laporan jaga chf maheli koto jumat

7/24/2019 Laporan Jaga Chf Maheli Koto Jumat

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Konsulen Jaga : dr. M. Fadil, SpJP

Residen Jaga : dr. Ivan/ dr. Nani/ dr. Nikko/dr. Erizon/ dr. Dia



Pasien baru1. Tn. Yoherman, 55 tahun

WD/ UAP TIMI 2/7 GS 5

!T Sta"e 1

2. T. Mahe#i $oto, 5% tahunWD/ &!' '& III e( &AD

Post PT&A 2 stent D)S tahun2*1+

!io-a#emia



Tn. Mahe#i $oto/ 5% th

K! : Sesa- naas an" menin"-at se0a- 5 hari SMS

RPS

Sesa- naas an" menin"-at se0a- 5 hari SMS.Sesa- tia- men(iut, tia- ien"aruhi o#eh (ua(aatauun ma-anan. Dirasa-an saat asienbera-ti3itas rin"an. i4aat sesa- sebe#umna 6se0a- 2 tahun tera-hir, i4aat P8D 6, D9) 6,9P 6, sembab i -a-i :.

8eri aa :, -erin"at in"in :, mua# :, muntah:

;erebar:ebar :, usin" :,in"san :



Pasien ost asan" stent bu#an 0anuari an maret2*1+, -ontro# teratur -e o#i 0antun" SUP r. M.

D0ami#, aat terai ator 1<1** m", ramiri# 1<1*m", urosemie 1<=* m", bisoro#o# 1<2,5 m",sim3astatin 1<=* m", #ansora>o# 1<+* m",a##ourino# 1<1** m".

Di IGD ? Sesa- naas 6, neri aa :

'a-tor resi-o &AD ?

: )<:smo-er 6 berhenti se0a- 2 tahun an" #a#u

@ !T :

@ DM :@ Dis#iiemia :

@ '! :



Pemeri-saan si-

$eaaan Umum ? sean"

$esaaran ? &M&

TD ? 1*2/7* mm!"

8ai ? % </m re"u#er

Pernaasan ? 2+ </m

Suhu ? +7,** (

Sat. 92 ? BC

eher ? EFP 5 6 2 (m!2*

Mata ? -on0un"ti3a tia- anemis, s-#era tia-i-teri-



Eantun"

Inse-si ? I(tus (oris ta- ter#ihat

Pa#asi ? I(tus (oris teraba 1 0ari #atera# M&S I& FI

Per-usi ? ;atas -anan? SD

;atas Atas ? I& II

;atas $iri 1 0ari #atera# M&S I& FIAus-u#tasi ? S1S2 re"u#er, murmur :/:, an "a##o :/:

Paru

Inse-si ? simetris -iri -ananPa#asi ? remitus -iri -anan

Per-usi ? sonor -iri -anan

Aus-u#tasi ? ;ron-o3esi-u#er, h 6/6 basah ha#us i basa#,

4h :/:



Abomen

Inse-si ? tia- tama- membun(it

Pa#asi ? sue#, hear an #ien tia- teraba

Per-usi ? timani

Aus-u#tasi ? ;U 6 norma#

)-stremitas

a-ra# han"at, uem :/:



EK" di I"D #a$ %&.'( )i*

S, HS rate %%</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HSurasi *,1*, ST JT (han"e :, F! :, F! :



Hb : 12,0 mg/dl

Leukosit : 9500/mm3

Ht : 37 %

Trombosit : 190.000/mm3

Na//!l : 13" /3,#/ 10#

$& : 121

'r/!r : "3/ 1,1

!!T : #3,#

!()

Tro* T

: 17

: + 0,01

+a*oraoriu$



nalisa "as Dara-

p : (,0

p120 : 0'

p20 : %0

12' : %3,3 4E : 5 &,%

S20 : %66 7



Rongen8-oraks :

18R 96 7, Sgo N, SgPo $enon#ol, pinggang #anung $endaar,apeks erana$, kranialisasi 5;, in<lra 5;.



