parade thorax 3rd week patar
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PARADE THORAX30-09-13
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Anyelir
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Pasien telah diparadekan sebelumnya
DK/ Post Insersi CTT Dx ai.
Hidropneumothorax dx e.c TB + Decomp
Cordis Fc II POD XXXI
Pemasanan !TT "30#$#%013&'
Operat(r' dr)Rei#dr)Herdiansyah
Air *ubble "+&
,ndulasi "+&
Pr(duksi inisial 300 ser(usanuin(us
11..Ny.Risnia RisnawatiNy.Risnia Risnawati//34 thn34 thn/ MRS 22-08-13
DPJP : dr. Rama SpBTK MR:13010422
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Anamnesis
.,' sesak na/as A.'
eak 3 bulan 2R pasien meneluh sesak na/asdisertai batuk-batuk berdahak kunin yan semakinberat dan dirasakan makin memberat terutama 3
hari terakhir) esak dirasakan semakin bertambahsaat aktiitas dan berkuran saat istirahat) esakdia4ali saat (s melahirkan anak ke-%) Ri4ayat darahtini "-&5 tunkai membenkak "-&) Ri4ayatpen(batan T* "-&5 demam lama "-&5 penurunanberat badan dalam 6 bulan terakhir "-&) Ri4ayathipertensi "-&5 kenin manis "-&5 penyakit antun"-&)
.arena keluhannya pasien ber(bat ke d(kter di
R,D 7arut5 kemudian diruuk ke RH
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tatus Presen
Status Generalis :
Kes : CM, tenang
N : 84/menit R: 20x/menit, reguler
TD : 110/80 mmHg S: !,2 C
STATUS LOKALIS
T"#ra$s : %/& simetris, R"'/', (" '/', )%S $anan*$iri
(SD+0//201-:.ir %ule +'-
nulasi +-
3r#u$si 10 55/24 6am
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R(ntent Th(ra83/!/"#3 "3/!/"#3
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R(ntent Th(ra8#3/!/"#3 !/!/"#3
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$/!/"#3 3#/%/"#3
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Post&CTT '3/%(Pre&CTT ")/%(
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ab(rat(rium
3/! */! #"/! #3/! #!/! ""/! "!/!Hb $5$ 953 :5$ $5; 95% 10)%
Ht %9 31 %: %$ 31 33
euk(sit 10)%00
9)%00 1;)%00 1:):00 10)100 9)%00
Tr(mb(sit
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ab(rat(rium putum
"%$#$#%013&'
3 *TA tidakditemukan
euk(sit' >%
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ab(rat(rium
nti,ioti-
Am(8yillin-!la
Ampiillin urbatam
!e/adr(8il
!e/epime R
!e/(pera@(ne
!e/(8itin R
!e/ta@idime !e/tria8(ne
!hl(rampheni(l
!ipr((8ain R
!(trim(8a@(le
2er(penem
Kultur an Resistensi S7utum +2/8-:
' Dit Kuman Mi5r#5#55us
nti,ioti-
Amikain
Ampiillin ulbatam B
Astre(nam
!e/epime
!e/ta@idime
!e/tria8(ne
!ipr((8ain R!(trim(8a@(le
7entamyin
e((8ain R
Tieylin
2er(penem
Kultur an Resistensi S7utum +21/-:
'Dit Kuman: Candida albicans'Klebsiella pneumoniae
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Analisis !airan Pleura
=ama %3#$ 19#9
P2= %< 96
2= :< ;
Cumlah eleuk(sit
;900 -
arna 2erah .unin
.erernihan .eruh .eruh
Albumin 990 $60
DH :1
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Penatalaksanaan
*edrest duduk5 nasal O% 3 #menit
BFGD R 1
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2elati
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DK/ Post Insersi CTT in POD ai.
