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TRAUMA THORAXTRAUMA THORAX
INSPEKSI :INSPEKSI : JEJAS JEJAS HEMATOMEHEMATOME RESP.TERTINGGAL.RESP.TERTINGGAL.
PALPASI:PALPASI: NYERINYERI TERABA FRAKTUR IGA TERABA FRAKTUR IGA KREPITASI KULIT A TULANGKREPITASI KULIT A TULANG PERKUSI:PERKUSI: SONORSONOR HIPERSONORHIPERSONOR BEDAHBEDAH AUSKULTASIAUSKULTASI SUARA NAFASSUARA NAFAS SUARA CAIRANSUARA CAIRAN SUARA JANTUNGSUARA JANTUNG
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Diagram shows howDiagram shows howanan unrestrainedunrestrained
driver will sustaindriver will sustain injuries to the chestinjuries to the chest
and head in aand head in acollision withcollision with
frontal impact.frontal impact.
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Diagram showsDiagram shows
how a whiplashhow a whiplash
nec injur! cannec injur! can
occuroccur in a "ac#in a "ac#impact collisionimpact collision
in the a"sence ofin the a"sence of
a head restraint.a head restraint.
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Trauma Thorax
• 25 % multi-trauma
• 25 % kematian trauma• Perlu operasi : hanya ±10 %• Sisanya cukup tindakan
sederhana
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Anatomi
Tekanan -!
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Anatomi
"ila ca#um
pleura tekananmen$adi positi :
kolaps
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Trauma thorax :
&an'sun' men'ancam nya(a
temukan pada primary sur#ey )!
Potensial men'ancam nya(a
temukan pada secondary sur#ey!
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Trauma thorax yan'
men'ancam nya(a : Primary Sur#ey )!
1* +,struksi air(ay
2* +pen pneumotoraks
* Tension pneumotoraks
.* /lail hest kontusio paru
5* asi hematotoraks
3* Tamponade $antun'
Trauma thorax yan'
men'ancam nya(a : Primary Sur#ey )!
1* +,struksi air(ay
2* +pen pneumotoraks
* Tension pneumotoraks
.* /lail hest kontusio paru
5* asi hematotoraks
3* Tamponade $antun'
A
"
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Distres $afasDistres $afasai"at suplai osigen tidaai"at suplai osigen tida
cuupcuup
Frekwensi n!s "enin#k$Frekwensi n!s "enin#k$% & '( ) *n+r",- er,/ +ksi#en& '( ) *n+r",- er,/ +ksi#en
% & 0( ) ##, n!s- sikn n!s */$n& 0( ) ##, n!s- sikn n!s */$n
Gerk 1/in# 2i3/n# 45rin# n+s$ri,s6Gerk 1/in# 2i3/n# 45rin# n+s$ri,s6
Gerk +$+$ ,e2er 4$r12e, $/#6Gerk +$+$ ,e2er 4$r12e, $/#6
Gerk 4re$rksi6 +$+$ se, i#Gerk 4re$rksi6 +$+$ se, i#
Sin+sis 4$n3 ,"*$6Sin+sis 4$n3 ,"*$6
Tn37$n3 ,in : Tn37$n3 ,in :% n3i 1e$- $eknn 3r2 nik- ri$"in3i 1e$- $eknn 3r2 nik- ri$"i
%
#e,is2 $/ 1+"#e,is2 $/ 1+"
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Dis$resDis$res NN!s!s
Beri +ksi#en $in##i 4& 896Beri +ksi#en $in##i 4& 896
Be*skn ;,n n!sBe*skn ;,n n!s Bersi2kn ;,n n!sBersi2kn ;,n n!s
Beri n!s */$nBeri n!s */$n
A$si ne/"+$+rksA$si ne/"+$+rks
T%$DA&A$
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1* +,struksi Air(ay :
aniestasi :-'an''uan air(ay-
4 sesak
4 stridor
4 serak
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1* +,struksi Air(ay Tindakan :
• 6alan naas deiniti
intu,asi!• "ila deormitas $elas menekan :
tarik den'an 7doek-klem8
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2* +pen Pneumo-thorax
9dara pilih masuk
li(at lu,an'tahanan le,ih kecil!
an''uan#entilasi
Suckin' chest (ound
aniestasi : "reathin' )
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2* +pen Pneumo-thorax : Tindakan
Tutup ) Pipa toraks - ;S<
Tutup rapat
atau :
=asa sisi
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'$(UMOTORA&) T(R*U&A'$(UMOTORA&) T(R*U&A
L/k 3in3in# 33 *is $er*/k s"L/k 3in3in# 33 *is $er*/k s"
sek,i $/ *ersi!$ kn se#er sn# 3rin $+rks
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Se2e,i ,s$ik $iis
Di7,eis$er 0 sisin> J3i k$/* s$/ r2
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* Tension Pneumo-thorax
Pneumothorax Tension >
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+. Tension 'neumo#
thora,
Pne/"+$2+r? Tensi+n Pn.
