SCENARIO 3

STEP 1
1. Multiple vulnus excoriatum
Multiple means more than one, vulnus wound ,excoriatum
means a abraded area where the skin is torn of
2. Abdominal sonography
Is a usefull way of examining internal organic in abdominal
Abdominal sonography is called abdominal ultrasound (USG) ,
reflected sound waves to produce a picture of the organ and
the other structure in the upper of abdominal.
3. Cito haemoglobin test
Is qualitative imunocromatographic assay for the termination
of human haemoglobin in stool sample.
4. Distended
One of part inflammation ,also called as udem.
5. Liver dullness percussion sign
Its the movement percussion sound
Is a sign of percussion liver too ascites or there are more
blood on the abdominal wall, si ut can produse movement
percussion sound from tympani to pekak
STEP 2
1.
2.
3.
4.
5.
6.
7.
8.

Why he came to the ER in a weak and pale condition?

Why was his right region on his stomach pain?
Interpretation of physical examination?
Interpretation of vital sign examination?
Interpretation of Laboratory result?
What organ on the upper right region of abdomen?
How could conjunctiva anemic?
Why the doctor suggest the patient to take a cito haemoglobin
test series and abdominal sonography?
9. How could the percussion sign be liver dullness?
10. Why the doctor said thats emergency condition?
11. How could the abdominal be distended?
12. Indication of surgery to this case?
13. What makes the diferent of laboratory result, especially for
haemoglobin?
14. What kind of condition that make the peristaltic sound of
abdomen decreased?
15. Which classification of vulnus he had?

16. What the gold standar examination in this case?

17. How to examine vulnus?
STEP 3
18. Why he came to the ER in a weak and pale condition?
Because he lost of his blood so much that causing anemic
condition
19. Why was his right region on his stomach pain?
Causes :
Cause by liver disorder
Galbladder disorder
Gastric disorder
Infection in digestive track or the pelvis
Because the trauma that make compression and deceleration
on abdominal wall. so, the location of trauma only the right
upper abdominal
20. Interpretation of physical examination?
21. Interpretation of vital sign examination?
BP ; 110/70 normal
HR ; 100 normal
RR ; 24/minute normal
T ; 37 C normal
22. Interpretation of Laboratory result?
All Hb test are decreased
normal : man : 14-18
Woman : 12-16
Child : 10-16
Neonatus : 12-24
WBC : increased,
Normal : 4000-10000
Neonatus : 9000-30.000
Platetelets : normal 200.000-400.000
HCT : decreased
Normal : 40-48%
RBC : decreased
Normal : man : 4,5-6,2 million
Woman : 4,2-5,4 million
23. What organ on the upper right region of abdomen?
Hepar and vesica fellea, part of colon transversum and part of
colon ascenden
Right kidney, colon, pancreas, gallbladder, duodenum
24. How could conjunctiva anemic?
Because decresed blood supply to sclera.

 Because of the trauma, that showed Hb decreased.trauma

makes rupture of hepar or aorta abdominalis makes
internal abdominal bleeding reseve of blood decreased
25. Why the doctor suggest the patient to take a cito haemoglobin
test series and abdominal sonography?
Cito Hb series : maybe done too find anemia, and than see
how much blood lost if theres bleeding, check for abdominal
bleeding is afecting the blood cell and count, find of
infection, screen for high and low values before surgery.
USG : its use to see damage of intra abdominal organ.
26. How could the percussion sign be liver dullness?
So trauma can devided by two mechanism ;
Compression : or concusive force. it makes external
compression to abdominal wall, and make rupture of
visceral organ, and make increased of intra luminal
pressure
Desceleration : can make torn of the fixation organ
Make bleeding of the internal abdominal makes accumulate
of blood on the internal abdominal liver dullness
27. Why the doctor said thats emergency condition?
Because he lost lot of his blood, an dthe doctor afraid if the
rupture spread and make infection
28. How could the abdominal be distended?
Because is aterm usually used to refered to distension or
swelling of abdomen and not of the stomach itself. Thia
condition, can be related to digestion such as malabsortion or
two disturbance in bowel function.
On abdomen examination,so probably due to accumulate of
fluid in the abdominal region. So the region of abdomen will
be distended.
Maybe it cause rupture of hepar, rupture aorta abdominalis.
29. Indication of surgery to this case?
30. What makes the diferent of laboratory result, especially for
haemoglobin?

In the beginning, the patient had bleeding and take out

whole blood. So, blood volume changed by crystalloid
fluid and hormonal efect (ACTH, aldosteron, and ADH ),
so theres refill of transcapiler.
31. Indication of abdominal sonography?

 Commonly used in the setting of abdominal pain or and

acute abdomen
Abdominal sonography also can be use if there is
suspicion of enlargement of one or more organs.
32. What kind of condition that make the peristaltic sound of
abdomen decreased?
33. Which classification of vulnus he had?
34. What the gold standar examination in this case?
(FAST) focus assessment with sonography in trauma.because
sonography can makes the picture of the organ, tissue, or the
blood flow.
35. How to examine vulnus?
LO
1. Indication of surgery to this case?
2. What kind of condition that make the peristaltic sound of
abdomen decreased?
3. Which classification of vulnus he had?
4. How to examine vulnus?
5. 9 Region abdomen
6. The diferent blunt and penetrating wound of abdomen?
7. Sign of intra peritoneal, retroperitoneal, and pelvic trauma
8. Signs of hypovolemic shock ec internal bleeding?
9. Diagnose proscedure abdominal trauma
10. Management of abdominal trauma
11. DD
12. Diagnosis
13. Definition & Classification
14. Epidemiology
15. Pathofisiology
16. Manifestation Clinic
17. Pmx. Penunjang
18. Management (tatalaksana)
19. Complication
20. Prognosis
11. Complication
12. Prognosis of abdominal trauma
13. Islamic knowledge of safar?