Selamat Pagi Dokter, izin melaporkan pasien bedah jantung dewasa di ICU, IWB dan GP2 hari

Minggu, 31 Maret 2019

ICU
Bed 1
Tn. Zeni Febri, 32 tahun
MR severe, ASD iatrogenik, EF 65%, TAPSE 27 mm
Post MVr dengan physio ring annuloplasty mitral no 26 mm (12 jahitan), evakuasi tip kateter di P1-
P2, commisuroplasty anterior ke P1, ASD closure POD.1 (WES) (DH)
Spontan on NK 5 lpm, RR 18 x/min, SpO2 100%
ABP 137/58 (82) mmHg, HR 91 x/min AF NVR, CVP 11 mmHg on support dobutamin 3 mcg/kgbb/min
Drain: 170 cc/14 jam
UO: 1.5 cc/kg/jam
BC: +368 cc/14 jam
Plan: weaning support, observasi irama

Bed 2
Tn. Wahyu Budiarjo, 63 th
CAD 2VD + LM disease, EF 74.1 %
Post CABG x2 (LIMA-LAD, SVG-OM) POD.4 (DA)
Spontan on NK 5 lpm, RR 18 x/min, SpO2 100%
ABP 169/65 (94) mmHg, HR 82 x/min SR, CVP 8 mmHg on support vascon 0.15 mcg/kgbb/min
Drain: 95 cc/22 jam
UO: 3.2 cc/kgbb/jam on lasix drip 5 mg/jam
BC: -2216 cc/22 jam
Plan: weaning support, aff drain, pindah IWB

Bed 3
Ny. Zakiyatul Mardiah, 60 tahun
MR severe, EF 77%, TAPSE 25 mm
Post MVr dengan physio ring annuloplasty mitral no 28 mm (18 jahitan), butterfly resetion P2,
foldingplasty P1 POD.2 (BA)
Intubated ASV mode, PEEP 5, FiO2 40%, RR 15 x/min, SpO2 100%
ABP 110/54 (70) mmHg, HR 93 x/min AF NVR, CVP 13 mmHg on support vascon 0.05 mcg/kg/min
Drain: 70 cc/22 jam
UO: 1-1.5 cc/kg/jam on lasix 20 mg/jam
BC: -750 cc/22 jam
Problem: hiperglikemi, GDS 202 pkl 22.00
Plan: regulasi GDS, weaning support, weaning ventilator, aff drain

Bed 4
Tn. Safriman, 63 tahun
CAD 3VD, EF 35%
Post CABG x3 (LIMA – LAD, SVG – LCx, SVG – OM (Y graft)) POD.1 (WES) (SG)
Intubated Spontan mode, PEEP 5, FiO2 40%, RR 15 x/min, SpO2 100%
ABP 150/71 (92) mmHg, HR 116 x/min ST, CVP 13 mmHg on support dobutamin 3 mcg/kg/min, NTG
0.5 mcg/kg/min
Drain: 130 cc/15 jam
UO: 2.3 cc/kg/jam
BC: -774 cc/15 jam
Plan: weaning support, weaning ventilator

Bed 5
Tn Glenn Scoot Nahlohy, 49 tahun
Diseksi aorta standford A debakey type 1, AR moderate, EF 55%
Post ascending replacement dengan rekonstruksi neo media + total arch replacement dengan
vascutek gelweave 4 branches #22, AVr commisuroplasty (resuspensi katup aorta) + post TEVAR
POD.6
Post Redo Explorasi Sternotomi, evakuasi hematom, control perdarahan POD.5 (DA)
E1M1Vett on recofol
On ventilator, PSIMV, PEEP 5, FiO2 50%, RR 21x/min SpO2 100%
ABP 109/43 (51) mmHg, HR 92 x/min AFNVR, CVP 7 mmHg, on adrenaline 0.05 mcg/kg/min, vascon
0.05 mcg/kg/min
Drain: 320 cc/22 jam
UO: anuria, on CVVH 150 cc/jam
BC: -1296 cc/22 jam
Plan: weaning support, weaning ventilator

