EMERGENCY CASE REPORTS

Wednesday, July 19th 2023

SURGICAL DEPARTEMENT

E M E R G E N C Y D E PA RT M E N T
Wa h i d i n S u d i r o h u s o d o G e n e r a l H o s p i t a l
Makassar
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PRODI ILMU BEDAH
FK UNHAS
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untuk menjadi Dokter Spesialis Ilmu
Bedah yang berbudi luhur, kompeten,
inovatif, dan berstandar global.
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menyempurnakan kurikulum pendidikan
sejalan dengan perkembangan dunia
dalam ilmu dan teknologi kedokteran.
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pada tingkat yang setara di tingkat
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EMERGENCY CASE REPORT
Wednesday, July 19th 2023
OUTPATIENT : 0 Patient
INPATIENR : 0 Patients
OBSERVATION : 0 Patient
OPERATION : 2 Patient
MORTALITY : 0 Patient
Total : 14 Patients
Wahidin Sudirohusodo Hospital
Makassar
 NEW PATIENTS DATA
SURGICAL EMERGENCY ROOM RSUP dr. WAHIDIN SUDIROHUSODO
Wednesday, July 19th, 2023
No. Nama Umur JK No. RM Nama DPJP Diagnosis

1. Ny. Sahria 63 P 1030541 dr. DJF Nodul Tiroid bilateral suspek malignancy + Dyspneu

Tn. Syamsuddin Melanoma Maligna pedis sinistra cTxN2M1 paru + multiple lymphadenopathy inguinal sinistra +
2. 72 L 951025 dr. WH
Supu dyspneu et causa pneuominia

3. Tn. Mail Rahim 37 L 1009368 dr.WS Adenocarcinoma colon on kemoterapi + general Weakness

4. Tn. Masire 59 L 1032512 dr. NA Open Pneumothoraks dextra ec vulnus punctum regio sternal

5. Tn. Muliadi 31 L 1032517 dr. IL Tumor colon descendens suspek malignancy cT3N0M0 + Abdominal pain

6. Tn. Andika N. A. 20 L 1032519 dr.KK Gross Hematuria et causa suspek rupture Buli-buli dd suspek rupture ginjal

7. Tn. Andi Nasruddin 48 L 1032516 dr. WS Peritonitis primer suspek peritonitis TB + Hipertensi abdominal grade I et causa ascites

8. Tn. U. Petrus P. 70 L 431165 dr. MW Aneurisma Aorta Abdominal

9. Tn. Taju 77 L 1032523 dr. WHY Mild TBI GCS 15 E4M6V5 + Fraktur liniea Temporal Sinistra + Fraktur displaced zygomaticomaxilla

10. Ny. Halimah 53 P 1032526 dr. DJF Carcinoma mammae sinistra cT2N1Mx Karnofsky 60% + moderate febrile neutropenia

Moderate TBI GCS 9 (E2M5V2) + epidural hematom regio temporo parietal sinistra + Intracerebral
11. Banong 72 P 1032531 dr.WHY
hematom regio temporal dextra

Mild TBI GCS 15 E4M6V5 + Fraktur Komunitif temporozygoma maxillozygoma + rupture bulbus occil
12. Dedy Sunarto 77 L 1032536 dr.SR
kanan

Trauma Maxillofacialis + fraktur depressed os frontalis, os zygomaticum, orbital roof dan lamina
13. Mary Andani 24 P 1032530 dr. SR
papyracea dextra + SDH Frontal

Syahda Yusuf Superficial mid dermal burn injury TBSA 60% + post debridement hari ke-1 + post tracheostomy et
14. 28 L 1032536 dr.SR
Wahyu causa trauma inhalasi supra glotis
 Name : Mrs. B Age : 72 yrs old
MR : 1032531 Consultant : dr. WHY

