DUTY REPORT

February 15 2023
th

Duty Team February 14th ,

2023
VISION AND MISSION OF PEDIATRIC SPECIALIST EDUCATION
MEDICAL FACULTY OF ANDALAS UNIVERSITY

Vision
• To become a leading pediatric specialist education provider and produce dignified and
excellent graduates in disaster health in 2028

Mission
• To practice a professional education for pediatricians and able to compete at the national
level and recognized at the international level
• To carry out research, produce publications and Intellectual Property Rights (IPR) in the field
of children's health through multicenter collaboration at national and international levels
• To conduct community-based on community service activities that contribute to improving
children's health status
• Take an active role in handling and providing child health services during disasters
 Duty Team
On site Consultant : dr. Nice Rachmawati, Sp. A (K)
Covid Consultant : Dr. dr. Finny Fitry Yani, Sp.A(K)
Neonates Covid Consultant : dr. Eny Yantri, Sp.A (K)

Senior : dr. Riana Youri

dr. Nanda Annesa
dr. Revi Rillian
Madya of Perinatology : dr. Andyan Yugatama
dr. Arifi
Madya of ER : dr. Basri Hadi
Madya of Ward : dr. Muhammad Iqbal
dr. Fajar Pradhana Putra
dr. Dwi Wahyu Kurniasari
dr. Doni Trinanda
dr. Yenni Astari
Junior of Ward : dr. Diana Sari
dr. Fitri Indria Rahmi
dr. Akmal Arif
Junior of Perinatology : dr. Meilani
 PATIENT
RECAPITULATION
 Room TOTAL
PICU 1 & HCU 1 : 8
PICU 2 – HCU 2 : 5
NICU 1 : 6
NICU 2 : 8
NICU 3 : 7
SCN : 6
ACUTE : 18
CHRONIC : 23
Rooming-In : 0
 Room TOTAL
Class 1st floor obsgyn : 2
Isolation Neonatus (Yellow :
Zone)
Isolation Neonatus (Red Zone) : 0
Bougenvile : 0
CAA : 0
HCU pediatric surgery : 0
edelweiss : 0
New Patient :
Deceased Patient : 0
NEW PATIENT
 NEW PATIENT
Covid criteria
No Patient’s Identity Working diagnosis Rooms

1 Syabila Purnama Systemic Lupus Erythematosus Non covid criteria Chronic

Cantika/girl/15 Neuropsyciatry systemic lupus
years eritromatosus ec axonal
neuropathy dd/ structural lesion
Acute diarrhea without
dehydration
Susp. Urinary tract infection
Anemia normocytic normochrome
due to Infection
Candidiasis oral
Overweight
Incomplete immunization

2 Patmalasari/ girl/ Acute lymphoblastic leukaemia Non covid criteria Chronic

17 years Over weight
 New patient

No Name Diagnose Room

4 Gerard Three Acute myeloid leukemia Chronic

Ariandy/ boy/ 2 Fever non netropaenia
years

5 Nursifa Natasya/ Suspect Thalasemia Chronic

girl/ 15 years

6 Arrumi Puti Acute lymphoblastic leukaemia rellaps Chronic

Hasanah/ girl/ 7 Neutropenia fever
years Anemia + trombositophenia ec ALL
Patient’s Identity

• Name : Syabila Purnama Cantika

• Gender : girl
• Age : 15 years 7 month old
• Date Of Birth : 09-07-2007
• Medical Record : 01 14 01 26

Intermittent fever since 1 week before admission

 Pediatric Assessment Triangle

Appearance Breathing

Tone : Normotonus Breath sound : stridor (-),

grunting (-)
Interactiveness : Interactive (+) Position : no sniffing,
Consolabillity : consolable (+) tripodding (-)
Look/Gaze: eye contact (+) Retraction : retraction (-)
Speech: speech (+) Nasal flare : nasal flare (-)
Circulation/ Body Colour

Pale : not pale

Cyanotic : not cyanotic
Mottling : not Mottled

Conclusion : Stable
 PRIMARY SURVEY
• Airway : Stridor (-/-), air entry right = left,
 Conclusion : clear
 Action: no action
• Breathing: nasal flare (-), retraction (-), vesicular breath sound, 20 x/minute, Oxygen saturation 99 %
 Conclusion : stable
 Action : no action
• Circulation : warm extremities, CRT < 2 second, HR 100 x/minute regular, BP: 120/80 mmHg, T 37 C, Pale (-), Mottled
(-), Cyanotic (-), Normal blood pressure without narrowing pulse pressure
 Conclusion : normal
 Action : none
• Disability : Pain (-), E4M6V5, Pupil isochor (2mm/2mm), light reflex +/+, Normal body postural, seizure (-), body
movement symmetrical, Spastic (-) Random blood glucose: 121 mg/dL
 Conclusion : normal
 Action: normal
• Exposure : Malar rash (+), Fracture (-), Hematoma (-), Burn injury (-), ptechie (-),
 Conclusion : malar rash
 Action : searching for etiology
 PEWS (Pediatric Early Warning Sign)

CONCLUSION : Score 0
Vital and reassess Q4H, regular charting and updates, continue current plan of care
 Present Illness History
2 months ago 2 months ago 1 weeks ago 4 days ago Before admission

• Finish • Control to allergy • Intermittent fever • Watery faeces 3 • Patient was

metylprednisolon immunology clinic already 3 times times per day, no referred from
pulse for the six with white • Pain in joint, blood allergy
times membrane in tenderness, more immunology
• Control to toungue swollen than before clinic with
pediatric • Fever for 4 days, • Hari loss more diagnosis SLE
neurology for with peak 38,5 C, no frequent with mild flare
MRI but did not shivering, no • Rash in the face is (SLEDAI Score >
manage yet sweating, no seizure more clear than 3)
• Speech was before
slurred
 SECONDARY SURVEY
Present • There was no cough, breathlessness, nausea, vomiting
Illness History • Micturition colour and frequency was normal
• Decrease of body weight from 62 to 60 kg in last 1 months

