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    Blunt Abdominal

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    Ignatius Jesin
    This curriculum vitae outlines the career and qualifications of Dr. H.M. Alsen Arlan. It details his education history including medical degrees from several Indonesian universities. It lists his work experience starting as a general physician and advancing to become the Director of Medical Services at RSUP Dr. Mohammad Hoesin Palembang hospital. The CV also notes several awards and honors received for his work. Attached is a document on tips and techniques for managing blunt abdominal trauma based on international medical references.

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    Blunt Abdominal

    Uploaded by

    Ignatius Jesin
    151 views39 pages
    This curriculum vitae outlines the career and qualifications of Dr. H.M. Alsen Arlan. It details his education history including medical degrees from several Indonesian universities. It lists his work experience starting as a general physician and advancing to become the Director of Medical Services at RSUP Dr. Mohammad Hoesin Palembang hospital. The CV also notes several awards and honors received for his work. Attached is a document on tips and techniques for managing blunt abdominal trauma based on international medical references.

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    This curriculum vitae outlines the career and qualifications of Dr. H.M. Alsen Arlan. It details his education history including medical degrees from several Indonesian universities. It lists his work experience starting as a general physician and advancing to become the Director of Medical Services at RSUP Dr. Mohammad Hoesin Palembang hospital. The CV also notes several awards and honors received for his work. Attached is a document on tips and techniques for managing blunt abdominal trauma based on international medical references.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    151 views39 pages

    Blunt Abdominal

    Uploaded by

    Ignatius Jesin
    This curriculum vitae outlines the career and qualifications of Dr. H.M. Alsen Arlan. It details his education history including medical degrees from several Indonesian universities. It lists his work experience starting as a general physician and advancing to become the Director of Medical Services at RSUP Dr. Mohammad Hoesin Palembang hospital. The CV also notes several awards and honors received for his work. Attached is a document on tips and techniques for managing blunt abdominal trauma based on international medical references.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 39

    DR. dr. HM. Alsen Arlan Sp.B.

    KBD MARS
    Curiculum Vitae

    DR. dr. H.M. Alsen Arlan, Sp.B KBD., MARS

    Tempat / Tgl lahir : Palembang, 4 Juni 1962


    Nip / Pangkat. Gol : 196206041989031005/Pembina Utama Muda IV.c
    Alamat Rumah : Komplek Taman Istana Blok A 3 – 4, Jln. Lingkar Istana, Demang
    Lebar Daun, Palembang.

    No. Telp : HP. 0811785284

    Status Kawin
    Istri : Dr. Hj. Desty Aryani M.Kes
    Anak : 1. dr. Apriandini Mirdasari Putri, dr. M Hafidh Komar, SpB KBD
     2. dr. M.Arisma Dwirian Putra
    Pendidikan

     S1 Dokter FK UNSRI Palembang, Lulus tahun 1988.

     Spesialis Bedah Bag. Bedah FK UNSRI /RS MH Palembang,


    Lulus tahun 2000.
     Sub Spesialis Bedah Digestive Konsultan Bag. Bedah FK UNPAD
    RS. Hasan Sadikin Bandung, Brevet tahun, 2004
    S3. (Doktor) ; Program Pascasarjana UNPAD, Bandung
    Bidang Studi Ilmu Kedokteran.Lulus 8 Mei 2008
    Program Studi Magister Administrasi Rumah Sakit
    Program Pasca Sarjana Universitas Respati Indonesia Jakarta 2013

    Diklat PIM II SPIMNAS, Lembaga Administrasi Negara Jakarta,


    21 Februari – 1 Mei 2012.
    Pekerjaan
    RSUD Baturaja OKU 1989 – 1990
    Puskesmas Kemalaraja, Baturaja OKU, 1990-1992
    Puskesmas Martapura OKU, 1992 – 1995.
    PPDS I Ilmu bedah FK Unsri/RSMH Palembang, 1995 – 2000
    Staff Bag. Bedah FK Unsri / RSMH Palembang. 2000 – 2002.
    Bandung,
    Trainee Konsultan Bedah Digestive, Bgn Bedah Digestive RS. Hasan Sadikin
    2002 – 2004.
    Palembang,
    Staff. Sub Bagian Bedah Digestive, Bag. Bedah FK Unsri / RS. Moh. Hoesin
    2004 – Sekarang.
    2010
    Kepala Instalasi Bedah Sentral, Rumah Sakit Muhammad Hoesin Palembang. 2008 –

    Juni
    Direktur Umum, SDM & Pendidikan RSUP Dr. Mohammad Hoesin Palembang.
    2010 sd. 20 September 2013
    23

    Direktur Medik dan Keperawatan 20 september 2013 sd –sekarang.


