mr hipertensi
TRANSCRIPT
-
7/25/2019 MR hipertensi
1/25
MORNING REPORT
Jumat, 23 Januari 2016
Dokter jaga : dr. Rusmunandar, Sp.Jp-FIHA
2/7/16 1Management of Hypertensive urgency
Fera Mulidar1407101030186
-
7/25/2019 MR hipertensi
2/25
Jumlah pasien yang dikonsulkan dari IGD ke bagian Kardiologi
Kamis 14 Januari 2016
2/7/16 2Management of Hypertensive urgency
No Identitas Pasien Diagnosa ital sign !erapi DPJP
1
Nama " drs# $%J#Kelamin " &aki'laki(sia " )* tahun+$ " 1'0*',4'*2
+-. !D" 200/120N" )" 20
'%mlodipin tab110 mg-alsartan 1,0 mg
-P/ obser3asi
DPJP " dr#usmunandar5p#JP
2 Nama" Ny#J#Kelamin " Perempuan(sia " 60 tahun+$ " 0'60'*'1
+-. 78N-% III'Ie8 +%D 9D$ tipe 2 9%KI stage IIpre renal9-ipertensi stgI
!D " 14)/,4N" *, " 2,5P:2 " );
-&asi 2 ampul ekstraselan
-
7/25/2019 MR hipertensi
3/25
2/7/16 3Management of Hypertensive urgency
3 ama ! "n# $s%#&elamin ! la'i(la'i
)sia ! 67 ta*un+M ! 1(07(76(,0
+HF fc-H$ ...(.
ec dd !1 HH2 +$
" !100/60 ! 76
!24
-'sigen 2(4/menit
-. 5*aro 7,0 mg-Furosemide 2amp/8 %am-"anapres 1 8 mg-5imvastatin 120mg-.5 31 talet
-"riedon M 11
-P/ >+-:
DPJP " dr%?hari Gani
5pPD KK
4
ama !y# F9#&elamin !perempuan
)sia ! 28 ta*un+M ! 1(07(76(,7
+HF fc-H$ . ecdd/ 1# HH
2# +$:os#ferisec dd/1# emamtipoid2# Malaria
3# .5&
" ! 104/62! 140 !32
-'sigen 4(6l/menit-rip furosemide 2
cc/%am-igo'sin 2 0;,mg-$spilet 180 mg-+
-
7/25/2019 MR hipertensi
4/25
&$5)5
Pasien bernama Ny# 5 usia 4* tahun datang dengan keluhan nyeri kepala kepala yangdirasakan se
-
7/25/2019 MR hipertensi
5/25
-
7/25/2019 MR hipertensi
6/25
-
7/25/2019 MR hipertensi
7/25
!horaks "Inspeksi " simetris saat statis dan dinamis
Palpasi " stem 7remitus kananFkiri
Perkusi " sonor dikedua lapang paru
%uskultasi " esikuler A9/9B rhonki A'/'B @hee?ing A'/'B
2/7/16 7Management of Hypertensive urgency
-
7/25/2019 MR hipertensi
8/25
JantungInspeksi " I8tus 8ordis tidak terlihat
Palpasi " i8tus 8ordis teraba di I+5 mid8la3i8ularis sinistra
Perkusi "
Catas atas " I+5 III mid8la3i8ularis sinistra
Catas kanan " I+5 parasternal dekstra
Catas kiri " I+5 mid8la3i8ularis sinistra 1
-
7/25/2019 MR hipertensi
9/25
%bdomen
Inspeksi " simetris distensi A'B
Palpasi " organomegali A'B G/-/& tidak membesar
Perkusi " timpanishifting dullnessA'B undulasi A'B
%uskultasi" Peristaltik A4 dalam 1 menitB
>kstremitas"
>kstremitas superior " sianosisA'/'B edemaA'/'B pu8atA'/'B akral dingin A'/'B +! H2
>kstremitas in7erior " sianosisA'/'B edemaA'/'B pu8atA'/'B akral dingin A'/'B +! H2
2/7/16 BManagement of Hypertensive urgency
-
7/25/2019 MR hipertensi
10/25
-
7/25/2019 MR hipertensi
11/25
A&=
2/7/16 11Management of Hypertensive urgency
.rama sinus; ritme reguler dengan H 67/menit; a'sisnormal; < @ave normal; H ?(; H ?(; 5" elevasi ?(; 5"depresi ?(;
-
7/25/2019 MR hipertensi
12/25
.A".F.&$5. M$5$$H1# $pa'a* diagnosa pada 'asus diatas 2# Iagaimana patogenesis penya'it pada pasien
terseut3# $pa pemeri'saan penun%ang yang diutu*'an
untu' memantu menega'an diagnosa diatas4# Iagaimana tatala'sana 'asus diatas
2/7/16 12Management of Hypertensive urgency
-
7/25/2019 MR hipertensi
13/25
$$.5$ M$5$$H1#
-
7/25/2019 MR hipertensi
14/25
.$=5$
2/7/16 14Management of Hypertensive urgency
HIPERTENSI R!ENSI
-
7/25/2019 MR hipertensi
15/25
-
7/25/2019 MR hipertensi
16/25
-
7/25/2019 MR hipertensi
17/25
"$"$$&5$$ &.5.5H.
