Dr.SOEBAGJO SpB.(K)TKV

Thoracic traumaDr.SUBAGJO SpB(K)TKV

2.Thoracic trauma1 out of 4 deathsblunt < 10% require operation.- penetrating 15% - require operationmajority require Simple procedures

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BEDAH THORAXBEDAH JANTUNGBEDAH NON JANTUNG / PARU

PEMERIKSAAN PRA BEDAHFAAL PARUBRONCHOSCOPYBRONCHOGRAFICT SCANFOTO THORAXFAAL HEPAR, GINJAL, HEMOSTASISDFNA/TTB : TRANSTORAKAL BIOPSI

TRAUMA ANAMNESAPEMERIKSAAN FISIK- INSPEKSI- PALPASI- PERKUSI- AUSKULTASIPEMERIKSAN TAMBAHAN: FOTO X RAY

IDENTIFIKASI AWAL (PRIMARY SURVEY)SUMBATAN AIRWAYTENSION PNEUMOTHORAXOPEN PNEUMOTHORAXFLAIL CHESTHEMOTHORAX MASIFTAMPONADE 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- rare occurrence- hoarseness- subcutaneous emphysema- treatment * intubation * tracheostomy

BREATHINGTENSION PNEUMOTORAX : EtiologyParenchymal and/or chest-wall injury.Air enters pleural space with no exitPositive pressure ventilation - collapse of affected lung - decrease venous return - decrease ventilation of opposite lung.

BREATHING

Tension pneumothorax sign/symptomsrespiratory distressDistended neck veinsUnilateral decrease in breath soundsHyperresonanceCyanosis, late

BREATHINGTENSION PNEUMOTHORAXimmidiate decompressionClinical diagnosis, not by X rayTherapy : nedlee decompression and chest tube after it has been inserted

BREATHING

2.Open pneumothoraxcover defectChest tubedefinitive operation

3. BREATHINGFLAIL CHEST /PULMONARY CONTUSION Reexpand lungOxygenJudicous fluid managementIntubation as indicatedanalgesia

FLAIL CHEST

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

4.CIRCULATION MASSIVE HEMOTHORAX :> 1500 ml blood lossSystemic/pulmonary vessel disruptionFlat vs distended neck veinsShock with no breath sound and/or percussion dullness

CIRCULATIONMASSIVE HEMOTHORAXrapid volume restorationchest decompression and X-rayautotransfusionoperative intervention

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CIRCULATIONCARDIAC TAMPONADEdecrease arterial pressuredistended neck veinsmuffled heart soundPEA THERAPY patent airway - iv therapy - pericardiocentesis - pericardiostomy

SECONDARY SURVEYPOTENTIALLY LETHAL CHEST TRAUMASIMPLE PNEUMOTHORAXHEMOTHORAXPULMONARY CONTUSIONTRACHEOBRONCHIAL TREE INJURIESBLUNT CARDIAC INJURYTRAUMATIC AORTIC DISRUPTIONTRAUMATIC DIAPHRAGMATIC INJURYMEDIASTINAL TRANSVERSING WOUNDS

1.SIMPLE PNEUMOTHORAXpenetrating/blunt traumahyperresonancedecrease breath soundstube thoracostomy

2.HEMOTHORAXchest wall injurylung/vessel lacerationtube thoracostomy

3.PULMONARY CONTUSIONMost commonOxygenate ventilateSelective intubation

4.TRACHEAL INJURYFrequently missed injuryBlunt/penetrating traumaPartial vs complateDiagnostic aid endoscopyTreatment * airway ventilation * operation

5.BLUNT CARDIAC INJURYInjury spectrumECG changes: monitor changeEchocardiographyTret dysrhytmiaa, Q complications

6.AORTIC RUPTURERapid aceleration/decelerationLigamentum arteriosumSalvage identify earlySurgical consultX-ray: widened mediastinum,obliteration of the aortic knob,depression of the left main stem bronchus,fractures of the first or second rib or scapulaAortogram. 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 radiographyTherapy direct closure

8.MEDIASTINAL TRANSVERSING WOUNDhemodinamically abnormalexsanguinating thoracic hemorrhagetension pneumothoraxPericardial tamponadeEsophageal or tracheobronchial injurySpinal cord injury hemodinamically normal- vascular: angiographytracheobronchial: bronchoscopyesophageal: esophagography,esophagoscopyTreatment mandatory surgical consultation, repair identified injuries,

OTHERS TRAUMATRAUMATIC ASPHYXIAPtechiaeSwellingPlethoraCerebral edema