CASE REPORT

OCCUPATIONAL ACCIDENT
 INTRODUCTION
Occupational accident  accident that associated to work

Ministry of National Work Safety and Health (DK3N)  the incidence of

occupational accident was increase  at 1999: 82.456 cases and at 2001: 104.774
cases

Occupational accident is caused by two factor: unsafe human act and unsafe
conditions

Traumatology  branch of medical that studies about wounds or injuries caused

by accidents or violence to person.

At this paper: Reported about one case occupational accident at ER RSUD NTB
Province that cause laceration wound and open fracture
 CASE REPORT

IDENTITY
 Name: Mr. H
 Gender : Male
 Age : 45 yo
 Religion : Moslem
 Job : Laborer
 Address : Kekait
 Status : Married
 Medical record number : 603049
 History of the accident
 Patient was taken to ER RSUD NTB Province at 12.00
AM 20th March 2018.
 Based on heteroanamnesis from his friend, he was found
fell from 2nd floor of building where he work as a laborer.
He fell at 10.00 AM and immediately escort to the
hospital.
 He was found in face downward position, his forehead hit
asphalt and used his right wrist as a holder to his body. He
didn’t use self protection while he work.
 History of syncope (-), vomitting (-), headache (+), but at
ER patient suddenly vomit three times (±250 cc)
 Physical examination
 GCS: E4V5M6
 Blood pressure: 117/77 mmHg
 Pulse rate: 89x/m
 RR: 26x/m
 Temperature: 37⁰C
 SPO2: 89%
 • There is an open wound located on the right
Wound forehead. The wound is regularly with star
description pattern
• Upper tip three centimeters from the hairline,
bottom tip four point five from right airbrow.
The length of the wound is four centimeters
and the width is three point two centimeters.
After the wound was tighten, the length is
four centimeters.
• The characteristic of the wound is the edge of
the wound is uneven, there are three angle of
wound: ten degrees. There is bridging tissue,
the skin is not intact, there is bleeding, when
the wound opened the bone is visible and
20/03/2018
12.00 WITA there is strange object, it is sand. There is
603049
visible skin discoloration around the wound.
 • There is an closed wound with irregular
Wound shape on nose.
description • Upper tip two point five centimeters from
the midline eyes, bottom tip four
centimeters from midline of lips. The
length of the wound is one centimeters
and the width is one centimeters.
• The characteristic of the wound is the
edge of the wound is irregular and the
epidermis of skin is ripp. There isn’t
clear cliff wound and the base of wound
is composed by dermis layer. The surface
20/03/2018 of wound is covered by blood with red
12.00 WITA
603049 color and course palpable. There isn’t
discoloration around the wound.
 • There is an closed wound with irregular
Wound shape on upper the lips.
description • Upper tip one centimeters from the nose,
bottom tip two centimeters from midline
of lips. The length of the wound is two
centimeters and the width is one
centimeters.
• The characteristic of the wound is the
edge of the wound is irregular and the
epidermis of skin is ripp. There isn’t
clear cliff wound and the base of wound
is composed by dermis layer. The surface
20/03/2018 of wound is covered by blood with red
12.00 WITA
603049 color and course palpable. There isn’t
discoloration around the wound.
 • There is an open wound located on the right
wrist. The wound is regularly with oval pattern
• The top of wound is twenty five centimeters
from the right elbow and thirteen from the end
of little finger. The length of the wound is two
centimeters and the width is one point five
centimeters. After the wound was tighten, the
length is one point five centimeters.
• The characteristic of the wound is the edge of
the wound is uneven, there are three angle of
wound: the top angle is sixty degrees, rigth and
left angle are forty five degrees. There is
bridging tissue, the skin is not intact, there is
20/03/2018 bleeding, and the bone is visible. When the
12.00 WITA
603049 wound was open there is strange object, it is
sand. There isn’t visible skin discoloration
around the wound.
 • There is an closed wound with irregular
shape on left anckle.
• The top of the wound is thirty five
centimeters from the knee and eighteen
centimeters from the end of toes. The
length of the wound is two point five
centimeters and the width is one point five
centimeters.
• The characteristic of the wound is the edge
of the wound is irregular and the epidermis
of skin is ripp. There isn’t clear cliff wound
and the base of wound is composed by
20/03/2018
12.00 WITA dermis layer. The surface of wound is
603049
covered by blood with dark red color and
course palpable. There isn’t discoloration
around the wound.
 Treatment
Diagnostic:
 Complete
blood count
 Rontgen of
right arm
 CT Scan Scalp
 Comminuted
fracture of os
radius dextra pars
tertia distal with
angulation to
dorsal.
 Soft tissue swelling
extracanial at dextra frontalis
 Suggestive fracture of os
frontal dextra
 Os nasal fracture and
deviation of nasal septum to
the right side
 Hematome at cavum nasi,
sinus maxillaris dextra, sinus
athmoidalis bilateral, sinus
sphenoidalis
 Cerebri oedema
Terapeutic
 IVFD Ringer Laktat 20 tpm + drip ketorolac 1 ampul
 Inj ketorolac 1 ampul
 Inj ceftriaxone 2gram/12 hours
 Inj ondansentron 8 mg/8 hours
 Inj ranitidin 1 ampul/12 hours
 Inj transamin 500 mg/8 hours
 Inj citicolin 500 mg/12 hours
 Inj novalgin 1 ampul/8 hours
 Wound hecting at right forehead and right wrist
 Bandaged at right arm
 Planning reconstruction of fracture at os nasal and os
radius. But patient was rejecting.
LITERATURE REVIEW
 TRAUMATOLOGY
 Traumatology is branch of medical that studies
about wounds or injuries caused by accidents. It
causing destruction of the skin continuity.
 Trauma can caused by 2 things:
› Blunt force
› Sharp force
 The difference of blunt and sharp force
Trauma Blunt Sharp

