1.

GIVEN THE PICTURES OF PATIENTS WITH WOUNDS, THE ASSIGNED

GROUP SHOULD RECONSTRUCT THE MOST PROPABLE HISTORY OF
THE PATIENT, THE MECHANISM OR HOW THE WOUND WAS
SUSTAINED, WHICH COULD EXPLAIN THE PHYSICAL EXAMINATION
FINDINGS.

On September 25, 2016, Mr. Tabs, a 30-year-old male patient

experienced a severe stabbing abdominal pain characterized as 5/10 in the
pain scale after having his dinner at around 8 PM. He stated that his
abdominal pain started at the area around his periumbilical area and shifted
to the right lower quadrant region. He thought he was just having abdominal
pains caused by something he ate that is why he never bothered to consult a
doctor and rather decided to sleep off what he is feeling.

The following day, upon waking up at 7:30 AM Mr. Tabs still feel the
pain in his right lower quadrant and is now accompanied by of appetite,
nausea and vomiting and frequency in defecation of loose watery stool. To
alleviate the pain, he claimed that he put Efficascent oil but did not take any
medication. He claims that it alleviated the pain for a while but after around
15 minutes, the abdominal pain again persisted. At around 9 AM, he feels like
he is feverish that is why he took Biogesic 500 mg Tablet.

At around 11 PM, Mr. Tabs abdominal pain worsens with the pain scale
of 9/10. With this reason, he was immediately rushed at Mariano Marcos
Memorial Hospital and Medical Center Emergency Room. His physical
examination revealed tenderness in the right iliac fossa, local guarding and
rebound tenderness at the McBurney point, consistent with signs of
complicated acute appendicitis. His body temperature was 38C, his pulse
rate was 90 beats/minute and his blood pressure was 90/50 mmHg. The
urine examination result was normal. Laboratory investigations, including
serum electrolyte levels and complete blood count, were within normal
limits, except for a moderately elevated white cell count (14,000/mm 3).
Hence, he was admitted at 11:30 PM. He was later diagnosed with acute
appendicitis and was scheduled for an emergency open appendectomy. His
operation begun at 12:50 AM and ended at 1:55 AM, with Dr. Paat as his
surgeon.

Mr. underwent open appendectomy, through a midline incision, for his

perforated appendicitis without any complications. He was then discharged
October 1, 2016 (5 days post operation) and was advised to have his follow
up checkup at the Out-Patient Department after one week. Due medications
was given and wearing of abdominal binder was advised.

However on October 4, 2016 at around 7:30 AM (3 days after he was

discharged), the patient came to the hospital emergency room due to the
gaping in his wound and that he felt like his sutures have loosen. The patient
also complaints of serous fluid drainage from his open midline abdominal
wound. He stated that while he was going down from his bed at around 7AM
to urinate, he strained which may have caused the removal of the suture and
the gaping of wound. It was also noted that he did not use his binder during
the event happened since he removed it when he sleeps since he feels
uncomfortable sleeping with it.

On physical examination, it was noted that he has: temperature of

37.6C, pulse rate of 81 beats/min, blood pressure of 130/80 mm Hg, and
respiratory rate of 18 breaths/min. The results of his cardiopulmonary
examinations are within normal limits. Examination of the abdomen reveals a
small amount of serous fluid from his surgical incision. There is no redness,
swelling, or tenderness around the incision however gaping of surgical
wound and loosened sutures was noted though protrusion of internal organs
was not noted.