1.

Male, 58 years old

CC : pain in swallowing
Since 3 days prior to admission, the patient
was complained pain in swallowing. Its followed
by difficulty in swallowing, he still can eat soft
diet. fever (+), hoarseness (-). Hot potatoes voice
(-), drooling (-). History of cough with purulent
discharge (-), difficulty in breathing (-), trauma (-),
Because of his complained, he was brougth to
Bandung General bospital and referred to Hasan
Sadikin hospital.

PHYSICAL EXAMINATION
General State : compos mentis
BP : 100/70 mmhg
HR : 86x/m
RR : 26x/m
Temp : 36,2 c
Saturation : 98%
Stridor (-), retraction suprasternal (-), retraction
intercostal (-), retraction epigastrium (-).

Local state :
Ears : mucosa not hyperemic +/+ discharge -/-,
cerument -/-,
ear drum intact +/+, cone
of reflex +/+, retroauricular not
hyperemic
+/+
Nasal cavity : mucosa not hyperemic +/+, discharge
-/- , inferior
turbinate eutrophy +/+, SD
(-), air passage +/+.
Oral cavity : Tonsil T1-T1, Pharynx hyperemic (+)
Maxillofacial : simmetric, no cranial nerve paralysis
Neck : Neck node enlargement (-), swelling (-), soft,
hyperemic (-), pain (-), fluctuation(-).

Clinical picture

Neck Soft Tissue X-Ray

LABORATORY FINDINGS
Hb
Wb
:
Ht
:
Plt
:
Blood glucose
SGOT
SGPT
Na / K
:
PT
INR
:
APTT
:
Ur
:
Cr
:

: 12,8
19000
38
213000
: 122
: 13
: 18
139/4,5
: 11,4
1,06
35,0
48
1,49

WD/ : Acute Epiglotitis + Acute pharingitis

Th/
-

Obs. Vital sign

O2 4 l/mnt
IVFD RL 1500 ml/day -> 20 gtt/ mnt
Cefotaxime 2 x 1 g iv
Dexamethasone 3 x 1 amp iv
Ranitidine 2 x 1 amp iv

2. Female, 23 years old

Patient was referred from Cicalengka Hospital with
WD/ Nasal Bone Fracture
cc : Wound at nose
Since 6 hours prior to admission. The patient had been hit with
her husbands hand wearing rings. The wound at nose was
caused by the rings. History of unconsciousness (-), vomitting
(-), Bleeding from both ears (-), Bruises at face (-).
Then family took the patient to Cicalengka Hospital and then
referred to Hasan Sadikin Hospital.

Physical Examination
General state:

Fully alert, BP: 120/80 mmHg, RR : 20 x/m

HR : 89 bpm , T: 36,9 C, Stridor (-), retraction (-)
Sat O2 99%

Local state :
Both ears

: external auditory canal not hyperemic +/+ discharge

-/-, ear wax -/- ear drum intact +/+, cone reflex
+/+, retro auricular not hyperemic +/+ .
Nasal cavity
: mucosa no hyperemic +/+, discharge -/-, inferior
turbinate
eutropy +/+, septum deviation(+), air passage +/
+
NPOP
:To: T1-T1 not hyperemic, pharynx not hyperemic
MF : asymmetric , Vulnus Laceratum a.r left dorsum nasi 2x1x0,5 cm
in size , terderness (+), edema (+), saddle nose (-), Crepition (-),
floating maxilla (-), eyelids echimosis (-), cranial nerve paralysis (-),
Neck
: neck node (-), bruises (-)

Clinical Pictures

Schedel AP & Lateral

(Cicalengka Hospital)

Nasal Spot and Waters X-Ray

(Hasan Sadikin Hospital)

Laboratory Finding
Hb :
Ht
L
:
Tr
:
SGOT
SGPT
Ur :
Cr

14,6
: 44
10.800
287.000
: 23
: 25
27
: 0,76

Blood Glucose : 171

Na
: 135
K
: 3,6
PT : 12,4
aPTT : 21,6

WD/ Nasal Bone Fracture + Vulnus Laceratum at

Dorsum nasi
Management :
IVFD RL 20 gtt/min
Primary Suture
Cefotaxime 2 x 1 gr iv
Ketorolac 2 x 1 amp
Plan to perform reposition of
nasal fracture
The patient was discharged
by her request

3. Girl, 11 years old

Patient was referred from Al Ihsan hospital and
consulted by Pediatric Department with
WD/ Sepsis + bronchopneumonia + Susp. Tonsilitis
Diphteria
CC: Difficulty in Swallowing
Since 3 days before admission, the patient complained
that difficulty in swallowing. The complain accompanied
by pain in swallowing (+) and fever(+). Difficulty in
breathing (-). Difficulty on opening his mouth (-).
Drooling (-), hot potato voice (-), History about dental
carries (-), HT (-), DM (-). History of lump on other body
region (-). His family brought him to Al Ihsan hospital
and then referred to Hasan Sadikin Hospital.

Physical Examination
General state:

Fully alert, BP: 120/80 mmHg, RR : 20 x/m

HR : 88 bpm , T: 37,1 C, Stridor (-), retraction (-)
Sat O2 99%

Local state :
Both ears : external auditory canal not hyperemic +/+
discharge -/- , ear wax -/- ear drum intact +/+, cone reflex +/
+, retro
auricular not hyperemic +/+
Nasal cavity
: mucosal not hyperemic +/+, inferior
turbinate eutropy
+/-, deviation of septum (-), air passage +/+
NPOP
: To: T2-T2 hyperemic, pharynx hyperemic (+),
pseudomembrane (-)
MF : symmetric, cranial nerve paralysis (-)
Neck
: at anterior neck region, swelling (-), hyperemic (-),
tenderness (-), fluctuation (-)

Clinical Picture

Chest X-Ray

Neck Soft Tissue X-Ray

Laboratory Finding
Hb :
Ht
L
:
Tr
:
SGOT
SGPT
Ur :
Cr

15,2
: 45 %
30.900
398.000
: 27
: 47
41
: 1,2

Blood Glucose : 120

Na : 144
K
: 3,9
PT : 12,5
aPTT : 30,3

From Pediatric Dept.

WD/ Sepsis + Bronchopneumonia + susp.
Tonsilitis diphteria

Management
O2 5 l/mnt
IVFD RL 4 cc/jam
Th/:
- Ampicillin 3x250 mg IV
- Paracetamol 3x250 mg po
03/01/15

21

WD/ susp. Tonsilitis diphteria + Sepsis +

Bronchopneumonia
Management :
- Obs. Vital Sign + upper airway obstruction
- IVFD lar 1:4 4 cc / hours
- Swap throat still wait for result
- Antibiotic, Analgetic and other submitted from
Pediatric Department.

Thank You