Scenario A Blok 12 Batch 2018

“Periculum in mora”
Mrs. A, a 48 years old woman, brought to the emergency department of RSMP by her family with a chief
complain of shortness of breath that keeps on worsening since 4 hours ago. The shortness of breath were not
triggered by activity or weathers change, and were not followed with wheezing. Mrs. A also complains of
productive cough accompanied with pain while swallowing and fever since one weeks ago, she went to the
Puskesmas and was given an antibiotic but she didnt take it. Her blood sugar level also being checked at the
Puskesmas, and the result was 280 mg/dl, and she also claimed that she often feels thirsty, famished, and urinate
a lot, then she was given an oral anti diabetic but she didnt take it regularly.
According to her family, Mrs. A had a medical history of Diabetes Mellitus since the age of forty, but she
didnt take her medicine regularly, and seldomly control her condition to the Puskesmas.
Physical Examination :
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW 40 kg
Vital Sign : BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR: 38x/menit (deep and fast breathing)
Head : Pale conjungtive (-/-), icteric sclera (-/-)
Neck : JVP 5-2 cmH2O
Thorax : Heart and lung within normal limits
Abdoment : flat, supple, bowel movement (+), hepar and lien were not palpable
Extremities : cold extremities (-), edema (-/-). Turgor return slowly.
Laboratory Examination:
Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte 250.000/ mm3
BSN 300 mg/dl
Urinalysis: Keton urin +3, glukose urin +3