SELAMA CC BERLANGSUNG

Visi Program Studi

Ilmu Bedah
• Menjadi Program studi dokter spesialis ilmu
bedah bereputasi International,
BEDA menghasilkan lulusan profesional, unggul di
bidang penanganan multiple trauma dan
H kanker lini pertama
 Misi Program Studi Ilmu Bedah

Menyelenggarakan pendidikan Berkualitas, berdasarkan

kurikulum KIBI dengan memberikan keunggulan pada
penanganan multiple trauma dan kanker lini pertama

BEDA Mengembangkan Penelitian dan pengabdian di bidang Ilmu

Bedah khususnya penanganan multiple trauma dan kanker lini

H pertama

Menyelenggarakan tata kelola program studi Berbasis Good

University Governance, menuju institusi bereputasi
Internasional
 MORNING REPORT
Saturday, January 6th 2024

Chief : dr. Lauraine (REN)

Senior : dr. Proginova (PRO), dr. Adly (DLY), dr. Rico (RCO)
Emergency : dr. Pigur (GUR), dr, Kevin (LEX), dr. Piether (PIT),
dr. Radian (RAD), dr. Rizki (RAS), dr. Endika (KUN),
dr. Nelsi (NEL)
Intensive : dr. Elena (LEN), dr. Yohari (YOH)
Inward : dr. Erlyn (ELY), dr. Nuriy (RIY)
Inward Emergency Patient
No Identity Diagnosis Plan

1. Mrs. N Neurosurgery O2 10 lpm NRM

Mild brain injury GCS E4V5M6 Head up 30º
56 y.o Cerebral oedema Inf. NaCl 0,9% 1500 cc/ 24 hours
01654527 Metamizole Inj.1 gr/ 8 hours
Plastic Reconstructive Aesthetic Blood Examination
Surgery Thorax AP X-ray, Cervical AP/Lat X-ray,
Fracture of Left Inferior Orbital Rim Skull AP/Waters X-ray
Fracture of Left Maxilla Head CT Scan + 3D without contrast
Fracture of Left Zygoma Arch
Neurosurgery
Inward
Conservative
Hyperosmotic Saline 3% Inf. 100 cc/ 8
hours
Observation of GCS/ VS/ Lateralization

Plastic, Reconstructive, and Aesthetic

Surgery
Liquid Diet
Oral Hygiene
Elective ORIF
 EMERGENCY PATIENTS
Inward
No Identity Diagnosis Plan

2. Mr. P Plastic and Reconstructive Inf. RL 1500cc/24 hours

73 y.o Surgery Inj. ATS 1.500 IU
01654498 Snake Bite Grade I, Right Inj. Ampicillin 1 gr / 8 hours
Antebrachii Region Inj. Metamizole 1 gr / 8 hours
Blood examination

Plastic and Reconstructive Surgery

Inward
Immobilization of Right Antebrachii
Region
Monitor signs of compartment
syndrome, neurotoxic, & hematotoxic
Evaluation Blood Routine, PT/APTT 24
hours
Inward Emergency Patient
No Identity Diagnosis Plan

3. Mr. A Neurosurgery Head Up 30°

24 y.o Mild Brain Injury GCS E4V5M6 O2 3 lpm
01654533 with persistent headache NaCl 0.9% IVFD 1500 cc/24 hours
Cerebral Edema Metamizole Inj. 1gr/8 hours
Omeprazole Inj. 40 mg/12 hours
Orthopaedic and Traumatology Routine Blood Examination
Closed Fracture of Right Clavicle Chest X-Ray
Allman Group I, Comminutive type Head CT Scan without contrast
Immobilization of Right Shoulder with Arm
Sling

Neurosurgery
Inward
Conservative
Hypertonic saline 3% inf 100cc/8 hours
Observation of VS/GCS/Lateralization

