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Trauma Thorax-Sis

This document discusses trauma to the chest or thorax, which is a common cause of injury-related deaths accounting for 25% of all trauma deaths. The chest contains vital organs for oxygenation like the lungs, and injuries can lead to hypoxia, bleeding, or cardiac failure. Chest injuries can be penetrating like stab wounds, or blunt force from impacts, falls, or crashes. Common injuries include rib fractures, flail chest, pneumothorax, hemothorax, lung contusions, and cardiac tamponade. Immediate life-threatening injuries require rapid assessment and interventions like needle decompression, tube thoracostomy, or emergency thoracotomy to relieve tension on the lungs or heart. Proper management

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Ari Wijaya
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129 views44 pages

Trauma Thorax-Sis

This document discusses trauma to the chest or thorax, which is a common cause of injury-related deaths accounting for 25% of all trauma deaths. The chest contains vital organs for oxygenation like the lungs, and injuries can lead to hypoxia, bleeding, or cardiac failure. Chest injuries can be penetrating like stab wounds, or blunt force from impacts, falls, or crashes. Common injuries include rib fractures, flail chest, pneumothorax, hemothorax, lung contusions, and cardiac tamponade. Immediate life-threatening injuries require rapid assessment and interventions like needle decompression, tube thoracostomy, or emergency thoracotomy to relieve tension on the lungs or heart. Proper management

Uploaded by

Ari Wijaya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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TRAUMA THORAX

[email protected]
Keperawatan UNEJ
HISTORY
ANGKA KEMATIAN TINGGI
ORGAN PENTING UNTUK OKSIGENISASI TUBUH
Trimodal Death Distribution
Introduction

 Chest trauma is often sudden and dramatic


 Accounts for 25% of all trauma deaths
 2/3 of deaths occur after reaching hospital
 Serious pathological consequnces: -
hypoxia, hypovolaemia, myocardial failure
Mechanism of Injury

Penetrating injuries
 E.g. stab wounds etc.
 Primarily peripheral lung
 Haemothorax
 Pneumothorax
 Cardiac, great vessel or oesophageal injury
Blunt injuries
 Either:
 direct blow (e.g. rib fracture)
 deceleration injury
 compression injury
 Rib fracture is the most common sign of blunt
thoracic trauma
 Fracture of scapula, sternum, or first rib
suggests massive force of injury
Chest wall injuries

 Rib fractures

 Flail chest

 Open pneumothorax
Rib fractures

 Most common thoracic injury


 Localised pain, tenderness, crepitus
 CXR to exclude other injuries
 Analgesia avoid taping
 Underestimation of effect
 Upper ribs, clavicle or scapula fracture:
suspect vascular injury
Flail chest

 Multiple rib fractures produce a mobile


fragment which moves paradoxically with
respiration
 Significant force required
 Usually diagnosed clinically
 Rx: ABC
Analgesia
Flail chest
Flail Chest - detail
Open pneumothorax

 Defect in chest wall provides a direct


communication between the pleural space
and the environment
 Lung collapse and paroxysmal shifting of
mediastinum with each respiratory effort ±
tension pneumothorax
 “Sucking chest wound”
 Rx: ABCs…closure of wound…chest
drain
Lung injury

 Pulmonary contusion
 Pneumothorax
 Haemothorax
 Parenchymal injury
 Trachea and bronchial injuries
 Pneumomediastinum
Pneumothorax

 Air in the pleural cavity


 Blunt or penetrating injury that disrupts the
parietal or visceral pleura
 Unilateral signs: movement and breath
sounds, resonant to percussion
 Confirmed by CXR
 Rx: chest drain
Pneumothorax classification
By side:
 left or right
 in both side
By lung collapse degree:
 Partial (paracostal)
 Subtotal (smaller than 2/3 of lung volume)
 Total (more than 2/3 of lung volume)
By mechanism of formation:
- open
- closed
- tension
Pneumothorax
Tension pneumothorax

 Air enters pleural space and cannot escape


 P/C: chest pain, dyspnoea
 Dx: - respiratory distress
- tracheal deviation (away) -
absence of breath sounds -
distended neck veins -
hypotension
 Surgical emergency
 Rx: emergency decompression before CXR
 Either large bore cannula in 2nd ICS, MCL or
insert chest tube
 CXR to confirm site of insertion
Haemothorax

