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    Stemi Ant DM

    Uploaded by

    wulan octaviani

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    © All Rights Reserved
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    Stemi Ant DM

    Uploaded by

    wulan octaviani
    3 views25 pages

    Original Title

    Stemi Ant Dm

    Copyright

    © © All Rights Reserved

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    3 views25 pages

    Stemi Ant DM

    Uploaded by

    wulan octaviani

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    Emergency Duty Report

    Wednesday, January 12th 2022

    Consultant in charge : dr. Kino Sp.JP (K)


    Resident In charge : dr. Sari/dr. Wenny/dr. Fakhri/dr. Fadma/dr. Alfino/dr. Sona/dr.
    Amin/dr. Alles/dr. Vira
    Patient in consult
    No Patient Diagnosis Treatment
    New Patient Problem
    Old Patient Patients Death Patient

    CVCU Ward CVCU Ward Yellow CVCU Ward CVCU Ward

    8 23 - -
    - - - - -
    New Patient
    Mr. Suhatrizal, 61 y.o, 01.12.66.40

    • Extensive Anterior STEMI 6


    hours onset TIMI 4/14 Killip I
    • Uncontrolled Type II Diabetes
    Mellitus
    • Hyponatremia (129)
    Mr. Suhatrizal, 61 y.o, 01.12.66.40

    Chief Complain:
    Chest pain since 6 hours before admission

    Recent history illness


    ▪ Chest pain since 6 hours before admission, felt heavy in the middle of the chest, no
    referred pain, duration > 30 minutes, diaphoresis (-), nausea (-) , vomiting (-).
    History of chest pain (-)
    ▪ Shortness of breath (-) when chest pain occurred, History of PND (-), DOE (-), OP
    (-), leg swelling (-). History of shortness of breath (-)
    ▪ Palpitation (-), dizziness (-), syncope (-)
    ▪ History of fever, cough, diarrhea, and close contact with Covid 19 patient (-)
    5
    • At ER : chest pain with scale: VAS 2/10

    Risk factor of CAD :


    • Smoker (+) more than 40 years, 1 pack/ day
    • DM (+) since 15 years ago, uncontrolled
    • Dyslipidemia (?)
    • Hypertension (-)
    • FH (-)

    Past history illness:


    • Asthma (-), Gastritis (-), Stroke (-)

    6
    Physical Examination

    ▪ General appearance : Moderate


    ▪ Consciousness : CMC
    ▪ Blood Pressure : 126/73 mmHg
    ▪ Pulse Rate : 96x/min
    ▪ Temperature : 36.7 oC
    ▪ Resp Rate : 20 x/m
    ▪ SpO2 : 99% on nasal canul 2 lpm

    7
    Physical Examination

    Neck : JVP 5 + 0 cmH20

    Pulmo
    Inspection : Simetris right = left
    Palpation : Fremitus right = left
    Percution : Sonor right = left
    Auscultation : Vesicular, rales -/-, wheezing -/-

    Cor
    Inspection : Ictus cordis was not visible
    Palpation : Ictus palpable 1 finger medial LMCS 5th ICS
    Percution : Upper : LSB 1nd ICS
    Right : RSB
    Left : 1 finger medial LMCS 5th ICS
    Auscultation : S1-S2 reguler, murmur(-), gallop (-) 8
    Physical Examination

    Abdomen
    Insp : Firm
    Palp : Hepar and lien was not palpable
    Perc : Tympani
    Ausc : Peristaltic sound (+) N

    Ekstremity
    Edema -/-, warm

    9
    ECG at emergency unit 12/01/2022 09.14 PM

    ST, QRS rate 101x/mnt, Normal axis , P wave N, PR int 0,16s, QRS dur 0,06 sec, ST elevation 1-6 mm in V1-V6,
    LVH (-), RVH (-), QTc 428msec 10
    Rontgen Thoraks

    CTR 50% , Sg Ao N, Sg Po N, CW (+), infiltrate


    (-), cranialization (-)

    11
    Laboratory Result
    • Hb : 15,7 mg/dL • GDS : 106 mmol/L
    • Ht : 47 % • Ureum : 76 mg/dl
    • Leukosit : 11.500/mm3 • Kreatinin : 1,1 mg/dl
    • Hb
    Trombosit : 235.000/mm
    11.3 mg/dl 3 • RBG
    CCT : 237
    68 ml/min
    mg/dl
    • Leucocyte
    DC : 0/0/64/30/6
    9.870/mm3 • Ureum
    Troponin I : 17 mg/dl : 14 ng/L
    • Ht : 32% • Creatinin : 1.0 mg/dl
    • Platelet
    Natrium : 132
    192.000/mm3
    mmol/L • CCT
    HbsAg ::60Negatif
    ml/min
    • Kalium : 4,6 mmol/L • Trop
    RapidI antigen ::14.808
    Negatifng/dL
    • Natrium
    Klorida : 129
    100 mmol/L • Osmolality : 277 mOsm/kg
    • Kalium
    Kalsium : 3,8
    9,3 mmol/L • Water deficit : - 2.01 l
    • Chloride : 96 mmol/L
    • Calsium : 8.0 mg/dL • HbsAg : Non Reactive
    • Rapid Antigen Covid 19 : Negatif
    • PT : 10.3 second
    • APTT : 29.7 second
    • INR : 0.93
    12
    TIMI SCORE

    • Age 61 yo : 0
    • Angina (+) : 1
    • SBP 101 : 0
    • HR 86 : 0
    • Killip I : 0
    • BW 60 kg : 1
    • Anterior ST elevation : 1
    • Time to treat > 4 hour : 1

    → 4/14

    13
    Diagnosis

    • Extensive Anterior STEMI 6 hours onset TIMI 4/14 Killip I


    • Uncontrolled Type II Diabetes Mellitus
    • Hyponatremia (129)
    • Hypocalcemia (8.0)

    14
    Therapy
    • IVFD NaCl 0.9% 500cc/24h
    • Drip glyceryl trinitrate 10 mcg/kgbb/min
    • Loading ASA 160 mg
    • Loading Ticagrelor 180mg
    • Insulin critical ill

    Plan

    • Primary PCI → Informed consent→patient and family agreed


    • Consult to Covid 19 team 🡪 Acc to Greenzone
    15
    Thank You

    16
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines
    ESC 2016 Heart Failure Guidelines

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