- The patient is a 7 year old child admitted to the PICU with fever, paleness, occasional coughing but no vomiting, diarrhea, or oxygen desaturation. - Laboratory tests showed anemia and elevated troponin levels. An echocardiogram found a small to moderate muscular VSD and small ASD/PFO with left-to-right shunting. - The patient is being treated with antibiotics, steroids, and blood thinners. Diuretics and an ACE inhibitor were added based on the echocardiogram results. Follow up in 3 months is recommended.

1. PICU Kiara 7 Agustus 2022
• Pasien masih ada demam subfebris 37.6 1 kali,
tampak pucat, tidak ada muntah/ diare, tidak ada
desaturase, balans masih positif tanpa klinis
overload. Batuk sesekali. Tidak ada kliniss
perdarahan.
• Oksigen 1 lpm, tidak ada retraksi/NCH, SpO2 100%
• Balans/24 jam: +32,5 ml
• Diuresis/24 jam: 3,4 ml/kg/jam
• Ceftriaxone E2, Remdesivir D2, Dexa H2, Lovenox H2
• Pindah ke bangsal Kiara lt 9 sore hari
Lab 7/8/22
• GDS: 87mg/dl
• GDT: Anemia normositik
normokrom,anisositosis
• Hemoglobin 8.2
• Hematokrit 23.2
• Eritrosit 2.40
• MCV/VER 96.7
• MCH/HER 34.2
• MCHC/KHER 35.3
• Trombosit 384.000
• Leukosit 7.650
• Ureum/Creatinin: 19.3/ 0.30
• SI: 80/ TIBC 188/ Sat Transferi 43
• PCT: 0.11
• CRP: 0.9
• Troponin I: 48.4

2. Bangsal Kiara 8 Agustus 2022
• Peningkatan usaha napas ketika minum dilambatkan tidak ada
• Remdesivir ⅗, Ceftriaxone E4, Dexametason 3
• BD/24: negatif 85.5 (2.5%); D/24: 4.05 ml/jam
• Pasien direncanakan naik minum bertahap dan weaning oksigen

3. Bangsal Kiara 9 Agustus 2022
• Peningkatan usaha napas ketika
minum dilambatkan masih ada
• Remdesivir 4/5, Ceftriaxone E5,
Dexametason 4, Lovenox 4
• BD/24: negatif 85.5 (2.5%);
D/24: 4.05 ml/jam
• Ronde dr. Rubi:
 Furosemid 2x3 mg
 Captopril 2x1,5 mg
 Echo ulang 3 bulan
Lab 9/8/22
• Hb 10,8
• Ht 30,2
• Leukosit 6280
• Trombosit 302000
• HJ 0,2/0,6/36,5/55,7/7
• Fibrinogen 137,9
• D-dimer 640

4. Echo 9/8/22
• mild tachypnoeic
• mild chest recession
• lung: rales minimal
• CVS; s1 normal s2 normal, ESM 3/6,LSB ICS 4
• echo:
• Dilated left atrium and left ventricle
• all pulmonary veins drain to left atrium
• mild TR
• mild MR due to dilated MV annulus
• mild hypertrophy of anterior RV wall
• small 2nd ASD/stretch PFO, L-R shunt
• small to ?moderate muscular VSD (poor echo window due to
imappropriate probe), L-R shunt
• mildly dilated pulmonary artery
• no PDA
• good biventricular function
• no pericardial effusion
• unable to assess coronary artery (no appropriate probe)
Kesan :
• small to ? moderate muscular VSD
• small 2nd ASD/stretch PFO
• hemodynamic compromised
• Saran:
• Frusemide 2 x 3 mg
• Captopril 2 x 1.5 mg
• Fu echo and clinical symptoms in 3
months

5. TERIMA KASIH