EMERGENCY SURGICAL SERVICES

Wednesday, October 2nd 2019

Consultant On Site :
dr. M. Ridho Nur Hidayah, Sp.OT

The Attending Doctor :

Chief : dr. Danny Tarigan
Pra Chief : dr. Yogi Mahery
Captain : dr. Sylvia
P1 : dr. Allen
P2 : dr. Maleakhi
Ward : dr. Ivan
dr. Nipolin
dr. Tafdhil
Traumatic patient : 1 patient
Non traumatic patient : 2 patient
Total : 3 patient
 TRAUMA CASES (1)

1. Ema Triandini/ ♀/ 23 Years Old

Dx. Closed segmented fracture of left femur bone + Closed fracture of
middle third tibia bone comminutive displaced + Closed fracture of
proximal third fibula bone oblique displaced
 NON TRAUMA CASES (2)

1. Septian Dimas Alexandra/ ♂ / 10 Days Old

Dx. Bowel obstruction due to susp. Meconeum plug syndrome DD/
Hirschsprung’s disease + Sepsis

2. Bambang Irawan/ ♂ / 38 Years Old

Working Diagnosis : Decreasing consciousness
Topic Diagnosis : Intracerebral + Sub arachnoid
Etiology Diagnosis : CVD hemorraghic
Additional Diagnosis : Hemipharese dextra + Hypertension
TRAUMA CASES
1. Ema Triandini/ ♀/ 23 Years Old
Admitted on Wednesday, October 2th 2019 at 17.10 PM

ALLOANAMNESIS
Pain and difficulty to move her left leg
Her left leg struck down by tree when driving motorcycle.
Her motorcycle fall down and his left leg hit the hard thing.
(± 30 hours before admission )
(Referred from Ibnu Sutowo Hospital Baturaja)

PRIMARY SURVEY
A. Clear
B. RR : 20 x/min
C. BP : 110/70
PR : 82 x/min
D. GCS : E4M6V5 : 15, Pupil Isochor, Light Reflex +/+
VAS : 4
SECONDARY SURVEY

Left femur region :

I : Deformity (+)
P: NVD was good,
Active and passive ROM was limited

Left cruris region :

I : Deformity (+)
P: NVD was good,
Active and passive ROM was limited
RADIOLOGY FINDING
Left Femur X-Ray AP/ Lat (M. Hoesin Hospital, October 2nd2019)
Segmented fracture of left femur bone
RADIOLOGY FINDING
Left Cruris X-Ray AP/ Lat (M. Hoesin Hospital, October 2nd2019)
fracture of tibia bone middle third comminutive displaced
fracture of fibula bone proximal third oblique displaced
LABORATORY FINDING
Hb : 9,1 gr/dl (12-16 gr/dl)
Ht : 27 vol % ( 40-48vol%)

DIAGNOSIS
Closed segmented fracture of left femur bone + Closed fracture of
middle third tibia bone comminutive displaced + Closed fracture of
proximal third fibula bone oblique displaced

MANAGEMENT
- IVFD RL gtt XXV /m (Fluid demand 1800 cc/24 hour)
- Ceftriaxone 1 g/12 hours IV
- Ketorolac 30 mg/8 hours IV
- Immobilisasi backslab
- Pro ORIF elective

Patient was treated in the ward

POST BACK SLAB
NON TRAUMA CASES
1. Septian Dimas Alexandra/ ♂ / 10 Days Old
Admitted on Wednesday, October 2nd 2019 at 07:20 AM

ANAMNESIS (alloanamnesis)
Abdominal distended
± 1 week before admission, patient’s mother said her baby’s abdomen
was distended, vomit(+), fever (-).
Spontantaneus delivery helped by midwife.
History of late meconium (+), defecation (+) 2 days after delivery.
Birth weight 2.800 gr.
(Consult from Pediatric Departement)

VITAL SIGN
Sens : hypoactive
HR : 148 x/min
RR : 64 x/min
T : 36,8°C
PHYSICAL EXAMINATION

Abdomen Region
I: distended (+)
P: soft
P: tympani
A: bowel sound (+)

NGT: Greenish fluid

DRE : Projectile defecation (+)

Pale Meconium (+)
RADIOLOGY FINDING
2 Position Abdominal X Ray (RSUD Sobirin, Sept 26th 2019)
Bowel distention (+)
Air fluid level (+)
Free air (-)
Herring bone (-)
LABORATORY FINDING (RSMH, October 2nd 2019)
Hb : 12,0 gr/dl (12-16 gr/dl)
Ht : 33 vol % ( 40-48vol%)
Leukosit : 6000 /mm3 (5000-10000/mm3)
Trombosit : 3000 /mm3 (150.000-450.000/mm3)
Diff. Count : 0/0/44/46/7
Natrium : 133 mEq/L (135-155 mEq/L)
Kalium : 2,8 mEq/L (3.5-5.5 mEq/L)
CRP : 79 (< 5)
DIAGNOSIS
Bowel obstruction due to susp. Meconeum plug syndrome DD/
Hirschsprung’s disease + Hipokalemia + Sepsis

