The patient came with decreased consciousness, had a complex condition where the patient had been short of

breath since 10 days and decreased consciousness, which was due to poor laboratory results, namely procalcitonin,
poor kidney function and electrolytes. Where we have to look for the decrease in consciousness due to what,
whether due to sepsis, uremic encephalopathy or electrolyte imbalance. And you have to know how to handle it
initially -------------------. Sepsis and septic shock are medical emergencies and should be treated immediately.
Resuscitation from sepsis hypoperfusion should be started with 30 ml/kg of IV crystalloid fluid within three hours.
Hemodynamic assessment including cardiac functions should be performed dynamically, and additional fluid use
should be guided by frequent reassessment of hemodynamic status, with the goal of maintaining a mean blood
pressure above 65 mmHg. If hemodynamic stability is not achieved with fluid resuscitation, vasopressor therapy
should be initiated. Norepinephrine is the first-choice vasopressor; vasopressin or epinephrine may be added.
microbiologic cultures should be performed. pathogens that cause pneumonia, including Streptococcus
pneumoniae, atypical bacteria and Gram-negative bacilli. Guidelines suggest the use of a β-lactam plus a macrolide,
β-lactam plus a fluoroquinolone or a fluoroquinolone alone as empirical treatment. Macrolide combinations showed
better outcomes.

Pasien datang dengan kondisi kesadaran menurun, mempunyai kondisi kompleks dimana pasien sesak nafas sejak 10
hari dan penurunan kesadaran, hal ini disebabkan oleh hasil laboratorium yang buruk yaitu prokalsitonin, fungsi
ginjal dan elektrolit yang buruk. Dimana kita harus mencari penurunan kesadaran karena apa, apakah karena sepsis,
uremic encephalopathy atau ketidakseimbangan elektrolit. Dan Anda harus tahu cara menanganinya sejak awal
-------------------. Sepsis dan syok septik merupakan keadaan darurat medis dan harus segera ditangani. Resusitasi dari
hipoperfusi sepsis harus dimulai dengan 30 ml/kg cairan kristaloid IV dalam waktu tiga jam. Penilaian hemodinamik
termasuk fungsi jantung harus dilakukan secara dinamis, dan penggunaan cairan tambahan harus dipandu oleh
penilaian ulang status hemodinamik secara berkala, dengan tujuan mempertahankan tekanan darah rata-rata di atas
65 mmHg. Jika stabilitas hemodinamik tidak tercapai dengan resusitasi cairan, terapi vasopresor harus dimulai.
Norepinefrin adalah vasopresor pilihan pertama; vasopresin atau epinefrin dapat ditambahkan. kultur mikrobiologi
harus dilakukan. patogen penyebab pneumonia, termasuk Streptococcus pneumoniae, bakteri atipikal, dan basil
Gram-negatif. Pedoman menyarankan penggunaan β-laktam ditambah makrolida, β-laktam ditambah fluoroquinolon
atau fluoroquinolone saja sebagai pengobatan empiris. Kombinasi makrolida menunjukkan hasil yang lebih baik.

bagaimana kita tahu pada pasien ini komplek terjadi, bagaimana penanganan yang terbaik bagi pasien ini

How do we know if this patient has a complex, what is the best treatment for this patient?

This patient has been consulted by IPD and why wasn't the suggestion for meropenen given? and what is the initial
management of sepsis?