TUTORIAL REPORT SCENARIO A BLOK XXI

GROWTH DEVELOPMENT AND GERIATRIC

Group 4

Tutor : dr. Putri Rizki Amalia Badri, M.KM

Member :

1. Clara Claudio Zeplin (702017034)

2. Yogi Saputra (702018007)
3. Yolanda Fitriani (702018012)
4. Helmi Naufal (702018029)
5. Shinta Kusuma Putri (702018044)
6. Sabrina Dwi Annisa (702018061)
7. Tasya Dwinur Shafira (702018073)
8. Indah Rahmayani (702018088)
9. Della Marsellah (702018089)
10. Coni Barokah (702018091)
11. Selvi Triami (702018096)

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH PALEMBANG

2021
 FOREWORD

Praise to Allah SWT for all His mercy and grace. We were able to
complete the tutorial report entitled "Tutorial Scenario A Block 21 " as a group
competency assignment. Shalawat along with greetings are always poured out to
our lord, the great prophet Muhammad SAW and his family, friends and followers
until the end of time

We recognize that this tutorial report is far from perfect. Therefore, we expect
constructive criticism and suggestions for improvement in the future. In
completing this tutorial report, the author received a lot of help, guidance and
advice. On this occasion, the author would like to respect and thank:

1. Allah SWT, who has given life with the coolness of faith.
2. Both parents who always provide material and spiritual support.
3. dr. Putri Rizki Amalia Badri, M.KM as the tutor for group 4.
4. Colleagues.
5. All those who help us.

May Allah SWT reward all the charities given to all those who
have supported the author and I hope this tutorial report is useful for us and the
development of science. May we always be protected by Allah SWT.

Palembang, September 2021

Writer
 TABLE OF CONTENTS

FOREWORD ...........................................................................................................
TABLE OF CONTENS ..........................................................................................

CHAPTER 1 INTRODUCTION ...........................................................................

1.1 Background ...................................................................................................
1.2 Purpose and Objectives .................................................................................

CHAPTER 2 DISCUSSION ...................................................................................

2.1 Tutorial Data .................................................................................................
2.2 Scenario .........................................................................................................
2.3 Clarification of Terms ...................................................................................
2.4 Identification of Problems .............................................................................
2.5 Priority of Problem ........................................................................................
2.6 Analysis of Problems ....................................................................................
2.7 Conclusion......................................................................................................
2.8 Conceptual Framework .................................................................................

REFERENCES ........................................................................................................
 CHAPTER I
INTRODUCTION

1.1 Issue Background

Growth Development And Geriatric is the 21th block in the seven
semester of Competency Based Curriculum of Medical Education Faculty of
Medicine, Muhammadiyah University of Palembang.
In this occasion already implemented tutorial with case A, A baby girl
was delivered spontaneously at PONEK RSMP Emergency Department, the
baby wasn’t crying, from a 43 weeks G1P0A0 mother ,and birth weigh 2800
gram. The Apgar score on the first minute was three, five on the fifth minute,
and eight on the tenth minute. There was fever history in mother when giving
birth with leukocytes 18.000/ mm3. The baby moved to perinatology care,
when being treated, the baby looks short of breath and starts to turn blue. The
amniotic fluid were Green.

1.2 Purpose and Objectives

The purpose and objectives of this case study tutorial, namely:
1. As a report task group tutorial that is part of CBC learning system at the
Faculty of Medicine, Muhammadiyah University of Palembang.
2. Can solve the case given in the scenario with the method of analysis and
learning group discussion.
3. Achieving the objectives of the tutorial learning method.
 CHAPTER II
DISCUSSION

2.1 Tutorial Data

Tutor : dr. Putri Rizki Amalia Badri, M.KM
Moderator : Coni Barokah
Desk Secretary : Indah Rahmayani
Board Secretary : Shinta Kusuma Putri
Day and date : Tuesday, September, 28th, 2021
(01.00 PM -03.30 PM)
Thursday, September, 30th, 2021
(01.00 PM -03.30 PM)
Rule of tutorial : 1. Gadget should be nonactive or in silent mode.
2. Everyone in the group should express their opinion.
3. Ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.