Chief Complain : Loss of Conciousness

History Taking :
Patient with the chief complaints loss of conciusness since 14 hours ago after a traffic
accident. There was no nausea and vomiting, and no fever. After the accident, the
patient was immediately taken to Maros Hospital and in an agitated state and referred
to the Wahidin Sudirohusodo Hospital. There is no history of seizures.
There is no history of blood discharge from ears and nose.
The therapy was given at the Maros Hospital:
- Citicolin 500 mg/8 hours/ intravenous
- Ranitidine 50 mg/12 hours/ intravenous
- Paracetamol 1 gram/8 hours/ intravenous
Mechanism of Trauma:
The patient was walking across the street and suddenly hit by a motorcycle
 PHYSICAL EXAMINATION

PRIMARY SURVEY
A : Clear, patent
B : 24 times per minute, symmetrical chest expansion
C : Pulse 86 times per minute, Warm, CRT < 2 second
D : GCS 9 E2M5V2, isochor pupil 2,5mm / 2,5mm, Direct Light Reflex (+/+), Indirect
Light Reflex (+/+)
E : Temperature 36.7 °C
 SECONDARY SURVEY
Regio capitis:
Inspection: edema and hematoma of the
inferior and superior right palpebra orbita
 NEUROLOGICAL STATUS
• GCS 9 E2M5V2
• Pupil isochor rounded 2,5 mm/2,5 mm, Direct Light Reflex +/+,
Indirect Light Reflex +/+
• Physiological reflex: +/+
• Pathological reflex: -/-
• Sensory motor is difficult to evaluate
• No Lateralization
• Otonomic: Urination was normal via urine catheter , defecation was normal
 CLINICAL DIAGNOSIS

• Moderate TBI GCS 9 (E2M5V2)

 LABORATORY FINDING (19-07-2023)
Parameter Results Normal Range Unit
WBC 11.2 9.00 – 30.00 103/uL
RBC 3.79 4.00 – 6.00 106/uL
HGB 10.4 14.5 – 22.5 gr/dL
HCT 32 48.0 – 69.0 %
PLT 226 150 – 400 103/uL
GDS 170 140 mg/dL
PT 10.1 10-14 detik
APTT 20.7 22-30 detik
Ureum 27 10-50 mg/dL
Creatinin 0.45 L < 1,3; P < 1,1 mg/ dL
SGOT 138 <38 U/L
SGPT 83 <11 U/L
Natrium 139 136 – 145 mmol/L
Kalium 4.1 3.5 – 5.1 mmol/L
Klorida 101 97 - 111 mmol/L
Thorax X RAY
CT Scan of Head (18-04-2023)
Working : Moderate TBI GCS 9 E2M6V2 + Epidural
Diagnosis Hematom Regio Temporoparietal Sinistra +
Intracerebral Hematom Regio Temporal
Dextra
Therapy : Head up 30 degrees
Oxygenation 5 LPM Via NRM
Sodium chloride 0.9% 28 tpm
Ceftriaxone 1gr/12 hr/iv
Metamizole 1 gr/ 8 hr/ iv
Ranitidine 50mg/12 hr /iv

PLAN : Craniotomy Evacuation + Craniectomy

Decompression
Intraoperative findings
Intraoperative Documentation
Operation Report
 Name : Tn. M Gender : Male
Age : 59 DPJP : dr. NA

Chief complain : Patient with shortness of breath

History taking : Patient with shortness of breath experienced since 1 day ago after
hitting his chest when he fell from a tree. Complaints accompanied
by pain in the chest and abdomen , especially when breathing. No
headache, no nausea and vomiting. No fever. There is no history of
cough mixed with blood spots. There is no history of seizures. There
is no history of loss of consciousness. Defecation looks normal.
Urinate normal impressions. Patient was referred from Dodi Sarjoto
Hospital with Pneumothorax dextra.

