Diagnosa dini demam berdarah dengue oleh: Abu Ikhsan M.

Kes Dengue Hemorrhagic Fever ( DHF) is a serious disease. if not diagnosed soon enough, it can cause death. Until now, early diagnosis can be done by using laboratory test, but this test is expensive and not all health community center have this tool. The other test is tourniquet test, but this test is not effective for early symptom and make discomfort to patient, especially for children. Afif test can be a solution to detect pethechie as early symptom of DHF. This test is easy, quick, cheap and more comfortable than tourniquet. Pendahuluan. Demam berdarah dengue adalah penyakit infeksi yang berbahaya, yang jika terlambat penanganannya dapat menyebabkan kematian. Permasalahan dalam penanganan DBD adalah salah diagnose dimana pasien dianggap mengidap penyakit lain seperti tipus, common cold, dan lainnya. Biasanya pasien yang datang ke sarana kesehatan mengeluh adanya panas, pusing, sakit kepala, mual dan kadang disertai nyeri otot abdomen. Data ini sulit bagi petugas untuk mendiagnosa secara pasti sehingga berdasarkan pengamatan , banyak petugas kesehatan dalam memberikan terapi bersifat simptomatik dan kuratif sekaligus preventif. Kondisi ini cenderung akan menyebabkan dampak merugikan bagi pasien karena pasien diharuskan mengkonsumsi antibiotic dua macam sekaligus. Bagi petugas lapangan pemberian antibiotic 2 macam sekaligus dianggap lebih baik, mengingat : 1. Tidak adanya fasilitas laboratorium untuk diagnose penunjang 2. Lebih ekonomis disbanding pasien harus dating lagi 3. Sebagai sarana untuk mendiagnosa penyakit lain, misalnya jika dengan obat tersebut tidak sembuh maka arah penyakit adalah penyakit yang tidak responsive ke antibiotic contoh : jika tipus dianggap responsive ke antibiotic, maka tidak responsive ke antibiotik menunjukan pasien mengidap penyakit non tipus. 4. Di daerah –daerah tertentu ( kota ), rata-rata hasil test Widal menunjukan titer tinggi, sehingga dianggap setiap pasien dengan panas harus diberikan antibiotic doble. Alasan lainnya adalah kekhawatiran akan adanya hilangnya market, bahwa jika berobat ke tempat tersebut tidak manjur padahal mereka hanya melakukan diagnose berdasarkan namnesa dan pemeriksaan fisik. Berdasarkan fakta dilapangan membedakan Tipus dengan common cold kadang tidak sulit, tapi membedakan keduanya dari DBD agak susah, kecuali setelah diterapi seperti diatas. Tanda dan gejala Tiphus Common cold Dbd

dan efisien untuk mendiagnosa karena dapat dilakukan pada satu hari setelah pasien menderita panas. 2. prosedur gampang.Abdominalis Pnas tinggi >38 C ++ yang menetap Respon terhadap + antiperetik*) Nyeri abdomen ++ Mual +++ Tes tourniquet *) - +++ +++ ++ ++ - +++ + ++ +++ - Respon terhadap antipiretik 1. Alat penyedot . Adapun tehnik tes Afif adalah sebgai berikut : Alat : 1. Gelas suction yang kecil 2. namun cara ini mengalami kelemahan diantaranya : dapat di lihat untuk panas setelah 3 hari dimana trombosit telah berkurang. Tes Afif Melihat berbagai kendala dalam diagnose DBD. salisilat. Tes tourniquet dilakukan pada saat klien dating dengan keluhan pada hari 1-2. mefenamat ) yang biasanya di jual diwarung. prosedur yang dijalani sangat tidak nyaman bagi pasien terlebih pada anak-anak. penggunaannya dengan cara mengobstruksi aliran vena. Mudah karena tidak memerlukan biaya yang mahal. Meskipun cara ini mudah dan sarana yang ada dapat mudah diperoleh. Respon terhadap antipiretik dilakukan melalui anannese apakah klien sebelumnya mengkonsumsi antipiretik ( paraaminofenol. sehingga terapi dapat dilakukan secara tepat dan efisien. Test ini bersifat non invansiv untuk mendiagnosa dini DBD. sehingga pada bagian distal lenan akan diperoleh gambaran petechie. Tes Tourniquet. maka penulis mencoba sebuah alternative diagnose dini dari DBD yang bersifat non invansif dan dapat digunakan secara mudah.

