emergency surgical service1
DESCRIPTION
Emergency Surgical Service1TRANSCRIPT
EMERGENCY SURGICAL SERVICESWednesday, March 16th 2016
On Site Consultant :
Dr. Iqmal Perlianta SpBP-REDokter On Duty :
Chief : Dr. Dudi ACO-Chief : Dr. TobroniOK : Dr. Zeiky Y
Dr. Chandra BP1 : Dr. Sopyan H
Dr. Luthfy WP2/P3 : Dr. Fredy
Dr. Andri SWard : Dr. Gulraj S
Dr. DimasHCU : Dr. Ary Rachmanto
Out Patients : 9 Patients
TraumaCases : 3 Patients
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Non Trauma Cases : 2 Patients +
Total Patient : 14 Patients
TRAUMA CASES (3)
1. Asril / ♂ / 42 years old
Rupture of stensoni duct + Rupture of zygomaticus mayor an minor muscle + Rupture of bucinator muscle + Rupture of masster muscle + Rupture of risorius muscle + Rupture of mandibular branch of the right facial nerve
2. Mudayu / ♀ / 60 years old
Closed severe Head injury of GCS 4T + ICH on the left temporal lobe + SDH on the left temporal lobe
3.Fitri isneni / ♀ / 30 years old
Closed Severe Head injury of GCS 7T + ICH of the left temporoparietal lobe + EDH of the right temporoparietal lobe + SAH + Cerebral edema
NON TRAUMA CASES (2)
1. Bastari / ♂ / 36 years old
Incarserated Right Groin Hernia + Iatrogenic lasertion of smalbowel (K40.3)
2. Asep Pamin / ♂ / 59 years old
Intra abdominal mass due to caecal tumor + Anemic
TRAUMA CASE
1. Asril / ♂ / 42 years old
Admitted on Wednesday, March 16th 2016 at 11.00 AM
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Anamnesis
Lacerated wound on face region
His face was hited by grindstone when he was working.
(About 1 hours before admission)
PRIMARY SURVEY
A. Good
B. RR : 16 x/min
C. BP : 140/90 mmHg PR : 92 x/min
Pain score : 6
SECONDARY SURVEY
On the right face region
I : There was lacerated wound about ± 10 x 3 in size ireguler edge muscle based.
asimetry of face.
Lacerated wound about 1 cm insize of bucal mucosa.
P : Step off (-), hipoestesi of the right facial side,
SECONDARY SURVEY
On the right face region
SECONDARY SURVEY
RADIOLOGICAL FINDING
Head AP/Lateral X-Ray
Fracture (-)
LABORATORY FINDING
Hb : 14.1 gr/dl (14 – 18 g/dl)
Ht : 42 vol% (40 – 48 vol%)
DIAGNOSIS
Lacerated wound on the right face region + Susp. Rupture of the right facialis nerve.
MANAGEMENT
IVFD RL gtt xxx/m
Inj. ATS 1500 IU im (99.56)
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Inj. Ketorolac 30 mg / 8 hours iv (99.39)
Inj. Ceftriaxone 1 gram /12 hours iv (99.21)
Debridement
Wound Exploration + Repair in OR
IO
We found rupture of masseter muscle, bucinator muscle, zygomaticus mayor and minor muscle, and risorius muscle.
In the further exploration we found rupture of right facial nerve mandibular branch.
Rupture of right orifice stensoni duct.
We perform debridement and repair.
Muscle we repair with PGA 3.0 R interupted.
Nerve we repair with PPL 7.0 R interupted.
Stensoni duct we repair with PPL 7.0 R interupted, and we put NGT 3 Fr.
Post op Diagnose
Rupture of stensoni duct + Rupture of zygomaticus mayor an minor muscle + Rupture of bucinator muscle + Rupture of masster muscle + Rupture of risorius muscle + Rupture of mandibular branch of the right facial nerve
Patien was treated in the ER
2. Mudayu / ♀ / 60 years old
Admitted on Wednesday, March 16th 2016 at 11.20 AM
ALLOANAMESIS
Decreased of conciousness after traffic accident
The motorcycle which is she ride on was sliped,
she fell with her head hit the hard thing.