Orthopaedic and Traumatology

Elective ORIF Closed Fracture of Right
Clavicle (S-Plate)
Inward Emergency Patient
No Identity Diagnosis Plan

4. Mr. I Neurosurgery O2 NRM 10 lpm

21 y.o Mild brain injury GCS E4V5M6 Head up 30°
01654538 Cerebral Edema IVFD NaCl 0.9% 1500 cc / 24 hours
Metamizole Inj.1 gr/8 hours
Blood examination
Head CT Scan without contrast

Neurosurgery
Inward
Conservative
Hyperosmotic Saline 3% Inf.
100cc/8hours
Observation of GCS/ VS/ Lateralization
Outward
No Identitas Diagnosis Keterangan
1. Mr. D Concussion Mefenamic Acid 3x500mg
43 y.o Outward with education
01664776
2. Ms. V Concussion Mefenamic Acid 3x500mg
19 y.o Outward with education
01666135
3. Mr. J Contusio Musculorum of Right Foot Mefenamic Acid 3x500mg
56 y.o Region Outward with education
01667700

Consult
No Identity Diagnosis Plan
- - -
-
Paviliun
No Identitas Diagnosis Plan
- - - -

Discarded From Medical Advice

No Identity Diagnosis Reason
- - - -
Death
No Identity Diagnosis Reason
- - - -
Name : Mrs. N
Age : 56 y.o
MR : 01654527
ADM : National Healthcare Insurance
Chief Complaint :
Persistent headache and pain at the face after MVA

History of Recent illness :

Seven hours prior to admission while the patient was riding a bicycle. Suddenly the patient hit
another motorcycle from opposite direction. The patient fell down with unknown position. There was
unconsciousness, no vomiting, and no seizure. After the accident, the patient complained of
persistent headache, pain at the face. By the family the patient was brought to Sarila Husada Sragen
Hospital, where the patient received painkiller, wound toilet and stitched. However, because of limited
facility, by the family the patient was brought to Moewardi General Hospital.

AMPLE Anamnesis :
Allergic : denied
Medication : denied
Previous Medical History : denied
Last Meal : 2 hours prior admission
Event Related To Injury : MVA
EWS : 1
 Primary Survey

A : Clear, cervical collar brace, O2 10 lpm NRM

B : I : Equal chest expansion left = right , RR : 20 x/mnt

P : Skin crepitation (-/-)

P : Sonor/sonor

A : Vesicular breathing sound (+/+), additional sound (-/-)

C : HR : 92 x/mnt, BP : 137/95 mmHg

D : GCS E4V5M6, isochoric pupils (3 mm/ 3 mm), light reflexes (+/+),

lateralization (-)

E : T : 36.7o C (axilla)
 Secondary Survey

Head : hematoma (+) at left frontotemporoparietal region size 4x3 cm, multiple
vulnus excoriatum at frontal region

Eyes : periorbital hematoma (-/-), conjunctival bleeding (-/-), visus ODS >2/60,
normal eye movement

Nose : rhinorrhea (-/-), dried blood (-/-)

Face : look at localized physical examination

Ear : otorrhea (-/-), tragus pain (-/+)

Neck : no abnormality

Chest : I : Equal chest expansion left = right, RR : 20 x/mnt

P : Skin Crepitation (-/-), Tenderness (-)

P : sonor/sonor

A : Vesicular breathing sound (+/+), additional sound (-/-)

Abdomen : no abnormality

Extremity : no abnormality
 Localized Physical Examination
R. Midfacial
I : oedema (-/+), mallar imminence flattening (-/+),
telecanthus (-), stitched wound at right frontal 1 stitch and
at left frontal 2 stitches
P : hypoesthesia infraorbital nerve (-/+)

R. Intraoral
I : malocclusion (dte), trismus (+) 2.3 cm, mucogingival
laceration (-), missing tooth at left superior incisivus 2, right
inferior caninus, right inferior premolar, right and left inferior
molar
P : moving tooth (-), moving maxilla (-/-)

