NEEDLE THORACOSTOMYHEIMLICH’ MANEUVER

SKILL LABORATORYRESPIRATORY SYSTEM

YANA AKHMADARTO YUWONO

PRAYUDI SANTOSO

TOPIC NEEDLE THORACOSTOMY

HEIMLICH’ MANEUVER

OBJECTIVE

BE ABLE TO PERFORM PROCEDURE OF NEEDLE THORACOSTOMY AND HEIMLICH’ MANEUVERKNOW INDICATIONS AND GOAL OF THE PROCEDURES

INTRODUCTION

NEEDLE THORACOSTOMY PROCEDURE FOR EMERGENCY

DECOMPRESSION OF THE CHEST UNTIL A CHEST TUBE CAN BE INSERTED

PATIENT WITH LIFE THREATENING TENSION PNEUMOTHORAX

PNEUMOTHORAX

THE PRESENCE OF AIR WITHIN PLEURAL SPACE

CATAGORIES :

• TRAUMATIC (ACCIDENTAL OR IATROGENIC)• SPONTANEOUS (WITHOUT AN OBVIOUS CAUSE)

- PRIMARY (NO UNDERLYING LUNG DISEASE)

- SECONDARY (HAS A PREDISPOSING LUNG DISEASE)

MECHANISMCOMMUNICATION BETWEEN THE ALVEOLI

AND THE PLEURAL SPACE (BRONCHOPLEURAL FISTULA)

COMMUNICATION BETWEEN THE ATMOSPHERE AND THE PLEURAL SPACE (PENETRATING CHEST WOUND OR TRAUMATIC)

CLINICAL MANIFESTATIONDEPEND ON THE VOLUME OF THE

PNEUMOTHORAX AND PRESENCE OR ABSENCE OF UNDERLYING LUNG DISEASE

SYMPTOM - DYSPNEA - CHEST PAIN : SHARP AND

ABRUPT

SMALL PNEUMOTHORAX : - ASYMPTOMATIC

TENSION PNEUMOTHORAX

OCCUR WHEN AIR IN THE PLEURAL SPACE EXCEEDS ATMOSPHERIC PRESSURE

MEDIASTINAL SHIFT TO CONTRALATERAL SIDE, PLACES TORSION ON THE INFERIOR VENA CAVA, VENOUS RETURN DECREASE, CARDIAC OUTPUT DECREASE, AND HIPOTENSION RESULT

THE LUNG CONTINOUS TO COMPRESS, INTRA PULMONARY SHUNTING THROUGH THE COLLAPSED LUNG CAUSED HYPOXEMIA

LIFE THREATENING

TREATMENT IS EMERGENCY DECOMPRESI OF THE CHEST

NEEDLE THORACOSTOMY

Learning Guide for needle thoracostomyA. Preparation the tools : needle no.16,

syringe 3cc, gloves, cotton swab, povidon iodine, normal salin, com, kidney basin, measuring glass with water tube, tape.

B. CLIENT ASSESSMENT1. Greet client respectfully and with

kindness2. The patient should be given adequate

explanation about needle thoracostomy and the goal or expected result of needle thoracostomy (Briefly)

C. PERFORMING NEEDLE THORACOSTOMY

1. Wash your hand and dry it with dry towel. Put on the gloves.

2. Clean the skin around the second intercostals space at the midclavicular line, using povidone –iodine solution. Use a circular motion, starting at the center and working outward.

3. Fill the syringe with 2 cc sterile normal saline

4.

Insert a sterile 16G or larger needle with attached syringe immediately over the superior portion of the rib and through the tissue covering the pleural cavity while aspirating

5.

When air is aspirated, advance catheter completely, and withdraw syringe. Withdraw syringe following connect the inserted needle with tubing immediately and place the other end of tubing in a measuring glass filled with water

6.

Leave the needle in place until a chest tube can be inserted.

HEIMLICH’ MANEUVER (ABDOMINAL THRUSTS)

INTRODUCTIONFOREIGN BODY AIRWAY OBSTRUCTION - VOMITUS, FOOD BOLUS, OTHER

MAY CAUSE EITHER PARTIAL OR COMPLETE OBSTRUCTION

PARTIAL OBTRUCTION : CONSCIOUS AND COUGHING

COMPLETE OBSTRUCTION : CANNOT TALK, COUGH OR BREATH

THE PATIENT CLUTCHES AT HIS/HER THROAT

(UNIVERSAL DISTRESS SIGNAL OF FOREIGN

BODY OBSTRUCTION) NEED OF EMERGENCY INTERVENTION THE PROCEDURE OF CHOICE FOR

CLEARING A FOREIGN BODY FROM AIRWAY

OBSTRUCTION : - ABDOMINAL THRUSTS

(HEIMLICH’MANEUVER) ADULT, CHILDREN - BACK BLOWS - CHEST THRUSTS

INFANT, ADVANCED PREGNANCY

HEIMLICH’ MANEUVERTHE PROCEDURE OF CHOICE FOR CLEARING

A FOREIGN BODY FROM AIRWAY

OBSTRUCTION :

THIS PROCEDUR NORMALY ARE FOLLOWED BY A MANUAL CHECK AND REMOVAL OF ANY OBSTRUCTING FOREIGN MATERIAL

FORCEFUL THRUSTS APPLIED TO THE EPIGASTRIUM CAN DISLODGE AN OBSTRUCTION CAUSED BY FOREIGN BODY

QUICK THRUSTS TO THE ABDOMEN

DISPLACE DIAPHRAGM UPWARD

INCREASING INTRATHORACIC PRESSURE AND CREATING EXPLUSIVE EXPIRATORY AIRFLOW

EXPEL THE FOREIGN BODY FROM THE AIRWAY

Learning Guide for Heimlich ManuverNo. STEPS/TASK

A. CLIENT ASSESSMENT

1. Greet client respectfully and with kindness

2 The patient should be given adequate explanation about Heimlich manuver and the goal or expected result Heimlich maneuver (Briefly)

B. PERFORMING ABDOMINAL THRUSTS (HEIMLICH’ MANUVER)

1. Standing behind the patient, wrap both arms around his waist.

2. Place your fist int the center of his abdomen, midway between the umbilicus and the xiphoid process. Rest the thumb side of your fist aginst his epigastrium and then grasp your fist with your other hand.

3. Using a quick motion, thrust your fists inward and upward

4. Repeat the process until the obstruction is removed