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Emergency Report

jan

Resident on duty:
dr. Alma Wijaya

Chief on duty:
Adit
Team:
Pras, Erika, Strata, Lucky, Nida, Vista

PATIENT LIST
Minor surgery

:2

Oncology surgery

Digestive surgery

Thorax cardiovascular surgery :


Plastic surgery

Urology surgery

:3

Neurosurgery

:1

Pediatric surgery

Orthopedic
Total

:1
:7

Patients List
N
o

Identity

Admissio
n to E.R.

Diagnosis

Management

Mr. Fajar,
26 yo/

Decemb
er 22nd,
2014 at
15.15

Severe Head
Injury GCS E2
Vx
M5+
Cerebral
contusion
+
SAH+
Susp.
Fracture Basis
Cranii
Fossa
Anterior
Et
Media + left
Pulmonary
contusion+
Closed
Fracture
of
right
Femur
Midle
3rd
Cominutive
Displaced+
Closed
Fracture right
Distal
End

Consult to neurology
surgery:
-Obsv. Vital sign
-Head up 30 degree
-IVFD NS 2500cc/24 hours
-Antibiotic
-H2 Blocker
-Analgetic
-Hospitalized ICU
Consult to Cardio
Thoracic Vascular
surgery:
-X-ray Thorax serial/ 12
hours
-Conservative therapy
Consult to ortophaedic:
-Skin traction right femur
-Spalk immobilisation for
antebrachii fracture
-Pro ORIF elective

Patients List
N
o

Identity

2. Mr.
Rizkian
12 yo/

3.

Admission
to E.R.

Diagnosis

Decembe
r 22nd
2014 at
18.05

Lacerated
wound at
right
antebrachii
region

Management

Debridement
ATS
Primary Suture
Oral Med:
Antibiotic
Analgetic
H2 Blocker
Consult to digestive
surgery:
Obsv. Vital sign
Co. Urology

Mr. Arkasi Decembe Obsv. Scrotal


mass e.c susp
61 yo/
r 22nd
inguinal
2014 at
bladder hernia
18.40
( post
Consult to urology:
Hernioraphy)
Antibiotic
H2 Blocker
Analgetic
Pro uretrocystography
If cant urinate, DC cateter
small caliber (RF)
Join treatment with

Patients List
N
o

Identity

Admissio
n to E.R.

Diagnosis

4 Mr.
. Rusbani
50 yo/

Decemb
er 22nd
2014 at
21.00

Fistula
Vesico
Cutaneus
post
open
prostatecto
my
+
Anemia
+
Trombositop
eni
+
hypoalbune
mia+ severe
Sepsis

Management

Co Urology surgery:
Observation of Vital
Sign
O2 6 lpm
IVFD Rl : D5 3:1
2000cc/day
Antibiotic
Analgetic
H2 Blocker
Blood Transfution 2
kolf
Albumin injection

Patients List
N
o

Identity

Admissio
n to E.R.

5 Mr.
. Samsul
Bahri
45 yo/

Decemb
er 22nd
2014 at
22.30

6 Mr.
. Mulyana
55 yo/

Diagnosis

Mild head
injury GCS
15 +
lacerated
wound at
right
periorbita
region +
lacerated
wound at
right knee
Decemb region
er 22nd
2014 at
22.55
Post
Open
Cystotomy
d.t
Susp
Stricture

Management

IVFD RL
Debridement
ATS
Primary Suture
Oral Med:
Antibiotic
Analgetic
H2 Blocker
IV Line
Antibiotic
analgetic
H2 blocker
Co Urologist surgery:
Pro BVUC

Patients List
N
o

Identity

7 Mr.
. Samuel
Salodon
g 31 yo/

Admissio
n to E.R.

Diagnosis

Decemb
er 23rd
2014 at
02.15

Closed
fracture of
the right
tibia distal
third (intra
artikular)
comminutive
displaced

Management

Consult to Ortopaedy
Posterior slab
Analgetic
H2 Blocker
Pro ORIF elective

1. Mr. Fajar, 26 yo/ December


22nd, 2014 at 15.15
Chief complain: Decreased of consciousness
History : 15 hours before admissions, when pts was riding
his motorcycle while drunk. Pts lose his balanced and
fell to the ground. His head and chest were bumped to
the road. History of fainting +, vomiting (-), bleeding
from ear/mouth/nose (+/+/+), pts helped by pedestrians,
and brought to Tamiang Layang Hospital. There they
foud deformity on his right hand and leg, so he were
treated with spalc. Then pts referred to Ulin Hospital for
further treatment.

