DUTY REPORT

May 31 2023
st

Duty Team, May 30th 2023

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

Vision
• To become a leading institution of Pediatric Specialist Education in Indonesia in 2020.

Mission
• To practice a professional education for pediatricians and able to compete at the national
level
• To carry out researches and publications at the national level
• To carry out a sustainable community service activities and contribute to solve public health
problems, especially in the field of child health
• To carry out a professional and qualified child health services based on Evidence-Based
Medicine
 Duty Team
On site Consultant : dr. Amirah Zatil Izzah, M. Biomed, SpA(K)
Covid Consultant : Dr. dr. Rinang Mariko, Sp.A(K)
Neonates Covid Consultant : dr. Eny Yantri, Sp.A (K)
Chiefs : dr. Idha Yulfiwanti
dr. Nanda Anessa
dr. Aldian Tri Wahyuda P
Madya of ER : dr. Muhammad Iqbal
Madya of Perinatology : dr. Poby Karmendra
dr. Putri Khairani
Madya of Ward : dr. Iqbal Al Rasyid
dr. Zulfahmi
dr. Maryam Syifaurrahmah
dr. Karina Astarini Mukhti
Junior of ER : dr. Fitria Indria Rahmi
Junior of Perinatology : dr. Stevanus E.N. Simanjuntak
Junior of Ward : dr. Ega Purnama Sari
dr. Revina Ilka Busri
 PATIENT RECAPITULATION
Room TOTAL
PICU 1 : 6 Patients
HCU 1 : 2 patients
PICU 2 : 8 patients
HCU 2 : 4 patients
NICU 1 : 6 Patients
NICU 2 : 8 patients
NICU 3 : 8 patients
SCN : 4 patients
Yellow zone : 1 patient
ACUTE WARD : 19 patients
CHRONIC WARD : 24 patients
 PATIENT RECAPITULATION
Room TOTAL
Dahlia : 0 patients
Room-in : 1 patient
PINERE : 1 patient
New Patient : 7 patients
Deceased Patient : 0 patients
 NEW PATIENT
No Patient’s Identity Working diagnosis Covid criteria Rooms

1 Farel/ boy/ 10 years old/ • Acute kidney Injury stadium failure ec Non Covid Intermmediet
01.17.76.04 jengkol acid intoxication
• Electrolyte Imbalance
• Hypertension stg I
• Incomplete immunization
2 Nurul Azmi/ girl/ 3 years - Gum bleeding ec thrombositopenia Non Covid Chronic
old/ - Acute leukemia
- Non neutrophenia fever dd non
neutrophenia
- Hyponatremia
3 M. Rizky/ boy/ 1 year 8 - Ewing Sarcoma Non Covid Chronic
months old/

4 Sahil Mukrim/ - Respiratory distress due to Non Covid PICU

bronchopneumonia
- Lung oedema due to CHF NYHA class
II due to PDA
- Anemia due to infection
- Hyponatremia, hypokalemia
- Pleural effusion post chest tube
 NEW PATIENT

No Patient’s Identity Working diagnosis Covid criteria Rooms

5 Marisa/ girl/ - Normocytic normochrome anemia due Non Covid Chronic

to autoimune disease dd chronic disease
- SLE
- Discoid Lupus eritematous
- Short stature
- Delay pubertas
- Secondary amenore ec SLE
6 Laili Fauziah By/ - NNBW 2780 gram Sc delivery due to Non Covid Rooming in
mother condition
7 Gibran/ boy/ 1 year old - Respiratory distress due to susp Non Covid PICU
aspiration pneumonia
- Massive acites
- Anasarka oedema
- Intrahepatal cholestasis due to CMV
 Deceased Patient

No Patient’s Identity Diagnosis Rooms

1 -
 Patient report : Patient’s Identity

• Name : Farel
• Gender : Boy
• Age : 10 years old
• Date Of Birth : 14-02-2013
• Medical Record : 01.17.76.04

