DSS

Question 1

Gejala DSS

Answer 1

DENGUE

Demam, Nausea, Gusi berdarah, flU, nyEri

Question 2

Warning signs

Answer 2

muntah terus2an, lethargy, bleeding sampe urin item, fluid accumulation, hepatomegaly, abdominal tenderness, perburukan nilai thrombocyte dan Hct

Question 3

Px fisik

Answer 3

petechiae, purpura, mucosal bleeding, torniquet test +, hepatosplenomegaly, ascites, efusi pleura

Question 4

Px penunjang

Answer 4

CBC dan electrolyte (thrombocytopenia <100.000/ μL, ↑Hct >20%, hypoalbuminemia,
hypoproteinemia, leukopenia <4000/ μL)
Late Dx: Serology setelah H-5 demam
Early Dx: Deteksi antigen NS1, RT-PCR
Chest X-Ray (deteksi efusi pleura)
Rumple-leed test

Question 5

Klasifikasi shock

Answer 5

1. Compensated -> GCS bagus, WPK memanjang, akral dingin, nadi perifer lemah, takikardi, sistol N/diastole↑, urin output turun
2. Decompensated -> GCS turun, WPK sangat lambat, akral dingin dan lembab, nadi tdk teraba, takikardi berat dengan bradikardi pada shock lanjut, hipotensi/BP tdk terukur, oligo-/anuria

Question 6

Initial tx (sama kaya emergency lainnya)

Answer 6

A
B
C

Question 7

Tatalaksana compensated (DHF III)

Answer 7

Dewasa: kristaloid 5-10mg/kgBB/jam dlm 1 jam
Anak: 10-20mg/kgBB/jam dalam 1 jam

Question 8

Setelah terapi kristaloid, lalu?

Answer 8

Cek improvement!
A&B: RR normal, tdk ada tanda2 fluid overload(sesak, batuk, tachypnea)
C: BP>120, HR normal, tdk ada tanda dehidrasi
U: 0.5mL/kgBB/jam anak, 1mL dewasa

Improve: kurangi IV perlahan.
5-7mL, 1-2 jam
3-5 mL, 2-4 jam
2-3mL, 2-4jam

anak
10 mL 1-2jam
7 mL 2jam
5mL 4 jam
3 mL

Not improving:
Cek Hct!
Hct naik: crystalloid lagi 10-20mL dlm 1 jam ->improve reduce 7-10mL -> masuk algoritma improve

Hct turun->tidak bleeding->colloid 10-20mL
Hct turun->bleeding->transfusi!

Question 9

Tatalaksana decompensated (DSS/DHV IV)

Answer 9

OK (oksigen + kristalloid)
O: 2-4L/min
K: 20mL/kg bolus 15-30menit

Question 10

Setelah initial tx decom?

Answer 10

Cek improvement!
Improve: dewasa 10mL/kg/jam 1 jam
3-5 mL 2-4jam
2-3mL 24-48jam

anak
10mL/kg/jam 1 jam
7.5 mL 2jam
5mL 4jam
3mL dalam 24-48jam

Question 11

Kriteria pulang

Answer 11

ga demam 1-2 hari, nafsu makan ok, ABCU normal, platelet >50.000