Visi dan Misi Program Studi Spesialis Ilmu Bedah

Fakultas Kedokteran Universitas Udayana

Visi
• Menjadikan Program Studi Spesialis Ilmu Bedah sebagai pusat pendidikan, pelayanan, dan penelitian yang
unggul, mandiri, dan berbudaya serta menghasilkan lulusan yang memiliki kelebihan khusus dalam bidang
traumatologi dan bedah akut yang dapat bersaing di tingkat regional, nasional, dan internasional pada tahun
2025.
Misi
• Menyelenggarakan Tri Dharma Perguruan Tinggi yang berkualitas, unggul, mandiri, dan berbudaya di bidang
Ilmu Bedah yang mampu bersaing secara global.
• Menyelenggarakan Pendidikan Ilmu Bedah yang didukung oleh pengembangan sumber daya manusia dengan
kepribadian, kemampuan, dan keterampilan yang berkualitas serta fasilitas yang memadai.
• Menyelenggarakan pendidikan Ilmu Bedah yang didukung oleh Kerjasama tim, etos kerja yang baik, dan
senantiasa membina hubungan baik dengan institusi baik di dalam maupun di luar negeri.
• Menyelenggarakan pendidikan Ilmu Bedah dengan keunggulan di bidang traumatologi dan bedah akut yang
dijabarkan dalam bentuk alokasi waktu tersendiri sebagai program unggulan lokal .

Trauma Consultant
Oncologist Surgeon Consultant
Plastic Surgeon Consultant
Urology Consultant
Neurosurgery Consultant
Orthopedic Consultant
Vascular Consultant
Cardiothoracic Consultant
Digestive Consultant : dr. I Made Mulyawan, Sp.B-KBD
Pediatric Surgeon Consultant
Chief of the Residents
Leader : PKJ
Senior residents
Junior residents
Urology residents
Neurosurgery Residents
Plastic Surgery Residents
Orthopedic Surgery Residents
MORNING REPORT
Thursday, 10th March 2022
: dr. I Gede Suwedagatha, Sp.B(K)Trauma
: dr. IB Made Suryawisesa, Sp.B(K)Onk
: dr. I Gst. Pt. Hendra Sanjaya, Sp.B, Sp.BP-RE(K)
: Dr. dr. AA. Gde Oka, Sp.U(K)
: Dr. dr. I Wayan Niryana, M.Kes, Sp.BS(K)
: Dr. dr. Made Bramantya Karna, Sp.OT(K)
: dr. IGAB Krisna Wibawa, Sp.B(K)V
: Dr. dr. Ketut Putu Yasa, Sp.B, Sp.BTKV(K)
: dr. I Made Darmajaya, Sp.B, Sp.BA,MARS
: TAP
: UCP/MYF/YDS
: NAT/GOI/KAY/MKG/ANU/PRN
: ASY
: TEJ BIO/MOT/ASK/GRY/MON/DWK
: EUN/HDR/NGT/RTH/GIN/GIT
: KRI
 RESUME

Total patients : 12 patients

Trauma : 4 patients
Non Trauma : 8 patients
Hospitalized : 6 patients
Surgery : 1 patients
Minor Surgery with LA : 2 patients
Consultation : 1 patients
Mortality : 0 patients
Emergency Unit
 Emergency Ward Bed 3
No Identity Diagnosis Management
1 Nyoman Srimpen / F / 47 yo • Multiple right posterior ribs fracture 3,4,5,6,7 • IVFD NaCl 0.9% 20dpm
/ 22013149 Dispplaced with complication • Pain management pethidine 100mg +
• Right pulmonum contusion ketorolac 60m in D5% / 24 hour IV
• Right pleural effusion, susp. hematothorax • Obs, sign respiratory distress
• Mild Head Injury (E4V5M6)
• Left Sylvian fissure tSAH Neurosurgery
• Right parietal tSAH • Head up 30⁰
• FBC • IVFD Nacl 0.9% 20 dpm
• Right mastoid bone fracture • O2 on FM 8 lpm
• Right temporal bone fracture • Fenitoin 100 mg / 8 hour PO
• Right Clavicle fracture alman group 1 • Omeprazole 20 mg/12 hour PO
• Fracture of right lateral margo corpus scapula • Paracetamol 1000 mg / 8 hour PO
• Acute pain (VAS 3)