0mp1ema in e.c susp TB + D2 Tipe II
Pemasanan !TT "30#$#%013&'Operat(r' dr) !itra#dr) Patar
Air *ubble "-&
,ndulasi "+&
Pr(duksi inisial %0 ser(usanuin(us
11..Ny.Ny.Bedah Jubaedah/Bedah Jubaedah/5151thnthn/ MRS 25-09-13
DPJP : dr. Rachim SpBTKV MR:13011675
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Anamnesis
.,' sesak na/as A.'
eak 1 bulan 2R pasien meneluh sesak na/asdisertai batuk berdahak putih yan dirasakan terusmenerus yan semakin berat terutama seak 1
minu 2R) esak bertambah saat aktiitas dantidak berkuran saat istirahat) Pasien harus tidurdenan 3 bantal) esak tidak disertai bunyimeni ) Ri4ayat tunkai membenkak "-&) Ri4ayatpen(batan T* "-&5 demam lama "-&5 penurunanberat badan dalam 6 bulan terakhir "-&) Ri4ayathipertensi "-&5 kenin manis "-&5 penyakit antun"-&) Ri4ayat HT "+& seak < tahun 2R5 k(ntr(ltidak teratur)
.arena keluhannya pasien diba4a ke RH)
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tatus Presen
Status Generalis :Kes : CM, tenang
N : 0/menit R: 24x/menit, reguler
TD : 110/!0 mmHg S: !,2 C
STATUS LOKALIS
T"#ra$s : %/& tia$ simetris, R"'/', (" '/', )%S $iri I
(SD+0//201-:.ir %ule +'-
nulasi +-
3r#u$si 10 55/24 6am ser#us
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R(ntent Th(ra8"!/!/"#3 'Post CTT(
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R(ntent Th(ra8"*/!/"#3 'Pre CTT( "*/!/"#3 'Post CTT(
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ab(rat(rium
"*/! "%/!Hb 115; 105;
Ht 33 %$
euk(sit 1:);00 1;)600
Tr(mb(sit 3$9)000 33
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ab(rat(rium putum
"%9#9#%013&'
3 *TA tidakditemukan
euk(sit' >%
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Analisis !airan Pleura
=ama %:#9
P2= $%
2= 1$
Cumlah el euk(sit %::1
arna 2erah.erernihan .eruh
Albumin 1$:0
DH 10):
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Penatalaksanaan
Diet lunak 1
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DK/ Post Insersi CTT Dx POD II ai. 0usi
P4eura Bi4atera4 e.c susp TB + HP 4ate
onset
Pemasanan !TT "%1#9#%013&'
Operat(r' dr) Herdiansyah
Air *ubble "-&
,ndulasi "+&
Pr(duksi inisial
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Anamnesis .,' sesak na/as
A.'eak 3 minu 2R pasien meneluh sesak na/asyan dirasakan terus menerus5 tidak berkuran saatistirahat5 sesak berkuran bila penderita p(sisi duduk)esak tidak disertai bunyi meni) eak 1 tahun 2R5pasien meneluh batuk berdahak yan dirasakan terusmenerus5 disertai serin berkerinat di malam hari dankeluhan penurunan berat badan) Ri4ayat tunkaimembenkak "-&) Ri4ayat pen(batan T* "-&5 demamlama "-&5 penurunan berat badan dalam 6 bulan terakhir"-&) Ri4ayat hipertensi "-&5 kenin manis "-&5 penyakit
antun "-&).arena keluhannya5 % minu 2R5 pasien diba4a keR,D 7arut5 dilakukan r(ntent5 dikatakan ada airandi paru-paru kiri) .emudian dipasan selan di paru-paru kiri5 namun keluhan sesak dirasakan tidakberkuran) elan paru kiri kemudian diabut) Oleh
keluara5 pasien diba4a ke RH)
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tatus Presen
Status Generalis :Kes : CM, tenang
N : 0/menit R: 24x/menit, reguler
TD : 110/!0 mmHg S: !,2 C
STATUS LOKALIS
T"#ra$s : %/& tia$ simetris, R"'/', (" '/', )%S $iri I
(SD+0//201-:.ir %ule +'-
nulasi +-
3r#u$si 100 55/24 6am
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R(ntent Th(ra83/!/"#3 "#/!/"#3 'Post CTT(
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R(ntent Th(ra8"#/!/"#3 'Pre CTT( "#/!/"#3
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ab(rat(rium
"#/! ""/! "5/! ")/! "!/!
