tension pneumothoraks dan tatalaksananya
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Transcript of tension pneumothoraks dan tatalaksananya
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Dr. Andreas AL.
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* The endotracheal tube is too
far dawn
The ideal position is for the
tip of the tube to be at the le-
vel of the clavicles
A lucent area at the anterior
costophrenic recess on the
right side with no lung mar-
kings ---- deep sulcus sign
----- indicative right pneumo
thorax
* The right hemidiapragm is
depressed and the mediasti-
num shifted away indicating
A tension pneumothorax
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If you see a significant tensionpneumothorax on radiograph,
YOU HAVE MISSED THE CLINICAL DIAGNOSIS
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Tension Pneumothorax
Associated Injuries
A penetrating injury to the chest
Blunt trauma
Penetration by a rib fracture
Many other mechanisms of
injury
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Tension Pneumothorax Morbidity/Mortality
Profound hypoventilation can result.
Death is related to delayed management.
An immediate, life-threatening chest injury.
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Tension Pneumothorax
Pathophysiology(1 of 2)
Occurs when air enters the pleural space from a lung
injury or through the chest wall without a means of exit.
Results in death if it is not immediately recognized and
treated
When air is allowed to leak into the pleural space duringinspiration and becomes trapped during exhalation, an
increase in the pleural pressure results.
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TENSION PNEUMOTHORAX
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Tension Pneumothorax Pathophysiology (2 of 2)
Increased pleural pressure produces mediastinal
shift.
Mediastinal shift results in:
Compression of the uninjured lung Kinking of the superior and inferior vena cava,
decreasing venous return to the heart, and
subsequently decreasing cardiac output
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Tension Pneumothorax
Assessment Findings (1 of 3)
Extreme anxiety
Cyanosis
Increasing dyspnea
Difficult ventilations while being assisted
Tracheal deviation (a late sign)
Hypotension
Identification is the most difficult aspect
of field care in a tension pneumothorax.
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Tension Pneumothorax
Assessment Findings (2 of 3)
Tachycardia
Diminished or absent breath sounds on
the injured side
Tachypnea
Respiratory distress
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Tension Pneumothorax
Assessment Findings (3 of 3)
Bulging of the intercostal muscles
Subcutaneous emphysema
Jugular venous distention
Unequal expansion of the chest
Hyperresonnace to percussion
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Tension Pneumothorax
Physical Findings
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Tension Pneumothorax Management (1 of 5)
Emergency care is directed at reducing thepressure in the pleural space.
Airway and ventilation: High-concentration oxygen
Positive pressure ventilation if necessary
The positive pressure ventilation makes a tensionpneumothorax worse (keep this in mind any timeyou see someone with sudden cardiopulmonarydeterioration after intubation)
Circulationrelieve the tensionpneumothorax to improve cardiac output.
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Tension Pneumothorax Management (2 of 5)
Nonpharmacological
Needle thoracostomy
Tube thoracostomyin-hospital management
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Management
TENSION PNEUMOTHORAX
NEEDLE
TORAKOSINTESIS
Tension
PneumothoraxSimple
pneumothorax
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Tension Pneumothorax Management(3 of 5)
Needle thoracostomy
Insert the needle just above the third rib to avoid the nerve,
artery, and vein that lie just beneath each rib.
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Tension Pneumothorax Management (4 of 5)
Tension pneumothorax associated with
penetrating trauma
May occur when an open pneumothorax has beensealed with an occlusive dressing.
Pressure may be relieved by momentarily removing
the dressing (air escapes with an audible release of
air).
After the pressure is released, the wound
should be resealed.
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Tension Pneumothorax
Management (5 of 5) Tension pneumothorax associated with closed
trauma If the patient demonstrates significant dyspnea and
distinct signs and symptoms of tension
pneumothorax: Provide thoracic decompression with either a large-bore
needle or commercially available thoracic decompression kit.
Insert a 2-inch 14- or 16-gauge hollow needle or catheter intothe affected pleural space.
Usually the second intercostal space in the midclavicular line
Insert the needle just above the third rib to avoid the nerve,
artery, and vein that lie just beneath each rib.
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WHAT IS THE SIGNIFICANCE OF
SUBCUTANEOUS EMPHYSEMA AFTER
CHEST TUBE PLACEMENT FOR A
PNEUMOTHORAX ? WHAT IS THETREATMENT? IS IT DANGEROUS ?
Sharing experience in ward.
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