05-Thorax
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Trauma ThoraxTrauma Thorax
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Trauma Thorax
• 25 % multi-trauma• 25 % kematian trauma• Perlu operasi : hanya ±10 %• Sisanya cukup tindakan sederhana
Trauma Thorax
• 25 % multi-trauma• 25 % kematian trauma• Perlu operasi : hanya ±10 %• Sisanya cukup tindakan sederhana
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Anatomi
Tekanan (-)
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Anatomi
Bila cavumpleura tekananmenjadi positif :kolaps
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Trauma thorax :Trauma thorax :
Langsung mengancam nyawa(temukan pada primary survey !)
Potensial mengancam nyawa (temukan pada secondary survey)
Langsung mengancam nyawa(temukan pada primary survey !)
Potensial mengancam nyawa (temukan pada secondary survey)
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Trauma thorax yang mengancam nyawa : (Primary Survey !)
1. Obstruksi airway
2. Open pneumotoraks3. Tension pneumotoraks4. Flail Chest + kontusio paru5. Masif hematotoraks
6. Tamponade jantung
Trauma thorax yang mengancam nyawa : (Primary Survey !)
1. Obstruksi airway
2. Open pneumotoraks3. Tension pneumotoraks4. Flail Chest + kontusio paru5. Masif hematotoraks
6. Tamponade jantung
AA
BB
CC
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1. Obstruksi Airway :
Manifestasi :-gangguan airway- = sesak = stridor = serak
1. Obstruksi Airway :
Manifestasi :-gangguan airway- = sesak = stridor = serak
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1. Obstruksi Airway – Tindakan :1. Obstruksi Airway – Tindakan :
• Jalan nafas definitif (intubasi)• Bila deformitas jelas menekan : tarik dengan “doek-klem”
• Jalan nafas definitif (intubasi)• Bila deformitas jelas menekan : tarik dengan “doek-klem”
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2. Open Pneumo-thorax 2. Open Pneumo-thorax
Udara pilih masuk liwat lubang(tahanan lebih kecil)
Gangguan ventilasi
Udara pilih masuk liwat lubang(tahanan lebih kecil)
Gangguan ventilasi
Sucking chest woundSucking chest wound
Manifestasi : Breathing !Manifestasi : Breathing !
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2. Open Pneumo-thorax : Tindakan
2. Open Pneumo-thorax : Tindakan
Tutup ! Pipa toraks - WSD Tutup ! Pipa toraks - WSD
Tutup rapatatau :
Tutup rapatatau :
Kasa 3 sisiKasa 3 sisi
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3. Tension Pneumo-thorax 3. Tension Pneumo-thorax
Pneumothorax Tension ? Pneumothorax Tension ?
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3. Tension Pneumo-thorax
Pneumothorax Tension Pn.
Insp. : Ekspansi # simetrisAusk. : Bs. Nafas satu sisi Perk. : Hipersonor satu sisi
Insp. : Ekspansi # simetrisAusk. : Bs. Nafas satu sisi Perk. : Hipersonor satu sisi
Trakea terdorong Vena leher distensi Syok
Trakea terdorong Vena leher distensi Syok
++
Manifestasi : Breathing !Manifestasi : Breathing !
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3. Tension Pneumo-thorax Tindakan :
3. Tension Pneumo-thorax Tindakan :
1. Dekompresi 2. Pipa Toraks1. Dekompresi 2. Pipa Toraks
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4. Flail Chest + Kontusio Paru 4. Flail Chest + Kontusio Paru
Pernafasan paradoksal Pernafasan paradoksalInspirasi EkspirasiInspirasi Ekspirasi
Manifestasi : Breathing !Manifestasi : Breathing !
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4. Flail Chest + Kontusio Paru 4. Flail Chest + Kontusio Paru
Yang lebih penting : Kontusio Paru-nyaYang lebih penting : Kontusio Paru-nya
Karena itu : Monitor A - B• Jaga Airway• Monitor pO2 dan pCO2• O2 100%• Ventilasi tambahan bila diperlukan = Bagging = Respirator
Karena itu : Monitor A - B• Jaga Airway• Monitor pO2 dan pCO2• O2 100%• Ventilasi tambahan bila diperlukan = Bagging = Respirator
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5. Massive Hematothorax 5. Massive Hematothorax
Bila > 1500 cc (initial)Bila > 200 cc/jam
Bila > 1500 cc (initial)Bila > 200 cc/jam
Manifestasi : -Breathing -CirculationManifestasi : -Breathing -Circulation
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5. Massive Hematothorax 5. Massive Hematothorax
Tindakan :
• Chest Tube• Bila massive : torakotomi
Tindakan :
• Chest Tube• Bila massive : torakotomi
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6. Tamponade Jantung6. Tamponade Jantung
1.Distensi VenaLeher
1.Distensi VenaLeher
2.Bunyi JantungJauh
2.Bunyi JantungJauh
3.Nadi kecil-cepat3.Nadi kecil-cepat
Manifestasi : Circulation (syok !) Manifestasi : Circulation (syok !)
