OF IMPRESI ICH ENG

Name : Boy, RF
Age : 5 th (18 kgs)
MR : 01178951
Chief Complaint :
Persisten headache and wound after MVA

Present illness history :

One hour prior to admission when the patient was
crossing the street, patient was hit by the motorcycle. His
head bumped to the ground. After the accident he still
conscious, vomiting, no seizure, and complained
persisten headache and wound at right side of the head.
Then his family took him to Dr. Moewardi hospital.
 Primary Survey

A : Clear
B : I : Equal chest expansion, RR = 24 x/mnt
P : Crepitation (-) / (-)
P : Sonor /Sonor
A : Vesicular breathing sound (+/+), Ronchi (-)/(-)
C : BP: 100/60 mmHg, Pulse: 88 x/mnt
D : GCS E4V5M6, pupil isocore 3mm/3mm, light reflexes
(+/+), no lateralization
E : T = 37o C, lesion (+) look at local physical exam.
 Secondary survey

Head : lesion (+), look at local physical examination.

Eyes : no abnormality
Ears : no abnormality
Nose : no abnormality
Mouth : no abnormality
Neck : no abnormality
Chest : no abnormality
Abdomen : no abnormality
Extremity : no abnormality
 Localized Status
Right Parietal Region
I : Open wound (+) size 2x0,5x0,5 cm
P: Hematom (+) size 4x4x3 cm, discontinuity (+),
depressed skull (+)
Ass I :
Cerebral Commotio GCS E4V5M6
Right Parietal Region Open Wound
Susp. OF impression Right Parietal Bone

Plan I :
- O2 2 lpm
- IVFD NaCl 0,9 % 1000 cc/24 hours
- Ceftriaxon inj. 1gr/24 hours (skin test)
- Metamizole inj. 180mg/8 hours
- Routine blood examination
- Head CT scan
Ass II :
OF. Impression Right Parietal bone
ICH Right Parietal region

Plan II:
Debridement + Elevation fracture Emergency
Boys 5th years old
Pre OP diagnosis : OF. Impression Right Parietal bone + ICH
Post OP diagnosis : OF. Impression Right Parietal bone + Tears of
duramater + ICH
Operation : Debridement + elevation + Duramater defect closure
Team : APY/PBD/VIA/Dr. Hanis S. Sp.BS
• Supine position left side down under GA, sterilized the operation field,
covered with sterile draping
• Perform a Lazy “S” incision over the depressed skull extending from the
wound deepened until the cranium layer
• Parietal bone depress fracture, dural tears and cerebral parenchyma exposed
was identified
• Instilled the field by H2O2, and rinse with saline
• Debridement, Elevated bone fragment, and removed impacted bone
• Bleeding from parenchima vessel, Control bleeding by bipolar hemostasis
and surgicell
• Crushed the edge of adjacent bone by Knabell until aproximately 0,5 cm
behind the edge of duramater defect
• Performed Hit stich suture behind the edge of duramater defect
• Closed duramater defect by Periosteal flap
• bone kept under subgaleal layer
• Inserted NGT no 14 for drainage
• Closed the wound by layers
• Operation accomplished
 Respon Time

Arrival time 17.50

Triage time 17.55
Surgery time 17.55
Radiology time 18.00 – 18.30
Laboratory time 18.05 – 18.40
Diagnose 18.50
Operation 21:15 – 23.10
Inward 23. 45