RESIDENTS OF PEDIATRIC SURGERY

ACTIVITIES

Emergency Department
September 2nd 2021
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No Identity Assessment before surgery POD Treatment ICD Assessment after surgery ICD Team
IX X
1 Hal, M, 11 y.o, Local peritonitis ec perforated POD 2 Laparotomy appendectomy, simple Local peritonitis ec perforated
01985364 appendicitis appendicitis NIN
sutured colon ascenden (31/8/21) DEW
MTA
Thank you
 Hal, M, 11 y.o, 01985364
Chief complaint: abdominal pain

Current medical history:

3 days before admission, patient complained abdominal pain, initially in the umbilical area, intermittent, nausea and vomiting was present, but no fever.
Within 8 hours the pain migrated to the right lower quadrant, continuous, fever (+), nausea (+) anorexia (+) vomiting (+) with food contents, no urinary
symptoms were present.
2 days before admission, the abdominal pain worsened in severity, fever (+), but no nausea and vomiting. The patient was treated symptomatically with
paracetamol and ranitidine in the midwives.
1 days before admission, patients still complained of abdominal pain, no fever, nausea and vomiting. And then go to paramedic, treated with PCT,
sucralfat and omeprazole  but no improvement
The day of admission, patient brought to the Pediatrician in Pacitan and suspected appendicitis - > referred
to Pacitan Hospital for surgery, but his parents directly brought to RSUP DR.SARDJITO
In the emergency room, patient complained of abdominal pain In the right lower quadrant (+) no fever, no nausea and vomiting, defecation (-) 4 days,
flatus (+)

No history of previous surgery

Conclussions : male, 11 years old, with abdominal pain in the right lower quadrant, history of fever, nausea and vomiting (+)
 Hal, M, 11 y.o, 01985364
Physical examination:

Consciousness: Compos Mentis, VAS: 6

VS: HR: 98 bpm, RR: 22 x/m, Temp: 36.9C, SpO2: 98% Room Air
BW : 25kg

Abdominal Status:
I: not distended, abdominal circumference : 54cm
A : peristaltic (+) 8x/min
P: defans muscular at RLQ
P: tymphany

Rovsing sign (+) Obturator sign (+) Psoas sign (-)

Hal, M, 11 y.o, 01985364
 Hal, M, 11 y.o, 01985364
Laboratory Sep 31th 2021
 Hal, M, 11 y.o, 01985364
Ro Thorax Aug 31st 2021
Hal, M, 11 y.o, 01985364
Diagnostic
Local peritonitis ec suspect perforated appendicitis

Plan
Pro laparotomy Appendectomy CITO
Monitoring of general condition/ vital sign/acute abdomen
Fasting
IVFD D5 ½ NS 67cc/hour
Inj Cefotaxim 1gr/8 hours
inj Metronidazole 250mg/8 hours
inj Paracetamol 250mg/8 hours
inform consent
pre operative antigen swab
rontgen thorax
 Hal, M, 11 y.o, 01985364
Laparotomi appendectomy, simple
sutured colon ascenden (31/8/21)
Hal, M, 11 y.o, 01985364
Diagnostic
Local peritonitis ec perforated appendicitis

Plan
Monitoring of general condition/ vital sign/acute abdomen
Early feeding
IVFD D5 ½ NS 72cc/hour
Inj Cefotaxim 1gr/8 hours
inj Metronidazole 250mg/8 hours
inj Paracetamol 250mg/8 hours
Thank you