View
310
Download
0
Category
Preview:
Citation preview
DR. dr. HM. Alsen Arlan Sp.B. KBD MARS
Curiculum Vitae
DR. dr. H.M. Alsen Arlan, Sp.B KBD., MARS
Tempat / Tgl lahir : Palembang, 4 Juni 1962
Nip / Pangkat. Gol : 196206041989031005/Pembina Utama Muda IV.c
Alamat Rumah : Komplek Taman Istana Blok A 3 – 4, Jln. Lingkar Istana, Demang
Lebar Daun, Palembang.
No. Telp : HP. 0811785284
Status Kawin
Istri : Dr. Hj. Desty Aryani M.Kes
Anak : 1. dr. Apriandini Mirdasari Putri, dr. M Hafidh Komar, SpB KBD
2. dr. M.Arisma Dwirian Putra
Pendidikan
S1 Dokter FK UNSRI Palembang, Lulus tahun 1988.
Spesialis Bedah Bag. Bedah FK UNSRI /RS MH Palembang,
Lulus tahun 2000.
Sub Spesialis Bedah Digestive Konsultan Bag. Bedah FK UNPAD
RS. Hasan Sadikin Bandung, Brevet tahun, 2004
S3. (Doktor) ; Program Pascasarjana UNPAD, Bandung
Bidang Studi Ilmu Kedokteran.Lulus 8 Mei 2008
Program Studi Magister Administrasi Rumah Sakit
Program Pasca Sarjana Universitas Respati Indonesia Jakarta 2013
Diklat PIM II SPIMNAS, Lembaga Administrasi Negara Jakarta,
21 Februari – 1 Mei 2012.
Pekerjaan
RSUD Baturaja OKU 1989 – 1990
Puskesmas Kemalaraja, Baturaja OKU, 1990-1992
Puskesmas Martapura OKU, 1992 – 1995.
PPDS I Ilmu bedah FK Unsri/RSMH Palembang, 1995 – 2000
Staff Bag. Bedah FK Unsri / RSMH Palembang. 2000 – 2002.
Trainee Konsultan Bedah Digestive, Bgn Bedah Digestive RS. Hasan Sadikin Bandung, 2002 – 2004.
Staff. Sub Bagian Bedah Digestive, Bag. Bedah FK Unsri / RS. Moh. HoesinPalembang, 2004 – Sekarang.
Kepala Instalasi Bedah Sentral, Rumah Sakit Muhammad Hoesin Palembang. 2008 –2010
Direktur Umum, SDM & Pendidikan RSUP Dr. Mohammad Hoesin Palembang. 23 Juni 2010 sd. 20 September 2013
Direktur Medik dan Keperawatan 20 september 2013 sd –sekarang.
Penghargaan
Satyalancana Karya Satya 20 Tahun dari Presiden Republik Indonesia
Tri Windu Bakti Karya Husada 24 tahun, Kementerian Kesehatan RI
Adhiaksa Utama Pengabdian IDI
Penghargaan Terbaik Diklat PIM II SPIMNAS, Lembaga Administrasi Negara Jakarta 21 Februari – 1 Mei 2012.
Tips and Trics
Blunt Abdominal Trauma
DR. Dr. H.M. Alsen Arlan, SpB-KBD,MARS
Bedah Digestive
Departemen Bedah – FK Unsri / RSUP Mohammad Hoesin
Palembang - 2018
Abdominal Trauma:
Penetrating (23,8%) > Blunt (12,1%)
Morbidity & mortality due to bleeding and/or
visceral perforation resulting in sepsis
Single or multiple concomitant organ injuries:
Triad of death : coagulopathy, acidosis, & hypothermia
8
Sabiston, Text Book of Surgery,2017
Abdominal Trauma
Early resuscitation (Damage Control Resuscitation) & rapid
assessment and control sources of bleeding and/or
contamination (Damage Control Surgery or Definitive
Surgery)
Retained foreign bodies traversing abdominal wall must be
maintained & protected from excessive movement during
initial evaluation
9
Classification Of Abdominal Trauma
Penetrating
High velocity (85% penetrate peritoneum)
Low velocity (95% need surgery)
Stab (1/3 do not penetrate the peritoneum, of those
50% need Surgery)
Blunt trauma
High energy transfer (car accident)
Low energy transfer (fall, fight)
Mattox 2013, in Trauma 7th ed
Spleen 40% to 55%
Liver 35% to 45%
Small Bowel 5% to 10%
Retroperitoneal 15 %
Advanced Trauma Life Support 10th
Sabiston, Text Book of Surgery,2017
Algorithm for the initial evaluation of a patient with suspected blunt abdominal trauma. CT = computed
tomography; DPA = diagnostic peritoneal aspiration; FAST = focused abdominal sonography for trauma; Hct =
hematocrit
Schwartz’s 2015, Principles of Surgery 10th Edition.
