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Slide Emcae DR Suleman, 12-2-2014
Slide Emcae DR Suleman, 12-2-2014
EMERGENCY ROOM
WAHIDIN SUDIROHUSODO
GENERAL HOSPITAL
MAKASSAR
Wednesday, February 12th 2014
Ambulation : - Patients
Hospitalized : 4 Patients
Observation : Patients
Operated : 4 Patients
Death : Patients
Total : 4 Patients
Name : Ch. A Sex :Male
Age : 1 years old MR :650850
Chief complaint : Burn wound
History taking : The condition had ben apparent since 1 hours before admitted to the
hospital due to accident.
Mechanism of injury : He was playing in the kitchen when suddenly he get sprinkled by a boiled
water.
E: T: 36,7C
Secondary Survey
Right hemithorax + abdomen
Back Region
I: Seen burn wound grade I-II A 18%, Hiperemis (+)
P: Tenderness (+)
Secondary Survey
Right tight Region
Ureum : 16 mg/dl
PROGNOSIS : good
PROGNOSIS : Good
History taking : Suffered since 20 days before admitted to ER. The first 15
days patient just stay at home and consume herbal
drug, the next 5 day patient was taken to Sinjai
hospital. This simptom followed by nausea, vomiting
and fever.
Micturation : Normally
Defecation : Diarrhea
General Status
Severe illness / well nourish / delirium
Vital Sign
BP : 90/60 mmHg
PR : 120x/mnt, weak, reguler,
RR : 36x/mnt, symmetric L=R, thoracoabdominal
type.
T(Ax) : 39,5C
Local Status
Abdominal
I : Convex, follow breath motion, skin color same with its vicinity,
bowel contour (-), bowel motion (-)
A : Peristaltic (+) decreased
P : Tumor mass (-) Tenderness (+) Defans muscular (+)
P : Tapping pain (+), hyper timpani
Digital Rectal Examination
MANAGEMENT : Oxigenation
IVFD
NGT
Urine Catheter
Medicaments
Report to senior pediatric surgeon
advice : laparotomy exploration
Operating Procedure
Patient laid in supine position under GA.
Sterilization and draping procedure
Midline incision 5 finger under procesus xyphoideus until 4
finger above suprapubik, deepen until peritoneum
Open peritoneum seen feses, with adhesion between
peritoneum and omentum
Released adhesion, identification hollow viscus, seen perforation
on sekum with diameter about 4x3cm, and perforation ascenden
colon on fleksura hepatika about 4x3 cm
Perform sekostomi and eksteriorisasi on asenden colon with
catheter fr-22 then fiksated
Control bleeding
Clean with NACL 0,9%
Close operating wound layer by layer with 1 drain
Operation finished
POST OP DIAGNOSIS : - Generalized peritonitis due to perforation
of sekum and flexura hepatica
- SIRS
PROGNOSIS : fair
FOLLOW UP : Vital sign, acute abdomen, and wound
healing
Name : Mr. F Sex : Male
Age : 56 years old No. Reg : 650837
E: T (ax) : 38,3 oC
Secondary Survey
Abdomen
I : Seen flat follow breath motion
A: Breath sound Normal
P: tenderness (-) TM (-)
P: Tapping pain (-) tympani
HCT : 39,2 %
CT / BT : 730 / 300
Ureum : 57 mg/dl
MANAGEMENT : O2
IVFD
Medicaments
Report to Senior thorax surgeon,
advice : thoracotomy
Operation Procedure
Patient lied left latera decubitus GA
Desinfection & drapping Procedure
Make anterolateral incision at ICS 5 deepend until pleura
parietalis open the pleura parietalis seen blood at right
cavus thorax
Explore seem the spear cut through the superior lobe to
inferior lobe until posterior wall right thorax thoracal 8
Cut the tip of the spear, and pull the rest out of cavum
thorax.
Stitch the superior, medial and inferior lobe with continous
suture using nylon 5.0
Decorticated all the surface of the pleura viceralis
Rince with Nacl + Betadine
Close the wound layer by layer, with 1 chest tube applied
POST : - Vulnus ictum penetran at right hemithorax
OPERATIVE - Right Pneumothorax
DIAGNOSIS - Right Hematothrax
Laceration of superior lobe
Laceration of medial lobe
Laceration of inferior lobe
PROGNOSIS : Good
Defecation : Normal
Micturated : Normal
Physical Examination
General Conditions:
Moderate illness / well nourish / conscious
Vital sign:
BP : 120/70 mmHg
PR : 96 x/mnt, regular, adequate.
RR : 24 x/mnt.
T(Ax) : 37,9 C
PHYSICAL EXAMINATION
Abdomen
I : Seen flat, follow breath motion, no bowel contour, no bowel motion
CT / BT : 800 / 300
Ureum : 27 mg/dl
MANAGEMENT : IVFD
Apply NGT
Apply Foley Catheter urine
Medicaments
Report to Senior Digestive Surgeon
advice : Immediate Laparotomy
OPERATION PROCEDURE
Patient laid supine under GA
Disinfection and drapping procedure
Performed midline incision 2 fingers above umbilicus
until suprapubic
Deepen until peritoneum, open peritoneum seen pus
Identification hollow fiscus, seen perforation of
appendix, perform appendektomi, continue with
tabacsac
Wash cavum abdomen with Nacl until clean
Close wound layer by layer with 1 drain
Operation done
POST OP DIAGNOSIS : Generalized peritonitis due to perforation of appendix
PROGNOSIS : Good