Page 164 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-008
Severe Tetanus in Unvaccinated Boys: A Case Series

Meilani Puspasari Simarmata, Aridamuriany Dwiputri Lubis, Yunnie Trisnawati,
Rina Amalia Caromina Saragih, Ayodhia Pitaloka Pasaribu, Hendri Wijaya
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara,/H. Adam Malik General Hospital,
Medan, North Sumatera, Indonesia
Abstract
Background Tetanus is an infectious disease prevented by immunization, however the mortality rate for
severe tetanus is 10% in developed countries. Severe tetanus can cause respiratory failure and autonomic
dysfunction, requiring close monitoring in Pediatric Intensive Care Unit (PICU). Objective To report
two cases of severe tetanus illustrating the difficulty for controlling spasm and autonomic dysfunction.
Cases Case 1, a 4-year-old unvaccinated boy, suffered a laceration on the head 2x2 cm 8 days before admission.
The wound becomes festering although has been stitched by the midwife. Case 2, a-7-year-old unvaccinated
boy, suffered a rusty nail stab on his right leg sole 7 days before admission and was cleaned with povidone
iodine at home. Fever, generalized rigidity, lockjaw, dysphagia, reflex prolonged spasm developed in both
patients. Patients were diagnosed severe tetanus. Human Tetanus Immunoglobulin (HTIG), metronidazole
and diazepam were given immediately. Within a few days monitoring, there was an increase in the frequency
and duration of reflex spasm despite given continuous diazepam, before transferred to PICU. In the first case,
muscle spasm was controlled with midazolam for 7 days before moved to the ward. The second patient was
given atracurium continuous 6 mcg/kg/minute, midazolam, fentanyl and was intubated to support the airway.
Nonetheless, severe generalized spasm persisted. On the fifth hospital stay, autonomic dysfunction developed
and presented as tachycardia and bradycardia. Autonomic dysfunction cannot be controlled and the patient
was die. Conclusion Severe tetanus can lead to life-threatening complication of autonomic dysfunction.
Keywords: Severe tetanus; unvaccinated; autonomic dysfunction

P-EPIC-009
Management of Difficult Airway Preoperative Amplatzer Ductal Occluder in
8-months-old Boy with Laringomalacia type III: A Case Report

Nadhira Lesarina, Ririe Fachrina Malisie, Yunnie Trisnawati, Aridamuriany Lubis, Rizky
Adriansyah, Hafaz Zakky Abdillah,
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara, Medan, North Sumatera, Indonesia

Abstract
Background Management of the difficult airway may be associated with high rate of complications. Cormack-
Lehane classification are regarded as poor grade of laryngoscopic views potentially resulting in difficult
intubation and associated problems. A difficult airway scenario can have many implications for pediatric
patients undergoing cardiac catheterization. Objective To demonstrate management of difficult airway and
identify airway assessment maneuvers that are commonly used to predict poor laryngoscope views during
preoperative in Laringomalacia type III infant with Atrial Septal Defect. Case An 8-month-old boy was
referred with chief complain difficulty of breath since the first two months of life. Stridor inspiratory increased
when the patient’s position is supine, during and after feeding. Fiberoptic laryngoscopy showed posterior
displacement of the epiglottis. Echocardiography have performed secundum Atrial Septal Defect and Patent
Ductus Arteriousus, and the patient need AmplaGTtzer Ductal Occluder intervention. Preoperative assessment
of the airway by evaluation of LEMON (Look, Evaluate, Mallampati score, Obstruction, Neck mobility),
Cormack-Lehane classification and craniofacial parameters have indicated the potential of difficult airways
(can’t intubate, can ventilate). After three times unsuccessful tracheal intubation attempts, tracheostomy
have chosen as an emergency procedure. Conclusion It is important that physician must understand the
patienprofiles associated with difficult airway management, the equipment and the techniques.
Keywords: difficult airway; preoperative; laringomalacia

116 KONIKA XVIII Abstract Book