skenario a blok 16 tahun 2016-1

8/19/2019 Skenario a Blok 16 Tahun 2016-1

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Skenario A Blok 16 Tahun 2016

Mr Y, a 40-year old, truck driver, was aditted to hos!ital with assive heo!toe"

#e co!lained that 6 hours a$o he had a severe o% cou$hin$ with %resh &lood o%

a&out 2 $lasses" #e also said that in the !revious onths, he had !roductive cou$h

with a lot o% !hle$, ild %ever, loss o% a!!etite, ra!id loss o% &ody wei$ht '!reviouswei$ht ( )0 k$*, and shortness o% &reath" Since a week a$o, he %elt his sy!tos

were worsenin$" +ro %urther interview, Mr" Y have siilar sy!tos 6 years a$o,

he was $iven edication a%ter consultin$ with doctor at that tie" But sto! the

treatent a%ter 2 weeks &ecause he was %eelin$ &etter"

Physical examination :

eneral a!!earance ( he looked severely sick and !ale" Body hei$ht ( 1) c, Body

wei$ht ( k$ B. ( 100/)0 #$, # ( 112/inute, ( 6/inute, te! ),6 3"

there was a tattoo on the chest" n chest auscultation there was an increase o%

vesicular sound at the ri$ht a!e lun$ with oderate rales"

5a&oratoriu (

BTA '-*, #& , $7, 5eucocyte 6000, 589 12 /:a,9i; count ( 0//2/)/1/, #<

Status '-*

ont$en ( in=ltrate ri$ht a!e lun$

1" >lari=kasi stilah

?o

"

stilah >lari=kasi

1" Massive #eo!toe Batuk &erdarah le&ih dari 200-600 cc/hari2" Severe o% cou$hin$ Batuk yan$ &erat" .roductive cou$h Batuk yan$ en$hasilkan dahak atau

lendir atau s!utu@ uunya en$alai

kesulitan &erna%as dan disertai

!en$eluaran dahak4" .hle$ Su&stansi kental dan te&al yan$

disekresikan oleh ukosa saluran!erna%asan

" Mild %ever 9ea yan$ di atas noral ta!i di &awah

0 36" .ale .ucat @ !eru&ahan warna en:adi !utih)" Tattoo Suatu tanda yan$ di&uat den$an

easukkan !i$en ke dala kulit" <esicular sound Suara !aru noral, ins!irasi le&ih !an:an$



dari eks!irasi serta le&ih :elas" Moderate rales Bisin$ ter!utus-!utus yan$ terden$ar !ada

saat inhalasi

2" denti=kasi Masalah1" Mr Y, a 40-year old, truck driver, was aditted to hos!ital with assive

heo!toe" #e co!lained that 6 ears a$o he had a severe o% cou$hin$

with %resh &lood o% a&out 2 $lasses"'vvv*

2" #e also said that in the !revious onths, he had !roductive cou$h with a

lot o% !hle$, ild %ever, loss o% a!!etite, ra!id loss o% &ody wei$ht

'!revious wei$ht ( )0 k$*, and shortness o% &reath" Since a week a$o, he

%elt his sy!tos were worsenin$"

" +ro %urther interview, Mr" Y have siilar sy!tos 6 years a$o, he was

$iven edication a%ter consultin$ with doctor at that tie" But sto! the


4" .hysical eaination (eneral a!!earance ( he looked severely sick and !ale" Body hei$ht ( 1)

c, Body wei$ht ( k$ B. ( 100/)0 #$, # ( 112/inute, (

6/inute, te! ),6 3" There was a tattoo on the chest" n chest

auscultation there was an increase o% vesicular sound at the ri$ht a!e

lun$ with oderate rales"

" 5a&oratoriu (

BTA '-*, #& , $7, 5eucocyte 6000, 589 12 /:a, 9i; count (

0//2/)/1/, #< Status '-*

6" ont$en ( in=ltrate ri$ht a!e lun$

" Analisis Masalah1" Mr Y, a 40-year old, truck driver, was aditted to hos!ital with assive

heo!toe" #e co!lained that 6 hours a$o he had a severe o% cou$hin$

with %resh &lood o% a&out 2 $lasses"a" A!a hu&un$an usia, :enis kelain dan !eker:aan den$an kasus ' ina,

thania, nadiya*&" Ba$aiana klasi=kasi &atuk &erdarah ' dita, ican, yukel* enurut

:ulahnya(- blood-streaked sputum S!utu !urulen da!at ter:adi !ada

&ronkiektasis terin%eksi- asi% yan$ !otensial %atal serin$ dida!atkan !ada &ronkiektasis,

tu&erkulosis, dan kanker !aru

c" Ba$aiana ekanise &atuk &erdarah ' ira, kiki, kak ina*



d" Ba$aiana da!ak dari &atuk &erdarah sa!ai 2 $elas' thania,

nadiya, dita*e" Ba$aiana tatalaksana awal !ada Mr Y 'ican, yukel, ira*

- .e&erian C2 &ila ada tanda-tanda $an$$uan !ertukaran $as, &ila

!erlu resusitasi cairan dan darah- Men$istirahatkan !asien den$an eirin$kan !asien ke arah sisi

