No Masalah Rencana Diagnosis Rencana Terapi Monitoring

Opasitas • Analisis dan Rencana Awal

Jika adenocarcinoma cek EGFR, ALK dan PD-L1
homogenhemithorax mutasi
dextra, asses: • Jika adenocarcinoma EGFR mutasi (+) -> TKI
• Jika adenocarcinoma EGFR mutation (-):
a. Tumor paru dextra • Tumor marker Jika ALK (+) -> Crizotinib, Alectinib • Vs, Cs
- Adenocarsinom (CEA, cyfra 21-1, Jika ALK (-), PD-L1 > 50% -> • Efek samping
a NSE) Immunotherapy or Chemotherapy platinum based + kemoterapi
- Squamous Ca • CT scan thorax Immunotherapy (opt.)
- Small cell kontras • Jika ALK (-), PD-L1 1-49% -> Chemotherapy
carcinoma • Bronkoskopi platinum based + Immunotherapy (optional)
• Core biopsi USG • Jika ALK (-), PD-L1 < 1 -> Chemotherapy platinum
guiding/ CT-guiding based
• Jika Squamous cell carcinoma -> cek ALK
Jika ALK (+) -> Crizotinib, Alectinib
Jika ALK (-) -> platinum-based chemotherapy
• Jika Small cell carcinoma -> platinum-based
chemotherapy
b. Tumor • Tumor marker
Mediastinum (LDH, B-HCG,
- Tymoma AFP) • Radioterapi, Reseksi tumor and kemoterapi • Vs, Cs
- Malignant • FNAB CT Guiding • kemoterapi • Efek samping
- lymphoma • Bronkoskopi • Reseksi tumor and kemoterapi kemoterapi
Germ cell
tumor
No Masalah Rencana Diagnosis Rencana Terapi Monitoring

Analisis dan Rencana Awal

Limfadenopati • USG Colli Tergantung hasil PA Vs, Cs
colli dextra • FNAB USG
guiding/CT-
guiding
Infeksi
No Problems Diagnosis Plan Therapy Plan Monitoring

CAP PSI score 142 Smear sputum Analysis

Moxifloxacin 400 mgand Initial
IV every Planning Vs, Cs, CBC, CXR
24 hours
class V gram 3 days after
D/S culture sputum antibiotic
administration

Sepsis MODS Lactate serum IVFD Asering 1500 ml/3 hours Vs, Cs
Blood culture D/S Fluid Maintenance according to no.5
Antibiotics according to no.3

Sepsis sofa score 2 - K/s sputum aerob • Antibiotik sesuai nomor • Vs/Cs
- K/s darah aerob • CBC dan PCT
- Laktat 3 hari post AB
Gejala
No Problems Diagnosis Plan Therapy Plan Monitoring

Retensi CO2 - Analysis and Initial Planning

Vs, Cs
Nebulisasi Salbutamol 2,5 mg/8 jam
Pursed lip breathing BGA evaluasi
Bagging wash out
Chest physiotherapy
Cardiomegaly pro Echocardiography Consultation to cardiologic Vs,Cs
evaluation departemen
susp CPCD

Hyperkalemia - Inj. Ca Gluconas 1 amp IV continue with 1 Vs, CS, SE evaluation

flacon D40% (25 ml) + Rapid insulin 2 IU IV
every 30 minutes (4 times)

Azotemia assess AKI dd Abdominal USG, Urynalisis Fluid Balance I=O+500 ml VS, CS, Urine output, RFT
ACKD Rehydration with PZ 0.9% 1000cc in 2 evaluation
hours, target urine production
0.5-1cc/kgBW/hour
Maintenance PZ 0.9% 1500cc/24 hours
Consult to Internal Dept:
Avoid nephrotoxic drugs
No Problems Diagnosis Plan Therapy Plan Monitoring

Respiratory failure type 2 - Analysis and Initial Planning Vs,

● Consultation to anesthesiology dept for Mechanical
ventilation
CS, BGA
evaluation
● NRM 8 lpm target SpO2 88-92%
● bagging washout / 4 hours
● Nebulization salbutamol 2.5 mg every 6 hours

Acute Lung Oedema - Furosemide bolus 40 mg IV Vs, Cs, Fluid balance

assess nephrogenic ALO Furosemide pump 5 mg/hours IV
Consult to internal med dept

CO2 retention - Ipratoprium bromide 500mcg/ salbutamol 2.5mg repeated Vs, Cs

every 8 hours BGA evaluation
Pursed lip breathing
Chest physiotherapy
No Masalah Rencana Diagnosis Rencana Terapi Monitoring

Analisis dan Rencana Awal

Hemoptisis grade • Bronkoskopi Miring ke posisi yang sakit (dextra) Vs, CS
I (Purcell criteria) Bronkoskopi Tanda sufokasi

Disfonia • Konsul THT Tergantung hasil Laringoskopi Vs, Cs

• Laringoskopi Tanda sumbatan
saluran napas atas

Decrease of According to no.2 Clear the airway Vs, Cs

consciousness O2 NC 4 lpm target SpO2 >94%
Other treatment according to no.2

Hypoalbuminemia - HCHP diet 2100 kcal/day + extra egg whites Vs,Cs, Albumin
VIP Albumin 1 capsule/ 8 hours Evaluation

Hyperbilirubinemia USG abdomen UDCA 1 tab / 8 hour po Vs, Cs, Bilirubin

Avoid hepatotoxic drug Evaluation
Hypokalemia - KSR 600 mg/8 hours pol Vs, Cs, Se Evaluation