2. 2 Case Scenario
“Silence of the Baby”

A baby girl was delivered spontaneously at PONEK RSMP Emergency

Department, the baby wasn’t crying, from a 43 weeks G1P0A0 mother ,and birth
weigh 2800 gram. The Apgar score on the first minute was three, five on the fifth
minute, and eight on the tenth minute. There was fever history in mother when
giving birth with leukocytes 18.000/ mm3. The baby moved to perinatology care,
when being treated, the baby looks short of breath and starts to turn blue. The
amniotic fluid were Green.

Physical Examination

General Appearance: hipoactive, whimpering, weak suction reflexes, BL: 49cm,

BBW: 2800 g, HC : 34 cm, Oxygen saturation 90%

Vital Sign: HR: 132x/M, RR: 70 x/M, Temp.: 36,6oC.

Specific Examination:

Head: Caput succesaneum (+) Nose: nasal flaring breathing (+), Cyanosis (+)

Thorax: Chest retraction (+) epigastrium, suprasternal, down score: 6

Pulmo: vesiculer (+/+), ronchi (+/+)

Cor: Hearth sounds I – II normal, Murmur (-)

Anus: meconium (+)

Laboratory Examination: Blood Chemistry: hemoglobin 16,0 mg/dl,

trombocyte 208.000/mm3,, leukocyte 34.000/mm3, LED: 15 mm/jam, CRP:
20mg/L

Rontgen thoraks:
2. 3 Clarification of Terms

1 Ronchi Continous sound, such as snoring in the throat

or bronchial tubes, due to partial obstruction
(dorlnad 2015).
2 Cyanosis A bluish discoloration of the skin and mucous
membranes due to excessive concentrations of
reduced hemoglobin in the blood (dorlnad
2015).

3 APGAR score Is a method who checked the condition of new

born (dorlnad 2015).

4 PONEK (Comprehensive emergency neonatal

obstetrics) is a comprehensive and integrated
emergency service for maternal and neonatal
cases for 24 hours through a referral network in
an area/region (dorlnad 2015).
5 Chest retraction The act of retracting, or the state of being
drawn back to the chest (dorlnad 2015).
6 Hypoactive An abnormal of motoric and cognitive activity
such as slowing the movement (dorlnad 2015).

7 Whimpering Making a series of low, feeble sounds

expressive of fear, pain, or unhappiness
(dorlnad 2015).

8 Down score Clinical diagnostic means for assessing

hypoxemia in clinical respiratory distressed
neonates (dorlnad 2015).

9 Amniotic fluid Is the clear liquid that sorrounds a developing

fetus in the mothers womb (dorlnad 2015).
10 Caput succesanum Common scalp swelling in newborn, it is a
subcutaneous swelling and edema of the scalp
beetwen the skin and periostinum due to local
venous congestion from the birth canal
 pressure the presenting part (dorlnad 2015).
11. Meconium A newborn’s first poop. This sticky, thick, dark
green poop is made up of cells, protein, fats,
and intestinal secretions, like bile
12. Shortnes of breath A term that describes a subjective perception
of the discomfort of breathing (dorlnad 2015).

13. Murmur Auscultatory sounds, especially periodic

sounds of short duration originating from the
heart or blood vessels (Dorland, 2015).

2. 4 Identification of Problem
1. A baby girl was delivered spontaneously at PONEK RSMP Emergency
Department, the baby wasn’t crying, from a 43 weeks G1P0A0 mother
,and birth weigh 2800 gram. The Apgar score on the first minute was
three, five on the fifth minute, and eight on the tenth minute.
2. There was fever history in mother when giving birth with leukocytes
18.000/ mm3. The baby moved to perinatology care, when being treated,
the baby looks short of breath and starts to turn blue. The amniotic fluid
were Green.
3. Physical Examination
General Appearance: hipoactive, whimpering, weak suction reflexes,
BL: 49cm, BBW: 2800 g, HC : 34 cm, Oxygen saturation 90%
Vital Sign: HR: 132x/M, RR: 70 x/M, Temp.: 36,6oC.
Specific Examination:
Head: Caput succesaneum (+) Nose: nasal flaring breathing (+),
Cyanosis (+)
Thorax: Chest retraction (+) epigastrium, suprasternal, down score: 6
Pulmo: vesiculer (+/+), ronchi (+/+)
Cor: Hearth sounds I – II normal, Murmur (-)
Anus: meconium (+)
 4. Laboratory Examination: Blood Chemistry: hemoglobin 16,0 mg/dl,
trombocyte 208.000/mm3,, leukocyte 34.000/mm3, LED: 15 mm/jam,
CRP: 20mg/L
Rontgen thoraks:

