t-CGSISTEMKONDUKSIUSTRIKJANTUNI.

SN NODE :

located upper RA
Nodus sinus atrial
pace 60 too ✗ / Meuit ,
→ pacemaker dominant
-
.
dali jointing

INTERMODAL bnpvlse laughing Antara SA & AV

:

TRACT

AV NODE : bagi all functional AV → tondukli lamb at → penwndaan sing Kat

Sblm Impulse mene apai
pale → go -60 ✗/ Merit .

ventricle
BUNDLE :
trans mist impulse ke bundle branch
OF HIS

Purkinje LBB : Impulse ke LV

system
Impulse ke RV
.

RB pg :

PURKINJE
: Impulse ke ditMY Venti Kel , pale to -40×1 me hit
SYSTEM

ELECTROPHYS.NL# .

Depolarization :
peen bateau potential membrane set jautung dais ⊖ Ice arak ④
↳ peughambatan Na Channel

Repolarization :
Resting con state
LENI
uad=eviw
Electrode
④
I LA RA lateral

I LL RA hyaror
HI LL LA Inferior
AUR RA

AVL LA lateral
art LL lmfaooo

EK6l2lEAD_ lEFTS1DE_ 1461-1-41*-1

EK6l5lEAD_
V1 :
ICS 4 Sternum Kanan 104 Sternum Kiri
V2 :
lCS4 Sternum Kiri 104 sternum Kanan
between V2 ✗ V4
V3 :
between V2&X4
middavicle Kanan ICSE
V4 :
middañdekiñlcsb
athtlalycihelcssdex
V5 : axillary line anterior less
V6 : midaxillaliskiu-IC.SE midahillatylcsbdx Mr vtvsvq

↳ Kadahgsptrvoepostuiorolvadayauggabsciat
lead
pike 12 .

biasanyadipakekuloauigaMIRV-tainbahaunyav4R.US
-

.
V9
1- lags V7 . V8 V9
,
 trials anya dips
GAMBARANEKI.MN
☒# large
boar wmd↑ di purkinje

015mV
:

li⑤ 5mm
☐
Oil MV
: small box
Qs
0,2g 1 MM
1- QT Interval
Isoelectric line
-

'
I
R 01045

! ¥ Heart Rate REGULER

11421=6 ULER
, :

I
P " '
"
st

%
"
!
! : i
I
'
_#au- R -

R
↳ hithhg R R Mama 6s
-

ji ! I '
im ! i ↳ Kotak keen lgoo : gunman Kotak teens Kali 10 .

Internal am
I Ketil
?
ˢ ,

frunlah R R 30 Kotak besar ✗ 10

'"""

Kotak began 300 fuenlah Kotak

-

:
-

besar .

P :
Depot atrium ST segment : waklu antara depot vuetiikel

Q :
Depot septum Inveutñkel
dan permulaanrepol
R :
Depot ⑦ pertain a
Q-1 Interval :
dani anal Q
taupe Tselesui
setelah R ukuraktiutas total Venti Kel
8 :
Defieksi -0
1- :
Rep of Venti Kel
Ctf co # teka nah intracardiac
.

P-t-MEKAN-m-N6.i-EK6.siwustalu-katdt.br dikardia . atrial flutter / fibnilasi antonia veutoikll

↳
,

Chronic Heart Failure → disebabkan 01 games Duan sthlktutal / kelainanjautung structural

Islamia / infra * miokard hipertrofi rent Kiri av block LBBB
.

.
,
.

Gejala : UMass sesakr DOE -10 .

PND ortopnea -

,
Idah -

X-RAY thorax :

kardiomegali.lu/ertnfiVeut.kongesh- vena pam . edema Interstitial ,

Edema tungkat takikardia rhonctparu Yuli pleura

,
efubt pleura ( Keeley B line ) rhiperlusen
.
,
.

kardiomegali . S3 gallop i Mur Mur -

. -

lab Oratorian :
CBC. CKMB Troponin T Elektro life Cr
.
e6FR ghlkosa
-

,
,
. .
.
.

Etoologi penyakitjantunglskemik.penyakitsiskmlm.mn
: & In Hanabi .

test fungsihati uunalitos LDL C -16 HDL

.
.
-

, .
.

genelik , Htpulensi ,
auitmia Biomarker → Msa fuga peptida natriuretic BC BNP ) & MINT pro BNP)
-

↳ onset akut BNP 35M / Ml & NT pro BNT 125

pqlml
Echocardiography peutlaian fought Sistohik went lañ
vent kiñtdpompa damn menyebabkanbendunganvaskulauisalñ Pam ( WEF )
Gagaljantung Kai : → :
-
.
-
.

