- Total ER cases were 134 with the most common being RTA (80 cases) and abdominal cases (37 cases) - 9 operative cases were reported including exploratory laparotomy, herniorrhaphy, appendectomy, embolectomy, and amputation - 2 cases were managed conservatively including a case of gallstone pancreatitis and a pelvic fracture

1. Post Emergency Meeting
07-10-22

2. • Total cases = 134
• RTA = 80
• MLC =14
• Burn = 2
• LAMA =1
• firearm = 1
• Expires = 1
• others = 37

3. • Morning SR Dr Obaid
• Night SR Dr Obaid
• Morning COD Night EOT Batch incharge Dr Shahzaib
• MorningEOT Night COD Batch incharge Dr Musfra
• Operated cases : 09
• Conservative: 02

4. CASE 1
• Pt Ahmed Ali presented in emergency with c/o
• Absolute constipation-1 day
vomiting – 1 day
Pt had hx of alcohol Intake for one year, no past surgical hx
• VITALS Pulse 94 BP 100/70 temp 98
• O/E : abdomen : distended ,generalized tenderness , BS sluggish
DRE : normal anal tone , balooning ,no fecal staining
• LABS TLC Hb PLT
• Na 140 , Cl 105 ,K 3.60 amylase 300 lipase 48
• USG abdomen : unremarkable

5. • PSB Dr Ahsan in the morning and advised exploration after 2nd report of
amylase and lipase (291 & 519)
• Procedure : exploratory laprotomy + abdominal lavage + placement of
drains
• Surgeons : Dr shahzaib , Dr usama, Dr waqas
• IOF : extensive sponification around pancrease with inflammatory
changes
1L reactionary fluid
Rest of visceras unremarkable

6. CASE 2
• Pt Zahid 40y /M presented in emergency with c/o
• Pain in Left inguinoscrotal region -2 days
• Non reducible left inguinoscrotal swelling – 2 days
• Patient had hx of inguinal hernia for 2 years
• Vitals : pulse 84 BP 110/80 Temp 98
• O/E : non reducible swelling , cough impulse negative , tenderness
present
• Abd SNT , BS + , DRE : collapsed rectum normal anal tone

7. • Hernia not reducible under sedation
• PSB Dr Obaid and advised exploration
• Procedure :Herniorraphy + Darns repair of Obstructed inguinal
hernia
• Surgeons:Dr Obaid ,Dr Shahzaib ,Dr Naila , Dr Hira , Dr Aizaz ,Dr Fahad
• IOF: left indirect hernial sac
Sac containg sigmoid colon ( viable)
Gut adherent to posterior wall of sac

9. CASE 3
• Patient Sehar 19y /F presented in emergency with c/o
• Right sided abdominal pain – 1 day
• Burning micturition – 1 day
• VITALS : pulse 108 BP 120/70 Temp 98
• O/E generalized guarding ;tenderness in right iliac fossa , right lumbar
region and right hypochondrium , BS audible
• DRE Normal anal tone , fecal staining present
• CBC TLC 20 NEUT 81%
• MANTRELS calculated was 7
• UPT negative , urine C/E normal

10. • USG : subhepatic inflammatory mass ,positive pseudokidney sign
• PSB Dr Ubaid and advised exploration
• Procedure : Exploratory laprotomy + appendectomy+ abdominal
lavage
• Surgeons : Dr Naila ,Dr usama, Dr Fawad UKSO Dr Hira
• IOF : perforated subhepatic appendix ( midshaft) attached to caecum
through dense adhesions
• healthy base
• 200ml pus drained

12. CASE 4
• Abu bakar 21 yr/M presented in emergency with c/o
Right iliac fossa pain -1 day
Vomiting – 1 day
VITALS : pulse 104 BP 110/70 Temp98
O/E tenderness in right iliac fossa present
CBC TLC 14.1 NEUT 70%
MANTRELS calculated was 6
PSB Dr obaid and advised to proceed with open appendectomy

13. • Procedure : Open appendectomy
• Surgeons : Dr Waqas , Dr tayyaba , UKSO Dr Shahzaib
• IOF : Acutely inflamed appendix
• Impending perforation at base
• 20 ml reactionary fluid

15. CASE 5
• Patient Parveen 40y/F presented in ER with c/o
• Pain left forearm / hand -2 days
• Patient is known case of TB and had previous hx of exploratory
laprotomy one and a half month back
• O/E left sided brachial ,radial ulnar pulses not palpable ,
• CXR showed B/L cervical rib
• Doppler showed thrombus in brachial radial and ulnar arteries ,
• Axillary and subclavian artery status normal
• Patient was prepared for thrombectomy after shifting in ward.