Bed 6
Tn. Kelana Jaya, 55 tahun
CAD 2VD, EF 36%
Post CABG x2 (LIMA – LAD, SVG – RCA distal) POD.1 (WES) (SG)
Spontan on NK 5 lpm, RR 18x/min, SpO2 100%
ABP 122/62 (78) mmHg, HR 74 x/min SR, CVP 8 mmHg on support dopamin 3 mcg/kg/min
Drain: 280 cc/18 jam
UO: 1 cc/kg/jam
BC: +697 cc/18 jam
Plan: pindah IWB

Bed 7
Tn. Bambang Prihanto, 53 tahun
CAD 3VD + LM disease, EF 68%
Post OPCAB x3 (LIMA – LAD, SVG – RCA distal, SVG – LCx) POD.1 (WES) (DH)
Spontan on NK 5 lpm, RR 24x/min, SpO2 100%
ABP 121/60 (79) mmHg, HR 70 x/min SR, CVP 12 mmHg tanpa support
Drain: 570 cc/16 jam
UO: 1.4 cc/kg/jam
BC: -190 cc/16 jam
Plan: pindah IWB

Bed 8
Ny. Jumilah, 34 th
MR severe, TR severe, ec RHD, EF 70%, TAPSE 2.1
Post MVR Biocor heart valve 25mm (12 jahitan pledget), TVr Kay Procedure, LAA eksklusi POD.10
Post subxyphoid pericardiostomy ec PE impending tamponade POD.1 (AT)
Spontan on NK 5 lpm, RR 24 x/min, SpO2 100%
ABP 106/60 (74) mmHg, HR 97 x/min AF NVR, CVP 15 mmHg, on support adrenalin 0.03 mcg/kg/min
Drain: 165 cc/17 jam
UO: 1 cc/kg/jam
BC: -13 cc/17 jam
Problem: AF RVR post op, saat ini maintenance cordarone 600 mg/24 jam
Plan: weaning support, pindah IWB

Bed 9
Ny. Hayatun Rahmi, 28 tahun
MS severe, MR mild-moderate, AR mild, TR severe, EF 30.5%, TAPSE 1.6
Post MVr dengan ring CG annuloplasty band #34 (12 jahitan) (reseksi retracted chorace PML,
splitting chordae, comissurotomy), TVr ring annuloplasty CG band #30 (8 jahitan + 1 jahitan pledget),
LAA eksklusi, evakuasi thrombus POD.3 (AT)
E1M1Vett on recofol drip dan ecron drip
Intubated, on ventilator, P-CMV mode, FiO2 40%, PEEP 4, RR 26x/min, SpO2 99%
ABP 106/81 (90) mmHg, PAP 67/38 (49) mmHg, HR 98x/min ST dg occassional VES, CVP 12 mmHg on
support vascon 0.5 mcg/kg/min, adrenaline 0.5 mcg/kg/min, dobutamine 10 mcg/kg/min,
Vasopresin 0.06 unit/kg/min
Drain: 80 cc/22 jam
UO: 2 cc/kgbb/jam + CVVH 200 cc/jam (mulai pkl 18.00)
BC: -1959 cc/22 jam
Problem: PH
Plan: aff drain, tatalaksana PH, weaning support, weaning ventilator

Bed 11
Ny. Warsih, 53 tahun
ASD secundum bidirectional shunt, Fistula LAD-MPA, TR severe, EF 66%, TAPSE 12 mm
Post ASD closure with pericardial patch + PFO creation, ligasi fistula koroner, TVr dengan cosgrove-
edwards band annuloplasty no 28 mm (10 jahitan) POD.3 (BA)
E4M6Vett
Intubated, on ventilator, P-SIMV mode, FiO2 40%, PEEP 5, RR 14x/min, SpO2 100%
ABP 88/37 (57), PAP 70/32 (45), HR 130 x/min AFRVR, CVP 14 on support adrenaline 0.3
mcg/kg/min, Norepinephrine 0.3 mcg/kg/min, dopamine 3 mcg/kg/min
Drain: 120 cc/22 jam
UO: 0.45 cc/kg/jam on Lasix drip 20 mg/jam
BC: +75 cc/22 jam (HD sled -1000 cc)
Problem: LCOS, oliguria, AFRVR on cordarone 540 mg/18 jam, hasil echo: RA-RV dilatasi, LVEF 52%,
LV D-shaped, pericard effusion superior RA 1.8 cm, pleural effusion kiri 2.8 cm
Plan: milking drain, echo evaluasi, HD, weaning support, weaning ventilator