↓ → resisting pewter the →

gadi longest part & edema pam → batukisesak .

tipe Reduced Mid Range -

Preserved
ntopnea → ali Ren batik vena daei extremities bawah 1 Tanda -19gal a tanda -19 Yala tanda I ggala
tanda rh basal Pant
→ :
kaodiomegah ,
takikardia ,
nadi keek .
53 gallop ,
2 .
LVEF < 40% LVEF 40 -49% LVEF 250%
-

Gagaljantung Kanan :
Hipehenstpnlmonal .
penyakit Kamp pulmonate tricuspid / tanking bawaan .

3 .
-

peptidaneuretik -

peplidaneuretik 17

↳ bias anya fuga bs dais g. joining kin tambah laisenia :( 1) tambon lanata 11 )
-
-
.

↳ tdkada kongesti pam tipi ada konopthi Porta edema pewter ascites D. tanning structural 1) tanning structural
vena .
spleen Omega ti ,
,
efuñ pleura ,
. P .
.
P -

WH LAE
Gaga I Jantuhg Akut WH LAE
&
kasns bant gag at
&
-
:
→ Denon → Janning
↓
KR#lAAÉA D. Distinct diastolic 2) Disfunaht Diastolic
:
.

ADHF

gagaljautungtanpapenyakitokhfat-torpemberaty.mg
perbumkantibatibadaii tinggi Kiri gaga / A : rest Ko
↳ CHE Kahlua vent .

→
/ ggalagagaljantvhg pompa Saat beban key am
KMTERIANYHI.dk
akut
jointing structural
lautmia
MI akut
p.jantunystuktwraltanpaggalaltandagag.at kekrbatasanaktivitas fink ④ , aktiutasttik
:
B :
I
:

bagaljantung kronik →
kompeusasitubuhtangka panjang → remodelling .

gauteng normal tidal meal Mbulkah g. gala gag at tankers .

Gag at Janning sistohk → abnormalities fuse Gistolik → finger pompa janning ↓↓ C :

p gauteng structural dgngefala
.
/ tanda gagaljanhtg I :
sedikitkekrbatasaelakfiutas fink ,
aktivitas took
M hat
↳ Frakhtefekht ↓↓ Lalu normal Meaimbulkqn gejnla g. ganhlug udiakat
-

& Masa
sekatang
.

Gagalgautung Diastolic → abnormalities fast diastolic Saat refill relaksawijautung Gagaljantung refrakkr II
kekrbatasancukupsigm-fikanpdak-TMK.
Junking akhutast. sk
& D:
-

.
:

→ k{tmhat
g. gala g. .

Mumbai
ÑEA:( keparahantondisi)
MAN¥gE¥aMkUN tidakdapatmaakukansegalaaktivitas.SI
II :

tanda g. yanking ④ :
.
Rh -0.53-0 lstirahat talk membatk
-

Tipi Kal
:
sesaknafas ootopreu , , angina , SII :
S3 ④ , ph ⊕ di Seling ah cap ang part
PND ⊕ , up at Idah . Beng Kak Peifer .
SKI :
Edema palm → 12h ④ Selumh lapatlg pane
-

spebifik :
JV PM ,
reftukshepato jugular , 53 gallop SII :
shock kardtogetvik-sb.IN < 90 MmHg
Atilla jointly kearah lateral .
+
hipoperfubtjaithgall .
 1441714A FRAMINGHAM Mayor / 1 Mayor -12min
or-ATALAKSANA-l.li
:
→ 2

Terapiolgigen

|
pmѥFmopnea.MMI
_

Edema trlhgkat bawds ,

↳ spot < 90% / Pa 02 < 60 MmHg → nasal 02 2-4hpm →
gantike Nrm Kalo DIM 30 Merit ga batik → CPAP Kalo

""Mt MMMM " " "Mt " "" " " Mi "
9 " ʳʰⁿᵈ " / " "" " " "" " "" '

th bas ah haws , DOE ④ .

hepatomlgati 2. Farmakologi
kardtomegalt .

kapabitds vital He Yz 1 .
Diuretic →
loop thuretik IV → Furosemide 40mg N
tellMA point akut.gg tflht pleura . 2. Vasodilator → Sisto 1 7 90 mmHg → Nitro gli swine to -

long / merit
gallop . tekanan vena takikardia CAR > lwx ) Ibo dinitrat 1mg / jam
716am H2O , 3. Vasto pressor → Sisto 1<90 mmHg →
Epinephrine 1mg bolus IV dap at diulang 3-5 merit
/
.

hefhlkshepato jugular 4. Atrial fib a- last → AF-RVR.HR > 110 → Rigoni n 015 My IV bolus

_peumnanBB74i5KgdlMbha#

I6agaljantungAkut_
Etiologic
-

acute coronary
:
syndrome
H :
Hypertensive emergency
A :
Amy tumid
M :
acute mechanical cause

p :
pulmonary embolism .

klaltfikabt
-

6. fainting Dekompen fast :

berfahap . E :
bketwia .
Wyeth i 6
:
Edema peu-pr.otopnea.ME
-

6. jointing vipertensive Akut

:
Meuidadak .
E :
hipetkllh ,
Alitalia atrial All i 6 .
:
this pnea , takipnea
taktkardia , rhonct , TD Sistolik 71801100 ✗ thorax : edema Pant

Syok kardiogenik bisabertahap / mendadak it progreslivitas 9. fanning / gangnam

-

: :

Mio Kardinal i 6 :
Hyw peltast organ target oliguria flukes akraldtngin , . . .
.