R. Mandible
I : oedema (-), asymmetry (-)
P : hypoesthesia mentale nerve (-/-)
1st Assessment :
Mild Brain Injury GCS E4V5M6 with persistent headache
Susp. Fracture of Left ZMC

1st Plan :
O2 10 lpm NRM
Head up 30º
Inf. NaCl 0,9% 1500 cc/ 24 hours
Metamizole Inj.1 gr/ 8 hours
Blood Examination
Thorax AP X-ray, Cervical AP/Lat X-ray, Skull AP/Waters X-ray
Head CT Scan + 3D without contrast
Cervical AP/Lat X-Ray at Moewardi Hospital
Skull AP/Waters X-Ray at Moewardi Hospital
Thorax AP X-Ray at Moewardi Hospital
Head CT Scan without Contrast at Moewardi General Hospital
Head CT Scan 3D at Moewardi General Hospital
2nd Assesment :
Neurosurgery
Mild brain injury GCS E4V5M6 (ICD X S06.301A)
Cerebral edema (ICD X S06.1)

Plastic, Reconstructive, and Aesthetic Surgery

Fracture of Left Inferior Orbital Rim (ICD X
S02.32XA)
Fracture of Left Maxilla (ICD X
S02.66XA)
Fracture of Left Zygoma Arch (ICD X S02.63X)

2nd Plan
Neurosurgery
Inward
Conservative
Hyperosmotic Saline 3% Inf. 100 cc/ 8 hours
Observation of GCS/ VS/ Lateralization

Plastic, Reconstructive, and Aesthetic Surgery

Liquid Diet
Oral Hygiene
Elective ORIF
Nama : Mr. P

Age : 73 y.o

MR : 01654498

ADM : National Health

Insurance
Chief Complaint :
Pain on right wrist after being bitten by a snake

History of present illness :

Four hours before admission while the patient work on farm, suddenly he was
bitten by a snake on his right wrist. Patient said the snake was black coloured.
After the incident, the patient complained of pain and swelling on his right wrist.
There was no nausea, no vomiting, no seizure, no shortness of breath, no visual
disturbance or active bleeding at the bite wound. Because of worsening pain
and swelling, the family brought the patient to Moewardi Hospital.
EWS Score : 2
 Primary Survey

A : Clear

B : I : equal chest expansion right = left, RR 20 x/minute

P: skin crepitation (-/-)

P: sonor/sonor

A: Vesicular breathing sound (+/+), additional sound (-/-)

C : BP : 138/86 mmHg HR: 94 x/minute

D : GCS E4V5M6, isochoric pupils width (3mm/3mm), Light Reflexes (+/+)

E : T: 36.5oC
 Secondary Survey

Head : No Abnormality
Eye : Subconjunctiva bleeding (-/-), ptosis (-/-)
Nose : Epistaxis (-)
Mouth : Mucogingival bleeding (-)
Ear : No Abnormality
Neck : No Abnormality
Chest : I : equal chest expansion right = left, RR 20 x/minute

P: skin crepitation (-/-)

P: sonor/sonor

A: Vesicular breathing sound (+/+), additional sound (-/-)

Abdomen : No Abnormality
Extremity : localized physical examination
 Localized Physical Examination
Right Antebrachii Region :
I : Oedema (+), fang mark (+) at and until
wrist joint region, bullae (-), hematoma (-),
active bleeding (-)
P : Tenderness (+), Passive Stretch Pain (-)
CRT < 2”, SpO2 digiti I-V: 100%
1st Assesment :
Snake Bite Grade I, Right Antebrachii Region (ICD X T63.001A)

1st Plan :
Inf. RL 1500cc/24 hours
Inj. ATS 1.500 IU
Inj. Ampicillin 1 gr / 8 hours
Inj. Metamizole 1 gr / 8 hours
Blood examination
 Snakebite Management Chart dr. Moewardi Hospital
On arrival
Attend to A-B-C, insert iv line,
routine blood test