2. 5 Priority of Problem
Identification number 1, A baby girl was delivered spontaneously at PONEK
RSMP Emergency Department, the baby wasn’t crying, from a 43 weeks
G1P0A0 mother ,and birth weigh 2800 gram. The Apgar score on the first
minute was three, five on the fifth minute, and eight on the tenth minute.
Because cause if not treated early it will lead to increased morbidity and
mortility. So it can be life threatening.

2. 6 Analysis of Problem
1. A baby girl was delivered spontaneously at PONEK RSMP Emergency
Department, the baby wasn’t crying, from a 43 weeks G1P0A0 mother
,and birth weigh 2800 gram. The Apgar score on the first minute was
three, five on the fifth minute, and eight on the tenth minute.
a. What the meaning A baby girl was delivered spontaneously at PONEK
RSMP Emergency Department, the baby wasn’t crying, from a 43
weeks G1P0A0 mother ,and birth weigh 2800 gram?
Jawab
 Maknanya bayi lahir spontan dengan post term lebih dari 42 minggu
dan tidak menangis kemungkinan akibat dari asfiksia neonatorum
dengan riwayat kehamilan ibu satu kali dan berat bayi masih dalam
batas normal.

This means that the baby is born spontaneously with a post term of
more than 42 weeks and does not cry, possibly due to asphyxia
neonatorum with a history of one-time pregnancy and the baby's weight
is still within normal limits.

Sintesis:
Bayi baru lahir normal adalah bayi baru lahir dari kehamilan yang
aterm (37-42 minggu) dengan berat badan lahir 2500-4000 gram
(Saifuddin, 2002)
Synthesis:
Normal newborns are newborns from pregnancy at term (37-42 weeks)
with a birth weight of 2500-4000 grams (Saifuddin, 2002).

Saifuddin, Adul Bari. 2002. Buku Acuan Nasional Pelayanan

Kesehatan Maternal dan Neonatal. Jakarta: Yayasan Bina Pustaka
Sarwono Prawirohardjo.

b. What is the anatomy and fisiology in this case?

jawab
anatomi
Saluran pernafasan dari atas kebawah dapat dirinci sebagai berikut,
rongga hidung, faring, laring, trakea, percabangan bronkus, paru- paru
(bronkiolus,alveolus). Rongga hidung dilapisi selaput lender yang
sangat kaya akan pembuluh darah, dan bersambung dengan lapisan
faring dan selaput lender.Faring adalah pipa berotot yang berjalan dari
dasar tengkorak sampai persambungannya dengan oesofagus pada
ketinggian tulang rawan krikoid. Faring terbagi menjadi 3 bagian yaitu
nasofaring, orofaring dan laringofaring kemudian Laring, laring
berperan untuk pembentukan suara dan untuk melindungi jalan nafas
terhadap masuknya makanan dan cairan. Trakea, merupakan lanjutan
dari laring yang dibentuk oleh 16 sampai 20 cincin kartilago yang
terdiri dari tulangtulang rawan yang terbentuk seperti C. Bronkus
merupakan percabangan trachea. Setiap bronkus primer bercabang 9
sampai 12 kali untuk membentuk bronki sekunder dan tersier dengan
diameter yang semakin kecil. Struktur mendasar dari paru-paru adalah
percabangan bronchial yang selanjutnya secara berurutan adalah
bronki,bronkiolus,bronkiolus terminalis, bronkiolus respiratorik, duktus
alveolar,dan alveoli. Dibagian bronkus masih disebut pernafasan
extrapulmonar dan sampai memasuki paru-paru disebut intrapulmonary.
Terakhir adalah Paru-paru yang berada dalam rongga torak,yang
terkandung dalam susunan tulang-tulang iga dan letaknya disisi kiri dan
kanan mediastinum yaitu struktur blok padat yang berada dibelakang
tulang dada. Paru-paru berbentuk seperti spins dan berisi udara dengan
pembagian udara Antara Paru kanan, yang memiliki tiga lobus Dan
paru kiri dua lobus(Mescher,2012).

