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    Surgery Department: Emergency Case Reports

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    Francesc Oktofabregas
    The document provides an emergency case report from Wahidin Sudirohusodo General Hospital in Makassar on June 7th, 2019. It summarizes information on 8 total patients seen that day, including 2 patients who were ambulated, 2 who were hospitalized, 4 under observation, and 2 who underwent operations. It then provides more detailed case reports on two patients - a 65-year-old male seen for a left inguinal mass who underwent herniorrhaphy, and a 16-year-old male seen for headache after a traffic accident who was diagnosed with mild traumatic brain injury and multiple excoriated wounds.

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    Surgery Department: Emergency Case Reports

    Uploaded by

    Francesc Oktofabregas
    31 views38 pages
    The document provides an emergency case report from Wahidin Sudirohusodo General Hospital in Makassar on June 7th, 2019. It summarizes information on 8 total patients seen that day, including 2 patients who were ambulated, 2 who were hospitalized, 4 under observation, and 2 who underwent operations. It then provides more detailed case reports on two patients - a 65-year-old male seen for a left inguinal mass who underwent herniorrhaphy, and a 16-year-old male seen for headache after a traffic accident who was diagnosed with mild traumatic brain injury and multiple excoriated wounds.

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    The document provides an emergency case report from Wahidin Sudirohusodo General Hospital in Makassar on June 7th, 2019. It summarizes information on 8 total patients seen that day, including 2 patients who were ambulated, 2 who were hospitalized, 4 under observation, and 2 who underwent operations. It then provides more detailed case reports on two patients - a 65-year-old male seen for a left inguinal mass who underwent herniorrhaphy, and a 16-year-old male seen for headache after a traffic accident who was diagnosed with mild traumatic brain injury and multiple excoriated wounds.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views38 pages

    Surgery Department: Emergency Case Reports

    Uploaded by

    Francesc Oktofabregas
    The document provides an emergency case report from Wahidin Sudirohusodo General Hospital in Makassar on June 7th, 2019. It summarizes information on 8 total patients seen that day, including 2 patients who were ambulated, 2 who were hospitalized, 4 under observation, and 2 who underwent operations. It then provides more detailed case reports on two patients - a 65-year-old male seen for a left inguinal mass who underwent herniorrhaphy, and a 16-year-old male seen for headache after a traffic accident who was diagnosed with mild traumatic brain injury and multiple excoriated wounds.

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    © All Rights Reserved
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    EMERGENCY CASE REPORTS

    Friday, June 7th 2019


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Friday, June 7th 2019
    Ambulation : - Patient
    Hospitalized : 2 Patients
    Observation : 4 Patients
    Operated : 2 Patients
    Death : - Patient
    Total : 8 Patients

    Wahidin Sudirohusodo General Hospital


    Makassar
    Name : Mr. M Age : 65 Y.O
    RM : 885045 DPJP : dr. WS

    Chief : Mass at left inguinal


    complain
    History : This condition had been apparent since 1 year before
    taking admitted to hospital. There was history of intermitten
    palpable mass. Since a day ago, the mass never disappear
    and feel pain. There were history of nausea and vomiting.
    There were no history of fever, micturation and
    defecation disturbance. There was history of surgical at
    same place 2 years ago in Maros General Hospital.

    Micturition : Normal, yellowish colour (1 cc/BW/hour)


