Dr.

I Nyoman Marsel Rama

Nama :
Grandita Bhaktiyasa (OKA)

NIM : 198070100011003
Mulai Pendidikan : JANUARI 2020

No Tanggal MRS IGD/POLI No RM

1 25/7/2021 IGD 11514329

2 23/7/2021 IGD 11514108

3 20/7/2021 IGD 11514006

4 19/7/2021 IGD 11513891

5 15/7/2021 IGD 11513641

6 17/7/2021 IGD 11479181

7 12/7/2021 IGD 11510940

8. 12/7/2021 IGD 11508764

9. 10/7/2021 IGD 11513311

10. 10/7/2021 IGD 11513275

11 3/7/2021 IGD 11512649

12 2/7/2021 IGD 11512735

13 24/6/2021 IGD 11510487

14 20/6/2021 IGD 11511558

15 16/6/2021 IGD 11511230

16 15/6/2021 IGD 11511182

17 11/6/2021 IGD 11510940

18 10/6/2021 IGD 11510884

19 8/6/2021 IGD 11510612

20 7/6/2021 IGD 11460757

21 6/6/2021 IGD 11504195

22 6/6/2021 IGD 11510483

23 5/6/2021 IGD 11510447

24 3/6/2021 IGD 11510288

25 3/6/2021 IGD 11510354

26 2/6/2021 IGD 11510175

27 1/6/2021 IGD 11510162

28 31/5/2021 IGD 11510134

29 28/5/2021 IGD 11509908

30 26/5/2021 IGD 11508954

31 24/5/2021 IGD 11198700

32 24/5/2021 IGD 11501952

33 22/5/2021 IGD 1131459

34 22/5/2021 IGD 11509489

35 19/5/2021 IGD 11509250

36 19/5/2021 IGD 11509254

37 19/5/2021 IGD 11509241

38 18/5/2021 IGD 11509155

39 15/5/2021 IGD 11508954

40 13/5/2021 IGD 11508989

41 13/5/2021 IGD 10718122

 Alamat
Nama Jenis Kelamin Usia (kota)

Sdr.Moch Fatkhur Rohman L 21TH

Tn. Robianto L 40Th

By.Ny Fitri Novitasari L 3Hari

 Tn. Tony Usmawardi L 55TH

Bayu L 33Th

Ny. Yayah Fadilah P 34TH

Nn.Tasya P 13Th

By. Ny. Muyassaroh P 3 Hari

Agus Dwi L 22Th

Tn. Moch Munib Hasyim L 46Th

Mamat Rifaldi L 34Th

Tn. Hepri Harianto L 59Th

An.Muhammad Keenan L 2Th

Muh Zeidan Alfayz L 5Th

Tn. Sugeng Subagio L 59Th

Tn. Moh.Hasta L 20Th

Nn. Tasya P 13Th

Nur Rofiq L 23Th

Asnawi L 60Th

Tn. Abdul Muin L 71Th

 By Ny Suheni L 1Hari

Zainul Arifin L 41Th

An. Muh. Rafay L 2Th

An. Soni Adinta L 9TH

Ny.Praditya P 26Th

Tn. M. Husin Ependi L 41Th

Ny. Yohana P 24Th

Tn. R. Djoko Santoso L 62TH

.Tn. Hadi Suyono L 40TH

Suparti P 66TH

Ny. Sunami P 77Th

Ny. Lis Nurhayati P 50Th

Ny. Maulidatul Khasanah P 35TH

M. Diki L 24Th
 Senewan L 57Th

Erwin Kiki L 23Th

Satria L 4Th

Ducha Fauzi L 28Th

Suparti P 66Th

M Rizal L 20Th

Susiati P 55Th
 SMF yang Berkorelasi de
Diagnosa DPJP

BD BO BA

CKS 225 + EDH Frontobasal D 62 cc + Cerebral edema + Fr

Maxilla D/S non le fort + Fr Communitive os frontal + Open FAR
Wound R supraorbita D

CKR 456 - 356 + EDH Frontal D 30 cc + Fracture

depressed sinus Frontal + Edema cerebri + Electric
burn injury r/ palmar D/S, extrimitas inferior S 3% +
Fr. Maxilla non lefort + Fr. Nasal + Fr. Rima orbita
superior D/S + Fr. Rima orbita inferior D + Open TAL
wound regio Supra orbita S + Multipel vulnus abrasio
regio fasialis + Lung contussion D/S + Internal
bleeding HD stabil + Vulnus abratio anterior side R
Shoulder

