lapag prdn
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On duty (ER Stage) :
Maisarah, Asti, Bagus
Emergency Room Case ReportFebruary 4th-9th 2013
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Minor surgey : 3
Urology :1
Digestive : 3
Ortopedics :2
Neurosurgery : 0
Pediatric Surgery : 0
Oncology :0
Vascular and Cardiothoracic :0
Plastic Surgery :0
Total patients : 9
Reported patients : 1
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Mr. Yamani/15 yo/Admitted to ER on
February, 7th 2013 at 11.00 am/Crush
injury a/r digiti IV-V manus dextra
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Chief complaint : crushed finger
The patient complained that his third, fourth and fifth finger on
the right hand was crushed because its minced in a bread
machine. The incident happened approximately 15 minutes
before the admission. On the fourth and fifth finger, skin,
muscle, and bone was crushed to pieces. Patient loss hissensation on the crushed part but sensation of pain can be
felt on the border betwen crushed part and not crushed part.
On third finger there is an open wound on the edge of finger.
they keep on bleeding. Before admission, patient put apressure on his injury with a cloth, spilled with stone oil.
The patient then sent to Ulin general hospital.
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Clear, snoring (-), gargling (-)
A Clear, RR=20/min, simmetric respiratory
movement, simmetric VBS
B BP: 120/80 mmhg, Pulse rate: 92 x/m
regular, strong pulsation
C GCS E4V5M6, round and simmetric
pupils , diameter (3mm/3mm), light
reflexes (+/+)
D
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A -
M -
P -
L 4 hours before
admission
E Bread factory
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Eye : anemic conjunctivae (-/-), icteric sclerae (-/-), periorbitalhematoma (-/-)
Mouth : Wet mucosa, cyanosis (-)
Neck : increase of JVP (-)
Head/Neck
I : Simmetric respiratory movement, retraction (-)
P : Simmetric VF
P : Sonor in all lung field
A : Simmetric VBS, Rh (-/-), Wh (-/-)
Thorax
I : Flat, hematoma (-)
A : Normal bowel sound P : H/L/M not palpable, tenderness (-), mass (-) P : Tympanic in all quadrants
Abdomen
Warm periphers, no edema in inferior extremities
Crush wound on fourth and fifth finger on the right hand
Open wound on third finger on the right hand
Extremities
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Region of third digiti
manus dextra
Look:Open wound, 1 cm
x 1 cm with soft
tissue loss, nailloss,
irregular edge,
dirty, bone expose,edema (-),
Bleeding (+)
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Region of third
digiti manus
dextra Feel:
Pain (+), Loss
of sensation (-),crepitation (-)
Region of third
digiti manus
dextra Move:
Active ROM:
Free
Passive ROM:
Free
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Region of fourth digiti
manus dextra
Look:crush wound,
length: app. 5 cm
with crushed bone,muscle, skin,
Up to phalangx
proximal,
irregular edge,dirty,
edema (-),
Bleeding (+)
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Region of fourth
digiti manus dextraFeel:
Pain (+),
Loss of
sensation (+)
Region of fourth
digiti manus dextra
Move:Active ROM:
limited
Passive ROM:limited
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Region of fifth digiti
manus dextra
Look:crush wound,
length: app. 5 cm
with crushed bone,muscle, skin,
Up to phalangx
proximal,
irregular edge,
dirty,
edema (-),
Bleeding (+)
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Continued
Region of fifth digiti
manus dextra
Feel:
Pain (+),
Loss of
sensation (+)
Region of fifth digiti
manus dextra
Move:Active ROM:
limited
Passive ROM:limited
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Hb : 12,5 g/dl
Leu : 7,8 thousand/ul
Eri : 4,76 million/ul
Ht : 40,0 %
Tr : 344.000
PT/APTT : 13,3/27,1
BSS : 97 mg/dlUr : 29 mg/dl
Cr : 0,72 mg/dl
SGOT : 17 U/l
SGPT : 17 U/l
Na/K/Cl: 143,5/4,03/106,6
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Crush injury a/r digiti IV-V manus dextra
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Management :
Referred to Orthopedic Consultant (Resident) :
Dressing
Emergency surgery : Repair Stump
HospitalizationAntibiotic, Analgetic, H2blocker
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