Co-ass On Duty :

Yulia, Daus, Mitha, Trias, Rahmat, Hana,

Resident On Duty : Dr. Alex
EMERGENCY CASE REPORT

November 24
th
,

2013
Chief On Duty :
Rohman


Minor Surgery = 0 Patients
Plastic Surgery = 0Patient
Orthopaedi = 0 Patient
Urology = 0 Patient
Pediatric Surgery = 1 Patient
Neurosurgery = 0 Patients
Oncology = 2 Patient
Thorax & Cardiovascular = 0 Patient
Digestive = 0 Patients

Total New Patients = 2 Patients
All Patient will be reported

No Identity Admission to
E.R.
Diagnosis Treatment
1 Mrs.
Suminah/
43yo
Dec 2
th
2013 at
15.00
Tumor a/r sternalis
susp malignansi et
cause susp metastasis
Ca Ovarium +
hipovolomic shock

IVFD RL rapidly 2 L :
Maintenance
Monitoring Vital Sign
Co. to Oncology:
-improvement of the
general state
-over admissions to
the obstetrics and
gynecology
department

2 Mrs.
Nushasanah/
41 yo
Dec 2
th
2013 at
18.00
Mamae Tumor dextra
suspect malignancy
T4cN3M1 + Pleural
effusion dextra+
Suspect metastasis
hepar

O2 3 l/m
IVFD RL
Antibiotic
Laboratory check
Co. to Oncology:
Hospitalizatedp
Co. to Digestive
surgery

No Identity Admission to
E.R.
Diagnosis Treatment
3 Boy. Rizqan
Ridani
Dec 2
th
2013 at
18.30
Blunt Abdomen
Trauma susp intra
abdominal bleeding

O2 3 l/m
IVFD RL
Antibiotic
Analgesic
H2 Blocker
Laboratory check
Thorax photo
BNO
Co. to Pediatric
Surgery:
Consulent will visited

Discharge by request
1. Mrs. Suminah/ 43yo/ 2 December 2013 at 15.00
Chief complaint : bleeding from the breast
History : Patient was complained with bleeding from the
breast since 8 hours before admission, with estimated
bleeding volume 500 cc. patients had been treated at Ulin
Hospital and diagnose with susp dermoid cyst at cavum
pelvis and Ca Mammae T4N3Mx and will control to
obstetrics and gynecology department for radiotherapy or
chemotherapy. Patient feel lethargic, and shortness of breath
(+).

Primary Survey
Clear, snoring (-), gurgling (-), C-spine
control (+)
A
Clear, RR=25 x/min, symmetric
respiratory movement chest, right
VBS= left VBS, Rh(-/-), Wh (-/-)
B
TD: 60/30 mmHg, Pulse rate: 89 x/m
regular but weak,
C
GCS E4V5M6, round and symmetric
pupils diameter (3mm/3mm),
D
Secondary survey

Eye : anemic conjunctivae (+/+), icteric sclerae (-/-),
Mouth : wet mucous
Neck : increase of JVP (-), enlargement of limph node (-)
Head/Neck
I : symmetric respiratory movement, retraction (-), look mass
P : symmetric VF
P : sonor in all lung field
A :symmetric VBS, right VBS= lef t VBS Rh (-/-), Wh (-/-)
Chest
I : Flat, hematoma (-), wound (-)
A : normal bowel sound
P : H/L/M not palpable, Pressure pain (-), DM (-)
P : tympanic in all quadrants
Abdomen
warm periphers (+), edeme (-), parese (-)
Extremities
Clinical Picture







Looks bandaged mass with active
bleeding
Abdomen CT-Scan+ Pelvis Result
(Nov,14 2013)

Cystic Mass 17x15x22 from cavum pelvic with n
calsification
mass appeared attached to the uterus and uterine
urged to the right lateral suspect Dermoid cyst


Hepatosplenomegaly
Hydronephrosis Grade 4 dextra
Ovarial cyst(Maligancy?)


Abdomen USG Result
(Oct,24 2013)
Laboratory Finding
Hb 9.1 g/dl
Leu 12.8 thou/ul
Erit 3.67 mil/ul
Ht 28,4 vol%
Tromb 392 ribu/ul
GDS 109 mg/dl
SGOT/PT 24/14
Na/K/Cl 134,4/ 5,0/102,9
Ureum /Creatinin : 36/1,0
PT/ APTT: 10,2/26,3
Working Diagnosis
Tumor a/r sternalis susp malignansi et
cause susp metastasis Ca Ovarium +
hipovolomic shock
Management
Resusitation
IVFD RL rapidly 2 L : Maintenance
Monitoring Vital Sign
Co. to Oncology:
-improvement of the general state
-over admissions to the obstetrics and gynecology
department
2. Mrs. Nushasanah/ 41 yo/ 2 Desember 2013 at 18.00
Chief complaint : shortness of breath
History : Patient was complained with shortness of
breathh since 1 weeks before admission, shortness of breath
is not affected by the activities and not influenced by climate.
initially sized of mass just like rambutan seed 2.5 years ago.
Patient refused for surgery management. Patient menarche
at 15 year old, and married at 22. first child its 18 year old.
Patient was referred by Ratu zalecha Hospital to Ulin
Hospital to got next treatment.

