PROGRAM PENDIDIKAN
ILMU KESEHATAN ANAK
VISI
MENJADI PUSAT PENDIDIKAN DOKTER SPESIALIS ANAK PILIHAN DI
TINGKAT NASIONAL YANG MENGHASILKAN DOKTER SPESIALIS ANAK
YANG KOMPETEN DAN BERKUALITAS INTERNASIONAL TAHUN 2020
MISI
1. MENYELENGGARAKAN PENDIDIKAN KEDOKTERAN BERBASIS
KOMPETENSI BERSTANDAR NASIONAL, MUTAKHIR, PROFESIONAL,
DAN BERLANDASKAN KEILMUAN BERBASIS BUKTI
2. MENYELENGGARAKAN PENELITIAN KEDOKTERAN DAN KESEHATAN
YANG INOVATIF, UNGGUL, KOMPETITIF DAN BERORIENTASI PADA
PENGEMBANGAN ILMU DAN BERMANFAAT BAGI MASYARAKAT
3. MENYELENGGARAKAN PELAYANAN KESEHATAN ANAK YANG
HOLISTIK DAN KOMPREHENSIF
4. BERPERAN AKTIF DALAM PENGEMBANGAN PENDIDIKAN,
PENELITIAN KEDOKTERAN, PELAYANAN KESEHATAN ANAK DAN
PENGABDIAN MASYARAKAT
DOCTORS ON DUTY
2
Junior On Duty Madya On Duty
dr. Riefky dr. Fitriani
dr. Michael dr. Marselya
Madya II On Duty Emergency on duty:
dr. Fandi A dr. Dewi Rahmawati S
dr. Yudi R
Onsite Supervisor : Supervisor On Duty
dr. Aditiawati, Sp.A(K) dr. Indrayadi, Sp.A(K)
CO-ASSISTANT ON DUTY
Jaga IKA – B Jaga IKA – C
M Ridho Dika
Rieska M Marini
Jaga IRD Jaga Neonatus
Noelene Kang Yee Lea
TOTAL NUMBER OF INPATIENTS
Box Patients New Discharge Patient with Deceased Total
Patients Patients Problems
4
Gastroenterologi 5 - - - - 5
Nutrition & metabolic disease 0 - - - - 0
Endocrine 1 - - - - 1
Infection 3 - - - - 3
Respirology 11 - - - - 11
Al- Immunology 6 - - - - 6
Neurology 12 - - - - 12
Nephrology 3 - - - - 3
Cardiology 4 - - - - 4
Hemato-Oncology 37 1 - - - 38
Neonatology 20 1 - - - 21
PICU 4 1 - - - 5
NICU 14 - - - - 14
Surgery - - - - - -
Total 120 3 - - - 123
NEW PATIENTS DURING ON DUTY
Identity Diagnose/ Severity Division
No Differential Diagnose Level
1 Afril/boy/8 y.o Thalassemia + AIHA + OMP 3 Hematooncology
2 By.Ny.Ade/girl/10 m.o Brochiolitis 2 PICU
3 By. Ny Cik Ayu/18 h Omphalocele + DSD + susp fistula 3 Neonatus
uretrovaginalis
4 M Nafis/boy/4 y.o Tonsilopharingitis acute 4 outpatient
5 Zafir/boy/2 y.o Suspect DBD grade I 4 outpatient
6 Raka/boy/2 y.o Rhinopharingitis 4 outpatient
DECEASED PATIENT
6
No. Identity Diagnose Box
112
NORMAL
NORMAL
CRT<3
NORMAL
NORMAL
7
ANAMNESIS
Identity : By. Ny Cik Ayu/18 h
Time of Admission in ER : 8.30 pm Still in ER
Chief complain : intestine outside of the belly and covered with a sac
Present Illness History
+18 hours ago patient was born helped by midwife spontaneously from 28 years old
mother G2P1A0, appropriate gestational age, crying spontaneously, apgar score (8/9),
birth weigh 3.000, birth length (?), head circumference (?), history of premature rupture
membrane (-), foul smelling liqour, maternal fever (-). History of vitamin K injection (+).
At birth there appears intestine outside of the belly and covered with a transparant sac,
the patient's family and the midwive is unaware of the abnormalities in the genital.
referred to RSMH by private car, accompanied by midwives without incubators.
Abdomen was covered with cloth.
History of pregnant:
The patient's mother never the patient's mother has never been examined
for ultrasound during pregnancy. Routine control in midwife, infection
during pregnancy (-), hypertension (-), history of taking drugs, alcohol,
and herbs (-), history radiation (-), smoking (-)
Medication history:
-
Family History:
• History of omphalocele in family/sibling was denied
• History of sex ambigu in family was denied
Physical Examination
Activity : active heart rate : 132x/m Pale : (-)
Crying : strong respiratory rate : 40x/m cyanosis : (-)
Muscle tone : eutony temperature : 36,8oC dypsneu (-)
Sucking reflex :good oxygen saturation : 98% icteric : (-)
Body weight : 3.100gr
Body length : 48cm.
Head circumference : 31cm
Specific Condition
Head : normocephal, dismorfic (-), nasal flare (-) icteric sclera (-), anemic conjunctiva (-), pupil isochor
3mm/3mm light reflex (+/ +)
Chest : symmetrical, retraction (-)
Heart : normal 1st and 2nd heart sound, murmur (-), gallop (-)
Lung : vesicular (+) normal, rales (-/-), wheezing (-/-)
Stomach :
Inspection : a small amount of intestine is outside the stomach, covered with peritoneum with diameter
6cm, content of the sac is unknown with hyperemis areas around it.
Percusion : timpani
Palpation : liver and spleen not palpable.
Auscultation: bowel sound (+),
Extremity : warm extremities (+), CRT <3’’.
Genitalia : the right and left scrotum / labia (+), testes are not palpable, there is only a suspected
urethral and vaginal orifice
10
11
12
PROBLEMS ASSESMENT
1. Omphalocele FT- AGA + Omphalocele + DSD + susp
2. DSD fistula uretrovagina + clinical sepsis
3. clinical sepsis
DIAGNOSIS/DIFFERENTIAL WORKING DIAGNOSIS
DIAGNOSIS FT- AGA + Omphalocele + DSD + susp
- fistula uretrovagina + clinical sepsis
13
PLAN EXAMINATION THERAPY
• Blood rutin examination, ESR, • Ceftazidime 3x150mg iv
CRP, IT Ratio. • Cover omphalocele with gauze
• Blood culture • Consultation surgical division
• Echocardiography o conservative defect is closed by itself
• DSD invastigation ( USG genitalia) o If the defect is closed, operation
DIET MONITORING
Total calories : 3,1x(110-120) = Vital sign
341-372 Hypotermia
Total fluid : 60 x 3,1 = 186 ml Sac of ophalocele
Formula feeding: 8 x 25 ml = 240 ml
ADMISSION Pediatric surgery
Neonatus
Laboratory Finding (4/3/2019) RSMH
4/3/2019 Result Normal Value Unit
Haematology :
Haemoglobin 19,5 12.0 – 14.4 g/dL
RBC 4.180 4.75 – 4.85 106/mm3
WBC 19.07 4.5 – 13.5 103/mm3
Ht 55 36-42
PLT 273 217 – 497x 103 /µL
Diff count 0-1/1-6/50-70/20-40/2-8 %
BSS 55 60-100 mg/dL
LED 2 <15 mm/hr
CRP <5 <9 U/L
i/t ratio
15
16
THANK
YOU
