DUTY REPORT

April 9 2021
th

Duty Team April 8th, 2021

VISION AND MISSION OF PEDIATRIC SPECIALIST EDUCATION
MEDICAL FACULTY OF ANDALAS UNIVERSITY

Vision
• To become a leading institution of Pediatric Specialist Education in Indonesia in 2020.

Mission
• To practice a professional education for pediatricians and able to compete at the national
level
• To carry out researches and publications at the national level
• To carry out a sustainable community service activities and contribute to solve public health
problems, especially in the field of child health
• To carry out a professional and qualified child health services based on Evidence-Based
Medicine
 Duty Team
On site Consultant Morning : Dr. Ade Nofendra, Sp. A
Covid Consultant : DR. dr. Finny Fitry Yani, Sp. A(K)
Covid Consultant for Neonates : Dr. Eny Yantri, Sp.A (K)
Senior : Dr. Ivanny Khosasih
Madya of ER : Dr. Imil Irsal Iman
Dr. Arifi
Madya of Ward : Dr. Dya Mulya
Dr. Shinta Asbi
Dr. Isnaini
Dr. Freidlander Pangestu
Madya of Perinatology : Dr. Toni Kurniawan
Dr. M. Luthfi
Junior of Ward : Dr. Sylvetri Lestari
Dr. Neila Azka
Junior of Perinatology : Dr. Nice Fenobileri
 PATIENT
RECAPITULATION
 Room TOTAL
PICU : 4
HCU : 2
NICU : 13
SCN : 7
ACUTE : 14
CHRONIC : 16
Rooming-In : 1
Rooming-In Yellow Zone : -
 Room TOTAL
Obsgyn ward yellow zone : 2
Isolation Neonatus (Yellow Zone) : 1
Isolation Neonatus (Red Zone) : -
Edelweiss (IPJT) : 2
Bougenvile : -
New Patient : 3
Deceased Patient : -
NEW PATIENT
 NEW PATIENT
No Patient’s Identity Hour Comorbid diagnosis Covid criteria Laboratory / Rooms
Radiology finding
1 Suhaila Ilma Nafia/ ER 16.00 • T cell Leukemia suspek Covid 19 Hb: 5.8gr/dl Yellow zone
01079834/ girl/ 7yo • Pancitopenia ec L 830 /mm3
Arrive on 23.00 maglinancy Tr 8000/mm3
ward • Neutropenia Fever

2. Fathan Randika ER 14.37 • Bronkopneumonia Suspec and Hb : 7.5 gr/dl IPJT

Pratomo/ boy/ 3 mo/ • Susp. Hirschprung probable Covid 19. L 28070/mm3
01102406 Arrive on • Malnutrition Type Marasmic Tr 406.000
ward

3 Fahira/ girl/ 4yo ER 15.00 • Urinary Tractus infection Non suspect and Intermediate
• West syndrome no probable covid
Arrived 22.00 • Cerebral palsy 19
0
 PATIENT REPORT
(Complicated / with problems)
Fathan/Boy/ 3 mo/01102406
 Identity
• Name : Fathan Randika Prat
omo
• Age : 3 month old
• Date of birth : December 30th , 2020
• Gender : Boy
• MR : 01102406
Chief Complaint:
Dypsnue since 1 month ago
 Pediatric Assesment Triangle

•Appearance (TICLS)
– Tonus : eutonus
– Interactiveness : not interactive
– Consolability : consolable
– Look or gaze : eye gaze (+)
– Speech and cry : grunting
•Breathing
breathlessness (+), retraction (+), nasal flare(+)
•Circulation
–Mottled (-), pale (+), cyanotic (-)
Impression: Respiratory Failure
 PRIMARY SURVEY
• Airway : patent
Breathing : RR 65 x/minute, nasal flare (+), retraction (+), there was Rhonki +/+, whee
zing and slem +/+
• Circulation : extremity is warm, pale (+), CRT < 2 seconds, HR 160 x/minute
• Disability : normal posture, no seizure, no spasm
• Exposure : turgor normal
– Allergy : no
– Medication : no
– Past medical history : no
– Last meal : no
– Events lead : pale
 Present Illness History

