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BAYI ATERM (SMK) + ASFIKSIA
BERAT + GANGGUAN NAPASSEDANG + OMPHALITIS + TRAUMA FLEXUS BRACHIALIS +
DUGAAN SEPSIS NEONATORUM
RENI ARIANI PAWAN
PEMBIMBING KLINIK :
dr. KARTIN AKUNE, S.A
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PENDAHULUAN
A!"#!$% %d%&%' !% #*%d%% d$%% -%$ -%r &%'$r$d%# d%% -*r%%! !*/%r% !0%, *r%r d%%d*#%.
C% !#!*d%* %d%&%' !%&%' !% -*# r%%
&%'$r %#$-% 1%#0r *#!*r%&. P*-*2#%#% #&$#*%&% %d% -%$ %2 -%r &%'$r. G%22% %%! %d% BBL %d%&%' #*%d%% -%$ %2
!*-*&% 0r%& %% -%$ d*2% %!"#!$% %2*&%' d$&%##% d$r*!!$%!$ d% -*r'%!$&, *%$
-*-*r%% !%% #*d$% *2%&%$ 2%22% %%!. S*!$! *0%0r %d%&%' !$dr0 #&$$! %2 $-&%#$-% $3%!$ $#r00r2%$!* d%&% %&$r% d%r%' %2$-& %d% 4 -&% *r%% #*'$d%.
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LAPORAN KASUS
IDENTITAS PASIEN:
N%% : B. S
5*$! K*&%$ : P*r*%
T%22%& L%'$r : 6 D*!*-*r7849 #& 88.48 W$%
T%22%& M%!# : 9 D*!*-*r
7849 #& 44.88 W$%
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ANAMNESIS
B%$ *r*% &%'$r %22%& 6 D*!*-*r 7849#& 88.48 d$ RS K0&0*d%&* d*2% !0% L*%#B0#02 K*%&%. B*r% -%d% &%'$r 788 2r%,
%;%2 -%d% <= /. S%% &%'$r $d%# &%2!2*%2$!. S$%0!$! (+), *r$$' (+), r*r%#!$d$d$2 d%d% (+). A$r #*-% -*r/%r *#0$.A2%r S/0r* 6>9>=. K*&%$% #02*$%& (>),%! (+),%&% (+), r%% &%'$r (+) r%% &*?!-%/'$%&$!, $/@*/ +@+, !% -*r-%, R$%%%*r%& G4P8A8, I- -%$ *&%##% **r$#!%%
#*'%$&% !*/%r% *r%r d$ !#*!%!!. T$d%#*2%&%$ d*% !%% #*'%$&%.
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PEMERIKSAAN FISIK
PEMERIKSAAN TANDAVITAL :
D5 : 4<8 ?@*$ R*!$r%!$: 4
?@*$
S' : 68C
CRT : 7d*$#
PEMERIKSAANFISIK :
BBL : 7988 2rPBL : <= /
LK : 6,9 /
LD : 69,9 /LP : 6< /
LL : 46 /
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S$!* R*!$r%!$ : S$%0!$! (+) '$&%2
d*2% O7
R*r%#!$ (+) N%1%! /$2 '$d2 (+) M*r$$' (+) A* (>) B$ %1%!:
-r0#03*!$#&*r B$ %1%! %-%'%
(>)
S$!* N*r0&02$! : A#$3$%! -%$
:#r%2 A#$1
K*!%d%r% :/00!*$! F0%*&&% : d%%r Sr% : -*&
*
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Downe’s Score :
Fr*#*!$ %1%! : 4 R*r%#!$ : 4 S$%0!$! : 4 Ud%r% M%!# : 8 M*r$$' : 4 T0%& : <K*!$&% : 2%% %1%!Kr$*r$% WHO : G%22% N%%!
S*d%2
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S$!* K%rd$03%!#&*r :
B$ ;%2 : S4>S7r*2&%r r$
B$!$2 ;%2 (>)
S$!* H*%0&02$:
P/% (>)
I#*r! (>)
S$!* G%!r0$*!$%& :
K*&%$% d$d$2%-d0* (>)
M%' (>) D$%r* (>)
B$!$2 !! : (+) #*!%0r%&
U-$&$#! : -*r%%'(>), $r$%!$ (>), *d*% (>)
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S$!* G*$%& :
A! $*r10r%%(>)
L%-$% %0r%-*!%r, &%-$%$0r% #*/$&
P**r$#!%% &%$:
E#!r*$%! :
A#r%& '%2%,&*2#%
Tr20r : B%$#
Tr%% L%'$r : (>) K*&%$%
K02*$%& : (>)
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Ballard’s Score :
M%r$%! N*r0!#&%r M%r$%! F$!$#
S$#% -' : 6 > K&$ : 7
P*r!*2$ ;*d*&% : 6> L%20 : 7
R*/0$& &*2% : 6 > P*r#%% P&%%r : 6 T%d% !*&*%2 :< > P%d%r% : 7
Sd 0&$*% : < > D% T*&$2% : 6
T$ #* *&$2% : < > K*&%$ : 6 T0%& : 6
E!$%!$ M$22 K*'%$&% : 6><8 $22
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E!$%!$ !$% #*'%$&% *r #r3%L-!/*/'0: B%$ %*r + S*!%$ M%!% K*'%$&%
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K%*20r$ !*!$!:
K%*20r$ A
G%22%%%!: r*r%#!$d$d$2 d%d%,!$%0!$!,*r$$'.