Primary Survey

A
B

Clear (-) with ETT , snoring (-), gurgling(+), stridor (-)

Clear, RR : 30 tpm, simetric respiratory movement,

VBS simetry, Rh -/+ deep and quick

Pulse 136 tpm, reguler, lift strong, the extremities warm


BP: 100/70 mmHg

GCS E2VxM5, P 3mm/3mm, light reflex +/+, parese -/-

Secondary Survey
Head/Nec
k

Chest

Abdomen

Extremitie
s

Eyes : racoon eyes (+/+), anemic conjungtivae (+/+),


icteric sclerae (-/-)
Nose : rhinohargia (+)
Ear : otohargia (+), battle sign (+)
Mouth : wet mucosa
Neck : Lymph nodes enlargement (-), JVP enhancement
(-), cephal hematom (-)
I : symmetric respiratory movement, lesion (+) a/r
hemithorax sinistra
P : symmetric VF (+/+)
P : sonor at all lung
A : symmetric VBS+/+, rhonchi (-/+), wheezing (-/-)
I : distention (-)
A : normal Bowel sound
P : Liver/spleen/kidney not palpable, mass not palpable,
tenderness (-) , rebound tenderness (-)
P : Tympani

Warm, see status localized

(-)

IVFD rl,Analgetic, antibiotic, piracetam,


anti coagulant

(-)

20 hours before admission

On the road

Localized Status

Localized Status

a/r femur dextra:


L: edem (+), deformity (+),
angulation (+)
F: F movement (+)
M: limited

Localized Status

a/r cruris sinistra:


L: wound (+), edem (+),
deformity (-)
F: Crepitation (-)
M: ROM active

Localized Status

a/r cruris dextra:


L: wound (+), edem (+), deformity (-)
F: crepitation (-)
M: ROM limited

Localized Status
a/r antebrachii
dextra:
L: edem (+),
deformity (+),
angulation (+)
F: crepitation (+)
M: ROM limited

Localized
Status

a/r Capitis:
L: racoon eyes (+),
otohargia (+),
Rhinohargia (+)
Hematom (-), batlle
sign (-)
F: crepitation (-)

Cervical X-Ray December, 22nd 2014

Thorax X-Ray December, 22nd 2014

Femur X-ray
December, 22nd 2014

Antebrachii Xray December, 22nd


2014

Pelvic X-ray December, 22nd 2014

Ct Scan December, 22nd 2014

LABORATORY FINDING

13,5
Result

HEMATOLOGY
Parameter

Normal Value

December 22nd, 2014


Hemoglobin

10,6

14,0-18,0 g/dl

Lekosit

16,1

4,0-10,5 ribu/ul

Eritrosit

4,31

4,5-6,0 juta/ul

Hematokrit

31,4

42-52 vol %

Trombosit

151

150-450 ribu/ul

MCV

72,9

80-97 fl

MCH

24,5

27-32 pg

MCHC

33,7

32-38 %

Ureum

47

10-50 g/dL

Creatinin

1,3

GDP

135

SGOT/ SGPT

133/49

0,7-1,4
mg/dL
<200
mg/dL
0-45 U/I

23

PEMERIKSAAN

HASIL

RUJUKAN

PT

12,3
1,08
11,4
20,8
26,1

9,9-13,5 dtk

INR
Control Normal PT
APTT
Control Normal
APTT

SATUAN

22,2-37 dtk

U/I

24

Working Diagnosis
Severe Head Injury GCS E2 Vx
M5+ Cerebral contusion + SAH+
Susp. Fracture Basis Cranii Fossa
Anterior
Et
Media
+
left
Pulmonary contusion+ Closed
Fracture of right Femur Midle 3rd
Cominutive Displaced+ Closed
Fracture right Distal End Radius
fryckman type III

Management
Consult to neurology surgery:
- Obsv. Vital sign
- Head up 30 degree
- IVFD NS 2500cc/24 hours
- Antibiotic
- H2 Blocker
- Analgetic
- Hospitalized ICU
Consult to Cardio Thoracic Vascular surgery:
- X-ray Thorax serial/ 12 hours
- Conservative therapy
Consult to ortophaedic:
- Skin traction dextra
- Spalc for antebrachii
- Pro ORIF elective

2. Mr. Rizkian
12 yo/ December
Suri/ 50 Yo/1-11-55-77
22nd 2014 at 18.05
Chief Complain : Wounded hand
History :
an hours before admission, pts fell at his home
while carring a plate. The plate became broken and
its wounded his right arm. A lot of bleeding comes
from the wound. He wrap his wound with some of
clothes. Pts then brought to Ulin general hospital by
his family for further treatment.

