aru t&'gg&
2+e'ya5&t a=5u"er +aru
2+&rau dar& 5a'a' 5e 5&r& 888
=&a'$=&= =&'dr$%a E&=e'%e'ger
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Ga%bara' K"&'&=0(P-A 5e
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Pe%er&5=aa' Pe'u'ja'g
0(F$t$ T$ra5=
a(#6 %e%be=ar
b(Pe%bu"u dara &"u= %e%be=ar
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Pe'ata"a5=a'aa'
0(I'd$%eta=&' I6 d$=&= /*.%g45gBB de'ga' =e"a'g >a5tu0. ja% d&ber&5a' 7 5a"& +adabay& +re%atur u=&a L 0%&'ggu
%e'utu+ du5tu=
.(I'd&5a=& $+era=& :
a( P-A +ada bay& ya'g t&da5 re=+$'terada+ %ed&5a%e't$=a(
b( P-A de'ga' 5e"ua'
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STENOSIS AO,TA
SEKITA, 9 -A,I SE!UAPJB(
E%+at 5a"& "eb& ba'ya5+ada a'a5 "a5&8"a5&(
Terd&r& ata= 7 :
0( Ste'$=&= a$rta a"u"ar
.( Ste'$=&= a$rta =uba"u"ar
7( Ste'$=&= a$rta=u+raa"u"ar
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Geja"a K"&'&=
Pa(a &an# bera") (aa" men&ebabkan#a#al 1an"un# (an kema"ian men(a(ak!
Pa(a anak lebih besar "amak sesak)
rasa saki" subs"ernal a(a saa" la"ihan)sinko a"au (i99iness!
Tamak asiano"ik) na(i normal kecuali
s"enosis bera"! +isin# sis"olik a(a suras"ernal (an
seki"ar karo"is) a(a sela i#a kanan!
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Pe%er&5=aa' Pe'u'ja'g
EK, normal) L3H /bera"0
Ra(iolo#i normal) (ila"asiaor"a ascen(ens) aor"ic
knobs menon1ol)kar(iome#ali bila #a#al
1an"un#!
Ekokar(io#ra:
menilaierbe(aan "ekanan ka"u(an le"ak kelainan!
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Pe'ata"a5=a'aa' &'tere'=& beda : 5$%&=ur$t$%&
+ada te%+at =te'$=&=( In"ervensi kar(iolo#i 7 balloon aor"ic
valvulo"om& /+A30 secara "ranska"e"er!
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Geja"a K"&'&=
Auskul"asi (aa" menilai bera"n&as"enosis ka"u ulmonal!
+J II "er(en#ar sli"!
.akin bera" s"enosis) makin lama e1eksiven"rikel) sli" (aa" "er(en#ar melebar!
+ila obs"ruksi heba"7 mu(ah caek)sesak na;as a(a ke#ia"an) sinko) n&eri(a(a) 1ari "abuh) "an(a a&ah 1an"un#kanan!
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Pe%er&5=aa' Pe'u'ja'g
EK, "an(a hier"ro: a"riumkanan) aksis (eviasi ke kanan!
Ra(iolo#i 1an"un# normal)
elebaran ar"eri ulmonalisos" s"eno"ik) vaskularisasiaru "i(ak menin#ka"!
Ekokar(io#ra: menilai
erbe(aan "ekanan ven"rikelkanan (an ar"eri ulmonalis(an le"ak kelainan!
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Pe'ata"a5=a'aa' J&5a 5eadaa' +a=&e' teru= %e%berat* aru=
d&"a5u5a' t&'da5a' ba""$$' PTB6!
Pe'ata"a5=a'aa' terga'tu'g dar&+erbedaa' te5a'a' dar& e5$5ard&$gra? da'5"&'&=* ada ya'g +er"u d&ea"ua=& &'gga .tau'* da' ada ya'g +er"u &'tere'=&
=egera(
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K-ARTASI- A-RTA
Ter(aa" a(a
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,e1ala Klinis
+iasan&a ba&i lahir (alam kea(aan baik)kemu(ian (alam beberaa hari 1a"uh(alam kea(aan memburuk!
