Dr.SOEBAGJO SpB.

(K)TKV
S1

Thoracic trauma
Dr.SUBAGJO SpB(K)TKV
 BEDAH THORAX
BEDAH JANTUNG
BEDAH NON JANTUNG / PARU
 PEMERIKSAAN PRA BEDAH
1. FAAL PARU
2. BRONCHOSCOPY
3. BRONCHOGRAFI
4. CT SCAN
5. FOTO THORAX
6. FAAL HEPAR, GINJAL,
HEMOSTASISD
7. FNA/TTB : TRANSTORAKAL BIOPSI
 TRAUMA
ANAMNESA
PEMERIKSAAN FISIK
- INSPEKSI
- PALPASI
- PERKUSI
- AUSKULTASI
PEMERIKSAN TAMBAHAN
: FOTO X RAY
 IDENTIFIKASI AWAL
(PRIMARY SURVEY)

1. SUMBATAN AIRWAY
2. TENSION PNEUMOTHORAX
3. OPEN PNEUMOTHORAX
4. FLAIL CHEST
5. HEMOTHORAX MASIF
6. TAMPONADE JANTUNG
Ilustrasi
 Thoracic trauma
- 1 out of 4 death
- blunt < 10 % require operation
- penetrating 15%-30% require operation
- majority require simple procedures
 PRIMARY SURVEY/LIFE
THREATENING INJURIES
MAJOR PROBLEMS SHOULD BE
CORRECTED AS THEY ARE IDENTIFIED
- airway obstruction
- tension pneumothorax
- open pneumothorax
- flail chest
- massive hemothorax
- cardiac tamponade
 AIRWAY OBSTRUCTION
laryngeal injury
- rare occurrence
- hoarseness
- subcutaneous emphysema
- treatment * intubation

* tracheostomy
 BREATHING

1. TENSION PNEUMOTORAX :
Etiology
Parenchymal and/or chest-wall injury.
Air enters pleural space with no exit
Positive pressure ventilation
- collapse of affected lung
- decrease venous return
- decrease ventilation of opposite lung.
BREATHING

Tension pneumothorax sign/symptoms

- respiratory distress
- Distended neck veins
- Unilateral decrease in breath sounds
- Hyperresonance
- Cyanosis, late
 BREATHING
TENSION PNEUMOTHORAX
- immidiate decompression
- Clinical diagnosis, not by X ray
Therapy : nedlee decompression and chest
tube after it has been inserted
BREATHING

2.Open pneumothorax
- cover defect
- Chest tube
- definitive operation
3. BREATHING
FLAIL CHEST /PULMONARY CONTUSION
Reexpand lung
Oxygen
Judicous fluid management
Intubation as indicated
analgesia
FLAIL CHEST

Terapi definitif
ditujukan pada
pengembangan paru, oksigenasi, cairan
yang cukup serta analgesia
Tekanan oksigen arterial dan kinerja
pernafasan, penilaiannya menentukan
kapan diberi intubasi dan ventilasi
4.CIRCULATION
MASSIVE HEMOTHORAX :
> 1500 ml blood loss
Systemic/pulmonary vessel disruption
Flat vs distended neck veins
Shock with no breath sound and/or
percussion dullness
CIRCULATION
MASSIVE HEMOTHORAX
- rapid volume restoration
- chest decompression and X-ray
- autotransfusion
- operative intervention

:
CIRCULATION
CARDIAC TAMPONADE
- decrease arterial pressure
- distended neck veins
- muffled heart sound
- PEA
THERAPY patent airway
- iv therapy
- pericardiocentesis
- pericardiostomy
 SECONDARY SURVEY
POTENTIALLY LETHAL CHEST
TRAUMA
1. SIMPLE PNEUMOTHORAX
2. HEMOTHORAX
3. PULMONARY CONTUSION
4. TRACHEOBRONCHIAL TREE INJURIES
5. BLUNT CARDIAC INJURY
6. TRAUMATIC AORTIC DISRUPTION
7. TRAUMATIC DIAPHRAGMATIC INJURY
8. MEDIASTINAL TRANSVERSING WOUNDS
 1.SIMPLE PNEUMOTHORAX
- penetrating/blunt trauma
- hyperresonance
- decrease breath sounds
- tube thoracostomy
 2.HEMOTHORAX

- chest wall injury

- lung/vessel laceration
- tube thoracostomy
 3.PULMONARY CONTUSION
Most common
Oxygenate ventilate
Selective intubation
 4.TRACHEAL INJURY

Frequently missed injury

Blunt/penetrating trauma
Partial vs complate
Diagnostic aid endoscopy
Treatment * airway ventilation

* operation
 5.BLUNT CARDIAC INJURY
Injury spectrum
ECG changes: monitor change
Echocardiography
Tret dysrhytmiaa, Q complications
 6.AORTIC RUPTURE
Rapid aceleration/deceleration
Ligamentum arteriosum
Salvage identify early
Surgical consult
X-ray: widened mediastinum,obliteration of the aortic
knob,depression of the left main stem bronchus,fractures
of the first or second rib or scapula
Aortogram.
Therapy primer suture aorta / resection and grafting
 7.DIAPHRAGMATIC RUPTURE

- most diagnosted on left

- blunt , large tears
- penetrating, small perforations
- misinterpreted x ray (elevated
diaphragm,acute gastric delatation,
aloculated pneumothorax
- contras radiography
Therapy direct closure
 8.MEDIASTINAL TRANSVERSING WOUND
hemodinamically abnormal
exsanguinating thoracic hemorrhage
tension pneumothorax
Pericardial tamponade
Esophageal or tracheobronchial injury
Spinal cord injury

hemodinamically normal
- vascular: angiography
- tracheobronchial: bronchoscopy
- esophageal: esophagography,esophagoscopy
- Treatment mandatory surgical consultation, repair
identified injuries,
 OTHERS TRAUMA
TRAUMATIC ASPHYXIA
Ptechiae
Swelling
Plethora
Cerebral edema