EMERGENCY CASE

REPORTS
th
Friday , December

17

2010

SURGERY DEPARTMENT
RS. Wahidin Sudirohusodo

EMERGENCY ROOM
WAHIDIN
SUDIROHUSODO
GENERAL HOSPITAL

EMERGENCY CASE REPORT

Friday, December 17th
2010
Ambulation
: 3 Patient
Hospitalized

patients

Observation

patient

Operated

patient

Death

patient

Total

patients

WAHIDIN SUDIROHUSODO
HOSPITAL

No. 6
Nam Mr.
:
Sex
e
syamsul
23 years No.
Age :
old
Reg
Chief complaint : Bloody urination
History taking

Mechanism of
injury

: Male
45 10
:
86

: Suffered since 38 hours before admitted to the hospital

due to blunt trauma. There is no history of loss of
consciousness and no vomiting

: He wanted to leave the boat and walked on bond

between boat and the pier, suddenly there was wave ,
he loss his balance and fell down with his stomach
bumped to boat
Injury sustain
: abdomen
Symptom & sign : Hematuri
Examination
: Physical examination, laboratory examination, abdominal
USG , abdominal CT

PHYSICAL EXAMINATION
Primary Survey
A: Clear
B: RR : 20 x/minutes, spontaneous, symmetric,
thoraco abdominal type
C: BP : 140/90 mmHg, HR : 84 x/minute, regular,
adequate
D: GCS 15 (E4M6V5), pupil equal 3 / 3 mm ,
LR +/+
E: T (ax) : 36,8 oC

Secondary Survey
Abdomen :
I : Bruise (-) , excoriated wound
(-), color same with vicinity,
edema(-), hematoma(-)
A: Peristaltic (+) normally
P : Tympani
P : Tenderness (+) at left lumbal
region

Secondary Survey
Costovertebral Region :
I : Bruise (-), alignment was good ,
edema(-) , hematoma(-),
P : Tenderness (-), tumor mass (-)
ren ballotement is not palpated
P : Tapping pain (-)
Suprapubic Region
I : Seen flat, skin color same with its vicinity ,
edema (-), hematoma (-)
P: Tenderness (+), tumor mass (-)

Secondary Survey
Genetalia Externa Region:
Penis:
I : Seen penis circumcised yet, , skin color same with
its vicinity, edema (-),hematoma (-), blood at OUE (-)
P : Tenderness (-), tumor mass (-)
Scrotum
I : Seen skin more dark than vicinity , edema(-),
hematoma(-)
P : Tenderness (-)
Perineum:
I : Seen skin more dark than vicinity, edema (-),
hematoma (-)
P: Tenderness (-), tumor mass (-)

Rectal Touch
Sphincter was tight
Mucosa was smooth
Ampoule filled with feces
Prostate is not palpated
Hand scone
Blood (-), slime (-), feces (+)

Laboratory Result
WBC

RBC

4,84 x 106 / L

HGB

14,6 g/dL

HCT

42,4%

PLT

287x103/ L

CT / BT

700 / 300

Blood Sugar :

15,5 x 103 / L

135 mg/dl

Ureum

21 mg/dl

Creatinin

0,9 mg/dl

GOT / GPT

16/ 15 /L

Laboratory Result
Urinalysis
Color

red

pH

6,0

BJ

1,015

Protein

150 mg/dl (+++)

Blood

Leukosit

100/L (++)

leukosit
sediments
Eritrosit
sediments
Cell epithelia
sediments
others sediments

negative

8-10

3-5

250/ L (++++)

USG Abdomen

WORKING : Gross hematuri due to left renal

DIAGNOSIS rupture 3rd Grade due to blunt

trauma
MANAGEME : Medicaments
NT
Report to urologic surgeon
advice : conservative
PROGNOSI : Fair - Good
S
FOLLOW UP : Vital sign and hematuri

Campbell-Walss Urology: 9th ed. 2007

Handbook of Urology; Diagnosis and Therapy 9th

ed. 2007

Grading Renal Trauma

(Campbell-Walss Urology: 9th ed. 2007)

Concomitant abdominal or other injuries

Yes

Request immediate
exploration
(no imaging assessment)

No
Does not request
immediate
exploration
(imaging
assessment
performed)

Surgical staging with

urologist present to
asses and reapir any
renal injury

Hemodynamically
stable?
Yes

Interventio
n
necessary

Mechanism and grade of renal

injury?
Blunt

Observ
e

Penetrating
Limite
d
injury

No

Renal
Exploration

Embolizatio
n

Extensiv
e Injury

Practical algorithm in the acute treatment of renal trauma

(Genitourinary Trauma; Urology Clinic of North America, Elsevier Saunders 2006: p.17)

Suspected Blunt Renal Injury

Determine Hemodynamic
Stability
Unstable - Any
hematuria

Stable
Gross Hematuria
Child >50 RBC/hpf
Adult Microhematuria SBP >90
mmHg
High index suspicious for renal
injury
Contrast enhanced spiral CTscan
With 10 minute delayed cuts

Child <50 RBC/hpf

Adult Microhematuria
SBP >90 mmHg
Observe
UA in 3
weeks

Grade 1 and 2

Grade 3 and
4 laceration

Observe
No intraperitoneal
injuries
Observe bedrest
Serial HCT

Grade 4 vascular &

Grade 5 Renal pedicle
trauma
Shattered/destroyed
kidney
Intraperitoneal
injuries
Requiring
exploration

On Table
IVP

Abnormal IVP
Expanding/pulsatile
hematoma

Normal IVP
Observe

Renal
exploration
Reconstruction
or
Nephrectomy

Selective reimaging
Angiography+embolizatio
n?
Ureteral Stenting?

Management algorithm for blunt renal trauma

(Genitourinary Trauma; Urology Clinic of North America, Elsevier Saunders 2006:
p.23)

Thank
you