    PHYSICAL EXAMINATION
    • GENERAL STATUS
    Karnofsky 70%/ well nourished/conscious
    • VITAL SIGN
    – BP : 120/80 mmHg
    – HR : 82 Bpm, regular, adequate.
    – RR: 20 x/mnt, spontaneous, symmetric
    adequate chest movement, thoracoabdominal
    type.
    – T (ax) : 36,5°C,
    Local Status
    Abdomen
    I : Flat, follow breath motion, bowel contour (-), bowel motion
    (-), seen lump at the left inguinal, same color than it vicinity
    A : Peristaltic (+) normal
    P : Tenderness (-), muscle defans (-) , Palpable soft mass
    measurement 8 cm x 5 cm, tenderness (-)
    P : Tymphani (+)
    Digital Rectal Examination
     Sphincter tone was tight,
     Mucous recti was smooth,
     Ampulla recti was filled with faeces
     No Palpable mass
     Prostat palpable
     Handscoen : Feces (+), blood (-), slime (-)
    Clinical Diagnosis
    • Incarcerated Left Hernia Inguinalis
    Lateralis
    Laboratory Findings
     Hb : 13,7 gr/dL  Ur : 24 mg/dL
     HCT : 38,6 %  Cr : 0.71 mg/dL
     WBC : 6.180 /uL  GDS : 147 mg/dL
     PLT : 205.000/uL  SGOT : 71 U/L
     PT : 11.8 detik  SGPT : 30 U/L
     INR : 1.14  Natrium : 132 mmol/L
     APTT : 25 detik  Kalium : 3,5 mmol/L
     Chlorida : 104 mmol/L
    WORKING DIAGNOSIS :  Incarcerated Left Hernia Inguinalis
    Lateralis

    MANAGEMENT :  IVFD
     Medicaments
     Apply Urine Catether
     Consult to digestive surgeon
    advice for hernioraphy
    Operation procedure
    • Patient was laid in supine position, under epidural anesthesia
    • Performed desinfection and draping procedure
    • Incision on historical surgical scar at regio left inguinal.
    • Deepen until fascia of M. Obiqus Abdominis externus, identification internal
    anulus and hernia sac
    • Opened hernia sac , seen hernia sac filled by intestine with bluish colour and
    omentum.
    • Opened internal anulus to set free strangulation, identification loop intestine
    seen viable.
    • Placed back 1 loop intestine and omentum that entangle to abdominal cavum
    • Separated hernia sac from another round tissue, and performed herniotomy
    • Performed hernioplasty with prolen mesh, and stitched on facia.
    • Rinse the wound with NaCl 0.9 %
    • Close the wound layer by layer
    • Operation finished
    Operation Finding
    POST OP DIAGNOSIS :  Incarcerated Left Hernia Inguinalis
    Lateralis

    PROGNOSIS :  Qua ad Vitam : Bonam


     Qua ad Functionam : Bonam
     Qua ad Sanationam : Bonam

    FOLLOW UP :  Wound care


     Observation of vital sign
    Name : Mr. M Age : 16 y.o
    RM : 885033 DPJP : dr. NAL

    Chief : Headache
    complain
    History : This condition has been suffered since 4 hours before
    taking admitted to hospital after traffic accident. There were
    history of nausea and vomitus. There were no history
    fever and seizure. There were no history of fluid or
    bloody dischare from ear and nose .

    Mechanism The patient was riding a motorcycle with helmet. He


    Of Trauma avoided a hole on the street then he hit power pole. He
    fell with his head bumped to the asphalt.
    Physical Examination

    Primary Survey :
    A : Clear, patent
    B : RR : 18 times/minutes, spontaneous, symmetric,
    vesicular, sonor, Rh -/-, Wh -/- ,.
    C : Pulse 88 bpm, regular, adequate, blood pressure
    : 120/80 mmHg
    D : GCS 14 (E4V4M6), pupil size 2.5/2.5 mm, LR
    (+/+),
    E : Temp 36,5 C
    Secondary Survey
    Head
    I : Periorbital hematom at
    left eye , there were multiple
    excoriated wound
    P : Tenderness (-)
    Clinical Diagnosis
    - Mild Traumatic Brain Injury GCS 14
    (E4V4M6)
    - Multiple Excoriated Wound
    Laboratory finding :
     Hb : 13,1 gr/dL  Ur : 35 mg/dL
     HCT : 42 %  Cr : 0,95 mg/dL
     WBC : 13.000 /uL  GDS : 158 mg/dL
    NEUT : 86,2%  Natrium : 141 mmol/L
    LYMPH : 8,0 %  Kalium : 3,2 mmol/L
    MONO : 5,4%  Chlorida : 103 mmol/L
    EO : 0,2%  SGOT : 18 U/L
    BASO : 0,2%  SGPT : 16 U/L
     PLT : 221.000/uL
     PT : 10.6 detik
     APTT : 24.2 detik
    Head CT-Scan
    X-Ray Cervical
    X-Ray Thorax
    WORKING :  Mild Traumatic Brain Injury GCS 14 (E4V4M6)
     Multiple Excoriated Wound
    DIAGNOSIS  Depressed Os Frontal Fracture