Perubahan klinis ini berhubun#an(en#an mulai menu"un&a (uk"usar"eriosus!
Tiba2"iba ba&i "i(ak mau minum) sesakna;as) (an er;usi eri;er menurun!
Na(i ;emoralis san#a" lemah!
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Pemeriksaan Penun1an#
Tie Pos"2Duk"al $o"o "hora>7 embesaran ven"rikel kiri)
aor"a hiolas"is) ) ben"uk E a(a eso;a#us
/+arium meal0 EK, 7 L3H
Tie Pre2Duk"al $o"o "hora> 7 embesaran 1an"un# (an
kon#es"i vena ulmonalis) "i(ak a(a ben"ukE
EK,7 RAD) R3H) (an a"au L3H
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Pena"alaksanaan
Pemberian P,E' un"uk memer"ahankanPDA
Terai "erha(a #a#al 1an"un#
Pembe(ahan *ak"u (ini 7 +alloon an#iolas"i
-erasi
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LAP-RAN KASUS
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Ide't&ta= Pa=&e' Nama 7 N&! S
Umur 7 6< "ahun Jenis Kelamin 7 Peremuan
Alama" 7 Desa Timur Jinan#) Ran(u
A#un# Peker1aan 7 Ibu Rumah Tan##a
Perka*inan 7 Su(ah menikah
No! R. 7 ?6!@%!@@
+an#sal 7 Ruan# Pera*a"an Khusus S"a"us 7 +PJS Jamkesmas
Tan##al .asuk 7 ' Desember %?'B
Tan##al Keluar 7 ' Desember %?'B
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A'a%'e=a Aut$a'a%'e=aD
Tan##al emeriksaan 7 'B Desember %?'B
ukul '!?? I+
Ke"ua' Uta%a : =e=a5 'a)a=
Ke"ua' Ta%baa' : =er&'g "e"a*"e%a=* 'yer& u"u at&
i ki S k
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Pasien (a"an# ke Ins"alasi ,a*a"Darura" RSU D1a"iro"o (en#ankeluhan =e=a5 'a)a= % hariS.RS! Sesak "eru"ama membera"
se1ak ' hari S.RS saa" se(an#is"iraha"! A(a kerin#a" (in#in!
Ti(ak a(a (emam) ba"uk mauunbun&i men#i saa" sesak! Ti(ak
a(a keluhan n&eri (a(a! Pasienmen#eluh serin# kelelahan saa"melakukan ak"ivi"as sehari2hari
seer"i men&au (an mencuci
Ri*a&a" Pen&aki" Sekaran#
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Sesak na;as 1u#a (iser"ai n&eri ulu ha"i (anlemas seluruh ba(an! Selain i"u) 1u#amen#eluh mual namun "i(ak mun"ah! +AK
(an +A+ lancar! Saki"n&a ini serin#kambuh2kambuhan sehin##a san#a"men##an##u ak"ivi"as sehari2hari!
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,&>ayat Pe'ya5&t -au"u
R! .aa# 7 /40
R! Asma 7 (isan#kal
R! Hier"ensi 7 (isan#kal
R! Pen&aki" 1an"un# 7 /40
R! Aler#i -ba" 7 (isan#kal
R! -erasi 7 (isan#kal
R! Tumor 5 Kanker 7 (isan#kal
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,&>ayat Pe'ya5&t Ke"uarga
Ti(ak a(a keluar#a &an# men#alamikeluhan serua!
Ri*a&a" Darah "in##i 7 (isan#kal
Ri*a&a" kencin# manis 7 (isan#kal Ri*a&a" Pen& Jan"un# 7 (isan#kal
Ri*a&a" sesak na;as 7 (isan#kal
Ri*a&a" Aler#i oba" 7 (isan#kal
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,&>ayat Pe'g$bata'
Sebelumn&a asien men#konsumsi oba"2oba"an &an# (iberikan SP! JP saa" asienkeluar er"ama kali (ari RS) &ai"u7
An"asi(a s&r 6 > C I Lasi> ' F ? F ?