!aru yan$ didu$a en:adi su&er !erdarahan disertai intu&asi

dan ventilator ekanik den$an satu :enis !i!a endotrakeal

&erdisain luen dua a$ar darah tak tu!ah untuk !erdarahan

yan$ asi% atau kateter &alon untuk enyu&at &ronkus yan$

&erdarah di!andu &ronkosko!i sehin$$a as=ksia lo&us yan$ sehat

terce$ah dan !erdarahan sto!- Tidak dian:urkan untuk e&erikan antitusi% terasuk narkotika,

antitro&osit, dan !elan:utan =siotera!i dada &erdrainase !ostural

atau !erti&an$kan lavase &ronkus den$an larutan salin noral

din$in !ada kasus yan$ tidak asi%

- Tera!i kausati% - Tera!i lain se!erti tera!i %oto laser yan$ sulit !ada heo!tisis

asi%, tera!i e&oli, dan reseksi &edah dari !aru atau lo&us yan$

&erdarah untuk inial !erdarahan 15/hari se!erti !ada kasus

=stula arteri trakealis, ke$anasan, traua dada, naun

kontroversial untuk kasus tu&erkulosis, &ronkiektasis terin%eksi,

&ronkitis au!un kelainan koa$ulasi

2" #e also said that in the !revious onths, he had !roductive cou$h with a

lot o% !hle$, ild %ever, loss o% a!!etite, ra!id loss o% &ody wei$ht

'!revious wei$ht ( )0 k$*, and shortness o% &reath" Since a week a$o, he%elt his sy!tos were worsenin$"a" Ba$aiana hu&un$an dan ekanise( 'kiki, kak ina, dita, ican,

thania*- Buan$ !roduk radan$ Batuk !rodukti% den$an secret- unitas !asien &urukD&eratnya in%eksi Mild %ever- e:ala alaise( >ehilan$an na%su akan E .enurunan &erat &adan

yan$ drastic- +i&rosis yan$ luas atro= E retraksi otot-otot interkostal D

enciutnya !aru yan$ sakit inFasi !aru yan$ sehat D hi!ertensi

arteri !ulonal >or !ulonal den$an $a$al :antun$ kanan

Sesak na%as&" Men$a!a $e:ala Mr Y seakin e&uruk selaa sein$$u terakhir

'nadiya, yukel, ira*

" +ro %urther interview, Mr" Y have siilar sy!tos 6 years a$o, he was

$iven edication a%ter consultin$ with doctor at that tie" But sto! the




a" A!a da!ak !en$hentian o&at yan$ dilakukan Mr Y ' kak ina, dita,

nadia*&" Men$a!a keluhan yan$ saa ti&ul la$i ' thania, ican, ira*

>arena adanya !ato$en yan$ a!u doran se!erti Mycobacterium

tuberculosis elalui !erlindun$an dirinya dala saran$ di a!eks !aru

yan$ en$invasi !arenki !aru-!aru E tidak ke nodus hiler !arudala &entuk saran$ !neuonia kecil di awalnya &eran$sur-an$sur

en:adi tu&erkel &eru!a $ranuloa yan$ terdiri atas sel-sel histiosit

dan sel datia-5an$hans 'sel &esar den$an &anyak inti* yan$ dikelilin$i

oleh li%osit dan &er&a$ai :arin$an ikat dala -10 in$$u &erlan:ut

eluas, teta!i se$era enye&uh den$an ser&ukan :arin$an =&rosis

lalu en:adi ka!ur dan $ranuloa &erke&an$ erusak :arin$an ikat

sekitarnya dan &a$ian ten$ahnya nekrosis kaseosa karena hidrolisis

!rotein li!id dan asa nukleat oleh enGi yan$ di!roduksi oleh

akro%a$, dan !roses yan$ &erle&ihan sitokin den$an T?+-nya atau

cry!tic disseinate yan$ :aran$ ter:adi !ada iunode=siensi dan usia

lan:ut4" .hysical eaination (

eneral a!!earance ( he looked severely sick and !ale" Body hei$ht ( 1)

c, Body wei$ht ( k$ B. ( 100/)0 #$, # ( 112/inute, (

6/inute, te! ),6 3" There was a tattoo on the chest" n chest

auscultation there was an increase o% vesicular sound at the ri$ht a!e

lun$ with oderate rales"a" Ba$aiana inter!retasi dari !eeriksaan !ada kasus ' yukel, kiki,