2 month 1 month 7 days 4 days

ago ago ago ago
• Dypsnue • Stomach more • Vomiting 5-6 • Dypsnoe and patient
• patient got distenstion dan times/day 10 ml , got medication again on
medication more huge after given Moaro bungo Hospital.
Muara Bungo formula milks. • And patient refers to M
Hospital Djamil Hospital because
suspc. Hisprung
• Patient got Fever, peak
38.7 der celcius
 SECONDARY SURVEY
Chief Complaint Dypsnue since 1 month ago
Present • Dypsnue of complaints since 2 months before admission to hospital, did not whistling,
Illness was not affected by activity, weather and food.
History • There is no weight gain since birth 2 months ago
• Increased dypsnue and takypnoe since 1 month before entering the hospital
• Increasingly bulging and distention stomach since 1 month ago.
• Vomiting since 1 week, frequency 5-6 times / minute, after drinking milk, approximately
10 cc.
• Defecation, colour and consistency was usual
• Urination, colour and frequency was usual
S • Oral intake of soy formula 5-6x60 cc
• There were no skin, gum, digestive tract bleeding
• History of contact with COVID-19 Patient was denied
• The patient was admitted to Muara Bungo Hospital for 10 days. 1 month later, the
difficulty recurred and was treated at Permata Hati Muara Bungo Hospital for 4 days
then he was referred to the surgical department of RSUP M. Djamil Padang with
Hirsprung suspects
 SECONDARY SURVEY
Past • Spontaneously born in a midwife with a gestational age of 35 weeks. Birth
Illness weight 2600 grams, immediately crying, no complaints of jaundice. The child is
History not breastfed. Children are allergic to cow's milkThere is no contact with
people with COVID-19There is no history of traveling outside the city

Family • No family member has the same disease

S Illness
History
 Severe ill, E4M6V5, BP 98/42 mmHg, HR 160 times/minute, strong pulse lift and sufficient
pulse filling, RR 44 times/minute, temperature 38.2 C, saturation 95 %
BW 2.7 kg Weight for age < (-3)SD
BL 51 cm Stature for age < (-3)SD
LILA 9 cm Weight for stature < (-3)SD
Impression Malnourished

O Skin Warm, mottled skin (-), thin subcuticular fat (+), icteric (-), petechie/purpura (-)
Head Round, symmetrical, Head circumference 44cm (microsephaly)
Eye Conjunctiva anemic -/-, sclera icteric -, pupil 2mm/2mm, Light Reflect
+/+,
Nose Nasal flare -
Mouth Circumoral cyanosis (-)
Neck enlarged lymph nodes are not palpable
 Thorax Inspection Retraction (+) in epigastrium and intercosta
Palpation Fremitus Left = Right

Percussion Sonor

Auscultation Broncho-vesicular, rhales (+/+), wheezing (-/-)

Regular hearth rhythm, murmur (+)
Abdomen Inspection Distention (+), abdomen circumferens 36cm

O Palpation liver and spleen was not palpable

Percussion Timpany

Auscultation Bowel sound (+)

Extremity CRT< 2 seconds, warm acral.

 Laboratory Hb 7.5 gr/dl AGD Before correction with bicnat
findings Leucocyte 28.070 /mm3 pH 7.14
Platelet 406.000/mm3 PCO2 26
Ht 23 PO2 130
Eritrocyte 5,78x106 /mm3 HCO3 8
Diff count 0/1/15/63/15/5 BE 20.1
Reticulocyte 1,99 SpO2 98
IT ratio 3,38%
MCV 91 After correction bicnat
O MCH 30 AGD
MCHC 33 pH 7.24
PT 13 PCO2 31
APTT 46.1 PO2 118
Ureum 31 mg/dl HCO3 13.2
Kreatinin 0,6 mg/dl BE -14
SpO2 98%
 CHEST X-R
AY
• Cor not enlarge
• Superior mediastinum not widened
• Bronchovascular pattern normal
• Coarse infiltrate at paracardial dext
ra
• Skeletal and soft tissue normal

• Impression:
• Bronchopneumonia
• Abdomen:
• The intestine is dilated with gas fluid
level.
 Working • Bronchopneumonia
Diagnosis • Susp. Hisprung disease
• Malnutrition Marasmik conditition V
• Microcephaly
• Anemia normositik normokrom e.c susp. Cronic diseases

A
 Plan - Complete blood count and peripheral blood smear
- Chest and abdomen AP Lat X ray
- Swab RT PCR SARS COV-2
- CPAP
- Antibotic intravena
- Consul with Surgeon pediatric
- Bicnat Correction
P Treatment CPAP PEEP 7 FiO2 30%
Bicnat 8 meq + Nacl 0.9% 8cc on 1 hour
Bicnat 8 meq + NaCl 0.9% 8 cc on 2 hour.
IVFD KAEN 1 B 270 cc/day = 11 cc/ hour
Ceftriaxon 2 x 125mg iv
Paracetamol 4 x 30 ml p.o
 Late Preterm, Boy Infection
Risk Factor

