2 desember 13 dr alex

Co-ass On Duty :Yulia, Daus, Mitha, Trias, Rahmat,

Hana,

Resident On Duty : Dr. Alex

EMERGENCY CASE REPORT

November 24th, 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 2th 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 SignCo. to Oncology:-improvement of the general state-over admissions to the obstetrics and gynecology department

2 Mrs. Nushasanah/ 41 yo

Dec 2th 2013 at 18.00

Mamae Tumor dextra suspect

malignancy T4cN3M1 + Pleural

effusion dextra+ Suspect metastasis

hepar

O2 3 l/mIVFD RLAntibioticLaboratory checkCo. to Oncology:HospitalizatedpCo. to Digestive surgery

No Identity Admission to

E.R.Diagnosis Treatment

3 Boy. Rizqan Ridani

Dec 2th 2013 at 18.30

Blunt Abdomen Trauma susp intra

abdominal bleeding

O2 3 l/mIVFD RLAntibioticAnalgesicH2 BlockerLaboratory checkThorax photoBNOCo. to Pediatric Surgery:Consulent will visited

Discharge by request

1. Mrs. Suminah/ 43yo/ 2 December 2013 at 15.00

Chief complaint : bleeding from the breastHistory : 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

HepatosplenomegalyHydronephrosis Grade 4 dextraOvarial cyst(Maligancy?)

Abdomen USG Result(Oct,24 2013)

Laboratory Finding

Hb 9.1 g/dlLeu 12.8 thou/ulErit 3.67 mil/ulHt 28,4 vol%Tromb 392 ribu/ulGDS 109 mg/dlSGOT/PT 24/14Na/K/Cl 134,4/ 5,0/102,9Ureum /Creatinin : 36/1,0PT/ APTT: 10,2/26,3

Working Diagnosis

Tumor a/r sternalis susp malignansi et cause susp metastasis Ca

Ovarium + hipovolomic shock

Management

ResusitationIVFD RL rapidly 2 L : Maintenance Monitoring Vital SignCo. 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 breathHistory : 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 dextraLook 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/dlLeu 6,7 thou/ulErit 3.79 mil/ulHt 32,3 vol%Tromb 219 ribu/ulGDS 139 mg/dlSGOT/PT 34/24Na/K/Cl 127.8/4.4 / 93.6Ureum /Creatinin : 11/o.2Albumin: 4.0

Working Diagnosis

Mamae Tumor dextra suspect malignancy T4cN3M1 + Pleural

effusion dextra+ Suspect metastasis hepar

Management

O2 3 l/mIVFD RLAntibioticLaboratory checkCo. to Oncology:

Co. to Digestive surgery

3. Boy. Rizqan Ridani/ 13 yo/ 2 Dec 2013 at 18.30

Chief complaint : abdominal painHistory : : 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 regularC

• 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 epigastricaLook laceration wound

X-Ray

recline stand

Laboratory Finding

Hb 11.2 g/dlLeu 19.6thou/ulErit 3.99 mill/ulHt 32.9 vol%Tromb 294 thou/ulGDS 168 mg/dlSGOT/PT 488/25Na/K/Cl 127.8/ 4.4 / 93.6Ureum /Creatinin : 11/0.2PT/ APTT: 11.8/23.4

Working Diagnosis

Blunt Abdomen Trauma susp intra abdominal bleeding

Management

O2 3 l/mIVFD RLAntibioticAnalgesicH2 BlockerLaboratory checkThorax photoBNOCo. to Pediatric Surgery:Consulent will visited