TRAUMA THORAX
Oleh : Moch. Achwandi, M.Kep.Ns., CWCS
Anatomy of The Chest
• Kerangka dada terdiri dari tulang dan tulang rawan,
dibatasi oleh :
a. Depan : Sternum dan tulang iga.
b. Belakang : 12 ruas tulang belakang (diskus
intervertebralis).
c. Samping : Costae beserta otot-otot intercostal.
d. Bawah : Diafragma
e. Atas : Dasar leher.
Anatomy of The Chest
Isi
a. Sebelah kanan dan kiri rongga toraks terisi
penuh oleh paru-paru beserta pembungkus
pleuranya.
b. Mediastinum : ruang di dalam rongga dada
antara kedua paru-paru. Isinya meliputi
jantung dan pembuluh-pembuluh darah besar,
oesophagus, aorta desendens, duktus torasika
dan vena kava superior, saraf vagus dan
frenikus serta sejumlah besar kelenjar limfe.
Anatomy of the chest
Anatomy of the chest
Anatomy of the chest
Anatomy of the chest
Injuries of chest
• Simple/Closed • Cardiac Tamponade
Pneumothorax • Traumatic Aortic
• Open Pneumothorax Rupture
• Tension Pneumothorax • Traumatic Asphyxia
• Flail Chest • Diaphragmatic Rupture
Simple/Closed Pneumothorax
• Opening in lung tissue
that leaks air into
chest cavity
• Blunt trauma is main
cause
• May be spontaneous
• Usually self correcting
S/S of Simple/Closed Pneumothorax
• Chest Pain
• Dyspnea
• Tachypnea
• Decreased Breath Sounds on Affected Side
Treatment for Simple/Closed
Pneumothorax
a. Pneumotoraks sedikit , Tanpa keluhan :
Observasi saja, Udara akan diresorbsi sendiri.
b. Bila tidak berhasil, dilakukan aspirasi udara
dari rongga pleura dengan alat pneumotoraks/
dengan ketheter IV nomor 16.
c. Bila dengan aspirasi tetap gagal dilakukan
pemasangan WSD + Suction.
Open Pneumothorax
• Rongga dada terbuka
sehingga udara masuk
ke rongga pleura
• Menyebabkan paru
kolap karena
peningkatan tekanan
intra pleura
• Dapat mengancan jiwa
dan memburuk
dengan cepat.
Open Pneumothorax
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothoarx
Inhale
Open Pnuemothorax
Inhale
S/S of Open Pneumothorax
• Dyspnea
• Sudden sharp pain
• Subcutaneous Emphysema
• Decreased lung sounds on affected side
• Red Bubbles on Exhalation from wound
(Sucking chest wound)
Subcutaneous Emphysema
• Air collects in subcutaneous fat from pressure
of air in pleural cavity
• Feels like rice crispies or bubble wrap
• Can be seen from neck to groin area
Treatment for Open Pneumothorax
• ABC’s with c-spine control as indicated
• High Flow oxygen
• Listen for decreased breath sounds on
affected side
• Pemasangan WSD
• Dilakukan Penutupan Fistel
• Pembedahan
Occlusive Dressing
Tension Pneumothorax
• Air builds in pleural space with no where for
the air to escape
• Results in collapse of lung on affected side
that results in pressure on mediastium,the
other lung, and great vessels
Tension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension Pneumothorax
The trachea is
pushed to
the good side
Heart is being
compressed
S/S of Tension Pneumothorax
• Anxiety/Restlessness • Accessory Muscle Use
• Severe Dyspnea • Narrowing Pulse
• Absent Breath sounds Pressures
on affected side • Hypotension
• Tachypnea • Tracheal Deviation
• Tachycardia (late if seen at all)
• Poor Color
Treatment of Tension Pneumothorax
• ABC’s with c-spine as indicated
• High Flow oxygen
• Treat for S/S of Shock
• Pemasangan Kontra Ventil : Needle Decompression
• WSD
• Penghisapan ( Suction )
• Setelah terpasang WSD, Paru mengembang, WSD di
klem 1-2 hari, Foto toraks ulang WSD dilepas
Needle Decompression
• Locate 2-3 Intercostal space midclavicular line
• Cleanse area using aseptic technique
• Insert catheter ( 14g or larger) at least 3” in length
over the top of the 3rd rib( nerve, artery, vein lie
along bottom of rib)
• Remove Stylette and listen for rush of air
• Place Flutter valve over catheter
• Reassess for Improvement
Needle Decompression
Hemothorax
• Occurs when pleural space fills with blood
• Usually occurs due to lacerated blood vessel in
thorax
• As blood increases, it puts pressure on heart
and other vessels in chest cavity
• Each Lung can hold 1.5 liters of blood
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
May put pressure on the heart
Hemothorax
Where does the blood come from.
S/S of Hemothorax
• Anxiety/Restlessness
• Tachypnea
• Signs of Shock
• Bloody Sputum
• Diminished Breath Sounds on Affected Side
• Tachycardia
• Flat Neck Veins
Treatment for Hemothorax
• ABC’s with c-spine control as indicated
• Secure Airway assist ventilation if necessary
• General Shock Care due to Blood loss
• Consider Left Lateral Recumbent position if not
contraindicated
• RAPID TRANSPORT
• Contact Hospital and ALS Unit as soon as possible
Flail Chest
The breaking of 2
or more ribs in 2
or more places
Flail Chest
S/S of Flail Chest
• Shortness of Breath
• Paradoxical Movement
• Bruising/Swelling
• Crepitus( Grinding of bone ends on palpation)
Flail Chest is a True Emergency
Treatment of Flail Chest
• ABC’s with c-spine control as indicated
• High Flow oxygen
• Monitor Patient for signs of Pneumothorax or
Tension Pneumothorax
• Use Gloved hand as splint till bulky dressing
can be put on patient
• Contact hospital and ALS Unit as soon as
possible
Bulky Dressing for splint of Flail
Chest
The END
• Questions?
• Comments
• Criticisms
• If not thank You