K%*20r$ B
%#$3$%!-*r#r%2
A$r #*-%
-*r/%r*#0$
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RESUME
B%$ *r*% -%r &%'$r !*/%r% !0%. B*r% -%d% &%'$r788 2r%, %;%2 -%d% <= /. S%% &%'$r $d%# &%2!2*%2$!. S$%0!$! (+), *r$$' (+), r*r%#!$ d$d$2 d%d%(+). A$r #*-% -*r/%r *#0$. A2%r S/0r* 6 %d%*$ *r%% %$ -' #**r%'%, *!#r*$%! -$r,
d* ;%2 488 #%&$@*$, d% *r%%!% &%-%,%d% *$ #*>9 %2%r !/0r* d$ d%%#% 9 %$ -'#**r%'%, *#!r*$%! %!$' %2%# #*-$r%, d*
;%2 488 #%&$@*$, *#!r*$%! *#%!$ !*d$#$ d%*r%%!% %!$' &%-% d% %d% *$ #*>48 %2%r !/0r*
d$d%%#% = %$ !*&r' -' #**r%'%, d* ;%2 488 #%&$@*$, 2*r%#% !*d$#$, *#!r*$%! *#!$!*d$#$ d% *r%%!% %!$' &%-%. K*&%$% #02*$%&(>),%! (+), %&% (+), r%% &%'$r (+) Tr%% P&*?!Br%/'$%&$!, $/@*/ +@+, !% -*r-%. D%r$ '%!$&
**r$#!%% d$d%%#% !#0r d0 < d% !#0r -%&&%rd 6><8$22
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DIAGNOSIS
B%$ A*r (SMK) + A!"#!$%-*r% + G%22% %%!
!*d%2 + S*!$! *0%0r+ O'%&$$! + Tr%%&*?! -r%/'$%&$!
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PENATALAKSANAAN TERAPI: H%2%#% -%$
Ar 0!$!$ #*%&% -%$
I!% &*d$r ;$#% *r&
K*r$2#% d% r%2!%2 %#$&
Ar #*-%&$ 0!$!$ -%$
P*$&%$% D* ;%2, r*!$r%!$, d%
%r% #&$.
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O#!$2* 4 &$*r *r*$ IFD D*#!r0!% 9 **! *r*$ I;*#!$ C*10%#!$ 7? 498 2 I;*#!$ G*%$!$ 7 ? 49 2
ANJRAN PEMERIKSAAN : P**r$#!%% G&% D%r%' S*%# D%r%' r$
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F0&&0
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FOLLOW UP
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FOLLOW UP
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FOLLOW UP
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DISKUSI
Diagnosis pada kasus ini ditegakkan dengan melakukan
anamnesis, pemeriksaan fisik dan pemeriksaan penunjang.
Pada kasus ini ditegakkan diagnosis bayi aterm (SMK) +
Asfiksia erat + !angguan "apas Sedang + Dugaan
Sepsis + #mp$alitis + %rauma &leksus ra'$ialis
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A!"#!$% %d%&%' #*%d%% BBL $d%# -*r%1%!!*/%r% !0% d% *r%r %d% !%% &%'$r
%% -*-*r%% !%% !**&%' &%'$r.
Ad% 6 1%#0r %2 d%% **-%-#%A!"#!$% %d% -%$ -%r &%'$r.
F%#0r I- F%#0r &%!*% d% %&$ !%
F%#0r -%$
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F%#0r I-
Pr**#&%!$% d% *#&%!$%, P*rd%r%'% %*%r %-0r%& (&%!*%
r*3$% %% !0&!$0 &%!*%),
P%r! &%% %% %r! %/*, P%r! d*2% $d%#% ($!%& 3%#
*#!r%#!$, sectio cesaria), D*% !*-*& d% !*&%% *r!%&$%, I1*#!$ -*r% ( %&%r$%, !$"&$d, TBC, HI), d% K*'%$&% &*-$' -&% ( &*-$' <7 $22
#*'%$&%).
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F%#0r &%!*% d% %&$ !%
I1%r# &%!*%,
H*%0 &%!*%, L$&$% %&$!%, T%&$!% *d*#,
S$& %&$!%, d% Pr0&%!! %&$ !%.