Bed 12A
Tn. Zaimi Effendi, 65 tahun
CAD 3VD, EF 32%
Post CABG X3 (LIMA-LAD, SVG-RCA, SVG-LCx distal) POD.5 (AT)
E4M6V5
Spontan on NK 5 lpm, RR 19 x/min, SpO2 100%
ABP 143/34 (83) mmHg, PAP 22/6 (12) mmHg, HR 59 x/menit SB, CVP 4 mmHg, on support
dobutamine 3 mcg/kg/min, IABP 1:1
UO: 1.5 cc/kg/jam
BC: -541 cc/22 jam
Echo evaluasi: VTI 18 %, SVR 1882 dyne.s/m3, CO 3.4 L/min, CI 2.05 L/min.m2
Plan: weaning support, echo evaluasi ulang, bila baik aff IABP

Bed 12B
Ny. Caecilia Rensiana, 61 tahun
CAD 3VD, EF 46%
CABG x5 (LIMA-LAD, SVG-Diagonal, SVG-OM1-OM2 sequential, SVG-RCA distal (endarterectomy)
POD.39
Prolonged ventilator post tracheostomi POD.20 (TW)
E3M2Vtracheostomy
On tracheostomi T-mask 6 lpm, RR 24 x/min SpO2 100%
ABP 89/41 (59) mmHg, HR 92 x/min SR, CVP 3 mmHg, on vascon 0.2 mcg/kgbb/min
UO: 0.8 cc/kg/jam on lasix drip 30 mg/jam
BC: +279 cc/22 jam
Problem: epistaxis pagi ini sudah stop, melena, Hb 7.5 (tgl 29/3/19), ulkus antrum gaster (hasil
gastroskopi), massa pada ileo-caecal (hasil colonoskopi)
Plan: weaning support, fisioterapi, paliatif care, dari pro cek CEA dan konsul bedah digestif, tunggu
protokol terapi

Bed 14
Tn. Machmud Ali, 63th
CAD 3VD, MR Severe, EF 40%, TAPSE 2.2
Post CABG x3 (LIMA-LAD, SVG-OM, SVG-PDA (endarterectomy)), MVR dengan biocor valve no.
25mm (15 jahitan pledget) POD.10 (AT)
E4M6Vett
Intubated mode PSIMV, PEEP 5, FiO2 40%, RR 22x/min, SpO2 100%
ABP 114/59 (77) mmHg, HR 105 x/min ST, CVP 8 mmHg, on support Dobutamine 5 mcg/kg/min
UO: 1.2 cc/kgBB/jam
BC: -669 cc/22 jam
Plan: Weaning support, weaning ventilator

IWB 1318
Bed 3
Tn. Alex, 42 th
Readmisi ec. Impending tamponade ec efusi pericard dan acute gastrointestinal infection
Post AVR dengan ONX mechanical heart valve no 25 mm (14/3/19)
Post subxyphoid pericardiostomy dan evakuasi PE POD.2 (TW)
Spontan on NK 3 lpm, RR 16 x/min, SpO2 100%
NBP 107/78 mmHg, HR 91 x/min SR, tanpa support
Drain: Intraperikard 30 cc/22 jam, pigtail minimal serous
UO: 2.1 cc/kgbb/jam on lasix intermitten 2x20 mg iv
BC: -1390 cc/22 jam
Plan: echo evaluasi, bila baik aff drain

Bed 4
Tn. Temmy Akbar Sanggiri, 32 tahun
MR severe ec definite IE, EF 72.4%, TAPSE 28
Post MVR ATS mechanical valve no 31 mm (18 jahitan pledget) + evakuasi vegetasi
POD.2 (AT)
Spontan on NK 5 lpm, RR 22x/min, SpO2 100%
NBP 108/68 mmHg, HR 74 x/min SR, tanpa support
Drain: 60 cc/22 jam
UO: 2 cc/kg/jam on lasix intermitten 2x20 mg iv
BC: -1052 cc/22 jam
Plan: aff drain

