EMERGENCY CASE REPORTS

Saturday, June 8th 2019

SURGERY DEPARTMENT

EMERGENCY ROOM
Wahidin Sudirohusodo General Hospital
Makassar
EMERGENCY CASE REPORT
Saturday, June 8th 2019
Ambulation : 3 Patients
Hospitalized
: 2 Patients

Observation : - Patient
Operated : - Patient
Death : - Patient
Total : 5 Patients

Wahidin Sudirohusodo General Hospital

Makassar
 Name : Inf. Mrs. RT Age : 25 days (M)
RM : 885071 DPJP : dr. AW
e

Chief complain : Abdominal distended

History taking : This condition had been suffered since 3 days before admitted to the
hospital. There was history of bilious vomiting since 3 days ago. There was
no history of fever.
There was no history of diarrhea. There was no history of bloody defecation
There was history of delayed passage of first fecal matter (at the 3rd day of
birth). There was no history of the same complain before.
The patient is the first child of P1A0 mother, normal birth delivery which is
helped by a doctor at 38 weeks' gestation with a 3000 gr of birth body
weight. There was no history of taking medicine during pregnancy. Ante
natal care during pregnancy by a midwife routinely. Prior medical care was
Luwuk Banggai Hospital
Micturation : Normally

Defecation : There was history of constipation after the first fecal matter was passaged
 PHYSICAL EXAMINATION
• GENERAL STATUS
Passive/well nourished/conscious
Weight 2770 gr, Height 49 cm

• VITAL SIGN
– HR : 146 bpm, regular, adequate.
– RR: 42 x/mnt, spontaneous, symmetric adequate
chest movement, thoracoabdominal type.
– T (ax) : 36,8°C
 PHYSICAL EXAMINATION
Head:
Flat anterior fontanel, Conjungtiva was not anemic,
sclera was not icteric, wet mouth dan lip mucous

Chest:
Symmetrical shape and movement, equal vesicular
breath sound, Rhonchi (-), Wheezing (-), regular breath
sound, Murmur (-)
PHYSICAL EXAMINATION

Abdomen :
I : Seen convex, bowel contour (+)
and bowel motion (-), skin color is
same with its vicinity.
A : Peristaltic (+) sound normal,
metallic sound (-)
P : Distended
P : hypertympani (+)
Genitoanal region :
I : Uncircumsised Penis, Scrotal
Edema (-), Anus (+)
P : There were 2 testicle with normal
size and consitency

Rectal Toucher
Anal Sphincter : tight, explosive feces (+)
Handscoen : meconium (+), blood (-), slime (-)
 Clinical Diagnosis
• Intestinal Obstruction due to suspicious
Hirschsprung Disease
DD/ Meconium Ileus
• Mild Dehidration
Plain Abdominal Radiograph
Plain Abdominal Radiograph
 Laboratory findings
• Hb : 16,3  GDS : 78
• Hct : 48  Na : 137
• WBC : 12,2 K : 4,9
• PLT : 368  Cl : 111
 SGOT : 28
 SGPT : 5
 Ur : 31
 Cr : 0,43
WORKING : • Intestinal Obstruction due to suspicious
Hirschsprung Disease DD/ Meconium Ileus
DIAGNOSIS • Mild Dehidration

MANAGEMENT : • IVFD 443 cc/hr

Maintenance 277 cc/hr
Rehidration 6%xBWx 1000 cc = 166 cc/hr
1st 6 hr = ½ M + ¼ D = 138.5 + 41.5 = 180 cc
2nd 18 hr = ½ M + ¾ D = 138.5 + 124.5 = 263 cc

• Medicament
• Applied OGT
• Applied Urinary catheter
• Rectal Washout (20 cc/kgBW)
• Prevent hypothermia
• Consult to pediatric
• Planning for Barium Enema
• Planning for Full Thickness Rectal Biopsy
 Rectal Washout

Before After
THANK YOU
Differential Diagnose
Diagnostic Scheme Hirschsprung
 Name : Mr. M Age : 46 years
RM : 885085 DPJP : dr. JR

Chief complain : Pain on the right foot

History taking : The condition has been apparent 14 days before admitted
to the hospital. The pain a with wound and swollen in the
leg. Initially, the foot is punctured by a nail, and eventually
wound are widened, redness, and followed by swelling.
History of Diabetes Mellitus since 10 years, taking oral
anti-hyperglycemic and insulin injection but not regularly.
History of debridement surgery 4 days ago at Polewali
Hospital. History of drinking alcohol is present.

Micturation :: Normal
Defecation Normal
General Status
Moderate illness / well nourish / conscious

Vital Sign
BP : 126/84 mmHg
PR : 90 x/mnt, strong, reguler,
RR : 20 x/mnt, symmetric L= R,
thoracoabdominal type.
T : 36,6 °C
PHYSICAL EXAMINATION
Right Foot Region :
I : Necrotic wound at
digiti II, Erythema ½ distal
right foot, edema (+)
P : warm, no palpable
mass
Saturation:
Digiti I : 90%
Digiti II : 0%
Digiti III : 100%
Digiti IV : 0%
Digiti V : 67%
• Palpation of artery:
- A. Femoralis (+)
- A. Popliteal (+)
- A. Tibialis Anterior (+)
- A. Tibialis Posterior (+)
- A. Dorsalis Pedis (-)
PHYSICAL EXAMINATION
Left Foot Region :
I : Necrotic wound (-),
Erythema (+), edema (+)
P : cold, no palpable
mass, paresthesia (-)
Saturation:
Digiti I : 96%
Digiti II : 98%
Digiti III : 99%
Digiti IV : 98%
Digiti V : 99%
• Palpation of artery:
- A. Femoralis (++)
- A. Popliteal (+)
- A. Tibialis Anterior (+)
- A. Tibialis Posterior (+)
- A. Dorsalis Pedis (+)
 Clinical Diagnosis
• Peripheral Arterial Disease
• Wagner 3-4 Diabetic Foot Ulcer
Foot X-ray
Thorax X Ray
 Laboratory findings :
• Hb : 10,0  PT : 12,7
• Hct : 30  INR : 1,24
• WBC : 42,4  APTT : 43,3
 PLT : 418  Na : 127
 SGOT : 9  K : 4,2
 SGPT : 9  Cl : 101
 Ur : 176
 Cr : 1,21
 GDS : 483
WORKING : • Peripheral Arterial Disease
DIAGNOSIS • Wagner 3-4 Diabetic Foot Ulcer

MANAGEMENT : • IVFD
• Medicaments
• Consult to Metabolic Endocrine

PLAN : • Debridement and amputation

THANK YOU
Ankle Brachial Index (ABI)