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F%#0r B%$ B%$ #r%2 -&%@r*%r ( #r%2 6=
$22 #*'%$&%),
A$r #*-% -*r/%r *#0$, d% K*&%$% #02*$%& %2 *-*r$
d%%# %d% *r%%!% -%$.
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P%d% #%!! $$ 1%#0r r*d$!0!$!$
*r;%d$% %!"#!$% %d%&%' d%r$ 1%#0r $-,%$ %r! &%% %% &%% d$ ;%&% &%'$r
#%r*% -%$ %#% -*r!%'% *'$r d%r%#%r*% %!0#% 0#!$2* *&%&$ &%!*%$d%# */#$ d% !%% *2'$r
d%r% #*-% %!# #* %&3*0&$ %r>%r-%$ !*'$22% *r$!$ /%$r% %2**-%-#% #*!&$% -*r%1%! #*$#%&%'$r %% -*-*r%% !%% !**&%' &%'$r
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Pena!ala"sanaan Ba#$ Bar% La&$r den'an as("s$a :
P%!%2 ;%&r $1! $r%3*%, B$&% -%$ $d%# d%&% #*%d%% d*'$dr%!$ -*r$#% $1!
D*#!r0!% 9
P%% !*&%& %d% 3$%&
5%2% %*!$ ;%&% %%! B*r$#% O#!$2* ( 7>6 &$*r @ *$ d*2% #%**r %!%& )
5$#% -%$ *2%&%$ %*%:
L%##% $d%#% r*!!$%!$ !*!%$ %'% %2d$*r&#%
L%##% *$&%$% &%;
B$&% *r;%d$ #*;%2 002 #*;%2
S*2*r% *r$#!% #%d%r 2�!% d%r%' ( -$&% 1%!$&$%!*r!*d$% )
P*-*r$% r$!$ %d*#%
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Mana)e*en lan)%!an +asca res%s$!as$ :
K*r$2#% d% *% ;%2% #*'%2%%-%$,
L%##% $$!$%!$ *! d$$,
P%% %d% 3$%& $% ;%
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Gangguan pernapasan merupakan suatu
keadaan meningkatnya kerja pernapasan yang
ditandai dengan gejala : takipnea, bayi
dengan sianosis sentral, tarikan dinding dada,
bayi apneu, dan merintih.
GANGGUAN NAPAS
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P**-%- :
P%d% -%$ #r%2 -&% : *%#$ *-r%* '$%&$,
%!"#!$%, *0$%, #*&%$% %% %&10r%!$#02*$%&
P%d% -%$ /# -&% : transient tachypnea of the
newbornJ, *0$%, %!$r%!$ *#0$, %!$d0!$!
*%-0&$#, #*&%$% %% %&10r%!$ #02*$%&.
B%$ 0r%& @ %!"#!$% %2 -*r'%!$& d*2% r*!!$%!$
%#% *2%&%$ 2%22% %%!
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P%d% #%!! $$, 2%22% %%! %2
*r;%d$ -*r#%$% d*2% %!"#!$%, #%r*%
-%$ d*2% %!"#!$% %2 -*r'%!$&d$r*!!$%!$ %#% *2%&%$ 2%22%
%%!. G%22% %%! %2 *r;%d$
*r20&02 2%22% %%! !*d%2
#%r*% 1r*#*!$ %%! %d%&%' 8>8
#%&$@*$ d*2% r*r%#!$ d% *r$$'.
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M%%;** -%$ d*2% 2%22% %%!!*d%2:
L%;#% *-*r$% 87 d*2% #*/*%% %&$r% !*d%2 B%$ d$%!%#% B$&% !' %#!$&% 6<>6,98 C %% 6=,9>68 C %2%$ #!' %-0r%&
B$&% !' 0r%& *r! %%$, %d% #%!! $$ !' -%$0r%& B$&% $d%# %d% %d%>%d% #*%r%' !*!$!, $&%$ #*-%&$ -%$!**&%' 7 ;%. A%-$&% -%$ $d%# *;##% *r-%$#%%% %d%>%d% *r-r#% !*%&%' 7 ;%. K*2#$%-*!%r !*!$!. P%d% -%$ $$ d$*##% %d%% %d%>%d%
!*!$! *0%0r. B$&% *&%' *;#% *r-%$#% (1r*#*!$ %%! *r,%r$#% d$d$2 d%d% -*r#r%2 %% !%r% *r$$'-*r#r%2 Kr%2$ *r%$ 87 !*/%r% -*r%'%.
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SEPSIS
S*!$! -%#*r$%& %d% *0%! %d%&%'!$dr0 #&$$! d*2% 2*;%&% $1*#!$
!$!*$# d% d$$#$ d*2%-%#*r*$% %d% -&% *r%%
#*'$d%.