Susp. Vomiting Malnourish Dyspnue Pale

Problem Hirschprung

Abdomen distension, abdomen X ray: Retraction epigatrium, Anamnesis,

abdomen Physical
Diagnostic The intestine is dilated with gas
distensionoratory, chest examination,
fluid level. Xray, Laboratory Laboratory

Operative Admitted to IPJT Red zone, Observatio

Terapi swab RT PCR n the
causes

Ad vitam: dubia ad bonam

Prognosis Ad functionam: dubia ad malam
Ad sanationam: dubia ad bonam
THANK YOU
 PATIENT
RECAPITULATION
 PICU
No Name Primary diagnosis Secondary diagnosis
1 Meysha Cantika Respiratory failure due to BP Septic shock on inotropic therapy
Ramadhani/ Girl / 11 mo Meningitis
AKI stadium Risk
Hypothyroid
2 Nadin Illona Grimonia / Girl Septic shock in inotropic therapy Meduloblastoma
/ 13 mo BP

3 Faiz Akbar Ramadhan / Boy Septic shock in inotropic therapy Cerebri Multiple abcess
/1 yo Hydrocephalus ec Ventriculitis
CSW ec moderate dehidration
Increased Intracranial Pressure.
 HCU
No Name Primary diagnosis Secondary diagnosis
1 Fani Arsila/ Girl / 1 yo Pneumonia Aspiration due to BP Congenital Heart Disease due to susp. ASD
CHF fc II – III due to asianotic congenital heart
disease due to ASD
Marasmic type of Malnutrition condition V
Failure to Thrive
2 Kaysan Alif Ghifari/ Boy / 1 Intraabdominal tumor due to Anemia due to Fe deff
yo susp. Hepatoblastoma Acute diarhea without dehidration

3 Filzatun Fitma / Girl / 15 yo CHF fc III – IV due to Rheumatic Rheumatic Heart Disease
Heart Disease Pulmonal Edema
Hyponatremia
4 Megantara Zia Sachi / girl / Sianotic Congenital Heart Disease Microcephali
6 mo due to susp.ToF Growth Faltering

5 Gabriel Elgano Shankara/ BP Down syndrome

Boy/ 8 mo Congenital Hypothyroidism
 NICU 1
No Name Primary diagnosis Secondary diagnosis
1 By. Marlisa/girl/ 01102041 Pneumonia Neonatal Subclinical Hypthyroidisme
Sepsis Staphylococcus
Normal Birth Weight Neonates 3300 gr
2 By. Ria Afrianti/ girl/ Pneumonia Neonatal Very Low Birth Weight Neonates1040 gr
01101552 NEC grade II
Trombocytopenia
Hypoalbuminemia
Hypoglicemia
3 By. Gusniwati/ girl/ Pneumonia Neonatal Very Low Birth Weight Neonates 1060 gr
01099205 Apneu of Prematurity
4 By. Abdul Rahim/ boy/ Pnuemonia Neonatal Sepsis
01101040 Down Syndrome
Post Sigmodectomi
5 By. Shahquinta/ girl / Meningocele Hypoalbuminemia
01102647

6 By. Nurmayenis/ boy / Pneumonia Neonatal Congenital Hydrocephalus

01101330 CTEV dextra
 NICU 2
No Name Primary diagnosis Secondary diagnosis
1 By. Nurafianti/girl/ Pneumonia Neonatal Very Low Birth Weight Neonates 1360 gr
01101864

2 By. Nopriani/ boy/ Respiratory distress due to TTN Low Birth Weight Neonates 2390 gr
01102852

3 By. Sri Sutriyanti/ boy/ TTN Normal Birth Weight Neonates 3200 gr
01102591
4 By. Rosyi/ girl /01102866 HMD grade II-III Thymus

5 By. Ingil II/ girl /01100677 HMD Apneu of Prematurity

Very Low Birth Weight 1203 gr
 SCN
No Name Primary diagnosis Secondary diagnosis
1 By. Ingil I/ girl / 01100675 Respiratory distress due to TTN Very Low Birth Weight Neonates 1040 gr