ICD 10
S22.39XB Fracture of rib
S42.0 Fracture of clavicle
S27.32 Contusion of lung
J91.8 Pleural effusion ICD 9
S09.90XA Unspecified injury of head 99.2 Injection or infusion of other therapeutic
S02.6 Fracture of mandible Z79.891 The use of analgetic
S02.8 Fractures of other specified skull and facial bones 93.96 Oxygen administration
S02.9 Fracture of unspecified skull and facial bones V71.9 Observation of unspecified suspected condition
 Emergency Ward Bed 4
No Identity Diagnosis Management
2 I Wayan Sumadi • Spontaneus bilateral pneumothorax susp • IVFD NaCl 0.9% : D10% : Aminoleban 1:1:1
/ M / 69yo / 21035049 / BPJS bronkopleura fistule 20dpm
• Melena Susp peptic ulcer • Gabaxa 100cc in NS 400cc every 8 hour
• Transaminitis (SGOT 525, SGPT 185) • Paracetamol 500mg every 8 hours
• Hipoalbumin (1.4) • Tranfusion of human albumin 1fls/day
• Hipoglycemia • Obs repiratory distress and WSD production
• Consult to Internist department
• POC : CT-Scan Thorax + C

ICD 10
J93.0 Spontaneous pneumothorax ICD 9
K92.1 Melena (K92. 1)
99.2 Injection or infusion of other therapeutic
R74.0 Nonspecific elevation of levels of transaminase and lactic V58.82 chest tube WSD
acid dehydrogenase
93.96 Oxygen administration
E16.2 Hypoglycemia V71.9 Observation of unspecified suspected condition

No Identity
3 Ida Bagus Agastya Palguna
/ M / 20yo / 22013169 / BPJS
Emergency Ward Bed 1
Diagnosis Management
CKS (E3V4M6)
- SDH Acute R. FrontoTemporal D (thickness 7 mm, MLS 3 mm ke kiri)
• Diet non chewing
- Multiple Contusio Cerebri R. FrontoTemporal D • Oral hygine with antiseptik liquid every 4hours
- Multiple Aerocele • Paracetamol 500mg every 8 hour
- Open Fr. Depressed Anterior Wall Sinus Frontal D et S • Tetagam Inj
- Open Fr. Depressed Posterior Wall Sinus Frontal D
- Open Fr. Depressed Os Frontal D et S • POC : ORIF Mini Plate Elective
- Fr. Depressed Os Temporal D
- Fr. Le Fort II Neurosurgery
- Fr. Fronto Zygoma D
- Fr. Fronto Zygoma S Elevasion recontruction fr. depressed + decortication of
- Fr. Maxila D frontal sinus + cranialitation emergemcy
- Fr. Maxila S
- Fr. Fronto nasal • Head up 30⁰
- Fr. Rima orbita inferior D • IVFD Nacl 0.9% 20 dpm
- Fr. Rima orbita inferior S • O2 on FM 8 lpm
- Fr. Maxila D
- Fr. Maxila S • Ceftriaxone 2g / 24 hours IV
- Close fr right radius ulna middle third • Fenitoin loading 1200 mg, maintenance 100 mg / 8
- Close fr right distal radius hours IV
- Open fr right femur middle third gustillo andersen gr II
- CF Right Segmental Radius • Omeprazole 40 mg/12 hours IV
- CF Right Distal Radius Frykman Type 3 • Petidine 100 mg on 500cc NaCl 0.9% / 24 hours IV
- CF Right Radius Proximal Third
- CF Right Ulna Middle Third
- OF Floating Knee Gustilo Anderson Grade 3A Orthopaedi
- OF Right Femur Distal Third Gustilo Anderson Grade 3A Immobilisation with Backslab
- CF Right Tibia Middle Third Debridement + External Fixation (Femur + Tibia)
- CF Right Fibula Proximal Third
ORIF PS (Radius + Ulna) Elective
ICD 10
S02.91 Unspecified fracture of skull
I60.0 Intracranial hemorrhage
S02.6 Fracture of mandible ICD 9
S02.8 Fractures of other specified skull and facial bones 99.2 Injection or infusion of other therapeutic
S02.9 Fracture of unspecified skull and facial bones Z79.891 The use of analgetic
S02.4 Fracture of malar, maxillary and zygoma bones 99.21 Injection of antibiotic93.96 Oxygen administration
S50-S59 Injuries to the elbow and forearm V71.9 Observation of unspecified suspected condition
S52.50 Fracture of lower end of radius
 Emergency Ward Bed 9
No Identity Diagnosis Management
4 Hari Susanto /M/ 48 yo •Obs Hematochezia e.c colorectal mass susp IVFD NaCl 0.9% ~ 20 dpm
/ BPJS/ 01231356 malignancy Gabaxa 100 cc with NS 400 cc in 8 hours IV
•Leukositosis (13.0) Transfusion PRC 1-2 kolf/day
•Moderate Anemic(7.5) Traneksamat acid 500mg/8 hour IV
Vitamin K 1 amp/8 hour IV
POC : Colonoscopy diagnostic