    Penghargaan

    Indonesia
    Satyalancana Karya Satya 20 Tahun dari Presiden Republik

    Tri Windu Bakti Karya Husada 24 tahun, Kementerian Kesehatan RI


    Adhiaksa Utama Pengabdian IDI
    Negara
    Penghargaan Terbaik Diklat PIM II SPIMNAS, Lembaga Administrasi
    Jakarta 21 Februari – 1 Mei 2012.
    Tips and Trics
    Blunt Abdominal Trauma
    DR. Dr. H.M. Alsen Arlan, SpB-KBD,MARS
    Bedah Digestive
    Departemen Bedah – FK Unsri / RSUP Mohammad Hoesin
    Palembang - 2018
    8

    Abdominal Trauma:
    Penetrating (23,8%) > Blunt (12,1%)
    Morbidity & mortality due to bleeding and/or
    visceral perforation resulting in sepsis
    Single or multiple concomitant organ injuries:
    Triad of death : coagulopathy, acidosis, & hypothermia
    Sabiston, Text Book of Surgery,2017
    9

     Abdominal Trauma
     Early resuscitation (Damage Control Resuscitation) & rapid
    assessment and control sources of bleeding and/or
    contamination (Damage Control Surgery or Definitive
    Surgery)
     Retained foreign bodies traversing abdominal wall must be
    maintained & protected from excessive movement during
    initial evaluation
    Classification Of Abdominal Trauma

     Penetrating
    High velocity (85% penetrate peritoneum)
    Low velocity (95% need surgery)
    Stab (1/3 do not penetrate the peritoneum, of those
    50% need Surgery)
     Blunt trauma
    High energy transfer (car accident)
    Low energy transfer (fall, fight)

    Mattox 2013, in Trauma 7th ed


    Spleen 40% to 55%
    Liver 35% to 45%
    Small Bowel 5% to 10%
    Retroperitoneal 15 %

    Advanced Trauma Life Support 10th


    Sabiston, Text Book of Surgery,2017
    Algorithm for the initial evaluation of a patient with suspected blunt abdominal trauma. CT = computed
    tomography; DPA = diagnostic peritoneal aspiration; FAST = focused abdominal sonography for trauma; Hct =
    hematocrit

    Schwartz’s 2015, Principles of Surgery 10th Edition.


    Advanced Trauma Life Support 10th ed
    Damage Control
    Damage limitation surgery
    • Goal ->
    1. STOP any active surgical bleeding
    2. Control contamination

    Bailey and Love’s 2008, Short Practice of Surgery 25th ed


    Bailey and Love’s 2008, Short Practice of Surgery 25th ed
    17

    TACD - VAC Bedside Laparotomy- ICU

    PIN IKABDI 12/8/2017

    Mattox 2013, in Trauma 7th ed


    Mattox 2013, in Trauma 7th ed
    19

    Sabiston, Text Book of Surgery,2017


    Mattox 2013, in Trauma 7th ed
    21

    R. Shayn Martin, J. Wayne Meredith,Sabiston,


    Text Book of Surgery,2017
    FIGURE 30-6
    Mattox 2013, in Trauma 7th ed Algorithm for the diagnosis and management of splenic injury
    Mattox 2013, in Trauma 7th ed
    Mattox 2013, in Trauma 7th ed
    1. Rido Kamulyan / ♂ / 18 YO Admition : 24 -11-17 06.30 WIB

    ANAMNESIS
    Pain On His Abdomen After Trafic Accident
    ± 3,5 Hour before admition his motorcycle had sliped, he fall with
    His abdomen hit by the hard thing.

