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EMERGENCY SURGICAL SERVICESWednesday, April 14th 2010

The Attending Doctors :

1. Zamir MD / Ariansyah MD2. Yudi Setiawan MD / Andi K MD 3. Dian Kurnia MD 4. Zulkarnain MD / Fauzi M MD5. Shalita MD / Hafidz MD6. Donny Rendra MD

EMERGENCY CASESA. TRAUMA CASES (7)1. Fire Burn Injury grade II 12 % (T 20)2. Close severe head injury of GCS 2 x (S06.1)3. Close moderate head injury of GCS 10 +

cerebral edema (S0.6.1) + Blunt thoracic injury without hemopneumothorax (S.20)

4. Open fracture of the distal third of the tibial and fibular bone transverse displaced grade III a (42.B2) (S82.7)

5. Close severe head injury of GCS 13 (S.06.0)+Linier fracture of the left Linier fracture of the left temporoparietal + EDH of the left temporoparietal + EDH of the left temporoparietal lobe (S06.3)+ cerebral edema temporoparietal lobe (S06.3)+ cerebral edema (S06.1)(S06.1)

6. Close moderate head injury of GCS 12 + linier fracture of occipitale lobe + EDH of the left occipitale lobe + Cerebral Edema

7. Close mild head injury of GCS 14 (S06.0)

B. NON TRAUMA CASE (1)

1. Moderate tetanus with philip’s score 15 (A.35)

TRAUMA CASES1. Mr. H / ♂ / 27 years old.

Admitted on Wednesday, April 14th 2010 (At 06.30 am)

Fire burn injury He got burn injury after stove explotion on his face, chest and extremity

( About 30’ before admission )

PRIMARY SURVEY A. Good B. RR : 20 x/m C. BP: 140/90 mmHg, PR : 90 x/m

SECONDARY SURVEY

There were fire burn injury grade II on: - Face : 1 %- Chest : 1 %- Right forearm : 4 %- Left forearm : 1 %- Right thigh : 3 %- Left thigh : 2 % Total : 12 %

Laboratory Findings: Laboratory Findings: Hb : 13,7 g/dlHb : 13,7 g/dl (14-18 g/dl)(14-18 g/dl)HtHt : 41 vol% : 41 vol% (40-48 vol%)(40-48 vol%)

DIAGNOSEFire Burn Injury grade II 12 % (T 20)

MANAGEMENT- O2

- IVFD- AB, AG, ATS- Urethral catheter- Mebo

The patient was cared in the ward

2. Mr. M / ♂/ 69 years old. Admitted on wednesday, April 14th 2010.(At 04.20 pm)

Decreasing of consciousness after having a traffic accident.

His motorcycle got hit by another. He fell and his head hit a road.

( About 3 hours before admission )

PRIMARY SURVEY

A. Snooring ETT + O2

B. RR : 18 x/m C. BP : 110/80 mmHg

PR : 78 x/m

D. GCS : E1M1Vx= 2x,

pupils were midriatic bilateral, pupils were midriatic bilateral, Light reflexes were (-) on both eyesLight reflexes were (-) on both eyes

SECONDARY SURVEY

On the right temporoparietal region

I : there was excoriated wound Hematoma (+)

On the left orbital regionI : hematoma(+)

On the left maxila mandibular region

I : deformity (+) Hematoma

DIAGNOSIS

Close severe head injury of GCS 2 x (S06.1)

MANAGEMENT- O2- IVFD

- NGT, Urethra catheter- AB, AG, ATS

The patient was treated in the ER

3. Mr. S / ♂/ 21 years old. Admitted on wednesday, April 14th 2010.(On 06.15 pm)

Decreasing of consciousness after having a traffic accident.

His motorcycle got slip. He fell and his head, chest and flank hit the road.