THERAPY:
 IVFD D10 1/5 NS 280 cc/ 24 hours
 Ampicillin 70 mg/ 6 hours IV
 Metronidazole 45 mg/ 12 hours IV
 Ceftazidime 140 mg/8 hours IV
 Hipokalemia correction
 Rectal wash out
 Pro Abdominal X Ray AP/ True Lateral

Patient was treated in NICU

Post Rectal Wash Out
2. Bambang Irawan/ ♂ / 38 Years Old
Admitted on Wednesday, October 2nd 2019 at 17.50 PM

ANAMNESIS
Decreasing of consciousness
± 20 days before admission, patient decreassing of consciousness
slowly. History of pain on head (-), nausea (-), vomite (-), weakness of
right extremity (+), history of trauma (-),
history hipertension (+) since 2 years ago uncontrolled.
history of hospitalized in RSMH 1 months ago dx. ICH and IVH 
conservative.
(Consult from neurologic departement)

VITAL SIGN
Sens : GCS E3 M5 VT :8T
TD : 160/100 mmHg
N : 96 x/mnt
RR : 18 x/mnt
T : 36,4 °C
Sp.O2 : 98%
PHYSICAL EXAMINATION

Head Region
I : Hematom (-)
P : Step off (-)
RADIOLOGY FINDING
Head Ct Scan (RSUD Sekayu, 30-9-2019)
ICH + SAH
LABORATORY FINDING
Hb : 16,5 gr/dl (12-16 gr/dl)
Ht : 46 vol % ( 40-48vol%)
Leukosit : 17.910 /mm3 (5000-10000/mm3)
Trombosit : 139.000/mm3 (150.000-450.000/mm3)
Ureum : 32 mg/dL (16.6-48.5 mg/dL)
Kreatinin : 0,48 mg/dL (0.70-1.20 mg/dL)
Natrium : 140 mEq/L (135-155 mEq/L)
Kalium : 3,6 mEq/L (3.5-5.5 mEq/L)
DIAGNOSIS
Working Diagnosis : Decreasing consciousness
Topic Diagnosis : Intracerebral + Sub arachnoid
Etiology Diagnosis : CVD hemorraghic
Additional Diagnosis : Hypertension

THERAPY:
 Head up 30°
 IVFD NaCl 0,9% gtt XXV/min (Fluid demand 1800 cc/24 hour)
 Inj Ceftriaxone 2gr/24 hours
 Inj Tramadol 100mg/12 hours
 Pro Craniectomy Decompression emergency

Patient was treated in the P1

INTRA OPERATIF
 We find the duramater is tense
 We do duroplasty
 Cranium put into abdomen

Patient was treated in P1

WARD REPORT
1. Rojali bin Rianto/ ♂ / 32 Years Old
Admitted on Wednesday, October 2nd 2019 at 01.43 AM
PREOPERATIF DIAGNOSIS
Closed Mild traumatic brain injury GCS 15 + EDH of right frontal region

INTRA OPERATIF
 We do 3 burrhole, continued with craniotomy
 We found clot 15 cc and we do clot evacuation

POST OPERATIF DIAGNOSIS

EDH of right frontal region

Patient was treated in the ward

2. By. Yoga Alpian/ ♂ / 3 Month Old
Admitted on Wednesday, September 25th 2019 at 22.05 PM
PREOPERATIF DIAGNOSIS
Stenosis Duodenum part I

INTRA OPERATIF
 In cavum peritoneum we found gaster - duodenum part I distended
 We found stenosis between duodenum part I and part II
 We do anastomosis duodeno-duodenal side to side with diamond shape
incision

POST OPERATIF DIAGNOSIS

Stenosis duodenum part I

Patient was treated in PICU

3. Mgs. Usman Said/ ♂ / 76 Years Old
Admitted on Monday, Sept 30th 2019 at 13.02 AM
PREOPERATIF DIAGNOSIS
SDH of right temporoparietal lobes

INTRA OPERATIF
 We do 1 burrhole,
 We find blood lysis ± 30 cc
 We insert cateter Foley no.18 F

POST OPERATIF DIAGNOSIS

SDH of right temporoparietal lobes

Patient was treated in the ICU

THANK YOU