000 . Kop dengan ukuran yang sesuai dengan tekanan sedang 0.5-1 psi atau hingga batas yang ditoleransi pasien.3. Amati adanya pethechie 1cm dari garis tepi No 1 2 3 Jumlah pethechie/cm 0 1-2 >3 Keterangan Suspect non DBD Suspect DBD Suspect DBD dengan trombosit < 100. 4.5-2 menit. 5. 2. Tunggu untuk waktu 1. Area yang dipilih : bagian dalam dari otot tricep Alat tersebut biasanya digunakan untuk membekam orang Prosedur : 1. 6. Pasien dibaringkan posisi supine Siapkan area yang akan di kop dengan meberi tanda pada pusat gelas Olesi minyak zaitun. 3. Minyak zaitun 4.

C o m p u t e r y a n g r u s a k d i p e r b a i k i l a g i a g a r t i d a k m e n g g a n g g u aktifitas kerja. 4.d ) C o m p u t e r .dan bertanggung jawab. K e s i m p u l a n Setelah penyusun menyelesaikan laporan Praktek Kerja Lapan g a n ( P K L ) ini.INDAH KIAT PULP & PAPER Tbk.CIREBON MILL.2. tangguh.Penulis juga tak lupa mengucapkan terima kasih kepada pembimbing yang telahmembimbing sampai Penulis menyelesaikan Laporan ini dan juga beserta karyawan-karyawan yang membantu Penulis selama PKL.P e n u l i s m o h o n m a a f a t a s s e g a l a k e s a l a h a n y a n g t e l a h d i p e r b u a t .handal. y a n g m a n a a t a s r a h m a t d a n h i d a y a h .D i p e r u s a h a a n j u g a t e r d a p a t d i v i s i y a n g m e r u p a k a n s a t u k e s a t u an dari padak e b u t u h a n y a n g d i i n g i n k a n d a l a m m e n j a l a n k a n s e b u a h p e k e r j a y a n g d i s e b u t Accounting.Penulis juga menyadari bahwa Penulis disini juga masih tahap . 1 .N y a akhirnya penulis dapatmenyelesaikan laporan Praktek Kerja L a p a n g a n ( P K L ) d i P T .CIREBON MILL . baik moriil maupun materiil danPenulis juga berterima kasih atas bimbingannya selama melaksanakan PKL dan jugaatas diberikannya kesempatan untuk Praktek Kerja Lapangan ( PKL ) dan mengenalidunia usaha di PT. b a i k d i s e n g a j a maupun tidak disengaja.Banten. Penulis panjatkan syukur kehadiratA l l a h S W T .e ) H a r g a i l a h K a r y a w a n k a r y a w a n l a m a . Penutup Dengan mengucapkan syukur Alhamdulillah . I N D A H K I A T Tbk.maka penyusun dapat menyimpulkan bahwa PT.IKPP. berwawasanluas.P e n u l i s i n g i n m e n y i m p u l k a n b a h w a P T .dan tidak lupa pula Penulis mengucapkan banyak terima kasihkepada semua pihak yang telah mendukung Penulis.c)Lebih meningkatkan ketertiban yang sudah berlaku.BAB IVPENUTUP 4 . b)Memberikan pelatihan-pelatihan kepada karyawan untuk meningkatkan mutudan kualitas SDM.  Perduli terhadap pendidikan. INDAH KIAT PULP & PAPER Tbk CIREBON MILL merupakan salah satu perusahaanyang memproduksi kertasterbesar didunia yang beroprasikan secara komersial dengan status Penanaman ModalAsing ( PMA ). Bagi siapa saja yangmau menanamkan modalnya dalam bentuk saham. PT.3.terutama di Indonesia dan khususnya di wilayahCirebon . dan sudah Go Publik ( Terbuka untuk Umum ).  Memiliki Karyawan atau tenaga kerja yang disiplin. I N D A H K I A T P U L P & P A P E R T b k CIREBON MILL adalah suatu perusahaan yang :  Memproduksi kertas terbesar di bagian Asia. Saran a)Membuat produk-produk yang lebih berkualitas dan ramah lingkungan.4.