Primary Survey

Secondary Survey

Clinical Pictures

Localized Status
a/r antebrachii:
L: edem (-), deformity (-),
wound (+), size diameter 5 cm,
base wound fascia (+)
F: tenderness (-), crepitation (-),
pain (+)
M: ROM Active

Post hecting

Working Diagnosis
Lacerated wound at right
antebrachii region

Management
Debridement
ATS
Primary Suture
Oral Med:
Antibiotic
Analgetic
H2 Blocker

3. Mr. Arkasi
61
yo/ December 22nd
Suri/ 50
Yo/1-11-55-77
2014 at 18.40
Chief Complain : bump at scrotum
History :
since one year before admission, pts complaint that
there was a bump on his left scrotum. At the
begining, the bump could go back in and out. 10
days before admission the bump on his scrotum got
bigger and couldnt go in anymore. Defecate (+),
pain (+), urinate (+). Pts then seek treatment to
Amuntai hospital, he was operated but at durante
operation, hernia sach wasnt found. The operation
back then was imidiately stop. Pts then brought to Ulin
Hospital for further examination.

Physical Examination

Compos Mentis
BP: 130/100mmhg
P: 82 tpm
RR: 20 tpm
T: 36,6 C

38

Clinical Picture

a/r scrotum and inguinal:


L: mass (+), size diameter 10 cm,

Mass at scrotal
region
10cm in diameter
Solid consistencies
Reguler edge

Surgical wound +

Fibrosis at OUE

LABORATORY FINDING

13,5
Result

HEMATOLOGY
Parameter

Normal Value

December 22nd, 2014


Hemoglobin

11,9

14,0-18,0 g/dl

Lekosit

11,7

4,0-10,5 ribu/ul

Eritrosit

4,26

4,5-6,0 juta/ul

Hematokrit

36,2

42-52 vol %

Trombosit

325

150-450 ribu/ul

MCV

85,1

80-97 fl

MCH

27,9

27-32 pg

MCHC

32,8

32-38 %

Ureum

30

10-50 g/dL

Creatinin

0,8

GDS

272

SGOT/ SGPT

43/48

0,7-1,4
mg/dL
<200
mg/dL
0-45 U/I

44

PEMERIKSAAN

HASIL

RUJUKAN

PT

12,8
1,11
11,4
27,6
26,1

9,9-13,5 dtk

INR
Control Normal PT
APTT
Control Normal
APTT

SATUAN

22,2-37 dtk

U/I

45

X-ray Pelvic

X-ray Abdomen

USG

USG

Expertise

Right scrotum:
Seen bowel filling the right scrotum
Right testis looks unclear
Left scrotum:
Seen bowel filling the left scrotum
Left testis looks unclear
Incidental finding at right ingunal regio:
Seen Vesica urinaria at right inguinal dextra regio
Conclution:
Support the sign of hernia scrotalis bilateral

Working Diagnosis
Obsv. Scrotal Mass e.c susp Inguinal
Bladder Interna

Management
Consult to digestive surgery:
Obsv. Vital sign
Co. Urology
Consult to urology:
Antibiotic
H2 Blocker
Analgetic
Pro uretrocystography
If cant urinate, DC cateter small caliber (RF)
Join treatment with digestive

4. Mr. Rusbani 50 yo/ December


22nd 2014 at 21.00
Chief Complain : discharge from operation site
History :
since 7 days ago before admission, pts
complain about his urin and blood comes out
from operation site. 15 days before admission,
because he had BPH pts got prostatectomy
treatment at Balangan hospital. Now, pts have
complaining about his scar from operation site
and swollen at his face and foot.

Physical Examination

Compos Mentis
BP: 130/90mmhg
P: 108 tpm
RR: 24 tpm
T: 36, C

54

Clinical picture

a/r

I:: Ascites, wound


abdomen
post op is wet, pus
(+),
A: P: Pain (+),
Urine (+)
Palpable pain (+) a/r
suprapubic
Release pain (-)
P: Shifting dullnes
(+)

LABORATORY FINDING

13,5
Result

HEMATOLOGY
Parameter

Normal Value

December 22nd, 2014


Hemoglobin

7.8

14,0-18,0 g/dl

Lekosit

1.3

4,0-10,5 ribu/ul

Eritrosit

2.85

4,5-6,0 juta/ul

Hematokrit

24.1

42-52 vol %

Trombosit

103

150-450 ribu/ul

MCV

84,6

80-97 fl

MCH

27,3

27-32 pg

MCHC

32,3

32-38 %

Ureum

151

10-50 g/dL

Creatinin

2.1

GDS

161

SGOT/ SGPT

28/19

0,7-1,4
mg/dL
<200
mg/dL
0-45 U/I

59

PEMERIKSAAN

HASIL

RUJUKAN

SATUAN

Albumin

2.6

3.5-5.5

g/dl

60

Working Diagnosis
Fistula Vesico Cutaneus post open
prostatectomy
+ Anemia +
Trombositopeni
+
hypoalbunemia+ severe Sepsis

