CLINICAL CONFRENCE

PICU DIVISION
(New Case)
June 18nd, 2023

Dhody Setiamal,Ayi Suwarayi/ Junior

L.M.Isvan Davis, St. Huzaifah,Nita Anugerawati N/Madya
Desi Nandiyarizky, Min Ayatina, Nurfajrin Utami, M. Rifani/Senior
 PATIENT IDENTITY
A.S, 5 month
MR Number 1026895
Date of Birth April 8th, 2023
Admission Date June 18th, 2023

MEDICAL DIAGNOSIS
• - Acute respiratory distress syndrome
• - Community acquired pneumonia
• - Leukocytosis
• - Reactive thrombocytosis
• - Increased transzaminase enzymes
• - Hypoalbuminemia
• - Hyponatremia
 HISTORY TAKING
Chief Complaint
Shorthnes of breath
History of Present Illness
A 5 month old girl referred from Tajjudin hospital with diagnosed Impending respiratory
failure + Community aquired pneumonia.
there was shortness of breath since 1 week before admitted to the hospital, getting worse
since 1 day, there ws cough, with mucus,no blood
No fever, history of fever, not continuous,, no seizures
Good appetited
Urination dan defecation was normal
 HISTORY TAKING
Mother with 2 child pregnancy at 30 years old, mother routinely controls doctors, regularly
consumes vitamins, no history of hypertension and diabetes mellitus and vaginal discharge
during pregnancy. History Anemia during pregnancy

Birth history
Child born section secarea, full term, crying immediately, Apgar Score unknown, birth
weight 2800 gram, body length 48 cm.

Breastfeeding History
Breastfeeding children only 2 weeks
History of being treated at Thajudin Khalid Hospital for 2 months in the
PICU and receiving therapy for vancomycin 40 mg/8 hours/iv, flucona-
zole 40 mg/8 hours/iv, gentamycin 17 mg/24 hours/iv, dexa 3 mg/12
hours/ib, nebu N-ace + nacl 1.5 ml 112/8 hours/inhalation, meropenem
250 mg/12 hours/iv, vitamin bcomp 1x 1 tab, folic acid 1x1 tab, l_bio
1x1 sachet, powder cough 3x1 pulv, vit.c 1x1 tab, n-ace 100mg/8jam/iv
then referred to RSWS
 PHYSICAL EXAMINATION
Vital Sign Anthropometry
General condition: Severe illness / Body weight : 3,8 kg
severly wasted/ GCS 15 E4M6V5
Height : 55 cm
Heart Rate : 130 times/min
Head Circumference : 36 cm (38-46 cm)
Temperature : 37°C
Weight for Height : under -3SD(malnourished)
Respiration Rate : 40 times/min
Height for Age : -2sd and -3SD ( short stature)
SpO2 : 99 %
Weight for Age : under – 3sd ( severly underweight)
Head Circumference : 36 cm
(38-44 cm)
Weight for Height : 38/36x100%= 105 % (good nourished)
Height for Age : 142/162x100%=87,6% (normal
stature)
Weight for Age : 38/53x100%= 71,6% (underweight)
 History of vaccine
Month Years
Vaccine
N 0 1 2 3 4 5 6 7 8 9 12 15 18 24 3 5 6 7 8
ot
gi
ve
n
Hep B V
BCG V
DPT V
Hib v
OPV v
IPV v

Measles v
Rotavirus V
Influenza V
Japanese V
Encephali-
tis

PCV V
Varicella V
Hepatitis A V

Typhoid V
PHYSICAL EXAMINATION
No pallor, no jaundice Pure regular I / II heart sound,
No lymphadenopathy No murmur
No Hyperemic pharynx Abdomen
T1-T1 tonsils, not Hyperemis Normal peristaltic sound
Liver and Spleen was not palpable
Pulmonary
There was subcostal retraction Ekstremity
vesicular breath sounds No edem
There was ronkhi CRT <3 second
,No wheezing

Cardiovascular
PHYSICAL EXAMINATION
Tuberculosis Score
Contact : 0
Mantoux : not yet
Nutrition : 0
Fever: 0
Cough : 0
Lymphadenopathy : 0
Joint swelling : 0
Chest X-ray: 0. Total: 0 not
yet mantoux
 LABORATORY FINDING
Tajuddin
Labora- Wahidin Wahidin
Khalik Normal Value
tory 18/06/23 20/06/23
17/6/23
Hb 13,1 12,1 11,5 12.0 – 16.0 gr/dL
WBC 42.900 23.200 31.100 4.0 – 10.0/μL
150.000 –
PLT 424.000 351.000 378.000
400.000/mm3
MCV 90,7 93 92 80 -100 μm3
MCH 30,3 30 30 27 - 32 Pg
%NEUT 73,4 81,9 59.8 52 – 75 103/μL
%LYMPH 11,5 14,1 19 20 – 40 103/μL
%MONO 14,9 4,7 11,5 2 – 8 103/μL
 Wahidin
Wahidin Normal
Laboratory 20/06/23
18/06/23 Value

10 - 50
Ureum 20
mg/dl

Creatinine 0,13 <1.3 mg/dl

SGOT 30 < 38 u/l

SGPT 66 < 41 u/l

3.5 – 5.0
Albumin 3,2
mg/dl

136-145
Natrium 136

Kalium 4,5 3,5-5,1

Clorida 100 97-111

CRP 4,6

Prokalsitonin 0,12
Peripheral blood 20/06/2023
Erythrocyte
normocytic normochromic, anisocytosis, ovalocyte (+), object inclusion (-) normoblast (-)
Leukocytes
increased, PMN > Lymphocytes, toxic granulation (+), vacuolization (+) of young cells (-)
Platelets
normal, Impression:Leukocytosis with signs of infection
Radiology finding
- Inserted Gastric tube at gaster
- Consolidation inhomogen in both lungs
- Cor: CTI normal,Aorta normal
- Both sinus and diafraghma normal
- Costae intact
- Soft tissue normal

Interprestation:
- Pnemonia bilateral
 ASSESMENT
• - Acute respiratory distress syndrome
• - Community acquired pneumonia
• - Leukocytosis
• - Reactive thrombocytosis
• - Increased transzaminase enzymes
• - Hypoalbuminemia
• - Hyponatremia
 Working diagnosis
• - Acute respiratory distress syndrome
• - Community acquired pneumonia
 treatment
 Oksigen 8L/minute
 Fluid requirement ( holiday segar)
304 cc/24 hours
Enteral : stop intake ( NGT decompression)
Parenteral : Infusion dextrose 5% 13cc/hours/iv
- 2)Vancomyn/8 hours/intravenous
- 2)Fluconazole/8 hours/intravenous
- 2)Gentamycin/24 hours/intravenous
 Planning
Septic Work up
THANK YOU