Professional Documents
Culture Documents
Curiculum vitae
Dr. Andreas Andri L, SpB, SpB.TKV, FInaCS, FIHA, FICS
Spesialis Bedah Umum, Konsultan Bedah Toraks Kardiovaskuler Rumah
Sakit Awal Bross Bekasi
Fakultas Kedokteran UNAIR 1984
PPDS-1 Bedah Umum FK UNAIR 2004
PPDS-2 Bedah TKV FK UI 2008
ATLS, DSTC, ACLS, TOT ATLS,
Clinical Teaching UI, OSCE UPH,
USG FAST, USG Vaskuler Singapore, USG Collour Duplex
Thoracoscophy Course Hongkong
hipoksia---
Rangsangan
Cytokines
-ARDS
-SIRS
-MOF
TRAUMA TORAKS
Trauma tumpul
Trauma tembus :
Luka tembak
Luka tusuk
Terjatuh pada benda
tajam
TRAUMA TORAKS
ANATOMI
Silinder
berongga
dengan 12
pasang kosta
Paru-paru :
lobus kanan &
kiri
Pleura
parietal &
viseral
Mediastinum
PEMERIKSAAN FISIK
Inspeksi : Jejas ?
Perkusi : ?
FLAIL CHEST
Penyebab :
tumbukan pada
sternum atau sisi
lateral dada
Fraktur lebih satu kosta (minimal dua) berturut-turut pada dua tempat
atau lebih pada masing-masing kosta
Flail Chest
Tahanan kedalam
Analgetik
Ventilasi
Penatalaksanaan
Bedah
TORAKO-ABDOMINAL
trauma tembus di bawah nipple
Kematian lebih banyak karena cedera intra abdomen
Approach bergantung pada perkiraan sumber
perdarahan utama:
Hepar/Lien Laparotomi
Jantung /bronchus/paru-paru Torakotomi
Diagnostik Laparoskopi vs
Torakoskopi
Bangun dong !
Cedera Impalement
Benda asing yang
menembus bagian
tubuh dan tetap berada
di tempatnya
Oleh karena ada efek
Tamponade-like effects,
ekstraksi benda asing
HARUS dalam narkose
dan a vue
OPEN PNEUMOTHORAKS
DIAGNOSIS
OPEN PNEUMOTORAKS
PENANGANAN
OPEN PNEUMOTORAKS
Efek
Flutter Type valve
PENANGANAN
OPEN PNEUMOTORAKS
PLESTER TIGA
SISI
Efek FLUTTER
TYPE VALVE
Pasang selang
dada
TENSION PNEUMOTORAKS
Akumulasi udara
sistim seperti
katup
Paru kolaps
mendorong
mediastinum
kesisi yang
berlawanan
DIAGNOSIS
TENSION PNEUMOTORAKS
PENANGANAN
TENSION PNEUMOTORAKS
NEEDLE
TORAKOSINTESIS
Tension
Pneumotoraks
Pneumotoraks
Sederhana
(3 of 5)
Needle thoracostomy
HEMOTORAKS MASSIVE
DIAGNOSIS
HEMOTORAKS MASSIVE
PENANGANAN
HEMOTORAKS MASSIVE
Atasi syok
TORAKOTOMI
Background: Traumatic hemothorax without early adequate evacuation of intrathoracic blood often results in
prolonged hospitalization and severe complications such as empyema and fibrothorax. The efficacy of video-assisted
thoracoscopic surgery (VATS) applied on this disease entity was studied. Methods: Chest trauma patients who
developed retained clotted hemothoraces after initial management with chest intubation were prospectively randomized
to treatment with either traditional posterolateral thoracotomy (group 1, n=9) or video-assisted thoracoscopic surgery
(group 2, n=9). In group 1 patients, the goal of operative procedure was to evacuate blood clots, with the thoracotomy
wound being less extensive as possible. Duration of chest tube drainage, total amount of tube drainage, hospital stay
and estimated costs of both groups were studied. Results: Patients in group 2 had shorter duration of postoperative tube
drainage (3.440.68 versus 5.671.53 days; p<0.001), shorter hospital days after the procedure (4.561.06 versus
9.112.64 days; p<0.001), and shorter total hospital stay (8.561.83 versus 15.223.58 days; p<0.001) compared
to group 1 patients. Hospital costs were also less in group 2 (NT$ 51,55616,561 versus 78,65614,105; p<0.001).
There were no mortalities in either group of patients. No conversion to thoracotomy procedure was needed in group 2
patients.
Conclusion: VATS performed early on patients who failed the initial chest intubation to treat traumatic
retained clotted hemothoraces significantly decreases the expected time of tube drainage, the length of hospital stay,
and total hospital cost. Thoracotomy itself, relatively time wasting and labor consuming, could be reserved as a second
choice in case there are contraindications to VATS procedure.
Key words: chest trauma, clotted hemothorax, video-assisted thoracic surgery (VATS)RAKOTOMI
TAMPONADE JANTUNG
Jantung diselimuti
oleh membran
fibrosa yang kuat,
fleksibel tetapi
tidak elastis yang
disebut PERIKARD
TAMPONADE JANTUNG
Jantung diselimuti oleh
membran fibrosa yang
kuat, fleksibel tetapi
tidak elastis yang
disebut Perikard
Anatomi Prekordial
kranial oleh sela iga III kiri
kaudal oleh arkus kosta kiri
lateral oleh garis
midklavikula kiri
medial oleh garis
parasternal kanan
Mungkin tidak
bergejala
cidera dada dan syok.
Indikasi
PERIKARDIOSINTESIS
bila penderita dalam
keadaan syok
hemoragik tidak
memberikan respon
pada resusitasi cairan
Tamponade Jantung
Trias Beck hanya 20% (bunyi jantung , distensi vena
jugularis, hipotensi), Jangan menunggu sampai semua
tanda muncul (pericard robek, otot ventrikel tebal)
Agitasi, takikardia, takipneu, diaforesis, akral dingin
PRINSIP : setiap luka tusuk di area prekordial harus
dianggap menembus jantung sampai terbukti tidak!!!
TORAKOTOMI URGENT
beberapa jam pasca trauma
Tamponade jantung
Hematotoraks masif
Kebocoran udara persisten
Endpoints of Resusciation
Stable hemodynamics
No hypoxemia, no hypercapnia
Lactate < 2 mmol/ L
Normal coagulation
Normothermia
Urinary output > 1 mL/kg/hour
No need for vasoactive or inotropic
stimulation
SUMMARY
Nn. Wwk// 20 th
Nn. Wwk// 20 th
`
Dx masuk :
Pneumothorax bilateral + Tension
Pneumothorax S + Emfisema Subkutis Luas
CF. Costa 2,5,6,7,8,9 (S) posterior