New

Backlog Discharged/Signe d Out Mortality Admitted

S ECTION OFNEUROS URGERY EMERGENCYROOM CENS US

RO Ronnie Baticolon, MD D IOD Marjorie B. Sierra, MD, OTRP

PHILIPPINE GENERAL HOSPITAL University of the Philippines-Manila The National University Hospital Taft Avenue, Ermita, Manila ISO 9001:2008 Certified PHIC Accredited Health Care Provider

September 10-11, 2011

NEW PATIENTS NAME, AGE/SEX CASE NUMBER BIDES, Richmond 9 mos/ M BASAG, Noli 44/M 3725996 LINDIO, Julia 3/F 3341548 SAMBUT, Ediemar B. 35/M 3725919 ROLE, Jemson M. 48/M 3725969 DOA PWI PLAN For shunt exteriorization/ LA IV sedation Will reuse shunt once cts acceptable Refer to pedia neuro Copious irrigation w/ PNSS ATS/ TeAna Cont Cefazolin 1g IV q8 Give Paracetamol 250mg/5mL, 3mL q4 PRN for HA Poss d/c if w/ no new sxs For cerebral angiography For repeat Cranial CT after 3 days Ffup labs: CBC, BT, PT/PTT, UA, BUN, Crea, Na, K, Cl, RBS, CXR For poss evacuation of hematoma if w/ dec sensorium Refer to SAPOD GCS Awake, good suck, good activity 15 Good activity, conversan t E4V4M6 1o SVC Pedia LOCATION

9/11/11

Shunt Extrusion

PER ACU Near suturing rm ACU 14 O2 support ACU Near suturing rm Trauma Rm

9/11/11

Compound R Frontal Fx

Sx

9/11/11

L Frontal EDH IVH prob traumatic r/o AVM; t/c ALD CVD bleed, L capsuloganglionic

Sx Traum a Neuro

9/10/11 09/10/1 1

E3V1M5-6

BACKLOGS NAME, AGE/SEX CASE NUMBER SILVERIO, Rynx James Cagrade 1mo/M 3729730 DOA PWI PLAN Cranial CT with CE on Mon (09/12/11) request given BUN, Crea done (09/10) Referral to Pedia Neuro, Plastic Surgery Apply Mupirocin, wet to dry dressing over fungating mass Pls prepare 1U pRBC for OR use DAT IVF + heplock DX: wound discharge GSCS, CBC, PT/PTT, FBS,BUN, Crea,Na, K, U/A,ECG done (09/10) For lumbar tap, CSF for GSCS,Q/Q - done (09/11) CXR, skull APL Mon (09/12) 7:30am Cranial CT plain with CE awaiting funds & BUN/ Crea Ceftazidime 1g IV q8 ( )ANST Vancomycin 2g IV q12 ( )ANST Refer to Plastic Surgery (done); IDS for co-mgt and SAPOD once labs in For debridement c/o plastic sx Status quo NSS Noted MRI: ill defined L posterior parietal lesion with edema U/A, CXR, ECG done (09/10) GI referral for rectal imprint referral dropped Neuro referral for co-mgt referral dropped Cont meds Cranial CT done9/9/11, retrieve result May have CL with SAP For review of CT For referral back to CIC Cont. meds DAT & SAP May go ahead with surgery by ortho Inc. ICP precaution by anes Dec mannitol 75cc q6 Cont. meds Cranial MRI with GAD with IGS protocol c/o FMAB (09/10) Please do not give Dexamethasone Possible IGS Biopsy/GA s/p TL MRI with Gad c/o Cardinal Santos (09/09), results retrieved (09/10) Continue meds and monitoring Admit to W6B28 once vacant DAT, Inc OFI with SAP IVF: PNSS 1Lx10 hours Mannitol to 75cc IV q8 x 2 doses Citicholine 1g PO, BID For possible discharge after 2 doses of mannitol GCS Good cry and activity 1o SVC PEDIA LOCATION

9/9/11

Nasoethmoidal Meningocoele

PER

BAGASIN, Miguel Garais 56/M 3729289

9/9/11

Non Healing Wound s/p Craniectomy, evacuation of hematoma, temporal-parietal, left (6/28/07) for intracranial bleed 2o to fall

15

NSS

ACU In front of trauma rm

FRANCISCO, Arman Bill 35/M 3681947

9/7/11

L Parietal Tumor

15

NSS

OU-21

PORONGAO, Christian 16/M 3600823 UMANDAL, Arturo 37/M 1566183

9/7/11 9/6/11

t/c Tumor recurrence, R TPO glioma s/p craniotomy excision (August 2010) CT scan(1 day post injury) (+)contusion hematoma(approx. 3cc) @ right frontal lobe; (+)hemorrhagic contusion a bilateral frontal lobe; (+) traumatic SAH at posterior interhemispheric zone, (-)MLS,(+)intact cisterns t/c CNS Infection Intradural, extramedullary tumor at T12 Traumatic SAH (ant. and post. interhemispheric) Linear fracture (L occipital)

15 15

Pedia Traum a

PER-8A OU-3

CUNANAN, John Brian 16/M 2363989 JUBAHIB, Richie 23/M 3727153 DILLO, Raymart 20/M 3725260

9/6/11 9/2/11

15 15

Pedia NSS

PER 19 OU-7

9/1/11

E3V4M6 (13)

Traum a

OU-9

TORRES, Ramiro Jr. Castro 29/M 3725886 HOME AGAINST ADVICE TUMALON, Tirso S. 78/M 3724584 HOME AGAINST ADVICE NONE

9/9/11

Contusion Hematoma, R parietal SDHwith cerebral edema, L parietal

NPO IVFpNSS 1Lq8H Ff up labs Tramadol 50mg IV q8 For repeat scan, plain tomorrow if with deterioration For home if no problem No need for further medical/ surgical intervention

15

SOD

9/9/11

CVD bleed, R capsuloganglionic prob tumor bleed

E4V1M 5

Neuro

CAPULONG, Cita Sael 54/F 3725841 ENCINAS, Irene Pajares 6/F 3725845 TINGSON, Jonathan Saldana 24/M 3725848

9/9/11

Right TP hemorrhagic contusion, right temporal linear fracture Left frontal EDH To rule out intracranial injury

Noted Cranial CT, for rpt Cranial scan today CBC, PT,PTT, RBS,Crea, Na, K, typing Mannitol 150 cc IV q4 Tramadol 50mg Iv q8 NPO for now Paracetamol 200mg IV q4 for pain NPO for now For cranial CT plain, Ffup CBC, PT, PTT, typing NVS q1 NPO Done cranial CT, retrieve results CBC, PT, PTT, typing For debridement craniectomy,cranialization of frontal sinus, duraplasty/GA ASAP Start PenG4M 'u' IV q4o ( )ANST Chloramphenicol 1g IV q8 NVS q1 NPO IVF: PNSS 1Lx8 Ff-up labs Mannitol 150cc q4 NSS: SOC, Evac of hematoma/ GA Requesting risk eval Secure 2U p RBC

E1V1M6 Awake, follows command E4V4M6

NSS Surge ry Traum a

W6B17

9/9/11 9/9/11

WB WB

ATARANTE, Mary Ann 18/F 3725844

9/9/11

To rule out intracranial injury

E3V5M6 (14)

Sx

WB

NERI, Rafael C. 60/M 3725920

9/10/11

CVD prob bleed, R basal ganglia

E3V1M6

Neuro

WB