Bed Side Teaching

Preceptor: dr. Rizal Daulay Sp.OT

Identification
Name: Ayunah
Sex: Female
Age: 51 y
Address: Desa Talang Kec. Banyu Asin
Chief Complaint
Knee swelling
Clinical History

1st day: Swolen,

Swelling knee Injection 10
redness, can’t
since 7 days ago times
bent
 2nd days:
3rd days: Come to
worst than
appears fluid RSMP
before
Clinical History
Patients present with swelling knee since seven days ago . Before that, this
patient come to doctor with mild pain of knee, pain is felt intermittent
since last year , the pain is felt when doing activity . Pain like needles . And
then, the doctor injected her 5 times at inside part of knees and 5 times
at outside part of knee. Injection spuits used 5 cc , the patient does not
know what is content of fluid injection . The patient admitted that needle
is inserted not too deep . After injection the patient felt her legs is good
and light. The next day , at 5 o'clock in the morning , the patient felt her
legs are very heavy , can not be bent and redness , slowly began to ache
and swell . Patients bring her back to the doctor , and the doctor providing
treatment using warm water bottle attached to a patient with knee
swelling. The doctor said that, if her knee start to issu discharge, she
must squeeze that. Patient doesn’t felt no improvement and bring him to
Sayang Bunda clinic , but was not given adequate management . At the
third day after injection , knees getting worst, swollen , red and painful
accompanied by a discharge of pus . The patient coming to RSMP because
it was already not stand .
General State
General Condition: Well
Sens: Compos Mentis
Vital Sign  AP: 160/100 P: 87 RR: 22 T:36,5
Local State
Look: Bulge (+), redness(+)
Feel: Tenderness (+), warm (+), dorsalis pedis
artery (+)
Move: No limitation
X-Ray
Laboratory
BSS: 483 mg/dl
Leucocyte: 16.400 mg/dl
CRP: 12 ml
Reduction urine: ++++
Assesment
Septic artritis of knee + selulitis + DM type II
Planning
- Synovectomy Debridement
-Artrosentesis