Minor Surgery :

Digestive Surgery : 1

Thorax Cardiovascular Surgery :

Plastic Surgery :

Urology Surgery : 2

Neurosurgery :

Pediatric Surgery :

Oncology Surgery :

Orthopaedy :

Total : 3

No Identity Admission to E.R. Diagnosis Treatment / Planning

1 Mr. Toni/32/1139109

9 February 2015/

15.00 wita

Fournier Gangrene + GGK

Obs. Vital SignIVFD NaCL 0,9AnalgeticAntibiotic

Consult to urologyIVFD NaCl 0.9AntibiotikAnalgetikUrine Culture, Blood Culture, Pus CulturePro Abcess drainage and debridementHiponatremia correctionConsult to Nephrology

No Identity Admission to E.R. Diagnosis Treatment / Planning

2 Ny. Poniri / 75

y.o/ 1.13.91.18

9th February 2015/18.000 WITA

Anemia + Post Colostomy ai Adeno

carcinoma colon

Obs. TNRSIVFD RL 20 tpmPro PRC Transfussion 1 Kolf

Co. Digestif surgeryHospitalized Pro PRC Transfussion

No Identity Admission to E.R. Diagnosis Treatment / Planning

3 MR. Herman/ 59 y.o/ 1.13.91 200.46

9th February

2015/ 18.55

Retensio Urine ec Blood Clot +

Post TURP + Hipokalemia

Obs. Vital SignIVFD NaCl 15 gtt/mDC 24 three waySpooling NaCl 40-60 gtt/mInj. Ceftriaxon 2x1 grInj. Asam Tranexamat 3x500mgPro USG Urology + ProstatHipokalemia correction

Consult To UrologyPro USG Urology + ProstatCystoscopy Blood evacuation

1. Mr. Toni/32/1139109

9 February 2015/ 15.00 wita

• Chief Complain : Swelling at scrotum• History : 3 days before admission, patient complained his

scrotum swollen. The scrotum get bigger and felt painfull. The scrotum become reddish and warm. 5 days before admission patient complained about swelling at his perianal. It felt warm and painfull. 2 days letter the swollen broken and produce pus. Fever (+), Continously fever. There no history of lump in and out at scrotum before. Defecation (+), No black feces, no diarrhea, no nausea and vomiting. Reddis Voiding (-), sandy voiding (-). Patient is a driver. History of diabetes mellitus denied. Patient went to Pelaihari Hospital then reffered to ULIN Hospital.

Vital sign

• Conciousnous : Composmentis• BP : 160/90 mmHg• Pulse rate : 98 x/minute, lift strong, regular• RR : 20 x/minute• Temp : 37,8˚C

General Status

• Eyes : anemic conjunctiva(+/+) icteric sclera (-)• Mouth : Wet mucous• Neck : Lymph nodes enlargement (-), JVP enhancement (-)

Head/Neck

• I : Symmetric respiratory movement, no retraction• P : Symmetric VF• P : Sonor at all lung fields• A : symmetric VBS, rhonchi (-), no wheezing

Chest

• I : Wound (-), distensi (-)• A : Bowel sound (+) normal• P : Liver/spleen/kidney not palpable, defans muscular (-), ascites (-),

Tendernes (+), Rebound Tenderness (-)Abdomen

• Warm extremities, edema (-), parese (-)Extremities

• Inspeksi : jejas (-/-), hematoma (-/-)• Palpasi : massa teraba (-/-), nyeri tekan (-/-)• Perkusi : nyeri ketok ginjal (-/-)

CVA

• Inspeksi : massa (-/-), hematoma (-/-), jejas (-/-)• Palpasi : massa tidak teraba, nyeri tekan (-/-)

Flank Area

• Inspeksi : buli tidak menonjol, jejas (-), hematoma (-), massa (-) • Palpasi : nyeri tekan (+)

Suprapubik

• OUE : bloody discharge (-), • Scrotum edema (+), kateter (+), Reddis (+), tenderness +,• Genitalia

Genitalia

• Edema (+), Pus (+),• RT : TSA Strong, slippery mucouse, ampulla colapsed (-), Tendernes (+), Mass (-)• HN : Feaces (+), Blood (-)

Perianal

9

Clinical Picture

Localized status

Laboratorium result(9 February 2015)Hb : 12,2WBC : 27.800Erytrocite : 4.75 jtHematocrit : 34.9Trombocite : 287SGOT : 151SGPT : 76

GDS : 157Ureum : 189Creatinin : 7.1Na : 127.4K : 5.9Cl :93.8

USG (9/2/15)

Working Diagnosis

Fournier Gangrene

ManagementObs. Vital SignIVFD NaCL 0,9AnalgeticAntibiotic

Consult to urologyIVFD NaCl 0.9AntibiotikAnalgetikUrine Culture, Blood Culture, Pus CulturePro Abcess drainage and debridementHiponatremia correctionConsult to Nephrology

2. Ny. Poniri/ 74 y.o/ 1.13.93.18 9h February 2015/ 18.00• Chief Complain : weakness• History : 2 weaks before admission patient felt weak n loss

of apetite. 23 days before admission patient had colostomy operation at SIAGA Hospital, after the operation patient get defecation at her stomach. The defecation from stomach is fluent. No black stool, no bloody stool, no nausea and vomiting, there’s no fever. Patient have the PA result as Adenocarcinoma colon. Patient got operation because uncapable to defecated, stomach distension, vomited, no flatus either. There is no history of chemotherapy or radiotherapy. Daily patient still capable to washherself, eat and selfcare by herself. But no longer to work. Because the complained patient came to ULINS Hospital.

