S1

Thoracic trauma
Dr.SUBAGJO SpB(K)TKV

Thoracic trauma
- 1 out of 4 death -

blunt < 10 % require operation - penetrating 15%-30% require operation - majority require simple procedures

#$12! !23*(#S S.2&*4 3( 52!!(5-(4 $S -.(% $!( "4(/-"+"(4 - air6ay obstruction - tension pneumothora7 - open pneumothora7 - flail chest - massi8e hemothora7 - cardiac tamponade

$"!9$% 23S-!&5-"2/ laryngeal injury

- rare occurrence - hoarseness - subcutaneous emphysema - treatment : intubation

: tracheostomy

B-.AT/01G
1.

TENSION PNEUMOTORAX : Etiology arenchymal and)or chest-6all injury; $ir enters pleural space 6ith no e7it ositi8e pressure 8entilation - collapse of affected lung - decrease 8enous return - decrease 8entilation of opposite lung;

B-.AT/01G Te# io# p#eumothora2 i)#3 ,mptom - re pirator, di tre - Di te#ded #ec4 5ei# - U#i"atera" decrea e i# !reath ou#d - /,perre o#a#ce - 6,a#o i 7 "ate

3!($-."/0
-(/S"2/ /(&#2-.2!$< - immidiate decompression - 5linical diagnosis= not by < ray -herapy > nedlee decompression and chest tube after it has been inserted

3!($-."/0 ?;2pen pneumothora7 - co5er defect - 6he t tu!e - defi#iti5e operatio#

8. B-.AT/01G 9:A0: 6/.ST 3;U:<O1A-= 6O1TUS0O1 !ee7pand lung 27ygen 1udicous fluid management "ntubation as indicated analgesia

9:A0: 6/.ST
-erapi definitif

dituju@an pada pengembangan paru= o@sigenasi= cairan yang cu@up serta analgesia -e@anan o@sigen arterial dan @inerja pernafasan= penilaiannya menentu@an @apan diberi intubasi dan 8entilasi

4.60-6U:AT0O1 <ASS0V. /.<OT/O-A> ? A 1500 ml blood loss Systemic)pulmonary 8essel disruption +lat 8s distended nec@ 8eins Shoc@ 6ith no breath sound and)or percussion dullness

60-6U:AT0O1 <ASS0V. /.<OT/O-A> - rapid 8olume restoration - chest decompression and <-ray - autotransfusion - operati8e inter8ention

5"!5&*$-"2/ 5$!4"$5 -$# 2/$4( - decrease arterial pressure - distended nec@ 8eins - muffled heart sound ($ -.(!$ % , patent air6ay - i8 therapy - pericardiocentesis - pericardiostomy

S.6O1DA-= SU-V.= ;OT.1T0A::= :.T/A: 6/.ST T-AU<A

1; ?; 3; 4; 5; B; C; D;

S"# *( /(&#2-.2!$< .(#2-.2!$< &*#2/$!% 52/-&S"2/ -!$5.(23!2/5."$* -!(( "/1&!"(S 3*&/- 5$!4"$5 "/1&!% -!$&#$-"5 $2!-"5 4"S!& -"2/ -!$&#$-"5 4"$ .!$0#$-"5 "/1&!% #(4"$S-"/$* -!$/S'(!S"/0 92&/4S

1.S0<;:. ;1.U<OT/O-A> penetrating)blunt trauma - hyperresonance - decrease breath sounds - tube thoracostomy
-

2./.<OT/O-A> chest 6all injury - lung)8essel laceration - tube thoracostomy

-

8.;U:<O1A-= 6O1TUS0O1 #ost common 27ygenate 8entilate Selecti8e intubation

4.T-A6/.A: 01JU-=
+requently missed injury 3lunt)penetrating trauma

artial 8s complate 4iagnostic aid endoscopy -reatment : air6ay 8entilation : operation

*.B:U1T 6A-D0A6 01JU-=

"njury spectrum (50 changes> monitor change (chocardiography -ret dysrhytmiaa= E complications

@.AO-T06 -U;TU-.

!apid aceleration)deceleration *igamentum arteriosum Sal8age identify early Surgical consult <-ray> 6idened mediastinum=obliteration of the aortic @nob=depression of the left main stem bronchus=fractures of the first or second rib or scapula $ortogram; -herapy primer suture aorta ) resection and grafting

A.D0A;/-AG<AT06 -U;TU-. - most diagnosted on left - blunt = large tears - penetrating= small perforations - misinterpreted 7 ray Fele8ated diaphragm=acute gastric delatation= aloculated pneumothora7 - contras radiography -herapy direct closure

B.<.D0AST01A: T-A1SV.-S01G COU1D hemodi#amica"", a!#orma" e7sanguinating thoracic hemorrhage tension pneumothora7 ericardial tamponade (sophageal or tracheobronchial injury Spinal cord injury hemodi#amica"", #orma" - 8ascular> angiography - tracheobronchial> bronchoscopy - esophageal> esophagography=esophagoscopy - -reatment mandatory surgical consultation= repair identified injuries=

OT/.-S T-AU<A T-AU<AT06 AS;/=>0A techiae S6elling lethora 5erebral edema