Ca"oril '%)B m# 6 > '
G Ten 6? m# ' > '
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,&>ayat S$=&a"8E5$'$%&
Pasien me(u(uki en(i(ikan "erakhir (iban#ku S.P! Pasien saa" ini beker1a seba#aiibu rumah "an##a! Pasien sekaran# "in##al
bersama suami (an ke(ua anakn&a! Suamiasien beker1a seba#ai buruh abrik un"ukmemenuhi kebu"uhan hi(u! Un"uk beroba"asien memun&ai +PJS .an(iri! Pasien
(ikenal baik oleh "e"an##a (an keluar#a(eka"n&a! Pen#hasilan suami cuku un"ukmemenuhi kebu"uhan keluar#a!
Ri " ,i i
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Ri*a&a" ,i9i
Pasien biasa makan % F 6 > sehari! .enu&an# serin# (ikonsumsi berua nasi)lauk2auk /"ahu (an "eme0 (an sa&ur!
Pasien serin# minum "eh manis! Se1aksaki" ini) na;su makan menurun!
Kesan7 Kebu"uhan #i9i kuran#!
A i Si "
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Anamnesis Sis"em
S! Serebrosinal7 enurunan kesa(aran) (emam) ke1an#!
S! Kar(iovaskular7 n(re(e#
S! Resirasi7 +a"uk kerin#) sesak na;as) ilek)
"arikan na;as! S! ,I7 n&eri ulu ha"i) mual) na;su makan "urun)
+A+ hi"am!
S! Urolo#i7 kencn# lancar) kunin#) 1ernih) n&eri
+AK S! In"e#umen7 ben#kak keema" e>"remi"as
S! .uskuloskele"al7 keluhan
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Pemeriksaan Fisik
Para%eter 0940.4./09
Te5a'a' dara
%%2gD
'6
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Kuli" 7 Sa*o ma"an#) "ur#or baik) ruam /20 .a"a 7 ca 252 ) si 252) "osis 252) reeks caha&a 454)
visus "i(ak (ieriksa
Hi(un# 7 sime"ris) sekre" 252) se"um (eviasi 252
Telin#a 7 ben"uk normal) sekre" 252) (ischar#e 252 Ten##orok 7 hieremis 2 ) n&eri "elan 2
.ulu" 7 sianosis 2) mukosa "i(ak kerin#
Leher 7 kuli" baik) n&eri "ekan /20) embesaran
K,+ /20) J6P 9 7
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P$ Thora> /Paru0
Inseksi 7 Hemi"hora> D S) re"raksio"o" erna;asan /20
Palasi 7 n&eri "ekan /20) massa /20) s"em
;remi"us D S Perkusi 7 sonor a(a ke(ua laan# aru
Auskul"asi 7 Suara na;as vesikuler /4540)
hee9in# /2520) ,$'5& 4D ba=aa"u= d& 5edua ba=a" +aru!
P$ Thora /Jan"un#0
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P$ Thora> /Jan"un#0
Inseksi 7 Pulsasi ic"us cor(is "i(ak "amak! Palasi 7 ulsasi ic"us cor(is "eraba % 1ari (i ICS 3
linea a>illaris an"erior sinis"ra) Thrill /20) li;" /20
Perkusi 7 +a"as kanan 7 ICS 3 linea s"ernalis (e>"ra!
+a"as kiri7 ICS 6I* "&'ea a5=&"ar&= a'ter&$r=&'&=tra!
+a"as a"as7 ICS III linea aras"ernal sinis"ra
Auskul"asi 7 +un&i Jan"un# I "un##al) II =+"&t)re#ular) %ur%ur =&=t$"&5 grade 741 d& ICS II=&'&=tra),allo/20!
