ecr pagi 27 maret 2013. tn e vulnus caesum phalanx distal manus sinistra, dr.wirantono, dm. melissa...
DESCRIPTION
ECR VulnusTRANSCRIPT
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Emergency Case Report
Konsulen : dr. Wirantono
Dokter Jaga UGD : dr. Celia
Penyusun :Felix Tasbun (2011-061-033)
Maya CH (2012-061-038)
Michael Carrey (2012-061-040)
Melissa Dharmawan (2012-061-041)
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AUTOANAMNESIS
• Keluhan Utama:
Luka pada jari tengah tangan kiri
• Keluhan Tambahan:
-
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IDENTITAS
• Nama : Tn. E
• Usia : 20 tahun
• Waktu Kejadian : Rabu, 27 Maret 2013 pk 08.25
• Waktu Kedatangan : Rabu, 27 Maret 2013 pk 09.25
• Datang dengan : Motor
• Pertolongan pertama : -
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KEWASPADAAN UNIVERSAL
• Sarung tangan
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PENANGANAN PRIMER
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JALAN NAPAS DENGAN KONTROL SERVIKAL
• Dapat berbicara dengan jelas, artikulasi jelas,mendengkur (-), obstruksi (-)
• Imobilisasi servikal
–
Collar neck : (-) – LSB : (-)
• Penilaian jalan nafas
– Suction : (-)
– Oropharyngeal airway : (-) – Endotracheal airway : (-)
• Jalan nafas selesai diperiksa pada : pkl 09.26
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PERNAPASAN DAN VENTILASI
• RR = 20 x/menit• Lihat :
– Bernafas spontan, teratur – Deformitas (-), retraksi (-), gerakan toraks simetris; – Sianosis (-), kesulitan bernafas (-),
• Rasa : – Ada hembusan udara dari hidung
• Dengar :
– Vesikuler , Ronchi (-/-), Wheezing (-)• Pernapasan selesai diperiksa pada : pkl. 09.28
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SIRKULASI
• Denyut nadi : 80 x/mnt (teratur, kuat, penuh)
• Tekanan darah: 110/80 mmHg
•
Ekstremitas : – CRT <2 detik, akral hangat
• Sirkulasi selesai diperiksa pada : pkl. 09.30.
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DISABILITY
• GCS: : 15 (E4V5M6)
• Pupil :
– isokor, Ø 3 mm/3 mm, refleks cahaya +/+• Motorik : 5555 5555
5555 5555
• Refleks fisiologis : Tidak diperiksa
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SUHU
• Suhu aksila : 36°C
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PENANGANAN SEKUNDER
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AUTOANAMNESIS
Pada ± 1 jam SMRS, tangan kiri pasien terpotong
pisau mesin pemotong kain. Pasien merasa nyeri dan
berdarah cukup banyak pada jari tengah tangan kiri.
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AUTOANAMNESIS
• Allergy : Disangkal
• Medication : Disangkal
•
Past illness : Disangkal• Last meal : ± 15 jam SMRS
• Event : Kecelakaan saat bekerja
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PEMERIKSAAN FISIK
Keadaan umum : Tampak kesakitan
Kepala : Deformitas (-)
Mata : Konjungtiva anemis -/- ,
Sklera ikterik -/-, pupilisokor Ø 3 mm/3 mm,
refleks cahaya +/+
Mulut : Mukosa oral basah
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PEMERIKSAAN FISIK
Hidung
Sekret -/- , septum nasi di tengah
Telinga Sekret -/- , serumen +/+
Leher
Trakea di tengah
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PEMERIKSAAN FISIK
• Thorax :I : Simetris dalam keadaan statis dan dinamis
P : Stem fremitus kanan = kiri
P : Sonor di kedua lapang paruA : Vesikuler +/+, Rh -/-, Wh -/-
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PEMERIKSAAN FISIK
Jantung:
– I : Iktus kordis tidak terlihat
– P : Iktus kordis tidak teraba
– P :
• Batas atas : ICS III
• Batas kanan : ICS IV linea sternalis sinistra
•Batas kiri : ICS V linea midklavikula sinistra
– A : Bunyi jantung I dan II teratur, gallop (-),
murmur (-)
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PEMERIKSAAN FISIK
Abdomen
• I : Datar
• P: Hepar dan lien tidak teraba, nyeri tekan(-)
• P: Timpani pada seluruh kuadran
• A: Bising usus (+) 3-4x/menit kuat padaseluruh kuadran
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PEMERIKSAAN FISIK
Punggung
I : Simetris dalam keadaan statis dan dinamis
P : Fremitus taktil kanan = kiriP : Sonor +/+, nyeri ketok CVA -/-
A : Suara nafas vesikuler, rh -/-, wh -/-
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PEMERIKSAAN FISIK
Ekstremitas : Akral hangat, CRT < 2 detik
Neurologis
Refleks fisiologis : Tidak diperiksa
Refleks patologis : Tidak diperiksa
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STATUS LOKALIS
• Look :
Tampak vulnus caesum pada digiti III phalanx distal manus
sinistra ukuran 4x1 cm, tepi luka tajam dan rata, dasar
subkutis, pendarahan aktif +.
