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Ambulation : patient
Hospitalized
: 4 patients
Observation : 1 patient
Operated : 3 patient
Death : patient
Total : 4 patients
Mechanism of : The patient was drunk with his friends and suddenly they
injury were fighting. He got stab by his friend
Primary Survey
A: Clear
Abdomen:
I : Seen Flat, seen scar post laparotomy, skin
colour same with vicinity, darm countour (-),
darm steifung (-)
A : Peristaltic (+)
P: Tenderness (-), Defans (-)
P : Tympani
Secondary Survey
Left Suprascapula Region :
I : Seen stabbed wound size 5x2 cm,edema (-),
hematoma (-), active bleeding (-)
P: Tenderness (+), crepitation (-)
CT / BT : 8‘00” / 2’00”
Ureum : 18mg/dl
Creatinin : 0,8 mg/dl
GOT / GPT : 24 / 29 μ/L
Chest X-Ray
USG
Abdomen CT scan
WORKING DIAGNOSE. : • Generalized Peritonitis ec susp hollow
viscus perforation ec v.ictum penetrans
• Laceration of the right kidney
MANAGEMENT • Medicaments
• Report to Senior Digestif surgeon,
advice : Laparotomy exploration
Consult to senior urology surgeon, advice:
Laparotomi exploration
Operating Procedure
1. Patient laid supine under GA
2. Asepsis and draping procedure
3. Perform midline incision and deepen shark and
blunt
4. Open the peritoneum, seen blood 500cc, the
evacuate the blood
5. Identification the retroperitoneal organ
6. Seen perirenal hematoma, evacuate hematoma.
Seen lacerate on the right kidney grade IIIA,
decided to do renoraphi
7. Control the bleeding
7. Stitch wound layer by layer
8. Done
WORKING POST : Generalized Peritonitis due to v.ictum
DIAGNOSIS penetrans
Gastric perforation of pyloric
Ascenden colon perforation
Laceration of the kidney gr. III
PROGNOSIS : Fair
FOLLOW UP Vital Sign
Acute Abdomen
Fluid Balance
No. 2
Name : Mr. I.P Sex : Male
Age : 15 years old No. Reg : 653391
Primary Survey
A: Clear
E: T (ax) : 36,8 oC
Secondary Survey
Left Auricula :
I : Seen bloody otorrhea, hematoma (-)
P: Tenderness (+), crepitation (-)
Right Shoulder :
I : Seen hematoma size 8x7cm,
edema (+)
P: Tenderness(+), crepitation(-), thrill (-)
Laboratory Result
WBC : 28,5 x 103 / μL
RBC : 3,47 x 106 / μL
HGB : 10 g/dL
HCT : 30,8 %
CT / BT : 6’00” / 2’00”
Ureum : 30 mg/dl
Creatinin : 0,8 mg/dl
GOT / GPT : 55 / 28 μ/L
Head CT Scan
Thorax x-ray
WORKING : Moderate Head injury GCS 12 (E3M5V4)
DIAGNOSIS EDH at Left Temporal
: O2
IVFD
Medicaments
Report to senior neurosurgeon
advice : Craniectomy
Operating Procedure
1. Patient laid supine under GA
2. Disinfectant and draping procedure
3. Perform horse shoe incision, depend until
periosteum
4. Perform 3 burr hole, continue craniotomy with
giggly saw, continue with hang Dura
5. Seen hematoma 20cc, evacuate hematoma,
control the bleeding
6. Clean the wound
7. Stitch wound layer by layer with 1 vacum drain
8. Done
WORKING POST : Moderate Head injury GCS 12 (E3M5V4)
DIAGNOSIS EDH at Left Temporal
PROGNOSIS : Good
History taking : The condition had been apparent since 9 hours before
admitted to the hospital due to traffic accident. There
were no history of vomiting, unconsciousness and
seizure. Prior medical care at Soppeng hospital.
E: T (ax) : 36,2oC
Secondary Survey
Right Zygoma Maxila Region :
I : Seen edema (+), hematoma (+)
P : Tenderness (+), crepitating (+)
Mandibula Region :
I : deformities (+), hematoma (+)
P : Tenderness (+), crepitating (+)
Lateral Nasal Region :
I : Deformitas (+), hematoma (-)
P : Tenderness (+), crepitating (-)
Laboratory Result
WBC : 19,2 x 103 / μL
HCT : 33,3 %
CT / BT : 6‘00” / 3’00”
Ureum : 30 mg/dl
MANAGEMENT : O2
IVFD
Medicaments
Report to senior plastic surgeon
advice : Plan for ORIF
Operation Procedure
• Patient laid supine under GA
• Disinfection and draping procedure
• Perform submucosal incision, seen fracture of parasimphysis
mandible fixation with miniplate 4 hole and 4 screw
• Perform right and left subcilier incision, deepen until osteum,
seen line fracture at zygoma fixation with miniplate 3 hole
and 3 screw
• Perform reposition nasal fracture and insert 1 sheet silicon.
• Insert 1 right nasal tampon
• Stitch operation wound layer by layer
• Done
POST OP : Maxilofacial Injury
DIAGNOSIS Multiple Panfacial Fracture
PROGNOSIS : GOOD
Vital sign
FOLLOW UP Wound healing
No.
Name : Mrs. J Sex : Female
Age : 24 years old No. Reg : 653449
History taking : The condition had been apparent since 6 hours before
admitted to the hospital due to traffic accident. There
were no history of vomiting and seizure. Prior medical
Maros hospital.
CT / BT : 7’00” / 3’00”
Ureum : 22 mg/dl
Creatinin : 0,7 mg/dl
GOT / GPT : 117 / 132 μ/L
Head CT Scan
Thorax X-Ray
WORKING : Moderate Head injury GCS 11 (E3M5V3)
DIAGNOSIS Linear Fracture at Left Frontal bone
ICH at right temporal region
MANAGEMENT : O2
IVFD
Medicaments
Report to senior neurosurgeon
advice : Conservative + Wound Care
Makalah III
(Nasional)
Makalah Akhir
• DSTC
• Perioperatif Semester IX
Semester X
• Panutan
• Santun
• Jujur
• Empati