Download - Mr Dhf Fathia
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IDENTITAS PASIEN
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ANAMNESIS
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RIWAYAT PENYAKIT SEKARANG
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HIPERTENSI (-)Diabetes Melitus (-)
Asthma (-)
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PEMERIKSAAN FISIK
Kesadaran : ComposmentisKeadaan umum : Tampak Sakit Sedang Tekanan darah : 110/80 mmHgNadi : 80 x/menitPernafasan : 18 x/menitSuhu : 36,4 ˚C
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Genitalia
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Pemeriksaan Hasil Nilai Rujukan
Hemoglobin 14,2 g/dl 11,4 – 17,7Leukosit 2.600/mm3 4000 – 10500Trombosit 54.000 mm3 140000 – 440000Hematokrit 46,0 U/l 35– 55
Pemeriksaan Penunjang (01/02/2016)
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PLANNING
• IVFD RL 30 tpm• Inj. Ranitidine 50 mg / 12 jam• Inf. Paracetamol 1 gr --> kp suhu > 38°C• P.O: Dexanta syr 3 x 1 C• Observasi klinis dan KU• DLO / 24 jam• MRS RPD/ Co.Sp.PD
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Observasi2/2/2016
• JAM 14.30• Subjective:Lemah, pusing, gusi berdarah• Objective:KU/Kes: Tampak lemah/ ComposmentisTD : 110/80 mmHgN : 80X/menit, lemahRR : 20 X/menitS : 34,5° CEks: akral dingin (+)Gingival Bleeding (+)
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Pemeriksaan Hasil Nilai Rujukan
Hemoglobin 13,9 g/dl 11,4 – 17,7Leukosit 3.800/mm3 4000 – 10500Trombosit 23.000 mm3 140000 – 440000Hematokrit 44,4 U/l 35– 55
Pemeriksaan Penunjang (02/02/2016)(jam 12.00)
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Assestment:-DHF grade IIIPlanning:-IVFD RL 6 cc/kg BB/jam evaluasi 4 jam 1200 cc (4 jam)-Observasi Klinis dan KU-DLO/12 jam
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Follow UpObservasi (IGD pukul 18.30)
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Pemeriksaan Hasil Nilai Rujukan
Hemoglobin 13,2 g/dl 11,4 – 17,7Leukosit 6.300 4000 – 10500Trombosit 16.000 mm3 140000 – 440000Hematokrit 42,7 U/l 35– 55
Pemeriksaan Penunjang (02/02/2016)(jam 23:53)
PPT : 18, 0 (kontrol: 14,1)APTT: 49,5 (Kontrol: 34,0)
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Follow UpFOLLOW UP (RPD)
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Pemeriksaan Hasil Nilai Rujukan
Hemoglobin 13,9 g/dl 11,4 – 17,7Leukosit 6.600/mm3 4000 – 10500Trombosit 13.000 mm3 140000 – 440000Hematokrit 37,7 U/l 35– 55
Pemeriksaan Penunjang (03/02/2016)(jam 08.00)
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TINJAUAN PUSTAKA
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DEFINISi
Demam dengue/DD dan demam berdarah dengue/DBD (dengue haemorrhagic fever/DHF)
adalah penyakit infeksi yang disebabkan oleh virus dengue dengan manifestasi klinis demam, nyeri
otot dan/atau nyeri sendi yang disertai leucopenia, ruam, limfadenopati, trombositopenia dan diathesis
hemoragik
DBD dibedakan dari DD berdasarkan adanya peningkatan permeabilitas vaskuler dan bukan
dari adanya perdarahan
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MANIFESTASI KLINIS
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Demam Dengue
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Demam Berdarah Dengue
Diagnosis klinis ditegakkan bila didapatkan >2 gejala klinis dengan trombositopenia dan hemokonsentrasi.
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DF/DHF GRADE SYMPTOMS LAB
DF Fever with two or more of following:HeadacheRetro orbital painMyalgiasArthralgias
Leucopenia, occasionally thrombocytopeniamay be present. No e ⁄ o plasma loss.
DHF I Above signs plus positive tourniquet sign
Thrombocytopenia < 100 000; Hct rise ≥ 20%
DHF II Above signs plus spontaneous bleeding
Thrombocytopenia < 100 000; Hct rise ≥ 20%
DHF* III Above signs plus circulatory failure(weak pulse, hypotension, restlessness)
Thrombocytopenia < 100 000; Hct rise ≥ 20%
DHF* IV Profound shock with undetectable BP and pulse
Thrombocytopenia < 100 000; Hct rise ≥ 20%
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Grafik 2 : Demam Bifasik pada Demam Berdarah Dengue
Grafik 3 : Kurva suhu pada demam berdarah dengue,saat suhu reda keadaan klinis pasien memburuk (syok)
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DD MANIFESTASI KLINIS DBD
++ NYERI KEPALA +
+++ MUNTAH ++
+ MUAL +
++ NYERI OTOT +
++ RUAM KULIT +
++ DIARE +
+ BATUK +
+ PILEK +
++ LIMFADENOPATI +
+ KEJANG +
- KESADARAN MENURUN ++
- OBSTIPASI +
+ UJI TORNIQUET POSITIF ++
++++ PETEKIE +++
- PERDARAHAN SALURAN CERNA +
++ HEPATOMEGALI +++
+ NYERI PERUT +++
++ TROMBOSITOPENIA +++
- SYOK +++
Tabel 2 : Manifestasi klinis DD dan DBD
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PEMERIKSAAN PENUNJANG
Pemeriksaan laboratorium
Pada pemeriksaan darah ditemukan : •Leukopenia pada akhir fase demam•Limfositosis biasanya terlihat sebelum fase syok•Hematokrit meningkat >20% (hemokonsentrasi), harus dimonitor setiap 3-4 jam pada kasus DHF atau DSS•Trombosit <100000 (trombositopenia)
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DIAGNOSIS BANDING
Chikungunya
ITP
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