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Cc: Swelling in chest increased since 3 months ago

Present Illness History: Swelling in chest increased since 3 months ago,size of eggs chicken, swelling was felt since 1 year ago,initially at nut, pain (+) Swelling in the face since 3 months ago, arise suddenly,pain(-) Breathlesness since 3 months ago, breathlesness increased if lie down and decreased if take a seat Fever since 1week ago,not continuely,no sweat,no tremble, now no fever, fever was felt 3 months ago Cough since 1 week ago,mucous (+),no bloody, cough was felt since 2 months ago Decrease of body weight since 1weeks Apetite normal History of smoking since 27 years ago, 3 wrap /day History of get cancer drug (-) Vomit (-) 1 Year ago the patiens has been treatment in pulmonology department for 3 weeks

Mixturation and defecation usuall The patients sister suffer thyroid cancer and had been operation 1997

Physical examination: GA: Moderate Consc: cmc BP: 120/70 mmHg Pulse: 80x/min RR: 20x/min T: 36,5 C

Eye: Conjunctiva anemis (-), Yellow greenish icteric (+) Neck :Venectasi (+) JVP 5-2 cm H2O Chest: Swelling size eggs chicken (7x5x1)cm,consistance hard,surface flate,immobile,pain(+),pulsasion (-) Heart:normal Lung: Vesicular, Rhales (-)/(-) Abdomen

Extrmities : RF (+)/(+) Normal,RP (-)/(-) Normal Edema (-)/(-)

Liver and splen unpalpable

Lab: Hb: 10,9 gr% Leuco: 18.400/mm3 Ht: 35 % Trombo: 147.000/mm3 Na/K/Cl/Ca: 122/3,3/102 mmol/L Albumin : 2,3 Total Bilirubin : 17,81 Biliirubin direk : 16 Bilirubin Indirect : 1,81 SGOT : 235 SGPT : 98 PT :26,2 APTT :75,3

WD:
Tumors of Mediastinum DD/ Bronchogenic Cancer Lymphoma Malignum

Therapy
Rest/ Daily Diet Ambroxol Syr 3x CI Tramadol 3x 1

Planning - Ro thorak - Citology sputum - CT scan thorak - TTNA

Critical Ill: Insulin 50 units dripped in 50 cc NaCl 0.9% with syringe pump started from 1.5cc/h Check RBG/h If RBG < 80: 0.5cc/h + D 40% 1 flacc RBG 80-110: 1cc/h RBG 110-160: 1.5cc/h RBG 160-220: 2cc/h RBG > 220: 2.5cc/h + insulin bolus 8u IV

Check K/6h If K < 3.5: KCl correction 40 meq K 3.5-4.5: 20 meq K 4.5-5.5: 10 meq K > 5.5: -

Ambroxol syr 3xcth2 PCT 3x500mg Amlodipine 1x5mg Candesartan 1x8mg Folic acid 1x5mg Bicnat 3x500mg

Cc: black stool since 1 week ago Present illness history:


Black stool since 1 week ago Fever since 1 week ago Cough since 1 week ago Decrease of body weight 5kg this month Liver disease history since 2 yrs ago, gastroscopy +

Physical examination: GA: moderate Consc: CMC BP: 110/60 mmHg Pulse: 96x/min RR: 23x/min T: 37.7 C

Eye; anemic conj +/+, icteric sclera -/Heart: cardiomegali -, murmur Lung: bronchovesiculer, rales +/+, wh -/Stomach: distension +, liver and spleen were hard to measure, shifting dullness + Extr: edema +/+, erythema of palmar +/+, flapping tremor -

Lab: Hb: 6.3 gr% Leuco: 5000/mm3 Ht: 19 % Trombo: /mm3 PT:16.2 APTT: 44.2 D-Dimer: 1.5 Alb/glob: 2.4/2.1 SGOT/SGPT: 21/21 Bil I/II: 0.87/0.91 HBsAg -

WD: Melena cb ruptur of esophageal varises cb SH post necrotic decompensated stage HAP Hyponatremia and hypokalemia cb low intake Severe anemia normocitic normochrom cb acute bleeding Susp malaria

Thy: Rest/flowing NGT fasting max 3 days hepar diet I IVFD Aminofusin:triofusin:NaCl 0.9% 1:2:1 8 h/kolf Stilamin 1 amp dripped in 50 cc NaCl 0.9%, bolus 4cc then continue drip with syringe pump 4.1cc/h IVFD NaCl 3% 12h/kolf Ceftriaxone vial 1x2gr Transamin amp 3x1 Vit K amp 3x1 Curcuma 3x1 Sistenol 3x1 KSR 1x1 Ambroxol syr 3xcth2 Cross match PRC tranfusion until Hb > 8gr% Klisma twice a day

Cc: pro 4th chemotherapy indicated by non Hodgkin limfoma malignant oculi dextra Present Illness History: Pro 4th chemotherapy indicated by non hodgkin limfoma malignant oculi dextra Fever Cough Decrease of appetite -

Physical Examination: GA: moderate Consc: CMC BP: 120/70 mmHg Pulse: 88x/min RR: 20x/min T: 36.7 C

