Professional Documents
Culture Documents
Michael Mulyono
Olivia Petrina
Adityo Baskoro
Dani Yudo
Classification
Penetrating Trauma
<20-30% memerlukan torakotomi
Blunt Trauma
<10% memerlukan torakotomi
Penetrating Trauma
Pneumothorax
Open
Closed (Simple and Tension)
Hematothorax
Hematopneumothorax
Vascular laceration
Tracheo-bronchial Rupture
Oesophagial Rupture
Cardiac penetrating wound
Tamponade
Diaphraghm Rupture
Blunt Trauma
Rib Fracture
Multiple Rib
Flail Chest
Visceral Damage
Pulmonary Contusion
Pneumothorax
Hematothorax
Traumatic Asphyxia
Major Death Cause
Airway Obstruction
Hypovolemia
Cardiac Tamponade
Tension Pneumothorax
Develops when a one-way valve air leak
occurs.
Air forced into the thoracic cavity without
means of escaping
Will cause:
Collapse of affected lung
Displaced mediastinum reduce VR
Compressing opposite lung
Clinical Manifestation
Dyspnea Diminished then absent
Tachypnea at first breath sounds on injured
Progressive side
ventilation/perfusion Cyanosis
mismatch
Atelectasis on uninjured side Diaphoresis
Hypoxemia JVD
Hyperinflation of injured side Hypotension
of chest Hypovolemia
Hyperresonance of injured
side of chest Tracheal Shifting
LATE SIGN
Management
Immediate
decompression
needle thoracostomy at
2nd intercostal space,
mid-clavicular line
Definitive treatment:
insertion of chest tube
into fifth intercostal
space, between the
anterior and midaxillary
line
Open Pneumothorax
Sucking chest wound
Large defects of the
chest wall causing
immediate
equilibration between
intrathoracic presure
and atmospheric
pressure
Involve defects of
more than two-thirds
the diameter of trachea
(Normal 1.0-1.5cm)
Management:
Closing defect with sterile
occlusive dressing and
taped on 3 sides
Open end of the dressing
allows air to escape
A chest tube should be
placed as soon as
possible
Definitive: surgical closure
of defect
Hematothorax
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
Blood loss in thorax causes a decrease in
tidal volume
Ventilation/Perfusion Mismatch & Shock
Typically accompanies pneumothorax
Hemopneumothorax
Management :
High flow O2
2 large bore IVs
Maintain SBP of 90-100
EVALUATE BREATH SOUNDS for fluid overload
Chest Tube Insertion
Consider thoracotomy
Clinical Manifestation
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension
Dull to percussion over injured side
Flail Chest
Occurs when a
segment of the chest
wall doesnt have bony
continuity with the rest
of the thoracic cage