Grade 0 Grade 1 Grade 2-4

6-24 hours Observation

Coagulation test:
PT/APTT, platelet Given SABU
Give ATS, Antibiotic,
Analgetic IV

Systemic Envenoming (-)

Local Envenoming (-) Normal ↑↑ Normal Coagulation Abnormal Coagulation
↑↑ test test

Discharge from hospital Given SABU IV

Stop SABU Compartement syndrome, respiratory
failure, acute renal failure, paralysis,
cardiac arrhythmia, shock, etc
Normal ↑↑
↑↑ Surgical Intervention/ medical
Discharge from hospital
intervention, give SABU
SABU Dose (Schwartz/Depkes, 2001):

• Grade 0 : no need SABU®, observe 12 hours

• Grade I : if necessary give SABU® 1-2 vials

Normal Abnorm
• Grade II : 3-4 vials SABU® al
• Grade III : 5-15 vials SABU®
Discharge from Give SABU until normal
• Grade IV : with additional 6-8 vials SABU®
Richard C Dart MD, PhD et al, the North American Congress of Clinical Toxicology, Salt Lake City
hospital
R. Kincaid, S Ruppert, Rattle Snake Envenomation and Compartment Syndrome: A Case Report Discharge from hospital
2nd Assesment :
Plastic and Reconstructive Surgery
Snake Bite Grade I, Right Antebrachii Region (ICD X T63.001A)

2nd Plan:
Plastic and Reconstructive Surgery
Inward
Immobilization of Right Antebrachii Region
Monitor signs of compartment syndrome, neurotoxic, & hematotoxic
Evaluation Blood Routine, PT/APTT 24 hours
Evaluation
 Name : Mr. A
Age : 24 y.o
MR : 01654533
ADM : National Health
Insurance
Chief Complaint :
Persistent headache and pain at right shoulder after MVA

History of Recent illness :

Six hours prior to admission, while the patient was riding a motorcycle without a standard
helmet. He suddenly fell down when avoiding a car in front of him. The patient fell down with
right shoulder hit the ground first. Unconciousness (+), vomiting (-), seizure (-). After the
incident patient complained about headache and pain at right shoulder which aggravated by
movement. By the helper the patient was brought to the Moewardi Hospital.

AMPLE Anamnesis :
Allergic : denied
Medication : denied
Previous Medical History : denied
Last Meal : two hours prior to the accident
Event Related To Injury : MVA
EWS Score: 1
 Primary Survey

A : Clear

B : I : Equal chest expansion left=right, RR : 20 x/mnt

P : Skin Crepitation (-/-)

P : Sonor/sonor

A : Vesicular breathing sound (+/+), additional sound (-/-)

C : HR : 92 x/mnt, BP : 133/62 mmHg

D : GCS E4V5M6, equal pupil width (3 mm/3 mm), light reflexes (+/+), lateralization (-)

E : T : 36,8o C (axilla)
 Secondary Survey

Head : Hematoma at right frontotemporal region 2x1 cm

Eyes : Hematoma periorbita (-/-) visus ODS >2/60, normal eye

movement

Nose : rhinorrhea (-/-), dried blood (-/-)

Ears : otorrhea (-/-), tragus pain (-/-)
Mouth : no abnormality
Neck : no abnormality
Thorax :
I : Equal chest expansion left = right, RR : 20 x/mnt
P : Skin Crepitation (-/-)
P : Sonor/sonor
A : Vesicular breathing sound (+/+), additional sound (-/-)
Abdomen : no abnormality
Genitalia : no abnormality
Extremities : localized physical examination
 Localized Physical Examination

