extern orthopedic-conference-prima
TRANSCRIPT
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Extern orthopedic conference
Ext. Prima B.
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Patient profile• ผปวยชายไทย อาย 22 ป• สถานภาพ โสด• ภมลำาเนา อำาเภอคง จงหวดนครราชสมา
• มาโรงพยาบาลมหาราชนครราชสมา วนท 21 มกราคม 2560 เวลา 10.00 น
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Chief complaint• ปวดไหลซาย 3 ชวโมงกอนมาโรงพยาบาล
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Present illness
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Primary survey• A : Can speak, c-spine not tender, full ROM of neck• B : Equal breath sound, CCT negative• C : BP 142/75 mmHg, PR 105 bpm, no active external bleeding• D : E4V5M6, pupil 3 mm RTLBE• E : No external wound, deformity and limit ROM at left shoulder
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Secondary survey• A : ปฏเสธประวตแพยาหรอแพอาหาร• M : ปฏเสธยาทใชประจำา• P : ปฏเสธประวตโรคประจำาตว• L : NPO 7.00 น. 21 มกราคม 2560• E : ผปวยลมจากเตยงแลวเอามอซายยนพนไว จากนนมอาการปวดไหลซาย
รสกไหลซายหลด ยกแขนซายไมได ขยบมอได เคยไหลซายหลด 2 ครงใน ชวง 2 เดอนทผานมา
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Physical examination• General appearance : A Thai man, alert, well co-operative• Vital signs : BP 142/75 mmHg, PR 105 bpm, RR 18 bpm, BT 36.5 ำC• HEENT : Not pale conjunctivae, anicteric sclera• Heart : Normal S1S2, no murmur• Lung : Clear both lungs• Abdomen : No distension, soft, not tender• Neurological : Grossly intact
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Physical examination• Left shoulder : Deformity, mild swelling, tender, limit active ROM
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Investigation• Film left shoulder AP• Film left shoulder transcapular view
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Diagnosis• Anterior left shoulder dislocation
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Management• MO 4 mg IV stat• Reduction• On arm sling• Home medication : Paracetamol (500) 1 tab oral prn for pain q 4-6 hr
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Shoulder dislocation
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