Ab(omen
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Ab(omen
Inseksi 7 (a"ar) sime"ris kanan (an kiri)sika"riks /20) s"riae /20) elebaran vena /20)
hieri#men"asi /20) #erakan eris"al"ik /20!
Auskul"asi 7 +isin# usus /40 normal '<>5meni") brui" /20
Perkusi 7 "imani (i seluruh kua(ranab(omen) 'yer& 5et$5 D d&
e+&ga=tr&u%! Palasi 7 suel) (e;ans muskular /20) massa
/20) hear) lien (an #in1al "i(ak "eraba) 'yer&te5a' d& e+&ga=tr&u%!
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A'gg$ta Gera5
Ka'a'K&r&-"o"
Tonus 7 baik baik
.assa 7 "i(ak a(a "i(ak a(aSen(i 7 "i(ak a(a kelainan "i(ak kelainan
,erakan7 baik baik
Kekua"an7 baik /B0 baik /B0
-e(em7 "i(ak a(a "i(ak a(a
Lain2lain7 "i(ak a(a
Kelen1ar ,e"ah +enin#
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Kelen1ar ,e"ah +enin#
Cervical 7 Ti(ak "eraba embesarankelen1ar #e"ah benin# submen"al)
subman(ibular (e>"ra e" sinis"ra)re"roaurikula (e>"ra e" sinis"ra) cervical(e>"ra e" sinis"ra) suraclavicula (e>"ra e"sinis"ra
Aksilla 7 Ti(ak "eraba embesarankelen1ar #e"ah benin# aksilaris (e>"ra e"sinis"ra) ek"oral (e>"ra e" sinis"ra!
PE!E,IKSAAN PENUNJANG
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J#ab ta'gga" 0 -e=e%ber ./09
Pe%er&5=a
a'2a=&" Satua'
N&"a&
N$r%a"
2e%at$"$g&
2e%$g"$b&
'
'6!% # 5 (L '' 2 '<
2e%at$5r&
t
'!B = 6' 2 '
#eu5$=&t !6? '?6 5 L )B 2 '6)B
Er&tr$=&t !B? '?6 5 L %)B F B)B
Tr$%b$=&t '@% '?6 5 L 'B? 2 B?
PE!E,IKSAAN PENUNJANG
-
8/20/2019 PPt Case 1 Internsip
81/100
J#ab ta'gga" 0 -e=e%ber ./09
Pe%er&5=a
a'2a=&" Satua'
N&"a&
N$r%a"
K&%&a -ara
Ureu% 6@!? m# 5 (L '?2B?
Kreat&'&' '!? m#5(L ?!B F '!@
BUN '!%B m#5(L 6?
A=a% Urat 3(/ #r5(L !B
SGOT B! U5L ?26'
SGPT 6B!? U5L ?26'
PE!E,IKSAAN PENUNJANG
-
8/20/2019 PPt Case 1 Internsip
82/100
PE!E,IKSAAN PENUNJANG#ab ta'gga" 0 -e=e%ber ./09
Pe%er&5=a
a'2a=&" Satua'
N&"a&
N$r%a"
E"e5tr$"&t
Natr&u% '
Ka"&u% 7(9 mmol 6!