ICD 10 ICD 9
K92.1 · Hematochezia 99.2 Injection or infusion of other therapeutic
288.60 - Leukocytosis 93.96 Oxygen administration
D64.9 for Anemia V71.9 Observation of unspecified suspected condition
99.0 Transfusion of blood and blood components
 Emergency Ward Bed 10
No Identity Diagnosis
5 Ni Made Pusparini • Post total thyroidectomy (7/3/2022)
/F/ 30yo/ 14075225 / BPJS • MNT Eutiroid (Colloid Nodule)
• Severe Hipokalsemia (5.9)
• Hipokalemia (3.35)
ICD 10
E07. 81Sick-euthyroid syndrome
E87.6 Hypokalemia
E88.6 - Hypokalemia
Management
- IVFD NaCl 0.9% 20 dpm
- Bolus Ca glukonas 1 ampul then maintenance
drip Ca Glukonas 2 ampul with D5 500 cc in 8
hours
- Inj Omeprazole 40mg/12hour IV
- CDR Fortoz tab every 24 hour PO
- Calcitriol 0.25 mg every 24 hour PO
- Calos 500 mg every 12 hour PO
- KSR 600 every 12 hour PO
ICD 9
99.2 Injection or infusion of other therapeutic
V71.9 Observation of unspecified suspected condition
 Emergency Ward Bed 11
No Identity Diagnosis Management
6 Made Saduarsa / 51 yo • Total ileus obstruktif ec susp Massa Pro Laparotomy eksplorasi K/p Kolostomi
/ M/ 22013177 / UMUM intraabdomen ekstralumen Puasa
• Intraabdominal hipertensi grade I NGT dan DK Dekompresi
• Leukositosis (18.28) Co TS Anestesi preop
• Transaminitis (OT 102.5 / PT 89.0) Ceftriaxone 2gr
• Hiponatremia (125) Observasi tanda akut abdomen
• Hipokalemia (3.35)

ICD 10
K56 intestinal obstruction ileus without hernia
R74.0 Nonspecific elevation of levels of transaminase and lactic ICD 9
I11 Hypertensive heart disease 99.2 Injection or infusion of other therapeutic
288.60 – Leukocytosis Z79.891 The use of analgetic
E87.6 Hypokalemia 99.21 Injection of antibiotic93.96 Oxygen administration
V71.9 Observation of unspecified suspected condition
D64.9 for Anemia
Consultation
 Neurology Ward bed 3

No Identity Diagnosis Management

1 I Ketut Kerenali
/ M/ 57yo/ 21065241/BPJS
•Cellulitis Pedis D Ceftriaxone 1g/24 hour IV
•Obs DOC ec septic encephalopathy Metronidazole 500mg/8 hour IV
•History of SNH (2014) Paracetamol 500mg/6 hous
•SuspI dd ACKD compress with gauze + NaCl 0.9%
•CHF FC II ec susp CAD Elevation Right Lower Extremity
•HT on treatment
•Leukositosis (23.47) Neurology
•Prolonged hemostatic Head up 30
Miring kanan kiri tiap 2 jam
Paracetamol 1000 mg every 8 hoursPO
Co Internist for treatment AKI dd ACKD

Cardiology
Asetosal 80 mg tiap 24 jam PO
Bisoprorol 1.25 mg tiap 24 jam PO
Ramipril 2.5 tiap 24 jam PO
Simvastatin 20 mg tiap 24 jam
Furosemide 40 mg k/p
ICD 10 ICD 9
L08.9 infection of skin and subcutaneous tissue, unspecified 99.2 Injection or infusion of other therapeutic
N18 Chronic Kidney Disease Z79.891 The use of analgetic
I11 Hypertensive heart disease 99.21 Injection of antibiotic
I50 Heart Failure
D72.829 Elevated white blood cell count 93.96 Oxygen administration
V71.9 Observation of unspecified suspected condition
Operation
 RR Operating Emergency Room
Rosidi/L/48thn/BPJS/22011081/dr.KYS

Diagnosis : Observation shock ec septic shock

Pneumonia CAP PSI IV
Susp Gastric Outlet Obstruction dd gastric
tumor
Hypokalemia (1.71)
Hypoalbumin (2.98)
Procedure : Insersi CVC Femoral D

Supervisor : DR.dr. I Nyoman Semadi SpB, SpBTKV (K)

Operator : UCP
Assistant : AGN/PRN/TAP
Mortality
Thank You
 Visi dan Misi Program Pendidikan Dokter Spesialis Ilmu
Bedah
Fakultas Kedokteran Universitas Udayana
VISI
• Menjadikan Institusi Pendidikan Dokter Spesialis Bedah Umum sebagai  pusat pendidikan,  pelayanan dan 
penelitian yang mandiri, unggul dan berbudaya yang dapat bersaing ditingkat nasional, regional dan internasional
pada tahun 2020.