MAR letak rendah dengan fistel perineal WID BA

 DOC (1x1-2x4) dt CVA ICH regio capsula interna S + DON
IVH + HT st II

CKS 225 + Open wound frontoparietal S +

Countercoop EDH regio frontotemporal D vol 36cc +
edema cerebri + diastasis sutura coronaria + fr linier TAL
os temporal D + fr arcus zygoma S + fr costae 4
posterolateral S + contusio pulmonum

Abses regio frontal + CKD St. V on Routine HD + DM FAR

Type II

Internal Bleeding Hemodinamic Stabil + Rupture

perineum gr IV + CF middle shaft L clavicle + Pelvic
ring injury Mixed Type + Vulnus Abrasio lateral side L
thigh + Closed Degloving Gluteus + Post
Debridement + NPWT (22/6/2021) + Post
WMA
Debridement + NPWT (28/6/2021) + Post Repair
Perineum (28/6/2021) + Post External Fiksasi Pelvis
(28/6/2021) + Post stoma protektif + Post eksternal
fixasi + Post Re-Debridement + NPWT (2/7/2021) +
Post Re-Debridement + NPWT (6/7/2021)

Atresia ani tanpa fistel letak rendah WID BA

Superficial - Mid Dermal Burn Injury 25% regio
facialis, thoracal, extremitas superior et inferior D/S DIO
dt Petasan

ALI grade III extremitas inferior sinistra + Sepsis + HF

stage C fc II dt CAD + CCS + DM type II on insulin EIR

DOC dt susp. enchepalitis TB + hydrocephalus + HT st

FAR
I
ALI Rutherford gr IIA exremitas inferior S + AKI + HF
st C FC II + HT st I + DM type II normoglikemia + EIR
hypoalbuminemia + Obesity
 Malignant round cell tumor intraabdomen +
Hidronephrosis S post DJ stent insertion post
eksplorasi  laparotomy + VC + Debulking tumor +
modified bogota bag (15/06/2021) + Internal
bleeding (tumor site) transient respons + post
damage kontrol surgery + embolisasi (16/06/2021) + LIK BA
post Aff packing + evaluasi source bleeding +
secondary closure  modified bogota bag
(19/06/2021)

EDH regio fossa posterior S 18cc, tebal 1.9cm + fr

TAL
linier os occipital

Total bowel obstruction dt ileum band ARS BD

CKS 325 + EDH regio Frontal S + Pneumoencephal

frontal D + Cerebral edema + Fr comminutive os
frontal + Fr ZMC S + Fr maxilla D/S non le fort + Fr
zygoma D + Fr parasymphisis D mandibula + Fr NOE
type II + Multiple Open wound regio frontal + TAL/WMA
Multiple vulnus abrasio facialis + Open wound labia
oris inferior + CF middle shaft L clavicle + Vulnus
abrasion anterolateral side L arm

Internal Bleeding Hemodinamik Stabil + Rupture

perineum gr IV + CF middle shaft L clavicle + Pelvic
WID BA
ring injury Mixed Type + Vulnus Abrasio lateral side L
thigh

CKS 225 + CH Frontal D + ICH Frontal S Vol 16

cc + Fr. comminutive Os Frontal + Fr Maxilla
D/S Non Lefort + Fr. Zygoma S + Fr. ZMC D + DIO
Fr. Nasal + Fr. Symphisis Mandibula + Open
wound supraorbita S + Multiple vulnus abrasio
facialis + CF L Galeazzi

Peritonitis generalisata ec susp perforasi hollow HER BD

organ + Sepsis + Leukopenia
Diabetic foot pedis D wagner V + Diabetes mellitus
Tipe 2 + Post amputasi below knee S ec diabetic foot EIR
pedis S + Hipoalbuminemia
 MAR tanpa fistel letak rendah +
Prematur/BBLR/SMK + Neonatal Pneumonia + Early WID BA
Onset Sepsis + PJB Asianotik Suspek ASD

HIL D Inkarserata + HT gr II STS BD

Low level bowel obstruction dt invaginasi ileocolica WID BA

CKR 456 tanpa perdarahan intrakranial + Fr. Rima

orbita superior + Fr. nasoorbita D + Fr. maxilla D non
LeFort + Stitched wound regio frontal S + Stitched FAR/RUM
wound regio nasoorbita S + Multiple vulnus abrasio
regio wajah

