emg report rspad april 11th , 2014.pptx

Upload: vannyanoy

Post on 09-Feb-2018

214 views

Category:

Documents


0 download

TRANSCRIPT

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    1/21

    Emergency ReportFriday, April 11th, 2014

    Beriman Parhusip, dr

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    2/21

    Attendings On Duty

    Pediatric surgery: dr. Irhamni, SpB, SpBA

    Digestive surgery: dr. T. Suhardi, SpB-KBD

    Orthopaedic surgery: dr. H. Satria, SpOT(K)

    Plastic surgery: dr. Asrofi, SpB, SpBP

    Neurologic surgery: dr. H. Setiajaya, SpBS

    Oncologic surgery: dr. D. Hangesti, SpB-Onk

    Thorax CV Surgery: dr. W. Hadi, SpB, SpBTKV

    Urologic surgery: dr. Hariyono, SpU

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    3/21

    Patient Distribution

    Out Patient : 0

    In patient : 0

    Operations : 2

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    4/21

    1. Mrs Refi, 22 y.oAdmission : 11-4-14; 11.30 a.m/MR 434603

    CC: pain at whole abdomen

    HT : Since 2 days prior to admission, she felt pain at

    whole abdomen. The pain was initially felt at lower

    abdomen and then spread to whole abdomen,continually, and became worse, followed by

    undefecating, nausea (+), vomiting (-), fever(+). History

    of late menstruation (-), trauma (-). History of

    leuchorrhea (+). There was no complaint in urination.

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    5/21

    Physical Examination

    General Status :

    Alert

    BP : 80/60RL 1500 cc110/70 mmHg PR : 120x/mnt RR : 24 x/mnt T : 37,0 0C

    Conjuntivas were anemic (+)

    Local Status :

    At abdomen : distention, tense, bowel sound (+),

    tenderness (+), rebound tenderness (+), muscular rigidity (+),mass (-)

    DRE : normal sphincter tone, smooth mucosa, ampulla wascollapsed, mass (-), tenderness at all direction

    Glove : stool (+), blood (-)

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    6/21

    Jenis Pemeriksaan

    (Hematologi)

    Hasil Nilai Rujukan

    SGOT 15 < 35 U/L

    SGPT 10

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    7/21

    Laboratory Finding

    Hb : 9.5 gr/dL

    Ht : 28 %

    WBC : 19.000 /mm3

    Plt : 419.000 /mm3

    AST : 15 U/L ALT : 10 U/L

    Na : 130 mmol/L

    K : 4.2 mmol/L

    Ur : 54 mg/dL

    Kr : 2.1mg/dL Glucose : 271 mg/dL

    PT : 11.7 sec (control 13,5)

    aPTT : 30 sec (control 30,5)

    PP test : negatif

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    8/21

    WD/

    Diffused peritonitis due to suspect tuboovarial abcess rupture

    DD/ mesenterial trombosis Sepsis

    T/

    NPO

    Infusion RL 2000 cc

    NGT and urine catheter insertion

    Antibiotic

    Analgetic

    Consult to obgyn

    Laparotomy exploration

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    9/21

    Obgyn consult

    There were no deviation in obstetri and

    gynecology departement

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    10/21

    Intraoperative finding

    We found : Reddish peritoneal fluid 500 cc

    Potruded a loop of ileum through mesoileal at 40 cmproximal to valvula Bauhini that caused ilealstrangulation

    Ileal strangulated 180 cm Remaining intestine 190 cm (160 cm from lig. Treitz

    + 30 cm from v. Bauhini)

    Organ solid within normal limit

    Ovarium and tuba within normal limit

    Intraoperative consult : none

    Blood lost : 50 cc

    Histophatology examination : none

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    11/21

    Post Op diagnosis :

    Diffused peritonitis due to ileal strangulation

    due to mesoileal hernia

    Sepsis

    Treatment :

    Segmental ileal resection and ileoileal end to

    end anastomosis

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    12/21

    Intraoperative Pictures

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    13/21

    2. Mrs,A. , 16 y.oAdmission : 11-4-14; 23.00 p.m/ MR 434194

    CC: pain at left upper leg and wound at perineal region

    HT : 6 hours prior to admission, when she was in theriding car with high velocity at Jagorawi toll road,

    without seat belt, the car hit the left side of limitingroad bar, caused she got out of the car. The mechanismof injury was unknown. History of loss ofuncousiousness (-), vomiting (-), no bleeding from ears,nose or mouth. She felt of pain at her left upper leg andwound at perineal region. The patient was brought toBhayangkara Hospital, and then referred to GatotSubroto Hospital.

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    14/21

    Primary Survey :

    A : clear

    B : RR = 22x, symmetrical chest expansion, equal VBS

    C : BP = 110/80 PR = 92x/m

    D : GCS = 15, isochorepupils, 3/3 mm, LR +/+. Motoric parese -/-

    Secondary Survey :

    Left facialis : excoriation (+), hematoma (-)

    Thorax : bruise (-)

    Abdomen : bruise (+), flat, bowel sound (+) normal, tenderness (-)

    Pelvic : bruise (-)

    Perianal : vulnus (+) 2x2 cm, at 1 oclock direction, 1 cm from analverge direct to left major labium. External sphincter muscle wasintact

    At left femur region : wound (-), deformity (+), tenderness (+), ROM

    limited due to pain

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    15/21

    Pelvic and femur X-rays

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    16/21

    FAST

    There were no fluids collection at hepatorenal

    space, splenorenal space, or retrovesica space

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    17/21

    Laboratory Finding

    Hb : 8.8 gr/dL

    Ht : 27 %

    WBC : 21.700 /mm3

    Plt : 433.000 /mm3

    AST : 177 U/L ALT : 99 U/L

    Ur : 37 mg/dL

    Kr : 0.8 mg/dL

    Na : 135 mmol/L K : 3.7 mmol/L

    Glucose : 159 mg/dL

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    18/21

    WD/

    Closed fracture of left shaft femur at middle third, oblique

    displaced Lacerated wound at perianal region

    Anemia due to haemorrhagic

    T/ Antibiotic and analgetic

    Orthopedic : skin tractionORIF

    Pediatric surgery : wound caredebridement + primary suture

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    19/21

    Intraoperative found

    Orthopedic: Hematoma (+) 300 cc Fracture of middle third of left femur, oblique displaced

    Pediatric :

    Wound at perianal region 2x2 cm, at 1 oclock direction, 1 cmfrom anal verge to left major labium

    Rupture of subcutaneus part of external sphinter muscle

    Blood lost : 100 cm

    Intraoperative consultation : none

    Histophatology examination : none

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    20/21

  • 7/22/2019 EMG Report RSPAD April 11th , 2014.pptx

    21/21

    Thank You