Advanced Trauma Life Support 10th ed
Damage ControlDamage limitation surgery
• Goal ->
1. STOP any active surgical bleeding
2. Control contamination
Bailey and Love’s 2008, Short Practice of Surgery 25th ed
Bailey and Love’s 2008, Short Practice of Surgery 25th ed
PIN IKABDI 12/8/2017
17
Bedside Laparotomy- ICUTACD - VAC
Mattox 2013, in Trauma 7th ed
Mattox 2013, in Trauma 7th ed
19
Sabiston, Text Book of Surgery,2017
Mattox 2013, in Trauma 7th ed
21
R. Shayn Martin, J. Wayne Meredith,Sabiston,
Text Book of Surgery,2017
Mattox 2013, in Trauma 7th edFIGURE 30-6
Algorithm for the diagnosis and management of splenic injury
Mattox 2013, in Trauma 7th ed
Mattox 2013, in Trauma 7th ed
1. Rido Kamulyan / ♂ / 18 YO Admition : 24 -11-17 06.30 WIB
ANAMNESIS
Pain On His Abdomen After Trafic Accident
± 3,5 Hour before admition his motorcycle had sliped, he fall with His abdomen hit by the hard thing.
SURVEY PRIMER
A. Good
B. RR : 20 x/mnt
C. BP : 100/ 70 mmHg
Pulse : 83 x/mnt
Temp : 36.4° C
D. GCS : E4M6V5 : 15 Pupil was Isochor,
Light reflexes +/+
SECONDARY SURVEY
Thorax :I : Excoriation at left clavicule 2 x 3,5 cm in sizeP : Pain (-), Crepitation (-)P : Sonor on Both HemithoraxA : Vesiculer on Both Hemithorax
AbdomenI : FLat, Bruised (+)P : Soft, Muskular Rigidity (-)P : TympaniA : Bowel Sound (+)
DRE : Blood (-), feses (+)NGT : Blood (-)
RADIOLOGI
Ro Thorax
Fracture (-), Hemopneumothorax (-)
RADIOLOGI
FAST
Fluid Collection (+)
LABORATORIUM
Hb : 12.8 gr/dl (12-16 gr/dl)
Ht : 37 vol % ( 40-48vol%)
DIAGNOSE
Abdominal blunt injury Without Peritonitis + Spleenic Injury
Grade II
PENATALAKSANAAN
02 nasal canule 3L/m
IVFD RL gtt xx /m
NGT + Uretral Catheter
Observation
CT Scan
USG
RADIOLOGI
CT Scan abdomen kontras tgl 24-11-17
Spleenic injury grade II
Follow-up at 12.00 AM (6 hour after admition)
S : Pain On Whole Abdomen
O : Sens : CM
RR : 24x/mnt
HR : 118
BP : 100/60mmHg
Temp : 36.4
AbdomenI : FLat, Bruised (+)P : Soft, Muskular Rigidity (-)P : TympaniA : Bowel Sound (+)
USG : Massive Fluid Collection
A : Abdominal blunt injury Without Peritonitis + Spleen Injury Grade II
P : Laparatomy exploration
INTRA OPERATION
In Cavum abdomen we found blood and blood clot ± 2000cc
We performed packing 4 big gauze
In Further Exploration we found laseration of spleen± 4cm with
irreguler edge
We Performed splenoraphy Bleeding was Stoped
1. Irsan bin Irfan/♂ / 6 tahun MRS : 21-08-2017
PKL : 15.34 WIB
ANAMNESIS
Nyeri Perut
± 1 jam smrs,motor yang ditumpangi penderita jatuh bertabrakan
dengan mobil dari arah belakang. Penderita terjatuh dengan perut
membentur benda keras
(Rujukan YK Madira)
SURVEY PRIMER
A. Baik
B. RR : 24 x/mnt
C. N : 110 x/mnt
T : 36,6° C
D. GCS : E4M6V5= 15 Pupil Isokhor, RC +/+
SURVEY SEKUNDER
Regio Thorax
I: jejas (-)
P: sonor kedua hemithorax
A: Vesikuler kedua hemithorax
Regio Abdomen
I: jejas (+)
P: defans muskular (-)
P: Tympani
A: BU (+) normal
Regio Flank Sinistra
I: Jejas (+)
P: nyeri tekan (-)
RT: ampula tidak kolaps, darah (-)
RADIOLOGI
FAST
Cairan Bebas (-)
LABORATORIUM
Hb : 12,5 gr/dl (12-16 gr/dl)
Ht : 38 vol % ( 40-48vol%)
URINALISA
Lekosit sedimen (routine) : 0-1 (0-5)
Eritrosit sedimen (routine) : 0-1 (0-1)
DIAGNOSA
Trauma tumpul abdomen tanpa tanda-tanda peritonitis
PENATALAKSANAAN
Observasi
Pasien rawat bangsal
Jacobs 2010, Advanced Trauma Operative Management 2nd ed
TERIMAKASIH
Recommended