SELAMA CC BERLANGSUNG

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NO GADGET NO FOOD & DRINK

 Visi Program Studi
Ilmu Bedah
• Menjadi Program studi dokter spesialis ilmu
bedah bereputasi International,
BEDA menghasilkan lulusan profesional, unggul di
bidang penanganan multiple trauma dan
H kanker lini pertama
 Misi Program Studi Ilmu Bedah

Menyelenggarakan pendidikan Berkualitas, berdasarkan

kurikulum KIBI dengan memberikan keunggulan pada
penanganan multiple trauma dan kanker lini pertama

BEDA Mengembangkan Penelitian dan pengabdian di bidang Ilmu

Bedah khususnya penanganan multiple trauma dan kanker
lini pertama
H
Menyelenggarakan tata kelola program studi Berbasis Good
University Governance, menuju institusi bereputasi
Internasional
 LAPORAN JAGA
Hari Senin, 8 Mei 2020

Chief : dr. Andi Muhammad Reva. A

Jaga 3 : dr. Putra (GAN), dr. Uray (YES)
Jaga IGD Shift I : dr. Ikhdin (IHI), dr. Siwi (SIW)
Shift II dr. Linda (JNA), dr. Meily
(MEL)
Jaga IPI / Bangsal : dr. Fahmi (FUD)
 REKAP KUNJUNGAN IGD

Rawat Inap
No Identitas Diagnosa Tindakan
1. Mr. M
Generalized Peritonitis due to IVFD RL 20 dpm
69 y.o
01503734 gaster perforation Ampicillin inj 1gr/8 hr
(ICD X K65) Metronidazole inj 500mg/8 hr
Gentamycin inj 80 mg/12 hr
Metamizole inj. 1 gr /8 hr
Ranitidin inj. 50 mg/12 hr
Blood examination
Chest X-Ray,

Digestive Surgery
Emergency Laparotomy +
Graham Patch Procedure
Rawat Inap
REKAP KUNJUNGAN IGD

No Identitas Diagnosa Tindakan

2. Mild brain injury GCS E4V5M6 02 3 lpm
Mr. A
(ICD X S06.2) Head up 30º
19 y.o Cerebral edema IVFD NaCl 0.9% 20 dpm
(ICD X G93.6) Metamizole IV 1 g/8 h
01503743
Fractures of : Ranitidin 50mg/12 h
Right Zygoma Arch Blood examination
AO 920.m1 (ICD X S02.402B) Head Ap and Waters X-ray, Chest X-
Right Inferior orbital rim ray
A0 921.M1 (ICD X S02.33) Head CT Scan + 3D
Right & Left Maxilla
AO 920.m1 (ICD X S02.401A) Plastic surgery
Left Upper Palpebra Sutured Clear liquid
Wound (ICD X S053.1313) Oral hygiene
Frontal Sutured Wound Elective ORIF
Repair vulnus
(ICD X S01.21XA)
Upper Labium oris Sutured Wound Neurosurgery
Conservative treatment
(ICD X S01.512A) Observation of VS/GCS/lateralization
Left Wrist Excoriation Wound

(ICD X S40.9 )
Left Leg Excoriation Wound

(ICD X S80.9 )
 Rawat Jalan
No Identitas Diagnosis Keterangan

1 Tn. M Cedera Kepala Asam Mefenamat 3 x 500mg

24 th Rawat jalan dengan Edukasi
01503747

Pavilliun
No Identitas Diagnosis Keterangan
- - - -

Konsulan
No Identitas Diagnosis Tindakan

- - - -
Meninggal

No Identitas Diagnosis Keterangan

APS
No Identitas Diagnosis Keterangan
- - - -
Name : Mr. M
Age : 69 y.o
MR No : 01503734
PM : National Health Insurance
Chief complaint :
Pain on the whole abdomen region