Past illness • Patient already known with SLE since junny 2022 with ANA IF result 1:1000, and already finish
history metyl prednisolone high dose for the 6 month
• Patient got medication before : Prednisone, Hydroxychloroquin, Vitamin D, Folic acid, Vitamin
B12, Vitamin B1, Vitamin B6
Birth history

S Immunization •

•
Spontan delivery, aterm, immediately cry

Did not get any immunization

 General appearance : Moderately ill
BP : 120/80 mmHg HR: 100 times/minute, RR 20 times/minute, Temp: 37 C

BW 60 kg Weight/age 100%
BL 155 cms Length/age 95,6%
BMI 24,9 kg/m2 Weight/height 136%
BMI/age 25 (P85-P90)
Impression Overweight
Skin there is malar rash in face, non cyanotic, no icteric
Head Round symmetrical, alopecia

O Eye
Nose
Conjungtiva anemic -/- sklera icterus -/-
Nasal flare (-), secret (-)
Ear Secret (-)
Mounth Cyanotic (-), dry lip mouth (-), oral trush (+)
Neck no enlargement of lymph, no neck rigidity, no meningeal sign
Thorax Inspection Normochest, retraction (-)
Pulmo Palpation Fremitus left=right
Percution Sonor
Auscultation Vesicular, no ronchi -/-, no wheezing -/-
 Thorax Inspection Ictus cordis is not visible
Cardio
Palpation Ictus cordis is palpable 1 finger LMCS RIC V

Percution Left border : 1 finger medial LMCS RIC V, Upper border: RIC 2 LMCS, Right border : RIC 4
sternalis dextra
Auscultation Sistolic murmur grade 3/6 at all ostium

Abdomen Inspection Not distended

O Palpation Supel, hepar not palpable, spleen not palpable, turgor was normal
Percution Tympani
Auscultation Normal

Extremity warm acral, capillary refilling time < 3 second, there is a pain in knee and elbow (look: swollen, not hyperemic,
feel: tenderness, move: not limited), but no increase in pain since 1 week ago, edema -/-

Puberty status A2M3P2

 Laboratorium Hb 9,5
Leucocyte 6.070
Thrombocyte 394.000 Urinalysis
Ht 30% Leucocyte 11-12
Erytrocite 3,64 x 106/ul Erytrocite 0-1
Reticulocyte 1,78% Protein +1
Diff count 0/0/0/75/19/3 Bacteria +
MCV 81
MCH 26 Conclusion Leukocyturia, Bacteriuria
MCHC 32
RDW-CV 17,1
Pathologic Mielosit 2%, metamielosit

O
cell 1%
Blood glucose 133 mg/dL

Conclusion Anemia normocytic

normocromic
SLEDAI SCORE 9
c

Problem Diagnose Therapy

• Fever • Systemic lupus erytomatosus • Methylprednisolon high dose 1000 mg in
• Hair loss • Neuropsyciatry systemic lupus 100 cc NaCl 0,9% (finish in 4 hour)
eritromatosus ec axonal • Hydroxichloroquin 1 x 200 ng po
• Malar rash
neuropathy dd/ structural lesion
• Diarrhea • calc 3 x 500 mg PO
• Acute diarrhea without • vitamin D 1 x 1000 IU PO
• Overweight
dehydration
• Folic acid1 x 1 mg po
• Oral thrush
• Susp. Urinary tract infection • vitamin B6 1 x 10 mg PO
• Leukocyturia
• Anemia normocytic normochrome • vit b 12 1 x 50 mg po
• Incomplete due to Infection • vit b1 1 x 10 PO
immunization • Candidiasis oral • Zinc 1x20 mg PO
• Bacteriuria
• Overweight
• Anemia
• Incomplete immunization
Plan

• Urine cultur
• MRI Brain
• Consult to Neuropediatric division
• Consult to Nefrology division
 Follow up
S/ no fever, no increasing of rash
O/ General appearance : moderate ill
BP 110/60 mmHg HR 100x times/minute, RR 20 times/minute, T : 36,7 oxygen saturation 98%
eye : Conjungtiva anemis -/-
Nose: Nasal flare (-), secret (-)
Thorax : Inspection: Normochest, no retraction , Palpation: fremitus right = left, Percution: sonor, Auscultation: vesiculer, rhales
wheezing (-/-)
A/ Systemic lupus erytomatosus
• Neuropsyciatry systemic lupus eritromatosus ec axonal neuropathy dd/ structural lesion
• Overweight
• Incomplete immunization
P/ Methylprednisolon high dose 1000 mg in 100 cc NaCl 0,9% (finish in 4 hour)
• Hydroxichloroquin 1 x 200 ng po
• calc 3 x 500 mg PO
• vitamin D 1 x 1000 IU PO
• Folic acid1 x 1 mg po
• vitamin B6 1 x 10 mg PO
• vit b 12 1 x 50 mg po
• vit b1 1 x 10 PO
 Risk Environment Genetic factor
factor (mutation)
Factor Immune disregulation

Multiple system immune defect

Problem Auto-antibodies Auto reactive T cell

Abnormal production of Abnormal release of

immune complex inflammatory cytokin

Diagnosti
Sistemik Lupus
c Fever
Eritematosus
Urinary
Tract
Malar rash with Flare Infection

Allopecia
Therapy
Tendinitis Urine Culture, Kortikosteroid
Scoring SLEDAI / day

Ad vitam: bonam
Ad functionam: dubia ad bonam
Prognosis Ad sanationam: dubia ad bonam
THANK YOU