The respiratory tract from top to bottom can be detailed as follows, the
nasal cavity, pharynx, larynx, trachea, bronchial tree, lungs
(bronchioles, alveoli). The nasal cavity is lined with a mucous
membrane that is very rich in blood vessels, and is continuous with the
pharyngeal lining and mucous membrane. The pharynx is a muscular
tube that runs from the base of the skull to its junction with the
esophagus at the level of the cricoid cartilage. The pharynx is divided
into 3 parts, namely the nasopharynx, oropharynx and laryngopharynx
then the larynx, the larynx plays a role in the formation of sound and to
protect the airway against the entry of food and fluids. Trachea, is a
continuation of the larynx which is formed by 16 to 20 cartilaginous
rings consisting of cartilage that is formed like C. Bronchus are
branches of the trachea. Each primary bronchus branches 9 to 12 times
to form secondary and tertiary bronchi with progressively smaller
diameters. The basic structure of the lungs is the bronchial tree, which
in sequence are the bronchi, bronchioles, terminal bronchioles,
respiratory bronchioles, alveolar ducts, and alveoli. The part of the
bronchus is still called extrapulmonary respiration and until it enters the
lungs it is called intrapulmonary. Finally, the lungs are in the thoracic
cavity, which is contained in the arrangement of the ribs and is located
on the left and right sides of the mediastinum, which is a solid block
structure behind the sternum. The lungs are shaped like spins and filled
with air with a division of air between the right lung, which has three
lobes and the left lung, two lobes (Mescher, 2012).
fisiologi pernafsanan
Proses pernapasan berlangsung melalui beberapa tahapan, yaitu :
1) Ventilasi paru, yang berarti pertukaran udara antara atmosfer dan
alveolus paru
2) Difusi oksigen dan karbondioksida antara alveoli dan darah
3) Pengangkutan oksigen dan karbondioksida dalam darah dan cairan
tubuh ke dan dari sel jaringan tubuh (Guyton, 2014).
Udara bergerak masuk dan keluar paru karena adanya selisih tekanan
yang terdapat antara atmosfer dan alveolus akibat kerja mekanik otot-
otot. Diantaranya itu perubahan tekanan intrapulmonar, tekanan
intrapleural, dan perubahan volume paru (Guyton, 2014).

The process of breathing takes place through several stages, namely:

1) Pulmonary ventilation, which means the exchange of air between the
atmosphere and the alveoli of the lungs
2) Diffusion of oxygen and carbon dioxide between the alveoli and the
blood
3) Transport of oxygen and carbon dioxide in the blood and body fluids
to and from body tissue cells (Guyton, 2014).
Air moves in and out of the lungs because of the pressure difference
between the atmosphere and the alveoli due to the mechanical work of
the muscles. Among them are changes in intrapulmonary pressure,
intrapleural pressure, and changes in lung volume (Guyton, 2014).

Keluar masuknya udara pernapasan terjadi melalui 2 proses mekanik,

yaitu :
1) Inspirasi : proses aktif dengan kontraksi otot-otot inspirasi untuk
menaikkan volume intratoraks, paru-paru ditarik dengan posisi yang
lebih mengembang, tekanan dalam saluran pernapasan menjadi negatif
dan udara mengalir ke dalam paruparu.
2) Ekspirasi : proses pasif dimana elastisitas paru (elastic recoil)
menarik dada kembali ke posisi ekspirasi, tekanan recoil paruparu dan
 dinding dada seimbang, tekanan dalam saluran pernapasan menjadi
sedikit positif sehingga udara mengalir keluar dari paru-paru, dalam hal
ini otot-otot pernapasan berperan ( Sherwood, 2014)

In and out of respiratory air occurs through 2 mechanical processes,

namely:
1) Inspiration: an active process with the contraction of the inspiratory
muscles to increase the intrathoracic volume, the lungs are pulled in a
more expanded position, the pressure in the respiratory tract becomes
negative and air flows into the lungs.
2) Expiration: a passive process in which the elasticity of the lungs
(elastic recoil) pulls the chest back to the expiratory position, the recoil
pressures of the lungs and chest wall are balanced, the pressure in the
respiratory tract becomes slightly positive so that air flows out of the
lungs, in this case the muscles. breathing plays a role (Sherwood, 2014)

Netter, Frank H. 2014. ATLAS OF HUMAN ANATOMY 25th Edition.

