300 likes | 514 Views
BEDAH THORAX KARDIOVASKULER. Dr.SOEBAGJO SpB.(K)TKV. S 1. Thoracic trauma. Dr.SUBAGJO SpB(K)TKV 2.Thoracic trauma 1 out of 4 deaths blunt < 10% require operation. - penetrating 15% - require operation majority require Simple procedures. BEDAH THORAX. BEDAH JANTUNG
E N D
BEDAH THORAX KARDIOVASKULER Dr.SOEBAGJO SpB.(K)TKV
S 1 Thoracic trauma Dr.SUBAGJO SpB(K)TKV 2.Thoracic trauma 1 out of 4 deaths blunt < 10% require operation. - penetrating 15% - require operation majority require Simple procedures
BEDAH THORAX • BEDAH JANTUNG • BEDAH NON JANTUNG / PARU
PEMERIKSAAN PRA BEDAH • FAAL PARU • BRONCHOSCOPY • BRONCHOGRAFI • CT SCAN • FOTO THORAX • FAAL HEPAR, GINJAL, HEMOSTASISD • FNA/TTB : TRANSTORAKAL BIOPSI
TRAUMA ANAMNESA PEMERIKSAAN FISIK - INSPEKSI - PALPASI - PERKUSI - AUSKULTASI PEMERIKSAN TAMBAHAN : FOTO X RAY
IDENTIFIKASI AWAL (PRIMARY SURVEY) • SUMBATAN AIRWAY • TENSION PNEUMOTHORAX • OPEN PNEUMOTHORAX • FLAIL CHEST • HEMOTHORAX MASIF • TAMPONADE JANTUNG
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 • 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 SURVEYPOTENTIALLY LETHAL CHEST TRAUMA • SIMPLE PNEUMOTHORAX • HEMOTHORAX • PULMONARY CONTUSION • TRACHEOBRONCHIAL TREE INJURIES • BLUNT CARDIAC INJURY • TRAUMATIC AORTIC DISRUPTION • TRAUMATIC DIAPHRAGMATIC INJURY • 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 WOUNDhemodinamically abnormal • exsanguinating thoracic hemorrhage • tension pneumothorax • Pericardial tamponade • Esophageal or tracheobronchial injury • Spinal cord injury hemodinamicallynormal - vascular: angiography • tracheobronchial: bronchoscopy • esophageal: esophagography,esophagoscopy • Treatment mandatory surgical consultation, repair identified injuries,
OTHERS TRAUMA TRAUMATIC ASPHYXIA • Ptechiae • Swelling • Plethora • Cerebral edema