Introduction: Anaphylactic reaction is systemic hypersensitivity reaction. It is type 1 hypersensitivity reaction. The incidence can be mild to severe due to the sudden release of mediators by effector cells. This research aimed to examine the prevalence of anaphylactic reaction in Dr. Soetomo General Hospital in January 2014 until May 2018.Methods: This study was a cross-sectional and retrospective study by assessing patients’ medical records and was analyzed descriptively.Results: 22 patients were identified as anaphylactic reaction. The prevalence of anaphylactic reaction from year to year cannot be identified surely because of underdiagnose and underreporting. The most common cause of anaphylactic reaction in Dr. Soetomo General Hsopital was drugs (50%). The most drugs were antibiotics (22.73%) and the most antibiotics were groups of penicillin (40%) and cephalosporin (40%). The most common clinical manifestation was skin-related (77.27%), which includes urticaria (4.55%), angioedem (27.27%), pruritus (27.27%) cold skin (0.09%), pallor (4.55%), and cyanosis (4.55%). Most patients became better (45.54%) after getting treatment from the doctor.Conclusion: The most common cause of anaphylactic reaction was drugs, the most drugs were antibiotics and the most antibiotics were groups of penicillin and cephalosporin. The most clinical manifestation was skin-related. Most of anaphylactic reaction’s patients became better after getting treatment from the doctor. Underdiagnose and underreporting are the problem often encountered in cases of anaphylactic reaction.
Latar Belakang: Pemilihan obat anestesi untuk induksi bagi seorang ahli anestesi merupakan hal yang krusial dan didasarkan atas efek farmakodinamik terhadap sistem kardiovaskular.Tujuan: Menganalisa apakah penggunaan propofol auto-coinduction (pre-dosing propofol) dapat digunakan sebagai alternatif midazolam sebagai obat coinduction, dilihat dari segi keamanan pasien (perubahan hemodinamik yang terjadi) dan biaya yang dikeluarkan.Metode: Penelitian eksperimental dengan desain pre-posttest single blind group ini melibatkan 52 pasien yang menjalani operasi elektif dengan anestesi umum di Kamar Operasi Gedung Bedah Pusat Terpadu (GBPT) RSUD Dr. Soetomo Surabaya pada bulan September-Oktober 2018. Dua kelompok pasien masing-masing mendapatkan midazolam 0,03 mg/KgBB (kelompok M, n=26) dan propofol 0,4 mg/KgBB (kelompok P, n=26) 2 menit sebelum induksi dengan propofol titrasi sampai hilang kontak verbal. Dosis propofol yang digunakan, tekanan darah sebelum dan sesudah dilakukan induksi serta biaya induksi dicatat.Hasil: Rerata Arterial Pressure (MAP) pra-induksi pada kelompok M adalah 96,35 ±11,366 mmHg dan pada kelompok P 90,54 ±7.732 mmHg, sedangkan MAP pascainduksi pada kelompok M sebesar 79.96 ±9.21mmHG dan pada kelompok P adalah 73,96 ±5,03mmHg (p=0,037). Total biaya yang digunakan pada kelompok M adalah Rp. 7.890 ±1.448.89 sedangkan pada kelompok P Rp. 7.082 ±1.403.89 (p=0.047).Kesimpulan: Terdapat perbedaan bermakna pada perubahan MAP yang disebabkan oleh penggunaan propofol auto-coinduction bila dibandingkan dengan midazolam coinduction. Tidak terdapat perbedaan signifikan penurunan tekanan darah dan nadi, serta dosis propofol yang digunakan antara kedua kelompok. Biaya induksi pada kelompok auto-coinduction propofol secara signifikan lebih rendah.