Jakarta: EGC
Guyton, Arthur C. 2015. Buku Ajar Fisiologi Kedokteran (11 ed.).
Penerbit Buku Kedokteran EGC.
Sherwood, Lauralee. 2014. Fisiologi Manusia Dari Sel ke Sistem: Edisi
6 . Jakarta: EGC;

c. What is the clasification of body weight in newborn?

jawab
 Klasifikasi menurut berat lahir adalah Bayi Berat Lahir Rendah (BBLR)
yaitu berat lahir < 2500 gram, bayi berat lahir normal dengan berat lahir
2500-4000 gram dan bayi berat lahir lebih dengan berat badan > 4000
gram (Sylviati, 2008).

Classification according to birth weight is Low Birth Weight Babies

(LBW), namely birth weight <2500 grams, normal birth weight babies
with birth weight 2500-4000 grams and babies with more birth weight
weighing > 4000 grams (Sylviati, 2008).

Sylviati M, 2008. Klasifikasi Bayi Menurut Berat Lahir dan Masa

Gestasi. In: Sholeh Kosim, dkk. Buku Ajar Neonatologi. Jakarta: Badan
Penerbit IDAI

d. What are the definition and the function of PONEK?

jawab
 e. What is the purpose of the APGAR score ?
jawab
To obtain information about the general clinical status of the newborn
and the infant's response to neonatal resuscitation. The Apgar score provides
an accepted and convenient method for reporting abstract the status of the
newborn infant immediately after birth and the response to resuscitation if
needed. This scoring system provided a standardized assessment for infants
after delivery (Perinasia, 2014).

Apgar is a quick test performed on a baby at 1 and 5 minutes after

birth. The 1-minute score determines how well the baby tolerated the birthing
process. The 5-minute score tells the health care provider how well the baby
is doing outside the mother's womb. The Apgar test is done by a doctor,
midwife, or nurse. The provider examines the baby's: Breathing effort; Heart
rate; Muscle tone; Reflexes; Skin colour (Hobel and Lamb, 2016).

f. How to calculate APGAR score?

jawab
Cara menentukan APGAR score adalah dengan menilai Appearance
(warna kulit), Pulse (denyut jantung), Grimace (respon refleks), Activity
 (tonus otot) dan Respiration (pernapasan). Setiap kriteria diberi nilai 0,
1 atau 2 sesuai dengan keadaan neonatus sehingga neonatus dapat
memperoleh nilai 0 sampai 10. Dengan interpretasi sebagai berikut

g. What the impact of posterm pregnancy?

jawab
Persalinan postterm dikaitkan dengan peningkatan risiko mortalitas dan
morbiditas perinatal termasuk ketuban yang mengandung mekonium,
sindrom aspirasi mekonium, oligohidramnion, makrosomia, cedera lahir
janin atau gangguan janin intrapartum.

Postterm delivery is associated with an increased risk of perinatal

mortality and morbidity including meconium-containing membranes,
meconium aspiration syndrome, oligohydramnios, macrosomia, fetal
birth injury or intrapartum fetal compromise.

Persalinan postterm ini cukup berisiko karena dapat menimbulkan

komplikasi baik pada ibu maupun pada bayi. Beberapa penelitian
menunjukkan bahwa persalinan postterm dapat meningkatkan risiko
kejadian endometritis, perdarahan postpartum, dan thromboembolic
disease pada ibu bersalin (Vitale, Marilli, & Cianci, 2015)

Postterm delivery is quite risky because it can cause complications for

both the mother and the baby. Several studies have shown that postterm
delivery can increase the risk of endometritis, postpartum hemorrhage,
and thromboembolic disease in women giving birth (Vitale, Marilli, &
Cianci, 2015)..

Vitale, S. G., Marilli, I., & Cianci, A. (2015). Diagnosis, antenatal

surveillance and management of prolonged pregnancy: current
perspectives. Minerva Ginecol, 67(4), 365– 373
 h. What are the general criteria of PONEK?
jawab
The general criteria of PONEK according to Kemenkes RI (2014) are :

 There are doctors on duty who are trained in the ER to handle both general
emergency cases and obstetric - neonatal emergencies.

 Doctors, midwives and nurses have attended the PONEK team training in
the hospital covering neonatal resuscitation, obstetric emergencies and
neonates.