WD/ - CHF fc III ec CAD

- Post PTCA 2 stent DES tahun 2013

- Hipokae!ia



Terai i IGD ?

IF'D 1 -o#/2= 0am

;o#us 'urosemi =* m" i3 ri urosemie mu#aien"an osis 5 m"/0am

a4at i ban"sa# 0antun"



EK" di *angsal #anung 05%0506% #a$ %=.'6 )i*

S, HS rate 7*</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS

urasi *,1*, ST JT (han"e :, F! :, F! :



WD/ - CHF FC III ec CAD- Post PTCA 2 stent DES tahun 2013

- Hipokae!ia



Terai i ban"sa# 0antun"

? IF'D 1 -o#/2= 0am

92 8M 1* /I

Dri urosemie mu#ai 5 m"/0am

Asi#et 1<1** m"

;isoro#o# 1<2,5 m"

ansora>o# 1<+* m"

amiri# 2<5 m"

Sirono#a-ton 1<25 m"

Sim3astatin 1<1* m"

$& 25 meK



P#an

&e- aa# hear, ro# #ii, asam urat, M"

&e- $ ost -ore-si

)-o-ario"ra



'o##o4:u i ban"sa# 0antun" 2%:12:2*15 0am *7.** WI;

S/ Sesa- naas 6 ber-uran"9/ -u -es TD 8 8 T

s" &M& BB/%7 %= </ 22L/ A

EFP 56* (m!2*

&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:

Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:

A/ : &!' '& III e( &AD

: Post PT&A 2 stent D)S tahun 2*1+: !io-a#emia

I : 1500 cc/24 jam

O : 3000 cc/24jam Balanced : -1500 cc

Diuresis : 2,08 cc/kgBB/jam



EK" di *angsal #anung 095%0506%

S, HS rate %=</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HSurasi *,1*, ST JT (han"e :, F! :, F! :





- Hipokae!ia



Terai ?

IF'D 1 -o#/2= 0am

92 8M 1* /I

Dri urosemie 5 m"/0am Asi#et 1<1** m"

;isoro#o# 1<2,5 m"

ansora>o# 1<+* m"

amiri# 2<5 m" Sirono#a-ton 1<25 m"

Sim3astatin 1<1* m"



P#an


&e- $ ost -ore-si

)-o-ario"ra



'o##o4:u i ban"sa# 0antun" 27:12:2*15 0am *7.** WI;


s" &M& 1**/%+ %* </ 22L/ A

EFP 56* (m!2*

&or ? S1S28, re", murmur :, "a##o : Pu#mo? 3esi-u#er, rh 6/6 basah ha#us i basa# aru, 4h :/:Abomen ? Sue#, ;U 6 8)-stremitas ? a-ra# han"at, eema :/:

I ? 15** ((/ 2= 0am

9 ? 17** ((/ 2= 0am ;& ? : 2** ((/ 2= 0amDiuresis ? 1,1 ((/-";;/0am



EK" di *angsal #anung 0(5%0506%

S, HS rate %*</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS

urasi *,1*, ST JT (han"e :, F! :, F! :, ;;; in-om#it



aboratorium

8a/ $/ &#/ &a ? 1+%/ =,*/ 1**/ 7,1



nalisa "as Dara-

p : (,'=

p120 : 0=

p20 : 006

12' : %(,9

4E : 5 (,&

S20 : %66 7





- Hipocase!ia




?