MISI
• Menyelenggarakan Tri Dharma Perguruan tinggi yang berkualitas, unggul, mandiri dan
berkepribadian di bidang ilmu bedah umum yang mampu bersaing di tingkat global.
• Menyelenggarakan  Pendidikan Ilmu Bedah Umum yang didukung oleh pengembangan sumber
daya manusia yang memiliki kepribadian, kemampuan dan keterampilan yang berkualitas serta
didukung oleh fasilitas lain yang memadai.
• Menyelenggarakan Pendidikan Ilmu Bedah Umum yang didukung oleh kerja sama tim, etos kerja 
dan senantiasa membina hubungan baik dengan institusi baik di luar maupun dalam negeri.
• Menyelenggarakan Pendidikan Ilmu Bedah Umum yang  selalu menjaga manajemen mutu (Total
Quality Management), pembaharuan ilmu dan teknologi secara berkelanjutan dengan
mengutamakan prinsip-prinsip kemanusiaan.
 Triage Neuro Bed 1
I Ketut Kerenali/ L/ 57th/ 21065241/BPJS

Main complaint : decrease of consciousness

Current Medical History

Patients come with a decrease of consciousness, occur suddenly 2 hours SMRS. The
patient is then taken to the ER for resuscitation. The family said yesterday the patient had
a fever and improved without medication.
According to the family, the pain in the right leg has been 1 week. The pain is feeling
more intense. Pain when moving in the cage, looks bula. Fever (+), nausea
(-), vomiting (-).

HT on treatment captopril 25 mg
History of stroke 8 year ago
Physical Examination

Status present:
GCS : E3V2M5
BP 90/60 mmHg
HR : 112 x/min
RR : 24 x/m
Temp 37.3°C
SpO2 99% on FM 6lpm
General Status Regio Pedis D

Eyes : ane -/-, ict -/- pr +/+ isokor Look

Thorax: Reddish, oedema on right foot.

- Cor S1S2 single regular murmur (-) Bula 5x5 cm, pus (-) blood (-) port entry (+)

- Pul : Ves +/+ , RH -/- , WH -/- Feel

Ext Warm ++|++ Warm (+) CRT < 2 sec

Move

Abdomen: Difficult to evaluated

I: Distension (+), darm contour (-), darm steifung

(-). Pulsation
A: BU (+) normal A. Femoral : +2/+2
Palp: Soefel A. Poplitea : +2/+2
Perk: Timpani (+) A.Tibial Posterior : +2/+2
A. Dorsalis Pedis : +2/+2
Laboratory 10/3/22 Sanglah General Hospital

WBC 23.47 / HB 13.6 / PLT 208

PPT 13.5/ APTT 42.8/ INR 1.2
BS 115 / BUN 37.9 / Cr 3.77/ eLFG 16.2
Na 140 / K 3.98
Ro. Pedis Dextra 10/03/22

Interpretation

No visualized picture of
osteomyelitis in the bones of the
pedis

Soft tissue swelling regio pedis

dextra
Diagnosis Management
Ceftriaxone 1g/24 hour IV
• Cellulitis Pedis D Metronidazole 500mg/8 hour IV
Paracetamol 500mg/6 hous
• Obs DOC ec septic compress with gauze + NaCl 0.9%
encephalopathy Elevation Right Lower Extremity
• History of SNH (2014) Neurology
• SuspI dd ACKD Head up 30
Miring kanan kiri tiap 2 jam
• CHF FC II ec susp CAD Paracetamol 1000 mg every 8 hoursPO
Co Internist for treatment AKI dd ACKD
• HT on treatment
• Leukositosis (23.47) Cardiology
Asetosal 80 mg tiap 24 jam PO
• Prolonged hemostatic Bisoprorol 1.25 mg tiap 24 jam PO
Ramipril 2.5 tiap 24 jam PO
Simvastatin 20 mg tiap 24 jam
Furosemide 40 mg k/p
 Triage bedah Bed 3
Nyoman Srimpen / P / 47 thn / 22013149

