EMERGENCY CASE REPORTS

Wednesday, July 19th 2023

SURGICAL DEPARTEMENT

E M E R G E N C Y D E PA RT M E N T
Wa h i d i n S u d i r o h u s o d o G e n e r a l H o s p i t a l
Makassar
EMERGENCY CASE REPORT
Wednesday, July 19th 2023
OUTPATIENT : 0 Patient
INPATIENR : 0 Patients
OBSERVATION : 0 Patient
OPERATION : 3 Patient
MORTALITY : 0 Patient
Total : 11 Patients
Wahidin Sudirohusodo Hospital
Makassar
 NEW PATIENTS DATA
SURGICAL EMERGENCY ROOM RSUP dr. WAHIDIN SUDIROHUSODO
Wednesday, July 19th, 2023
N Nama Umu JK No. RM Nama DPJP Diagnosis
o. r
1. Ny. Sahria 63 P 1030541 dr. DJF Nodul Tiroid bilateral suspek malignancy CT4N1M0, karnofsky 60% +
Dyspneu
2. Tn. Syamsuddin 72 L 951025 dr. WH Melanoma Maligna pedis sinistra cTxN2M1 paru + multiple
Supu lymphadenopathy inguinal sinistra + dyspneu et causa pneumonia
3. Tn. Mail Rahim 37 L 1009368 dr.WS Adenocarcinoma colon cT3N1M0 on kemoterapi + general Weakness post
kemoterapi
4. Tn. Masire 59 L 1032512 dr. NA Open Pneumothoraks dextra ec vulnus ictum penetrans regio sternal +
fraktur Sternocostal V
5. Tn. Muliadi 31 L 1032517 dr. IL Tumor colon descendens suspek malignancy cT3N0M0, karnofsky 70% +
Abdominal pain
6. Andhika agung 20 L 1032536 dr.KK & dr.JR Anterior vesica urinaria rupture + traumatic hernia
diaphragmatika sinistra
7. Tn. Taju 77 L 1032523 dr. WHY Mild TBI GCS 15 E4M6V5 + Fraktur liniea Temporal Sinistra + Fraktur
displaced zygomaticomaxilla
8. Ny. Halimah 53 P 1032526 dr. DJF Carcinoma mammae sinistra cT2N1M0 Karnofsky 60% + moderate febrile
neutropenia

9. Banong 72 P 1032531 dr.WHY Moderate TBI GCS 9 (E2M5V2) + epidural hematom regio temporo parietal
sinistra + Intracerebral hematom regio temporal dextra

10. Dedy Sunarto 77 L 1032536 dr.SR Mild TBI GCS 15 E4M6V5 + Fraktur Komunitif temporozygoma
maxillozygoma + rupture bulbus occil kanan

11. Mary Andani 24 P 1032530 dr. SR Trauma Maxillofacialis + fraktur linear os frontalis, os zygomaticum +
kontuio cerebri
 Name : Mrs. B Age : 72 yrs old
MR : 1032531 Consultant : dr. WHY

Chief Complain : Loss of Conciousness

History Taking :
Patient with the chief complaints loss of conciusness since 14 hours ago after a traffic
accident. There was no nausea and vomiting, and no fever. There is no history of
seizures.
After the accident, the patient was immediately taken to Maros Hospital and in an
agitated state and referred to the Wahidin Sudirohusodo Hospital. There is no history of
blood discharge from ears and nose.
The therapy was given at the Maros Hospital:
- Citicolin 500 mg/8 hours/ intravenous
- Ranitidine 50 mg/12 hours/ intravenous
- Paracetamol 1 gram/8 hours/ intravenous
Mechanism of Trauma:
The patient was walking across the street and suddenly hit by a motorcycle from right
side
 PHYSICAL EXAMINATION

PRIMARY SURVEY
A : Clear, patent
B : 22 times per minute, symmetrical chest expansion
C : Pulse 69 times per minute, Warm, CRT < 2 second
D : GCS 9 E2M5V2, isochor pupil 2,5mm / 2,5mm, Direct Light Reflex (+/+), Indirect
Light Reflex (+/+)
E : Temperature 36.7 °C
 NEUROLOGICAL STATUS
• GCS 9 E2M5V2
• Pupil isochor rounded 2,5 mm/2,5 mm, Direct Light Reflex +/+,
Indirect Light Reflex +/+
• Physiological reflex: +/+
• Pathological reflex: -/-
• Sensory motor is difficult to evaluate
• No Lateralization
• Otonomic: Urination was normal via urine catheter , defecation was normal
 SECONDARY SURVEY
Regio capitis:
Inspection: edema and hematoma of the
inferior and superior right palpebra orbita,
hematom at parietal dextra
 CLINICAL DIAGNOSIS