2 By. Shinta/boy/ 01102646 Respiratory distress due to TTN Normal Birth Weight Neonates 2525 gr
Neonatal Jaundice

3 By. Helci/ girl/ 01099582 Pneumonia Neonatal Very Low Birth Weight Neonates 1160 gr
Neonatal Jaundice

4 By. Nanda/ boy/ 01102228 Meconeum Aspiration Low Birth WeightNeonates 2440 gr
Mother with HIV and ARV therapy

5 By. Fitrya/ girl/ 01101593 HMD grade II-III Apneu of Prematurity

Low Birth Weight Neonates 1870 gr
6 By. Uriati/ girl/ 01101062 TTN Low Birth Weight Neonates 1500 gr
Neonatal Jaundice
7. By. Yasiroh/girl/ 01101776 Sepsis due to Klebsiella
 Yellow Zone
No Name Primary diagnosis Secondary diagnosis
1 By. Rini Nazar/ girl/ Pneumonia Neonatal Multiple Congenital Anomali
01102747 Neonatal Jaundice

2 By. Eni Darti/ boy/ Aspiration Pneumonia Multiple Congenital Anomali

01102739 Post laparotomy Gastrostomi due to Atresia
Oesophagus
AKI risk

3 By. Intan/ girl/ 01102760 Pneumothorax Sinistra Low Birth Weight Neonates 1860 gr
Neonatal Jaundice
No Name
Bougenville
Primary diagnosis Secondary diagnosis
1. M. Daffa / Boy / 1 year, 5 month old Covid 19 Confirmed Enterocutan fistula
Post sertoli procedure
2. Izzan/ Boy/ 2 year 8 month old Covid 19 Confirmed AML

YELLOW ZONE

No Name Primary diagnosis Secondary diagnosis

1. M. Rozi / Boy/ 17 yo Susp. Pulmonary TB with pleural effusion Trombocytopenia
dd/ Pulmonary Carcinoma Hyponatremia
 IPJT
No Name Primary diagnosis Secondary diagnosis
1. Hanasya/ girl/ 13 yo Sepsis History of septic shock dd/DSS
Suspect UTI
Hypokalemia
Undernourished
Probable covid
 Acute Ward
No Identity Primary Diagnosis Secondary Diagnosis
1 By Ny Fauziah/ girl / 4 years old Cholestasis extrahepatal due to atresia Kolestasis Intrahepatal due to
bilier CMV infection
2 Gabriel / boy / 6 months old Bronchopneumonia Susp Transcient
Hypogammaglobulinemia
Laringmalacia type 1
ASC Sekundrum
Down Syndrome
3 M. Alfatih / boy / 3 months old Cholestasis extrahepatal due to atresia Chilestasis Intrahepatal due to
bilier cmv infection
Coagulation disorder
4 Madina/ girl / 7 years old Post op VP shunt due to Obstruction ASD with TVH
hydrocephalus SOL
5 Qadisa / girl / 4 years old Nephrotic syndrome
6 Revita / girl / 9 years old ALL Neutrophenia Fever
Selulitis femur sinistra
7 Ayu Permata / girl / 17 years old LGK +Hyperleucocytosis AKI std Risk
8 M. Syifaurrahman / boy / 14 years old Limfoma Non Hogkin
 Acute Ward
No Identity Primary Diagnosis Secondary Diagnosis
9 M. Ayyub / boy / 5 months old Post op evacuation due to abses serebri
10 Shazia / girl / 1 year old DM type 1
11 Abiyan / boy / 2 years old DM Type 1
12 Bilqis/ girl ALL
13 Rengganis/girl
 Chronic Ward
No Identity Primary Diagnosis Secondary Diagnosis
1 Revi / girl / 16 years old Hypocalemoa persistant
2 Nayla / girl / 9 years old CKD stg V on CAPD
3 Faris Lutfi / boy / 2 years old UTI complex
4 Lora Silvia / girl / 14 years old Nephrotic syndrome relaps • Hypoalbuminemia

5 Aqila / girl / 7 years old Thalasemia • TB Lymp

6 Diva / girl / 15 years old SLE

7 Shakeel / boy . 3 years old AML

8 Trias / boy / 13 years old Hodgkin Lymphoma

9 Harmi Hidayat boy . 17 years old T-Cell Leukemia

10 Syazia/ girl / 9 mo ToF

11. Shavira / girl / 5 years old Wilms Tumor

 Chronic Ward
No Identity Primary Diagnosis Secondary Diagnosis
12 Elma / girl / 13 years old Rhabdomyosarcoma on
radiotherapy
13 M. Yoand / boy / 5 years old Hodgkin Lymphoma
14 Citra/ girl All
15 Albercio/ boy Neuroblastoma
16 M.Habib Fauzan/boy/12 yo ALL Hematemesis