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RESPIRATION (R)
Determine spontaneous breathing pattern
[R4] Not intubated, regular breathing pattern; in a nonintubated patient and grade simply as regular R4.
[R3] Not intubated, Cheyne-Stokes breathing pattern; Cheyne-Stokes R3 breathing.
[R2] Not intubated, irregular breathing pattern; irregular R2.
APGAR Score
0 1 2
Appearance Pucat Badan merah, ekstremitas Seluruh tubuh kemerahan
(warna kulit) biru
Pulse rate - < 100 x/i > 100 x/i
* Tanda kunci
Derajat dehidrasi : min. 2 tanda + 1 tanda kunci (dibaca dr kanan ke kiri).
Down Score
0 1 2
Frekwensi nafas < 60 x/i 60-80 x/i > 80 x/i <4: Distres nafas ringan
O2 nasal kanul
Retraksi (-) Ringan Berat
Sianosis (-) Hilang dengan Menetap 4-7: Distres nafas sedang
O2 dengan O2 CPAP
Air entry Udara masuk Kurang baik Tidak masuk
bilateral baik > 7: Distres nafas berat / Ancaman gagal
Merintih (-) Terdengar Terdengar nafas
Dengan tanpa stetoskop Intubasi
stetoskop AGDA
Gizi Buruk
Kondisi Syok Letargis Dehidrasi
I (+) (+) (+) O2; RLD; D10% bolus 5 cc/kgbb; Resomal 5 cc/kgbb per
NGT.
II (-) (+) (+) Bolus D10% 5 cc/kgbb, D10% 50 cc/NGT; 2 jam pertama
berikan resomal /30 menit, dosis 5 cc/kgbb/x.
III (-) (-) (+) D10% 50 cc per oral atau NGT; 2 jam pertama berikan
resomal/30 menit, dosis 5 cc/kgbb/x.
IV (-) (+) (-) Bolus D10% 5 cc/kgbb, D10% 50 cc per NGT; 2 jam
pertama berikan F75/30 menit, ¼ dosis utk dosis 2 jam
dengan BB (NGT).
V (-) (-) (-) D10% 50cc oral.
Hipoglikemia berat
Neonatus < 30
1 bulan – 16 tahun < 40
Normal
Neonatus 30 – 60
0 – 1 tahun 50 – 80
1 – 16 tahun 70 – 100
Hiperglikemia
Puasa (batas atas ) WHO : 110
Random > 150
Klein GW et al. Hyperglycemia in the pediatric intensive care unit. Curr Opin Clin Nutr Metab Care 2007;10:187-92.
Hematology Index
ANC
Neutrofil batang + Neutrofil segmen → < 500: Kontraindikasi Kemoterapi
= x L
100
MCH
Hb gr/100ml x 10 → Mean corpuscular Hb = KHR
=
Jumlah Eritrosit (.juta/mm3) → N = 27 – 31 pikogr/sel darah merah
→ Mikrositer, makrositer
MCHC
Hb gr/100ml x 10 → N = 30 – 36 gr/ 100 ml darah
=
Ht vol% → Hipokrom, hiperkrom
MCV
Ht vol % x 10 → N = 81 – 90 mikr/m3
=
Jumlah Eritrosit (.juta/mm3) → Makrositer, mikrositer
Mentzer index
MCV → > 16%: defisiensi Fe
= x 100%
RBC
RDW index
MCV → jika > 220: ADB
= x RDW
RBC → jika < 220: thalasemia min.(92%)
Hill Formula
[ pCO2 = (1,54 - HCO3) + 8,36 ± 1,1 ]