CKR 456 + Multiple abrasio regio fascialis + Multiple TAL

open wound regio frontal D
Total Bowel Obstruction dt adhesi gr I-II ileoileal
+ Appendicitis akut perforata + AKI + ARS BD
Hiponatremia + Hipoalbuminemia +
Hyperkalemia + Sepsis
DOC dt CVA IVH + SAH + Hydrocephalus TAL
Contusio pulmonum + Fraktur Costae
Segmental 4,5,6 Posterolateral S + Fraktur
Costae linear 3,7 Posterior S + CKR 456 tanpa
lesi intrakranial + Stitched Wound regio TAL
frontoparietal S + Abrasio regio frontal + CF
middle shaft L clavicle + CF L scapular body +
Vulnus laceratum anterior side L knee + Vulnus
laceratum L great toe
COB 113 + ICH burst lobe Frontobasal D + SDH TAL/SUS
Temporoparietal D (1.8cm 9 slices)
Wound dehiscence regio femoral S post bypass
femoropopliteal + CLI regio extremitas inferior S + EIR
Hipoalbumin
CVA ICH Ganglia Basalis D vol. 8 cc
+ IVH +SAH + Edema Cerebri + Moderate TAL
hydrocephalus + HT urgency + Pneumonia

DOC dt Susp. Metabolic dd septic encephalopathy

+CVA Trombosis 2nd Attack + Moderate TAL
Communicating Hydrocephalus + Azotemia pre renal
+ Hipernatremia
Rupture pseudoaneurysm mediana cubiti D + CKD St SUS
V on routine HD
DOC dt SOP cerebri ec susp Craniopharyngioma +
Moderate obstructive Hydrocephalus + distress FAR
reapiratory
 CKR 456 tanpa pendarahan intrakranial +
Multiple Vulnus Abratio regio Facialis + Fr.
Maxilla Non Lefort D + Fr. Maxilla Non Lefort S
+ Fr. Zygoma D/S + Fr. Parasymphyisis
Mandibula D + Fr. Corpus Mandibula S
(tambahan dr.wma) + Fr. Nasal + Multiple WMA
vulnus abratio regio facialis + Vulnus appertum
regio frontal D + Vulnus appertum regio
periorbital inferior D + Vulnus appertum regio
frontal D + Vulnus laceratum regio periorbital D
+ Vulnus laceratum regio palpebra inferior D

Peritonitis generalisata dt appendicitis perforasi +

adhesi ileo-ileal gr II WAN BD

Superficial Mid dermal burn Injury 25% regio wajah,

Extremitas superior D/S, Extremitas Inferior D/S dt WMA
api + suspect Trauma Inhalasi

Peritonitis generalisata dt Appendicitis perforata ARS BD

CLI ektremitas inferior S + HT stage II + DM tipe II + EIR

AKI
Pneumothorax D post chest tube + stab wound regio
abdomen + ruptur hepar zona 4 & 8 + ruptur STS BD
diafragma
Abdominal Pain dt appendecitis acute perforata + STS BD
thrombositopenia + AIHA
SMF yang Berkorelasi dengan Diagnostik
Planning

BT BS BP BR BU LL

BS TDE EDH Frontobasal D + dekortikasi sinus

frontal + muscle patch

TDE EDH frontal D + cranioplasty +

dekortikasi sinus frontal dengan
BS muscle patch + elevasi fr depresed
frontal S + rekonstruksi rima orbita
superior D/S

Sigmoidostomy
 BS EVD Kocher D

BS TDE EDH + debridement + hecting

BS Insisi drainage abses

BP Re-Debridement NPWT

Sigmoidostomy

Debridement GA + Evaluasi laring

BP durante op

BT Amputasi below knee S 

Burrhole ventriculostomy + insersi

BS
EVD Kocher D

BT Thrombectomy S
 Rebogota Bag + evaluasi tumor site

BS TDE EDH

eksplorasi laparotomi + release

band

dekortikasi sinus frontal +

craniectomy + direct platting
BS BP
frontal + Debridement primary
hecting + direct platting mandibulla

repair perineum + Sigmoidostomy

Debridement + Primary Hecting

BP GA +
Archbarr wire + Palatorapphy

peritoneal lavage

BT amputasi below knee D +

retrograde thrombectomy
 Sigmoidostomy

HTHR D
explorasi laparotomy release
invaginasi

BS BP Debridement primary hecting GA

BS Debridement primary hecting LA

Laparotomi + Eksplorasi +
Appendectomy + Insersi drain
abdomen
BS EVD kocher point D/S