measurements of tumor markers are usually combined with other tests. 1. Some of these substances are also found in other conditions and diseases.aspx on the Internet.cancer. known as a mutation or alteration. Although an abnormal tumor marker level may suggest cancer. in the tumor tissue. A decrease or return to a normal level may indicate that the cancer is responding to therapy. These substances can be found in the blood. The American Society of Clinical Oncology (ASCO). education.000 cancer professionals worldwide.cancer. whereas an increase may indicate that the cancer is not responding. tumor marker levels are not altered in all people with cancer. or tissue sample and sends it to the laboratory. is an alliance of cancer centers. which is also a nonprofit organization. Risk markers can indicate that cancer is more likely to occur. How are tumor markers used in cancer care? Tumor markers are used in the detection.aspx?id=48 on the Internet. tumor marker levels may be used to check for recurrence (cancer that has returned). After treatment has ended. Some tumor marker levels can also be altered in patients with noncancerous conditions. Usually these “serial measurements” are more meaningful than a single measurement. has published clinical practice guidelines on a variety of topics. diagnosis. and then periodically to monitor for recurrence. which can be found at http://www. in the urine. Tests for risk markers can help the doctor to estimate a person’s chance of developing a certain cancer. the tumor marker levels are often measured over a period of time to see if the levels are increasing or decreasing. Scientists have not found markers for every type of cancer. whereas tumor markers can indicate the presence of cancer (1). this alone is usually not enough to diagnose cancer. tumor marker levels reflect the stage (extent) of the disease. Therefore. To date. April 2009Penyusun (TOO-mer MAR-kirz) These substances are normally present in small amounts in the blood or other tissues. and gastrointestinal tract cancers). 4.nccn.org/resourcecenters/resource_topics/tumor_markers/Pages/default. breast.net/patient/ASCO+Resources/Patient+Guides on the Internet.belajar. or in other tissues. including tumor markers for breast and colorectal cancer. Can tumor markers be used as a screening test for cancer? . The NCCN provides Treatment Summaries for People with Cancer™. CEA (ovarian. More information can be found athttp://www. When the amount of these substances rises above normal. and after therapy. Cancer cells can sometimes make these substances. called Patient Guides. 3. The presence of such a change is sometimes called a risk marker. What are tumor markers? Tumor markers are substances produced by tumor cells or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. Different tumor markers are found in different types of cancer. Tumor marker levels may be measured before treatment to help doctors plan appropriate therapy. lung. during. These guidelines. researchers have identified more than a dozen substances that seem to be expressed abnormally when some types of cancer are present. are available on the ASCO Web site at http://www. a nonprofit organization that represents more than 25. pancreas. The Academy publishes Practice Guidelines and Recommendations for Use of Tumor Markers in the Clinic.aacc. Does the NCI have guidelines for the use of tumor markers? No. to diagnose cancer. especially if the cancer is early stage. urine. CA 15-3 and 27-29 (breast cancer). 6. In addition. In some types of cancer.) Tumor marker levels also may be used to check how a patient is responding to treatment. jadi harap di makhlumi. Tumor marker levels may be checked at the time of diagnosis. 5. and management of some types of cancer. and professional development. such as a biopsy. (More information aboutstaging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers. where various methods are used to measure the level of the tumor marker. 2.dan Penulis juga masih banyak membutuhkan bimbingankepada semua pihak. The National Academy of Clinical Biochemistry (NACB) is a professional organization dedicated to advancing the science and practice of clinical laboratory medicine through research. which focuses on the appropriate use of tumor markers for specific cancers. and PSA (prostate cancer). The National Comprehensive Cancer Network® (NCCN). Most of the guidelines are available in English and Spanish versions.com/Treatment-Summaries/CancerTypes. the NCI does not have such guidelines. How and when are tumor markers measured? The doctor takes a blood. If the tumor marker is being used to determine whether a treatment is working or if there is recurrence. some organizations do have these guidelines for some types of cancer.Cirebon. cancer might be present in the body. in specific genes. which include tumor marker information for several types of cancer.gov/cancertopics/factsheet/Detection/staging on the Internet. The summaries are on the NCCN’s Web site athttp://www. and levels of the same tumor marker can be altered in more than one type of cancer. However. Examples of biomarkers include CA 125 (ovarian cancer). What are risk markers? Some people have a greater chance of developing certain types of cancer because of a change. before.

So far.Screening tests are a way of detecting cancer early. (More information about PSA screening is available in the NCI fact sheet Prostate-Specific Antigen (PSA) Test. . Sensitivity refers to the test’s ability to identify people who have the disease. Scientists are studying whether measurement of CA 125. prostate-specific antigen (PSA) levels are often used to screen men for prostate cancer. before there are any symptoms. CA 125 measurement is not sensitive or specific enough to be used to screen all women for ovarian cancer. For example. For a screening test to be helpful.gov/cancertopics/factsheet/Detection/PSA on the Internet. is useful to find ovarian cancer before symptoms develop.) Another tumor marker. Moreover. it is not clear if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. Even commonly used tests may not be completely sensitive or specific. CA 125 is used to monitor response to treatment and check for recurrence in women with ovarian cancer. is sometimes used to screen women who have an increased risk forovarian cancer. Elevated PSA levels can be caused by prostate cancer or benign conditions. It is not yet known if early detection using PSA screening actually saves lives. but this is controversial. along with other tests and exams. which can be found athttp://www. Specificity refers to the test’s ability to identify people who do not have the disease. CA 125. Most tumor markers are not sensitive or specific enough to be used for cancer screening.cancer. it should have high sensitivity and specificity. and most men with elevated PSA levels turn out not to have prostate cancer. Mostly.

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