Girl S/ 12 yo /PICU

Admission : 28-12-17

Diagnosis
• Post ROSC + Septic shock
• Pressure ulcer grade IV at sacral, left major trochanter, left lateral maleolus, right calcaneal
• Pressure ulcer grade III ar right lateral maleolus
• Phlebitis at the right brachial
• Tetraparesis due to suspected spinal cord injury
• Anemia
• Electrolyte imbalance
Surgical History:
- none
Present state
Alert, weak,
BP: 110/70 HR: 80x/mnt T: 36,5°C
RR: on ventilator, PC, fiO2: 25%, RR: 20x/min, PS: 22, PEEP: 5, TV: 500
 Clinical Picture
th
February 11 , 2018
 Clinical Picture
th
February 11 , 2018
 Clinical Picture
th
February 11 , 2018
 Clinical Picture
th
February 11 , 2018
 Clinical Picture
th
February 5 , 2018
 Laboratorium
Darah Lengkap, Fungsi Ginjal, Fungsi Hepar, Elektrolit No BGA Normal 11/2/18
No Parameter Normal 7/2/18 9/2/18 11/2/2018 1 pH 7.35-7.45 7.391
1 Hemoglobin 12-16 8.0 7.3 8.2 2 pCO2 35-45 45.5
2 Hematokrit 35-47 24.1 23.4 26.4 3 pO2 80-105 45.4
3 Leukosit 4400-11300 10.800 8.350 8.500 4 HCO3 22-26 27.9
4 Trombosit 150000-450000 139.000 129.000 237.000 5 TCO2 23.05-27.35 29.3
5 Ureum/Creatinine 15-50/ 0.5-1.2 20/ 0.59 6 BE (-2)-(+2) 3.2
6 GDS <140 106 161 7 SaO2 75-100 77.9
7 SGOT/SGPT 15-37/14-59 18/10 145/46
No Urinalysis Normal 6/2/18
8 PT/APTT 11-15/21-41 10.90/ 19.10
1 pH 5.0-8.0 7.0
9 INR 0.8-1.2 1.00
2 Leukosit esterase (-) +2
10 Natrium 135-153 140 142
3 Eritrosit (-) +2
11 Kalium 3.6-5.5 1.7 3.0
Microscopic
12 Albumin 3.4-5.0 3.10
4 Erythrocyte 0-3/HPF 2
13 Asam laktat 0.7-2.5 5.8
5 Leucocyte 0-5/HPF 8
14 D-dimer <0.55
6 Bacteria (-) (-)
15 Fibrinogen 238-498
7 Fungi (-) (+)
 Wound culture, Pus Feb 2 nd 2018
• Isolate 1: Pseudomonas aeruginosa
• Gentamycin S
• Amikacin S
• Piperacilin/Tazobactam S
• Cefazolin R
• Ceftazidime S
• Ciprofloxacin S
• Tigecycline R
• Aztreonam I
• Meropenem S
 Blood culture, Feb 2nd 2018
• Isolate 1: No Bacterial growth
 Management
• Closed observation
• Wound care with duoderm gel
• Moisture and hygiene of the
skin around the wound
• Change position every 2 hour
• Antidecubitus bed
• PRC Tranfusion
• Electrolyte correction
• P/ MRI February 20th 2018
• P/ Defect closure with skin
flap
Th/
• Dopamin
• Dobutamin
• Meropenem 3x 800 mg iv
• Metronidazole 3x 500 mg iv
• Fluconazole 1x 300 mg iv
• Ranitidine 2 x 40 mg iv
• Paracetamol 4x 600 mg iv
• Asam folat 1x 1 mcg PO via
NGT
• KCl pulv 100 mg/ 8 jam PO