TD tistolik rendall normal -

,
fought Sisto UK ventured art .
AI -ATAlAkSANA

D. OKSIGEN :
sat < 90% ,pa0r< 60 MmHg
↳ Akemi aowiokatdakllt
↳ Angina pektoris UAP , Stderasi LSTEMIINSTEMI ) 2) Clopidogrel
.
:
300mg → dilanfutkan 75mg / halt

PAT0F1Sl0 3) Aspirin
.
: 160 -320mg

Mantfestastakutplakateromadiartatkoroner → mpturoflaprsanfibrosaplakmengaditipis 4) .
NIHAT :
nttrogltsetineoib -016mg / ISDN Lib -15mg sublingual
→ agregasitrombosit & aktivasijalurkoagulasi → terbentuktrombus → penyumbatan ↳ Mulatto DIM b- Meritt Max 3 dons .

pernbuluhdardh Konner → pelepasanzatvasoaktif-vasokonstu-k-ahrandaraht.hr 5) Heparin :(STEM ) 015mg / kgbb

. IV bows .

→
supplant 02 ↓↓ → lnfrakmtokard .

6) Morfin
.
:
Motfinsulfat I -5mg IV. diulang 10 -

bomenttkalau N -16 sublingual

ykepy-miokard~AMMatitikdtlrabatehekan.mhoskmal.la
leher.rahang.keu.ngatdingin.MU larkelengankiri ,

atmuntah abdominal pain sesak Natas

Gegala
. . .

:
MI Posterior :
Depriest V1 V3
Angina alipikallekutralen
-

sinkop . intermittent persistent ) .

↳ peoutpanasipegal etevacn V7 V9 -

PF :
ketingatding.in S3 gallop ,

≥8 lead
.

thbasah . murmur . EnZlMJantUN ISKEMTLM :

Depriest
AI D. MB spehttisitastt Mehingkatsetelah 3 -9dam dalam 24dam Elerast AVR & V1
CK peak
-
:
, ,

1-2 halt
( nyeltdadaakut + EKG ) ibepneñstsegmeh . ketnbañ normal
"ʳtʰ9d°Mbaⁿᵗ MI V. Kanan :# wast V3 -
V4
← D. Troponin -1 spe.si/isitas----,mem-ngxatsetelahz-agam.peakdalamiz -48dam
-

ST eletah
-

persisted Tanpastelevastpetslsltll tahan 10-14 halt

LSTE -

ACS ) ( NSTE -
ACS )
↓ ↓ 3) Troponin -1 : spesitisitastttt.meningk.at 3 -4dam .
peak 245am tahan . 4- than

STEMI Peoiksaenzlm LOKAÑ Elerasi

- STEM / gapalutungguentim Janning
Janning vi. reraskuiaeisasi k
eatin Janning
labPehUajanglai# Antero -

septal VI. VI. V3 V4 .

elttlmjantung
meningkat tidakmeaingkat -

CBC , 6DS.EWHNU-tikoagulah-Datdhifdng.si ginjat lipid .

anterior V3 V4 ,
↓
↓
UAP stelerasi
NSTEMI -
EKG : lead 12 kealali V2 & V3 ,
≥ 1mm
septum VI. V2
↳ Kato di lead V2 & V3 Kalau ST ≥ 2mm ( 401ha )
lateral V5 , V6
Ftbmnolitik :
Alteplase 15mg IV bolus 72.5mm ( < 40mn )
" " 5mm ( )
0175 Mglkgseldma 30 Medit ( Max 50mg ) Antero -

lateral I , AVL V3 V4 V5 , V6
, , ,

posterior V7 V9 ,

Interior II. II. AVF

V. Kanan VBR -

V4R
Hipertensi Dutslipidemta
↳ Kla Siti Kasi : ↳ risk factors
preheperlellst 120-13%0
-
=

gg
- Grade I = 140-159
/go.gg
-

Grade I =

7160 / > 100

TATALAKSANA
7551hm :
CCB
< 55 thn : ACE I -

/ ARB
-
Kalay gatercapat :
ACE I / ARB 1- CCB
↓
ACE -1 / AFB t CCB 1- Diuretic

↓
Act -
I / ARB 1- ECB + Diuretic 1- spironolactone

CCB :
Amlodi pine 1×10 Mg
-

Ace i -

: Cato put 3×1215 Mg

Rawuprtl I ✗ 10 mg

-
ARB : candesartan 1×8 My

- Diuretic loop :
furosemide 1×40 MD

-
Diuretic aldosterone antagonist :
spironolactone I ✗ 25mg
CtEST✗-RAY_ .
dr. Allen sp P .