Primary Survey
Clear, snoring (-), gurgling (-), C-spine
control (+)
A
Clear, RR=24 x/min, symmetric
respiratory movement chest, right
VBS < left VBS, Rh(-/-), Wh (-/-)
B
TD: 110/70 mmHg, Pulse rate: 92 x/m
regular.
C
GCS E4V5M6, round and symmetric
pupils diameter (3mm/3mm),
D
Secondary survey

Eye : anemic conjunctivae (+/+), icteric sclerae (-/-),
Mouth : wet mucous
Neck : increase of JVP (-), enlargement of limph node (-)
Head/Neck
I : symmetric respiratory movement, retraction (-), look mass
P : symmetric VF
P : sonor in all lung field
A :symmetric VBS, right VBS= lef t VBS Rh (-/-), Wh (-/-)
Chest
I : Flat, hematoma (-), wound (-)
A : normal bowel sound
P : H/L/M not palpable, Pressure pain (-), DM (-)
P : tympanic in all quadrants
Abdomen
warm periphers (+), edeme (-), parese (-)
Extremities
Clinical Picture







a/r thorax dextra
Look mas 12x10x7 cm, irregular
edge, fixed, edema(+)
laseration(+), active bleeding (+)
lymph nodes (+) axillary dextra,
supraaclavicular dextra.
Thorax Photo

Post CTT Thorax Photo

Abdomen USG
Kesan:
HeparMetastase pleural
type metastase
Other in normal
condition
Laboratory Finding
Hb 10.4 g/dl
Leu 6,7 thou/ul
Erit 3.79 mil/ul
Ht 32,3 vol%
Tromb 219 ribu/ul
GDS 139 mg/dl
SGOT/PT 34/24
Na/K/Cl 127.8/4.4 / 93.6
Ureum /Creatinin : 11/o.2
Albumin: 4.0
Working Diagnosis
Mamae Tumor dextra suspect
malignancy T4cN3M1 + Pleural
effusion dextra+ Suspect metastasis
hepar
Management
O2 3 l/m
IVFD RL
Antibiotic
Laboratory check
Co. to Oncology:

Co. to Digestive surgery

3. Boy. Rizqan Ridani/ 13 yo/ 2 Dec 2013 at 18.30
Chief complaint : abdominal pain
History :
: Patient had a traffic accident since 8 hours before
admission. Patient fall from motor cycle with chest bumped
to asphalt. Patent was complained with abdominal pain, pain
feel in upper abdomen. Head ache(-) nausea(-) vomit(-),
history of unconscious (-) Bleeding from ear nose (-/-/-).
Patient was referred by Tanjung Hospital to Ulin Hospital to
got next treatment.
Primary Survey
Clear, snoring (-), gurgling (-), C-spine
control (+)
A
Clear, RR=32 x/min, symmetric
respiratory movement chest, right
VBS= left VBS, Rh(-/-), Wh (-/-)
B
TD: 90/60 mmHg, Pulse rate: 92 x/m
regular
C
GCS E4V5M6, round and symmetric
pupils diameter (3mm/3mm),
D
A
-
M
Ceftriaxone,
Ranitidin, antrain
P
-
L
10 hours before
admission
E
On the road
Secondary survey

Eye : anemic conjunctivae (-/-), icteric sclerae (-/-), looks bruised
around the eyes
Mouth : wet mucous
Neck : increase of JVP (-), enlargement of limph node (-)
Head/Neck
I : symmetric respiratory movement, retraction (-),
P : symmetric VF
P : sonor in all lung field
A :symmetric VBS, right VBS= lef t VBS Rh (-/-), Wh (-/-)
Chest
I : Flat, hematoma (+) a/r epigastrica, wound (-)
A : normal bowel sound
P : H/L/M not palpable, Pressure pain (+), DM (-)
P : tympanic in
Abdomen
warm periphers (+), edeme (-), parese (-)
Extremities
Clinical Picture







a/r thorax et epigastrica
Look laceration wound
X-Ray
recline stand
Laboratory Finding
Hb 11.2 g/dl
Leu 19.6 thou/ul
Erit 3.99 mill/ul
Ht 32.9 vol%
Tromb 294 thou/ul
GDS 168 mg/dl
SGOT/PT 488/25
Na/K/Cl 127.8/ 4.4 / 93.6
Ureum /Creatinin : 11/0.2
PT/ APTT: 11.8/23.4
Working Diagnosis
Blunt Abdomen Trauma susp intra abdominal
bleeding
Management
O2 3 l/m
IVFD RL
Antibiotic
Analgesic
H2 Blocker
Laboratory check
Thorax photo
BNO
Co. to Pediatric Surgery:
Consulent will visited