Bed 6
Ny. Ida Farida, 64 tahun
CAD 3VD, MR moderate EF 53%
Post OPCAB x2 (LIMA-LAD, SVG-RCA distal) POD.4 (DH)
Spontan on NK 5 lpm, RR 18 x/min, SpO2 100%
NBP 106/60 mmHg, HR 68 x/min SR, tanpa support
UO: 1.8 cc/kg/jam on lasix intermitten 2x20 mg iv
BC: -290 cc/22 jam
Plan: mobilisasi, pindah ruang rawat

Bed 7
Ny. Lie Sak Tjhion, 50 tahun
MS severe, Mild MR, moderate TR, EF 63.7, TAPSE 1.6
Post MVR dengan St Jude mechanical mitral valve no 31 mm (16 jahitan pledget), TVr dengan
Cosgrove Edward annuloplasty band no 28 mm (9 jahitan), LAA eksklusi POD.3 (BA)
Spontan on NK 5 lpm, RR 18 x/min, SpO2 100%
NBP 112/83 mmHg, HR 90 x/min SR, tanpa support
UO: 2.1 cc/kg/jam on lasix intermitten 2x20 mg iv
BC: -1390 cc/22 jam
Plan: mobilisasi, pindah ruang rawat

Bed 8
Tn. Irsan Badru, 22 tahun
Pseudoanuerisma A. Femoralis dextra
Post repair pseudoaneurisma A. Femoralis dextra POD.2 (DA)
Spontan on NK 5 lpm, RR 13 x/min, SpO2 100%
NBP 107/71 mmHg, HR 86 x/min SR, tanpa support
UO: 2-3 cc/kg/jam
BC: -1438 cc/22 jam
Plan: pindah ruang rawat

Bed 9
Ny. Tati Ambarwati, 61 tahun
CAD 3VD, EF 29.9%
Post CABG x4 (LIMA - Diagonal, (SVG - LAD (endarterectomy), SVG - OM, SVG - RCA distal
(endarterectomy) (Y-Graft)) POD.3 (TW)
Spontan on NK 5 lpm, RR 18x/min, SpO2 100%
NBP 118/59 mmHg, HR 98 x/min SR, on support adrenaline 0.08 mcg/kg/min
Drain: 70 cc/22 jam
UO: 1.5-2 cc/kg/jam on lasix drip 5 mg/jam
BC: -683 cc/22 jam
Plan: weaning support, aff drain

IWB 1319
Bed 1
Tn. Safar Porotuo, 57 tahun
CAD 3VD, MR Severe, EF 58%, TAPSE 21.1 mm
Post CABG x3 (LIMA-LAD, SVG-OM, SVG-RCA distal), MVr ring cosgroove annuloplasty band no 30
mm (9 jahitan) POD.5 (SG)
Spontan on NK 5 lpm, RR 18 x/min, SpO2 100%
NBP 78/51 mmHg, HR 63 x/min SR, on support vascon 0.03 mcg/kg/min
UO: 2.5 cc/kg/jam
BC: -1230 cc/22 jam
Plan: weaning support

Bed 4
Tn. Abubakar Midurby, 74 tahun
CAD 3VD, EF 64%
Post CABG x3 (LIMA - LAD, SVG - OM, SVG - RCA distal (endarterectomy)) POD.3 (DA)
Spontan on NK 5 lpm, RR 20x/min, SpO2 100%
NBP 107/70 mmHg, HR 78x/min SR, on support dobutamine 3 mcg/kg/min
Drain: 110 cc/22 jam
UO: 1.6 cc/kgbb/jam on lasix intermitten 2x20 mg iv
Balans: -219 cc/22 jam
Plan: weaning support, aff drain

