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    Emcase 8 Juni 2019 Fix Edit

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    Komet Rama Daud
    The document reports on emergency cases from June 8th, 2019 at Wahidin Sudirohusodo General Hospital in Makassar. It describes two cases: 1. A 25 day old infant admitted with abdominal distension. Tests indicate intestinal obstruction likely due to Hirschsprung's disease or meconium ileus. Treatment included IV fluids, rectal washout, and planning for further tests. 2. A 46 year old man admitted with right foot pain and swelling. He has a history of diabetes. Examination found necrosis and ulcers on his right foot. Tests indicate peripheral arterial disease and diabetic foot ulcer. Treatment included IV fluids and consultation with metabolic/endocrine specialists. Further deb

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    Emcase 8 Juni 2019 Fix Edit

    Uploaded by

    Komet Rama Daud
    11 views39 pages
    The document reports on emergency cases from June 8th, 2019 at Wahidin Sudirohusodo General Hospital in Makassar. It describes two cases: 1. A 25 day old infant admitted with abdominal distension. Tests indicate intestinal obstruction likely due to Hirschsprung's disease or meconium ileus. Treatment included IV fluids, rectal washout, and planning for further tests. 2. A 46 year old man admitted with right foot pain and swelling. He has a history of diabetes. Examination found necrosis and ulcers on his right foot. Tests indicate peripheral arterial disease and diabetic foot ulcer. Treatment included IV fluids and consultation with metabolic/endocrine specialists. Further deb

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    Emcase 8 Juni 2019 fix edit

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    The document reports on emergency cases from June 8th, 2019 at Wahidin Sudirohusodo General Hospital in Makassar. It describes two cases: 1. A 25 day old infant admitted with abdominal distension. Tests indicate intestinal obstruction likely due to Hirschsprung's disease or meconium ileus. Treatment included IV fluids, rectal washout, and planning for further tests. 2. A 46 year old man admitted with right foot pain and swelling. He has a history of diabetes. Examination found necrosis and ulcers on his right foot. Tests indicate peripheral arterial disease and diabetic foot ulcer. Treatment included IV fluids and consultation with metabolic/endocrine specialists. Further deb

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    11 views39 pages

    Emcase 8 Juni 2019 Fix Edit

    Uploaded by

    Komet Rama Daud
    The document reports on emergency cases from June 8th, 2019 at Wahidin Sudirohusodo General Hospital in Makassar. It describes two cases: 1. A 25 day old infant admitted with abdominal distension. Tests indicate intestinal obstruction likely due to Hirschsprung's disease or meconium ileus. Treatment included IV fluids, rectal washout, and planning for further tests. 2. A 46 year old man admitted with right foot pain and swelling. He has a history of diabetes. Examination found necrosis and ulcers on his right foot. Tests indicate peripheral arterial disease and diabetic foot ulcer. Treatment included IV fluids and consultation with metabolic/endocrine specialists. Further deb

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 39

    EMERGENCY CASE REPORTS

    Saturday, June 8th 2019


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Saturday, June 8th 2019
    Ambulation : 3 Patients
    Hospitalized
    : 2 Patients

    Observation : - Patient
    Operated : - Patient
    Death : - Patient
    Total : 5 Patients

    Wahidin Sudirohusodo General Hospital


    Makassar
    Name : Inf. Mrs. RT Age : 25 days (M)
    RM : 885071 DPJP : dr. AW
    e

    Chief complain : Abdominal distended

    History taking : This condition had been suffered since 3 days before admitted to the
    hospital. There was history of bilious vomiting since 3 days ago. There was
    no history of fever.
    There was no history of diarrhea. There was no history of bloody defecation
    There was history of delayed passage of first fecal matter (at the 3rd day of
    birth). There was no history of the same complain before.
    The patient is the first child of P1A0 mother, normal birth delivery which is
    helped by a doctor at 38 weeks' gestation with a 3000 gr of birth body
    weight. There was no history of taking medicine during pregnancy. Ante
    natal care during pregnancy by a midwife routinely. Prior medical care was
    Luwuk Banggai Hospital
    Micturation : Normally

    Defecation : There was history of constipation after the first fecal matter was passaged
    PHYSICAL EXAMINATION
    • GENERAL STATUS
    Passive/well nourished/conscious
    Weight 2770 gr, Height 49 cm

    • VITAL SIGN
    – HR : 146 bpm, regular, adequate.
    – RR: 42 x/mnt, spontaneous, symmetric adequate
    chest movement, thoracoabdominal type.
    – T (ax) : 36,8°C
    PHYSICAL EXAMINATION
    Head:
    Flat anterior fontanel, Conjungtiva was not anemic,
    sclera was not icteric, wet mouth dan lip mucous

    Chest:
    Symmetrical shape and movement, equal vesicular
    breath sound, Rhonchi (-), Wheezing (-), regular breath
    sound, Murmur (-)
    PHYSICAL EXAMINATION

