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Cardiac Thoracic & Vascular Trauma;Every Doctor should know
Soebandrijo, Darmawan Ismail
Sub Bag Bedah Toraks Kardiak & Vaskuler
SMF. Ilmu Bedah FK UNS RSUD Dr MoewardiSurakarta
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Apa yang anda lakukan?
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Apa yang anda lakukan?
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Apa yang anda lakukan?
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Airway-Breathing & Vaskuler
Airway
Dada organ vital
VaskulerThorak & kardiak
Abdomen
Pelvis
Femur & fraktur di tempat lain
Perdarahan eksternal
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Deadly cases
Airway obstruction
Tension pneumothorax & sucking chestwound
Massive hemothorax
Tracheobronchial injury
Flail chest
Pericardial tamponade
Laceration of vascular structure
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How to diagnose?
1. AirwayL: gerakan dada,
L: suara nafas & ST,
F: hembusan nafas
2. BreathingL: tanda2 sesak, DVJ, gerakan dada paradoksal & tertinggal
L: SD, ST
F: Perkusi !! (palpasi krepitasi)
3. CirculationL: anemis, cyanosis, DVJL: SJ, SJ menjauh
F: akral dingin, CRT, nadi, tekanan darah
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Airway obstruction
Clinical finding
Shortness of breath (dyspnea)
Stridor
Apnea
Management Chin lift
Jaw thrust
Triple finger manuever
Evacuate foreign body (cross finger)
Hemlich manuver
Cricothyroidostomy
Tracheostomy
ET insertion
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Tension Pneumothorax
Build up of air under
pressure in the thorax.
Excessive pressure
reduces effectivenessof respiration
Air is unable to escape
from inside the pleural
spaceProgression of Simple
or Open Pneumothorax
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Anx: Progressive shortness of breath
PE :
Pneumothorax percusion: hypersonor
Neck vein distension (severe case)
Treatment :
Needle thoracocentesis
Consult : chest tube insertion
Tension Pneumothorax (simplify)
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CXR image
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Needle thoracocentesis
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OPEN (SUCKING) CHEST WOUND
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SUCKING CHEST WOUND
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SUCKING CHEST WOUND
Upon exhaling, air in
the chest escapes
through the flutter-typevalve created by taping
3 sides only
With inhaling, the patch
should suck against theskin, preventing air
entry
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Hemothorax
Hemothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500 mL of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
MASSIVE (criteria)
Blood loss in thorax causes a decrease in tidal volume
Ventilation/Perfusion Mismatch & Shock
Typically accompanies pneumothorax
Hemopneumothorax
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Blunt or penetrating chest
trauma
Shock
Dyspnea Tachycardia
Tachypnea
Diaphoresis
Hypotension
Dull to percussion over injuredside
Treatment
Chest tube insertion & consult
Hemothorax (simplify)
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Trauma.org
CXR Image
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FLAIL CHEST
PARADOXICAL RESPIRATIONS
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Flail chest
Multiple rib fractures produce a mobilefragment which moves paradoxically withrespiration
Significant force required
Usually diagnosed clinically
Treatment
ABCAnalgesia
Fixation : internal &/ external
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Flail Chest
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Tracheobronchial Injury
MOI
Blunt trauma
Penetrating trauma
50% of patients with injury die within 1 hr of injury
Disruption can occur anywhere in tracheobronchial tree
Signs & Symptoms
Dyspnea
Cyanosis
Hemoptysis
Massive subcutaneous emphysema Crepitation
Suspect/Evaluate for other closed chest trauma
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Tracheobronchial Injury
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Tracheobronchial Injury
Observe for development of Subcutaneusemphysema & tension pneumothorax (deadly)
Treatment
Keep airway clear Administer high flow O2
Consider intubation if unable to maintainpatient airway
If tension needle thoracocentesis Consult : tracheal repair or tracheostomy
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Restriction to cardiac filling caused by blood or other fluid
within the pericardium
Occurs in
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Pericardial or CardiacPericardial or Cardiac tamponadetamponade
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Dyspnea
Possible cyanosis
Becks Triad
DVJ
Distant heart tones
Hypotension ornarrowing pulsepressure
Weak, thready pulse
Shock
Pericardial Tamponade (simplify) Kussmauls sign
Decrease or absence of
JVD during inspiration
Pulsus Paradoxus
Drop in SBP >10 duringinspiration
Due to increase in CO2
during inspiration
Electrical AlteransP, QRS, & T amplitude
changes in every other
cardiac cycle
PEA
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Pericardial Tamponade (ilustrations)
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Laceration of vascular structures
General sign
Hypovolemia & shock
Penetrating trauma (mostly)
External bleeding
Pemeriksaan teliti
Balut tekan
Torniquet
Penjahitan
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Laceration of vascular structures
External bleeding
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Uncontrolled bleeding or
Massive vascular trauma victims
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Laceration of vascular structures
Internal bleeding Resusitasi cairanThoracic
Px . Pada B (Chest XR)
Abdominal Px: Cairan bebas dari peritoneum, berupa distensi, pekak
alih & undulasi
FAST (USG) or CT
Pelvicum Px: distraction test, culdocentesis, floating prostat
USG
Femur Px: Expanding hematoma, Iskemia distal (XRay)
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ATLS & ACLS
Prinsip ABC
Beda setting
Contoh:
saat berpidato atau main tenis tiba2 tak sadar,
perawatan di RS tiba2 tak sadar
Bisa simultan
Contoh: pasien tua, trauma & mempunyai riw.Gangguan disritmia, kel: sesak nafas progresif dan
kemudian cardiac arrest saat di UGD
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Keterlambatan penangan akibat
kurang waspada
Kasus trauma dengan gangguan kesadaran
Selalu ingat ABC, sblm D
Kasus fraktur
Selalu ingat NVD karena ada golden periode utk
lesi vaskuler.
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Always !!!
PREPARE
FORTHE WORST
HOPEHOPEFOR THE BEST
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