( About 4 hours before admission )

PRIMARY SURVEY A. Good B. RR : 24 x/m C. BP : 120/80 mmHg

PR : 90 x/m

D. GCS : E2M5V3= 10, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the right temporal regionI : Hematoma (+)

On the Chest regionI : There was excoriated

wound, about 7 cm at the level of ICS VIII-X at the right midaxilaris line

P : sonor on both hemithoraxA : Vesicular on both

hemithorax

RADIOLOGICAL FINDINGRADIOLOGICAL FINDINGHEAD CT-SCAN:HEAD CT-SCAN:Cerebral edemaCerebral edema

RADIOLOGICAL FINDINGRADIOLOGICAL FINDINGChest X ray:Chest X ray:Normal ThoraxNormal Thorax

Laboratory Findings: Laboratory Findings: Hb Hb : 13,5 g/dl: 13,5 g/dl (14-18 g/dl)(14-18 g/dl)HtHt : 40 vol%: 40 vol% (40-48 vol%)(40-48 vol%)

DIAGNOSISClose moderate head injury of GCS 10 +

cerebral edema (S0.6.1) + Blunt thoracic injury without hemopneumothorax (S.20)

MANAGEMENT-O2- IVFD - NGT, Urethra catheter- AB, AG, ATSThe patient was treated in the Ward

4. Girl R / ♀ / 12 years oldAdmitted on Wednesday, April 14th 2010.(At 08.30 pm)

pain and difficulty to move her left leg after having a traffic accident She hit by a motorcycle while crossing a street. She fell and his left leg hit a road. ( About 4 hours before admission )

PRIMARY SURVEY A. GoodB. RR: 22 x/mC. PR: 100 x/m

SECONDARY SURVEY

On the Left leg region

I : Deformity (+), lacerated wound about 6 cm in length that had been suture

P:NVD was good, ROM active passive were limited

RADIOLOGICAL FINDINGleft leg x-ray : Fracture of the distal third of the tibial bone transverse displaced and Fracture of the distal third of the fibular bone transverse displaced

LABORATORY FINDINGSLABORATORY FINDINGSHb : 10,4 g/dlHb : 10,4 g/dl N: 14-18 g/dlN: 14-18 g/dlH t : 31 vol%H t : 31 vol% N: 40-48 vol%N: 40-48 vol%

DIAGNOSEOpen fracture of the distal third of the tibial and fibular bone transverse displaced grade III a (42.B2) (S82.7)MANAGEMENT IVFD AB, AG, ATS Immobilize fracture with back slab Plan to perform ORIF

The patient was cared in the ward

5. Mr. R / ♂/ 27 years old. Admitted on wednesday, April 14th 2010.(At 10.39 pm)

Decreasing of consciousness after struck down by a tree.

His head was struck down by a tree when he was working( About 12 hours before admission )

PRIMARY SURVEY A. Good B. RR : 20 x/m C. BP : 120/80 mmHg

PR : 80 x/m D. GCS : E3M6V4= 13, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the frontoparietal regionI : there was lacerated wound

about 15 cm in lenght

RADIOLOGICAL FINDINGRADIOLOGICAL FINDINGHEAD CT-SCAN:HEAD CT-SCAN:Linier fracture of the left Linier fracture of the left temporoparietal bone + EDH of the left temporoparietal bone + EDH of the left temporoparietal lobe + cerebral edematemporoparietal lobe + cerebral edema

Laboratory Findings: Laboratory Findings: Hb Hb : 11,3 g/dl: 11,3 g/dl (14-18 g/dl)(14-18 g/dl)HtHt : 33 vol%: 33 vol% (40-48 vol%)(40-48 vol%)

DIAGNOSISClose moderate head injury of GCS 13 (S.06.0) +Linier Linier

fracture of the left temporoparietal bone + EDH of the left fracture of the left temporoparietal bone + EDH of the left temporoparietal lobe (S06.3)+ cerebral edema (S06.1)temporoparietal lobe (S06.3)+ cerebral edema (S06.1)

MANAGEMENT- O2- IVFD - NGT, Urethra catheter- AB, AG, ATS- Craniotomy Emergency The Patien was treaded in the ward

6. Mr. D / ♂/ 28 years old. Admitted on thursday, April 15th 2010.(At 01.24 am)

Decreasing of consciousness after having a traffic accident.