 Have a Standard Operating Procedure for admission and handling of

obstetric and neonatal emergencies.

 No down payment policy for patients with obstetric and neonatal

emergencies.

 Has a certain delegation procedure of authority.

 Have a standard response time in the emergency room for 10 minutes, in

the delivery room less than 30 minutes, blood service less than 1 hour.

 There is an operating room that is ready (24 hours standby) to perform the
operation, if there is an obstetric or general emergency case.

 There are delivery rooms that can set up surgery in less than 30 minutes.

 Have a crew / crew who are ready to carry out operations or carry out
tasks at any time, even though they are on call.

 There is support from all parties in the PONEK service team, including
midwifery doctors, pediatricians, doctors / anesthetists, internal medicine
doctors, other specialists as well as general practitioners, midwives and
nurses.

 Available 24-hour blood service.

 There are other supporting services that play a role in PONEK, such as 24-
hour Laboratory and Radiology, 24-hour recovery room, medicines and
supporting tools that are always available.

 Equipment

- All equipment must be clean (free of dust, dirt, spots, liquids, etc.)

- Metal surfaces must be free of rust or spots

- All fixtur es must be sturdy (no loose or unstable parts)

- The painted surface must be intact and free from major scratches

- Gika gear wheels (available) must be complete and functioning properly

- Instruments that are ready to use must be sterilized

- All electrical equipment must be functioning properly (switches, cables

and plugs are firmly attached)

• Material

- All materials must be of high quality and sufficient in quantity to meet the
needs of this unit.

i. What is the pathofisiologi in the identification number 1?

j. What is theinterpretation of APGAR score in this case?
k. How to determine about gestational weight with newborn?

2. There was fever history in mother when giving birth with leukocytes
18.000/ mm3. The baby moved to perinatology care, when being treated,
the baby looks short of breath and starts to turn blue. The amniotic fluid
were Green.
a. What is the corelation between the history in mother and symptomps in
the baby?
 b. What is the meaning the baby looks short of breath and starts to turn
blue and the amniotic fluid were green?
jawab

sintesis
Sindroma aspirasi mekonium (SAM) merupakan sekumpulan gejala
yang diakibatkan oleh terhisapnya cairan amnion mekonial ke dalam
saluran pernapasan bayi. Sindroma aspirasi mekonium adalah salah satu
penyebab yang paling sering menyebabkan kegagalan pernapasan pada
bayi baru lahir aterm maupun post-term

synthesis
Meconium aspiration syndrome (SAM) is a collection of symptoms
caused by the inhalation of meconial amniotic fluid into the infant's
respiratory tract. Meconium aspiration syndrome is one of the most
common causes of respiratory failure in term and post-term newborns

c. What is patofisiology the baby looks short of breath and starts to turn
blue and the amniotic fluid were green?
d. What is the causes the amniotic fluid were green.?
e. What are the clasification of amniotic fluid ?
f. What is the etiology of short of breath?

3. Physical Examination
General Appearance: hipoactive, whimpering, weak suction reflexes,
BL: 49cm, BBW: 2800 g, HC : 34 cm, Oxygen saturation 90%
Vital Sign: HR: 132x/M, RR: 70 x/M, Temp.: 36,6oC.
Specific Examination:
Head: Caput succesaneum (+) Nose: nasal flaring breathing (+),
Cyanosis (+)
Thorax: Chest retraction (+) epigastrium, suprasternal, down score: 6
Pulmo: vesiculer (+/+), ronchi (+/+)
 Cor: Hearth sounds I – II normal, Murmur (-)
Anus: meconium (+)
a. What is the interpretation of physical examination?
b. What is the abnormal mechanism of physical examination?
c. How to calculate down score?
d. What is the indication of down score?
e. What is the interpretation of specific examination?
f. What is the abnormal mechanism of specific examination?

4. Laboratory Examination: Blood Chemistry: hemoglobin 16,0 mg/dl,

trombocyte 208.000/mm3,, leukocyte 34.000/mm3, LED: 15 mm/jam, CRP:
20mg/L
Rontgen thoraks:

a. What is the interpretation of labrotary examination?

b. What is the abnormal mechanism of laboratory examination?
c. What is the interpretation of rontgen thoraks examination?
d. What is the abnormal mechanism of rontgen thoraks examination?

