27-28 march 2016

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General Surgery !

"ige#ti$e Surgery 2

%hora& 'ardio$a#cular Surgery !

(la#tic Surgery !

)rology Surgery !

*euro Surgery 1

(ediatric Surgery !

+ncology Surgery !

+rthopaedy !

%otal 3

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(atient ,i#t*o -dentity

dmi##ion to

ER

"iagno#e %reatment

1. 'h. ulia/y.o

May 12th 2016

Mild head inury open racture rightdepre# rontali# #4in lo## rightracture rima or5ita

+5#er$ation ital#ign7ead up 30 deg+&ygen-F" *S

72 5loc4eranalgeticnti5iotic'omplate 5loodcount't #can

'on#ult to pla#tic#urgery pro local8ap electi$e

'on#ult to neuro

#urgery citode5ridement

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(atient ,i#t

*o -dentity

dmi##ion to

ER "iagno#e %reatment

2. Mr. Ra5ian#yah /30 y.o

May 12th 2016 ppendiciti# acute S +5#nalgeticnti5iotic72 5loc4er

'omplete 5loodcount'omplete urine9!Ray

'on#ult to

dige#ti$e#urgery citoappendictomy

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(atient ,i#t

*o -dentity

dmi##ion to

ER "iagno#e %reatment

3. Mr. %amrin/3y.o

May 12th 2016 ppendiciti# acute S +5#nalgeticnti5iotic72 5loc4er

'omplete 5loodcount9!ray

'on#ult dige#ti$e#urgery cito

appendictomy

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1. ch. ulia / y.o

• CC: headache

7hr before admission patient felt when she got a ride on a

motorcycle, and the right head heated the street. Helm (-),

vomit (-) bloody nose (-), bloody ear (-), bloody mouth (-),

patient brought to atu !anggul hospital for the first aid,

and then reverse to "lin hospital for furder treatment.

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(rimary Sur$ey

• 'lear: #noring ;!

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A-

M -

P -

L 3 hours beforeadmission

E At the garage

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(hy#ical E&amination

•Head : Normocephali open !ound "-#•Eye : Anemic con$% "-&-# icteric sclera "-&-#•

Nec' : ()P enhancement "-&-# lymphatic nodesenlargement "-&-#

Head&Nec

'

• * : symmetric respiratory mo+ement• P : symmetric ),• P : onor both lung• A : symmetric ). Rh "-&-# /h "-&-#

0hest

• - 8at ;!< la#eration ;!

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,ocal Statu#

• a/r right 4nee

• , open Cound ;

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or4ing "iagno#i#

• ,acerated Cound at right 4nee

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(lanning

• +5#er$ation ital#ign

• nalgetic

•nti5iotic

• %S!%%

• "e5ridement

• (rimary Suture

• (atient di#charge 5ypermi##ion

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2. Mr. ra5ian#yah/ 30 y.o

0hief 0omplain:

pain at loCer rightg a5domen

History of 0urrent isease:

Since 3 day 5eore admi##ion: he elt painat hi# a5domen. %he pain Ca# initially eltat loCer right a5domen: and no reered

pain to other a5domen region. 7e elt paincontinou# and getting #e$ere #ince 1day5eore admi##on . *au#ea ;

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(rimary #ur$ey

# : Clear, without c-spine control

$ : %% && 'm, symmetrical shape and movement

symmetrical breathing sound

C : $:*&+ + mmhg H% : +'m

: /C! 012345, pupil round e6ual 1 mm, light refle' 88

laterali9ation (-) , $H(--) $!(-) $(--) $% (-)

Secondary #ur$ey

= llergy ;!<

M = Medication ;!<( = (a#t illne## ;!<

, = ,a#t meal 3 hour# 5eore accident

E = En$ironment at ut#al arena

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General Statu#

• 7ead #imetric: normocephal: 5rill haematom ;!< 5atle#ign ;!< : >+;!/!< >R;!<

• Eye nemic con. ;!/!

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'linical picture

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,a5oratory

E2amination Result Normal +alue

hemoglo5in 12:3 11.00!16.00 g/dl

,euco#it ?: .0!10.A %hou#and /ul

eritro#it :I .A0!6.00 milion /ul

hematocrit 0:I 2.00!A2.00 olJ

trom5ocit 2A0 1A0!A0 %hou#and /ulRandom >loodGluco#e

100 @200 Mg/d,

SG+% 3A 0!6 )/-

SG(% 1K 0!A )/-

)rea 2? 10!A0 Mg/d,

'reatinine 0:K 0.K!1. Mg/d,

5

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,a5oratory


(% I:I I.I!13:A #econ

(%% 23:A 22:2! 3K #econ

-*R 0:?K

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'% #can

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or4ing "iagno#i#

Mild head inury G'S 1'ere5ral contu##ion at right

temporal

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Management

•S +5#•+2•7ead up 30 deg•-F" *S•nalgetic•nti5iotic•72 5loc4er•'omplete 5lood count•'% ! Scan

