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    Emergency Case Reports: Surgery Department

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    Mukhizal
    The emergency case report from Wahidin Sudirohusodo General Hospital in Makassar, Indonesia describes two cases treated on November 18, 2018. The first case was an 18 day old infant admitted for abdominal distension suspected to be caused by Hirschsprung disease. The second case was an 11 year old boy brought in after being shot in the left chest area by a friend's gun. Both patients were given initial treatments and evaluations in the emergency room, including IV fluids and diagnostic tests, before being admitted for further management.

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    Emergency Case Reports: Surgery Department

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    Mukhizal
    5 views27 pages
    The emergency case report from Wahidin Sudirohusodo General Hospital in Makassar, Indonesia describes two cases treated on November 18, 2018. The first case was an 18 day old infant admitted for abdominal distension suspected to be caused by Hirschsprung disease. The second case was an 11 year old boy brought in after being shot in the left chest area by a friend's gun. Both patients were given initial treatments and evaluations in the emergency room, including IV fluids and diagnostic tests, before being admitted for further management.

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    The emergency case report from Wahidin Sudirohusodo General Hospital in Makassar, Indonesia describes two cases treated on November 18, 2018. The first case was an 18 day old infant admitted for abdominal distension suspected to be caused by Hirschsprung disease. The second case was an 11 year old boy brought in after being shot in the left chest area by a friend's gun. Both patients were given initial treatments and evaluations in the emergency room, including IV fluids and diagnostic tests, before being admitted for further management.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    5 views27 pages

    Emergency Case Reports: Surgery Department

    Uploaded by

    Mukhizal
    The emergency case report from Wahidin Sudirohusodo General Hospital in Makassar, Indonesia describes two cases treated on November 18, 2018. The first case was an 18 day old infant admitted for abdominal distension suspected to be caused by Hirschsprung disease. The second case was an 11 year old boy brought in after being shot in the left chest area by a friend's gun. Both patients were given initial treatments and evaluations in the emergency room, including IV fluids and diagnostic tests, before being admitted for further management.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    EMERGENCY CASE REPORTS

    Sunday, 18 November 2018


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Sunday, 18 November 2018
    Ambulation : 2 Patient
    Hospitalized : 4 Patients
    Observation : Patient
    Operated : - Patient
    Death : Patient
    Total : 6 Patients

    Wahidin Sudirohusodo General Hospital


    Makassar
    Name : By. Ms J Age : 18 days
    RM : 863232 DPJP : dr. UM

    Chief complain : Abdominal distention


    History taking : This condition has been complained since his age 2 days. There were
    no history of meconium release in first 24 hours. There were no history
    of nausea, vomit and fever. Prior medical care at fak-fak general
    hospital and perform rectal wash out symptom releave.
    Patient is the five child, born per section caesarian by obstetric doctor at
    fak-fak general hospital west papua, with birth weight 3250 gram and
    length 42 cm. The mother's history has regular ANC at primary health
    center by midwife. The patient's mother had no history of taking any
    medication, no history of smoking and alcohol.

    Micturition : Normally
    Physical Examination
    General Status:
    Active/ well nourished (Weight: 2700 gram, Length: 52cm)

    Vital Sign:
    HR: 125 x/min RR: 36 x/min T(Ax): 36,5°C

    Head: concave anterior fontanel, conjunctiva isn’t anemic, dry


    mouth and lip mucosa, skin turgor : slow to return
    Chest: symmetrical shape and movement, equal vesicular
    breath sound, ronkhi (-), wheezing (-), regular heart sound,
    murmur (-)
    Abdomen
    Local Status
    I: seen distended, follow breath motion, skin color is the same with its vicinity,
    bowel contour (+), bowel motion (+).
    A: peristaltic sound (+) increased, metallic sound (-)
    P: soft, palpable mass (-)
    P: hipertympani
    Digital Rectal Examination
    • Spinchter tone was tight
    • Mucosa was smooth
    • Ampula filled with feses
    • Handscone blood (-), slime (-) , feses (+)
    Clinical diagnose
    • Low level Total Intestinal obstruction due to
    suspicious Hirschprung disease
    • Moderate dehidration
    Laboratory findings :

    • Hb : 12,1 • Ureum : 108


    • Hct : 40 • Kreatinin: 1,71
    • WBC : 13600 • SGOT : 225
    • PLT : 409.000 • SGPT : 92
    • Natrium : 179 • CT : 8’00
    • Kalium : 4,4 • BT : 2’30
    • Klorida : 135
    • GDS : 118
    Abdominal (supine)
    Abdominal (LLD)
    WORKING DIAGNOSE : • Low level Total Intestinal obstruction due
    to suspicious Hirschprung disease
    • Moderate dehidration

    MANAGEMENT : • IVFD
    • Apply nasogastric tube and urine catheter
    • Rectal washout 20cc/kg/12 j NaCl 0.9%
    • Medicaments
    • Consult NICU
    • Plan to Barium enema and rectal biopsy
    Name : Ch. MA Age : 11 y.o
    RM : 863237 DPJP : dr.NA

    Chief : Gun shoot wound at left chest


    complain
    History taking : The incident happened 2 hours ago before admitted to
    hospital due to being gun shoot. Patients complain feel pain
    at the left chest and left upper abdomen when he try to take a
    breath. There were no history of bloody vomiting and bloody
    faeces. Prior medical care at Antang primary health center.
    Mechanism Of : The patient was playing a gun shoot with his friend at home.
    Injury Suddenly his friend try to shoot and accidently there was a
    bullet in his gun when patient was bend over position
    Physical Examination
    Primary Survey :
    A : Clear
    B : RR : 24x/minutes, spontaneous, seen symmetric
    movement, symetric breath sounds. SpO2 99%
    C : blood pressure 100/60 mmHg, Hr 82x/minute
    D : GCS 15 (E4M6V5), Isochoric pupil 2/2 mm, LR (+/+).
    E : T 36,5 ‘C (axilla).
    Secondary Survey

    Thorax:
    I : symmetric movement, seen open
    wound 0,5 cm on left chest at level ICS V
    P : symmetric vocal fremitus, tenderness
    at left thorax
    P : sonor at both hemitoraks
    A : vesicular breath sounds on left and
    right hemitorax.
    Rh -/-, Wh -/-
    Secondary Survey
    Abdomen :
    • I : flat , follow breath motion, same colour with its
    vicinity
    • A : Peristaltic (+) normally
    • P : Tenderness (+) Left Upper Quadrant, defans
    muscular (-)
    • P : Tympani (+) , liver dullness (+)
    Clinical Diagnosis
    • Vulnus ictum penetrant (GSW) at left
    Hemithorax region with stable hemodinamic
    • Foreign body at left hemithorax region
    Laboratory findings :
     Hb : 12,9  SGOT : 49
     Hct : 37  SGPT : 14
     WBC : 16.400  Ureum : 21
     PLT : 267.000  Kreatinin: 0,40
     APTT : 26,7  Na : 140
     PT : 11,8 K : 3,9
     INR : 1,14  Cl : 104
     GDS : 125
    Chest X-Ray (PA view)
    Chest X-Ray (Lateral view)
    USG Abdomen
    Working Diagnosis
    • Vulnus ictum penetrant (GSW) at left
    Thoracoabdominal with stable hemodinamic
    • Foreign body at left upper abdominal
    Management
    • Oxygen 2-3L/i/via nasal canul
    • IVFD
    • Medicament
    • Consult to pediatric surgeon 
    – Selective non operative management
    Prognosis and follow up
    • Prognosis : Dubia
    • Follow up :
    – Vital Sign
    – Acute Abdomen
    THANK YOU

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