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(About 3 hours before admission)
PRIMARY SURVEY
A. Snoring ETT + O2 10 lt/m B. RR : 16 x/min
C. BP : 150/90 mmHg PR : 92 x/min D. GCS : E1M3VT = 4T, Pupil was anishokor left > right, LR -/-
SECONDARY SURVEY
On temporal region
I : Hematom (+)
RADIOLOGICAL FINDING
Head CT Scan
ICH on the left temporal lobe
SDH on the left temporal lobe
LABORATORY FINDING
Hb : 11.3 gr/dl (14 – 18 g/dl)
Ht : 34 vol% (40 – 48 vol%)
DIAGNOSIS
Closed severe Head injury of GCS 4T + ICH on the left temporal lobe
+ SDH on the left temporal lobe
MANAGEMENT
Head Up 30o IVFD NACL gtt xxx / m ( Fluid demands 2000 cc/day )
Inj Ceftriaxone 2 x 1 gr Inj tramadol 2 x 100 mg
Inj Manitol 20 % 4 x 60 g Plan to craniotomy if GCS Increased
Patient treated in the HCU
3. Fitri isneni / ♀ / 34 years old
Admitted on Wednesday, March 17th 2016 at 01.33 AM
ALLOANAMESIS
Decreased of conciousness after traffic accident
She fell from motorcycle after being snatched from behind, she fell with her head hit the hard thing.
(About 12 hours before admission)
Refered from Siti Aisyah General Hospital
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PRIMARY SURVEY
A. ETT + O2 10 lt/m
B. RR : 24 x/min
C. BP : 122/81 mmHg PR : 82 x/min
D. GCS : E2M5VT = 7T, Pupil was ishokor, LR +/+ Slow
SECONDARY SURVEY
On the right temporal region
I : Hematom (+)
On the right orbita region
I : Hematom (+)
RADIOLOGICAL FINDING
Head CT Scan
ICH of the left temporoparietal lobe
EDH of the right temporoparietal lobe
SAH
Cerebral Edema
LABORATORY FINDING
Hb : 12 gr/dl (14 – 18 g/dl)
Ht : 35 vol% (40 – 48 vol%)
DIAGNOSIS
Closed Severe Head injury of GCS 7T + ICH of the left temporoparietal lobe + EDH of the right temporoparietal lobe + SAH + Cerebral edema
MANAGEMENT
Head Up 30o
IVFD NACL gtt xxx / m ( Fluid demands 2000 cc/day )
Inj tramadol 2 x 100 mg
Inj Ceftriaxone 2 x 1 gr
Craniotomy and craniectomy
Patient treated in the ICU
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IO
We performed question mark incision at right temporal region, then We performed 4 burr hole
In the epidural space we found blood and blood clot 30 cc
We put 1 drain in the subgaleal space
We performed question mark incision at left temporal region than we performed 6 burr hole and craniectomy.
We found duramater was tense, in the subdural space we found 30 cc blood and blood clot.
We put duragen and duraplag in epidural space
Calvaria bone we put at abdominal subcutis
DIAGNOSE POST OP
Severe Head injury of GCS 7T + ICH of the left temporoparietal lobe
+ EDH of the right temporoparietal lobe + SAH + Cerebral edema
Patient treated in the ICU
NON TRAUMA CASES
1. Bastari / ♂ / 36 years old
Admitted on Wednesday, March 16th 2016 at 11.17 PM
ANAMESIS
Bulge on his right groin
About 3 days before admision, he complain bulge on his right groin that cannot be reduced into the abdominal cavity, pain (+), nausea (+), vomite (+), Flatus (-), defecate (-).
