1. EMERGENCY REPORT RSO Prof Dr R Soeharso Solo Thursday, April 30th, Consultant : dr. Tito Sumarwoto, Sp.OT(K)
dr. Bayuaji dr. Zen dr. Harry dr. Sidiq

2. Emergency Room Patient
Inward patient No
Identity
Assesment
Plan 1
Jilan 35 y.o
Burst fracture of 2nd Lumbar Vertebrae Frankel E
Closed fracture of left middle third of clavicle comminutive Allman group I
Consult to spine
ORIF 2
Agus 18 y.o
Closed fracture of left sub trochanter Fielding I
Closed posterior dislocation of left elbow
Emergency Close reduction + slab 3
Sumartini 33 y.o
CF of right shaft tibia fibula oblique type. 2

3. Out No Identity Assesment Action Putri R 21 y.o 27 52 301.
Putri R
21 y.o
Ligamentous injury knee (D)
Kocher Slab
Analgetic 2
Balqis
29 y.o
Contusio musculorum r. elbow (D)
Arm sling 3
Kardi
12 y.o
Contusio musculorum r.antebrachii (S)
Armsling 4
Lukman
11 y.o
CF Radius ulna distal third (D)
Closered + LAC 3

4. VIP No
Identity
Assesment
Plan - 4

5. Refuse for treatment No
Identity
Assesment
Action 1. - 5

6. 1st patient

7. IDENTITY Name : Agus Novrianto Sex : Male Age : 18 y.o
Medical Record :
Ward : PK

8. A: Clear, stable c-spine
Primary Survey
Male 18 y.o came to ER with chief complain pain on his left hip after MVA
A: Clear, stable c-spine
B: Spontaneous, thoracoabdominally, RR: 20 x/m
C: HR: 90 x/m, BP : 120/65 mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,5 0C, lesion (+) look at physical examination 8

9. History Taking Chief Complaint : Pain on the left hip
Present illness :
3 hours prior to admission, the patient had a motor vehicle accident. He fell with position his left arm bear the body, and his left hip hit the ground. After that he felt pain on his left hip that aggravated by movement and unable to walk. He also complain pain on his left elbow.
There is no pain on other parts of the body.
Past illness :
There is no history of pain, deformity, or trauma before the accident.

10. Abdominal : no abnormality
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 10

11. Physical Examination
Left hip region : L : skin intact, swelling (+), bruising (+), deformity (+) exorotation, shortening (+) F : NVD (-), Tenderness (+) over proximal femur, Bryant triangle symmetric, (+), LLD : + 1 cm M : ROM hip and knee limited due to pain ROM ankle & toes full Left elbow: L : skin intact, swelling (+), deformity (+) posterior angulation F : NVD (-), Tenderness (+) around the elbow, Hueter line is broken M : ROM elbow limited due to pain

15. 1st Assessment Injury around the left hip
DD CF of left sub trochanter femur
CF of left intertrochanter femur
Injury around left elbow
DD posterior dislocation of left elbow
Fracture dislocation of left elbow

16. 1st Plan
Analgetic
Immobilization
Laboratory examination
X ray

19. 2nd assessment Closed fracture of left sub trochanter Fielding I
AO 31 - A3
Closed posterior dislocation of left elbow
AO 2.3 – B2
Tscherne 1
ISS : 9
VAS : 5-6

20. 2nd Plan
Definitive treatment : CF left intertrochanter femur  ORIF CF left distal radius  Emergency Closed Reduction + slab

22. 2nd patient

23. IDENTITY Name : Jilan Sex : Male Age : 35 y.o Medical Record : 275246
Ward : PS

24. A: Clear, stable c-spine
Primary Survey
Male 35 y.o, came to emergency room with chief complain pain on his lower back after MVA
A: Clear, stable c-spine
B: Spontaneous, thoracoabdominally, RR: 18 x/m
C: HR: 98 x/m, BP : 120 / 68 mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,7 C, lesion (+) look at physical examination 24

25. Secondary survey Chief complaint : Pain on lower back
Present illness :
3 hours prior to admission patient was involved in MVA. He fell down with unknown position. After that the patient felt pain on his lower back and unable to walk due to pain. Patient also complain pain on his left shoulder. There was no pain on other part of the body.
Past Illness :
There was no history of pain, deformity, or trauma before the accident.

26. Abdominal : no abnormality
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 26

27. Local Physical Examination
Thoracolumbar region :
L : skin intact, swelling (+) around thoracolumbar junction, deformity (-)
F : NVD (-) tenderness (+) around thoracolumbar junction, step off (-)
M : ROM lower extremity full
Left shoulder Region :
L : skin intact, swelling (+), bruising (-), skin tenting (-)
F : NVD (-), tenderness (+) at middle part of clavicle
M : ROM hard to evaluated due to pain, ROM elbow, wrist and finger full

28. Neurological Examination
Sensoric : normal
Motoric :
Reflex :
Bulbocavernous reflex (+)
Sacral sparring : (+) D S C5 5 C6 C7 C8 T1 L2 L3 L4 L5 S1

31. 1st Assessment
Injury around Thoracolumbar region DD : Compression fracture of thoracolumbar spine Burst fracture of thoracolumbar spine Fracture dislocation of thoracolumbar spine Closed fracture of left middle third clavicle

32. Plan
Immobilization
Analgetic
X ray
Laboratory examination

35. 2nd Assessment
Burst fracture of 2nd Lumbar Vertebrae Frankel E AO : 53.A3 Closed fracture of left middle third of clavicle comminutive Allman group I AO : 15. B3 VAS : 4-5 ISS : 9

36. Plan
Definitive treatment Burst fracture  consult to Sub Spine Clavicle  ORIF

37. 3rd patient

38. IDENTITY Name : Sumartini Sex : Female Age : 33 y.o
Medical Record :
Ward : PS

39. A: Clear, stable c-spine
Primary Survey
Female 33 y.o, came to emergency room with chief complain pain on the right lower leg after MVA
A: Clear, stable c-spine
B: Spontaneous, thoracoabdominally, RR: 18 x/m
C: HR: 98 x/m, BP : 120 / 70mmHg
D: GCS E4V5M6, isochoric pupil (3 mm/3 mm)
E: T : 36,7 C, lesion (+) at the lower leg 39

40. Secondary survey Chief complaint : Pain on right lower leg
Present illness :
4 hours prior to admission she involved in MVA. She fell from her motorcycle with her right leg hit the ground. After that the patient felt pain at the right lower leg that aggravated by movement and she was unable to walk due to pain.
Past Illness :
There was no history of pain, deformity, or trauma before the accident.

41. Abdominal : no abnormality
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 41

42. Local Physical Examination
Right lower leg region :
L : skin intact, swelling (+), bruising(-), deformity (+), valgus angulation.
F : NVD (-), Tenderness (+) at the shaft tibia fibula
M : ROM knee and ankle hard to evaluate due to pain

45. 1st Assessment
CF of right shaft tibia fibula DD : CF of right shaft tibia isolated

47. 2nd Assessment
CF of right shaft tibia fibula oblique type. AO: 42.B2 VAS : 4 ISS : 9 Tscherne : 2

48. Plan
Definitive Treatment : ORIF

49. THANK YOU