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Thoracic Trauma

(Pneumothorax and Hemothorax)

By
Andika Anjani Agustin, S.ked

INTRODUCTION

Most of the thoracic trauma patients


died while coming in hospital, in
addition, many deaths could be
prevented by efforts of an accurate
diagnosis and management.

THORACIC TRAUMA

DEFINITION
Thoracic trauma is wound or injury
affecting the thorax cavity which can
cause damage to the wall of the
thorax or the contents of the thorax
cavity caused by sharp or blunt
objects and can cause a state of
acute emergency thorax

ETIOLOGY
a. Penetrating trauma
- Gunshot wounds
- Stab wounds / puncture
b. Blunt trauma
- Motor accident
- Fall
- A blow to the chest

Clinical diagnosis and treatment should not


be delayed by waiting for x-ray

Anxiety
Severe dyspnea
Absent breath sounds on affected side
Hyper-resonance
Tachypnea
Tachycardia
Poor color
Accessory muscle used
JVD
Tracheal deviation

Treatment
Requires Tension pneumothorax
decompression immediate and rapid initial
treatment with the form of large-sized
needle insertion in the intercostal space in
the midclavicular to line hemithorax
disordered.
Definitive treatment chest tube
installation, in the 5th intercostal space
(height nipple) in the anterior of the line
midaxilaris.

Treatment
Initial treatment closing the wound with
sterile gauze plastered only on three sides
closure like this Valve Type flutter effect
when inspiration gauze covering the wound will
close prevent air leakage from the inside.
Immediately post WSD away from the
primary wound
Gauze cover in the form of Plastic Wrap /
Petrolotum Gauze
The final stage sewing primary wound

HEMOTHORAKS

Massive Hemothorax
Rapid accumulation of blood> 1500 mL in
the pleural cavity
Blood loss hypoxia. Neck veins may
collapse (flat) due to severe
hypovolemia

Massive Hemothorax

Starting with the rapid infusion of crystalloid


solution with a large needle give specific blood
type or autotranfusi.

Along with the infusion pairs of chest tube no.


38 French mounted as high as nipples, anterior
midaksilaris line decompression of the pleural
cavity.

Thoracotomy when the blood came out early


1500 ml or <1500 cc but active bleeding or 200
ml / hr in 2 to 4 hours.

General Management
ATLS Principles Resuscitation
Early assessment and primary survey
Simultaneous aggressive resuscitation
Secondary survey with full examination
Transfer to a definitive site of care.

Conclusion
Thorax injuries are often
accompanied by multiple injury and
can be life threatening.
While therapy with relatively simple
actions intubation, ventilation,
chest tube or perikardiosintesis with
needles.
The ability to recognize these injury
and the ability to act can save lives.

Thank You