Dr.SOEBAGJO SpB.

(K)TKV

S1

Thoracic trauma
Dr.SUBAGJO SpB(K)TKV

BEDAH THORAX
BEDAH

JANTUNG
BEDAH NON JANTUNG / PARU

PEMERIKSAAN PRA BEDAH

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FAAL PARU
BRONCHOSCOPY
BRONCHOGRAFI
CT SCAN
FOTO THORAX
FAAL HEPAR, GINJAL,
HEMOSTASISD
FNA/TTB : TRANSTORAKAL BIOPSI

TRAUMA
ANAMNESA
PEMERIKSAAN FISIK
- INSPEKSI
- PALPASI
- PERKUSI
- AUSKULTASI
PEMERIKSAN TAMBAHAN
: FOTO X RAY

IDENTIFIKASI AWAL
(PRIMARY SURVEY)

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SUMBATAN AIRWAY
TENSION PNEUMOTHORAX
OPEN PNEUMOTHORAX
FLAIL CHEST
HEMOTHORAX MASIF
TAMPONADE JANTUNG

Ilustrasi

Thoracic trauma
-

1 out of 4 death
- blunt < 10 % require operation
- penetrating 15%-30% require operation
- majority require simple procedures

PRIMARY SURVEY/LIFE
THREATENING INJURIES
MAJOR PROBLEMS SHOULD BE
CORRECTED AS THEY ARE
IDENTIFIED
- airway obstruction
- tension pneumothorax
- open pneumothorax
- flail chest
- massive hemothorax
- cardiac tamponade

AIRWAY OBSTRUCTION
laryngeal injury
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rare occurrence
- hoarseness
- subcutaneous emphysema
- treatment * intubation
* tracheostomy

BREATHING
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TENSION PNEUMOTORAX :
Etiology
Parenchymal and/or chest-wall injury.
Air enters pleural space with no exit
Positive pressure ventilation
- collapse of affected lung
- decrease venous return
- decrease ventilation of opposite lung.

BREATHING
Tension pneumothorax sign/symptoms
- respiratory distress
- Distended neck veins
- Unilateral decrease in breath sounds
- Hyperresonance
- Cyanosis, late

BREATHING
TENSION PNEUMOTHORAX
- immidiate decompression
- Clinical diagnosis, not by X ray
Therapy : nedlee decompression and chest
tube after it has been inserted

BREATHING
2.Open pneumothorax
- cover defect
- Chest tube
- definitive operation

3. BREATHING
FLAIL CHEST /PULMONARY CONTUSION
Reexpand lung
Oxygen
Judicous fluid management
Intubation as indicated
analgesia

FLAIL CHEST
definitif ditujukan pada
pengembangan paru, oksigenasi, cairan
yang cukup serta analgesia
Tekanan oksigen arterial dan kinerja
pernafasan, penilaiannya menentukan
kapan diberi intubasi dan ventilasi
Terapi

4.CIRCULATION
MASSIVE HEMOTHORAX :
> 1500 ml blood loss
Systemic/pulmonary vessel disruption
Flat vs distended neck veins
Shock with no breath sound and/or
percussion dullness

CIRCULATION
MASSIVE HEMOTHORAX
- rapid volume restoration
- chest decompression and X-ray
- autotransfusion
- operative intervention

CIRCULATION
CARDIAC TAMPONADE
- decrease arterial pressure
- distended neck veins
- muffled heart sound
- PEA
THERAPY patent airway
- iv therapy
- pericardiocentesis
- pericardiostomy

SECONDARY SURVEY
POTENTIALLY LETHAL CHEST
TRAUMA
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SIMPLE PNEUMOTHORAX
HEMOTHORAX
PULMONARY CONTUSION
TRACHEOBRONCHIAL TREE INJURIES
BLUNT CARDIAC INJURY
TRAUMATIC AORTIC DISRUPTION
TRAUMATIC DIAPHRAGMATIC INJURY
MEDIASTINAL TRANSVERSING WOUNDS

1.SIMPLE PNEUMOTHORAX
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penetrating/blunt trauma
hyperresonance
decrease breath sounds
tube thoracostomy

2.HEMOTHORAX
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chest wall injury

lung/vessel laceration
tube thoracostomy

3.PULMONARY CONTUSION
Most common
Oxygenate ventilate
Selective intubation

4.TRACHEAL INJURY
Frequently

missed injury
Blunt/penetrating trauma
Partial vs complate
Diagnostic aid endoscopy
Treatment * airway ventilation
* operation

5.BLUNT CARDIAC INJURY

Injury

spectrum
ECG changes: monitor change
Echocardiography
Tret dysrhytmiaa, Q complications

6.AORTIC RUPTURE

Rapid aceleration/deceleration
Ligamentum arteriosum
Salvage identify early
Surgical consult
X-ray: widened mediastinum,obliteration of the aortic
knob,depression of the left main stem bronchus,fractures
of the first or second rib or scapula
Aortogram.
Therapy primer suture aorta / resection and grafting

7.DIAPHRAGMATIC RUPTURE
- most diagnosted on left
- blunt , large tears
- penetrating, small perforations
- misinterpreted x ray (elevated
diaphragm,acute gastric delatation,
aloculated pneumothorax
- contras radiography
Therapy direct closure

8.MEDIASTINAL TRANSVERSING
hemodinamically abnormal

WOUND

exsanguinating thoracic hemorrhage

tension pneumothorax
Pericardial tamponade
Esophageal or tracheobronchial injury
Spinal cord injury
hemodinamically normal
vascular: angiography
tracheobronchial: bronchoscopy
esophageal: esophagography,esophagoscopy
Treatment mandatory surgical consultation,
repair identified injuries,

OTHERS TRAUMA
TRAUMATIC ASPHYXIA
Ptechiae
Swelling
Plethora
Cerebral edema