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1 day BHA
3 days BHA
than other kids. progressive minutes. Before
Diagnosed enlarged. Fever and after seizure
hydrocephalus. (+), 40C. conscious. Bluish
Performed VP- appearance.
Diarrhea (-), Taken to
shunt. coughing (-), Sumedang
vomiting (-), hospital
Physical Examination
General Status:
P : 148 BPM, RR : 28 BPM Temp: 38,4C Weight 5 kg
Local Status:
Head circumference 53 cm (40-44 cm)
Anterior fontanelle open, convex, tense, 10x9 cm.
At left Keens point: shunt pump effective, slow filling
Neurological Status:
CCS 11, nuchal rigidity (-)
Pupil round equal ODS 3mm, LR ODS +/+
Visus : difficult to be evaluated
Funduscopy: difficult to be evaluated
Eye ball movement: dolls eye (+)
Other cranial nerve: difficult to be examined
Motoric : no hemiparesis
Sensoric: difficult to be examined
Physiologic Reflex : +/+
6
Pathologic Reflex : Babinski (-/-)
Chest X-Ray, RSHS, 07/03/2015
within normal limits
7
Non-Contrast Head CT Scan, RSHS,
08/03/2015
Shunt placement in
posterior horn, left
lateral ventricle
Multiple septa (+)
8
Lab Result Ur/Cr 11/0,17
Hb 9,0 Na/K 133/4,9
Hct 30 Glucose 83
Leu 8,600 NS1 Dengue Non Reactive
Thro 70,000
9
NP 2: Risye Krisnawaty//65 yo/15060232/Oncology/BW
CC : Generalized Weakness
History :
Since 3 days before hospital admission, the patient felt
generalized weakness, and was unable to stand. Because of this she fell
to the floor when getting out of bed in the morning. Complaint of
headache (+), vomiting (+), seizures (-), disturbance of vision (-). She
was taken to Santosa hospital, and referred to Hasan Sadikin hospital.
Past history:
1 year before admission, the patient started feeling headaches,
which can still be relieved with medication. The complaint was not
accompanied with vomiting, seizures, or motoric weakness.
7 months before admission, the patient felt weakness of her left
extremities. Also, her headache was getting worse, vomiting (+). She
had confused speech. She was taken to Santosa hospital, diagnosed
with brain tumor, and had craniotomy tumor removal in July, 2014 by
dr. Beny A.W., SpBS. After the operation, she felt her headache has
resolved, and had no other complaints. She had 24x radiotherapy in
December, 2014
1 month before admission, the patient started feeling the same
headaches again.
10
NP 2: Risye Krisnawaty//65 yo/15060232/Oncology/BW
1 month BHA
7 months BHA
Headaches, Headache
3 days BHA
1 year BHA
13
Contrast enhanced MRI, Santosa hosp,
26/07/2014
14
Contrast enhanced MRI, Santosa hosp,
26/07/2014
15
Contrast enhanced MRI, Santosa hosp,
26/07/2014
16
Postop Contrast enhanced CT scan, Santosa
hosp, 18/12/2014
17
Postop Non - Contrast CT scan, Santosa hosp,
26/02/2015
18
Comparison of Post-Op CT scans
20
Emergency Patients
ER 1: Yasid//8 yo/1500006708/Trauma/MZ
CC : Headache
History :
1 hour before hospital admission, while the patient was playing in his house in
Pasteur area, he slipped from the second floor stairs, with his head hitting the
ground. History of unconsciousness (+), vomiting (-), bleeding from ear, nose or
mouth (-). He was brought directly to emergency department, Hasan Sadikin
hospital.
General Status:
BP: 110/70 mmHg, P : 80x, Temp: afebrile, RR : 18x
Local Status:
At right parietal: hematoma (+), multiple lacerated wounds
each 1x0,5x0,5 cm based on subcutaneous tissue
At right shoulder: swelling (+), bruising (+), deformity (-)
At right wrist: swelling (+), bruising (+), deformity (-)
Neurological Status:
GCS : 15, Pupils round, isocor RLO 3 mm, LR ODS +/+
No motoric paresis.
22
Cervical and Chest X-Ray, RSHS, 07/03/2015
No fracture line
23
Skull X-ray, RSHS, 07/03/2015
No fracture line
24
Lab Result
Hb 15,1
Hct 43
Leu 12,200
Thro 169,000
WD/ Mild head injury + multiple lacerated wound of right parietal + closed
fracture of right distal radius, incomplete buckle type
25
Urgent Consults
Emergency Operations
Pre Op
Post Op
NCCU
POD /
Bed Name Sex Age GCS initial GCS today Diagnosis Procedure Problem Therapy KS
HR
NCCU
SOL supratentorial at right frontal due to susp. Craniotomy Tumor Removal R/ Pindah ruangan
1 Agus M 45 yo POD 1 15 15 FM
Oligodendroglioma (01.2) biasa
5
Closed observation
SOL Supratentorial at Right Sphenoorbital due to Hiponatremia
K/ IPD
susp. Sphenoorbita Meningioma Craniotomy Tumor Removal Hipokalemia
6 Entin F 38 yo POD 3 15 E1M1Vt = 2t Tampung Urin 24 RS
ICD 10: Benign Neoplasm of Cerebral Meninges (01.2) Polyuria
Jam
(D.32.0) CPP 2 CmH2O
Loading cairan
POD /
Bed Name Sex Age GCS initial GCS today Diagnosis Procedure Problem Therapy KS
HR
NPIU
Shunt malfunction due to post VP shunt due to
hydrocephalus + Seizure observation +
thrombocytopenia + severe malnutrition
Sami Kedira ICD 10 : Febrile convulsions (R56.0), Presence of Endoscopic Septa Fenestration +
6 M 6 mo PH 1 CCS 11 CCS 11 Rawat bersama IKA MS
Ramadan cerebrospinal fluid drainage device (Z98.2) + VP-shunt (02.34)
Communicating hydrocephalus (G91.0) +
Unspecified severe protein-calorie malnutrition
(E43) + Secondary thrombocytopenia (D69.5)
Thank You for Your Attention
Chief on call : dr. Oskar A. Widarta
Chief on site : dr. Guata Naibaho
Jaga 2 : dr. Petra O.P. Wahjoepramono
Jaga 3 : dr. Rhonaz P. Agung
Jaga 5 : dr. Lukas Galileo
Jaga 5b : dr. Festus Andrianto Susilo