LAPORAN DISKUSI TUTORIAL

MODUL 4 SKENARIO 1
“Holidays Are So Disastrous”

Pembimbing
dr. Nabil Hajar, M.Biomed
Disusun Oleh:
Kelompok 4 Blok 19
Pertemuan I:
Moderator : Yassir Amrina Rosyada (H2A019045)
Sekretaris : Fisabili Firdaus (H2A019037)
                                  Pertemuan II:
Moderator :
                  Sekretaris            :

Anggota:
1. Ulfa Wahyuningsih (H2A019033)
2. Ricko Dien Ariwangsa (H2A019034)
3. Fathia Farhani (H2A019036)
4. Fisabili Firdaus (H2A019037)
5. Zata Amani Fahdina Putri    (H2A019041)
6. As’ari Fadlil Kholik (H2A019042)
7. Putri Nabilah Rochmaningrum (H2A019043)
8. Hasna Nabiilal Nur Aini (H2A019044)
9. Yassir Amrina Rosyada (H2A019045)

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SEMARANG
2021/2022
 Mr. AC aged 30 years came to the ER accompanied by his family with the main
complaint of severe shortness of breath. Thirty minutes ago Mr. AC fell for a moment about to
land with a parachute. The patient fell on the rocky ground with his right chest hit by a pile of
rocks, a height of about 100m. On primary survey examination, the airway was clear, breathing:
RR 16x/minute, regular, adequate depth, tracheal deviation (-), bruises on the right chest 3 cm
below the mammary papilla, asymmetrical chest movements, hyperresonant percussion, absent
lung sounds. on the right hemithorax. Circulation: pulse 70x/minute, lifting strength, regular,
blood pressure 140/80 mmHg, cyanosis (-), warm extremities. Disability: GCS E3M5V5, direct
indirect pupillary reflex (+), lateralization (-). Exposure: bruises on the right chest, right forearm
and abrasions on the extremities. Doctors perform initial treatment and a chest X-ray
examination. Based on the results of the physical examination and x-rays, the doctor
recommends action.

Step 1
1. Tracheal deviation : trachea is pushed to one side of the body due to abnormal
pressure inside the chest cavity
2. Primary survey : Is a quick way to find out how to treat any life threatening
conditions a casualty may have in order of priority
 3. Airway : examination related to the smoothness of the airway,
which includes examination of the airway which can be caused by foreign bodies, facial
bone fractures, fractures of the mandible or maxilla, fractures of the larynx or trachea.
4. Cyanosis : characterized by a blueish discoloration of the skin or mucous
membranes, is a condition when the fingers, nails, and lips appear bluish in color due to a
lack of oxygen in the blood
5. Respiratory rate : Respiratory rate, is a fundamental vital sign that is sensitive to
different pathological conditions.
6. GCS : Glasgow Coma Scale. is an awareness level checking tool that is
often used and used as a gold standard when validating a new comma scale.
7. Hyperresonant : An exaggerated chest resonance heard in various abnormal
pulmonary conditions and suggests too much air around your lungs or in the lung tissue
itself.
Step 2
1. Why patient percussion hyperresonant ?
2. What cause the basic lung sound disappear ?
3. Why tracheal deviation can be happened ?
4. What are the disease can be caused by thoracic trauma ?
5. What the diagnosis for the case ?
Step 3
1. Why patient percussion hyperresonant ?
Percussion is tapping on a surface to find out the structure underneath. Taps on
the chest wall are transmitted to the underlying tissue, reflected back, and sensed by the
examiner's tactile senses (in the form of vibrations) and hearing. Percussion can help
determine the structure of the underlying tissue whether it is filled with air, fluid, or solid
objects. The audible sounds and the perceived tactile sensations depend on the air-tissue
ratio. Vibrations generated by percussion can only assess lung tissue as deep as 5-6 cm.
Percussion results of hyperresonant patients due to reduced lung percussion
density. The characteristics of hyperresonance are, louder intensity, lower pitch, long
duration, and resonating close to the tympanic sound. Hyperresonant percussion is
usually found in patients with emphysema, asthma, and pneumothorax.
2. What cause the basic lung sound disappear ?
This is due to damage that causes air to enter the pleural cavity and the air cannot
get out, this condition is called the ventilal phenomenon (one-way-valve). As a result of
trapped air in the pleural cavity causing intrapleural pressure to increase resulting in
collapse of the lungs, to shift the mediastinum to the contralateral lung, suppression of
venous return resulting in hypoxia. As a result of the air entering the lungs causes the
basic lung sounds to disappear during a physical examination
3. Why tracheal deviation can be happened ?
Tracheal deviation can be happened when there is a pressure builds up in chest
cavity and trachea can get pushed to one side of throat wherever pressure is lover.
 Tracheal deviation is most commonly caused by injuries or conditions that cause pressure
to build up in chest cavity or neck.

4. What are the disease can be caused by thoracic trauma ?

Tracheal deviation can be happened when there is a pressure builds up in chest
cavity and trachea can get pushed to one side of throat wherever pressure is lover.
Tracheal deviation is most commonly caused by injuries or conditions that cause pressure
to build up in chest cavity or neck.
5. What the diagnosis for the case ?
A traumatic pneumothorax can result from either penetrating or non-penetrating
chest trauma. Penetrating chest trauma, the wound allows air to enter the pleural space
directly through the chest wall or through the visceral pleura from the tracheobronchial
tree. Non-penetrating trauma, a pneumothorax may develop if the visceral pleura is
lacerated secondary to a rib fracture, dislocation. Traumatic PTX can be classified as
iatrogenic and noniatrogenic

Step 4

Pneumothoax

Diagnosis Pharmacological
Additional support
Primary Physical and and non-
examination -
secondary examination to differential pharmachologic
interpretation
support the diagnosis al treatment
diagnose
Step 5
1. Primary and secondary for pneumothorax
2. Physical examination to support the diagnose in pneumothorax
3. Additional support examination and interpretation
4. Diagnose and differential diagnosis
5. Pharmacological and non-pharmacological treatment
6. Other trauma in thorax