Raka Dwiyantoro, L, 7 tahun, 1973526, Perawatan hari ke-42

Diagnosis :
- Deep dermal burn injury 10% ec api
- Mid dermal burn injury 5% ec api
- Superficial dermal burn injury 1% ec api
GAR
- Post surgical debridement + STSG (10/6/2021) BED 1
- Riw. Hematemesis melena e.c. stress ulcer
- Infeksi saluran kemih
Tanggal : 30 Juni 2021
Hari ke : Perawatan Hari ke-42
DPJP : dr. Siti Isya Wahdini, Sp.BP-RE(K)

Subjective : Laboratorium Balans Cairan Kumulatif per 23 jam

Demam (+), BAB hitam (+), muntah (06.00-05.00)
darah (+) makan (-) diare cair ampas Lab 28/6/21 CM : 1489 cc/ 23 jam (PO 165 cc)
(-) Al 15.60 Hb 8.4 AT 277 Na 136 K CK : 1090 cc/ 23 jam (hematemesis
Objective: 4.09 Cl 100 alb 2.78 melena 170, urine 920)
KU : CM cukup IWL : 437 cc/ 23 jam
TD: 138/67 mmHg Lab 26/6/21 BC : - 38 cc/ 31 jam
HR: 138 x/m AL 18.01 Hb 9.2 AT 469 UO : 2.10 cc/kgBB/jam
RR: 23 x/m Procalcitonin 0.63 Urinalisa pH
T: 36.4 °C 8.5 BJ 1.010 Nitrit (-) Leukosit Plan:
Sp02 : 100% on room air esterase (-) Leukosit 15 Bacteria - Awasi KU/VS/BC target UO 1cc/kgBB/jam,
109.9 - Balans cairan /3 jam
BB 19 kg, TB 110 cm - inj. Paracetamol 200mg iv (k/p)
- inj Omeperazole 20 mg/12 jam iv
TBSA : [√(19*110)/60 = 0.76m2 Lab 24/6/21
- Sucralfat 500 mg /6 jam per sonde
Al 14.49 Hb 8.7 Hmt 26.9 AT 485
- Zinc 20mg / 24 jam
IWL= (25+LB%) x TBSA Alb 2.81 OT 36 PT 36 BUN 5.7 Cr - Zamel 7,5 cc/24jam
       =(25+16)×0.76x24 0.15 Na 138 K 3.25 Cl 105 GDS 88 - Maintenance Cairan: IV: inf KaEn 3A 3 cc /
       =456 cc/24 jam jam
       = 19 cc/jam Lab 21/6/21 - Rencana Nutrisi : Entramix 4x175 cc, sonde
Al 9.93 Hb 9.4 AT 414 PPT lengkap 3x200 cc, ekstra bubur 3x1
Cairan maintenance: 19.4/15.0 aPTT 67.3/32.6 INR - Pastikan patensi VAC
Holiday segar: 1.57 BUN 6.20 Cr 0.54 Na 139 Cl - Colistine 800.000/8jam
1450 cc/24jam (sesuai TS UPA PICU) 95 Mg 2.77 Ca 2.92 Phospat - GV Rabu 30/6/2021
Anorganik 20.4
Kebutuhan kalori:(25xBB)+(40x
%LB)= Lab 20/6/21
= (25x19)+(40x16) Al 18.14 Hb 9.2 AT 460 PPT
= 475+640 15.4/13.5 aPTT 42.9/32.0 INR
= 1115 kkal 1.20 Alb 2.95 BUN 7.50 Cr 0.34
Karbohidrat 100% = 1115 kkal GDS 109 Na 138 K 3.74 Cl 104 Mg
Protein 20% = 223 kkal 1.46 Ca 2.37 Phospat Anorganik
Lemak 20% = 223 kkal 5.4

Swap Antigen 19/6/21

Swap antigen SARS COV-2
negative
Bernadus Barry Pratama, L, 11 thn, 1976238, Perawatan hari ke-18
Diagnosis :
- Mid Dermal Burn Injury 8% ec Scald
- Deep Dermal Burn Injury 6 % ec Scald
Tanggal
Hari ke
: 30 Juni 2021
: Perawatan Hari ke-18
GAR
BED 2
DPJP : dr. Siti Isya Wahdini, Sp.BP-RE(K)

