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Emergency Case Report

2014, 5 TH – 6 TH December

Resident on Duty : dr. Alma Wijaya
Chief Co-Assistant : Ady
Team :
Endah, Erina, Mira, Firdha, Dyah, Bimo

Minor Surgery

:-

Digestive Surgery

:

Thorax Cardiovascular Surgery

:

Plastic Surgery

:

Urology Surgery

: 1 -

Neurosurgery

: 3

Pediatric Surgery

:

Oncology Surgery

:1

Orthopaedy

:

Total

:5

-

No

1

Identity

Ms. Annisa/
12y.o/
1.13.07.94

Admission
to E.R.

5th
December
2014/ 06.00
p.m

Diagnosis

Mild Head Injury GCS 15
+ Susp. Skull base
fracture anterior at medial
fossa + linier fracture at
right temporal region

Treatment / Planning

IVFD RL maintenance
Antibiotic
H2 blocker
Analgesic
Consulted to Neurology Surgery
Departement
Completely blood count
CT Scan Head

No

2

Identity

Mr. Kadiran/ 78
y.o/ 1.13.07.98

Admission
to E.R.

5th
December
2014/ 07.12
p.m

Diagnosis

Post Cytostomy d.t Susp.
Posterior Urethral
Stricture+ Benign Prostate
Hyperplasia + scrotal
absces

Treatment / Planning

IVFD RL:D5 maintenance
Antibiotic
Analgetic
H2 Blocker
Consulted to Urology Departement
USG Urology and scrotum
Planned to BVUC from wards

No

3

Identity

Mr. Ani Safitri/
18 y.o/
1.13.07.96

Admission
to E.R.

2014, 5TH
December/
06.30 p.m

Diagnosis

Treatment / Planning

Hipovolemic shock Rapid
Respon + severe head
injury GCS 7 E2M3V2 dd
Secondary Brain damage
+ Open Fraktur of left
humerus distal third +
open fracture of the left
femur midle third + open
fracture of left lateral
maleolus + closed fracture
of the right femur middle
third + obs blunt
abdominal trauma

Fluid Resusitation
Vital sign observation
Antibiotic
Analgesic
H2 blocker
Tetatus profilaksis
Co neurosurgeon :
Pro head CT if transportable
CO digestive surgeon :
Vital sign stabilisation
Pro Abdominal USG if transportable
Co orthopaedic surgeon :
Pro debridement and fixation when
Vital sign stable

R.30 p. Pro EVD Cito Antibiotik pre operation H2 Blocker Analgesic . Badriansyah/ 68 y.o/ 1.05 Admission to E. Identity Mr.No 4.13.t Stroke Haemorraghic Consul Neurology Surgery Dept. 5th December 2014/ 09.m Diagnosis Treatment / Planning Intraventrikular Haemorrhagic d.08.

13.08.o/ 1.R.15 a. 6th December 2014/ 01.m Diagnosis Left breast cancer T4dN3M1 lung + Anemia With Karnofsky 50 Treatment / Planning Consul Oncology dept IVFD RL:D5 maintenance Antibiotic H2 Blocker Analgesic Dressing once in two days Transf. Rayati/ 48 y. PRC Hb ≥10 Pro Chemotherapy .16 Admission to E.No 5 Identity Mrs.

94 5th December 2014/ 06. Because the complain patient in Amuntai Hospital.00 p. Annisa/ 12y. The patient was hit by a motorcycle at high speed. During treatment in there.13. Ms. patient was taken to ER Amuntai.o/ 1. And both the patient’s eyes and behind the ears suffered bruising. .07. patient referred to Ulin General Hospital for further treatment.m Chief Complain : Headache History: 2 days ago before admission. After the incident. the patient also complaint persistent headache.1. patient experienced dizziness and vomiting of blood. the patient had an accident .

light reflexes (+/+). strong lifted. CRT < 2 sec. no paralysis . bleeding from the mouth • Clear. • GCS E4V5M6.Primary Survey A B C D • Snoring (-). RR= 20 bpm. gurgling (-). symmetric VBS • BP : 110/80 mmHg • Pulse rate : 80 bpm. reguler. round and equal pupils diameter (3mm/3mm). symmetric respiratory movement.

A - M - P - L 1 hour before admission E On the road .

icteric sclera (-). no retraction • P : Symmetric VF • P : Sonor at all lung fields • A : Symmetric VBS.Physical Examination Head/Neck Chest Abdomen Extremities • Eyes : No anemic conjunctiva. no oedema. mass not palpable. bruise (+) . tenderness (-). Liver/spleen/kidney not palpable. no rhonchi. Batle sign (+/+) • Nose : No epistaxis • Mouth : Wet mucosa • Ear : behind the ear bruise (+/+) • Neck : Lymph nodes enlargement (-). no wheezing • I : Inguinal lymph nodes enlargment (-) • A : Bowel sound (+) • P : soeple. no parese. distension (-) at lower abdomen • P : Tymphani • Warm. JVP enhancement (-) • I : Symmetric respiratory movement. racon eye (+/+).