Chief Complaint: Pain in his face and right chest

Current Medical History

Wangaya Hospital referral patient with Mild Head Injury + SAH + Fr Os Mastoid D +
Temporal D + Fr Clvicula D + Fr Scapula D + Fr Costa 3-7 Posterior D

The patient came conscious escorted by ambulance with complaints of pain in the face and
posterior right chest after traffic accident 6 hours arrived at Hospital.
History of unconsciousness (+) 5 minutes, tightness (-), headache (-), nausea/vomiting (-),
seizures (-)

MOI:
The patient riding motorcycle, used helmet, avoiding pedestrians crossing then the patient
falls into right side with the body hitting the asphalt first
• Primary Survey
• A: Clear, C-Spine stable
• B: Spontan, RR 20x/menit, SpO2 97% room air
• C: Stable, BP 120/70mmHg, Pulse 89x/m, adequate reguler, CRT < 2"
• D: GCS E4V5M6, PR +/+ isokor 3mm/3mm
• E: Tax 36.7°C

• Secondary Survey
• Head: cephalhematome (-)
• Eyes : anemis -/- ,periorbital hematome -/+
• ENT : battle sign -/-, otorea +/-
• Maxillofacial: malokulsi (-), step off (-), lesion (-), excoriatum zygoma D
• Neck : lesion (-) tenderness (-), step off (-)
Thorax: Abdomen
I : woung (-), symmetric +/+ I : Distention (-), lesions (-)
P: VF +/+ A : bowel sounds (+) 6x/mnt
P : sonor / sonor P : tenderness (-)
A: P: Tympani (+)
Cor : S1S2 tunggal, reg, murmur (-) Ekstremitas: warm (+) CRT <2 sec
Pulmo : ves decrease/+, rh-/-, wh -/-
Laboratory 10/3/2022 Wangaya Hospital
Wbc 10.51/ Hb 11.7/ Plt 285
Swab antigen 10/3/22 (-)
Shoulder Ap/lat 10/3/22
Shoulder Axial 10/3/22
Thorax 10/3/22
• Consolidation of the lower middle zone
of the right lung, susp. contutio
pulmonum dd/ pneumonia
• Right pleural effusion, susp.
hematothorax
• Complete fracture of os costae 3-7
posterior right accompanied by complete
fracture displaced shortened os clavicula
right and incomputite fracture margo
lateralis os scapula right
• Soft tissue swelling regio supraclavicula
right to hemithorax right lateral aspect
CT-Scan Kepala RS Wangaya 10/3/22
CT-Scan Kepala RS Wangaya 10/3/22
CT-Scan Kepala RS Wangaya 10/3/22
CT-Scan Kepala RS Wangaya 10/3/22

• Konsolidasi zona tengah bawah paru kanan, susp. contutio pulmonum

dd/ pneumonia
• Efusi pleura kanan, susp. hematothorax
• Fraktur komplit os costae 3-7 posterior kanan disertai fraktur komplit
displaced shortened os clavicula kanan dan fraktur inkomplit margo
lateralis os scapula kanan
• Soft tissue swelling regio supraclavicula kanan hingga hemithorax
kanan aspek lateral
DIAGNOSIS
• Fr Costae 3,4,5,6,7 Posterior D
Dispplaced with complication
• Contusio pulmonum D
• Right pleural effusion, susp.
hematothorax
• Mild Head Injury (E4V5M6)
• tSAH Sylvian fissure S
• tSAH Parietal D
• FBC
• Fr Os Mastoid D
• Fr Os Temporal D
• Fr Clavicula D alman group 1
• Fr margo lateral corpus scapula D
• Acute pain (VAS 3)
MANAGEMENT
• Inpatient
• IVFD NaCl 0.9% 20dpm
• Pain management pethidine 100mg + ketorolac 60m
in D5% / 24 hour IV
• Evaluation AGD
• Obs, sign respiratory distress
• Neurosurgery
• Konservatif*
• Head up 30⁰
• IVFD Nacl 0.9% 20 dpm
• O2 on FM 8 lpm
• Fenitoin 100 mg / 8 hour PO
• Omeprazole 20 mg/12 hour PO
• Paracetamol 1000 mg / 8 hour PO
 Triage Bedah Bed 4
I Wayan Sumadi / L / 69th / 21035049 / BPJS

Chief Complaint: Dyspnea (+)

Patients with a history of spontaneous pneumothorax since 1 week ago, initially the patient
complained of tightness the longer the more burdensome
Patients also complained of weakness since 1 week ago and bloody stool (+) blackened liquid
consistency since 10 days of SMRS nausea vomiting (-), Previously had a history of recurrent
shortness of breath (-) weight loss (-), history of long cough