NORMAL CHEST X-RAY

Gabriel di bala liat dont hear ke Dalam
Kalo keeping tedi hot aye
-

How to
,
mga Kareena
Kaya khepitahi
.

: →
1- fubkutan → Alone abu -

seeing wgp ( ? ) →

1) Identities
Kalo de
:
M IF → adabayangan ↳ Kato Hitam
pal past
linfiflenahebkutan
.
.

:
maenmae .

2) .
Ponti → AP / PA 2- Tinker liat :

PA COR blah gang hs cloning kraken

potion rapes scapula ga overlap tin pane ↳ Fibrosis
:
,
contralateral massive pneumothorax Massive
efusi Pleura
.

→ ,

AP Seeymla
:
lebih Mahila → jadi Kaya overlap → fadi tuka bikini bags an ↳ Atelectasis Matta
↳ biagauyn
.
.

kosongankeliatanubihpntih ↳ Bronko entasis pagy.in

diaterdorong / teetaeik /menyempit ? timid
.

3) Exposure
.
:
Density . → liat daei trakea → tmkea em bbakeliatan sampe -14 3 .
CTR
-
dibawah -19 gabrels Keli atom habis he bifnrkah ↳ Cali pinggang paling War

vertebra , Kalo keliatan dtatliperdeus . →

pam Wahroonga
tbh hilum → bahayh Kalou ↳ Cari Cardiac Glue He sign .

aela
.

pneumothorax
-

thpodus →
pane pnhtr →
pneumonia du nantigakeloatah
4) G-at
.

fudut → tunpnl ga
4) Rotation
.

-
ti metis / tidak . → liat dei sternum -
clarinda Iuuhon Kalo trumpet tanya uiwayat
5) Breath - .
Awww : 7- &
peugobatan
↳ boat
'
Mimi cutup ya Wakhi di
x-ray →
drafragma phony posterior :S -9
Afan Emfitema / AW .

Antenor 6 ribs
1%
-

Kalo blah EMÑhʰ

Ffubi → meniscus
→ -

poggewor to ribs .

€,
6) .
Liat Udara lambing . Atelectasis → gander measure .

5. .
liat fndut Kardon fantail .

6. hat
.

thiafragaos
↳ tenting → Kaho fitment
7. Arakan bnnboraskullr 213
.

normal wya .
Chaya Kabali) ↓
Kunis
pain
8. Hikes
pembefaran ga
.

→
↳
.

/ ↳ meeting point bonkers Flattening sesaknafae

→
, . arkei -
vena .

KGB ↓
u .

Hatdips Edema pane first Hung fast . . Dramma Kanan hamsnya

tumor pane → dais epitel bonkers
-
.
blah Tinggi 1 Iga devi Kui
9. Infiltrate
 Definite Patriot TB kakifikabipabieutb .

peayatit
PARI .
① Terkonfirhhabibaktuiohogis
.

↳ tayman pogitif → sputum & g- owing an Item +B)

D. lokabi anatomical
4 .
Pi way at Peng obatausebelamnya
3) Halil peanuts aan wfikepekaanobat
1) Patten TB pane BTA ④ .

4) Status HIV
.

2) patient B pam hard biakkan Mtb ⊕

TUBERCUL.tl#
.

3) tmsien IB Pam hustles upat Mlb ⊕

.

4) pagien CB Ekstrapay lerlanfironabiseearabakteñ

↳ mycobacterium
.

tuberculosis →
paheuki on pane (alveolus ) man BTA / TUM
5) Banak Yang
.

terdiaynowsdgnbaklemrog.is .

transmits : Manuka -
Manuka (droplets ) Kalo bratteli Ga confirm
② Terdiagnosis Keimig ←
taps Klaus dai doktor oke beat porgolsatan
↳ father frontal organism
,

3 : . konsenthibi organism , 1) BTA -0 foto thorax wondering

.
.
.

Lama Mengwimp Udara Konta Mikati .

2) BTA ⊖ dgntidakadnpvrbaikanklinis SHU
.
di button antibiotic non OAT ,

rest ko TB
dan prettya father
.

tisiko TB : HIV steroids DM penKoki Altom < b- then

fakhr usia 3) 1B ekstrapane → terdiaymsis Minos calamitous lnetopatologis taupa BTA④
-

,
, , , . , . & .
.

tarsia kontdkerat resin tmggi TB

.
,
4) TB auakter diagnosis dgn Sistan storing
.

.
.

pathogenesis

virulently
↳ bergantung davi

droplets
.
→ taken bwnkial -
→ deposit dibntiolus /alveolus -ggNaTBPaM_ .