Bed 5
Ny. Nurtje, 53 tahun
MR severe, MS moderate, TR severe, efusi pleura Dex, EF 57%, TAPSE 1.26
Post MVr (reseksi chordae PML, transfer chordae A2-A3, commisuroplasty, CG band no 36 mm, 11
jahitan), TVr kay procedure, LAA eksklusi POD.6 (AT)
Spontan on Nk 5 lpm, RR 20 x/menit, SpO2 100%
NBP 94/51 mmHg, HR 86 x/min AFNVR tanpa support
Drain: 500 cc/22 jam
UO: 2.1 cc/kg/jam on lasix drip 10 mg/jam
BC: -1270 cc/22 jam
Plan: monitoring output drain, cek albumin

Bed 6
Tn. Suparman, 58 tahun
CAD 3VD, EF 52%
Post CABG x4 (LIMA-LAD, SVG-distal LCx, SVG-Diagonal, SVG-PDA) POD.5 (AT)
Spontan on NK 3 lpm, RR 22x/menit, SpO2 100%
NBP 138/87, HR 76x/menit SR, tanpa support
Drain: 210 cc/22 jam
UO: 3 cc/kgbb/jam on lasix intermitten 2x20 mg iv
BC: -1840 cc/22 jam
Plan: weaning lasix

Bed 7
Nn. Silji Agsila, 24 tahun
Pneumothorax dextra + empysema subkutis
ASD secundum (L-R), TR moderate, PH
Post ASD closure dengan PFO creation (pericardial patch), TVr De Vega (10 jahitan) POD.5
Post chest tube insertion no 24 fr hemithorax dextra ec pneumothorax dextra POD.3 (TW)
Spontan on NK 3 lpm, RR 18x/min, SpO2 100%
NBP 89/62 mmHg, HR 78x/min SR, tanpa support
Drain thorax dextra diklem, tidak sesak, emfisema subkutis tidak meluas
Pigtail: 5 cc/22 jam
UO: 2 cc/kgbb/jam
Balans: -1000 cc/22 jam
Plan: Ro Thorax post klem chest tube 24 jam, bila baik aff drain

Bed 8
Tn. Muhammad Hanif Rachman, 47 tahun
CAD 3VD, EF 63%
Post OPCAB x3 (LIMA-LAD, SVG-OM1 (endarterectomy), SVG-PDA) POD.4 (DH)
Spontan on NK 3 lpm, RR 18 x/min, SpO2 100%
NBP 93/57 mmHg, HR 83 x/min SR, tanpa support
UO: 1.8 cc/kgbb/jam on lasix drip 20 mg/jam
BC: -1330 cc/22 jam
Problem: riwayat bicara pelo
Plan: pindah ruang rawat

Bed 9
Tn. Hermansyah, 52 tahun
CAD 2VD, EF 54%, fistula coroner
Post CABG x2 (LIMA-LAD, SVG-RCA Distal) POD 2 (SG)
Spontan on NK 5 lpm, RR 20 x/min, SpO2 100%
NBP 100/56 mmHg, HR 69 x/min SR, tanpa support
Drain: 80 cc/22 jam
UO: 2 cc/kg/jam on lasix intermitten 2x20 mg iv
BC: -920 cc/22 jam
Plan: aff drain

IW Kelas
1305/01
Tn. Eka Sumbada Anggara, 46 tahun
CAD 3VD, EF 86.8%
Post CABG x3 (LIMA-LAD, SVG-OM2, SVG-PDA) POD.3 (DA)
Plan: mobilisasi bertahap
1305/2
Tn. Abdulah Sani, 68 tahun
CAD 3VD, MR severe, TR moderate, EF 36.6%, TAPSE 1.4
Post CABG x4 (LIMA-LAD, SVG-Diagonal-OM (sequential), SVG-PDA (endarterectomy)), MVR dengan
Biocor valve no. 27 mm (15 jahitan pledget) POD.16 (AT)
Plan: mobilisasi bertahap

1306/2
Ny. Cu Lena Susanti, 51 th
MS Severe, MR mild, TR severe, EF 58.1% TAPSE 17.4 mm
Post MVR dengan Medtronic mechanical heart valve 31 mm (16 jahitan pledget), TVr dengan
Cosgrove annuloplasty band 28 mm (10 jahitan) POD.4 (BA)
Plan: mobilisasi, echo evaluasi

