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BTKV

Muhammad Sandriyan
1510029020

chest trauma
Injuries involving the thorax cavity
which can cause damage to the walls
of the thorax or the contents of the
thorax cavity caused by penetrating
or non penetrating injury

etiology
penetrating
1.open pneumothorax
2.Hemothorax
3.Tracheobronchial trauma
4.Pulmonary contusio
5.Diafragma rupture
6.Mediastinum trauma

Non penetrating
Tension pneumothorax
Flail chest
Fractur costae
diafragma rupture
Mediastinum trauma

chest trauma
Tissue hypoxia
Hipercarbia
Acidosis respiratorik/ metabolik

Lifethreatening chest
trauma
Primary survey
Airway (patency?, muscle retraction?,
foreign body on airway?)
Breathing (expose n evaluate, cyanosis
or not)
Circulation (pulse,blood pressure,
peripheral circulation, cardiac monitor)

Deadly dozen
Immediate life threatening injuries
1.Airway obstruction
Unconscious patient, teeth, secretion, blood,
neck hematom,oedema
therapy: release cause of obstruction
2. Tension Pneumothorax
air hunger, takipnea,dispnea, distended neck
veins, tracheal deviation, hyper resonances,
absent
breath
sounds
hemithorax,
hypotension, cyanosis
tx: Needle decompression
definitive> chest tube insertion

Tension pneumothorax

3. open pneumothorax
This is due to a large open defect in the
chest (> 3 cm), leading to equilibration
between intrathoracic and atmospheric
pressure
sucking chestwound, hipersonor,
tx: closing the defect with a sterile
occlusive dressing taped on three sides
Definitive: debridement n closure

4. pericardial tamponade
Pericardium to fill with blood from the
heart, great vessels, pericard vessel
Trias beck (Jugular veins distension,
hypotension, and muffled heart sounds)
Kussmaul, pulsus paradoxical, ekg low
voltage, distended neck veins
Tx: pericardiocentesis subxiphoid

5. massive haemothorax
Accumulation of blood in a hemithorax
can significantly(>1,5L)
haemorrhagic shock, unilateral absence
of breath sounds, dullness to
percussion, and flat neck veins
Tx: simultaneous restoration of blood
volume and decompression of the chest
cavity

6. flail chest
A flail chest occurs when a segment of the
chest wall does not have bony continuity
with the rest of the thoracic cage
Paradoxical motion, Associated pain with
restricted chest wall movement and
underlying lung injury contribute to the
patient's hypoxia
movement of the thorax is asymmetrical
and uncoordinated
Tx: ventilation adequate,o2, fluid rescu,

Potentially lethal injuries


1. pulmonary contusio w/ or w/out
flail chest
worsening hypoxemia 24-48 hr
intubated

2 myocardial contusio
Blunt chest trauma

Abnormalities
ecg
(Multiple
prematureventricular
contractions,
unexplained
sinus
tachycardia,
atrial
fibrillation, and ST segment changes are the
most common electrocardiographic findings
They should be admitted to the critical care
unit for close observation and cardiac
monitoring

3. Traumatic Aortic Rupture


a discrepancy of the blood pressure
between left and right arm or
between upper and lower limbs, a
widened pulse pressure and chest
wall contusion, mediastinum
widened, ct scan or aortagraphy

Traumatic Diaphragmatic
Rupture
Most accurate evaluation is by
videoassisted thoracoscopy or
laparoscopy, the latter offering the
advantage of easier repair and
additional evaluation of the
abdominal organs

5. Tracheobronchial Tree Injuries


Severe subcutaneous emphysema
Bronchoscopy is diagnostic.
Treatment involves intubation of the
unaffected bronchus followed by
operative repair

6. Esophageal Trauma
should be considered for any patient who
(1) has a left pneumothorax or
hemothorax without a rib fracture,
(2) has received a severe blow to the
lower sternum or epigastrium and is in
pain or shock out of proportion to the
apparent injury, or
(3) has particulate matter in their chest
tube after the blood begins to clear

subcutaneous or mediastinal
emphysema, pleural effusion,
retrooesophageal air, and
unexplained fever within 24 hours of
injury

Thank you