Duty report

Friday, March 17th 2017

Surgical resident : Dennis W. Pratama,

M.D.
Surgical interns : Danny, Erni,
 Attending surgeons on-call
Pediatric surgery : Suharyo, M. D., SpB, SpBA
Digestive surgery : A. Zumaro, M. D., SpB(K)BD
Orthopedic surgery : Muljana Hasan, M. D., SpOT,
Plastic &reconstructive surgery : Anastasia Dessy Harsono, M. D.,
SpBP-RE
Neurologic surgery : M. Agus Aulia, M. D., SpBS
Oncologic surgery : Marina T. Gultom, M. D., SpB
TCV surgery : Andreas Andry Lensoen M. D., SpBTKV
Urologic surgery : Haryono, M. D., SpU
Patients recapitulation
Total
Outpatient 0
Inpatient 1
Operation 1
Died 0
Operation
Mr. A . 24 y. o., Dx: Electrical Burn, gr II-III 10%
TBSA of the neck, the posterior trunk, both
upper extremities and the right inferior
extremity. Immediate escharotomy.
Inpatient
Mr. B, 54 y. o., Dx: intracranial hemorrhage,
subarachnoid hemorrhage, Chronic kidney disease on
haemodyalisis conservative treatment, ICU
admission.

( do you realize that this

patient might be
progressing???)
Mr A, 24 y.o.
Chief Complaint
Electrical burn on both arms, both hands, the right hip and the
right leg.
History of Present Illness
Approximately 8 hours ago, the patient was lifting an iron pole
and it striked as well as stuck among the-high voltage-
power lines. Suddenly the patient was experiencing the
electrical conductivity through the iron pole. The patient fainted
and fell to the ground. He was unconscious for about 5 minutes.
No vomiting nor nausea. The patient was taken to the Ridwan
Hospital, where later he had an iv line inserted and through
which 500 m.l. lactated Ringers solution was given.
Due to some lack of facility overthere, later the patient
eventually was referred to the Gatot Soebroto Army Central
History of Past Illnesses:
allergy (-), asthma (-)
Physical findings.
Primary survey:
A: clear, no hoarseness, no burnt nasal hair.
B: spontaneous, 24x / min, 99% saturation (of what, carbon-dioxyde,
nitrous oxide or oxygen???). Vesicular breath sounds + / +, rales -/-,
wheezing -/-. No circular eschar on the chest. No increased
work of breathing.
C: Heart rate 124 x / minute, warm extremities.
The initial urine production was 250 m.l. clear yellowish.
His urine production is currently 0.5 m.l. / kg / h.
An intravenous line was noted in the right wrist. Some
escharous tissues were evident in the right lower
extremity.
D: GCS 15, isocoric pupils 3mm / 3mm .
E:
Local findings of wound.
Posterior trunk 2% gr 2A-B.
Superior left extremity 3% gr 2A.
Superior right extremity 2% gr 2A.
Inferior right extremity 3% gr 2B-3.

Total 10%.
There were enter(???, or did you intend to write entry which means that this
was actually a fire-arm injury!!!) wounds on both palms and exit

wound (???) on the dorsum of the right foot.

(some words
of deliberation
please !!!)
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of deliberation
please !!!)
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of deliberation
please !!!)
F:
IVFD RL as a mode of ressuscitation 40x 60 kg x
10 (of what???) = 2400 m.l.
1200 m.l. for the first 8 hours already achieved
1200 m.l. for the next 16 hours = 75 m.l. / hour,
periodic evaluation of the color of urine, urine
target of 1-2 m.l. / kg / hr.
Physical findings.
CM, ABP: 130/80 mmHg, RR : 24 tpm, P: 76 tpm, T (did you really
intend to mention in Kelvin gradation???):36,8 C.
o

Eyes : no anaemic.
Cor : normal 1st& 2nd heart sounds, murmur (-),
gallopping rhythm (-).
Pulmo : vesicular sounds +/+, rales -/-, wheezing -/-.
Abdomen : within normal limits.
Extremity : CRT<2, warm.

Local findings of wound:

Posterior trunk 2% gr 2A-B.
Superior left extremity sin (another un-necessary word!!!) 3% gr 2A.
Superior right extremity 2% gr 2A.
Inferior right extremity 3% gr 2B-3.
Laboratory findings

Complete Blood Count: Hgb 12.3

g/dL/ Hct 37( %) / WBC 11500(of what???))/
Platelet Count (another un-necessary word!!!) 333.000 (of

what???)) / UL (what Is this???))

PT/APTT 1,0x/1,0x
AST/ALT 24/32
Ur/Cr 25 mg/dL /0,7 mg/dL
Electrolytes: Na/K/Cl 134 mmol/L/3,2
Working diagnosis

Electrical burn, gr II-III 10% TBSA of the neck, the

posterior trunk, both upper extremities and the right
inferior extremity.
Plan of management(Anastasia Dessy Harsono, M. D.)

Immediate escharotomy of the right foot.

CVC (or are you actually mean a CVP catheter???) insertion.
Fluid Resuscitation 40x 60 kg x 10 = 2400 m.l.
1200 m.l. for the first 8 hours was already achieved.
1200 m.l. for the next 16 hours = 75 m.l. / hour,
periodic evaluation of the color of urine, urine target
was of 1-2 m.l. / kg / hr.
 Antibiotics: 3x1gr Amoxiclav (as it was in plural, what was/were the other
one/s???).

Analgesics: 3x1gr Paracetamol (as it was in plural, what was/were the

other one/s???).

2x40mg Omz (oral or parenterals???).

2x400mg Vit C (oral or parenterals???).
Check the serial ECG tracings Consultation to the
cardiologist. (it is believed that anybody should capable of noticing any heart block
shown in the ECG tracing of any burn victim!!!) .

Treat wound using Silver Sulfadiazine (solution or ointment???).

Operation
report
Surgeon in charge: Anastasia Desy Harsono, M. D., SpBP-RE.
Operator: Dennis W Pratama, M. D.
Assistant: Anwar Lewa, M. D .

Patient was supine on general anesthesia.

Aseptic and antiseptic procedure around the operation field.
Using a no. 22 blade and a humbey knife, an escharotomy design
was created at thedorsal part of the right foot, with the base of
wound was thesubcutaneous tissue until bleeding dot (singular or
plural???) appeared at the wound.

Hemostasis was performed to control bleeding.

The operation was commenced.
(some words
of deliberation
please !!!)
(some words
of deliberation
please !!!)
Todays condition
It was a pleasure for me to
serve
these 2 clients during my
watch
(are these tables still related to this report!!!)