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MORBIDITY ^0MORTALITY MEETING August 2020.pptx 2.pptx

  2. Patient’s Details • Age :72 years old • Sex :Male • Race :Chinese • Date of arrival to ED :12/10/2022 at 2111
  3. CASE SUMMARY • Mr T was brought to ED GZ Zone on 12/10/2022 at around 2111H • Mr T was referred from HTK for alleged MB skidded TRO 1) right shoulder ligamentous injury and 2) laceration wound over left ring finger • Mr T had his MB skidded at 1100H. He was riding his MB when he suddenly fell over the right sided • Mr T sustained pain over his right shoulder and bilateral hand
  4. • On arrival to trauma lane GZ at, Mr T was on the wheelchair and responsive • GCS E4V5M6, not tachypneic, no active bleeding • Mr T was on right arm sling and bandaged over left ring finger • Vital signs : BP 153/76, P 76, SpO2 98% under RA • Lungs clear, CVS DRNM, P/A : soft non tender, no bruises/wound
  5. • ROM neck full, no cervical/ spinal tenderness, chest/ pelvis non tender • Able to move all limbs, however ROM limited over right shoulder due to pain, noted deep laceration wound over left 4th finger measuring 1x2cm with no active bleeding, multiple abrasion wound over bilateral hand, able to move all fingers however minimally due to pain • FAST SCAN negative
  6. • Mr T was given IV tramadol 50mg STAT, IV maxolon 10mg STAT for pain control. • CXR, PXR, X-ray right shoulder, X-ray left shoulder from HTK was unremarkable • Repeated X-ray right shoulder and X-ray bilateral hand done
  7. • Impression : Alleged MB skidded sustained 1) tuft fracture over left 4th distal phalange, 2) chip fracture over right distal end of proximal 5th phalange • Plan : - Allow discharge with medication (C tramal 50mg TDS, T maxolon 10mg TDS, C cloxacillin 500mg QID x5/7, LA chloramphenicol ointment) - for T&S, zimmer splint over left 4th and right 5th finger
  8. Part 2 • Mr T visited ED back on 15/10/2022 (Post trauma Day 3) c/o pus discharge over open wound of left ring finger x 3/7 • associated with pain and swelling • visited GP on 15/10/22, noted pus discharge • hence referred to ED for infected wound over left ring finger
  9. O/E: GCS full, pink, not septic looking, good pulse volume, CRT<2sec, warm peripheries BP 130/69 PR 70 RR 19 Spo2 98% Temp 37 L/E Left Hand: • On zimmer splint • Sutures intact • Minimal pus discharge • No erythematous or swelling • Tenderness over ringer finger upon palpation • CRT<2seconds in all fingers • ROM full in DIPJ, PIPJ, MCPJ and wrist joint • Sensation intact
  10. FBC STAT: WBC 8.9 Hb 12.2 PLT 328 X-ray left hand: - Fracture over distal phalanx of left ring finger - No gas shadow or osteomyelitis changes • Impression: Infected wound over open fracture of distal phalanx of left ring finger  Refer ortho
  11. Seen by ortho team: • Discharge with T Cloxacillin 500mg QID and analgesics • For daily NS dressing • TCA ortho clinic in 1/12
  12. Take home message • Always refer orthopaedics team when there is open fracture • Always do proper documentations