Present illness :
Three days prior to the admission, the patient complained about
sudden continuous pain that start in the epigastric area with
nausea. The pain move over to the whole abdomen in several
hours, no vomiting and fever. Last defecation was the day before.
Micturition was normal. By his family, he was brought to
Gemolong hospital, got 3position abdomen Xray, NGT and DC.
Due to reques byt his family he was taken to Dr. Moewardi
Hospital

Past illness :
Routine analgetic drugs consumption since 5 years ago
Screening Covid19
Fever (-)
Cough (-)
Cold (-)
Short breath (-)
Traveling out the
city or country (-)

EWS Score : 2
 Physical Examinations

Vital Sign :
BP : 110/70 mmHg Pulse : 92 x/mnt
RR : 20 x/mnt Temp. : 36,8°C
Head : No abnormality
Eyes : No abnormality
Nose : NGT Inserted 16 Fr, 50 cc product, clear
Mouth : No abnormality
Ear : No abnormality
Neck : No abnormality
Chest : No abnormality
Abdomen : look at localized physical examination
Genitalia : DC Inserted 16 Fr 60cc/hour product, yellowish
 Localize Status
Abdomen :
I : Distended (+)
A : Bowel sound (+) decreased
P : Involuntary muscle rigidity (+)
P : Hypertymphanic (+), Liver dullness (-)

Direct Rectal Examination :

Normal anal sphincter muscle tone, normal ampoule, smooth muccosa, no
mass, pain (+) all toucher field, blood and mucous (-), faeces (+)
1st Assessment :
Generalized Peritonitis due to suspicious of gaster perforation
(ICD X K25.1)

1st Plan :
IVFD RL 20 dpm
Ampicillin inj 1gr/8 hr
Metronidazole inj 500mg/8 hr
Gentamycin inj 80 mg/12 hr
Metamizole inj. 1 gr /8 hr
Ranitidin inj. 50 mg/12 hr
Blood examination
Chest X-Ray,
2nd Assessment :
Generalized Peritonitis due to gaster perforation (ICD X K25.1)

2nd Plan :
Digestive Surgery
Emergency Laparotomy Graham Patch Procedure
 OPERATION REPORT
Mr. M, 69 y.o, 01121950
Pre operative diagnosis : Generalized Peritonitis due to susp gaster perforation
Post operative diagnosis : Generalized Peritonitis due to gaster perforation (Pylorus)
Operation procedure : Laparotomy Graham patch Procedure + PA examination +
microbiology examination
Team : GAN/IHI/ARV/ dr. Agus Rahardjo, Sp.B(K)BD

• Patient supine under general anesthesia, desinfection and drapped the abdomen.
• Performed midline incision 12 cm length from processus xyphiodeus to suprapubic,
continue the dissection deeper layer by layer until the peritoneum.
• Peritoneal cavity opened, air and fluid encountered +/- 70 cc, yellow fluid  culture
• Explore the cavum abdomen, Gaster was identified with single perforation (+) at the
pylorus, Ǿ 1cm  refreshening at the edge perforation  send to PA
• Performed Graham patch procedure; place the omentum above the hole, sutured
with multifilamen non absorbable no. 1
• Explore the intestinal system until ileocecal junction, mass (-), colon ascenden until
rectum no abnormlity
• Cleaned the peritoneal cavity with normal saline
• Inserted pelvical drain with NGT no.18 F
• Peritoneum and fascia was sutured with multifilamen absorbable no. 0 continous
• Subcutis was sutured with multifilamen absorbable 2.0 simple interrupted
• Cutis was sutured with multifilamen non absorbable 2.0 simple interrupted
• Operation accomplished.
 Arrival time 18.10
Triage time 18.15
Surgery time 18.20
Laboratory time 18.30 - 19.30
Radiology time 18.30 – 19.30
Diagnose time 19.40
Surgery time 21.30 – 23.45
Inward 00.10
NAME : Mr. A
AGE : 19 y.o
MR : 01503743
ADM : National Health insurance
Chief Complaint :
Persistent headache after MVA

