1. ETD HANDOVER
7/6/23 - 8/6/23
Surgeon: Mr Raeros
Reg Call: Dr Hema
OT Call: Dr Ismail
Ward Call: Dr Amnie
ETD Call: Dr Siti Fatimah
2. Case 1
POW B22
Nur Fathia Sofea Binti Abdullah
211206130936
2 years old girl
NKMI
Wt 9 kg
3. HOPI
p/w : pain over right leg for 1 day
Alleged RTA ~8am (7/6/23), pilon rider
- Child in between parents, hug by mother
- MB hit the back of lorry, fell and rolled few times on grass within mother
embrace
Post trauma, child crying and mother noted deformity over right ankle
Otherwise no LOC/ ENT bleed/ no vomiting
4. O/E
Child was crying, fretful
HR: 87
T: 36.9
SpO2: 98% under RA
RR: 24
No obvious wound noted over back, and
bilateral upper and lower limb, chest and
abdomen region
No step deformity
Child moving bilateral upper limbs and left lower
limb
Right lower limb:
- No open wound / bruising
- Compartment soft
- DPA/PTA palpable
- CRT<2s all toes
9. Diagnosis
1. Closed right distal third tibia fracture (Salter Harris Type 2)
2. Closed right distal third fibula fracture
Plan:
1. For above knee cast
2. Admit for observation of compartment
3. Watchout for compartment syndrome
4. Elevate right lower limb
5. Allow orally
6. Syrup paracetamol 15mg/kg TDS
10. Case 2
FOW B30
Then Yen Choon
450302135460
78 years old lady
U/L DM, HTN and DLP
H/o CVA > 10yrs ago - Left sided hemiparesis
ADL semi-dependent
Ambulate using walking sticks assisted by caretaker
Wt 60kg, Ht 155cm, BMI 24.9
11. HOPI
Presented with left hip pain for 1 week
H/o fall 1 week ago and landed over left hip, fell in toilet due to slippery floor
- Post-trauma, unable to ambulate
- No LOC, no ENT bleed
- No SOB, no chest pain
12. O/E
Alert
BP 128/78
HR 63
SpO2 100% under RA
T 36.7
HPC 12.7
Lungs : clear
No cervical / midline spine tenderness, no step deformity
Left lower limb appear shortened and externally rotated
- Bruising over the proximal thigh region
- DPA/PTA palpable
- CRT<2s all toes
- Non tender on palpation left knee
20. Blood Ix
Hb 9.9, WBC 7.5, Plt 364
Na 133, Cl 99, Urea 5.1, Creat 51
PT 12.6, INR 1.12, APTT 24.1
21. Diagnosis: Close left intertrochanteric femur fracture
Plan:
1. For skin traction over left lower limb
2. HPC QID
3. For short PFN over left femur
4. T paracetamol 1g TDS, C tramadol 50 mg TDS
5. For TED stocking
6. Incentive spirometry
7. Send PBF, iron studies, folate, vit B12, HbA1c, FLP
8. Refer APS
9. Refer orthogeri
10. Start S/c clexane 40 mg OD
11. Reindent old meds
12. Refer physio, occupational therapy once in ward
22. Case 3
MOW B9A
Chai Phang Liun
631013135483
60 years old gentleman
U/L
- Paraplegia secondary to T3-T4 fracture (since 1978) - since 45 years ago
- Neurogenic bladder (CBD dependent)
- Kyphoscoliosis
- Chronic lung disease with cor pulmonale (under respi follow up)
Previously ADL dependent, wheelchair ambulation
Wt 55kg, Ht 165cm, BMI 20.2
23. HOPI
P/w swelling over left thigh x 4/7
Alleged slipped and fell in bathroom, landed over left thigh
No pain but noted increasing swelling over left thigh
No fever
No URTI symptoms
No SOB/chest pain
24. O/E
Alert, GCS full
BP: 133/65
PR: 79
SpO2: 99% under RA
T: 36.3
Left lower limb:
- Bruising over proximal to mid-thigh region
(medially)
- Compartment soft
- Unable to appreciate DPA PTA due to
swelling over left lower limb
- Doppler biphasic for DPA and PTA
Fixed flexion deformity of bilateral knee about 90
degree
Sensation reduced from T2 downwards
Power bilateral upper limbs full
30. Blood Ix
Hb 12.9 / WBC 11.7 / Plt 193
Na 137 / K 4.0 / Cl 104 / Urea 9.4 / Creat 180
PT 12 / INR 1.06 / APTT 28.7
TB 13 / TP 66 / Alb 37 / Glb 29 / ALT 9 / ALP 132 / AST 14
31. Diagnosis: Closed left subtrochanteric femur fracture
Plan:
1. HPC QID
2. Refer anes for early premed
3. For ECHO
4. Aim for operative management - PFN left femur
5. Refer chest physio
6. For incentive spirometry
7. Refer respi for lung function test
8. Continue analgesia: T paracetamol 1g TDS, C tramadol 50 mg TDS
32. Case 4
YZ
Othman bin Junaidi
780503135717
44 years old gentleman
U/L
- Epilepsy (last attack in 1998, on T phenytoin 100mg OD)
