Anda di halaman 1dari 42

KASUS DARURAT

KEPALA LEHER
TULANG BELAKANG/SPINE
THORAKS
ABDOMEN
PELVIS
EKSTREMITAS SUPERIOR
EKSTREMITAS INFERIOR

KASUS DARURAT THORAKS


TRAUMA

RUPTUR AORTA
RUPTUR DIAPHRAGMATIC /HERNIA
FLAIL CHEST
TERHIRUP BENDA ASING
TERTELAN BENDA ASING
FRAKTUR COSTA/STERNAL
HAEMOTHORAKS
PNEUMOTHORAKS
PERFORASI ESOFAGUS

KASUS DARURAT THORAKS


NON TRAUMA

PPOM
PNEUMONIA
EDEMA PULMONUM
EMBOLI PULMONUM
HEMOPTYSIS

RUPTUR AORTA
MENGANCAM JIWA
KLL
JATUH DARI KETINGGIAN
SERING DI DISTAL DARI A.SUBCLAVIA
KIRI
NYERI INTERSCAPULA/DADA
BEDA TEK.DRH BRACHIAL
BEDA DENYUT BRACHIAL-FEMORAL

RUPTUR AORTA
FOTO THORAKS :
PELEBARAN MEDIASTINUM >8 CM
OUTLINE AORTA KABUR
HEMOTHORAKS KIRI
MAIN BRONCHUS TERDESAK KE KANAN
TRACHEA TERDESAK KE KANAN
KEMUNGKINAN ADANYA FRAKTUR COSTA

MAUPUN RUPTUR DIAFRAGMA

RUPTUR AORTA

PPOM
smoking,
chronic asthma,
alpha-1 antitrypsin deficiency and
chronic infection

PPOM
INFEKSI
BATUK
SESAK, WHEEZING
SIANOSIS, GAGAL JANTUNG

BERAT

VASODILATASI PERIFER
TREMOR
KETAKUTAN

FOTO THORAKS
HIPERINFLASI PARU
DIAFRAGMA MENDATAR
PULMONAL VASKULARISASI

MENURUN
BARREL- SHAPED CHEST
ICS MELEBAR

FOTO THORAKS

RUPTUR/HERNIA DIAFRAGMA
BIASANYA OK TRAUMA TUMPUL ATAU

PENETRASI PD DADA/ABDOMEN
DIAGNOSIS SULIT, BIASANYA
DG.KOMPLIKASI
ISCHEMIA,
OBSTRUKSI, PERFORASI, PARU
KOLAPS
SERING PD SISI KIRI
TRAUMA TUMPUL
ROBEKAN
POSTERO-LATEERAL

KLINIS
SERING BERSAMA DG.TRAUMA YG.

LAIN
TACHYPNEA, HIPOTENSI, SUARA
NAFAS MENURUN, SUARA USUS (+)
PADA FASE LANJUT, ABDOMINAL
DYSCOMFORT,
MENYERUPAI
ULKUS PEPTIKUM, PENY.EMPEDU,
SINDROMA DIFUNGSI USUS

FOTO THORAKS
FASE AKUT SULIT
GBR UDARA & CAIRAN ATAU MASA

SOLID DI ATAS DIAFRAGMA


BISA DG. NG TUBE
MEDIASTINUM TERDESAK,
DIAFRAGMA TERANGKAT
KL PERLU FOTO THORAKS LATERAL
NON AKUT
KONTRAS STUDY

FOTO THORAKS

FLAIL CHEST
TIMBUL BILA ADA INKONTINUITAS

ANTARA SEGMEN DINDING DADA DG.


DADA KESELURUHAN PD SAAT RELAKS
BIASANYA TRAUMA DG.FRAKTUR > 2
COSTA
TAMPAK GANGGUAN GRK DDG DADA
ATAU GRK PARADOKSAL
BIASANYA MSBBKAN KONTUSIO
PULMONUM
HIPOKSIA

KLINIS
Dyspnoea
Tachycardia
Cyanosis
Tachypnoea
Hypotension
Perabaan DDG dada abnormal pd grkn

dan krepitasi costa


Derajat hipoksi tgt beratnya kontusio
pulmonum.