History of taking rheumatic medicine for 10 years (meloxicam)

Patients have chest tubes attached to thorax right and left since 2/3/22 but complaints do not
Bilateral Thorax WSD Chest Tube Insetsi 2/3/22
Thrifty
Hypoglycemia
Anemia post transfusion PRC 1 kolf
 Triage Bedah Bed 4
I Wayan Sumadi / L / 69th / 21035049 / BPJS

Medical History :
IVFD NaCl 0.9% : D10% : Aminoleban 1:1:1 20tpm
Meropenem 3x1gr
Antrain 2x1amp
Pantoprazole 2x1amp
Kalnex 3x1amp
Vit K 2x1amp
PCT 3x1 tab
Sucralfat syr 3x1CI
Lactulosa Syr 3xCI
Status Present
GCS : E4V5M6
BP : 110/70mmHhg
HR : 86 x/minute
RR : 22 x/minute
SpO2 : 98 x/minute
Temp : 36.5 C
VAS : 2
LAB 4/3/2022
WBC 10.9 / HGB 10.0 / PLT 130
Bun 79 / Sc 1.4
SGOT 525 / SGPT 185
Albumin 1.4
GDS 84
Ro Thorax 2/3/2022
Ro Thorax 8/3/2022
CT Scan of the abdomen 23/2/2022
• Perivesical hematoma bilateral susp extraperitoneal urinary bladder
rupture, with malpositioned extravesical balloon catheter, impact on
posterior urethra
• Intravesical blood clot
• There is no hematoma or parenchymal laceration on the left kidney
• Liver, GB, spleen, pancreas, and right and left kidneys do not show
abnormalities
• Ascites
• Linear fracture of the right L5 transverse process, right posterior superior
iliac spine, right sacrum ala, left inferior pubic ramus and right left and
right inferior comminuted pubic ramus fractures
• Lymphadenopathy subcentimeter in right and left paraaorta and inguinal
DIAGNOSIS
• Pneumothorax spontan bilateral susp
fistula bronkopleura
• Melena Susp ulkus peptikum
• Transaminitis (SGOT 525, SGPT 185)
• Hipoalbumin (1.4)
• Hipoglikemi
MANAGEMENT
Trauma department
IVFD NaCl 0.9% : D10% : Aminoleban 1:1:1 20tpm
Gabaxa 100cc in NS 400cc every 8 hour
Paracetamol 500mg every 8 hours
CT-Scan Thorax + C di ruangan
Trf human albumin 1fls/day
Obs repiratory distress and prod. WSD
Co TS Interna with melenaiprofloxacin drip 2 x 200 mg IV
IVFD NS 20tpm
Omperazole 40 mg every 24 hours
Pain management: Petidine 100 mcg + Ketorolac 60 mg in
D5% / 24 hours IV
Hemodynamic observation and signs of acute abdomen
Reinstall DK and evaluate
Check UL
Orthopedics
bed rest
Conservative
 Triage Bedah bed 1
Ida Bagus Agastya Palguna/ L / 20 th / 22013169 / BPJS

Chief Complaint: unconsciousness

Current Medical History

Referal patient from Mangusada Hospital, came unconscious after accident.
History of conscious (-), vomiting (-), convulsions (-)

MOI:
Patient ride motorcycle, wearing a helmet, was hit by a car from the opposite direction
then crashed with an unknown mechanism