Physical Examination Head/Neck Chest Abdomen Extremities • Eyes : No anemic conjunctiva. mass not palpable. no rhonchi. JVP enhancement (-) • I : Symmetric respiratory movement. tenderness (-). bruise (+/+) • Nose : No epistaxis • Mouth : Wet mucosa • Ear : behind the ear bruise (+/+) • Neck : Lymph nodes enlargement (-). bruise (+) . icteric sclera (-). no oedema. no parese. no wheezing • I : Inguinal lymph nodes enlargment (-) • A : Bowel sound (+) • P : soeple. Liver/spleen/kidney not palpable. no retraction • P : Symmetric VF • P : Sonor at all lung fields • A : Symmetric VBS. distension (-) at lower abdomen • P : Tymphani • Warm.

Clinical Picture – Local Status At Orbita • racon eye (+/+) .

Clinical Picture – Local Status • At Auricular Batle sign (+/+) .

CT SCAN HEAD 5TH Dec 2014 .

CT SCAN HEAD 5TH Dec 2014 .

CT SCAN HEAD 5TH Dec 2014 .

Laboratory • Hb 9.5 mg/dL .1% • SGOT/PT 23/12 U/I • Ur/cr 14/0.5 g/dl • Leukosit 10500/ul • Eritrosit 3300000/ul • Hct 27% • Trombosit 288000/ul • RDW-CV 14.

Skull base fracture anterior at medial fossa + linier fracture at right temporal region .Working Diagnosis Mild Head Injury GCS 15 + Susp.

Management IVFD RL 1500cc/day Antibiotic H2 blocker Analgesic Consulted to Neurology Surgery Departement Completely blood count CT Scan Head .

The complaint also accompaied by scrotal oedema since 10 days ago The patient then brought to tanah bumbu hospital and got open cystostomy The patient has history of urination since one year ago.m • Chief Complain : unable to void • History: Since one week before hospital admission patient been complained couldn’t urinate.2. This is the first time patient experienced the complain. Kadiran/ 78 y. Mr.07.12 p. .13. Because his complain patient referred to Ulin General Hospital for further treatment.o/ 1.98 5th December 2014/ 07.

8ºC .Physical Examination • Conciousness : Compos Mentis • Vital sign : • BP = 120/80 mmHg • PR = 80bpm • RR = 20 bpm • T = 36.

Liver/spleen/kidney not palpable.Physical Examination Head/Neck Chest Abdomen Extremities • Eyes : anemic conjunctiva. • Nose : No epistaxis • Mouth : Wet mucosa • Neck : Lymph nodes enlargement (-). no retraction • P : Symmetric VF • P : Sonor at all lung fields • A : Symmetric VBS. no oedema. icteric sclera (-). • P : Tymphani • Warm. no wheezing • I : Inguinal lymph nodes enlargment (-). no rhonchi. mass not palpable. tenderness (-). cytostomy (+) • A : Bowel sound (+) • P : soeple. no parese . JVP enhancement (-) • I : Symmetric respiratory movement.

oedem (-).Clinical Picture – Local Status At scrotum region • L : swelling lump. absess • F : Abscess (+) fluctuation - .

oedem (-).Clinical Picture – Local Status At scrotum region L : swelling lump. absess .

Abd AP .

9 g/dl • Leucocyte 21000 /µl • Hematocrit 38 vol% • Trombocyte 635000/ µl • Glucose 133 mg/dl • SGOT/SGPT 32/37 U/l • Ur/cr 36/0.9 mg/dL .Laboratory • Hb 12.

Working Diagnosis Post Cytostomy d.t Susp. Posterior Urethral Stricture+ Benign Prostate Hyperplasia + scrotal absces .

Management IVFD RL:D5 maintenance Antibiotic Analgetic H2 Blocker Consulted to Urology Departement USG Urology and scrotum Planned to BVUC from wards .

m   Chief Complain: decrease of concious History : 12 hours before admission. Ani Safitri/ 18 y.3.96 2014.07. the patient want to go to school and then was hit with a high-speed car. The patient was found unconcious Then the patient was taken to the ER primary health care in Sampit by the citizen the patient didn’t got primary survey adequately and then referred to to Ulin General Hospital for further treatment.30 p. . Mr.13.o/ 1. 5TH December/06.

round and equal pupils diameter (3mm/3m). D • GCS E2V2M3. symmetric VBS C • BP : not palpableres 90/60mmHg • Pulse rate : 80 bpm. reguler. light reflexes (+/+). symmetric respiratory movement. Snoring (-). RR= 22 bpm.Primary Survey A • Clear. strong lifted. B • Clear. no paralysis . CRT >2 sec. gurgling (-).

A - M - P - L A Day before admission Road E .

(-/-). distension (-). tenderness (-). Rh (-/-). • P : Tympanic in all quadrants Extremities • • Warm. paralysis (-) Wound (+) .Secondary survey •Eye : Anemic conj. hematoma (-) • A : Normal bowel sound • P : H/L/M not palpable. Wh (-/-) Abdomen • I : Wound (-). •Mouth : Moist mucous membrane •Neck : JVP enhancement (-/-). edema (-). icteric sclera (-/-). lymphatic nodes enlargement (-/-) Head/Neck Chest • • • • I : Symmetric respiratory movement. retraction (-) P : Symmetric VF P : Sonor in all lung field A : Symmetric VBS.