pCO2 Lab < N Asidosis Metabolik + Alkalosis Respiratorik
pCO2 Lab N Asidosis metabolik murni
pCO2 Lab > N Asidosis metabolik + Asidosis respiratorik
Holiday Segar
BB [kg] Kebutuhan Cairan
INFUS
Cairan Ca++ K+ Na+ Osm Cl- HCO3-
mEq/L mEq/L mEq/L mOsm/L mEq/L mEq/L
Aminofusin L600 - 30 40 - 14 - Mg: 10 mEq/L
Asering 2,7 4 130 273,4 108,7 - Asetat-: 28 mEq/L
D5% - - - 252 - - Glu: 50 g/L
D5% NaCl 0,225% 38,5 354 38,5 200 Kkal/L
D5% NaCl 0,45% 77 406 77 Glu: 50 g/L
D5% NaCl 0,9% 154 560 154 190 Kkal/L
D40% - - - 2.018 - - Dextrose: 400 mg/L
Darrow 1/2
Gelofusin 154 274 120 Gelatin 40 g/L
HES 6% 154 308 154 Starch 60 g/L
KAEn 3A
KAEn 3B
Lipofundin - - - 380 - - 1908 Kkal/L
NaCl 0,9% - - 154 308 154 -
Ringer Fundin
Ringer Laktat 2,7 4 130,3 274 109,4 27,7
Ringer Sol 4,5 4 147,2 311 155,7
Parenteral
cc / hari kkal
= x
100 BBS
Potensi Tinggi Genetik (PTG)
TB Ayah + TB Ibu + 13
♂ = ± 8,5
2
TB Ayah + TB Ibu - 13
♂ = ± 8,5
2
Schofield Formula
0-3thn ♂ 0,167(BB) + 15,17(TB) - 617,6 Gagal jantung : 1,15 – 1,25
♀ 16,252(BB) + 10,232(TB) - 413,5 Gagal tumbuh : 1,5 - 2
3-10thn ♂ 19,59(BB) + 1,303(TB) + 414,9 Luka bakar : 1,5 – 2,5
♀ 16,969(BB) + 1,618(TB) + 371,2 Operasi : 1,05 – 1,5
10-18thn ♂ 16,25(BB) + 1,372(TB) + 515,5 Sepsis : 1,2 – 1,6
♀ 8,365(BB) + 4,65(TB) + 200 Starvation : 0,7 – 0,85
Trauma : 1,1 – 1,8
Trauma kepala : 1,3
Status Nutrisi
Obesitas
< 5 tahun > 5 tahun < 2tahun > 2 tahun
WHO (BB/TB) CDC (BB/TB) WHO CDC (IMT)
Transfusi
Kebutuhan
Albumin [mg] (3,0 – Alb lab) x bb x 0,8
Cryoprecipitate [cc] 10 cc/ kgbb
FFP [cc] 10-15 cc/ kgbb
PRC [cc] 4 x bb x ∆ Hb
Trombosit [Unit] 1 Unit /10 kgbb
Whole Blood [cc] 6 x bb x ∆ Hb
Kemampuan
Hb < 5 3 cc/ kgbb/ x transfusi
Hb 5 – 7 5 cc/ kgbb/ x transfusi
Hb 7 – 10 7 cc/ kgbb/ x transfusi
Kemampuan (Max)
Hb < 3 3 cc/ kgbb/ x transfusi
Hb < 5 5 cc/ kgbb/ x transfusi
Hb 5 – 10 10 cc/ kgbb/ x transfusi
Utility
Umur ETT Laryngoscope NGT Foley
[mm] (Miller) (Fr) (Fr)
Premie Or < 3 kg 2.,5-3.0 0 5-8 5
Term Newborn 1 – 7 days 3.0 1 5-8.5 5
1 – 3 wks 3.0 1 8.5 5
1 month 3.0-3.5 1 8 5-8
6 mos 3.5-4.0 1 8 5-8
12 mos 4.0-4.5 1-2 10-12 8-10
2 yrs 4.5-5.0 1-2 10-14 8-10
3 yrs 4.5-5.0 1-2 10-14 10
4 yrs 5.0-5.5 2 10-14 10
5 yrs 5.0-5.5 2 10-14 10
6 yrs 5.5 2 12-14 10
8 yrs 6.0 cuff 2-3 12-14 10
10 yrs 6.0-6.5 cuff 2-3 14-16 10-12
12 yrs 6.5-7.0 cuff 2-3 14-16 10-12
14 yrs > 7.0-7.5 cuff 3 16+ 14
Stabilization of the Critically Ill Children
Children’s Hospital Colorado