-
Kato dikit : Mati difagosit dime and dgnsilia ↳ total / pane hathk ≥ 2min99 U ↳ gejala Sistani K
:
: Dear am > I met an
-

Kalo banyak : Yang diuraadikot Sisa multiple Kasi

-

di batak datah malaise

makoofag . 8 esak natas Keringat Malam
Melt dad a BB tuner
2) .

MultipleKasi tiap 23-32

jam diouakoofag → tumbrels 2- kminggn
anorexia
3) TB Primer
.

↳ papanui perf aura → dibawah Wbns superior / at as tomes

↳ TB pasta primer
chemo tin Makki Wfla Masi → to key Gwon
→ Unfelt or
↳ foxes btwn → Mehar di limfatik → b- mfangitis regional
-

pernahtctpaparbakkei TB
Kab mediastinum
-

telyadi Seldom Pelto de latent Chetan tahan ) SHH Tufton primer lneaktiutas )
-

→ pembesaran
↳ caritas Pada Wbns superior pane & keoufakan pane was
↳ pokers lotion + limfadenitis regional Komp lets primer .

↳ necrosis easeosu → fibrosis / kaesifitasi ↳ Kalo Match7 : Ada peugkafhetan → n .

caseofa
↳ Asymptomatic & tuberculin poof dalam 4-6 minesme b- Komitas t ) → pneumothorax
↳ cut Kalo immune tubuh telex fadi nyebarheonatogln
,
↳ meleeas → satang pneumonia
bulan
TB akttfbeberapa ↳ memad at → tuber kuloma
Kompleks primer
-
:

↳ Berth
↳ seenbreh prema tampa betas
.

seen

↳ seenhuh dgnmeniaygalkan bekas ( galis fibrotic kalsifikali .

him , taping gohn ) → Dormant

↳ Panah → nyebarkesekitar → TB Miller tutus .
klhlrifikabipasilnttbi .
Meng waves
'

MMM OB mi her piga

→
TB pane
I. to Kali anatomy →

TB Ekstra
frame → Unfed evite CB , meningitis TB ,
TB
peewits Spondilihs TB
, , TB tupar .

I. P.B Tb pane / Ekstra

pune (t) TCM
→

Klink
gefala t) Baldini f)
my A)
P .
→
,
.
✗ -

VI. A. peugobatan → 1 Kahrs 13am

.
 LHTOBATI.kompoh.fi
Mllkallall :

y.pn.aguam-dimetformine-hfdakmenbe.ba
'bkan

kejadianCVDt.IN/)DfR/NEMFfAB0(#
pnglikeniia

TATAYAa.km.sn?N.=!t-:a.y-taromim-
" ""
,

" "* * "" %

suknsasozcmax )
"
4EH%Mⁿs:HˢᵗmM→"ⁿʰʳiᵈoʰwdat
I> www.ty-genunaoi
-

.
Def B12 .

¥
lemaklo -25% ( ma✗zo% )
snltmilutea :b
.li?,??agmidefEfkHipogh-kemiakuat
4. 6
-

( Atihdh Protein D.
Nefnpati 0189119130 / day Glimepitide £
f- duKagg→TltAfn
→
icompiikasimikoovaskulartl
-

→ ↳ Dmsudahhemodtalisa → I -429 / kosbb / day

gyz,
SE.tupoglikemia.BR/T-mafeu-teutaugpeyalanan
DM
-
Nat" "M< 1500M ( HMaʳYaʳʰ9Mʳʰ " "
ftp.pwgeitazone-th-poglikemiauinganiHDII?6DPPt
Gadag ,de

%hfʰ↓%ahHaebab
g.

DiaBetlfMeU
Swat -3591dm

µ%y§↓y&a§§qNdggiMa
.

peugeudalianupemautauan DM
-

↳ SE :bB↑ Edema gngattantuag , ,

•E
.

peuyuiitimoeresikomsa osteoporosis
carapemantailanglukosadarah latihattfasthllht :3 -511 / Minogue 4. Glim'd
Rapaglinide -3617Mt
:

lemahbadan
-

iapogeieauiaoiagan *
>
30-45 Merit 5.Pewhambatata-bwatidasi-Acarbose-aoppx.eu 't
-
.

mengenalggalahipogñkemia
/
-

✗esemutan -

latihanjagmauiyangteratur ↳ akglukosanyasebelumolahtdgd ↳ •I. dosisnyauamsseungditesuaikan

-
Get B → 60% → Thfrlbifll -

fatal
Vldagtiptin }
-
Plktwatankaki 6. peuyhaenbatDP9-4.si/agliptinnitneraasibaik ganyebatnnhipog ,
.