    MANAGEMENT :  Head up 30°and O2


     IVFD
     Broad spectrum antibiotics
     Apply urine catheter
     Planning : Craniectomy Elevation Segment
    Fracture
    Procedure Operation
    • Patient was laid supine under general anesthesia
    • Disinfection and draping procedure
    • Performed bifrontal incision, deepened the incision until pericranium and
    perfomed anterior flap
    • Seen depressed frontal bone and sinus fracture
    • Performed craniectomy with rongeur then perform decortication at
    frontal sinus
    • Performed sinus irigation with povidone iodine and normal saline then
    closed frontal sinus with surgicel and spongostan
    • Performed bleeding control and fibrin glue aplication
    • Continue with elevation frontal bone fracture procedure
    Procedure Operation
    • Continue procedure
    • Performed elevation segment fracutre
    • Performed cranioplasty on segment fracture with mesh and 6 mini
    screw with size 1.6 x 5 mm
    • Close the wound layer by layer and leaving 1 vacuum drain
    • End of procedure
    Operative Finding
    POST OP DIAGNOSIS :  Mild Traumatic Brain Injury GCS 14

    (E4V4M6)
     Multiple Excoriated Wound
     Depressed Os Frontal Fracture

    Prognosis :
    Quo ad Vitam Dubia
    Quo ad Sanationan Dubia
    Quo ad Fungtionam Dubia

    FOLLOW UP :  Vital sign


     GCS
     Wound Healing
     Drain production
    Name: Mr. R Age : 16 y.o.
    RM : 885066 DPJP : dr. NAL

    Chief : Decrease Consciousness


    complain
    History : This condition had appeared 8 hours before admitted to
    taking the hospital, after having a traffic accident. There was a
    history vomiting (3 times). There was no history of
    consciousness after the accident. There were no history
    of fever and seizure .There were no history of fluid or
    bloody dischare from ear and nose.
    Mechanism : The patient fell from his motorcycle with unclear injury
    of injury mechanism.
    Micturition : 1cc/KgBW via Urine Catheter
    PHYSICAL EXAMINATION
    Primary Survey
    A: Clear
    B: RR : 20x/minutes, spontaneous, thoraco-abdominal
    symmetric
    C: BP : 120/70mmhg HR : 64 bpm, regular, adequate
    D: GCS 13 (E3V4M6), pupil size 3 mm/ 3 mm, LR +/+
    E: T (ax) : 36,8 C
    Physical Examination
    Secondary Survey :
    Head :
    I : Periorbital hematom at right & left eye , there were multiple
    excoriated wound
    P : Tenderness (+)
    Clinical Diagnosis
    • Traumatic Brain Injury GCS 13 (E3V4M6)
    • Multiple Excoriated Wound
    • Left Periorbital Hematom
    • Right Periorbital Hematom
    Head CT-Scan
    X-Ray Cervical
    X-Ray Thorax
    Laboratory findings :
     HB : 11.8  GDS : 100
     Hct : 33  Na : 139
     WBC : 11.9 K : 3.6
     PLT : 265  Cl : 107
     SGOT : 18
     SGPT : 10
     Ur : 16
     Cr : 0.86
    WORKING DIAGNOSIS : - Traumatic brain injury GCS 13 (E4V4M6)
    - Right Frontal Epidural Hematom
    - Bilateral Frontal Lobe Intracerebral Hemorrhage
    - Frontal , Zygoma and Right Lamina Papyracea Bone
    Fracture
    - Multihematosinus
    - Bilateral Frontotemporoparietal Subgaleal Hematom
    - Multiple Excoriated Wound
    - Left Periorbital Hematom
    - Right Periorbital Hematom

    MANAGEMENT : • O2
    • Head up 30o
    • IVFD
    • Urine Catether
    • Medicament
    • Wound Care
    • Planning: Conservatif
    THANK YOU

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