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8/20/2019 PPt Case 1 Internsip
83/100
EK, / ' Desember %?'B0
Kesan 7 ,ambaran EK, (i(aa"kan#ambaran Su+rae'tr&5u"ar Ta5&5ard&(en#an ra"e '< >5m
M $o"o Thoraks /'B Desember %?'B0
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84/100
M2$o"o Thoraks /'B Desember %?'B0
Kesan 7 5ard&$%ega"&
Echocar(io#rah&
-
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85/100
Echocar(io#rah&
Echocar(io#rah&
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86/100
# &/In"erre"asi0 Ka"u2Ka"u7 PR bera") TR bera" Dimensi Ruan#2ruan# Jan"un#7
LA normal /LA ma&or !@ cm0
L3 normal /L3ID( %!< cm0
RA (ila"asi /RA ma&or
Ti(ak a(a L3H Tamak (e;ek iAS 6!?6 cm /RI. an" '!%6 cm) RI. os"erior
?!% cm0 (en#an bi(ireksional shun" (ominan R "o L
Kesimulan7 AS- =e5u'du% be=ar de'ga' d$%&'a' , t$# =u't P2T berat
RESU.E
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8/20/2019 PPt Case 1 Internsip
87/100
Telah (ieriksa seoran# eremuan usia 6<"ahun) (a"an# ke I,D (en#an keluhan =e=a5'a)a= % hari S.RS) membera" ' hari saa"is"iraha"! Ker&'gat d&'g&'/40! Demam /20) ba"uk/20) bun&i men#i /20) n&eri (a(a /20! Pasien =er&'g5e"e"aa' saa" berak"ivi"as sehari2hari seer"imen&au (an mencuci ba1u) namun n&amanaabila beris"iraha" se1enak! Sesak 1u#a (iser"ai'yer& u"u at& (an lemas seluruh ba(an! !ua"
/40) mun"ah /20) na;su makan menurun! +AK (an+A+ lancar! Saki"n&a ini serin# kambuh sehin##amen##an##u ak"ivi"as sehari2hari!
RESU.E
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8/20/2019 PPt Case 1 Internsip
88/100
Pasien mulai serin# lelah "eru"amase"elah melahirkan anak er"ama "ahun lalu (an +er'a %e'ga"a%&5e"ua' ya'g =a%a sebelum .RS(an sema" (ira*a" > (alam < bulan"erakhir!
Pasien biasa kon"rol ke S!JP (an
men(aa" oba" An"asi(a s&r 6 > C I)Lasi> ' F ? F ?) Ca"oril '%)B m# 6 > ')(an G Ten 6? m# '>'!
Pemeriksaan $isik
-
8/20/2019 PPt Case 1 Internsip
89/100
Pemeriksaan $isik
Kea(aan Umum7 Tamak saki" bera") lemah Kesa(aran 7 Comos .en"is
Tan(a vi"al7 Normo"ensi) Takikar(ia) Takineu
Ter(aa" enin#ka"an J3P /B46 cmH%?0
Thora> 7 Paru Ronki /4540 basah halus (i ke(ua basal aru
Jan"un# +a"as kiri7 ICS 3I) linea aksilaris an"erior sinis"ra)"er(en#ar bun&i Jan"un# I "un##al) II sli") re#ular) murmursis"olik #ra(e 65< (i ICS II sinis"ra) ,allo /20!
Ab(omen7 n&eri ke"ok (an n&eri "ekan (i ei#as"rium! Pemeriksaan lain (alam ba"as normal!
Ti(ak "amak a(an&a kelemahan a(a ema" eks"remi"as!
Pemeriksaan Penun1an#
-
8/20/2019 PPt Case 1 Internsip
90/100
Pemeriksaan Penun1an#
Lab (arah7 (i(aa"kan hiokalemiarin#an
EK, 7 (i(aa"kan Suraven"rular
Takikar(i (en#an ra"e '5m M $o"o Thora>7 (i(aa"kan kesan
kar(iome#ali
Echocar(io#rah&7 (i(aa"kan kesanASD sekun(um besar (en#an (ominan R"o L shun" 4 PHT bera"
Dia#nosis
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8/20/2019 PPt Case 1 Internsip
91/100
Dia#nosis
-&ag'$=&= Kerja
Pen&aki" 1an"un# ba*aan "ie Atrial SeptalDefect sekun(um besar (en#an komlikaside
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8/20/2019 PPt Case 1 Internsip
92/100
Pena"alaksanaan
-
8/20/2019 PPt Case 1 Internsip
93/100
Pena"alaksanaan
.e(ikamen"osa 7 -ksi#en nasal canul % lm
In;us P "m
In1! $urosemi(e % > %? m# In1! -mera9ole % > ? m#
In1! Amio(arone 'B? m# bolus (alam '?