BS Debridement Primary Hecting

GA

BT BS TDE SDH + Burst lobe +

Trakeostomy

BT Debridement regio femoral +

amputasi below Knee S

BS EVD Kocher S

BS EVD Kocher S

BT Repair pseudoaneurysm

BS EVD kocher D
 BP Archbarr wiring + reposisi nasal

Eksplorasi laparotomi + adesiolisis

+ appendektomi

BP Debridement GA

Explorasi laparotomy +
appendectomy

BT Thrombectomy + by pass Femoro-

popliteal

Eksplorasi Laparotomi + repair

diafragma

Appendectomy per laparotomi

 Trauma / Non OPERATIF / NON
Trauma (T/ NT) OPERTIF (O/NO) CITO/ ELEKTIF Tgl Operasi

T O CITO 25/7/2021

T O CIYO 21/7/2021

NT O CITO 20/7/2021
NT O CITO 19/7/2021

T O CITO 15/7/2021

NT O CITO 17/7/2021

T O Elektif 12/7/2021

NT O CITO 12/7/2021

T O CITO 10/7/2021

NT O CITO 10/7/2021

NT O CITO 3/7/2021

NT O CITO 2/7/2021
NT O Elektif 26/6/2021

T O CITO 20/6/2021

NT O CITO 16/6/2021

T O CITO 15/6/2021

T O CITO 11/6/2021

T O CITO 10/6/2021

NT O CITO 8/6/2021

NT O CITO 7/6/2021
NT O CITO 6/6/2021

NT O CITO 6/6/2021
NT O CITO 5/6/2021

T O CITO 3/6/2021

T O CITO 2/6/2021

NT O CITO 2/6/2021

NT O CITO 1/6/2021

T O CITO 31/5/2021

T O CITO 28/5/2021

NT O CITO 26/5/2021

NT O CITO 24/5/2021

NT O CITO 24/5/2021

NT O CITO 22/5/2021

NT O CITO 22/5/2021
T O CITO 19/5/2021

NT O CITO 19/5/2021

T O CITO 19/5/2021

NT O CITO 18/4/2021

NT O CITO 15/5/2021

T O CITO 13/5/2021

NT O CITO 13/5/2021
 Jenis Operasi

1 2 3 4

TDE EDH Frontobasal D + dekortikasi sinus

frontal + muscle patch

TDE EDH frontal D + cranioplasty +

dekortikasi sinus frontal dengan
muscle patch + elevasi fr depresed
frontal S + rekonstruksi rima
orbita superior D/S

Sigmoidostomy
 EVD Kocher D

TDE EDH debridement + hecting

Insisi drainage abses

Re-Debridement NPWT

Sigmoidostomy

Debridement GA + Evaluasi laring

durante op

Amputasi below knee S 

Burrhole ventriculostomy + insersi

EVD Kocher D

thrombectomy S
Rebogota Bag + evaluasi tumor site

TDE EDH

Eksplorasi laparotomi release band

dekortikasi sinus frontal +

craniectomy + direct platting
direct platting mandibulla
frontal + Debridement primary
hecting

repair perineum Sigmoidostomy

Debridement + Primary Hecting GA Archbarr wire Palatorapphy

peritoneal lavage

amputasi below knee D retrograde

thrombectomy
 Sigmoidostomy

HTHR D
explorasi laparotomy release
invaginasi

Debridement primary hecting GA

Debridement primary hecting LA

Laparotomi + Eksplorasi +
Appendectomy + Insersi drain
abdomen

EVD kocher point D/S

Debridement Primary Hecting

GA

TDE SDH + Burst lobe Trakeostomy

Debridement regio femoral +

amputasi below Knee S

EVD Kocher S

EVD Kocher S

Repair pseudoaneurysm

EVD kocher D
 Archbarr wiring + reposisi nasal

Eksplorasi laparotomi + adesiolisis

+ appendektomi

Debridement GA

Explorasi laparotomy +
appendectomy
Thrombectomy + by pass Femoro-
popliteal

Eksplorasi Laparotomi + repair

diafragma

Appendectomy per laparotomi

 Status PPDS untuk tindakan operasi
Tgl KRS KET

Bimbingan Operator Asisten Observer

OKA OKA ZAM 30/7/2021

ZET OKA

OKA FRI
OKA JUN

TAF OKA

OKA JUN

MIR OKA

OKA FRI

HUD OKA

NEL OKA

FON OKA ANA

KEN OKA
ICA OKA

TAF OKA

ZET OKA

MIR OKA

ZET OKA

NAY OKA

OKA ATA

ATA OKA TAF

 GIR OKA

KEN OKA
ZAM OKA

OKA ANA

OKA AMI

NAY OKA

HUD/OKA ZAM

OKA` ZUL

ICA OKA

ATA OKA

TAF OKA

TAF OKA

ZAM OKA

TAF OKA
KEN OKA

MIR OKA

OKA MIR

OKA ZET

ZAM OKA

ANA OKA