Introduction: Fluid and electrolyte disorders can be affected by various conditions or diseases. Electrolyte disorders are often found in pediatric patients with critically ill conditions and are associated with increased morbidity also mortality that requires extra care in the Pediatric Intensive Care Unit (PICU). Objective: To describe the electrolyte profile of critically ill patients with electrolyte disorders admitted to the Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital. Materials and Methods: The study was conducted prospectively with a descriptive method in patients with electrolyte disorders aged 1 month -18 years old admitted to PICU Dr. Soetomo General Hospital, Surabaya in a period from August to November 2018. Data on patient age, gender, electrolyte profile (sodium, potassium, calcium, chloride), and origin before PICU admission were recorded. Results and Discussion: From 37 patients with electrolyte disorders showed that patients were dominated by the male in 56.8% (n=21), in the age group of infants or 1-12 months old in 45.9% (n=17). Common main diagnosis in most patients were digestive system disorders in 27% (n=10), followed by central nervous system, respiratory system, kidney and cardiovascular disorders, and the origin before PICU admission were from Emergency Room (ER) in 62.2% (n=23). There were found 97 incidences of electrolyte disorders. Most frequent electrolyte disorders were hypocalcemia in 59.5% (n=22), hypokalemia in 54.1% (n=20), hyponatremia in 40.5% (n=15) and the least was hypochloremia in 35.1% (n=13). Mean serum sodium level was 138.18 ± 12.071, serum potassium level was 3.608 ± 1.2247, serum calcium level was 8.057 ± 1.9473 and serum chloride level was 101.45 ± 13.266. Conclusions: Critically ill patients admitted in PICU tend to experience low electrolyte levels. ABSTRAK Pendahuluan: Gangguan cairan dan elektrolit dapat dipengaruhi oleh berbagai kondisi atau penyakit. Gangguan elektrolit sering ditemukan pada pasien anak dengan kondisi sakit kritis dan dikaitkan dengan peningkatan morbiditas serta mortalitas yang memerlukan perawatan ekstra di Pediatric Intensive Care Unit (PICU). Tujuan: Untuk menggambarkan profil elektrolit pada pasien sakit kritis yang dirawat di PICU RSUD Dr. Soetomo, Surabaya. Metode dan Bahan: Penelitian ini dilakukan secara prospektif dengan metode deskriptif pada pasien dengan gangguan elektrolit berusia 1 bulan -18 tahun yang dirawat di PICU Rumah Sakit Umum Daerah (RSUD) Dr. Soetomo, Surabaya dalam periode dari bulan Agustus 2018 hingga November 2018. Data berupa usia, jenis kelamin, profil elektrolit serum (natrium, kalium, kalsium, klorida), dan asal pasien dicatat. Hasil dan Pembahasan: Dari 37 pasien, menunjukkan bahwa pasien didominasi oleh laki-laki sebesar 56,8% (n = 21), pada kelompok usia bayi atau usia 1-12 bulan sebesar 45,9% (n = 17). Diagnosis utama terbanyak pada pasien adalah gangguan sistem pencernaan sebesar 27% (n = 10), diikuti oleh gangguan sistem saraf, pernapasan, ginjal, dan sistem kardiovaskular. Asal pas...
Background: Thoracic trauma causes 20% of all deaths from trauma. One that has high morbidity and mortality is flail chest and the sternum fracture is a small part of the cause of flail chest. Given its extremely rare occurrence, a sternum fracture is often a forgotten diagnostic trap in flail chest. Case Report: There were 2 cases reported with thoracic trauma. The first case is multitrauma with 50 Injury Severity Score (ISS), head trauma, abdominal trauma and limb trauma. After hemodynamic stabilization for 3 days, the patient is difficult to wean from mechanical ventilation. After no longer found a source of bleeding and hemodynamically stable patients were immediately prepared for emergency surgery and the cause was found to be a sternum fracture that was not identified before. The second case is thoracic trauma with ISS 17, clinically seen as flail chest and normal anteroposterior chest X-ray. After continued CT scan thorax found a sternum fracture that causes inadequate breathing. External fixation was immediately carried out and the results were satisfactory. Discussion: Sternum fractures are often caused by severe anterior thoracic trauma mechanisms and can cause flail chest manifestations so as to increase morbidity and mortality even more so when accompanied by trauma to other organ systems and the use of long-term mechanical ventilators and sepsis. The incidence of sternum fractures is very rare and lateral chest X-rays in cases of trauma are also rarely performed so that sternum fractures are often not identified. By knowing the mechanism of trauma, clinical symptoms that do not match the antero-posterior chest X-ray picture and the difficulty of weaning from mechanical ventilation, the use of ultrasound for screening is expected to help avoid the trap of late identification of sternal fractures. Conclusion: In thoracic trauma with a chest failure, early diagnostics followed by 43 Volume X, Nomor 1, Tahun 2018 Jurnal Anestesiologi Indonesia external fixation will reduce morbidity and mortality in patients with sternal fractures. ABSTRAKLatar Belakang: Trauma toraks menyebabkan 20% dari semua kematian akibat trauma. Salah satu yang memiliki morbiditas dan mortalitas tinggi adalah flail chest dan fraktur sternum merupakan sebagian kecil dari penyebab flail chest. Mengingat kejadiannya yang sangat jarang maka fraktur sternum sering menjadi jebakan diagnostik yang terlupakan pada flail chest. Laporan Kasus: Terdapat 2 kasus yang dilaporkan dengan trauma toraks. Kasus pertama adalah multitrauma dengan Injury Severity Score (ISS) 50, trauma kepala, trauma abdomen dan trauma ekstremitas. Setelah dilakukan stabilisasi hemodinamik selama 3 hari, pasien sulit disapih dari ventilasi mekanik. Setelah tidak ditemukan lagi sumber perdarahan dan hemodinamik stabil pasien segera disiapkan operasi darurat dan ditemukan penyebabnya adalah fraktur sternum yang tidak teridentifikasi sebelumnya. Kasus kedua adalah trauma toraks dengan ISS 17, secara klinis tampak flail chest dan foto toraks antero-posterior yang normal. S...
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