• Feel :
Nyeri (+)
• Move :
Keterbatasan gerak (+)
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Diagnosis Kerja
- Vulnus caesum pada digiti III phalanx distal
manus sinistra
![Page 25: ECR Pagi 27 Maret 2013. Tn E Vulnus Caesum Phalanx Distal Manus Sinistra, Dr.wirantono, Dm. Melissa - Copy - Copy](https://reader030.vdokumen.com/reader030/viewer/2022012402/55cf9cf3550346d033aba3a2/html5/thumbnails/25.jpg)
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Terapi
• Wound toilet dengan NaCl 0.9 % dan betadine
+ hecting (benang prolene 4-0, 6 jahitan)
• TT dan ATS
• Claneksi 500 mg tab No XV 3dd1
• Mefinal tab No X 3dd1
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TEORI
VULNERA(LUKA)
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• Klasifikasi
– Secara umum
• 1. Simpleks : bila hanya melibatkan kulit
• 2. Komplikatum : bila melibatkan kulit dan jaringandibawahnya
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• Etiologi
– 1. Trauma Mekanis
– 2. Trauma Elektris
– 3. Trauma Termis
– 4. trauma Kimia
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Jenis – jenis Luka
• 1. Luka tertutup ( tidak adanya hubungan antara luka dengandunia luar)
– Luka memar ( vulnus contusum )
– Vulnus traumaticum
• 2. Luka Terbuka ( terjadi hubungan antara luka dengan dunia luar)
– A. vulnus excoriatio ( luka lecet)
– B. vulnus scissum/ incivisivum (lika sayat)
–
C. vulnus laceratum ( luka robek) – D. vulnus punctum (luka tusuk)
– E. vulnus caesum ( luka potong)
– F. vulnus scoperotum (luka tembak)
– G. vulnus morsum ( luka gigit)
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Anglo Saxon
• Abrasi
• Laserasi
• Penetrating wound
• Avulsi
• Open chrushing injury
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Tanda – tanda Luka
• 1. Tanda-tanda umum
– Shock
– Chrush syndrome
• 2. Tanda-tanda lokal
– Nyeri
– perdarahan
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PENGOBATAN
LUKA( Umum dan Khusus)
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PENGOBATAN
DEFINITIF
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Luka tertutup
• Umumnya tidak diperlukan tindakan bedah,
kecuali ada ruptur organ dalam
• Pemeriksaan fisik sangat penting
• Untuk mengetahui adanya perdarahan
interna dipakai “Von Slany test” ( HB, HT,
leukosit). Jika hasilnya positif, artinya terjadi
perdarahan interna.
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Luka Terbuka
• PRINSIP : mengubah luka kontaminasi
menjadi luka steril
• Tindakan : menarik tepi luka dan
membukanya lebar-lebar, periksa, apakah
terdapat:» 1. Diskontinuitas organ-organ di bawah luka
»
2. Benda asing» 3. Perdarahan
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Toilet
Luka
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• 1. Persiapan luka
• 2. Anestesi luka
• 3. Pembersihan luka dan sekitarnya
• 4. Menutup luka
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