• 'on#ult to *euro#urgery 7o#pitalized

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3. Mr. %amrin/ 3 y.o

0hief 0omplain :

(ain at loCer right a5domen

0urrent History :

Since 3 day 5eore admi##ion: he elt pain at hi#a5domen. %he pain Ca# initially elt at loCer righta5domen: no reered pain to other region. 7e eltpain continou# and getting #e$ere #ince 2hr

5eore admi##on . *au#ea ;

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ital #ign

• >( 130/?0 mmhg

• 7r K? >pm

•

RR 20 tpm• % 3? 0'

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General Statu#

• 7ead #imetric: normocephal•

Eye nemic con. ;!/!

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'linical picture

"RE normal #phyncter tone:#mooth muco#a: ma## ;!

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,a5oratory


hemoglo5in 1.I 11.00!16.00 g/dl

,euco#it 21.K .0!10.A %hou#and /ul

eritro#it A.0I .A0!6.00 milion /ul

hematocrit .6 2.00!A2.00 olJ

trom5ocit 30? 1A0!A0 %hou#and /ul

Random >loodGluco#e

131 @200 Mg/d,

SG+% 26 0!6 )/-

SG(% 2K 0!A )/-

)rea 2? 10!A0 Mg/d,

'reatinine 1.2 0.K!1. Mg/d,

, 5 t

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,a5oratory


(% 11.2 I.I!13:A #econ

(%% 31.A 22:2! 3K #econ

-*R 0.I?

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9 ray

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)SG a5domen ;2K!03!2016<

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or4ing "iagno#i#

(eritoniti# diu#e due to #u#p.

pendiciti# peroration

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M*GEME*%

•S +5#•-F" R,•nti5iotic•nalgetic•72 5loc4er•'omplete 5lood count•9!Ray

•'o to "ige#ti$e Surgery pro ,aparotomye&ploration cito

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-ntra +perati Finding

e ound

- (eritonium 8uid mi&ed Cith pu# L 100 cc

- ppendi& retrocaecally: 10cm cm in length: 1.Acm in diameter: gangrenou#: ecolith ;

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. Mr. >ahrudin / 2 y.o

0hief 0omplain:

"ecrea#e o conciou#ne##

History of 0urrent isease:Since 6 hour# 5eore admi##ion: patient got

accident at nir. 7e Ca# riding motorcycle: helmet;!

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(rimary #ur$ey

# : Clear, without c-spine control

$ : %% && 'm, symmetrical shape and movement

symmetrical breathing sound

C : $:**+ 7+ mmhg H% : 'm

: /C! *1 012;45, pupil round e6ual 1 mm, light refle' 88

laterali9ation (-) , $H(--) $!(-) $(--) $% (-)

Secondary #ur$ey

= llergy ;!<

M = Medication( = (a#t illne## ;!<

, = ,a#t meal A hour# 5eore accident

E = En$ironment on the #treet

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General Statu#

Physicaldiagnosis

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'linical picture

Ma2ilofacial statusAt orbita diplopia cannot e$aluated

due to decrea#e conciou#ne## andedema right palpe5rae

At right 4ygoma : 'repitation ;

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,a5oratory


hemoglo5in 12.? 11.00!16.00 g/dl

>' 13.3 .0!10.A %hou#and /ul

eritro#it :A3 .A0!6.00 milion /ul

hematocrit 3K.? 2.00!A2.00 olJ

(latelet# 2?K 1A0!A0 %hou#and /ul

Random >loodGluco#e

I3 @200 Mg/d,

SG+% 6 0!6 )/-

SG(% 32 0!A )/-

)rea 3I 10!A0 Mg/d,

'reatinine 0.I 0.K!1. Mg/d,

,a5oratory

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,a5oratory


(% 10.2 I.I!13:A #econ

(%% 23:? 22:2! 3K #econ

-*R 0:?A

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&!ray

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'% Scan

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or4ing "iagno#i#

Moderate head inury G'S 13E"7 Cith diameter Amm at right rontaland 'ere5ral contu##ion at right rontal

'lo#ed racture o right zygoma

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Management

•S +5#•+2•7ead up 30 deg•-F" *S•nalgetic•nti5iotic•72 5loc4er•'omplete 5lood count•'% ! Scan

• 'on#ult to *euro#urgery 7o#pitalized

• 'on#ult to (la#tic #urgery ho#pitalized

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27-28 march 2016

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