Right Shoulder Region

L : Swelling (+), skin intact (+),
vulnus excoriatum (+), skin
tenting (-), unclear deformity,
F : Tenderness (+), NVD (-),
Crepitation (-), badge Sign (-)
M : active ROM right shoulder
limited due to pain
active ROM elbow full
1st ASSESMENT :
Mild Brain Injury GCS E4V5M6 with persistent headache (ICD X S06.2)
Susp. Closed Fracture of the Right Clavicle (ICD X S42.0)

1st PLAN :
Head Up 30°
O2 3 lpm
NaCl 0.9% IVFD 1500 cc/24 hours
Metamizole Inj. 1gr/8 hours
Routine Blood Examination
Chest X-Ray
Head CT Scan without contrast
Immobilization of Right Shoulder with Arm Sling
Chest X-Ray at Moewardi Hospital
Cervical X-Ray at Moewardi General Hospital
Head CT Scan without contras at Moewardi Hospital
2nd ASSESMENT :
Neurosurgery
Mild Brain Injury GCS E4V5M6 (ICD X S06.2)
Cerebral Edema (ICD X G93.1)

Orthopaedic and Traumatology

Closed Fracture of Right Clavicle Allman Group I, Comminutive type (ICD X S42.0)

2nd PLAN :
Neurosurgery
Inward
Conservative
Hypertonic saline 3% inf 100cc/8 hours
Observation of VS/GCS/Lateralization

Orthopaedic and Traumatology

Elective ORIF Closed Fracture of Right Clavicle (S-Plate)
Name : Mr. I
Age : 21 y.o
MR : 01654538
ADM : National Health Insurance
Chief Complaint :
Persistent headache after MVA

History of Recent illness :

One hours before admission, when the patient was riding a motorcycle, suddenly the
patient was hit a car from behind. The patient fell down with unknown position. There
was unconsciousness, no vomiting, and no seizure. After the incident, the patient
complained of persistent headache. By the helper the patient was brought to
Moewardi Hospital.

AMPLE Anamnesis :
Allergic : denied
Medication : denied
Previous Medical History : denied
Last Meal : 6 hours prior to accident
Event Related To Injury : MVA
EWS : 1
 Primary Survey

A : Clear, neck collar brace, NRM 10 lpm

B : I : Equal chest expansion right = left, RR : 20 x/mnt

P : Skin Crepitation (-/-)

P : sonor / sonor

A : Vesicular breathing sound (+/+), additional sound (-/-)

C : HR : 98 x/mnt, BP : 128/80 mmHg

D : GCS E4V5M6, isochoric pupil width (3 mm/3 mm), light reflexes (+/+),
lateralization (-)

E : T : 36,4o C
 Secondary Survey

Head : hematoma (+) Left Parietal Region size 2x1cm

Eyes : Periorbital hematoma (-/-), subconjungtiva bleeding (-/-),

visus ODS > 2/60, Eye movement (N/N)

Ears : Otorrhea (-/-), dry blood (-/-)

Nose : rhinorrhea (-/-), dry blood (-/-)

Neck : no abnormality

Chest : I : Equal chest expansion left=right, 22x/mnt

P : Skin Crepitation (-/-), Tenderness (-/-)

P : Sonor/sonor

A : Vesicular breathing sound (+/+), additional sound (-/-)

Abdomen : no abnormality

Extremity : no abnormality
Nexus Criteria
1st Assessment :

Mild Brain Injury GCS E4V5M6 with Persistent Headache

1st Plan :

O2 NRM 10 lpm

Head Up 30°

Inf. NaCl 0.9% 1500 cc / 24 hours

Metamizole Inj. 1 g/8 hours

Blood examination

Head CT Scan Without Contrast

Head CT Scan without Contrast at Moewardi Hospital
2nd Assessment :
Neurosurgery
Mild Brain Injury GCS E4V5M6 (ICD X S06.0)
Cerebral Edema (ICD X S06.1)

2nd Plan :
Neurosurgery
Inward
Conservative
Hypertonic saline 3% Inf. 100cc/8hours
Observation of VS,GCS, & Lateralization