Vital sign

• Conciousnous : Composmentis• BP : 120/80 mmHg• Pulse rate : 92 x/minute, lift strong, regular• RR : 20 x/minute• Temp : 36.5˚C

General Status•• Eyes : anemic conjunctiva (-/-) icteric sclera (-)• Mouth : Wet mucous, • Neck : Lymph nodes enlargement (-), JVP enhancement (-)

Head/Neck

• I : Symmetric respiratory movement, no retraction• P : Symmetric VF• P : Sonor at all lung fields• A : symmetric VBS, rhonchi (-), no wheezing

Chest

• I : Wound (-), distension (-)• A : Bowel sound (+) normal• P : mass palpable (-), pain (-)• P : Tymphani, CVA pain +/-

Abdomen

• a/r cruris dextra• Look: Swelling (-), Deformities (-), Open wound (+),• Feel: Crepitation (-), pain (-)• Move: ROM unlimited

Extremities

Clinical Picture

Local Status

Ar. Abdomen• I : Wound (-), distension (-), Stoma

(+), stool (+)• A : Bowel sound (+) normal• P : mass palpable (-), pain (-)• P : Tymphani, CVA pain +/-

Laboratorium result(9 February 2015)Hb : 9.0WBC : 5.600Erytrocite : 3.33jtHematocrit : 27.9Trombocite : 397.000SGOT : 15SGPT : 8

GDS : 119PT/APTT :INR : Ureum : 27Creatinin : 0.6

Patologi Anatomi

Working Diagnosis

Anemia + Post Colostomy ai Adeno carcinoma colon

ManagementObs. TNRSIVFD RL 20 tpmPro PRC Transfussion 1 Kolf

Co. Digestif surgeryHospitalized Pro PRC Transfussion

3. Mr. Herman/ 59 y.o/ 1.13.91.20 9th February 2015/ 18.55• Chief Complain : unable to urinate• History : 12 hours before admission patient got bloody

urinate, after that patient cannot urinate. Patient felt pain at his lower abdomen. His lower abdomen got bigger and more pain. Patient with history prostate operation 10 days ago. In 10 days after operation no history of bloody urinate, no pain at urinate, after operation urinate is fluent. Patient got operation by history of hard to urinate, and cannot urinate, no sandy urinate, no bloody urinate, no back pain, no fever. Before bloody urinate no history of trauma. Because the complained patient went to TPT hospital and get referred to ULIN Hospital

Vital sign

• BP : 120/80 mmHg• Pulse rate : 96 x/minute, lift strong, regular• RR : 12 x/minute• Temp : 36,8˚C

General Status

• Eyes : anemic conjunctiva(-/-) icteric sclera (-)• Mouth : Wet mucous• Neck : Lymph nodes enlargement (-), JVP enhancement (-)

Head/Neck

• I : Symmetric respiratory movement, no retraction• P : Symmetric VF• P : Sonor at all lung fields• A : symmetric VBS, rhonchi (-), no wheezing

Chest

• I : Wound (-), distensi (-)• A : Bowel sound (+) normal• P : Liver/spleen/kidney not palpable• P : defans muscular (-), ascites (-), undulasi (-)

Abdomen

• Warm extremities, edema (-), parese (-)Extremities

• Inspeksi : jejas (-/-), hematoma (-/-)• Palpasi : massa teraba (-/-), nyeri tekan (-/-)• Perkusi : nyeri ketok ginjal (-/-)

CVA

• Inspeksi : massa (-/-), hematoma (-/-), jejas (-/-)• Palpasi : massa tidak teraba, nyeri tekan (-/-)

Flank Area

• Inspeksi : buli menonjol, jejas (-), hematoma (-), massa (-) • Palpasi : nyeri tekan (+)

Suprapubik

• OUE : bloody discharge (+), • Scrotum edema (-), kateter (-), Reddis (-), tenderness -

Genitalia

28

Clinical Picture ( After Cathether insertion)

Laboratorium result(6 February 2015)Hb : 13.4WBC : 11.500Erytrocite : 4.75jtHematocrit : 39.3Trombocite : 148.000SGOT : 25SGPT : 17Na : 145.9K : 2.8Cl : 96.6

GDS : 114PT/APTT : 8,4/18,4INR : 0.75Ureum : 23Creatinin: 1,0

Working Diagnosis

•Retensio Urine ec Blood Clot + Post TURP + Hipokalemia

Management• Obs. Vital Sign• IVFD NaCl 15 gtt/m• DC 24 three way• Spooling NaCl 40-60 gtt/m• Inj. Ceftriaxon 2x1 gr• Inj. Asam Tranexamat 3x500mg• Pro USG Urology + Prostat• Hipocalemia correction

Consult To Urology• Pro USG Urology + Prostat• Cystoscopy Blood evacuation

Tugas

• Dr. Hendra• Cairan pada urology• AB pada Urology• Komplikasi TURP

• BUKU • Ileus 1,5 kali Vertebrae• Kriteria ileus dari foto abdomen• Tugas Hipokalemia• Sindroma post turp• Knp bisa hiponatremia• Knp bisa hypokalemia• Furosemide berapa bikin hipokalemia

• Perkusi pada perforasi, pekak hepar menghilang