5. How to diagnose in this case?

6. What are differential diagnosis in this case?
jawab
7. What are supporting examination?
jawab
Darah perifer lengkap
Analisis gas darah menunjukan hipoksemia
Foto thoraks menunjukkan hiperinflasi( bercak-bercak infiltrat), diafragma
mendatar, dan corakan kedua lapang paru kasar/bercak ireguler. Dapat
ditemukan pneumotoraks atau pneumomediastrinum.

Complete peripheral blood Blood gas analysis showed hypoxaemia Chest

X-ray showed hyperinflation (spots of infiltrate), flattened diaphragm, and
rough/irregular spots on both lung fields. Pneumothorax or
pneumomediastrinum may be found.
8. What is the working diagnosis in this case?
9. What are the treatment in this case?
jawab
non farmakologis
Bersihkan sisa meconium dengan meconium aspirator
Rawat incubatoritor
Monitor keadaan umum TTV, CRT, Down score
Pertimbangkan pemberiaan CPAP

non-pharmacological
Clean residual meconium with a meconium aspirator Treat incubator
Monitor general condition TTV, CRT, Down score Consider giving CPAP

farmakologis
Resusitasi Cairan
infus D10 % 60-70 ml/ KgBB/Hari

pharmacology
Resuscitation Infusion fluids D10 % 60-70 ml/ KgBW/Day

Antibiotik :
penggunaan antibiotik spektrum luas terindikasi
hanya pada kasus dengan infiltrat pada foto toraks.
Ampicilin 100 mg/kgBB/Hari interval 12 jam
Gantamicin 5 mg/ kg BB/ hari dalam interval 48 jam

Antibiotics: the use of broad-spectrum antibiotics is indicated only in cases

with infiltrates on chest X-ray. Ampicillin 100 mg/kg/day at 12-hour
intervals Gantamicin 5 mg/kg/day at 48-hour intervals

• Surfaktan :
Mekonium menghambat aktivitas surfaktan endogen. Terapi surfaktan
 dapat meningkatan oksigenasi, menurunkan komplikasi pulmonal

• Surfactant : Meconium inhibits endogenous surfactant activity.

Surfactant therapy can improve oxygenation, reduce pulmonary
complications

10. What are the complications in this case?

jawab
Gagal nafas  kematian
Pneumothorax atau penumpukan udara berlebihan di rongga pleura yang
menyebabkan paru-paru sulit mengembang
Hipertensi pulmonal persisten pada bayi baru lahir, yaitu tekanan darah
tinggi di pembuluh paru-paru yang dapat membuat bayi kesulitan bernapas
Kerusakan otak permanen karena kondisi aspirasi mekonium yang parah
dapat membatasi oksigen ke otak

Respiratory failure death Pneumothorax or excessive accumulation of air

in the pleural cavity that makes it difficult for the lungs to expand
Persistent pulmonary hypertension in newborns, which is high blood
pressure in the pulmonary vessels that can make it difficult for the baby to
breathe Permanent brain damage due to meconium aspiration conditions
severe can limit oxygen to the brain

11. What is the prognosis in this case?

jawab
Quo ad vitam  Dubia Ad bonam
Quo ad fungsionam  Dubia Ad bonam
Quo ad sanationam  Dubia Ad bonam

Prognosis akhir bergantung pada luasnya jejas sistem saraf pusat akibat
 asfiksia, dan adanya masalah-masalah terkait seperi adanya sirkulasi janin

12. What is the Indonesian Doctor Competency Standards in this case?

jawab
Kompetensi Dokter Umum: 3B (mendiagnosis dan memberikan
tatalaksana awal pada pasien. Setelah itu, pasien dirujuk ke dokter yang
lebih ahli.)
General Practitioner Competence: 3B (diagnosing and providing initial
treatment to the patient. After that, the patient is referred to a more skilled
doctor.)

13. How does the Islamic view in this case?

2. 7 Hypothesis
The baby looks shorts of breath and starts to turn blue because of she
experienced respiratory distress ec suspect meconium aspiration.

2. 8 Conceptual Framework

Infection

Amniotic fluid mixed with

meconium

Aspiration into the lungs

The process of changing between

fluid and air at the time of birth is
disrupted (RDS)
Cyanosis and short of breath

REFERENCES