Malaria Cerebral

Agnes Wanda Suwanto

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Definisi

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EPIDEMOLOGI

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 PATOFISIOLOGI
Hipertropi Ventrikel Kiri

Risk : 1. Hipertensi
2. Peningkatan BB

Tekanan After Load Stimulus mekanis sistem renin-

pertumbuhan sel miokard pertumbuhan

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PROGNOSIS

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LAPORAN KASUS

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 Summary of Data Base
Mr. S/Male/55 y.o/W 24 B
Chief Complaint : chest pain
The patient suffered from chest pain since 5 hours before
admission, at the left area, heavy sensation, radiated to the
back, did not radiated to the jaw/left arm, lasted for 30
minutes, while patient was sleeping (at 4 o’clock in the
morning). The complaint was accompanied by shortness of
breath. Actually, the patient has been suffering from shortness
of breath since one year ago, but it has got worsened since
the last two weeks. The shortness of breath occurred during
activities (walking more than 5 meters), and subsided during
rest.
 Physical Examination
BP: 116/93 (ER) HR: 112 bpm (ER) RR: 20tpm T.ax: 37 0C
120/80 mmHg HR: 93 bpm (Ward); PR: 93 bpm
(irregular-irregular)
General Appearance : looked moderately ill GCS : 456
BW: 46 Kg; BH 165 cm; BMI: 16.89 Kg/m2
Head Anemic conjunctiva(-) Icteric sclerae (-) LN enlargement (-)
Neck JVP : R + 2cm H2O; 300
Chest Heart Ictus visible and palpable at 6th ICS, 7 cm lateral from MCL S
(3cm of wide)
RHM ≈ 2 cm SL Dextra;LHM ≈ ictus
S1, S2 single, no murmur
Lung Symmetric; SF D=S; S| S V|V no additional breath sound
S| S V|V
S| S V|V
Abdomen Flat, BS (N), Liver span68 cm, traube’s space tympanic, soft,
tenderness (+) at epigastric area
Extremities Warm; Edema (-)
 Laboratory Findings
Lab Result Normal Value Lab Result Normal Value

Leukocyte 9.050 3,500-10,000/µL Sodium 136 136-145 mmol / L

Hemoglobine 11.5 11.0-16.5 g/dl Potassium 3.50 3.5-5.0 mmol / L

PCV 34.3 35-50% Chloride 99 98-106 mmol / L

Thrombocyte 264,000 150,000- RBS 135 > 200 mg/ dL

SGOT 43 11-41U/L Ureum 35 10-50 mg/dL

SGPT 30 10-41U/L Creatinine 1.04 0.7-1.5 mg/dL

Albumin 4.02 3.5-5.5 g/dL

05/08/2012
CK 160 39-308 U/L
CKMB 44 7-25 U/L
Trop I 0.50 (+)>1.0 U/L
 Urinalysis
Lab Value Lab Value
SG 10 x

PH Epithelia

Leucocyte Cylinder
Nitrite Hyaline
Protein Granular
Glucose Leukocyte
Erythrocyte Erythrocyte

Keton urine 40 x
Urobilinogen Erythrocyte
Bilirubin Leukocyte
Crystal
Bacteria
 Blood Gas Analysis
Result Normal Value
pH 7.50 7.35 – 7.45
PCO2 41.7 35 – 45
PO2 147.7 80 – 100
HCO3 31.8 22 – 26
SaO2 99.1 90 – 100
BE 8.7 -3 -+3
Conclusion: metabolic alkalosis uncompensated + hyperoxemia
 ECG Interpretation
 HR 100 bpm
 PR Interval: hard to be evaluated
 QRS Complex: 0.06“
 QT Interval: 0.32 “
 Frontal Axis: normal
 Horizontal Axis: CWR
 T inverted at V5-V6
 QS pattern at V1+V2
Conclusion: AF 100bpm, ischemic at lateral wall,
OMI anterior wall
 X-RAY INTERPRETATION
 AP position, symmetric, enough KV, enough
inspiration
 Trachea: deviated t the right
 Soft tissue: thin, and bone: normal
 Hemidiaphragma D:dome shape; coverewd by
cardiac imaging
 Sinus phrenicocostalis D: sharp; S: cut by film
 Pulmo : thickening of hillus D, BVP normal
 Cor : CTR 70%
 Conclusion: cardiomegaly
 CUE & CLUE PL IDx PDx PTx PMo
Male/55 YO 1. Atypical 1.1 AF -O2 8-10 LPM NRBM -Subj
-left chest pain, Chest 1.2 GERD -Bed rest -VS
radiated to the back, Pain -Semifowler postiion -UOP
for 30 minutes -Heart diet 1,700 -
-SOB;DOE;PND Kcal.Day, low sodium Cardiac
-History of smoking <2 gr/day enxym
(+) -ISDN 3x10mg (PO) -ECG
-History of HT (+) (EM) -
-BP 120/80 mmHG
-HR112 93x/m
irreguler-irreguler
-RR 4018 tpm
-ECG: AF HR 110 bpm,
OMI anterior,
ischemia lateral wall
-CPK 160 U/L
-CKMB 4 U/L
-Trop I 0.5 U/L
 CUE & CLUE PL IDx PDx PTx Pmo
Male/55 YO 2.Af RVR  2.1 -O2 8-10 LPM NRBM -S
-left chest pain, NVR dt. -Bed rest -VS
radiated to the No.1 -Semifowler postiion -ECG
back, for 30 -Heart diet 1,700 Kcal.Day, low
minutes sodium <2 gr/day
-SOB;DOE;PND -EM:
-History of Inj. amiodarone 150mg (IV)
smoking (+) bolus  drip amiodarone
-History of HT (+) 150mg in 100cc NaCl 0.9%
-BP 120/80 -Internal medicine ER:
mmHG Inj. Digoxin 0.5mg (IV) bolus at
-HR112 93x/m 12.30  4 hours later (still
irreguler- RVR): Inj. Digoxin 0.5mg (IV)
irreguler bolus at 16.30(NVR)
-RR 4018 tpm -Ward:
-ECG: AF HR 110 Digoin 1x0.25 mg (PO)
bpm, OMI -ASA 1x80mg
anterior,
ischemia lateral
wall
 CUE & CLUE PL IDx PDx PTx PMo
Male/55 YO 3.HF 3.1 CAD -Lipid profile -Bed rest, -S
-SOB,DOE,PND Stg. C 3.2 HHD -Echo- semifowler -VS
-History of leg swelling FC III cardiography position -UOP
-History of HT -Heart diet 1,700
(180/…mmHg) Kcal.Day, low
-History of smoking sodium <2 gr/day
-BP 120/80 mmHG -ISDN 3x10mg
-HR112 93x/m irreguler- -Captopril 3x12.5
irreguler mg (postponed)
-RR 4018 tpm -Simvastatin
-ictus: 3cm wide, at ICS 6, 1x20mg
7cm lat from MCL Sx, RHM
2 cm lat from SL D
-CXR: cardiomegaly
Male/55 YO 4.GERD -Endoscopy -Inj. Ranitidin -S
-Abdominal pain, at 2x50mg (IV) -VS
epigastric area
-Burning sensation
-Chest pain
-Tenderness at epigastric
area
TERIMA KASIH

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