308

IDENTITAS

Nama : Tn. A
Usia : 48 tahun
Diagnosa : Fracture Radius Dextra + Closed Fracture Fibula Sinistra
Rencana : ORIF + Plate Screw
MRS : 13/10/2017
ANAMNESA

Keluhan Utama : Sesak Nafas

Sejak 1 hari SMRS, pasien sedang mengendarai motor di daerah Jakarta Timur, tidak
memakai helm dalam kecepatan sedang tiba-tiba motor tergelincir dan membentur trotoar
jalan. Pingsan (-), PTHM (-). Karena kejadian tersebut, pasien mengeluh sesak nafas. Pasien
dibawa ke RS Pondok Kopi dan dipasang chest tube di dada kiri, lalu dirujuk ke RSHS.
PEMERIKSAAN FISIK

Kesadaran : Compos Mentis

Airway : Clear, tanpa Collar Brace
Breathing : RR 24 kali, SaO2 98% bnc 3 L/ mnt,VBS ki<ka
Circulation : TD 110/90 mmHg, HR = Nadi 100 x /menit
PEMERIKSAAN FISIK

Head : Pupil isokor 3mm/3mm, Deviasi Nasal Septum (-).

Neck : tidak ada kelainan
Thoraks : Gerak Simetris,VBS ki<ka, Rh-/-,Wh -/-
Abdomen : Distensi (-), BU (+) N.
Extremitas : CRT < 2 detik, ROM tungkai atas kanan dan tungkai kiri bawah terbatas.
PENUNJANG
PENUNJANG
LABORATORIUM

Hb 12,5 /Ht 37,3/Tr 339.0000/L 26.690/Ur

26,0/Cr 0,65/GDS 138/Na 131/K 4,2
DIAGNOSA

Hematothoraks sinistra + Trauma tumpul thoraks + Closed fracture distal end radius
dextra + Closed fracture fibula sinistra
KONSIDERASI PASIEN DENGAN TRAUMA TUMPUL
THORAKS
 EMERGENCY ANAESTHETIC MANAGEMENT OF
EXTENSIVE THORACIC
TRAUMA
High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of
increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important
role in the management of extensive thoracic trauma.
Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz.
pleura, lungs, heart, great vessels,trachea and oesophagus. It may lead to pneumothorax, cardiac
tamponade or life threatening haemorrhage. With aggressive care and management of these
factors, majority of patients can survive and return to normal life.
 Extensive thoracic injuries are always life threat-ening and they should be managed
aggressively as an emergency.
Thoracic traumas are classified as:
1.Non-penetrating usually caused by blunt trauma, deceleration or blast forces.
2. Penetrating injuries caused by gunshots, stabs, arrows and high velocity splinters. The
majority of chest wounds result from blunt trauma, secondary to a motor vehicle or road
traffic accident. Most of the deaths in these cases are due to asphyxia and haemorrhage and
are avoidable.
 The extent of injuries following blunt trauma generally depends on the-
i)Mass of the offending object.
ii)Physical characteristics of the resulting shockwave and,
iii)Ability of target tissues to dissipate the shockwave.
 The deceleration injuries are either due to impact or momentum. The impact injury causes
fracture of the ribs or sternum with little damage to underlyingtissues whereas momentum injury
affects the organs suspended in the thoracic cage viz. lungs, heart, aorta. The amount of destruction
of the organ is proportional to the shearing forces.

Tissue destruction following a gunshot depends upon the kinetic energy (KE) transmitted to the
tissues on impact; which is the product of bullet weight (W) and velocity (V) as-KE = WV2/2G (
W= we igh t,V= ve lo city,G=acceleration due to gravity) i.e. soft bullets that fragment after striking
cause more local destruction than hardbullets whereas rifles generally cause wider area tissue
destruction.
PRINCIPLE MANAGEMENT

Assessment and Ressucitation

Physical Examination
Diagnostic Studies
Live Saving Surgery
Terima Kasih