Professional Documents
Culture Documents
BEDAH TKV
3 Day Program
1st day
Diskusi materi dasar BTKV & Emergency
Mencari kasus yg menarik di ruangan lapor
residen/konsulen & buat status
2nd
Melanjutkan diskusi
Diskusi kasus / kalo tidak ada kasus, pakai metode
phantom
Visite (bed side teaching)
3rd
Melanjutkan diskusi utk menambah nilai jika diperlukan
Membahas kasus BTKV yang menarik (bahan dari
konsultan, residen atau co ass)
Penilaian
Selama diskusi penilaian
kemampuan kognitif & sikap, sesuai
formulir mini
Visite (bed side teaching)
penilaian ketrampilan & sikap,
sesuai formulir mini
Keaktifan dalam diskusi
Penulisan laporan kasus (kelompok)
ABC
LLF
Diagnostic cepat & tepat
Penatalaksanaan tepat
1.
2.
3.
4.
Life saving
Definitive
Pemeriksaan penunjang
Merujuk
2. Breathing
L: tanda2 sesak, DVJ, gerakan dada paradoksal &
tertinggal
L: SD, ST
F: Perkusi !!
3. Circulation
L: anemis, cyanosis, DVJ
L: SJ, SJ menjauh
F: akral dingin, CRT, nadi, tekanan darah
Pathophysiology of Trauma
Blunt Trauma
Results from kinetic energy forces
Subdivision Mechanisms
Blast
Crush (Compression)
Deceleration
Age Factors
Pathophysiology of Trauma
Penetrating Trauma
Low Energy
Arrows, knives, handguns
Injury caused by direct contact and cavitation
High Energy
Military, hunting rifles & high powered hand guns
Extensive injury due to high pressure cavitation
Tracheobronchial
tree lacerations
(rupture)
Esophageal
lacerations
Penetrating cardiac
injuries
Pericardial
tamponade
Spinal cord injuries
Diaphragm trauma
Intra-abdominal
trauma associated
organ injury
Airway obstruction
Clinical finding
Shortness of breath (dyspnea)
Stridor
Apnea
Management
Chin lift
Jaw thrust
Triple finger manuever
Evacuate foreign body
Hemlich manuver
ET insertion
Cricothyroidostomy
Tracheostomy
DONT FORGET
CERVICAL SPINE
CONTROL !!!!
Tension Pneumothorax
Build up of air under
pressure in the
thorax.
Excessive pressure
reduces effectiveness
of respiration
Air is unable to
escape from inside
the pleural space
Progression of Simple
or Open
Pneumothorax
Tension Pneumothorax
(simplify)
Treatment :
Needle thoracocentesis
Consult : chest tube insertion
Hemothorax
Hemothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500 mL
of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
MASSIVE (criteria)
Hemothorax
Blunt or penetrating
chest trauma
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension
(simplify)
Flail chest
Multiple rib fractures produce a mobile
fragment which moves paradoxically
with respiration
Significant force required
Usually diagnosed clinically
Treatment
ABC
Analgesia
Fixation : internal &/ external
Tracheobronchial Injury
MOI
Blunt trauma
Penetrating trauma
Dyspnea
Cyanosis
Hemoptysis
Massive subcutaneous emphysema
Suspect/Evaluate for other closed chest trauma
Tracheobronchial Injury
Observe for development of
Subcutaneus emphysema &
tension pneumothorax (deadly)
Treatment
Keep airway clear
Administer high flow O2
Consider intubation if unable to
maintain patient airway
If tension needle
thoracocentesis
Consult : tracheal repair or
tracheostomy
Pericardial Tamponade
Restriction to cardiac filling caused by blood or
other fluid within the pericardium
Occurs in <2% of all serious chest trauma
However, very high mortality
Pericardial Tamponade
Dyspnea
Possible cyanosis
Becks Triad
DVJ
Distant heart tones
Hypotension or
narrowing pulse
pressure
Weak, thready pulse
Shock
(simplify)
Kussmauls sign
Decrease or
absence of JVD
during inspiration
Pulsus Paradoxus
Drop in SBP >10
during inspiration
Due to increase in
CO2 during
inspiration
Electrical Alterans
P, QRS, & T
amplitude changes
in every other
Pericardial Tamponade
(ilustrasi)
Laceration of vascular
structures
General sign
Hypovolemia & shock
Penetrating trauma
Internal bleeding
Thoracic Chest XR
Abdominal FAST or CT
Pelvicum CXR
Femur expanding hematoma + XR
Laceration of vascular
structures
Internal bleeding consult
External bleeding