EMERGENCY REPORT

RSO Prof. Dr. R. Soeharso Surakarta,

Saturday, December 15th 2017

Team :
dr. Hanif
dr. Dono
dr. Rasyid
dr. Krisnanto

Consultant : dr. Anung Budi S, SpOT(K)

 Patient Admission
Inpatient
No Identity Diagnosis Plan

4
 Patient Admission
Outpatient
No Identity Diagnosis Plan

2
1st Patient
 IDENTITY
• Name : Painah
• Sex : Female
• Age : 54 y.o
• Medical Record : 312669
• Ward : PS
 Primary Survey

Female 54 y.o came to E.R. with chief complain pain on the

right thigh

A: Clear, stable c-spine

B: Spontaneous, thoracoabdominally, RR: 20 x/m
C: HR: 82 x/m, BP : 180/90 mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,5 0C, lesion (+) look at physical examination
 History Taking
• Chief Complaint :
Pain on the right thigh
• Present illness :
1 months prior to admission, patient complained pain on
the right thigh after she slipped her leg when walking. The
pain was aggravated by movement and she was unable to
walk. Weight loss (+) 5 kg in 2 months, night pain (+),
prolonged fever (-), chronic cough (-). There is no
complain on another part of her body

• Past illness :
history of hypertension (+), DM (-), history of tumor on
family (-)
 Secondary Survey

Head : no abnormality
Neck : no abnormality
Eyes : no abnormality
Nose : no abnormality
Ears : no abnormality
Mouth : no abnormality
Chest : no abnormality
Abdominal : no abnormality
Extremities : Lesion (+) look at physical examination
 Physical Examination
Right Thigh region
L : skin intact, swelling (+), bruising (+), deformity (+)
shortening and exorotation
F : NVD (-), Tenderness (+) mid femur
M : ROM hip and knee limited due to pain
ROM ankle & toes full

LLD: 2 cm
Clinical Pictures
 1st Assessment

• Susp pathological fracture of right shaft femur

DD pathological fracture of right subtrochanter
femur
 1st Plan

• Analgetic
• Laboratory examination
• X ray
 Laboratory
• Hb : 12,0 • CRP : positive
• AL : 10.00 • Protein : 6,8
• Hct : 30.000 • Albumin : 3,7
• AT : 258.000 • Globulin : 3,1
• LED I : 47 • ALP : 146
• LED II : 75 • GDS : 160
• PT : 14,6 • Ur : 27
• APTT : 36,6 • Cr : 0,71
• HBSAg : negative • SGOT : 99
• SGPT : 21
 2nd Assessment
• Pathologic fracture of right Shaft femur
due to susp metastatic bone disease DD
multiple myeloma

• ISS :9
• VAS : 8
 2nd Plan
• Initial treatment :
Immobilization  skin traction
Supportive treatment

• Definitive treatment :
Work up diagnostic : bone survey
consult to sub MST
consult to internist
2nd Patient
 IDENTITY
• Name : Sukiyem
• Sex : Female
• Age : 57 y.o
• Occupation : Farmer
• Medical Record : 312671
• Ward : PS
 Primary Survey

Female 57 y.o came to E.R. with chief complain pain on the

left knee

A: Clear, stable c-spine

B: Spontaneous, thoracoabdominally, RR: 20 x/m
C: HR: 82 x/m, BP : 155/75 mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,7 0C, lesion (+) look at physical examination
 History Taking
Chief Complaint :
Pain on the left knee
Present Illness :
2 hours prior to admission, the patient was fell with
her left knee hit the ground in flexed position. He
feel pain at his left knee that aggrevated by
movement. There is no pain at the knee before the
accident. There is no pain on other body part. No
History of Unconsciousness or vomiting
Past Illness:
There was no history of hypertension and DM
 Secondary Survey

Head : no abnormality
Eyes : no abnormality
Nose : no abnormality
Ears : no abnormality
Mouth : no abnormality
Chest : no abnormality
Abdominal : no abnormality
Extremities : Lesion (+) look at physical examination
 Physical Examination

Left knee region :