His motorcycle got hit by another. He fell and his head hit a road.

( About 4 hours before admission )

PRIMARY SURVEY A. good B. RR : 22 x/m C. BP : 130/70 mmHg

PR : 90 x/m

D. GCS : E3M5V4= 12, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the left temporal regionI : Hematoma (+)

RADIOLOGICAL FINDINGRADIOLOGICAL FINDINGHEAD CT-SCAN:HEAD CT-SCAN: linier fracture of occipitale bone + EDH of the left occipitale lobe + Cerebral

Edema

DIAGNOSISClose moderate head injury of GCS 12

+ linier fracture of occipitale bone + EDH of the left occipitale lobe + Cerebral Edema

MANAGEMENT- O2- IVFD - NGT, Urethra catheter- AB, AG, ATS

The Patient was treated in the ER

7. Mr. PW / ♂/ 17 years old. Admitted on thursday, April 15th 2010.(On 02.04 am)

Pain on his head after having a traffic accident.

His motorcycle got hit by another. He fell and his head hit a road.

( About 4 hours before admission )

PRIMARY SURVEY A. good B. RR : 20 x/m C. BP : 120/80 mmHg

PR : 80 x/m

D. GCS : E3M6V5= 14, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the left temporal regionI : Hematoma (+)

Laboratory Findings: Laboratory Findings:

Hb Hb : 12,9 g/dl: 12,9 g/dl (14-18 g/dl)(14-18 g/dl)

HtHt : 39 vol%: 39 vol% (40-48 vol%)(40-48 vol%)

DIAGNOSIS

Close mild head injury of GCS 14 (S06.0)

MANAGEMENT- O2- IVFD - AB, AG, ATS

The Patient was treated in the ER

NON TRAUMA CASES1. Mr. A / ♂ / 64 years old.

Admitted on Wednesday, April 14th 2010 (At 10.56 am)

Couldn’t open his mouth since 18 hours before admission History of being stabbed by porcelain 10 days ago

VITAL SIGNSens : CMBP : 120/80 mmhgPR : 60 x/m

RR : 20 x/mT : 36,4 °C

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

On the Right Forearm region :

I : there was lacerated wound about 2 cm in size

NEUROLOGY EXAMINATIONNEUROLOGY EXAMINATION

Trismus : (+)Spontaneus Seizure : (-)Provocated seizure : (-)Opistotonus : (+)

PHILIPS SCOREIncubation periode ( 10 days) : 3Location (Right forearm) : 2Hystory of immunitation (none) : 10Predisposing factor : 0Total : 15

DIAGNOSEModerate tetanus with philip’s score 15 (A.35)

MANAGEMENT

- O2

- IVFD- NGT, Uretral Cateter- Therapeutic Tetagam- AB, AG- Anti Convulcion- Debridement

The patient was cared in the ER

PATIENT IN THE WARDPATIENT IN THE WARD

1.1. Mr. P / Mr. P / ♂♂ / 33 years old / 33 years oldAdmitted on thusday, April 13th 2010

DIAGNOSIS :DIAGNOSIS :Blunt abdominal trauma with sign of peritonitisBlunt abdominal trauma with sign of peritonitis

IO :IO : In the abdominal cavity we found blood and blood cloated In the abdominal cavity we found blood and blood cloated

about 300 cc, and hematoma in omentumabout 300 cc, and hematoma in omentum On exploration, we found saphonification in gastrocolica On exploration, we found saphonification in gastrocolica

and minor curvatura of gaster came from pancreas and minor curvatura of gaster came from pancreas

On further exploration, any organ was goodOn further exploration, any organ was good We put 2 drain intraperitonealWe put 2 drain intraperitoneal

DIAGNOSE POST OPERATION:

PANCREAS INJURY