Abdominal pain since 5 days ago

 Pediatric Assessment Triangle

Appearance Breathing

Tone : Normotonus Breath sound : broncovesicular,

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

Pale : not pale

Cyanotic : not cyanotic
Mottling : not mottled

Conclusion : stable
Action: continue primary survey
 PRIMARY SURVEY
• Airway : Stridor (-/-), air entry right = left,
 Conclusion : Airway patent
 Action: No action
• Breathing: nasal flare (-), subcostal retraction (-), Oxygen saturation 99 %.
 Conclusion : no desaturation
 Action : No action
• Circulation : Warm acral, CRT < 2 seconds, BP: 140/100, HR 106x/minute regular, RR 22x/minute T 37,0oC,
Pale (-), Mottled (-), Cyanotic (-)
 Conclusion : Hypertension
 Action : search for etiology
• Disability : Pain (-), aware, Pupil isochor, Normal body postural, seizure (-), body movement : symmetrical.
 Conclusion : Aware
 Action: No action

• Exposure : Rash (-), Fracture (-), Hematoma (-), Burn injury (-), ptechie (-), spontaneous hemorrhage (-)
 Conclusion : no abnormality found in exposure
 Action : none
 PEWS (Pediatric Early Warning Sign)

CONCLUSION : Score 0
Visit and reassess every 4 hours update, continue current plant of care
 SECONDARY SURVEY
PRESENT ILLNESS HISTORY
5 days ago 1 day before
- Patient got abdominal pain since 5 days ago especially on
lower stomach region
• Patient defecate but only a little
- Patient has history of consuming jengkol 1 day before,
amount
around 4 pieces on breakfast, lunch and dinner
• Urination increased than before
- Patient vomited after consuming jengkol about more than
• Patient was brought to muaro
five times a day a quarter of glass every vomit
bungo hospital and then
• Patient then got hematuria accompanied by powdery
referred to RSUP Dr. M. Djamil
substance on urine for 1 day. Urination was decreased,
dysuria was found.
• Patient also got flank pain since 4 days ago until now.
• Patient cannot defecate and flatus
• Appetite was decreased
• Patient then was brought to midwife and got analgesic and
the pain was subsided after taking it.
 Present illness • The patient does not feel any breathlessness
history • History of fever was not found
• Seizure was not found
• Patient was referred from Hanafi muaro bungo hospital with diagnosis Obstructive ileus+ CKD+
Electrolyte Imbalance and was given ranitidine IV, Ceftriaxone IV and Dulcolax
• History of consuming herbs was not found.
• History of hypertension before was denied.

Birth History • Normal delivery with normal birth weight 2500 gram, PB 48 cm

S History of
immunization
• The mother does not remember, covid immunization was not given
Interpretation: The child doesn’t get complete immunization

Past
Ilness History • No history of same illness before

Family illness • No history of same illness in family member

history • No history of same illness in the area around the house
 General appearance : moderate ill,E4M6V5
BP : 140/100 (P99) mmHg HR: 106 times/minute (strong pulse), RR: 22 times/minute, Temp: 37.0C, oxygen saturation 99 % (room
air)
BW 25 Kg Weight/age 78%
BL 128 cm P5: 80/40 Height/age 92%
P50: 98/59
IBW 26Kg Weight/height 96%
P90:112/74
Interpretation Well nourished
P95: 116/78
P99: 123/86
Skin Warm Pcrit: 153/116
Head Round symmetrical

O Eye
Nose
Conjungtiva anemic -/- sklera icterus -/-, sunken eyes -/- pupil isocor 2 mm/2 mm, light reflect +/+
Nasal flare (-), secret (-) epistaxis (-)
Ear Secret (-)
Mouth dry lip mouth (-) Tonsil: T1-T1 not hyperaemic, no exudate, faring not hyperaemic, gum bleeding (-)

Thorax Inspection Normochest, retraction (-)

Pulmo Palpation fremitus right = left

Percution Sonor
Auscultation vesiculer, no rales , no wheezing
 Thorax Inspection Ictus cordis was not visible
Cardio

Palpation Ictus cordis palpable 1 finger mideal linea midclavicular sinistra

Percution Left border: LMCS RIC V, upper border: RIC II, Right border: RIC III parasternalis (D)

Auscultation Heart sound I-II regular, no murmur

Abdomen Inspection Distention (-), defans muscular (-)

O Palpation Supel, hepar and spleen was not palpable, turgor < 2 second, lower stomach tenderness (+),
rebound tenderness (-)
Percution Thympany, Costovertebral angle pain (+/+)
Auscultation Normal

Extremity Warm acral, capillary refilling time < 2 second, edema -/-
cyanotic (-)