    SURVEY PRIMER
    A. Good
    B. RR : 20 x/mnt
    C. BP : 100/ 70 mmHg
    Pulse : 83 x/mnt
    Temp : 36.4° C
    D. GCS : E4M6V5 : 15 Pupil was Isochor,
    Light reflexes +/+
    SECONDARY SURVEY

    Thorax :
    I : Excoriation at left clavicule 2 x 3,5 cm in size
    P : Pain (-), Crepitation (-)
    P : Sonor on Both Hemithorax
    A : Vesiculer on Both Hemithorax

    Abdomen
    I : FLat, Bruised (+)
    P : Soft, Muskular Rigidity (-)
    P : Tympani
    A : Bowel Sound (+)

    DRE : Blood (-), feses (+)


    NGT : Blood (-)
    RADIOLOGI
    Ro Thorax
    Fracture (-), Hemopneumothorax (-)
    RADIOLOGI
    FAST
    Fluid Collection (+)
    LABORATORIUM
    Hb : 12.8 gr/dl (12-16 gr/dl)
    Ht : 37 vol % ( 40-48vol%)

    DIAGNOSE
    Abdominal blunt injury Without Peritonitis + Spleenic Injury
    Grade II

    PENATALAKSANAAN
     02 nasal canule 3L/m
     IVFD RL gtt xx /m
     NGT + Uretral Catheter
     Observation
     CT Scan
     USG
    RADIOLOGI
    CT Scan abdomen kontras tgl 24-11-17
    Spleenic injury grade II
    Follow-up at 12.00 AM (6 hour after admition)
    S : Pain On Whole Abdomen
    O : Sens : CM
    RR : 24x/mnt
    HR : 118
    BP : 100/60mmHg
    Temp : 36.4
    Abdomen
    I : FLat, Bruised (+)
    P : Soft, Muskular Rigidity (-)
    P : Tympani
    A : Bowel Sound (+)
    USG : Massive Fluid Collection
    A : Abdominal blunt injury Without Peritonitis + Spleen Injury
    Grade II
    P : Laparatomy exploration
    INTRA OPERATION
    In Cavum abdomen we found blood and blood clot ± 2000cc
    We performed packing 4 big gauze
    In Further Exploration we found laseration of spleen± 4cm with
    irreguler edge
    We Performed splenoraphy  Bleeding was Stoped
    1. Irsan bin Irfan/♂ / 6 tahun MRS : 21-08-2017
    PKL : 15.34 WIB

    ANAMNESIS
    Nyeri Perut
    ± 1 jam smrs,motor yang ditumpangi penderita jatuh bertabrakan
    dengan mobil dari arah belakang. Penderita terjatuh dengan perut
    membentur benda keras
    (Rujukan YK Madira)

    SURVEY PRIMER
    A. Baik
    B. RR : 24 x/mnt
    C. N : 110 x/mnt
    T : 36,6° C
    D. GCS : E4M6V5= 15 Pupil Isokhor, RC +/+
    SURVEY SEKUNDER

    Regio Thorax
    I: jejas (-)
    P: sonor kedua hemithorax
    A: Vesikuler kedua hemithorax

    Regio Abdomen
    I: jejas (+)
    P: defans muskular (-)
    P: Tympani
    A: BU (+) normal

    Regio Flank Sinistra


    I: Jejas (+)
    P: nyeri tekan (-)

    RT: ampula tidak kolaps, darah (-)


    RADIOLOGI
    FAST
    Cairan Bebas (-)
    LABORATORIUM
    Hb : 12,5 gr/dl (12-16 gr/dl)
    Ht : 38 vol % ( 40-48vol%)
    URINALISA
    Lekosit sedimen (routine) : 0-1 (0-5)
    Eritrosit sedimen (routine) : 0-1 (0-1)

    DIAGNOSA
    Trauma tumpul abdomen tanpa tanda-tanda peritonitis
    PENATALAKSANAAN
     Observasi

    Pasien rawat bangsal


    Jacobs 2010, Advanced Trauma Operative Management 2nd ed
    TERIMAKASIH

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