Morning report

Tuesday
8.8.2023
Dr. Fahmi eqab
Students: Hala Hadidi, Mesk Banat, Tasneem Albakri, Lara qammoh, Roa
alhabosh
On call on Monday ,7-8-2023
• Total visits: Visit: 18
5 cut wound, Inhaled burn &scald burn, 2 appendicitis, 1 biliary colic, 2 quarrel, 2
Abdominal pain, 3 RTA, 1 burn, Falling down
• Admission: 7
• Inhaled burn &scald burn : to ICU
• 2 appendicitis
• 1 biliary colic
• 2 quarrel
a. Abdominal pain
• Operations: 0
• Mortality :0
Inhalational burn + scald burn
Female patient , came to the ER due to burn with boiling water with rice , she is a
known case of epilepsy , while she was cooking and handling the pot she had a
seizure without mouth secretion . So the content of the pot spilled on her face,
mouth , upper trunk and the left arm ,she inhaled some of the boiling water
So she is complaining of scald burn with blister (grade 2 ) on the left arm , anterior
upper chest , neck , mouth with swelling in both lips and 4and inhalational burn in
the oral cavity .
TBSA : 23%
She also complains of shortness of breath , with audible breathing sound. She
vomit 4 times in the hospital .
• Management : ICU admission for observation , intubation under GA ( because in
laryngoscope there is mild laryngeal edema ) . After that dressing for the scald
burns
Burn
• Kawkab momani 61 year old female patient came to ER at 6 pm
complain from pain for 1 day after being burn before one week by
boiling water ( burn was on her dorsum area of the left foot, it was
associated with blister “ Grade 2”, TBSA = 1%), she directly apply cold
water on the area then went to the pharmacy and take azithromycin
and iluset plus cream.
• Before one day she start complaining from pain in the burned area
and today come to ER at 7:15 pm.
• Medical history: HTN, DM, Asthma.
• Surgical history: hysterectomy, cholecystectomy.
• Allergy: egg, penicillin.
• Social: not smoker, has insurance
In ER: dressing with silvaren cream
Advised to change the dressing every
Other day and follow up in plastic
surgery clinic.
Cut wound after quarrel
Oday abu ruman, 30 year male patient came to the ER after quarrel
with 2 wounds on his left arm and left shoulder blad.
Patient mentioned he was hit on the head with a stick aside from being
hit with fists
• He said after being hit with stick he felt severe dizziness but didn’t
loss consciousness.
• No previous medical problems and no surgery.
• Physical examination:
• He was conscious and alert.
• Description of wounds in next slide
• Ct brain showed he had pneumocephalus
• Labs were normal.
2 Cut wound one on the lateral side of the left arm longitudinally about
12 cm it was superficial cut wound surrounding skin is intact
• The wound was cleaned using normal saline and iodine and
anesthesia by local lidocaine injection the polyprolene 0.2 ( 10
sutures)
The secound wound was on the left shoulder blade longitudinal slightly
oblique about 20 cm it was superficial cut wound surround skin was
intact and not injured
• The wound was cleaned using normal saline and iodine and
anesthesia by local lidocaine injection suture used polyprolene 0.2
( 9 sutures)
Cut wound
Khalid mefleh , 36 year old patient , came to the ER due to quarrel , due
to that he fall on his face without loss of consciousness , and he doesn’t
complain of pain
Physical examination :
Superficial cut wound on right lateral side of the forehead , 3 cm ,
regular border , intact surrounding skin
Managements : clean the wound using normal saline and iodine , then
lidocain injection , then suturing using nylon suture , thickness : 0.5 . 5
sutures
• Follow up after 5 days to remove the sutures .
Appendicitis
Ala’a Nasrallah, 35 year old male patient, married), works as officer Lives in albaqaa, came to
ER at 12 pm complaining From right lower abdominal pain of 9 hours duration
The patient was doing relatively well until’ 3 Am when he start to complain of gradual colicky
Pain startat epigastric then migrated to the right lower quadrant, not radiate to other area, it
was intermittent (each episode persist for 30 min- I relived for 5 minutes ), exacerbated by
movement relieved by lying forward. Patient take paracetamol but the pain not releive pt said
the pain seveirty 8 out of 10and dirupting his movement and sleeping. Pain associated with
chills without fever , anorexia, fatigue, nausea, no vomiting ,no change in bowel habits, no
urinary symptoms , no urinary. Symptom no similar attack, no trauma
PM: Beta thalassemia
Surgical: Splenectomy before 20 years “take vaccination”hemophilus influenza, pneumococcal
, meningococcal.
• Social: Smoker 1pock / day (15years)
Physical examination : COA (time, person, place), not obese, not cachexie,
in pain, not pale
Vital Signs :T =37.4 HR-82 BP= 113/8502= 48%.
Abdominal examination :
By inspection : there is a midline scar due to previous splenectomy
By palpation : Soft lax abdomen , right iliac fossa tenderness and
rebeound tenderness , no deep or superficial masses
• Signs : positive dunphys sign , rovsing sing , psoas and obturator sign
Investigation :
Upon arrival to Er : blood sample , ringer lactate , iv analgesic , perfalgan
Labs : leukocytosis (28
• Imaging : US :
• Mild amount of free fluid is seen in the RIP between bowel

Evidence of echogenic fat surrounding blind ended tube like

structure that might represent the appendix and measures about 0.6 cm
CBD: Not dilated.

Right kidney: no hydronephrosis is seen

Left kidney: no hydronephrosis

Urinary bladder: near empty

• Management : alverado score : 8/10