meni" Preara" Kalium oral % > ' "able"
+eraros" Na % > %? m#
Pro#nosis
-
8/20/2019 PPt Case 1 Internsip
94/100
Pro#nosis
Guo a( vi"am 7 (ubia Guo a( ;un#"ionam 7 (ubia a( malam
Guo a( sana"ionam7 (ubia a( malam
$ollo* U
-
8/20/2019 PPt Case 1 Internsip
95/100
$ollo* UKeg&ata' Per&$de P"a''&'g. Se=a5 ber5ura'g* 'yer&
dada 8D* 'yer& u"u at&
ber5ura'g* %ua"
ber5ura'g* %u'ta 8D
. C$%+$= !e't&=4 ta%+a5
"e%a
Ta'da &ta"
. T- : ;41; %%2g
. N : ;9 4%e'&t
. , : . 4%e'&t
. T : 7;(/
. S+O.: ,$'5& %a=& d& ba=a"
. A== : -e
-
8/20/2019 PPt Case 1 Internsip
96/100
EK, / '< Desember %?'B0
Kesan 7 ,ambaran EK, (i(aa"kan#ambaran irama 3en"rikular (en#an ra"e? >5m
$ollo* U
-
8/20/2019 PPt Case 1 Internsip
97/100
$ollo* UKeg&ata' Per&$de P"a''&'g. Se=a5 ber5ura'g* 'yer&
dada 8D* 'yer& u"u at&ber5ura'g* %ua" 8D *
%u'ta 8D
. C$%+$= !e't&=4 ta%+a5
"e%a
Ta'da &ta". T- : 00943/ %%2g
. N : 31 4%e'&t
. , : . 4%e'&t
. T : 7;(.
. S+O.: 3
,$'5& %&'&%a" d& ba=a"
. A== : -e
-
8/20/2019 PPt Case 1 Internsip
98/100
$ollo* UKeg&ata' Per&$de P"a''&'g. Se=a5 ber5ura'g* 'yer&
dada 8D* 'yer& u"u at&
8D* %ua" 8D* %u'ta 8D
. C$%+$= !e't&=4 ta%+a5
"e%a
Ta'da &ta"
. T- : 00/43/ %%2g
. N : 3/ 4%e'&t
. , : ./ 4%e'&t
. T : 71(3
. S+O.: 3
,$'5& 8D
. A== : -e C I• .oni"or "an(a vi"al (an
S?%• Pro Acc KRS• Terai KRS7
Amio(aron '> %?? m# Lasi> %? m# F ? F ? Ramiril ? F ? F %!B m# Kon"rol oli Jan"un#
se"elah oba" habis
-
8/20/2019 PPt Case 1 Internsip
99/100
Da;"ar Pus"aka
-
8/20/2019 PPt Case 1 Internsip
100/100
Da;"ar Pus"aka
+raun*al() Eu#ene e" al! +raun*al(Qs Hear" DiseaseA Te>"book -; Car(iovascular .e(icine! Elsevier! %?'B!
Lill& Leonar( S! Pa"hoh&siolo#& o; Hear" Disease!ol"ers Klu*er! B"h e(i"ion! %?''!
Rilan"ono) Lil& Ismu(ia"i! +uku A1ar Kar(iolo#i! Jakar"a 7$akul"as Ke(ok"eran Universi"as In(onesia! %??! .anurun# D! De;ek Se"um A"rial! In7 Su(o&o A)
Se"i&oha(i +) Al*i I) Sima(ibra"a .) Se"ia"i S) e(i"ors!+uku A1ar Ilmu Pen&aki" Dalam! 3 e(! Jakar"a7 In"erna
Publishin# %??@! Tool Eric J! Te>"book o; Car(iovascular .e(icine!
Liinco"" illiams ilkins! %n( E(i"ion! %??%!