Treatment history
Loading crystaloid 2500 cc--> Plasmanat 300 cc
Omeprazole 2x40 mg IV
Drip Paracetamol 3x1 g IV
As. Tranexamat 3x1 g IV
Regio Facialis: Palpasi:
Inspeksi
- Step off Rima Orbita Superior -/-
- Hematoma Palpebra +/+
- Step off Rima Orbita Inferior +/+
- Edema Periorbita +/+
- Malar edema -/- - Step off Frontozygoma +/+
- Malar depressed -/- - Step off Arcus Zygoma +/-
- Edema Nasal (-) - Step off Maxilla +/+
- Edema perinasal (-)
- Krepitasi Nasal (+)
- Saddle nose deformity (-)
- Deviasi septum (-) - Floating Maxilla (-)
- Hematome septum -/- - Step off mandibula (-)
- Deformitas Mandibula (-) - Unstable Mandibula (-)
- Edema mandibula (-)
- Vulnus appertum regio frontalis
12x5cm dasar dura, cephal hematome
R. Temporal D 2x1 cm*
Pemeriksaan Intraoral Pemeriksaan Ophtalmology
- Oklusi kesan baik - Visus ODS sulit dievaluasi ec edem
- Trismus (-) MIO 3 cm - GBM ODS sulit dievaluasi ec edem
- Laserasi palatum (-) - Diplopia sulit dievaluasi -/-
- Step off palatum (-) - Nyeri (+)
- Perdarahan aktif (-)  - SCB -/-
- Sublingual hematome (-)
Disgnosis
- CKS (E3V4M6)
- SDH Akut R. FrontoTemporal D
(thickness 7 mm, MLS 3 mm ke kiri)
- Multiple Contusio Cerebri R.
FrontoTemporal D
- Multiple Aerocele
- Open Fr. Depressed Anterior Wall
Sinus Frontal D et S
- Open Fr. Depressed Posterior Wall
Sinus Frontal D
- Open Fr. Depressed Os Frontal D et S
- Fr. Depressed Os Temporal D
- Fr. Le Fort II
- Fr. Fronto Zygoma D
- Fr. Fronto Zygoma S
- Fr. Maxila D
- Fr. Maxila S
- Fr. Fronto nasal
- Fr. Rima orbita inferior D
- Fr. Rima orbita inferior S
- Fr. Maxila D
- Fr. Maxila S
- Close fr right radius ulna middle third
- Close fr right distal radius
- Open fr right femur middle third gustillo andersen gr II
- CF Right Segmental Radius
- CF Right Distal Radius Frykman Type 3
- CF Right Radius Proximal Third
- CF Right Ulna Middle Third
- OF Floating Knee Gustilo Anderson Grade 3A
- OF Right Femur Distal Third Gustilo Anderson Grade 3A
- CF Right Tibia Middle Third
MANAGEMENT

• Diet non chewing

• Oral hygine dengan antiseptik liquid tiap 4jam
• Parasetamol 500mg tiap 8jam
• Tetagam Inj
• POC : ORIF Mini Plate Elektif

TS Bedah Saraf
Elevasi Rekonstruksi Fr. Depressed + Dekortikasi Sinus Frontal +
Kranialisasi Cito
- Head up 30⁰
- IVFD Nacl 0.9% 20 tpm
- O2 on FM 8 lpm
- Ceftriaxone 2g / 24 jam IV
- Fenitoin loading 1200 mg, lanjut 100 mg / 8 jam IV
- Omeprazole 40 mg/12 jam IV
- Petidine 100 mg dalam 500cc NaCl 0.9% / 24 jam IV

TS Ortho
Immobilisation with Backslab
Debridement + External Fixation Cito (Femur + Tibia)
ORIF PS (Radius + Ulna) Elective
 Triage Bedah Bed 10
Hari Susanto/L/48th/BPJS/01231356

Chief Complaint: Rectal bleeding

Current Medical History

Patients with complaints of rectal bleeding since 2 weeks ago. The stool mixes
with feces and is dark red. Odorless feces, mucus (-), pain during defication (-)
history of discharge of lumps when defication denied by the patient.
Active bleeding during defication denied by patient.
Change bowel habbit (+)
Decreased appetite (+) and weightloss (+) 3 kg in 3 months

Medical History
Patient denied have chronic disease
Physical Examination

Status present:
GCS : E4V5M6
BP120/80mmHg
HR : 80 x/min
RR : 18 x/m
SpO2 98%
General Status Rectal Toucher

Eyes : ane -/-, ict -/- pr +/+ isokor Spincter ani (+), mucosa normal, ampula recti
kolaps (-) , palpable massa (-)
Thorax:
HS : Feses(+), blood(+), mucus (-)
- Cor S1S2 single regular murmur (-)
- Pul : Ves +/+ , RH -/- , WH -/-
Ext Warm ++|++

Abdomen:
I: Distension (-)
A: BU (+) normal
Palp: Soefel
Perk: Timpani (+)
Laboratory 10/3/22 Surya Husada Hospital

WBC 13.0/ HB 7.5 / PLT 323

Laboratory 10/3/22
Diagnosis
• Obs Hematochezia e.c tumor
colorectal susp malignancy
• Leukositosis (13.0)
• Anemia sedang (7.5)
Management
IVFD NaCl 0.9% ~ 20 tpm
Gabaxa 100 cc dalam NS 400 cc tiap 8 jam IV
Transfusi PRC 1-2 kolf/hari
Asam traneksamat 500mg/8jam IV
Vitamin K 1amp/8jam IV
POC : Colonoscopy diagnostic
 Triage Bedah Bed 11
Ni Made Pusparini / P / 30th/ 14075225 / BPJS