1307/1
Tn. Ngatman, 61 tahun
CAD 3VD, EF 31%
Post CABG x4 (LIMA-LAD, SVG-OM, SVG-Diagonal, SVG-RCA distal (endarterectomy)) POD.5 (TW)
UO: 1-2cc/kgbb/jam
BC: -1450 cc/22 jam
Plan: mobilisasi bertahap

GP2 Lt 6
2602/1
Tn. Dani Hamdani, 33 th
ASD secundum bidirectional shunt
Post ASD closure dengan pericardial patch POD.4 (BA)
Plan: mobilisasi, rencana rawat jalan

2602/2
Tn. Edy Sugianto, 47 tahun
MR severe, MS mod-Severe, TR moderate, PH, EF 66%, TAPSE 2.1
Post MVR (SJM valve #33, 18 jahitan), TVr dengan De Vega procedure POD.5 (TW)
Plan: Mobilisasi

2603/01
Ny. Ermawati, 39 tahun
Surgical Site infection post ASD closure dengan pericardial patch (6/3/2019) (DA)
Problem: SSI pada luka sternotomy, granulasi baik, slough minimal
Plan: Rawat luka sternotomy per 2 hari dengan cutimed dan prontosan, follow up hasil kultur pus

2603/02
Ny Siti Kotijah, 38 tahun
MR severe, TR severe, PH, EF 56%, TAPSE 1.7
Post MVr (commisuroplasty, foldingplasty P1, Physio ring annuloplasty no 26 mm, 12 jahitan), TVr
kay procedure POD.6 (DH)
Plan: mobilisasi bertahap, echo evaluasi

2604/1
Tn. Iwan Gunawan, 50 tahun
MR Severe, TR mild-moderate, EF 67.4% TAPSE 1.9 cm
Post MVr Medtronic profile 3D annuloplasty ring no 26 mm, 12 jahitan (foldingplasty, jahit cleft P2-
P3), TVr Kay procedure POD.5 (DH)
Plan: mobilisasi bertahap

2604/2
Tn. Ocim Bin Ade, 38 tahun
MS Severe, MR moderate, AS severe, AR moderate, EF 54.7% TAPSE 2.2
Post AVR dengan ATS mechanical aortic valve no 22 mm (12 jahitan pledget), MVr (komisurotomi,
peeling AML - PML, reseksi restricted chordae pML, Ring CG band annuloplasty no 36 mm (12
jahitan)), eksklusi LAA POD.3 (AT)
Plan: mobilisasi bertahap

2605/1
Nn. Endah Tuti Rohmatun, 24 th
ASD secundum, L-R shunt, EF 73%
Post ASD closure pericardial patch POD.4 (SG)
Plan: mobilisasi

2605/2
Ny. Ati Lestari, 56 tahun
ASD secundum (L-R), TR mild, EF 69%, TAPSE 2.5 cm
Post ASD direct closure, TVr De Vega Procedure POD.3 (TW)
Plan: mobilisasi

2606/1
Tn. Margo Wahyudi, 57 th
CAD 3VD, EF 59%
Post CABG x3 (LIMA-LAD, SVG RCA distal, SVG-LCx distal) POD.4 (SG)
Plan: mobilisasi, rencana rawat jalan

2606/2
Tn. Habibi, 31 tahun
VSD SADC, AR moderate, EF 57%, TAPSE 3.25
Post VSD closure gore-tex patch 0.6 mm, AVR ATS Medtronic Aortic no 22 mm (13 jahitan pledget +
2 jahitan) POD.5 (DH)
Plan: mobilisasi bertahap, echo evaluasi

2607/1
Ny. Indri Noviani, 25 tahun
PDA, AR severe, EF 59.9%
Post PDA closure, AVR dengan ATS AP Mechanical Valve no 18 mm (6 jahitan pledget) POD.3 (DA)
Plan: mobilisasi bertahap
PPDS Jaga
dr. Luqman Alwi

PPDS Jaga berikutnya

dr. Faizunnur

Konsulen Jaga
dr. Amin Tjubandi, Sp.BTKV (K)