- Hemophilia A
- Wheelchair ambulation since 2004
Wt 65kg, Ht 168cm, BMI 23
33. HOPI
P/w wound over left calf x 2/52
Started off with dry scab, patient scratched due to itchiness
Scab peeled off and started bleeding since 2/52 ago
- Associated with pain
- Feverish x 1/7
- No loss of appetite
- No nausea / vomiting / diarrhea
Having left calf swelling since 2004, increasing in size for past 2 years
34. O/E
Alert, GCS full
BP: 116/72
PR: 100
SpO2: 100% under RA
HPC: 7.2
Left lower limb:
- Swelling over left calf
- 2x2 cm wound over posterior mid calf
with surrounding necrotic skin
- No pus discharge
- Multiple foul smelling blood clots
- No crepitus
39. Blood ix
Hb 5.7 / WBC 14.9 / Plt 672
Iron 2.9 / UIBC 33 / TIBC 36 / Transferrin sat 8
40. Diagnosis: Left leg infected hematoma
Plan:
1. Refer hematology
2. IV Augmentin 1.2 g TDS
3. For swab C+S
4. Not for surgical intervention for now
5. Peri ortho to review
41. Case 5
MOW B7A
Kasuadi bin Sordi
710724135143
52 years old gentleman
NKMI
Wt 60kg, Ht 163cm, BMI 22.5
42. HOPI
Alleged cut by grass-cutting blade around 3.40 pm 7/6/2023 over volar aspect of
left mid-forearm
Post trauma sustained pain and bleeding over left forearm
No LOC
No injury elsewhere
43. O/E
Alert, GCS full
BP: 128/72
PR: 88
SpO2: 100% under RA
Left upper limb:
- Wound measuring 5x4 cm over mid
forearm volar aspect
- With muscle cut
- No bone exposed
- Radial & ulnar pulse palpable strong
- Radial, ulnar and median nerve intact
- Able to extend and flex fingers
- Able to flex wrist
48. Blood ix
Hb 13.3 / WBC 12.2 / Plt 254
Na 133 / K 3.6 / Cl 94 / BU 8.1 / Creat 145
PT 11.4 / INR 1.01 / APTT 26.1
49. Diagnosis: Deep laceration wound over left forearm with
muscle cut
Plan:
1. Put on above elbow backslab
2. To post case for wound debridement, wound exploration, foreign body
removal and muscle repair of left upper limb
3. Start on IV cefuroxime 1.5 g stat then 750 mg TDS, IV flagyl 500 mg TDS
4. Neurovascular charting
5. Analgesic: T paracetamol 1g TDS, C tramadol 50 mg TDS
50. Case 6
MOW B35
Mazaki bin Ahmad
850417136351
38 years old gentleman
NKMI
Wt 70kg, Ht 168cm, BMI 24.8
51. HOPI
p/w : low back pain X 1/7 post
Alleged RTA at 5pm 7/6/2023 while on the way back from work
- Helmeted motorbike vs car
- Car in front brake suddenly, patient riding motorbike hit the car from behind,
subsequently fall over left side
- No LOC / ENT bleed
- Able to ambulate initially, went back home by himself
- Pain worsening while at home and came to Hospital
52. O/E
Alert, GCS full
BP: 110/88
PR: 94
SpO2: 98% under RA
T: 36.8
HPC: 7.9
Bilateral lower limb ROM full
Reflex bilateral lower limb normal
No abrasion wound over back region
No point tenderness over spine & cervical
No step deformity
Anal tone intact
Perianal sensation intact
53. O/E
Power Left Right
L1 5 5
L2 5 5
L3 5 5
L4 5 5
L5 5 5
S1 5 5
Sensation Left Right
L1 2 2
L2 2 2
L3 2 2
L4 2 2
L5 2 2
S1 2 2
59. Diagnosis: L1 compression fracture
Plan:
1. Continue rest in bed
2. Analgesia: T paracetamol 1g TDS, C tramadol 50 mg TDS, C celebrex 200
mg OD
3. ASIA chart
4. Ct scan
5. Refer spine
60. Case 7
FOW B9A
Morlia binti Nawi
721105135770
51 years old lady
U/L DM, HPT, DLP
Wt 60, Ht 155, BMI 24.9
61. HOPI
P/w swelling over right lower limb x 8/7
No recent trauma / insect bite
Started off with scratching
Feverish x 1/7
No vomiting / diarrhea
62. O/E
Alert, GCS full
BP: 133/70
PR: 90
SpO2: 99% under RA
T: 38
HPC: 14.9
Right lower limb:
- Swelling over lateral aspect of distal leg
extending posteriorly
- Mixed area of fluctuancy & induration
- Wound over medial aspect of distal leg
2x1 cm
- No pus discharge, minimal slough
- DPA/PTA palpable
Monofilament: Right 10/10, Left 10/10
ABSI: Right 1.19, Left 1.18
69. Blood ix
Hb 9.8 / WBC 13.9 / Plt 538
Na 134 / Cl 100 / BU 4.04 / Creat 45
70. Diagnosis: Partially treated abscess of right leg
Plan:
1. For IV unasyn 3g stat then TDS
2. HPC QID
3. Trace and indent old medication
4. KIV I&D later if swelling more fluctuant / worsening
5. Send HbA1c, FLP
6. Trace RP