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6. Tamponade Jantung : Tindakan6. Tamponade Jantung : Tindakan
Percardiocentesis• pasang EKG • darah tidak beku !
Percardiocentesis• pasang EKG • darah tidak beku !
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Potensial mengancam nyawa
(temukan pada secondary survey)
Potensial mengancam nyawa
(temukan pada secondary survey)
Sering :-Fraktur Iga-Pneumothorax – simple-Hemothorax (bukan masif)-Kontusio paruJarang :-Robekan pembuluh darah besar-Robekan trakea – bronkus-Robekan esofagus-Dll
Sering :-Fraktur Iga-Pneumothorax – simple-Hemothorax (bukan masif)-Kontusio paruJarang :-Robekan pembuluh darah besar-Robekan trakea – bronkus-Robekan esofagus-Dll
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Fraktur IgaFraktur Iga : :
-Satu / beberapa iga, biasanya tidak berbahaya-Berbahaya bila : = Pada orang usia lanjut (pneumonia) = Bila disertai kontusio paru -Tidak memerlukan tindakan (seperti plester dll)-Bila sangat nyeri intercostal block
Fraktur IgaFraktur Iga : :
-Satu / beberapa iga, biasanya tidak berbahaya-Berbahaya bila : = Pada orang usia lanjut (pneumonia) = Bila disertai kontusio paru -Tidak memerlukan tindakan (seperti plester dll)-Bila sangat nyeri intercostal block
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Pneumothorax sederhana Pneumothorax sederhana
Tertutup
•Trauma / non trauma•Bila trauma sering ada fraktur Iga
Tertutup
•Trauma / non trauma•Bila trauma sering ada fraktur Iga
Terbuka
•Trauma tajam / tumpul
Terbuka
•Trauma tajam / tumpul
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Pneumothorax sederhana
• mungkin sesak / tidak sesak• terdeteksi pada pem.fisik dan X-toraks• tidak semua perlu pemasangan “WSD”
Pneumothorax sederhana
• mungkin sesak / tidak sesak• terdeteksi pada pem.fisik dan X-toraks• tidak semua perlu pemasangan “WSD”
XX
XX
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Bila akan dilakukan tekanan positif : selalu pasang pipa toraksBila akan dilakukan tekanan positif : selalu pasang pipa toraks
Pneumothorax sederhana
Pneumothorax sederhana
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Hemothorax (bukan masif) Hemothorax (bukan masif)
• Terdeteksi pada pem.fisik / X-toraks• Tidak semua perlu pipa toraks• Terdeteksi pada pem.fisik / X-toraks• Tidak semua perlu pipa toraks
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Kontusio ParuKontusio Paru
Ventilasi tambahan :
Tergantung keadaan-Breathing--pO2-pCO2
Ventilasi tambahan :
Tergantung keadaan-Breathing--pO2-pCO2
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Ruptur Trakea – Bronkus Ruptur Trakea – Bronkus
Bila lubang besar :• presentasi pada primary survey
Bila lubang besar :• presentasi pada primary survey
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Ruptur Aorta Ruptur Aorta
Bila ruptur bebas mati
Bila masih tertahan T.adventitia :• Sewaktu-waktu bisa mati• Tanda-tanda lain : - syok - X toraks : mediastinum lebar - X toraks : fraktur 3 kosta atas - tanda lain pada X toraks
Bila ruptur bebas mati
Bila masih tertahan T.adventitia :• Sewaktu-waktu bisa mati• Tanda-tanda lain : - syok - X toraks : mediastinum lebar - X toraks : fraktur 3 kosta atas - tanda lain pada X toraks
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Traumatic AsphyxiaTraumatic Asphyxia
• Biasanya tidak berbahaya
• Biasanya tidak berbahaya
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30
AGD 118AGD 118
Terima Kasih