IF'D 1 -o#/2= 0am 92 8M 1* /I


ASA 1<1** m"

;isoro#o# 1<2,5 m" ansora>o# 1<+* m" i3

amiri# 2<5 m"


Sim3astatin 1<1* m"

&a "#u(onas 1 "r



P#an


&e- &a ost -ore-si



'o##o4:u i ban"sa# 0antun" 2:12:2*15 0am *7.** WI;


s" &M& B5/%+ %2 </ 22L/ A

EFP 56* (m!2*


I ? 1+** ((/ 2= 0am

9 ? 155* ((/ 2= 0am ;& ? : 25* ((/ 2= 0amDiuresis ? 1,*7 ((/-";;/0am



EK" di *angsal #anung 035%0506%

S, HS rate %5</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS




aboratorium

Tota# (ho#/ !D/ D/ Tri"#iseria ? 151/ 22/ 1*B/ 1*1

Asam urat ? 12,1

$a#sium ? ,2



nalisa "as Dara-

p : (,&9

p120 : '

p20 : 000

12' : 0&,=

4E : %,%

S20 : %66 7





- Hipocase!ia pe"#aikan




?

IF'D 1 -o#/2= 0am 92 8M 1* /I


Ator 1<1** m"

;isoro#o# 1<2,5 m" ansora>o# 1<+* m"

amiri# 2<5 m"


Sim3astatin 1<1* m"



P#an

Pantau ba#an(e (airan/hari

)-o-ario"ra

AGD

Do4ntitrasi urosemie



'o##o4:u i ban"sa# 0antun" 2B:12:2*15 0am *7.** WI;


s" &M& 1**/%+ %5 </ 22L/ A

EFP 56* (m!2*


I ? 1=** ((/ 2= 0am

9 ? 1%** ((/ 2= 0am ;& ? : 2** ((/ 2= 0amDiuresis ? 1,1 ((/-";;/0am



EK" di *angsal #anung 0=5%0506%

S, HS rate %5</I, a<is AD, "e#omban" P norma#, P inter3a# *,2*, HS





?

IF'D 1 -o#/2= 0am 92 8M 1* /I


Ator 1<1** m"

;isoro#o# 1<2,5 m" ansora>o# 1<+* m"

amiri# 2<5 m"


Sim3astatin 1<1* m"



P#an

Pantau ba#an(e (airan/hari

)-o-ario"ra

AGD/hari

Do4ntitrasi urosemie



444.theme"a##er.(om

Framingham Criteria for Congestive Heart Failure



Framingham Criteria for Congestive Heart Failure

Dia$nosis of CHF "e%ui"es the si!utaneous p"esence of

at east 2 !a&o" c"ite"ia o" 1 !a&o" c"ite"ion in con&unction 'ith 2 !ino" c"ite"ia(

)a&o" c"ite"ia*+Pa"o,s!a noctu"na .spnea+

eck ein .istention+aes+a.io$"aphic ca".io!e$a inc"easin$ hea"t sie on chest "a.io$"aph4+ Acute pu!ona" e.e!a+S3 $aop+Inc"ease. cent"a enous p"essu"e 516 c! H27 at "i$ht at"iu!4+Hepato&u$ua" "efu,

+Wei$ht oss 58(9 k$ in 9 .as in "esponse to t"eat!ent

)ino" c"ite"ia*+:iate"a anke e.e!a+octu"na cou$h+Dspnea on o".ina" e,e"tion+Hepato!e$a+Peu"a effusion+Dec"ease in ita capacit # one thi". f"o! !a,i!u! "eco".e.+Tachca".ia hea"t "ate5120 #eats/!in(4)ino" c"ite"ia a"e accepta#e on if the can not #e att"i#ute. to anothe"

!e.ica con.ition such as pu!ona" hpe"tension; ch"onic un$ .isease;

ci""hosis; ascites; o" the neph"otic sn."o!e4(The F"a!in$ha! Hea"t Stu. c"ite"ia a"e 100< sensitie an. =>< specific fo" i.entifin$ pe"so

hea"t faiu"e(



Metabo#i( a(iosis? athohsio#o",ia"nosis an mana"ement AT?E EIE'S @

EPhoo$( 20 )ac!ian Pu#ishe"s Jefrey A. Kraut and Nicolaos E. Madias

laporan jaga chf maheli koto jumat

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