Hb 1%)3 105$ 1053 $53 10)0
Ht 3< 31 %9 %6 30
euk(sit 1%)%00 13)100 $)%00 3)6$00 9)300
Tr(mb(sit 6
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ab(rat(rium putum
"%;#9#%013&'
3 *TA tidakditemukan
euk(sit' >%
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Analisis !airan Pleura
=ama %1#9
P2= %02= $0
Cumlah el euk(sit 11%
arna .unin
.erernihan Aak.eruh
Albumin 1%10
DH 336
7luk(sa :6
Pr(tein %%93
Rialta "+&
Triliserida ;1
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ab(rat(rium
nti,ioti-
Am(8yillin-!la
Ampiillin urbatam
!e/adr(8il
!e/epime R
!e/(pera@(ne
!e/(ta8ime R
!e/ta@idime R
!e/tria8(ne
!hl(rampheni(l
!(trim(8a@(le R
2er(penem
Kultur an Resistensi Cairan 3leura+21/-:'Dit Kuman: Streptococcus viridans
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Penatalaksanaan
*edrest duduk5 nasal O% 3 #menit
BFGD R 1
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GA2*OJA=
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Pasien dik(nsulkan dari baian B.A denan '
Dk#
P(st Reinsersi tt d8 ai Tensi(n pneum(th(raks
d8 e) Ruptur blep e) T* miller + Destr(yedlun + Adult type T* POD ;:
DO ' 1
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PF 8
t)7eneralis '
.u ' !2
T ' 116#:$mmH R ' %68#mnt= ' 10%8#mnt ' 3:5%
a#r Th(raks '
* L 7 imetris5 F* ka M ki5 rh -#-5 4h -#-
D ' undulasi "+&5 air bubble "-&5
pr(duksi 10 #%; am
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Anamnesis
., ' esak na/as
A. ' N 6 hari 2R pasien meneluhkan sesakna/as yan dirasakan semakin lama semakinbertambah5 keluhan sesak na/as tidak disertai
denan suara meni atau men(r(k) .eluhan sesakna/as disertai denan batuk yan terus menerus5demam yan hilan timbul "+& seak 1 bulan 2R)Ri4ayat penyakit paru di linkunan rumah "+&)
karena keluhannya pasien diba4a ke R *ina sehat5karena alasan penuh maka pasien diba4a ke RH)
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ab(rat(rium
#/! $/! #/! #*/! "#/! "!/!
Hb 135: 1151 105< 956 95% 9)%
Ht ;3 3; 33 30 30 %$
euk(sit 1:):00 %;)
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Analisis !airan Pleura%#9#%013
P2= $6
2= 1;
Cumlah eleuk(sit
arna .unin
.erernihan Aak keruh
Albumin %90
DH 311
7luk(sa ?%
Pr(tein
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ab(rat(rium putum "%1#$#%013&'
Dit) .umanS.viridans
putum %;#$#%013 '
Cenis sample 'sputum
Pr(sedurpe4arnaan n
Tidak ditemukan*TA
euk(sit ' >%
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30-09-%013 %;-09-%013
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1
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0%-09-%013 01-09-%013
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%9#$#%013%%#0$#%013
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16#$#13 "p(st-!TT& 19#$#%013
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16#$#13
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1
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!T-an Th(ra8Pre !(ntrast
!T Th
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!T-an Th(ra8P(st !(ntrast
!T Th
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!T-an Th(ra8P(st !(ntrast
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!T-an Th(ra8
Pneum(th(rak kanan denan e/usi pleura danpenebalan pleura kanan minimal)
.(ns(lidasi disertai bayanan hip(dens multipleberbaai ukuran pada parenkim paru atas sampaiba4ah kedua paru denan inltrat dan arisbr(sis serta ambaran r(und lass di sebaianbesar kedua lapan paru dan pembesaran .7*peribr(nkial kanan !(nenital ysti
aden(mat(id mal/(rmati(n "!!A2& disertai T*!paruQ
Tidak tampak kardi(meali
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Penatalaksanaan
Obs T=R Diet T.TP O% %-; l#mnt R# *r(nh(s(py Pulm( BPD tidak A!! BPD minta
dipasan !TT riid Th#
OAT '9 Ri/ampisin 18%
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TERB2A .ABH
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