Insp. : Ekspansi # simetris
Ausk. : Bs. Nafas satu sisi ↓
Perk. : Hipersonor satu sisi
Trakea terdorong
Vena leher distensi
!ok
aniestasi : "reathin' )
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* Tension Pneumo-thorax
Tindakan :
1*
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T($)%O$T($)%O$ '$(UMOTORA&)'$(UMOTORA&)
Ke#w$n >n# "en#n1" ;iwKe#w$n >n# "en#n1" ;iw Di#n+sis 3i$e#kkn se1r k,inisDi#n+sis 3i$e#kkn se1r k,inis
4$i3k "en/n##/ !+$+ sinr7@64$i3k "en/n##/ !+$+ sinr7@6 3is$res n!s3is$res n!s
n3i 1e$n3i 1e$
2i+$ensi2i+$ensi
en ,e2er 3is$ensien ,e2er 3is$ensi
$r12e $er3+r+n# ke sisi se2$$r12e $er3+r+n# ke sisi se2$ erk/si 2iers+n+r 3i sisi ski$erk/si 2iers+n+r 3i sisi ski$
#erk /3r "s/k#erk /3r "s/k ↓↓ 3i sisi ski$3i sisi ski$
s/r n!ss/r n!s ↓↓ 3i sisi ski$3i sisi ski$
-( A/A
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T($)%O$T($)%O$ '$(UMOTORA&)'$(UMOTORA&)
Se#er ,k/kn 3ek+"resi 3en#nSe#er ,k/kn 3ek+"resi 3en#n/nksi ;r/" *esr 4-86/nksi ;r/" *esr 4-86
P/nksi 3 se, i# ke 3/ 4ICS '6P/nksi 3 se, i# ke 3/ 4ICS '63 #ris $en#2 se,n#k 4"i33 #ris $en#2 se,n#k 4"i31,i1/,r ,ine61,i1/,r ,ine6
Drin $+rks 3isn# ses/32n>Drin $+rks 3isn# ses/32n>
'($A$-A$A$
P t k t i
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Pneumotoraks tension
Udara masuk rongga pleura dan tidak bisa keluar lagi
Setiap nafas akan memasukkan tambahan udara lagi
Tekanan rongga dada ↑ mediastinum tergeser, VR ↓ dan CO ↓
Terjadi distres nafas dan hipoksia
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* *
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Jarum, spuit ! "", air
Jarum # $ "m
ia pneu 0123 gelem"ung udara aan ia pneu 0123 gelem"ung udara aan
eluar.eluar.
ia pneu 0#23 air aan terhisap nafas e ia pneu 0#23 air aan terhisap nafas e
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%ater&sealed
drainage
"m ba'ah air
Untuk pneumotoraks
Bila ada hemotoraks
( )
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Di#n+n K- Kw+ J- Bi#$e,,+ LM. P$2+2>si+,+#> n3 "n#e"en$ +! $2e 5i, 12es$. Miner Anes$esi+, '999:07.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi
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D+r"n T. T2+r1i1 Tr/". F,i, 12es$: $2+2>si+,+#i1 ee1$s n3 in 1+n$r+,. Pr+#r" n3*s$r1$s +! $2e 0s$ In$ern$i+n, E3/1$i+n, n3 S1ien$i1 S>"+si/" +! $2e S+1ie$> +! Cri$i1,Cre Me3i1ine Jn/r> '8709- '99' Sn Die#+- C,i!+rni.
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T2is ,esi+n is 1,ini1, n3in#- T2is ,esi+n is 1,ini1, n3in#-
n3 resir$+r> 1+"r+"ise inn3 resir$+r> 1+"r+"ise in
5i, 12es$ is "+re $2e res/,$ +!5i, 12es$ is "+re $2e res/,$ +!/n3er,>in# /,"+nr> 1+n$/si+n/n3er,>in# /,"+nr> 1+n$/si+n
n3n3 en$i,$i+n er!/si+nen$i,$i+n er!/si+n
"is"$12"is"$12 $2n $2e 1$/,$2n $2e 1$/,s$r/1$/r, 3e!e1$ $+ $2e 12es$s$r/1$/r, 3e!e1$ $+ $2e 12es$
w,,.w,,.D+r"n T. T2+r1i1 Tr/". F,i, 12es$: $2+2>si+,+#i1 ee1$s n3 in 1+n$r+,. Pr+#r" n3*s$r1$s +! $2e 0s$ In$ern$i+n, E3/1$i+n, n3 S1ien$i1 S>"+si/" +! $2e S+1ie$> +! Cri$i1,Cre Me3i1ine Jn/r> '8709- '99' Sn Die#+- C,i!+rni.