Chief Complaint: Tingling sensation on her both hands

Current Medical History

Pasien mengeluh tangan kesemutan sejak 6 jam SMRS dan semakin
memberat, tangan juga terasa kaku dan mati rasa sejak 1 jam yang lalu
Mual (-), muntah (-), suara serak (-)

The patient feel tingling since 6 hour SMRS. Worsening. become stiffness and
numbness in last 1 hour ago.
Nausea and vomiting (-) hoarseness (-)
• Medical History
• History lump in her neck in 2017.
• FNAB in 2018 at Prima Medika Hospital
• Total thyroidectomy (7/3/2022) at Sanglah Hospital
Physical Examination

Status present:
GCS : E4V5M6
BP 120/70 mmHg
HR : 82 x/min
RR : 18 x/m
Temp 36.8°C
SpO2 99% room air
General Status Regio Colli
Eyes : ane -/-, ict -/- pr +/+ isokor
Scar post op (+)
Thorax:
- Cor S1S2 single regular murmur (-)
Chovtek sign (-)
- Pul : Ves +/+ , RH -/- , WH -/-
Carpopedal spasm (+)
Ext Warm ++|++
Lab 10/3/22

• WBC 7.57/ HB 10.9/ PLT 211

• Ca 5.9
• Na 141/ K 3.35
DIAGNOSIS
• Post total thyroidectomy (7/3/2022)
• MNT Eutiroid (Colloid Nodule)
• Severe Hipokalsemia (5.9)
• Hipokalemia (3.35)
MANAGEMENT
- IVFD NaCl 0.9% 20 dpm
- Bolus Ca glukonas 1 ampul then maintenance
drip Ca Glukonas 2 ampul with D5 500 cc in 8
hours
- Inj Omeprazole 40mg/12hour IV
- CDR Fortoz tab every 24 hour PO
- Calcitriol 0.25 mg every 24 hour PO
- Calos 500 mg every 12 hour PO
- KSR 600 every 12 hour PO
Thank You
 Triage Bedah bed 12
Made Saduarsa / 51th / L / 22013177 / UMUM

Referral patient at Bhakti Rahayu Hospital with total obstructive ileus

S
The patient came with complaints of flatulence since 1 week yll. Initially the patient complained of bloating
after not being able to fart and defecate since that morning. Bloating did not improve with medication. The
patient feels the urge to defecate but nothing comes out. Nausea/vomiting (+) since 3 days. decreased eating
and drinking, pain (-), small bowel movements like goat droppings (+), weight loss (-). Fever (-).

RPD
HT, DM and heart denied
Amputation of left leg in 2004

RPO
NGT decompression
IVFD NS:D5 2:1 20 tpm
Ondansetron 3x4 mg
Ranitidine 3x50 mg
Physical Examination

Status present:
GCS : E4V5M6
BP 110/80 mmHg
HR : 100 x/min
RR : 22 x/m
Temp 36.9°C
SpO2 97% room air
General Status
Eyes : ane -/-, ict -/- pr +/+ isokor RT : TSA (+) kuat, mukosa licin, ampula rekti tidak
kolaps, nyeri tekan (-), tidak teraba massa
Thorax:
HS : feses (-), darah (-), lendir (-)
- Cor S1S2 single regular murmur (-)
- Pul : Ves +/+ , RH -/- , WH -/-
Ext Warm ++|++

St Lokalis
Abdomen
I : distensi (+), darm contour (-), darm steifung (-)
A : BU (+) 5x/min, metalic sound (+)
P : Supel, Massa (-), NT (-)
P : hipertympani
IAP : 15.4 cmH20
Lab 10/3/22

• Lab 10/03/22
• WBC 18.28 / HB 15.6 / PLT 381
• PPT 11.9 / APTT 27.2 / INR 1.05
• SGOT 102.5 / SGPT 89
• BUN 24.6 / SC 0.79 / e-LFG
103.97
• Na 125 / K 3.35 / Cl 86.3 / Ca 8
BOF RS Bakti Rahayu 11/3/22
DIAGNOSIS MANAGEMENT

• - Total ileus obstruktif ec susp Massa Pro Laparotomy eksplorasi K/p Kolostomi
intraabdomen ekstralumen Puasa
• - Intraabdominal hipertensi grade I NGT dan DK Dekompresi
• - Leukositosis (18.28) Co TS Anestesi preop
• - Transaminitis (OT 102.5 / PT 89.0) Ceftriaxone 2gr
• - Hiponatremia (125) Observasi tanda akut abdomen
• - Hipokalemia (3.35)
Thank You