/ If"Yµ↑{"¥"ᵗp¥ᵗf↑?&¥m¥ʰ%¥
SE.Angioderma.urtikaeia.pahkveatitspolifags.ae
matakabur →
ᵗ%
-

iinageipim

(defisiewn
Mahatma """

Seek 302 distungñereksilpnvilusvulvae

.ie?.::::::T
Glukagon
m:...m.i&-fel8-loZ-
pengobatannonfarmaaoi.gs saxagu.mn
-

→
-

→
→
"" " " """

!÷!!¥÷|¥÷
dgnmodifikafigayahidup-t-valuatitt.tt'll 3h41AM
£

Entwine
640-1
www.afidebDPP/.retikokardiNaskulart
somatostatin kakis
exertatidetankoeahma.at
-

tidakbolehberjalantanpaalaskati .
Dueageutide
termasukdtpasirokaki 8. Insulin

Kateyoy
:

DM Tipi Autoimmune puneiiksaankakilhan → latorkalau

→ :
-

I. rapid aspart.iispn.cewu-n.ae
:

kulitterkelupas kemerahan / luka 130 llomenit )

-
↳ onset Lio -30mm't ) ; Peak
-

↳
,

↓ Tipe2 Pehllhlnecerpnrgnesifetayproduksi Ursuline Peñksaalaskakisebelumpakai I. Short Regular inertia -60min)

↓
- : :
: .

III. Intermediate NPHonktll.is -4dam)

-

jagakakitetapbergihitidakbasah ,
:
; peak 14 -10dam)

Oles Krim pelembabdtkulitklll.MG II. long :

baryu-ne.Deterrmironatli-3tamsitems-temsae.li )
Gestational
.

Trimester 2nd / 3rd ( biwayat DM Lebanon hamil

.

Whaling Deguideconsetlois
:
I. 1) items tartan
potongkukuteoatur
: - -

70% NPH 30% Regular onset 115-30 merit )

tdkfllas )
VI. Caurpuroun
kltinokankakiosllakakisetllah
:

1) Mfpltifik
,

monogenic Diabetes syndrome Aspartpntamineisoioaspart

-

: 70%
kekamarmaudi
↳ Diabetes neonatal / MODY -

Kaos Kakiyanglllmblltutdk
begpgpat
yngua.mg?kebuHhan1nsubinehan-an--0i5Ul1k9bb
Prandial 60%
"
Basanti .

#Ñ "

lndulinohatrpurggunaanglnkokorhkoid .
-

Kalas & Mata Kant temtur

→ Dosisawal
↳ Penyesuaiandosishañanbedasarkan
6- low / hari
GDP :

HIV/AIDS post transplantation organ Alas Kati Yang Maman

-

,
.
-

ctomgldlitumnkandosisorunit
70 -130mg / dl Pertahankandosis

¥¥%%aan6Wk0saDaMh
-

nalkkdndosissultiapbhaugky-py.mg#tTT60/bDS/6DP
7130mg / dl
-
:

µµTEpyAD1A6NffADM_ 61716172M lsomosldi.naikkandosisauiiiapsho.li

: -
>

( Rapid / Short )
4. Pemeliksaan HBAIC -

prandial → tiapjamce -12-6

↳ liateflkterafh-8-kmingg.it
-
Basal → Jamlomalam ( Intermediate / long )

1) Dimitry 1/ lehihfaktorrlhko
.
1Mt > 23
dgn Gejalaklasik DM -161757200mg /dl
-

Dipuiksatiapoobuianl> 10%7

pasienmencapaitargetmim-malaxitanun-faktorketumh.am
_

DM HBAIC GDP GDZPP ( 11,1mmol / L ) D. Pantaucdukosamandiñ

4) Glyeated HBAIC -01245116A -11.73
vihrayatpenyalcitkatdiovaskular .
Albumin -

ATAU
-

HIM > 140 / go / peuggunaanterapitltn Diabetes 76,5 7126 7200

DM -1617137126mg /dl
.

HDL <
35mg /dl / c-67250mg / dl ggalaklasik
Pre
Monottapi metformin
-

17.0mmol / l ) : 311500mg PO
-

perenymansindromeovanumpolilcistik .
Diabetes 517-614 100-125140-199
may Celimepivid 1112mg Po
-

aklilitasfisikyaelgkurang /dl( 11,1mmol/l) repaglinid 3114mg Po

obesity berat / aeautosis nigricans
-
Normal < 5,7 < too < 140 GDZPP 3200mg
Acarbose 311100mg PO
ATAU
.

2) Pre diabetes IHBAIC ≥ 517% ) → puilgnmtm

- -
.
Dual tempi :
metforminebxy-oomg-ceh-mepin.dk 2mg PO
HBAIC ≥ 6.5% Aearbose 311100mg PO
Gestational metformin 311500mg +

31.wauitadgnliway.at DM .

Metformine 3×500 Mg + Insulineglargine

4) 7451ohm
.
.

5) Ekaterina normal
.
→ Wang minimum stern
keto a si dos is Dlabetik
↳ Dekompensast / imbalance
Hyperosmolarity per gli amie State (HHS )
metabolite →
dilandattiiaswipogeikeouik ↳ Htperglikunik hiperos molar non kettik +
gang yuan Kes a damn
-

acidosis ketosis ↓↓
↑ gut Kosa glukosa pewter
.

