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
