EMERGENCY DUTY REPORT

Wednesday September 11, 2019

Consultant incharge : dr. Muhammad Syukri, SpJP (K)
Residen incharge : dr.Erizon/dr.Prima/dr. Deddy/dr. Sisca/dr. Yola/dr. Wenny/dr.
Intan/ dr. Fakhri
 Consult patients
No Name Diagnose Follow up

G1P0A0H0 gravid
Mrs Evi, 41 yo 35-36 weeks + PRM
1 + History of • Lee revised score I (0,9% cardiovascular risk)
Ablation o.i. SVT
PVC frequent RVOT
Mr. Kajai, 70 yo origin •Potassium should be corrected (5.0)
2
Hypocalemia •Hospitalized together in neuro department
Stroke Infarct
Non cardiac chest
pain • Lansoprazole 2x 30 mg
3 Mr. Darmaswar Dispepsia syndrome • Sulcrafat 4x 10cc
chan, 71 yo
Stroke Infarct • There is no emergency event in cardiovascular,
 List of Patients

Patient in
Old patient New Patient Patient death
problem

HCU interm
CVCU ward CVCU Ward interne ediate CVCU ward CVCU ward

8 15 - - 1 1 - - - -
 New Patient
1. Mrs Arnialis Bachtiar, 66 yo 2. Mr Hendy, 49 yo
 Acute STEMI Anterior 3 hour onset
 ADHF wet and warm on CHF ec TIMI 3/14 Killip I post PPCI 1 stent
CAD, HHD at prox-mid LAD at CAD 2VD + LM
disease (incomplete at proximal RCA
 CAP
and distal LM)
 Hypokalemia  HT stage I
 PATIENT WILL BE REPORTED
Mrs Arnialis Bachtiar, 50 yo

Chief complaint
Shortness of breath has been increased since 2 days before admission

Present Illness
Shortness of breath has been increased since 2 days before admission, not
whistling, not influenced by food nor weather. History of PND (-), DOE (+), OP
(-), leg swelling (-) History of shortness of breath (+) since 1 year before
admission.
Chest pain denied, history previous chest pain was declined
Palpitation (-) dizziness (-) syncope (-)
Fever (+) cough (+) since 2 week before admission
Patient was come back from mekka 10 days ago, patient was hospitalized for 6
days in mekka. Patient suffered from heart failure for years and and routinely
consumed furpsemid 1x40 mg, candesartan 1x4 mg, clopidogrel 1x75 mg,
bisoprolol 1x2,5 mg
In ER : Shortness of breath (+), chest pain (-)
Risk factors for CAD :
 Hypertension(+) since 2009 controlled with candesartan
 DM (-)
 Dyslipidemia (?)
 FH (-)

Past Illness
asthma (-), gastritis (-), stroke (-) , allergy (-)
Physical Examination
General appearance : Moderate
Sens : CMC
Blood Pressure : 143/68 mmHg
Heart Rate : 122 x/min
Resp Rate : 20 x / m
Neck : JVP 5+3 cmH20
Peripheral saturation : 98%
Pulmo:
insp : Symetric right = left
palp : Fremitus right = left
perc : Sonor right = left
ausc : Vesicular, fine and coarse rales +/+ (minimal at base),
wheezing -/-

Cor :
insp : Ictus cordis not visible
palp : Ictus cordis was palpable at at 2 finger lateral LMCS 6th ICS
perc : Upper : 2nd ICS
Right : LSB
Left : at 2 finger lateral LMCS 6th ICS
ausc : S1-S2 reguler, murmur (-) gallop(-)
Abdomen
insp : Supple
palp : Hepar and lien was not palpable
perc : Tympani
ausc : Peristaltic sound (+) N

Extremities :
Pitting Edema - /-, warm
ECG emergency M.Djamil (11/05/2019) 17.00 pm

ST, QRS rate 122x/mnt, Axis N, p wave N, PR int 0,08s, QRS dur 0.06s
ST, QRS rate 122x/mnt, Axis N, p wave N, PR int 0,08s, QRS dur 0.06s
T inverted V1-V4, LVH (-) RVH (-). QTc 444 ms
T inverted V1-V4, LVH (-) RVH (-). QTc 444 ms
Chest X-Ray

CTR 65% , Sg Ao N, Sg Po , CW (-), Apex downward,

CTR 65% , Sg Ao N, Sg Po , CW (-), Apex downward,
infiltrate (+), cranialization (-)
 Laboratorium
 Hb : 11 mg/dL
 Ht : 31 %
 Leukosit : 11.240 /mm3
 Trombosit : 313.000/mm3
• GDS : 107
 Sodium : 130 mmol/L • Ureum : 13
 Potassium : 2,5 mmol/L • Kreatinin : 0,7
 Calcium : 9,2 mmol/L • LFG : 107
 Chloride : 96 mmol/L

 pH/PCO2/PO2/HCO3/BE/SaO2 :
7,61/19,8/90/20,1/0,7/97%
 Result : alkalosis respiratoric
Working diagnosis
 ADHF wet and warm on CHF ec susp CAD, HHD
 Hypertension stage I
 Susp CAP
 Hipokalemia
Therapy at ER
IVFD RL 500cc/24 hours
Furosemide 20 mg iv

Plan
Admitted to CVCU  Full Ward  full intermediate
Consulted to pulmonology department
Pulmonology department
A / CAP
Advice :
Th/
Inj. Ceftriaxone 1x 2gr
Inj. Moxifloxacin 1x 400 mg
N acetylsistein 2x 300 mg
Salbutamol 3x1 resp nebule
P/ Sputum Cultur and sensitivity test
Intermediate 11/09/2019 04.00 am
s/ shortness of breath decreased
o/ GA Conc BP HR RR T
mod CMC 125/70 98x/’ 20x/’ af
JVP : 5+2 cmH2O
Cor : S1N S2N reguler, murmur (-), gallop (-)
Pulmo : vesikuler, rales +/+ , wh -/-
Abd : supel, hepar & lien was not palpable
Ext : oedem - /-, warm
 ECG at Intermediate 12/05/2019 6 pm

SR, QRS rate 110x/mnt, Axis N, p wave N, PR int 0,06s, QRS dur 0.08s, T inverted V1-
SR, QRS rate 110x/mnt, Axis N, p wave N, PR int 0,06s, QRS dur 0.08s, T inverted V1-
V4, LVH (-) RVH (-) QTc 413 ms PVC (+)
V4, LVH (-) RVH (-) QTc 413 ms PVC (+)
Working diagnosis

 ADHF wet and warm on CHF ec CAD, HHD

 CAP
 Hypokalemia
Therapy at Intermediate
Ranitidin 2x 50 mg
Furosemide 2x 20mg Ceftriaxone 1x2gr (IV)
Candesartan 1 x 8mg Moxifloxacin 1 x 400 mg (IV)
Clopidogrel 1x 75 mg Nacetylsistein 2 x 300 mg
Atorvastatin 1x20 mg Salbutamol 3 x1 resp nebule
KCL 40 mEq
Plan
Echocardiography full study
Check Potassium after correction
Initiate B-Blocker
THANK YOU
ESC 2016 Heart Failure Guideline
ESC 2016 Heart Failure Guideline
ESC 2016 Heart Failure Guidelin
ESC 2016 Heart Failure Guidelin
ESC 2016 Heart Failure Guidelin
ESC 2016 Heart Failure Guidelin
ESC 2016 Heart Failure Guidelin
ESC 2016 Heart Failure Guidelin