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    Stab Wound at Thorax + Ruptur Lien

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    Mohamad Zulfikar
    1) A 38-year-old male presented to the emergency room with a stab wound to the left chest and arm from a fight. 2) Physical examination revealed decreased breath sounds on the left side and a stab wound with protruding tissue in the left chest. 3) X-rays showed decreased lung volume in the left hemithorax. 4) The patient underwent emergency surgery including splenectomy and repair of a ruptured diaphragm.

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    Stab Wound at Thorax + Ruptur Lien

    Uploaded by

    Mohamad Zulfikar
    46 views24 pages
    1) A 38-year-old male presented to the emergency room with a stab wound to the left chest and arm from a fight. 2) Physical examination revealed decreased breath sounds on the left side and a stab wound with protruding tissue in the left chest. 3) X-rays showed decreased lung volume in the left hemithorax. 4) The patient underwent emergency surgery including splenectomy and repair of a ruptured diaphragm.

    Original Description:

    ruptur lien

    Original Title

    Stab wound at thorax + ruptur lien

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    1) A 38-year-old male presented to the emergency room with a stab wound to the left chest and arm from a fight. 2) Physical examination revealed decreased breath sounds on the left side and a stab wound with protruding tissue in the left chest. 3) X-rays showed decreased lung volume in the left hemithorax. 4) The patient underwent emergency surgery including splenectomy and repair of a ruptured diaphragm.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    46 views24 pages

    Stab Wound at Thorax + Ruptur Lien

    Uploaded by

    Mohamad Zulfikar
    1) A 38-year-old male presented to the emergency room with a stab wound to the left chest and arm from a fight. 2) Physical examination revealed decreased breath sounds on the left side and a stab wound with protruding tissue in the left chest. 3) X-rays showed decreased lung volume in the left hemithorax. 4) The patient underwent emergency surgery including splenectomy and repair of a ruptured diaphragm.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    EMERGENCY CASE REPORTS

    Sunday, November 15th, 2010


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    WAHIDIN SUDIROHUSODO
    GENERAL HOSPITAL
    MAKASSAR
    No. 2
    Name : Mr. A Sex : Male
    Age : 38 years old No. Reg : 44 79 41

    Chief complaint : Stab wound at left chest


    History taking : Suffered since 4 hours before admitted to the hospital
    due to fighting. History loss of consciousness (+)
    vomiting (-). Prior medical care at Akademis Hospital.
    Mechanism of : He was take a rest at security pos suddenly he was
    injury attack by unknown people using a sharp weapon. He
    was stabbed at left chest and left arm.

    Injury sustain : Chest, abdomen, arm


    Symptom & sign : Stab wound
    Examination : Physical examination, laboratory examination, thorax X
    ray
    PHYSICAL EXAMINATION
    Primary Survey
    A: Clear

    B: RR :24 x/minute, spontaneous, symmetric, thoraco


    abdominal type

    C: BP :110/ 70 mmHg, HR :84 x/minute, regular, adequate

    D: GCS 15 (E4 M6 V5), pupil equal 2,5 /2,5 mm , LR +/+

    E: T (ax) : 36,7 oC
    Secondary Survey
    Right zygoma region :
    I : Seen lacerated wound size 3 x 0,5 cm, edema(-),
    hematoma(-), active bleeding(-), deformity (-)
    P : Tenderness (+), Crepitating (-)

    Left arm region :


    I : Seen lacerated wound size 4 x 0,5 cm, edema(-),
    hematoma(-), active bleeding(-), deformity (-)
    P : Tenderness (+), Crepitating (-)
    Secondary Survey
    Thorax region :
    I : Movement of the left hemithorax is later than
    right hemithorax, seen stab wound at left
    hemithorax, with protrusion of omentum
    P : Vocal fremitus of the left hemithorax was less
    than right, tenderness (+)
    P : sonor, left < right side
    A : Breath sound left < right hemithorax
    Secondary Survey
    Abomen :
    I : Seen stab wound at left hemithorax size 4 x 0,5
    cm with protrusion of omentum,active bleeding (+)
    A : Peristaltic bowel sound (+), decrease.
    P : Tympani, Tapping pain (+), Shifting dullness (+).
    P : Tenderness (+) ,defans muscular (+)
    Laboratory Result
    WBC : 18, 65 x 103 / L

    RBC : 4.54 x 106 / L

    HGB : 13,7 g/dL

    HCT : 38, 7 %

    PLT : 321 x 103 / L

    CT / BT : 700 / 300

    Blood Sugar : 206 mg/dl

    Ureum : 28 mg/dl

    Creatinin : 1, 0 mg/dl

    SGOT/SGPT : 21 / 22 u/l
    Thorax AP X-Ray
    WORKING DIAGNOSE : Stab wound penetrans suspect spleen
    rupture

    MANAGEMENT : O2
    IVFD + resuscitation
    Medicaments
    Report to Senior Digestif surgeon,
    advice : Immediately laparatomy
    exploration
    Operation Procedure
    Patient lied supine under epidural and GA
    Desinfection & drapping Procedure
    Midline incision 2 finger under Proc. Xyphoideus until 3
    finger upper SOP
    Open peritoneum Identification solid organ seen hilus lymph
    laceration perform splenectomy.
    Identified diaphragm seen rupture at posterior perform
    stitch with continuous suture
    Identified hollow viscous didnt found any abnormalities
    Wash peritoneal cavity with normal saline.
    Stitch the wound layer by layer and leaving 2 drain
    Continue with chest tube on left hemithorax
    POST : Stab wound penetran with spleen rupture
    OPERATIVE grade IV
    DIAGNOSIS left diaphragm rupture

    PROGNOSIS : Good

    FOLLOW UP : Vital Sign

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