    Abdomen :
    I : Seen convex, bowel contour (+)
    and bowel motion (-), skin color is
    same with its vicinity.
    A : Peristaltic (+) sound normal,
    metallic sound (-)
    P : Distended
    P : hypertympani (+)
    Genitoanal region :
    I : Uncircumsised Penis, Scrotal
    Edema (-), Anus (+)
    P : There were 2 testicle with normal
    size and consitency

    Rectal Toucher
    Anal Sphincter : tight, explosive feces (+)
    Handscoen : meconium (+), blood (-), slime (-)
    Clinical Diagnosis
    • Intestinal Obstruction due to suspicious
    Hirschsprung Disease
    DD/ Meconium Ileus
    • Mild Dehidration
    Plain Abdominal Radiograph
    Plain Abdominal Radiograph
    Laboratory findings
    • Hb : 16,3  GDS : 78
    • Hct : 48  Na : 137
    • WBC : 12,2 K : 4,9
    • PLT : 368  Cl : 111
     SGOT : 28
     SGPT : 5
     Ur : 31
     Cr : 0,43
    WORKING : • Intestinal Obstruction due to suspicious
    Hirschsprung Disease DD/ Meconium Ileus
    DIAGNOSIS • Mild Dehidration

    MANAGEMENT : • IVFD 443 cc/hr


    Maintenance 277 cc/hr
    Rehidration 6%xBWx 1000 cc = 166 cc/hr
    1st 6 hr = ½ M + ¼ D = 138.5 + 41.5 = 180 cc
    2nd 18 hr = ½ M + ¾ D = 138.5 + 124.5 = 263 cc

    • Medicament
    • Applied OGT
    • Applied Urinary catheter
    • Rectal Washout (20 cc/kgBW)
    • Prevent hypothermia
    • Consult to pediatric
    • Planning for Barium Enema
    • Planning for Full Thickness Rectal Biopsy
    Rectal Washout

    Before After
    THANK YOU
    Differential Diagnose
    Diagnostic Scheme Hirschsprung
    Name : Mr. M Age : 46 years
    RM : 885085 DPJP : dr. JR

    Chief complain : Pain on the right foot


    History taking : The condition has been apparent 14 days before admitted
    to the hospital. The pain a with wound and swollen in the
    leg. Initially, the foot is punctured by a nail, and eventually
    wound are widened, redness, and followed by swelling.
    History of Diabetes Mellitus since 10 years, taking oral
    anti-hyperglycemic and insulin injection but not regularly.
    History of debridement surgery 4 days ago at Polewali
    Hospital. History of drinking alcohol is present.

    Micturation :: Normal
    Defecation Normal
    General Status
    Moderate illness / well nourish / conscious

    Vital Sign
    BP : 126/84 mmHg
    PR : 90 x/mnt, strong, reguler,
    RR : 20 x/mnt, symmetric L= R,
    thoracoabdominal type.
    T : 36,6 °C
    PHYSICAL EXAMINATION
    Right Foot Region :
    I : Necrotic wound at
    digiti II, Erythema ½ distal
    right foot, edema (+)
    P : warm, no palpable
    mass
    Saturation:
    Digiti I : 90%
    Digiti II : 0%
    Digiti III : 100%
    Digiti IV : 0%
    Digiti V : 67%
    • Palpation of artery:
    - A. Femoralis (+)
    - A. Popliteal (+)
    - A. Tibialis Anterior (+)
    - A. Tibialis Posterior (+)
    - A. Dorsalis Pedis (-)
    PHYSICAL EXAMINATION
    Left Foot Region :
    I : Necrotic wound (-),
    Erythema (+), edema (+)
    P : cold, no palpable
    mass, paresthesia (-)
    Saturation:
    Digiti I : 96%
    Digiti II : 98%
    Digiti III : 99%
    Digiti IV : 98%
    Digiti V : 99%
    • Palpation of artery:
    - A. Femoralis (++)
    - A. Popliteal (+)
    - A. Tibialis Anterior (+)
    - A. Tibialis Posterior (+)
    - A. Dorsalis Pedis (+)
    Clinical Diagnosis
    • Peripheral Arterial Disease
    • Wagner 3-4 Diabetic Foot Ulcer
    Foot X-ray
    Thorax X Ray
    Laboratory findings :
    • Hb : 10,0  PT : 12,7
    • Hct : 30  INR : 1,24
    • WBC : 42,4  APTT : 43,3
     PLT : 418  Na : 127
     SGOT : 9  K : 4,2
     SGPT : 9  Cl : 101
     Ur : 176
     Cr : 1,21
     GDS : 483
    WORKING : • Peripheral Arterial Disease
    DIAGNOSIS • Wagner 3-4 Diabetic Foot Ulcer

    MANAGEMENT : • IVFD
    • Medicaments
    • Consult to Metabolic Endocrine

    PLAN : • Debridement and amputation


    THANK YOU
    Ankle Brachial Index (ABI)

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