Professional Documents
Culture Documents
Trauma tumpul
• Pada trauma tumpul tidak terjadi diskontinuitas dinding toraks. Penyebabnya antara lain
kecelakaan lalu lintas, terjatuh, cedera olahraga, dsb. Kelainan tersering akibat trauma
tumpul toraks adalah kontusio paru.
Contoh kasus
Patomekanisme
Akselerasi
• Gaya perusak berbanding lurus dengan masa dan
percepatan (Hukum Newton II). Kerusakan yang terjadi
bergantung juga pada luas jaringan tubuh yang menerima
gaya perusak dari trauma tersebut.
Deselerasi
• Kerusakan yang terjadi oleh karena pada saat trauma
organ-organ dalam keadaan masih bergerak dan gaya
yang merusak terjadi akibat tumbukan pada dinding
thoraks dan/atau organ tubuh lainnya atau karena
tarikan dari jaringan pengikat organ tersebut
Patomekanisme
Torsio dan rotasi
• Gaya torsi dan rotasi yang terjadi umumnya diakibatkan oleh
adanya deselerasi organ-organ dalam yang sebagian strukturnya
memiliki jaringan pengikat/terfiksasi.
Blast injury
• Kerusakan jaringan terjadi tanpa adanya kontak langsung dengan
penyebab trauma, sebagai contoh ledakan kendaraan saat terjadi
kecelakaan lalu lintas. Gaya merusak diterima oleh tubuh melalui
penghantaran gelombang energi.
Patofisiologi
Kematian sel
Hipoksia
Hiperkarbia
Asidosis
Kegagalan ventilasi
Kegagalan pertukaran gas
Kegagalan sirkulasi
Kelainan akibat trauma thoraks
• Trauma pada dinding thoraks dan paru
• Trauma pada aorta dan jantung
Trauma pada dinding thoraks dan paru
a. Fraktur iga
b. Flail chest
c. Ruptur Diafragma
d. Kontusio paru
e. Pneumothoraks
f. Open pneumothoraks
g. Tension pneumothoraks
h. Hemothoraks
i. Hematothoraks massif
j. Cedera trakea dan bronkus
Trauma pada aorta dan jantung
• Temponade jantung
• Kontusio miokard
• Diseksi aorta
Penatalaksanaan
• Management principles of general trauma management
(primary survey - secondary survey)
• Management of chest trauma can be divided into three distinct levels of
care;
a. pre-hospital trauma life support
b. in-hospital or emergency room trauma life support
c. surgical trauma life support
Prehospital trauma life
support
• Assessment of breathing and clinical examination of the thorax (respiratory
movements and quality of respiration) are necessary to recognize major thoracic
injuries such as tension pneumothorax, open pneumothorax, flail chest, pulmonary
contusion and massive haemothorax.
• Inspection, palpation, percussion and especially auscultation (sensitivity
90%, specificity 98%) will provide information as to whether a tension
pneumothorax is present.
• Clinical diagnosis of tension pneumothorax, may require immediate intervention, by
initial needle decompression of the pleura space.
Emergency room trauma life support
• Repetition of clinical examination in primary survey together with anamnestic information
on the mechanism of thoracic trauma will provide information on potential severity of
thoracic injury.
• When the extent of trauma cannot be defined it is recommend to perform
contrast-enhanced CT scan. As the sensitivity of a chest X-ray in the emergency room is
only 58.3%.
• Thoracic ultrasound examination is valid when CT scan is not necessary, in comparison with
chest X-ray it shows equivalent sensitivity and specificity for diagnosis of pneumothorax.
Ultrasonography in the emergency room is also a reliable method to exclude
pleural/pericardial effusion.
Primary survey
• As in all trauma patients, the primary survey of patients with thoracic injuries
begins with the airway, followed by breathing and then circulation.
• AIRWAY PROBLEMS
• BREATHING PROBLEMS
• CIRCULATION PROBLEMS
Airway
Primary • Airway obstruction
Survey • Tracheobranchial tree injury
Breathing
• Tension pneumothorax
• Open pneumothorax
• Massive hemothorax
Circulation
• Massive hemothorax
• Cardiac tamponade
Primary survey immediately life threatening injuries should be exclude or treated such as :
• Airway obstruction
Airway obstruction results from swelling, bleeding, or vomitus that is aspirated into the airway,
interfering with gas exchange.
• Tension pneumothorax
Tension pneumothorax develops when a “one-way valve” air leak occurs from the lung or
through the chest wall
Tension pneumothorax
• Pain
• Difculty breathing
• Tachypnea
• Decreased breath sounds on the
affected side
• Noisy movement of air through the
chest wall injury
Massive hematothorax
• Massive hemothorax results from the rapid
accumulation of more than 1500 mL of
blood or one third or more of the patient’s
blood volume in the chest
cavity
• Based on the rate of continuing blood loss
(200mL/hr for 2 to 4 haours)
Massive hematothorax
Massive hemothorax is initially managed by :