Present Illness :
Five days prior to admission, when the patient was riding a
motorcycle using a standard helmet, suddenly he was slipped out
when avoid people whose crossing the street in the middle of the
rain. He fell in unknown position, after the accident he complained of
headache and pain on his face, unconciuss (+), vomit (+) 1 time,
seizure (-). By the helper he was taken to Gemolong Hospital, and
got stiched on his wound. Due to family request he was refered to dr.
Moewardi Hospital
Screening Covid19
Fever (-)
Cough (-)
Cold (-)
Short breath (-)
Traveling out the city or
country (-)

Score : 1
 Primary Survey

A : Clear

B : I : equal chest expansion, RR : 20 x/min

P : Crepitation (-/-)
P : sonor/sonor

A : Vesicular sound (+/+), Additional sound (-/-)

C : BP : 112/72 mmHg, HR : 64x/min

D : GCS E4V5M6, isocoric pupils (3mm/3mm), Light reflexes (+ /+),

lateralization (-)
E : t : 36.7°C, Lesion (+) check on localize status
 Secondary Survey
Head : Hecting wound at upper palpebra of left orbitawith silk 3.0, 2 knots.

Excoriation wound at Frontal region with size 4x3cm.

Eye : Periorbital Hematoma (-/-), visus ODS >2/60, Normal eyeball
movement, interchantal distance 3cm, equal pupil width 3mm/3mm,
light reflexes (+/+).
Nose : no abnormality
Ear : tragus pain (-/-)
Mouth : Hecting wound at lower labia oris with silk 3.0, 1 knot.
Face : see on localize status
Neck : no abnormality
Chest : no abnormality
Abdomen : no abnormality
Genitalia : no abnormality
Extremity : Excoriation wound at Left Wrist Region with size 7x2cm, and at
Left Leg Region with size 20x10cm.
 Localize Status
Midfacial Region:
I : Swelling (-/-), malar flattening (+/-), Excoriation
wound at left midfacial region, size 3x1cm
P : Infraorbital nerve hipoesthesia (+/-)

Intraoral Region:
I : Malocclusion (+) open bite, trismus (-), mucoginggival laceration (+)
between right upper 2nd incisivus and 1st caninus, broken teeth (+) at
right upper 1st,2nd incisivus and caninus , missing tooth (+) at left upper
1st incisivus
P: Unstable maxilla (-), moving teeth (-)
1st Assesment :
Mild brain injury GCS E4V5M6
Fracture of Right & Left Maxilla AO 920.m1
Left Upper Palpebra Sutured Wound
Frontal Sutured Wound
Upper Labium oris Sutured Wound
Left Wrist Excoriation Wound
Left Leg Excoriation Wound

1st PLAN :
02 3 lpm
Head up 30º
IVFD NaCl 0.9% 20 dpm
Metamizole IV 1 g/8 h
Ranitidin 50mg/12 h
Blood examination
Head Ap and Waters X-ray, Chest X-ray
Head CT Scan + 3D
2nd Assesment :
Mild brain injury GCS E4V5M6 (ICD X S06.2)
Cerebral edema (ICD X G93.6)
Fractures of :
Right Zygoma Arch AO 920.m1 (ICD X S02.402B)
Right Inferior orbital rim A0 921.M1 (ICD X S02.33)
Right & Left Maxilla AO 920.m1 (ICD X S02.401A)
Left Upper Palpebra Sutured Wound (ICD X S053.1313)
Frontal Sutured Wound (ICD X S01.21XA)
Upper Labium oris Sutured Wound (ICD X S01.512A)
Left Wrist Excoriation Wound (ICD X S40.9 )
Left Leg Excoriation Wound (ICD X S80.9 )

2nd PLAN :
Neurosurgery
Plastic surgery
Conservative treatment
Observation of VS/GCS/lateralization Clear liquid
Oral hygiene
Elective ORIF
Repair vulnus
 Arrival 10.35
Triage 10.40
Surgery 11.00
Radiology 11.20 – 12.35
Laboratory 11.45 – 12.45
Diagnose 13.00
Inward 13.30
THANK YOU