Professional Documents
Culture Documents
Usia
pembekuan
Nutrisi
adekuat
Infeksi
Sirkulasi dan Oksigenasi
Hematom
Jika besarlama diserapmenghambat
Benda asing
Membentuk abses
Diabetes
Hambatan terhadap sekresi insulin akan
Keadaan Luka
Obat
a.
Bleeding
Pain
Swelling
Redness
Fever
Broken sutures
Open wound
serosanguinous
Insisi Midline/Vertical
Paling mudah
Teknik cepat untuk mencapai cavum
abdominal
Lebih sedikit terdapat kehilangan darah
Resiko untuk terjadinya wound dehiscence
meningkat
Insisi Transversal
Lebih bagus untuk kosmetik
Lebih sedikit menimbulkan nyeri
Insiden wound dehiscence lebih sedikit
Terbatasnya lapangan untuk explorasi
Suture Placement
Proses inflamasikolagenesiszona degradasi
Choice of Closure
Running sutures
Lebih cepat dilakukan
Hanya memerlukan beberapa ikatan
Kekuatan merata dan perfusi jaringan lebih baik
Jika satu jahitan terlepas, maka akan membahayakan
jahitan lainnya
Interupted sutures
Memerlukan waktu penjahitan lebih lama
Lebih banyak ikatan
Kekuatan perfusi biasanya tidak merata
Ada kecenderungan untuk mengikat kuat yang akan
menyebabkan rentanterjadi nekrosis
Jika satu jahitan terlepas tidak akan membahayakan
jahitan lainnya.
Peritoneum
Penutupan peritoneum masih kontroversi
Proses penyembuhan mesotelial dari
Drug therapy
Broad Spectrum Antibiotic therapy
Medical treatment
When appropriate, frequent changes in
Surgical intervention
Surgical removal of contaminated, dead
tissue
Resuturing
Placement of a temporary or permanent
piece of mesh to bridge the gap in the
wound
immediate steps taken to close the incision
in the operating room
Prevention
When appropriate, have antibiotic therapy
prior to surgery.
When appropriate, have antibiotic therapy
after surgery.
When using wound dressing, maintain light
pressure on wound.
Keep wound area clean.
Comply with post-operative instructions.
Name : Lorince
Sex
: Female
Age
: 43 years old
Religion
: Protestan
Address
: Soe
Chief Complain :
Present Complain:
Patients come to the hospital with a referral from the
Soe Hospital due to intestinal spilled since 12 hours
before entering the hospital. Patients had previously
undergone SC 12 days ago. 2 days after SC patients
complained of cough, has been given the treatment
and felt better but after the medicine runs out,
patient complained cough again and causing his
intestines out of the stomach through the SC stitches.
There is clear discharge (+), fever (-), vomiting (-),
headache (-).
Primary Survey
A
: clear, patent
B
: Spontan, RR 24 x/m
C
: BP 120/80, Pulse 84x/m, warm
T : 37.5 OC
: Alert
through the SC
stitches.
Secondary Survey
Head :
Eyes
: Hematom (-/-)
Conjungtiva
: Anemis (-/-)
Sclera
: Icterik (-/-)
pupil
: isokor, pupil reflects (+/+)
Ears : othorea(-/-),
Nose : Normal
Mouth : Normal
COR
S1/2 single, murmur (-), gallop (-)
PULMO
ABDOMEN
Inspection : Intestines out of the stomach
Extremity :
Look:normal
Feel normal
WBC : 22.43
RBC : 3.78
HB : 9.8
HCT : 32.8
PLT : 726
Alb. 2.79
CT : 800
BT : 200
Burst abdomen
IVFD RL 20 tpm
Inj. Ceftriaxon 2 x 1 gr/IV
Infus metronidazol 3 x 500 mg
consulted to OBGYN