History of reducible bulge since 3 years ago
Refered from Kayu agung General Hospital
VITAL SIGN
RR : 22 x/min T : 36.1 o C
BP : 140/100 mmHg PR : 113 x/min
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VAS : 4
SECONDARY SURVEY
On the abdominal region
I : Distended
P : Soft, pain (±)
P : Timpani
A : Bowel sound (+) increase
DRE : Blood (-), feses (-)
NGT : Clear fluid
On Right Groin Region :
I : There was a bulge, colour same with around
P : The upper border of bulge was diffusely demarcated.
SECONDARY SURVEY
LABORATORY FINDING (Kayu agung general hospital)
Hb : 16.5 gr/dl (14 – 18 g/dl)
Ht : 46 vol% (40 – 48 vol%)
Leuko : 16.000 /mm3 (4.500-11.000 /mm3)
Trombo : 301.000 /uL (150.000 – 450.000 /uL)
DIAGNOSIS
Incasereted right groin hernia
MANAGEMENT
IVFD RL gtt XXX/minutes
Inj Ceftriaxone 2x1gr
NGT
Catheter urethra
Hernioraphy emergency
IO:
In the hernial sac we found omentum and colon transversum that still viable.
We perform to reposition and failed than we perform omentectomy.
We did reposition again than failed
We decided to perform reposition from laparatomy.
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When incisi we found distanded small bowel and iatrogenic laceration of ileum at 250 cm from treizt ligament.
We perform decompresion of small bowel which is distanded
The laceration we suture with PGA 3.0 R continous
We did reposition again and we succeed
We did omentectomy than herniotomy and Hernioraphy with mesh.
Abdominal cavity was clean with NaCl 0.9%
We put rectal tube.
Diagnosa post opreration:
Incarserated Right Groin Hernia + Iatrogenic lasertion of smalbowel (K40.3)
The Patient was treated in the
2. Asep Pamin / ♂ / 59 years old
Admitted on Wednesday, March 16th 2016 at 20.59 PM
ANAMESIS
Body weakness and bulge in the abdomen.
About ± 2 month ago patien was complained bulged in his abdomen. Defecate (+) nigrescent wich increasing frequent, flatus (+), nausea (-), vomite (-).
VITAL SIGN
RR : 18 x/min T : 36.0 o C
BP : 120/70 mmHg PR : 76 x/min
SECONDARY SURVEY
Conjuntiva : Anemic (+)
On the abdominal region
I : Flat
P : Soft, palpable mass on right lower quadrant
P : Timpani
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A : Bowel sound (+)
DRE :
TSA was good, ampula not colaps, mass (-), Blood (-), feses (+)
RT
LABORATORY FINDING
Hb : 7 gr/dl (14 – 18 g/dl)
Ht : 20 vol% (40 – 48 vol%)
Leuko : 5.400 /mm3 (4.500-11.000 /mm3)
Trombo : 186.000 /uL (150.000 – 450.000 /uL)
Na : 132 u/L (136-145 u/L)
K : 3.6 u/L (3,5-5,1 u/L)
BSS : 73 mg/dL (<200 mg/dL)
CEA : 0.97
DIAGNOSIS
Intra abdominal mass due to caecal tumor + Anemic
MANAGEMENT
IVFD RL/D5% gtt XXX/minutes
Blood Transfusion
Plan to Abdominal CT Scan
The Patient was treated in the ER
EMERGENCY OPERATION REPORT
1. Misgian / ♂ / 61 days
Admitted on : March 14th 2016 at 06.05 PM
Pre Op diagnose :
Diffuse peritonitis due to viceral organ perforation DD/ Gastric perforation
IO :
- In the abdominal cavity we found gas and bowel content about ± 1200 cc that came from perporation of gaster at the prepyloric site about 0.5 cm in size. And we found to adhesif from bowel with bowel and bowel with abdominal wall
- We performed freshning of the perforation site and we suture with silk 2.0 R interupted. the tissue was send to PA departement
- We clean abdominal cavity with warm normal saline
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- We put 3 drain intraperioneal tube
Post op diagnose :
Perforation of gaster at the prepyloric site
Patien treated in the ICU
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