Subjective : Laboratorium : Balans Cairan Kumulatif per 23 jam

Demam (+), nyeri luka (+), belum (06.00-05.00)
bisa BAB sejak MRS, mual (+) Lab 28/6/21 CM : 2437 cc/ 23 jam (PO 1220 cc)
Al 8.94 Hb 13.9 AT 642 Na 138 K CK : 2790 cc/23 jam
5.04 Cl 104 aAlb 3.10
Objective: IWL : 1397.5 cc/23 jam
KU : CM Cukup BC : - 1750.5 cc/23 jam
Lab 24/6/21
TD : 149/70 mmHg UO : 2.12 cc/kgBB/jam
Al 9.02 Hb 13.1 AT 554 Alb 2.54
HR: 85 x/m
OT 29 PT 53 BUN 13.4 Cr 0.32 Na
RR: 24 x/m Plan:
137 K 4.25 Cl 104 GDS 101
SpO: 99 % on room air - Awasi KU/VS/BC target UO 1
T: 36.1 °C cc/kgBB/jam
Lab 21/6/21
CVP: 8 - Rawat luka bakar dengan salep
Al 16.10 Hb 12.8 AT 417 PPT kloramfenikol + tulle
15.9/15.0 aPTT 39.2/32.6 INR
BB: 57 kg - rawat luka bakar di abdomen dengan
1.25 Alb 2.54 SGOT 34 SGPT 96
TB: 161 cm burnazin cream
BUN 13.50 Cr 0.54 GDS 100 Na
TBSA: √BBxTB/60 - Cairan maintenance KAEN 3B~ 5
136 K 4.12 Cl 102 Procalsitonin
= √57x161/60 cc/jam, Po 2120 cc/24 jam
5.57
= 1.59 - Inj meropenem 1.6 gram / 12 jam IV
- inj Paracetamol 600 mg / 6 jam IV
UL 18/6/21
IWL= (25+%LB) x TBSA x 24 jam - inj ondansetron 4 mg IV (k/p jika mual)
Sedimen :
=(25+13,25)×1,59x24 - Nutrisi : Peptisol 7x150 ml, Ekstra bubur
- eritrosit 4
= 60.8 cc/jam 3x1 porsi
- leukosit 2
= 1459.6 cc/24 jam - Balance tiap 3 jam
-sel epitel 1.1 - Pastikan VAC paten
- Silinder 0.1
Cairan maintenance Holiday Segar = - Vit C 1x1 tablet
- bacteria 2.7
2240 cc/24 jam (sesuai TS UPA PICU) - MST 10 mg jika nyeri
-kristal 0.0
IV Kaen 3B 5 cc/jam ~ 120 cc/24 jam - GV dengan MAC 29/6/2021
PO enteral 2120 cc/24 jam
Lab 18/6/21
Al 4.66 Hb 12.9 At 166 Alb 2.10
Kebutuhan kalori :
Bun 8.2 Cr 5.9 procalsitonin 30.58
(20xBB)+(70x%LB)
Lab 13/06/2021
= (20x57)+(70x13.25)
Swab Ag Negatif,
= 1140+927.5
= 2067.5 kkal
AL 13.16, AE 6.5, Hb 17.7, Ht 52.7,
Karbohidrat 100%: 2067.5 kkal
AT 288
Protein 20%: 413.5 kkal
PPT 14.5/15, APTT 16.6/30.2, INR
Lemak 20%:  413.5 kkal
1.12, Alb 4.07, OT 28, PT 17, BUN
6.6, Cr 0.56, GDS 123,
LDH 260, CRP <5, Na 131, K 4.62,
Mubin, L, 50 th, 1976637, Perawatan hari ke-15
Diagnosis :
- Mid dermal burn injury 25% tereduksi 15% sisa 10% due to electricity
- Deep dermal burn injury 4% due to electricity
- Full thickness burn 8%  injury due to electricity
GAR
- Post Surgical debridement dan disartikulasi digiti I manus sinistra (18/6/2021) BED 3
- Pneumonia Bilateral
Tanggal : 30 Juni 2021
Hari ke : Perawatan Hari ke-15
DPJP : dr. Siti Isya Wahdini, Sp.BP-RE(K)
Subjective: Laboratorium : Balans Cairan Kumulatif per 23 jam
Demam (-) (06.00-05.00)
Lab 28/6/21 CM : 3515 cc/ 23 jam (PO 3330 cc)
Objective: Al 16.16 Hb 11.1 AT 357 Na 129 K CK : 3520 cc/ 23 jam
KU : CM, Cukup 4.29 Cl 93 Alb 2.75 IWL : 1632.31 cc/ 23 jam
TD : 148/56 mmHg BC : - 1376.31 cc/ 23 jam
HR: 73 x/m Lab 25/6/21 UO : 3.06 cc/kgBB/jam
RR: 20 x/m Alb 2.65
SpO2: 100% on NK 3 Lpm PCR SarsCov negatif Plan:
T: 37.2 - Oksigenasi dengan suplementasi O2 NK
Lab 24/6/21 3 lpm
Cairan Maintenance Al 15.57 Hb 10.8 Hmt 32.6 AT 223 - Awasi KU, VS dan balans cairan. Target
BB: 50 kg, TB: 165 cm Alb 2.39 OT 25 PT 94 BUN 11.6 Cr UO: 1-2 cc/kgBB /jam
TBSA 0.57 Na 130 K 3.81 Cl 97 GDS 121 - Inj. Ranitidine 50 mg/ 12 jam
TBSA : [√(50*165)/60 = 1,51 - Inj. PCT 1000 mg (k/p demam)
Lab 23/6/21 - Analgetik dengan Fentanyl continuous 1
IWL= (25+%LB) x TBSA LDH 272 CRP >150 mcg/kgBB/jam
       = (25+22) x 1,51 Swab PCR : negatif -Azitromycin 500 mg/24 jam PO
       = 70.97 cc/jam - Amikasin 500 mg/12 jam
       = 1703.28 cc/24 jam Lab AGD 23/6/21 - Cek Elektolit post Koreksi
pH 7.52 pCO2 39.2 pO2 153.7
Cairan maintenance: SO2 99% BEecf 9.1 HCO3 32.6
(1500xTBSA)+IWL PO2/FIO2 540.5
= (1500×1,51)+1703.28
= 3968.28 cc/24 jam Lab 22/6/21
PO 3668.28 cc/24jam Al 39.25 Hb 10.7 AT 214
IV 300 cc/24 jam ~ 12.5 cc/jam
Lab 21/6/21
Kebutuhan kalori:
(25xBB)+(40x%LB)= Al 18.12 Hb 8.7 AT 218 Alb 2.44
(25x50)+(40x22)= 2130 kkal/24 jam BUN 13.6 SGOT 40 SGPT 82 Cr
Karbohidrat : 1278 kkal 0.52 GDS 141 Na 131 K 3.82 Cl 98
Protein : 426 kkal
Lemak : 426 kkal Lab 20/6/21
AL 16.81 Hb 8.2 AT 174 Alb 2.0
BUN 15.4 Cr 0.59 GDS 133 Na 130
K 4.22 Cl 97 Mg 1.72 Ca 1.85
procalsitonin 8.35