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All Journal Jurnal Keperawatan dan Fisioterapi (JKF) JURNAL PENELITIAN KEPERAWATAN MEDIK
Agus Sumedi
Universitas Islam Sumatera Utara
Nursing Other

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Peranan Plasmafaresis pada Keracunan Bisa Ular Tipe Neurotoksik Agus Sumedi
Jurnal Penelitian Keperawatan Medik Vol 1 No 1 (2018): Jurnal Penelitian Keperawatan Medik
Publisher : Fakultas Keperawatan Institut Kesehatan Deli Husada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36656/jpkm.v1i1.17

Abstract

Female 19-year old with severe general neuroparalytic, admitted in intensive care unit with respiratory failure. He suffer from snake bite during night sleeping 2 hours before arrived in emergency unit of RSCM hospital. In early after snake bite, patient complained nausea, dizziness, limb parasthesia then felt uncomfortable eyesight. During observation in emergency unit anti venom serum (AVS) was given immediately 2 vial (10 ml) in 250 ml normal saline for an hour and then 2 vials in 250 normal saline in 3 hours ,but about 3 hours post bitten, patient suffer from ptosis, opthalmoplegia and quadriplegia, respiratory shortness followed by respiratory arrest. We diagnosed it as respiratory failure and neuromotoric paralytic ec. snake venom intoxication. After intubation and second dose AVS, patient moved to ICU for mechanical ventilation support and further treatment. We did CVVHDF for three days, AVS shcedulles 6 vials in 24 hours for 6 days. Until 7 days stay in ICU there were neuroparalytic improvement but not progressively and patient still on ventilator. Pasmapharesis then performed at 8thand 12th day in ICU. Weaning process going on smoothly and patient extubated at 14th day. Patient discharged from ICU at 16th day with fully aware, normal heart rate and blood pressureand score muscle strength is 4 until 5. We concluded that the neurotoxin venom in this case destructed vesicles presynaptic of nerve terminalmake resistant to AVS and neostigmin. We suspect this patient was exposedto high dose and more toxic venom where released continuously from bite site tissue or lymph circulation to blood and threaten recovery process. Plasmapharesis improve neuroparalytic and sympathetic overactivity significantlyand decrease lenght of stay in ICU.
PENATALAKSANAAN SEPSIS AKI PADA PASIEN MULTIPLE MYELOMA DENGAN HIPERKALSEMIA BERAT Agus Sumedi
JURNAL KEPERAWATAN DAN FISIOTERAPI (JKF) Vol 1 No 1 (2018): Jurnal Keperawatan & Fisioterapi (JKF)
Publisher : Fakultas Keperawatan dan Fisioterapi Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (307.474 KB) | DOI: 10.35451/jkf.v1i1.45

Abstract

This case report talking about a female 56 yo with Multiple Myeloma (MM) suffer from Pneumonia and Acute Kidney Injury (AKI). MM is haematology cancer produce free light chain that impair renal tubulus, cause anemia, bone lesion and hypercalcemia. This patient came to hospital withsevere pneumonia, acute kidney injury andsevere hypercalcemia. In intensive care unit supported by mechanical ventilation, diuretic, antibiotics administration,haemodialysis,vasoactive agents, bisphosphonat and others.The acitenobacter baumanni was identified from sputum culture and then developed become multidrugs resistant leading to septic syock and multi organs dysfunction and death in two weeks.
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