kak ina*&" Ba$aiana ekanise dari hasil !eeriksaan a&noral !ada kasus

' thania, ican, nadiya*

#eo!tisis Aneia !aleadan$ enahun alaise( Body hei$ht ( 1) c, Body wei$ht (

k$3or !ulonale B. ( 100/)0 #$ D # ( 112/inuteD (

6/inuteeaksi radan$ te! ),6 3"n=ltrat radan$ di a!e !aru se&a$ai :arin$an kaya oksi$en yan$

en:adi !enun:an$ aero&isitas BTA chest auscultation( increase o%

vesicular sound at the ri$ht a!e lun$ with oderate rales

c" A!a hu&un$an riwayat !e&uatan tato !ada kasus 'dita, yukel ira*

adanya !eradan$an di &a$ian kulit yan$ ditatokan atau !enularan #<dari :aru suntik yan$ di$unakan untuk enato

d" a!a :enis-:enis suara ta&ahan !ada !eeriksaan auskultasi !aru

' kiki, ican, dita*- suara !okok

o vesikuler( luen &ronkial ter&uka, alveoli noral

o &ronkovesikuler

o &ronkial( alveoli terisi eksudat



- suara ta&ahano ronki( &asah

kerin$o &unyi $esekan !leura( !arietal dan visceral aki&at

!eradan$ano hi!!ocrates succusion( hidro!neuotoraks

o !neuothora click

e" Ba$aiana cara !eeriksaan auskultasi !ada !aru 'kak ina, ira,

thania

" 5a&oratoriu (

BTA '-*, #& , $7, 5eucocyte 6000, 589 12 /:a, 9i; count (

0//2/)/1/" Status #< '-*

a" Ba$aiana inter!retasi dari !eeriksaan !ada kasus 'kak ina,

yukel, kiki*&" Ba$aiana ekanise dari hasil !eeriksaan a&noral !ada kasus'

ira, nadiya, dita*c" Men$a!a leukosit !ada kasus noral 'ican, thania, ira*

>arena li!idnya disenan$i oleh Myco&acteriu den$an dindin$ kuan

terdiri atas asa leak, !e!tido$likan, dan ara&inoan sehin$$a

da!at en:adi !arasit di sito!lasa akro%a$ yan$ seestinya

e%a$osit BTAd" Men$a!a BTA ne$ati% 'nadiya, dita, ican* karena ker:a o&at anti TB di

6 tahun yan$ lalue" Ba$aiana cara !eeriksaan BTA 'kak ina, kiki, yukel*

%" Ba$aiana hu&un$an status #< den$an kasus

6" ont$en ( in=ltrate ri$ht a!e lun$a" Ba$aiana inter!retasi dari !eeriksaan !ada kasus 'yukel, kak

ina*&" Ba$aiana ekanise dari hasil !eeriksaan a&noral !ada kasus

'ican, dita, nadiya*n=ltrat radan$ di a!e !aru se&a$ai :arin$an kaya oksi$en yan$

en:adi !enun:an$ aero&isitas BTAc" Ba$aiana $a&aran ront$en noral dan ront$en !ada kasus' kiki,

thania, ira*

)" Te!late ( 3A S8MHA IIIa" 99&" 9> c" 8!ideiolo$id" 8tiolo$ie" .ato=siolo$i%" Mani%estasi >linis$" .eeriksaan old standar



h" .eeriksaan !enun:an$i" +aktor resiko

:" 3ara !ene$akkan dia$nosisk" >o!likasil" Tatalaksana" .ence$ahan

n" .ro$nosiso" S>9

4" 5earnin$ ssue1" Anatoi dan =siolo$i !aru 3A S8MHAAAAIIIIIIIIIIII

" #i!otesis Tuan Y 40 tahun didu$a enderita TB .aru den$an $e:ala klinis 'D* den$an

BTA '-* dan status #< '-*

.edoan ?asional.enan$$ulan$an Tu&erkulosis 2014 di !oin dia$nosis

tatalaksana

e%erensi

3eva J" .itoyo" 2014" Hemoptisis dalam Bab 43 Kegawadaruratan Medik Buku Ajar

Ilmu Penyakit alam PAPI !ilid III "alaman 4#43" Kakarta" nterna .u&lishin$"

LulkiFi Ain, Asril Bahar" 2014" $uberkulosis Paru dalam Bab #% $uberkulosis Buku

Ajar Ilmu Penyakit alam PAPI !ilid I "alaman &'3" Kakarta" nterna .u&lishin$"

3leo!as Martin uende" 2014( Pemeriksaan $oraks dan Paru dalam Bab 3 Ilmu

iagnostik )isik Buku Ajar Ilmu Penyakit alam PAPI !ilid I "alaman #*4" Kakarta"nterna .u&lishin$"

skenario a blok 16 tahun 2016-1

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