• Moderate TBI GCS 9 (E2M5V2)

 LABORATORY FINDING (19-07-2023)
Parameter Results Normal Range Unit
WBC 11.2 9.00 – 30.00 103/uL
RBC 3.79 4.00 – 6.00 106/uL
HGB 10.4 14.5 – 22.5 gr/dL
HCT 32 48.0 – 69.0 %
PLT 226 150 – 400 103/uL
GDS 170 140 mg/dL
Natrium 139 136 – 145 mmol/L
Kalium 4.1 3.5 – 5.1 mmol/L
Klorida 101 97 - 111 mmol/L
CT Scan of Head (18-04-2023)

5 cm
6 cm
3 cm

2 cm 2 cm
2 cm
Thorax X RAY
Working : Moderate TBI GCS 9 E2M6V2 + Epidural
Diagnosis Hematom Regio Temporoparietal dextra +
Intracerebral Hematom Regio Temporal
sinistra
Therapy : Head up 30 degrees
Oxygenation 5 LPM Via NRM
Sodium chloride 0.9% 28 tpm
Ceftriaxone 1gr/12 hr/iv
Metamizole 1 gr/ 8 hr/ iv
Ranitidine 50mg/12 hr /iv

PLAN : Craniotomy Evacuation EDH + Craniectomy

Decompression
Intraoperative findings
Intraoperative Documentation
Operation Report
POST OP DIAGNOSIS : Moderate TBI GCS 9 E2M6V2 +
Epidural Hematom Regio
Temporoparietal dextra +
Intracerebral Hematom Regio
Temporal sinistra
PROGNOSIS :
ad vitam • Dubia
ad functionam • Dubia
ad sanationam • Dubia

FOLLOW UP : • Vital Sign and GCS

• Wound care
• drain Production
 Name : Tn. M Gender : Male
Age : 59 DPJP : dr. NA

Chief complain : Patient with shortness of breath

History taking : Patient with shortness of breath experienced since 1 day ago after
hitting his chest when he fell from a tree. Open wound with
progressive bleeding at midle chest.
No headache, no nausea and vomiting. No fever. There is no history
of cough mixed with blood spots. There is no history of seizures.
There is no history of loss of consciousness. Defecation looks normal.
Urinate normal impressions. Patient was referred from Dodi Sarjoto
Hospital with Pneumothorax dextra.

Mechanism of trauma: The patient fell from a tree with a height of

less than 1,5 meters with his chest and stomach hitting the ground.
The patient's chest is pierced by a bamboo stick and then the patient
pulls it out himself
 Physical Examination

Primary Survey :
A : Clear, patent
B : Chest develop asimetris with lagging movement of Hemithorax dextra,
RR 29x/m, SpO2 98 % via nasal kanul
C : BP : 142/89 mmHg, HR: 69 x/menit, , regular, there is no actif bleeding,
CRT < 2 detik
D : GCS 15 E4M6V5, Pupil isokor 2,5 mm, RCL +/+, RCTL +/+, lateralisasi -
E : suhu 36,7 °C
Thorax Local Status
Inspection : assymetrical movement of hemithorax dextra
There is open wound in the thoracic region with a length of 5
cm and a width of 1 centimeter, active bleeding (+),pulsative (-),
expanding hematom (-),

Auscultation : decreased in the hemithorax dextra vesicular +, rhonki-/-,

wheezing -/-, normal heart sound
Palpation : crepitation (-), deformities (-)

Percusion : hypersonor on the right hemithorax

 Clinical Diagnosis
• Vulnus ictum penetrans regio sternal
• Suspek Pneumothoraks Dextra
X-Ray (Thorax) RS Dodi Sarjoto
19/07/2023
 Laboratory Finding
 HB : 13.5
 HCT : 40
 WBC : 9000
 PLT : 220.000
 RBC : 4.24
 Na : 137
K : 4.0
 Cl : 106
WORKING : Vulnus ictum penetrans regio sternal
DIAGNOSIS Open Pneumothoraks Dextra
MANAGEMENT : IVFD Asering 300cc / 24 jam 
Ceftriaxone 150 mg / 12 jam / intravena
Ranitidin 5 mg / 12 jam / intravena 
Paracetamol 45mg / 8 jam / intravena

PLAN : • Insersi Chest Tube + WSD dextra

• Wound exploration
• Thoracotomy (indicated ?)
Operation Findings
POST OP DIAGNOSIS : • Open Pneumothorax Dextra
• Hemothorax dextra
• Trauma Thorax Penetran
• Fraktur Sternocostal V kanan
PROGNOSIS :
ad vitam • Dubia ad bonam
ad functionam • Dubia ad bonam
ad sanationam • Dubia ad bonam