Puberty status A1P1G1

Genitalia
 Laboratorium
Hb 11.7 g/dL Natrium : 127 mmol/L
Leucocyte 16.290/mm3 Pottasium : 4.8 mmol/L
Thrombocyte 374.000/mm3 Chloride : 100 mmol/L
Ht 30%
MCV 69 Blood gas
MCH 27 analysis
MCHC 39 pH 7.469
RDW-CV 12.3 pCO2 29.6
pO2 52.1
PT : 10,3 HCO3- 21.8
APTT : 27.1 BE -0.5

O
INR : 0,95 SpO2 89.5%
Ureum : 220 mg/dl
Creatinine : 7,3 mg/dl
Random blood : 101 mg/dl
glucose
Impression Leucocytosis
LFG : 9 ( Decrease 93%) Hyperuricemia
Hyponatremia
AKI std Failure
Respiratory Alkalosis
 Laboratorium
Urinalysis BJ 10-20 Conclusion : Leukosituria
(Dipstick) pH 6 Hematuria
Lekcocyte +2 (75
leukocyte/ uL)
Erythrocyte +4 (250
erythrocyte/ uL)
Nitrit –
Protein +1
Glucose normal
Keton+1
Urobilinogen normal

O
Bilirubin -
Chest X-Ray
• Trachea in the middle
• Mediastinum not wider
• Both hillus not thickened
• Cor was normal
• Broncho vascular pattern was normal
• There are no infiltrate and nodul
• Both hemidiaphragm are smooth and
costophrenicus sinus are sharp
• Conclusion : Cor and pulmo was
normal
Abdominal X-Ray
• Preperitoneal fat line was clear
• Psoas line was clear
• Distribution of gas in intestinal
was good
• There are no radio opaque or
radio lucent lesion
• Conclusion : Abdominal x-ray
was normal
 Therapy
Problem Diagnosis
• Nefritic Soft meal 1600 kkal
• Stomach pain • Acute kidney Injury stadium failure
ec jengkol acid intoxication • Inj Ceftriaxon 2 x 650 mg IV
• Hematuria
• Urinary tract infection • Bicnat 2-1-1 tab PO
• Constipation
• Electrolyte Imbalance • Paracetamol 4x250 mg PO
• Incomplete
immunization • Hypertension stg I • Captopril 3x6,25 mg PO
• Hyponatremia • Incomplete immunization • Lactulosa 2 x 10 cc
• Decreasing LFG
• History of decreasing
urination
• Hypertension
Planning

• Consult to pediatric nephrology division

• Fluid balance-diuresis
• Urinalysis (djenkolic acid crystal)
• Repeat renal function test + calcium test
• Renal ultra sonograph
• Hemodyalisis
• Catch up immunization
Follow up May 31st, 2023
• S/ Abdominal pain was decreased
• O/ General appearance: moderately ill, BP 120/70mmHg, Heart rate 96 bpm, respiratory rate 20
times/minute, SpO2 99% (room air), Diuresis 2,2
Eye: not anemic, not icteric, no palpebral udem
Toraks: vesiculer, no rhales, no wheezing
Cor: normal rhythm, no murmur
Abdomen: not distended, hepar and lien not palpable, CVA pain (+/+)
Ekstremity: warm acral CRT < 2 seconds
A/ Acute kidney Injury stadium failure ec jengkol acid intoxication, Electrolyte Imbalance, Hypertension stg I, Incomplete
immunization
P/ Nefritic Soft meal 1600 kkal
Bicnat 2-1-1 tab PO
Paracetamol 4x250 mg PO
Captopril 3x6,25 mg PO
Lactulosa 2 x 10 cc
 Jengkol Consumption
Risk
Factors Formation of jengkolic Going through filtration Jengkolic acid bond with
crystal on glomerulus albumin in stable condition

Clogging of urinary tract Problem of urine flow

Problem
dysuria hematuria Ureum blood
concentration increased AKI

Diagnostic Renal function test, Urinalysis, Blood gas analysis,Renal

Ultrasound

Sodium bicarbonate, IVFD Fluid,Diuretic, Hemodyalisis

Therapy

AD VITAM : DUBIA ad BONAM

Prognosis AD FUNTIONAM : DUBIA ad BONAM
AD SANATIONAM : DUBIA
THANK YOU