EMERGENCY DUTY REPORT

Wednesday September 11, 2019

Consultant incharge : dr. Muhammad Syukri, SpJP (K)
Residen incharge : dr.Erizon/dr.Prima/dr. Deddy/dr. Sisca/dr. Yola/dr. Wenny/dr.
Intan/ dr. Fakhri
 Consult patients
No Name Diagnose Follow up

Mrs Evi, 41 yo G1P0A0H0 gravid 35-36 weeks

1 + PRM + History of Ablation • Lee revised score I (0,9% cardiovascular risk)
o.i. SVT

Mr. Kajai, 70 yo
PVC frequent RVOT origin •Potassium should be corrected (5.0)
2 Hypocalemia •Hospitalized together in neuro department
Stroke Infarct

Non cardiac chest pain • Lansoprazole 2x 30 mg

4
Mr. Darmaswar chan, 71 Dispepsia syndrome • Sulcrafat 4x 10cc
yo Stroke Infarct • There is no emergency event in cardiovascular,
 EMERGENCY DUTY REPORT
Wednesday September 11,
2019
Consultant incharge : dr. Muhammad Syukri, SpJP (K)
Residen incharge : dr.Erizon/dr.Prima/dr. Deddy/dr. Sisca/dr. Yola/dr. Wenny/dr.
Intan/ dr. Fakhri
 List of Patients

Old patient New Patient Patient in Patient death

problem

HCU interm
CVCU ward CVCU Ward CVCU ward CVCU ward
interne ediate

8 15 - - 1 1 - - - -
 New Patient
1. Mrs Arnialis Bachtiar, 66 yo 2. Mr Hendy, 49 yo
Acute STEMI Anterior 3 hour onset
 ADHF wet and warm on CHF ec TIMI 3/14 Killip I post PPCI 1
CAD, HHD stent at prox-mid LAD at
 Susp CAP CAD 2VD + LM disease
 Hipokalemia (incomplete at proximal
RCA and distal LM)
 HT stage I
Hendri, 49 yo

Chief complaint
Chest pain since 3 hours before admission

Present Illness
 Chest pain since 3 hours before admission, felt heavy in the middle of chest,
continuously, referred to the left arm, duration 30’, diaphoresis (+), nausea (-) and
vomiting (-). There is no history of chest pain before
 Shortness of breath (-). History of PND (-), DOE (-),OP (-), leg swelling (-)
 Palpitation (-), dizziness (-), syncope (-).
 Patient was referred from RST with D/ STEMI anterior and got therapy ASA 160
mg, Clopidogrel 300 mg, ISDN 5 mg
 At emergency : chest pain (+) with pain scale (2/10)
 Risk factors
 Smoker more than 10 years, 2 packs/day
 Hypertension (+) since 1 years ago
 Dislipidemia ?
 FH (-)
 DM (-)

Past Illness
 asthma (-), gastritis (-), stroke (-)
Physical Examination
 General appearance : Moderate
 Sens : CMC
 Blood Pressure : 157/67 mmHg
 Pulse Rate : 74 x/min
 Resp Rate : 20 x / m
 Neck : JVP 5+0 cmH20
 SaO2 : 98 %
Pulmo:
insp : Symetric right = left
palp : Fremitus right = left
perc : Sonor right = left
ausc : Vesicular, rales -/-, wheezing -/-,

Cor :
insp : Ictus cordis not visible
palp : Ictus palpable at 1 finger lateral LMCS Vth ICS
perc : Upper : 2nd ICS
Right: LSB 4th ICS
Left : at 1 finger lateral LMCS Vth ICS
ausc : S1N-S2N reguler, Murmur -, gallop -
Abdomen
insp : Supel
palp : Hepar and lien was not palpable
perc : Tympani
ausc : Peristaltic sound (+) N

Extremities :
Edema -/-, warm
ECG RST 11/09/2019 21.00 WIB

SR, QRS rate 68x/mnt, Axis N, Gel P N, PR int 0.12s, QRS dur 0.08 s,
SR, QRS
ST elevation rateat
2–4 mm 68x/mnt, Axis N, Gelat
V1- V5, hyperacute P N, PR int
V2-V4, 0.12s,
LVH QRS (-),
(-),RVH durQTc
0.08380
s, ms
ST elevation 2–4 mm at V1- V5, hyperacute at V2-V4, LVH (-),RVH (-), QTc 380 ms
ECG M Djamil 11/09/2019 21.30 WIB

SR, QRS rate 74x/mnt, Axis N, Gel P N, PR int 0.12s, QRS dur 0.08 s,
SR,STQRS rate 74x/mnt,
elevation 2–4 mmAxis N,V5,
di V1- GelLVH
P N,(-),RVH
PR int 0.12s, QRS
(-), QTc 396dur
ms0.08 s,
ST elevation 2–4 mm di V1- V5, LVH (-),RVH (-), QTc 396 ms
Laboratory Findings