FOLLOW UP : • Vital Sign and GCS

• Wound care
• WSD Production
• In the haemodynamically unstable patient with
penetrating injury to the upper torso whose bleeding is
occurring into the chest cavity, it is important to insert
a chest tube as soon as possible during the initial
assessment and resuscitation. (DSTC)
• The incision is made through the fourth or fifth inter-
costal space from the costochondral junction
anteriorly to the mid-axillary line posteriorly,
following the upper border of the lower rib in order to
avoid damage to the intercostal neurovascular bundle.
• The muscle groups are divided down to the
periosteum of the lower rib. The muscle groups of the
serratus ante- rior posteriorly and the intercostals
medially and anteri- orly are divided. The trapezius
and the pectoralis major are avoided. Care should be
taken at the anterior end of the incision, where the
internal mammary artery runs and may be transected.
 Name : Tn. AN Gender : Male
Age : 20 DPJP : dr. KK

Chief complain : shortness of breath

History taking : shortness of breath felt since 2 hours ago after a traffic accident. This
complaint is accompanied by pain in both chest.
the patient also complained of urine mixed with fresh blood since the
accident.
pain in lower abdomen, the pain increases when the patient walks.
No history of loss consciousness, no history of nausea and vomiting,
no history seizure.

Mechanism of trauma: The patient was riding a motorcycle with a

high speed, then suddenly hit a truck from the opposite direction and
the patient fell to the road with the body tilted to the right.
 Physical Examination

Primary Survey :
A : Clear, patent
B : asymmetric left hemithorax sinistra movement, RR 35x/m, SpO2 95 %
via nasal kanul
C : BP : 100/70 mmHg, HR: 121 x/menit,regular, urinary bleeding, CRT < 2
detik
D : GCS 15 E4M6V5, Pupil isokor 2,5 mm, RCL +/+, RCTL +/+, lateralisasi -
E : suhu 36,5 °C
 Local Status
Thorakal
Inspection: asymmetrical, hematoma (+) the axillary media region
dextra.
Palpation: crepitation (-), no tenderness
Percussion: sonor / dullness
Auscultation: vesicular +/-

Costovertebrae region Dextra:

inspection: bone alignment is intact, gibbus (-), hematoma (-), mass is
(-).
Palpation: renal ballotement not palpable, mass not palpable,
tenderness not present.
Percussion: Knock pain is present

Costovertebrae region sinistra:

Inspection: good bone alignment, no gibbus, no hematoma, no mass.
Palpation: renal ballotement not palpable, mass not palpable,
tenderness not present
Percussion: Knock pain is absent

Suprapubic region
Inspection: No visible hematoma, no bulging
Palpation: tenderness (+)
Regio genitalia extrerna:
Penis
Inspection: OUE appears to be at the tip of the glans penis,
hematome is absent,
Catheterized with 18 fr, with massive blood production
Palpation: No tenderness, no mass

Scrotum
Inspection: Skin color appears darker than surrounding, no
hematoma.
Palpation: Palpable 2 testicles, normal size and consistency
impression. No tenderness
Perineum:

Inspection: normal skin color, no hematoma.

Palpation: no tenderness
 Clinical Diagnosis
• Suspect hemothorax sinistra
• Blunt thoraxic trauma
• Suspect bladder trauma dd/ renal trauma
X-Ray (Thorax) RSWS
19/07/2023
 Laboratory Finding
 HB : 11.3  SGOT : 1184
 HCT : 34  SGPT : 858
 WBC : 22.300  UREUM : 37
 PLT : 204.000  KREATININ : 2.68
 RBC : 4.20  GDS : 126
 Na : 141  PT : 13.3
K : 3.5  APTT : 28.2
 Cl : 105
WORKING : Traumatic Diaphragmatic Hernia sinistra
DIAGNOSIS Ruptur buli anterior
Blunt thorax trauma
anterior vesica urinaria rupture
Fraktur diasthasis symphysis pubis

MANAGEMENT : - IVFD NaCl 0.9% 20 tpm

- ceftazidime 1 gr/12 jam/iv
- omeprazole 40mg/24 jam/iv-
- asam traneksamat 500mg/8jam/iv
- Nasogastric tube decompression
- Orthopedic (konservatif)

PLAN : • Torakotomi explorasi repair defect

• Insersi Chest Tube + WSD dextra
• Repair vesica urinaria
Operation Findings
Operation Findings
POST OP DIAGNOSIS : Traumatic Diaphragmatic Hernia sinistra
Ruptur buli anterior
Blunt thorax trauma
anterior vesica urinaria rupture
Fraktur diasthasis symphysis pubis
PROGNOSIS :
ad vitam • Dubia
ad functionam • Dubia
ad sanationam • Dubia

FOLLOW UP : • Vital Sign and GCS

• Wound care
• WSD Production
• Urin production