PATIENT PARADE Ali Sundoro, dr., SpBP-RE (K) Mei 5th, 2015

Parade Dr. Irra R, SpB, SpBP-RE(K)30Agustus 2015Jocliedian G. LilihataWorking Diagnosis : (patient was consulted from emg internal dept)

- Ulcus decubitus gr 2-3 ar scrum, trochanter dx, pedis bilateral - DM type 2 with neuropathy, Anemia inflamasi, Hiponatremia, susp TB paru

Present State CMBP : 110/80 mmHg RR : 22 x/min HR : 88 x/min t : 36,4

Mr. Jakfar / 72 y.o / Fresia 2Admission : August 19th, 2015Consultant : Irra Rubianti dr., Sp.B., SpBP-RE clinical picture 19/8/2015

21/08/2015

Clinical Pictures 24/08/2015

27/8/15

Post Local ND

Lab19/08/201521/08/1524/08/2015Hb8,29,08,9Hct 252727Leukosit13.20013.90013.800Trombosit278.000320.000382.000Ur / Cr16,0,6Na / K123128/4.0Alb/ Tot. Prot1,7/4,9gdp/2jpp150/23590/195GDS114Laboratory FindingKultur Pus 19/8/15

ManagementInternal Department DepartmentIVFD NaCl 0,9% 1500 cc /24 hDiet DM 1500 kkal/ day- Novorapid 6-6-6 u/SC , Lantus 0-0-10 u/SC- Meropenem 3x500mg iv- Check BTA sputum SPS

Plastic Department:

Moblization every 2 hoursTarget Hb >10, Na >135, Alb >2,5Wound Hygiene + Local Necrotic debridement Dressing change with hydrogels + moist gauzeConsult to IKFR dept to mobilization + chest fisiotherapy

Working Diagnosis :Residive Squamous Cell Carcinoma + Xeroderma Pigmentosa + heliophobia

Operation history :2009 : excisi + STSG +FTSG 2010 : excisi + STSG2011 : biopsi excisi +stsg2014 : radical excisi + FTSG

Present State CMBP : 100/60 mmHg RR : 18 x/min HR : 88 x/min T : 36,7CAt nasal : nostrils (+), nose (-)At left frontal : mass (+), brown, immobile, pain (+)At fascial, trunk, extremities supeior et inferior bilateral : brownish pigmentation (+)

boy Ramdan/ 9 y.o / Kemuning 2Admission : August 10th, 2015Consultant : Irra Rubianti dr., Sp.B., SpBP-RE(K) Clinical picture 14/8/2015

Lab18/8/2015Hb14,1Hct 39Leukosit8600Trombosit336.000Ur / Cr18/0,35Na / K135/3,5GDS151SGOT/PT19/8PT/INR/APTT14,9/35,9/1,13Laboratory FindingmanagementJoin conferencePlan for recontruction ( excisi + Flap )Working Diagnosis :Post necrotomy debridement due to vein compromis in patient post closed defect with latisimus dorsi + craniectomy debridement due to Neglected electrical burn injury grade 2-3 TBSA 14 % at scalp, posterior trunk, right hand, bilateral lower extremities and genitalia with bone expose and temporoparietal osteomyelitis at cranial region

Operation History :- 6-8-2015 : closed defect with latisimus dorsi + craniectomy debridement12-8-2015 : necrotomy debridement 18-8-2015 : necrotomy debridement

Local stateAt cranial : bone expose (+), necrotic (+)

State BP : 110/80 mmHg RR : 20 x/minHR : 88 x/min Temp : 36.5oC

Mr. Asep Taofik/ 26 yo/kemuning 4Admission : July 4th, 2015Consultant : Irra Rubianti dr., Sp.B., SpBP-RE(K)Clinical picture (4/7/2014)

Clinical picture (27/7/2015)

Clinical picture 31/7/2015

Clinical picture 2/8/2015

6-8-2015

12-8-2015

12-8-2015

14-08-2015

Intra op ND 18-08-2015

20-08-2015

22-08-2015

24-08-2015

30/08/2015

Laboratory FindingsLab4/7/1524-07-201531/07/201518-08-201524-08-2015PT/APTT/INR12.4/22.8/1.1613,2/29,2/0,9710,4/23,8/0,969,7/0,90/22,8Hb13.515,214,711,514,2Hct 4045443445Leukosit970010.4008.30087009500Trombosit532000379,000328.000339.000509.000Ur / Cr21/0.4423/0,6919/0,4517/0,40Na / K128/5.3135/5,2134/4,3138/4,1139/4,6Random Glucose11713014111387Alb/TP2.8/5.73.4/6.43,6/6,13,7/6,24,0/6,4Schedel AP/L

Necrotic tissue Culture (12-08-2015)AntibiotikResultAmikacinSAmpicillin SulbactamRAztreonamRCefepimeRCeftazidimeRCeftriaxonRCephazolinRCiprofloxacinSCotrimoxazoleRGentamycinRMeropenemSPiperacillin TazobactamITigecyclinSFounded Klebsiella pneumoniae ManagementIVFD RL:D5 2:1 1500 cc/24 hourRegular diet 2000kkal/24 hourCiprofloxacine 2x 500 mr IVMetronidazole 3x 500 mg IVPCT 3x1 gr IVBed preparation Dressing change with tulle, moist gauze every dayR/ STSG + lokal flap