TRAUMA THORAX &

ABDOMEN

RSUP SANGLAH DENPASAR

 PRINSIP

 AIRWAY

 BREATHING

 CIRCULATION
 Thoracic Trauma

 1 out of 4 deaths
 Blunt : < 10% require operation
 Penetrating : 15% - 30% require
operation
 Majority : require simple procedures
ANATOMI
 Initial Assessment /
Management

Primary Survey
 Identifies most life-threatening

injuries
Resuscitation
 Airway control

 Ensure oxygenation / ventilation

 Needle / tube thoracostomy

Open Pneumothorax
 Breathing
Open Pneumothorax

 Cover defect
 Chest tube
 Definitive operation
 TENSION PNEUMOTHORAX

 Berkembang bila
terjadi fenomena
ventil akibat
kebocoran udara
dari paru
 Breathing

Tension pneumothorax :
Etiology
 Air enters pleural space with no
exit
 Positive pressure ventilation
• Collapse of affected lung
 Parenchymal and / or chest-wall
injuries
• ↓ Venous return
• ↓ Ventilation of opposite lung
TENSION PNEUMOTHORAX
 Breathing
Tension Pneumothorax :
Signs / Symptoms
 Respiratory distress
 Distended neck veins
 Unilateral ↓in breath sounds
 Hyperresonance
 Cyanosis, late
 Breathing

Tension
Pneumothorax
 Immediate
decompression
 Clinical diagnosis,
not by x-ray
 FLAIL CHEST

Tulang iga patah pada dua tempat,

lebih dari dua iga
FLAIL CHEST
FLAIL CHEST
 Circulation

Massive Hemothorax
 ≥ 1500 ml blood loss
 Systemic / pulmonary vessel
disruption
 Flat vs distended neck veins
 Shock with no breath sounds and
/or percussion dullness
TAMPONADE JANTUNG
 Circulation

Cardiac Tamponade
 ↓Arterial pressure
 Distended neck veins
 Muffled heart
sounds

 Circulation
Cardiac Tamponade
 Patent airway
 IV therapy
 Pericardiocentesis
 Pericardiotomy
BEBERAPA KEADAAN YANG
DAPAT DIKENALI PADA SURVEY
SEKUNDER
1.FRAKTUR IGA
2.KONTUSIO PARU
3.KEADAAN LAIN SEPERTI : RUPTUR
AORTA, RUPTUR DIAFRAGMA,
PERFORASI ESOFAGUS DLL
Questions
TRAUMA ABDOMEN
 Anatomy

External
 Anterior abdomen
 Flank
 Back
 Anatomi

DEPAN BELAKANG
Anatomy
 Organ yang sering cedera :
 Hati 40%
 Usus halus 30%
 Diafragma 20%
 Usus besar 15%
Assessment : Physical Exam
 Primary survey : A
B
C
Assessment : Physical Exam

 Inspection
 Auscultation

 Percussion

 Palpation
Assessment : Physical Exam

 Auscultation
 Percussion

 Palpation
Questions