Wound’s shape Irregular Regular

Wound’s edge Irregular Regular

Bridging tissue + -

Hair Not cut off Cut off

Wound’s base Irregular Line or point likely

Around wound There is another wound There isn’t

 Wound caused by blunt trauma
 Abrasions wound  hit the epidermis layer
causing partial or complete epidermis loss. The
characteristic:
› Partial or complete epitel loss
› Surface covered by crusta
› There are accumulation of PMN cell
› There isn’t scar sequele
 Contusions wound  occured at subcutan tissue
causing blood vessel demage, therefor the blood
is infiltrate to the interstisial areas. This wound is
can or not follow the skin demage and it must be
difference with livor mortis.

Contusions Livor mortis

Location in everywhere Location at the lower body

Followed by edema and there There isn’t edema and

is intravital sign intravital sign
It is still visible when the It is not visible
wound was pressing or
cutting
 Laceration wound  all of the skin layer are
demage. There are four mechanisme of this
wound:
› Direct contact with skin
› Contact with tangensial direction
› Contact with rotate object
› Open fracture that demage the skin layer
Degree of injury
 Based on KUHP
 Mild injuries
The wound doesn’t cause disease or obstacles to
doing the job or daily activity
 Intermediete injuries

The wound cause illness or obstacles to doing the

job or daily activity
 Severe injuries based on KUHP pasal 90:
› Illness or injured that doesn’t give hope to healed, or
cause a danger of death.
› Unable to doing a job
› Losing one of the senses
› Causing a severe disability
› Suffered paralyzed
› Causing disturbance of thougt ability for more four
weeks
› Causing the abortion of pregnancy
 Occupational accident
 Occupational accident  accident that associated to
work
 Factor that related to:
› Unsafe condition
› Unsafe action
 Factor that causing:
› Technical factor: the place of work, equipments condition,
transportation and tools
› Non technical factor: less knowledge and ability, working
without self protection,
› Enviroment: natural disaster
 Discussion
 Based on the physical examination, there are three types of
wound, they are abration with open fracture, contutions
and laceration wound. These wound could caused by blunt
trauma.
 The laceration wound and open fracture can cause
disability or a denger of death if not treat immediately.
 Based on KUHP pasal 90, these wound are classified into
severe wound because can causing a denger of death.
 Patient was treat appropriate to the standard of hospital
service, but he was reject to did surgery because of the cost
problem.
 Conclusion
 It has been reported about a forty five years old
man who had occupational accident. Based on
the physical examination there are three types of
wound, they are abration, contutions and
laceration wound with open fracture. The patient
was treat appropriate to the standard of hospital
service but he was reject to did surgery. These
wound can cause disability and a danger of death.
 Reference
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Indonesia: 2008.
 Ridley John. Kecelakaan dalam Ikhtisar Kesehatan dan Keselamatan
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TERIMA KASIH