Eye: anemic conj -/-, icteric sclera /Pulmo: vesiculer, rh -/-, wh -/Cor: cardiomegali -, murmur Abd: liver and spleen were unpalpable Extr: edema -/-

Lab: Hb: 11.5 gr% Leuco: 3700/mm3 Ht: 31 % Trombo: 5000/mm3 Na/K/Cl: 135/4.3/107 mg% RBG: 106 mg% Ur/Creat: 17/1 mg%

WD: Pro 4th chemotherapy indicated by non hodgkin limfoma malignant oculi dextra

Therapy: Rest/soft diet high calories high protein IVFD NaCl 0.9% 8h/kolf PCT 500mg 3x1 NTR 2x1

Cc: diarrhea since 5 days ago Present illness history: Diarrhea since 5 days ago Abdominal pain since 5 days ago Thirst (+), weak (+) Decrease of appetite since 5 days ago Nausea +

Physical Examination: Vital sign : GA : moderate; blood pressure 110/70; pulse 90x; T: 36.7 ; RR : 22x Eyes :anemic conj -/-, icteric sclera -/Lung: vesiculer, rales -/-, wh -/Heart: cardiomegali -, murmur Stomach: liver and spleen were unpalpable Daldiyono score: 1

Lab: Hb: 16.7 gr% Leuco: 8400/mm3 Trombo: 251000/mm3 Ht: 48% Na/K/Cl: 138/3.9/105 mmol/L RBG: 88 mg% Ur/creat: 24/1.1 mg%

WD: Acute gastroenteritis colliform type without dehydration

Thy: Rest/soft diet low fiber IVFD NaCl 0.9% 8h/kolf PCT when needed NTR 2x1 Oralit when needed

Cc: fever since 2 weeks ago Present Illness History: Fever since 2 weeks ago Headache since 2 weeks ago Nausea since 2 weeks ago Fatigue since 2 weeks ago

Physical examination: GA: moderate Consc: CMC BP: 130/70 Pulse: 110x RR: 22x T: 38 C

Eye: anemic conj -/-, icteric sclera -/Lung: vesiculer, rh -/-, wh -/Heart: cardiomegali -, murmur Stomach: liver and spleen were unpalpable Extr: edema -/-

Lab: Hb: 12.4 gr% Ht: 39% Leuco: 10700/mm3 Trombo: 178000/mm3 Na/K/Cl: 129/3.2/95 mmol/L RBG: 115mg% Ur/creat: 20/1 mg% S. tyhphii H: 1/80 S. thyphii O: 1/80

Wd: Susp Malaria

Thy: Rest/daily diet IVFD RL 6h/kolf PCT 3x500mg NTR 2x1 Domperidone 10mg 3x1

Cc: increase of breathlessness since 2 days ago Present illness history: Increase of breathlessness since 2 days ago Cough since 3 months ago Mixturation frequence decreased since 3 months ago Diabetic history since 15 yrs ago

Physical examination: Consc: CMC GA: moderate BP: 160/100 Pulse: 82x RR: 24x T: 36.2 C

Eye: anemic conjunct +/+ Lung: bronchovesiculer, rales +/+ Ext: edema +/+

Lab: Hb: 9.8 gr% Ht: 30% Leuco: 14.300/mm3 Trombo: 395000/mm3 Ur/creat: 175/10.1 mg%

BGA pH: 7.25 pO2: 38 pCO2: 23 HCO3-: 9.9 SO2: 61 BEecf: -17.5

WD/ Stage V CKD cb nephropathy DM with metabolic acidosis BP duplex (CAP) with type I respiratory failure Type II DM controlled by diet normoweight + necrotic digiti I pedis dextra Pulmonary TB Bilateral pleural effusion cb specific DD/ cb hypoalbuminemia

Thy: Rest/soft diet DD 1700 kkal low salt II low protein 40 gr/NRM 10 L/1 IVFD Easpfrimmer 500 cc/24h Lasix amp 1x1 Ceftriaxone vial 1x2gr Folic acid 1x5mg Amlodipine 5mg 1x1 Candesartan 8mg 1x1 Ambroxol syr 3xcth2 Cross match PRC tranfusion post lasix until Hb > 10gr% Meylon correction 150 mg in 150 cc naCl 0.9% fast drip

Cc; epigastric pain since 1 week ago Present illness history: Epigastric pain since 1 week ago Cough since 1 week ago Fever since 3 days ago Hypertension history since 1 month ago

Physical examination Consc: CMC GA: moderate BP: 160/80 pulse; 80x RR: 21x T: 36.8 Lung: bronchovesiculer, rales +/+

Lab: Hb: 10.2 Leuco: 13600

WD/ Gastropathy NSAID DD/ gastric ulcer CAP Geriatric Stage II Hypertension cb essensial

Thy: Rest/low salt II gastric diet II/O2 5 L/1 IVFD D5% 8h/kolf Ceftriaxone vial 1x2gr Azythromicine 1x500mg Ozid amp 1x1 Sucralfat syr 3xcth2 Ambroxol syr 3xcth2 Amlodipine 1x5mg Candesartan 1x8mg