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S*!$! #%*20r$ A :
K*!&$% -*r%%! (%*%, %#$*%,r*r%#!$ d$d$2 d%d%, 2r$2, !$%0!$!).
K*;%2.
T$d%# !%d%r.
S! -' $d%# 0r%&.
P*r!%&$% d$ &$2#2% %2 #r%2
'$2$*$!. K0d$!$! *-r# d*2% /*% d%
dr%%$!.
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S*!$! K%*20r$ B:
Tr*0r L*%r2$ %% &2&%$. M*2%# %% %#$3$%! -*r#r%2.
Irr$%-*&@r**&. M%'. P*r #*-2. A$r #*-% -*r/%r *#0$. M%&%! $ K0d$!$ *-r# !*!d%' '%r$ #*
*%.
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P%d% #%!! $$ #%*20r$ A %$2%22% %%!, d% # #r$*r$% B%$ %#$3$%! -%$ -*r#r%2 !*r% %$r#*-% -*r/%r *#0$.
I*rr*%!$ : D2%% S*!$!
An!$,$o!$" -ara Dos$s dala* *'
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An!$,$o!$" -araPe*,er$
an
Dos$s dala* *'
.ar$ /01 .ar$ 23
A*+$s$l$n IV4 IM 56 *'7"'se!$a+ /8 )a* 56*'7"' se!$a+2)a*
A*+$s$l$n%n!%"*en$n'$!$s
IV /66*'7"'se!$a+ /8 )a*
/66 *'7"'se!$a+ 2)a*
Se9o!a"s$* IV4 IM 56*'7"' se!$a+/8 )a* 56 *'7"' se!$a+2 )a*
Se9o!a"s$*%n!%"*en$n'$!$s
IV 56*'7"' se!$a+ )a*
56 *'7"' se!$a+ )a*
Gen!a*$s$n IV4 IM ; 8 "'
<*'7"' se"al$se&ar$
=>5*'7"' se!$a+/8 )a*
8 "'
5*'7"' se"al$
se&ar$
=>5*'7"' se!$a+
/8 )a*
Pada "as%s $n$ +en'o,a!an #an' d$,er$"an ,er%+a $n)e"s$
ce9o!a?$* /56 *' 7 /8 )a* dan $n)e"s$ 'en!a*$c$n / ? /5 *'>
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OMPHALITIS
O1%&$$! %d%&%' $1*#!$ %d% %&$ !%-%$ -%r &%'$r %2 d$%d%$ d*2%
#&$ #**r%'% d$!*r%$ !.
F%#0r1%#0r %2 **-%-#%*r;%d$% $1*#!$ %&$ !% %d% -%$
-%r &%'$r %d%&%' !*-%2%$ -*r$# :
FAKTOR BAKTERI
FAKTOR MATERNAL
FAKTOR TRADISI
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TRAUMA FLEKSUSBRACHIALIS Tr%% %d% &*#!! -r%#$%&$! %2 d%%
**-%-#% %r%&$!$! &*2% %%! d*2% %%%% %r%&$!$! &*2% -%%' %% %2%, %%&*-$' &%$ %r%&$!$! d%% *r;%d$ %d% !*&r'
&*2%. Tr%% &*#!! -r%#$%&$! !*r$2 *r;%d$ %d%
*%r$#% &%*r%& %2 d$%#!%#% %d% #*%&%d% &*'*r, !*&%% *r!%&$% -%' %d%
r*!*%!$ 3*r*#! %% -$&% &*2% d$*#!*!$#%-*r&*-$'% d$%%! #*%&% %d% r*!*%!$ -0#02!*r% %d%% *%r$#% -*r&*-$'% %d% -%'
T F& B '$ &$
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Tr%% F&*?! Br%/'$%&$!*r-%2$ *;%d$ :
A> Paral$s$s Er,0D%c&ene %d%&%' K*r!%#%/%-%2>/%-%2 C9 C d%r$ &*#!! -$0#$%&$!**-%-#% #*&*%'% d% #*&'%
&*2% # *#!$, %-d#!$, d% *%r&*2% #*&%r !*r% '$&%2% r**#! -$!*!d% 0r0.
(T*r;%d$ %d% #%!! $$)
A> Paral$s$s Kl%*+"e %d%&%' K*r!%#%/%-%2>/%-%2 C I'4 &*#!! -r%#$%&$!**-%-#% #*&*%'% &*2% 00>00*#!! *r2*&%2%, %#% -%$ $d%# d%%*2*%&.
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K*!$&%
A!"#!$% %d%&%' !% #*%d%% d$%% -%$ -%r &%'$r $d%#d%% -*r%%! !*/%r% !0%, *r%r d% %d*#%.
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7/23/2019 Refka Peristi Reni
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