Acute Promyelocytic - LDH Konsul TS IPD pro Kemoterapi jika Vs, Cs

Leukemia - Asam urat KU stabil ESO Kemoterapi
Tanda2 leukostasis

Anemia HDT, Si, TIBC, Ferritin Konsul TS IPD Vs, Cs

normokromik Transfusi PRC 1 kolf/24 jam s/d Hb DL post transfusi
normositik 10
Manajemen penyakit dasar
Trombositopenia HDT Konsul TS IPD Vs, Cs
IPF Transfusi TC jika PLT <10.000 Tanda2 perdarahan
Manajemen penyakit dasar

Transaminitis assess Abdominal USG Consult to Internal Dept: Vs, CS

- Impending Acute Anti HCV IVFD Comafusin hepar:D10 (1:1)/24 hours LFT evaluation
liver failure UDCA 3x250 mg
- DIH

Prolonged FH INR Consult to Internal Dept: Vs, Cs

Inj. Vitamin K 1 amp/8 hours Spontaneous and
internal bleeding signs
FH evaluation
No Problems Diagnosis Plan Therapy Plan Monitoring

Analysis and Initial Planning

Stable COPD group A Spirometry pre and post • Salbutamol 2,5 mcg/8 hours - Vs, Cs
bronchodilator after aff nebulization
chest tube and in stable • Chest physiotherapy
condition and the patient
pain free
TB
No Problems Diagnosis Plan Therapy Plan Monitoring

. Lung TB MDR case loss to follow 2nd line LPA and DST culture If Eligible for STR: VS, CS
up Analysis and Initial Planning
If eligible BPaLM, give BPaLM: 6 Bdq-Pa-Lzd-M AFB smear, Sputum culture
every month
If eligible, but resisten fluoroquinolone, BPaL: 6
Bdq-Pa-Lzd ATD side effect
If not eligible BPaLM but eligible for STR, give
STR: 4-6 Bdq-Lfx-Cfz-HDT-Z-E-Eto / 5 Lfx-Cfz-
Z-E
If not eligible, individual regimen: 3 drugs Group A
(Bdq – Lfx – Lnz) + 2 drugs Group B (Cfz – Cs) +
add on Group C (E)
TB Paru kasus baru TCM MTb sputum Berdasarkan hasil GeneXpert MTb sputum: Vs, CS
Kultur MTb Jika GeneXpert MTB (+) Rifampicin sensitive: OAT ESO OAT
lini 1 BB 60 kg (R600 H300 Z1500 dan E1000 tiap 24 BTA evaluasi akhir fase intensif
jam )
Jika GeneXpert MTB (+), Rifampicin resisten : cek
LPA lini 2
Jika eligible BPaLM, berikan BPaLM: 6 Bdq-Pa-Lzd-
M
Jika eligible, tapi resisten fluoroquinolone, BPaL: 6
Bdq-Pa-Lzd
Jika tidak eligible BPaLM namun eligible STR,
berikan STR: 4-6 Bdq-Lfx-Cfz-HDT-Z-E-Eto / 5 Lfx-
Cfz-Z-E
Jika tidak eligible, individual regimen: 3 drugs
Group A (Bdq – Lfx – Lnz) + 2 drugs Group B (Cfz –
Cs) + add on Group C (E)
Jika GeneXpert MTB (-) : OAT dapat diberikan
sesuai kriteria klinis
No Problems Diagnosis Plan Therapy Plan Monitoring

Meningoencephalitis VS, Cs
1. ME TB Geneexpert CSF Analysis and Initial Planning
ATD according to no.6 Seizure, sign of increase
2. ME bacterial culture CSF Consult to Neurology Dept: ICP
3. Hepatic Inj. Dexamethasone 5 mg/6 hours (tappering
down every 7 days)
Enchepalopathy Inj Mecobalamin 2x1 amp iv
Inj Fursultiamin 2x1 amp iv
Mycobacterium Other Than Culture D/S MOTT According to BW (35 kgs): Vs, Cs, AFBand culture
Tuberculosis Rifampicin 450 mg daily evaluation
Isoniasid 200 mg daily
Etambutol 500 mg daily
Azithromycin 250 mg
Post tuberculosis obstructive Spirometry after aff chest According to no.3 Vs, Cs
syndrome tube and in stable condition
Kelainan pleura
No Problems Diagnosis Plan Therapy Plan Monitoring

Minimal Left Pleural USG Thorax Analysis and Initial- Vs,Planning

Observation pleural effusion Cs
Effusion Pleural fluid analysis volume - CXR evaluation

Left fluidopneumothorax - Pleural fluid analysis - Chest tube insertion - Vs, Cs

on chest tube D-0 - Continuous suction -20 cmH2O - CXR evaluation
- Chest physiotherapy
- Lactulosa syr 15 ml/8 hours

Hemorrhagic right VATS Pleural fluid evacuation USG guiding VS, Cs

pleural effusion CXR evaluation

efusi pleura bilateral analisis cairan pleura Evakuasi cairan pleura jika Vs, Cs
minimal jika ada sampel evaluasi klinis dan radiologis CXR evaluasi
memberat
Gangguan hepar
No Problems Diagnosis Plan Therapy Plan Monitoring

Hepatocellular Consult to Internal Analysis and InitialVs,Planning

Consult to Internal Department
Cs
Carcinoma Medicine Dept Curcuma 3x1 tab
Avoid hepatotoxic drug
Hepatitis B reactive - Consult to Internal Department Vs, Cs
Entecavir 0,5 mg

hiperbilirubinemia USG abdomen, HbsAg, UDCA 3x1 kapsul Vs, Cs

anti HCV Konsul TS IPD LFT evaluasi