Emergency Room Case Report February 4th-9th 2013

On duty (ER Stage) : Maisarah, Asti, Bagus

Minor surgey : 3 Urology :1 Digestive : 3 Ortopedics :2 Neurosurgery : 0

Pediatric Surgery : 0
Oncology :0 Vascular and Cardiothoracic :0 Plastic Surgery :0 Total patients : 9

Reported patients : 1

Mr. Yamani/15 yo/Admitted to ER on February, 7th 2013 at 11.00 am/Crush injury a/r digiti IV-V manus dextra

 Chief complaint : crushed finger The patient complained that his third, fourth and fifth finger on the right hand was crushed because its minced in a bread machine. The incident happened approximately 15 minutes before the admission. On the fourth and fifth finger, skin, muscle, and bone was crushed to pieces. Patient loss his sensation on the crushed part but sensation of pain can be felt on the border betwen crushed part and not crushed part. On third finger there is an open wound on the edge of finger. they keep on bleeding. Before admission, patient put a pressure on his injury with a cloth, spilled with stone oil. The patient then sent to Ulin general hospital.

A B
C D

Clear, snoring (-), gargling (-)

Clear, RR=20/min, simmetric respiratory movement, simmetric VBS

BP: 120/80 mmhg, Pulse rate: 92 x/m regular, strong pulsation GCS E4V5M6, round and simmetric pupils , diameter (3mm/3mm), light reflexes (+/+)

M
P L E

4 hours before admission Bread factory

Head/Neck

Eye : anemic conjunctivae (-/-), icteric sclerae (-/-), periorbital hematoma (-/-) Mouth : Wet mucosa, cyanosis (-) Neck : increase of JVP (-)

Thorax

I : Simmetric respiratory movement, retraction (-) P : Simmetric VF P : Sonor in all lung field A : Simmetric VBS, Rh (-/-), Wh (-/-)

Abdomen

I : Flat, hematoma (-) A : Normal bowel sound P : H/L/M not palpable, tenderness (-), mass (-) P : Tympanic in all quadrants

Extremities

Warm periphers, no edema in inferior extremities Crush wound on fourth and fifth finger on the right hand Open wound on third finger on the right hand

Region of third digiti manus dextra Look: Open wound, 1 cm x 1 cm with soft tissue loss, nail loss, irregular edge, dirty, bone expose, edema (-), Bleeding (+)

 Region of third digiti manus dextra Feel: Pain (+), Loss of sensation (-), crepitation (-)

Region of third digiti manus dextra Move: Active ROM: Free Passive ROM: Free

Region of fourth digiti manus dextra Look: crush wound, length: app. 5 cm with crushed bone, muscle, skin, Up to phalangx proximal, irregular edge, dirty, edema (-), Bleeding (+)

Region of fourth digiti manus dextra Feel: Pain (+), Loss of sensation (+)

Region of fourth digiti manus dextra Move: Active ROM: limited Passive ROM: limited

Region of fifth digiti manus dextra Look: crush wound, length: app. 5 cm with crushed bone, muscle, skin, Up to phalangx proximal, irregular edge, dirty, edema (-), Bleeding (+)

Continued
Region of fifth digiti manus dextra Move: Active ROM: limited Passive ROM: limited

Region of fifth digiti manus dextra Feel: Pain (+), Loss of sensation (+)

Hb : 12,5 g/dl Leu : 7,8 thousand/ul Eri : 4,76 million/ul Ht : 40,0 % Tr : 344.000 PT/APTT : 13,3/27,1 BSS : 97 mg/dl Ur : 29 mg/dl Cr : 0,72 mg/dl

SGOT : 17 U/l SGPT : 17 U/l Na/K/Cl: 143,5/4,03/106,6

Crush injury a/r digiti IV-V manus dextra

Management : Referred to Orthopedic Consultant (Resident) : Dressing Emergency surgery : Repair Stump Hospitalization Antibiotic, Analgetic, H2blocker