1. Mr.

Sudin (20Years Old)

Mechanism of the Trauma
Finger pulled into the meat milling machine
Injury of target organ
Manus dextra
Symptoms and signs
Pain, Bleeding
Treatment Pre Hospital (Before UKIS ER)
-

PRIMARY SURVEY
Airway
: CLEAR
Look : no obstruction
Listen : no extra breath sound
Feel : there were warm air from both nose and mouth\
Breathing : CLEAR
Ins : chest wall movement symmetrical, RR 20 x/min,
bruise (-), hematoma ()
Pal
: vocal fremitus symmetrical
Per
: sonor right = left
Aus : basic breath sound vesicular, rh -/-, wh -/-

 Circulation : No Sign Of Shock

Warm extremities
Pulse = 100 x/menit
Temp = 36,50C
CRT <2
Blood pressure: 120/80 mmHg
Disability
GCS 15 (E4M6V5)
pupil isochoric 3/3 mm, centered
Direct light reflex/indirect light reflex +/+
Exposure
There was no life threatening wounds

SECONDARY SURVEY
AMPLE
Allergy
: Medication
: Past Illness
: Last Meal : In the evening
Event
: Accident

HEAD TO TOE
Head : Normocephaly
Eyes : Pupil circular, isochoric 3mm/3mm, centered,
Direct Light Reflex +/+, Indirect Light Reflex +/+,
CA -/Ear : Normal, LCS (-), Blood (-)
Neck : Bruise (-), Hematoma (-)

Thorax :
- Inspection : bruise (-), movement of chest wall
symmetrical
- Palpation: Vocal fremitus symmetrical
- Percussion : sonor right=left, percussion pain (-)
- Auscultation: basic breath sound vesicular
right=left, wh-/-, rh-/-.

Abdomen :
- Inspection
: flat
- Auscultation: bowel sound (+) 8x/min
- Palpation : tenderness (-), defense muscular
(-), pain palpitation (-)
- Percussion : tympani, percussion pain (-)

Extremities : = Status Localis

Status Localis : Manus dextra

Look
the right fingers trapped into a meat milling
machine
Blood (+) Active bleeding (+)

Feel
pain (+)
Movement:
limited, cant move his hand

Clinical Image

Radiological Image

History of illness
Patient male 20 years old came to the ER with
complaints of pain on the right fingers. 3 hours before
brought to ER patient got a work accident. His right
fingers was pulled into the meat milling machine. Then
his right fingers injured and bleeding.. Then patient go
to UKI hospital because his hand trapped into the meat
milling machine.

Working diagnose
Finger entrapped + traumatic amputasi digitorum
manus dextra

CONSERVATIVE TREATMENT
- Rontgen thorax AP, lateral
-IVFD: RL + ketorolac III Amp/24 jam
- MM: Ceftriaxone 2 Amp
Ranitidine 1 Amp
Ketorolac 3 Amp

OPERATIVE TREATMENT
Cito operation
Estrikasi +debridement + repair digitorum manus dextra

Examination

Result

Na

146,7

3,71

Cl

102

Examination

Result

Masa Protombin

13,7

Examination

Result

Hb

14,1

Leukosit

12,7

Hematokrit

41,7

Trombosit

264

Examination

Result

GDS

92

Examination

Result

Ureum

22

Creatinine

0,8

1. Mr. Sumi (55 Years Old)

Mechanism of the Trauma
Accident
Injury of target organ
Head
Symptoms and signs
Pain, Cephalgia
Treatment Pre Hospital (Before UKIS ER)
Nasal kanul O2 4lpm, Collar neck, Narfoz 4mg inj IV

PRIMARY SURVEY
Airway
: CLEAR
Look : no obstruction
Listen : no extra breath sound
Feel : there were warm air from both nose and mouth\
Breathing : CLEAR
Ins : chest wall movement symmetrical, RR 22 x/min,
bruise (-), hematoma ()
Pal
: vocal fremitus symmetrical
Per
: sonor right = left
Aus : basic breath sound vesicular, rh -/-, wh -/-

 Circulation : No Sign Of Shock

Warm extremities
Pulse = 78 x/menit
Temp = 36,40C
CRT <2
Blood pressure: 130/80 mmHg
Disability
GCS 15 (E4M6V5)
pupil isochoric 3/3 mm, centered
Direct light reflex/indirect light reflex +/+
Exposure
There was no life threatening wounds

SECONDARY SURVEY
AMPLE
Allergy
: Medication
: Past Illness
: gastritis
Last Meal : In the afternoon
Event
: Accident

HEAD TO TOE
Head : Normocephaly
Eyes : Pupil circular, isochoric 3mm/3mm, centered,
Direct Light Reflex +/+, Indirect Light Reflex +/+,
CA -/Ear : Normal, LCS (-), Blood (-)
Neck : Bruise (-), Hematoma (-), Palpation pain (-)
Krepitasi (-)

Thorax :
- Inspection : bruise (-), movement of chest wall
symmetrical
- Palpation: Vocal fremitus symmetrical
- Percussion : sonor right=left, percussion pain (-)
- Auscultation: basic breath sound vesicular
right=left, wh-/-, rh-/-.

Abdomen :
- Inspection
: flat
- Auscultation: bowel sound (+) 5x/min
- Palpation : tenderness (-), defense muscular
(-), pain palpitation (-)
- Percussion : tympani, percussion pain (-)

Status Localis : Regio

Temporalis dextra & Frontalis
sinistra
Look
Blood (-) Active bleeding (-)
Hematom (+)

Feel
pain (+)
Movement:
-

Radiological Image

History of illness
Patient female 55 years old came to the ER with
complaints of pain on head and headache . 4 hours
before brought to ER patient got a treatment from RS
Siaga Medika. She got an accident as she walking on the
left side of the road and suddenly loss of conciousness
because (car/motorcycle) crash over her. Vomitting 2x.

Working diagnose
CKR

CONSERVATIVE TREATMENT
- Hospitalize
-Rontgen cervical AP-Lateral
- O2 3 lpm
- Head up 300
- IVFD: 1 RL + III amp dexketoprofen/24 jam
1 RL + Neurobion 1 amp/24 jam
- MM: Ranitidine 2x1 mg IV