.

Clinical Picture – Local Status At head region • L : Swelling (+). oedem (-). deformitas (-). wound (+) • F : pain (-) .

.

4 g/dl Leucocyte 37900/µl Hematocrit 36.Laboratory        Hb 12.8 mg/dL Na/K/Cl 139/5/102 mmol/l .3 vol% Trombocyte 385000/ µl SGOT/SGPT 207/116U/l Ur/Cr 41/2.

.

.

Working Diagnosis Hipovolemic shock Rapid Respon + severe head injury GCS 7 E2M3V2 dd Secondary Brain damage + Open Fraktur of left humerus distal third + closed fracture of the left femur midle third + open fracture of left lateral maleolus + closed fracture of the right femur middle third + obs blunt abdominal trauma .

Management oR ndiauFeitsulsi gonbsiveartltVi ciotbA iint Agcneasli H ockbe2lr asksliiopuaTfrset Cnoeousrguero:n anreasptbP hloerafC diT CsvgueO riedo:sint onisatilagbstni altVi A PobradonrU m easptbnloS arlifGi C hotpsargucerdo:in P dow enrixm barhteianefdnt eagbstnlsialtVi .

Mr. The patient felt the headache did not relief by analgesia and. The patient has history of uncontrolled hipertention since couple years ago.13. nausea. .08. History of fainting – seizure -. Badriansyah/ 68 y.30 p. and vomiting. Vomiting 4 times and contains the food eaten.o/ 1.m • Chief Complain : Headache • History: since 4 days ago the patient complain about headache.05 5th December 2014/ 09.4.

Physical Examination • Conciousness : Compos Mentis • Vital sign : • BP = 160/100 mmHg • PR = 90 bpm • RR = 20 bpm • T = 36.5ºC .

tenderness (-). • P : Tymphani • Warm. • Nose : No epistaxis • Mouth : Wet mucosa • Neck : Lymph nodes enlargement (-). Liver/spleen/kidney not palpable.Physical Examination Head/Neck Chest Abdomen Extremities • Eyes : anemic conjunctiva. mass not palpable. no wheezing • I : Inguinal lymph nodes enlargment (-) • A : Bowel sound (+) • P : soeple. no parese . JVP enhancement (-) • I : Symmetric respiratory movement. no oedema. no rhonchi. icteric sclera (-). no retraction • P : Symmetric VF • P : Sonor at all lung fields • A : Symmetric VBS.

.

Clinical Picture – Local Status .

CT Scan Head .

CT Scan Head .

2 g/dl • Leucocyte 13600 /µl • Hematocrit 36.5 vol% • Trombocyte 269000/ µl • Glucose 114 mg/dl • Cholest.Laboratory • Hb 13. 177 mg/dl • TGT 60 mg/dl .

Working Diagnosis Intraventrikular Haemorrhagic d.t Stroke Haemorraghic .

Management ConsuN l euroolgySurgeryDept. ProEVDCtoi Anbtioiktipreoperaotin H2Bol cker Anagl esci .

Rayati/ 48 y. The lump is getting bigger day by day. Now the lump are accompanied with bleeding ulcer. the patient has a history of FNAB but the patient refuse chemotherapy.08.5.o/ 1. And the patient complaint shortness of breath.13. Mrs.15 a.m • Chief Complain : lumb in the breast • History: since one year before admission the patient complained of a lump in the left breast. .16 6th December 2014/ 01.

Physical Examination • Conciousness : Compos Mentis • Vital sign : • BP = 110/80 mmHg • PR = 92 bpm • RR = 24 bpm • T = 36.5ºC .

no parese . no retraction. Liver/spleen/kidney not palpable. no wheezing Abdomen • I : Inguinal lymph nodes enlargment (-) • A : Bowel sound (+) • P : soeple. no rhonchi. Lump (+) left breast. • P : Symmetric VF • P : Sonor at all lung fields • A : Symmetric VBS. tenderness (-). no oedema. • P : Tymphani Extremities • Warm. mass not palpable. JVP enhancement (-) Chest • I : Symmetric respiratory movement. • Nose : No epistaxis • Mouth : Wet mucosa • Neck : Lymph nodes enlargement (-).Physical Examination Head/Neck • Eyes : anemic conjunctiva. icteric sclera (-).

Clinical Picture – Local Status .

.

9 vol% • Trombocyte 576000/µl • Eritrocyte 2720000/ul .Laboratory • Hb 7.6 g/dl • Leucocyte 13400 /µl • Hematocrit 24.

Working Diagnosis Left breast cancer T4dN3M1 lung metastase + Anemia With Karnofsky 50 .

Management ConsuO l ncoolgydept IVFDRL:D5manitenance Anbtioicti H2Bolcker Anaglesci Dressnigoncenitwodays Transf.PRCHb≥10 ProChemohterapy .