Mechanism of trauma: The patient fell from a tree with a height of

less than 2.5 meters with his chest and stomach hitting the ground.
The patient's chest is pierced by a bamboo stick and then the patient
pulls it out himself
 Physical Examination

Primary Survey
Moderate Illness / Composmentis

Primary Survey :
A : Clear, patent
B : Chest develop asimetris with Hemithorax dextra left behind, RR
28x/m, SpO2 98 % via nasal kanul
C : BP : 142/89 mmHg, HR: 69 x/menit, , regular, there is no aktif bleeding,
CRT < 2 detik
D : GCS 15 E4M6V5, Pupil isokor 2,5 mm, RCL +/+, RCTL +/+, lateralisasi -
E : suhu 36,7 °C
Thorax Local Status
Inspection : There is open wound in the thoracic region with a
length of 5 cm and a width of 1 centimeter, active
bleeding (-), asymmetric chest movement with a
hemithorax dextra left behind
Auscultatio : decreased in the hemithorax dextra vesicular +,
n rhonki-/-, wheezing -/-
Palpation : Decreased tactile fremitus of the dextra hemithorax ,
tenderness (+) at the dextra hemithorax
Percusion : hypersonor on the right hemithorax
 Clinical Diagnosis
• Open Pneumothoraks Dextra ec. Vulnus punctum
regio sternal
X-Ray (Thorax) RS Dodi Sarjoto
19/07/2023
 Laboratory Finding
 HB : 13.5
 HCT : 40
 WBC : 9000
 PLT : 220.000
 RBC : 4.24
 Na : 137
K : 4.0
 Cl : 106
WORKING : - Open Pnuemothorax dextra ec.
DIAGNOSIS Vulnus punctum regio sternal

MANAGEMENT : IVFD Asering 300cc / 24 jam 

Ceftriaxone 150 mg / 12 jam / intravena
Ranitidin 5 mg / 12 jam / intravena 
Paracetamol 45mg / 8 jam / intravena

PLAN : • Insersi Chest Tube + WSD dextra

Operation Findings
 Operation Report
1. The patient lies in the supine position under the influence of general
anesthesia
2. Disinfection and drapping procedures are performed on the thoracic
region
3. Identification showed an open wound in the thoracic region with a length
of 5 cm and a width of 1 centimeter, no active bleeding was found, an
incision was made over the wound layer by layer until it reached the base of
the wound
4. Identification obtained blood clot cloth, osteochondral fracture, no active
bleeding was found, a bubble test was performed with negative results
5. It was decided to do debridement by refreshing the edges of the wound
until healthy tissue was obtained
6. Bleeding control
7. Wash the surgical wound with 0.9% NaCl until it looks clean
8. Cover the surgical wound layer by layer
9. The operation is complete
 Operation Report
1. The patient is in a semi-sitting position with the right arm placed behind the
head
2. Determine where the chest tube is placed at intercostal 5 in front of the media
dextra axillaris line
3. Asepsis, antisepsis, and draping procedures
4. Infiltrate local anesthetic (lidocaine 2%) sufficiently above rib 6
5. Incise the skin above the 6th rib about 2 centimeters, deepen sharply and
bluntly slowly until it penetrates the parietal pleura, insert a finger to evaluate
adhesions
6. Insert a 20 gauge trochar, with the clamp as a guide, remove the mandarin
trochar, clamp the distal part of the trochar, connect it to the chest tube bottle,
7. Fix with a horizontal mat, slip knot with 1-0 silk thread, connect to the water
sealed drainage bottle, remove the distal clamp.
8. Undulations appear, bubbles appear, no fluid production
9. Cover the surgical wound with sterile gauze
10. The operation is completed
POST OP DIAGNOSIS : • Open Pneumothorax Dextra +
Trauma Thorax Penetran + Fraktur
Sternocosta V kanan
• Post Operasi Incersi Chest tube +
WSD Dextra Day-0
PROGNOSIS : • Dubia

FOLLOW UP : • Vital Sign and GCS

• Wound care
• WSD Production
 Name : Tn. AN Gender : Male
Age : 20 DPJP : dr. KK

Chief complain : shortness of breath

History taking : shortness of breath felt since 2 hours ago after a traffic accident. This
complaint is accompanied by pain in both chest.
the patient also complained of urine mixed with fresh blood since the
accident.
pain in lower abdomen, the pain increases when the patient walks.
No history of loss consciousness, no history of nausea and vomiting,
no history seizure.