L : skin intact, swelling (+), bruising (+), deformity (-)
F : NVD (-),Tenderness (+) on the anterior, camel sign (+),
Bulging Test (+)
M : ROM Knee hard to evaluate due to pain, Stability test not
assessed
ROM Ankle and Toes is full
 1st Assessment
- Closed Fracture of Left Patella
 1st Plan
• Immobilization
• Analgetic Inj
• X-ray Examination
X-Ray
 2nd Assessment
• Closed Fracture of left Patella comminutive
type

AO 3.4.C.2
ISS :9
 2nd Plan
Definitive treatment:
• Open reduction and internal fixation
3rd Patient
 IDENTITY
• Name : Destriyanto
• Sex : Male
• Age : 18 y.o
• Occupation : Student
• Medical Record : 308573
• Ward : CK
 Primary Survey
Male 18 years old came to the emergency department
with chief complaint pain on the right shoulder and left
wrist.

A: Clear, stable c-spine

B: Spontaneous, thoracoabdominal, RR: 20 x/m
C: HR: 99 x/m, BP : 130/80 mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,5 C, lesion (+) look at physical examination
 History Taking
• Chief Complaint : Pain on the right shoulder and left
wrist

• History of illness :
12 hours prior to admission, patient was involved in a
MVA, patient fell down with his right shoulder hit the
ground first and leaned on his left hand. After the
accident, patient felt pain on the right shoulder and
left wrist that aggravated by movement. There is no
pain on the other part of the body. There is no history
of unconsciousness, nausea, nor vomiting.

• History of past illness :

There was no history of hypertension and DM
 Secondary Survey

Head : no abnormality
Neck : no abnormality
Eyes : no abnormality
Nose : no abnormality
Ears : no abnormality
Mouth : no abnormality
Chest : no abnormality
Abdominal : no abnormality
Back : no abnormality
Extremities : Lesion (+) look at physical examination
 Physical Examination
RIght Shoulder Region
L : Skin intact, swelling over the clavicle, unclear
deformity, no skin tenting
F :No NVD, Tenderness over middle third of right
clavicle.
M : ROM shoulder was difficult to be evaluated
due to pain. ROM elbow was full.
Clinical Appearance
 1st Assessment

• Closed fracture of the right clavicle.

• Injury around left wrist
 1st Plan
• Immobilization
• Analgetic
• X-Ray examination
• Laboratorium examination
X-Ray
 2nd Assessment
• Closed Fracture middle third of right
Clavicle comminutive type Allman Group I
(AO: 15.B3)

• DRUJ disruption of left wrist

VAS : 4-5
(ISS: score 9)
 2nd Plan
Definitive Treatment :
• ORIF
4th Patient
 IDENTITY

Name : Soni
Sex : Male
Age : 10 yo
MR : 312672
Ward : CK
 Primary Survey
Boy, 10 y.o came to emergency room with chief complain
pain on his left elbow

A: Clear, stable C-Spine

B: Spontaneous, RR: 20 x/m
C: BP : 110/80 mmHg, Pulse/HR: 88x/m
D: GCS E4V5M6, isochor pupil (3 mm/3 mm),
E: T : 36,9 C, lesion (+) look at physical examination
 History Taking
Chief Complaint :
Pain on the left elbow
Present Illness :
6 hours prior to admission, the patient fell down
when he was riding a bike with his left arm elbow
in flexion position. He felt pain at his left elbow that
aggravated by movement. There was no pain
before accident at the elbow. There is no pain at
the other body part.
 Secondary Survey

Head : no abnormality
Eyes : no abnormality
Nose : no abnormality
Ears : no abnormality
Mouth : no abnormality
Chest : no abnormality
Abdominal : no abnormality
Extremities : Lesion (+) look at physical examination
Clinical Pictures
 Physical Examination

Left elbow region :

L : skin intact, swelling (+), deformity unclear, Anterior Pucker
sign (-)
F : NVD (-), Tenderness (+) on medial condyle
M : ROM Elbow hard to evaluate due to pain
ROM wrist and Fingers full
 1st Assessment
• Injury around left elbow
DD:
Closed Fracture of Supracondyler Humeri
Closed Fracture of medial Condyle Humeri
 1st Plan
• Immobilization
• Analgetic Inj
• X-Ray Examination
X-Ray
 2nd Assessment
• Closed Epiphysiolysis of left medial
condyle Humerus Kilfoyle type 3

ISS: 9
 2nd Plan

• Definitive Treatment:
Open reduction internal fixation