FOTO THORAKS
FRAKTUR MULTIPEL COSTA
MGK LEPASNYA COSTO-CHONDRAL
GBR. KONTUSIO PULMONUM
HEMOTHORAKS
HEMOPNEUMOTHORAKS

FOTO THORAKS

TERHIRUP BENDA ASING


BIASANYA ANAK-ANAK
DARURAT BILA OBSTRUKSI NAFAS
KLINIS :
Tanpa gx
Obstruksi nafas akut
Batuk persisten
Auskultasi normal

tak terdengar lokal

wheezing

Radiologis
Benda asing radio opaque (+)/(-)
Gambaran sekunder ??
Loss of volume
Kolaps segmental
Konsolidasi
Hiperinflasi
Ball valve effect

Foto thoraks

TERTELAN BENDA ASING


B.asing biasanya tersangkut di daerah

penyempitan :
Cricopharyngeus
Arcus aorta
Main bronchus kiri
Esofago-gastric junction

Gigi palsu
Duri ikan
Tulang dsb

Tertelan b.asing
Klinis :
Terasa adanya b.asing
Keluhan yg berhub dg perforasi esofagus

Radiologi :
Bayangan b.asing opaque (lat cervical

soft tissue/AP)
Soft tissue swelling
opaque
Contrast study

b.asing non

Radiologis

Radiologis

HEMOTHORAKS
Akumulasi darah di dlm ruang pleura

OK trauma tumpul/tajam di dada


Sering berhub.dg pneumothoraks
Sering self limiting
Klinis :
Tgt jmlh darah
Derajat bervariasi sp shock hipovolemik
Suara nafas turun

Radiologis

PERFORASI ESOFAGUS
Muntah yg keras
Trauma tumpul/tajam/iatrogenic
Perforasi b.asing
Bag.atas
retropharyngeal space
Bag.bwh
mediastinum
Keradangan

absces

PERFORASI ESOFAGUS
Klinis :
Nyeri retrosternal

menelan dan grk

fleksi
Tanda jarang dan lambat
Emfisema subcutis
Suara jantung yg kasar (Hammans
crunch)
Hydrothoraks
Empyema dsb

Radiologis
subcutaneous emphysema,
pneumomediastinum,
left sided pleural effusion,
Hydropneumothorax
mediastinal widening
Udara retrofaringeal
Pleural effusions, pulmonary infiltrates
true mediastinal airfluid level

Radiologis

PNEUMONIA
KLINIS :
Batuk produktif
Sesak
Pleuritic chest pain
Myalgia
Hemoptysis
Inspirasi
krepitasi kasar

Radiologis
Lobar pneumonia: Opacification of a

lobe;
Primary TB: Right paratracheal (40%)
and right hilar adenopathy (60%) with
consolidation in the lower or mid-zones.
Post-primary TB: Ill-defined consolidation
in the apical segments
Right middle and lower lobe pneumonia
Lingular segment pneumonia: Loss of the
left heart border.

Radiologis

Radiologis

Radiologis

PNEUMOTHORAKS
Akumulasi udara di cav.pleura
Biasanya OK trauma tumpul/tajam
(i) Simple: No communication with

the atmosphere or mediastinum. No


mid-line shift.
(ii) Communicating:Associated with
chest wall defect.
(iii) Tension : akumulasi udara yg
progresif

Klinis
Chest pain and shortness of breath
Signs of a tension pneumothorax

include:
Tachycardia
Jugulo-venous distension
Absent breaths sounds
Hyper-resonance to percussion
Tracheal and cardiac terdesak
signs of cardio-respiratory distress.

Radiologis
Simpel :
Loss of volume paru sisi defect
Pneumothoraks minimal bisa tampak

Tension :
THIS IS A CLINICAL AND NOT A

RADIOLOGICAL DIAGNOSIS!
Mediastinal shift to the opposite side

Radiologis

Simple pneumothorax

Iatrogenic tension pneumothorax.

Radiologis

Traumatic tension pneumothorax.