↳ Pato mekautsme pro dukhiglukagon

:
→ → Intake

↳ Pato Mekants me resistlust Insulin e :

absolut /relalif →
Glucagon Kate Kola Min Kostis 01 Growth Mormon M
. , . → c. a- Kou sis
-

ftp.adidiurltisglikohlh-kakibatkegagalangn-njal
↳ Pen deKatan Diagnose :
↳ Pen deKatan thiaowosa :

D. DM → DM den 9am Intent amah gang yuan peuglihatan.kala-kejang.mu at muntah Ketu hall Saraf ( 6th argi disorientate hemiparek )
.
-
-

2) Diag Rosa
. , .
:

Debi drati berat → turgor kuht Mutola tipi Kering mu Koga pipi Keung Mata cekleng Akraldingin
.

6gal a Kunis Dehidrasi pen Kes Kuss Maul SYOK hemorrhagic Deman
-
,
.
. .
-

: , .
,
, , .

lab : Kadar glukosa 7 250mg % pH arteti < 7135 HCO 3 ↓ ↓ anion gap ↑ , . . .

Keeton serum positif 73mm Bik Arbon at serum < 15 me 9 OSM Plasma
, ( boo 310 Mos / me ) ,
-

dau ni lanes lips titis

pñnsip Penang anan :
murggaatikan cairan
garam Yang ,
meneKan umak ,

Mene Kan ghlko Genesis

PENATALAKSANAAN ly
.
Rehidrasi catran : NaCl 019% II. 2 liter t
jam pertama
I 1 Liter fam kedua .

2) Insulin -12 jam seldah Mhi draw

Infers
.

Awal bolus IV 10 Ui / 0115 hi / kgbb .

& insulin
regular oituilkybbljam
-

Ting Kat Kan Dobis insulin e 1 ui setiap I -2 jam hila 6 he Kosa darah talk
adapeuuvunan 40%
atau as am bata tidak MumbaiK .

kuranqi dont 1- 2 Ui hila Kadar glukofa < 250mg /all

-
pettahan Kan glukofn darrah 140 -
180 mg / dl
-

Jang an heutikan latus tubulin → Haiti Kan pika glukofadarah < 80mg / dl (setaura 1ham aja)
-
Bila Glu Kofu darah < 100mg Idle tunes → Nail → gantt D 10% →
prrtahaukan gin 140 Ito -

my 1dL
Peetimbaugkan be Kalan ps shh ks Makan
-

-
Whilehe
hrfube IV fu hyun diberheulikan I 2 town Sitelah be mulai -

Panful Kalinin < 6.0 they → lo lo Mey ( jam

frka
- -

-
Bienal Kalan pH it a tall HCO 3- <5,0 Me 91 I

- Antibiotic pkaadawfeklt .

Ursuline :
syringe pump → 50 Wi & 50 a wall 09 %
-

↳ fikaglukolhdarah 7300mg tell → but / pain

too -300 mg / all → Hi / fam
< V00 My /at → 115 At / fam
-

Infills Mikio dit µ :

24 ill & wow Nail 019 % .

↳ pika Glu Kota darah 2300 mg / all → 241PM

WO 300mg / all → 121pm
-

< NO 6 tpm
night →
.­
HlPo6h_keMiA_ . Diabetic Foot -

klasitikañ TEXAS :

STADIUM -
'
0 1 2 3
↳ lnsulineberlebihcotlobedehihanlsnlforuurea)
gagalginjalkwm-ktanpalukalhlkafupetfiu.at
A
,
lukasampai hlkasaonpai
TRlASH1P06HkEMlA_ .
DM pascalukakulit hdaksampai
tendon / kaput utah
tendon / Kapral
sendi
twang / Sardi

Gejalahipogbikemia ↓ B -
Denganlufekeñ

f-
-
-

konsentrasiglukosaplasmarendah Neuropathy ← Trauma → vascular C -

Denganiskemia -

hilangnyagyalahipoglikemiasetetahkonsentrasiglukosa Plasma meningeal ← disease D

.

Denganlnfdad-xlsklmiabgalatldrenergikipncat.nu ↓ -

↓
ngatdillglnigemetaraniamasisakitkepalaetnenoantuk
-

MᵈÑ " →

( ,aµnpµ
SLMSOÑK AUTONOMIC
disorientate Perkes weakness
Mikrovasklllar Makwvaskular
Ayala Neunglikopenik :
slurred speech ,
Uman .
,
.