16. • Procedure : embolectomy of left brachial , radial and ulnar arteries +
Fogarty + fasciotomy
• Surgeons: Dr naila,Dr shahzaib,Dr tayyaba
• IOF:Multiple thrombi received from brachial ,radial and ulnar
arteries(4,5 and 7 cm)
• Sluggish contractility of muscles of forearm ( lateral
compartment)
• healthy contractile muscles ( medial compartment)
• Good blood flow after fogarty

18. CASE 6
• Pt hameed 40y /M k/c of CA nasopharynx was referred from
oncology for feeding jejunostomy
• VITALS : pulse temp BP
• Pt had previous hx of exploratory laprotomy 1 yr back ,and feeding
gastrostomy 5 months back ,
• CT scan showed mass extending in hypopharynx and proximal
esophagus
• PSB Dr Obaid and advised to proceed with feeding jejunostomy

19. • Procedure : feeding jejunostomy
• Surgeon : Dr shahzaib,Dr tayyaba UKSO Dr Naila
• IOF: healthy viable gut
• Multiple interloop adhesions

20. CASE 7
• Pt munawar ,22y /M presented in ER with c/o
• Right iliac fossa pain – 2 days
• Fever – 1 day
• No hx of burning micturition ,
• VITALS pulse 104 BP 110/70 Temp 98
• O/E tenderness in right iliac fossa
• MANTRELS calculated was 8
• PSB Dr Obaid and advised Open appendectomy

21. • Procedure : open appendectomy
• Surgeons : Dr Waqas ,Dr tayyaba ,dr shahzaib
• IOF : Acutely inflamed appendix

23. Ward Cases ( CASE 8)
• Pt yaseen 65y/M presented in ER on 3-10-22 with abdominal
distention , patient was admitted in ward on conservative
management ( with amylase lipase awaited and CT scan to be done )
• CT scan abdomen showed possible intestinal perforation with
hydropneumoperitoneum and multiple fluid filled bowel loops
• B/L pleural effusion with right side atelectasis
• USG : Whole of abdomen obscured by bowel gas shadows
• LABS: tlc 18*10*3, Na 141 , K 3.41 , Amylase 100 ,lipase 93
• PSB Prof Farooq Rana and advised urgent exploration

24. • Procedure: exploratory laprotomy
• Surgeons: Dr Naila , Dr Shahzaib , Dr tayyaba ,Dr fawad
• Incision : midline umbilicus sparing
• IOF : Gush of air on opening abdomen
• Pus flakes all over abdomen
• Whole of small and large gut upto rectum ,liver pancrease ,gall
bladder visualized , and were normal

26. Ward Case ( CASE 9)
• Pt Ghulam Muhammad 65y/M Presented in ER on 3-10-22 with
cellulitis of right leg
• Pt admitted in ward following Debridement and fasciotomy right
lower limb
• VITALS: 120/80 pulse 90 temp 100
• TLC 20.1 Hb 8.1 PLT 350
• PSB Dr Ammara in ward and advised right above knee amputation

27. • Procedure : right above knee amputation
• Surgeons:Dr usama ,Dr Fawad
• IOF : Healthy viable muscles
• Good blood flow

28. CASE 1( conservative)
• Pt mubeen kanwal 52 y /F DM+ presented in ER with c/o
• Pain epigastrium/RHC – 3 days
• nausea, vomiting- 3 days
• VITALS: Pulse BP Temp
• O/E abdomen soft ,BS+,tenderness in right hypochondrium ,
• LABS: TLC 22 Hb 11.5 PLT 252
• Amylase 1000 lipase 2600 potassium 3.72 , sodium 139
• USG: 7mm calculus in gall bladder, ( CBD not commented)

29. • Ranson score at admission was 2
• PSB Dr Ubaid and advised to be admitted in ward on basis of gallstone
pancreatitis

30. CASE 2
• PT nabeeha 15y/F presented in ER with hx of RTA padestrian vs car
• VITALS : pulse BP Temp
• O/E Abd was SNT , DRE : no blood staining , normal anal tone
• X-ray pelvis showed right superior pubic ramus fracture
• peripheral pulses palpable , neurolical status intact
• Serial FAST scans were unremarkable
• Patient was advised pelvic binder and conservative management by
ortho
• PSB Dr Obaid and advised to be admitted in ward for observation