-
7/25/2019 MR hipertensi
18/25
%lgorithm 7or !reatment o7 -ypertension
Not at !oa" #"ood Pressure $%&'()*( mmHg+
$%&()( mmHg or t/ose 01t/ d1a2etes or 3/ron13 k1dne4 d1sease+
In1t1a" Drug 5/o13es
Drug$s+ or t/e 3ompe""1ng
1nd13at1ons
:ther antihypertensi3e drugs
Adiureti8s %+>I %C CC ++CB
as needed#
61t/ 5ompe""1ng
Ind13at1ons
71est4"e 8od113at1ons
Stage 9 H4pertens1on
A5CP 160 or DCP 100 mm-gB
2'drug 8ombination 7or most Ausually
thia?ide'type diureti8 and
%+>I or %C or CC or ++CB
Stage & H4pertens1on
A5CP 1401) or DCP 0 mm-gB
!hia?ide'type diureti8s 7or most#
$ay 8onsider %+>I %C CC ++C
or 8ombination#
61t/out 5ompe""1ng
Ind13at1ons
Not at !oa"
#"ood Pressure
:ptimi?e dosages or add additional drugs
until goal blood pressure is a8hie3ed#
+onsider 8onsultation @ith hypertension spe8ialist#
P 12" 5 21 t1 D1 5" A t1/ t 1 A t
-
7/25/2019 MR hipertensi
19/25
Calcium
antagonists
Calcium
antagonists
AT1-receptors
blockers
AT1-receptors
blockers-blockers-blockers
-blockers-blockers
DiureticsDiuretics
ACE inhibitorsACE inhibitorsThe most rational combinationsThe most rational combinations
Classes of antihypertensive
agents proven to be beneficial
in controlled interventional trial
Classes of antihypertensive
agents proven to be beneficial
in controlled interventional trial
Poss12"e 5om21nat1on o D1eren3e 5"asses o Ant1/4pertens1e Agents
9(( European So31et4 o H4pertens1on-European So31et4 o 5ard1o"og4
!u1de"1nes or management o arter1a" /4pertens1on
-
7/25/2019 MR hipertensi
20/25
"$"$$&5$$
2/7/16 20Management of Hypertensive urgency
-
7/25/2019 MR hipertensi
21/25
A$.= I9A+".A
1# $pa'a* peredaan*ipertensi urgensi denganemergensi
2# $pa sa%a oat yangdiguna'an pada *ipertensidisertai dengan 'eadaan'*usus
2/7/16 21Management of Hypertensive urgency
-
7/25/2019 MR hipertensi
22/25
H$5. IA$9$ M$..
1# Hipertensi urgensi
-
7/25/2019 MR hipertensi
23/25
Mana%emen 'risis*ipertensi
2/7/16 23Management of Hypertensive urgency
-
7/25/2019 MR hipertensi
24/25
5."A5.5
-
7/25/2019 MR hipertensi
25/25
TERI8A;ASIH
2/7/16 2,Management of Hypertensive urgency