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se#"en$, !r1$/rese#"en$, !r1$/re +! $2e ri*+! $2e ri*
4 ri"4 ri"
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se#"en$, !r1$/rese#"en$, !r1$/re +! $2e ri*+! $2e ri*
+ ri"+ ri"
freefree
6oating6oating
ri"ri"
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.* /lail hest =ontusio Paru
Pernaasan paradoksal?nspirasi @kspirasi
aniestasi : "reathin' )
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.* /lail hest =ontusio Paru
an' le,ih pentin' : =ontusio Paru-nya
=arena itu : onitor A - "
• 6a'a Air(ay• onitor p+2 dan p+2• +2 100%• Bentilasi tam,ahan
,ila diperlukan 4 "a''in'
4 Cespirator
7/A%/ 8H()T7/A%/ 8H()T
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7/A%/ 8H()T7/A%/ 8H()T
Kren $2 $/,n# i# & Kren $2 $/,n# i# &
en$i,sien$i,si ↓↓ kren :kren :% n>erin>eri% #n##/n "eknik n!s#n##/n "eknik n!s%
k+n$/si+ r/k+n$/si+ r/
Beri +ksi#en 4;ik 36Beri +ksi#en 4;ik 36
Beri n,#esi >n# 1/k/Beri n,#esi >n# 1/k/
K/rn#i #erk i# >n# $2:K/rn#i #erk i# >n# $2:% kssi ,eis$er ,e*rkssi ,eis$er ,e*r
% in$/*si $r12e 3n n!s */$n 'in$/*si $r12e 3n n!s */$n '
"in##/"in##/
TINDAKAN
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7lail 8hest
Fikssi ,eis$er ,e*r7 Men#/rn#i #erk r3+ks, >n#"en##n##/ en$i,si7 Men#/rn#i n>eri
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5* assi#e Dematothorax
"ila E 1500 cc
initial!
"ila E 200 ccF$am
aniestasi : -"reathin'-irculation
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5* assi#e Dematothorax
Tindakan :
• hest Tu,e• "ila massi#e : torakotomi
3 Tamponade 6antun'
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3* Tamponade 6antun'
1*
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3* Tamponade 6antun' : Tindakan
Percardiocentesis
• pasan' @=• darah tidak ,eku )
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Potensial men'ancam nya(a
temukan pada secondary sur#ey!
Serin' :"/raktur ?'a
"Pneumothorax simple"Demothorax ,ukan masi!"=ontusio paru
6aran' :
"Co,ekan pem,uluh darah ,esar "Co,ekan trakea ,ronkus"Co,ekan esoa'us"
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/raktur ?'a/raktur ?'a ::
"atu $e$erapa iga% $iasan!a
tidak $er$aha!a"Ber$aha!a $ila :
& Pada orang usia lan'ut(pneumonia)
& Bila disertai kontusio paru"Tidak memerlukan tindakan
(seperti plester dll)"Bila sangat n!eri inter*ostal
$lo*k
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Pneumothorax sederhana
Tertutup
•Trauma non trauma•Bila trauma sering ada
fraktur Iga
Ter$uka
•Trauma ta'am tumpul
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Pneumothorax sederhana
• mungkin sesak
tidak sesak• terdeteksi pada
pem.fisik dan +"toraks• tidak semua perlu
pemasangan ,-/
H
H
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Bila akan dilakukan tekanan positif :
selalu pasang pipa toraks
Pneumothorax
sederhana
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Demothorax ,ukan masi!
• Terdeteksi pada pem*isik F H-toraks• Tidak semua perlu pipa toraks
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&ontusio 'aru&ontusio 'aru
Bentilasi tam,ahan :
Ter'antun' keadaan-"reathin'-
-p+2
-p+2
R T * R t T *
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Ruptur Traea 9 *ronusRuptur Traea 9 *ronus
"ila lu,an' ,esar :• presentasi pada
primary sur#ey
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Ruptur AortaRuptur Aorta
Bila ruptur $e$as mati
Bila masih tertahan T.ad0entitia :
• e1aktu"1aktu $isa mati• Tanda"tanda lain :
" s!ok
" + toraks : mediastinum le$ar
" + toraks : fraktur 2 kosta atas
" tanda lain pada + toraks
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Traumatic Asphyxia
• "iasanya
tidak
,er,ahaya
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