Hb : 12,4 g/dl Na : 141 mmol/l

Ht : 37% K : 3,3 mmol/l
Leukosit : 13.880/mm3 Cl : 107 mmol/l
Trombosit : 440000/ mm3
HbsAg : NR
RBG : 101 mg/dl
CKMB : 61 u/l
Ur : 25 mg/dl
Hs Trop I : 807 ng/l
Cr : 1,0 mg/dl
CCT : 78 ml/m
TIMI RISK
 Age 49 yo : 0
 HT / DM / Angina : 1
 SBP 157 : 0
 HR 74 : 0
 Killip I : 0 3/14
 BW 56 kg : 1
 ST elevation ant/LBBB: 1
 Time to treat > 4 hour : 0
DIAGNOSIS
Acute STEMI Anterior 3 hour onset TIMI 3/14 Killip I pro PPCI
Ht stage I
Therapy in ER
 IVFD RL 500cc /24 hours
 ISDN 5 mg SL  drip NTG start 10 mcg/minute
 Loading ASA 160 mg
RST
 Loading Clopidogrel 300 mg

Plan :
 PPCI (Loading ASA 160 mg, Ticagrelor 180 mg )
 Admitted to CVCU full  ward full  ROI Full  HCU Interna
Angiography
 LM : Stenosis 50-60% at distal LM
 LAD : Subtotal occlution at mid LAD with Thrombus burden grade
III
Stenosis 60-70% at distal LAD
 LCX : Normal
 RCA : Stenosis 60-70% at prox RCA, type A lession
 Result : CAD 2VD + LM disease
 PPCI 1 stent at mid-dist LAD at CAD 2VD + LM disease with
Thrombus burden grade III
HCU Interne (12/09/2019) 00.00 WIB
S/ chest pain(-)
O/ GA Conc BP HR RR T
mod CMC 127 /56 82 x/’ 20 x/’ af

JVP : 5+0cmH2O
Cor : S1N S2N reguler, Murmur(-)gallop (-)
Pulmo : vesikuler, ronchi -/-, wh -/-
Abd : supel, hepar & lien was not palpable
Ext : oedem -/-, warm
ECG post PPCI

SR, QRS rate 74, Axis N, P wave N, PR int 0,12, QRS dur 0,06,
ST elevation 2-3 mm at V1-V4 with Biphasik T , LVH (-), RVH (-), Qtc 401 ms
DIAGNOSIS
STEMI Anterior 3 hours onset TIMI 3/14 Killip I post PPCI 1
stent
at prox-mid LAD at CAD 2VD + LM disease (incomplete at
proximal RCA and distal LM)
Hypertension stage I
Therapy in HCU
 IVFD RL 500 cc/ 24 hour
 ASA 1 x 80 mg ( tomorrow )
 Ticagrelor 2x90 mg ( tomorrow )
 Bisoprolol 1 x 2,5 mg
 Ramipril 1x2,5 mg
 Atorvastatin 1 x 40 mg
 Laxantia 1 x 15 mg
 Ranitidine 2 x 50 mg (iv)
Plan
 Check lipid profile
 Check Ur/Cr
 Chest x-ray
HCU Interne (12/09/2019) 06.00 WIB
S/ chest pain(-)
O/ GA Conc BP HR RR T
mod CMC 117/87 76 x/’ 20 x/’ af

JVP : 5+0cmH2O
Cor : S1N S2N reguler, Murmur(-)gallop (-)
Pulmo : vesikuler, ronchi -/-, wh -/-
Abd : supel, hepar & lien was not palpable
Ext : oedem -/-, warm
Input :
Output :
Diuresis
Fluid Balance
DIAGNOSIS
STEMI Anterior 3 hours onset TIMI 3/14 Killip I post PPCI 1
stent at mid-dist LAD at CAD 2VD + LM disease (incomplete
at proximal RCA and distal LM)
Ht stage 1
Therapy in HCU
 IVFD RL 500 cc/ 24 hour
 ASA 1 x 80 mg
 Ticagrelor 2x90mg
 Ramipril 1 x 2,5mg
 Bisoprolol 1x2,5 mg
 Atorvastatin 1 x 40 mg
 Laxantia 1 x 15 mg
 Ranitidine 2 x 50 mg (iv)
Plan
 Check lipid profile
 Check Ur/Cr
 Chest x-ray
Thank you
CTR 59 %, Sg Ao N, Sg Po N, cardiac waist (+), apex downward (-), cranialization
(+) infiltrat (+), costofrenicus sharp