EMERGENCY CASE REPORTS

Sunday, 18 November 2018

SURGERY DEPARTMENT

EMERGENCY ROOM
Wahidin Sudirohusodo General Hospital
Makassar
EMERGENCY CASE REPORT
Sunday, 18 November 2018
Ambulation : 2 Patient
Hospitalized : 4 Patients
Observation : Patient
Operated : - Patient
Death : Patient
Total : 6 Patients

Wahidin Sudirohusodo General Hospital

Makassar
 Name : By. Ms J Age : 18 days
RM : 863232 DPJP : dr. UM

Chief complain : Abdominal distention

History taking : This condition has been complained since his age 2 days. There were
no history of meconium release in first 24 hours. There were no history
of nausea, vomit and fever. Prior medical care at fak-fak general
hospital and perform rectal wash out symptom releave.
Patient is the five child, born per section caesarian by obstetric doctor at
fak-fak general hospital west papua, with birth weight 3250 gram and
length 42 cm. The mother's history has regular ANC at primary health
center by midwife. The patient's mother had no history of taking any
medication, no history of smoking and alcohol.

Micturition : Normally
Physical Examination
General Status:
Active/ well nourished (Weight: 2700 gram, Length: 52cm)

Vital Sign:
HR: 125 x/min RR: 36 x/min T(Ax): 36,5°C

Head: concave anterior fontanel, conjunctiva isn’t anemic, dry

mouth and lip mucosa, skin turgor : slow to return
Chest: symmetrical shape and movement, equal vesicular
breath sound, ronkhi (-), wheezing (-), regular heart sound,
murmur (-)
Abdomen
Local Status
I: seen distended, follow breath motion, skin color is the same with its vicinity,
bowel contour (+), bowel motion (+).
A: peristaltic sound (+) increased, metallic sound (-)
P: soft, palpable mass (-)
P: hipertympani
 Digital Rectal Examination
• Spinchter tone was tight
• Mucosa was smooth
• Ampula filled with feses
• Handscone blood (-), slime (-) , feses (+)
 Clinical diagnose
• Low level Total Intestinal obstruction due to
suspicious Hirschprung disease
• Moderate dehidration
 Laboratory findings :

• Hb : 12,1 • Ureum : 108

• Hct : 40 • Kreatinin: 1,71
• WBC : 13600 • SGOT : 225
• PLT : 409.000 • SGPT : 92
• Natrium : 179 • CT : 8’00
• Kalium : 4,4 • BT : 2’30
• Klorida : 135
• GDS : 118
Abdominal (supine)
Abdominal (LLD)
WORKING DIAGNOSE : • Low level Total Intestinal obstruction due
to suspicious Hirschprung disease
• Moderate dehidration

MANAGEMENT : • IVFD
• Apply nasogastric tube and urine catheter
• Rectal washout 20cc/kg/12 j NaCl 0.9%
• Medicaments
• Consult NICU
• Plan to Barium enema and rectal biopsy
 Name : Ch. MA Age : 11 y.o
RM : 863237 DPJP : dr.NA

Chief : Gun shoot wound at left chest

complain
History taking : The incident happened 2 hours ago before admitted to
hospital due to being gun shoot. Patients complain feel pain
at the left chest and left upper abdomen when he try to take a
breath. There were no history of bloody vomiting and bloody
faeces. Prior medical care at Antang primary health center.
Mechanism Of : The patient was playing a gun shoot with his friend at home.
Injury Suddenly his friend try to shoot and accidently there was a
bullet in his gun when patient was bend over position
 Physical Examination
Primary Survey :
A : Clear
B : RR : 24x/minutes, spontaneous, seen symmetric
movement, symetric breath sounds. SpO2 99%
C : blood pressure 100/60 mmHg, Hr 82x/minute
D : GCS 15 (E4M6V5), Isochoric pupil 2/2 mm, LR (+/+).
E : T 36,5 ‘C (axilla).
Secondary Survey

Thorax:
I : symmetric movement, seen open
wound 0,5 cm on left chest at level ICS V
P : symmetric vocal fremitus, tenderness
at left thorax
P : sonor at both hemitoraks
A : vesicular breath sounds on left and
right hemitorax.
Rh -/-, Wh -/-
 Secondary Survey
Abdomen :
• I : flat , follow breath motion, same colour with its
vicinity
• A : Peristaltic (+) normally
• P : Tenderness (+) Left Upper Quadrant, defans
muscular (-)
• P : Tympani (+) , liver dullness (+)
 Clinical Diagnosis
• Vulnus ictum penetrant (GSW) at left
Hemithorax region with stable hemodinamic
• Foreign body at left hemithorax region
 Laboratory findings :
 Hb : 12,9  SGOT : 49
 Hct : 37  SGPT : 14
 WBC : 16.400  Ureum : 21
 PLT : 267.000  Kreatinin: 0,40
 APTT : 26,7  Na : 140
 PT : 11,8 K : 3,9
 INR : 1,14  Cl : 104
 GDS : 125
Chest X-Ray (PA view)
Chest X-Ray (Lateral view)
USG Abdomen
 Working Diagnosis
• Vulnus ictum penetrant (GSW) at left
Thoracoabdominal with stable hemodinamic
• Foreign body at left upper abdominal
 Management
• Oxygen 2-3L/i/via nasal canul
• IVFD
• Medicament
• Consult to pediatric surgeon 
– Selective non operative management
 Prognosis and follow up
• Prognosis : Dubia
• Follow up :
– Vital Sign
– Acute Abdomen
THANK YOU