Professional Documents
Culture Documents
(Basic Knowledge)
Introduction
Chest trauma is often sudden and
dramatic
Accounts for 25% of all trauma
deaths
2/3 of deaths occur after reaching
hospital
Serious pathological consequnces:
hypoxia,
hypovolaemia,
myocardial failure
Mechanism of Injury
Penetrating Trauma
Low Energy
Arrows, knives, handguns
Injury caused by direct contact
High Energy
Military, hunting rifles & high powered hand
guns
Extensive injury due to high pressure
Trauma tusuk sering pada daerah2
konflik.
Rifles: senapan
Blunt injuries
Either:
direct blow (e.g. rib fracture)
deceleration injury
compression injury
Age Factors
Blow:pukulan
Tracheobronchial
tree lacerations
(rupture)
Esophageal
lacerations
Penetrating cardiac
injuries
Pericardial
tamponade
Spinal cord injuries
Diaphragm trauma
Intra-abdominal
trauma associated
organ injury
ABCDE
Sub Department of Cardio Thoracic & Vascular Surgery
responsible in ABC
Airway obstruction
Clinical finding
Shortness of breath (dyspnea)
Stridor
Apnea
Management
Chin lift
Jaw thrust
Triple finger manuever
Evacuate foreign body
ET insertion
Cricothyroidostomy
Tracheostomy
Keluhan pertama: sesak nafas. Slain itu stidor, gurgling (karena cairan), lbh
berat lg apneu.
u/ cedera spinal paling aman pake jaw thrust
1.Yg bs dilakuin u/ pertolongan pertama: chin lift, jaw thrust dan crossing
finger manuver. Bs jg triple finger manuver.
2.Apapun yg kliatan dr cavum oris harus diangkat (crossing finger manuver).
3.Kalo pasien masih blm bs nafas initial breathing
4.Kalo udah niup (bagging) tp dada ga ngembang mungkin jalan nafasny ada
sumbatan (obstruksi jalan nafas yg ga kliatan).
5.Pake heimlich manuver slanjutnya kalo pasien sadar. Kalo ga sadar, pake
abdominal thrust.
6.Kalo masih belum bs nafas, cricotiroidostomi
7.Kalo ditiup dada ngembang dan airway baik tp krn hipoksia lama jadi
apneu dilakukan breathing support. Kalo ud cricottiroidostomi tetep ga
ngembang sumbatan ada di bawah membrana cricothyroidea
endotrakeal tube u/ dorong sumbatan ke kanan dan paru2 kiri ngembang.
Tension Pneumothorax
Ventile phenomenon
Build up of air under
pressure in the thorax.
Excessive pressure
reduces effectiveness
of respiration
Air is unable to escape
from inside the pleural
space
Progression of Simple
(closed) or Open
Pneumothorax
Breathing
Ventile phenomenon pas inspirasi udara bs masuk tp pas ekspirasi ga bs
kluar tekanan makin tinggi neken jantung tension pneumothoraks.
Kalo uda ada diagnosis tension pneumothoraks, ga usah foto rontgen krn pas
nunggu hasil, pasien bs meninggal.
CXR image
Tension Pneumothorax
(simplify)
Treatment :
Needle thoracocentesis
Consult : chest tube insertion
Dari anamnesis didapatkan sesak
nafas.
Needle thoracocentesis
Suara seperti nyedot udara terdengar di dada. Hrs ada luka terbuka di dada
(2/3 diameter trakea lukanya)
Hemothorax
Hemothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500 mL
of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
MASSIVE (criteria)
Hemothorax
Blunt or penetrating
chest trauma
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension massive
(simplify)
CXR Image
Trauma.org
Gambaran CT scan
Tension udara radiolusen (lbh gelap)
Hemothorax cairan radioopak (lbh terang).
Flail chest
Multiple rib fractures produce a mobile
fragment which moves paradoxically
with respiration
Significant force required
Usually diagnosed clinically
Treatment
ABC
Analgesia
Fixation : internal &/ external
PARADOXICAL RESPIRATIONS
Tracheobronchial Injury
MOI
Blunt trauma
Penetrating trauma
Dyspnea
Cyanosis
Hemoptysis
Massive subcutaneous emphysema
Suspect/Evaluate for other closed chest trauma
Tanda khas: emfisema yg luas disubkutan (jd bengkak secara luas gitu), ada
batuk darah stelah kecelakaan.
Kalo dipalpasi, kayak ada tas kresek. Begitu dipencet, pas dilepas jd
Tracheobronchial Injury
Observe for development of
Subcutaneus emphysema &
tension pneumothorax (deadly)
Treatment
Keep airway clear
Administer high flow O2
Consider intubation if unable to
maintain patient airway
If tension needle
thoracocentesis
Consult : tracheal repair or
tracheostomy
Lakukan multiple insisi di tepi atas clavicula, lalu darah keluar buka pake
tumpul sampai udara ada yg keluar. Tp ini sudah ga dianjurkan.
Pericardial Tamponade
Restriction to cardiac filling caused by
blood or other fluid within the pericardium
Occurs in <2% of all serious chest trauma
However, very high mortality
Pericardial Tamponade
(simplify)
Kussmauls sign
Decrease or
absence of JVD
during inspiration
JVD
Pulsus Paradoxus
Distant heart tones
Drop in SBP >10
Hypotension or
during inspiration
narrowing pulse
Due to increase in
pressure
CO2 during
Weak, thready pulse
inspiration
Shock
Electrical Alterans
P, QRS, & T
amplitude changes
in every other
Cardiac tamponade sianosis, nadi kecil, penurunan kesadaran.
cycleterbendung,
Trias back tjd karena penekanan atrium kanancardiac
1venous return
Dyspnea
Possible cyanosis
Becks Triad
Pericardial or Cardiac
tamponade
Pericardial Tamponade
(ilustrations)
Laceration of vascular
structures
General sign
Shock Hypovolemia (co morbid cardiogenic)
Penetrating trauma (mostly)
Internal bleeding
Thoracic Chest XR
Abdominal FAST or CT
Pelvicum CXR
Femur expanding hematoma + XR
Flow chart:
Syok hipovolemia
External bleeding
internal
(selesaikan lbh dl)
Penyebab, liat:
Dijait diperban+ - fraktur tulang
plester
panjang femur (bs
(pake ini dl) sampai 1,5 L)
- thorax sbnrnya
Resusitasi cairan
di breathing ini
(pasang infus)
mriksanya. Tp
tensi belum naik
lakuin perkusi
lg.
Tangani
internal
bleeding abdominal tes
undulasi dan pekak
beralih. Tp
sensitivitasnya
rendah, >300 cc
baru +
- pelvis rumit krn
ada os pubisnya.
c/ pd kehamilan
Laceration of vascular
structures
Internal bleeding consult
External bleeding