MTBS koass
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soal
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Soal 1
• Sorang anak perempuan 18 bulan dibawa ibunya berobat ke dokter karena batuk
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• Informasi apa lagi yang diperlukan untuk membuat diagnosis pada pasien ini?
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Jawab: 1. cari tanda bahaya umum
Tanyakan: • Apakah anak bisa makan/minum/menyusu ?• Apakah anak selalu memuntahkan apa yang
dimakan/diminum?• Apakah anak kejang?
Lihat:• Kesadaran: letargi/tidak sadar?
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Jawab 2. keluhan utama: batuk/sukar bernapas
• Tanya: berapa lama batuk & sesak?
• Lihat: - Hitung frekuensi napas dalam 1 menit - Adakah tarikan dinding dada?
• Dengar: adakah Stridor?
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klasifikasikan
Bila ada:• Tanda bahaya umum (+) atau tarikan dinding dada/
stridor: penyakit sangat berat/ PNEUMONIA BERAT• Tindakan: beri antibiotik injeksi dosis pertama, rujuk
Antibiotik lini pertama:• Injeksi Ampisilin: dosis 50 mg/kgBB (IM)• Injeksi Gentamisin: dosis 7,5 mg/kgBB (IM)
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• Bila ada napas cepat tetapi tidak ada tanda bahaya umum atau tidak ada tarikan dinding dada atau stridor: PNEUMONIA
TERAPI:• Cotrimoksasole/ • Amoksisilin • Suportif: banyak minum, pelega tenggorokan
(jeruk nipis kecap)• Kunjungan ulang 2 hari lagi• Bila batuk > 3 minggu rujuk ke RS
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• Bila tidak ada tanda bahaya umum atau tarikan dinding dada atau stridor:
BUKAN PNEUMONIA
• Terapi: pelega tenggorokan• Kunjungan ulang 5 hari lagi• Bila batuk > 3 minggu rujuk
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• Seorang anak laki-laki 4 tahun, dari kota Jogjakarta dibawa ibunya berobat ke Poliklinik karena demam tinggi sudah 4 hari
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MTBS untuk anak 2 bulan – 5 tahun
• Pertanyaan atau kondisi apa yang harus dicari/dilihat?
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tanyakan
Tanda bahaya umum• Apakah anak tinggal didaerah malaria? Endemis
tinggi/rendah? Dalam 2 minggu ini dari daerah malaria?
• Berapa lama demam?• Dalam 2 minggu ini apakah diterapi dengan obat anti
malaria?• Apakah anak menderita campak dalam 3 bulan
terakhir?
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Lihat/raba
• Tanda bahaya umum: kejang/ letargi/ kesadaran ?
• Kaku Kuduk?• Pilek?• Tanda campak?
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Apakah infeksi dengue?
• Tanya demam: tinggi? Terus menerus? Tetangga demam?• Nyeri ulu hati? Pembesaran hati?• Rumpel Leede? Ptekie?• BAB hitam?• Ascite? Efusi pleura?
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• Probable Dengue? • Fase apa? • Bagaimana terapinya?
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Dengue case classification by severity
Withoutwith
warning signs1.Severe plasma leakage 2.Severe haemorrhage3.Severe organ impairment
Severe dengueDengue ± warning signs
Probable dengue
Live in/travel to dengue endemic area. Fever and 2 of the following criteria:• Nausea, vomiting• Rash• Aches and pains• Tourniquet test positive• Leucopenia• Any warning signLaboratory confirmed dengue(important when no sign of plasma leakage)
Warning signs*• Abdominal pain or tenderness• Persistent vomiting• Clinical fluid accumulation• Mucosal bleed• Lethargy; restlessness• Liver enlargement >2cm• Laboratory: Increase in HCT concurrent with rapid decrease in platelet count
* Requiring strict observation and medical intervention
1. Severe plasma leakage leading to:• Shock (DSS)• Fluid accumulation with
respiratory distress
2. Severe bleeding as evaluated by clinician
3. Severe organ involvement• Liver: AST or ALT>=1000 • CNS: Impaired consciousness • Heart and other organs
Criteria for dengue ± warning signs Criteria for severe dengue
WH
O/T
DR
2009
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1 2 3 4 5 6 7 8 9 10
40
Viraemia
Course of dengue illness: Febrile Critical Recovery Phases
Shock Bleeding
ReabsorptionFluid overloadDehydration
Organ Impairment
Days of illness
Temperature
Potential clinical issues
Laboratory changes
Serology and virology
Platelet
Hematocrit
IgM/IgG
Adapted from WCL Yip, 1980 by Hung NT, Lum LCS, Tan LH
WHO 2009
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Terima kasih
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