1. Male, 58 years old

CC : pain in swallowing Since 3 days prior to admission, the patient was complained pain in swallowing. Its followed by difficulty in swallowing, he still can eat soft diet. fever (+), hoarseness (-). Hot potatoes voice (-), drooling (-). History of cough with purulent discharge (-), difficulty in breathing (-), trauma (-), Because of his complained, he was brougth to Bandung General bospital and referred to Hasan Sadikin hospital.

PHYSICAL EXAMINATIONGeneral State : compos mentis BP : 100/70 mmhg HR : 86x/m RR : 26x/m Temp : 36,2 c Saturation : 98%

Stridor (-), retraction suprasternal (-), retraction intercostal (-), retraction epigastrium (-).

Local state :

Ears : mucosa not hyperemic +/+ discharge -/-, cerument -/-, ear drum intact +/+, cone of reflex +/+, retroauricular not hyperemic +/+ Nasal cavity : mucosa not hyperemic +/+, discharge -/- , inferior turbinate eutrophy +/+, SD (-), air passage +/+.Oral cavity : Tonsil T1-T1, Pharynx hyperemic (+)Maxillofacial : simmetric, no cranial nerve paralysisNeck : Neck node enlargement (-), swelling (-), soft, hyperemic (-), pain (-), fluctuation(-).

Clinical picture

Neck Soft Tissue X-Ray

LABORATORY FINDINGS Hb: 12,8Wb: 19000Ht : 38Plt : 213000Blood glucose : 122SGOT : 13SGPT : 18Na / K : 139/4,5PT : 11,4INR: 1,06APTT : 35,0Ur: 48Cr: 1,49

WD/ : Acute Epiglotitis + Acute pharingitisTh/

Obs. Vital signO2 4 l/mntIVFD RL 1500 ml/day -> 20 gtt/ mntCefotaxime 2 x 1 g ivDexamethasone 3 x 1 amp ivRanitidine 2 x 1 amp iv

2. Female, 23 years oldPatient was referred from Cicalengka Hospital withWD/ Nasal Bone Fracture

cc : Wound at noseSince 6 hours prior to admission. The patient had been hit with her husbands hand wearing rings. The wound at nose was caused by the rings. History of unconsciousness (-), vomitting (-), Bleeding from both ears (-), Bruises at face (-).Then family took the patient to Cicalengka Hospital and then referred to Hasan Sadikin Hospital.

Physical ExaminationGeneral state: Fully alert, BP: 120/80 mmHg, RR : 20 x/mHR : 89 bpm , T: 36,9 C, Stridor (-), retraction (-)Sat O2 99%

Local state :Both ears : external auditory canal not hyperemic +/+ discharge -/-, ear wax -/- ear drum intact +/+, cone reflex +/+, retro auricular not hyperemic +/+ .Nasal cavity : mucosa no hyperemic +/+, discharge -/-, inferior turbinate eutropy +/+, septum deviation(+), air passage +/+NPOP :To: T1-T1 not hyperemic, pharynx not hyperemicMF : asymmetric , Vulnus Laceratum a.r left dorsum nasi 2x1x0,5 cm in size , terderness (+), edema (+), saddle nose (-), Crepition (-), floating maxilla (-), eyelids echimosis (-), cranial nerve paralysis (-), Neck : neck node (-), bruises (-)

Clinical Pictures

Schedel AP & Lateral (Cicalengka Hospital)

Nasal Spot and Waters X-Ray (Hasan Sadikin Hospital)

Laboratory FindingHb: 14,6 Ht: 44L: 10.800Tr: 287.000SGOT: 23SGPT: 25Ur: 27Cr: 0,76Blood Glucose : 171Na : 135K : 3,6

PT : 12,4aPTT: 21,6

WD/ Nasal Bone Fracture + Vulnus Laceratum at Dorsum nasiManagement :IVFD RL 20 gtt/minPrimary Suture Cefotaxime 2 x 1 gr ivKetorolac 2 x 1 amp Plan to perform reposition of nasal fractureThe patient was discharged by her request

3. Girl, 11 years old Patient was referred from Al Ihsan hospital and consulted by Pediatric Department withWD/ Sepsis + bronchopneumonia + Susp. Tonsilitis Diphteria

CC: Difficulty in Swallowing Since 3 days before admission, the patient complained that difficulty in swallowing. The complain accompanied by pain in swallowing (+) and fever(+). Difficulty in breathing (-). Difficulty on opening his mouth (-). Drooling (-), hot potato voice (-), History about dental carries (-), HT (-), DM (-). History of lump on other body region (-). His family brought him to Al Ihsan hospital and then referred to Hasan Sadikin Hospital.

Physical ExaminationGeneral state: Fully alert, BP: 120/80 mmHg, RR : 20 x/mHR : 88 bpm , T: 37,1 C, Stridor (-), retraction (-)Sat O2 99%

Local state :Both ears : external auditory canal not hyperemic +/+ discharge -/- , ear wax -/- ear drum intact +/+, cone reflex +/+, retro auricular not hyperemic +/+ Nasal cavity : mucosal not hyperemic +/+, inferior turbinate eutropy +/-, deviation of septum (-), air passage +/+NPOP : To: T2-T2 hyperemic, pharynx hyperemic (+), pseudomembrane (-) MF : symmetric, cranial nerve paralysis (-)Neck : at anterior neck region, swelling (-), hyperemic (-), tenderness (-), fluctuation (-)

Clinical Picture

Chest X-Ray

Neck Soft Tissue X-Ray

Laboratory FindingHb: 15,2Ht : 45 %L: 30.900Tr: 398.000SGOT: 27SGPT: 47Ur: 41Cr : 1,2Blood Glucose : 120Na: 144K: 3,9

PT : 12,5aPTT: 30,3

ManagementO2 5 l/mntIVFD RL 4 cc/jamTh/: Ampicillin 3x250 mg IVParacetamol 3x250 mg po**WD/ Sepsis + Bronchopneumonia + susp. Tonsilitis diphteria From Pediatric Dept.

WD/ susp. Tonsilitis diphteria + Sepsis + BronchopneumoniaManagement :Obs. Vital Sign + upper airway obstruction IVFD lar 1:4 4 cc / hoursSwap throat still wait for resultAntibiotic, Analgetic and other submitted from Pediatric Department.

Thank You

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