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KM 2 dan Kenanga

Dr. Almahitta, Sp.BP(RE)K

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 (-)

Clinical picture 26/11/2015





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

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

Management

• Wound hygiene• Head Mobilization

– Wound care with duoderm gel every 2 -3 days • Antibiotic and another therapy according to Pediatric department

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



Post Op 21/12/2015

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

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

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

THANK YOU

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

07.12.15

11.12.15

18.12.15

21.12.15

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

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

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