Mechanism of trauma: The patient was riding a motorcycle with a

high speed, then suddenly hit a truck from the opposite direction and
the patient fell to the road with the body tilted to the right.
 Physical Examination

Primary Survey :
A : Clear, patent
B : asymmetric left hemithorax sinistra movement, RR 35x/m, SpO2 95 %
via nasal kanul
C : BP : 100/70 mmHg, HR: 121 x/menit,regular, urinary bleeding, CRT < 2
detik
D : GCS 15 E4M6V5, Pupil isokor 2,5 mm, RCL +/+, RCTL +/+, lateralisasi -
E : suhu 36,5 °C
 Local Status
Thorakal
Inspection: asymmetrical, hematoma (+) the axillary media region
dextra.
Palpation: crepitation (-), no tenderness
Percussion: sonor / dullness
Auscultation: vesicular +/-

Costovertebrae region Dextra:

inspection: bone alignment is intact, gibbus (-), hematoma (-), mass is
(-).
Palpation: renal ballotement not palpable, mass not palpable,
tenderness not present.
Percussion: Knock pain is present

Costovertebrae region sinistra:

Inspection: good bone alignment, no gibbus, no hematoma, no mass.
Palpation: renal ballotement not palpable, mass not palpable,
tenderness not present
Percussion: Knock pain is absent

Suprapubic region
Inspection: No visible hematoma, no bulging
Palpation: tenderness (+)
Regio genitalia extrerna:
Penis
Inspection: OUE appears to be at the tip of the glans penis,
hematome is absent,
Catheterized with 18 fr, with massive blood production
Palpation: No tenderness, no mass

Scrotum
Inspection: Skin color appears darker than surrounding, no
hematoma.
Palpation: Palpable 2 testicles, normal size and consistency
impression. No tenderness
Perineum:

Inspection: normal skin color, no hematoma.

Palpation: no tenderness
 Clinical Diagnosis
• Suspek hemothorax sinistra
• Suspek trauma buli
X-Ray (Thorax) RSWS
19/07/2023
 Laboratory Finding
 HB : 11.3  SGOT : 1184
 HCT : 34  SGPT : 858
 WBC : 22.300  UREUM : 37
 PLT : 204.000  KREATININ : 2.68
 RBC : 4.20  GDS : 126
 Na : 141  PT : 13.3
K : 3.5  APTT : 28.2
 Cl : 105
WORKING : Traumatic Diaphragmatic Hernia sinistra
DIAGNOSIS Ruptur buli anterior
Blunt thorax trauma
anterior vesica urinaria rupture
Fraktur diasthasis symphysis pubis

MANAGEMENT : - IVFD NaCl 0.9% 20 tpm

- ceftazidime 1 gr/12 jam/iv
- omeprazole 40mg/24 jam/iv-
- asam traneksamat 500mg/8jam/iv
- Nasogastric tube decompresion

PLAN : • Torakotomi explorasi repair defect

• Insersi Chest Tube + WSD dextra
• Repair vesica urinaria
Operation Findings
Operation Findings
POST OP DIAGNOSIS : Traumatic Diaphragmatic Hernia sinistra
Ruptur buli anterior
Blunt thorax trauma
anterior vesica urinaria rupture
Fraktur diasthasis symphysis pubis
PROGNOSIS :
ad vitam • Dubia
ad functionam • Dubia
ad sanationam • Dubia

FOLLOW UP : • Vital Sign and GCS

• Wound care
• WSD Production
• Urin production