 Blunt or penetrating trauma


 Requires rapid decompression and fluid
resuscitation
 May require surgical intervention
 Clinically: hypovolaemia
absence of breath sounds dullness to percussion
 CXR may be confused with collapse
 Decompression always by chest catchment in 7
ICS on middle or posterior axillary line
Hemothorax classification
By side:
 left or right
 in both side
By blood lost volume :
 Small (< 10% of BCV, or <500 ml)
 Middle (10-20 % of BCV, or 500-1000ml)
 Big (10-20 % of BCV, or 1000-2000ml)
 Total ( > 40 % of BCV, or >2000ml)
Hemothorax classification

By bleeding presence:
- stopped (Reviloi – Gregoire test negative)
- continues (Reviloi – Gregoire test positive)
By clots presence:
- clotted
- unclotted
By infection complication presence:
- non-infected
- infected
Indication for urgent
thoracotomy
 In pneumothorax:
Absence of active air catchment during more than
2 days (presence of pneumothoraz on CXR)

 In hemothorax:
Evacuation of > 1000ml blood simultaneously or
bleeding continues during 4 hours with blood
loss > 200 ml per hour
Cardiac Tamponade

 Blood in the pericardial sac


 Most frequently penetrating injuries
 Shock, JVP, PEA, pulsus paradoxus
 Classically, Beck’s triad: -
distended neck veins -
muffled heart sounds -
hypotension
 Rx: Volume resuscitation
Pericardiocentesis
Cardiac
tamponade
ILUSTRASI KASUS
LAKI 28 TAHUN SOPIR TRUK TERTUSUK BESI SETELAH TRUKNYA MENABRAK
PANCANG BESI DARI TRUK DIDEPANNYA YANG BERISI BESI BANGUNAN .
SADAR , NGOROK , NADI 120 X / MENIT , NAFAS 40 X/MENIT
TEKANAN DARAH 80/60 MMHG.
TRAUMA

KEMATIAN CEPAT

Trauma ORGAN central

OTAK
PEMBULUH DARAH BESAR
JANTUNG
TERANCAM KEMATIAN

A
B
C
D

Ini harus bisa ditolong !!!!!


GANGGUAN JALAN NAFAS ??
KORBAN GELISAH DAN TERIAK .
TOLONG SAYA CEPAT, DADAKU SAKIIT …

DIAM , DADA TAK BERGERAK


SUARA NAFAS NGOROK
BERNAFAS DENGAN OTOT LEHER TEGANG
FIKSASI LEHER

 JAW THRUST
 CERVICAL COLLAR
LIHAT

Pupil ?
Test nafas !

Darah di mulut ?
Penekanan trakhea ?

Bersihkan
Intubasi
Crycothyroidotomi
Reposisi sternum
OKSIGEN 10 L / MENIT
NON REBREATHING MASK
MONITOR OXYMETRI / SAT OKSIGEN
GANGGUAN
PENGEMBANGAN PARU ??

 LIHAT
 RABA
 KETOK
 DENGAR
TRAUMA DADA ?
SESAK / FREKWENSI NAFAS CEPAT
 CARI

 JEJAS
 LUKA TEMBUS
 BENTUK DINDING DADA TAK SIMETRIS
 KREPITASI
 PERKUSI HIPERSONOR ATAU REDUP
 SUARA NAFAS HILANG /JAUH
 BUNYI JANTUNG HILANG
TUMPUL
 DADA SIMETRIS. VENA LEHER LEBAR
TRAKHEA TIDAK DITENGAH

SUARA NAFAS HILANG HIPERSONOR

TENSION
PNEUMOTORAK

PNEUMOTORAK

NEEDLE
TORAKOSENTESIS
WSD SELA IGA 2
SELA IGA 5
SUARA NAFAS REDUP HEMOTORAK
HILANG WSD

Infus 2 liter 1500 CC


Siapkan darah atau
tranfusi
3 CC / BB / JAM

STOP BLEEDING MASSIVE HEMOTORAK

( TORAKOTOMI )
DADA TAK SIMETRIS
(FLAIL CHEST )
PNEUMO / WSD
HEMOTORAK
???

OXYGEN
KONTUSIO PARU
BAGGING
OR VENTILATOR
EDEMA
LUKA TEMBUS

SUCKING WOUND
TEST CAIRAN PNEUMOTORAK
WSD &
TUTUP LUKA
HEMATO ?
DARURAT
Jahit tiga sisii
LUKA TEMBUS DADA KIRI
SUARA JANTUNG HILANG

LIHAT !!!
VENA LEHER LEBAR

TAMPONADE JANTUNG
PERICARDIOSENTESIS
EMFISEMA SUBCUTAN
TRAUMATIK ASPIKSIA
44

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