Management

Co Urology surgery:
Observation of Vital Sign
O2 3-4 rpm
IVFD Rl : D5 3:1 2000cc/day
Antibiotic
Analgetic
H2 Blocker
Blood Transfution 2 kolf
Albumin injection

6. Mr.Suri/
Samsul
Bahri 45 yo/
50 Yo/1-11-55-77
December 22nd 2014 at 22.30
Chief Complain : Had an accident (?)
History :
an hours before admission, pts rode his motorcycle
with his wife. They were suddenly got crushed with
another motocycle from the back. He and his wife
fell to the ground. He wore a helmet, but still injury
his forehead. There were no history of bleeding from
ears, mouth and nose. Fainting (-), vomit (-). Pts
then brought to Ulin general hospital by his family
for further treatment.

Primary Survey

Secondary Survey

Clinical Pictures

Localized Status
a/r peri orbita dextra
L: edem (+), deformity (-), wound (+),
size diameter 2 cm, base wound bone
(+), active bleeding (-)
F: tenderness (+), crepitation (-), pain
(+)

Localized Status
a/rfemur dextra
L: edem (+), deformity (-),
wound (+), size diameter 5 cm,
base wound bone (+)
F: tenderness (+), crepitation
(-), pain (+)
M: ROM limited due to pain

Post hecting

Skull X-ray

Thorax X-ray

Knee X-ray

Working Diagnosis
CKR + Vulnus laxceratum a/r
periorbita dextra, genu dextra

Management
IVFD RL
Debridement
ATS
Primary Suture
Oral Med:
Antibiotic
Analgetic
H2 Blocker

7. Mr. Mulyana 55 yo/ December


22nd 2014 at 22.55
Chief Complain : Cant urinate
History :
2 days before admission, pts complaint that he
cant urinate. Then pts seek treatment to Tanah
Bumbu. Because he cant get to wore urin cateter,
he got open cystotomy. Pts complaining about
having difficulty to urinate since 5 days before
admission. The pain from cant urinate
continously increase day after day. History of
stone voiding (-), sandy voiding (-). Pts had
history of blood voiding.

Physical Examination

Compos Mentis
BP: 130/90mmhg
P: 10 tpm
RR: 24 tpm
T: 36, C

78

LABORATORY FINDING

13,5
Result

HEMATOLOGY
Parameter

Normal Value

December 19nd, 2014


Hemoglobin

12.1

14,0-18,0 g/dl

Lekosit

17300

4,0-10,5 ribu/ul

Eritrosit

4,76

4,5-6,0 juta/ul

Hematokrit

36

42-52 vol %

Trombosit

213

150-450 ribu/ul

Ureum

49

Creatinin

GDS

134

SGOT/ SGPT

17/17

Albumin

4.49

PT

4 minute

APTT

2 minute 10 second

10-50 g/dL
0,7-1,4
mg/dL
<200
mg/dL
0-45 U/I

80

PEMERIKSAAN

HASIL

RUJUKAN

PT

4
1,08
11,4
210
26,1

9,9-13,5 dtk

INR
Control Normal PT
APTT
Control Normal
APTT

SATUAN

22,2-37 dtk

U/I

81

USG

Expertise
Conclusion:
1. Pelvicocaliectasis Ren Bilateral
2. Cystitis
3. Susp. Distal Ureter Calculy and
diverticel at left lateral vesikurinaria
4. Hyperplasia Prostat

Urine out put

Cystostomy bag

Working Diagnosis
Post Open Cystotomy ec Susp Strictur
Uretra Posterior

Management
IV Line
Antibiotic
analgetic
H2 blocker
Co Urologist surgery:
Pro BVUC

8. Mr. Samuel
Salodong 31 yo/
Suri/ 50 Yo/1-11-55-77
December 23rd 2014 at 02.15
Chief Complain : pain at right leg
History :
3 days before admission, pts fell from stair. He
dislocate his foot cause it used to support his body.
Pts complain pain and swelling at his leg. History of
fainting (-), bleeding at his ears, nose, and mouth (-)
Pts then brought to Ulin general hospital by his
family for further treatment.

Primary Survey

Secondary Survey

Clinical Pictures

Localized Status
a/r cruris dextra et pedis dextra
L: edem (+), deformity (+), wound (-),
angulation (+)
F: tenderness (+), crepitation (+),
pain (+)
M: ROM limited

Cruris X-ray

Pedis X-ray

Working Diagnosis
Closed fracture cruris 1/3 distal intra
artikular cominutive displaced dextra

Management
Consult to Ortopaedy
Posterior slab
Analgetic
H2 Blocker
Pro ORIF elective