( Anhidoosis ( capillary
thickening ) ( atherosclerosis > occlusive > Ischemia )
Deformity callus ) ( loss protective ,

automating
,

sensation ) " BAM 1

Hlpoglikemla ↓ £
,
nutrient
capillary How↓↓
-

klabtfikasi Wagner :
← tidal
Sadar Marot
Diabetic foot ulceration /
Sadar 0 :
bsitidakresikotodiahetictoot
↓

tanpainfekh-isuingadac.at/usjnga20-30gr -1301USD 40%50 Mew

1 :MkUs superficial
ldnltanglukosamurm
Ukllsdislttatselulilistanpaabsesokdainantulang
-

2 :
-

1MUSD 10%8 "M / KOH

obatpmdihentikansevueutolra 3 :
ulkusdalamdgnkelainankulitoeabs.es/uasdisutatkelainan twang
Panta "9ᵗᵈK°ˢ " dam" / " Menil
- -

4 :
bangrenterbataspadaibujouikakiotumit .

pantauglukosadamhsetiap , zjam
↓
- _

5 :
gangrensdumhkaki .

pertahankanglukosa > 100mg /dl

Belumsadar
↓ cektiaplsmewit

[
-

g. damn < 50 1740%50 Ml

:

g. darth 400 :D 40%25 Ml

Kalam Sadat g. damn 100-200 :D 10% lnfuslanjut

g. damn > 200 pertimbangkantumnandoips 1710% Infus
:

↓
3kañcek6DS
↓ CEKGDS / 2dam
61757100 :( anjutlnfus D1o%
GDS > 200 :
pertimbangkanganti D5% / Nacl0i9%
↓
3kañcek6DS
↓cek6Ds14JaM
61757100 :( dnjutlnfus 1710%
6ps > 200 :
plrtimbangkanganhlntus 175% / Nacl 01970
↓

zkalicek 6175
61757100 → perklraallcek 611s
sampaiefekotlohabis
↓
Masihbelumbaik
↓
-

Celukagon 015 -1mg IV / IM

-

ttidrokortison 100mg / 4dam kalauhipogliketni

setamallrjam
→
Mshbelumbaikl
ATAU belumsadar
Dexamethasone 10mg bolus IV
caeifaktorlain .

lanjutlrmgtiapbjamt
Manitou 115 otgrlkgbb -

tiap 6- 8dam
TROI
"

Hipotiroid tiiputiroid
-

goiter -

goiter
-

bradikatdikardi -

tachycardia
-

dry skin -
wet skin
-

BBM -

BB ↓↓
-

konstipaeñ -
mane
-

dry hair - hair loss

-
cold intolerance -

neat intolerance

brave 's :
Hiputiroid + goiter . Usia Muda
optnalmopati.myredemapeu-orbit.at

1=-14 TSHS ↓ :
Hiputinid
THIS ↑ 1=-144
:
Hipotiroid

TATALAKSANA-tlipertim.cl :
Propythiowractl LPTU ) 3×100 Mg Po Selamat 2h41am
Methimatole 10mg / halt

-
Hito timid : sodium levotyroxine 2×25 Meg selama 3 hair

thyroid Strom : Pet 3111g IV ,

Ptl 411400mg PO ,
Methtmazoll 61120mg
tepatitisA_
→ teen oral
Blood ,
sex

↳ 75% Dewas a → simtomatik

70% < 6 tahan → asimtomatik
Sendai tinjapncat
gyiala Deena M leman letih Hsu urine teh lktetik nyeri otot &
-

:
. peuumnan nafhl Makan ,
-
-

, .
,
,

hepatomegalt.feku-S.sk/eralkHoik-penunjang:tes
PF :

urine → bilirubin urine

soot & Slept ≥ 2x lung ñhañ

→
PATOFIST.lt#I:.
IgM anti HAV
Diagnostic :

Hep A. Virus → kehati → replikadihati efekditlepatotit

-

.
→ .

↳ Hints anam.pt peuunjang :

.

↓
↳ Banding lktetik obstukhf Hep : , B & Cakut .
Sirois Hepa tis
Ake Inflates r Ming get
PENATALAKSANAAN
low at ← Hep -
←
Saat jaundice
oral
kaloñadequat
feed Poitier
1) .
Am pan
2) Tirah
.
baling
3) Pengobatansimtomatik → Ibuprofen 2×400 mg / hats
.

Milat → Pompeiidone 3×10 My / hari

penult pain → rani ti dine 2×150 Mg / OMZ I ✗ Wmg Po

4) konseting EdaKasi →
.
&
vakhnah-ttep.tt .

tri are Akut

↳ Shigella ,
entamoeba salmonella , , e- colt

osmotic → masala U absorb a

: → lactose intolerance
-

sekretovik → watery spt air out ,

betas → cholera
-

Dip Moti litas → camp uran seknltorik + osmotik

↓↓
↳ trans mist Makan an terlalueepat → absorb a- H2O

↳ IBS

stool test → occult blood Ieukosit

↳ Penury ang
:
, ,

entamoeba histolytica

TATALAKSANA :
fW✗ain 2×500 Mg Selama 10 hari
-

altaplugie 2 ✗ stab
-

Dehidrasi → tempt Cavan 50% @ sjam

50% @ 16 jam